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Boehmer AA, Rothe M, Ruckes C, Eckardt L, Kaess BM, Ehrlich JR. Catheter ablation for atrial fibrillation in elderly patients: an updated meta-analysis of comparative studies. Can J Cardiol 2024:S0828-282X(24)00850-X. [PMID: 39127258 DOI: 10.1016/j.cjca.2024.08.263] [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: 04/12/2024] [Revised: 07/23/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Age is a relevant risk factor for the development of atrial fibrillation (AF) and is associated with increased recurrence rates in the setting of rhythm-control. Catheter ablation is increasingly advocated in elderly despite conflicting data regarding its efficacy and safety in this patient cohort. Therefore, we aimed to analyze currently available evidence regarding catheter ablation for AF in patients ≥75 years compared to younger patients. METHODS We performed a systematic literature search and meta-analysis on efficacy and safety of catheter ablation in patients ≥75 years with AF. Primary efficacy and safety endpoints were: first recurrence of atrial arrhythmia following first-time ablation and occurrence of death, stroke, or any procedure-related complication. Secondary outcomes included procedure and fluoroscopy time. RESULTS We identified 301 potentially relevant studies of which 39 underwent detailed analysis. A total of 19 studies (MINORS score ≥13) reporting on 108,419 patients (101,844 <75 years, 6,575 ≥75 years) undergoing first-time catheter ablation for AF were included. Risk of arrhythmia recurrence following catheter ablation (39% vs. 32%; RR [95% CI] 1.24 [1.09-1.41]; P=0.001) and occurrence of safety endpoints (10.8% vs. 8.5%; RR [95% CI] 1.64 [1.53-1.76], P<0.00001) were significantly higher in patients ≥ 75 years compared to younger patients. There was no difference concerning procedure (P=0.33) or fluoroscopy time (P=0.91) between younger and elderly patients. CONCLUSION In patients ≥75 years of age catheter ablation for AF has higher risk of arrhythmia recurrence and is associated with an increased risk of procedure-related complications and safety endpoint occurrence compared to younger patients.
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Affiliation(s)
| | - Moritz Rothe
- Department of Cardiology, St. Josefs-Hospital Wiesbaden, Germany
| | | | - Lars Eckardt
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Bernhard M Kaess
- Department of Cardiology, St. Josefs-Hospital Wiesbaden, Germany
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von Olshausen G, Drca N, Paul-Nordin A, Bourke T, Bastani H, Saygi S, Svennberg E, Åkerström F, Saluveer O, Jensen-Urstad M, Braunschweig F. Incidence of atrial fibrillation in patients with atrioventricular nodal re-entrant tachycardia and its association with long-term outcome. Heart Rhythm O2 2024; 5:538-542. [PMID: 39263614 PMCID: PMC11385394 DOI: 10.1016/j.hroo.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024] Open
Abstract
Background Atrioventricular nodal re-entrant tachycardia (AVNRT) is the most common paroxysmal supraventricular tachycardia. We sought to investigate the incidence of atrial fibrillation in patients with electrophysiologically confirmed/ablated AVNRT and its association with transient ischemic attack (TIA)/stroke as well as mortality during long-term follow-up. Methods From the Karolinska Ablation Registry, 2855 consecutive patients with a first-time ablation for AVNRT between 2005 and 2018 were analyzed. Results Patients were 52.1 ± 15.9 years old and 59.3% were women. During follow-up of up to 10 years (median 6.0 years; interquartile range 3.3 to 9.2 years), new onset or recurrence of atrial fibrillation occurred in 317 (11.1%) patients (incidence rate 19 cases per 1000 person-years). Excluding those with history of atrial fibrillation, new onset of atrial fibrillation occurred in 153 (6.1%) patients. In multivariable analysis, history of atrial fibrillation, arterial hypertension, history of TIA/stroke, and heart failure remained independently associated with new onset or recurrence of atrial fibrillation during follow-up. Death of any cause and TIA/stroke occurred in 141 (4.9%) patients and 107 (3.7%) patients, respectively. In multivariable analysis, occurrence of atrial fibrillation during follow-up remained independently associated with both outcomes. The prevalence of atrial fibrillation according to age at the end of follow-up was high among young patients (<60 years of age: 12.7%; 60-69 years of age: 10.6%). Conclusion In this large cohort of patients with diagnosed AVNRT, the incidence of atrial fibrillation was high (11.1%) during long-term follow-up. Occurrence of atrial fibrillation during follow-up remained independently associated with death for any cause as well as with TIA/stroke. Therefore, a closer monitoring for atrial fibrillation in patients with AVNRT including those at young age is advisable.
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Affiliation(s)
- Gesa von Olshausen
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Medical Department I (Cardiology, Angiology, Pneumology), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nikola Drca
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Astrid Paul-Nordin
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Tara Bourke
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Hamid Bastani
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Serkan Saygi
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Emma Svennberg
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Finn Åkerström
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Ott Saluveer
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
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3
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Boehmer AA, Kaess BM, Ruckes C, Meyer C, Metzner A, Rillig A, Eckardt L, Nattel S, Ehrlich JR. Pulmonary Vein Isolation or Pace and Ablate in Elderly Patients With Persistent Atrial Fibrillation (ABLATE Versus PACE)-Rationale, Methods, and Design. Can J Cardiol 2024:S0828-282X(24)00579-8. [PMID: 39067619 DOI: 10.1016/j.cjca.2024.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/18/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024] Open
Abstract
Age is a major risk-factor for atrial fibrillation (AF) and associated hospitalisations. With increasing emphasis on rhythm control, pulmonary vein isolation (PVI) is often suggested, even to elderly patients (≥ 75 years of age). Efficacy of PVI aiming at rhythm control is limited in persistent AF. Pacemaker implantation with atrioventricular node (AVN) ablation may represent a reasonable alternative, with the aim of controlling symptoms and improving quality of life in elderly patients. In this investigator-initiated, randomised, multicentre trial, we test the hypothesis that pacemaker implantation and AVN ablation provides superior symptom control over PVI in elderly patients with symptomatic persistent AF, without any increase in adverse event profile. In the ABLATE Versus PACE (NCT04906668) prospective open-label superiority trial, 196 elderly patients with normal ejection fraction and symptomatic persistent AF despite guideline-indicated medical therapy will be randomised to either cryoballoon PVI (ABLATE) or dual-chamber pacemaker implantation with subsequent AVN ablation (PACE), and followed for a minimum of 12 months. The primary efficacy outcome is a composite end point of rehospitalisation for atrial arrhythmia or cardiac decompensation/heart failure, (outpatient) electrical cardioversion, or upgrade to cardiac resynchronisation therapy owing to worsening of left ventricular ejection fraction to ≤ 35%. Secondary end points include death from any cause, stroke, quality of life, and procedure-related complications. Sample size is designed to achieve 80% power for the primary end point (2-tailed alpha of 5%). ABLATE Versus PACE will determine whether pacemaker implantation and AVN ablation can improve symptom-control in elderly patients with persistent AF over PVI without increasing safety end points.
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Affiliation(s)
| | | | - Christian Ruckes
- Interdisciplinary Center for Clinical Trials, University Medical Center, Mainz, Germany
| | | | | | - Andreas Rillig
- University Hospital of Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Eckardt
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Münster, Germany
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4
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Middelfart C, Tønnesen J, Zörner CR, Da Riis-Vestergaard L, Pham MHX, Pallisgaard JL, Ruwald MH, Rasmussen PV, Johannessen A, Hansen J, Worck R, Gislason G, Hansen ML. Two decades of SVT ablation in Denmark: a trend towards higher age, more comorbidity, and less prior use of antiarrhythmic and rate-limiting pharmacotherapy-a nationwide registry-based Danish study. J Interv Card Electrophysiol 2024; 67:837-846. [PMID: 38109025 PMCID: PMC11166800 DOI: 10.1007/s10840-023-01692-9] [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: 08/30/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND AND AIMS Trends in patient selection and use of pharmacotherapy prior to catheter ablation (CA) for supraventricular tachycardia (SVT) are not well described. This study examined temporal trends in patients undergoing first-time CA for regular SVT, including atrioventricular nodal re-entry tachycardia (AVNRT), accessory pathways (APs), and ectopic atrial tachycardia (EAT) on a nationwide scale in Denmark in the period 2001-2018. METHODS AND RESULTS Using Danish Nationwide registers, 9959 patients treated with first-time CA for SVT between 2001 and 2018 were identified, of which 6023 (61%) received CA for AVNRT, 2829 (28%) for AP, and 1107 (11%) for EAT. Median age was 55, 42, and 55 in the AVNRT, APs, and EAT group, respectively. The number of patients receiving CA increased from 1195 between 2001 and 2003 to 1914 between 2016 and 2018. The percentage of patients with a CHA2DS2-VASc score ≥ 2 increased in all patient groups. The number of patients who underwent CA with no prior use of antiarrhythmic- or rate limiting medicine increased significantly, though prior use of beta-blockers increased for AVNRT patients. Use of verapamil decreased in all three SVT groups (P < 0.05). Use of amiodarone and class 1C antiarrhythmics remained low, with the highest usage among EAT patients. CONCLUSION Between 2001 and 2018, CA was increasingly performed in patients with SVT, primarily AVNRT- and EAT patients. The burden of comorbidities increased. Patients undergoing CA without prior antiarrhythmic- or rate-limiting drug therapy increased significantly. Use of beta-blockers increased and remained the most widely used drug.
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Affiliation(s)
- Charlotte Middelfart
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.
| | - Jacob Tønnesen
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Christopher R Zörner
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Lise Da Riis-Vestergaard
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Maria Hang Xuan Pham
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Jannik Langtved Pallisgaard
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Martin H Ruwald
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Peter Vibe Rasmussen
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Arne Johannessen
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Jim Hansen
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Rene Worck
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Morten Lock Hansen
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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5
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Peng G, Zei PC. Diagnosis and Management of Paroxysmal Supraventricular Tachycardia. JAMA 2024; 331:601-610. [PMID: 38497695 DOI: 10.1001/jama.2024.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Importance Paroxysmal supraventricular tachycardia (PSVT), defined as tachyarrhythmias that originate from or conduct through the atria or atrioventricular node with abrupt onset, affects 168 to 332 per 100 000 individuals. Untreated PSVT is associated with adverse outcomes including high symptom burden and tachycardia-mediated cardiomyopathy. Observations Approximately 50% of patients with PSVT are aged 45 to 64 years and 67.5% are female. Most common symptoms include palpitations (86%), chest discomfort (47%), and dyspnea (38%). Patients may rarely develop tachycardia-mediated cardiomyopathy (1%) due to PSVT. Diagnosis is made on electrocardiogram during an arrhythmic event or using ambulatory monitoring. First-line acute therapy for hemodynamically stable patients includes vagal maneuvers such as the modified Valsalva maneuver (43% effective) and intravenous adenosine (91% effective). Emergent cardioversion is recommended for patients who are hemodynamically unstable. Catheter ablation is safe, highly effective, and recommended as first-line therapy to prevent recurrence of PSVT. Meta-analysis of observational studies shows single catheter ablation procedure success rates of 94.3% to 98.5%. Evidence is limited for the effectiveness of long-term pharmacotherapy to prevent PSVT. Nonetheless, guidelines recommend therapies including calcium channel blockers, β-blockers, and antiarrhythmic agents as management options. Conclusion and Relevance Paroxysmal SVT affects both adult and pediatric populations and is generally a benign condition. Catheter ablation is the most effective therapy to prevent recurrent PSVT. Pharmacotherapy is an important component of acute and long-term management of PSVT.
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Affiliation(s)
- Gary Peng
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul C Zei
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Jemtrén A, Saygi S, Åkerström F, Asaad F, Bourke T, Braunschweig F, Carnlöf C, Drca N, Insulander P, Kennebäck G, Nordin AP, Sadigh B, Rickenlund A, Saluveer O, Schwieler J, Svennberg E, Tapanainen J, Turkmen Y, Bastani H, Jensen-Urstad M. Risk assessment in patients with symptomatic and asymptomatic pre-excitation. Europace 2024; 26:euae036. [PMID: 38363996 PMCID: PMC10873488 DOI: 10.1093/europace/euae036] [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: 11/04/2023] [Accepted: 01/23/2024] [Indexed: 02/18/2024] Open
Abstract
AIMS Controversy remains as to whether the exercise stress test (EST) is sufficient for risk evaluation in patients with pre-excitation. This study aims to clarify the usefulness of EST in risk stratification in both asymptomatic and symptomatic patients presenting with pre-excitation. METHODS AND RESULTS This prospective study includes consecutive asymptomatic and symptomatic patients with pre-excitation referred for risk assessment. All participants performed an incremental EST (bicycle) prior to an electrophysiology study (EPS). Primary data from the EST included loss of pre-excitation during exercise, and primary data from the EPS included the measurement of accessory pathway effective refractory period (APERP), shortest pre-excited RR interval (SPERRI), and inducible arrhythmia with the use of a beta-adrenergic receptor agonist if deemed necessary. One hundred and sixty-four patients (59 asymptomatic, 105 symptomatic) completed an EST and EPS. Forty-five patients (27%) demonstrated low-risk findings on EST, of which 19 were asymptomatic and 26 were symptomatic. Six patients with low-risk EST findings had SPERRI/APERP ≤ 250 ms at EPS, and two of them were asymptomatic. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of low-risk EST for excluding patients with SPERRI/APERP ≤ 250 ms were 40, 91, 87, 51, and 60%, respectively. The number of patients with inducible arrhythmia at EPS was similar in the asymptomatic (36, 69%) and symptomatic (73, 61%) groups. CONCLUSION Sudden loss of pre-excitation during EST has a low NPV in excluding high-risk APs. The EPS with the use of isoproterenol should be considered to accurately assess the risk of patients with pre-excitation regardless of symptoms (ClinicalTrials.gov Identifier: NCT03301935).
