1
|
Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Interv Card Electrophysiol 2024; 67:921-1072. [PMID: 38609733 DOI: 10.1007/s10840-024-01771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society (HRS), the Asia Pacific HRS, and the Latin American HRS.
Collapse
Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | - Gregory F Michaud
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| |
Collapse
|
2
|
Dello Russo A, Tondo C, Schillaci V, Casella M, Iacopino S, Bianchi S, Fassini G, Rossillo A, Compagnucci P, Schiavone M, Salito A, Maggio R, Cipolletta L, Themistoclakis S, Pandozi C, Filannino P, Rossi P, Bonanno C, Parisi Q, Malacrida M, Solimene F. Intracardiac echocardiography-guided pulsed-field ablation for successful ablation of atrial fibrillation: a propensity-matched analysis from a large nationwide multicenter experience. J Interv Card Electrophysiol 2024; 67:1257-1266. [PMID: 37985538 DOI: 10.1007/s10840-023-01699-2] [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: 09/26/2023] [Accepted: 11/13/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Intracardiac echocardiography (ICE) is increasingly employed in atrial fibrillation (AF) ablation procedures, with the potential to enhance procedural efficacy. Nevertheless, there is currently a lack of evidence assessing the impact of ICE on the efficiency, effectiveness, and safety outcomes in the context of novel pulsed-field ablation (PFA) for AF. PURPOSE We aimed to assess whether the use of ICE could improve procedural parameters in a large population undergoing AF ablation with FARAPULSE™ catheter. METHODS Consecutive patients who had undergone PFA of AF from nine Italian centers were included. In procedures where the ICE catheter was employed for guidance (ICE-guided group), it was used to maneuver the PFA catheter within the left atrium to achieve optimal contact with atrial structures. RESULTS We analyzed 556 patients: 357 (66%) with paroxysmal AF, 499 (89.7%) de novo PVI. ICE-guided procedures (n = 138) were propensity matched with patients with a standard approach (n = 138), and their outcomes were compared. During ICE-guided procedures, no improvement in procedural metrics was recorded (ICE vs Standard, 23 ± 6 min vs 18.5 ± 9 min for time to PVI, p < 0.0001; 38.8 ± 7 vs 32.5 ± 5 number of PFA deliveries to achieve PVI, p < 0.0001; 68.8 ± 19 min vs 71.8 ± 29 min for primary operator time, p = 0.5301; 16.1 ± 8 min vs 18.2 ± 10 min for fluoroscopy time, p = 0.5476) except for support time (76.8 ± 26 min vs 91.4 ± 37 min, p = 0.0046). No major procedure-related adverse events were reported. CONCLUSION Our findings confirmed that PFA could be consistently performed in a rapid, safe, and efficacious manner. The use of ICE to guide PFA was not associated with an improvement in procedural metrics.
Collapse
Affiliation(s)
- Antonio Dello Russo
- Department of Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Via Conca, 71 - 60126, Ancona, Italy.
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy.
| | | | | | - Michela Casella
- Department of Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Via Conca, 71 - 60126, Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | | | - Stefano Bianchi
- Fatebenefratelli Isola Tiberina - Gemelli Isola Hospital, Rome, Italy
| | | | | | - Paolo Compagnucci
- Department of Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Via Conca, 71 - 60126, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | | | | | | | - Laura Cipolletta
- Department of Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Via Conca, 71 - 60126, Ancona, Italy
| | | | | | | | - Pietro Rossi
- Fatebenefratelli Isola Tiberina - Gemelli Isola Hospital, Rome, Italy
| | | | - Quintino Parisi
- Department of Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Via Conca, 71 - 60126, Ancona, Italy
| | | | - Francesco Solimene
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
- Montevergine Clinic, Mercogliano, AV, Italy
| |
Collapse
|
3
|
Sousonis V, Asvestas D, Vavouris E, Karanikas S, Ypsilanti E, Tzeis S. The use of Intracardiac Echocardiography in Catheter Ablation of Atrial Fibrillation. Curr Cardiol Rep 2024:10.1007/s11886-024-02091-w. [PMID: 38995505 DOI: 10.1007/s11886-024-02091-w] [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] [Accepted: 06/28/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE OF THE REVIEW Intracardiac echocardiography (ICE) provides real-time, fluoroless imaging of cardiac structures, allowing optimal catheter positioning and energy delivery during ablation procedures. This review summarizes the use of ICE in catheter ablation of atrial fibrillation (AF). RECENT FINDINGS Growing evidence suggests that the use of ICE improves procedural safety and facilitates radiofrequency and cryoballoon AF ablation. ICE-guided catheter ablation is associated with reduced procedural duration and fluoroscopy use. Recent studies have examined the role of ICE in guiding novel ablation techniques, such as pulsed field ablation. Finally, the use of ICE allows for early detection and timely management of potentially serious procedural complications. Intracardiac echocardiography offers significant advantages during AF ablation procedures and its use should be encouraged to improve procedural safety and efficacy.
Collapse
Affiliation(s)
- Vasileios Sousonis
- Department of Cardiology, Mitera Hospital, 6 Erithrou Stavrou str., Marousi, Athens, 151 23, Greece
| | - Dimitrios Asvestas
- Department of Cardiology, Mitera Hospital, 6 Erithrou Stavrou str., Marousi, Athens, 151 23, Greece
| | - Emmanouil Vavouris
- Department of Cardiology, Mitera Hospital, 6 Erithrou Stavrou str., Marousi, Athens, 151 23, Greece
| | - Stavros Karanikas
- Department of Cardiology, Mitera Hospital, 6 Erithrou Stavrou str., Marousi, Athens, 151 23, Greece
| | - Elissavet Ypsilanti
- Department of Cardiology, Mitera Hospital, 6 Erithrou Stavrou str., Marousi, Athens, 151 23, Greece
| | - Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6 Erithrou Stavrou str., Marousi, Athens, 151 23, Greece.
| |
Collapse
|
4
|
Badertscher P, Knecht S, Rosso R, Krisai P, Spreen D, Katic J, Du Fay de Lavallaz J, Sticherling C, Kühne M. How to perform pulmonary vein isolation using a pentaspline pulsed field ablation system for treatment of atrial fibrillation. Heart Rhythm 2024:S1547-5271(24)02832-7. [PMID: 38964447 DOI: 10.1016/j.hrthm.2024.06.058] [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: 06/02/2024] [Revised: 06/25/2024] [Accepted: 06/25/2024] [Indexed: 07/06/2024]
Affiliation(s)
- Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Raphael Rosso
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - David Spreen
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Josip Katic
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland; Clinic for Heart and Cardiovascular Diseases, University Hospital Split, Split, Croatia
| | - Jeanne Du Fay de Lavallaz
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Basel, Switzerland.
| |
Collapse
|
5
|
Rosso R. Catheter ablation guided by intracardiac echocardiography: The "ICE" age during global warming. Heart Rhythm 2024:S1547-5271(24)02813-3. [PMID: 38925333 DOI: 10.1016/j.hrthm.2024.06.039] [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: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Raphael Rosso
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
6
|
Papadopoulos CH, Kadoglou NPE, Theodosis-Georgilas A, Karabinos I, Loizos S, Papadopoulos KG, Chrysocheris M, Ninios V, Frogoudaki A, Drakopoulou M, Angelaki M, Rallidis L, Kassinos N, Sahpekidis V, Makavos G, Yiangou K, Karagiannis S, Zois N, Patrianakos A, Ikonomidis I, Tsiapras D, Kouris N, Aggeli K, Pappas K, Prappa E, Stefanidis A. Transoesophageal echocardiography beyond the echo-laboratory. An expert consensus paper of the working group of echocardiography of the hellenic society of cardiology. Hellenic J Cardiol 2024:S1109-9666(24)00128-3. [PMID: 38901557 DOI: 10.1016/j.hjc.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 06/09/2024] [Accepted: 06/12/2024] [Indexed: 06/22/2024] Open
Abstract
Transoesophageal echocardiography (TOE) is a well-established and valid imaging modality, providing more accurate and of higher quality information than transthoracic echocardiography (TTE) for several specific diagnoses and recently a useful guide of an increasing number of catheter-based and surgical interventions. The present paper represents an effort by the Echocardiography Working Group (WG) of the Hellenic Society of Cardiology to state the essential steps of the TOE exam performed beyond the echo lab: a) in the operating rooms intraoperatively during either transcatheter interventions, or cardiothoracic surgery and b) in the intensive care unit for critically ill patients' monitoring. This paper includes information and tips and tricks about the pre-procedural evaluation, the procedural echocardiographic guidance, and post-procedural evaluation of the result and potential complications.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Vlasis Ninios
- 2nd Cardiology Department, Interbalkan Center, Thessaloniki, Greece
| | | | - Maria Drakopoulou
- 1st Cardiology Department, Hippokration University Hospital, Athens, Greece
| | - Maria Angelaki
- 1st Cardiology Department, Korgialenio - Benakio Red Cross Hospital, Athens, Greece
| | | | | | | | | | | | | | - Nikolaos Zois
- Private Practice, Cardiology Department, University Hospital of Ioannina, Greece
| | | | | | - Dimitrios Tsiapras
- 2nd Cardiology Department, Onassis Cardiosurgical Center, Piraeus, Greece
| | | | - Konstantina Aggeli
- 1st Cardiology Department, Hippokration University Hospital, Athens, Greece
| | | | - Efstathia Prappa
- Cardiology Department, General Hospital of Evaggelismos, Athens, Greece
| | | |
Collapse
|
7
|
Ahn H, Lim HE, On YK, Selma JM, Kueffer FJ, van Bragt KA, Obidigbo V, Oh IY. Long-term Outcome of Cryoballoon Ablation in Korean Patients With Atrial Fibrillation: Real-world Experience From the Cryo Global Registry. Korean Circ J 2024; 54:54.e62. [PMID: 38956935 DOI: 10.4070/kcj.2024.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/05/2024] [Accepted: 05/07/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Atrial fibrillation (AF), the most common atrial arrhythmia (AA), is an increasing healthcare burden in Korea. The objective of this sub-analysis of the Cryo Global Registry was to evaluate long-term efficacy, symptom burden, quality of life (QoL), and healthcare utilization outcomes and factors associated with AA recurrence in Korean patients treated with cryoballoon ablation (CBA). METHODS Patients were treated and followed up according to local standard-of-care in 3 Korean hospitals. Kaplan-Meier estimates were used in analyzing (1) efficacy defined as freedom from ≥30 second recurrence of AA at 24 months, (2) healthcare utilization, and (3) predictors of 24-month AA recurrence. Patient-reported QoL (using European Quality of Life-5 Dimensions-3 Levels) and predefined AF-related symptoms were assessed at baseline and 24-month follow-up. RESULTS Efficacy was 71.9% in paroxysmal AF (PAF) and 49.3% in persistent AF (PsAF) patients (p<0.01). A larger left atrial diameter (LAD), an increased time from AF diagnosis to CBA, and PsAF were independent predictors of AA recurrence. The percentage of patients with no AF symptoms significantly increased from baseline (24.5%) to 24-month (89.5%) follow-up (p<0.01). Improvement in QoL from baseline to 24 months was not statistically different between AF cohorts. PAF patients experienced greater freedom from repeat ablations (93.9% vs. 81.4%) and cardiovascular hospitalizations (91.3% vs. 72.5%, p<0.001 for both). CONCLUSIONS In alignment with global outcomes, CBA is an effective treatment for AF in the Korean population, with patients possessing a large LAD and not receiving ablation soon after diagnosis being the most at risk for AA recurrence. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02752737.
Collapse
Affiliation(s)
- Houngbeom Ahn
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hong Euy Lim
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Young Keun On
- Division of Cardiology, Department of Medicine, Cardiac Arrhythmia Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jada M Selma
- Cardiac Ablation Solutions, Medtronic, Inc., Minneapolis, MN, USA
| | - Fred J Kueffer
- Cardiac Ablation Solutions, Medtronic, Inc., Minneapolis, MN, USA
| | | | | | - Il-Young Oh
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
| |
Collapse
|
8
|
Ma C, Wu S, Liu S, Han Y. Chinese guidelines for the diagnosis and management of atrial fibrillation. Pacing Clin Electrophysiol 2024; 47:714-770. [PMID: 38687179 DOI: 10.1111/pace.14920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 11/30/2023] [Indexed: 05/02/2024]
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, significantly impacting patients' quality of life and increasing the risk of death, stroke, heart failure, and dementia. Over the past two decades, there have been significant breakthroughs in AF risk prediction and screening, stroke prevention, rhythm control, catheter ablation, and integrated management. During this period, the scale, quality, and experience of AF management in China have greatly improved, providing a solid foundation for the development of the guidelines for the diagnosis and management of AF. To further promote standardized AF management, and apply new technologies and concepts to clinical practice timely and fully, the Chinese Society of Cardiology of Chinese Medical Association and the Heart Rhythm Committee of Chinese Society of Biomedical Engineering jointly developed the Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation. The guidelines comprehensively elaborated on various aspects of AF management and proposed the CHA2DS2‑VASc‑60 stroke risk score based on the characteristics of the Asian AF population. The guidelines also reevaluated the clinical application of AF screening, emphasized the significance of early rhythm control, and highlighted the central role of catheter ablation in rhythm control.
