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Preda A, Bonvicini E, Coradello E, Testoni A, Gigli L, Baroni M, Carbonaro M, Vargiu S, Varrenti M, Colombo G, Paolucci M, Mazzone P, Guarracini F. The Fluoroless Future in Electrophysiology: A State-of-the-Art Review. Diagnostics (Basel) 2024; 14:182. [PMID: 38248058 PMCID: PMC10814721 DOI: 10.3390/diagnostics14020182] [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: 12/16/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
Fluoroscopy has always been the cornerstone imaging method of interventional cardiology procedures. However, radiation exposure is linked to an increased risk of malignancies and multiorgan diseases. The medical team is even more exposed to X-rays, and a higher incidence of malignancies was reported in this professional group. In the last years, X-ray exposure has increased rapidly, involving, above all, the medical team and young patients and forcing alternative fluoroless imaging methods. In cardiac electrophysiology (EP) and pacing, the advent of 3D electroanatomic mapping systems with dedicated catheters has allowed real-time, high-density reconstruction of both heart anatomy and electrical activity, significantly reducing the use of fluoroscopy. In addition, the diffusion of intracardiac echocardiography has provided high anatomical resolution of moving cardiac structures, providing intraprocedural guidance for more complex catheter ablation procedures. These methods have largely demonstrated safety and effectiveness, allowing for a dramatic reduction in X-ray delivery in most arrhythmias' ablations. However, some technical concerns, as well as higher costs, currently do not allow their spread out in EP labs and limit their use to only procedures that are considered highly complex and time-consuming and in young patients. In this review, we aim to update the current employment of fluoroless imaging in different EP procedures, focusing on its strengths and weaknesses.
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Affiliation(s)
- Alberto Preda
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Eleonora Bonvicini
- Division of Cardiology, Department of Medicine, Verona University Hospital, 37129 Verona, Italy
| | - Elena Coradello
- Division of Cardiology, Department of Medicine, Verona University Hospital, 37129 Verona, Italy
| | - Alessio Testoni
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Lorenzo Gigli
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Matteo Baroni
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marco Carbonaro
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Sara Vargiu
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marisa Varrenti
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Giulia Colombo
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marco Paolucci
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Patrizio Mazzone
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Fabrizio Guarracini
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
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Chieffo E, D’Amore S, De Regibus V, Dossena C, Frigerio L, Taravelli E, Ferrazzano C, De Iuliis P, Cacucci M, Landolina ME. Atrioventricular nodal reentry tachycardia treatment using CARTO 3 V7 activation mapping: a new era of slow pathway radiofrequency ablation is under coming. Front Cardiovasc Med 2023; 10:1144988. [PMID: 37840959 PMCID: PMC10570829 DOI: 10.3389/fcvm.2023.1144988] [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: 01/21/2023] [Accepted: 08/28/2023] [Indexed: 10/17/2023] Open
Abstract
Background Slow pathway (SP) ablation is the cornerstone for atrioventricular nodal reentry tachycardia (AVNRT) treatment, and a low-voltage bridge offers a good target during mapping using low x-ray exposure. We aimed to assess a new tool to identify SP by activation mapping using the last CARTO3® version, i.e., CARTO PRIME® V7 (Biosense Webster, Diamond Bar, CA, USA). Methods and results Right atrial septum and triangle of Koch 3D-activation map were obtained from intracardiac contact mapping during low x-ray CARTO 3® procedure. In 60 patients (mean age 60.3 ± 14.7, 61% females) undergoing ablation for AVNRT, an automatic activation map using a DECANAV® mapping catheter and CARTO® Confidense™, Coherent, and FAM DX software modules were obtained. The SP was identified in all patients as the latest atrioventricular node activation area; RF catheter ablation (RFCA) in that region elicited junctional beats. The mean procedural time was 150.3 ± 48.3 min, the mean fluoroscopy time exposure was 2.9 ± 2 min, the mean dose-area product (DAP) was 16.5 ± 2.7 cGy/cm2. The mean number of RF applications was 3.9 ± 2, the mean ablation index was 428.6 ± 96.6, and the mean contact force was 8 ± 2.8 g. There were no adverse event during the procedure, and no AVNRT recurrences occurred during a mean follow-up of 14.3 ± 8.3 months. Conclusion Ablation of the SP by automatic mapping using Confidense™, Coherent, and FAM DX software modules is an innovative, safe, and effective approach to AVNRT ablation. The CARTO3® V7 system shows on a 3D map the latest AV node activation area during sinus rhythm allowing low fluoroscopy time and highly effective RFCA.
