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Turagam MK, Kawamura I, Neuzil P, Nair D, Doshi S, Valderrabano M, Hala P, Della Rocca D, Gibson D, Funasako M, Ha G, Lee B, Musikantow D, Yoo D, Flautt T, Dukkipati S, Natale A, Gurol ME, Halperin J, Mansour M, Reddy VY. Severity of Ischemic Stroke After Left Atrial Appendage Closure vs Nonwarfarin Oral Anticoagulants. JACC Clin Electrophysiol 2024; 10:270-283. [PMID: 37999669 DOI: 10.1016/j.jacep.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Strokes after left atrial appendage closure (LAAC) prophylaxis are generally less severe than those after warfarin prophylaxis-thought to be secondary to more hemorrhagic strokes with warfarin. Hemorrhagic strokes are similarly infrequent with direct oral anticoagulant (DOAC) prophylaxis, so the primary subtype after either LAAC or DOAC prophylaxis is ischemic stroke (IS). OBJECTIVES The purpose of this study was to compare the severity of IS using the modified Rankin Scale in atrial fibrillation patients receiving prophylaxis with DOACs vs LAAC. METHODS A retrospective analysis was performed of consecutive patients undergoing LAAC at 8 centers who developed an IS (ISLAAC) compared with contemporaneous consecutive patients who developed IS during treatment with DOACs (ISDOAC). The primary outcome was disabling/fatal stroke (modified Rankin Scale 3-5) at discharge and 3 months later. RESULTS Compared with ISDOAC patients (n = 322), ISLAAC patients (n = 125) were older (age 77.2 ± 13.4 years vs 73.1 ± 11.9 years; P = 0.002), with higher HAS-BLED scores (3.0 vs 2.0; P = 0.004) and more frequent prior bleeding events (54.4% vs 23.6%; P < 0.001), but similar CHA2DS2-VASc scores (5.0 vs 5.0; P = 0.28). Strokes were less frequently disabling/fatal with ISLAAC than ISDOAC at both hospital discharge (38.3% vs 70.3%; P < 0.001) and 3 months later (33.3% vs 56.2%; P < 0.001). Differences in stroke severity persisted after propensity score matching. By multivariate regression analysis, ISLAAC was independently associated with fewer disabling/fatal strokes at discharge (OR: 0.22; 95% CI: 0.13-0.39; P < 0.001) and 3 months (OR: 0.25; 95% CI: 0.12-0.50; P < 0.001), and fewer deaths at 3 months (OR: 0.28; 95% CI: 0.12-0.64; P < 0.001). CONCLUSIONS Ischemic strokes in patients with atrial fibrillation are less often disabling or fatal with LAAC than DOAC prophylaxis.
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Affiliation(s)
- Mohit K Turagam
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Iwanari Kawamura
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Devi Nair
- St. Bernard's Heart and Vascular Center, Jonesboro, Arkansas, USA
| | - Shephal Doshi
- Pacific Heart Institute, Santa Monica, California, USA
| | | | - Pavel Hala
- Homolka Hospital, Prague, Czech Republic
| | | | | | | | - Grace Ha
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bridget Lee
- St. Bernard's Heart and Vascular Center, Jonesboro, Arkansas, USA
| | | | - David Yoo
- Scripps Health, San Diego, California, USA
| | | | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Houston, Texas, USA
| | - Mahmut E Gurol
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Moussa Mansour
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vivek Y Reddy
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Di Biase L, Lakkireddy DJ, Marazzato J, Velasco A, Diaz JC, Navara R, Chrispin J, Rajagopalan B, Natale A, Mohanty S, Zhang X, Della Rocca D, Dalal A, Park K, Wiley J, Batchelor W, Cheung JW, Dangas G, Mehran R, Romero J. Antithrombotic Therapy for Patients Undergoing Cardiac Electrophysiological and Interventional Procedures: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 83:82-108. [PMID: 38171713 DOI: 10.1016/j.jacc.2023.09.831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/24/2023] [Accepted: 09/21/2023] [Indexed: 01/05/2024]
Abstract
Electrophysiological and interventional procedures have been increasingly used to reduce morbidity and mortality in patients experiencing cardiovascular diseases. Although antithrombotic therapies are critical to reduce the risk of stroke or other thromboembolic events, they can nonetheless increase the bleeding hazard. This is even more true in an aging population undergoing cardiac procedures in which the combination of oral anticoagulants and antiplatelet therapies would further increase the hemorrhagic risk. Hence, the timing, dose, and combination of antithrombotic therapies should be carefully chosen in each case. However, the maze of society guidelines and consensus documents published so far have progressively led to a hazier scenario in this setting. Aim of this review is to provide-in a single document-a quick, evidenced-based practical summary of the antithrombotic approaches used in different cardiac electrophysiology and interventional procedures to guide the busy clinician and the cardiac proceduralist in their everyday practice.
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Affiliation(s)
- Luigi Di Biase
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York, USA.
| | | | - Jacopo Marazzato
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alejandro Velasco
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Juan Carlos Diaz
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Rachita Navara
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Jonathan Chrispin
- Clinical Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
| | | | - Xiaodong Zhang
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Aarti Dalal
- Division of Cardiology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Ki Park
- Department of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Jose Wiley
- Division of Cardiology, Mount Sinai Medical Center, New York, New York, USA
| | - Wayne Batchelor
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Jim W Cheung
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York, USA
| | - George Dangas
- Division of Cardiology, Mount Sinai Medical Center, New York, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jorge Romero
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York, USA
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Pandey AC, Shen CP, Chu E, Della Rocca D, Janczyk G, Pangborn K, Natale A, Price MJ, Gibson D, Reddy VY. Inotropes to Differentiate Dense Spontaneous Echo Contrast From Thrombus in the Left Atrial Appendage. JACC Clin Electrophysiol 2023; 9:2655-2657. [PMID: 38032576 DOI: 10.1016/j.jacep.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/01/2023] [Accepted: 09/01/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Amitabh C Pandey
- Tulane University School of Medicine, New Orleans, Louisiana, USA; Scripps Clinic, La Jolla, San Diego, California, USA; Scripps Research Translational Institute, La Jolla, California, USA
| | | | - Edward Chu
- Mount Sinai Hospital, New York, New York, USA
| | | | - Gwen Janczyk
- Scripps Clinic, La Jolla, San Diego, California, USA
| | | | - Andrea Natale
- Scripps Clinic, La Jolla, San Diego, California, USA; Texas Cardiac Arrhythmia Institute, Austin, Texas, USA; Los Robles Regional Medical Center, Thousand Oaks, California, USA
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Di Biase L, Zou F, Lin AN, Grupposo V, Marazzato J, Tarantino N, Della Rocca D, Mohanty S, Natale A, Alhuarrat MAD, Haiman G, Haimovich D, Matthew RA, Alcazar J, Costa G, Urman R, Zhang X. Feasibility of three-dimensional artificial intelligence algorithm integration with intracardiac echocardiography for left atrial imaging during atrial fibrillation catheter ablation. Europace 2023; 25:euad211. [PMID: 37477946 PMCID: PMC10403247 DOI: 10.1093/europace/euad211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023] Open
Abstract
AIMS Intracardiac echocardiography (ICE) is a useful but operator-dependent tool for left atrial (LA) anatomical rendering during atrial fibrillation (AF) ablation. The CARTOSOUND FAM Module, a new deep learning (DL) imaging algorithm, has the potential to overcome this limitation. This study aims to evaluate feasibility of the algorithm compared to cardiac computed tomography (CT) in patients undergoing AF ablation. METHODS AND RESULTS In 28 patients undergoing AF ablation, baseline patient information was recorded, and three-dimensional (3D) shells of LA body and anatomical structures [LA appendage/left superior pulmonary vein/left inferior pulmonary vein/right superior pulmonary vein/right inferior pulmonary vein (RIPV)] were reconstructed using the DL algorithm. The selected ultrasound frames were gated to end-expiration and max LA volume. Ostial diameters of these structures and carina-to-carina distance between left and right pulmonary veins were measured and compared with CT measurements. Anatomical accuracy of the DL algorithm was evaluated by three independent electrophysiologists using a three-anchor scale for LA anatomical structures and a five-anchor scale for LA body. Ablation-related characteristics were summarized. The algorithm generated 3D reconstruction of LA anatomies, and two-dimensional contours overlaid on ultrasound input frames. Average calculation time for LA reconstruction was 65 s. Mean ostial diameters and carina-to-carina distance were all comparable to CT without statistical significance. Ostial diameters and carina-to-carina distance also showed moderate to high correlation (r = 0.52-0.75) except for RIPV (r = 0.20). Qualitative ratings showed good agreement without between-rater differences. Average procedure time was 143.7 ± 43.7 min, with average radiofrequency time 31.6 ± 10.2 min. All patients achieved ablation success, and no immediate complications were observed. CONCLUSION DL algorithm integration with ICE demonstrated considerable accuracy compared to CT and qualitative physician assessment. The feasibility of ICE with this algorithm can potentially further streamline AF ablation workflow.