Collapse
Affiliation(s)
- Changsheng Ma
- Chinese Society of Cardiology, Chinese Medical Association, Heart Rhythm Committee of Chinese Society of Biomedical Engineering, Beijing, China
| | - Shulin Wu
- Chinese Society of Cardiology, Chinese Medical Association, Heart Rhythm Committee of Chinese Society of Biomedical Engineering, Beijing, China
| | - Shaowen Liu
- Chinese Society of Cardiology, Chinese Medical Association, Heart Rhythm Committee of Chinese Society of Biomedical Engineering, Beijing, China
| | - Yaling Han
- Chinese Society of Cardiology, Chinese Medical Association, Heart Rhythm Committee of Chinese Society of Biomedical Engineering, Beijing, China
| |
Collapse
|
9
|
Hu T, Chen T, Maduray K, Han W, Zhong J. Intracardiac Echocardiography: An Invaluable Tool in Electrophysiological Interventions for Atrial Fibrillation and Supraventricular Tachycardia. Rev Cardiovasc Med 2024; 25:191. [PMID: 39076314 PMCID: PMC11270097 DOI: 10.31083/j.rcm2506191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 07/31/2024] Open
Abstract
Researchers have investigated ways to develop optimal imaging techniques to increase the safety and effectiveness of electrophysiological (EP) procedures. Intracardiac echocardiography (ICE) is an advanced imaging tool that can directly visualize cardiac anatomical structures in high resolution, assess tissue heterogeneity and arrhythmogenic substrates, locate intracardiac catheters, monitor catheter-tissue contact and ablation injury in real-time, excluding intracardiac thrombi, and quickly detect procedural complications. Additionally, real-time imaging via ICE can be integrated with a three-dimensional (3D) electroanatomical mapping (EAM) system to reconstruct cardiac anatomy. This technique also promotes the development of zero-radiation EP procedures. Many EP studies and procedures have implemented ICE because it has several advantages over fluoroscopy and transesophageal echocardiography (TEE). ICE-guided EP procedures can be performed under conscious sedation; esophageal intubation and additional anesthesiologists are not required. Atrial fibrillation (AF) and supraventricular tachycardias (SVT) are the most common tachyarrhythmias in clinical settings. A comprehensive understanding of critical anatomical structures, such as the atrial septum, fossa ovalis (FO), and great heart vessels, is needed for the successful catheter ablation of these arrhythmias.
Collapse
Affiliation(s)
- Tong Hu
- National Key Laboratory for Innovation and Transformation of Luobing
Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research,
Chinese Ministry of Education, Chinese National Health Commission and Chinese
Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong
University, 250012 Jinan, Shandong, China
| | - Tongshuai Chen
- National Key Laboratory for Innovation and Transformation of Luobing
Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research,
Chinese Ministry of Education, Chinese National Health Commission and Chinese
Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong
University, 250012 Jinan, Shandong, China
| | - Kellina Maduray
- National Key Laboratory for Innovation and Transformation of Luobing
Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research,
Chinese Ministry of Education, Chinese National Health Commission and Chinese
Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong
University, 250012 Jinan, Shandong, China
| | - Wenqiang Han
- National Key Laboratory for Innovation and Transformation of Luobing
Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research,
Chinese Ministry of Education, Chinese National Health Commission and Chinese
Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong
University, 250012 Jinan, Shandong, China
| | - Jingquan Zhong
- National Key Laboratory for Innovation and Transformation of Luobing
Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research,
Chinese Ministry of Education, Chinese National Health Commission and Chinese
Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong
University, 250012 Jinan, Shandong, China
- Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of
Medicine, Shandong University, 266035 Qingdao, Shandong, China
| |
Collapse
|
10
|
Osorio J, Miranda-Arboleda AF, Velasco A, Varley AL, Rajendra A, Morales GX, Hoyos C, Matos C, Thorne C, D'Souza B, Silverstein JR, Metzl MD, Hebsur S, Costea AI, Kang S, Sellers M, Singh D, Salam T, Nazari J, Ro AS, Mazer S, Moretta A, Oza SR, Magnano AR, Sackett M, Dukes J, Patel P, Goyal SK, Senn T, Newton D, Romero JE, Zei PC. Real-world data of radiofrequency catheter ablation in paroxysmal atrial fibrillation: Short- and long-term clinical outcomes from the prospective multicenter REAL-AF Registry. Heart Rhythm 2024:S1547-5271(24)02524-4. [PMID: 38768839 DOI: 10.1016/j.hrthm.2024.04.090] [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: 04/11/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND The safety and long-term efficacy of radiofrequency (RF) catheter ablation (CA) of paroxysmal atrial fibrillation (PAF) has been well established. Contemporary techniques to optimize ablation delivery, reduce fluoroscopy use, and improve clinical outcomes have been developed. OBJECTIVE The purpose of this study was to assess the contemporary real-world practice approach and short and long-term outcomes of RF CA for PAF through a prospective multicenter registry. METHODS Using the REAL-AF (Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation; ClincalTrials.gov Identifier: NCT04088071) Registry, patients undergoing RF CA to treat PAF across 42 high-volume institutions and 79 experienced operators were evaluated. The procedures were performed using zero or reduced fluoroscopy, contact force sensing catheters, wide area circumferential ablation, and ablation index as a guide with a target of 380-420 for posterior and 500-550 for anterior lesions. The primary efficacy outcome was freedom from all-atrial arrhythmia recurrence at 12 months. RESULTS A total of 2470 patients undergoing CA from January 2018 to December 2022 were included. Mean age was 65.2 ±11.14 years, and 44% were female. Most procedures were performed without fluoroscopy (71.5%), with average procedural and total RF times of 95.4 ± 41.7 minutes and 22.1±11.8 minutes, respectively. At 1-year follow-up, freedom from all-atrial arrhythmias was 81.6% with 89.7% of these patients off antiarrhythmic drugs. No significant difference was identified comparing pulmonary vein isolation vs pulmonary vein isolation plus ablation approaches. The complication rate was 1.9%. CONCLUSION Refinement of RF CA to treat PAF using contemporary tools, standardized protocols, and electrophysiology laboratory workflows resulted in excellent short- and long-term clinical outcomes.
Collapse
Affiliation(s)
- Jose Osorio
- HCA Electrophysiology, Mercy Hospital, Miami, Florida
| | | | - Alejandro Velasco
- University of Texas Health Sciences Center at San Antonio, San Antonio, Texas
| | | | - Anil Rajendra
- Arrhythmia Institute at Grandview, Birmingham, Alabama
| | | | | | - Carlos Matos
- Brigham and Women`s Hospital, Boston, Massachusetts
| | | | - Benjamin D'Souza
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | | | - Steven Kang
- Sutter Alta Bates Summit Medical Center, Oakland, California
| | | | | | - Tariq Salam
- Pulse Heart Institute/Multicare, Tacoma, Washington
| | | | | | - Sean Mazer
- New Mexico Heart Institute, Albuquerque, New Mexico
| | | | | | | | | | | | - Parin Patel
- Ascension Medical Group, Indianapolis, Indiana
| | | | | | | | | | - Paul C Zei
- Brigham and Women`s Hospital, Boston, Massachusetts.
| |
Collapse
|
11
|
Vio R, Forlin E, China P. Recurrences after Pulsed Field Ablation of Atrial Fibrillation: Incidence, Mechanisms, Predictors, and Comparison with Thermal Energy. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:817. [PMID: 38793000 PMCID: PMC11123187 DOI: 10.3390/medicina60050817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/12/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
Pulsed Field Ablation (PFA) is the latest and most intriguing technology for catheter ablation of atrial fibrillation, due to its capability to generate irreversible and cardiomyocytes-selective electroporation of cell membranes by delivering microsecond-lasting high-voltage electrical fields, leading to high expectations. The first trials to assess the clinical success of PFA, reported an arrhythmia-free survival at 1-year of 78.5%, while other trials showed less enthusiastic results: 66.2% in paroxysmal and 55.1% in persistent AF. Nevertheless, real world data are encouraging. The isolation of pulmonary veins with PFA is easily achieved with 100% acute success. Systematic invasive remapping showed a high prevalence of durable pulmonary vein isolation at 75 and 90 days (range 84-96%), which were significatively lower in redo procedures (64.3%). The advent of PFA is prompting a reconsideration of the role of the autonomic nervous system in AF ablation, as PFA-related sparing of the ganglionated plexi could lead to the still undetermined effect on late arrhythmias' recurrences. Moreover, a new concept of a blanking period could be formulated with PFA, according to its different mechanism of myocardial injury, with less inflammation and less chronic fibrosis. Finally, in this review, we also compare PFA with thermal energy.
Collapse
Affiliation(s)
- Riccardo Vio
- Department of Cardiothoracic, Vascular Medicine and Intensive Care, Dell’Angelo Hospital, 30174 Mestre-Venice, Italy; (E.F.); (P.C.)
| | - Enrico Forlin
- Department of Cardiothoracic, Vascular Medicine and Intensive Care, Dell’Angelo Hospital, 30174 Mestre-Venice, Italy; (E.F.); (P.C.)
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Paolo China
- Department of Cardiothoracic, Vascular Medicine and Intensive Care, Dell’Angelo Hospital, 30174 Mestre-Venice, Italy; (E.F.); (P.C.)
| |
Collapse
|
12
|
Rai R, Singh V, Ahmad Z, Jain A, Jat D, Mishra SK. Autonomic neuronal modulations in cardiac arrhythmias: Current concepts and emerging therapies. Physiol Behav 2024; 279:114527. [PMID: 38527577 DOI: 10.1016/j.physbeh.2024.114527] [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: 02/19/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 03/27/2024]
Abstract
The pathophysiology of atrial fibrillation and ventricular tachycardia that result in cardiac arrhythmias is related to the sustained complicated mechanisms of the autonomic nervous system. Atrial fibrillation is when the heart beats irregularly, and ventricular arrhythmias are rapid and inconsistent heart rhythms, which involves many factors including the autonomic nervous system. It's a complex topic that requires careful exploration. Cultivation of speculative knowledge on atrial fibrillation; the irregular rhythm of the heart and ventricular arrhythmias; rapid oscillating waves resulting from mistakenly inconsistent P waves, and the inclusion of an autonomic nervous system is an inconceivable approach toward clinical intricacies. Autonomic modulation, therefore, acquires new expansions and conceptions of appealing therapeutic intelligence to prevent cardiac arrhythmia. Notably, autonomic modulation uses the neural tissue's flexibility to cause remodeling and, hence, provide therapeutic effects. In addition, autonomic modulation techniques included stimulation of the vagus nerve and tragus, renal denervation, cardiac sympathetic denervation, and baroreceptor activation treatment. Strong preclinical evidence and early human studies support the annihilation of cardiac arrhythmias by sympathetic and parasympathetic systems to transmigrate the cardiac myocytes and myocardium as efficient determinants at the cellular and physiological levels. However, the goal of this study is to draw attention to these promising early pre-clinical and clinical arrhythmia treatment options that use autonomic modulation as a therapeutic modality to conquer the troublesome process of irregular heart movements. Additionally, we provide a summary of the numerous techniques for measuring autonomic tone such as heart rate oscillations and its association with cutaneous sympathetic nerve activity appear to be substitute indicators and predictors of the outcome of treatment.
Collapse
Affiliation(s)
- Ravina Rai
- Department of Zoology, School of Biological Sciences, Dr. Harisingh Gour Central University, Sagar 470003 MP, India
| | - Virendra Singh
- School of Biochemical Engineering, Indian Institute of Technology (Banaras Hindu University), Varanasi 221005 UP, India
| | - Zaved Ahmad
- Department of Zoology, School of Biological Sciences, Dr. Harisingh Gour Central University, Sagar 470003 MP, India
| | - Abhishek Jain
- Sanjeevani Diabetes and Heart Care Centre, Shri Chaitanya Hospital, Sagar, 470002, MP, India
| | - Deepali Jat
- Department of Zoology, School of Biological Sciences, Dr. Harisingh Gour Central University, Sagar 470003 MP, India.
| | | |
Collapse
|
13
|
Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2024:S1547-5271(24)00261-3. [PMID: 38597857 DOI: 10.1016/j.hrthm.2024.03.017] [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: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society.