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Affiliation(s)
- Anette Jemtrén
- Heart and Lung Disease Unit, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Serkan Saygi
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Finn Åkerström
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Fahd Asaad
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Tara Bourke
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Carina Carnlöf
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Nikola Drca
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Per Insulander
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Göran Kennebäck
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Astrid Paul Nordin
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Bita Sadigh
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Anette Rickenlund
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ott Saluveer
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Jonas Schwieler
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Emma Svennberg
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Jari Tapanainen
- Department of Clinical Sciences, Danderyd Hospital Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Yusuf Turkmen
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Hamid Bastani
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
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7
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Penela D, Falasconi G, Carreño JM, Soto-Iglesias D, Fernández-Armenta J, Acosta J, Martí-Almor J, Benito B, Bellido A, Chauca A, Scherer C, Viveros D, Alderete J, Silva E, Ordoñez A, Francisco-Pascual J, Rivas-Gandara N, Meca-Santamaria J, Franco P, De Lucia C, Ali H, Cappato R, Cámara O, Francia P, Berruezo A. A hybrid clinical and electrocardiographic score to predict the origin of outflow tract ventricular arrhythmias. J Interv Card Electrophysiol 2023; 66:1877-1888. [PMID: 36795268 DOI: 10.1007/s10840-023-01507-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/04/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND To predict the outflow tract ventricular arrhythmias (OTVA) site of origin (SOO) before the ablation procedure has important practical implications. The present study sought to prospectively evaluate the accuracy of a clinical and electrocardiographic hybrid algorithm (HA) for the prediction of OTVAs-SOO, and at the same time to develop and to prospectively validate a new score with improved discriminatory capacity. METHODS In this multicenter study, we prospectively enrolled consecutive patients referred for OTVA ablation (N = 202), and we divided them in a derivation sample and a validation cohort. Surface ECGs during OTVA were analyzed to compare previous published ECG-only criteria and to develop a new score. RESULTS In the derivation sample (N = 105), the correct prediction rate of HA and ECG-only criteria ranged from 74 to 89%. R-wave amplitude in V3 was the best ECG parameter for discriminating LVOT origin in V3 precordial transition (V3PT) patients, and was incorporated to the novel weighted hybrid score (WHS). WHS correctly classified 99 (94.2%) patients, presenting 90% sensitivity and 96% specificity (AUC 0.97) in the entire population; WHS mantained a 87% sensitivity and 91% specificity (AUC 0.95) in patients with V3PT subgroup. The high discriminatory capacity was confirmed in the validation sample (N = 97): the WHS exhibited an AUC (0.93), and a WHS ≥ 2 allowed a correct prediction of LVOT origin in 87 (90.0%) cases, yielding a sensitivity of 87% and specificity of 90%; moreover, the V3PT subgroup showed an AUC of 0.92, and a punctuation ≥ 2 predicted an LVOT origin with a sensitivity of 94% and specificity of 78%. CONCLUSIONS The novel hybrid score has proved to accurately anticipate the OTVA's origin, even in those with a V3 precordial transition. A Weighted hybrid score. B Typical examples of the use of the weighted hybrid score. C ROC analysis of WHS and previous ECG criteria for prediction of LVOT origin in the derivation cohort. D ROC analysis of WHS and previous ECG criteria for prediction of LVOT origin in the V3 precordial transition OTVA subgroup.
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Affiliation(s)
- Diego Penela
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | - Giulio Falasconi
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
- University of Barcelona, Campus Clínic, Barcelona, Spain
| | - Jose Miguel Carreño
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | - David Soto-Iglesias
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | | | - Juan Acosta
- Virgen del Rocío University Hospital, Sevilla, Spain
| | - Julio Martí-Almor
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | - Begoña Benito
- Hospital Vall d'Hebron, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Aldo Bellido
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | - Alfredo Chauca
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | - Claudia Scherer
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | - Daniel Viveros
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
- University of Barcelona, Campus Clínic, Barcelona, Spain
| | - Jose Alderete
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
- University of Barcelona, Campus Clínic, Barcelona, Spain
| | | | - Augusto Ordoñez
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | | | | | | | - Paula Franco
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | | | - Hussam Ali
- IRCCS Multimedica Group, Sesto San Giovanni, Italy
| | | | | | - Pietro Francia
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Antonio Berruezo
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain.
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8
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Kahle AK, Alken FA, Scherschel K, Meyer C. Prognostic implications of baseline rhythm during catheter ablation for atrial tachycardia. Clin Res Cardiol 2023:10.1007/s00392-023-02292-3. [PMID: 37710016 DOI: 10.1007/s00392-023-02292-3] [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: 03/13/2023] [Accepted: 08/21/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Atrial tachycardias (AT) occurring in patients after previous atrial fibrillation (AF) ablation are increasingly observed in clinical practice. Catheter ablation is the treatment of choice but an optimal workflow to improve patient outcome has not been defined. The purpose of this study was to assess procedural and clinical outcome depending on baseline rhythm at the beginning of AT ablation. METHODS A total of 380 patients (69 (61-75) years, 56.6% male) who underwent catheter ablation for consecutive AT after previous AF ablation were studied. RESULTS At the beginning of the procedure, 140 patients (36.8%) presented in sinus rhythm (SR), 208 (54.7%) with AT and 32 (8.4%) with AF. Patients in SR or with AT underwent shorter procedures (173 (132-213) minutes vs. 161 (120-203) minutes vs. 226 (154-249) minutes; p = 0.002) with more frequent termination to SR (87.9% vs. 81.3% vs. 56.3%; p < 0.001) than patients with AF. Acute procedural success did not differ between patients in SR or with AT but was higher compared to those with AF (96.4% vs. 97.1% vs. 87.5%; p = 0.033). During a follow-up of 290 (181-680) days, patients in baseline SR experienced arrhythmia recurrences less often (36.4% vs. 49.5% vs. 68.8%; p = 0.002) than patients with AT or AF. CONCLUSION Baseline rhythm during AT ablation predicts procedural and clinical outcome. Whereas acute procedural success does not differ between patients in SR or with AT, patients presenting in SR have a more favorable mid-term success rate.
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Affiliation(s)
- Ann-Kathrin Kahle
- Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Kirchfeldstrasse 40, 40217, Düsseldorf, Germany
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Fares-Alexander Alken
- Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Kirchfeldstrasse 40, 40217, Düsseldorf, Germany
| | - Katharina Scherschel
- Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Kirchfeldstrasse 40, 40217, Düsseldorf, Germany
- Institute of Neural and Sensory Physiology, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Heinrich Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Christian Meyer
- Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Kirchfeldstrasse 40, 40217, Düsseldorf, Germany.
- Institute of Neural and Sensory Physiology, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Heinrich Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany.
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9
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Batra G, Aktaa S, Camm AJ, Costa F, Di Biase L, Duncker D, Fauchier L, Fragakis N, Frost L, Hijazi Z, Juhlin T, Merino JL, Mont L, Nielsen JC, Oldgren J, Polewczyk A, Potpara T, Sacher F, Sommer P, Tilz R, Maggioni AP, Wallentin L, Casadei B, Gale CP. Data standards for atrial fibrillation/flutter and catheter ablation: the European Unified Registries for Heart Care Evaluation and Randomized Trials (EuroHeart). EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:609-620. [PMID: 36243903 PMCID: PMC10495697 DOI: 10.1093/ehjqcco/qcac068] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/02/2022] [Accepted: 10/12/2022] [Indexed: 09/13/2023]
Abstract
AIMS Standardized data definitions are essential for monitoring and assessment of care and outcomes in observational studies and randomized controlled trials (RCTs). The European Unified Registries for Heart Care Evaluation and Randomized Trials (EuroHeart) project of the European Society of Cardiology aimed to develop contemporary data standards for atrial fibrillation/flutter (AF/AFL) and catheter ablation. METHODS AND RESULTS We used the EuroHeart methodology for the development of data standards and formed a Working Group comprising 23 experts in AF/AFL and catheter ablation registries, as well as representatives from the European Heart Rhythm Association and EuroHeart. We conducted a systematic literature review of AF/AFL and catheter ablation registries and data standard documents to generate candidate variables. We used a modified Delphi method to reach a consensus on a final variable set. For each variable, the Working Group developed permissible values and definitions, and agreed as to whether the variable was mandatory (Level 1) or additional (Level 2). In total, 70 Level 1 and 92 Level 2 variables were selected and reviewed by a wider Reference Group of 42 experts from 24 countries. The Level 1 variables were implemented into the EuroHeart IT platform as the basis for continuous registration of individual patient data. CONCLUSION By means of a structured process and working with international stakeholders, harmonized data standards for AF/AFL and catheter ablation for AF/AFL were developed. In the context of the EuroHeart project, this will facilitate country-level quality of care improvement, international observational research, registry-based RCTs, and post-marketing surveillance of devices and pharmacotherapies.
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Affiliation(s)
- Gorav Batra
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, 751 85 Uppsala, Sweden
| | - Suleman Aktaa
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Institute for Data Analytics, University of Leeds and Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | | | - Francisco Costa
- Cardiology Department, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz, 1449-005 Lisboa, Portugal
| | - Luigi Di Biase
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, New York City, NY 10467, USA
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, 30625 Hannover, Germany
| | - Laurent Fauchier
- Service de Cardiologie, Center Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, 37044 Tours, France
| | - Nikolaos Fragakis
- 3rd Cardiology Department, Hippokration General Hospital, Aristotle University Medical School, 54124 Thessaloniki, Greece
| | - Lars Frost
- Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, and Department of Clinical Medicine, Aarhus University, 8200 AarhusDenmark
| | - Ziad Hijazi
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, 751 85 Uppsala, Sweden
| | - Tord Juhlin
- Department of Cardiology, Skåne University Hospital, 221 85 Lund, Sweden
| | - José L Merino
- Arrhythmia and Robotic Electrophysiology Unit, Hospital Universitario La Paz, IdiPaz, Universidad Autonoma, 28046 Madrid, Spain
| | - Lluis Mont
- Hospital Clinic, Universitat de Barcelona, Institut de Recerca Biomèdica August Pi Sunyer (IDIBAPS), 08036 Barcelona, Spain; CIBER cardiovascular, 28029 Madrid, Spain
| | - Jens C Nielsen
- Department of Cardiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Jonas Oldgren
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, 751 85 Uppsala, Sweden
| | - Anna Polewczyk
- Department of Physiology, Patophysiology and Clinical Immunology, Collegium Medicum of The Jan Kochanowski University, 25-369 Kielce, Poland; Department of Cardiac Surgery, Department of Cardiac Surgery Świętokrzyskie Center of Cardiology, Kielce, Poland
| | - Tatjana Potpara
- School of Medicine, University of Belgrade and Intensive Arrhythmia Care, Cardiology Clinic, Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Frederic Sacher
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), LIRYC Institute, 33600 Bordeaux, France
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany
| | - Roland Tilz
- Department of Rhythmology, University Heart Center Luebeck, 23538 Lübeck, Germany
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, 50121 Florence, Italy
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, 751 85 Uppsala, Sweden
| | - Barbara Casadei
- Division of Cardiovascular Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford OX4 2PG, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Institute for Data Analytics, University of Leeds and Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
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10
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Al-Betar MT, Masa'deh R, Hamaideh SH, Ahmed FR, Bakkali H, AbuRuz ME. Quality of life among patients with supraventricular tachycardia post radiofrequency cardiac ablation in Jordan. Acute Crit Care 2023; 38:333-342. [PMID: 37652863 PMCID: PMC10497898 DOI: 10.4266/acc.2023.00052] [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: 01/06/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Supraventricular tachycardia (SVT) is a common arrhythmia with associated symptoms such as palpitation, dizziness, and fatigue. It significantly affects patients' quality of life (QoL). Radiofrequency cardiac ablation (RFCA) is a highly effective treatment to eliminate arrhythmia and improve patients' QoL. The purpose of this study was to assess the level of QoL among patients with SVT and examine the difference in QoL before and after RFCA. METHODS One group pre-posttest design with a convenience sample of 112 patients was used. QoL was assessed by 36-Item Short Form (SF-36). Data were collected at admission through face-to-face interviews and 1-month post-discharge through phone interviews. RESULTS There was a significant difference between QoL before (33.7±17.0) and 1 month after (62.5±18.5) the RFCA. Post-RFCA patients diagnosed with atrioventricular nodal reentrant tachycardia had higher QoL than other types of SVT. Moreover, there were significant negative relationships between QoL and the number and duration of episodes pre- and post-RFCA. There were no significant differences in QoL based on: age, sex, working status, marital status, smoking, coronary artery disease, diabetes mellitus, and hypertension. CONCLUSIONS After RFCA, the QoL of patients with ST improved for both physical and mental component subscales.
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Affiliation(s)
| | - Rami Masa'deh
- Faculty of Nursing, Applied Science Private University, Amman, Jordan
| | - Shaher H. Hamaideh
- Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Fatma Refaat Ahmed
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Hajar Bakkali
- Department of Nursing, Cairo University, EgyptGiza, Egypt
- Department of Nursing, Former Specialized in Adult Cardiac Care Surgeries, Co-operative Union Cardiac Hospital, Al-Asimah, Kuwait
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11
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von Olshausen G, Tabrizi F, Sigurjónsdóttir R, Ringborn M, Höglund N, Hassel Jönsson A, Holmqvist F, Braunschweig F. Cardiac tamponades related to interventional electrophysiology procedures are associated with higher risk of short-term hospitalization for pericarditis but favourable long-term outcome. Europace 2023; 25:euad140. [PMID: 37306316 PMCID: PMC10259250 DOI: 10.1093/europace/euad140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/18/2023] [Indexed: 06/13/2023] Open
Abstract
AIMS To investigate the association of iatrogenic cardiac tamponades as a complication of invasive electrophysiology procedures (EPs) and mortality as well as serious cardiovascular events in a nationwide patient cohort during long-term follow-up. METHODS From the Swedish Catheter Ablation Registry between 2005 and 2019, a total of 58 770 invasive EPs in 44 497 patients were analysed. From this, all patients with periprocedural cardiac tamponades related to invasive EPs were identified (n = 200; tamponade group) and matched (1:2 ratio) to a control group (n = 400). Over a follow-up of 5 years, the composite primary endpoint-death from any cause, acute myocardial infarction, transitory ischaemic attack (TIA)/stroke, and hospitalization for heart failure-revealed no statistically significant association with cardiac tamponade [hazard ratio (HR) 1.22 (95% CI, 0.79-1.88)]. All single components of the primary endpoint as well as cardiovascular death revealed no statistically significant association with cardiac tamponade. Cardiac tamponade was associated with a significantly higher risk with hospitalization for pericarditis [HR 20.67 (95% CI, 6.32-67.60)]. CONCLUSION In this nationwide cohort of patients undergoing invasive EPs, iatrogenic cardiac tamponade was associated with an increased risk of hospitalization for pericarditis during the first months after the index procedure. In the long-term, however, cardiac tamponade revealed no significant association with mortality or other serious cardiovascular events.