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Affiliation(s)
- Luigi Di Biase
- Montefiore-Einstein Center for Heart & Vascular Care, Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY, USA
| | - Fengwei Zou
- Montefiore-Einstein Center for Heart & Vascular Care, Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY, USA
| | - Aung N Lin
- Montefiore-Einstein Center for Heart & Vascular Care, Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY, USA
| | | | - Jacopo Marazzato
- Montefiore-Einstein Center for Heart & Vascular Care, Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY, USA
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Nicola Tarantino
- Montefiore-Einstein Center for Heart & Vascular Care, Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY, USA
| | | | - Sanghamitra Mohanty
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX, USA
| | - Andrea Natale
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX, USA
| | - Majd Al Deen Alhuarrat
- Montefiore-Einstein Center for Heart & Vascular Care, Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY, USA
| | | | | | | | | | | | - Roy Urman
- Biosense Webster, Inc., Irvine, CA, USA
| | - Xiaodong Zhang
- Montefiore-Einstein Center for Heart & Vascular Care, Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY, USA
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Romero J, Gabr M, Alviz I, Briceno D, Diaz JC, Rodriguez D, Patel K, Polanco D, Trivedi C, Mohanty S, Della Rocca D, Lakkireddy D, Natale A, Di Biase L. Improved Survival in Patients with Atrial Fibrillation and Heart Failure Undergoing Catheter Ablation Compared to Medical Treatment: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Cardiovasc Electrophysiol 2022; 33:2356-2366. [PMID: 35842804 DOI: 10.1111/jce.15622] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Increasing evidence has suggested improved outcomes in atrial fibrillation (AF) patients with heart failure (HF) undergoing catheter ablation (CA) as compared to medical therapy. We sought to investigate the benefit of CA on outcomes of patients with AF and HF as compared to medical therapy. METHODS AND RESULTS A systematic review of PubMed, Embase, and Cochrane Central Register of Clinical Trials was performed for clinical studies evaluating the benefit of CA for patients with AF and HF. Primary endpoint was all-cause mortality. Secondary endpoints included atrial-arrhythmia recurrence and improvement in left ventricular ejection fraction (LVEF). Eight randomized controlled trials were included with a total of 2121 patients (mean age: 65 ± 5 years; 72% male). Mean follow-up duration was 32.9 ± 14.5 months. All-cause mortality in patients who underwent CA was significantly lower than in the medical treatment group (8.8% vs. 13.5%, RR 0.65, 95% CI 0.51-0.83, P=0.0005). A 35% relative risk reduction and 4.7% absolute risk reduction in all-cause mortality was observed with CA. Rates of atrial-arrhythmia recurrence were significantly lower in the CA group (39.9% vs 69.6%, RR 0.55, 95% CI 0.40-0.76, P=0.0003). Improvement in LVEF was significantly higher in patients undergoing CA (+9.4 ±7.6%) as compared to conventional treatment (+3.3±8%) (Mean difference 6.2, 95% CI 3.6-8.8, P<0.00001). Conclusion CA for AF in patients with HF decreases all-cause mortality, improves atrial-arrhythmia recurrence rate and LVEF when compared to medical management. CA should be considered the treatment of choice to improve survival in this select group of patients. Nonetheless, the benefit of CA in patients with severely reduced ejection fraction and NYHA class IV heart failure has not been clearly elucidated. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jorge Romero
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine. Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Mohamed Gabr
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine. Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Isabella Alviz
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine. Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - David Briceno
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine. Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Juan Carlos Diaz
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine. Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Daniel Rodriguez
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine. Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Kavisha Patel
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine. Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Dalvert Polanco
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine. Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX
| | | | | | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX
| | - Luigi Di Biase
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine. Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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Romero J, Velasco A, Díaz JC, Alviz I, Briceno D, Grushko M, Palma E, Ferrick K, Parashar A, Bello J, Zhang X, Gabr M, Purkayastha S, Polanco D, Grupposo V, Della Rocca D, Lakkireddy D, Natale A, Di Biase L. Fluoroless Versus Conventional Mapping and Ablation of Ventricular Arrhythmias Arising From the Left Ventricular Summit and Interventricular Septum. Circ Arrhythm Electrophysiol 2022; 15:e010547. [PMID: 35759380 DOI: 10.1161/circep.121.010547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jorge Romero
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R., A.V., I.A., D.B., M.G., E.P., K.F., A.P., J.B., X.Z., M.G., S.P., D.P., V.G., L.D.B.)
| | - Alejandro Velasco
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R., A.V., I.A., D.B., M.G., E.P., K.F., A.P., J.B., X.Z., M.G., S.P., D.P., V.G., L.D.B.)
| | | | - Isabella Alviz
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R., A.V., I.A., D.B., M.G., E.P., K.F., A.P., J.B., X.Z., M.G., S.P., D.P., V.G., L.D.B.)
| | - David Briceno
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R., A.V., I.A., D.B., M.G., E.P., K.F., A.P., J.B., X.Z., M.G., S.P., D.P., V.G., L.D.B.)
| | - Michael Grushko
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R., A.V., I.A., D.B., M.G., E.P., K.F., A.P., J.B., X.Z., M.G., S.P., D.P., V.G., L.D.B.)
| | - Eugen Palma
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R., A.V., I.A., D.B., M.G., E.P., K.F., A.P., J.B., X.Z., M.G., S.P., D.P., V.G., L.D.B.)
