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Oancea AF, Morariu PC, Buburuz AM, Miftode IL, Miftode RS, Mitu O, Jigoranu A, Floria DE, Timpau A, Vata A, Plesca C, Botnariu G, Burlacu A, Scripcariu DV, Raluca M, Cuciureanu M, Tanase DM, Costache-Enache II, Floria M. Spectrum of Non-Obstructive Coronary Artery Disease and Its Relationship with Atrial Fibrillation. J Clin Med 2024; 13:4921. [PMID: 39201063 PMCID: PMC11355151 DOI: 10.3390/jcm13164921] [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: 07/28/2024] [Revised: 08/08/2024] [Accepted: 08/17/2024] [Indexed: 09/02/2024] Open
Abstract
This article aims to analyze the relationship between non-obstructive coronary artery disease (NOCAD) and atrial fibrillation (AF), exploring the underlying pathophysiological mechanisms and implications for clinical management. NOCAD and AF are prevalent cardiovascular conditions that often coexist, yet their interrelation is not well understood. NOCAD can lead to ischemic necrosis of cardiomyocytes and their replacement with fibrous tissue, sustaining focal ectopic activity in atrial myocardium. Atrial fibrillation, on the other hand, the most common sustained cardiac arrhythmia, is able to accelerate atherosclerosis and increase oxygen consumption in the myocardium, creating a mismatch between supply and demand, and thus promoting the development or worsening of coronary ischemia. Therefore, NOCAD and AF seem to be a complex interplay with one begets another.
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Affiliation(s)
- Alexandru-Florinel Oancea
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Paula Cristina Morariu
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Ana Maria Buburuz
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Ionela-Larisa Miftode
- Department of Internal Medicine II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.-L.M.); (A.V.); (C.P.)
- St Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania
| | - Radu Stefan Miftode
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Ovidiu Mitu
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Alexandru Jigoranu
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Diana-Elena Floria
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Amalia Timpau
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Andrei Vata
- Department of Internal Medicine II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.-L.M.); (A.V.); (C.P.)
- St Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania
| | - Claudia Plesca
- Department of Internal Medicine II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.-L.M.); (A.V.); (C.P.)
- St Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania
| | - Gina Botnariu
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
- Unit of Diabetes, Nutrition and Metabolic Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Alexandru Burlacu
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Cardiovascular Disease Institute, 700503 Iasi, Romania
| | - Dragos-Viorel Scripcariu
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Regional Institute of Oncology, 700483 Iasi, Romania
| | - Mitea Raluca
- Faculty of Medicine Victor Papilian, University of Lucian Blaga, 550169 Sibiu, Romania;
| | - Magdalena Cuciureanu
- Department of Pharmacology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Daniela Maria Tanase
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Irina Iuliana Costache-Enache
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Mariana Floria
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
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Fan A, Liu G, Wu X. Nanosecond pulse electric field treatment initiates mitochondrial apoptosis pathway by inducing mitochondrial morphological changes in myocardial cells. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01828-5. [PMID: 39093488 DOI: 10.1007/s10840-024-01828-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/09/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND As an emerging myocardial ablation technique, the mechanism of nanosecond pulse electric field (nsPEF) ablation is currently less studied. Mitochondria are one of the important membrane structure organelles in cells, participating in numerous life activities within the cell. This study aimed to explore the morphological changes of mitochondria in living cells following nsPEF treatment. METHODS Myocardial cells were treated with a self-made solid-state LTD high-voltage nanosecond pulse generator with a pulse width of 100 ns for 80 times. The changes in mitochondrial membrane potential and cell apoptosis in rat myocardial cells after nsPEFs were investigated using JC-1 assay kit, apoptosis double staining assay kit, and mitochondrial fluorescence probe. RESULTS The results showed that after nsPEF treatment, the mitochondrial membrane potential decreased, apoptosis increased, and the average mitochondrial area decreased from 0.48 µm2 in live myocardial cells to 0.16 µm2. The average circumference ranges from 3.17 µm dropped to 1.60 µm. The shape factor decreased from 1.92 to 1.41. The aspect ratio has decreased from 2.16 to 1.59. nsPEF treatment induces changes in the morphology of myocardial cell mitochondria. CONCLUSIONS Based on the results of mitochondrial membrane potential and apoptosis, it can be inferred that under this equipment and parameter conditions, nsPEF treatment first causes changes in mitochondrial morphology, and then initiates the mitochondrial apoptosis pathway, which may provide experimental basis for investigating the potential mechanism of nsPEF ablation of myocardial cells.
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Affiliation(s)
- Aqing Fan
- University of Science and Technology of China, Hefei, 230000, China
| | - Gengliang Liu
- University of Science and Technology of China, Hefei, 230000, China
| | - Xiaodong Wu
- Suzhou Institute of Biomedical Engineering Technology, Chinese Academy of Sciences, No. 88 Keling Road, Huqiu District, Suzhou City, 215163, Jiangsu Province, China.
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Chen H, Li F, Ge Y, Liu J, Xing X, Li M, Ge Z, Zuo X, Fan C, Wang S, Wang F. DNA Framework-Enabled 3D Organization of Antiarrhythmic Drugs for Radiofrequency Catheter Ablation. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2401960. [PMID: 38843807 DOI: 10.1002/adma.202401960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/06/2024] [Indexed: 06/13/2024]
Abstract
Preorganizing molecular drugs within a microenvironment is crucial for the development of efficient and controllable therapeutic systems. Here, the use of tetrahedral DNA framework (TDF) is reported to preorganize antiarrhythmic drugs (herein doxorubicin, Dox) in 3D for catheter ablation, a minimally invasive treatment for fast heartbeats, aiming to address potential complications linked to collateral tissue damage and the post-ablation atrial fibrillation (AF) recurrence resulting from incomplete ablation. Dox preorganization within TDF transforms its random distribution into a confined, regular spatial arrangement governed by DNA. This, combined with the high affinity between Dox and DNA, significantly increases local Dox concentration. The exceptional capacity of TDF for cellular internalization leads to a 5.5-fold increase in intracellular Dox amount within cardiomyocytes, effectively promoting cellular apoptosis. In vivo investigations demonstrate that administering TDF-Dox reduces the recurrence rate of electrical conduction after radiofrequency catheter ablation (RFCA) to 37.5%, compared with the 77.8% recurrence rate in the free Dox-treated group. Notably, the employed Dox dosage exhibits negligible adverse effects in vivo. This study presents a promising treatment paradigm that strengthens the efficacy of catheter ablation and opens a new avenue for reconciling the paradox of ablation efficacy and collateral damage.
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Affiliation(s)
- Hangwei Chen
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200800, China
| | - Fan Li
- Institute of Molecular Medicine, Shanghai Key Laboratory for Nucleic Acids Chemistry and Nanomedicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Yulong Ge
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200800, China
| | - Junyi Liu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200800, China
| | - Xing Xing
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200800, China
| | - Min Li
- Institute of Molecular Medicine, Shanghai Key Laboratory for Nucleic Acids Chemistry and Nanomedicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Zhilei Ge
- School of Chemistry and Chemical Engineering, New Cornerstone Science Laboratory, Frontiers Science Center for Transformative Molecules, Zhangjiang Institute for Advanced Study and National Center for Translational Medicine, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Xiaolei Zuo
- Institute of Molecular Medicine, Shanghai Key Laboratory for Nucleic Acids Chemistry and Nanomedicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
- School of Chemistry and Chemical Engineering, New Cornerstone Science Laboratory, Frontiers Science Center for Transformative Molecules, Zhangjiang Institute for Advanced Study and National Center for Translational Medicine, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Chunhai Fan
- Institute of Molecular Medicine, Shanghai Key Laboratory for Nucleic Acids Chemistry and Nanomedicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
- School of Chemistry and Chemical Engineering, New Cornerstone Science Laboratory, Frontiers Science Center for Transformative Molecules, Zhangjiang Institute for Advanced Study and National Center for Translational Medicine, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Shaopeng Wang
- Institute of Molecular Medicine, Shanghai Key Laboratory for Nucleic Acids Chemistry and Nanomedicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Fang Wang
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200800, China
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Kaye AD, Jones NT, Tran T, Khaled ME, Tilmon S, Lieu M, Drinkard J, Torres YL, Herron E, Ahmadzadeh S, Shekoohi S, Varrassi G. Ablation Compared to Pharmacological Treatment for the Reduction of Atrial Fibrillation Recurrence: A Meta-Analysis. Cureus 2024; 16:e62728. [PMID: 39036176 PMCID: PMC11259506 DOI: 10.7759/cureus.62728] [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: 05/17/2024] [Accepted: 06/12/2024] [Indexed: 07/23/2024] Open
Abstract
Atrial fibrillation (AF) is one of the most common heart arrhythmias, and due to its variable presentation, detecting and treating AF appropriately can reduce some of its serious complications. Among treatment options, surgical ablation and antiarrhythmic drug therapy are two of the most widely used choices. A systematic review and meta-analysis were conducted to examine the rates of AF recurrence in those treated with ablation compared to pharmacological treatment. Google Scholar and PubMed were searched for study trials published within the last decade that calculated the recurrence of AF symptoms in patient groups that received ablation or pharmacological treatment. Selected studies were analyzed in RevMan 5.4 software (The Cochrane Collaboration, London, England, UK), and each study's odds ratio and overall odds ratio were calculated using a 95% confidence interval. A total of seven studies with 2324 patients were analyzed for the meta-analysis, with 1162 patients receiving ablation and 1162 patients receiving pharmacological treatment. There was a statistically significant decrease in the recurrence of AF in the ablation group compared to the pharmacological treatment group, with a pooled odds ratio of 0.24 (CI 95% 0.14-0.39). AF treated with ablation was more effective in reducing AF recurrence than general pharmacological treatment.
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Affiliation(s)
- Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Nicholas T Jones
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Tyler Tran
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Munira E Khaled
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Sean Tilmon
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Michael Lieu
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Joseph Drinkard
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Yair Lopez Torres
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Edwin Herron
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
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Lin W, Zhang L, Wu S, Yang F, Zhang Y, Xu X, Zhu F, Fei Z, Shentu L, Han Y. Optimizing the management of electrophysiology labs in Chinese hospitals using a discrete event simulation tool. BMC Health Serv Res 2024; 24:67. [PMID: 38216934 PMCID: PMC10787488 DOI: 10.1186/s12913-024-10548-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 01/02/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND The growing demand for electrophysiology (EP) treatment in China presents a challenge for current EP care delivery systems. This study constructed a discrete event simulation (DES) model of an inpatient EP care delivery process, simulating a generalized inpatient journey of EP patients from admission to discharge in the cardiology department of a tertiary hospital in China. The model shows how many more patients the system can serve under different resource constraints by optimizing various phases of the care delivery process. METHODS Model inputs were based on and validated using real-world data, simulating the scheduling of limited resources among competing demands from different patient types. The patient stay consists of three stages, namely: the pre-operative stay, the EP procedure, and the post-operative stay. The model outcome was the total number of discharges during the simulation period. The scenario analysis presented in this paper covers two capacity-limiting scenarios (CLS): (1) fully occupied ward beds and (2) fully occupied electrophysiology laboratories (EP labs). Within each CLS, we investigated potential throughput when the length of stay or operative time was reduced by 10%, 20%, and 30%. The reductions were applied to patients with atrial fibrillation, the most common indication accounting for almost 30% of patients. RESULTS Model validation showed simulation results approximated actual data (137.2 discharges calculated vs. 137 observed). With fully occupied wards, reducing pre- and/or post-operative stay time resulted in a 1-7% increased throughput. With fully occupied EP labs, reduced operative time increased throughput by 3-12%. CONCLUSIONS Model validation and scenario analyses demonstrated that the DES model reliably reflects the EP care delivery process. Simulations identified which phases of the process should be optimized under different resource constraints, and the expected increases in patients served.
