1
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Yogasundaram H, Papireddy MR, Nazarian S, Guandalini GS, Markman TM, Schaller RD, Riley MP, Lin D, Dixit S, D'Souza B, Kumareswaran R, Callans DJ, Frankel DS, Garcia FC, Zado E, Deo R, Epstein AE, Supple GE, Marchlinski FE, Hyman MC. Long-term risk of right coronary artery injury after catheter ablation of cavotricuspid isthmus-dependent flutter. Heart Rhythm 2024:S1547-5271(24)03329-0. [PMID: 39304007 DOI: 10.1016/j.hrthm.2024.09.029] [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: 02/12/2024] [Revised: 09/03/2024] [Accepted: 09/11/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Radiofrequency ablation (RFA) of cavotricuspid isthmus (CTI)-dependent atrial flutter requires ablation of the tricuspid annulus overlying the right coronary artery (RCA). Although it is considered safe, reports of acute and subacute RCA injury in human and animal studies raise the possibility of late RCA stenosis. OBJECTIVE The objective of this study was to compare the incidence and severity of angiographic RCA stenoses in patients who have undergone CTI RFA with a control group to assess the long-term risk of RCA damage. METHODS A 2-center retrospective case-cohort study was performed including all patients from 2002 to 2018 undergoing atrial fibrillation (AF) with CTI ablation (CTI + AF) or AF ablation alone with subsequent coronary angiography (CAG). The AF alone group served as controls because of anticipated similarity of baseline characteristics. Coronary arteries that are anatomically remote to the CTI were examined as prespecified falsification end points. CAG was scored by a blinded observer. RESULTS There were 156 patients who underwent pulmonary vein isolation with subsequent CAG (CTI + AF, n = 81; AF alone, n = 75) with no difference in baseline characteristics including age, sex, comorbidities, and medications. Mean time from ablation to CAG was similar (CTI + AF, 5.0 ± 3.7 years; AF alone, 5.4 ± 3.9 years; P = .5). The mid and distal RCA showed no difference in the average number of angiographic stenoses or lesion severity. In regression analysis, CTI ablation was not a predictor of RCA stenosis severity (P = .6). There was no difference in coronary disease at sites remote to the CTI ablation (P = NS for all). CONCLUSION There was no observed relationship between CTI RFA and the number or severity of angiographically apparent RCA stenoses in long-term follow-up.
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Affiliation(s)
- Haran Yogasundaram
- Cardiovascular Division, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Muralidhar Reddy Papireddy
- Cardiovascular Division, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Saman Nazarian
- Cardiovascular Division, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gustavo S Guandalini
- Cardiovascular Division, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Timothy M Markman
- Cardiovascular Division, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert D Schaller
- Cardiovascular Division, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael P Riley
- Cardiovascular Division, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Lin
- Cardiovascular Division, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sanjay Dixit
- Cardiovascular Division, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin D'Souza
- Penn Presbyterian Medical Center, Heart and Vascular Pavilion, Philadelphia, Pennsylvania
| | - Ramanan Kumareswaran
- Cardiovascular Division, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J Callans
- Cardiovascular Division, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David S Frankel
- Cardiovascular Division, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fermin C Garcia
- Cardiovascular Division, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erica Zado
- Cardiovascular Division, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rajat Deo
- Cardiovascular Division, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew E Epstein
- Cardiovascular Division, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory E Supple
- Cardiovascular Division, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis E Marchlinski
- Cardiovascular Division, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew C Hyman
- Cardiovascular Division, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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Andrade JG, Macle L. Atrial Fibrillation after Atrial Flutter Ablation: An Existential Journey to Escape an Inevitable Fate. Can J Cardiol 2024; 40:1590-1591. [PMID: 38522620 DOI: 10.1016/j.cjca.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 03/26/2024] Open
Affiliation(s)
- Jason G Andrade
- Vancouver General Hospital, Vancouver, British Columbia, Canada; Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Québec, Canada.
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Grubb A, Aleong R, Rosenberg MA, Chang S, Padalia K, Ashur C, Adewumi J, Saqi B, Varela D, Sandhu A, Cerbin L, Barrett C, Tumolo AZ, Varosy P, Zipse MM, Tzou WS, Garg L, Sabzwari SRA. Development and validation of the Atri-Risk Conduction Index risk score to predict risk of atrial fibrillation after typical atrial flutter ablation. Heart Rhythm 2024; 21:1621-1629. [PMID: 38762137 DOI: 10.1016/j.hrthm.2024.04.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Identification of patients at risk for atrial fibrillation (AF) after typical atrial flutter (tAFL) ablation is important to guide monitoring and treatment. OBJECTIVE The purpose of this study was to create and validate a risk score to predict AF after tAFL ablation METHODS: We identified patients who underwent tAFL ablation with no AF history between 2017 and 2022 and randomly allocated to derivation and validation cohorts. We collected clinical variables and measured conduction parameters in sinus rhythm on an electrophysiology recording system (CardioLab, GE Healthcare). Univariate and multivariate logistic regressions (LogR) were used to evaluate association with AF development. RESULTS A total of 242 consecutive patients (81% male; mean age 66 ± 11 years) were divided into derivation (n =142) and validation (n = 100) cohorts. Forty-two percent developed AF over median follow-up of 330 days. In multivariate LogR (derivation cohort), proximal to distal coronary sinus time (pCS-dCS) ≥70 ms (odds ratio [OR] 16.7; 95% confidence interval [CI] 5.6-49), pCS time ≥36 ms (OR 4.5; 95% CI 1.5-13), and CHADS2-VASc score ≥3 (OR 4.3; 95% CI 1.6-11.8) were independently associated with new AF during follow-up. The Atri-Risk Conduction Index (ARCI) score was created with 0 as minimal and 4 as high-risk using pCS-dCS ≥70 ms = 2 points; pCS ≥36 ms = 1 point; and CHADS2-VASc score ≥3 = 1 point. In the validation cohort, 0% of patients with ARCI score = 0 developed AF, whereas 89% of patients with ARCI score = 4 developed AF. CONCLUSION We developed and validated a risk score using atrial conduction parameters and clinical risk factors to predict AF after tAFL ablation. It stratifies low-, moderate-, and high-risk patients and may be helpful in individualizing approaches to AF monitoring and anticoagulation.
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Affiliation(s)
- Alex Grubb
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ryan Aleong
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michael A Rosenberg
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Shu Chang
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kishan Padalia
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Carmel Ashur
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Joseph Adewumi
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Bilal Saqi
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Daniel Varela
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Amneet Sandhu
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Cardiac Electrophysiology Section, Division of Cardiology, Rocky Mountain VA Medical Center, Aurora, Colorado
| | - Lukasz Cerbin
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Christopher Barrett
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Cardiac Electrophysiology Section, Division of Cardiology, Denver Health Medical Center, Denver, Colorado
| | - Alexis Z Tumolo
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Paul Varosy
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Cardiac Electrophysiology Section, Division of Cardiology, Rocky Mountain VA Medical Center, Aurora, Colorado
| | - Matthew M Zipse
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Wendy S Tzou
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Lohit Garg
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Syed Rafay A Sabzwari
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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Chew DS, Sacks NC, Emden MR, Cyr PL, Sherwood R, Pokorney SD. Catheter ablation for supraventricular tachycardia and health resource utilization and expenditures: A propensity-matched cohort study. Int J Cardiol 2024; 403:131831. [PMID: 38331201 DOI: 10.1016/j.ijcard.2024.131831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/13/2024] [Accepted: 02/01/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Few data are available regarding temporal patterns of health resource utilization (HRU) and expenditures among patients undergoing catheter ablation for paroxysmal supraventricular tachycardia (PSVT). This study aimed to describe expenditures and HRU in patients with PSVT who underwent catheter ablation compared to a matched cohort of patients on medical therapy alone. METHODS Using a large US administrative database, we identified adult patients (age 18 to 65 years) with a new PSVT diagnosis between 2008 and 2016. Propensity-score matching was used to assemble a PSVT cohort treated with ablation or medical therapy alone (N = 2556). Longitudinal trends in HRU and expenditures in the 3-years preceding and following PSVT diagnosis were compared. RESULTS There were no significant differences in expenditures between groups except within the first year after PSVT diagnosis: $48,004 ablation vs. $17,560 medical therapy (p < 0.001). This difference was driven by procedural expenditures, where the mean cost of catheter ablation was $32,057 ± SD 26,737. In Years 2 and 3 post-ablation, HRU and expenditures decreased to the levels associated with the medical therapy group, although fewer ablation patients required any prescription for beta-blockers, calcium channel blockers, or anti-arrhythmic drugs (32% ablation vs. 42% medical therapy group, p < 0.001). CONCLUSION Catheter ablation reduces medication burden in PSVT, yet health resource use and expenditures were similar beyond 2 years post-ablation when compared to PSVT patients on medical therapy alone. Additional studies are required to better understand drivers of these sustained health expenditures, and barriers to achieving cost-savings for a potentially curative procedure.
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Affiliation(s)
- Derek S Chew
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Naomi C Sacks
- Precision Health Economics and Outcomes Research, Boston, MA, USA; Tufts University School of Medicine, Boston, MA, USA
| | - Maia R Emden
- Precision Health Economics and Outcomes Research, Boston, MA, USA
| | - Philip L Cyr
- Precision Health Economics and Outcomes Research, Boston, MA, USA; College of Health and Human Services, University of North Carolina, Charlotte, NC, USA
| | | | - Sean D Pokorney
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
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Bertels RA, Françoijs MW, Averdieck CW, Kammeraad JAE, Filippini LH, de Kezel CCA, Frerich S, Fejzic Z, du Plessis FA, Rammeloo LAJ, Kuipers IM, Blom NA. The effect of electro-anatomical mapping on the success rate and fluoroscopy time in supra-ventricular tachycardia ablation in children: single centre retrospective study. Cardiol Young 2024; 34:1077-1082. [PMID: 38073594 DOI: 10.1017/s1047951123004092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2024]
Abstract
AIMS To evaluate the effect of electro-anatomical mapping on success rate and fluoroscopy time in ablation of supraventricular tachycardia substrates in a large group of children. METHODS Patients referred from multiple centres in the Netherlands and who received a first ablation for supraventricular tachycardia substrates in the Leiden University Medical Center between 2014 and 2020 were included in this retrospective cohort study. They were divided in procedures in patients with fluoroscopy and procedures in patients using electro-anatomical mapping. RESULTS Outcomes of ablation of 373 electro-anatomical substrates were analysed. Acute success rate in the fluoro-group (n = 170) was 95.9% compared to 94.5% in the electro-anatomical mapping group (n = 181) (p = 0.539); recurrence rate was 6.1% in the fluoro-group and 6.4% in the electro-anatomical mapping group (p = 0.911) after a 12-months follow-up. Redo-ablations were performed in 12 cases in the fluoro-group and 10 cases in the electro-anatomical mapping group, with a success rate of 83.3% versus 80.0%, resulting in an overall success rate of 95.9% in the fluoro-group and 92.8% in the electro-anatomical mapping group (p = 0.216) after 12 months. Fluoroscopy time and dose area product decreased significantly from 16.00 ± 17.75 minutes (median ± interquartile range) to 2.00 ± 3.00 minutes (p = 0.000) and 210.5 µGym2 ± 249.3 to 32.9 µGym2 ± 78.6 (p = 0.000), respectively. In the fluoro-group, four complications occurred (2.0%) and in the electro-anatomical mapping group no complications occurred. CONCLUSION These results demonstrate that ablations of supraventricular tachycardia substrates in children remain a highly effective and safe treatment after the introduction of electro-anatomical mapping as a standard of care, while significantly reducing fluoroscopy time and dose area product.
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Affiliation(s)
- Robin A Bertels
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Maud W Françoijs
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Catharina W Averdieck
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Luc H Filippini
- Juliana Children's Hospital, HAGA Hospital, The Hague, The Netherlands
| | | | - Stefan Frerich
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Zina Fejzic
- Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Lucas A J Rammeloo
- VU Medical Center, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Irene M Kuipers
- Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Nico A Blom
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
- Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Nartowicz SA, Ciepłucha A, Waśniewski M, Miechowicz I, Rajewska-Tabor J, Bartczak-Rutkowska A, Lesiak M, Pyda M, Trojnarska O. A Twenty-Year Follow-Up of Adults with Ebstein Anomaly with Special Focus on Supraventricular Arrhythmias, Supraventricular Arrhythmias and Effectiveness of Catheter Ablation in 20-Year Follow-Up of Adults with Ebstein Anomaly. J Clin Med 2024; 13:2039. [PMID: 38610805 PMCID: PMC11012800 DOI: 10.3390/jcm13072039] [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: 02/28/2024] [Revised: 03/19/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Ebstein anomaly (EA) is a rare congenital heart disease characterized by the apical displacement of the tricuspid leaflets, creating an enlarged functional right atrium. Supraventricular arrhythmias (SVA) are common, and catheter ablation remains challenging. SVA is considered a risk factor for sudden cardiac death in this population. Still, there are very few real-life data on the impact of SVA treated invasively or conservatively on a patient's prognosis. We aimed to analyze the incidence of SVA in adults with EA, evaluate the effectiveness of catheter ablation, and analyze the impact of SVA and catheter ablation on survival in this population. Methods and results: 71 pts (median age 53 years; range 24-84 years) with EA were evaluated retrospectively from 1988 to 2020. Forty patients (56.3%) had SVA, and eighteen of them (45.0%) required at least one catheter ablation (35 procedures in total). Indications for ablation were mostly intra-atrial reentrant tachycardia (IART) and atrioventricular reentrant tachycardia (AVRT) (14 pts [77.8% and 9 pts [50.0%], respectively. IART and AVRT coexisted in nine pts. One patient suffered from persistent atrial fibrillation. Procedural effectiveness was reported in 28 (80%) cases; over a longer follow-up (mean 12.6 ± 5.4 years), only eight (44.4%) patients were completely free from SVA after the first ablation. In total, 10 patients (14%) died due to cardiovascular events. There was no difference in survival between patients with or without SVA (p = 0.9) and between ablated and non-ablated EA individuals (p = 0.89). Conclusions: Supraventricular arrhythmia is frequent in adults with Ebstein anomaly. Patients often require more than one catheter ablation but eventually become free from arrhythmias. The imaging parameters assessed by echocardiography or cardiac magnetic resonance do not seem to be associated with ablation outcomes. The impact of supraventricular arrhythmia itself or treatment with radiofrequency ablation is questionable and should be thoroughly investigated in this population.