| | - Kevin Ferrick
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R., A.V., I.A., D.B., M.G., E.P., K.F., A.P., J.B., X.Z., M.G., S.P., D.P., V.G., L.D.B.)
| | - Akhil Parashar
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R., A.V., I.A., D.B., M.G., E.P., K.F., A.P., J.B., X.Z., M.G., S.P., D.P., V.G., L.D.B.)
| | - Juan Bello
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R., A.V., I.A., D.B., M.G., E.P., K.F., A.P., J.B., X.Z., M.G., S.P., D.P., V.G., L.D.B.)
| | - Xiaodong Zhang
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R., A.V., I.A., D.B., M.G., E.P., K.F., A.P., J.B., X.Z., M.G., S.P., D.P., V.G., L.D.B.)
| | - Mohamed Gabr
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R., A.V., I.A., D.B., M.G., E.P., K.F., A.P., J.B., X.Z., M.G., S.P., D.P., V.G., L.D.B.)
| | - Sutopa Purkayastha
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R., A.V., I.A., D.B., M.G., E.P., K.F., A.P., J.B., X.Z., M.G., S.P., D.P., V.G., L.D.B.)
| | - Dalvert Polanco
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R., A.V., I.A., D.B., M.G., E.P., K.F., A.P., J.B., X.Z., M.G., S.P., D.P., V.G., L.D.B.)
| | - Vito Grupposo
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R., A.V., I.A., D.B., M.G., E.P., K.F., A.P., J.B., X.Z., M.G., S.P., D.P., V.G., L.D.B.)
| | - Domenico Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX (D.D.R., A.N.)
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX (D.D.R., A.N.)
| | - Luigi Di Biase
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R., A.V., I.A., D.B., M.G., E.P., K.F., A.P., J.B., X.Z., M.G., S.P., D.P., V.G., L.D.B.)
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Gianni C, Della Rocca D, MacDonald BC, Quintero Mayedo A, Mohanty S, Bassiouny MA, Burkhardt JD, Horton RP, Gallinghouse GJ, Sanchez JE, Natale A, Al-Ahmad A. Risk Assessment and Management of Patients Undergoing Left Atrial Appendage Isolation. Curr Cardiovasc Risk Rep 2022. [DOI: 10.1007/s12170-022-00693-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Al-Ahmad A, Gianni C, Della Rocca D, Mohanty S, Tschopp DR, Horton RP, Natale A. PO-625-07 NOVEL STREAMLINED TECHNIQUE FOR LEFT ATRIAL APPENDAGE CLOSURE USING VERSACROSS LARGE ACCESS SYSTEM. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mariani MV, Piro A, Magnocavallo M, Chimenti C, Della Rocca D, Santangeli P, Natale A, Fedele F, Lavalle C. ORIGINAL ARTICLESCatheter Ablation For Papillary Muscle Arrhythmias A Systematic Review. Pacing Clin Electrophysiol 2022; 45:519-531. [PMID: 35147225 PMCID: PMC9302647 DOI: 10.1111/pace.14462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/07/2021] [Accepted: 01/30/2022] [Indexed: 11/25/2022]
Abstract
Background Catheter ablation of papillary muscle ventricular arrhythmias (PM‐VAs) has been associated with unsatisfactory results. Features that may affect acute and long‐term procedural outcomes are not well established. Objective To systematically review the available data in the literature assessing efficacy and safety of PM‐VAs catheter ablation. Methods An online search of PubMed, Cochrane Registry, Web of Science, Scopus and EMBASE libraries (from inception to March 1, 2021) was performed, in addition to manual screening. Twenty‐one observational noncontrolled case‐series were considered eligible for the systematic review, including 536 patients. Results Postero‐medial PM harbored 60.8% of PM‐VAs, while antero‐lateral PM and right ventricular PMs 34.9% and 4.3% of cases, respectively. The mean acute success rate of the index ablation procedure was 88.1% (95% CI 82.8% to 91.9%, p < .001, I2 0%). After a mean follow‐up period of 15.5 ± 17.4 months, pooled long‐term arrhythmia‐free rate was 69.2%, while the pooled long‐term success rate after multiple ablation procedure was 84.9%. Overall, procedure complications occurred in nine patients (1.7%) and no procedure‐related deaths were reported. The use of intracardiac echocardiography (ICE) as well as contact force sensing (CFS) and irrigated catheters during ablation was associated with higher rates of arrhythmia‐freedom at long‐term follow‐up. Conclusions Catheter ablation is an effective and safe strategy for PM‐VAs, with an acute success rate of 88.1%, a long‐term success rate of 69.2%, with a relatively low procedural complication rate. The use of ICE, irrigated catheters and catheters with CFS capability was associated with higher rates of arrhythmia‐freedom at long‐term follow‐up.
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Affiliation(s)
- Marco Valerio Mariani
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences "Sapienza" University of Rome, Rome, Italy
| | - Agostino Piro
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences "Sapienza" University of Rome, Rome, Italy
| | - Michele Magnocavallo
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences "Sapienza" University of Rome, Rome, Italy
| | - Cristina Chimenti
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences "Sapienza" University of Rome, Rome, Italy
| | | | - Pasquale Santangeli
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Francesco Fedele
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences "Sapienza" University of Rome, Rome, Italy
| | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences "Sapienza" University of Rome, Rome, Italy
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Piayda K, Sievert K, Della Rocca D, Adeola O, Alkhouli M, Yoo D, Benito-González T, Cruz-González I, Galea R, Skurk C, De Backer O, Nielsen-Kudsk J, Grygier M, Beaty E, Newton J, Pérez de Prado A, Räber L, Gibson D, Van Niekerk C, Ellis C, Horton R, Natale A, Grundwald I, Zeus T, Sievert H. Safety and feasibility of peri-device leakage closure after LAAO: an international, multicentre collaborative study. EUROINTERVENTION 2021; 17:e1033-e1040. [PMID: 34219662 PMCID: PMC9724933 DOI: 10.4244/eij-d-21-00286] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Residual peri-device leakage (PDL) is frequent after left atrial appendage occlusion (LAAO). Little is known about management strategies, procedural aspects and outcomes of interventional PDL closure. AIMS The aim of this study was to assess the safety and feasibility of PDL closure after LAAO. METHODS Fifteen centres contributed data on baseline characteristics, in-hospital and follow-up outcomes of patients who underwent PDL closure after LAAO. Outcomes of interest included acute success and complication rates and long-term efficacy of the procedure. RESULTS A total of 95 patients were included and a cumulative number of 104 leaks were closed. The majority of PDLs were detected within 90 days (range 41-231). Detachable coils were the most frequent approach (42.3%), followed by the use of the AMPLATZER Vascular Plug II (29.8%) and the AMPLATZER Duct Occluder II (17.3%). Technical success was 100% with 94.2% of devices placed successfully within the first attempt. There were no major complications requiring surgical or transcatheter interventions. During follow-up (96 days [range 49-526]), persistent leaks were found in 18 patients (18.9%), yielding a functional success rate of 82.7%, although PDLs were significantly reduced in size (pre-leak sizemax: 6.1±3.6 mm vs post-leak sizemax: 2.5±1.3 mm, p<0.001). None of the patients had a leak >5 mm. Major adverse events during follow-up occurred in 5 patients (2 ischaemic strokes, 2 intracranial haemorrhages, and 1 major gastrointestinal bleeding). CONCLUSIONS Several interventional techniques have become available to achieve PDL closure. They are associated with high technical and functional success and low complication rates.
