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Radiation Risks and Interventional Cardiology: The Value of Radiation Reduction Exposure. J Cardiovasc Dev Dis 2023; 10:jcdd10030121. [PMID: 36975885 PMCID: PMC10054529 DOI: 10.3390/jcdd10030121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/31/2023] [Accepted: 02/22/2023] [Indexed: 03/18/2023] Open
Abstract
Fluoroscopically guided cardiac procedures are an essential component of care in the practice of cardiology, and are, in most cases, lifesaving [...]
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Wu G, Luo Q, Bao Y, Wei Y, Lin C, Zhang N, Ling T, Chen K, Pan W, Wu L, Xie Y, Jin Q. The feasibility of using remote magnetic navigation system as the primary technological training tool for novice cardiac electrophysiology operators in the catheter ablation of left-sided accessory pathway. Cardiol J 2022; 30:VM/OJS/J/87161. [PMID: 35373327 PMCID: PMC10713225 DOI: 10.5603/cj.a2022.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND For novice operators, mastering catheter ablation of left-sided accessory pathway (LSAP) in a short duration of time without compromising efficacy and safety remains a challenge. In this study an attempt to shorten the learning curve by using robotics via a remote magnetic navigation (RMN) system was performed. METHODS Novice physician fellows without prior catheter ablation experience initiated their process of learning LSAP ablation using the Niobe™ RMN system. Their procedure parameters were recorded and compared with experienced operators using RMN and manual catheter navigation (MCN). RESULTS Novice operators quickly shortened the total procedure time after their first five procedures. In subsequent procedures, no significant difference in procedure time, fluoroscopy exposure or ablation time was observed between novice and experienced RMN operators. When compared to MCN operators, novice operators avoided excessive radiation exposure beginning with their first RMN procedure, while lower fluoroscopy doses were noted after five procedures. It was observed that procedure parameters did not differ significantly according to LSAP location. CONCLUSION The RMN system is a practical and easy to use tool for novice electrophysiology operators to quickly master LSAP ablation, without compromising efficacy or safety. Additionally, when compared to MCN it also protects the operators and patients from excessive radiation exposure during the procedure.
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Affiliation(s)
- Guanhua Wu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingzhi Luo
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yangyang Bao
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yue Wei
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Changjian Lin
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ning Zhang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianyou Ling
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kang Chen
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenqi Pan
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liqun Wu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Xie
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Qi Jin
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Hartmann J, Jungen C, Stec S, Klatt N, Willems S, Makimoto H, Steven D, Pürerfellner H, Martinek M, Meyer C. Outcomes in patients with dual antegrade conduction in the atrioventricular node: insights from a multicentre observational study. Clin Res Cardiol 2020; 109:1025-1034. [PMID: 32002633 PMCID: PMC7375989 DOI: 10.1007/s00392-020-01596-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/05/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Supraventricular tachycardias induced by dual antegrade conduction via the atrioventricular (AV) node are rare but often misdiagnosed with severe consequences for the affected patients. As long-term follow-up in these patients was not available so far, this study investigates outcomes in patients with dual antegrade conduction in the AV node. METHODS AND RESULTS In this multicentre observational study, patients from six European centres were studied. Catheter ablation was performed in 17 patients (52 ± 16 years) with dual antegrade conduction via both AV nodal pathways between 2012 and 2018. Patients with the final diagnosis of a manifest dual AV nodal non-re-entrant tachycardia had a mean delay of the correct diagnosis of over 1 year (range 2-31 months). Two patients received prescription of non-indicated oral anticoagulation, two further patients suffered from inappropriate shocks of an implantable cardioverter defibrillator. In 12 patients, a co-existence of dual antegrade and re-entry conduction in the AV node was present. Mean fast pathway conduction time was 138 ± 61 ms and mean slow pathway conduction time was 593 ± 134 ms. Successful radiofrequency catheter ablation was performed in all patients. Post-procedurally oral anticoagulation was discontinued, without detection of cerebrovascular events or atrial fibrillation during a long-term follow-up of median 17 months (range 6-72 months). CONCLUSION This first multicentre study investigating patients with supraventricular tachycardia and dual antegrade conduction in the AV node demonstrates that catheter ablation is safe and effective while long-term patient outcome is good. Autonomic tone dependent changes in ante- vs. retrograde conduction via slow and/or fast pathway can challenge the diagnosis and therapy in some patients.