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Affiliation(s)
- Sonia Alicja Nartowicz
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.C.); (M.W.); (I.M.); (J.R.-T.); (M.L.); (M.P.); (O.T.)
| | - Aleksandra Ciepłucha
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.C.); (M.W.); (I.M.); (J.R.-T.); (M.L.); (M.P.); (O.T.)
| | - Michał Waśniewski
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.C.); (M.W.); (I.M.); (J.R.-T.); (M.L.); (M.P.); (O.T.)
| | - Izabela Miechowicz
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.C.); (M.W.); (I.M.); (J.R.-T.); (M.L.); (M.P.); (O.T.)
- Department of Computer Science and Statistics, Medical University of Poznan, 60-806 Poznań, Poland
| | - Justyna Rajewska-Tabor
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.C.); (M.W.); (I.M.); (J.R.-T.); (M.L.); (M.P.); (O.T.)
| | - Agnieszka Bartczak-Rutkowska
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.C.); (M.W.); (I.M.); (J.R.-T.); (M.L.); (M.P.); (O.T.)
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.C.); (M.W.); (I.M.); (J.R.-T.); (M.L.); (M.P.); (O.T.)
| | - Małgorzata Pyda
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.C.); (M.W.); (I.M.); (J.R.-T.); (M.L.); (M.P.); (O.T.)
| | - Olga Trojnarska
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.C.); (M.W.); (I.M.); (J.R.-T.); (M.L.); (M.P.); (O.T.)
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Nishio R, Doi S, Fukunaga H, Dohi T. Acute myocardial infarction following radiofrequency catheter ablation in a child: a case report on the mechanism of coronary artery occlusion assessed by cardiovascular imaging. Eur Heart J Case Rep 2024; 8:ytae179. [PMID: 38680826 PMCID: PMC11049577 DOI: 10.1093/ehjcr/ytae179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/20/2024] [Accepted: 04/07/2024] [Indexed: 05/01/2024]
Abstract
Background Radiofrequency ablation is a common treatment for atrioventricular nodal re-entrant tachycardia, even in paediatric patients weighing ≥15 kg, where outcomes are similar to those in adults. However, reports of acute coronary artery occlusion after radiofrequency ablation for atrioventricular nodal re-entrant tachycardia are rare. Case summary An 11-year-old girl with symptomatic atrioventricular nodal re-entrant tachycardia refractory to drug treatment underwent radiofrequency ablation. During the procedure, ST elevation was observed, and coronary angiography revealed occlusion of the right coronary artery at the segment 4 atrioventricular branch. Intravascular ultrasonography showed a narrowed lumen and an abnormal area of low echogenicity in the adjacent myocardium. After dilation with a 1.5 mm diameter balloon, blood flow was successfully restored. Follow-up coronary computed tomography angiography revealed residual stenosis in the right coronary artery at the segment 4 atrioventricular branch; however, blood flow to the distal occlusion was preserved. The patient was discharged without further complications. Discussion To the best of our knowledge, this is the first report of coronary artery occlusion following radiofrequency ablation for atrioventricular nodal re-entrant tachycardia, evaluated using intravascular ultrasonography and coronary computed tomography angiography. Based on the imaging findings, direct thermal injury was considered the cause of occlusion.
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Affiliation(s)
- Ryota Nishio
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Tokyo, Japan
| | - Shinichiro Doi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Tokyo, Japan
| | - Hideo Fukunaga
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Tokyo, Japan
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Rodriguez Muñoz D, Ramos Jimenez J, Marco Del Castillo Á, Lozano Granero C, García Alberola A, Jiménez Sánchez D, Guntúriz Beltrán C, Ramos Ruiz P, Arias MÁ, Di Nubila B, Betancur A, González Torrecilla E, Dallaglio P, Alonso Fernández P, Ayala More HD, Calero S, Lumia G, Salgado Aranda R, Lázaro Rivera C, Rodríguez Mañero M, Syed A, Arribas Ynsaurriaga F, Salguero-Bodes R. Symptom burden guiding invasive electrophysiological study in paroxysmal supraventricular tachycardia: The believe SVT registry. Am Heart J 2024; 269:15-24. [PMID: 38042457 DOI: 10.1016/j.ahj.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/04/2023] [Accepted: 11/18/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Patients with palpitations clinically suggestive of paroxysmal supraventricular tachycardia (PSVT) are often managed conservatively until ECG-documentation of the tachycardia, leading to high impact on life quality and healthcare resource utilization. We evaluated results of electrophysiological study (EPS), and ablation when appropriate, among these patients, with special focus on gender differences in management. METHODS BELIEVE SVT is a European multicenter, retrospective registry in tertiary hospitals performing EPS in patients with palpitations, without ECG-documentation of tachycardia or preexcitation, and considered highly suggestive of PSVT by a cardiologist or cardiac electrophysiologist. We analyzed clinical characteristics, results of EPS and ablation, complications, and clinical outcomes during follow-up. RESULTS Six-hundred eighty patients from 20 centers were included. EPS showed sustained tachycardia in 60.9% of patients, and substrate potentially enabling AVNRT in 14.7%. No major/permanent complications occurred. Minor/transient complications were reported in 0.84% of patients undergoing diagnostic-only EPS and 1.8% when followed by ablation. During a 3.4-year follow-up, 76.2% of patients remained free of palpitations recurrence. Ablation (OR: 0.34, P < .01) and male gender (OR: 0.58, P = .01) predicted no recurrence. Despite a higher female proportion among patients with recurrence, (77.2% vs 63.5% among those asymptomatic during follow-up, P < .01), 73% of women in this study reported no recurrence of palpitations after EPS. CONCLUSIONS EPS and ablation are safe and effective in preventing recurrence of nondocumented palpitations clinically suggestive of PSVT. Despite a lower efficacy, this strategy is also highly effective among women and warrants no gender differences in management.
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Affiliation(s)
- Daniel Rodriguez Muñoz
- Cardiology Department, University Hospital 12 de Octubre, Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain.
| | - Javier Ramos Jimenez
- Cardiology Department, University Hospital 12 de Octubre, Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
| | - Álvaro Marco Del Castillo
- Cardiology Department, University Hospital 12 de Octubre, Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
| | | | | | | | | | - Pablo Ramos Ruiz
- Cardiology Department, University Hospital Santa Lucía, Cartagena, Spain
| | | | - Bruna Di Nubila
- Cardiology Department, St. Bartholomew's Hospital, London, United Kingdom
| | - Andrés Betancur
- Cardiology Department, University Hospital Santa Creu I Sant Pau, Barcelona, Spain
| | | | - Paolo Dallaglio
- Cardiology Department, Bellvitge University Hospital, Barcelona, Spain
| | | | | | - Sofía Calero
- Cardiology Department, University Hospital Albacete, Albacete, Spain
| | - Giuseppe Lumia
- Cardiology Department, University Hospital Sant'Eugenio, Rome, Italy
| | | | - Carla Lázaro Rivera
- Cardiology Department, University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Moisés Rodríguez Mañero
- Cardiology Department, University Hospital Santiago de Compostela, Santiago de Compostela, Spain
| | - Ahsan Syed
- Cardiology Department, St. Bartholomew's Hospital, London, United Kingdom
| | - Fernando Arribas Ynsaurriaga
- Cardiology Department, University Hospital 12 de Octubre, Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
| | - Rafael Salguero-Bodes
- Cardiology Department, University Hospital 12 de Octubre, Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
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9
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Peng G, Zei PC. Diagnosis and Management of Paroxysmal Supraventricular Tachycardia. JAMA 2024; 331:601-610. [PMID: 38497695 DOI: 10.1001/jama.2024.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Importance Paroxysmal supraventricular tachycardia (PSVT), defined as tachyarrhythmias that originate from or conduct through the atria or atrioventricular node with abrupt onset, affects 168 to 332 per 100 000 individuals. Untreated PSVT is associated with adverse outcomes including high symptom burden and tachycardia-mediated cardiomyopathy. Observations Approximately 50% of patients with PSVT are aged 45 to 64 years and 67.5% are female. Most common symptoms include palpitations (86%), chest discomfort (47%), and dyspnea (38%). Patients may rarely develop tachycardia-mediated cardiomyopathy (1%) due to PSVT. Diagnosis is made on electrocardiogram during an arrhythmic event or using ambulatory monitoring. First-line acute therapy for hemodynamically stable patients includes vagal maneuvers such as the modified Valsalva maneuver (43% effective) and intravenous adenosine (91% effective). Emergent cardioversion is recommended for patients who are hemodynamically unstable. Catheter ablation is safe, highly effective, and recommended as first-line therapy to prevent recurrence of PSVT. Meta-analysis of observational studies shows single catheter ablation procedure success rates of 94.3% to 98.5%. Evidence is limited for the effectiveness of long-term pharmacotherapy to prevent PSVT. Nonetheless, guidelines recommend therapies including calcium channel blockers, β-blockers, and antiarrhythmic agents as management options. Conclusion and Relevance Paroxysmal SVT affects both adult and pediatric populations and is generally a benign condition. Catheter ablation is the most effective therapy to prevent recurrent PSVT. Pharmacotherapy is an important component of acute and long-term management of PSVT.
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Affiliation(s)
- Gary Peng
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul C Zei
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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10
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Preda A, Bonvicini E, Coradello E, Testoni A, Gigli L, Baroni M, Carbonaro M, Vargiu S, Varrenti M, Colombo G, Paolucci M, Mazzone P, Guarracini F. The Fluoroless Future in Electrophysiology: A State-of-the-Art Review. Diagnostics (Basel) 2024; 14:182. [PMID: 38248058 PMCID: PMC10814721 DOI: 10.3390/diagnostics14020182] [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: 12/16/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
Fluoroscopy has always been the cornerstone imaging method of interventional cardiology procedures. However, radiation exposure is linked to an increased risk of malignancies and multiorgan diseases. The medical team is even more exposed to X-rays, and a higher incidence of malignancies was reported in this professional group. In the last years, X-ray exposure has increased rapidly, involving, above all, the medical team and young patients and forcing alternative fluoroless imaging methods. In cardiac electrophysiology (EP) and pacing, the advent of 3D electroanatomic mapping systems with dedicated catheters has allowed real-time, high-density reconstruction of both heart anatomy and electrical activity, significantly reducing the use of fluoroscopy. In addition, the diffusion of intracardiac echocardiography has provided high anatomical resolution of moving cardiac structures, providing intraprocedural guidance for more complex catheter ablation procedures. These methods have largely demonstrated safety and effectiveness, allowing for a dramatic reduction in X-ray delivery in most arrhythmias' ablations. However, some technical concerns, as well as higher costs, currently do not allow their spread out in EP labs and limit their use to only procedures that are considered highly complex and time-consuming and in young patients. In this review, we aim to update the current employment of fluoroless imaging in different EP procedures, focusing on its strengths and weaknesses.
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Affiliation(s)
- Alberto Preda
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Eleonora Bonvicini
- Division of Cardiology, Department of Medicine, Verona University Hospital, 37129 Verona, Italy
| | - Elena Coradello
- Division of Cardiology, Department of Medicine, Verona University Hospital, 37129 Verona, Italy
| | - Alessio Testoni
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Lorenzo Gigli
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Matteo Baroni
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marco Carbonaro
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Sara Vargiu
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marisa Varrenti
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Giulia Colombo
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marco Paolucci
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Patrizio Mazzone
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Fabrizio Guarracini
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
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11
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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1-e156. [PMID: 38033089 PMCID: PMC11095842 DOI: 10.1161/cir.0000000000001193] [Citation(s) in RCA: 286] [Impact Index Per Article: 286.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines liaison
| | | | | | | | | | - Paul L Hess
- ACC/AHA Joint Committee on Performance Measures liaison
| | | | | | | | | | - Kazuhiko Kido
- American College of Clinical Pharmacy representative
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12
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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 83:109-279. [PMID: 38043043 PMCID: PMC11104284 DOI: 10.1016/j.jacc.2023.08.017] [Citation(s) in RCA: 95] [Impact Index Per Article: 95.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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13
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Rane S, Bohora S, Acharya D, Parikh R, Bansal R. Incidence, clinical characteristics, electrophysiological characteristics and outcomes of patients with baseline PR prolongation undergoing radiofrequency ablation for Atrioventricular nodal reentrant tachycardia. Indian Pacing Electrophysiol J 2024; 24:16-19. [PMID: 38142870 PMCID: PMC10927978 DOI: 10.1016/j.ipej.2023.11.005] [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: 05/20/2023] [Revised: 09/04/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
AIMS AND OBJECTIVES Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common supraventricular tachycardia (SVT). Prolonged PR interval(>200 ms) on baseline electrocardiogram (ECG) is uncommon in such patients. The aim of the current study was to evaluate the incidence, clinical, electrophysiological characteristics, and outcomes of patients with baseline prolongation of PR interval undergoing radio-frequency ablation (RFA) for AVNRT. METHODS Over 10 years, out of the total number of 1435 patients with diagnosed AVNRT, 16 patients had prolonged PR intervals at baseline. All underwent elective RFA. A retrospective analysis of clinical, and electrophysiological characteristics and outcomes was done. The PR interval and atria-ventricular block cycle length values were compared with those patients with a normal interval at baseline and had undergone a successful slow pathway modification for AVNRT. RESULTS Out of 1435 patients with AVNRT, 16 (0.9 %) patients had baseline PR prolongation on ECG. The mean(+SD) age of the study population was 62.9 + 15.9 years. 10 (62.5 %) were males. The average PR interval was 264.2 + 24.1 ms. Slow fast AVNRT was seen in all. The anatomical site of success for ablation was the lower part of Koch's triangle in all patients. During ablation, a good sustained junctional rhythm was noted in all, with no AV (Atrioventricular) block or PR prolongation noted during ablation in any of the patients. PR interval decreased by more than 20 ms in 10 (62.5 %) patients. AVBCL (AV node block cycle length) increased on an average of 58.7 ms post-ablation. Only one patient developed AV block on follow-up. CONCLUSION A prolonged PR interval on baseline ECG is uncommon in patients with AVNRT. In these patients, slow pathway modification can be done safely and effectively. AVBCL (AV node block cycle length) increases immediately post-ablation. The risk of AV block though low persists on follow-up.