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Affiliation(s)
- Wenjuan Lin
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Lin Zhang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Shuqing Wu
- Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Fang Yang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yueqing Zhang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Xiaoying Xu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Fei Zhu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Zhen Fei
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Lihua Shentu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yi Han
- Health Economic Research Institute, Sun Yat-sen University, 132 East Waihuan Road, Guangzhou, Guangdong Province, 510006, PR China.
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Niu J, Zhang M, Liu P, Hua C, Zhong G. Research progress on predicting atrial fibrillation recurrence after radiofrequency ablation based on electrocardiogram-related parameters. J Electrocardiol 2023; 81:146-152. [PMID: 37708737 DOI: 10.1016/j.jelectrocard.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/18/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia. It is associated with increased stroke risks, thromboembolism, and other complications, which are great life and economic burdens for patients. In recent years, with the maturity of percutaneous catheter radiofrequency ablation (RFA) technology, it has become a first-line therapy for AF. However, some patients still experience AF recurrence (AFR) after RFA, which can cause serious consequences. Therefore, it is critical to identify appropriate parameters that are predictive of prognosis and to be able to translate the parameters easily into the clinical setting. Here, we reviewed possible predicting indicators for AFR, focusing on all the electrocardiogram indicators, such as P wave duration, PR interval and so on. It may provide valuable information for guiding clinical works.
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Affiliation(s)
- Jiayin Niu
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Min Zhang
- Research Ward, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Pengfei Liu
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Cuncun Hua
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Guangzhen Zhong
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Research Ward, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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7
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Kaszala K, Ellenbogen KA. Is it good to be cool before you PFA? J Cardiovasc Electrophysiol 2023; 34:2134-2135. [PMID: 36218018 DOI: 10.1111/jce.15700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/06/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Karoly Kaszala
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
- Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA
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8
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Parra-Lucares A, Villa E, Romero-Hernández E, Méndez-Valdés G, Retamal C, Vizcarra G, Henríquez I, Maldonado-Morales EAJ, Grant-Palza JH, Ruíz-Tagle S, Estrada-Bobadilla V, Toro L. Tic-Tac: A Translational Approach in Mechanisms Associated with Irregular Heartbeat and Sinus Rhythm Restoration in Atrial Fibrillation Patients. Int J Mol Sci 2023; 24:12859. [PMID: 37629037 PMCID: PMC10454641 DOI: 10.3390/ijms241612859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Atrial fibrillation (AF) is a prevalent cardiac condition predominantly affecting older adults, characterized by irregular heartbeat rhythm. The condition often leads to significant disability and increased mortality rates. Traditionally, two therapeutic strategies have been employed for its treatment: heart rate control and rhythm control. Recent clinical studies have emphasized the critical role of early restoration of sinus rhythm in improving patient outcomes. The persistence of the irregular rhythm allows for the progression and structural remodeling of the atria, eventually leading to irreversible stages, as observed clinically when AF becomes permanent. Cardioversion to sinus rhythm alters this progression pattern through mechanisms that are still being studied. In this review, we provide an in-depth analysis of the pathophysiological mechanisms responsible for maintaining AF and how they are modified during sinus rhythm restoration using existing therapeutic strategies at different stages of clinical investigation. Moreover, we explore potential future therapeutic approaches, including the promising prospect of gene therapy.
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Affiliation(s)
- Alfredo Parra-Lucares
- Critical Care Unit, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago 8380420, Chile
- Cardiovascular Department, Hospital Clínico Universidad de Chile, Santiago 8380420, Chile
| | - Eduardo Villa
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago 8380420, Chile
| | | | - Gabriel Méndez-Valdés
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago 8380420, Chile
| | - Catalina Retamal
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago 8380420, Chile
| | - Geovana Vizcarra
- Division of Internal Medicine, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago 8380420, Chile
| | - Ignacio Henríquez
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago 8380420, Chile
| | | | - Juan H. Grant-Palza
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago 8380420, Chile
| | - Sofía Ruíz-Tagle
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago 8380420, Chile
| | | | - Luis Toro
- Division of Nephrology, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago 8380420, Chile
- Centro de Investigación Clínica Avanzada, Hospital Clínico, Universidad de Chile, Santiago 8380420, Chile
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9
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Baena-Montes JM, Kraśny MJ, O’Halloran M, Dunne E, Quinlan LR. In Vitro Models for Improved Therapeutic Interventions in Atrial Fibrillation. J Pers Med 2023; 13:1237. [PMID: 37623487 PMCID: PMC10455620 DOI: 10.3390/jpm13081237] [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] [Received: 06/30/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
Atrial fibrillation is the most common type of cardiac arrhythmias in humans, mostly caused by hyper excitation of specific areas in the atrium resulting in dyssynchronous atrial contractions, leading to severe consequences such as heart failure and stroke. Current therapeutics aim to target this condition through both pharmacological and non-pharmacological approaches. To test and validate any of these treatments, an appropriate preclinical model must be carefully chosen to refine and optimise the therapy features to correctly reverse this condition. A broad range of preclinical models have been developed over the years, with specific features and advantages to closely mimic the pathophysiology of atrial fibrillation. In this review, currently available models are described, from traditional animal models and in vitro cell cultures to state-of-the-art organoids and organs-on-a-chip. The advantages, applications and limitations of each model are discussed, providing the information to select the appropriate model for each research application.
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Affiliation(s)
- Jara M. Baena-Montes
- Physiology and Cellular Physiology Research Laboratory, School of Medicine, Human Biology Building, University of Galway, H91 TK33 Galway, Ireland
| | - Marcin J. Kraśny
- Smart Sensors Lab, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
- Translational Medical Device Lab (TMDLab), Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Martin O’Halloran
- Translational Medical Device Lab (TMDLab), Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
- Electrical & Electronic Engineering, School of Engineering, University of Galway, H91 TK33 Galway, Ireland
| | - Eoghan Dunne
- Translational Medical Device Lab (TMDLab), Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Leo R. Quinlan
- Physiology and Cellular Physiology Research Laboratory, School of Medicine, Human Biology Building, University of Galway, H91 TK33 Galway, Ireland
- CÚRAM SFI Centre for Research in Medical Devices, University of Galway, H91 TK33 Galway, Ireland
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10
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Kingma J, Simard C, Drolet B. Overview of Cardiac Arrhythmias and Treatment Strategies. Pharmaceuticals (Basel) 2023; 16:844. [PMID: 37375791 DOI: 10.3390/ph16060844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Maintenance of normal cardiac rhythm requires coordinated activity of ion channels and transporters that allow well-ordered propagation of electrical impulses across the myocardium. Disruptions in this orderly process provoke cardiac arrhythmias that may be lethal in some patients. Risk of common acquired arrhythmias is increased markedly when structural heart disease caused by myocardial infarction (due to fibrotic scar formation) or left ventricular dysfunction is present. Genetic polymorphisms influence structure or excitability of the myocardial substrate, which increases vulnerability or risk of arrhythmias in patients. Similarly, genetic polymorphisms of drug-metabolizing enzymes give rise to distinct subgroups within the population that affect specific drug biotransformation reactions. Nonetheless, identification of triggers involved in initiation or maintenance of cardiac arrhythmias remains a major challenge. Herein, we provide an overview of knowledge regarding physiopathology of inherited and acquired cardiac arrhythmias along with a summary of treatments (pharmacologic or non-pharmacologic) used to limit their effect on morbidity and potential mortality. Improved understanding of molecular and cellular aspects of arrhythmogenesis and more epidemiologic studies (for a more accurate portrait of incidence and prevalence) are crucial for development of novel treatments and for management of cardiac arrhythmias and their consequences in patients, as their incidence is increasing worldwide.
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Affiliation(s)
- John Kingma
- Department of Medicine, Ferdinand Vandry Pavillon, 1050 Av. de la Médecine, Québec City, QC G1V 0A6, Canada
| | - Chantale Simard
- Faculty of Pharmacy Ferdinand Vandry Pavillon, 1050 Av. de la Médecine, Québec City, QC G1V 0A6, Canada
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval 2725 Chemin Sainte-Foy, Québec City, QC G1V 4G5, Canada
| | - Benoît Drolet
- Faculty of Pharmacy Ferdinand Vandry Pavillon, 1050 Av. de la Médecine, Québec City, QC G1V 0A6, Canada
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval 2725 Chemin Sainte-Foy, Québec City, QC G1V 4G5, Canada
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11
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Bray JJH, Warraich M, Whitfield MG, Peter CU, Baral R, Ahmad M, Ahmad S, Abraham GR, Kirresh A, Sahibzada MS, Muzaffar A, Tomson J, Lambiase PD, Captur G, Banerjee A, Providencia R. Oral Class I and III antiarrhythmic drugs for maintaining sinus rhythm after catheter ablation of atrial fibrillation. Cochrane Database Syst Rev 2023; 3:CD013765. [PMID: 36915032 PMCID: PMC10014144 DOI: 10.1002/14651858.cd013765.pub2] [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] [Indexed: 03/16/2023]
Abstract
BACKGROUND Recurrence of atrial tachyarrhythmias (ATa) following catheter ablation for atrial fibrillation (AF) is a common problem. Antiarrhythmic drugs have been used shortly after ablation in an attempt to maintain sinus rhythm, particularly Class I and III agents. However, it still needs to be established if the use of Class I or III antiarrhythmic medications, or both, reduce the risk of recurrence of ATa. OBJECTIVES To assess the effects of oral Class I and III antiarrhythmic drugs versus control (standard medical therapy without Class I or III antiarrhythmics, or placebo) for maintaining sinus rhythm in people undergoing catheter ablation for AF. SEARCH METHODS We systematically searched CENTRAL, MEDLINE, Embase, Web of Science Core Collection, and two clinical trial registers without restrictions on language or date to 5 August 2022. SELECTION CRITERIA We sought published, unpublished, and ongoing parallel-design, randomised controlled trials (RCTs) involving adult participants undergoing ablation for AF, with subsequent comparison of Class I and/or III antiarrhythmic use versus control (standard medical therapy or non-Class I and/or III antiarrhythmic use). DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane and performed meta-analyses with risk ratios (RR) and Peto odds ratios (Peto OR). Our primary outcomes were recurrence of atrial tachyarrhythmias; adverse events: thromboembolic events; adverse events: myocardial infarction; adverse events: new diagnosis of heart failure; and adverse events: requirement for one or more hospitalisations for atrial tachyarrhythmia. Our secondary outcomes were: all-cause mortality; and requirement for one or more repeat ablations. Where possible, we performed comparison analysis by Class I and/or III antiarrhythmic and divided follow-up periods for our primary outcome. We performed comprehensive assessments of risk of bias and certainty of evidence applying the GRADE methodology. MAIN RESULTS We included nine RCTs involving a total of 3269 participants. Participants were on average 59.3 years old; 71.0% were male; and 72.9% and 27.4% had paroxysmal and persistent AF, respectively. Class I and/or III antiarrhythmics may reduce recurrence of ATa at 0 to 3 months postablation (risk ratio (RR) 0.74, 95% confidence interval (CI) 0.59 to 0.94, 8 trials, 3046 participants, low-certainty evidence) and likely reduce recurrence at > 3 to 6 months, our a priori primary time point (RR 0.85, 95% CI 0.78 to 0.93, 5 trials, 2591 participants, moderate-certainty evidence). Beyond six months the evidence is very uncertain, and the benefit of antiarrhythmics may not persist (RR 1.14, 95% CI 0.84 to 1.55, 4 trials, 2244 participants, very low-certainty evidence). The evidence suggests that Class I and/or III antiarrhythmics may not increase the risk of thromboembolic events, myocardial infarction, all-cause mortality, or requirement for repeat ablation, at 0 to 3, > 3 to 6, and > 6 months (where data were available; low- to very low-certainty evidence). The use of Class I and/or III antiarrhythmics postablation likely reduces hospitalisations for ATa by approximately 57% at 0 to 3 months (RR 0.43, 95% CI 0.28 to 0.64, moderate-certainty evidence). No data were available beyond three months. No data were available on new diagnoses of heart failure. Fewer data were available for Class I and III antiarrhythmics individually. Based on only one and two trials (n = 125 to 309), Class I antiarrhythmics may have little effect on recurrence of ATa at 0 to 3, > 3 to 6, and > 6 months (RR 0.88, 95% CI 0.64 to 1.20, 2 trials, 309 participants; RR 0.54, 95% CI 0.25 to 1.19, 1 trial, 125 participants; RR 0.87, 95% CI 0.57 to 1.32, 1 trial, 125 participants; low-certainty evidence throughout); requirement for hospitalisation for ATa at 0 to 3 months (low-certainty evidence); or requirement for repeat ablation at 0 to 3 months (low-certainty evidence). No data were available for thromboembolic events, myocardial infarction, new diagnosis of heart failure, or all-cause mortality at any time points, or hospitalisation or repeat ablation beyond three months. Class III antiarrhythmics may have little effect on recurrence of ATa at up to 3 months and at > 3 to 6 months (RR 0.76, 95% CI 0.50 to 1.16, 4 trials, 599 participants, low-certainty evidence; RR 0.82, 95% CI 0.62 to 1.09, 2 trials, 318 participants, low-certainty evidence), and beyond 6 months one trial reported a possible increase in recurrence of ATa (RR 1.95, 95% CI 1.29 to 2.94, 1 trial, 112 participants, low-certainty evidence). Class III antiarrhythmics likely reduce hospitalisations for ATa at 0 to 3 months (RR 0.40, 95% CI 0.26 to 0.63, moderate-certainty evidence), and may have little effect on all-cause mortality (low- to very low-certainty evidence). The effect of Class III antiarrhythmics on thromboembolic events and requirement for repeat ablation was uncertain (very low-certainty evidence for both outcomes). No data were available for myocardial infarction or new diagnosis of heart failure at any time point, outcomes other than recurrence beyond 6 months, or for hospitalisation and repeat ablation > 3 to 6 months. We assessed the majority of included trials as at low or unclear risk of bias. One trial reported an error in the randomisation process, raising the potential risk of selection bias; most of the included trials were non-blinded; and two trials were at high risk of attrition bias. AUTHORS' CONCLUSIONS We found evidence to suggest that the use of Class I and/or III antiarrhythmics up to 3 months after ablation is associated with a reduced recurrence of ATa 0 to 6 months after ablation, which may not persist beyond 6 months, and an immediate reduction in hospitalisation for ATa 0 to 3 months after ablation. The evidence suggests there is no difference in rates of all-cause mortality, thromboembolic events, or myocardial infarction between Class I and/or III antiarrhythmics versus control.