Collapse
Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece.
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil; Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France; Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain; Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Case Western Reserve University, Cleveland, OH, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA; Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| |
Collapse
|
14
|
Gardziejczyk P, Piotrowski R, Kryński T, Sikorska A, Kułakowski P, Baran J. Bipolar catheter ablation with dedicated radiofrequency system for highly refractory ventricular arrhythmia-Does the rate of success depend on arrhythmia origin? J Cardiovasc Electrophysiol 2024; 35:667-674. [PMID: 38293729 DOI: 10.1111/jce.16186] [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: 07/04/2023] [Revised: 11/28/2023] [Accepted: 01/06/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Despite rapid technological progress, some arrhythmias are still resistant to standard unipolar ablation. These include arrhythmias arising from the base of the heart, cardiac crux, or epicardium. Bipolar radiofrequency ablation (B-RFA) may be useful in some cases, however, data on the efficacy of this approach in various arrhythmia localizations are scarce. The aim of this study was to assess the efficacy of B-RFA in patients with ventricular arrhythmias originating from various locations, occurring refractory to standard unipolar ablation approaches. METHODS An observational, single center study was conducted over a 30-month period. B-RFA were performed using dedicated radio frequency (RF) generator and electroanatomic mapping system. RESULTS Twenty-four procedures, in 23 patients with a median (range) of 1 (1-2) previously failed unipolar ablation procedures, were included in the final analysis. There were 12 ablations of ventricular arrhythmias originating from interventricular septum with an acute success rate of 75%, and 12 from left ventricular (LV) summit with an acute success rate of 58%. The midterm success rate (median interquartile range follow-up of 205 days [188-338]) was 66% and 50%, respectively. CONCLUSIONS B-RFA is a promising method of catheter ablation for refractory cardiac arrhythmias. A higher success rate was observed in ablation for difficult ventricular arrhythmias originating from interventricular septal region than LV summit.
Collapse
Affiliation(s)
- Piotr Gardziejczyk
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Roman Piotrowski
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Tomasz Kryński
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Agnieszka Sikorska
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Piotr Kułakowski
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Jakub Baran
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| |
Collapse
|
15
|
Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Sepehri Shamloo A, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O’Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2024; 26:euae043. [PMID: 38587017 PMCID: PMC11000153 DOI: 10.1093/europace/euae043] [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: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 04/09/2024] Open
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .
Collapse
Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología ‘Ignacio Chávez’, Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O’Neill
- Cardiovascular Directorate, St. Thomas’ Hospital and King’s College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| |
Collapse
|
16
|
MA CS, WU SL, LIU SW, HAN YL. Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation. J Geriatr Cardiol 2024; 21:251-314. [PMID: 38665287 PMCID: PMC11040055 DOI: 10.26599/1671-5411.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, significantly impacting patients' quality of life and increasing the risk of death, stroke, heart failure, and dementia. Over the past two decades, there have been significant breakthroughs in AF risk prediction and screening, stroke prevention, rhythm control, catheter ablation, and integrated management. During this period, the scale, quality, and experience of AF management in China have greatly improved, providing a solid foundation for the development of guidelines for the diagnosis and management of AF. To further promote standardized AF management, and apply new technologies and concepts to clinical practice in a timely and comprehensive manner, the Chinese Society of Cardiology of the Chinese Medical Association and the Heart Rhythm Committee of the Chinese Society of Biomedical Engineering have jointly developed the Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation. The guidelines have comprehensively elaborated on various aspects of AF management and proposed the CHA2DS2-VASc-60 stroke risk score based on the characteristics of AF in the Asian population. The guidelines have also reevaluated the clinical application of AF screening, emphasized the significance of early rhythm control, and highlighted the central role of catheter ablation in rhythm control.
Collapse
|
17
|
Headrick A, Ou Z, Asaki SY, Etheridge SP, Hammond B, Gakenheimer-Smith L, Pilcher T, Niu M. Intracardiac echocardiography in paediatric and congenital cardiac ablation shortens procedure duration and improves success without complications. Europace 2024; 26:euae047. [PMID: 38366154 PMCID: PMC10898927 DOI: 10.1093/europace/euae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/17/2024] [Accepted: 02/12/2024] [Indexed: 02/18/2024] Open
Abstract
AIMS Common to adult electrophysiology studies (EPSs), intracardiac echocardiography (ICE) use in paediatric and congenital heart disease (CHD) EPS is limited. The purpose of this study was to assess the efficacy of ICE use and incidence of associated complications in paediatric and CHD EPS. METHODS AND RESULTS This single-centre retrospective matched cohort study reviewed EPS between 2013 and 2022. Demographics, CHD type, and EPS data were collected. Intracardiac echocardiography cases were matched 1:1 to no ICE controls to assess differences in complications, ablation success, fluoroscopy exposure, procedure duration, and arrhythmia recurrence. Cases and controls with preceding EPS within 5 years were excluded. Intracardiac echocardiography cases without an appropriate match were excluded from comparative analyses but included in the descriptive cohort. We performed univariable and multivariable logistic regression to assess associations between variables and outcomes. A total of 335 EPS were reviewed, with ICE used in 196. The median age of ICE cases was 15 [interquartile range (IQR) 12-17; range 3-47] years, and median weight 57 [IQR 45-71; range 15-134] kg. There were no ICE-related acute or post-procedural complications. There were 139 ICE cases matched to no ICE controls. Baseline demographics and anthropometrics were similar between cases and controls. Fluoroscopy exposure (P = 0.02), procedure duration (P = 0.01), and arrhythmia recurrence (P = 0.01) were significantly lower in ICE cases. CONCLUSION Intracardiac echocardiography in paediatric and CHD ablations is safe and reduces procedure duration, fluoroscopy exposure, and arrhythmia recurrence. However, not every arrhythmia substrate requires ICE use. Thoughtful selection will ensure the judicious and strategic application of ICE to enhance outcomes.
Collapse
Affiliation(s)
- Andrew Headrick
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children’s Hospital, 81 Mario Capecchi Dr, Salt Lake City, UT 84112, USA
| | - Zhining Ou
- Department of Internal Medicine, Division of Epidemiology, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - S Yukiko Asaki
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children’s Hospital, 81 Mario Capecchi Dr, Salt Lake City, UT 84112, USA
| | - Susan P Etheridge
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children’s Hospital, 81 Mario Capecchi Dr, Salt Lake City, UT 84112, USA
| | - Benjamin Hammond
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children’s Hospital, 81 Mario Capecchi Dr, Salt Lake City, UT 84112, USA
| | - Lindsey Gakenheimer-Smith
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children’s Hospital, 81 Mario Capecchi Dr, Salt Lake City, UT 84112, USA
| | - Thomas Pilcher
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children’s Hospital, 81 Mario Capecchi Dr, Salt Lake City, UT 84112, USA
| | - Mary Niu
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children’s Hospital, 81 Mario Capecchi Dr, Salt Lake City, UT 84112, USA
| |
Collapse
|
18
|
Spartalis M, Erath JW, Mulder BA, Vandenberk B. Editorial: Rising stars in cardiac rhythmology: 2023. Front Cardiovasc Med 2024; 10:1351604. [PMID: 38268855 PMCID: PMC10806213 DOI: 10.3389/fcvm.2023.1351604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/29/2023] [Indexed: 01/26/2024] Open
Affiliation(s)
- Michael Spartalis
- 3rd Department of Cardiology, Sotiria Thoracic Diseases General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Julia W. Erath
- Division of Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, J. W. Goethe University, Frankfurt, Germany
| | - Bart A. Mulder
- Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Bert Vandenberk
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| |
Collapse
|
19
|
Shang X, Sun M, Wang Z, Jin Z, Liang M. Comparison of intracardiac vs. transesophageal echocardiography for "one-stop" procedures of combined radiofrequency catheter ablation and left atrial appendage closure with the Watchman device in the treatment of atrial fibrillation. Front Cardiovasc Med 2023; 10:1265550. [PMID: 38028460 PMCID: PMC10666739 DOI: 10.3389/fcvm.2023.1265550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Background and objective This study aimed to assess the efficacy and safety of "one-stop" procedures that combined radiofrequency catheter ablation and left atrial appendage closure (LAAC) with the Watchman device under the guidance of intracardiac echocardiography (ICE) vs. transesophageal echocardiography (TEE) in patients with atrial fibrillation. Methods and results In this study, we prospectively enrolled patients who underwent "one-stop" procedures under the guidance of ICE (n = 193, 109 men, 65.02 ± 8.47 years) or TEE (n = 109, 69 men, 64.23 ± 7.75 years) between January 2021 and October 2022. Intraprocedural thrombus formation in the left atrial appendage (LAA) was observed in 3 (1.46%) patients in the ICE group and 15 (11.63%) patients in the TEE group (P < 0.05) before LAAC. Total fluoroscopy time and dose in the ICE group were less than those in the TEE group. The total "one-stop" turnaround time and LAAC procedure time in the ICE group were significantly shorter than those in the TEE group (P < 0.05). Postoperative esophagus discomfort, nausea and vomiting, and hypotension were more often seen in the TEE group (P < 0.001). There was no significant difference in matched cases between ICE and fluoroscopy measurements (P = 0.082). The TEE results related to LAAC and clinical events were similar between the two groups during the follow-up (P > 0.05). Conclusion The ICE-guided "one-stop" procedure was safe and feasible with less radiation exposure, shorter turnaround time, and fewer complications and intraoperative thrombus formations than the TEE group. ICE offered accurate measurements in the LAA dimension during LAAC. Echocardiography during the "one-stop" procedures was necessary to rule out the intraoperative thrombus.
Collapse
Affiliation(s)
- Xining Shang
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), General Hospital of Northern Theater Command, Shenyang, China
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
- Department of Cardiology, General Hospital of Northern Theater Command of China Medical University, Shenyang, China
| | - Mingyu Sun
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), General Hospital of Northern Theater Command, Shenyang, China
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Zulu Wang
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), General Hospital of Northern Theater Command, Shenyang, China
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Zhiqing Jin
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), General Hospital of Northern Theater Command, Shenyang, China
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Ming Liang
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), General Hospital of Northern Theater Command, Shenyang, China
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| |
Collapse
|
20
|
Debreceni D, Janosi KF, Turcsan M, Toth D, Bocz B, Simor T, Kupo P. Feasibility and safety of cavotricuspid isthmus ablation using exclusive intracardiac echocardiography guidance: a proof-of-concept, observational trial. Front Cardiovasc Med 2023; 10:1244137. [PMID: 37900565 PMCID: PMC10601457 DOI: 10.3389/fcvm.2023.1244137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Catheter ablation is the preferred treatment for typical atrial flutter (AFl), but it can be challenging due to anatomical abnormalities. The use of 3D electroanatomical mapping systems (EAMS) has reduced fluoroscopy exposure during AFl ablation. Intracardiac echocardiography (ICE) has also shown benefits in reducing radiation exposure during AFl ablation. However, there is a lack of evidence on the feasibility of ICE-guided, zero-fluoroscopy AFl ablation without the use of EAMS. Methods In this prospective study, we enrolled 80 patients with CTI-dependent AFl. The first 40 patients underwent standard fluoroscopy + ICE-guided ablation (Standard ICE group), while the other 40 patients underwent zero-fluoroscopy ablation using only ICE (Zero ICE group). Procedure outcomes, including acute success, procedure time, fluoroscopy time, radiation dose, and complications, were compared between the groups. Results The acute success rate was 100% in both groups. Out of the 40 cases, the zero-fluoroscopy strategy was successfully implemented in 39 cases (97.5%) in the Zero ICE group. There were no significant differences in procedure time [55.5 (46.5; 66.8) min vs. 51.5 (44.0; 65.5), p = 0.50] and puncture to first ablation time [18 (13.5; 23) min vs. 19 (15; 23.5) min, p = 0.50] between the groups. The Zero ICE group had significantly lower fluoroscopy time [57 (36.3; 90) sec vs. 0 (0; 0) sec, p < 0.001] and dose [3.17 (2.27; 5.63) mGy vs. 0 (0; 0) mGy, p < 0.001] compared to the Standard ICE group. Total ablation time was longer in the Standard ICE group [597 (447; 908) sec vs. 430 (260; 750), p = 0.02], but total ablation energy [22,458 (14,836; 31,116) Ws vs. 17,043 (10,533; 29,302) Ws, p = 0.10] did not differ significantly. First-pass bidirectional conduction block of the CTI and acute reconnection rates were similar between the groups. No complications or recurrences were observed during the follow-up period. Conclusion Our study suggests that zero-fluoroscopy CTI ablation guided solely by ICE for AFl is feasible and safe. Further investigation is warranted for broader validation.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Peter Kupo
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
| |
Collapse
|
21
|
Tan MC, Tan JL, Lee WJ, Srivathsan K, Sorajja D, El Masry H, Scott LR, Lee JZ. Adverse events in cryoballoon ablation for pulmonary vein isolation: Insight from the Food and Drug Administration Manufacturer and User Facility Device Experience. J Arrhythm 2023; 39:784-789. [PMID: 37799789 PMCID: PMC10549805 DOI: 10.1002/joa3.12898] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/13/2023] [Accepted: 07/03/2023] [Indexed: 10/07/2023] Open
Abstract
Background Real-world clinical data on the adverse events related to the use of cryoballoon catheter for pulmonary vein isolation remains limited. Objective To report and describe the adverse events related to the use of Artic Front cryoballoon catheters (Arctic Front, Arctic Front Advance, and Arctic Front Advance Pro) reported in the Food and Drug Administration's (FDA) Manufacturers and User Defined Experience (MAUDE) database. Methods We reviewed all the adverse events reported to the FDA MAUDE database over a 10.7-year study period from January 01, 2011 to September 31, 2021. All events were independently reviewed by two physicians. Results During the study period, a total of 320 procedural-related adverse events reported in the MAUDE database were identified. The most common adverse event was transient or persistent phrenic nerve palsy (PNP), accounting for 48% of all events. This was followed by cardiac perforation (15%), pulmonary vein stenosis (8%), transient ischemic attack or stroke (6%), vascular injury (4%), transient or persistent ST-elevation myocardial infarction (3%), hemoptysis (2%), pericarditis (2%), and esophageal ulcer or fistula (1%). There were six reported intra-procedural death events as a result of cardiac perforation. Conclusion The two most common procedural adverse events associated with cryoballoon ablation were PNP and cardiac perforation. All cases of procedural mortality were due to cardiac perforation.