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Affiliation(s)
- Sameer Rane
- Department of Cardiology U.N.Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Asarwa, Ahmedabad, 380016, Gujarat, India.
| | - Shomu Bohora
- Department of Cardiology U.N.Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Asarwa, Ahmedabad, 380016, Gujarat, India.
| | - Debashish Acharya
- Department of Cardiology, Hi-Tech Medical College & Hospital, Hi-Tech Hospital Road, Pandra, Rasulgarh, Bhubaneswar, 751025, Odisha, India.
| | - Rujuta Parikh
- Department of Cardiology U.N.Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Asarwa, Ahmedabad, 380016, Gujarat, India.
| | - Raghav Bansal
- Department of Cardiology U.N.Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Asarwa, Ahmedabad, 380016, Gujarat, India.
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14
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Amer M, Annie FH, Adhikari S, Mukherjee D. Impact of Ablation during Index Hospitalization on All-Cause Mortality in Patients with Typical Atrial Flutter: Insights from National Multicenter Database. Int J Angiol 2023; 32:233-237. [PMID: 37927845 PMCID: PMC10624536 DOI: 10.1055/s-0043-1768981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Background We sought to assess the impact of ablation during index hospitalization (IH) on all-cause mortality (ACM) in patients presenting with newly diagnosed typical atrial flutter (tAFL) as compared with patients without ablation, irrespective of optimal rate or rhythm control medications. Methods We identified patients with newly diagnosed tAFL in the TriNetX Research Network between January 20, 2010, and January 20, 2021. Using International Classification of Diseases, 10th revision (ICD-10) codes, patients were stratified into those who had undergone ablation during IH and those who did not undergo the procedure. Results were assessed using propensity score matching (PSM) analysis as well as Kaplan-Meier curves. Results A total of 12,986 (N) patients (aged 35-85 years) met our inclusion criteria. Of those, 3,665 had undergone ablation during IH compared with 9,321 patients who did not. Patients in the ablation group (mean age 64.3 ± 10.1 years) had a higher prevalence of hypertension (80 vs. 78.3%, p = 0.02), respectively. PSM created two well-matched groups of 3,652/3,652 patients each with an ACM of ablation of 4.5 versus 7.8% ( p = 0.01) at 6 months, 6.6 versus 11.4% ( p = 0.01) at 12 months, and 14.5 versus 20.9% ( p < 0.001) at 36 months of follow-up. Survival data were confirmed through Kaplan-Meier analysis using a log-rank test. Conclusion From a large, federated, multicenter population database, we report significant survival benefit of ablation during IH in patients presenting with new tAFL diagnosis. Kaplan-Meier mortality curves confirmed survival advantage with ablation at 6, 12, and 36 months of follow-up in this cohort.
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Affiliation(s)
- Muhammad Amer
- CAMC Vascular Center of Excellence, Charleston Area Medical Center, Charleston, West Virginia
| | - Frank H. Annie
- CAMC Health Education and Research Institute, Charleston, West Virginia
| | - Shubash Adhikari
- CAMC Vascular Center of Excellence, Charleston Area Medical Center, Charleston, West Virginia
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15
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Borkowski P, Nazarenko N, Mangeshkar S, Borkowska N, Singh N, Garg V, Parker M, Naser AM. Atrial Flutter in the Elderly Patient: The Growing Role of Ablation in Treatment. Cureus 2023; 15:e50096. [PMID: 38186540 PMCID: PMC10770799 DOI: 10.7759/cureus.50096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
The prevalence of atrial flutter (AFL) is increasing among the elderly population, and managing this condition presents specific challenges within this demographic. As patients age, they often exhibit reduced responsiveness to conservative treatment, necessitating a more invasive approach. We present a case of a 93-year-old female who presented to the hospital with acute decompensated heart failure (ADHF) and AFL. A year prior, she was diagnosed with arrhythmia-induced cardiomyopathy. Despite recovering her ejection fraction (EF) through guideline-directed medical therapy (GDMT), her EF deteriorated again. The patient declined invasive management for her arrhythmia on multiple occasions. Managing such patients is challenging since the approach with pharmacotherapy alone often fails to maintain sinus rhythm or adequately control the ventricular rate. Growing evidence shows that invasive management, especially ablation, may be a safe and effective procedure for this patient population. Furthermore, the studies suggest that ablation may yield particular benefits for patients with simultaneous heart failure and atrial fibrillation/AFL (AF/AFL). Unfortunately, limited data exist regarding the invasive management of AFL in the elderly. Therefore, this case report aims to provide a comprehensive review of the current evidence regarding the safety and efficacy of ablation as a therapeutic option for AFL in elderly patients, with a particular focus on how patients with concomitant heart failure may benefit from ablation.
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Affiliation(s)
- Pawel Borkowski
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Natalia Nazarenko
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Shaunak Mangeshkar
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Natalia Borkowska
- Pediatrics, Samodzielny Publiczny Zakład Opieki Zdrowotnej (SPZOZ), Krotoszyn, POL
| | - Nikita Singh
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Vibhor Garg
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Matthew Parker
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Ahmad Moayad Naser
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
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16
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Penela D, Chauca A, Fernández-Armenta J, Pavón R, Benito B, Acosta J, Lozano JM, Falasconi G, San Antonio R, Soto-Iglesias D, Martí-Almor J, Ordoñez A, Bellido A, Carreño JM, Matiello M, Cano L, Pedrote A, Viveros D, Alderete J, Francia P, Algarra-Cullell M, Silva E, Meca-Santamaria J, Franco P, Cappato R, Berruezo A. Outcomes of cavotricuspid isthmus-dependent flutter ablation: randomized study comparing single vs. multiple catheter procedures-the SIMPLE study. J Interv Card Electrophysiol 2023; 66:1979-1988. [PMID: 36877415 DOI: 10.1007/s10840-023-01511-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/14/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Catheter ablation is recommended as first-line therapy for patients with symptomatic typical AFl. Although the conventional multi-catheter approach is the standard of care for cavotricuspid isthmus (CTI) ablation, a single-catheter approach was recently described as a feasible alternative. The present study sought to compare safety, efficacy, and efficiency of single vs. multi-catheter approach for atrial flutter (AFl) ablation. METHODS In this randomized multi-center study, consecutive patients referred for AFl ablation (n = 253) were enrolled and randomized to multiple vs. single-catheter approach for CTI ablation. In the single-catheter arm, PR interval (PRI) on the surface ECG was used to prove CTI block. Procedural and follow-up data were collected and compared between the two arms. RESULTS 128 and 125 patients were assigned to the single-catheter and to the multi-catheter arms, respectively. In the single-catheter arm, procedure time was significantly shorter (37 ± 25 vs. 48 ± 27 minutes, p = 0.002) and required less fluoroscopy time (430 ± 461 vs. 712 ± 628 seconds, p < 0.001) and less radiofrequency time (428 ± 316 vs. 643 ± 519 seconds, p < 0.001), achieving a higher first-pass CTI block rate (55 (45%) vs. 37 (31%), p = 0.044), compared with the multi-catheter arm. After a median follow-up of 12 months, 11 (4%) patients experienced AFl recurrences (5 (4%) in the single-catheter arm and 6 (5%) in the multi-catheter arm, p = 0.99). No differences were found in arrhythmia-free survival between arms (log-rank = 0.71). CONCLUSIONS The single-catheter approach for typical AFl ablation is not inferior to the conventional multiple-catheter approach, reducing procedure, fluoroscopy, and radiofrequency time.
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Affiliation(s)
- Diego Penela
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - Alfredo Chauca
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | | | - Ricardo Pavón
- Hospital Universitario Virgen de Valme, Sevilla, Spain
| | | | - Juan Acosta
- Virgen del Rocío University Hospital, Sevilla, Spain
| | | | - Giulio Falasconi
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | - Rodolfo San Antonio
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - David Soto-Iglesias
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - Julio Martí-Almor
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - Augusto Ordoñez
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - Aldo Bellido
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | | | - Maria Matiello
- Hospital Universitario General de Cataluña, Barcelona, Spain
| | - Lucas Cano
- Puerta del Mar University Hospital, Cádiz, Spain
| | | | - Daniel Viveros
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | - Jose Alderete
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | - Pietro Francia
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza, Rome, Italy
| | | | | | | | - Paula Franco
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | | | - Antonio Berruezo
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain.
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17
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Joglar JA, Kapa S, Saarel EV, Dubin AM, Gorenek B, Hameed AB, Lara de Melo S, Leal MA, Mondésert B, Pacheco LD, Robinson MR, Sarkozy A, Silversides CK, Spears D, Srinivas SK, Strasburger JF, Tedrow UB, Wright JM, Zelop CM, Zentner D. 2023 HRS expert consensus statement on the management of arrhythmias during pregnancy. Heart Rhythm 2023; 20:e175-e264. [PMID: 37211147 DOI: 10.1016/j.hrthm.2023.05.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023]
Abstract
This international multidisciplinary expert consensus statement is intended to provide comprehensive guidance that can be referenced at the point of care to cardiac electrophysiologists, cardiologists, and other health care professionals, on the management of cardiac arrhythmias in pregnant patients and in fetuses. This document covers general concepts related to arrhythmias, including both brady- and tachyarrhythmias, in both the patient and the fetus during pregnancy. Recommendations are provided for optimal approaches to diagnosis and evaluation of arrhythmias; selection of invasive and noninvasive options for treatment of arrhythmias; and disease- and patient-specific considerations when risk stratifying, diagnosing, and treating arrhythmias in pregnant patients and fetuses. Gaps in knowledge and new directions for future research are also identified.
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Affiliation(s)
- José A Joglar
- The University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Elizabeth V Saarel
- St. Luke's Health System, Boise, Idaho, and Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
| | | | | | | | | | | | | | - Luis D Pacheco
- The University of Texas Medical Branch at Galveston, Galveston, Texas
| | | | - Andrea Sarkozy
- University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium
| | | | - Danna Spears
- University Health Network, Toronto, Ontario, Canada
| | - Sindhu K Srinivas
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | - Carolyn M Zelop
- The Valley Health System, Ridgewood, New Jersey; New York University Grossman School of Medicine, New York, New York
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18
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Luo Q, Xie Y, Bao Y, Wei Y, Lin C, Zhang N, Ling T, Chen K, Pan W, Wu L, Jin Q. Different electrophysiological characteristics of cavo-tricuspid isthmus dependent atrial flutter guided by robotic magnetic navigation in patients with and without prior cardiac surgery. Clin Cardiol 2023; 46:1185-1193. [PMID: 37489870 PMCID: PMC10577525 DOI: 10.1002/clc.24098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 06/21/2023] [Accepted: 07/13/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUD Cavo- tricuspid isthmus dependent atrial flutter (CTI- AFL) is a common atrial arrhythmia in patients with prior cardiac surgery (postsurgical AFL) and without prior cardiac surgery (nonsurgical AFL). However, there is only limited data regarding the eletrophysiological differences between the CTI- AFL in the postsurgical patients and the nonsurgical patients. HYPOTHESIS We aimed to investigate the differences in clinical and electrophysiological characteristics between the postsurgical group and nonsurgical group and to evaluate the acute and long-term outcomes after ablation guided by robotic magnetic navigation (RMN) in both the groups. Methods Fourty-two consecutive patients with nonsurgical AFL and 21 with postsurgical AFL were retrospectively analyzed in our center. Electrocardiographic (ECG) analysis and three-dimensional electrophysiological study were performed in all the patients. RESULTS The results revealed that only 55.6% of postsurgical patients with proven counterclockwise (CCW) AFL presented with a typical ECG suggesting this mechanism. In contrast, 86.1% of nonsurgical patients demonstrated a typical ECG pattern for CCW AFL. In addition, we employed a reverse "U-curve" to facilitate radiofrequency delivery when ablating near the inferior vena cava ostium in the present study. Compared with the nonsurgical group, electroanatomical mapping showed the mean AFL cycle length was significantly longer (253.3 ± 40.4 vs. 234.1 ± 24.2 ms, p = 0.03) and the right atrium volume was larger (114.8 ± 26.0 vs. 97.5 ± 19.1 mL, p = 0.004) in the postsurgical group. Additionally, the procedural time (75.9 ± 21.3 vs. 61.6 ± 26.6 minutes, p = 0.03) and ablation time (53.0 ± 21.4 vs. 36.7 ± 25.6 minutes, p = 0.02) are much longer in the postsurgical group. However, the navigation index in the postsurgical group was significantly smaller (0.35 ± 0.08 vs. 0.43 ± 0.13, p = 0.01). Moreover, the acute and long-term success rates were comparable between the two groups. CONCLUSIONS Catheter ablation of CTI-AFL with and without prior cardiac surgery guided by RMN are associated with high acute and long-term success rates, despite the procedural and ablation times are much longer in the postsurgical patients. However, ECG characteristics of the tachycardia may be misleading as they are more often atypical in patients after cardiac surgery.