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Affiliation(s)
- Enrico Chieffo
- Department of Cardiology, ASST Ospedale Maggiore, Crema, Italy
| | - Sabato D’Amore
- Department of Cardiology, ASST Ospedale Maggiore, Crema, Italy
| | | | - Cinzia Dossena
- Department of Cardiology, ASST Ospedale Maggiore, Crema, Italy
| | - Laura Frigerio
- Department of Cardiology, ASST Ospedale Maggiore, Crema, Italy
| | - Erika Taravelli
- Department of Cardiology, S. Croce e Carle Hospital, Cuneo, Italy
| | | | | | - Michele Cacucci
- Department of Cardiology, ASST Ospedale Maggiore, Crema, Italy
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Rodríguez Muñoz D, Marco del Castillo Á, Rajjoub Al-Mahdi EA, Lázaro Rivera C, Guisasola Cienfuegos M, Ramos Jiménez J, Borrego Bernabé L, Arribas Ynsaurriaga F, Salguero-Bodes R. Systematic Workflow and Electrogram guidance to reduce X-ray Exposure Time during cryoballoon ablation of atrial fibrillation: the SWEET-Cryo strategy. Europace 2023; 25:euad231. [PMID: 37497862 PMCID: PMC10443437 DOI: 10.1093/europace/euad231] [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: 04/18/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023] Open
Abstract
AIMS Cryoballoon pulmonary vein isolation (CB-PVI) offers similar efficacy to point-by-point radiofrequency PVI for patients with atrial fibrillation (AF), but generally with higher X-ray exposure. Strategies aimed at reducing fluoroscopy mostly rely on other costly imaging techniques, limiting their applicability. We designed a Systematic Workflow and Electrogram guidance to reduce X-ray Exposure Time during CB-PVI (SWEET-Cryo) strategy and analysed its impact on fluoroscopy use and acute procedural and clinical outcomes. METHODS AND RESULTS We enrolled 100 patients with paroxysmal or persistent AF undergoing CB-PVI by two operators with different levels of expertise. Patients treated with the SWEET-Cryo strategy (prospective cohort; n = 50) or conventional fluoroscopy (retrospective control cohort; n = 50) were compared. When applied by the senior operator, the SWEET-Cryo strategy significantly reduced the mean fluoroscopy time (FT) (2.6 ± 1.25 vs. 20.3 ± 10.8 min) and mean dose area product (DAP) (5.1 ± 3.8 vs. 35.3 ± 22.3 Gy cm2) compared with those of the control group, respectively (P < 0.001). Significant reductions in FT (6.4 ± 2.5 min vs. 32.5 ± 10.05) and DAP (13.9 ± 7.7 vs. 92.3 ± 63.8) were also achieved by the less experienced operator (P < 0.001). No difference was observed in acute and long-term complications or freedom from AF between fluoroscopy strategies during a 33-month median follow-up. Mean FT was maintained below 3 min in randomly selected cases performed during the follow-up period. CONCLUSION In contrast to conventional protocols and regardless of the operator's experience, the optimized SWEET-Cryo strategy dramatically reduced fluoroscopy exposure during CB-PVI. The efficacy, safety, or added costs of the ablation procedure were not compromised.
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Affiliation(s)
- Daniel Rodríguez Muñoz
- Cardiology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041 Madrid, Spain
| | - Álvaro Marco del Castillo
- Cardiology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041 Madrid, Spain
| | - Ez Alddin Rajjoub Al-Mahdi
- Cardiology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041 Madrid, Spain
| | - Carla Lázaro Rivera
- Cardiology Department, Hospital Universitario Fundación Jiménez Díaz, Av. de los Reyes Católicos, 2, 28040 Madrid, Spain
| | - María Guisasola Cienfuegos
- Cardiology Department, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Asturias, Spain
| | - Javier Ramos Jiménez
- Cardiology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041 Madrid, Spain
| | - Luis Borrego Bernabé
- Cardiology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041 Madrid, Spain
| | - Fernando Arribas Ynsaurriaga
- Cardiology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041 Madrid, Spain
- Department of Medicine, Universidad Complutense, Av. Séneca, 2, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
| | - Rafael Salguero-Bodes
- Cardiology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041 Madrid, Spain
- Department of Medicine, Universidad Complutense, Av. Séneca, 2, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
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Piros K, Perge P, Salló Z, Herczeg S, Nagy VK, Osztheimer I, Merkely B, Gellér L, Szegedi N. Zero fluoroscopy ablation for atrioventricular nodal reentrant tachycardia and typical atrial flutter is equally safe and effective with EnSite NavX, Carto3, and Rhythmia mapping systems. Front Cardiovasc Med 2023; 10:1185187. [PMID: 37560116 PMCID: PMC10407085 DOI: 10.3389/fcvm.2023.1185187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/10/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE Our purpose was to compare the procedural characteristics, success rate, and complication rate of the conventional fluoroscopic (CF) and the zero-fluoroscopic (ZF) approach in patients undergoing catheter ablation of AVNRT or typical atrial flutter (Aflu). METHODS 186 consecutive patients with an indication for AVNRT or Aflu ablation were enrolled. Based on the operator's preference, the patients were assigned to either CF or ZF group. In the ZF group EnSite NavX, Carto3, or Rhythmia EAMS were used for catheter guidance. RESULTS The median age was 56 (IQR = 42-68) years, 144 patients had AVNRT, and 42 had Aflu ablation. CF approach was chosen in 123 cases, while ZF in 63 cases. ZF approach was used more often in case of AVNRT patients [56 (39%) vs. 7 (17%), p = 0.006] and in the case of female patients [43 (68%) vs. 20 (32%), p = 0.008]. Acute procedural success was obtained in all cases. There was no difference in the complication rate (1 vs. 1, p > 0.99) between the two groups. No difference was found regarding the procedure time between the CF and ZF groups [CF: 55 (46-60) min, ZF 60 (47-65) min; p = 0.487] or in the procedure time for the different EAMS [EnSite NavX: 58 (50-63) min, Carto3: 60 (44.5-66.3) min, Rhythmia: 55 (35-69) min; p = 0.887]. A similar success rate was seen at the 3-month follow-up in the two groups [41 (100%) vs. 96 (97%); p = 0.55]. DISCUSSION The ZF approach demonstrated non-inferiority in safety and efficacy compared with CF for the AVNRT and Aflu ablations.