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Affiliation(s)
- Gesa von Olshausen
- Department of Cardiology, Karolinska University Hospital, Solna, S1:02, SE-17176 Stockholm, Sweden
- Medical Department I (Cardiology, Angiology, Pneumology), Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, DE-81675 Munich, Germany
| | - Fariborz Tabrizi
- Department of Clinical Sciences, Karolinska Institute, Arrhythmia Center Stockholm, South Hospital, Sjukhusbacken 10, SE-11883, Stockholm, Sweden
| | - Rúna Sigurjónsdóttir
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Blåa Stråket 3, 141345 Göteborg, Sweden
| | - Michael Ringborn
- Thoracic Center, Blekinge County Hospital, Lasarettsvägen, SE-371 85, Karlskrona, Sweden
| | - Niklas Höglund
- Department of Public Health and Clinical Medicine, Umeå University, SE-90187 Umeå, Sweden
| | - Anders Hassel Jönsson
- Department of Cardiology, Linköping University Hospital, SE-581 85 Linköping, Sweden
| | - Fredrik Holmqvist
- Department of Cardiology, Skåne University Hospital Lund, SE-221 85 Lund, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Karolinska University Hospital, Solna, S1:02, SE-17176 Stockholm, Sweden
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12
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Miller J, Sewani A, Rezazada J, Alawneh Y, Kazemian P, Terricabras M, Wright G, Tavallaei MA. Quantification of Mechanical Characteristics of Conventional Steerable Ablation Catheters for Treatment of Atrial Fibrillation Using a Heart Phantom. Cardiovasc Eng Technol 2023; 14:419-427. [PMID: 36828976 DOI: 10.1007/s13239-023-00662-6] [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: 09/05/2022] [Accepted: 02/06/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE Accurate and reliable catheter navigation is important in formation of adequate lesions during radiofrequency cardiac catheter ablation. To inform future device design efforts and to characterize the limitations of conventional devices, the focus of this study is to assess and quantify the mechanical performance of manual ablation catheters for pulmonary vein isolation procedures within a phantom heart model. METHODS We measured three important metrics: accuracy of catheter tip navigation to target anatomical landmarks at the pulmonary veins (PVs), orientation of the catheter relative to the tissue at the targets, and the delivered force values and their stability and variations at those targets. A stereovision system was used for navigational guidance and to measure the catheter's tip position and orientation relative to the targets. To measure force, piezoelectric sensors were used which were integrated at the targets, whereby operators were instructed to stabilize the catheter to achieve a chosen reference force value. RESULTS An overall positioning accuracy of 1.57 ± 1.71 mm was achieved for all targets. No statistical significance was observed in position accuracy between the right and left PVs (p = 0.5138). The orientation of the catheter relative to tissue surface was 41° ± 21° with no statistical significance between targets. The overall force stability was 41 ± 6 g with higher difficulty in force stabilization in the right compared to the left PV (40 ± 8 vs. 43 ± 2 g, p < 0.0001). CONCLUSION Based on our results, future improvements to manual catheter navigation for ablation should focus on improving device performance in orientation control and improved force stability.
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Affiliation(s)
- Jacob Miller
- Toronto Metropolitan University, Toronto, ON, Canada.
- Sunnybrook Research Institute, Toronto, ON, Canada.
| | - Alykhan Sewani
- Toronto Metropolitan University, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - Jeffrey Rezazada
- Toronto Metropolitan University, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - Yara Alawneh
- Toronto Metropolitan University, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
| | | | | | | | - M Ali Tavallaei
- Toronto Metropolitan University, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
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13
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Doldi F, Geßler N, Anwar O, Kahle AK, Scherschel K, Rath B, Köbe J, Lange PS, Frommeyer G, Metzner A, Meyer C, Willems S, Kuck KH, Eckardt L. In-hospital mortality and major complications related to radiofrequency catheter ablations of over 10 000 supraventricular arrhythmias from 2005 to 2020: individualized case analysis of multicentric administrative data. Europace 2023; 25:130-136. [PMID: 36006798 PMCID: PMC10103566 DOI: 10.1093/europace/euac146] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/11/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS The incidence of in-hospital post-interventional complications and mortality after ablation of supraventricular tachycardia (SVT) vary among the type of procedure and most likely the experience of the centre. As ablation therapy of SVT is progressively being established as first-line therapy, further assessment of post-procedural complication rates is crucial for health care quality. METHODS AND RESULTS We aimed at determining the incidence of in-hospital mortality and bleeding complications from SVT ablations in German high-volume electrophysiological centres between 2005 and 2020. All cases were registered by the German Diagnosis Related Groups-and the German Operation and Procedure Classification (OPS) system. A uniform search for SVT ablations from 2005 to 2020 with the same OPS codes defining the type of ablation/arrhythmia as well as the presence of a vascular complication, cardiac tamponade, and/or in-hospital death was performed. An overall of 47 610 ablations with 10 037 SVT ablations were registered from 2005 to 2020 among three high-volume centres. An overall complication rate of 0.5% (n = 38) was found [median age, 64; ±15 years; female n = 26 (68%)]. All-cause mortality was 0.02% (n = 2) and both patients had major prior co-morbidities precipitating a lethal outcome irrespective of the ablation procedure. Vascular complications occurred in 10 patients (0.1%), and cardiac tamponade was detected in 26 cases (0.3%). CONCLUSION The present case-based analysis shows an overall low incidence of in-hospital complications after SVT ablation highlighting the overall very good safety profile of SVT ablations in high-volume centres. Further prospective analysis is still warranted to guarantee continuous quality control and optimal patient care.
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Affiliation(s)
- Florian Doldi
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
| | - Nele Geßler
- Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Omar Anwar
- Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Ann-Kathrin Kahle
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Katharina Scherschel
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Benjamin Rath
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
| | - Julia Köbe
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
| | - Philipp Sebastian Lange
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
| | - Gerrit Frommeyer
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
| | - Andreas Metzner
- Universitäres Herz- und Gefäßzentrum UKE Hamburg, Klinik und Poliklinik für Kardiologie, Hamburg, Germany
| | - Christian Meyer
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Stephan Willems
- Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Lars Eckardt
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
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14
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Carnlöf C, Iwarzon M, Jensen-Urstad M, Gadler F, Insulander P. Women with atrial fibrillation undergoing pulmonary vein isolation are more symptomatic but improve more in health-related quality of life and symptom burden than men. SCAND CARDIOVASC J 2022; 56:316-324. [PMID: 35941825 DOI: 10.1080/14017431.2022.2107235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Gender differences in symptoms and perceived health-related quality of life (HRQOL) in patients with atrial fibrillation (AF) referred to pulmonary vein isolation (PVI) have been reported previously. Women experience a lower HRQOL, faster heart rate, and more symptoms such as palpitation and dyspnea than men. Furthermore, they experience worse physical functioning independently of other heart diseases or age. This study evaluates referral patterns and symptoms, morbidity, functional impairment, and HRQOL from a gender perspective in patients with AF before and 6 months after PVI. The study includes 242 patients (121 men), mean age 62 ± 9 years, referred for PVI. Symptoms were assessed with the Symptom Checklist: Frequency and Severity (SCL), HRQOL with Short Form 36 (SF-36), and the functional impairment with Sickness Impact Profile (SIP). The patients' own experiences of the referral process and history of their disease were evaluated with a supplementary questionnaire. The results showed that women improved more than men in HRQOL, SIP, and SCL 6 months post PVI. There were no sex differences in proportion of paroxysmal and persistent AF or ablation outcome. At baseline, women scored higher than men in both scales of the SCL (p < 0.001), scored lower in all components in SF-36, and scored higher in five categories of the SIP. Women were not more reluctant to accept referral for ablation when offered. The conclusion is that women with AF undergoing PVI are more symptomatic but also improve more in HRQOL and in symptom burden than men.
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Affiliation(s)
- Carina Carnlöf
- Karolinska Institutet and Heart, Vascular & Neurology Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Iwarzon
- Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden
| | - Mats Jensen-Urstad
- Karolinska Institutet and Heart, Vascular & Neurology Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Gadler
- Karolinska Institutet and Heart, Vascular & Neurology Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Per Insulander
- Karolinska Institutet and Heart, Vascular & Neurology Theme, Karolinska University Hospital, Stockholm, Sweden
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15
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Gagyi RB, Noten AME, Lesina K, Mahmoodi BK, Yap SC, Hoogendijk MG, Wijchers S, Bhagwandien RE, Szili-Torok T. Single-beat global atrial mapping facilitates the treatment of short-lived atrial tachycardias and infrequent premature atrial contractions. J Interv Card Electrophysiol 2022; 66:951-959. [PMID: 36282368 PMCID: PMC10172249 DOI: 10.1007/s10840-022-01405-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/18/2022] [Indexed: 11/29/2022]
Abstract
Abstract
Background
Short runs of atrial tachycardias (ATs) and infrequent premature atrial contractions (PACs) are difficult to map and ablate using sequential electrophysiology mapping techniques. The AcQMap mapping system allows for highly accurate mapping of a single atrial activation.
Objectives
We aimed to test the value of a novel dipole charge density-based high-resolution mapping technique (AcQMap) in the treatment of brief episodes of ATs and PACs.
Methods
Data of all patients undergoing catheter ablation (CA) using the AcQMap mapping system were reviewed.
Results
Thirty-one out of 219 patients (male n = 8; female n = 23) had short runs of ATs (n = 23) and PACs (n = 8). The mean procedural time was 155.3 ± 46.6 min, with a mean radiation dose of 92.0 (IQR 37.0–121.0) mGy. Total radiofrequency application duration 504.0 (271.0–906.0) s. Left atrial localization of ATs and PACs was identified in 45.1% of the cases, right atrium localization in 45.1%, and septal origins in 9.8% of the cases. Acute success was achieved in 30/31 (96.8%), and recurrence during the follow-up developed in six patients (19.4%), including four patients with PACs and two patients with short-lived ATs. One patient presented procedure-related groin hematoma as minor complication.
Conclusion
Brief episodes of highly symptomatic ATs and infrequent PACs can be mapped using charge density mapping and successfully ablated with high acute and long-term success rates.
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Affiliation(s)
- Rita B Gagyi
- Department of Cardiology, Electrophysiology, Erasmus MC, University Medical Center Rotterdam, 2040, 3000, Rotterdam, Netherlands
| | - Anna M E Noten
- Department of Cardiology, Electrophysiology, Erasmus MC, University Medical Center Rotterdam, 2040, 3000, Rotterdam, Netherlands
| | - Krista Lesina
- Department of Cardiology, Electrophysiology, Erasmus MC, University Medical Center Rotterdam, 2040, 3000, Rotterdam, Netherlands
| | - Bakhtawar K Mahmoodi
- Department of Cardiology, Electrophysiology, Erasmus MC, University Medical Center Rotterdam, 2040, 3000, Rotterdam, Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Electrophysiology, Erasmus MC, University Medical Center Rotterdam, 2040, 3000, Rotterdam, Netherlands
| | - Mark G Hoogendijk
- Department of Cardiology, Electrophysiology, Erasmus MC, University Medical Center Rotterdam, 2040, 3000, Rotterdam, Netherlands
| | - Sip Wijchers
- Department of Cardiology, Electrophysiology, Erasmus MC, University Medical Center Rotterdam, 2040, 3000, Rotterdam, Netherlands
| | - Rohit E Bhagwandien
- Department of Cardiology, Electrophysiology, Erasmus MC, University Medical Center Rotterdam, 2040, 3000, Rotterdam, Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Electrophysiology, Erasmus MC, University Medical Center Rotterdam, 2040, 3000, Rotterdam, Netherlands.
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Sau A, Ibrahim S, Ahmed A, Handa B, Kramer DB, Waks JW, Arnold AD, Howard JP, Qureshi N, Koa-Wing M, Keene D, Malcolme-Lawes L, Lefroy DC, Linton NWF, Lim PB, Varnava A, Whinnett ZI, Kanagaratnam P, Mandic D, Peters NS, Ng FS. Artificial intelligence-enabled electrocardiogram to distinguish cavotricuspid isthmus dependence from other atrial tachycardia mechanisms . EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:405-414. [PMID: 36712163 PMCID: PMC9708023 DOI: 10.1093/ehjdh/ztac042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/12/2022] [Indexed: 06/18/2023]
Abstract
Aims Accurately determining atrial arrhythmia mechanisms from a 12-lead electrocardiogram (ECG) can be challenging. Given the high success rate of cavotricuspid isthmus (CTI) ablation, identification of CTI-dependent typical atrial flutter (AFL) is important for treatment decisions and procedure planning. We sought to train a convolutional neural network (CNN) to classify CTI-dependent AFL vs. non-CTI dependent atrial tachycardia (AT), using data from the invasive electrophysiology (EP) study as the gold standard. Methods and results We trained a CNN on data from 231 patients undergoing EP studies for atrial tachyarrhythmia. A total of 13 500 five-second 12-lead ECG segments were used for training. Each case was labelled CTI-dependent AFL or non-CTI-dependent AT based on the findings of the EP study. The model performance was evaluated against a test set of 57 patients. A survey of electrophysiologists in Europe was undertaken on the same 57 ECGs. The model had an accuracy of 86% (95% CI 0.77-0.95) compared to median expert electrophysiologist accuracy of 79% (range 70-84%). In the two thirds of test set cases (38/57) where both the model and electrophysiologist consensus were in agreement, the prediction accuracy was 100%. Saliency mapping demonstrated atrial activation was the most important segment of the ECG for determining model output. Conclusion We describe the first CNN trained to differentiate CTI-dependent AFL from other AT using the ECG. Our model matched and complemented expert electrophysiologist performance. Automated artificial intelligence-enhanced ECG analysis could help guide treatment decisions and plan ablation procedures for patients with organized atrial arrhythmias.