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Affiliation(s)
- Jens Hartmann
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Christiane Jungen
- Department of Cardiology-Electrophysiology, University Heart and Vascular Center, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Sebastian Stec
- Subcarpathian Center for Cardiovascular Intervention, G.V.M. Carint, Sanok, Poland
- Medinice Research and Development Centre, Aeropolis-Jasionka, Rzeszow, Poland
- ELMedica EP-Network, Kielce, Poland
| | - Niklas Klatt
- Department of Cardiology-Electrophysiology, University Heart and Vascular Center, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Stephan Willems
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Hisaki Makimoto
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Daniel Steven
- Department of Cardiology-Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - Helmut Pürerfellner
- Department of Cardiology, Academic Teaching Hospital, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Martin Martinek
- Department of Cardiology, Academic Teaching Hospital, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Christian Meyer
- Department of Cardiology-Electrophysiology, University Heart and Vascular Center, Hamburg, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany.
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Symptomatic arrhythmias after catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT): results from the German Ablation Registry. Clin Res Cardiol 2019; 109:858-868. [PMID: 31784903 DOI: 10.1007/s00392-019-01576-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In atrioventricular nodal reentrant tachycardia (AVNRT), catheter ablation is considered as first-line therapy. Despite high success rates, some patients present with arrhythmia recurrence or develop other types of arrhythmias over time. OBJECTIVE To assess the incidence of symptomatic arrhythmias after initially successful AVNRT ablation and to analyze their clinical implications in a real-world cohort. METHODS We included 2,795 patients from the German Ablation Registry undergoing first ablation of AVNRT between 01/2007 and 01/2010. In patients alive at long-term follow-up, patient-specific characteristics and long-term follow-up data were compared between patients with (group A) and without (group B) any symptomatic arrhythmia during follow-up. RESULTS Symptomatic arrhythmias occurred in 17.2% of patients during a mean follow-up of 678 days after AVNRT ablation. The patients with symptomatic arrhythmias were more often female and suffered from structural heart disease. Arrhythmia occurrence was clinically relevant regarding symptoms and patient satisfaction. Serious adverse events including stroke, transient ischemic attack, pacemaker implantation, as well as continued use of antiarrhythmic medication occurred more often in group A. A second ablation procedure was performed in 26% of symptomatic patients to optimize the symptomatic outcome, whereas cardiovascular events or patient satisfaction were not further improved. CONCLUSION During long-term follow-up, one out of six patients experienced symptomatic arrhythmias after AVNRT ablation, associated with an increase of serious adverse events. A subset of patients required medical or interventional antiarrhythmic therapy, possibly attributable to the co-existence of other arrhythmias. Screening for arrhythmic and cardiac co-morbidity before and after ablation may support comprehensive therapy planning and outcome.
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Kringeland EA, Deisenhofer I, Hessling G, Schuster P. Troponin T release comparing manually or magnetically guided radiofrequency ablation for AVNRT- a MAGMA AVNRT substudy. SCAND CARDIOVASC J 2018; 52:362-366. [PMID: 30570356 DOI: 10.1080/14017431.2018.1562203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Catheter ablation is regarded as first-line therapy for symptomatic atrioventricular nodal reentry tachycardia (AVNRT). Ablation induces intended myocardial damage and the extent of myocardial damage may differ between ablation methods. The objective of this MAGMA AVNRT(NCT00875914) substudy was to compare high-sensitive cardiac troponin T (hs-cTnT) levels as a surrogate marker for myocardial damage after manually guided (MAN) AVNRT ablation versus AVNRT ablation using remote magnetic navigation (RMN). DESIGN In total, 70 patients (mean age 44 ± 14 years, 26% male) undergoing catheter ablation for AVNRT in the MagMa-AVNRT-Trial were randomized to remote magnetic navigation (n = 34, 49%) or manually guided catheter ablation (n = 36, 51%). hs-cTnT was measured the day after the procedure. RESULTS The median follow-up time was 6.2 ± 1.1 years. Acute success was 100% in both groups. hs-cTnT release was significantly lower in the remote magnetic navigation group (52 ng/L versus 95 ng/L, p < .01), even though the ablation time was longer and number of applications was higher with remote magnetic navigation (4.2 min vs 2.8 min, p = .017; 4.9 vs 3.3 applications, p = .01). hs-cTnT released per minute ablation time was also lower with remote magnetic navigation (12 ng/L versus 34 ng/L, p < .01). Both groups exhibited similar clinical long-term follow up regarding recurrence and complications. CONCLUSION Remote magnetic navigation controlled catheter ablation of AVNRT has similar clinical outcome, but leads to less hs-cTnT release than manually guided catheter ablation. This might correspond to less unintended myocardial damage with RMN, which might be advantageous in complex ablation procedures.