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Abuissa H, Roka A. How to Perform a Completely Fluoroless Ablation. J Innov Card Rhythm Manag 2023; 14:5455-5464. [PMID: 37216085 PMCID: PMC10193879 DOI: 10.19102/icrm.2023.14055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 01/17/2023] [Indexed: 05/24/2023] Open
Abstract
Radiation exposure related to electrophysiology catheter ablation procedures carries small but non-negligible stochastic and deterministic effects on health. Lead aprons can also place considerable pressure on the spinal column, resulting in potentially detrimental consequences. Fortunately, however, advancements in tools used for arrhythmia mapping and ablation have made it feasible to reduce or essentially eliminate the need for fluoroscopy, with no impact on the efficacy or safety of such procedures, as demonstrated by several long-term outcome studies. In this review, we describe our stepwise approach to safely and efficiently perform a completely fluoroless ablation.
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Affiliation(s)
- Hussam Abuissa
- Department of Clinical Cardiac Electrophysiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Attila Roka
- Department of Clinical Cardiac Electrophysiology, Creighton University School of Medicine, Omaha, NE, USA
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Huang J, Chen H, Zhang Q, Yang R, Peng S, Wu Z, Liu N, Tang L, Liu Z, Zhou S. Development and Validation of a Novel Prognostic Tool to Predict Recurrence of Paroxysmal Atrial Fibrillation after the First-Time Catheter Ablation: A Retrospective Cohort Study. Diagnostics (Basel) 2023; 13:diagnostics13061207. [PMID: 36980515 PMCID: PMC10047797 DOI: 10.3390/diagnostics13061207] [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: 02/10/2023] [Revised: 03/07/2023] [Accepted: 03/11/2023] [Indexed: 03/30/2023] Open
Abstract
There is no gold standard to tell frustrating outcomes after the catheter ablation of paroxysmal atrial fibrillation (PAF). The study aims to construct a prognostic tool. We retrospectively analyzed 315 patients with PAF who underwent first-time ablation at the Second Xiangya Hospital of Central South University. The endpoint was identified as any documented relapse of atrial tachyarrhythmia lasting longer than 30 s after the three-month blanking period. Univariate Cox regression analyzed eleven preablation parameters, followed by two supervised machine learning algorithms and stepwise regression to construct a nomogram internally validated. Five factors related to ablation failure were as follows: female sex, left atrial appendage emptying flow velocity ≤31 cm/s, estimated glomerular filtration rate <65.8 mL/(min·1.73 m2), P wave duration in lead aVF ≥ 120 ms, and that in lead V1 ≥ 100 ms, which constructed a nomogram. It was correlated with the CHA2DS2-VASc score but outperformed the latter evidently in discrimination and clinical utility, not to mention its robust performances in goodness-of-fit and calibration. In addition, the nomogram-based risk stratification could effectively separate ablation outcomes. Patients at risk of relapse after PAF ablation can be recognized at baseline using the proposed five-factor nomogram.
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Affiliation(s)
- Junjie Huang
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Hao Chen
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Quan Zhang
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Rukai Yang
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Shuai Peng
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Zhijian Wu
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Na Liu
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Liang Tang
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Zhenjiang Liu
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Shenghua Zhou
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
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Effects of Pulsed Radiofrequency Source on Cardiac Ablation. Bioengineering (Basel) 2023; 10:bioengineering10020227. [PMID: 36829721 PMCID: PMC9952521 DOI: 10.3390/bioengineering10020227] [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: 12/28/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Heart arrhythmia is caused by abnormal electrical conduction through the myocardium, which in some cases, can be treated with heat. One of the challenges is to reduce temperature peaks-by still guaranteeing an efficient treatment where desired-to avoid any healthy tissue damage or any electrical issues within the device employed. A solution might be employing pulsed heat, in which thermal dose is given to the tissue with a variation in time. In this work, pulsed heat is used to modulate induced temperature fields during radiofrequency cardiac ablation. A three-dimensional model of the myocardium, catheter and blood flow is developed. Porous media, heat conduction and Navier-Stokes equations are, respectively, employed for each of the investigated domains. For the electric field, solved via Laplace equation, it is assumed that the electrode is at a fixed voltage. Pulsed heating effects are considered with a cosine time-variable pulsed function for the fixed voltage by constraining the product between this variable and time. Different dimensionless frequencies are considered and applied for different blood flow velocity and sustained voltages. Results are presented for different pulsed conditions to establish if a reasonable ablation zone, known from the obtained temperature profiles, can be obtained without any undesired temperature peaks.