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Affiliation(s)
- Kerstin Piayda
- Cardiovascular Center (CVC) Frankfurt, Frankfurt, Germany
| | - Kolja Sievert
- Cardiovascular Center (CVC) Frankfurt, Frankfurt, Germany
| | | | | | | | | | | | | | - Roberto Galea
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | - Marek Grygier
- Poznan University of Medical Sciences, Poznan, Poland
| | - Elijah Beaty
- Wake Forest Baptist Health, Winston-Salem, NC, USA
| | | | | | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | - Rodney Horton
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA,Scripps Health, La Jolla, CA, USA
| | | | - Tobias Zeus
- University Hospital Düsseldorf, Düsseldorf, Germany
| | - Horst Sievert
- CardioVascular Center (CVC) Frankfurt, Seckbacker Landstraβe 65, 60389 Frankfurt, Germany. E-mail:
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11
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Akella K, Sardana M, Pathak S, Trivedi R, Lavigne P, Doshi R, Sabbath A, Grees A, Mahbub E, Lachhar G, Murtaza G, Riggio D, Sharma S, Howard J, Ahmad Z, Rogers C, Dalal P, Iyengar N, Lakkireddy D, Gopinathannair R, Della Rocca D, Chung J, Siordia J, Taranto L, Dvergsten E, Gosselin K, Farah D. TCT-183 A Simple Point-Based Clinical Prediction Score to Predict Stroke After Left Atrial Appendage Closure: An Analysis of the National Readmissions Database. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Piayda K, Sievert K, Della Rocca D, Adeola O, Alkhouli M, Yoo D, Benito-González T, Cruz-Gonzalez I, Galea R, Skurk C, De Backer O, Nielsen-Kudsk JE, Grygier M, Beaty E, Newton J, Perez de Prado A, Raber L, Gibson D, Van Niekerk C, Ellis C, Horton R, Natale A, Grunwald I, Zeus T, Sievert H. TCT-310 Percutaneous Peridevice Leakage Closure After Insufficient Left Atrial Appendage Occlusion: Results From a Worldwide Collaborative Study. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Romero J, Gabr M, Alviz I, Briceno D, Diaz JC, Rodriguez D, Patel K, Polanco D, Trivedi C, Mohanty S, Della Rocca D, Lakkireddy D, Natale A, Di Biase L. Focal impulse and rotor modulation guided ablation versus pulmonary vein isolation for atrial fibrillation: A meta-analysis of head-to-head comparative studies. J Cardiovasc Electrophysiol 2021; 32:1822-1832. [PMID: 33844385 DOI: 10.1111/jce.15036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Empirical pulmonary vein isolation (PVI) remains the cornerstone for catheter ablation of atrial fibrillation (AF). Various ablation strategies and modalities are continually tested with the aim of improving ablation outcomes. Although focal impulse and rotor modulation (FIRM)-guided ablation is currently used as an adjunct to PVI, evidence supporting this strategy is conflicting. We sought to examine whether the utilization of FIRM-guided ablation with or without PVI is associated with a decrease in all-atrial arrhythmia recurrence as compared to PVI alone. METHODS A systematic review of PubMed, Cochrane, and Embase was performed for head-to-head study designs comparing outcomes of patients who underwent FIRM-guided ablation with or without PVI to those who underwent PVI alone. The primary efficacy endpoint was all-atrial arrhythmia recurrence. The secondary endpoints were complications rates and procedural characteristics. RESULTS Overall, six studies comprising 674 patients undergoing either FIRM-guided ablation ± PVI versus PVI were included (mean age 63.4 ± 9.2, male 74%, 9% paroxysmal AF, 91% nonparoxysmal AF). After a mean follow-up of 18.8 months, FIRM-guided ablation with or without PVI was not associated with improvement in all-atrial arrhythmia recurrence rate compared to PVI alone (43.4% vs. 45.9%, risk ratio [RR]: 1.06; 95% confidence interval [CI]: 0.77-1.47; p = .70). No statistically significant difference was noted in complication rates between the two groups (RR: 1.66; 95% CI: 0.08-34.54; p = .74). CONCLUSION In this meta-analysis of head-to-head comparison studies, FIRM-guided ablation with or without PVI did not provide any benefit in improving all-atrial arrhythmia recurrence at follow-up when compared to PVI alone.
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Affiliation(s)
- Jorge Romero
- Division of Cardiology, Department of Medicine, Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mohamed Gabr
- Division of Cardiology, Department of Medicine, Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Isabella Alviz
- Division of Cardiology, Department of Medicine, Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David Briceno
- Division of Cardiology, Department of Medicine, Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Juan Carlos Diaz
- Division of Cardiology, Department of Medicine, Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Daniel Rodriguez
- Division of Cardiology, Department of Medicine, Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kavisha Patel
- Division of Cardiology, Department of Medicine, Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Dalvert Polanco
- Division of Cardiology, Department of Medicine, Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Chintan Trivedi
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
| | - Sanghamitra Mohanty
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
| | - Domenico Della Rocca
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
| | | | - Andrea Natale
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
| | - Luigi Di Biase
- Division of Cardiology, Department of Medicine, Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York, USA
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Mohanty S, Trivedi C, Gianni C, Rocca DD, MacDonald B, Mayedo A, Burkhardt J, Gallinghouse G, Al-Ahmad A, Horton R, Di Biase L, Natale A. PREVALENCE OF NON-PV TRIGGERS IN HIV-POSITIVE PATIENTS WITH ATRIAL FIBRILLATION UNDERGOING CATHETER ABLATION. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01783-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Forleo GB, Schiavone M, Della Rocca D, Solimene F, Schillaci V, Covino G, Sassara M, Savarese G, Donzelli S, Badolati S, Gerosa C, Lavalle C, Gasperetti A, Mitacchione G, Lovecchio M, Valsecchi S, Santini L. Effective nonapical left ventricular pacing with quadripolar leads for cardiac resynchronization therapy. Kardiol Pol 2021; 79:442-448. [PMID: 33750083 DOI: 10.33963/kp.15882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Current guidelines recommend avoiding apical left ventricular (LV) pacing for cardiac resynchronization therapy (CRT). AIMS We investigated the feasibility of nonapical pacing with the current quadripolar LV lead technology. METHODS We analyzed consecutive patients who received CRT with an LV quadripolar lead. The post--implantation position of each electrode of the LV lead was designated as basal, mid, or apical. The pacing capture threshold (PCT) and phrenic nerve stimulation (PNS) threshold were assessed for each electrode. RESULTS We enrolled 168 patients. A total of 8 CRT defibrillators were from Biotronik (with Sentus OTW QP leads), 98 were from Boston Scientific (with 21 Acuity X4 Spiral and 77 Acuity X4 Straight leads), and 62 from St. Jude Medical (with Quartet leads). The median (interquartile range) number of electrodes at nonapical segments per patient was 3 (1-4) with Biotronik Sentus leads, 4 (3-4) with spiral -design Boston Scientific leads, 4 (3-4) with straight Boston Scientific leads, and 3 (3-4) with St. Jude Medical Quartet leads (P = 0.045). Three patients (38%) with Biotronik Sentus leads, 21 (100%) with spiral -design Boston Scientific leads, 69 (90%) with straight -design Boston Scientific leads, and 49 (79%) with St. Jude Medical Quartet leads (P <0.001) had at least 1 electrode located at nonapical segments linked with a PNS -PCT safety margin of more than 2 V. During the 6-month follow -up, PNS was detected in 4 patients and was eliminated with reprogramming. No significant changes in PCT were detected during follow -up. CONCLUSIONS Quadripolar leads allowed nonapical pacing with acceptable electrical parameters in the majority of CRT recipients, although differences were found among the currently available devices.