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Affiliation(s)
| | | | | | - Peter Schuster
- a Department of Cardiology , Haukeland University Hospital , Bergen , Norway.,c Department of Clinical Science , University of Bergen , Bergen , Norway
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Stavrakis S, Jackman WM, Lockwood D, Nakagawa H, Beckman K, Elkholey K, Wang Z, Po SS. Slow/Fast Atrioventricular Nodal Reentrant Tachycardia Using the Inferolateral Left Atrial Slow Pathway. Circ Arrhythm Electrophysiol 2018; 11:e006631. [DOI: 10.1161/circep.118.006631] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stavros Stavrakis
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center (S.S., W.M.J., D.L., H.N., K.B., K.E., S.S.P.)
| | - Warren M. Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center (S.S., W.M.J., D.L., H.N., K.B., K.E., S.S.P.)
| | - Deborah Lockwood
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center (S.S., W.M.J., D.L., H.N., K.B., K.E., S.S.P.)
| | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center (S.S., W.M.J., D.L., H.N., K.B., K.E., S.S.P.)
| | - Karen Beckman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center (S.S., W.M.J., D.L., H.N., K.B., K.E., S.S.P.)
| | - Khaled Elkholey
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center (S.S., W.M.J., D.L., H.N., K.B., K.E., S.S.P.)
| | - Zulu Wang
- Department of Cardiology, Shengyang Northern Hospital, China (Z.W.)
| | - Sunny S. Po
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center (S.S., W.M.J., D.L., H.N., K.B., K.E., S.S.P.)
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First experience with zero-fluoroscopic ablation for supraventricular tachycardias using a novel impedance and magnetic-field-based mapping system. Clin Res Cardiol 2018; 107:578-585. [PMID: 29476203 PMCID: PMC6002461 DOI: 10.1007/s00392-018-1220-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 02/20/2018] [Indexed: 12/21/2022]
Abstract
AIMS Zero- and near-zero-fluoroscopic ablation techniques reduce the harmful effects of ionizing radiation during invasive electrophysiology procedures. We aimed to test the feasibility and safety of a zero-fluoroscopic strategy using a novel integrated magnetic and impedance-based electroanatomical mapping system for radiofrequency ablation (RFA) of supraventricular tachycardias (SVTs). METHODS We retrospectively studied 92 consecutive patients undergoing electrophysiology studies with/without RFA for supraventricular tachycardia (SVT) performed by a single operator at a single center. The first 42 (Group 1) underwent a conventional fluoroscopic-guided approach and the second 50 (Group 2) underwent a zero-fluoroscopic approach using the Ensite Precision™ 3-D magnetic and impedance-based mapping system (Abbott Inc). RESULTS Group 1 comprised 14 AV-nodal re-entrant tachycardia (AVNRT), 12 typical atrial flutter, 4 accessory pathway (AP), 2 atrial tachycardia (AT), and 9 diagnostic EP studies (EPS). Group 2 comprised 16 AVNRT, 17 atrial flutter, 6 AP, 3 AT, 2 AV-nodal ablations, and 7 EPS. A complete zero-fluoroscopic approach was achieved in 94% of Group 2 patients. All procedures were acutely successful, and no complications occurred. There was a significant reduction in fluoroscopy dose, dose area product, and time (p < 0.0001, for all), with no difference in procedure times. Ablation time for typical atrial flutter was shorter in Group 2 (p = 0.006). CONCLUSIONS A zero-fluoroscopic strategy for diagnosis and treatment of SVTs using this novel 3D-electroanatomical mapping system is feasible in majority of patients, is safe, reduces ionizing radiation exposure, and does not compromise procedural times, success rates, or complication rates.