Collapse
Affiliation(s)
- Min Choon Tan
- Department of Cardiovascular MedicineMayo Clinic ArizonaPhoenixArizonaUSA
- Department of Internal MedicineNew York Medical College at Saint Michael's Medical CenterNewarkNew JerseyUSA
| | - Jian Liang Tan
- Department of Cardiovascular MedicineHospital of the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Wei Jun Lee
- International Medical UniversityKuala LumpurMalaysia
| | | | - Dan Sorajja
- Department of Cardiovascular MedicineMayo Clinic ArizonaPhoenixArizonaUSA
| | - Hicham El Masry
- Department of Cardiovascular MedicineMayo Clinic ArizonaPhoenixArizonaUSA
| | - Luis R. Scott
- Department of Cardiovascular MedicineMayo Clinic ArizonaPhoenixArizonaUSA
| | - Justin Z. Lee
- Department of Cardiovascular MedicineCleveland ClinicClevelandOhioUSA
| |
Collapse
|
22
|
Turcsan M, Janosi KF, Debreceni D, Toth D, Bocz B, Simor T, Kupo P. Intracardiac Echocardiography Guidance Improves Procedural Outcomes in Patients Undergoing Cavotricuspidal Isthmus Ablation for Typical Atrial Flutter. J Clin Med 2023; 12:6277. [PMID: 37834921 PMCID: PMC10573340 DOI: 10.3390/jcm12196277] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Atrial flutter (AFL) represents a prevalent variant of supraventricular tachycardia, distinguished by a macro-reentrant pathway encompassing the cavotricuspid isthmus (CTI). Radiofrequency (RF) catheter ablation stands as the favored therapeutic modality for managing recurring CTI-dependent AFL. Intracardiac echocardiography (ICE) has been proposed as a method to reduce radiation exposure during CTI ablation. This study aims to comprehensively compare procedural parameters between ICE-guided CTI ablation and fluoroscopy-only procedures. A total of 370 consecutive patients were enrolled in our single-center retrospective study. In 151 patients, procedures were performed using fluoroscopy guidance only, while 219 patients underwent ICE-guided CTI ablation. ICE guidance significantly reduced fluoroscopy time (73 (36; 175) s vs. 900 (566; 1179) s; p < 0.001), fluoroscopy dose (2.45 (0.6; 5.1) mGy vs. 40.5 (25.7; 62.9) mGy; p < 0.001), and total procedure time (70 (52; 90) min vs. 87.5 (60; 102.5) min; p < 0.001). Total ablation time (657 (412; 981) s vs. 910 (616; 1367) s; p < 0.001) and the time from the first to last ablation (20 (11; 36) min vs. 40 (25; 55) min; p < 0.01) were also significantly shorter in the ICE-guided group. Acute success rate was 100% in both groups, and no major complications occurred in either group. ICE-guided CTI ablation in patients with AFL resulted in shorter procedure times, reduced fluoroscopy exposure, and decreased ablation times, compared to the standard fluoroscopy-only approach.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Peter Kupo
- Heart Institute, Medical School, University of Pecs, Ifjusag utja 13, H-7624 Pecs, Hungary; (M.T.); (K.-F.J.); (D.D.); (D.T.); (B.B.); (T.S.)
| |
Collapse
|
23
|
Hussain S, Sohrabi C, Providencia R, Ahsan S, Papageorgiou N. Catheter Ablation for the Management of Atrial Fibrillation: An Update of the Literature. Life (Basel) 2023; 13:1784. [PMID: 37629641 PMCID: PMC10455869 DOI: 10.3390/life13081784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Catheter ablation has been shown to be more effective at maintaining sinus rhythm and improving quality of life when compared to antiarrhythmic drugs. Radiofrequency and cryoablation are two effective methods. However, catheter-only ablation strategies have not consistently produced high success rates in treating longstanding and persistent AF patients. The emerging treatment of choice for such cases is hybrid ablation, which involves a multidisciplinary and minimally invasive approach to achieve surgical ablation of the direct posterior left atrial wall in combination with endocardial catheter ablation. Studies have shown promising results for the hybrid approach when compared with catheter ablation alone, but it is not without risks. Large and randomised studies are necessary to further evaluate these strategies for managing AF.
Collapse
Affiliation(s)
- Shahana Hussain
- Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London EC1A 7BE, UK
| | - Catrin Sohrabi
- Royal Free London NHS Foundation Trust, London NW3 2QG, UK
| | - Rui Providencia
- Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London EC1A 7BE, UK
| | - Syed Ahsan
- Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London EC1A 7BE, UK
| | - Nikolaos Papageorgiou
- Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London EC1A 7BE, UK
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK
| |
Collapse
|
24
|
Raja Shariff RE, Soesanto AM, Scalia GM, Ewe SH, Izumo M, Liu L, Li WCW, Kam KKH, Fan Y, Hong GR, Kinsara AJ, Tucay ES, Oh JK, Lee APW. Echocardiographic Imaging in Transcatheter Structural Intervention: An AAE Review Paper. JACC. ASIA 2023; 3:556-579. [PMID: 37614546 PMCID: PMC10442887 DOI: 10.1016/j.jacasi.2023.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/24/2023] [Accepted: 05/27/2023] [Indexed: 08/25/2023]
Abstract
Transcatheter structural heart intervention (TSHI) has gained popularity over the past decade as a means of cardiac intervention in patients with prohibitive surgical risks. Following the exponential rise in cases and devices developed over the period, there has been increased focus on developing the role of "structural imagers" amongst cardiologists. This review, as part of a growing initiative to develop the field of interventional echocardiography, aims to highlight the role of echocardiography in myriad TSHIs available within Asia. We first discuss the various echocardiography-based imaging modalities, including 3-dimensional echocardiography, fusion imaging, and intracardiac echocardiography. We then highlight a selected list of structural interventions available in the region-a combination of established interventions alongside novel approaches-describing key anatomic and pathologic characteristics related to the relevant structural heart diseases, before delving into various aspects of echocardiography imaging for each TSHI.
Collapse
Affiliation(s)
| | - Amiliana M. Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | | | | | - Masaki Izumo
- Department of Cardiology, St Marianna University School of Medicine, Miyamae Ward, Kawasaki, Kanagawa, Japan
| | - Liwen Liu
- Department of Ultrasound, Xijing Hypertrophic Cardiomyopathy Center, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Williams Ching-Wei Li
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kevin Ka-Ho Kam
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong
| | - Yiting Fan
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Geu-Ru Hong
- Yonsei University College of Medicine, Sinchon-dong, Seodaemun-gu, Seoul, South Korea
| | - Abdulhalim Jamal Kinsara
- Ministry of National Guard—Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, COM-WR, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Edwin S. Tucay
- Philippine Heart Center, Diliman, Quezon City, Metro Manila, Philippines
| | - Jae K. Oh
- Mayo Clinic, Rochester, Minnesota, USA
| | - Alex Pui-Wai Lee
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong
| |
Collapse
|
25
|
Sommer P, Sciacca V, Anselmino M, Tilz R, Bourier F, Lehrmann H, Bulava A. Practical guidance to reduce radiation exposure in electrophysiology applying ultra low-dose protocols: a European Heart Rhythm Association review. Europace 2023; 25:euad191. [PMID: 37410906 PMCID: PMC10365833 DOI: 10.1093/europace/euad191] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023] Open
Abstract
Interventional electrophysiology offers a great variety of treatment options to patients suffering from symptomatic cardiac arrhythmia. Catheter ablation of supraventricular and ventricular tachycardia has globally evolved a cornerstone in modern arrhythmia management. Complex interventional electrophysiological procedures engaging multiple ablation tools have been developed over the past decades. Fluoroscopy enabled interventional electrophysiologist throughout the years to gain profound knowledge on intracardiac anatomy and catheter movement inside the cardiac cavities and hence develop specific ablation approaches. However, the application of X-ray technologies imposes serious health risks to patients and operators. To reduce the use of fluoroscopy during interventional electrophysiological procedures to the possibly lowest degree and to establish an optimal protection of patients and operators in cases of fluoroscopy is the main goal of modern radiation management. The present manuscript gives an overview of possible strategies of fluoroscopy reduction and specific radiation protection strategies.
Collapse
Affiliation(s)
- Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Georgstr. 11, Bad Oeynhausen 32545, Germany
| | - Vanessa Sciacca
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Georgstr. 11, Bad Oeynhausen 32545, Germany
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, ‘Citta della Salute e della Scienza di Torino’ Hospital, University of Turin, Torino, Italy
| | - Roland Tilz
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Luebeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center, Technical University, Munich, Germany
| | - Heiko Lehrmann
- Department of Cardiology and Angiology (Campus Bad Krozingen), University Hospital Freiburg, Bad Krozingen, Germany
| | - Alan Bulava
- Department of Cardiology, Ceske Budejovice Hospital and Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| |
Collapse
|
26
|
Sant`Anna RT, de Lima GG, Saffi MAL, Kruse ML, Leiria TLL. Atrial Fibrillation Ablation: Impact of Intracardiac Echocardiography in Reducing Procedure Time and Hospitalization. Arq Bras Cardiol 2023; 120:e20220306. [PMID: 37194828 PMCID: PMC10263395 DOI: 10.36660/abc.20220306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 11/07/2022] [Accepted: 02/15/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Intracardiac echocardiography (ICE) allows visualization of cardiac structures and recognition of complications during atrial fibrillation ablation (AFA). Compared to transesophageal echocardiography (TEE), ICE is less sensitive to detecting thrombus in the atrial appendage but requires minimal sedation and fewer operators, making it attractive in a resource-constrained setting. OBJECTIVE To compare 13 cases of AFA using ICE (AFA-ICE group) with 36 cases of AFA using TEE (AFA-TEE group). METHODS This is a single-center prospective cohort study. The main outcome was procedure time. Secondary outcomes: fluoroscopy time, radiation dose (mGy/cm2), major complications, and length of hospital stay in hours. The clinical profile was compared using the CHA2DS2-VASc score. A p-value <0.05 was considered a statistically significant difference between groups. RESULTS The median CHA2DS2-VASc score was 1 (0-3) in the AFA-ICE group and 1 (0-4) in the AFA-TEE group. The total procedure time was 129 ± 27 min in the AFA-ICE group and 189 ± 41 min in the AFA-TEE group (p<0.001); the AFA-ICE group received a lower dose of radiation (mGy/cm2, 51296 ± 24790 vs. 75874 ± 24293; p=0.002), despite the similar fluoroscopy time (27.48 ± 9. 79 vs. 26.4 ± 9.32; p=0.671). The median length of hospital stay did not differ; 48 (36-72) hours (AFA-ICE) and 48 (48-66) hours (AFA-TEE) (p=0.27). CONCLUSIONS In this cohort, AFA-ICE was related to shorter procedure times and less exposure to radiation without increasing the risk of complications or the length of hospital stay.
