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Boga M, Orbán G, Perge P, Salló Z, Tanai E, Ferencz AB, Tóth P, Komlósi F, Osztheimer I, Nagy KV, Merkely B, Gellér L, Szegedi N. Adherence to the CLOSE Protocol and Low Baseline Generator Impedance Are Independent Predictors of Durable Pulmonary Vein Isolation. J Clin Med 2024; 13:1960. [PMID: 38610727 PMCID: PMC11012634 DOI: 10.3390/jcm13071960] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) is predominantly attributed to pulmonary vein reconnection (PVR). Predictors of AF recurrence have been widely studied; however, data are scarce on procedural parameters that predict chronic PVR. We aimed to study PVR rates and predictors of PVR. Methods: We retrospectively included 100 patients who underwent repeated ablation due to AF recurrence after initial PVI with the CARTO system. PVR was determined during the repeated procedure by electrophysiological evaluation, and initial procedural characteristics predicting PVR were studied, including adherence to the CLOSE protocol, use of high power, first-pass isolation (FPI), and baseline generator impedance (BGI). Results: Thirty-eight patients underwent initial CLOSE-guided PVI, and sixty-two underwent initial non-CLOSE PVI. A repeat procedure was performed 23 ± 16 months after the initial procedure. In total, PVR was found in 192 of 373 PVs (51.5%), and all PVs were isolated in 17/100 (17%) patients. Factors associated with all PVs being isolated were adherence to the CLOSE protocol, a higher power setting, the presence of bilateral FPI, and lower BGI (88% vs. 28%, p < 0.0001; 37.5 W vs. 30 W, p = 0.0276; 88.2% vs. 40.4%, p = 0.0007; and 127.6 Ω vs. 136.6 Ω, p = 0.0027, respectively). In initial procedures with adherence to the CLOSE protocol, the FPI rate was significantly higher (73.7% vs. 25%, p < 0.0001), while there were no significant differences in terms of procedure time and left atrial dwell time (81 vs. 85 min, p = 0.83; and 60 vs. 58 min, p = 0.08, respectively). BGI ≥ 130 Ω (AUC = 0.7403, sensitivity: 77.1%, specificity: 68.8%, p = 0.0032) was associated with a significantly higher probability of PVR (OR = 6.757; p < 0.0001). In multivariable analysis, independent predictors for PVR were non-adherence to the CLOSE protocol and BGI ≥ 130 Ω. Conclusions: Our findings indicate that adherence to the CLOSE protocol and baseline generator impedance < 130 Ω during AF ablation are independent predictors of PVI durability.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Nándor Szegedi
- Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary; (M.B.); (G.O.)
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Szegedi N, Salló Z, Nagy VK, Osztheimer I, Hizoh I, Lakatos B, Boussoussou M, Orbán G, Boga M, Ferencz AB, Komlósi F, Tóth P, Perge P, Kovács A, Merkely B, Gellér L. Long-Term Durability of High- and Very High-Power Short-Duration PVI by Invasive Remapping: The HPSD Remap Study. Circ Arrhythm Electrophysiol 2024; 17:e012402. [PMID: 38284286 PMCID: PMC10876176 DOI: 10.1161/circep.123.012402] [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: 06/07/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND High-power short-duration ablation has shown impressive efficacy and safety for pulmonary vein isolation (PVI); however, initial efficacy results with very high power short-duration ablation were discouraging. This study compared the long-term durability of PVI performed with a 90- versus 50-W power setting. METHODS Patients were randomized 1:1 to undergo PVI with the QDOT catheter using a power setting of 90 or 50 W. Three months after the index procedure, patients underwent a repeat electrophysiology study to identify pulmonary vein reconnections. Patients were followed for 12 months to detect AF recurrences. RESULTS We included 46 patients (mean age, 64 years; women, 48%). Procedure (76 versus 84 minutes; P =0.02), left atrial dwell (63 versus 71 minutes; P =0.01), and radiofrequency (303 versus 1040 seconds; P <0.0001) times were shorter with 90- versus 50-W procedures, while the number of radiofrequency applications was higher with 90 versus 50 W (77 versus 67; P =0.01). There was no difference in first-pass isolation (83% versus 82%; P =1.0) or acute reconnection (4% versus 14%; P =0.3) rates between 90 and 50 W. Forty patients underwent a repeat electrophysiology study. Durable PVI on a per PV basis was present in 72/78 (92%) versus 68/77 (88%) PVs in the 90- and 50-W energy setting groups, respectively; effect size: 72/78-68/77=0.040, lower 95% CI=-0.051 (noninferiority limit=-0.1, ie, noninferiority is met). No complications occurred. There was no difference in 12-month atrial fibrillation-free survival between the 90- and 50-W groups (P =0.2). CONCLUSIONS Similarly high rates of durable PVI and arrhythmia-free survival were achieved with 90 and 50 W. Procedure, left atrial dwell, and radiofrequency times were shorter with 90 W compared with 50 W. The sample size is too small to conclude the safety and long-term efficacy of the high and very high-power short-duration PVI; further studies are needed to address this topic. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05459831.