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Affiliation(s)
- Arunashis Sau
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Safi Ibrahim
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Amar Ahmed
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Balvinder Handa
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Daniel B Kramer
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Jonathan W Waks
- Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Ahran D Arnold
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - James P Howard
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Norman Qureshi
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Michael Koa-Wing
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Daniel Keene
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Louisa Malcolme-Lawes
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - David C Lefroy
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Nicholas W F Linton
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Phang Boon Lim
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Amanda Varnava
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Zachary I Whinnett
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Prapa Kanagaratnam
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Danilo Mandic
- Department of Electrical and Electronic Engineering, Imperial College London, South Kensington Campus, Exhibition Road, London SW7 2AZ, UK
| | - Nicholas S Peters
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - Fu Siong Ng
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
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17
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Boissonnet CP, Giorgi MA, Köhler GC, García Roura L, Ginestar JM. Real-world data metanalysis: procedural success and clinical outcomes after radiofrequency ablation of atrial fibrillation in South America. Hosp Pract (1995) 2022; 50:259-266. [PMID: 36047648 DOI: 10.1080/21548331.2022.2114721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To profile patients' characteristics, in-hospital results, and recurrence rates after radiofrequency ablation of atrial fibrillation (RAAF) in South America. METHODS We comprehensively searched for single-center studies from South America with ≥10 patients receiving RAAF, published or presented from January 1, 2010, through June 29, 2020, excluding those reports aimed to specific populations such as permanent atrial fibrillation, structural cardiopathies, or re-do procedures. RESULTS Main pooled estimates from a random-effects meta-analysis that included 3909 patients from 27 cohorts (from 5 countries): a) Patients characteristics: age 57.6 years (95% CI 55.7-59.5), male gender 71.5% (95% CI 67.0-75.6%), hypertension 54.2% (95% CI 45.4-62.8%), paroxysmal atrial fibrillation 79.8% (95% CI 71.3-94.5%), CHADS score 1.2 (95% CI 0.5-1.9), b) Acute procedural success 91.1% (95% CI 82.2-95.8%), c) In-hospital complications: stroke 0.6% (95% CI 0.3-1.2%), cardiac tamponade 2.3% (95% CI 1.4-3.7), hematoma 3.5% (95% CI 2.0-6.1), pseudoaneurysm 1.2% (95% CI 0.6-2.3), arteriovenous fistula 2.5% (95% CI 1.6-4.1). There were no cases of esophageal-atrial fistula nor death. Pooled estimate for arrhythmia recurrence (excluded 3-months blanking period) at 12 months was 19.9% (95% CI 17.0-23.1). CONCLUSION In-hospital results of RAAF reported for South American centers were worse than published international registries, even when included populations profile was of lower risk, as reflected in younger age and less prevalence of non-paroxysmal AF. Late recurrence rates seemed appropriate. This study provides a real-life framework for the analysis of the performance of this technology in the region.
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Affiliation(s)
- Carlos Pablo Boissonnet
- Health Economics and Technology Assessment Unit, Instituto Universitario CEMIC and Centro de Educación Médica E Investigaciones Clínicas "Norberto Quirno" CEMIC, Buenos Aires, Argentina.,Cardiology Section. Department of Internal Medicine, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" CEMIC, Buenos Aires, Argentina
| | - Mariano Aníbal Giorgi
- Health Economics and Technology Assessment Unit, Instituto Universitario CEMIC and Centro de Educación Médica E Investigaciones Clínicas "Norberto Quirno" CEMIC, Buenos Aires, Argentina.,Cardiology Section. Department of Internal Medicine, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" CEMIC, Buenos Aires, Argentina.,Department of Pharmacology, Instituto Universitario CEMIC, Buenos Aires, Argentina
| | | | - Luciano García Roura
- Department of Pharmacology, Instituto Universitario CEMIC, Buenos Aires, Argentina
| | - Juan María Ginestar
- Department of Pharmacology, Instituto Universitario CEMIC, Buenos Aires, Argentina
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18
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Bisbal F, Abugattas JP, Trotta O, Gonzalez-Ferrer JJ, Sauri-Ortiz A, Arias MA, Subirana I, Duytshaever M, De Pooter J, Sarrias A, Adeliño R, Alarcón F, Mont L, Pérez-Villacastín J, Osca-Asensi J, Villuendas R, Pachón-Iglesias M, El Haddad M, Bayés-Genís A, de Greef Y. Personalized assessment of the cumulative complication risk of the atrial fibrillation ablation track: The AF-TRACK calculator. Heart Rhythm O2 2022; 3:656-664. [PMID: 36589911 PMCID: PMC9795263 DOI: 10.1016/j.hroo.2022.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Atrial fibrillation (AF) ablation strategy is associated with a non-negligible risk of complications and often requires repeat procedures (AF ablation track), implying repetitive exposure to procedural risk. Objective The purpose of this study was to develop and validate a model to estimate individualized cumulative risk of complications in patients undergoing the AF ablation track (Atrial Fibrillation TRAck Complication risK [AF-TRACK] calculator). Methods The model was derived from a multicenter cohort including 3762 AF ablation procedures in 2943 patients. A first regression model was fitted to predict the propensity for repeat ablation. The AF-TRACK calculator computed the risk of AF ablation track complications, considering the propensity for repeat ablation. Internal (cross-validation) and external (independent cohort) validation were assessed for discrimination capacity (area under the curve [AUC]) and goodness of fit (Hosmer-Lemeshow [HL] test). Results Complications (N = 111) occurred in 3.7% of patients (2.9% of procedures). Predictors included female sex, heart failure, sleep apnea syndrome, and repeat procedures. The model showed fair discrimination capacity to predict complications (AUC 0.61 [0.55-0.67]) and likelihood of repeat procedure (AUC 0.62 [0.60-0.64]), with good calibration (HL χ2 12.5; P = .13). The model maintained adequate discrimination capacity (AUC 0.67 [0.57-0.77]) and calibration (HL χ2 5.6; P = .23) in the external validation cohort. The validated model was used to create the Web-based AF-TRACK calculator. Conclusion The proposed risk model provides individualized estimates of the cumulative risk of complications of undergoing the AF ablation track. The AF-TRACK calculator is a validated, easy-to-use, Web-based clinical tool to calibrate the risk-to-benefit ratio of this treatment strategy.
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Affiliation(s)
- Felipe Bisbal
- Heart Institute–Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Cardiovascular Disease Networking Biomedical Research Center (CIBERCV), Spain
- Address reprint requests and correspondence: Dr Felipe Bisbal, Heart Institute–Hospital Universitari Germans Trias i Pujol, Carretera Canyet s/n, 08916 Badalona, Spain.
| | | | - Omar Trotta
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | | | - Isaac Subirana
- Cardiovascular Disease Networking Biomedical Research Center (CIBERCV), Spain
| | | | | | - Axel Sarrias
- Heart Institute–Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Raquel Adeliño
- Heart Institute–Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Lluís Mont
- Cardiovascular Disease Networking Biomedical Research Center (CIBERCV), Spain
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | - Roger Villuendas
- Heart Institute–Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Antoni Bayés-Genís
- Heart Institute–Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Cardiovascular Disease Networking Biomedical Research Center (CIBERCV), Spain
| | - Yves de Greef
- ZNA Heart Center, Middelheim, Antwerpen, Belgium
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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19
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Rhythmia zero-fluoroscopy workflow with high-power, short-duration ablation: retrospective analysis of procedural data. J Interv Card Electrophysiol 2022; 65:499-507. [PMID: 35763115 PMCID: PMC9640468 DOI: 10.1007/s10840-022-01283-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022]
Abstract
Background Fluoroscopy is commonly used during atrial fibrillation (AF) ablation to guide catheter navigation and placement. Technology improvements have significantly reduced fluoroscopy time, and subsequent radiation dose, necessary to perform successful ablations. However, there is still no amount of radiation exposure known to be completely safe. The aim of this manuscript is to describe a detailed zero-fluoroscopy RHYTHMIA HDx workflow for AF ablation. Methods This was an observational, single-center experience to describe the technique, acute procedural success, and safety using a novel zero-fluoroscopy workflow with the RHYTHMIA HDx mapping system and intracardiac echocardiography (ICE). Seventy-two consecutive patients undergoing de novo or redo AF ablation were retrospectively analyzed. Venous access was guided with ultrasound. ICE combined with the mapping system’s magnetic tracking and sheath detection was used for precise catheter placement in the coronary sinus, at the transseptal puncture, and in the left atrium. A high-power, short-duration ablation strategy guided by local impedance was used. Pulmonary vein isolation was performed or touched up for all patients with additional lines added at the operator’s discretion. Results Using this zero-fluoroscopy workflow, all patients achieved acute isolation with no significant procedure-related complications. Average procedure time was 73.7 ± 16.2 min, which included persistent (58%) and paroxysmal (42%) AF cases, and no procedures required conversion to fluoroscopy. Conclusions In this experience, a zero-fluoroscopy workflow using the RHYTHMIA HDx mapping system combined with ICE was feasible and safe for ablation in a heterogenous AF population. This approach, in the appropriate patient population, can eliminate radiation exposure to patients and staff.
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20
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Barra S, Primo J, Gonçalves H, Boveda S, Providência R, Grace A. Is amiodarone still a reasonable therapeutic option for rhythm control in atrial fibrillation? Rev Port Cardiol 2022; 41:783-789. [DOI: 10.1016/j.repc.2021.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 02/26/2021] [Accepted: 03/08/2021] [Indexed: 10/18/2022] Open
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21
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Freedman BL, Yang S, Shim D, d'Avila A, Waks JW, Tung P. Feasibility and safety of same-day discharge and shortened bedrest after atrial fibrillation ablation. J Interv Card Electrophysiol 2022; 65:209-217. [PMID: 35633430 PMCID: PMC9142825 DOI: 10.1007/s10840-022-01255-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/13/2022] [Indexed: 11/24/2022]
Abstract
Background While initial studies suggest that same-day discharge or shortened bedrest may be feasible for some patients following atrial fibrillation (AF) ablation, the risks and benefits of this approach remain unclear for patients undergoing hemostasis with figure-of-eight (FO8) suture technique. Methods We prospectively evaluated access site bleeding, length of hospitalization, urinary catheterization, and other clinical outcomes in patients undergoing AF ablation with 3 hours of bedrest between April and May 2021, and compared them to a control group that had undergone AF ablation with 6 hours of bedrest from April to July 2019. FO8 sutures were used for hemostasis in all patients. Independent risk factors for bleeding and urinary catheterization were determined using multiple logistic regression. Results Same-day discharge was achieved in 74% of patients in the 3-hour bedrest group compared to 7% of patients in the 6-hour bedrest group (p < 0.001). There were no differences between 3-hour and 6-hour bedrest groups in the rates of serious adverse events (2% vs. 1%, p = 0.45) or rehospitalizations or ED visits (1% vs. 3%, p = 0.45) within 30 days of ablation. The 3-hour bedrest group showed a non-significant trend toward more access site bleeding (15% vs. 8%, p = 0.10), but had a significant reduction in urinary catheterization (27% vs. 64%, p < 0.001) and opioid analgesia use (20% vs. 33%, p = 0.04). Conclusions Same-day discharge after 3 hours of bedrest is safe and feasible following AF ablation and is not associated with higher rates of complications or rehospitalizations at 30 days. Reduced bedrest resulted in decreased opioid analgesia and urinary catheterization. Supplementary Information The online version contains supplementary material available at 10.1007/s10840-022-01255-4.
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Affiliation(s)
- Benjamin L Freedman
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Shu Yang
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - David Shim
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.,Division of Cardiology, Veterans Affairs Portland Health Care, Portland, OR, USA
| | - Andre d'Avila
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Jonathan W Waks
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Patricia Tung
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
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22
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Jemtrén A, Bergfeldt L, Insulander P, Rubulis A, Tapanainen J, Jensen-Urstad M. Accessory pathway properties are similar in symptomatic and asymptomatic preexcitation. J Interv Card Electrophysiol 2022; 65:193-199. [PMID: 35618980 PMCID: PMC9550742 DOI: 10.1007/s10840-022-01252-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Patients with WPW syndrome have an increased mortality rate compared to the general population. Although asymptomatic preexcitation has previously been considered benign, recent studies have found that also asymptomatic patients have clinical and electrophysiological factors associated with increased risk of sudden cardiac death. This study compares the baseline electrophysiological characteristics of accessory pathways in symptomatic and asymptomatic patients with preexcitation. We hypothesized that a significant proportion of asymptomatic patients has inducible orthodromic tachycardia during programmed electrical stimulation. METHODS This retrospective study includes 1853 patients with preexcitation who underwent invasive electrophysiological testing in two Swedish University Hospitals between 1991 and 2018. The mean age was 36 ± 17 years with a range of 3-89 years. Thirty-nine percent was women. A total of 269 patients (15%) were children younger than 18 years. Electrophysiological data included effective refractory period of the accessory pathway (APERP, in 1069 patients), tachycardia cycle length, inducibility and type of tachycardia, and AP localization. RESULTS A total of 1703 (93%) patients reported symptoms suggesting tachyarrhythmias before the study and 128 (7%) were asymptomatic. The proportion of potentially dangerous pathways with short APERP (≤ 250 ms) were similar in symptomatic and asymptomatic patients (187/949, 20% vs. 25/108, 23%) (P = 0.40) as was the mean APERP (303 ± 68 ms vs. 307 ± 75) (P = 0.61). The proportion of patients who had inducible arrhythmia was larger in the symptomatic group (64% vs. 31%) (P < 0.001). CONCLUSION The results of this study strengthen the present guideline recommendation (IIA) to consider invasive risk assessment in patients with asymptomatic preexcitation.
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Affiliation(s)
- Anette Jemtrén
- Department of Cardiology, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Lennart Bergfeldt
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per Insulander
- Department of Cardiology, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Aigars Rubulis
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jari Tapanainen
- Department of Cardiology, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden.