Collapse
Affiliation(s)
- Roberto Tofani Sant`Anna
- Instituto de CardiologiaPorto AlegreRSBrasil Instituto de Cardiologia , Porto Alegre , RS – Brasil
| | - Gustavo Glotz de Lima
- Instituto de CardiologiaPorto AlegreRSBrasil Instituto de Cardiologia , Porto Alegre , RS – Brasil
- Universidade Federal de Ciências da Saúde de Porto AlegrePorto AlegreRSBrasil Universidade Federal de Ciências da Saúde de Porto Alegre , Porto Alegre , RS – Brasil
| | - Marco Aurélio Lumertz Saffi
- Hospital de Clínicas de Porto AlegrePorto AlegreRSBrasil Hospital de Clínicas de Porto Alegre , Porto Alegre , RS – Brasil
| | - Marcelo Lapa Kruse
- Instituto de CardiologiaPorto AlegreRSBrasil Instituto de Cardiologia , Porto Alegre , RS – Brasil
| | - Tiago Luiz Luz Leiria
- Instituto de CardiologiaPorto AlegreRSBrasil Instituto de Cardiologia , Porto Alegre , RS – Brasil
| |
Collapse
|
27
|
Khan JA, Parmar M, Bhamare A, Agarwal S, Khosla J, Liu B, Abraham R, Khan T, Clifton S, Munir MB, DeSimone CV, Deshmukh A, Po S, Stavrakis S, Asad ZUA. Same-day discharge for left atrial appendage occlusion procedure: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2023; 34:1196-1205. [PMID: 37130436 DOI: 10.1111/jce.15914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/02/2023] [Accepted: 04/13/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Most patients undergoing a left atrial appendage occlusion (LAAO) procedure are admitted for overnight observation. A same-day discharge strategy offers the opportunity to improve resource utilization without compromising patient safety. We compared the patient safety outcomes and post-discharge complications between same-day discharge versus hospital admission (HA) (>1 day) in patients undergoing LAAO procedure. METHODS A systematic search of MEDLINE and Embase was conducted. Outcomes of interest included peri-procedural complications, re-admissions, discharge complications including major bleeding and vascular complications, ischemic stroke, all-cause mortality, and peri-device leak >5 mm. Mantel-Haenszel risk ratios (RRs) with 95% CIs were calculated. RESULTS A total of seven observational studies met the inclusion criteria. There was no statistically significant difference between same-day discharge versus HA regarding readmission (RR: 0.61; 95% confidence interval [CI]: [0.29-1.31]; p = .21), ischemic stroke after discharge (RR: 1.16; 95% CI: [0.49-2.73]), peri-device leak >5 mm (RR: 1.27; 95% CI: [0.42-3.85], and all-cause mortality (RR: 0.60; 95% CI: [0.36-1.02]). The same-day discharge study group had significantly lower major bleeding or vascular complications (RR: 0.71; 95% CI: [0.54-0.94]). CONCLUSIONS This meta-analysis of seven observational studies showed no significant difference in patient safety outcomes and post-discharge complications between same-day discharge versus HA. These findings provide a solid basis to perform a randomized control trial to eliminate any potential confounders.
Collapse
Affiliation(s)
- Jehanzeb Ahmed Khan
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Miloni Parmar
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Aditi Bhamare
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Siddharth Agarwal
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Jagjit Khosla
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Briana Liu
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Rachel Abraham
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Taha Khan
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Shari Clifton
- Robert M Bird Health Sciences Library, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Muhammad Bilal Munir
- Section of Electrophysiology, Division of Cardiology, University of California Davis, Davis, California, USA
| | | | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sunny Po
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Stavros Stavrakis
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Zain Ul Abideen Asad
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| |
Collapse
|
28
|
Pisani CF, Scanavacca M. Intracardiac Echocardiography Must Be Used in All Patients Who Underwent AF Ablation? Arq Bras Cardiol 2023; 120:e20230290. [PMID: 37341300 PMCID: PMC10263402 DOI: 10.36660/abc.20230290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Affiliation(s)
- Cristiano F. Pisani
- InCorHCFMUSPSão PauloSPBrasilUnidade Clínica de Arritmia do Instituto do Coração (InCor) do Hospital das Clínicas da FM USP (HC-FMUSP), São Paulo, SP – Brasil
| | - Mauricio Scanavacca
- InCorHCFMUSPSão PauloSPBrasilUnidade Clínica de Arritmia do Instituto do Coração (InCor) do Hospital das Clínicas da FM USP (HC-FMUSP), São Paulo, SP – Brasil
| |
Collapse
|
29
|
Chen T, Chang L, Rong B, Zhang K, Fan G, Kong J, Ling M, Kong Q, Maduray K, Zhao C, Zhong J. Combination of Intracardiac Echocardiography and Contact Force Sensing for Left Ventricular Papillary Muscle Arrhythmias. J Clin Med 2023; 12:jcm12093154. [PMID: 37176594 PMCID: PMC10179325 DOI: 10.3390/jcm12093154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/04/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVES The catheter ablation of ventricular arrhythmias (VAs) arising from the left ventricular (LV) papillary muscles (PMs) is challenging. This study sought to address whether the combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) can improve the acute and long-term ablation outcomes of left ventricular papillary muscle arrhythmias. METHODS AND RESULTS From May 2015 to August 2022, a total of thirty-three patients underwent catheter ablation for LV PM arrhythmias: VAs were located in anterolateral PMs in 11 and posteromedial PMs in 22. A combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) was used in 21 of the 33 procedures. A mean of 6.93 ± 4.91 for lesions was used per patient, comparable between the CFS/ICE and no ICE/CFS (4.90 ± 2.23 vs. 10.17 ± 5.89; p = 0.011). The mean CF achieved in the ICE/CFS group was 7.52 ± 3.31 g. Less X-ray time was used in the combination group (CFS/ICE: 165.67 ± 47.80 S vs. no ICE/CFS: 365.00 ± 183.73 S; p < 0.001). An acute success rate of 100% was achieved for the ICE/CFS group (n = 22) and 66.67% for the no ICE/CFS group (n = 8). VA recurrence at the 11.21 ± 7.21-month follow-up was 14.2% for the ICE/CFS group and 50% for the no ICE/CFS group (p = 0.04). No severe complications occurred in all patients. CONCLUSIONS The combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) could provide precise geometries of cardiac endocavitary structures and accurate contact information for the catheter during ablation, which improved acute and long-term ablation outcomes. The routine adoption of this strategy should be considered to improve the outcomes of LV PM VA ablation.
Collapse
Affiliation(s)
- Tongshuai Chen
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Lujie Chang
- Department of Pediatric Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Bing Rong
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Kai Zhang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Guanqi Fan
- Department of Radiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Jing Kong
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Mingying Ling
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Qingyu Kong
- Department of Pediatric Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Kellina Maduray
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Cuifen Zhao
- Department of Pediatric Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Jingquan Zhong
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
- Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| |
Collapse
|
30
|
Impact of Systematic Use of Intracardiac Ultrasound during Transseptal Catheterization in the Electrophysiology Laboratory. J Cardiovasc Dev Dis 2023; 10:jcdd10020062. [PMID: 36826558 PMCID: PMC9960297 DOI: 10.3390/jcdd10020062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/22/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023] Open
Abstract
AIMS To explore the impact of the use of intracardiac echocardiography (ICE) in the ablation of supraventricular arrhythmias requiring transseptal catheterization (TSC), whilst analyzing the reduction in periprocedural complications and complications specifically related to TSC. METHODS A retrospective multicenter study collecting data from consecutive atrial fibrillation (AF) and supraventricular ablation procedures that required TSC was performed in five Italian centers. Based on physician discretion, TSC was performed with or without ICE. Periprocedural complications, separating all complications from complications directly related to TSC, were collected. Independent predictors of periprocedural complications and TSC-related complications were investigated. RESULTS A total of 2181 TSCs were performed on 1862 patients at five Italian centers from 2006 to 2021, in 76% of cases by AF ablation and in 24% by ablation of other arrhythmias with a circuit in the left atrium. Overall, 1134 (52%) procedures were performed with ICE support and 1047 (48%) without ICE. A total of 67 (3.1%) complications were detected, 19 (1.7%) in the ICE group and 48 (4.6%) in the no ICE group, p < 0.001. A total of 42 (1.5%) complications directly related to TSC: 0.9% in the ICE group and 3.1% in the no ICE group (p < 0.001). The independent predictors of all complications were age (OR 1,02 95% C.I 1.00-1.05; p = 0.036), TSC with the use of ICE (OR 0.27 95% C.I 0.15-0.46; p < 0.001) and AF ablation (OR 2,25 95%C.I 1.05-4.83; p = 0.037). The independent predictors for TSC complications were age (OR 1.03 95% C.I 1.01-1.06; p = 0.013) and TSC with the use of ICE (OR 0.24 95% C.I 0.11-0.49; p < 0.001). CONCLUSIONS ICE reduced periprocedural and TSC-related complications during electrophysiological procedures for ablation of left atrial arrhythmias.
Collapse
|
31
|
Deshpande S, Sawatari H, Ahmed R, Nair RG, Khan H, Khanji MY, Somers VK, Chahal CAA, Padmanabhan D. Impact of intracardiac echocardiography on readmission morbidity and mortality following atrial fibrillation ablation. J Cardiovasc Electrophysiol 2022; 33:2496-2503. [PMID: 36128625 DOI: 10.1111/jce.15683] [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: 06/15/2022] [Revised: 09/08/2022] [Accepted: 09/17/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The use of intracardiac echocardiography (ICE) is beneficial during the ablation of atrial fibrillation (AF). Evidence is conflicting regarding the clinical impact of using ICE on arrhythmia recurrence and mortality. METHODS Patients undergoing catheter ablation of AF during 2010-2017 were identified using the International Classification of Diseases-9th and 10th Revision-Clinical Modification (ICD-9-CM and ICD-10-CM) from the Nationwide Readmissions Database. Propensity matching was used to generate a control group. Patient demographics, Charlson comorbidity indexes, time from discharge to readmission, and the reason of readmission were extracted. RESULTS From 2010 to 2017, 51 129 patients were included in the analysis out of which ICE was used in 8005 (15.7%) patients. The in-hospital mortality at readmission was significantly higher in the patients without ICE use (2.9% vs. 1.7%, p = .02). The length of stay (LOS) at readmission was significantly higher in non-ICE arm (median [interquartile range, IQR]: 3 [2-6] vs. 2 [3-5] days, p < .0001) with similar healthcare-associated cost (HAC) in both the groups (median [IQR]: US$7507.3 [4057.8-15 474.2] vs. 7339.4 [4024.8-15 191.6], p = .43). Freedom from readmission was 12% higher (hazard ratio [HR] [95% confidence interval, CI]: 0.88 [0.83-0.94], p < .0001) with the use of ICE at 90-day follow-up, which was driven by 24% reduction in heart failure (HF) at follow-up (HR [95% CI]: 0.76 [0.60-0.96], p = .02). CONCLUSIONS ICE use during AF ablation procedure reduces readmissions at 90 days by 12%, driven by a 24% decrease in HF-related admissions. The non-ICE arm showed a significantly higher LOS which offsets marginally higher HAC in the ICE arm.
Collapse
Affiliation(s)
- Saurabh Deshpande
- Department of Cardiac Electrophysiology, Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Hiroyuki Sawatari
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Raheel Ahmed
- Department of Cardiology, Northumbria Healthcare NHS Foundation Trust, Newcastle, UK
| | - Rakesh Gopinathan Nair
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Hassan Khan
- Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Mohammed Y Khanji
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Virend K Somers
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - C Anwar A Chahal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Cardiac Electrophysiology Section, Division of Cardiovascular Diseases, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Deepak Padmanabhan
- Department of Cardiac Electrophysiology, Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
32
|
Safety and feasibility of same-day discharge for catheter ablation of atrial fibrillation: a systematic review and meta-analysis. J Interv Card Electrophysiol 2022; 65:803-811. [PMID: 35147827 DOI: 10.1007/s10840-022-01145-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/31/2022] [Indexed: 12/16/2022]
Abstract
PURPOSE Most centers performing catheter ablation (CA) of atrial fibrillation (AF) admit the patients for an overnight hospital stay to monitor for post-procedure complications, but the clinical benefits of this overnight hospital admission policy have not been carefully investigated. We hypothesized that same-day discharge strategy is safe and feasible in patients with AF undergoing CA. METHODS A systematic review of studies comparing the safety of same-day discharge vs hospital admission for AF patients undergoing CA was conducted in PubMed/MEDLINE, Embase, Scopus, and Web of Science. No randomized controlled trials met the inclusion criteria; therefore, observational cohort studies were included. Mantel-Haenszel risk ratios were calculated and I2 statistics were reported for heterogeneity assessment. RESULTS A total of 8 observational studies with 10,102 patients were included. There were no statistically significant differences between same-day discharge vs hospital admission in all studied outcomes including post-discharge 30-day hospital visits (RR: 0.90; 95% CI: 0.40-2.02; p = 0.81), post-discharge vascular/bleeding complications (RR: 0.93; 95% CI: 0.46-1.88; p = 0.85), post-discharge stroke/transient ischemic attack/thromboembolism (RR: 0.70; 95% CI: 0.23-2.20; p = 0.55), and post-discharge recurrent arrhythmias (RR: 0.81; 95% CI: 0.60-1.09; p = 0.1). CONCLUSION In carefully selected AF patients undergoing CA, same-day discharge strategy is feasible and safe. There are no significant differences in post-discharge 30-day hospital visits, post-discharge vascular complications, and other safety outcomes. Randomized trials are needed to validate these hypothesis-generating findings.