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Affiliation(s)
- Jonathan JH Bray
- Oxford Heart Centre, Oxford University Hospitals Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford, UK
| | - Mazhar Warraich
- Department of Cardiology, Walsall Healthcare NHS Trust, Walsall, UK
| | - Michael G Whitfield
- Institute of Health Informatics Research, University College London, London, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - Christina Udani Peter
- Department of Cardiology, Addenbrookes Hospital (Cambridge University Hospitals), Cambridge, UK
| | | | - Mahmood Ahmad
- Department of Cardiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Shazaib Ahmad
- Department of Anaesthesia, St Helier Hospital, London, UK
| | | | - Ali Kirresh
- Department of Cardiology, Royal Free Hospital, London, UK
| | | | - Adnan Muzaffar
- Department of Acute Medicine, Scunthrope General Hospital, Scunthorpe, UK
| | - Joseph Tomson
- Department of Cardiology, Royal Free Hospital, London, UK
| | - Pier D Lambiase
- Centre for Cardiology in the Young, The Heart Hospital, University College London Hospitals, London, UK
| | - Gabriella Captur
- Royal Free Hospital, London, UK
- MRC Unit of Lifelong Health and Ageing, University College London, London, UK
| | - Amitava Banerjee
- Institute of Health Informatics Research, University College London, London, UK
| | - Rui Providencia
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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12
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Faraz F, Rehman MEU, Sabir B, Ghaffar A, Iftikhar A, Maqsood A, Ahmad Cheema H, Yasmin F, Aamir M, Ahmed MU, Asghar MS. Efficacy of Catheter Ablation for Atrial Fibrillation in Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101524. [PMID: 36455792 DOI: 10.1016/j.cpcardiol.2022.101524] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in patients with hypertrophic cardiomyopathy (HCM). Catheter ablation (CA) has emerged as an effective therapy for AF. We conducted a meta-analysis to update the current clinical evidence on the efficacy of CA for AF in patients with HCM. We searched PubMed, Embase, Cochrane and Clinicaltrials.gov for interventional and observational studies assessing single and multiple procedure success rate of CA in HCM patients. Our meta-analysis included 25 studies involving 1817 patients. Success rate following single procedure was 40.4% (95% CI 33.1 to 48.0%) at latest follow-up. The pooled success rate following multiple procedures was 51.4% (95% CI 42.9% to 60.0%) at latest follow-up. In the subgroup analysis for AF subtype, TCA was more successful for paroxysmal AF compared to non-paroxysmal AF. For the subset of studies reporting drug-free success rate, single and multiple procedures had a success rate of 33.4% (95% CI 19.3 to 49.1%) and 51.8% (95% CI 41.3 to 62.2%) at latest follow-up, respectively. CA is a suitable option for AF in patients with HCM. Success rate is greater in paroxysmal AF, after multiple procedures and with antiarrhythmic drugs.
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Affiliation(s)
- Fatima Faraz
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | | | - Beenish Sabir
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Areeba Ghaffar
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Ahmad Iftikhar
- Department of Medicine, The University of Arizona, Tucson, AZ
| | - Aimen Maqsood
- Department of Medicine, Mohtarma Benazir Bhutto Shaheed Medical College, Mirpur, Azad and Jammu Kashmir
| | | | - Farah Yasmin
- Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Aamir
- Lehigh Valley Heart Specialists, Lehigh Valley Health Network, Allentown, PA
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13
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Liu T, Tang Z, Cai C, Wu N, Jia J, Yang G, Zhang W. Cost-effectiveness analysis of digital therapeutics for home-based cardiac rehabilitation for patients with atrial fibrillation after catheter ablation. Digit Health 2023; 9:20552076231211548. [PMID: 38025109 PMCID: PMC10631335 DOI: 10.1177/20552076231211548] [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: 02/16/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background In recent years, numerous guidelines and expert consensuses have recommended that digital technologies and products, such as digital therapeutics (DTx), be incorporated into cardiac rehabilitation (CR). Objective The study aims to compare the cost-effectiveness of DTx for home-based CR (HBCR) with that of the conventional HBCR for patients with atrial fibrillation (AF) after catheter ablation in a real-world clinical setting. Methods Based on a single-center, prospective, blinded, randomized, parallel controlled trial of DTx-based HBCR for AF patients after catheter ablation, 100 AF patients undergoing catheter ablation were selected and randomized at a 1:1 ratio into a UC group (conventional HBCR) and DT group (DTx-based HBCR). The intervention lasted for 12 weeks. Medical cost data and clinical efficacy data (VO2max) were acquired from trial data. Effect data (QALYs, anxiety and depression status, health beliefs related to cardiovascular disease, and exercise self-efficacy) were obtained from a patient questionnaire. The cost-effectiveness analysis was conducted to assess the economic benefits of DTx-based HBCR versus conventional HBCR, and the robustness of the results was verified by sensitivity analysis. Results In the DT group (n = 49), the mean QALYs increased 0.119 ± 0.09, VO2max increased 9.3 ± 8.0 mL/(min*kg), anxiety, depression, health belief, and exercise self-efficacy had improved, and the total medical cost was 75,080.55 ± 19,746.62 CNY. In the UC group (n = 48), the mean QALYs increased 0.077 ± 0.06, VO2max increased 4.9 ± 6.6 mL/(min*kg), anxiety, depression, health belief, and exercise self-efficacy had improved, and the total medical cost was 73,972.66 ± 16,582.04 CNY. The difference in the medical cost was 1107.89 CNY, and the incremental cost-effectiveness ratio was 33,572.42 CNY/QALY, which was lower than the willingness-to-pay threshold of 85,698 CNY (China's per capita GDP in 2022). Conclusion DTx-based HBCR is more effective and cost-effective than conventional HBCR.
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Affiliation(s)
- Tianyi Liu
- School of Business, Nanjing University, Nanjing, China
| | - Zhijie Tang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Cheng Cai
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Nan Wu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Jia
- School of Business, Nanjing University, Nanjing, China
- Departments of General Practice, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Gang Yang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wenhong Zhang
- School of Business, Nanjing University, Nanjing, China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
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14
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Puvanasunthararajah S, Camps SM, Wille ML, Fontanarosa D. Combined clustered scan-based metal artifact reduction algorithm (CCS-MAR) for ultrasound-guided cardiac radioablation. Phys Eng Sci Med 2022; 45:1273-1287. [PMID: 36352318 DOI: 10.1007/s13246-022-01192-6] [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: 06/02/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022]
Abstract
Cardiac radioablation is a promising treatment for cardiac arrhythmias, but accurate dose delivery can be affected by heart motion. For this reason, real-time cardiac motion monitoring during radioablation is of paramount importance. Real-time ultrasound (US) guidance can be a solution. The US-guided cardiac radioablation workflow can be simplified by the simultaneous US and planning computed tomography (CT) acquisition, which can result in US transducer-induced metal artifacts on the planning CT scans. To reduce the impact of these artifacts, a new metal artifact reduction (MAR) algorithm (named: Combined Clustered Scan-based MAR [CCS-MAR]) has been developed and compared with iMAR (Siemens), O-MAR (Philips) and MDT (ReVision Radiology) algorithms. CCS-MAR is a fully automated sinogram inpainting-based MAR algorithm, which uses a two-stage correction process based on a normalized MAR method. The second stage aims to correct errors remaining from the first stage to create an artifact-free combined clustered scan for the process of metal artifact reduction. To evaluate the robustness of CCS-MAR, conventional CT scans and/or dual-energy CT scans from three anthropomorphic phantoms and transducers with different sizes were used. The performance of CCS-MAR for metal artifact reduction was compared with other algorithms through visual comparison, image quality metrics analysis, and HU value restoration evaluation. The results of this study show that CCS-MAR effectively reduced the US transducer-induced metal artifacts and that it improved HU value accuracy more or comparably to other MAR algorithms. These promising results justify future research into US transducer-induced metal artifact reduction for the US-guided cardiac radioablation purposes.
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Affiliation(s)
- Sathyathas Puvanasunthararajah
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia. .,Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, Australia.
| | | | - Marie-Luise Wille
- Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, Australia.,School of Mechanical, Medical & Process Engineering, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, Australia.,ARC ITTC for Multiscale 3D Imaging, Modelling, and Manufacturing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Davide Fontanarosa
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.,Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, Australia
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15
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Moshkovits Y, Grynberg D, Heller E, Maizels L, Maor E. Differential effect of high-frequency electroporation on myocardium vs. non-myocardial tissues. Europace 2022; 25:748-755. [PMID: 36305566 PMCID: PMC9935033 DOI: 10.1093/europace/euac191] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/30/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Pulsed-field ablation (PFA) is an emerging non-thermal ablation method based on the biophysical phenomenon of electroporation. Data on PFA cardiac selectivity nature and tissue-specific thresholds are lacking. We aim to compare the in vivo differential effect of high-frequency irreversible electroporation (HF-IRE) protocols on various tissues. METHODS AND RESULTS Twenty-three Sprague-Dawle rodents were allocated into three different protocols of 300, 600, and 900 V, respectively, while delivering twenty 100 µs bursts of a 150 kHz biphasic square wave to five tissues; cardiac muscle, skeletal muscle, liver, carotid artery and sciatic nerve. Lesions were evaluated quantitatively by histologic analysis and by morphometric evaluation. There were eight, seven and eight animals in the 300, 600, and 900 V protocols, respectively. High-frequency electroporation protocols showed a graded effect on myocardial tissue with larger lesions in the 900 V protocol compared with the other two protocols as demonstrated by width (P = 0.02), length (P = 0.01) and fibrosis ratio (P = 0.001). This effect was not observed for other tissues with attenuated degree of damage. No damage to the carotid artery was observed in all protocols. Partial damage to the sciatic nerve was observed in only two samples (25%) in the 600 V group and in one sample (14.3%) in the 900 V group. CONCLUSION Electroporation effect is tissue-specific such that myocardium is more prone to electroporation damage compared with neural and vascular tissues. Our results suggest no neural or vascular damage with using a low-amplitude HF-IRE protocol. Further investigation is warranted to better identify other tissue-specific thresholds.