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Kanaoka K, Nishida T, Nishioka Y, Myojin T, Kubo S, Soeda T, Okada K, Noda T, Iwanaga Y, Miyamoto Y, Sakata Y, Imamura T, Saito Y. The impact of hospital case volume on the outcomes after catheter ablation for atrial fibrillation according to the ablation technology. J Cardiovasc Electrophysiol 2022; 33:1394-1402. [PMID: 35437814 DOI: 10.1111/jce.15495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The appropriate hospital case volume for catheter ablation (CA) in patients with atrial fibrillation (AF) according to the ablation technology has not been fully examined. This study aimed to investigate the association between the hospital case volume for AF and periprocedural complications and AF recurrence. METHODS In this retrospective cohort study, we used data from the National Database of Health Insurance Claims and Specific Health Checkups, which covers almost all healthcare insurance claims data in Japan. We included patients with AF who underwent first-time CA from April 2014 to March 2020. Using mixed-effect logistic regression, we analyzed the effect of the annual case volume for AF ablation on acute periprocedural complications and 1-year success rate off antiarrhythmic drugs according to the ablation technology (radiofrequency ablation or cryoballoon ablation). RESULTS Among 270 116 patients, 207 839 (77%) patients underwent radiofrequency ablation and 56 648 (21%) patients underwent cryoballoon ablation. Of all patients, acute complications occurred in 5411 (2.0%) patients, and the recurrence at 1 year was 71 511 (27%). In the radiofrequency ablation group, acute complications and 1-year AF recurrence according to case volume decreased as the annual case volume increased to up to 150-200 cases/year. However, in the cryoballoon ablation group, these outcomes were similar regardless of the case volumes. CONCLUSION The case-volume effect was noted in the radiofrequency ablation group, but not in the cryoballoon ablation group. Our results may affect the selection of ablation technology, especially in smaller case-volume hospitals.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.,Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Taku Nishida
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yuichi Nishioka
- Department of Public Heath, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoya Myojin
- Department of Public Heath, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Shinichiro Kubo
- Department of Public Heath, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tatsuya Noda
- Department of Public Heath, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiro Miyamoto
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tomoaki Imamura
- Department of Public Heath, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
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24
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Kreidieh O, Varley AL, Romero J, Singh D, Silverstein J, Thosani A, Varosy P, Hebsur S, Godfrey BE, Schrappe G, Justice L, Zei PC, Osorio J. Practice Patterns of Operators Participating in the Real-World Experience of Catheter Ablation for Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation (REAL-AF) Registry. J Interv Card Electrophysiol 2022; 65:429-440. [PMID: 35438393 DOI: 10.1007/s10840-022-01205-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/29/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The Real-World Experience of Catheter Ablation for Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation (REAL-AF) is a multicenter prospective registry of atrial fibrillation (AF) ablation. We sought to describe the baseline workflows of REAL-AF operators. METHODS REAL-AF enrolls high volume minimum fluoroscopy radiofrequency ablators. A 150 item questionnaire was administered to participating operators. Responses were analyzed using standard methods. RESULTS Forty-two respondents had a mean 178.2 ± 89.2 yearly AF ablations, with 42.4 ± 11.9% being paroxysmal (PAF). Most operators performed ablation with uninterrupted or minimally interrupted anticoagulation (66.7% and 28.6%). Left atrial appendage (LAA) thrombus was most commonly ruled out with transesophageal echocardiography (33.3% and 42.9% for PAF and persistent AF). Consistent with registry design, radiofrequency energy (92.1% ± 18.8% of cases) and zero fluoroscopy ablation (73.8% goal 0 fluoroscopy) were common. The majority of operators relied on index-guided ablation (90.5%); Mean Visitag surpoint targets were higher anteriorly vs posteriorly (508.3 ± 49.8 vs 392.3 ± 37.0, p < 0.01), but power was similar. There was considerable heterogeneity related to gaps in current knowledge, such as lesion delivery targets and sites of extra-pulmonary vein ablation (most common was the posterior wall followed by the roof). Peri-procedural risk factor management of obesity, hypertension, and sleep apnea was common. There was a mean of 3.0 ± 1.2 follow-up visits at 12 months. CONCLUSIONS REAL-AF operators were high volume low fluoroscopy "real world" operators with good follow-up and adherence to known best-practices. There was disagreement related to knowledge gaps in guidelines.
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Affiliation(s)
- Omar Kreidieh
- Brigham And Women's Hospital, Harvard Medical School, 44 Washington Street, Boston, MA, 02115, USA.
| | - Allyson L Varley
- Heart Rhythm Clinical and Research Solutions, Birmingham, AL, USA
| | - Jorge Romero
- Brigham And Women's Hospital, Harvard Medical School, 44 Washington Street, Boston, MA, 02115, USA
| | - David Singh
- Division of Cardiology, Queen's Medical Center, Honolulu, HI, USA
| | | | | | - Paul Varosy
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Shrinivas Hebsur
- Michigan Heart and Vascular Institute, St Mary Mercy Hospital, Livonia, MI, USA
| | | | - Gunther Schrappe
- Heart Rhythm Clinical and Research Solutions, Birmingham, AL, USA
| | - Linda Justice
- Heart Rhythm Clinical and Research Solutions, Birmingham, AL, USA
| | - Paul C Zei
- Brigham And Women's Hospital, Harvard Medical School, 44 Washington Street, Boston, MA, 02115, USA
| | - Jose Osorio
- Arrhythmia Institute at Grandview Health, Birmingham, AL, USA
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25
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Nikoo MH, Khorshidifar M, Nasrollahi E, Bahramvand Y, Nouri F, Attar A. Ventricular versus atrial side ablation for treatment of atrioventricular accessory pathways: a randomized controlled clinical trial. J Interv Card Electrophysiol 2022; 64:103-110. [PMID: 35013893 DOI: 10.1007/s10840-021-01100-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The earliest atrial (A)/ventricular (V) activation potentials, or fused A/V potentials, are commonly used as ablation targets for atrioventricular (AV) accessory pathways (APs). However, these targets can be achieved in a relatively wide area of the heart around AV rings at both atrial and ventricular sides. The aim of this study is to analyze the height of intracardiac A and V waves and their correlation to find the most appropriate side for successful delivery of radiofrequency energy, atrial or ventricular edge. METHODS Ninety patients diagnosed with orthodromic AV re-entrant tachycardia (AVRT) or Wolff-Parkinson-White syndrome were enrolled. Local atrial/ventricular (A/V) amplitude potentials with the earliest activation or fused AV potentials were measured. Patients were randomly assigned into two groups with a 2:1 ratio. In group 1, ablation was done at the site where A was greater than V. In group 2, V was greater than A. Primary endpoint was success at first attempt, achieving antegrade AP conduction block, AV block during right ventricle pacing, or AVRT termination with no AP conduction. RESULTS Fifty-one patients (56.7%) were male. Thirty patients had an ablation at an atrial site (A > V) and 60 at a ventricular site (V > A). Ablation was more successful at the ventricular site (87% vs 100%, P = 0.011). All 30 patients in the atrial arm and 71% of the ventricular group underwent ablation via the antegrade method. CONCLUSIONS Success of catheter ablation of APs is higher where V > A (ventricular site of AP), indicating the priority of the ventricular edge of the mitral ring for a better outcome.
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Affiliation(s)
- Mohammad Hossein Nikoo
- Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Meghdad Khorshidifar
- Students' Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elham Nasrollahi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Yaser Bahramvand
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Nouri
- Students' Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Attar
- Department of Cardiovascular Medicine, TAHA Clinical Trial Group, School of Medicine, Shiraz University of Medical Sciences, 71344-1864, Shiraz, Iran.
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26
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Maduray K, Moneruzzaman M, Changwe GJ, Zhong J. Benefits and Risks Associated with Long-term Oral Anticoagulation after Successful Atrial Fibrillation Catheter Ablation: Systematic Review and Meta-analysis. Clin Appl Thromb Hemost 2022; 28:10760296221118480. [PMID: 35924410 PMCID: PMC9358599 DOI: 10.1177/10760296221118480] [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] [Indexed: 11/19/2022] Open
Abstract
Oral anticoagulation (OAC) prevents thromboembolism yet greatly increases the risk of bleeding, inciting concern among clinicians. Current guidelines lack sufficient evidence supporting long-term OAC following successful atrial fibrillation catheter ablation (CA). A literature search was performed in PubMed, Google Scholar, Medline, and Scopus to seek out studies that compare continued and discontinued anticoagulation in post-ablation Atrial fibrillation (AF) patients. Funnel plots and Egger’s test examined potential bias. Via the random-effects model, summary odds ratios (OR) with 95% confidence intervals (CI) were calculated using RevMan (5.4) and STATA (17.0). Twenty studies, including 22 429 patients (13 505 off-OAC) were analyzed. Stratified CHA2DS2-VASc score ≥2 examining thromboembolic events (TE) favored OAC continuation (OR 1.86; 95% CI: 1.02-3.40; P = .04). Sensitivity analysis demonstrated this association was attenuated. The on-OAC arm had greater incidence of major bleeding (MB) (OR 0.16; 95% CI: 0.08-0.95; P < .00001), particularly intracranial hemorrhage (ICH) and gastrointestinal bleeding (GI); (OR 0.17; 95% CI: 0.08-0.36; P < .00001) and (OR 0.12; 95% CI: 0.04-0.32; P < .0001), respectively. Our findings support sustained anticoagulation in patients with a CHA2DS2-VASc score of ≥2. Due to reduced outcome robustness, physician discretion is still advised.
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Affiliation(s)
- Kellina Maduray
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, 91623Shandong University, Jinan, China
| | - Md Moneruzzaman
- Department of Physical Medicine and Rehabilitation, 572575Qilu hospital, Cheeloo college of Medicine, Shandong University, Jinan, China
| | - Geoffrey J Changwe
- Department of Cardiothoracic Surgery, 619938National Heart Hospital, Lusaka, Zambia
| | - Jingquan Zhong
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, 91623Shandong University, Jinan, China.,Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
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27
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Zhao X, Ziv O, Mohammadpour R, Crosby B, Hoyt WJ, Jenkins MW, Snyder C, Hendon C, Laurita KR, Rollins AM. Polarization-sensitive optical coherence tomography monitoring of percutaneous radiofrequency ablation in left atrium of living swine. Sci Rep 2021; 11:24330. [PMID: 34934120 PMCID: PMC8692484 DOI: 10.1038/s41598-021-03724-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 12/06/2021] [Indexed: 11/12/2022] Open
Abstract
Radiofrequency ablation (RFA) is commonly used to treat atrial fibrillation (AF). However, the outcome is often compromised due to the lack of direct real-time feedback to assess lesion transmurality. In this work, we evaluated the ability of polarization-sensitive optical coherence tomography (PSOCT) to measure cardiac wall thickness and assess RF lesion transmurality during left atrium (LA) RFA procedures. Quantitative transmural lesion criteria using PSOCT images were determined ex vivo using an integrated PSOCT-RFA catheter and fresh swine hearts. LA wall thickness of living swine was measured with PSOCT and validated with a micrometer after harvesting the heart. A total of 38 point lesions were created in the LA of 5 living swine with the integrated PSOCT-RFA catheter using standard clinical RFA procedures. For all lesions with analyzable PSOCT images, lesion transmurality was assessed with a sensitivity of 89% (17 of 19 tested positive) and a specificity of 100% (5 of 5 tested negative) using the quantitative transmural criteria. This is the first report of using PSOCT to assess LA RFA lesion transmurality in vivo. The results indicate that PSOCT may potentially provide direct real-time feedback for LA wall thickness and lesion transmurality.
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Affiliation(s)
- Xiaowei Zhao
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Ohad Ziv
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Heart and Vascular Research Center, MetroHealth Medical Center, Cleveland, OH, USA
| | | | - Benjamin Crosby
- Department of Chemistry, Case Western Reserve University, Cleveland, OH, USA
| | - Walter J Hoyt
- Department of Pediatrics, Ochsner Health, New Orleans, LA, USA
| | - Michael W Jenkins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - Christopher Snyder
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Christine Hendon
- Department of Electrical Engineering, Columbia University, New York, NY, USA
| | - Kenneth R Laurita
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Heart and Vascular Research Center, MetroHealth Medical Center, Cleveland, OH, USA
| | - Andrew M Rollins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
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28
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Loring Z, Bahnson TD. Is there a mortality benefit of atrial fibrillation ablation? J Cardiovasc Electrophysiol 2021; 33:194-196. [PMID: 34911158 DOI: 10.1111/jce.15328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Zak Loring
- Clinical Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Duke University, Durham, North Carolina, USA
| | - Tristram D Bahnson
- Clinical Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Duke University, Durham, North Carolina, USA.,Duke Center for Atrial Fibrillation, Duke Health System, Durham, North Carolina, USA
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29
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Li JL, Wang LQ, Zhang N, Su XT, Lin Y, Yang JW, Shi GX, Liu CZ. Acupuncture as an adjunctive therapy for arrhythmia: a Delphi expert consensus survey. Cardiovasc Diagn Ther 2021; 11:1067-1079. [PMID: 34815957 DOI: 10.21037/cdt-21-201] [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: 03/31/2021] [Accepted: 07/28/2021] [Indexed: 11/06/2022]
Abstract
Background Current evidence suggests that acupuncture is an effective adjunctive therapy that can bring potential benefits to patients with cardiac arrhythmias. However, there are relevant gaps in the optimal therapeutic strategy, which may cause uncertainties on the best practice of acupuncture treatment for arrhythmia. We aim to develop consensus-based recommendations for clinical guidance on acupuncture treatment of cardiac arrhythmias. Methods A multidisciplinary panel of specialists was invited to participate in a two-round semi-open clinical issue investigation. Meanwhile, relevant literature reviews were searched in 3 databases to provide evidence. Subsequently, an initial consensus voting list on acupuncture as an adjunctive therapy for cardiac arrhythmias was derived from the clinical investigation and literature review. Finally, 30 authoritative experts reached a consensus on the key issues of the voting list by a three-round modified Delphi survey. Consensus was defined when >80% agreement was achieved. Results Following the three-round Delphi survey, there were 32 items (91.43%) finally reaching consensus, including the following 5 domains: (I) the benefits of acupuncture for the appropriate population; (II) the general therapeutic principle; (III) the acupuncture strategy; (IV) the relevant adverse events; (V) others. Conclusions Consensus was achieved on some key elements. Given the lack of guidelines and the substantial heterogeneity of previous studies, these recommendations are of value in providing guidance for clinical practice of acupuncturists and in assisting patients with arrhythmia to obtain standardized acupuncture treatment. It also pointed out some problems that need to be carefully explored in future studies.