Collapse
|
33
|
Khalaph M, Sommer P, Lucas P, Guckel D, Fink T, Sciacca V, Hamriti ME, Imnadze G, Braun M, Sohns C, Bergau L. First clinical experience using a visualized sheath for atrial fibrillation ablation. Pacing Clin Electrophysiol 2022; 45:922-929. [PMID: 35716400 DOI: 10.1111/pace.14555] [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: 04/25/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Recently, a novel steerable sheath allowing its real-time visualization within a 3D-mapping system was introduced to facilitate atrial fibrillation (AF) ablation. AIM This study aimed to assess safety and efficacy of AF ablation using the visualized sheath and to compare its performance with a matched control group of patients who received ablation with conventional and non-visualized sheaths. METHODS The study included consecutive patients between 09/2019 and 02/2021 who underwent routine AF ablation using the visualized sheath. Patients were regularly followed-up in our outpatient's clinic. Arrhythmia recurrence was defined as any atrial fibrillation (AF)/ atrial tachycardia (AT) episode lasting > 30 s after a blanking period of 3 months. RESULTS A total number of 100 patients undergoing ablation using the visualized sheath were compared to a group of 99 matched patients. No major complications were observed. Total procedure duration (108 ± 22 min vs. 112 ± 12 min; p = 0.045), fluoroscopy time (7 ± 3 min vs. 10 ± 5 min; p < 0.001) and -dose (507 ± 501 cGy*cm2 vs. 783 ± 433 cGy*cm2 ; p < 0.001) were significantly lower using the visualized sheath. The benefit in terms of procedure duration was mainly driven by a shortened left atrial dwell time (73 ± 13 min vs. 79 ± 12 min; p = 0.001). During a mean follow-up of 12 months, the overall procedural success was 85% in the visualized sheath group versus 83% in the control group (p = 0.948). CONCLUSION AF ablation using the novel visualized sheath is safe and effective and leads to a measurable decrease of procedure duration and radiation exposure. The integration of the novel sheath might help to further improve safety and efficacy of AF ablation.
Collapse
Affiliation(s)
- Moneeb Khalaph
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bochum, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bochum, Germany
| | - Philipp Lucas
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bochum, Germany
| | - Denise Guckel
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bochum, Germany
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bochum, Germany
| | - Vanessa Sciacca
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bochum, Germany
| | - Mustapha El Hamriti
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bochum, Germany
| | - Guram Imnadze
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bochum, Germany
| | - Martin Braun
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bochum, Germany
| | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bochum, Germany
| | - Leonard Bergau
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bochum, Germany
| |
Collapse
|
34
|
Ho RT. Does applying ICE make the pain better? J Cardiovasc Electrophysiol 2022; 33:2048-2049. [PMID: 35711035 DOI: 10.1111/jce.15601] [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: 06/05/2022] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Reginald T Ho
- Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| |
Collapse
|
35
|
Weng S, Tang M, Zhou B, Ding L, Yu F, Qi Y, Zhang H, Jia Y, Hua W, Zhang S. Spatial Distribution of Idiopathic Ventricular Arrhythmias Originating Around the Pulmonary Root: Lessons From Intracardiac Echocardiography. JACC Clin Electrophysiol 2022; 8:665-676. [PMID: 35589180 DOI: 10.1016/j.jacep.2022.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/18/2022] [Accepted: 01/23/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the spatial distribution of ventricular arrhythmias (VAs) and their relationship with anatomic landmarks in the right ventricular outflow tract (RVOT). BACKGROUND Although controversy has mainly focused on whether VAs ablated in the RVOT originate above or below the pulmonary sinus, little is known about their actual distribution. METHODS We performed mapping and ablation in the reconstructed RVOT using intracardiac echocardiography (ICE) and summarized the spatial electroanatomic characteristics of RVOT-VAs. RESULTS A total of 50 VAs were recruited and were distributed among the 3 subregions: the pulmonary sinuses (19 of 50, 38%), sinus junctions (18 of 50, 36%), and infundibulum (13 of 50, 26%). In total, 70% (35 of 50) of ablation targets were within 10 mm (mean 4.3 ± 2.7 mm) of the pulmonary valve hinge point. An ablation target with both amplitude ≤1.14 mV and duration ≥101.5 milliseconds predicted an origin above the pulmonary sinus with a sensitivity of 84.2% and specificity of 84.4%. For the ablation targets (13 of 50, 26%) located in the infundibulum of the RVOT, 4 were surrounded by trabeculations, whereas only 1 ablation target in the sinus junction abutted the trabeculation (30.8% vs 5.6%). CONCLUSIONS Ablation targets of RVOT-VAs were mainly distributed around the hinge point of the pulmonary valve and the trabeculation of the infundibulum. ICE can clearly and precisely locate those anatomic landmarks of the RVOT.
Collapse
Affiliation(s)
- Sixian Weng
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Min Tang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China.
| | - Bin Zhou
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Lei Ding
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Fengyuan Yu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Yingjie Qi
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Hongda Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Yuhe Jia
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Wei Hua
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Shu Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| |
Collapse
|
36
|
Alyesh D, Choe W, Demo H, Razminia M, Sundaram S. The Advanced Application of Intracardiac Echocardiography for Cardiac Electrophysiology Ablation Procedures. Curr Cardiol Rep 2022; 24:505-511. [PMID: 35260997 DOI: 10.1007/s11886-022-01672-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The advanced use of intracardiac echocardiography (ICE) is both a significant leap forward and an underutilized and unrealized innovation for electrophysiological (EP) procedures [1]. ICE can inform operators of complex anatomic heterogeneity as well as close anatomic relationships beyond fluoroscopy and even electroanatomic mapping. We will review the myriad advantages of advanced ICE application to EP ablation procedures. RECENT FINDINGS While 3D mapping has significantly advanced diagnosis and treatment efficiency for ablation procedures quite rapidly, widespread adoption of advanced ICE techniques beyond a supplemental technology has not been as swift. The advanced application of ICE has the ability to vastly improve the safety of EP procedures while reducing or eliminating required fluoroscopic guidance in many aspects [2]. The advanced application of ICE offers many opportunities to improve procedural efficacy and safety. Further research should focus on quantifying these benefits and understanding how best to disseminate these techniques for broader electrophysiological practice.
Collapse
Affiliation(s)
- Daniel Alyesh
- South Denver Cardiology Associates, Littleton, CO, USA.
| | - William Choe
- South Denver Cardiology Associates, Littleton, CO, USA
| | - Hany Demo
- Swedish Covenant Hospital, 5140 North California Avenue Suite 780, Chicago, IL, 60625, USA
| | - Mansour Razminia
- Amita Health-Elign Campus, 1975 Lin Lor Lane, Suite 155, Elgin, IL, 60123, USA
| | - Sri Sundaram
- South Denver Cardiology Associates, Littleton, CO, USA
| |
Collapse
|
37
|
Xu J, Gao Y, Liu C, Wang Y. Radiofrequency ablation for treatment of atrial fibrillation with the use of intracardiac echocardiography vs without intracardiac echocardiography: A meta-analysis of observational and randomized studies. J Cardiovasc Electrophysiol 2022; 33:897-907. [PMID: 35212079 DOI: 10.1111/jce.15423] [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: 11/13/2021] [Revised: 01/24/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
AIMS Intracardiac echocardiography (ICE) provides superior quality images and can monitor catheter location within the heart continuously. Given the limited evidence, we conducted the meta-analysis to evaluate outcomes with ICE in radiofrequency (RF) ablation of atrial fibrillation (AF). METHODS AND RESULTS PubMed/MEDLINE, Embase and Cochrane were searched for studies reporting RF ablation for treatment of AF with the use of ICE vs without ICE and 12 studies were included. Sensitivity analyses limiting studies to ablation with the use of contact force (CF) catheters were conducted and subgroup analyses were performed according to the published year. In main analyses, RF ablation with ICE for treatment of AF was associated with significant reduction in total X-ray time (MD, -9.80; 95% CI, -15.57 to -4.04; I2 =99%; p <0.01), total procedure time (MD, -17.65; 95% CI, -30.22 to -5.09; I2 =89%; p <0.01), and complications (RR, 0.90; 95% CI, 0.87 to 0.92; I2 =20%; p<0.01) vs without ICE. The ICE-guided group tended to decrease total absorbed X-ray dose (SMD, -0.91; 95% CI, -1.86 to 0.04; I2 =96%; p =0.06). Freedom from arrhythmia (RR, 1.06; 95% CI, 0.98 to 1.14; I2 =0%; p =0.13) was comparable between the two groups. CONCLUSION In patients with AF, ICE-guided RF ablation is correlated with significant reductions in total X-ray time, total procedure time, and complications vs ablation without ICE. Total absorbed X-ray dose tends to reduce in the ICE group and freedom from arrhythmia is comparable between the two groups. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Jingmiao Xu
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Cardiovascular Key Lab of Zhejiang Province, Hangzhou, China
| | - Ying Gao
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Cardiovascular Key Lab of Zhejiang Province, Hangzhou, China
| | - Chunhui Liu
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Cardiovascular Key Lab of Zhejiang Province, Hangzhou, China
| | - Yaping Wang
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Cardiovascular Key Lab of Zhejiang Province, Hangzhou, China
| |
Collapse
|
38
|
Kowlgi GN, Siontis KC. Safety of Catheter Ablation in Obese Patients: Less Complicated than you Think. J Cardiovasc Electrophysiol 2022; 33:664-666. [PMID: 35118744 DOI: 10.1111/jce.15394] [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] [Received: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 11/28/2022]
Abstract
Cardiac arrhythmias affect over 2% of the population with an incidence of 0.5% per year, highlighting the growing scope of the problem. This article is protected by copyright. All rights reserved.
Collapse
|
39
|
Bertini M, Pompei G, Tolomeo P, Malagù M, Fiorio A, Balla C, Vitali F, Rapezzi C. Zero-Fluoroscopy Cardiac Ablation: Technology Is Moving Forward in Complex Procedures—A Novel Workflow for Atrial Fibrillation. BIOLOGY 2021; 10:biology10121333. [PMID: 34943247 PMCID: PMC8698328 DOI: 10.3390/biology10121333] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/04/2021] [Accepted: 12/13/2021] [Indexed: 12/01/2022]
Abstract
Simple Summary Electrophysiological procedures are mainly performed using fluoroscopy, exposing both healthcare staff and patients to a non-negligible dose of radiation. To date, simple ablation procedures have often been approached with zero fluoroscopy. In complex ablation procedures, such as atrial fibrillation (AF) ablation, zero fluoroscopy is still challenging mainly because of transseptal puncture. We report a workflow to perform a complete zero-fluoroscopy AF ablation using a 3D electro-anatomical mapping system, intracardiac echocardiography and a novel steerable guiding sheath visible on the mapping system. We describe two cases, one with paroxysmal AF and the other with persistent AF during which this novel workflow was successfully applied with complete zero-fluoroscopy exposure and achieving pulmonary vein isolation. Abstract Background and Rationale. A fluoroscopy-based approach to an electrophysiological procedure is widely validated and has been recognized as the gold standard for a long time. The use of fluoroscopy exposes both the healthcare staff and the patient to a non-negligible dose of radiation. To minimize the risks associated with the use of fluoroscopy, it would be reasonable to perform ablation procedures with zero fluoroscopy. This approach is widely used in simple ablation procedures, but not in complex procedures. In atrial fibrillation (AF) ablation procedures, fluoroscopy remains the main technology used, in particular to guide the transseptal puncture. Main results and Implications. We present a workflow to perform a complete zero-fluoroscopy ablation for AF ablation procedures using a 3D electro-anatomical mapping system, intracardiac echocardiography and a novel steerable guiding sheath that can be visualized on the mapping system. We present two cases, one with paroxysmal AF and the other one with persistent AF during which we applied this novel workflow achieving a successful pulmonary vein isolation without complications and complete zero-fluoroscopy exposure.