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Affiliation(s)
- Giovanni B Forleo
- Department of Cardiology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy.
| | - Marco Schiavone
- Department of Cardiology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Domenico Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, Texas, United States
| | - Francesco Solimene
- Department of Electrophysiology, Clinica Montevergine, Mercogliano, Italy
| | - Vincenzo Schillaci
- Department of Electrophysiology, Clinica Montevergine, Mercogliano, Italy
| | - Gregorio Covino
- Department of Cardiology, San Giovanni Bosco Hospital, Naples, Italy
| | - Massimo Sassara
- Department of Electrophysiology, Belcolle Hospital, Viterbo, Italy
| | - Gianluca Savarese
- Department of Cardiology, San Giovanni Battista Hospital, Foligno, Italy
| | | | - Sandra Badolati
- Department of Cardiology, S. Andrea Hospital, La Spezia, Italy
| | - Carmelo Gerosa
- Department of Cardiology, Manzoni Hospital, Lecco, Italy
| | - Carlo Lavalle
- Department of Cardiology, Policlinico Umberto I, Rome Italy
| | - Alessio Gasperetti
- Department of Cardiology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Gianfranco Mitacchione
- Department of Cardiology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | | | | | - Luca Santini
- Department of Electrophysiology, G. B. Grassi Hospital, Ostia, Italy
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16
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Romero J, Bello J, Díaz JC, Grushko M, Velasco A, Zhang X, Briceno D, Gabr M, Purkayastha S, Alviz I, Polanco D, Della Rocca D, Krumerman A, Palma E, Lakkireddy D, Natale A, Di Biase L. Tumescent local anesthesia versus general anesthesia for subcutaneous implantable cardioverter-defibrillator implantation. Heart Rhythm 2021; 18:1326-1335. [PMID: 33684548 DOI: 10.1016/j.hrthm.2021.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/20/2021] [Accepted: 03/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Subcutaneous implantable cardioverter-defibrillator (S-ICD) is an effective alternative to transvenous implantable cardioverter-defibrillator. General anesthesia (GA) is considered the standard sedation approach because of the pain caused by the manipulation of subcutaneous tissue with S-ICD implantation. However, GA carries several limitations, including additional risk of adverse events, prolonged in-room times, and increased costs. OBJECTIVE The purpose of this study was to define the effectiveness and safety of tumescent local anesthesia (TLA) in comparison to GA in patients undergoing S-ICD implantation. METHODS We performed a prospective, nonrandomized, controlled, multicenter study of patients referred for S-ICD implantation between 2019 and 2020. Patients were allocated to either TLA or GA on the basis of patient's preferences and/or anesthesia service availability. TLA was prepared using lidocaine, epinephrine, sodium bicarbonate, and sodium chloride. All patients provided written informed consent, and the institutional review board at each site provided approval for the study. RESULTS Sixty patients underwent successful S-ICD implantation from July 2019 to November 2020. Thirty patients (50%) received TLA, and the rest GA. There were no differences between groups with regard to baseline characteristics. In-room and procedural times were significantly shorter with TLA (107.6 minutes vs 186 minutes; P < .0001 and 53.2 minutes vs 153.7 minutes; P < .0001, respectively). Pain was reported less frequently by patients who received TLA. The use of opioids was significantly reduced in patients who received TLA (23% vs 62%; P = .002). CONCLUSION TLA is an effective and safe alternative to GA in S-ICD implantation. The use of TLA is associated with shorter in-room and procedural times, less postprocedural pain, and reduced usage of opioids and acetaminophen for analgesia.
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Affiliation(s)
- Jorge Romero
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Juan Bello
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | | | - Michael Grushko
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Alejandro Velasco
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Xiaodong Zhang
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - David Briceno
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Mohamed Gabr
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Sutopa Purkayastha
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Isabella Alviz
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Dalvert Polanco
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | | | - Andrew Krumerman
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Eugen Palma
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | | | - Andrea Natale
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Luigi Di Biase
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
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Briceño DF, Romero J, Patel K, Liaqat W, Zhang XD, Alviz I, Yang R, Rodriguez D, Lakkireddy D, Rocca DD, Tarantino N, Gopinathannair R, Natale A, Di Biase L. First-line ablation of ventricular tachycardia in ischemic cardiomyopathy: stratification of outcomes by left ventricular function. J Interv Card Electrophysiol 2020; 62:391-400. [PMID: 33179155 DOI: 10.1007/s10840-020-00912-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE First-line catheter ablation of ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with ischemic cardiomyopathy (ICM) has been associated with improved outcomes; however, most benefit seems to be in patients with moderately depressed left ventricular ejection fraction (LVEF). Herein, outcomes were stratified based on LVEF. METHODS A meta-analysis of randomized controlled trials (RCTs) evaluating first-line ablation versus medical therapy in patients with VT and ICM was performed. Risk estimates and 95% confidence intervals (CI) were measured. RESULTS Four RCTs with a total of 505 patients (mean age 66 ± 9 years, 89% male, 80% with previous revascularization) were included. Mean LVEF was 35 ± 8%. At a mean follow-up of 24 ± 9 months, a significant benefit in survival-free from appropriate implantable cardioverter-defibrillator (ICD) therapies was observed in all patients undergoing first-line catheter ablation compared with medical management (RR 0.70, 95% CI 0.56-0.86). In patients with moderately depressed LVEF (> 30-50%), first-line VT ablation was associated with a statistically significant reduction in the composite endpoint of survival free from VT/VF and appropriate ICD therapies (HR 0.52, 95% CI 0.36-0.76), whereas there was no difference in patients with severely depressed LVEF (≤30%) (HR 0.56, 95% CI 0.24-1.32). Funnel plots did not show asymmetry suggesting lack of bias. CONCLUSIONS Patients with ICM and VT undergoing first-line ablation have a significantly lower rate of appropriate ICD therapies without a mortality difference compared with patients receiving an initial approach based on medical therapy. The beneficial effect of a first-line ablation approach was only observed in patients with moderately depressed LVEF (> 30-50%).
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Affiliation(s)
- David F Briceño
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Jorge Romero
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Kavisha Patel
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Wasla Liaqat
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Xiao-Dong Zhang
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Isabella Alviz
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Ruike Yang
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
- Division of Cardiology, Department of Medicine, Henan Provincial People's Hospital, Zhengzhou, China
| | - Daniel Rodriguez
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
| | | | | | - Nicola Tarantino
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Luigi Di Biase
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA.