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Busch S, Forkmann M, Kuck KH, Lewalter T, Ince H, Straube F, Wieneke H, Julian Chun KR, Eckardt L, Schmitt C, Hochadel M, Senges J, Brachmann J. Acute and long-term outcome of focal atrial tachycardia ablation in the real world: results of the german ablation registry. Clin Res Cardiol 2018; 107:430-436. [PMID: 29344680 DOI: 10.1007/s00392-018-1204-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Catheter ablation of focal atrial tachycardia (FAT) can be a challenging procedure and results have been rarely described. The purpose of this study was to determine the characteristics and results of FAT ablation in the large cohort of the German Ablation Registry. METHODS The German Ablation Registry is a nationwide prospective multicenter database including 12566 patients who underwent an ablation procedure between 2007 and 2010. Among them 431 (3.4%) underwent an FAT ablation and 413 patients with documented locations were analyzed. Patients were divided into three groups according to the FAT location: biatrial (BiA, n = 31, 7.5%), left atrial (LA, n = 110, 26.5%), and right atrial (RA, n = 272, 66%). RESULTS Acute success rate was 84% (68 vs. 85 vs. 85% in biA, LA, and RA, respectively, p = 0.038). 4.8% of patients had an early recurrence during hospitalization, most in biatrial location (p < 0.001). No major acute complication occurred. At 12 months, 81% were asymptomatic or improved. The incidence of major adverse cardiovascular and cerebrovascular events (MACCE) was 3.7%. Arrhythmia freedom without antiarrhythmic drugs was 58% and was lower in biA (34 vs. 56% in LA vs. 62% in RA, p = 0.019). Early recurrence during hospitalization was an outstanding predictive factor for recurrence during follow-up. CONCLUSION In this large patient population, FAT ablation had a relatively high acute success rate with a low complication rate. During follow-up, the recurrence rate was high, particularly in biatrial location. This was frequently predicted by an early recurrence during hospitalization.
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Affiliation(s)
- Sonia Busch
- Klinik für Kardiologie, Angiologie und Pneumologie, II. Medizinische Klinik, Klinikum Coburg, Ketschendorfer Str. 33, 96450, Coburg, Germany.
| | - Mathias Forkmann
- Klinik für Kardiologie, Angiologie und Pneumologie, II. Medizinische Klinik, Klinikum Coburg, Ketschendorfer Str. 33, 96450, Coburg, Germany
| | - Karl-Heinz Kuck
- Klinik für Kardiologie und internistische Intensivmedizin, Klinik für Kardiologie, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Thorsten Lewalter
- Peter Osypka Herzzentrum München, Abteilung fuer Kardiologie und Innere Medizin, Graz, Germany
| | - Hüseyin Ince
- Vivantes Klinikum Am Urban, Berlin, Klinik fuer Kardiologie und Internistische Intensivmedizin, Berlin, Germany
| | | | - Heinrich Wieneke
- Klinik fuer Kardiologie und Angiologie, Contilia Herz- und Gefäßzentrum Essen, Essen, Germany
| | - K R Julian Chun
- CCB Cardioangiologisches Centrum Bethanien Frankfurt am Main, Frankfurt am Main, Germany
| | - Lars Eckardt
- Abteilung für Rhythmologie (Elektrophysiologie und kardiologische Elektrochirurgie), Universitätsklinikum Muenster, Muenster, Germany
| | - Claus Schmitt
- Staedtisches Klinikum Karlsruhe, Medizinische Klinik IV, Karlsruhe, Germany
| | - Matthias Hochadel
- Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Johannes Brachmann
- Klinik für Kardiologie, Angiologie und Pneumologie, II. Medizinische Klinik, Klinikum Coburg, Ketschendorfer Str. 33, 96450, Coburg, Germany
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