Collapse
Affiliation(s)
- Matteo Bertini
- Correspondence: ; Tel.: +39-0532236269; Fax: +39-0532236593
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Sánchez‐Millán PJ, Gutiérrez‐Ballesteros G, Molina‐Lerma M, Macías‐Ruiz R, Jiménez‐Jáimez J, Tercedor L, Álvarez M. Ablation with zero-fluoroscopy of premature ventricular complexes from aortic sinus cusps: A single-center experience. J Arrhythm 2021; 37:1497-1505. [PMID: 34887954 PMCID: PMC8637083 DOI: 10.1002/joa3.12642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/04/2021] [Accepted: 09/22/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Catheter ablation of premature ventricular complexes from aortic sinus cusps (ASC-PVC) is a complex procedure that conventionally requires coronary catheterization (CC) to localize coronary artery ostium (CAO). Little published information is available on the mapping and ablation with zero-fluoroscopy (ZF) of ASC-PVC. The aim of the study was to determine the efficacy and safety of ASC-PVC ablation with a ZF approach guided by 3D intracardiac echocardiography integration in the electroanatomical mapping system (ICE 3D-EAM). METHODS This observational study included one patient cohort treated conventionally and another treated with ICE 3D-EAM-guided ZF ablation. Clinical, efficacy, and safety outcomes were evaluated acutely and at 3 months follow-up. RESULTS The study included 21 patients with ASC-PVC: 10 in the ZF group (age 49 ± 16 years, 60% males) and 11 in the control group (age 47 ± 15 years, 27% males). Fluoroscopy was not required for any patient in the ZF group. Acute success was obtained in 80% of the ZF group vs 55% of the control group (P = .36). The recurrence rate was 30% in the ZF group vs 27% in the control group (P = 1). One nonsevere complication was observed in the ZF group (P = .48). CONCLUSIONS ZF catheter ablation of ASC-PVC guided by ICE 3D-EAM is feasible, effective, and safe.
Collapse
Affiliation(s)
- Pablo J. Sánchez‐Millán
- Arrhythmia UnitHospital Universitario Virgen de las NievesGranadaSpain
- Instituto de investigación biosanitaria de Granada (FIBAO)GranadaSpain
| | - Guillermo Gutiérrez‐Ballesteros
- Arrhythmia UnitHospital Universitario Virgen de las NievesGranadaSpain
- Instituto de investigación biosanitaria de Granada (FIBAO)GranadaSpain
| | - Manuel Molina‐Lerma
- Arrhythmia UnitHospital Universitario Virgen de las NievesGranadaSpain
- Instituto de investigación biosanitaria de Granada (FIBAO)GranadaSpain
| | - Rosa Macías‐Ruiz
- Arrhythmia UnitHospital Universitario Virgen de las NievesGranadaSpain
- Instituto de investigación biosanitaria de Granada (FIBAO)GranadaSpain
| | - Juan Jiménez‐Jáimez
- Arrhythmia UnitHospital Universitario Virgen de las NievesGranadaSpain
- Instituto de investigación biosanitaria de Granada (FIBAO)GranadaSpain
| | - Luis Tercedor
- Arrhythmia UnitHospital Universitario Virgen de las NievesGranadaSpain
- Instituto de investigación biosanitaria de Granada (FIBAO)GranadaSpain
| | - Miguel Álvarez
- Arrhythmia UnitHospital Universitario Virgen de las NievesGranadaSpain
- Instituto de investigación biosanitaria de Granada (FIBAO)GranadaSpain
| |
Collapse
|
41
|
Prasitlumkum N, Cheungpasitporn W, Chokesuwattanaskul R, Kewcharoen J, Tokavanich N, Navaravong L, Jongnarangsin K. Comparison between same-day discharge and overnight stay after atrial fibrillation ablation: Systematic review and meta-analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:2054-2066. [PMID: 34657314 DOI: 10.1111/pace.14380] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/08/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND In the modern era, atrial fibrillation (AF) ablation trend has been shifted toward same-day discharge (SDD), from a traditional overnight stay. Yet, recent studies have not well stated the safety profiles which remained poor-understood and dispersed. We hence performed systematic review and meta-analysis to assess the adverse outcomes of SDD in comparison with an overnight stay. METHODS Databases were searched through January 2021. Effect estimates from the individual studies were extracted and combined using random-effects, generic inverse variance method of der Simonian and Laird. The primary outcomes included total cumulative complications and immediate complications following AF ablation. RESULTS Ten observational studies were met our inclusion criteria, comprising of total population of 11,660 patients, with SDD 51.3%. For total cumulative complications, there were no differences observed between SDD and overnight stay (5.2% vs. 6.2%: pooled OR 0.77: 95% CI 0.55-1.08, p = .13 with I2 = 27.1%). In addition, comparable immediate complications were also demonstrated (5.2 % vs. 4.3: pooled OR 1.08: 95% CI 0.72-1.62, p = .718, with I2 = 37.3 %). CONCLUSION Our study suggested that SDD had similar complication rates, both total cumulative and immediate outcomes, compared with overnight stay in selected patients following AF ablation. Nevertheless, randomized control trials are warranted to validate the findings.
Collapse
Affiliation(s)
- Narut Prasitlumkum
- Division of Cardiology, University of California Riverside, Riverside, California, USA
| | | | - Ronpichai Chokesuwattanaskul
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Center of Excellence in Arrhythmia Research Chulalongkorn University, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jakrin Kewcharoen
- Department of Cardiology, Loma Linda University, Loma Linda, California
| | - Nithi Tokavanich
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Center of Excellence in Arrhythmia Research Chulalongkorn University, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Leenhapong Navaravong
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| |
Collapse
|
42
|
Kawaji T, Aizawa T, Hojo S, Kushiyama A, Yaku H, Nakatsuma K, Kaneda K, Kato M, Yokomatsu T, Miki S. The impact of current strategy using intracardiac echocardiography, lesion index, and minimum substrate ablation on clinical outcomes after catheter ablation procedure for atrial fibrillation. J Arrhythm 2021; 37:1278-1286. [PMID: 34621426 PMCID: PMC8485827 DOI: 10.1002/joa3.12611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/01/2021] [Accepted: 07/21/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE We developed the intracardiac echocardiography (ICE) technique to minimize radiation exposure and other recent technology during ablation procedure for atrial fibrillation (AF). The aim of this study was to validate the impact of the current strategy using the recent technology for AF ablation on outcomes after procedure. METHODS We evaluated the safety and efficacy of the current strategy in consecutive set of patients undergoing first-time ablation for AF (N = 233) compared with the conventional strategy in earlier consecutive set of patients (N = 223). The current strategy included the technique of ICE to reduce radiation exposure, Ablation Index®-guided pulmonary veins isolation, and minimum substrate ablation targeting only for induced AF. Outcome measures were radiation exposure, procedure time, in-hospital adverse outcomes, and event-free survival from tachyarrhythmias. RESULTS Puncture-to-ablation time was slightly, but significantly increased in the current strategy than in the conventional strategy (48.0 minutes vs 44.7 minutes, P = .002), although total procedure time was significantly decreased in the current strategy (143.9 minutes vs 156.9 minutes, P < .001). Likewise, radiation time and absorbed dose were significantly decreased in the current strategy (9.8 minutes vs 38.8 minutes, P < .001; 102.3 mGy vs 490.5 mGy, P < .001). The incidence of overall in-hospital adverse outcomes was 3.9% in the current strategy and each complication rate was comparable with the conventional protocol. The event-free survival from recurrent atrial tachyarrhythmias was not significantly different between two groups (72.3% vs 77.1% at 2-year, P = .32). CONCLUSION The current strategy using the recent technology with ICE, lesion index, and minimum substrate ablation was feasible and reduced total procedure time and radiation exposure. However, the arrhythmia-free survival could not be improved.
Collapse
Affiliation(s)
- Tetsuma Kawaji
- Department of Cardiology Mitsubishi Kyoto Hospital Kyoto Japan
- Department of Cardiovascular Medicine Graduate School of Medicine Kyoto University Kyoto Japan
| | - Takanori Aizawa
- Department of Cardiovascular Medicine Graduate School of Medicine Kyoto University Kyoto Japan
| | - Shun Hojo
- Department of Cardiology Mitsubishi Kyoto Hospital Kyoto Japan
| | | | - Hidenori Yaku
- Department of Cardiology Mitsubishi Kyoto Hospital Kyoto Japan
| | - Kenji Nakatsuma
- Department of Cardiology Mitsubishi Kyoto Hospital Kyoto Japan
| | - Kazuhisa Kaneda
- Department of Cardiology Mitsubishi Kyoto Hospital Kyoto Japan
| | - Masashi Kato
- Department of Cardiology Mitsubishi Kyoto Hospital Kyoto Japan
| | | | - Shinji Miki
- Department of Cardiology Mitsubishi Kyoto Hospital Kyoto Japan
| |
Collapse
|
43
|
Katić J, Anić A, Brešković T, Jurišić Z. Higher than recommended lesion size index target values for pulmonary vein isolation result in better clinical outcomes in paroxysmal atrial fibrillation patients. J Interv Card Electrophysiol 2021; 64:463-468. [PMID: 34453647 DOI: 10.1007/s10840-021-01053-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/16/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Catheter ablation is a cornerstone of the therapy for paroxysmal atrial fibrillation. The importance of effective lesion size formation during pulmonary vein isolation is gauged through conduction recovery and recurrence of arrhythmia. Therefore, the lesion size index (LSI) is designed to utilize traditional intraprocedural parameters and predict procedural success. The impact of the optimal LSI index and the respective segments of the pulmonary veins has not been commonly evaluated. We aimed to assess whether higher and targeted LSI on the different segments of pulmonary veins could actually lead to better clinical outcomes of paroxysmal atrial fibrillation ablation. METHODS Retrospective analyses of drug-refractory paroxysmal atrial fibrillation patients who underwent first catheter ablation were conducted. Targeted LSI of 6.5 at the anterior wall and 5.2 at the posterior wall, roof, and floor of the pulmonary vein was applied. The primary endpoint was defined as arrhythmias recurrence assessed by routine electrocardiograms and 24-h ambulatory electrocardiographic monitoring at 3, 6, and 12 months post-ablation. RESULTS Among the included 39 patients, the single-procedure 12-month freedom from arrhythmias was reached in 92.3% of patients. Interestingly, there was no tendency towards an increased number of adverse effects using a higher LSI index. CONCLUSIONS Atrial fibrillation ablation guided by targeted LSI value showed efficiency on the freedom from arrhythmias during 1-year follow-up period without harmful effects.
Collapse
Affiliation(s)
- Josip Katić
- Clinic for Heart and Cardiovascular Diseases, University Hospital Split, Spinčićeva 1, 21000, Split, Croatia.
| | - Ante Anić
- Clinic for Heart and Cardiovascular Diseases, University Hospital Split, Spinčićeva 1, 21000, Split, Croatia
| | - Toni Brešković
- Clinic for Heart and Cardiovascular Diseases, University Hospital Split, Spinčićeva 1, 21000, Split, Croatia
| | - Zrinka Jurišić
- Clinic for Heart and Cardiovascular Diseases, University Hospital Split, Spinčićeva 1, 21000, Split, Croatia
| |
Collapse
|
44
|
Duncker D, Svetlosak M, Guerra F, Nagy KV, Vanduynhoven P, Mikhaylov EN, Kosiuk J. Reprocessing of electrophysiology material in EHRA countries: an EHRA Young EP survey. Europace 2021; 23:479-485. [PMID: 33083819 DOI: 10.1093/europace/euaa250] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/20/2020] [Indexed: 11/12/2022] Open
Abstract
Data on reprocessing of electrophysiology (EP) materials are sparse. Reprocessing of catheters and other materials in daily routine varies through countries and may depend on specific material characteristics, supplier, or federal law. The aim of this study was to collect data on reprocessing usage through EHRA countries. An online survey consisting of 27 questions was distributed to EHRA Young EP members and members of national EP working groups. Two hundred and two participants from 34 EHRA countries completed the survey. One hundred and seven respondents (53.0%) reported having used and using reprocessed EP material, 30 (14.9%) respondents have used reprocessed EP material in the past but not at the time of the survey, 65 (32.2%) had never used reprocessed EP material. The most reprocessed EP materials include cables (70%), diagnostic EP catheters with deflectable (64%) or fixed curve (63%), non-irrigated ablation catheters (51%), and other conventional diagnostic catheters (41%). The most durable material was diagnostic EP catheters with a fixed curve (61%), the most sensitive material was ablation catheters with contact force sensors (21%). Important benefits were seen in reducing costs for the providing hospital (65%) and the healthcare provider (42%) and making EP procedures available for a greater number of patients (42%). Main concerns were on quality aspects (58%), contamination (52%), and loss of precision (47%). Reprocessing of EP materials is heterogeneously managed among EHRA countries. The present survey shows that European electrophysiologists consider the use of reprocessed EP material as generally safe and cost-effective.