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.
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Romero J, Alviz I, Parides M, Diaz JC, Briceno D, Gabr M, Gamero M, Patel K, Braunstein ED, Purkayastha S, Polanco D, Valencia CR, Della Rocca D, Velasco A, Yang R, Tarantino N, Zhang XD, Mohanty S, Bello J, Natale A, Jorde UP, Garcia M, Di Biase L. T-wave inversion as a manifestation of COVID-19 infection: a case series. J Interv Card Electrophysiol 2020; 59:485-493. [PMID: 33128658 PMCID: PMC7602831 DOI: 10.1007/s10840-020-00896-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 10/01/2020] [Indexed: 12/19/2022]
Abstract
Purpose Cardiac involvement with COVID-19 infection has become evident by elevated troponin, cardiac arrhythmias, ST segment elevation, myocarditis, fulminant heart failure, and sudden cardiac death. We aimed to describe the association of COVID-19 and T-wave inversion (TWI) in a large case series. Methods We conducted an observational, retrospective study of confirmed COVID-19 cases with at least one electrocardiogram (ECG) in a large hospital in New York City (March 23, 2020–April 23, 2020). Patients with new TWI or pseudonormalization were further analyzed. Mortality and the need for invasive mechanical ventilation were the main outcomes. Results A total of 3225 patients were screened; 195 (6%) were selected for further analysis: 181 with TWI and 14 with T-wave pseudonormalization. Mean age was 66 ± 7 years; 51% were male. TWI were more commonly noted in the lateral (71%), followed by anterior (64%), inferior (57%), and septal (26%) leads. A total of 44 patients (23%) had elevated troponin. A total of 50 patients died (26%). Mortality rates of 35%, and 52% were observed in patients with diffuse TWI, and elevated troponin, respectively. Mortality rate of 80% was observed in patients with both elevated troponin and diffuse TWI. Additionally, 30% of the entire cohort and 58% of patients with elevated troponin required invasive mechanical ventilation. Conclusion Our study demonstrates that new TWI is a relatively common finding in COVID-19 patients. Importantly, our findings suggest that new TWI or T-wave pseudonormalization, particularly with elevated troponin, was associated with higher rates of mechanical ventilation and in-hospital mortality. Supplementary Information The online version of this article (10.1007/s10840-020-00896-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jorge Romero
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, NY, USA
| | - Isabella Alviz
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, NY, USA
| | - Michael Parides
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, NY, USA
| | - Juan Carlos Diaz
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, NY, USA
| | - David Briceno
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, NY, USA
| | - Mohamed Gabr
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, NY, USA
| | - Maria Gamero
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, NY, USA
| | - Kavisha Patel
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, NY, USA
| | - Eric D Braunstein
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, NY, USA
| | - Sutopa Purkayastha
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, NY, USA
| | - Dalvert Polanco
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, NY, USA
| | - Carolina R Valencia
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, NY, USA
| | | | - Alejandro Velasco
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, NY, USA
| | - Ruike Yang
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, NY, USA
| | - Nicola Tarantino
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, NY, USA
| | - Xiao-Dong Zhang
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, NY, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Juan Bello
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, NY, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Ulrich P Jorde
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, NY, USA
| | - Mario Garcia
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, NY, USA
| | - Luigi Di Biase
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, NY, USA. .,Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.
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Casella M, Dello Russo A, Bergonti M, Catto V, Conte E, Sommariva E, Gasperetti A, Vettor G, Tundo F, Sicuso R, Rizzo S, Mushtaq S, Della Rocca D, Pompilio G, Di Biase L, Andreini D, Natale A, Basso C, Tondo C. Diagnostic Yield of Electroanatomic Voltage Mapping in Guiding Endomyocardial Biopsies. Circulation 2020; 142:1249-1260. [PMID: 32791857 DOI: 10.1161/circulationaha.120.046900] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Electroanatomic voltage mapping (EVM) is a promising modality for guiding endomyocardial biopsies (EMBs). However, few data support its feasibility and safety. We now report the largest cohort of patients undergoing EVM-guided EMBs to show its diagnostic yield and to compare it with a cardiac magnetic resonance (CMR)-guided approach. METHODS We included 162 consecutive patients undergoing EMB at our institution from 2010 to 2019. EMB was performed in pathological areas identified at EVM and CMR. CMR and EVM sensitivity and specificity regarding the identification of pathological substrates of myocardium were evaluated according to EMB results. RESULTS Preoperative CMR showed late gadolinium enhancement in 70% of the patients, whereas EVM identified areas of low voltage in 61%. Right (73%), left (19%), or both ventricles (8%) underwent sampling. EVM proved to have sensitivity similar to CMR (74% versus 77%), with specificity being 70% and 47%, respectively. In 12 patients with EMB-proven cardiomyopathy, EVM identified pathological areas that had been undetected at CMR evaluation. Sensitivity of pooled EVM and CMR was as high as 95%. EMB analysis allowed us to reach a new diagnosis, different from the suspected clinical diagnosis, in 39% of patients. The complications rate was low, mostly related to vascular access, with no patients requiring urgent management. CONCLUSIONS EVM proved to be a promising tool for targeted EMB because of its sensitivity and specificity for identification of myocardial pathological substrates. EVM was demonstrated to have accuracy similar to CMR. EVM and CMR together conferred a positive predictive value of 89% on EMB.
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Affiliation(s)
- Michela Casella
- Department of Clinical Electrophysiology and Pacing(M.C., V.C., A.G., G.V., F.T., R.S., C.T.), Centro Cardiologico Monzino IRCCS, Milano, Italy.,Cardiology and Arrhythmology Clinic, Department of Clinical, Special and Dental Sciences(M.C.), University Hospital "Umberto I - Lancisi - Salesi," Marche Polytechnic University, Ancona, Italy
| | - Antonio Dello Russo
- Department of Biomedical Sciences and Public Health(A.D.R.), University Hospital "Umberto I - Lancisi - Salesi," Marche Polytechnic University, Ancona, Italy
| | - Marco Bergonti
- Department of Clinical Sciences and Community Health, University of Milan, Italy(M.B., G.P., D.A., C.T.)
| | - Valentina Catto
- Department of Clinical Electrophysiology and Pacing(M.C., V.C., A.G., G.V., F.T., R.S., C.T.), Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Edoardo Conte
- Cardiovascular Computed Tomography and Radiology Unit(E.C., S.M., D.A.), Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Elena Sommariva
- Unit of Vascular Biology and Regenerative Medicine(E.S., G.P.), Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Alessio Gasperetti
- Department of Clinical Electrophysiology and Pacing(M.C., V.C., A.G., G.V., F.T., R.S., C.T.), Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Giulia Vettor
- Department of Clinical Electrophysiology and Pacing(M.C., V.C., A.G., G.V., F.T., R.S., C.T.), Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Fabrizio Tundo
- Department of Clinical Electrophysiology and Pacing(M.C., V.C., A.G., G.V., F.T., R.S., C.T.), Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Rita Sicuso
- Department of Clinical Electrophysiology and Pacing(M.C., V.C., A.G., G.V., F.T., R.S., C.T.), Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Stefania Rizzo
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Azienda Ospedaliera-University of Padua, Padova, Italy(S.R., C.B.)
| | - Saima Mushtaq
- Cardiovascular Computed Tomography and Radiology Unit(E.C., S.M., D.A.), Centro Cardiologico Monzino IRCCS, Milano, Italy
| | | | - Giulio Pompilio
- Unit of Vascular Biology and Regenerative Medicine(E.S., G.P.), Centro Cardiologico Monzino IRCCS, Milano, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Italy(M.B., G.P., D.A., C.T.)