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Affiliation(s)
- Qingzhi Luo
- Department of Cardiovascular MedicineRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yun Xie
- Department of Cardiovascular MedicineRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yangyang Bao
- Department of Cardiovascular MedicineRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yue Wei
- Department of Cardiovascular MedicineRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Changjian Lin
- Department of Cardiovascular MedicineRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Ning Zhang
- Department of Cardiovascular MedicineRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Tianyou Ling
- Department of Cardiovascular MedicineRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Kang Chen
- Department of Cardiovascular MedicineRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Wenqi Pan
- Department of Cardiovascular MedicineRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Liqun Wu
- Department of Cardiovascular MedicineRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Qi Jin
- Department of Cardiovascular MedicineRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
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Andrikopoulos G, Tampakis K, Sykiotis A, Pastromas S. Transient conduction disturbances acutely after pulsed-field cavotricuspid isthmus ablation: a case report. Eur Heart J Case Rep 2023; 7:ytad370. [PMID: 37575541 PMCID: PMC10413419 DOI: 10.1093/ehjcr/ytad370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
Background Cavotricuspid isthmus pulsed-field ablation has been recently described to be safely performed despite initial reports on coronary arterial spasm while conduction disturbances as a complication of cavotricuspid isthmus ablation are rare and have been reported exclusively for radiofrequency catheter ablation. Case summary A 64-year-old female patient with mechanical prosthetic valves underwent atrial fibrillation ablation using the pentaspline pulsed-field ablation catheter. At the end of the uneventful pulmonary vein isolation, an atrial tachycardia depended to the cavotricuspid isthmus occurred. A single pulsed-field application at the cavotricuspid isthmus resulted in right bundle branch block combined with posterior fascicular hemiblock and PR prolongation that resolved spontaneously within 12 h. Discussion This is the first report of transient conduction disturbances as a complication of cavotricuspid isthmus pulsed-field ablation. Although the underlying mechanism, either single or miscellaneous, was not verified, this case highlights that caution should be taken when the pentaspline pulsed-field ablation catheter is used for cavotricuspid isthmus ablation.
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Affiliation(s)
- George Andrikopoulos
- First Department of Cardiology/Electrophysiology and Pacing, Henry Dunant Hospital Center, 107 Mesogeion ave, 11526 Athens, Greece
| | - Konstantinos Tampakis
- First Department of Cardiology/Electrophysiology and Pacing, Henry Dunant Hospital Center, 107 Mesogeion ave, 11526 Athens, Greece
| | - Alexandros Sykiotis
- First Department of Cardiology/Electrophysiology and Pacing, Henry Dunant Hospital Center, 107 Mesogeion ave, 11526 Athens, Greece
| | - Sokratis Pastromas
- First Department of Cardiology/Electrophysiology and Pacing, Henry Dunant Hospital Center, 107 Mesogeion ave, 11526 Athens, Greece
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Narasimhan B, Gandhi K, Moras E, Wu L, Da Wariboko A, Aronow W. Experimental drugs for supraventricular tachycardia: an analysis of early phase clinical trials. Expert Opin Investig Drugs 2023; 32:825-838. [PMID: 37728554 DOI: 10.1080/13543784.2023.2259309] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Supraventricular tachycardias (SVT) are a diverse group of commonly encountered arrhythmias arising at or above the atrioventricular (AV) node. Conventional anti-arrhythmic medications are restricted by extensive side-effect profiles and limited efficacy. Catheter ablation has emerged as a first-line therapy for many arrhythmias but is not a suitable option for all patients. This has prompted the exploration of novel pharmacological approaches targeting specific molecular mechanisms of SVT. AREAS COVERED This review article aims to summarize recent advancements in pharmacological therapeutics for SVT and their clinical implications. The understanding of molecular mechanisms underlying these arrhythmias, particularly atrial fibrillation, has opened up new possibilities for targeted interventions. Beyond the manipulation of ion channels and membrane potentials, pharmacotherapy now focuses on upstream targets such as inflammation, oxidative stress, and structural remodeling. This review strives to provide a comprehensive overview of recent advancements in pharmacological therapeutics directed at the management of SVT. We begin by providing a brief summary of the mechanisms and management of commonly encountered SVT before delving into individual agents, which in turn are stratified based on their molecular treatment targets. EXPERT OPINION The evolving landscape of pharmacologic therapy offers hope for more personalized and tailored interventions in the management of SVT.
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Affiliation(s)
- Bharat Narasimhan
- DeBakey Cardiovascular Institute, Houston Methodist, Houston, TX, USA
| | - Kruti Gandhi
- Department of Internal Medicine, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Errol Moras
- Department of Internal Medicine, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Lingling Wu
- Department of Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Akanibo Da Wariboko
- Department of Internal Medicine, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Wilbert Aronow
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
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Deshmukh A, Iglesias M, Khanna R, Beaulieu T. Atrial flutter-related health care use and costs: An analysis of a nationally representative administrative claims database in the United States. Heart Rhythm O2 2023; 4:367-373. [PMID: 37361619 PMCID: PMC10288018 DOI: 10.1016/j.hroo.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Background Atrial flutter (AFL) is a common arrhythmia associated with significant morbidity, yet the incremental burden of this condition has not been well documented. Objective Using real-world data, we sought to evaluate the healthcare use and cost burden of incident AFL in the United States. Methods From 2017 to 2020, persons with an incident diagnosis of AFL were identified through Optum Clinformatics, a nationally representative administrative claims database of commercially insured individuals in the United States. We constructed 2 cohorts (AFL patient; non-AFL comparator) and used a matching weights method to balance covariates between cohorts. Using logistic regression and general linear models, 12-month all-cause and cardiovascular (CV)-related health care use (inpatient, outpatient, emergency room [ER] visits, and other) as well as medical expenditures were compared between the matched cohorts. Results The matching weight sample sizes were 13,270 for AFL and 13,683 for the non-AFL cohorts. In the AFL cohort, ∼71% were at least 70 years of age, 62% identified as male, and 78% identified as White. The AFL cohort had significantly higher health care use, including all-cause (relative risk [RR] 1.14; 95% confidence interval [CI] 1.11-1.18) and CV-related ER visits (RR 1.60; 95% CI 1.52-1.70) compared with the non-AFL cohort. Mean total health care costs (per patient annually) were almost $21,783 (95% CI $18,967-$24,599) higher among patients with AFL compared to those without AFL ($71,201 vs $49,418, respectively; P <.001). Conclusion Amidst the backdrop of an aging population, findings from this study draw attention to the importance of timely and adequate treatment of AFL.
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Affiliation(s)
- Abhishek Deshmukh
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Maximiliano Iglesias
- Johnson & Johnson Medical Devices, Franchise Health Economics and Market Access, Irvine, California
| | - Rahul Khanna
- MedTech Epidemiology and Real-World Data Sciences, Johnson and Johnson, New Brunswick, New Jersey
| | - Tara Beaulieu
- MedTech Epidemiology and Real-World Data Sciences, Johnson and Johnson, New Brunswick, New Jersey
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Chen JL, Hsiao CH, Yen CC. Prognostic value of cardiac troponin in elderly patients with paroxysmal supraventricular tachycardia: A multicenter study. Am J Emerg Med 2023; 69:167-172. [PMID: 37149956 DOI: 10.1016/j.ajem.2023.04.041] [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: 02/10/2023] [Revised: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND An elevated level of cardiac troponin I (cTnI) frequently accompanies an episode of supraventricular tachycardia (SVT). However, the predictive value of cTnI in elderly SVT patients has not been examined. METHODS We collected the electronic medical records of elderly SVT patients (over 65 years old) who visited four Taiwanese emergency departments over a 2-year period. The patients who underwent cTnI testing were included in the cohort and further categorized based on their cTnI results (positive or negative). The study's primary outcomes were the 5-year risks of major adverse cardiovascular events (MACE) and SVT recurrence. RESULTS One hundred and twenty-four patients met the inclusion criteria. Of these patients, 39 (31.5%) had a positive cTnI result, and 85 (68.5%) had a negative cTnI result. Patients with a positive cTnI result were older (p = 0.029) and had a longer hospital stay (p = 0.023) than those with a negative cTnI result. Multivariate analysis showed that age > 75 years (OR = 2.41; 95% CI 1.07-5.45; p = 0.034) was an independent predictor for cTnI elevation. In the survival analysis, no difference in the incidence of five-year MACE (p = 0.656) was observed between the cTnI-positive and cTnI-negative groups. Multivariate analysis revealed that a history of coronary artery disease was the only significant independent risk factor for MACE (HR = 4.30; 95% 95% CI 1.41-13.05; p = 0.010). For SVT recurrence, the multivariate analysis revealed that previous SVT (HR = 3.37; 95% CI 1.53-7.39; p = 0.002), smoking history (HR = 2.32; 95% CI 1.03-5.24; p = 0.043), and RFA treatment (HR = 0.20; 95% CI 0.06-0.65; p = 0.008) were significant independent predictors. CONCLUSIONS An increased cardiac troponin level may not effectively indicate the risk of MACE in elderly SVT patients. Physicians might want to be cautious when interpreting troponin test results for this specific patient group.
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Affiliation(s)
- Jyun-Long Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Chien-Han Hsiao
- Department of Linguistics, Indiana University, Bloomington, IN, USA
| | - Chieh-Ching Yen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan; Department of Emergency Medicine, Jen-Ai Hospital, Dali Branch, Taichung, Taiwan.
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Chyou JY, Barkoudah E, Dukes JW, Goldstein LB, Joglar JA, Lee AM, Lubitz SA, Marill KA, Sneed KB, Streur MM, Wong GC, Gopinathannair R. Atrial Fibrillation Occurring During Acute Hospitalization: A Scientific Statement From the American Heart Association. Circulation 2023; 147:e676-e698. [PMID: 36912134 DOI: 10.1161/cir.0000000000001133] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Acute atrial fibrillation is defined as atrial fibrillation detected in the setting of acute care or acute illness; atrial fibrillation may be detected or managed for the first time during acute hospitalization for another condition. Atrial fibrillation after cardiothoracic surgery is a distinct type of acute atrial fibrillation. Acute atrial fibrillation is associated with high risk of long-term atrial fibrillation recurrence, warranting clinical attention during acute hospitalization and over long-term follow-up. A framework of substrates and triggers can be useful for evaluating and managing acute atrial fibrillation. Acute management requires a multipronged approach with interdisciplinary care collaboration, tailoring treatments to the patient's underlying substrate and acute condition. Key components of acute management include identification and treatment of triggers, selection and implementation of rate/rhythm control, and management of anticoagulation. Acute rate or rhythm control strategy should be individualized with consideration of the patient's capacity to tolerate rapid rates or atrioventricular dyssynchrony, and the patient's ability to tolerate the risk of the therapeutic strategy. Given the high risks of atrial fibrillation recurrence in patients with acute atrial fibrillation, clinical follow-up and heart rhythm monitoring are warranted. Long-term management is guided by patient substrate, with implications for intensity of heart rhythm monitoring, anticoagulation, and considerations for rhythm management strategies. Overall management of acute atrial fibrillation addresses substrates and triggers. The 3As of acute management are acute triggers, atrial fibrillation rate/rhythm management, and anticoagulation. The 2As and 2Ms of long-term management include monitoring of heart rhythm and modification of lifestyle and risk factors, in addition to considerations for atrial fibrillation rate/rhythm management and anticoagulation. Several gaps in knowledge related to acute atrial fibrillation exist and warrant future research.
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24
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Doldi F, Geßler N, Anwar O, Kahle AK, Scherschel K, Rath B, Köbe J, Lange PS, Frommeyer G, Metzner A, Meyer C, Willems S, Kuck KH, Eckardt L. In-hospital mortality and major complications related to radiofrequency catheter ablations of over 10 000 supraventricular arrhythmias from 2005 to 2020: individualized case analysis of multicentric administrative data. Europace 2023; 25:130-136. [PMID: 36006798 PMCID: PMC10103566 DOI: 10.1093/europace/euac146] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/11/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS The incidence of in-hospital post-interventional complications and mortality after ablation of supraventricular tachycardia (SVT) vary among the type of procedure and most likely the experience of the centre. As ablation therapy of SVT is progressively being established as first-line therapy, further assessment of post-procedural complication rates is crucial for health care quality. METHODS AND RESULTS We aimed at determining the incidence of in-hospital mortality and bleeding complications from SVT ablations in German high-volume electrophysiological centres between 2005 and 2020. All cases were registered by the German Diagnosis Related Groups-and the German Operation and Procedure Classification (OPS) system. A uniform search for SVT ablations from 2005 to 2020 with the same OPS codes defining the type of ablation/arrhythmia as well as the presence of a vascular complication, cardiac tamponade, and/or in-hospital death was performed. An overall of 47 610 ablations with 10 037 SVT ablations were registered from 2005 to 2020 among three high-volume centres. An overall complication rate of 0.5% (n = 38) was found [median age, 64; ±15 years; female n = 26 (68%)]. All-cause mortality was 0.02% (n = 2) and both patients had major prior co-morbidities precipitating a lethal outcome irrespective of the ablation procedure. Vascular complications occurred in 10 patients (0.1%), and cardiac tamponade was detected in 26 cases (0.3%). CONCLUSION The present case-based analysis shows an overall low incidence of in-hospital complications after SVT ablation highlighting the overall very good safety profile of SVT ablations in high-volume centres. Further prospective analysis is still warranted to guarantee continuous quality control and optimal patient care.