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Pang N, Gao J, Zhang N, Guo M, Wang R. Cavotricuspid isthmus ablation for atrial flutter guided by contact force related parameters: A systematic review and meta-analysis. Front Cardiovasc Med 2023; 9:1060542. [PMID: 36684611 PMCID: PMC9853203 DOI: 10.3389/fcvm.2022.1060542] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/14/2022] [Indexed: 01/08/2023] Open
Abstract
Background Contact force (CF) and related parameters have been evaluated as an effective guide mark for pulmonary vein isolation, yet not for linear ablation of the cavotricuspid isthmus (CTI) dependent atrial flutter (AFL). We thus studied the efficacy and safety of CF related parameter-guided ablation for CTI-AFL. Methods Systematic search was performed on databases involving PubMed, EMbase, Cochrane Library and Web of Science (through June 2022). Original articles comparing CF related parameter-guided ablation and conventional parameter-guided ablation for CTI-AFL were included. One-by-one elimination, subgroup analysis and meta-regression were used for heterogeneity test between studies. Results Ten studies reporting on 761 patients were identified after screening with inclusion and exclusion criteria. Radiofrequency (RF) duration was significantly shorter in CF related parameter-guided group (p = 0.01), while procedural time (p = 0.13) and fluoroscopy time (p = 0.07) were no significant difference between two groups. CF related parameter-guided group had less RF lesions (p = 0.0003) and greater CF of catheter-tissue (p = 0.0002). Touch-up needed after first ablation line was less in CF related parameter-guided group (p = 0.004). In addition, there were no statistical significance between two groups on acute conduction recovery rates (p = 0.25), recurrence rates (p = 0.92), and complication rates (p = 0.80). Meta-regression analysis revealed no specific covariate as an influencing factor for above results (p > 0.10). Conclusion CF related parameters guidance improves the efficiency of CTI ablation, with the better catheter-tissue contact, the lower RF duration and the comparable safety as compared with conventional method, but does not improve the acute success rate and long-term outcome.
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Affiliation(s)
- Naidong Pang
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China,The First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jia Gao
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Nan Zhang
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Min Guo
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Rui Wang
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China,*Correspondence: Rui Wang,
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He M, Qiu J, Bai Y, Wang Y, Chen G. Massive pleural effusion following high-power and short-duration radiofrequency ablation for treatment of atrial fibrillation: A case report and review of the literature. Front Cardiovasc Med 2022; 9:996481. [PMID: 36324739 PMCID: PMC9620720 DOI: 10.3389/fcvm.2022.996481] [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: 07/17/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Postpericardial injury syndrome (PPIS) is defined as pericarditis or pericardial effusion that results from recent myocardial infarction or intracardiac interventions. These symptoms typically include fever, leukocytosis, a high erythrocyte sedimentation rate, and elevated C-reactive protein levels. Additionally, pericardial effusion and pleural effusion may be present. It is considered to be a common complication in cardio-surgery with an occurrence of 3-30%. In the past 20 years, a high number of patients with atrial fibrillation have suffered from PPIS following radiofrequency catheter ablation. However, previous reports focused on identifying cardiac tamponade and pericardial effusion as their main clinical manifestations. Solitary pulmonary involvement following PPIS with the radiofrequency catheter ablation may occur. We report a case of PPIS that presented pleural effusion as the dominant feature soon after the operation and systematic review to illustrate the clinical characteristics of PPIS.
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Gagyi RB, Szegedi N, Simon J, Wijchers S, Bhagwandien R, Kong MH, Ruppersberg P, Szili-Torok T. Left atrial anatomical variations correlate with atrial fibrillation sources near the left atrial ridge. Front Cardiovasc Med 2022; 9:928384. [PMID: 36247472 PMCID: PMC9554407 DOI: 10.3389/fcvm.2022.928384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/31/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Anatomical variations and characteristics of the left atrium (LA) may have a previously undescribed effect on source locations in atrial fibrillation (AF). This is the first study aiming to investigate the relationship between anatomical characteristics of the LA and non-PV sources detected by electrographic flow (EGF) mapping in patients with persistent AF. Materials and methods We analyzed cardiac computed tomography (CT) and EGF mapping data in patients who underwent radiofrequency catheter ablation (CA). EGF mapping is a novel method based on Horn–Schunk flow estimation algorithm, used to estimate cardiac action potential flow in the atria that can detect AF sources in patients with persistent AF. By analyzing EGF maps obtained during CA procedures, we localized non-PV sources in the LA. Results Thirty patients were included in this study (mean age 62.4 ± 6.8 years). Ten patients had AF sources near the LA ridge, while twenty patients had no leading source (source activity > 26%) near the LA ridge. LA anatomical characteristics, left atrial appendage (LAA) length, and ostial diameter showed no correlation with the presence of a leading source. We documented 19 patients with abutting LAA and left superior pulmonary vein (LSPV) (distance < 2 mm), and 11 patients with non-abutting LAA–LSPV (distance > 2 mm). Three out of 19 patients presented with a leading source near ridge in the abutting LAA–LSPV group, while 7 out of 11 patients presented with a leading source near the ridge in the non-abutting LAA-LSPV group (p = 0.01). Conclusion Our data suggests that non-abutting LAA-LSPV is associated with the presence of AF sources near the LA ridge.