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York(L.D.B.)
| | - Daniele Andreini
- Cardiovascular Computed Tomography and Radiology Unit(E.C., S.M., D.A.), Centro Cardiologico Monzino IRCCS, Milano, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Italy(M.B., G.P., D.A., C.T.)
| | - Andrea Natale
- Texas Cardiac Arrhyhtmia Institute, St David's Hospital, Austin(D.D.R., A.N.)
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Azienda Ospedaliera-University of Padua, Padova, Italy(S.R., C.B.)
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Pacing(M.C., V.C., A.G., G.V., F.T., R.S., C.T.), Centro Cardiologico Monzino IRCCS, Milano, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Italy(M.B., G.P., D.A., C.T.)
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20
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Romero J, Patel K, Briceno D, Alviz I, Gabr M, Diaz JC, Trivedi C, Mohanty S, Della Rocca D, Al-Ahmad A, Yang R, Rios S, Cerna L, Du X, Tarantino N, Zhang XD, Lakkireddy D, Natale A, Di Biase L. Endo-epicardial ablation vs endocardial ablation for the management of ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2020; 31:2022-2031. [PMID: 32478430 DOI: 10.1111/jce.14593] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/28/2020] [Accepted: 05/25/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The pathologic process of ARVC (arrhythmogenic right ventricular cardiomyopathy) typically originates in the epicardium or subepicardial layers with progression toward endocardium. However, in the most recent ARVC international task force consensus statement, epicardial ventricular tachycardia (VT) ablation is recommended as a Class I indication only in patients with at least one failed endocardial VT ablation attempt. OBJECTIVE The aim of this meta-analysis is to assess the outcomes of ARVC patients undergoing combined endo-epicardial VT ablation, as compared to endocardial ablation alone. METHODS A systematic review of PubMed, Embase, and Cochrane was performed for studies reporting clinical outcomes of endo-epicardial VT ablation vs endocardial-only VT ablation in patients with ARVC. Fixed-Effect model was used if I2 < 25 and the Random-Effects Model was used if I2 ≥ 25%. RESULTS Nine studies consisting of 452 patients were included (mean age 42.3 ± 5.7 years; 70% male). After a mean follow-up of 48.1 ± 21.5 months, endo-epicardial ablation was associated with 42% relative risk reduction in VA recurrence as opposed to endocardial ablation alone (risk ratio [RR], 0.58; 95% confidence interval [CI], 0.45-0.75; P < .0001). No significant differences were noted between endo-epicardial and endocardial VT ablation groups in terms of all-cause mortality (RR, 1.19; 95% CI, 0.03-47.08; P = .93) and acute procedural complications (RR, 5.39; 95% CI, 0.60-48.74; P = .13). CONCLUSIONS Our findings suggest that in patients with ARVC, endo-epicardial VT ablation is associated with a significant reduction in VA recurrence as opposed to endocardial ablation alone, without a significant difference in all-cause mortality or acute procedural complications.
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Affiliation(s)
- Jorge Romero
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Kavisha Patel
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - David Briceno
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Isabella Alviz
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Mohamed Gabr
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Juan Carlos Diaz
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | | | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Ruike Yang
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.,Division of Cardiology, Department of Medicine, Henan Provincial People's Hospital, Zhengzhou, China
| | - Saul Rios
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Luis Cerna
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Xianfeng Du
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Nicola Tarantino
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Xiao-Dong Zhang
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Luigi Di Biase
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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21
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Murtaza G, Turagam M, Akella K, Rocca DD, Atkins D, Winterfield J, Gautam S, Gold MR, Gopinathannair R, Lakkireddy DR, Koerber S. USE OF ANTIBIOTIC ENVELOPES TO PREVENT CARDIAC IMPLANTABLE ELECTRONIC DEVICE RELATED INFECTIONS: A META-ANALYSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Murtaza G, Sharma S, Akella K, Rocca DD, Atkins D, Lakkireddy DR, Gopinathannair R. ROLE OF CARDIAC SYMPATHETIC DENERVATION IN VENTRICULAR TACHYCARDIA: A META-ANALYSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31046-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Mohanty S, Trivedi C, Rocca DD, Gianni C, Bassiouny M, Salwan A, Anannab A, Macdonald B, Mayedo A, Burkhardt J, Gallinghouse G, Al-Ahmad A, Horton R, Di Biase L, Natale A. STROKE RISK IN PATIENTS WITH PAROXYSMAL AND PERSISTENT ATRIAL FIBRILLATION TREATED WITH ANTI-ARRHYTHMIC DRUGS VS. CATHETER ABLATION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30962-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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24
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Gianni C, Chen Q, Della Rocca D, Canpolat U, Ayhan H, MacDonald B, Mohanty S, Trivedi C, Natale A, Al-Ahmad A. Radiofrequency Balloon Devices for Atrial Fibrillation Ablation. Card Electrophysiol Clin 2019; 11:487-493. [PMID: 31400873 DOI: 10.1016/j.ccep.2019.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Despite technological advancements, radiofrequency catheter ablation for pulmonary vein isolation remains a challenging procedure, as maneuvering the catheter to obtain effective lesions is technically complex and time consuming. For this reason, balloon-based ablation systems have been developed, which can quickly and easily isolate the pulmonary veins (single-shot), with outcomes comparable with point-by-point catheter ablation in the paroxysmal atrial fibrillation population. In this review, we discuss 3 balloon-based devices that use radiofrequency to obtain permanent lesions, a relatively emerging technology that may pose as an alternative option to cryoenergy or laser for single-shot pulmonary vein isolation.
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Affiliation(s)
- Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Qiong Chen
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Department of Cardiopulmonary Function Test, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, China
| | - Domenico Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Uğur Canpolat
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hacettepe University, Ankara, Turkey
| | - Hüseyin Ayhan
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Department of Cardiology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Bryan MacDonald
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Dell Medical School, University of Texas, Austin, TX, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Dell Medical School, University of Texas, Austin, TX, USA; Department of Biomedical Engineering, University of Texas, Austin, TX, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA; MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Division of Cardiology, Stanford University, Stanford, CA, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.