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Affiliation(s)
| | | | - Eyal Heller
- Leviev Heart Center, Sheba Medical Center, Derech Sheba 2, Ramat-Gan 52621, Israel,Sackler School of Medicine, Tel Aviv University, Tel-Aviv 39040, Israel
| | - Leonid Maizels
- Leviev Heart Center, Sheba Medical Center, Derech Sheba 2, Ramat-Gan 52621, Israel,Sackler School of Medicine, Tel Aviv University, Tel-Aviv 39040, Israel
| | - Elad Maor
- Corresponding author. Tel: +972546444022; fax: +97246385777. E-mail address:
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16
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Zhang S, Cui Y, Li J, Tian H, Yun Y, Zhou X, Fang H, Zhang H, Zou C, Ma X. Concomitant transcatheter occlusion versus thoracoscopic surgical clipping for left atrial appendage in patients undergoing ablation for atrial fibrillation: A meta-analysis. Front Cardiovasc Med 2022; 9:970847. [PMID: 36148075 PMCID: PMC9485627 DOI: 10.3389/fcvm.2022.970847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background Both catheter left atrial appendage occlusion combined with ablation (COA) and thoracoscopic surgical left atrial appendage clipping combined with ablation (TCA) have shown favorable outcomes in management of patients with atrial fibrillation (AFib). However, studies comparing the endpoints of both techniques are still lacking. Herein, a meta-analysis of safety and efficacy outcomes of COA versus TCA was performed in patients with AFib. Methods Pubmed, Embase, Cochrane, and Web of Science databases were searched for retrieving potential publications. The primary outcome was the incidence of stroke during follow-up period of at least 12 months. Secondary outcomes were acute success rate of complete left atrial appendage (LAA) closure by COA or TCA, postprocedural mortality and complications, and all-cause mortality during follow-up period of at least 12 months. Results 19 studies of COA containing 1,504 patients and 6 studies of TCA with 454 patients were eligible for analysis. No significant difference in stroke and all-cause mortality was found in patients undergoing COA versus TCA after at least a 12-month follow-up (stroke: p = 0.504; all-cause mortality: p = 0.611). COA group had a higher acute success rate compared with TCA group (p = 0.001). COA placed the patients at a higher risk of hemorrhage during the postprocedural period compared with TCA (p = 0.023). A similar risk of other postprocedural complications (stroke/transient ischemic attack and pericardial effusion) and mortality was found in the COA group in comparison with TCA group (p>0.05). Conclusion This meta-analysis showed that COA and TCA did not differ in stroke prevention and all-cause mortality in patients with AFib after a follow-up of at least 12 months. Postprocedural complications and mortality were almost comparable between the two groups. In the near future, high-quality randomized controlled trials exploring the optimal surgical strategies for AFib and endpoints of different procedures are warranted. Systematic review registration [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42022325497].
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Affiliation(s)
- Shijie Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Yuqi Cui
- Center for Precision Medicine and Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO, United States
- Department of Cardiology, Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong, China
| | - Jinzhang Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongbo Tian
- Department of Cardiology, Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong, China
| | - Yan Yun
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xiaoming Zhou
- Department of Endocrinology, Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong, China
| | - Hui Fang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong, China
| | - Haizhou Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong, China
| | - Chengwei Zou
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong, China
- Chengwei Zou,
| | - Xiaochun Ma
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong, China
- School of Chemistry and Chemical Engineering, University of Jinan, Jinan, Shandong, China
- *Correspondence: Xiaochun Ma,
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17
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Wang HX, Li N, An J, Han XB. Percutaneous transhepatic access for catheter ablation of a patient with heterotaxy syndrome complicated with atrial fibrillation: A case report. World J Clin Cases 2022; 10:7006-7012. [PMID: 36051120 PMCID: PMC9297398 DOI: 10.12998/wjcc.v10.i20.7006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/14/2022] [Accepted: 05/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is one of the most common arrhythmias, and radiofrequency catheter ablation is the most effective treatment strategy. The inferior vena cava (IVC) is a common approach for radiofrequency ablation of AF. However, this approach may not be applied to some cases such as chronic venous occlusions, surgical ligation of the IVC, and heterotaxy syndrome (HS).
CASE SUMMARY A 68-year-old man with HS suffered from severely symptomatic persistent AF for 9 years, and we successfully ablated by percutaneous transhepatic access.
CONCLUSION In patients without femoral vein access, the use of the hepatic vein for pulmonary vein isolation is a viable alternative for invasive electrophysiology procedures.
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Affiliation(s)
- Hai-Xiong Wang
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan 030000, Shanxi Province, China
| | - Na Li
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan 030000, Shanxi Province, China
| | - Jian An
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan 030000, Shanxi Province, China
| | - Xue-Bin Han
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan 030000, Shanxi Province, China
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18
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Calvert P, Farinha JM, Gupta D, Kahn M, Proietti R, Lip GYH. A comparison of medical therapy and ablation for atrial fibrillation in patients with heart failure. Expert Rev Cardiovasc Ther 2022; 20:169-183. [DOI: 10.1080/14779072.2022.2050695] [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: 10/18/2022]
Affiliation(s)
- Peter Calvert
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - José Maria Farinha
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Matthew Kahn
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Riccardo Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Denmark
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19
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Tereshchenko SN, Uskach TM. Treatment strategies for patients with atrial fibrillation and chronic heart failure. TERAPEVT ARKH 2022; 93:1545-1550. [DOI: 10.26442/00403660.2021.12.201205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/16/2022] [Indexed: 11/22/2022]
Abstract
Atrial fibrillation (AF) is associated with significant morbidity and mortality and may lead to the development of chronic heart failure (CHF). Each condition predisposes to the other, requiring a careful choice of the treatment strategy. This article is devoted to the prevalence and prognostic implications of both diseases. The article presents data from meta-analyzes related to the management of this group of patients. The aspects of rhythm control strategy in AF and concomitant CHF are described according to the recent studies and clinical guidelines. The features of anticoagulant therapy in patients with AF and CHF are outlined. Much attention is given to the importance of the safety profile of the anticoagulant therapy in terms of the bleeding risk in patients with concomitant AF and CHF.
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20
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Buja LM, Schoen FJ. The pathology of cardiovascular interventions and devices for coronary artery disease, vascular disease, heart failure, and arrhythmias. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00024-4] [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: 11/29/2022] Open
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21
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Yamaji H, Higashiya S, Murakami T, Kawamura H, Murakami M, Kamikawa S, Kusachi S. Rates of atrial flutter occurrence and cavotricuspid isthmus reconduction after prophylactic isthmus ablation performed during atrial fibrillation ablation: a clinical study, review, and comparison with previous findings. J Interv Card Electrophysiol 2021; 64:67-76. [PMID: 34755243 DOI: 10.1007/s10840-021-01087-8] [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: 08/28/2021] [Accepted: 11/04/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Based on the high rate of coexisting atrial fibrillation (AF) and atrial flutter (AFL), prophylactic cavotricuspid isthmus ablation (CTIA) adjunctive to AF ablation has recently been attempted in patients with AF and without AFL. The present study aimed to determine the rates of AFL occurrence and CTI reconduction after performing CTI ablation adjunctive to AF ablation. METHODS We analyzed the data of 3833 consecutive patients with AF, who underwent prophylactic CTIA with AF ablation between 2009 and 2020. RESULTS In all patients, CTIA and AF ablations were successful. Clinical AFL occurred in seven patients (0.18%, 7/3,833), and the observed rate was lower than those reported for cases of AF ablation without CTIA and for those of CTIA for pure AFL. A second ablation was needed in 745 patients at a median of 253 days (25 and 75 percentiles, 116 and 775 days) after the first ablation. In 12.1% (90/745) of the patients, CTI reconduction was observed. The reconduction rate was lower than that previously reported for CTIA for pure AFL. CONCLUSIONS The present retrospective study found acceptably low rates of clinical AFL occurrence and CTI reconduction following prophylactic CTIA performed with AF ablation, which was supported by the findings obtained after performing a comparison of the rates with those of other ablations (AF ablation only and CTIA for pure AFL). Considering the high correlation between AF and AFL, the present study provided information regarding the efficacy of adjunctive CTIA.
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Affiliation(s)
- Hirosuke Yamaji
- Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan.
| | - Shunichi Higashiya
- Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Takashi Murakami
- Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Hiroshi Kawamura
- Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Masaaki Murakami
- Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Shigeshi Kamikawa
- Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Shozo Kusachi
- Department of Medical Technology, Okayama University Graduate School of Health Okayama, Japan Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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22
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Carandina A, Rodrigues GD, Di Francesco P, Filtz A, Bellocchi C, Furlan L, Carugo S, Montano N, Tobaldini E. Effects of transcutaneous auricular vagus nerve stimulation on cardiovascular autonomic control in health and disease. Auton Neurosci 2021; 236:102893. [PMID: 34649119 DOI: 10.1016/j.autneu.2021.102893] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/24/2021] [Accepted: 10/04/2021] [Indexed: 01/01/2023]
Abstract
Autonomic nervous system (ANS) dysfunction is a well-known feature of cardiovascular diseases (CVDs). Studies on heart rate variability (HRV), a non-invasive method useful in investigating the status of cardiovascular autonomic control, have shown that a predominance of sympathetic modulation not only contributes to the progression of CVDs but has a pivotal role in their onset. Current therapies focus more on inhibition of sympathetic activity, but the presence of drug-resistant conditions and the invasiveness of some surgical procedures are an obstacle to complete therapeutic success. On the other hand, targeting the parasympathetic branch of the autonomic nervous system through invasive vagus nerve stimulation (VNS) has shown interesting results as alternative therapeutic approach for CVDs. However, the invasiveness and cost of the surgical procedure limit the clinical applicability of VNS and hinder the research on the physiological pathway involved. Transcutaneous stimulation of the auricular branch of the vagus nerve (tVNS) seems to represent an important non-invasive alternative with effects comparable to those of VNS with surgical implant. Thus, in the present narrative review, we illustrate the main studies on tVNS performed in healthy subjects and in three key examples of CVDs, namely heart failure, hypertension and atrial fibrillation, highlighting the neuromodulatory effects of this technique.
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Affiliation(s)
- Angelica Carandina
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Gabriel Dias Rodrigues
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Pietro Di Francesco
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Annalisa Filtz
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Chiara Bellocchi
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Ludovico Furlan
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Stefano Carugo
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Nicola Montano
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Eleonora Tobaldini
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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23
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Zhu T, Wang Z, Wang S, Shi T, Zhu X, Ma K, Wang Z, Gao J, Jiang H. Pulsed Field Ablation of Superior Vena Cava: Feasibility and Safety of Pulsed Field Ablation. Front Cardiovasc Med 2021; 8:698716. [PMID: 34434976 PMCID: PMC8382124 DOI: 10.3389/fcvm.2021.698716] [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: 04/22/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Studies have shown that pulsed field ablation (PFA) has excellent effectiveness and safety in pulmonary vein isolation (PVI). However, there are few reports about the application of PFA, especially the alternating current (AC) biphase PFA, in superior vena cava (SVC) isolation, and its effectiveness and safety are still unclear. Objective: To investigate the efficacy and safety of the AC biphase PFA for SVC isolation, and to provide evidence for the clinical use of PFA for SVC. Methods: Eight pigs and two dogs were included in the study. PFA was delivered to these pigs and dogs. Pacing threshold and electrogram data were recorded before and after PFA. Voltage mapping of SCV was obtained before, after, and 3 weeks after PFA. At the end, all animals were euthanatized for gross pathology analysis. Results: For eight pigs, the median pacing threshold was 1.5 (1.4, 2.75) mA before PFA, while > 6.0 mA after PFA for all animals. The average electrogram amplitude reduction was 61.33 ± 24.90% for ablations with the initial amplitude≥0.5 mv. For two dogs, pacing threshold change and electrogram amplitude reduction were also observed. No phrenic palsy or sinus node injury was observed during PFA in any animal. Furthermore, voltage mapping showed that the voltage amplitude was significantly decreased in all animals and this could be kept for more than 3 weeks. Moreover, transmural tissue damage with reserved vessel and nerve were shown, no SVC stenosis was found at 3 weeks after PFA. Conclusion: PFA can effectively isolate SVC. Transmural tissue damage of SVC can be achieved without phrenic palsy, sinus node injury nor SVC stenosis.