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Affiliation(s)
- Florian Doldi
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
| | - Nele Geßler
- Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Omar Anwar
- Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Ann-Kathrin Kahle
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Katharina Scherschel
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Benjamin Rath
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
| | - Julia Köbe
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
| | - Philipp Sebastian Lange
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
| | - Gerrit Frommeyer
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
| | - Andreas Metzner
- Universitäres Herz- und Gefäßzentrum UKE Hamburg, Klinik und Poliklinik für Kardiologie, Hamburg, Germany
| | - Christian Meyer
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Stephan Willems
- Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Lars Eckardt
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
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Pang N, Gao J, Zhang N, Guo M, Wang R. Cavotricuspid isthmus ablation for atrial flutter guided by contact force related parameters: A systematic review and meta-analysis. Front Cardiovasc Med 2023; 9:1060542. [PMID: 36684611 PMCID: PMC9853203 DOI: 10.3389/fcvm.2022.1060542] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/14/2022] [Indexed: 01/08/2023] Open
Abstract
Background Contact force (CF) and related parameters have been evaluated as an effective guide mark for pulmonary vein isolation, yet not for linear ablation of the cavotricuspid isthmus (CTI) dependent atrial flutter (AFL). We thus studied the efficacy and safety of CF related parameter-guided ablation for CTI-AFL. Methods Systematic search was performed on databases involving PubMed, EMbase, Cochrane Library and Web of Science (through June 2022). Original articles comparing CF related parameter-guided ablation and conventional parameter-guided ablation for CTI-AFL were included. One-by-one elimination, subgroup analysis and meta-regression were used for heterogeneity test between studies. Results Ten studies reporting on 761 patients were identified after screening with inclusion and exclusion criteria. Radiofrequency (RF) duration was significantly shorter in CF related parameter-guided group (p = 0.01), while procedural time (p = 0.13) and fluoroscopy time (p = 0.07) were no significant difference between two groups. CF related parameter-guided group had less RF lesions (p = 0.0003) and greater CF of catheter-tissue (p = 0.0002). Touch-up needed after first ablation line was less in CF related parameter-guided group (p = 0.004). In addition, there were no statistical significance between two groups on acute conduction recovery rates (p = 0.25), recurrence rates (p = 0.92), and complication rates (p = 0.80). Meta-regression analysis revealed no specific covariate as an influencing factor for above results (p > 0.10). Conclusion CF related parameters guidance improves the efficiency of CTI ablation, with the better catheter-tissue contact, the lower RF duration and the comparable safety as compared with conventional method, but does not improve the acute success rate and long-term outcome.
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Affiliation(s)
- Naidong Pang
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China,The First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jia Gao
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Nan Zhang
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Min Guo
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Rui Wang
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China,*Correspondence: Rui Wang,
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Ono K, Iwasaki Y, Akao M, Ikeda T, Ishii K, Inden Y, Kusano K, Kobayashi Y, Koretsune Y, Sasano T, Sumitomo N, Takahashi N, Niwano S, Hagiwara N, Hisatome I, Furukawa T, Honjo H, Maruyama T, Murakawa Y, Yasaka M, Watanabe E, Aiba T, Amino M, Itoh H, Ogawa H, Okumura Y, Aoki‐Kamiya C, Kishihara J, Kodani E, Komatsu T, Sakamoto Y, Satomi K, Shiga T, Shinohara T, Suzuki A, Suzuki S, Sekiguchi Y, Nagase S, Hayami N, Harada M, Fujino T, Makiyama T, Maruyama M, Miake J, Muraji S, Murata H, Morita N, Yokoshiki H, Yoshioka K, Yodogawa K, Inoue H, Okumura K, Kimura T, Tsutsui H, Shimizu W. JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias. J Arrhythm 2022; 38:833-973. [PMID: 36524037 PMCID: PMC9745564 DOI: 10.1002/joa3.12714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Mkoko P, Barole N, Solomon K, Chin A. Feasibility and safety of interventional electrophysiology and catheter ablation in the South African public sector: Challenges and opportunities for comprehensive cardiac electrophysiology in South Africa. J Arrhythm 2022; 38:1042-1048. [PMID: 36524030 PMCID: PMC9745492 DOI: 10.1002/joa3.12783] [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: 06/23/2022] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 11/09/2022] Open
Abstract
Aims The spectrum and outcomes of catheter ablation procedures performed in South Africa are unknown, and therefore, the feasibility of interventional electrophysiology in the South African public sector is undetermined. Methods and Results This study was a retrospective review of all patients that underwent invasive electrophysiology procedures and catheter ablation at Groote Schuur Hospital (GSH) and the University of Cape Town Private Academic Hospital (UCTPAH) between 01 January 2013 and 31 December 2020.One thousand one hundred eighty-six invasive electrophysiology procedures were performed during the study period. Of these were 1102 catheter ablation procedures. There were 76 redo catheter ablation procedures, predominantly for atrial fibrillation (AF), which accounted for 39% (30/76) of the repeat procedures. There were only 0.8% (9/1102) catheter ablation related complications which were mostly access related. Atrial fibrillation accounted for most of the ablation procedures, 28.9% (318/1102); these were mainly performed at UCTPAH than at GSH, 300 vs 18 p < .0001. Cavotricuspid isthmus (CTI) dependent atrial flutter ablation was the second most commonly performed catheter ablation procedure, accounting for 21.6% (238/1102) of the catheter ablation procedures. More CTI dependent atrial flutter ablations were performed at GSH than a UCTPAH, 156 vs 82 p < .0001. The overall success rate of catheter ablation was 92%. Conclusion A broad spectrum of catheter ablation procedures was performed with a high success rate and limited complications, thus demonstrating the feasibility of safe cardiac electrophysiology and catheter ablation in the South African public sector.
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Affiliation(s)
- Philasande Mkoko
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, The University of Cape TownObservatorySouth Africa
- Groote Schuur Hospital, E17 Cardiac ClinicObservatorySouth Africa
| | | | - Kayla Solomon
- Groote Schuur Hospital, E17 Cardiac ClinicObservatorySouth Africa
| | - Ashley Chin
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, The University of Cape TownObservatorySouth Africa
- Groote Schuur Hospital, E17 Cardiac ClinicObservatorySouth Africa
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Tsiachris D, Antoniou C, Doundoulakis I, Manolakou P, Kordalis A, Konstantinou D, Gatzoulis K, Tsioufis K, Stefanadis C. Three-dimensional electroanatomically guided slow pathway elimination is associated with procedural improvements and clinical benefit in atrioventricular node reentrant tachycardia patients. J Arrhythm 2022; 38:1035-1041. [PMID: 36524035 PMCID: PMC9745481 DOI: 10.1002/joa3.12778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/28/2022] [Accepted: 09/02/2022] [Indexed: 09/10/2024] Open
Abstract
Background Slow pathway (SP) ablation, in the context of atrioventricular node reentrant tachycardia (AVNRT) treatment could result in either complete elimination or only modification of the SP with ambiguity regarding associated benefits. Three-dimensional electroanatomical mapping (3D-EAM) may be used adjunctively aiming to complete SP elimination. Our purpose was to compare a 3D-EAM-based strategy targeting SP elimination to the conventional fluoroscopic approach with respect to clinical outcomes. Methods One hundred and two consecutive AVNRT patients (36 males, mean age 53.2 ± 13.7 years) underwent in two successive periods a conventional fluoroscopic ablation approach (n = 42) or a 3D-EAM-guided ablation focusing on complete SP elimination (n = 60). Results Several procedural parameters improved with 3D-EAM use, including fluoroscopy time (2.4 ± 4.7 min vs. 13 ± 4.5 min), dose-area product (1061 ± 3122 μGy × m2 vs. 5002 ± 3032 μGy × m2) and slow pathway elimination frequency (95% vs. 50%, all p < .001). Procedural time was slightly prolonged in the 3D-EAM group (101 ± 31 min vs. 87 ± 24 min, p = .013). Two major complications occurred in the conventional group. Altogether, over a mean follow-up of approximately 2.7 years, recurrence occurred in 6 of 42 (14.3%) in the conventional group as compared to 1 of 62 (1.7%) in the EAM-based group (p = .019). In the Kaplan-Meier analysis, time-to-event was significantly longer for the EAM-based patients (p < .030). Moreover, the EAM-based strategy was associated with less redo procedures' rates (9.5% in the non-EAM group vs. 0% in the EAM group, p = .026). Conclusions The present study showed that an EAM-based SP elimination strategy is not only feasible and safe but it is also accompanied by improved clinical outcomes in the setting of AVNRT ablation.
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Affiliation(s)
- Dimitrios Tsiachris
- Athens Heart CenterAthens Medical CenterAthensGreece
- First Department of CardiologyNational and Kapodistrian University, “Hippokration” HospitalAthensGreece
| | | | - Ioannis Doundoulakis
- Athens Heart CenterAthens Medical CenterAthensGreece
- First Department of CardiologyNational and Kapodistrian University, “Hippokration” HospitalAthensGreece
| | | | - Athanasios Kordalis
- First Department of CardiologyNational and Kapodistrian University, “Hippokration” HospitalAthensGreece
| | | | - Konstantinos Gatzoulis
- First Department of CardiologyNational and Kapodistrian University, “Hippokration” HospitalAthensGreece
| | - Konstantinos Tsioufis
- First Department of CardiologyNational and Kapodistrian University, “Hippokration” HospitalAthensGreece
| | - Christodoulos Stefanadis
- Athens Heart CenterAthens Medical CenterAthensGreece
- Section of Cardiovascular MedicineYale University School of MedicineNew HavenConnecticutUSA
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Halvorsen S, Mehilli J, Cassese S, Hall TS, Abdelhamid M, Barbato E, De Hert S, de Laval I, Geisler T, Hinterbuchner L, Ibanez B, Lenarczyk R, Mansmann UR, McGreavy P, Mueller C, Muneretto C, Niessner A, Potpara TS, Ristić A, Sade LE, Schirmer H, Schüpke S, Sillesen H, Skulstad H, Torracca L, Tutarel O, Van Der Meer P, Wojakowski W, Zacharowski K. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J 2022; 43:3826-3924. [PMID: 36017553 DOI: 10.1093/eurheartj/ehac270] [Citation(s) in RCA: 308] [Impact Index Per Article: 154.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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30
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Sim MG, Chan SP, Kojodjojo P, Tan ES. Late pacemaker implantation after atrioventricular nodal reentrant tachycardia ablation: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2022; 33:2297-2304. [PMID: 36124400 DOI: 10.1111/jce.15680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/13/2022] [Accepted: 08/24/2022] [Indexed: 12/07/2022]
Abstract
INTRODUCTION Catheter ablation (CA) of atrioventricular nodal reentrant tachycardia (AVNRT) is associated with late pacemakers for AV block (AVB). We performed a systematic review and meta-analysis of the pooled incidence of late pacemakers for AVB after CA of AVNRT. METHODS AND RESULTS Relevant studies were identified from 4 electronic databases (PubMed, EMBASE, Scopus, Cochrane Trial Register) from inception to 2022. A random effects model was used to calculate the odds of late pacemakers in CA of AVNRT compared to atrioventricular reentrant tachycardia (AVRT). Of 533 articles screened, 13 were included in systematic review. CA for AVNRT was performed in 16,471 patients (mean age 54±17 years, 63% females), of which 68 (0.4%) underwent pacemaker implantation for late AVB. Meta-analysis was performed in 5 of the 13 studies (mean follow-up duration 7±4 years). Patients who underwent CA of AVNRT were older (58±17 vs 52±20 years, p<0.001), and more likely female (60% vs 41%, p<0.001) than AVRT. Pooled estimates of late pacemakers for AVB were higher in CA of AVNRT than AVRT (0.5% vs 0.2%, p=0.006), with CA in AVNRT associated with almost 2-fold increased odds of late pacemakers indicated for AVB (OR 1.94, 95%CI 1.08-3.47, p=0.027) compared to AVRT. CONCLUSION AVNRT ablation is safe but associated with a low but definitely increased risk of requiring pacing in the later years due to AVB. This association is confirmed by pooling over 16,000 AVNRT patients receiving clinically indicated ablation and is helpful in providing informed consent for prospective patients undergoing ablation for AVNRT. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ming Gin Sim
- Yong Loo Lin School of Medicine, National University, Singapore
| | - Siew Pang Chan
- Yong Loo Lin School of Medicine, National University, Singapore
| | - Pipin Kojodjojo
- Yong Loo Lin School of Medicine, National University, Singapore.,Department of Cardiology, National University Heart Centre, Singapore.,Department of Cardiology, Ng Teng Fong General Hospital, Singapore
| | - Eugene Sj Tan
- Yong Loo Lin School of Medicine, National University, Singapore.,Department of Cardiology, National University Heart Centre, Singapore
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31
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Sau A, Ibrahim S, Ahmed A, Handa B, Kramer DB, Waks JW, Arnold AD, Howard JP, Qureshi N, Koa-Wing M, Keene D, Malcolme-Lawes L, Lefroy DC, Linton NWF, Lim PB, Varnava A, Whinnett ZI, Kanagaratnam P, Mandic D, Peters NS, Ng FS. Artificial intelligence-enabled electrocardiogram to distinguish cavotricuspid isthmus dependence from other atrial tachycardia mechanisms . EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:405-414. [PMID: 36712163 PMCID: PMC9708023 DOI: 10.1093/ehjdh/ztac042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/12/2022] [Indexed: 06/18/2023]
Abstract
Aims Accurately determining atrial arrhythmia mechanisms from a 12-lead electrocardiogram (ECG) can be challenging. Given the high success rate of cavotricuspid isthmus (CTI) ablation, identification of CTI-dependent typical atrial flutter (AFL) is important for treatment decisions and procedure planning. We sought to train a convolutional neural network (CNN) to classify CTI-dependent AFL vs. non-CTI dependent atrial tachycardia (AT), using data from the invasive electrophysiology (EP) study as the gold standard. Methods and results We trained a CNN on data from 231 patients undergoing EP studies for atrial tachyarrhythmia. A total of 13 500 five-second 12-lead ECG segments were used for training. Each case was labelled CTI-dependent AFL or non-CTI-dependent AT based on the findings of the EP study. The model performance was evaluated against a test set of 57 patients. A survey of electrophysiologists in Europe was undertaken on the same 57 ECGs. The model had an accuracy of 86% (95% CI 0.77-0.95) compared to median expert electrophysiologist accuracy of 79% (range 70-84%). In the two thirds of test set cases (38/57) where both the model and electrophysiologist consensus were in agreement, the prediction accuracy was 100%. Saliency mapping demonstrated atrial activation was the most important segment of the ECG for determining model output. Conclusion We describe the first CNN trained to differentiate CTI-dependent AFL from other AT using the ECG. Our model matched and complemented expert electrophysiologist performance. Automated artificial intelligence-enhanced ECG analysis could help guide treatment decisions and plan ablation procedures for patients with organized atrial arrhythmias.
