Contact-Force-Sensing-Based Radiofrequency Catheter Ablation in Paroxysmal Supraventricular Tachycardias (COBRA-PATH): a randomized controlled trial

Recent Advances in the Management of Non-rheumatic Atrial Fibrillation: A Comprehensive Review

Atrial fibrillation (AF) is a prevalent cardiac arrhythmia characterized by irregular atrial electrical activity, posing significant challenges to patient management and healthcare systems worldwide. Non-rheumatic AF, distinct from AF due to rheumatic heart disease, encompasses a spectrum of etiologies, including hypertension, coronary artery disease, and structural heart abnormalities. This review examines the latest advancements in managing non-rheumatic AF, encompassing diagnostic approaches, pharmacological therapies, and innovative non-pharmacological interventions. Diagnostic strategies ranging from traditional electrocardiography to advanced imaging modalities are explored alongside emerging biomarkers and wearable technologies facilitating early detection and management. Pharmacological management options, including novel anticoagulants and rhythm control agents, are evaluated in light of current guidelines and recent clinical trials. Non-pharmacological interventions, such as catheter ablation and device-based therapies, are discussed regarding their evolving techniques and outcomes. Special considerations for diverse patient populations, including elderly individuals and athletes, are addressed, emphasizing personalized approaches to optimize therapeutic outcomes. The review concludes with insights into future directions for AF management, highlighting promising avenues in gene therapy, regenerative medicine, and precision medicine approaches. By synthesizing recent research findings and clinical innovations, this review provides a comprehensive overview of the dynamic landscape of non-rheumatic AF management, offering insights for clinicians, researchers, and healthcare stakeholders.

Anesthetic Techniques for Ablation in Atrial Fibrillation: A Comparative Review

Atrial fibrillation, the most prevalent cardiac arrhythmia, has witnessed significant advancements in treatment modalities, transitioning from invasive procedures like the maze procedure to minimally invasive catheter ablation techniques. This review focuses on recent improvements in anesthetic approaches that enhance outcomes in catheter atrial fibrillation ablation. We highlight the efficacy of contact force sensing catheters with steerable introducer sheaths, which outperform traditional catheters by ensuring more effective contact time and lesion formation. Comparing general anesthesia with conscious sedation, we find that general anesthesia provides superior catheter stability due to reduced respiratory variability, resulting in more effective lesion formation, and reduced pulmonary vein reconnection. The use of high-frequency jet ventilation under general anesthesia, delivering low tidal volumes, effectively minimizes left atrial movement, decreasing catheter displacement and procedure time, and reducing recurrence in paroxysmal atrial fibrillation. An alternative, high-frequency low tidal volume ventilation using conventional ventilators, also shows improved catheter stability and lesion durability compared to traditional ventilation methods. However, a detailed comparative study of high-frequency jet ventilation, high-frequency low tidal volume ventilation, and conventional mechanical ventilation in catheter ablation for atrial fibrillation is lacking. This review emphasizes the need for such studies to identify optimal anesthetic techniques, potentially enhancing patient outcomes in atrial fibrillation treatment. Our findings suggest that careful selection of anesthetic methods, including ventilation strategies, plays a crucial role in the success of catheter ablation for atrial fibrillation, warranting further research for evidence-based practice.

Role of oesophageal cooling in the prevention of oesophageal injury in atrial fibrillation catheter ablation: a systematic review and meta-analysis of randomized controlled trials

AIMS

To evaluate the efficacy of oesophageal cooling in the prevention of oesophageal injury in patients undergoing atrial fibrillation (AF) catheter ablation.

METHODS AND RESULTS

Comprehensive search of MEDLINE, EMBASE, and Cochrane databases through April 2022 for randomized controlled trials (RCTs) evaluating the role of oesophageal cooling compared with control in the prevention of oesophageal injury during AF catheter ablation. The study primary outcome was the incidence of any oesophageal injury. The meta-analysis included 4 RCTs with a total of 294 patients. There was no difference in the incidence of any oesophageal injury between oesophageal cooling and control [15% vs. 19%; relative risk (RR) 0.86; 95% confidence interval (CI) 0.31-2.41]. Compared with control, oesophageal cooling showed lower risk of severe oesophageal injury (1.5% vs. 9%; RR 0.21; 95% CI 0.05-0.80). There were no significant differences among the two groups in mild to moderate oesophageal injury (13.6% vs. 12.1%; RR 1.09; 95% CI 0.28-4.23), procedure duration [standardized mean difference (SMD) -0.03; 95% CI -0.36-0.30], posterior wall radiofrequency (RF) time (SMD 0.27; 95% CI -0.04-0.58), total RF time (SMD -0.50; 95% CI -1.15-0.16), acute reconnection incidence (RR 0.93; 95% CI 0.02-36.34), and ablation index (SMD 0.16; 95% CI -0.33-0.66).

CONCLUSION

Among patients undergoing AF catheter ablation, oesophageal cooling did not reduce the overall risk of any oesophageal injury compared with control. Oesophageal cooling might shift the severity of oesophageal injuries to less severe injuries. Further studies should evaluate the long-term effects after oesophageal cooling during AF catheter ablation.

Deep-Learning-Based Detection of Paroxysmal Supraventricular Tachycardia Using Sinus-Rhythm Electrocardiograms

BACKGROUND

Paroxysmal supraventricular tachycardia (PSVT) is a common arrhythmia associated with palpitation and a decline in quality of life. However, it is undetectable with sinus-rhythmic ECGs when patients are not in the symptomatic onset stage.

METHODS

In the current study, a convolution neural network (CNN) was trained with normal-sinus-rhythm standard 12-lead electrocardiographs (ECGs) of negative control patients and PSVT patients to identify patients with unrecognized PSVT. PSVT refers to atrioventricular nodal reentry tachycardia or atrioventricular reentry tachycardia based on a concealed accessory pathway as confirmed by electrophysiological procedure. Negative control group data were obtained from 5107 patients with at least one normal sinus-rhythmic ECG without any palpitation symptoms. All ECGs were randomly allocated to the training, validation and testing datasets in a 7:1:2 ratio. Model performance was evaluated on the testing dataset through F1 score, overall accuracy, area under the curve, sensitivity, specificity and precision.

RESULTS

We retrospectively enrolled 407 sinus-rhythm ECGs of PSVT procedural patients and 1794 ECGs of control patients. A total of 2201 ECGs were randomly divided into training (n = 1541), validation (n = 220) and testing (n = 440) datasets. In the testing dataset, the CNN algorithm showed an overall accuracy of 95.5%, sensitivity of 90.2%, specificity of 96.6% and precision of 86.0%.

CONCLUSION

Our study reveals that a well-trained CNN algorithm may be a rapid, effective, inexpensive and reliable method to contribute to the detection of PSVT.