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Affiliation(s)
- Nándor Szegedi
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zoltán Salló
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Vivien Klaudia Nagy
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - István Osztheimer
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - István Hizoh
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Lakatos
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Melinda Boussoussou
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Gábor Orbán
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Boga
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Arnold Béla Ferencz
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Ferenc Komlósi
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Patrik Tóth
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Péter Perge
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Attila Kovács
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - László Gellér
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Komlósi F, Tóth P, Bohus G, Vámosi P, Tokodi M, Szegedi N, Salló Z, Piros K, Perge P, Osztheimer I, Ábrahám P, Széplaki G, Merkely B, Gellér L, Nagy KV. Machine-Learning-Based Prediction of 1-Year Arrhythmia Recurrence after Ventricular Tachycardia Ablation in Patients with Structural Heart Disease. Bioengineering (Basel) 2023; 10:1386. [PMID: 38135977 PMCID: PMC10740977 DOI: 10.3390/bioengineering10121386] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Ventricular tachycardia (VT) recurrence after catheter ablation remains a concern, emphasizing the need for precise risk assessment. We aimed to use machine learning (ML) to predict 1-month and 1-year VT recurrence following VT ablation. METHODS For 337 patients undergoing VT ablation, we collected 31 parameters including medical history, echocardiography, and procedural data. 17 relevant features were included in the ML-based feature selection, which yielded six and five optimal features for 1-month and 1-year recurrence, respectively. We trained several supervised machine learning models using 10-fold cross-validation for each endpoint. RESULTS We observed 1-month VT recurrence was observed in 60 (18%) cases and accurately predicted using our model with an area under the receiver operating curve (AUC) of 0.73. Input features used were hemodynamic instability, incessant VT, ICD shock, left ventricular ejection fraction, TAPSE, and non-inducibility of the clinical VT at the end of the procedure. A separate model was trained for 1-year VT recurrence (observed in 117 (35%) cases) with a mean AUC of 0.71. Selected features were hemodynamic instability, the number of inducible VT morphologies, left ventricular systolic diameter, mitral regurgitation, and ICD shock. For both endpoints, a random forest model displayed the highest performance. CONCLUSIONS Our ML models effectively predict VT recurrence post-ablation, aiding in identifying high-risk patients and tailoring follow-up strategies.