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Affiliation(s)
- Rita B. Gagyi
- Department of Cardiology, Electrophysiology, Erasmus MC, Rotterdam, Netherlands
| | - Nándor Szegedi
- Heart and Vascular Center, The Semmelweis University Hospital, Budapest, Hungary
| | - Judit Simon
- Heart and Vascular Center, The Semmelweis University Hospital, Budapest, Hungary
| | - Sip Wijchers
- Department of Cardiology, Electrophysiology, Erasmus MC, Rotterdam, Netherlands
| | - Rohit Bhagwandien
- Department of Cardiology, Electrophysiology, Erasmus MC, Rotterdam, Netherlands
| | | | | | - Tamas Szili-Torok
- Department of Cardiology, Electrophysiology, Erasmus MC, Rotterdam, Netherlands
- *Correspondence: Tamas Szili-Torok,
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Zhao X, Liu JF, Su X, Long DY, Sang CH, Tang RB, Yu RH, Liu N, Jiang CX, Li SN, Guo XY, Wang W, Zuo S, Dong JZ, Ma CS. Direct autotransfusion in the management of acute pericardial tamponade during catheter ablation for atrial fibrillation: An imperfect but practical method. Front Cardiovasc Med 2022; 9:984251. [PMID: 36211564 PMCID: PMC9537684 DOI: 10.3389/fcvm.2022.984251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Acute pericardial tamponade (APT) is one of the most serious complications of catheter ablation for atrial fibrillation (AF-CA). Direct autotransfusion (DAT) is a method of reinjecting pericardial blood directly into patients through vein access without a cell-salvage system. Data regarding DAT for APT are rare and provide limited information. Our present study aims to further investigate the safety and feasibility of DAT in the management of APT during the AF-CA procedure. Methods and results We retrospectively reviewed 73 cases of APT in the perioperative period of AF-CA from January 2014 to October 2021 at our institution, among whom 46 were treated with DAT. All included patients successfully received emergency pericardiocentesis through subxiphoid access guided by X-ray. Larger volumes of aspirated pericardial blood (658.4 ± 545.2 vs. 521.2 ± 464.9 ml), higher rates of bridging anticoagulation (67.4 vs. 37.0%), and surgical repair (6 vs. 0) were observed in patients with DAT than without. Moreover, patients with DAT were less likely to complete AF-CA procedures (32/46 vs. 25/27) and had a lower incidence of APT first presented in the ward (delayed presentation) (8/46 vs. 9/27). There was no difference in major adverse events (death/disseminated intravascular coagulation/multiple organ dysfunction syndrome and clinical thrombosis) (0/0/1/0 vs. 1/0/0/0), other potential DAT-related complications (fever/infection and deep venous thrombosis) (8/5/2 vs. 5/3/1), and length of hospital stay (11.4 ± 11.6 vs. 8.3 ± 4.7 d) between two groups. Conclusion DAT could be a feasible and safe method to deal with APT during AF-CA procedure.
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Affiliation(s)
- Xin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jian-feng Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Cardiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xin Su
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - De-yong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Cai-hua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ri-bo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Rong-Hui Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chen-xi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Song-nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xue-yuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Song Zuo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jian-zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chang-sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- *Correspondence: Chang-sheng Ma
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Dong Y, Xiao S, He J, Shi K, Chen S, Liu D, Huang B, Zhai Z, Li J. Angiotensin receptor-neprilysin inhibitor therapy and recurrence of atrial fibrillation after radiofrequency catheter ablation: A propensity-matched cohort study. Front Cardiovasc Med 2022; 9:932780. [PMID: 35990986 PMCID: PMC9386595 DOI: 10.3389/fcvm.2022.932780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCompared with conventional medicines, angiotensin receptor-neprilysin inhibitor (ARNI) could further improve the prognosis for multiple cardiovascular diseases, such as heart failure, hypertension, and myocardial infarction. However, the relationship between ARNI therapy and the recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation is currently unknown.MethodsThis study is a retrospective cohort study. Patients with consecutive persistent or paroxysmal AF undergoing first-time radiofrequency ablation were enrolled from February 2018 to October 2021. We compared the risk of AF recurrence in patients with catheter ablation who received ARNI with the risk of AF recurrence in those who received the angiotensin-converting enzyme inhibitor (ACEI). The propensity-score matched analysis was conducted to examine the effectiveness of ARNI. We used a Cox regression model to evaluate AF recurrence events.ResultsAmong 679 eligible patients, 155 patients with ARNI treatment and 155 patients with ACEI treatment were included in the analyses. At a median follow-up of 228 (196–322) days, ARNI as compared with ACEI was associated with a lower risk of AF recurrence [adjusted hazard ratio (HR), 0.39; 95% confidence interval (CI), 0.24–0.63; p < 0.001]. In addition, no interaction was found in the subgroup analysis.ConclusionAngiotensin receptor-neprilysin inhibitor treatment was associated with a decreased risk of AF recurrence after first-time radiofrequency catheter ablation.