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Affiliation(s)
- Tongjian Zhu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhen Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Songyun Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tiancai Shi
- Sichuan Jinjiang Electronic Technology Co. Ltd., Sichuan, China
| | - Xiaolin Zhu
- Sichuan Jinjiang Electronic Technology Co. Ltd., Sichuan, China
| | - Kezhong Ma
- Department of Cardiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Zhuo Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jinnian Gao
- Sichuan Jinjiang Electronic Technology Co. Ltd., Sichuan, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
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24
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Anagnostopoulos I, Kousta M, Kossyvakis C, Lakka E, Paraskevaidis NT, Schizas N, Deftereos S, Giannopoulos G. The role of left atrial peak systolic strain in atrial fibrillation recurrence after catheter ablation. A systematic review and meta-analysis. Acta Cardiol 2021; 77:536-544. [PMID: 34412575 DOI: 10.1080/00015385.2021.1965747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND This systematic review and meta-analysis was performed to assess the prognostic role of left atrial peak systolic longitudinal strain (LA-PLSsys) as a predictor of atrial fibrillation (AF) recurrence after catheter ablation. METHODS We systematically searched major electronic databases and grey literature for studies assessing the role of pre-ablation LA-PLSsys, measured in at least two segments, in post-ablation AF recurrence, after a follow-up period of at least 6 months. RESULTS Seventeen eligible studies were included, resulting in 1704 patients (68.6% men) with a pooled mean age of 59.9 ± 10.6 years, 65.9% with paroxysmal AF. Recurrence occurred in 32.7% of patients. Those without recurrence had significantly higher LA-PLSsys (pooled mean ± SD: 22.22 ± 10.64%, weighted mean difference: 5.43%, 95%CI: 4.03-6.84%, I2: 82.7%). Subgroup analysis revealed that the methodology used (echocardiographic view and segments assessed), was a significant source of heterogeneity (p = 0.02). Meta-regression analysis demonstrated that the effect size was inversely related to the baseline LA volume index (p = 0.004), while concerns are also raised about patients with extremely high/low pre-ablation LA strain. CONCLUSIONS Pre-ablation LA-PLSsys seems to be a useful predictor of post-ablation AF recurrence, that could optimise patients selection. Nevertheless, the substantial heterogeneity that was noted may limit its clinical use. Further investigation using a uniform methodological assessment technique is required to derive a reference range, with adequate positive and negative predictive value for recurrence.
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Affiliation(s)
| | - Maria Kousta
- Cardiology Department, Athens General Hospital “G. Gennimatas”, Athens, Greece
| | | | - Eleni Lakka
- Cardiology Department, Athens General Hospital “G. Gennimatas”, Athens, Greece
| | | | - Nikolaos Schizas
- Department of Cardiothoracic Surgery, Evangelismos Hospital, Athens, Greece
| | - Spyridon Deftereos
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
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25
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Matsuda Y, Masuda M, Asai M, Iida O, Kanda T, Mano T. Central retinal artery occlusion after catheter ablation of atrial fibrillation. Clin Case Rep 2021; 9:e04255. [PMID: 34026203 PMCID: PMC8123533 DOI: 10.1002/ccr3.4255] [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: 02/19/2021] [Revised: 03/31/2021] [Accepted: 04/20/2021] [Indexed: 11/25/2022] Open
Abstract
Central retinal artery occlusion (CRAO) is a rare but severe and urgent complication of atrial fibrillation ablation. Awareness of this ophthalmologic complication and prompt treatment are needed because ischemic damage to the retina is irreversible from 4 hours after the onset of CRAO.
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Affiliation(s)
| | | | | | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular CenterAmagasakiJapan
| | - Takashi Kanda
- Kansai Rosai Hospital Cardiovascular CenterAmagasakiJapan
| | - Toshiaki Mano
- Kansai Rosai Hospital Cardiovascular CenterAmagasakiJapan
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26
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Stewart MT, Haines DE, Miklavčič D, Kos B, Kirchhof N, Barka N, Mattison L, Martien M, Onal B, Howard B, Verma A. Safety and chronic lesion characterization of pulsed field ablation in a Porcine model. J Cardiovasc Electrophysiol 2021; 32:958-969. [PMID: 33650743 PMCID: PMC8048690 DOI: 10.1111/jce.14980] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 01/06/2021] [Accepted: 01/23/2021] [Indexed: 12/11/2022]
Abstract
Background Pulsed field ablation (PFA) has been identified as an alternative to thermal‐based ablation systems for treatment of atrial fibrillation patients. The objective of this Good Laboratory Practice (GLP) study was to characterize the chronic effects and safety of overlapping lesions created by a PFA system at intracardiac locations in a porcine model. Methods A circular catheter with nine gold electrodes was used for overlapping low‐ or high‐dose PFA deliveries in the superior vena cava (SVC), right atrial appendage (RAA), and right superior pulmonary vein (RSPV) in six pigs. Electrical isolation was evaluated acutely and chronic lesions were assessed via necropsy and histopathology after 4‐week survival. Acute and chronic safety data were recorded peri‐ and post‐procedurally. Results No animal experienced ventricular arrhythmia during PFA delivery, and there was no evidence of periprocedural PFA‐related adverse events. Lesions created in all anatomies resulted in electrical isolation postprocedure. Lesions were circumferential, contiguous, and transmural, with all converting into consistent lines of chronic replacement fibrosis, regardless of trabeculated or smooth endocardial surface structure. Ablations were non‐thermally generated with only minimal post‐delivery temperature rises recorded at the electrodes. There was no evidence of extracardiac damage, stenosis, aneurysms, endocardial disruption, or thrombus. Conclusion PFA deliveries to the SVC, RAA, and RSPV resulted in complete circumferential replacement fibrosis at 4‐week postablation with an excellent chronic myocardial and collateral tissue safety profile. This GLP study evaluated the safety and efficacy of a dosage range in preparation for a clinical trial and characterized the non‐thermal nature of PFA.
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Affiliation(s)
- Mark T Stewart
- Cardiac Rhythm Management, Medtronic, Inc., Minneapolis, Minnesota, USA
| | - David E Haines
- Beaumont Health System, Div of Cardiology, EP Services, Oakland University William Beaumont School of Medicine, Royal Oaks, Michigan, USA
| | - Damijan Miklavčič
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Bor Kos
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Nicole Kirchhof
- Cardiac Rhythm Management, Medtronic, Inc., Minneapolis, Minnesota, USA
| | - Noah Barka
- Cardiac Rhythm Management, Medtronic, Inc., Minneapolis, Minnesota, USA
| | - Lars Mattison
- Cardiac Rhythm Management, Medtronic, Inc., Minneapolis, Minnesota, USA
| | - Matt Martien
- Cardiac Rhythm Management, Medtronic, Inc., Minneapolis, Minnesota, USA
| | - Birce Onal
- Cardiac Rhythm Management, Medtronic, Inc., Minneapolis, Minnesota, USA
| | - Brian Howard
- Cardiac Rhythm Management, Medtronic, Inc., Minneapolis, Minnesota, USA
| | - Atul Verma
- Southlake Regional Health Centre, Arrhythmia Services, University of Toronto, Newmarket, Ontario, Canada
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27
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Bubnova MG, Aronov DM. Atrial Fibrillation: the Association with Physical Activity and the Effects of Cardiac Rehabilitation. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-10-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of this review was to present modern studies that examine the relationship of physical activity and risk of atrial fibrillation (AF) development and the impact of cardiac rehabilitation programs in patients with all forms of AF. Data of 52 Russian and foreign scientific sources published in 1998- 2020 were presented. In our study, 48 patients with paroxysmal AF after radiofrequency ablation (RFA) were randomly assigned to a physical rehabilitation/standard therapy or control (standard therapy) group. Aerobic physical training was conducted for 6 months 3 times a week. AF is one of the most common cardiac arrhythmias. Despite modern advances, results of treatment of this disease are far from optimal. Many problems of patients with AF can be addressed through enrolment in multidisciplinary cardiac rehabilitation programs. But this question remains open. This is mainly due to the complexity of selection of physical rehabilitation program for patients with AF. It is known that physical activity can trigger an episode of AF. In the following review article, the approaches to functional capacity assessment of patient with AF are described, recommendations for prescribing safe exercise training to achieve a therapeutic effect are presented. Various aspects of the effects of physical rehabilitation are discussed, including its impact on cardiovascular risk factors, influence on atrial remodeling processes and associated biomarkers, prevention of AF progression and occurrence of cardiovascular complications. Results of our own research indicate effectiveness of physical training in patients with AF after RFA: increase in exercise duration by 18.6% (p<0.001) and load by 24.8% (p<0.01) during exercise test, increase in level of everyday physical activity by 23.8% (p=0.001); left atrium dimensions remain stable comparing with control group. That was combined with a decrease of post ablation atrial arrhythmias: after 6 months, they were registered in 4.5% of trained patients vs 17.4% of control group patients (p<0.01). Steady growth in the number of patients with AF and catheter ablation procedures around the world dictates the need for organization of multi-purpose medical rehabilitation.
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Affiliation(s)
- M. G. Bubnova
- National Medical Research Center for Therapy and Preventive Medicine
| | - D. M. Aronov
- National Medical Research Center for Therapy and Preventive Medicine
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28
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Habijan M, Babin D, Galić I, Leventić H, Romić K, Velicki L, Pižurica A. Overview of the Whole Heart and Heart Chamber Segmentation Methods. Cardiovasc Eng Technol 2020; 11:725-747. [DOI: 10.1007/s13239-020-00494-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/06/2020] [Indexed: 12/13/2022]
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29
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Chen JY, Wu HDI, Chang KC. Pulmonary vein volume and myocardial sleeve extension estimated by 3D computed tomography and voltage mapping predict arrhythmogenic triggers of paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2020; 62:177-185. [PMID: 33011885 DOI: 10.1007/s10840-020-00892-x] [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: 06/26/2020] [Accepted: 09/28/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Relationship between pulmonary vein (PV) anatomy and the pathophysiology of paroxysmal atrial fibrillation (PAF) remains incompletely studied. The aim of this study was to determine whether PV anatomy predicts arrhythmogenic PVs. METHODS Twenty-six consecutive PAF patients with spontaneous PAF or consistently frequent ectopic beats during electrophysiological study were enrolled. Computed tomography (CT) images for PVs were reconstructed into 3D images. The PV diameter and volume were measured based on the 3D images. The PV myocardial sleeve area was measured based on the 3D voltage mapping results. The PV myocardial sleeve area index was calculated by dividing the sleeve area of each PV by the average sleeve area of all PVs in each patient. RESULTS The diameter and volume of the arrhythmogenic PVs were larger than those of the non-arrhythmogenic PVs (21.08 ± 4.57 mm vs. 16.47 ± 3.31 mm, P < 0.001 and 7.70 ± 3.28 cm3 vs. 4.09 ± 1.99 cm3, P < 0.001, respectively). The myocardial sleeve area and sleeve area index of the arrhythmogenic PVs were also larger than those of the non-arrhythmogenic PVs (8.62 ± 5.33 cm2 vs. 4.77 ± 3.84 cm2, P < 0.001 and 1.59 ± 0.35 vs. 0.81 ± 0.38, P < 0.001, respectively). Multivariate analysis showed the PV myocardial sleeve area index was the independent predictor for arrhythmogenic PVs (P < 0.001). CONCLUSIONS PV size plays an important role in triggering PAF. A large myocardial sleeve extension is a powerful and independent predictor for arrhythmogenic PV, which may be useful anatomical markers to facilitate PAF ablation.