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Affiliation(s)
- Ferenc Komlósi
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122 Budapest, Hungary; (F.K.); (G.B.); (M.T.); (N.S.); (Z.S.); (K.P.); (P.P.); (P.Á.); (B.M.); (L.G.)
| | - Patrik Tóth
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122 Budapest, Hungary; (F.K.); (G.B.); (M.T.); (N.S.); (Z.S.); (K.P.); (P.P.); (P.Á.); (B.M.); (L.G.)
| | - Gyula Bohus
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122 Budapest, Hungary; (F.K.); (G.B.); (M.T.); (N.S.); (Z.S.); (K.P.); (P.P.); (P.Á.); (B.M.); (L.G.)
| | - Péter Vámosi
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122 Budapest, Hungary; (F.K.); (G.B.); (M.T.); (N.S.); (Z.S.); (K.P.); (P.P.); (P.Á.); (B.M.); (L.G.)
| | - Márton Tokodi
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122 Budapest, Hungary; (F.K.); (G.B.); (M.T.); (N.S.); (Z.S.); (K.P.); (P.P.); (P.Á.); (B.M.); (L.G.)
| | - Nándor Szegedi
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122 Budapest, Hungary; (F.K.); (G.B.); (M.T.); (N.S.); (Z.S.); (K.P.); (P.P.); (P.Á.); (B.M.); (L.G.)
| | - Zoltán Salló
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122 Budapest, Hungary; (F.K.); (G.B.); (M.T.); (N.S.); (Z.S.); (K.P.); (P.P.); (P.Á.); (B.M.); (L.G.)
| | - Katalin Piros
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122 Budapest, Hungary; (F.K.); (G.B.); (M.T.); (N.S.); (Z.S.); (K.P.); (P.P.); (P.Á.); (B.M.); (L.G.)
| | - Péter Perge
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122 Budapest, Hungary; (F.K.); (G.B.); (M.T.); (N.S.); (Z.S.); (K.P.); (P.P.); (P.Á.); (B.M.); (L.G.)
| | - István Osztheimer
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122 Budapest, Hungary; (F.K.); (G.B.); (M.T.); (N.S.); (Z.S.); (K.P.); (P.P.); (P.Á.); (B.M.); (L.G.)
| | - Pál Ábrahám
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122 Budapest, Hungary; (F.K.); (G.B.); (M.T.); (N.S.); (Z.S.); (K.P.); (P.P.); (P.Á.); (B.M.); (L.G.)
| | - Gábor Széplaki
- Mater Private Hospital, 69 Eccles St., D07 WKW8 Dublin, Ireland;
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122 Budapest, Hungary; (F.K.); (G.B.); (M.T.); (N.S.); (Z.S.); (K.P.); (P.P.); (P.Á.); (B.M.); (L.G.)
| | - László Gellér
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122 Budapest, Hungary; (F.K.); (G.B.); (M.T.); (N.S.); (Z.S.); (K.P.); (P.P.); (P.Á.); (B.M.); (L.G.)
| | - Klaudia Vivien Nagy
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122 Budapest, Hungary; (F.K.); (G.B.); (M.T.); (N.S.); (Z.S.); (K.P.); (P.P.); (P.Á.); (B.M.); (L.G.)
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Tóth P, Komlósi F, Vámosi P, Arnóth B, Szegedi N, Salló Z, Piros K, Perge P, Osztheimer I, Ábrahám P, Széplaki G, Merkely B, Gellér L, Nagy KV. Sex differences in one-year recurrence and all-cause mortality following catheter ablation of ventricular tachycardia in structural heart disease. Front Cardiovasc Med 2022; 9:1061471. [PMID: 36561769 PMCID: PMC9763270 DOI: 10.3389/fcvm.2022.1061471] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
Aims We aimed to establish sex-specific predictors for 1-year VT recurrence and 1-year all-cause mortality in patients with structural heart disease undergoing catheter ablation. Methods We analyzed data of 299 patients recorded in our structured registry. These included medical history, echocardiography parameters, laboratory results, VT properties, procedural data. Results Out of the 299 patients, 34 (11%) were female. No significant difference was found between women and men in terms of VT recurrence (p = 0.74) or mortality (p = 0.07). In females, severe mitral regurgitation (MR), tricuspid regurgitation (TR), presentation with incessant VT, and preprocedural electrical storm (ES) were associated with increased risk of VT recurrence. Diabetes, implanted CRT, VT with hemodynamic instability, ES and advanced MR were the risk factors of mortality in women. ACEi/ARB use predicted a favorable outcome in both endpoints among females. In men, independent predictors of VT recurrence were the composite parameter of ES and multiple ICD therapies, presentation with incessant VT, severe MR, while independent predictors of mortality were age, LVEF, creatinine and previously implanted CRT. Conclusion According to our investigation, there are pronounced sex differences in predictors of recurrence and mortality following VT ablation.