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Liu X, Liu Y, Li B, Wang L, Zhang W. Case report: An unusual case of desmin myopathy associated with heart failure and arrhythmia. Front Cardiovasc Med 2022; 9:944459. [PMID: 35958417 PMCID: PMC9357943 DOI: 10.3389/fcvm.2022.944459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionDesmin myopathy is a novel desmin (DES) indel mutation that causes severe atypical cardiomyopathy as well as atrioventricular block and skeletal myopathy. The mutation of the gene of the nodal tail causes myocardial injury. Rarely does desmin myopathy cause bilateral ventricular changes.Case presentationWe present a case of a 48-year-old man admitted with dyspnea and edema of both lower extremities. Due to bilateral lower limb weakness and calf muscle atrophy, gene sequencing was performed. The results showed that there was a pure missense mutation in the 8th exon region of the DES gene (c.1366G>A), encoding amino acid p.G456R (glycine>arginine). Supplementary examination suggests a high possibility of heart failure, atrial flutter, and desmin myopathy. Atrial flutter was treated by radiofrequency ablation. The clinical symptoms were stable after oral administration of rivaroxaban, coenzyme Q10, and ARNI.ConclusionIn our case, mutation results are the gold standard for the diagnosis of nodular myopathy. Cardiac magnetic resonance can define the extent and degree of cardiomyopathy and quantitatively evaluate cardiac function. At present, there is a lack of specific treatment for proteolytic myopathy. Therefore, the treatment for heart failure proves effective. Due to the multiple systems involved, early diagnosis and multidisciplinary management are critical to improving patient outcomes.
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Niculae A, Peride I, Nechita AM, Petcu LC, Tiglis M, Checherita IA. Epidemiological Characteristics and Mortality Risk Factors Comparison in Dialysis and Non-Dialysis CKD Patients with COVID-19-A Single Center Experience. J Pers Med 2022; 12:jpm12060966. [PMID: 35743751 PMCID: PMC9224649 DOI: 10.3390/jpm12060966] [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: 05/16/2022] [Revised: 06/05/2022] [Accepted: 06/11/2022] [Indexed: 01/08/2023] Open
Abstract
(1) Background: Despite some controversies between studies, chronic kidney disease (CKD) has a negative impact on COVID-19 outcomes, with patients presenting a higher mortality risk than in the general population. Studies have shown an association between COVID-19 severe cases and different inflammatory biomarkers. The aim of this study was to emphasize the epidemiological characteristics of CKD patients diagnosed with COVID-19 and to determine if the risk of mortality, and the severity of this infection might be influenced by different parameters. (2) Methods: Our retrospective study included CKD patients with COVID-19—362 in the non-dialysis group and 132 in the dialysis group. (3) Results: There were significant statistical differences between our groups regarding age (p < 0.001), hemoglobin (p < 0.001), interleukin-6 (p < 0.001), serum albumin (p = 0.016), procalcitonin (p = 0.002), ferritin (p < 0.001), and of course serum creatinine (p < 0.001). Even if the risk of death was higher in the dialysis group (Exp(b) = 1.839), the survival proportions were similar in both groups. (4) Conclusions: High values of hemoglobin, serum creatinine, and LDH at admission, age, length of hospital stay ≤ 10 days, and a pulmonary impairment > 25% are responsible for an adverse outcome in non-dialysis and dialysis patients diagnosed with COVID-19.
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Affiliation(s)
- Andrei Niculae
- Clinical Department No. 3, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.N.); (I.A.C.)
- Department of Nephrology and Dialysis, “St. John” Emergency Clinical Hospital, 042122 Bucharest, Romania;
| | - Ileana Peride
- Clinical Department No. 3, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.N.); (I.A.C.)
- Department of Nephrology and Dialysis, “St. John” Emergency Clinical Hospital, 042122 Bucharest, Romania;
- Correspondence: (I.P.); (M.T.)
| | - Ana-Maria Nechita
- Department of Nephrology and Dialysis, “St. John” Emergency Clinical Hospital, 042122 Bucharest, Romania;
| | - Lucian Cristian Petcu
- Department of Biophysics and Biostatistics, Faculty of Dentistry, “Ovidius” University, 900684 Constanta, Romania;
| | - Mirela Tiglis
- Clinical Department No. 14, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Correspondence: (I.P.); (M.T.)
| | - Ionel Alexandru Checherita
- Clinical Department No. 3, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.N.); (I.A.C.)
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Giaccardi M, Mascia G, Poli C, Susi F, Signorini U, Di Mario C. Impact of general anesthesia on esophageal stability during pulmonary vein isolation. J Cardiovasc Med (Hagerstown) 2022; 23:344-346. [PMID: 34907144 DOI: 10.2459/jcm.0000000000001288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Marzia Giaccardi
- Cardiology and Electrophysiology Unit, Department of Internal Medicine, Azienda USL Toscana Centro, Florence
| | - Giuseppe Mascia
- Department of Internal Medicine (DIMI) Clinic of Cardiovascular Diseases, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa
| | - Claudio Poli
- Department of Anesthesiology, Piero Palagi Hospital, Azienda USL Toscana Centro
| | - Filippo Susi
- Cardiology and Electrophysiology Unit, Department of Internal Medicine, Azienda USL Toscana Centro, Florence
| | - Umberto Signorini
- Cardiology and Electrophysiology Unit, Department of Internal Medicine, Azienda USL Toscana Centro, Florence
| | - Carlo Di Mario
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
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Troisi F, Guida P, Quadrini F, Di Monaco A, Vitulano N, Caruso R, Orfino R, Cecere G, Anselmino M, Grimaldi M. Zero Fluoroscopy Arrhythmias Catheter Ablation: A Trend Toward More Frequent Practice in a High-Volume Center. Front Cardiovasc Med 2022; 9:804424. [PMID: 35571172 PMCID: PMC9095839 DOI: 10.3389/fcvm.2022.804424] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAwareness of radiation exposure risks associated to interventional cardiology procedures is growing. The availability of new technologies in electrophysiology laboratories has reduced fluoroscopy usage during arrhythmias ablations. The aim of this study was to describe procedures with and without X-Rays and to assess feasibility, safety, and short-term efficacy of zero fluoroscopy intervention in a high-volume center oriented to keep exposure to ionizing radiation as low as reasonably achievable.MethodsCardiac catheter ablations performed in our hospital since January 2017 to June 2021.ResultsA total of 1,853 procedures were performed with 1,957 arrhythmias treated. Rate of fluoroless procedures was 15.4% (285 interventions) with an increasing trend from 8.5% in 2017 to 22.9% of first semester 2021. The most frequent arrhythmia treated was atrial fibrillation (646; 3.6% fluoroless) followed by atrioventricular nodal reentrant tachycardia (644; 16.9% fluoroless), atrial flutter (215; 8.8% fluoroless), ventricular tachycardia (178; 17.4% fluoroless), premature ventricular contraction (162; 48.1% fluoroless), and accessory pathways (112; 31.3% fluoroless). Although characteristics of patients and operative details were heterogeneous among treated arrhythmias, use of fluoroscopy did not influence procedure duration. Moreover, feasibility and efficacy were 100% in fluoroless ablations while the rate of major complications was very low and no different with or without fluoroscopy (0.45 vs. 0.35%).ConclusionLimiting the use of X-Rays is necessary, especially when the available technologies allow a zero-use approach. A lower radiation exposure may be reached, reducing fluoroscopy usage whenever possible during cardiac ablation procedures with high safety, full feasibility, and efficacy.