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Affiliation(s)
- Jan-Yow Chen
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yu-Der Road, North District, Taichung, 40447, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Hong-Dar Isaac Wu
- Department of Applied Mathematics and Institute of Statistics, National Chung Hsing University, Taichung, Taiwan
| | - Kuan-Cheng Chang
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yu-Der Road, North District, Taichung, 40447, Taiwan. .,School of Medicine, China Medical University, Taichung, Taiwan.
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30
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Chen SA, Zhang MM, Zheng M, Liu F, Sun L, Bao ZY, Chen FK, Li HX, Gu X. The preablation monocyte/ high density lipoprotein ratio predicts the late recurrence of paroxysmal atrial fibrillation after radiofrequency ablation. BMC Cardiovasc Disord 2020; 20:401. [PMID: 32894051 PMCID: PMC7487477 DOI: 10.1186/s12872-020-01670-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/13/2020] [Indexed: 12/23/2022] Open
Abstract
Background The monocyte/high-density lipoprotein ratio (MHR) has emerged as a promising alternative biomarker in the fields of cardiovascular disease and atrial fibrillation (AF). This retrospective study was aimed to explore the predictive value of the MHR for the late recurrence of AF after radiofrequency ablation. Methods From April 2015 to October 2018, patients with paroxysmal AF who had undergone radiofrequency catheter ablation at Subei People’s Hospital of Jiangsu Province were enrolled in our study. All the participants were observed until November 2019 after the procedure. During the postoperative follow up, the patients were categorized into the recurrence group and maintenance of sinus rhythm group based on who had experienced AF recurrence. Results One hundred twenty-five patients were diagnosed with paroxysmal AF, with an average age of 61.2 ± 9.3 years. Forty-seven patients had developed late recurrence during a mean follow up of 25.1 ± 12.0 months. The AF recurrence event rates were significantly increased in the highest MHR tertile compared with those in the lowest MHR tertile (22.0% vs. 57.1%; P < 0.05). On multivariate logistic regression analysis, the preablation MHR (OR = 1.34; 95% CI = 1.12 ~ 1.60; P = 0.001) and left atrial diameter (LAD) (OR = 1.21, 95% CI = 1.08 ~ 1.35; P = 0.001) were independent risk factors predicting the recurrence of AF after radiofrequency ablation. Furthermore, receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) of the MHR was 0.712 (95% CI = 0.618 ~ 0.806; P = 0.000) and that of LAD was 0.739 (95% CI = 0.653 ~ 0.814; P = 0.000). Z-test found no significant difference between the MHR and LAD regarding the AUC (Z = 0.451; P = 0.652). Conclusion An elevated preablation MHR was associated with an increased risk of the postoperative recurrence of AF. Additionally, the MHR independently predicted the late recurrence of paroxysmal AF after radiofrequency ablation, with the same predictive value as LAD.
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Affiliation(s)
- She-An Chen
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, No. 98, Nantong West Road, Yangzhou, 225001, Jiangsu, China.,Clinical Medical College, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Man-Man Zhang
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, No. 98, Nantong West Road, Yangzhou, 225001, Jiangsu, China
| | - Meifang Zheng
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, No. 98, Nantong West Road, Yangzhou, 225001, Jiangsu, China.,Clinical Medical College, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Fei Liu
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, No. 98, Nantong West Road, Yangzhou, 225001, Jiangsu, China
| | - Lei Sun
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, No. 98, Nantong West Road, Yangzhou, 225001, Jiangsu, China
| | - Zheng-Yu Bao
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, No. 98, Nantong West Road, Yangzhou, 225001, Jiangsu, China
| | - Fu-Kun Chen
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, No. 98, Nantong West Road, Yangzhou, 225001, Jiangsu, China
| | - Hong-Xiao Li
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, No. 98, Nantong West Road, Yangzhou, 225001, Jiangsu, China
| | - Xiang Gu
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China. .,Department of Cardiology, Northern Jiangsu People's Hospital, No. 98, Nantong West Road, Yangzhou, 225001, Jiangsu, China.
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31
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Saad-Omer SM, Ryad R, Limbana T, Zahid T, Jahan N. Catheter Ablation vs. Medical Treatment in Patients With Atrial Fibrillation. Cureus 2020; 12:e9700. [PMID: 32818123 PMCID: PMC7426661 DOI: 10.7759/cureus.9700] [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: 07/14/2020] [Accepted: 08/12/2020] [Indexed: 12/04/2022] Open
Abstract
Atrial fibrillation has become the most commonly seen cardiac arrhythmia in clinical practice affecting almost 5.6 million Americans with that number expected to rise in the near future. The current literature review is aimed to assess the efficacy of catheter ablation in the treatment of patients with atrial fibrillation when compared to standard medical therapy. A PubMed search for studies of "Atrial Fibrillation" found 83,251 articles. Following the application of inclusion/exclusion criteria, we identified 44 articles of relevance that compared catheter ablation and medical therapy in the treatment of atrial fibrillation. These 44 articles included 20 Observational studies, eight randomized clinical trials, three clinical trials, five cohort studies, and eight review articles. Our review determined that catheter ablation was associated with a much lower rate of reoccurrence of atrial fibrillation when compared to medical therapy, as well as decreased cardiovascular outpatient visits and thromboembolic complications. The effect of quality on life when compared to medical treatment, however, was found to be inconclusive.
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Affiliation(s)
- Suhail M Saad-Omer
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Robert Ryad
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Therese Limbana
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Tehrim Zahid
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nusrat Jahan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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32
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Suryanarayana PG, Ayers M, Trerotola SO, Nazarian S. Direct hepatic vein puncture and transseptal access for atrial flutter and fibrillation ablation in a patient with prior ligation of the inferior vena cava. HeartRhythm Case Rep 2020; 6:382-385. [PMID: 32695582 PMCID: PMC7360982 DOI: 10.1016/j.hrcr.2020.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Prakash Goutham Suryanarayana
- Cardiac Electrophysiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Ayers
- Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott O Trerotola
- Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Saman Nazarian
- Cardiac Electrophysiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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33
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Insight into atrial fibrillation through analysis of the coding transcriptome in humans. Biophys Rev 2020; 12:817-826. [PMID: 32666467 DOI: 10.1007/s12551-020-00735-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/08/2020] [Indexed: 12/11/2022] Open
Abstract
Atrial fibrillation is the most common sustained cardiac arrhythmia in humans, and its prevalence continues to increase because of the aging of the world population. Much still needs to be learned about the molecular pathways involved in the development and the persistence of the disease. Analysis of the transcriptome of cardiac tissue has provided valuable insight into diverse aspects of atrial remodeling, in particular concerning electrical remodeling-related to ion channels-and structural remodeling identified by dysregulation of processes linked to inflammation, fibrosis, oxidative stress, and thrombogenesis. The huge amount of data produced by these studies now represents a valuable source for the identification of novel potential therapeutic targets. In addition, the shift from cardiac tissue to peripheral blood as a substrate for transcriptome analysis revealed this strategy as a promising tool for improved diagnosis and therefore better patient care.
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34
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Farokhnia N, Caprio A, Kashyap V, Al'Aref S, Baskaran L, Mosadegh B, Dunham S. A Catheter-Deployable Soft Robotic Inflatable Basket for Enhanced Conformability to the Left Atrium of the Heart. Adv Healthc Mater 2020; 9:e1900951. [PMID: 31945275 DOI: 10.1002/adhm.201900951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/11/2019] [Indexed: 11/10/2022]
Abstract
This paper presents the design, fabrication, and test results for a novel basket catheter that utilizes soft robotic technology, which can conform to complex patient anatomy. Two designs of basket-shaped balloons in three sizes are fabricated based on a CO2 laser cutting method from thin (<50 µm) thermoplastic polyurethane. The balloons are deployed in four soft-material 3D printed left atria, whose geometries are based on volume rendered segmentation of cardiac computed tomography (CT) scans. The coverage and conformability to the realistic patient anatomies is tracked with the small patches of pH paper that indicate, via a color change, contact with a basic solution that lined the 3D printed atriums. The conformability of these inflatable basket catheters is demonstrated as high as (85%) for the optimized design. To visualize the balloon's performance, microCT images of balloons deployed in 3D printed models are shown. These images show the ability of the balloons to adapt to complex patient anatomy and do not exhibit any spline bunching or other deleterious mechanical behavior. This platform has the potential to be coupled with electrical sensors for simultaneous multisensor mapping of atrial fibrillation and other cardiac arrhythmias.
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Affiliation(s)
- Nazanin Farokhnia
- Dalio Institute for Cardiovascular Imaging Department of Radiology Weill Cornell Medicine New York NY 10021 USA
| | - Alexandre Caprio
- Dalio Institute for Cardiovascular Imaging Department of Radiology Weill Cornell Medicine New York NY 10021 USA
| | - Varun Kashyap
- Dalio Institute for Cardiovascular Imaging Department of Radiology Weill Cornell Medicine New York NY 10021 USA
| | - Subhi Al'Aref
- Dalio Institute for Cardiovascular Imaging Department of Radiology Weill Cornell Medicine New York NY 10021 USA
| | - Lohendran Baskaran
- Dalio Institute for Cardiovascular Imaging Department of Radiology Weill Cornell Medicine New York NY 10021 USA
| | - Bobak Mosadegh
- Dalio Institute for Cardiovascular Imaging Department of Radiology Weill Cornell Medicine New York NY 10021 USA
| | - Simon Dunham
- Dalio Institute for Cardiovascular Imaging Department of Radiology Weill Cornell Medicine New York NY 10021 USA
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35
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Kuck KH, Merkely B, Zahn R, Arentz T, Seidl K, Schlüter M, Tilz RR, Piorkowski C, Gellér L, Kleemann T, Hindricks G. Catheter Ablation Versus Best Medical Therapy in Patients With Persistent Atrial Fibrillation and Congestive Heart Failure. Circ Arrhythm Electrophysiol 2019; 12:e007731. [DOI: 10.1161/circep.119.007731] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Optimal treatment of patients with persistent atrial fibrillation (AF) and heart failure (HF) with reduced left ventricular ejection fraction (LVEF) and an indication for internal defibrillator therapy is controversial.
Methods:
Patients with persistent/longstanding persistent AF and LVEF ≤35% were randomly allocated to catheter ablation of AF or best medical therapy (BMT). The primary study end point was the absolute increase in LVEF from baseline at 1 year. Secondary end points included 6-minute walk test, quality-of-life, and NT-proBNP (N-terminal pro-brain natriuretic peptide). Pulmonary vein isolation was the primary ablation approach; BMT comprised rate or rhythm control. All patients were discharged after index hospitalization with a cardioverter-defibrillator or cardiac resynchronization therapy defibrillator implanted. The study was terminated early for futility.
Results:
Of 140 patients (65±8 years, 126 [90%] men) available for the end point analysis, 68 and 72 patients were assigned to ablation and BMT, respectively. At 1 year, LVEF had increased in ablation patients by 8.8% (95% CI, 5.8%–11.9%) and in BMT patients by 7.3% (4.3%–10.3%;
P
=0.36). Sinus rhythm was recorded on 12-lead electrocardiograms at 1 year in 61/83 ablation patients (73.5%) and 42/84 BMT patients (50%). Device-recorded AF burden at 1 year was 0% or maximally 5% of the time in 28/39 ablation patients (72%) and 16/36 BMT patients (44%). There was no difference in secondary end point outcome between ablation patients and BMT patients.
Conclusions:
The AMICA trial (Atrial Fibrillation Management in Congestive Heart Failure With Ablation) did not reveal any benefit of catheter ablation in patients with AF and advanced HF. This was mainly because of the fact that at 1 year, LVEF increased in ablation patients to a similar extent as in BMT patients. The effect of catheter ablation of AF in patients with HF may be affected by the extent of HF at baseline, with a rather limited ablation benefit in patients with seriously advanced HF.
