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Jin X, Zhou Y, Wu Y, Xie M. Safety and efficacy of steerable versus non-steerable sheaths for catheter ablation of atrial fibrillation systematic review and meta-analysis. BMJ Open 2023; 13:e068350. [PMID: 37734901 PMCID: PMC10514598 DOI: 10.1136/bmjopen-2022-068350] [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: 09/15/2022] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVES With the development of radiofrequency (RF) ablation technology. In recent years, more and more patients with atrial fibrillation (AF) have been treated with RF ablation. Steerable sheaths (SS) have been widely used in RF ablation of AF. The aim of this meta-analysis was to compare the efficacy and safety of AF ablation using SS and non-steerable sheaths (NSS). METHODS From the beginning to March 2022, we conducted a comprehensive, systematic search of the databases PubMed, MEDLINE, EMBASE, Web of Science and the Cochrane Library to finish the study. For categorical and continuous data, we used ORs and mean difference to calculate the effect. We also estimated the 95% CI. RESULTS Five studies of RF ablation of AF were selected, three prospective and two retrospective, involving 282 SS and 236 NSS ablation patients. The rate of recurrence of AF or atrial arrhythmias was 27.3% versus 42.8% (OR: 0.52, 95% CI 0.36, 0.76, z=3.41, p=0.0006) and acute pulmonary vein (PV) reconnection (8.7% vs 17.4%, OR: 0.47, 95% CI 0.23, 0.95, z=2.10, p=0.04). In the SS group and the NSS group, the total ablation time (p=0.25), fluoroscopy time (p=0.26) and total operative time (p=0.35) were not significantly different. CONCLUSIONS Compared with the use of NSS, the use of SS for RF ablation of AF can effectively reduce the recurrence rate of AF and the occurrence of acute PVs reconnection events. However, there is no advantage in shortening the total RF time, fluoroscopy time, total surgical time and reducing complications.
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Affiliation(s)
- Xinyao Jin
- Department of Cardiology, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Yuqing Zhou
- First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuanhong Wu
- Department of Cardiology, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Mingbin Xie
- Department of Cardiology, Hangzhou Red Cross Hospital, Hangzhou, China
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Bonczar M, Piątek-Koziej K, Wolska J, Tomala O, Stitou EA, Pękala J, Pękala P, Walocha J, Hołda M, Koziej M. Variations in human pulmonary vein ostia morphology: A systematic review with meta-analysis. Clin Anat 2022; 35:906-926. [PMID: 35460116 DOI: 10.1002/ca.23896] [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: 04/07/2022] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/09/2022]
Abstract
This study aimed to establish the most accurate and up-to-date anatomical knowledge of pulmonary veins (PV), ostia variations, diameters and ostial area, to provide physicians, especially heart and thoracic surgeons with exact knowledge concerning this area. The main online medical databases, such as PubMed, Embase, Scopus, Web of Science, and Google Scholar, were searched to gather all studies in which the variations, maximal diameter, and ostial area of the PVs were investigated. During the study, the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. Additionally, the critical appraisal tool for anatomical meta-analysis (CATAM) was used to provide the highest quality findings. The most common ostia variation is the classical one, which contains the left superior pulmonary vein (LSPV), left inferior pulmonary vein (LIPV), right superior pulmonary vein (RSPV) and right inferior pulmonary vein (RIPV). The mean diameter and ostial area of each pulmonary vein were established in the general population and in multiple variations considering the method of collecting the data and geographical location. Significant variability in PV ostia is observed. Left-sided PVs have smaller ostia than the corresponding right-sided PVs, and the inferior PVs ostia are smaller than the superior. The LCPV ostium size is the largest among all veins analyzed, while the RMPV ostium is the smallest. The results of this meta-analysis are hoped to help clinicians in planning and performing procedures that involve the pulmonary and cardiac areas, especially catheter ablation for atrial fibrillation.