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Affiliation(s)
- Federica Troisi
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
- *Correspondence: Federica Troisi
| | - Pietro Guida
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
| | - Federico Quadrini
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
| | - Antonio Di Monaco
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Nicola Vitulano
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
| | - Rosa Caruso
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
| | - Rocco Orfino
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
| | - Giacomo Cecere
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, Turin, Italy
| | - Massimo Grimaldi
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
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Vallès E, Jiménez J, Martí-Almor J, Toquero J, Ormaetxe JM, Barrera A, García-Alberola A, Rubio JM, Moriña P, Grande C, Fé Arcocha M, Peinado R, Cózar R, Hernández J, Pérez-Alvarez L, Gaztañaga L, Ferrero-De Loma-Osorio A, Ruiz-Granell R, Villuendas R, Martínez-Alday JD. Cryoballoon Ablation for Persistent and Paroxysmal Atrial Fibrillation: Procedural Differences and Results from the Spanish Registry (RECABA). J Clin Med 2022; 11:jcm11051166. [PMID: 35268259 PMCID: PMC8910954 DOI: 10.3390/jcm11051166] [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: 01/17/2022] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Cryoballoon ablation (CBA) has become a standard treatment for paroxysmal atrial fibrillation (PaAF) but limited data is available for outcomes in patients with persistent atrial fibrillation (PeAF). Methods: We analyzed the first 944 patients included in the Spanish Prospective Multi-center Observation Post-market Registry to compare characteristics and outcomes of patients undergoing CBA for PeAF versus PaAF. Results: A total of 944 patients (57.8 ± 10.4 years; 70.1% male) with AF (27.9% persistent) were prospectively included from 25 centers. PeAF patients were more likely to have structural heart disease (67.7 vs. 11.4%; p < 0.001) and left atrium dilation (72.6 vs. 43.3%; p < 0.001). CBA of PeAF was less likely to be performed under general anesthesia (10.7 vs. 22.2%; p < 0.001), with an arterial line (32.2 vs. 44.6%; p < 0.001) and assisted transeptal puncture (11.9 vs. 17.9%; p = 0.025). During an application, PeAF patients had a longer time to −30 °C (35.91 ± 14.20 vs. 34.93 ± 12.87 s; p = 0.021) and a colder balloon nadir temperature during vein isolation (−35.04 ± 9.58 vs. −33.61 ± 10.32 °C; p = 0.004), but received fewer bonus freeze applications (30.7 vs. 41.1%; p < 0.001). There were no differences in acute pulmonary vein isolation and procedure-related complications. Overall, 76.7% of patients were free from AF recurrences at 15-month follow-up (78.9% in PaAF vs. 70.9% in PeAF; p = 0.09). Conclusions: Patients with PeAF have a more diseased substrate, and CBA procedures performed in such patients were more simplified, although longer/colder freeze applications were often applied. The acute efficacy/safety profile of CBA was similar between PaAF and PeAF patients, but long-term results were better in PaAF patients.
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Affiliation(s)
- Ermengol Vallès
- Hospital del Mar, Universitat Autònoma de Barcelona, IMIM, 08003 Barcelona, Spain; (J.J.); (J.M.-A.)