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Di Biase L, Romero J, Zado ES, Diaz JC, Gianni C, Hranitzki PM, Sanchez JE, Mohanty S, Al-Ahmad A, Mohanty P, Trivedi C, Della Rocca D, Santangeli P, Burkhardt JD, Garcia FC, Marchlinski FE, Natale A. Variant of ventricular outflow tract ventricular arrhythmias requiring ablation from multiple sites: Intramural origin. Heart Rhythm 2019; 16:724-732. [DOI: 10.1016/j.hrthm.2018.11.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Indexed: 10/27/2022]
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Gedikli O, Mohanty S, Trivedi C, Rocca DD, Chen Q, Tapia A, Sharma S, Burkhardt J, Sanchez J, Gallinghouse J, Al-Ahmad A, Horton R, Lakkireddy D, Natale A. DOES MORPHOLOGY OF THE THROMBUS FORMED IN THE LEFT ATRIAL APPENDAGE INDICATE PERI-DEVICE LEAK IN PATIENTS WITH WATCHMAN DEVICE: RESULTS FROM A SINGLE-CENTER STUDY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31152-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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27
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Mohanty S, Trivedi C, Rocca DD, Chen Q, Gedikli O, Gianni C, Tapia AC, Sharma S, Burkhardt J, Sanchez J, Gallinghouse G, Al-Ahmad A, Horton R, Lakkireddy D, Natale A. ASSOCIATION OF BODY MASS INDEX WITH ABLATION SUCCESS AND COMORBIDITIES IN PATIENTS WITH ATRIAL FIBRILLATION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31119-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mohanty S, Trivedi C, Rocca DD, Chen Q, Gedikli O, Gianni C, Tapia AC, Sharma S, Burkhardt J, Sanchez J, Gallinghouse G, Al-Ahmad A, Horton R, Lakkireddy D, di Biase L, Natale A. PREVALENCE OF TRIGGERS FROM NON-PULMONARY VEIN SITES IN PATIENTS WITH PRIOR CORONARY ARTERY BYPASS GRAFTING OR MAZE PROCEDURE UNDERGOING CATHETER ABLATION FOR ATRIAL FIBRILLATION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31156-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mohanty S, Mohanty P, Natale V, Trivedi C, Rocca DD, Chen Q, Gedikli O, Tapia AC, Assadourian J, di Biase L, Natale A. ASSOCIATION OF SUBCLINICAL ATRIAL FIBRILLATION WITH RISK OF STROKE: RESULTS FROM A META-ANALYSIS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31157-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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30
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Gadiyaram V, Gianni C, Trivedi C, Mohanty S, Rocca DD, Al-Ahmad A, Burkhardt J, Gallinghouse G, Hranitzky P, Sanchez J, Biase LD, Horton R, Price M, Gibson D, Natale A. LEFT ATRIAL APPENDAGE OCCLUSION FOLLOWING LEFT ATRIAL APPENDAGE ISOLATION. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)30946-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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31
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Romero J, Michaud GF, Avendano R, Briceño DF, Kumar S, Carlos Diaz J, Mohanty S, Trivedi C, Gianni C, Della Rocca D, Proietti R, Perrotta L, Bordignon S, Chun JKR, Schmidt B, Garcia M, Natale A, Di Biase L. Benefit of left atrial appendage electrical isolation for persistent and long-standing persistent atrial fibrillation: a systematic review and meta-analysis. Europace 2018; 20:1268-1278. [DOI: 10.1093/europace/eux372] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 12/05/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jorge Romero
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, USA
| | - Gregory F Michaud
- Department of Cardiology, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, EE. UU, USA
| | - Ricardo Avendano
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, USA
| | - David F Briceño
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, USA
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, University of Sydney, Hawkesbury Rd & Darcy Road, Westmead NSW, Sydney, Australia
| | - Juan Carlos Diaz
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, USA
| | - Sanghamitra Mohanty
- Department of Cardiology, Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, 3000 N. IH-35, Suite 720, Austin, TX, USA
| | - Chintan Trivedi
- Department of Cardiology, Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, 3000 N. IH-35, Suite 720, Austin, TX, USA
| | - Carola Gianni
- Department of Cardiology, Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, 3000 N. IH-35, Suite 720, Austin, TX, USA
| | - Domenico Della Rocca
- Department of Cardiology, Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, 3000 N. IH-35, Suite 720, Austin, TX, USA
| | - Riccardo Proietti
- Dipartimento di Cardiologia, Luigi Sacco, Ospedale Luigi Saco, Via G.B Grassi, 74, Milano MI, Italy
| | - Laura Perrotta
- Department of Cardiology and Angiology, Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Wilhelm-Epstein-Straße 4, Frankfurt/Main, Alemania, Germany
| | - Stefano Bordignon
- Department of Cardiology and Angiology, Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Wilhelm-Epstein-Straße 4, Frankfurt/Main, Alemania, Germany
| | - Julian K R Chun
- Department of Cardiology and Angiology, Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Wilhelm-Epstein-Straße 4, Frankfurt/Main, Alemania, Germany
| | - Boris Schmidt
- Department of Cardiology and Angiology, Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Wilhelm-Epstein-Straße 4, Frankfurt/Main, Alemania, Germany
| | - Mario Garcia
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, USA
| | - Andrea Natale
- Department of Cardiology, Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, 3000 N. IH-35, Suite 720, Austin, TX, USA
| | - Luigi Di Biase
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, USA
- Department of Cardiology, Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, 3000 N. IH-35, Suite 720, Austin, TX, USA
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Briceño DF, Romero J, Villablanca PA, Londoño A, Diaz JC, Maraj I, Batul SA, Madan N, Patel J, Jagannath A, Mohanty S, Mohanty P, Gianni C, Della Rocca D, Sabri A, Kim SG, Natale A, Di Biase L. Long-term outcomes of different ablation strategies for ventricular tachycardia in patients with structural heart disease: systematic review and meta-analysis. Europace 2017; 20:104-115. [DOI: 10.1093/europace/eux109] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/07/2017] [Indexed: 11/14/2022] Open
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Ribatti V, Santini L, Forleo GB, Della Rocca D, Panattoni G, Scali M, Schirripa V, Danisi N, Ammirati F, Santini M. [Electromagnetic interference in the current era of cardiac implantable electronic devices designed for magnetic resonance environment]. G Ital Cardiol (Rome) 2017; 18:295-304. [PMID: 28492569 DOI: 10.1714/2683.27472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In the last decades we are observing a continuous increase in the number of patients wearing cardiac implantable electronic devices (CIEDs). At the same time, we face daily with a domestic and public environment featured more and more by the presence and the utilization of new emitters and finally, more medical procedures are based on electromagnetic fields as well. Therefore, the topic of the interaction of devices with electromagnetic interference (EMI) is increasingly a real and actual problem.In the medical environment most attention is paid to magnetic resonance, nevertheless the risk of interaction is present also with ionizing radiation, electrical nerve stimulation and electrosurgery. In the non-medical environment, most studies reported in the literature focused on mobile phones, metal detectors, as well as on headphones or digital players as potential EMI sources, but many other instruments and tools may be intentional or non-intentional sources of electromagnetic fields.CIED manufacturers are more and more focusing on new technological features in order to make implantable devices less susceptible to EMI. However, patients and emitter manufacturers should be aware that limitations exist and that there is not complete immunity to EMI.
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Affiliation(s)
| | - Luca Santini
- U.O.C. Cardiologia, Ospedale G.B. Grassi, Ostia (RM)
| | | | | | | | - Marta Scali
- Policlinico Universitario "Tor Vergata", Roma
| | | | - Nicola Danisi
- U.O.C. Cardiologia, Ospedale G.B. Grassi, Ostia (RM)
| | | | - Massimo Santini
- Centro Studi Regionale per la Diagnosi e Cura delle Aritmie Cardiache, Presidio Ospedaliero San Filippo Neri, Roma
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