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Landra F, Nesti M, Garibaldi S, Mirizzi G, Startari U, Panchetti L, Piacenti M, Taddeucci S, Formichi BA, Stefani M, Galiberti S, Lionetti V, Solinas P, Levantesi BM, Italia C, Rossi A. A proposed index of myocardial staining for vein of Marshall ethanol infusion: an Italian single-center experience. J Interv Card Electrophysiol 2024; 67:1267-1277. [PMID: 38206450 PMCID: PMC11288988 DOI: 10.1007/s10840-023-01732-4] [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: 10/15/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Mitral isthmus (MI) conduction block is a fundamental step in anatomical approach treatment for persistent atrial fibrillation (PeAF). However, MI block is hardly achievable with endocardial ablation only. Retrograde ethanol infusion (EI) into the vein of Marshall (VOM) facilitates MI block. Fluorographic myocardial staining (MS) during VOM-EI could be helpful in predicting procedural alcoholization outcome even if its role is qualitatively assessed in the routine. The aim was to quantitatively assess MS during VOM-EI and to evaluate its association with MI block achievement. METHODS Consecutive patients undergoing catheter ablation for PeAF at Fondazione Toscana Gabriele Monasterio (Pisa, Italy) from February 2022 to May 2023 were considered. Patients with identifiable VOM were included. A proposed index of MS (MSI) was retrospectively calculated in each included patient. Correlation of MSI with low-voltage zones (LVZ) extension after VOM-EI and its association with MI block achievement were assessed. RESULTS In total, 42 patients out of 49 (85.8%) had an identifiable VOM. MI block was successfully achieved in 35 patients out of 42 (83.3%). MSI was significantly associated with the occurrence of MI block (OR 1.24 (1.03-1.48); p = 0.022). A higher MSI resulted in reduced ablation time (p = 0.014) and reduced radiofrequency applications (p = 0.002) to obtain MI block. MSI was also associated with MI block obtained by endocardial ablation only (OR 1.07 (1.02-1.13); p = 0.002). MSI was highly correlated with newly formed LVZ extension (r = 0.776; p = 0.001). CONCLUSIONS In our study cohort, optimal MSI predicts MI block and facilitates its achievement with endocardial ablation only.
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Affiliation(s)
- Federico Landra
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci 1, Siena, Italy.
| | | | | | | | | | | | | | - Simone Taddeucci
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci 1, Siena, Italy
| | | | | | | | | | | | | | | | - Andrea Rossi
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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Rachieru C, Luca CT, Văcărescu C, Petrescu L, Cirin L, Cozma D. Future Perspectives to Improve CHA 2DS 2VASc Score: The Role of Left Atrium Remodelling, Inflammation and Genetics in Anticoagulation of Atrial Fibrillation. Clin Interv Aging 2023; 18:1737-1748. [PMID: 37873054 PMCID: PMC10590594 DOI: 10.2147/cia.s427748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/07/2023] [Indexed: 10/25/2023] Open
Abstract
In 10% of ischemic strokes, non-valvular atrial fibrillation (NVAF) is detected retroactively. Milder, or even asymptomatic forms of NVAF have shown high mortality, thrombotic risk, and deterioration of cognitive function. The current guidelines for the diagnosis and treatment of AF contain "grey areas", such as the one related to anticoagulant treatment in men with CHA2DS2-VASc score 1 and women with score 2. Moreover, parameters such as renal function, patient weight or left atrium remodelling are missing from the recommended guidelines scores. Vulnerable categories of patients including the elderly population, high hemorrhagic risk patients or patients with newly diagnosed paroxysmal episodes of atrial high rate at device interrogation are at risk of underestimation of the thrombotic risk. This review presents a systematic exposure of the most important gaps in evaluation of thrombotic and hemorrhagic risk in patients with NVAF. The authors propose new algorithms and risk factors that should be taken into consideration for an accurate thrombotic and hemorrhagic risk estimation, especially in vulnerable categories of patients.
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Affiliation(s)
- Ciprian Rachieru
- Faculty of Medicine, Department of Internal Medicine I, Discipline of Medical Semiology I “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Internal Medicine Department, County Emergency Hospital, Timisoara, 300079, Romania
- Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
| | - Constantin-Tudor Luca
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Institute of Cardiovascular Diseases Timisoara, Timisoara, 300310, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, Timisoara, 300310, Romania
| | - Cristina Văcărescu
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Institute of Cardiovascular Diseases Timisoara, Timisoara, 300310, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, Timisoara, 300310, Romania
| | - Lucian Petrescu
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
| | - Liviu Cirin
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
| | - Dragos Cozma
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Institute of Cardiovascular Diseases Timisoara, Timisoara, 300310, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, Timisoara, 300310, Romania
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Crea F. Addressing the pandemic of atrial fibrillation: optimization of catheter ablation and new therapeutic targets. Eur Heart J 2023; 44:2413-2416. [PMID: 37442559 DOI: 10.1093/eurheartj/ehad438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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