Clinical Trial Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT00652522.
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Affiliation(s)
- Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany (K.-H.K., R.R.T.)
| | - Béla Merkely
- Semmelweis Medical University, Budapest, Hungary (B.M., L.G.)
| | - Ralf Zahn
- Heart Center, Ludwigshafen, Germany (R.Z.)
| | - Thomas Arentz
- University Heart Center Freiburg-Bad Krozingen, Germany (T.A.)
| | | | | | - Roland Richard Tilz
- Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany (K.-H.K., R.R.T.)
| | | | - László Gellér
- Semmelweis Medical University, Budapest, Hungary (B.M., L.G.)
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36
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Li KHC, Sang T, Chan C, Gong M, Liu Y, Jesuthasan A, Li G, Liu T, Lam MHS, Wu WK, Chan MTV, Liu FZ, Chen C, Ho J, Xia Y, Tse G. Anaesthesia use in catheter ablation for atrial fibrillation: a systematic review and meta-analysis of observational studies. HEART ASIA 2019; 11:e011155. [PMID: 31565074 DOI: 10.1136/heartasia-2018-011155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 12/20/2022]
Abstract
Objectives This meta-analysis and systematic review seeks to compare both characteristic parameters and procedural outcomes of atrial fibrillation (AF) catheter ablation in patients under general anaesthesia (GA)/deep sedation and mild/moderate sedation. Background Catheter ablation has become a widely applied intervention for treating symptomatic AF and arrhythmias that are refractory to medical therapy. It can be conducted through from mild sedation to GA. Methods PubMed and Embase were searched up to July 2018 for randomised controlled trials, cohort and observational studies that assessed the outcomes of catheter ablation under GA/deep sedation or mild/moderate sedation. Nine studies were included in this meta-analysis after screening with the inclusion and exclusion criteria. Heterogeneity between studies and publication bias was evaluated by I2 index and Egger's regression, respectively. Results Our meta-analysis found catheter AF ablation with GA/deep sedation to be associated with reduced risk of recurrence (RR: 0.79, 95% CI 0.56 to 1.13, p=0.20) and complications (RR: 0.95, 95% CI 0.64 to 1.42, p=0.82), though statistically insignificant. In terms of procedural parameters, there was no significant difference between the two groups for both procedural time (SMD: -0.13, 95% CI -0.90 to 0.63, p=0.74) and fluoroscopy time (SMD: -0.41, 95% CI -1.40 to 0.58, p=0.41). Univariate meta-regression did not reveal any covariates as a moderating factor for complication and recurrence risk. Conclusion Apart from an increased likelihood of procedural success, ablation by GA/deep sedation was found to be non-significantly different from the mild/moderate sedation approach in both procedural parameters and outcome measures.
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Affiliation(s)
| | - Tian Sang
- Anaesthesia and Intensive Care, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Cheng Chan
- Anaesthesia and Intensive Care, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Mengqi Gong
- Atrial fibriallation cente, Tianjin Institute of Cardiology, Tianijin, China
| | - Yingzhi Liu
- Anaesthesia and Intensive Care, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Aaron Jesuthasan
- Cardiovascular research center, Newcastle University, Newcastle, UK
| | - Guangping Li
- Atrial fibriallation cente, Tianjin Institute of Cardiology, Tianijin, China
| | - Tong Liu
- Atrial fibriallation cente, Tianjin Institute of Cardiology, Tianijin, China
| | - Michael H S Lam
- Department of Cardiology, Sheffield Hallam University, Sheffield, UK
| | | | - Matthew T V Chan
- Anaesthesia and Intensive Care, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Fang-Zhou Liu
- Atrial fibriallation cente, Tianjin Institute of Cardiology, Tianijin, China
| | - Cheng Chen
- Department of Cardiology, Dalian University, Dalian, China
| | - Jeffery Ho
- Anaesthesia and Intensive Care, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Yunlong Xia
- First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Gary Tse
- Chinese University of Hong Kong, Shatin, Hong Kong
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37
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Vos LM, Kotecha D, Geuzebroek GSC, Hofman FN, van Boven WJP, Kelder J, de Mol BAJM, van Putte BP. Totally thoracoscopic ablation for atrial fibrillation: a systematic safety analysis. Europace 2019; 20:1790-1797. [PMID: 29361045 PMCID: PMC6212776 DOI: 10.1093/europace/eux385] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 01/06/2018] [Indexed: 11/14/2022] Open
Abstract
Aims Thoracoscopic surgical ablation has evolved into a successful strategy for symptomatic atrial fibrillation (AF) refractory to other therapy. More widespread referral is limited by the lack of information on potential complications. Our aim was to systematically evaluate 30-day complications of totally thoracoscopic surgical ablation. Methods and results We retrospectively studied consecutive patients undergoing totally thoracoscopic surgical ablation at a referral centre in the Netherlands (2007-2016). Patients received pulmonary vein isolation, with additional lesion lines as needed, and left atrial appendage exclusion. The primary outcomes were freedom from any complications and freedom from irreversible complications at 30-days. Secondary outcomes included intra- and post-operative complications according to severity. Included were 558 patients with median age 62 years (interquartile range 56-68 years), 70% male and 53% with a previous failed catheter ablation. The cohort consisted of 43% paroxysmal AF, 47% persistent AF, and 10% long-standing persistent AF. Freedom from any 30-day complication was 88.2%, and from complications with life-long affecting consequences 97.5%. The intra-operative complication rate was 2.3% with no strokes or death observed. The median hospital length of stay was 4 days. The percentage of patients with major and minor complications at 30-days was 3.2% and 8.1%, respectively, with one patient dying of an ischaemic stroke. The only patient groups with excess complications were women aged ≥70 years and patients with a history of congestive heart failure. Conclusions Totally thoracoscopic ablation is associated with a low complication rate in a referral centre and may be a useful alternative to other rhythm control strategies.
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Affiliation(s)
- Lara M Vos
- Department of Cardiothoracic Surgery, St. Antonius Hospital, EM Nieuwegein, the Netherlands.,Department of Cardiothoracic Surgery, Academic Medical Center, DD, Amsterdam, the Netherlands
| | - Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Vincent Drive, Birmingham, UK
| | | | - Frederik N Hofman
- Department of Cardiothoracic Surgery, St. Antonius Hospital, EM Nieuwegein, the Netherlands
| | - Wim Jan P van Boven
- Department of Cardiothoracic Surgery, Academic Medical Center, DD, Amsterdam, the Netherlands
| | - Johannes Kelder
- Department of Cardiothoracic Surgery, St. Antonius Hospital, EM Nieuwegein, the Netherlands
| | - Bas A J M de Mol
- Department of Cardiothoracic Surgery, Academic Medical Center, DD, Amsterdam, the Netherlands
| | - Bart P van Putte
- Department of Cardiothoracic Surgery, St. Antonius Hospital, EM Nieuwegein, the Netherlands.,Department of Cardiothoracic Surgery, Academic Medical Center, DD, Amsterdam, the Netherlands
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38
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Ablación de fibrilación auricular, ictus y hemorragia digestiva: desenlace fatal. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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39
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Elisabeth Noten AM, Kis Z, Akca F, Bhagwandien R, Wijchers S, Yap SC, Szili-Torok T. Robotic navigation shows superior improvement in efficiency for atrial fibrillation ablation. J Atr Fibrillation 2019; 11:2108. [PMID: 31139295 DOI: 10.4022/jafib.2108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 07/18/2018] [Accepted: 11/30/2018] [Indexed: 12/27/2022]
Abstract
Background Because of the expanding atrial fibrillation (AF) burden, AF catheter ablation (CA) techniques have to become more efficient. Efficient AF CA procedures are characterized by successful pulmonary vein isolation (PVI) within reasonable procedure time. Currently there are many PVI techniques available and all show substantial improvements over time. However, the magnitude of improvement in procedural efficiency has not yet been compared between different techniques. The aim of this study was to compare efficiency improvement between manually (MAN) guided, cryoballoon (CB) and remote magnetic navigation (RMN) guided PVI. Methods A total of 221 patients were included in this retrospective study. Procedural parameters of 115 patients treated with first-generation PVI techniques (MAN-1, CB-1, RMN-1) performed in 2010, were compared to 106 patients who were treated with the latest, second generation techniques (MAN-2, CB-2, RMN-2). Efficiency was characterized by the following parameters: total ablation time, total procedure time, first pass isolation (FPI) (i.e. successful isolation after the first pulmonary vein (PV) encirclement) and touch-up rates. Results Every technique showed significant improvement of procedure times from the first to the second generation (P<0.001). In-between second generation techniques, the procedure times were comparable. The greatest magnitude of procedure time improvement was observed within the RMN groups (∆-180min), which was significantly greater compared to CB (∆-48 min, P<0.001) and MAN (∆-98min, P=0.011) groups. The highest FPI rates were observed in RMN-2 (78% and 74%; left and right PVs respectively), which was significantly higher compared to other techniques (MAN-2: 24% and 24%; CB-2: 50% and 48%; P<0.001). Conclusions The highest magnitude of efficiency improvement was detected in RMN guided PVI.
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Affiliation(s)
| | - Zsuzsanna Kis
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Ferdi Akca
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Rohit Bhagwandien
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Sip Wijchers
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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40
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Stewart MT, Haines DE, Verma A, Kirchhof N, Barka N, Grassl E, Howard B. Intracardiac pulsed field ablation: Proof of feasibility in a chronic porcine model. Heart Rhythm 2019; 16:754-764. [DOI: 10.1016/j.hrthm.2018.10.030] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Indexed: 02/07/2023]
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41
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Zorzi A, Cipriani A, Corrado D. Anti-arrhythmic therapy in athletes. Pharmacol Res 2019; 144:306-314. [PMID: 31028906 DOI: 10.1016/j.phrs.2019.04.027] [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: 01/24/2019] [Revised: 04/12/2019] [Accepted: 04/23/2019] [Indexed: 11/25/2022]
Abstract
The spectrum of arrhythmias that may be encountered in athletes ranges from isolated ectopic beats to ventricular tachycardia, usually in the context of a structurally normal heart. Anti-arrhythmic therapy in these individuals may be particularly challenging because of the young age, the hypervagotonic state, the desire to maintain a high physical performance, the reluctance to take medications and the need to avoid molecules included in the list of prohibited drugs of the World Anti-Doping Agency. Furthermore, the possible serious adverse effects of anti-arrhythmic drugs should be balanced against the benign nature of arrhythmias in patients with no underlying heart disease. The review summarizes the most common arrhythmias of athletes and the possible therapeutic options, including anti-arrhythmic drugs and non-pharmacological interventions. Eligibility criteria according to current guidelines are also addressed.
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Affiliation(s)
- Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padova, Italy.
| | - Alberto Cipriani
- Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padova, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padova, Italy
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Tsiachris D, Giannopoulos G, Deftereos S, Kossyvakis C, Tsioufis C, Siasos G, Oikonomou E, Gatzoulis K, Tousoulis D, Stefanadis C. Biomarkers Determining Prognosis of Atrial Fibrillation Ablation. Curr Med Chem 2019; 26:925-937. [DOI: 10.2174/0929867325666180320122930] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/29/2016] [Accepted: 12/29/2016] [Indexed: 11/22/2022]
Abstract
Catheter ablation for rhythm control is recommended in specific patient populations
with paroxysmal, persistent, or long-standing persistent atrial fibrillation. Pulmonary
vein isolation is the cornerstone of the ablative therapy for atrial fibrillation. However, relapse
is still common since the single procedure efficacy of atrial fibrillation ablation was estimated
to be 60-80% in paroxysmal and 50-70% in persistent atrial fibrillation. It is important to
identify predictors of successful atrial fibrillation patients ablation. In the present review, we
will assess the role of available biomarkers to predict responders of an initial atrial fibrillation
catheter ablation. Emphasis has been given on the role of myocardial injury biomarkers, natriuretic
peptides and traditional inflammatory markers. Novel inflammatory markers, oxidative
stress biomarkers and microRNAs have also been examined as predictors of a successful atrial
fibrillation procedure. Notably, the impact of procedural and short-term administration of
steroids, as well as the role of colchicine on preventing atrial fibrillation recurrence after ablation
is thoroughly presented.