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Affiliation(s)
- Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | | | - Joanna Wolska
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Olaf Tomala
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - El-Ayachi Stitou
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Przemysław Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, UK
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
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Velagić V, de Asmundis C, Mugnai G, Hünük B, Hacioğlu E, Ströker E, Moran D, Ruggiero D, Poelaert J, Verborgh C, Umbrain V, Paparella G, Beckers S, Brugada P, Chierchia GB. Learning curve using the second-generation cryoballoon ablation. J Cardiovasc Med (Hagerstown) 2017; 18:518-527. [DOI: 10.2459/jcm.0000000000000493] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Nuevas técnicas en ablación de fibrilación auricular: tecnologías emergentes (ablación multielectrodo y balón láser). REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Pulmonary vein anatomy assessed by cardiac magnetic resonance imaging in patients undergoing initial atrial fibrillation ablation: implications for novel ablation technologies. J Interv Card Electrophysiol 2016; 46:89-96. [PMID: 26810707 DOI: 10.1007/s10840-016-0106-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 01/18/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Novel atrial fibrillation (AF) ablation tools have been designed to facilitate "single-shot" pulmonary vein (PV) isolation using multi-electrode or balloon-based catheters. However, in contrast to point-by-point radiofrequency ablation, these tools may be more dependent on suitable PV anatomy to achieve circumferential PV isolation. METHODS Three hundred and twenty-two patients underwent gadolinium-enhanced cardiac magnetic resonance angiography to delineate PV anatomy prior to initial AF ablation. Long (a) and short (b) axis measurements of the PV orifice were used to calculate the eccentricity index of the PV ostium. RESULTS Long axis dimensions of the left superior PV were 18.2 ± 3.3 mm, left inferior PV 17.7 ± 3.9 mm, right superior PV (RSPV) 20.4 ± 4.3, and right inferior PV 18.7 ± 4.7 mm. The long axis dimension of the RSPV was significantly larger than other PVs (p < 0.001). Forty-two patients (13 %) had at least one PV with a long axis dimension >25 mm and 16 patients (5 %) had at least one PV with a long axis dimension >28 mm. Left-sided PV ostia were significantly more ellipse-shaped than the right-sided PVs, which tended to be more spherical. A significant positive correlation was noted between increasing PV size and increased orifice eccentricity. CONCLUSIONS In this large cohort undergoing initial AF ablation, over 10 % of patients had at least one standard PV with a dimension >25 mm. Additionally, significant differences were noted between left- and right-sided veins with regard to orifice eccentricity. These findings have implications for the design of AF ablation tools and may account for differential isolation rates between PVs noted in some recent studies of novel ablation technologies.
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Klein G, Lickfett L, Schreieck J, Deneke T, Wieczorek M, Burkowitz J, Alvarez-Ossorio L, Brüggenjürgen B. Comparison of ‘anatomically designed’ and ‘point-by-point’ catheter ablations for human atrial fibrillation in terms of procedure timing and costs in German hospitals. Europace 2015; 17:1030-7. [DOI: 10.1093/europace/euu386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 12/10/2014] [Indexed: 12/26/2022] Open
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Arora KS, Khan N, Abboudi H, Khan MS, Dasgupta P, Ahmed K. Learning curves for cardiothoracic and vascular surgical procedures--a systematic review. Postgrad Med 2014; 127:202-14. [PMID: 25529043 DOI: 10.1080/00325481.2014.996113] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of this systematic review is to evaluate the learning curve (LC) literature and identify the LC of cardiothoracic and vascular surgical procedures. SUMMARY AND BACKGROUND The LC describes an observation that a learner's performance improves over time during acquisition of new motor skills. Measuring the LC of surgical procedures has important implications for surgical innovation, education, and patient safety. Numerous studies have investigated LCs of isolated operations in cardiothoracic and vascular surgeries, but a lack of uniformity in the methods and variables used to measure LCs has led to a lack of systematic reviews. METHODS The MEDLINE®, EMBASE™, and PsycINFO® databases were systematically searched until July 2013. Articles describing LCs for cardiothoracic and vascular procedures were included. The type of procedure, statistical analysis, number of participants, procedure setting, level of participants, outcomes, and LCs were reviewed. RESULTS A total of 48 studies investigated LCs in cardiothoracic and vascular surgeries. Based on operating time, the LC for coronary artery bypass surgery ranged between 15 and 100 cases; for endoscopic vessel harvesting and other cardiac vessel surgery between 7 and 35 cases; for valvular surgery, which included repair and replacement, between 20 and 135 cases; for video-assisted thoracoscopic surgery, between 15 and 35 cases; for vascular neurosurgical procedures between 100 and 500 cases, based on complications; for endovascular vessel repairs between 5 and 40 cases; and for ablation procedures between 25 and 60 cases. However there was a distinct lack of standardization in the variables/outcome measures used, case selection, prior experience, and supervision of participating surgeons and a range of statistical analyses to compute LCs was noted. CONCLUSION LCs in cardiothoracic and vascular procedures are hugely variable depending on the procedure type, outcome measures, level of prior experience, and methods/statistics used. Uniformity in methods, variables, and statistical analysis is needed to derive meaningful comparisons of LCs. Acknowledgment and application of learning processes other than those reliant on volume-outcomes relationship will benefit LC research and training of surgeons.