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Affiliation(s)
- Jin-Ling Li
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Li-Qiong Wang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Na Zhang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xin-Tong Su
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Ying Lin
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jing-Wen Yang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Guang-Xia Shi
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Cun-Zhi Liu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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30
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Turner H, Beinhoff P, Sonnen AJ, Hang D, Lincoln AH, Sutter HA, Almassi GH, Pagel PS. Progressive Dyspnea and Exercise Intolerance Four Months After Left Ventricular Outflow Tract Radiofrequency Ablation for Frequent Premature Ventricular Contractions. J Cardiothorac Vasc Anesth 2021; 36:2789-2792. [PMID: 34758926 DOI: 10.1053/j.jvca.2021.10.016] [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: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Halen Turner
- Department of Surgery, the Medical College of Wisconsin, Milwaukee, WI
| | - Paul Beinhoff
- Department of Surgery, the Medical College of Wisconsin, Milwaukee, WI
| | - Aly J Sonnen
- Department of Surgery, the Medical College of Wisconsin, Milwaukee, WI
| | - Dustin Hang
- Department of Anesthesiology, the Medical College of Wisconsin, Milwaukee, WI
| | - Anne H Lincoln
- Department of Anesthesiology, the Medical College of Wisconsin, Milwaukee, WI
| | - Heather A Sutter
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, the Medical College of Wisconsin, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, the Medical College of Wisconsin, Milwaukee, WI
| | - Paul S Pagel
- Anesthesiology Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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31
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Garcia R, Waldmann V, Vanduynhoven P, Nesti M, Jansen de Oliveira Figueiredo M, Narayanan K, Conte G, Guerra JM, Boveda S, Duncker D. Worldwide sedation strategies for atrial fibrillation ablation: current status and evolution over the last decade. Europace 2021; 23:2039-2045. [PMID: 34308973 DOI: 10.1093/europace/euab154] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/24/2021] [Indexed: 01/29/2023] Open
Abstract
Catheter ablation for atrial fibrillation (AF) has become one of the most common procedures in the electrophysiology lab with rapidly increasing volumes. Peri-procedural anaesthesia for AF ablation varies between centres, from general anaesthesia to deep or conscious sedation. The aim of this survey was to assess current sedation practices for AF ablation worldwide and its evolution over the last decade. Centres regularly performing AF ablation responded to an online survey. A total of 297 centres participated in the survey. Overall, the median (interquartile range) number of AF ablation procedures increased from 91 (43-200) to 200 (74-350) per year (P < 0.001) between 2010 and 2019. The proportion of cryoablation also increased from 17.0% to 33.2% (P < 0.001). In 2019, the most used sedation technique was general anaesthesia (40.5%), followed by conscious sedation (32.0%) and deep sedation (27.5%). Between 2010 and 2019, the proportion of procedures performed under general anaesthesia (+4.4%; P = 0.02) and deep sedation (+4.8%; P < 0.01) increased, whereas the use of conscious sedation decreased (-9.2%; P < 0.001). The most commonly used hypnotic drugs were propofol and midazolam, whereas the most commonly used opioid drugs were remifentanyl and fentanyl. This worldwide survey shows that the number of AF ablation procedures has more than doubled over the last decade and general anaesthesia remains most commonly used. Studies comparing outcomes between different sedation strategies are needed to guide optimal decision-making.
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Affiliation(s)
- Rodrigue Garcia
- Department of Cardiology, University Hospital of Poitiers, 2 rue de la Milétrie, F-86021 Poitiers, France.,Univ Poitiers, Faculté de Médecine et Pharmacie, F-86021, Poitiers, France
| | - Victor Waldmann
- Department of Cardiology, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
| | - Philippe Vanduynhoven
- Department of Cardiology, Arrhythmia Clinic Algemeen Stedelijk Ziekenhuis Aalst, Aalst, Belgium
| | - Martina Nesti
- Department of Cardiology and Neurology, San Donato Hospital, Arezzo, Italy
| | | | - Kumar Narayanan
- Department of Cardiology, Medicover Hospitals, Hyderabad, India
| | - Giulio Conte
- Department of Cardiology, Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Jose M Guerra
- Arrhythmia Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Serge Boveda
- Cardiology-Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez, 31076 Toulouse, France.,Universiteit Ziekenhuis, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Jette Brussels, Belgium
| | - David Duncker
- Department of Cardiology and Angiology, Hannover Heart Rhythm Center, Hannover Medical School, Hannover, Germany
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32
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Molitor N, Yalcinkaya E, Auricchio A, Burri H, Delacretaz E, Kühne M, Menafoglio A, Reek S, Reichlin T, Herrera-Siklody C, Zimmerli M, Sticherling C, Duru F. Swiss National Registry on Catheter Ablation Procedures: Changing Trends over the Last 20 Years. J Clin Med 2021; 10:3021. [PMID: 34300187 PMCID: PMC8304673 DOI: 10.3390/jcm10143021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/25/2021] [Accepted: 07/01/2021] [Indexed: 11/16/2022] Open
Abstract
The Swiss Ablation Registry provides a national database for electrophysiologic studies and catheter ablations. We analyzed the database to provide an in-depth look at changing trends over the last 20 years. During the study period a total of 78622 catheter ablations (age 61.0 ± 1.2 years; 63.7% male) were performed in 29 centers. The number of ablations increased by approximately ten-fold in 20 years. Ablation for atrial fibrillation (AF) was the main driver behind this increase, with more than hundred-fold (39.7% of all ablations in 2019). Atrioventricular-nodal-reentrant-tachycardia (AVNRT) and accessory pathways, being the main indications for ablation in 2000 (44.1%/25.1%, respectively), made up of only a small proportion (15.2%/3.5%,) respectively in 2019. Fluoroscopy, ablation, and procedure durations were reduced for all ablations over time. The highest repeat ablations were performed for ventricular tachycardia and AF (24.4%/24.3%). The majority of ablations (63.0%) are currently performed in private hospitals and non-university public hospitals whereas university hospitals had dominated (82.4%) at the turn of the century. A pronounced increase in the number of catheter ablations in Switzerland was accompanied by a marked decrease in fluoroscopy, ablation, and procedure durations. We observed a shift toward more complex procedures in older patients with comorbidities.
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Affiliation(s)
- Nadine Molitor
- Department of Cardiology, University Heart Center Zurich, 8091 Zurich, Switzerland; (N.M.); (E.Y.)
| | - Emre Yalcinkaya
- Department of Cardiology, University Heart Center Zurich, 8091 Zurich, Switzerland; (N.M.); (E.Y.)
| | - Angelo Auricchio
- Department of Cardiology, Istituto Cardiocentro Ticino, 6900 Lugano, Switzerland;
| | - Haran Burri
- Department of Cardiology, University Hospital Geneva, 1205 Geneva, Switzerland;
| | - Etienne Delacretaz
- Department of Cardiology, Hirslanden Clinique Cecil, 1011 Lausanne, Switzerland;
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland; (M.K.); (C.S.)
| | - Andrea Menafoglio
- Department of Cardiology, Hospital of Bellinzona and Valli, 6500 Bellinzona, Switzerland;
| | - Sven Reek
- Department of Cardiology, Hirslanden Clinica Aarau, 5001 Aarau, Switzerland;
| | - Tobias Reichlin
- Department of Cardiology, Inselspital University Hospital Bern, University of Bern, 3010 Bern, Switzerland;
| | | | | | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland; (M.K.); (C.S.)
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, 8091 Zurich, Switzerland; (N.M.); (E.Y.)
- Center for Integrative Human Physiology, University of Zurich, 8091 Zurich, Switzerland
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33
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Soto-Becerra R, Taype-Rondan Á, Cabrera-Saldaña M, Guevara-Caicedo C, Zelaya-Castro PD, Medina-Maguiña JM, Huerta-Robles RE, Junes-Gonzales W, Aráoz-Tarco O, Sangines-Montes A, Zegarra-Carhuas R. [Ablation of cardiac arrhythmias using a three-dimensional electro-anatomical mapping system in the Instituto Nacional Cardiovascular - INCOR]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2021; 2:150-158. [PMID: 37727518 PMCID: PMC10506558 DOI: 10.47487/apcyccv.v2i3.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/31/2021] [Indexed: 09/21/2023]
Abstract
Objective To describe the initial experience in ablation of cardiac arrhythmias using 3D mapping at the Instituto Nacional Cardiovascular INCOR (Lima, Peru). Methods A retrospective descriptive study was carried out. During February 2020, data was collected from the medical records of all patients in whom ablation was performed using 3D mapping from July 2017 to December 2019. This procedure was performed in patients with symptomatic arrhythmia refractory to antiarrhythmic therapy. Results Data were collected from 123 patients (median age: 46 years, 64.2% male), who had a median time of illness of 6 years. Among the arrhythmias treated, 19% had atrial fibrillation, 17.5% atrial tachycardia, 17.5% idiopathic ventricular arrhythmias, 16.6% Wolf Parkinson White syndrome / Atrioventricular reentrant tachycardia, 11.1% ventricular arrhythmias of the His-Purkinje conduction system, 9.5% scar related ventricular tachycardia associated, 6.4% atrial flutter and 2.4% intranodal tachycardia. The median fluoroscopy time was 26 minutes. Ablation was acutely successful in 95.9% of cases, acute complications were observed in 4.8%, and recurrence-free survival during the first year of follow-up was 74%. Conclusions Our experience in ablation of cardiac arrhythmias using 3D mapping had a high acute success rate, low frequency of complications, and one-year recurrence-free survival of 74 %.
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Affiliation(s)
- Richard Soto-Becerra
- Unidad de Arritmias, Instituto Nacional Cardiovascular INCOR, EsSalud, Lima, Perú.Unidad de ArritmiasInstituto Nacional Cardiovascular INCOR, EsSaludLimaPerú
| | - Álvaro Taype-Rondan
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú.Universidad San Ignacio de LoyolaUnidad de Investigación para la Generación y Síntesis de Evidencias en SaludUniversidad San Ignacio de LoyolaLimaPeru
| | - Mario Cabrera-Saldaña
- Unidad de Arritmias, Instituto Nacional Cardiovascular INCOR, EsSalud, Lima, Perú.Unidad de ArritmiasInstituto Nacional Cardiovascular INCOR, EsSaludLimaPerú
| | - Carolina Guevara-Caicedo
- Unidad de Arritmias, Instituto Nacional Cardiovascular INCOR, EsSalud, Lima, Perú.Unidad de ArritmiasInstituto Nacional Cardiovascular INCOR, EsSaludLimaPerú
| | - Pio D. Zelaya-Castro
- Unidad de Arritmias, Instituto Nacional Cardiovascular INCOR, EsSalud, Lima, Perú.Unidad de ArritmiasInstituto Nacional Cardiovascular INCOR, EsSaludLimaPerú
| | - José M. Medina-Maguiña
- Servicio de Cardiología clínica, Instituto Nacional Cardiovascular INCOR, EsSalud, Lima, Perú.Servicio de Cardiología clínicaInstituto Nacional Cardiovascular INCOR, EsSaludLimaPerú
| | - Rocío E. Huerta-Robles
- Servicio de Cardiología clínica, Instituto Nacional Cardiovascular INCOR, EsSalud, Lima, Perú.Servicio de Cardiología clínicaInstituto Nacional Cardiovascular INCOR, EsSaludLimaPerú
| | - Wendy Junes-Gonzales
- Servicio de Cardiología clínica, Instituto Nacional Cardiovascular INCOR, EsSalud, Lima, Perú.Servicio de Cardiología clínicaInstituto Nacional Cardiovascular INCOR, EsSaludLimaPerú
| | - Ofelia Aráoz-Tarco
- Universidad Peruana Cayetano Heredia, Lima. Perú.Universidad Peruana Cayetano HerediaUniversidad Peruana Cayetano HerediaLimaPeru
| | - Alejandro Sangines-Montes
- Executive Clinical Account Specialist Biosense Webster Inc. California, USA.Executive Clinical Account Specialist Biosense Webster IncCaliforniaUSA
| | - Ricardo Zegarra-Carhuas
- Unidad de Arritmias, Instituto Nacional Cardiovascular INCOR, EsSalud, Lima, Perú.Unidad de ArritmiasInstituto Nacional Cardiovascular INCOR, EsSaludLimaPerú
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34
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Straube F, Dorwarth U, Hartl S, Brueck B, Pongratz J, Kosmalla A, Wankerl M, Hoffmann E. Benefit of ultra-high-density mapping-guided radiofrequency reablation in pulmonary vein isolation non-responders after initial cryoballoon procedure. Europace 2021; 22:906-915. [PMID: 32361733 DOI: 10.1093/europace/euaa055] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 02/28/2020] [Indexed: 01/20/2023] Open
Abstract
AIMS Symptomatic atrial arrhythmias despite complete pulmonary vein isolation (PVI) are common. The purpose was to evaluate ultra-high-density multi-electrode electroanatomical mapping-guided radiofrequency ablation (RFA) in PVI non-responders. METHODS AND RESULTS Ultra-high-density multi-electrode electroanatomical mapping-guided RFA in consecutive symptomatic atrial fibrillation (AF) patients after initial cryoballoon PVI was performed. Patients were included if all pulmonary veins (PVs) were still isolated. Radiofrequency targets were atrial tachycardia (AT), extra-PV trigger, and/or substrate. Procedural results and outcome were evaluated. Of 95 patients, 67 (70.5%) with complete PVI were included (70 years, CHA2DS2Vasc 2.9, left atrium 45 mm, persistent AF 45%, AT 45%). The median time to reablation was 26 months. One hundred and seven maps (1.6/patient) and 11.890 ± 9.018 electrograms were acquired in 33 ± 12 min. Twenty-eight percent of the left atrial (LA) wall showed pathological voltage signals, predominantly at the anterior (37%) and septal wall (26%). Atrial tachycardia (49 left, 4 right) were ablated in 35 patients (52%), extra-PV trigger in two patients (3%). One atrioventricular nodal re-entry tachycardia and seven right atrial isthmus ablation (10%) were performed. In 32 patients (48%), no AT was present and substrate-based ablation was performed. Mean LA area ablated was 7 ± 6 cm2 (7%). No major complication occurred. The mean follow-up time was 772 ± 317 days. Freedom from atrial arrhythmia recurrence off antiarrhythmic drugs was 49% at 12 months. CONCLUSION Pulmonary vein isolation non-responders are older, mainly suffering from complex atrial arrhythmias. Left atrial substrate is predominantly located at the anterior and septal wall. Ultra-high-density multi-electrode electroanatomical mapping-guided RFA is safe and effective. At 1 year, 5 out of 10 patients were in stable sinus rhythm off antiarrhythmic drugs.