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Affiliation(s)
| | | | - Spyridon Deftereos
- 2nd Department of Cardiology, 'Attikon' University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Charis Kossyvakis
- Department of Cardiology, 'Georgios Genimmatas' General Hospital of Athens, Athens, Greece
| | - Constantinos Tsioufis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece
| | - Gerasimos Siasos
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece
| | - Evangelos Oikonomou
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece
| | - Konstantinos Gatzoulis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece
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43
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Zhang G, Wu Y. Circulating Galectin-3 and Atrial Fibrillation Recurrence after Catheter Ablation: A Meta-Analysis. Cardiovasc Ther 2019; 2019:4148129. [PMID: 31772609 PMCID: PMC6739774 DOI: 10.1155/2019/4148129] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/04/2019] [Accepted: 03/11/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Galectin-3 (Gal-3) is involved in fibrosis and heart failure. However, epidemiological studies evaluating the association between Gal-3 and atrial fibrillation (AF) recurrence after catheter ablation showed inconsistent results. We conducted a meta-analysis to comprehensively evaluate the relationship between baseline circulating Gal-3 levels and AF recurrence in patients undergoing catheter ablation. METHODS Relevant studies were identified by systematically searching the PubMed and Embase databases. A random-effect model was used to synthesize the results. Sensitivity analyses, performed by omitting one study at a time, were used to evaluate the robustness of the results. RESULTS Seven prospective cohort studies including 645 AF patients were included. Within a follow-up duration of up to 18 months, 244 patients developed AF recurrence. Pooled results showed that baseline circulating Gal-3 levels were significantly higher in patients with AF recurrence compared to those without (standardized mean difference: 0.74; 95% confidence interval (CI): 0.21 - 1.27; p = 0.007; I2 = 89%). Moreover, higher baseline Gal-3 levels were independently associated with a significantly higher risk of AF recurrence after catheter ablation (risk ratio: 1.17 per unit of Gal-3; 95% CI: 1.01 - 1.35; p = 0.03; I2 = 40%), which was independent of age, gender, and left atrial dimension. Sensitivity analyses did not significantly affect the results. However, there was a significant publication bias for predicting efficacy of associating preprocedural Gal-3 levels with AF recurrence. CONCLUSIONS Higher preprocedural Gal-3 levels may be associated with increased risk of AF recurrence in patients undergoing catheter ablation.
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Affiliation(s)
- Guangping Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yongquan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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44
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Habibi M, Cooper JM, Love CJ, Sinha SK. Transseptal puncture facilitated by “reverse tenting” using a left atrial ablation catheter. HeartRhythm Case Rep 2019; 5:159-162. [PMID: 30891415 PMCID: PMC6404362 DOI: 10.1016/j.hrcr.2018.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
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45
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AlTurki A, Proietti R, Dawas A, Alturki H, Huynh T, Essebag V. Catheter ablation for atrial fibrillation in heart failure with reduced ejection fraction: a systematic review and meta-analysis of randomized controlled trials. BMC Cardiovasc Disord 2019; 19:18. [PMID: 30646857 PMCID: PMC6332840 DOI: 10.1186/s12872-019-0998-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/08/2019] [Indexed: 12/25/2022] Open
Abstract
Background Previous randomized controlled trials (RCT)s showed similar outcomes in patients with atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) treated with anti-arrhythmic drugs (AAD) compared to rate control therapy. We sought to evaluate whether catheter ablation is superior to medical therapy in patients with AF and HFrEF. Methods We searched electronic databases for all RCTs that compared catheter ablation and medical therapy (with or without use of AAD). We used random-effects models to summarize the studies. The primary end-point was all-cause mortality. Secondary outcomes included heart failure-related hospitalizations and change in left ventricular ejection fraction (LVEF). Results We retrieved and summarized 7 randomized controlled trials, enrolling 856 patients (429 in the catheter ablation arm and 427 in the medical therapy arm). Compared with medical therapy (including use of AAD), AF catheter ablation was associated with a significant reduction in mortality (risk ratio 0.50; 95% confidence interval [CI]: 0.34 to 0.74; P = 0.0005) and heart failure-related hospitalizations (risk ratio 0.56; 95% CI: 0.44 to 0.71; P < 0.0001). Furthermore, catheter ablation led to significant improvements in LVEF (weighted mean difference, 7.48; 95% CI: 3.71 to 11.26; P < 0.0001). Conclusions Compared to medical therapy, including use of AAD, catheter ablation for AF was associated with a significant reduction in mortality and heart failure-related hospitalizations as well as an improvement in LVEF in patients with HFrEF. Larger trials are needed to confirm whether rhythm control with ablation is superior to rate control in patients with AF and heart failure.
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Affiliation(s)
- Ahmed AlTurki
- Division of Cardiology, McGill University Health Center, 1650 Cedar Ave, Room E5-200, Montreal, QC, H3G 1A4, Canada
| | - Riccardo Proietti
- Department of Cardiac, Thoracic, and Vascular Sciences, Padua, Italy
| | - Ahmed Dawas
- Division of Cardiology, McGill University Health Center, 1650 Cedar Ave, Room E5-200, Montreal, QC, H3G 1A4, Canada
| | - Hasan Alturki
- School of Medicine and Medical Science, University College, Dublin, Ireland
| | - Thao Huynh
- Division of Cardiology, McGill University Health Center, 1650 Cedar Ave, Room E5-200, Montreal, QC, H3G 1A4, Canada
| | - Vidal Essebag
- Division of Cardiology, McGill University Health Center, 1650 Cedar Ave, Room E5-200, Montreal, QC, H3G 1A4, Canada. .,Hôpital Sacré-Coeur de Montréal, Montreal, Quebec, Canada.
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Atrial Fibrillation Ablation, Stroke, and Hematemesis: Fatal Outcome. ACTA ACUST UNITED AC 2018; 72:506-507. [PMID: 30029982 DOI: 10.1016/j.rec.2018.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/04/2018] [Indexed: 11/24/2022]
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Left atrial appendage ligation and atrial fibrillation: A tool to “snare” greater success? Heart Rhythm 2018. [DOI: 10.1016/j.hrthm.2018.03.007] [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: 11/18/2022]
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Lambert L, Marek J, Fingrova Z, Havranek S, Kuchynka P, Cerny V, Simek J, Burgetova A. The predictive value of cardiac morphology for long-term outcome of patients undergoing catheter ablation for atrial fibrillation. J Cardiovasc Comput Tomogr 2018; 12:418-424. [PMID: 29945850 DOI: 10.1016/j.jcct.2018.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/30/2018] [Accepted: 06/15/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Catheter ablation (CA) is an established therapy for selected patients with atrial fibrillation (AF), but predictors of CA ablation outcome are still not fully elucidated. The aim of the study was to identify structural and morphological parameters from computed tomography (CT) as predictors of successful CA of AF in a single center prospective cohort. METHODS An analysis of CT scans dedicated to LA evaluation was performed in 99 patients (63 ± 8 years old, 70% males, 59% paroxysmal AF) scheduled for CA of AF. Survival free of atrial fibrillation/flutter/tachycardia at 1- and 3-years was assessed. RESULTS In overall study population, both 1- and 3-year responders had smaller distance to the first division in left superior pulmonary vein (16.3 ± 5.42 mm vs. 19.1 ± 7.0 mm and 14.9 ± 3.6 mm vs. 18.7 ± 7.0 mm; p < 0.05). One-year responders had larger ostium area of left inferior pulmonary vein (median 236 mm2 [IQR = 97] vs. 222 mm2 [IQR = 71]; p = 0.03) and less acute angle between the interatrial septum and the right superior pulmonary vein (102 ± 20° vs. 95 ± 10°; p = 0.03). Three-years' responders had smaller ostium area of the right superior pulmonary vein (248 ± 94 mm2 vs. 364 ± 282 mm2; p = 0.02). Multivariate Cox regression analysis identified different predictors in paroxysmal and non-paroxysmal AF. For patients with paroxysmal AF, the predictors were angle to right superior pulmonary vein and left superior/inferior pulmonary veins carina thickness with hazard ratios of 0.965 (95%CI 0.939 to 0.992, p = 0.010) and 0.747 (95%CI 0.591 to 0.944, p = 0.015). In patients with persistent AF, the predictors were gender and NYHA stage with hazard ratios of 4.9 (95%CI 1.758 to 13.579, p = 0.002) and 0.365 (95%CI 0.148 to 0.899, p = 0.028) respectively. CONCLUSIONS The anatomy of LA, especially morphology of pulmonary veins, seems to be one of the predictors of clinical outcome after CA for paroxysmal AF. In non-paroxysmal AF LA anatomy is less relevant in prediction of clinical outcome.
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Affiliation(s)
- Lukas Lambert
- Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Josef Marek
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Zdenka Fingrova
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Stepan Havranek
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
| | - Petr Kuchynka
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Vladimir Cerny
- Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Jan Simek
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Andrea Burgetova
- Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
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Haegeli LM, Stutz L, Mohsen M, Wolber T, Brunckhorst C, On CJ, Duru F. Feasibility of zero or near zero fluoroscopy during catheter ablation procedures. Cardiol J 2018; 26:226-232. [PMID: 29611170 DOI: 10.5603/cj.a2018.0029] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 01/21/2018] [Accepted: 01/22/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Awareness of risks associated with radiation exposure to patients and medical staff has significantly increased. It has been reported before that the use of advanced three-dimensional electroanatomical mapping (EAM) system significantly reduces fluoroscopy time, however this study aimed for zero or near zero fluoroscopy ablation to assess its feasibility and safety in ablation of atrial fibrillation (AF) and other tachyarrhythmias in a "real world" experience of a single tertiary care center. METHODS This was a single-center study where ablation procedures were attempted without fluoroscopy in 34 consecutive patients with different tachyarrhythmias under the support of EAM system. When transseptal puncture (TSP) was needed, it was attempted under the guidance of intracardiac echocardiography (ICE). RESULTS Among 34 patients consecutively enrolled in this study, 28 (82.4%) patients were referred for radiofrequency ablation (RFA) of AF, 3 (8.8%) patients for ablation of right ventricular outflow tract (RVOT) ventricular extrasystole (VES), 1 (2.9%) patient for ablation of atrioventricular nodal reentry tachycardia (AVNRT), 2 (5.9%) patients for typical atrial flutter ablation. In 21 (62%) patients the en- tire procedure was carried out without the use of fluoroscopy. Among 28 AF patients, 15 (54%) patients underwent ablation without the use of fluoroscopy and among these 15 patients, 10 (67%) patients required TSP under ICE guidance while 5 (33%) patients the catheters were introduced to left atrium through a patent foramen ovale. In 13 AF patients, fluoroscopy was only required for double TSP. The total procedure time of AF ablation was 130 ± 50 min. All patients referred for atrial flutter, AVNRT, and VES of the RVOT ablation did not require any fluoroscopy. CONCLUSIONS This study demonstrates the feasibility of zero or near zero fluoroscopy procedure including TSP with the support of EAM and ICE guidance in a "real world" experience of a single tertiary care center. When fluoroscopy was required, it was limited to TSP hence keeping the radiation dose very low.
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Affiliation(s)
- Laurent M Haegeli
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland. .,Division of Cardiology, Medical University Department, Kantonsspital Aarau, Switzerland.
| | - Linda Stutz
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Mohammed Mohsen
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Thomas Wolber
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Corinna Brunckhorst
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Chol-Jun On
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Firat Duru
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
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Nørgaard MW, Pedersen PU, Bjerrum M. Understanding how patients use visualization during ablation of atrial fibrillation in reducing their experience of pain, anxiety, consumption of pain medication and procedure length: Integrating quantitative and qualitative results. Appl Nurs Res 2018; 39:229-240. [DOI: 10.1016/j.apnr.2017.11.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 11/19/2017] [Indexed: 11/26/2022]
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