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Affiliation(s)
- Arunashis Sau
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Safi Ibrahim
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Amar Ahmed
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Balvinder Handa
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Daniel B Kramer
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Jonathan W Waks
- Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Ahran D Arnold
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - James P Howard
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Norman Qureshi
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Michael Koa-Wing
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Daniel Keene
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Louisa Malcolme-Lawes
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - David C Lefroy
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Nicholas W F Linton
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Phang Boon Lim
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Amanda Varnava
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Zachary I Whinnett
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Prapa Kanagaratnam
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Danilo Mandic
- Department of Electrical and Electronic Engineering, Imperial College London, South Kensington Campus, Exhibition Road, London SW7 2AZ, UK
| | - Nicholas S Peters
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Fu Siong Ng
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
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De Ponti R, Marazzato J, Angeli F, Vilotta M, Blasi F, Bagliani G, Leonelli FM, Marazzi R. Atypical Cases of Typical Atrial Flutter? A Case Study. Card Electrophysiol Clin 2022; 14:483-494. [PMID: 36153128 DOI: 10.1016/j.ccep.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ablation of typical atrial flutter has a high safety and efficacy profile, but hidden pitfalls may be encountered. In some cases, a longer cycle length with isoelectric lines is associated with a different or more complex arrhythmogenic substrate, which may be missed if conduction block of the cavotricuspid isthmus is performed in the absence of the clinical arrhythmia. Prior surgery may have consistently modified the atrial substrate and complex or multiple arrhythmias associated with an isthmus-dependent circuit can be encountered. In these cases, electroanatomic mapping is useful to guide the procedure and plan an appropriate ablation strategy.
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Affiliation(s)
- Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy.
| | - Jacopo Marazzato
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS, Via Crotto Roncaccio, 16, Tradate, Varese 21049, Italy
| | - Manola Vilotta
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy
| | - Federico Blasi
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Giuseppe Bagliani
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti Umberto I-Lancisi-Salesi", Via Conca 71, Ancona 60126, Italy
| | - Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA
| | - Raffaella Marazzi
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy
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Sasaki T, Nakamura K, Minami K, Take Y, Nakatani Y, Miki Y, Goto K, Kaseno K, Yamashita E, Koyama K, Naito S. Local impedance measurements during contact force-guided cavotricuspid isthmus ablation for predicting an effective radiofrequency ablation. J Arrhythm 2022; 38:245-252. [PMID: 35387143 PMCID: PMC8977576 DOI: 10.1002/joa3.12680] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/05/2022] [Accepted: 01/16/2022] [Indexed: 01/13/2023] Open
Abstract
Background An ablation catheter capable of contact force (CF) and local impedance (LI) monitoring (IntellaNav StablePoint, Boston Scientific) has been recently launched. We evaluated the relationship between the CF and LI values during radiofrequency catheter ablation (RFCA) along the cavotricuspid isthmus (CTI). Methods Fifty consecutive subjects who underwent a CTI-RFCA using IntellaNav StablePoint catheters were retrospectively studied. The initial CF and LI at the start of the RF applications and mean CF and minimum LI during the RF applications were measured. The absolute and percentage LI drops were calculated as the difference between the initial and minimum LIs and 100 × absolute LI drop/initial LI, respectively. Results We analyzed 602 first-pass RF applications. A weak correlation was observed between the initial CF and LI (r = 0.13) and between the mean CF and LI drops (r = 0.22). The initial LI and absolute and percentage LI drops were greater at effective ablation sites than ineffective ablation sites (median, 151 vs. 138 Ω, 22 vs. 14 Ω, and 14.4% vs. 9.9%; p < .001), but the initial and mean CF did not differ. At optimal cutoffs of 21 Ω and 10.8% for the absolute and percentage LI drops according to the receiver-operating characteristic analysis, the sensitivity, and specificity for predicting an effective ablation were 57.4% and 88.9% and 80.0%, and 61.1%, respectively. Conclusions The effective sites during the CF-guided CTI-RFCA had greater initial LI and LI drops than the ineffective sites. Absolute and percentage LI drops of 21 Ω and 10.8% may be appropriate targets for an effective ablation.
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Affiliation(s)
- Takehito Sasaki
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashi CityJapan
| | - Kohki Nakamura
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashi CityJapan
| | - Kentaro Minami
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashi CityJapan
| | - Yutaka Take
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashi CityJapan
| | - Yosuke Nakatani
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashi CityJapan
| | - Yuko Miki
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashi CityJapan
| | - Koji Goto
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashi CityJapan
| | - Kenichi Kaseno
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashi CityJapan
| | - Eiji Yamashita
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashi CityJapan
| | - Keiko Koyama
- Division of RadiologyGunma Prefectural Cardiovascular CenterMaebashi CityJapan
| | - Shigeto Naito
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashi CityJapan
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Mahmoud M, Haloot J, El Kortbi K, Rodriguez Fuenmayor V, Cheema M, Badin A. Supraventricular Tachycardia Ablation and Its Effects on Anxiety Medications. Cureus 2022; 14:e24609. [PMID: 35664386 PMCID: PMC9148719 DOI: 10.7759/cureus.24609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Patients with true paroxysmal supraventricular tachycardia (PSVT) are frequently misdiagnosed with panic or anxiety disorders due to similar symptoms of palpitations, light-headedness, dyspnea, or chest discomfort. Unrecognized PSVT can lead to unnecessary management with anxiety medications. Treatment of PSVT with catheter ablation may lead to a reduction in anxiety medications. Methods: A total of 175 patients underwent successful PSVT ablation between January 1, 2010 and December 31, 2020. We examined symptoms at presentation, psychiatric medications prior to PSVT ablation, comorbidities, and psychiatric medications at three months post-ablation. Results: Fifteen percent of patients who underwent successful PSVT ablation were being treated with psychiatric medications and included in the final study population. The most common symptoms were palpitations (80.77%), followed by dizziness (42.31%), and shortness of breath (34.62%). The average number of medications prior to ablation was 1.42 and decreased to 1.08 at three months post-ablation (p = 0.04). The average number of selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and other anxiolytics also decreased but was not statistically significant. CONCLUSION In patients with anxiety and PSVT, catheter ablation reduced the average number of psychiatric medications.
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Affiliation(s)
- Mohamed Mahmoud
- Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Justin Haloot
- Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Khadija El Kortbi
- General Practice, Hassan II University, Faculty of Medicine, Casablanca, MAR
| | | | - Mubeen Cheema
- Cardiovascular Disease, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Auroa Badin
- Cardiac Electrophysiology, Riverside Methodist Hospital, Columbus, USA
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35
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Ono K, Iwasaki YK, Akao M, Ikeda T, Ishii K, Inden Y, Kusano K, Kobayashi Y, Koretsune Y, Sasano T, Sumitomo N, Takahashi N, Niwano S, Hagiwara N, Hisatome I, Furukawa T, Honjo H, Maruyama T, Murakawa Y, Yasaka M, Watanabe E, Aiba T, Amino M, Itoh H, Ogawa H, Okumura Y, Aoki-Kamiya C, Kishihara J, Kodani E, Komatsu T, Sakamoto Y, Satomi K, Shiga T, Shinohara T, Suzuki A, Suzuki S, Sekiguchi Y, Nagase S, Hayami N, Harada M, Fujino T, Makiyama T, Maruyama M, Miake J, Muraji S, Murata H, Morita N, Yokoshiki H, Yoshioka K, Yodogawa K, Inoue H, Okumura K, Kimura T, Tsutsui H, Shimizu W. JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias. Circ J 2022; 86:1790-1924. [DOI: 10.1253/circj.cj-20-1212] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Yu-ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Masaharu Akao
- Department of Cardiovascular Medicine, National Hospital Organization Kyoto Medical Center
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
| | - Kuniaki Ishii
- Department of Pharmacology, Yamagata University Faculty of Medicine
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshinori Kobayashi
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | | | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | | | - Tetsushi Furukawa
- Department of Bio-information Pharmacology, Medical Research Institute, Tokyo Medical and Dental University
| | - Haruo Honjo
- Research Institute of Environmental Medicine, Nagoya University
| | - Toru Maruyama
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital
| | - Yuji Murakawa
- The 4th Department of Internal Medicine, Teikyo University School of Medicine, Mizonokuchi Hospital
| | - Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center
| | - Eiichi Watanabe
- Department of Cardiology, Fujita Health University School of Medicine
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Mari Amino
- Department of Cardiovascular Medicine, Tokai University School of Medicine
| | - Hideki Itoh
- Division of Patient Safety, Hiroshima University Hospital
| | - Hisashi Ogawa
- Department of Cardiology, National Hospital Organisation Kyoto Medical Center
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Chizuko Aoki-Kamiya
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center
| | - Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Eitaro Kodani
- Department of Cardiovascular Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Takashi Komatsu
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine
| | | | | | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Yukio Sekiguchi
- Department of Cardiology, National Hospital Organization Kasumigaura Medical Center
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Noriyuki Hayami
- Department of Fourth Internal Medicine, Teikyo University Mizonokuchi Hospital
| | | | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University, Faculty of Medicine
| | - Takeru Makiyama
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Mitsunori Maruyama
- Department of Cardiovascular Medicine, Nippon Medical School Musashi Kosugi Hospital
| | - Junichiro Miake
- Department of Pharmacology, Tottori University Faculty of Medicine
| | - Shota Muraji
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | | | - Norishige Morita
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | - Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Sapporo City General Hospital
| | - Koichiro Yoshioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
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Two-year outcomes of pulmonary vein isolation and cava-tricuspid isthmus radiofrequency ablation vs pharmacological only antiarrhythmic therapy: a single center experience. EUREKA: HEALTH SCIENCES 2022. [DOI: 10.21303/2504-5679.2022.002278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The benefit of radiofrequency ablation (RFA) in rhythm control in atrial fibrillation (AF) and flutter patients is uncertain, but risk of death, arrhythmia recurrence and other post ablation complications remains high. Existing data on the impact of pulmonary vein isolation and cava-tricuspid isthmus RFA on long-term prognosis of patients with AF and flutter and its advantage over pharmacological antiarrhythmic therapy (AAT) are insufficient and contradictory.
The aim: we sought to evaluate two-year outcomes of pulmonary vein isolation and cava-tricuspid isthmus RFA vs pharmacological only AAT according to a single center experience.
Material and methods: we enrolled 174 patients after pulmonary vein isolation RFA, cava-tricuspid isthmus RFA and their combination and 122 patient who did not undergo RFA and got pharmacological AAT only.
Results: there was no significant difference in mortality between the RFA and AAT only groups (5.8 % and 9.0 % respectively) with the same structure of causes of death. The Caplan-Meyer curve analysis demonstrated better survivance (p=0.031) after RFA just during first year of observation. RFA effectiveness in arrhythmia relapse prevention was the highest for cava-tricuspid isthmus RFA procedure and worst – in group of combined pulmonary vein isolation and cava-tricuspid isthmus procedures. RFA showed an advantage over AAT in smaller quantities of non-fatal cardiovascular events (p<0.001) and cardiovascular hospitalizations (p=0.0026).
Conclusions: RFA of pulmonary vein isolation and cava-tricuspid isthmus RFA decrease arrhythmia episodes frequency, risk of non-fatal cardiovascular events and cardiovascular hospitalizations. Timely combined PVI and CTI procedure is associated with worsening of all outcomes.
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Tan ESJ, Chan SP, Seow SC, Teo WS, Ching CK, Chong DTT, Tan VH, Chia PL, Foo DCG, Kojodjojo P. Outcomes of supraventricular tachycardia ablation: Results from the Singapore ablation and cardiac devices registry. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 45:50-58. [PMID: 34792208 DOI: 10.1111/pace.14410] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/11/2021] [Accepted: 11/14/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND The Singapore Cardiac Databank was designed to monitor the performance and outcomes of catheter ablation. We investigated the outcomes of paroxysmal supraventricular tachycardia (PSVT)-ablation in a prospective, nationwide, cohort study. METHODS Atrioventricular nodal re-entrant tachycardia (AVNRT), atrioventricular re-entry tachycardia (AVRT), or atrial tachycardia (AT)-ablations in Singapore from 2010 to 2018 were studied. Outcomes include acute success, periprocedural-complications, postoperative pacing requirement, arrhythmic recurrence and 1-year all-cause mortality. RESULTS Among 2260 patients (mean age 45 ± 18 years, 50% female, 57% AVNRT, 37% AVRT, 6% AT), overall acute success rates of PSVT-ablation was 98.4% and increased in order of AT, AVRT, and AVNRT (p < .001). Periprocedural cardiac tamponade occurred in two AVRT patients. A total of 15 pacemakers (6 within first 30-days, 9 after 30-days) were implanted (seven AV block, eight sinus node dysfunction [SND]), with the highest incidence of pacemaker implantation after AT-ablation (5% vs. 0.6% AVNRT vs. 0.1% AVRT, p < .001). Repeat ablations (0.9% AVNRT, 7% AVRT, 4% AT, p < .001) were performed in 78 (3.5%) patients and 13 (0.6%) patients died within a year of ablation. Among outcomes considered adjusting for age, sex, PSVT-type and procedure-time, AT was independently associated with 6-fold increased odds of total (adjusted odds ratio [AOR] 6.32, 95% confidence interval [CI] 1.95-20.53) and late (AOR 6.38, 95% CI 1.39-29.29) pacemaker implantation, while AVRT was associated with higher arrhythmic recurrence with repeat ablations (AOR 4.72, 95% CI 2.36-9.44) compared to AVNRT. CONCLUSIONS Contemporary PSVT ablation is safe with high acute success rates. Long-term outcomes differed by nature of the PSVT.