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Affiliation(s)
- Karan Singh Arora
- Department of Urology, King's Health Partners, MRC Centre for Transplantation, King's College London, Guy's Hospital , St Thomas Street, London , UK
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Brunelli M, Raffa S, Große A, Hanazawa K, Sammut M, Roos M, Frommhold M, Wauters K, Geller JC. Residual conduction after pulmonary vein isolation with a circular multielectrode radiofrequency ablation catheter: The role of adenosine and orciprenalin during a prolonged observation time. Int J Cardiol 2013; 168:4122-31. [DOI: 10.1016/j.ijcard.2013.07.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 04/07/2013] [Accepted: 07/07/2013] [Indexed: 11/26/2022]
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Malmborg H, Lönnerholm S, Blomström P, Blomström-Lundqvist C. Ablation of atrial fibrillation with cryoballoon or duty-cycled radiofrequency pulmonary vein ablation catheter: a randomized controlled study comparing the clinical outcome and safety; the AF-COR study. Europace 2013; 15:1567-73. [PMID: 23703361 DOI: 10.1093/europace/eut104] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS The urge to facilitate the atrial fibrillation (AF) ablation procedure has led to the development of new ablation catheters specifically designed as 'one-shot tools' for pulmonary vein isolation (PVI). The purpose of this study was to compare the efficacy, safety, and procedure times for two such catheters using different energy sources. METHODS AND RESULTS One hundred and ten patients, referred for ablation of paroxysmal or persistent AF, were randomized to treatment with either the cryoballoon or the circular multipolar duty-cycled radiofrequency-based pulmonary vein ablation catheter (PVAC). Complete PVI was achieved in 98 vs. 93% patients in the cryoballoon and PVAC group, respectively, with complication rates of 8 vs. 2% (P = 0.2). Complete freedom from AF, without antiarrhythmic drugs, after one single ablation procedure was seen in 46% in the cryoballoon vs. 34% after 12 months (P = 0.2). Procedure times were comparable, but fluoroscopy time was shorter for the cryoballoon (32 ± 16 min) than for the PVAC procedures (47 ± 17 min) (P < 0.001). A significant improvement of quality of life (QoL) and arrhythmia-related symptoms was seen in both groups after ablation. CONCLUSION Both catheters proved comparably effective and safe in achieving acute PVI, apart from the shorter fluoroscopy times achieved with the cryoballoon. At follow-up, there was no statistically significant difference between the groups regarding freedom from AF and clinical success. The QoL increased to the same levels as for the general Swedish population in both groups.
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Affiliation(s)
- Helena Malmborg
- Department of Medical Sciences, Department of Cardiology, Uppsala University, Uppsala SE 751 85, Sweden
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Kagadis GC, Katsanos K, Karnabatidis D, Loudos G, Nikiforidis GC, Hendee WR. Emerging technologies for image guidance and device navigation in interventional radiology. Med Phys 2012; 39:5768-81. [PMID: 22957641 DOI: 10.1118/1.4747343] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Recent developments in image-guidance and device navigation, along with emerging robotic technologies, are rapidly transforming the landscape of interventional radiology (IR). Future state-of-the-art IR procedures may include real-time three-dimensional imaging that is capable of visualizing the target organ, interventional tools, and surrounding anatomy with high spatial and temporal resolution. Remote device actuation is becoming a reality with the introduction of novel magnetic-field enabled instruments and remote robotic steering systems. Robots offer several degrees of freedom and unprecedented accuracy, stability, and dexterity during device navigation, propulsion, and actuation. Optimization of tracking and navigation of interventional tools inside the human body will be critical in converting IR suites into the minimally invasive operating theaters of the future with increased safety and unsurpassed therapeutic efficacy. In the not too distant future, individual image guidance modalities and device tracking methods could merge into autonomous, multimodality, multiparametric platforms that offer real-time data of anatomy, morphology, function, and metabolism along with on-the-fly computational modeling and remote robotic actuation. The authors provide a concise overview of the latest developments in image guidance and device navigation, while critically envisioning what the future might hold for 2020 IR procedures.
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Affiliation(s)
- George C Kagadis
- Department of Medical Physics, School of Medicine, University of Patras, Rion, Greece.
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