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Affiliation(s)
- Florian Straube
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Hospital Bogenhausen, Englschalkinger Str. 77, 81925 Munich, Germany
| | - Uwe Dorwarth
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Hospital Bogenhausen, Englschalkinger Str. 77, 81925 Munich, Germany
| | - Stefan Hartl
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Hospital Bogenhausen, Englschalkinger Str. 77, 81925 Munich, Germany
| | - Benedikt Brueck
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Hospital Bogenhausen, Englschalkinger Str. 77, 81925 Munich, Germany
| | - Janis Pongratz
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Hospital Bogenhausen, Englschalkinger Str. 77, 81925 Munich, Germany
| | - Alexander Kosmalla
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Hospital Bogenhausen, Englschalkinger Str. 77, 81925 Munich, Germany
| | - Michael Wankerl
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Hospital Bogenhausen, Englschalkinger Str. 77, 81925 Munich, Germany
| | - Ellen Hoffmann
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Hospital Bogenhausen, Englschalkinger Str. 77, 81925 Munich, Germany
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Li SN, Zhang JR, Zhou L, Xi H, Li CY, Zhao L. Sacubitril/Valsartan Decreases Atrial Fibrillation Susceptibility by Inhibiting Angiotensin II-Induced Atrial Fibrosis Through p-Smad2/3, p-JNK, and p-p38 Signaling Pathways. J Cardiovasc Transl Res 2021; 15:131-142. [PMID: 34075552 DOI: 10.1007/s12265-021-10137-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/17/2021] [Indexed: 02/07/2023]
Abstract
Sacubitril/valsartan (SAC/VAL) prevents angiotensin II (AngII) from binding AT1-R and blocks degradation of natriuretic peptides. Despite its efficacy in reducing ventricular fibrosis and preserving cardiac functions, which has been extensively demonstrated in myocardial infarction or pressure overload models, few studies have been conducted to determine whether SAC/VAL could attenuate atrial fibrosis and decrease atrial fibrillation (AF) susceptibility. Our study provided evidence for the inhibition of atrial fibrosis and reduced susceptibility to AF by SAC/VAL. After 28 days of AngII continuous subcutaneous stimulation, rats in SAC/VAL group exhibited reduced extent of atrial fibrosis, inhibited proliferation, migration, and differentiation of atrial fibroblasts, and decreased susceptibility to AF. We further found that inhibition of p-Smad2/3, p-JNK, and p-p38MAPK pathways is involved in the role of SAC/VAL on AngII-induced atrial fibrosis in vivo. These results emphasize the importance of SAC/VAL in the prevention of AngII-induced atrial fibrosis and may help to enrich the options for AF pharmacotherapy.
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Affiliation(s)
- Song-Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chao Yang District, Beijing, 100029, China
| | - Jing-Rui Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chao Yang District, Beijing, 100029, China
| | - Lu Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chao Yang District, Beijing, 100029, China
| | - Hui Xi
- Department of Cardiology, Peking University International Hospital, Beijing, China
| | - Chang-Yi Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chao Yang District, Beijing, 100029, China.
| | - Lei Zhao
- Department of Radiololgy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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Khoynezhad A, Warrier N, Worthington T, Shandling A. A narrative review of hybrid ablation for persistent and longstanding persistent atrial fibrillation. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:947. [PMID: 34350262 PMCID: PMC8263859 DOI: 10.21037/atm-21-196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/26/2021] [Indexed: 01/14/2023]
Abstract
Atrial fibrillation is the most common sustained arrhythmia and is characterized by rapid and irregular atrial activation with loss of atrial contraction. There has been a significant evolution of treatments over the past 30 years. Initially, cardiac surgeons developed approaches via sternotomy with superior efficacy, however early iterations of the procedure were associated with prolonged recovery time and frequent need for pacemaker placement. The current surgical approach to the maze procedure via sternotomy yields excellent efficacy and is a Class 1 recommendation for patients with atrial fibrillation undergoing a concomitant procedure. Several years following the initial development of the surgical maze procedure, cardiac electrophysiologists developed less invasive, however less efficacious catheter ablation options by percutaneous approach. Both the surgical and transcatheter approaches have their advantages and disadvantages with varying risks of complications and efficacy. Through the combination of expertise of cardiac surgeons paired with the electrophysiology team, a hybrid ablation procedure has been developed offering an increased efficacy with a less-invasive approach than the current gold standard treatment of Cox-maze IV procedure. This review will discuss the hybrid ablation procedure, review recent associated clinical trials, and discuss advantages and challenges associated with this multidisciplinary approach for management of patients with AF.
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Affiliation(s)
- Ali Khoynezhad
- MemorialCare Heart and Vascular Institute, Long Beach, CA, USA
| | - Nikhil Warrier
- MemorialCare Heart and Vascular Institute, Long Beach, CA, USA
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Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomström-Lundqvist C, Calkins H, Corrado D, Deftereos SG, Diller GP, Gomez-Doblas JJ, Gorenek B, Grace A, Ho SY, Kaski JC, Kuck KH, Lambiase PD, Sacher F, Sarquella-Brugada G, Suwalski P, Zaza A. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J 2021; 41:655-720. [PMID: 31504425 DOI: 10.1093/eurheartj/ehz467] [Citation(s) in RCA: 522] [Impact Index Per Article: 174.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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38
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Plachinski SJ, Salman SS, Carey J, Flanagan CM, Novalija J, Pagel PS, Almassi GH. Iatrogenic Aortic Insufficiency After Radiofrequency Ablation of the Left Ventricular Outflow Tract. J Cardiothorac Vasc Anesth 2021; 36:1726-1729. [PMID: 34103217 DOI: 10.1053/j.jvca.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/24/2021] [Accepted: 05/03/2021] [Indexed: 01/20/2023]
Affiliation(s)
- Sarah J Plachinski
- Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Sumaiya S Salman
- Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - James Carey
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | | | - Jutta Novalija
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI; Department of Anesthesiology, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Paul S Pagel
- Department of Anesthesiology, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
| | - G Hossein Almassi
- Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI; Department of Cardiothoracic Surgery, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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Prospective blinded evaluation of smartphone-based ECG for differentiation of supraventricular tachycardia from inappropriate sinus tachycardia. Clin Res Cardiol 2021; 110:905-912. [PMID: 33961097 PMCID: PMC8103426 DOI: 10.1007/s00392-021-01856-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/12/2021] [Indexed: 11/26/2022]
Abstract
Introduction Supraventricular tachycardias (SVT) are often difficult to document due to their intermittent, short-lasting nature. Smartphone-based one-lead ECG monitors (sECG) were initially developed for the diagnosis of atrial fibrillation. No data have been published regarding their potential role in differentiating inappropiate sinus tachycardia (IST) from regular SVT. If cardiologists could distinguish IST from SVT in sECG, economic health care burden might be significantly reduced.
Methods We prospectively recruited 75 consecutive patients with known SVT undergoing an EP study. In all patients, four ECG were recorded: a sECG during SVT and during sinus tachycardia and respective 12-lead ECG. Two experienced electrophysiologists were blinded to the diagnoses and separately evaluated all ECG. Results Three hundred individual ECG were recorded in 75 patients (47 female, age 50 ± 18 years, BMI 26 ± 5 kg/m2, 60 AVNRT, 15 AVRT). The electrophysiologists’ blinded interpretation of sECG recordings showed a sensitivity of 89% and a specificity of 91% for the detection of SVT (interobserver agreement κ = 0.76). In high-quality sECG recordings (68%), sensitivity rose to 95% with a specificity of 92% (interobserver agreement of κ = 0.91). Specificity increased to 96% when both electrophysiologists agreed on the diagnosis. Respective 12-lead ECG had a sensitivity of 100% and specificity of 98% for the detection of SVT. Conclusion A smartphone-based one-lead ECG monitor allows for differentiation of SVT from IST in about 90% of cases. These results should encourage cardiologists to integrate wearables into clinical practice, possibly reducing time to definitive diagnosis of an arrhythmia and unnecessary EP procedures. Graphical abstract A smartphone-based one lead ECG device (panel A) can be used reliably to differentiate supraventricular tachycardia (panel B) from inappropriate sinus tachycardia when compared to a simultaneously conducted gold-standard electrophysiology study (panels C, D).![]()
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40
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Foo FS, Stiles MK, Clare GC, Lever N, Hooks D, Heaven D, Boddington D. Recent trends in cardiac electrophysiology and catheter ablation in New Zealand. Intern Med J 2021; 50:1247-1252. [PMID: 32043731 DOI: 10.1111/imj.14781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/14/2020] [Accepted: 01/26/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Catheter ablation has rapidly become an integral part of the management of many arrhythmias. AIMS To provide a history of clinical cardiac electrophysiology (EP) in New Zealand (NZ) and analysis of recent trends in EP procedures and catheter ablations across NZ, which has not previously been reported. METHODS EP case type and volume were obtained from the EP databases from each of the four public and four private EP centres in NZ from 1 January 2014 to 31 December 2018. Procedure rates were expressed as per million population. RESULTS A total of 7695 EP cases was performed, including 5929 (77%) in the public sector. Atrial fibrillation (AF) ablation was the most common procedure at 29%. EP procedure rates increased by 21% (to 353 per million in 2018), predominantly due to AF ablation rates increasing by 46%. Ventricular tachycardia ablation rates increased by 41% but only comprised 8% of procedures. There was a striking difference in the growth of EP procedure rates in the public compared to the private sector (4% vs 106%), as well as considerable differences in EP procedure and AF ablation rates across the public EP centres. NZ had lower ablation rates compared to countries with similar healthcare expenditure. CONCLUSION There has been a substantial increase in EP procedure and AF ablation rates in NZ and international trends suggest this growth will continue. However, there is considerable variation in procedure rates and growth trends between EP centres, highlighting inequities in access within the country.
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Affiliation(s)
- Fang Shawn Foo
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand.,Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.,Department of Cardiology, North Shore Hospital, Auckland, New Zealand
| | - Martin K Stiles
- Department of Cardiology, Waikato Hospital, Hamilton, New Zealand.,Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Geoffrey C Clare
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand.,Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Nigel Lever
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.,Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Darren Hooks
- Department of Medicine, University of Otago, Christchurch, New Zealand.,Department of Cardiology, Wellington Hospital, Wellington, New Zealand
| | - David Heaven
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand.,Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Dean Boddington
- Department of Cardiology, Tauranga Hospital, Tauranga, New Zealand
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Stabile G, Bertaglia E, Guerra F, Palmisano P, Zoni Berisso M, Soldati E, Bisignani G, Forleo GB, Zanotto G, Landolina M, Boriani G, D'Onofrio A, De Ponti R, Ricci RP. Organization and procedures in contemporary catheter ablation centres: data from the 2018 Italian Catheter Ablation Registry. J Cardiovasc Med (Hagerstown) 2021; 22:631-636. [PMID: 34009836 DOI: 10.2459/jcm.0000000000001183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS This report describes the findings of the 2018 Italian Catheter Ablation Registry of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC). METHODS The Italian Catheter Ablation Registry systematically collects data on the ablation procedures performed in Italy. Data collection was retrospective. A standardized questionnaire was completed by participating centres. RESULTS We collected data on 15 714 catheter ablation procedures performed in Italy during 2018 in 94 electrophysiology centres. In most centres (75/94, 80%), a single electrophysiology laboratory was available, and a hybrid electrophysiology laboratory was available in 15% (14/94) of centres. In most (93%) centres, at least two electrophysiologists were involved in the catheter ablation procedures. In only 13 out of 94 (14%) electrophysiology laboratories, an anaesthesiologist assists every electrophysiology procedure; in most cases (74/94, 79%), an on-demand anaesthesiology service was available. On-site cardiothoracic surgery was reported in 43 out of 94 (46%) centres.Nonfluoroscopic navigation systems were available in most centres (88/94, 93%). Intracardiac echocardiography was used in 59 out of 94 (63%) electrophysiology laboratories. Atrial fibrillation (31%) was the most frequently treated ablation target, followed by atrioventricular nodal re-entrant tachycardia (20%) and cavo-tricuspid isthmus (15%). In 61.7% of all procedures, a 3D mapping system was used. In about one-third of procedures, a near-zero approach was performed. CONCLUSION In most Italian electrophysiology centres, a single electrophysiology laboratory was available and at least two electrophysiologists were involved in the ablation procedures. An increasing number of procedures were performed by means of a nonfluoroscopic mapping system with a near-zero approach.
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Affiliation(s)
- Giuseppe Stabile
- Anthea Hospital, Bari.,Clinica Montevergine, Mercogliano.,Clinica San Michele, Maddaloni (CE)
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Ospedali Riuniti, Ancona
| | | | | | | | | | | | | | | | - Giuseppe Boriani
- Università di Modena e Reggio Emilia, Policlinico di Modena, Modena
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Asatryan B, Seiler J, Bourquin L, Knecht S, Servatius H, Madaffari A, Baldinger SH, Badertscher P, Küffer T, Spies F, Tanner H, Kühne M, Osswald S, Roten L, Sticherling C, Reichlin T. Pre-procedural arrhythmia burden and the outcome of catheter ablation of idiopathic premature ventricular complexes. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:703-710. [PMID: 33675240 DOI: 10.1111/pace.14211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/22/2021] [Accepted: 02/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Radiofrequency catheter ablation of idiopathic premature ventricular complexes (PVCs) is an effective method for eliminating symptoms and preventing/reversing arrhythmia-induced cardiomyopathy. One reason for procedural failure is low PVC frequency during the procedure. We aimed to investigate the relation between pre-procedural PVC burden and outcome of idiopathic PVC catheter ablation. METHODS Patients who underwent idiopathic PVC ablation between 2013 and 2019 at two tertiary referral centers were retrospectively included. All procedures were performed using irrigated-tip ablation catheters and a 3D electro-anatomical mapping system. Sustained ablation success was defined as a ≥80% reduction of pre-procedural PVC burden determined by 24h-Holter at follow-up. RESULTS Overall, 254 patients (median age 54 years [IQR 42-64]; 47% male) were enrolled. The median pre-ablation PVC-burden was 22% (IQR 11-31%), which was reduced to a post-ablation PVC burden of 0.3% (IQR 0-4%) after a median of 90 days. Sustained ablation success was achieved in 182 patients (72%). Pre-procedural PVC burden did not differ between patients with sustained ablation success and recurrence during follow-up (median 21% vs. 22%, p = .76). When assessed in pre-ablation PVC-burden groups of ≤5%, 6-15%, 16-30%, and ≥31%, sustained ablation success was achieved in 67%, 75%, 71%, and 72%, respectively, with no significant difference (p = .89). Sustained ablation outcome for PVC-burden ≤5% versus >5% showed no difference either (67% vs. 72%, p = .52). CONCLUSIONS Pre-procedural Holter-determined PVC burden does not predict the outcome of idiopathic PVC ablation. Thus, catheter ablation may be a reasonable first choice also for patients with symptomatic yet rare PVCs.