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Affiliation(s)
- Eugene S J Tan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Siew Pang Chan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Swee-Chong Seow
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Wee Siong Teo
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Chi Keong Ching
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Daniel T T Chong
- Department of Cardiology, National Heart Centre, Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Vern Hsen Tan
- Department of Cardiology, Changi General Hospital, Singapore, Singapore
| | - Pow-Li Chia
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - David C G Foo
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.,Department of Cardiology, Ng Teng Fong General Hospital, Singapore, Singapore
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- Department of Cardiology, National University Heart Centre, Singapore, Singapore
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Wang XH, Kong LC, Shuang T, Li Z, Pu J. Macro-reentrant atrial tachycardia after tricuspid or mitral valve surgery: is there difference in electrophysiological characteristics and effectiveness of catheter ablation? BMC Cardiovasc Disord 2021; 21:538. [PMID: 34772362 PMCID: PMC8588703 DOI: 10.1186/s12872-021-02368-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background Macro-reentrant atrial tachycardias (MATs) are a common complication after cardiac valve surgery. The MAT types and the effectiveness of MAT ablation might differ after different valve surgery. Data comparing the electrophysiological characteristics and the ablation results of MAT post-tricuspid or mitral valve surgery are limited. Methods Forty-eight patients (29 males, age 56.1 ± 13.3 years) with MAT after valve surgery were assigned to tricuspid valve (TV) group (n = 18) and mitral valve (MV) group (n = 30). MATs were mapped and ablated guided by a three-dimensional navigation system. The one-year clinical effectiveness was compared in two groups. Results Nineteen MATs were documented in TV group, including 16 cavo-tricuspid isthmus (CTI)-dependent AFL and 3 other MATs at right atrial (RA) free wall, RA septum and left atrial (LA) roof. Thirty-nine MATs were identified in MV group, including15 CTI-dependent AFL, 8 RA free wall scar-related, 2 RA septum scar-related, 8 peri-mitral flutter, 3 LA roof-dependent, 2 LA anterior scar-related, and 1 right pulmonary vein-related MAT. Compared with TV group, MV group had significantly lower prevalence of CTI-dependent AFL (38.5% vs. 84.2%), higher prevalence of left atrial MAT (35.9 vs.5.3%) and higher proportion of patients with left atrial MAT (40 vs. 5.6%), P = 0.02, 0.01 and 0.01, respectively. The acute success rate of MAT ablation (100 vs. 93.3%) and the one-year freedom from atrial tachy-arrhythmias (72.2 vs. 76.5%) was comparable in TV and MV group. No predictor for recurrence was identified. Conclusion Although the types of MATs differed significantly in patients with prior TV or MV surgery, the acute and mid-term effectiveness of MAT ablation was comparable in two groups. Trial registration: This study was registered as a part of EARLY-MYO-AF clinical trial at the website ClinicalTrials. gov (NCT04512222). Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02368-w.
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Affiliation(s)
- Xin-Hua Wang
- Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.
| | - Ling-Cong Kong
- Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Tian Shuang
- Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Zheng Li
- Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Jun Pu
- Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.
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Dale Z, Chandrashekar P, Al-Rashdan L, Kim M, Masri A, Nazer B. Management Strategies for Atrial Fibrillation and Flutter in Patients with Transthyretin Cardiac Amyloidosis. Am J Cardiol 2021; 157:107-114. [PMID: 34366115 DOI: 10.1016/j.amjcard.2021.07.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022]
Abstract
Atrial fibrillation (AF) and flutter (AFL) frequently complicate transthyretin cardiac amyloidosis (ATTR-CM). Management poses challenges as rate control drugs are poorly tolerated and data addressing tolerability and efficacy of rhythm control is limited. We report outcomes of AF/AFL in ATTR-CM in a single center observational study of patients seen at our Amyloidosis Center with wild-type or hereditary ATTR-CM diagnosed between 2005-2019 including 84 patients (average age 74 ± 10 years, 94% male) with 27.6 ± 22.8 months follow-up. AF/AFL occurred in 61 patients (73%). Rapid ventricular response was common as was attempted rate control. However, discontinuation of rate control drugs was frequent (80%), often for adverse effects. Rhythm control was attempted in 64%, usually with cardioversion (DCCV) or ablation. Post-DCCV recurrence was common (91%) and time to recurrence was similar with or without anti-arrhythmic drugs (5.8 months (IQR 1.9-12.5) vs 6.2 months (IQR 1.9-12.5) p = 0.83). Ablation was performed in 23% with AFL (all for typical AFL) with 14% recurrence after mean of 60.9 months. Ablation for AF was performed in 12% with 86% recurrence after median of 6.2 months (IQR 5.6-12.3). Most patients (62%) with rhythm control had subjective improvement (≥1 NYHA class or resolved palpitations). In conclusion, AF/AFL was common in our cohort. Rate control was poorly tolerated and often abandoned. Rhythm control led to symptomatic improvement in a majority of cases, but durable success was limited. DCCV was modestly successful and not significantly improved with anti-arrhythmics. Ablation was successful with typical AFL but had limited success in AF.
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Affiliation(s)
- Zack Dale
- Center for Amyloidosis, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Pranav Chandrashekar
- Center for Amyloidosis, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Lana Al-Rashdan
- Center for Amyloidosis, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Morris Kim
- Center for Amyloidosis, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Ahmad Masri
- Center for Amyloidosis, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Babak Nazer
- Center for Amyloidosis, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon.
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Klaver MN, De Potter TJR, Iliodromitis K, Babkin A, Cabrita D, Fabbricatore D, Boersma LVA. Ultralow temperature cryoablation using near-critical nitrogen for cavotricuspid isthmus-ablation, first-in-human results. J Cardiovasc Electrophysiol 2021; 32:2025-2032. [PMID: 34196991 PMCID: PMC8457224 DOI: 10.1111/jce.15142] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/29/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cryoablation has evolved as a safe alternative to radiofrequency ablation in the treatment of several supraventricular arrhythmias and has potential advantages, yet is limited by the properties of the cryogen used. We investigated a novel ultralow temperature cryoablation (ULTC) system using nitrogen near its liquid-vapor critical point as a freezing source, achieving temperatures as low as -196 degrees Celsius in a long linear catheter with a continuous energy release. Initial safety, procedural and efficacy outcomes of ULTC are described in patients undergoing cavotricuspid isthmus (CTI) ablation. METHODS AND RESULTS The Cryocure studies (NCT02355106, NCT02839304) are prospective, single-arm, multi-center, first-in-human clinical studies in 17 patients with atrial flutter (AFL) and 13 patients with atrial fibrillation (AF). A total of 30 patients, mean age 65 ± 8 years old and 67% male, were enrolled and underwent ablation of the CTI. Acute success, defined as the confirmation of stable bidirectional conduction block across the CTI, was achieved in all 30 patients. After 12 months of follow-up, 14 out of 17 AFL patients remained free from any AFL. One (3.3%) procedure-related but not device-related serious adverse event was reported, involving transient inferolateral ST-elevation associated with temporary AV conduction block. CONCLUSION In this first-in-human clinical study the safety and performance results demonstrate the capabilities of ultralow temperature near-critical nitrogen as an effective energy source for CTI ablation. Ongoing, larger, studies should confirm our findings and evaluate the capabilities to create linear and focal transmural lesions in other arrhythmias.
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Affiliation(s)
- Martijn N. Klaver
- Department of CardiologySt. Antonius HospitalNieuwegeinThe Netherlands
- Department of CardiologyAmsterdam University Medical CentersThe Netherlands
| | | | | | | | | | | | - Lucas V. A. Boersma
- Department of CardiologySt. Antonius HospitalNieuwegeinThe Netherlands
- Department of CardiologyAmsterdam University Medical CentersThe Netherlands
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Xu G, Chen Z, Lin H. Efficacy and safety of the application of extensive ablation in patients with atrioventricular re-entrant tachycardia (a retrospective study). Sci Rep 2021; 11:13423. [PMID: 34183741 PMCID: PMC8239005 DOI: 10.1038/s41598-021-92935-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/17/2021] [Indexed: 11/23/2022] Open
Abstract
Radiofrequency catheter ablation (RFCA) has become the standard effective therapy for supraventricular tachycardia, but the reported success rates of ablation have differed across a large number of single-center studies. The main reason for tachycardia recurrence is accessory pathway (Ap)-mediated tachycardia, and the use of the RFCA strategy may be related to recurrence. This study compared the efficacy and safety of two different RFCA strategies for Ap-mediated tachycardia. We compared patients (group M) who underwent RFCA at multiple sites to patients (group S) who underwent RFCA at a single site during the index procedure for Ap-mediated tachycardia. The efficacy and safety were assessed in the two groups. Follow-up was conducted, and the main complications and the incidence of recurrence after RFCA procedures were recorded. Eight hundred eighty-two patients with 898 Aps were enrolled in group S, and 830 patients with 843 Aps were enrolled in group M. The cumulative number of recurrences (rates) in group M and group S at the 1st, 3rd, 6th, 12th, and 24th months after ablation were 4 (0.5%) and 17 (1.9%), p < 0.05; 5 (0.6%) and 27 (3.0%), p < 0.05; 6 (0.7%) and 34 (3.8%), p < 0.05; 6 (0.7%) and 43 (4.8%), p < 0.05; and 7 (0.8%) and 45 (5.0%), p < 0.05, respectively. Complications of chest pain, overactive vasovagal reaction, steam pop, and angina pectoris were rare in both groups. One patient in group M suffered from myocardial infarction before extensive ablation. No valve damage, cardiac tamponade, or other serious adverse events occurred in either group. The extensive ablation strategy reduced the recurrence rate and the need for subsequent ablation of the Ap without increasing the risk of complications.
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Affiliation(s)
- Guangze Xu
- Department of Cardiology, Lihuili Hospital of Ningbo University, #57 Xingning Rd, Ningbo, Zhejiang, People's Republic of China.
| | - Zhikui Chen
- Department of Cardiology, Lihuili Hospital of Ningbo University, #57 Xingning Rd, Ningbo, Zhejiang, People's Republic of China
| | - Haiyan Lin
- Department of Cardiology, Lihuili Hospital of Ningbo University, #57 Xingning Rd, Ningbo, Zhejiang, People's Republic of China
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Decroocq M, Rousselet L, Riant M, Norberciak L, Viart G, Guyomar Y, Graux P, Maréchaux S, Germain M, Menet A. Periprocedural, early, and long-term risks of pacemaker implantation after atrioventricular nodal re-entry tachycardia ablation: a French nationwide cohort. Europace 2021; 22:1526-1536. [PMID: 32785702 DOI: 10.1093/europace/euaa151] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/13/2020] [Indexed: 01/22/2023] Open
Abstract
AIMS Pacemaker implantation (PI) after atrioventricular nodal re-entry tachycardia (AVNRT) ablation is a dreadful complication. We aimed to assess periprocedural, early, and late risks for PI. METHODS AND RESULTS All 27 022 patients who underwent latest AVNRT ablation in France from 2009 to 2017, were identified in the nationwide medicalization database. A control group of 305 152 patients hospitalized for arm, leg, or skin injuries with no history of AVNRT or supraventricular tachycardia were selected. After propensity score matching, both groups had mean age of 53 ± 18 years and were predominantly female (64%). During this 9-year period, 822 of 27 022 (3.0%) AVNRT patients underwent PI, with significant higher risk in propensity-matched AVNRT patients compared to propensity-matched controls [2.9% vs. 0.9%; hazard ratio 3.4 (2.9-3.9), P < 0.0001]. This excess risk was significant during all follow-up, including periprocedural (1st month), early (1-6 months), and late (>6 months) risk periods. Annualized late risk per 100 AVNRT patients was 0.2%. In comparison to controls, excess risk was 0.2% in <30-year-old AVNRT patients; 0.7% in 30-50-year-old; 1.1% in 50-70-year-old and 6.5% over 70-year-olds. Risk for PI was also significantly different according to three procedural factors: centres, experience, and ablation date, with a 30% decrease since 2015. CONCLUSION Periprocedural, early, and late risks for PI were higher after AVNRT ablation compared to propensity-matched controls. Longer follow-up is needed as the excess risk seems to persist late after AVNRT ablation.