Collapse
Affiliation(s)
- David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Martin Svetlosak
- Department for Arrhythmias and Cardiostimulation, National Institute for Cardiovascular Diseases, Pod Krásnou hôrkou 1, 83348 Bratislava, Slovakia
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, University Hospital 'Ospedali Riuniti Umberto I- Lancisi - Salesi', Marche Polytechnic University, via Conca 71, 60126 Ancona, Italy
| | | | | | - Evgeny N Mikhaylov
- Arrhythmia Department, Neuromodulation Laboratory, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation.,Department of Bioengineering Systems, Saint-Petersburg Electrotechnical University 'LETI', Saint Petersburg, Russian Federation
| | | |
Collapse
|
45
|
Suzuki A, Fujiwara R, Asada H, Iwasa K, Miyata T, Song WH, Higuchi K, Seo H, Sakamoto Y, Shimizu M, Soga F, Shibata H, Kozuki A, Nagoshi R, Lehmann HI, Kijima Y, Shite J. Peri-Balloon Leak Flow Velocity Assessed by Intra-Cardiac Echography Predicts Pulmonary Vein Electrical Gap - Intra-Cardiac Echography-Guided Contrast-Free Cryoballoon Ablation. Circ J 2021; 86:256-265. [PMID: 34334554 DOI: 10.1253/circj.cj-21-0423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The use of iodine contrast agents is one possible limitation in cryoballoon ablation (CBA) for atrial fibrillation (AF). This study investigated intracardiac echography (ICE)-guided contrast-free CBA.Methods and Results:The study was divided into 2 phases. First, 25 paroxysmal AF patients (Group 1) underwent CBA, and peri-balloon leak flow velocity (PLFV) was assessed using ICE and electrical pulmonary vein (PV) lesion gaps were assessed by high-density electroanatomical mapping. Then, 24 patients (Group 2) underwent ICE-guided CBA and were compared with 25 patients who underwent conventional CBA (historical controls). In Group 1, there was a significant correlation between PLFV and electrical PV gap diameter (r=-0.715, P<0.001). PLFV was higher without than with an electrical gap (mean [±SD] 127.0±28.6 vs. 66.6±21.0 cm/s; P<0.001) and the cut-off value of PLFV to predict electrical isolation was 105.7 cm/s (sensitivity 0.700, specificity 0.929). In Group 2, ICE-guided CBA was successfully performed with acute electrical isolation of all PVs and without the need for "rescue" contrast injection. Atrial tachyarrhythmia recurrence at 6 months did not differ between ICE-guided and conventional CBA (3/24 [12.5%] vs. 5/25 [20.0%], respectively; P=0.973, log-rank test). CONCLUSIONS PLFV predicted the presence of an electrical PV gap after CBA. ICE-guided CBA was feasible and safe, and could potentially be performed completely contrast-free without a decrease in ablation efficacy.
Collapse
Affiliation(s)
- Atsushi Suzuki
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | - Ryudo Fujiwara
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | - Hiroyuki Asada
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | - Kohei Iwasa
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | | | - Woo Hyung Song
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | - Kotaro Higuchi
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | - Hidenobu Seo
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | - Yuki Sakamoto
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | | | - Fumitaka Soga
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | | | - Amane Kozuki
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | - Ryoji Nagoshi
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | - H Immo Lehmann
- Department of Cardiology, Massachusetts General Hospital, Corrigan Minehan Heart Center.,Harvard Medical School
| | - Yoichi Kijima
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | - Junya Shite
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| |
Collapse
|
46
|
Varley AL, Kreidieh O, Godfrey BE, Whitmire C, Thorington S, D'Souza B, Kang S, Hebsur S, Ravindran BK, Zishiri E, Gidney B, Sellers MB, Singh D, Salam T, Metzl M, Ro A, Nazari J, Fisher WG, Costea A, Magnano A, Oza S, Morales G, Rajendra A, Silverstein J, Zei PC, Osorio J. A prospective multi-site registry of real-world experience of catheter ablation for treatment of symptomatic paroxysmal and persistent atrial fibrillation (Real-AF): design and objectives. J Interv Card Electrophysiol 2021; 62:487-494. [PMID: 34212280 PMCID: PMC8249214 DOI: 10.1007/s10840-021-01031-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/24/2021] [Indexed: 12/16/2022]
Abstract
Purpose Catheter ablation has become a mainstay therapy for atrial fibrillation (AF) with rapid innovation over the past decade. Variability in ablation techniques may impact efficiency, safety, and efficacy; and the ideal strategy is unknown. Real-world evidence assessing the impact of procedural variations across multiple operators may provide insight into these questions. The Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal (PAF) and Persistent (PsAF) Atrial Fibrillation registry (Real-AF) is a multicenter prospective registry that will enroll patients at high volume centers, including academic institutions and private practices, with operators performing ablations primarily with low fluoroscopy when possible. The study will also evaluate the contribution of advent in technologies and workflows to real-world clinical outcomes. Methods Patients presenting at participating centers are screened for enrollment. Data are collected at the time of procedure, 10–12 weeks, and 12 months post procedure and include patient and detailed procedural characteristics, with short and long-term outcomes. Arrhythmia recurrences are monitored through standard of care practice which includes continuous rhythm monitoring at 6 and 12 months, event monitors as needed for routine care or symptoms suggestive of recurrence, EKG performed at every visit, and interrogation of implanted device or ILR when applicable. Results Enrollment began in January 2018 with a single site. Additional sites began enrollment in October 2019. Through May 2021, 1,243 patients underwent 1,269 procedures at 13 institutions. Our goal is to enroll 4000 patients. Discussion Real-AF’s multiple data sources and detailed procedural information, emphasis on high volume operators, inclusion of low fluoroscopy operators, and use of rigorous standardized follow-up methodology allow systematic documentation of clinical outcomes associated with changes in ablation workflow and technologies over time. Timely data sharing may enable real-time quality improvements in patient care and delivery. Trial registration Clinicaltrials.gov: NCT04088071 (registration date: September 12, 2019) Supplementary Information The online version contains supplementary material available at 10.1007/s10840-021-01031-w.
Collapse
Affiliation(s)
- Allyson L Varley
- Heart Rhythm Clinical and Research Solutions, LLC, AL, Birmingham, USA.
- Birmingham VA Health System, AL, Birmingham, USA.
| | - Omar Kreidieh
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, MA, Boston, USA
| | - Brigham E Godfrey
- Heart Rhythm Clinical and Research Solutions, LLC, AL, Birmingham, USA
- Arrhythmia Institute at Grandview Medical Center, AL, Birmingham, USA
| | - Carolyn Whitmire
- Grandview Medical Group Research, Grandview Medical Center, AL, Birmingham, USA
| | - Susan Thorington
- Grandview Medical Group Research, Grandview Medical Center, AL, Birmingham, USA
| | - Benjamin D'Souza
- Department of Medicine, Penn Presbyterian Medical Center, University of Pennsylvania, PA, Philadelphia, USA
| | | | | | | | | | - Brett Gidney
- Santa Barbara Cottage Hospital, CA, Santa Barbara, USA
| | | | - David Singh
- Center for Heart Rhythm Disorders, The Queen's Medical Center, HI, Honolulu, USA
| | - Tariq Salam
- PulseHeart Institute, Multicare Health System, WA, Tacoma, USA
| | - Mark Metzl
- NorthShore University HealthSystem, IL, Evanston, USA
| | - Alex Ro
- NorthShore University HealthSystem, IL, Evanston, USA
| | - Jose Nazari
- NorthShore University HealthSystem, IL, Evanston, USA
| | | | - Alexandru Costea
- Division of Cardiovascular Health and Disease, University of Cincinnati, OH, Cincinnati, USA
| | - Anthony Magnano
- Department of Cardiology, Ascension St. Vincent's Health System, FL, Jacksonville, USA
| | - Saumil Oza
- Department of Cardiology, Ascension St. Vincent's Health System, FL, Jacksonville, USA
| | - Gustavo Morales
- Arrhythmia Institute at Grandview Medical Center, AL, Birmingham, USA
| | - Anil Rajendra
- Arrhythmia Institute at Grandview Medical Center, AL, Birmingham, USA
| | | | - Paul C Zei
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, MA, Boston, USA
| | - Jose Osorio
- Heart Rhythm Clinical and Research Solutions, LLC, AL, Birmingham, USA
- Arrhythmia Institute at Grandview Medical Center, AL, Birmingham, USA
| |
Collapse
|
47
|
Abstract
Catheter-based ultrasonography is a widely used tool in cardiac electrophysiology practice, and intracardiac echocardiography is supplanting other forms of imaging to become the dominant imaging modality. Given advances in pericardial access, intrapericardial echocardiography can be performed using ultrasound catheters as well. Intrapericardial echocardiography and echocardiography from the coronary sinus, also an epicardial structure, allows interventionalists to obtain unique views from virtually any vantage point, compared with other forms of echocardiography. Both intrapericardial echocardiography and coronary sinus echocardiography are safe and important alternatives that can be used during complex procedures in the electrophysiology laboratory.
Collapse
Affiliation(s)
- Nicholas Palmeri
- Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Boston, MA 02215, USA
| | - Andre D'Avila
- Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Boston, MA 02215, USA
| | - Eduardo B Saad
- Cardiac Arrhythmia and Pacing, Center for Atrial Fibrillation - Hospital Pró-Cardíaco and Hospital Samaritano Botafogo, Rio de Janeiro, RJ, Brazil.
| |
Collapse
|
48
|
Restrepo AJ, Dickfeld TM. Image Integration Using Intracardiac Echography and Three-dimensional Reconstruction for Mapping and Ablation of Atrial and Ventricular Arrhythmias. Card Electrophysiol Clin 2021; 13:365-380. [PMID: 33990275 DOI: 10.1016/j.ccep.2021.03.007] [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] [Indexed: 11/28/2022]
Abstract
This article reviews the basis for image integration of intracardiac echocardiography (ICE) with three-dimensional electroanatomic mapping systems and preprocedural cardiac imaging modalities to enhance anatomic understanding and improve guidance for atrial and ventricular ablation procedures. It discusses the technical aspects of ICE-based integration and the clinical evidence for its use. In addition, it presents the current technical limitations and future directions for this technology. This article also includes figures and videos of clinical representative arrhythmia cases where the use of ICE is key to a safe and successful outcome.
Collapse
Affiliation(s)
- Alejandro Jimenez Restrepo
- Section of Cardiology, Marshfield Clinic Health System, 1000 North Oak Avenue, Marshfield, WI 54449, USA.
| | - Timm Michael Dickfeld
- Section of Cardiac Electrophysiology, Maryland Arrhythmia and Cardiac Imaging Group (MACIG), University of Maryland School of Medicine, 22 South Greene Street, Room N3W77, Baltimore, MD 21201, USA
| |
Collapse
|
49
|
Yastrebov K. Ultrasound-guided point-of-care ablation for atrial fibrillation in intensive care. J Arrhythm 2021; 37:470-471. [PMID: 33850597 PMCID: PMC8021980 DOI: 10.1002/joa3.12503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 11/21/2022] Open
|
50
|
Santoro A, Baiocchi C, D'Ascenzi F, Mondillo S, Valente S. Zero-fluoroscopy catheter ablation of premature ventricular contractions at left coronary cusp near left main coronary artery. Clin Case Rep 2020; 8:1952-1956. [PMID: 33088527 PMCID: PMC7562889 DOI: 10.1002/ccr3.3035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 11/16/2022] Open
Abstract
The left coronary cusp is the commonest site of origin for coronary cusp PVC. Catheter ablation without fluoroscopy is highly effective, feasible, and safe but it could be related to risks because of proximity to the coronary arteries. The use of ICE integration allowed an improvement in the safety and efficiency of these procedures.
Collapse
Affiliation(s)
- Amato Santoro
- Cardiology Department Azienda Ospedaliera Universitaria Senese Viale Bracci 1, Siena Italy
| | - Claudia Baiocchi
- Cardiology Department Azienda Ospedaliera Universitaria Senese Viale Bracci 1, Siena Italy
| | - Flavio D'Ascenzi
- Cardiology Department Azienda Ospedaliera Universitaria Senese Viale Bracci 1, Siena Italy
| | - Sergio Mondillo
- Cardiology Department Azienda Ospedaliera Universitaria Senese Viale Bracci 1, Siena Italy
| | - Serafina Valente
- Cardiology Department Azienda Ospedaliera Universitaria Senese Viale Bracci 1, Siena Italy
| |
Collapse
|