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Affiliation(s)
- Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luc Bourquin
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Badertscher
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Thomas Küffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Spies
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Kühne
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Sticherling
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Attanasio P, Huemer M, Kaehler N, Keller T, Schreiber T, Niehues R, Katsani-Potempa D, Klein RM, Landmesser U, Deisenhofer I, Tutdibi O, Bourier F. Safe procedures despite ultra low radiation doses during catheter ablations of atrial and ventricular arrhythmias-A multicenter experience. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:807-813. [PMID: 33665850 DOI: 10.1111/pace.14205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/05/2021] [Accepted: 02/07/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Despite the development of non-fluoroscopic catheter visualization options, fluoroscopy is still used in most ablation procedures. The aim of this multicenter study was to evaluate the safety and efficacy of a new ultra-low dose radiation protocol for EP procedures in a large number of patients. METHODS AND RESULTS A total of 3462 consecutive patients (male 1926 (55.6%), age 64.4 ± 14.0 years, BMI 26.65 ± 4.70) undergoing radiofrequency ablation (left atrial (n = 2316 [66.9%], right atrial (n = 675 [19.5%], or ventricular (n = 471 [13.6%]) in three German centers were included in the analysis. Procedures were performed using a new ultra-low dose protocol operating at 8nGy for fluoroscopy and 36nGy for cine-loops. Additionally a very low framerate (2-3FPS) was used. Using the new protocol very low Air kerma-area product (KAP) values were achieved for left atrial ablations (104.25 ± 84.22 μGym2 ), right atrial ablations (70.98 ± 94.79 μGym2 ) and ablations for ventricular tachycardias or PVCs (78.62 ± 66.59 μGym2 ). Acute procedural success was achieved in 3289/3388 (97.1%) while the rate of major complications was very low compared to previously published studies not using low dose settings (n = 20, 0.6%). CONCLUSION The ultra-low dose, low framerate protocol leads to very low radiation doses for all EP procedures while neither procedural time, fluoroscopy time nor success or complication rates were compromised. When compared to current real-world Air KAP data the new ultra-low dose fluoroscopy protocol reduces radiation exposure by more than 90%.
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Affiliation(s)
- Philipp Attanasio
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Martin Huemer
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Nora Kaehler
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Theresa Keller
- Institute for Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Schreiber
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Reinhard Niehues
- Augusta Krankenhaus Düsseldorf, Department of Cardiology, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Dimitra Katsani-Potempa
- Augusta Krankenhaus Düsseldorf, Department of Cardiology, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Rolf Michael Klein
- Augusta Krankenhaus Düsseldorf, Department of Cardiology, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany.,Department of Cardiology, University Hospital Witten/Herdecke, Witten, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Munich, Germany
| | - Osman Tutdibi
- Augusta Krankenhaus Düsseldorf, Department of Cardiology, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Munich, Germany
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Wazni OM, Dandamudi G, Sood N, Hoyt R, Tyler J, Durrani S, Niebauer M, Makati K, Halperin B, Gauri A, Morales G, Shao M, Cerkvenik J, Kaplon RE, Nissen SE. Cryoballoon Ablation as Initial Therapy for Atrial Fibrillation. N Engl J Med 2021; 384:316-324. [PMID: 33197158 DOI: 10.1056/nejmoa2029554] [Citation(s) in RCA: 353] [Impact Index Per Article: 117.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND In patients with symptomatic paroxysmal atrial fibrillation that has not responded to medication, catheter ablation is more effective than antiarrhythmic drug therapy for maintaining sinus rhythm. However, the safety and efficacy of cryoballoon ablation as initial first-line therapy have not been established. METHODS We performed a multicenter trial in which patients 18 to 80 years of age who had paroxysmal atrial fibrillation for which they had not previously received rhythm-control therapy were randomly assigned (1:1) to receive treatment with antiarrhythmic drugs (class I or III agents) or pulmonary vein isolation with a cryoballoon. Arrhythmia monitoring included 12-lead electrocardiography conducted at baseline and at 1, 3, 6, and 12 months; patient-activated telephone monitoring conducted weekly and when symptoms were present during months 3 through 12; and 24-hour ambulatory monitoring conducted at 6 and 12 months. The primary efficacy end point was treatment success (defined as freedom from initial failure of the procedure or atrial arrhythmia recurrence after a 90-day blanking period to allow recovery from the procedure or drug dose adjustment, evaluated in a Kaplan-Meier analysis). The primary safety end point was assessed in the ablation group only and was a composite of several procedure-related and cryoballoon system-related serious adverse events. RESULTS Of the 203 participants who underwent randomization and received treatment, 104 underwent ablation, and 99 initially received drug therapy. In the ablation group, initial success of the procedure was achieved in 97% of patients. The Kaplan-Meier estimate of the percentage of patients with treatment success at 12 months was 74.6% (95% confidence interval [CI], 65.0 to 82.0) in the ablation group and 45.0% (95% CI, 34.6 to 54.7) in the drug-therapy group (P<0.001 by log-rank test). Two primary safety end-point events occurred in the ablation group (Kaplan-Meier estimate of the percentage of patients with an event within 12 months, 1.9%; 95% CI, 0.5 to 7.5). CONCLUSIONS Cryoballoon ablation as initial therapy was superior to drug therapy for the prevention of atrial arrhythmia recurrence in patients with paroxysmal atrial fibrillation. Serious procedure-related adverse events were uncommon. (Supported by Medtronic; STOP AF First ClinicalTrials.gov number, NCT03118518.).
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Affiliation(s)
- Oussama M Wazni
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Gopi Dandamudi
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Nitesh Sood
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Robert Hoyt
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Jaret Tyler
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Sarfraz Durrani
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Mark Niebauer
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Kevin Makati
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Blair Halperin
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Andre Gauri
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Gustavo Morales
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Mingyuan Shao
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Jeffrey Cerkvenik
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Rachelle E Kaplon
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Steven E Nissen
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
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45
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Li CY, Zhang JR, Hu WN, Li SN. Atrial fibrosis underlying atrial fibrillation (Review). Int J Mol Med 2021; 47:9. [PMID: 33448312 PMCID: PMC7834953 DOI: 10.3892/ijmm.2020.4842] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/07/2020] [Indexed: 01/17/2023] Open
Abstract
Atrial fibrillation (AF) is one of the most common tachyarrhythmias observed in the clinic and is characterized by structural and electrical remodelling. Atrial fibrosis, an emblem of atrial structural remodelling, is a complex multifactorial and patient-specific process involved in the occurrence and maintenance of AF. Whilst there is already considerable knowledge regarding the association between AF and fibrosis, this process is extremely complex, involving intricate neurohumoral and cellular and molecular interactions, and it is not limited to the atrium. Current technological advances have made the non-invasive evaluation of fibrosis in the atria and ventricles possible, facilitating the selection of patient-specific ablation strategies and upstream treatment regimens. An improved understanding of the mechanisms and roles of fibrosis in the context of AF is of great clinical significance for the development of treatment strategies targeting the fibrous region. In the present review, a focus was placed on the atrial fibrosis underlying AF, outlining its role in the occurrence and perpetuation of AF, by reviewing recent evaluations and potential treatment strategies targeting areas of fibrosis, with the aim of providing a novel perspective on the management and prevention of AF.
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Affiliation(s)
- Chang Yi Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Jing Rui Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Wan Ning Hu
- Department of Cardiology, Laboratory of Molecular Biology, Head and Neck Surgery, Tangshan Gongren Hospital, Tangshan, Hebei 063000, P.R. China
| | - Song Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
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46
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Magnano M, Bissolino A, Bocchino PP. Isoprenaline infusion during EP test in asymptomatic Wolff-Parkinson-White: Are we using the optimal threshold value? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:416-417. [PMID: 33432999 DOI: 10.1111/pace.14162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/20/2020] [Accepted: 01/03/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Massimo Magnano
- Department of Medical Sciences, Division of Cardiology, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Arianna Bissolino
- Department of Medical Sciences, Division of Cardiology, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Pier Paolo Bocchino
- Department of Medical Sciences, Division of Cardiology, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
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47
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Quesada A, Cózar R, Anguera I. [Spanish Catheter Ablation Registry. 19th Official Report of the Heart Rhythm Association of the Spanish Society of Cardiology (2019)]. Rev Esp Cardiol 2020; 73:1049-1060. [PMID: 32982011 PMCID: PMC7509535 DOI: 10.1016/j.recesp.2020.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION AND OBJECTIVES This report presents the findings of the 2019 Spanish Catheter Ablation Registry. METHODS Data collection was retrospective. A standardized questionnaire was filled by each of the participant centers. RESULTS Data sent by 102 centers were analyzed, with a total number of ablation procedures performed of 18 549 (the highest historically reported in this registry) for a mean of 181.9 ± 137.0 and a median of 144.5 procedures per center. The ablation targets most frequently treated were atrial fibrillation (n = 5164; 27.8%), cavotricuspid isthmus (n = 3925; 21.1%) and atrioventricular nodal reentrant tachycardia (n = 3768; 20.3%). A new peak is observed in the ablation of atrial fibrillation, increasing the distance from the other substrates. The overall success rate was again 91%. The rate of major complications was 1.9%, and the mortality rate was 0.03%. An electroanatomic mapping system was used in 44.5% of all procedures, with contact force-sensing irrigated catheters become the preferred for complex substrates, as atrial fibrillation (84.8%) or ventricular tachycardia (around 90%). 1.5% of the ablations were performed in pediatric patients. CONCLUSIONS The Spanish Catheter Ablation Registry enrolls systematically and uninterruptedly the ablation procedures performed in Spain, showing a progressive increasing in the number of ablations over the years with a high success rate and low percentages of complications.
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Affiliation(s)
- Aurelio Quesada
- Unidad de Arritmias, Hospital General Universitario de Valencia, Valencia, España
| | - Rocío Cózar
- Unidad de Arritmias, Hospital Virgen Macarena, Sevilla, España
| | - Ignasi Anguera
- Unidad de Arritmias y Electrofisiología, Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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48
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Chaumont C, Mirolo A, Savouré A, Godin B, Auquier N, Viart G, Hatrel A, Gillibert A, Eltchaninoff H, Anselme F. Very long‐term outcomes after catheter ablation of atrioventricular nodal reentrant tachycardia: How does cryoenergy differ from radiofrequency? J Cardiovasc Electrophysiol 2020; 31:3215-3222. [DOI: 10.1111/jce.14784] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Corentin Chaumont
- Department of Cardiology Rouen University Hospital Rouen France
- UNIROUEN, INSERM U1096 FHU REMOD‐VHF Rouen France
| | - Adrian Mirolo
- Department of Cardiology Rouen University Hospital Rouen France
- UNIROUEN, INSERM U1096 FHU REMOD‐VHF Rouen France
| | - Arnaud Savouré
- Department of Cardiology Rouen University Hospital Rouen France
- UNIROUEN, INSERM U1096 FHU REMOD‐VHF Rouen France
| | - Bénédicte Godin
- Department of Cardiology Rouen University Hospital Rouen France
- UNIROUEN, INSERM U1096 FHU REMOD‐VHF Rouen France
| | - Nathanaël Auquier
- Department of Cardiology Groupe Hospitalier du Havre Le Havre France
| | - Guillaume Viart
- Department of Cardiology Rouen University Hospital Rouen France
| | - Amandine Hatrel
- Department of Cardiology Rouen University Hospital Rouen France
- Department of Cardiology Elbeuf Hospital Elbeuf France
| | - André Gillibert
- Department of Biostatistics Rouen University Hospital Rouen France
| | - Hélène Eltchaninoff
- Department of Cardiology Rouen University Hospital Rouen France
- UNIROUEN, INSERM U1096 FHU REMOD‐VHF Rouen France
| | - Frédéric Anselme
- Department of Cardiology Rouen University Hospital Rouen France
- UNIROUEN, INSERM U1096 FHU REMOD‐VHF Rouen France
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49
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Creta A, Ventrella N, Providência R, Earley MJ, Sporton S, Dhillon G, Papageorgiou N, Chow A, Lambiase PD, Lowe M, Schilling RJ, Finlay M, Hunter RJ. Same‐day discharge following catheter ablation of atrial fibrillation: A safe and cost‐effective approach. J Cardiovasc Electrophysiol 2020; 31:3097-3103. [DOI: 10.1111/jce.14789] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/03/2020] [Accepted: 10/07/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Antonio Creta
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Nicoletta Ventrella
- Faculty of Medicine and Surgery Campus Bio‐Medico University of Rome Rome Italy
| | - Rui Providência
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Mark J. Earley
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Simon Sporton
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Gurpreet Dhillon
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Nikolaos Papageorgiou
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Anthony Chow
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Pier D. Lambiase
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Martin Lowe
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Richard J. Schilling
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Malcolm Finlay
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Ross J. Hunter
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
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50
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Quesada A, Cózar R, Anguera I. Spanish Catheter Ablation Registry. 19th Official Report of the Heart Rhythm Association of the Spanish Society of Cardiology (2019). ACTA ACUST UNITED AC 2020; 73:1049-1060. [PMID: 33153956 DOI: 10.1016/j.rec.2020.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/20/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES This report presents the findings of the 2019 Spanish Catheter Ablation Registry. METHODS Data collection was retrospective. A standardized questionnaire was filled by each of the participant centers. RESULTS Data sent by 102 centers were analyzed, with a total number of ablation procedures performed of 18549 (the highest historically reported in this registry) for a mean of 181.9±137.0 and a median of 144.5 procedures per center. The ablation targets most frequently treated were atrial fibrillation (n=5164; 27.8%), cavotricuspid isthmus (n=3925; 21.1%) and atrioventricular nodal reentrant tachycardia (n=3768; 20.3%). A new peak is observed in the ablation of atrial fibrillation, increasing the distance from the other substrates. The overall success rate was again 91%. The rate of major complications was 1.9%, and the mortality rate was 0.03%. An electroanatomic mapping system was used in 44.5% of all procedures, with contact force-sensing irrigated catheters become the preferred for complex substrates, as atrial fibrillation (84.8%) or ventricular tachycardia (around 90%). 1.5% of the ablations were performed in pediatric patients. CONCLUSIONS The Spanish Catheter Ablation Registry enrolls systematically and uninterruptedly the ablation procedures performed in Spain, showing a progressive increasing in the number of ablations over the years with a high success rate and low percentages of complications.
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Affiliation(s)
- Aurelio Quesada
- Unidad de Arritmias, Hospital General Universitario de Valencia, Valencia, Spain.
| | - Rocío Cózar
- Unidad de Arritmias, Hospital Virgen Macarena, Sevilla, Spain
| | - Ignasi Anguera
- Unidad de Arritmias y Electrofisiología, Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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