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Affiliation(s)
- Marie Decroocq
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, F-59000 Lille, France
| | - Louis Rousselet
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département d'Information Médicale, Université Catholique de Lille, F-59000 Lille, France
| | - Margaux Riant
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Recherche Médicale, Université Catholique de Lille, F-59000 Lille, France
| | - Laurène Norberciak
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Recherche Médicale, Université Catholique de Lille, F-59000 Lille, France
| | - Guillaume Viart
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, F-59000 Lille, France
| | - Yves Guyomar
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, F-59000 Lille, France
| | - Pierre Graux
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, F-59000 Lille, France
| | - Sylvestre Maréchaux
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, F-59000 Lille, France
| | - Marysa Germain
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département d'Information Médicale, Université Catholique de Lille, F-59000 Lille, France
| | - Aymeric Menet
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, F-59000 Lille, France
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomström-Lundqvist C, Calkins H, Corrado D, Deftereos SG, Diller GP, Gomez-Doblas JJ, Gorenek B, Grace A, Ho SY, Kaski JC, Kuck KH, Lambiase PD, Sacher F, Sarquella-Brugada G, Suwalski P, Zaza A. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J 2021; 41:655-720. [PMID: 31504425 DOI: 10.1093/eurheartj/ehz467] [Citation(s) in RCA: 522] [Impact Index Per Article: 174.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Ngo L, Ali A, Ganesan A, Woodman R, Adams R, Ranasinghe I. GENDER DIFFERENCES IN COMPLICATIONS FOLLOWING CATHETER ABLATION OF ATRIAL FIBRILLATION. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:458-467. [PMID: 33963402 DOI: 10.1093/ehjqcco/qcab035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/27/2021] [Accepted: 05/05/2021] [Indexed: 11/13/2022]
Abstract
AIM Population studies that provide unbiased estimates of gender differences in risk of complications following catheter ablation of atrial fibrillation (AF) are sparse. We sought to evaluate the association of female gender and risk of complications following AF ablation in a nation-wide cohort. METHODS AND RESULTS We identified 35,211 patients (29.5% females) undergoing AF ablations from 2008-17 using national hospitalization data from Australia and New Zealand. The primary outcome was any procedural complication occurring up to 30-days after discharge. Logistic regression was used to adjust for differences in baseline characteristics between sexes. Compared with males, females were older (mean age 64.9 vs. 61.2 years), had higher rates of hypertension (14.0% vs. 11.6%) and hematological disorders (5.3% vs. 3.8%) and experienced a higher rate of procedural complications (6.96% vs. 5.41%) (all p<0.001). This gender disparity remained significant after adjustment (OR 1.25 [95%CI 1.14-1.38], p<0.001) and was driven by an increased risk of vascular injury (OR 1.86 [1.23-2.82], p=0.003), pericarditis (OR 1.86 [1.16-2.67], p=0.008), pericardial effusion (OR 1.71 [1.35-2.17], p< 0.001), and bleeding (OR 1.30 [1.15-1.46], p<0.001). Notably, the gender difference persisted over time (OR for the most recent period 1.19 [1.003-1.422], p=0.046) despite a declining complication rate in both men and women. CONCLUSION Females undergoing AF ablations experienced a 25% higher risk of procedural complications compared with males, a disparity that has persisted over time despite a falling complication rate. Efforts to reduce this gender disparity should focus on reducing the incidence of pericardial effusion, pericarditis, vascular injury, and bleeding.
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Affiliation(s)
- Linh Ngo
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Queensland, Australia.,Department of Cardiology, The Prince Charles Hospital, Queensland, Australia.,Cardiovascular Centre, E Hospital, Hanoi, Vietnam
| | - Anna Ali
- Faculty of Health and Medical Sciences, The University of Adelaide, South Australia, Australia
| | - Anand Ganesan
- Department of Cardiovascular Medicine, Flinders Medical Centre, South Australia, Australia.,College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Robert Adams
- College of Medicine and Public Health, Flinders University, South Australia, Australia.,Respiratory and Sleep Services, Southern Adelaide Local Health Network, South Australia, Australia
| | - Isuru Ranasinghe
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Queensland, Australia.,Department of Cardiology, The Prince Charles Hospital, Queensland, Australia
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Makker P, Saleh M, Vaishnav AS, Coleman KM, Beldner S, Ismail H, Sharma N, Jadonath R, Goldner B, Mitra R, Epstein L, John R, Mountantonakis SE. Clinical predictors of heart block during atrioventricular nodal reentrant tachycardia ablation: A multicenter 18-year experience. J Cardiovasc Electrophysiol 2021; 32:1658-1664. [PMID: 33844364 DOI: 10.1111/jce.15037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Catheter ablation is considered the first-line treatment of symptomatic atrioventricular nodal reentrant tachycardia (AVNRT). It has been associated with a risk of heart block (HB) requiring a pacemaker. This study aims to determine potential clinical predictors of complete heart block as a result AVNRT ablation. METHODS Consecutive patients undergoing catheter ablation for AVNRT from January 2001 to June 2019 at two tertiary hospitals were included. We defined ablation-related HB as the unscheduled implantation of pacemaker within a month of the index procedure. Use of electroanatomic mapping (EAM), operator experience, inpatient status, age, sex, fluoroscopy time, baseline PR interval, and baseline HV interval was included in univariate and multivariate models to predict HB post ablation. RESULTS In 1708 patients (56.4 ± 17.0 years, 61% females), acute procedural success was 97.1%. The overall incidence of HB was 1.3%. Multivariate analysis showed that age more than 70 (odds ratio [OR] 7.907, p ≤ .001, confidence interval [CI] 2.759-22.666), baseline PR ≥ 190 ms (OR 2.867, p = .026, CI 1.135-7.239) and no use of EAM (OR 0.306, p = .037, CI 0.101-0.032) were independent predictors of HB. CONCLUSION Although the incidence of HB post AVNRT ablation is generally low, patients can be further stratified using three simple predictors.
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Affiliation(s)
- Parth Makker
- Department of Cardiac Electrophysiology, Northwell Health, New York, New York, USA
| | - Moussa Saleh
- Department of Cardiac Electrophysiology, Northwell Health, New York, New York, USA
| | - Aditi S Vaishnav
- Department of Cardiac Electrophysiology, Northwell Health, New York, New York, USA
| | - Kristie M Coleman
- Department of Cardiac Electrophysiology, Northwell Health, New York, New York, USA
| | - Stuart Beldner
- Department of Cardiac Electrophysiology, Northwell Health, New York, New York, USA
| | - Haisam Ismail
- Department of Cardiac Electrophysiology, Northwell Health, New York, New York, USA
| | - Nikhil Sharma
- Department of Cardiac Electrophysiology, Northwell Health, New York, New York, USA
| | - Ram Jadonath
- Department of Cardiac Electrophysiology, Northwell Health, New York, New York, USA
| | - Bruce Goldner
- Department of Cardiac Electrophysiology, Northwell Health, New York, New York, USA
| | - Raman Mitra
- Department of Cardiac Electrophysiology, Northwell Health, New York, New York, USA
| | - Laurence Epstein
- Department of Cardiac Electrophysiology, Northwell Health, New York, New York, USA
| | - Roy John
- Department of Cardiac Electrophysiology, Northwell Health, New York, New York, USA
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Ebner B, Grant J, Vincent L, Maning J, Olorunfemi O, Olarte N, Colombo R, Lambrakos L, Mendoza I. Comparison of in-hospital outcomes of patients undergoing catheter ablation for typical versus atypical atrial flutter. J Interv Card Electrophysiol 2021; 63:295-302. [PMID: 33770337 DOI: 10.1007/s10840-021-00982-4] [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: 01/17/2021] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Catheter ablation (CA) is indicated as definitive therapy for patients with either typical or atypical atrial flutter (TAFlutter and AAFlutter, respectively) which is unresponsive to medical therapy. There is a paucity of data regarding in-hospital outcomes of patients undergoing CA. METHODS Retrospective study using the NIS to identify patients ≥18 years who underwent CA between 2015 and 2017. Individuals were identified using ICD-10-CM/PCS for TAFlutter, AAFlutter, and CA. RESULTS A total of 17,390 patients underwent CA for Aflutter (33% AAFlutter and 67% TAFlutter). The TAFlutter group was younger (mean 65.9 years vs. 67.2 years), with less females (30% vs. 43%, p ≤ 0.001 for both) compared to the AAFlutter group. The TAFlutter group had a higher rate of diabetes, tobacco use, obesity, and chronic obstructive pulmonary disease (p ≤ 0.001 for all). The AAFlutter cohort had increased prior strokes and atrial fibrillation (p ≤ 0.001 for both). The mean CHA2DS2-VASc score was found to be 2.3 in AAFlutter compared to 2.1 in TAFlutter (p ≤ 0.001). There were significantly higher proportions of thromboembolic events, transfusions, and longer length of stay in the TAFlutter group (p ≤ 0.001 for all) with the AAFlutter group having significantly higher rates of cardioversion, implantation of cardiac devices, and increased hospital charges (p ≤ 0.001 for all); no significant difference was found in mortality after controlling for comorbidities. CONCLUSIONS We found higher complication rates in CA for patients with TAFlutter, but no difference in in-hospital all-cause mortality. Variation in CA depending upon the mechanism of AFlutter may underlie these differences, and warrant further study.
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Affiliation(s)
- Bertrand Ebner
- Department of Internal Medicine, University of Miami Hospital Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Avenue, Miami, FL, 33136, USA.
| | - Jelani Grant
- Department of Internal Medicine, University of Miami Hospital Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Avenue, Miami, FL, 33136, USA
| | - Louis Vincent
- Department of Internal Medicine, University of Miami Hospital Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Avenue, Miami, FL, 33136, USA
| | - Jennifer Maning
- Department of Internal Medicine, University of Miami Hospital Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Avenue, Miami, FL, 33136, USA
| | - Odunayo Olorunfemi
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Neal Olarte
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rosario Colombo
- Cardiovascular Division, Jackson Memorial Hospital, Miami, FL, USA
| | - Litsa Lambrakos
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ivan Mendoza
- Cardiovascular Division, Jackson Memorial Hospital, Miami, FL, USA
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Sutton BS, Bermingham SL, Diamantopoulos A, Rosemas SC, Tsintzos SI, Xia Y, Reynolds MR. Economic value of insertable cardiac monitors in unexplained syncope in the United States. Open Heart 2021; 8:e001263. [PMID: 33622962 PMCID: PMC7907887 DOI: 10.1136/openhrt-2020-001263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 09/17/2020] [Accepted: 01/31/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Early use of insertable cardiac monitor (ICM) is recommended for patients with unexplained syncope following initial clinical workup, due to its superior ability to establish symptom-rhythm correlation compared with conventional testing (CONV). However, ICMs incur higher upfront costs, and the impact of additional diagnoses and resulting treatment on downstream costs and outcomes is unclear. We aimed to evaluate the cost-effectiveness of ICM compared with CONV for the diagnosis of arrhythmia in patients with unexplained syncope, from a US payer perspective. METHODS A Markov model was developed to estimate lifetime costs and benefits of arrhythmia diagnosis with ICM versus CONV, considering all related diagnostic and arrhythmia-related treatment costs and consequences. Cohort characteristics and costs were informed by original claims database analyses. Risks of mortality, syncopal recurrence, injury due to syncope and quality of life consequences from syncopal events were identified from the literature. RESULTS ICM was less costly and more effective than CONV. Most of the observed US$4532 cost savings were attributed to reduced downstream diagnostic testing. For every 1000 patients, ICM was projected to yield an additional 253 arrhythmia diagnoses and lead to treatment in an additional 168 patients. The ICM strategy resulted in overall improved outcomes (0.30 quality-adjusted life years gained), due to a reduction in syncope recurrence and injury resulting from arrhythmia treatment. The results were robust to changes in the base case parameters but sensitive to the model time horizon, underlying probability of syncope recurrence and prevalence of arrhythmias. CONCLUSIONS Our model projected that early ICM for the diagnosis of unexplained syncope reduced long-term costs, and led to an improvement in overall clinical outcomes by shortening time to arrhythmia treatment. The cost of ICM was outweighed by savings arising from fewer downstream diagnostic episodes, and the increased cost of treatment was counterbalanced by fewer syncope-related event costs.
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Affiliation(s)
| | | | | | | | - Stelios I Tsintzos
- Health Economics and Reimbursement, Medtronic Europe SA, Tolochenaz, Vaud, Switzerland
| | - Ying Xia
- Medtronic Inc, Minneapolis, Minnesota, USA
| | - Matthew R Reynolds
- Cardiovascular Medicine, Baim Institute for Clinical Research, Boston, Massachusetts, USA
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Frisch DR, Frankel E, Gill D, Danaf JA. Algorithm for cavo-tricuspid isthmus flutter on surface ECGs: the ACTIONS study. Open Heart 2021; 8:openhrt-2020-001431. [PMID: 33504631 PMCID: PMC7843312 DOI: 10.1136/openhrt-2020-001431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/19/2020] [Accepted: 12/01/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Cavo-tricuspid isthmus atrial flutter (CTI-AFL) is an important arrhythmia to recognise because there is a highly effective and relatively low-risk ablation strategy. However, clinical experience has demonstrated that providers often have difficulty distinguishing AFL from atrial fibrillation. METHODS We developed a novel ECG-based three-step algorithm to identify CTI-AFL based on established CTI flutter characteristics and verified on consecutive ablation cases of typical flutter, atypical flutter and atrial fibrillation. The algorithm assesses V1/inferior lead F-wave concordance, consistency of P-wave morphology and the presence of isoelectric intervals in the inferior leads. In this observation study, the algorithm was validated on a cohort of 50 second-year medical students. Students were paired in a control and experimental group, and each pair received 10 randomly selected ECGs (from a pool of 50 intracardiac electrogram-proven CTI-AFL and 50 AF or atypical AFL cases). The experimental group received a cover sheet with the CTI algorithm, and the control group received no additional guidance. RESULTS There was a statistically significant difference in the mean number of correctly identified ECGs among the students in the experimental and control groups (8.12 vs 5.68, p<0.001). Students who used the algorithm correctly identified 2.44 more ECGs as being CTI-AFL or not CTI-AFL. Using the electrophysiology study as the gold standard, the algorithm had an accuracy of 81%, sensitivity of 81%, specificity of 82%, positive predictive value of 78% and negative predictive value of 84% in identifying CTI-AFL. CONCLUSION We developed a three-step ECG algorithm that provides a simple, sensitive, specific and accurate tool to identify CTI-AFL.
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Affiliation(s)
- Daniel R Frisch
- Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Eitan Frankel
- Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Deanna Gill
- Internal Medicine, Emory University Hospital, Atlanta, Georgia, USA
| | - Jad Al Danaf
- Division of Cardiovascular Medicine, University of Utah Health, Salt Lake City, Utah, USA
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