- Correspondence:
| | - Jesús Jiménez
- Hospital del Mar, Universitat Autònoma de Barcelona, IMIM, 08003 Barcelona, Spain; (J.J.); (J.M.-A.)
| | - Julio Martí-Almor
- Hospital del Mar, Universitat Autònoma de Barcelona, IMIM, 08003 Barcelona, Spain; (J.J.); (J.M.-A.)
| | - Jorge Toquero
- Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain;
| | - José Miguel Ormaetxe
- Hospital Universitario de Basurto, 48013 Bilbao, Spain; (J.M.O.); (L.G.); (J.D.M.-A.)
| | - Alberto Barrera
- Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain;
| | | | | | - Pablo Moriña
- Hospital Juan Ramón Jiménez, 21005 Huelva, Spain;
| | - Carlos Grande
- Hospital Universitari Son Espases, 07010 Palma de Mallorca, Spain;
| | | | | | - Rocío Cózar
- Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain;
| | - Julio Hernández
- Hospital Universitario Nuestra Señora de la Candelaria, 38010 Santa Cruz de Tenerife, Spain;
| | | | - Larraitz Gaztañaga
- Hospital Universitario de Basurto, 48013 Bilbao, Spain; (J.M.O.); (L.G.); (J.D.M.-A.)
- Clínica IMQ Zorrotzaurre, 48014 Bilbao, Spain
| | | | - Ricardo Ruiz-Granell
- Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (A.F.-D.L.-O.); (R.R.-G.)
| | | | - Jesús Daniel Martínez-Alday
- Hospital Universitario de Basurto, 48013 Bilbao, Spain; (J.M.O.); (L.G.); (J.D.M.-A.)
- Clínica IMQ Zorrotzaurre, 48014 Bilbao, Spain
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Kwon HJ, Choi JH, Kim HR, Park SJ, Jeong DS, On YK, Kim JS, Park KM. Radiofrequency vs. Cryoballoon vs. Thoracoscopic Surgical Ablation for Atrial Fibrillation: A Single-Center Experience. MEDICINA-LITHUANIA 2021; 57:medicina57101023. [PMID: 34684060 PMCID: PMC8538093 DOI: 10.3390/medicina57101023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 12/04/2022]
Abstract
Background and Objectives: Cryoballoon ablation (CBA) and totally thoracoscopic surgical ablation (TTA) have emerged as alternatives to radiofrequency catheter ablation (RFCA) for atrial fibrillation. In this study, we describe our experience comparing patient characteristics and outcomes of RFCA, CBA, and TTA. Materials and Methods: We retrospectively analyzed data from patients who underwent RFCA, CBA, or TTA. Both atrial fibrillation (AF)- and atrial tachyarrhythmia (ATa)-free survival rates were compared using time to recurrence after a 3-month blanking period (defined by a duration of more than 30 s). All patients were regularly followed using 12-lead ECGs or Holter ECG monitoring. Results: Of 354 patients in this study, 125 underwent RFCA, 97 underwent CBA and 131 underwent TTA. The TTA group had more patients with persistent AF, a larger LA diameter, and a history of stroke. The CBA group showed the shortest procedure time (p < 0.001). The CBA group showed significantly lower AF-free survival at 12 months than the RFCA and TTA groups (RFCA 84%, CBA 74% and TTA 85%, p = 0.071; p = 0.859 for TTA vs. RFCA, p = 0.038 for RFCA vs. CBA and p = 0.046 for TTA vs. CBA). There were no significant differences in ATa-free survival among the three groups (p = 0.270). There were no procedure-related adverse events in the RFCA group, but some complications occurred in the CBA group and the TTA group (6% and 5%, respectively). Conclusions: RFCA and CBA are effective and safe as first-line treatments for paroxysmal and persistent AF. In some high-risk stroke patients, TTA may be a viable option. It is important to consider patient characteristics when selecting an ablation method for AF.
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Affiliation(s)
- Hee-Jin Kwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.-J.K.); (J.H.C.); (H.R.K.); (S.-J.P.); (Y.K.O.); (J.S.K.)
| | - Ji Hoon Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.-J.K.); (J.H.C.); (H.R.K.); (S.-J.P.); (Y.K.O.); (J.S.K.)
| | - Hye Ree Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.-J.K.); (J.H.C.); (H.R.K.); (S.-J.P.); (Y.K.O.); (J.S.K.)
| | - Seung-Jung Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.-J.K.); (J.H.C.); (H.R.K.); (S.-J.P.); (Y.K.O.); (J.S.K.)
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Young Keun On
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.-J.K.); (J.H.C.); (H.R.K.); (S.-J.P.); (Y.K.O.); (J.S.K.)
| | - June Soo Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.-J.K.); (J.H.C.); (H.R.K.); (S.-J.P.); (Y.K.O.); (J.S.K.)
| | - Kyoung-Min Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.-J.K.); (J.H.C.); (H.R.K.); (S.-J.P.); (Y.K.O.); (J.S.K.)
- Correspondence: ; Tel.: +82-2-3410-3419
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Müller-Leisse J, Hillmann HAK, Veltmann C, Duncker D. ["Zero fluoro"-a chance for more women in electrophysiology]. Herzschrittmacherther Elektrophysiol 2021; 32:285-287. [PMID: 33944993 DOI: 10.1007/s00399-021-00767-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/14/2021] [Indexed: 11/25/2022]
Abstract
Many young women in cardiology are concerned about radiation exposure, and this issue contributes to the low number of female interventional cardiologists. The proportion of women in interventional electrophysiology is particularly low. However, radiation exposure during catheter ablation of arrhythmias can be minimized and even avoided completely using modern 3D mapping systems. The "zero fluoro" approach can improve patients' safety but also motivate more women to become interventional electrophysiologists.
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Affiliation(s)
- Johanna Müller-Leisse
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Henrike Aenne Katrin Hillmann
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Christian Veltmann
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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