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Affiliation(s)
- Patrik Tóth
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Ferenc Komlósi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Péter Vámosi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bence Arnóth
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Nándor Szegedi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zoltán Salló
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Katalin Piros
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Péter Perge
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Pál Ábrahám
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Gábor Széplaki
- Mater Private Hospital, Dublin, Ireland,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - László Gellér
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Klaudia Vivien Nagy
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary,*Correspondence: Klaudia Vivien Nagy
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Vámosi P, Nagy KV, Tóth P, Komlósi F, Merkely B, Geller L. PO-697-08 NEW ALGORITHM FOR MACHINE LEARNING-BASED PREDICTION OF 1-YEAR ALL-CAUSE MORTALITY IN PATIENTS UNDERGOING VENTRICULAR TACHYCARDIA ABLATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1008] [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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Afshar A, Nagy KV, Vámosi P, Komlósi F, Tóth P, Szegedi N, Osztheimer I, Salló Z, Tokodi M, Merkely B, Geller LA. MACHINE LEARNING-BASED PREDICTION OF 1-YEAR ALL-CAUSE MORTALITY IN PATIENTS UNDERGOING VT ABLATION WITH TOPOLOGICAL DATA ANALYSIS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01066-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: 11/25/2022]
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Jelitai M, Barth AM, Komlósi F, Freund TF, Varga V. Activity and Coupling to Hippocampal Oscillations of Median Raphe GABAergic Cells in Awake Mice. Front Neural Circuits 2022; 15:784034. [PMID: 34975416 PMCID: PMC8718440 DOI: 10.3389/fncir.2021.784034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Ascending serotonergic/glutamatergic projection from the median raphe region (MRR) to the hippocampal formation regulates both encoding and consolidation of memory and the oscillations associated with them. The firing of various types of MRR neurons exhibits rhythmic modulation coupled to hippocampal oscillatory activity. A possible intermediary between rhythm-generating forebrain regions and entrained ascending modulation may be the GABAergic circuit in the MRR, known to be targeted by a diverse array of top-down inputs. However, the activity of inhibitory MRR neurons in an awake animal is still largely unexplored. In this study, we utilized whole cell patch-clamp, single cell, and multichannel extracellular recordings of GABAergic and non-GABAergic MRR neurons in awake, head-fixed mice. First, we have demonstrated that glutamatergic and serotonergic neurons receive both transient, phasic, and sustained tonic inhibition. Then, we observed substantial heterogeneity of GABAergic firing patterns but a marked modulation of activity by brain states and fine timescale coupling of spiking to theta and ripple oscillations. We also uncovered a correlation between the preferred theta phase and the direction of activity change during ripples, suggesting the segregation of inhibitory neurons into functional groups. Finally, we could detect complementary alteration of non-GABAergic neurons' ripple-coupled activity. Our findings support the assumption that the local inhibitory circuit in the MRR may synchronize ascending serotonergic/glutamatergic modulation with hippocampal activity on a subsecond timescale.
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Affiliation(s)
- Marta Jelitai
- Subcortical Modulation Research Group, Institute of Experimental Medicine, Budapest, Hungary
| | - Albert M Barth
- Subcortical Modulation Research Group, Institute of Experimental Medicine, Budapest, Hungary
| | - Ferenc Komlósi
- Subcortical Modulation Research Group, Institute of Experimental Medicine, Budapest, Hungary
| | - Tamás F Freund
- Laboratory of Cerebral Cortex Research, Institute of Experimental Medicine, Budapest, Hungary
| | - Viktor Varga
- Subcortical Modulation Research Group, Institute of Experimental Medicine, Budapest, Hungary
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