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Fox SR, Toomu A, Gu K, Kang J, Sung K, Han FT, Hoffmayer KS, Hsu JC, Raissi F, Feld GK, McCulloch AD, Ho G, Krummen DE. Impact of artificial intelligence arrhythmia mapping on time to first ablation, procedure duration, and fluoroscopy use. J Cardiovasc Electrophysiol 2024; 35:916-928. [PMID: 38439119 DOI: 10.1111/jce.16237] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 02/04/2024] [Accepted: 02/22/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Artificial intelligence (AI) ECG arrhythmia mapping provides arrhythmia source localization using 12-lead ECG data; whether this information impacts procedural efficiency is unknown. We performed a retrospective, case-control study to evaluate the hypothesis that AI ECG mapping may reduce time to ablation, procedural duration, and fluoroscopy. MATERIALS AND METHODS Cases in which system output was used were retrospectively enrolled according to IRB-approved protocols at each site. Matched control cases were enrolled in reverse chronological order beginning on the last day for which the technology was unavailable. Controls were matched based upon physician, institution, arrhythmia, and a predetermined complexity rating. Procedural metrics, fluoroscopy data, and clinical outcomes were assessed from time-stamped medical records. RESULTS The study group consisted of 28 patients (age 65 ± 11 years, 46% female, left atrial dimension 4.1 ± 0.9 cm, LVEF 50 ± 18%) and was similar to 28 controls. The most common arrhythmia types were atrial fibrillation (n = 10), premature ventricular complexes (n = 8), and ventricular tachycardia (n = 6). Use of the system was associated with a 19.0% reduction in time to ablation (133 ± 48 vs. 165 ± 49 min, p = 0.02), a 22.6% reduction in procedure duration (233 ± 51 vs. 301 ± 83 min, p < 0.001), and a 43.7% reduction in fluoroscopy (18.7 ± 13.3 vs. 33.2 ± 18.0 min, p < 0.001) versus controls. At 6 months follow-up, arrhythmia-free survival was 73.5% in the study group and 63.3% in the control group (p = 0.56). CONCLUSION Use of forward-solution AI ECG mapping is associated with reductions in time to first ablation, procedure duration, and fluoroscopy without an adverse impact on procedure outcomes or complications.
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Affiliation(s)
- Sutton R Fox
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Avinash Toomu
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Kelly Gu
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Jessica Kang
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Kevin Sung
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Frederick T Han
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Kurt S Hoffmayer
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Jonathan C Hsu
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Farshad Raissi
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Gregory K Feld
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Andrew D McCulloch
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Biomedical Engineering, University of California San Diego, La Jolla, California, USA
| | - Gordon Ho
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - David E Krummen
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
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Aldaas OM, Malladi C, Han FT, Hoffmayer KS, Krummen D, Ho G, Raissi F, Birgersdotter-Green U, Feld GK, Hsu JC. Pulsed field ablation versus thermal energy ablation for atrial fibrillation: a systematic review and meta-analysis of procedural efficiency, safety, and efficacy. J Interv Card Electrophysiol 2024; 67:639-648. [PMID: 37855992 PMCID: PMC11016003 DOI: 10.1007/s10840-023-01660-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 09/07/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Pulsed field ablation (PFA) induces cell death through electroporation using ultrarapid electrical pulses. We sought to compare the procedural efficiency characteristics, safety, and efficacy of ablation of atrial fibrillation (AF) using PFA compared with thermal energy ablation. METHODS We performed an extensive literature search and systematic review of studies that compared ablation of AF with PFA versus thermal energy sources. Risk ratio (RR) 95% confidence intervals (CI) were measured for dichotomous variables and mean difference (MD) 95% CI were measured for continuous variables, where RR < 1 and MD < 0 favor the PFA group. RESULTS We included 6 comparative studies for a total of 1012 patients who underwent ablation of AF: 43.6% with PFA (n = 441) and 56.4% (n = 571) with thermal energy sources. There were significantly shorter procedures times with PFA despite a protocolized 20-min dwell time (MD - 21.95, 95% CI - 33.77, - 10.14, p = 0.0003), but with significantly longer fluroscopy time (MD 5.71, 95% CI 1.13, 10.30, p = 0.01). There were no statistically significant differences in periprocedural complications (RR 1.20, 95% CI 0.59-2.44) or recurrence of atrial tachyarrhythmias (RR 0.64, 95% CI 0.31, 1.34) between the PFA and thermal ablation cohorts. CONCLUSIONS Based on the results of this meta-analysis, PFA was associated with shorter procedural times and longer fluoroscopy times, but no difference in periprocedural complications or rates of recurrent AF when compared to ablation with thermal energy sources. However, larger randomized control trials are needed.
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Affiliation(s)
- Omar Mahmoud Aldaas
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Chaitanya Malladi
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Frederick T Han
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Kurt S Hoffmayer
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - David Krummen
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Gordon Ho
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Farshad Raissi
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Ulrika Birgersdotter-Green
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Gregory K Feld
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Jonathan C Hsu
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA.
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of CA - San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA.
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Ahlers M, Darden D, Hoffmayer K, Feld GK, Krummen DE, Ho G. A perfect storm of ventricular fibrillation: Infarct, posterior fascicle, and the moderator band. HeartRhythm Case Rep 2023; 9:943-947. [PMID: 38204826 PMCID: PMC10774567 DOI: 10.1016/j.hrcr.2023.10.005] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Affiliation(s)
- Michael Ahlers
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Diego, La Jolla, California
| | - Douglas Darden
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Diego, La Jolla, California
| | - Kurt Hoffmayer
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Diego, La Jolla, California
| | - Gregory K. Feld
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Diego, La Jolla, California
| | - David E. Krummen
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Diego, La Jolla, California
| | - Gordon Ho
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Diego, La Jolla, California
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Aldaas OM, Darden D, Mylavarapu PS, Aldaas AM, Han FT, Hoffmayer KS, Krummen D, Ho G, Raissi F, Feld GK, Hsu JC. Safety and efficacy of catheter ablation of atrial fibrillation in the very elderly (≥80 years old): Insights from the UC San Diego AF Ablation Registry. Clin Cardiol 2023; 46:1488-1494. [PMID: 37626475 PMCID: PMC10716336 DOI: 10.1002/clc.24137] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/12/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Catheter ablation improves outcomes in symptomatic atrial fibrillation (AF) patients. However, its safety and efficacy in the very elderly (≥80 years old) is not well described. HYPOTHESIS Ablation of AF in the very elderly is safe and effective. METHODS We performed a retrospective study of all patients who underwent catheter ablation enrolled in the University of California, San Diego AF Ablation Registry. The primary outcome was freedom from atrial arrhythmias on or off antiarrhythmic drugs (AADs). RESULTS Of 847 patients, 42 (5.0%) were 80 years of age or greater with a median age of 81.5 (80-82.3) and 805 (95.0%) were less than 80 years of age with a median age of 64.4 (57.6-70.2). Among those who were ≥80 years old, 29 were undergoing de novo ablation (69.0%), whereas in the younger cohort, 518 (64.5%) were undergoing de novo ablation (p = .548). There were no statistically significant differences in fluoroscopy (p = .406) or total procedure times (p = .076), AAD use (p = .611), or procedural complications (p = .500) between groups. After multivariable adjustment, there were no statistically significant differences in recurrence of any atrial arrhythmias on or off AAD (adjusted hazard ratio [AHR]: 0.75; 95% confidence interval [CI]: 0.45-1.23; p = .252), all-cause hospitalizations (AHR: 0.86; 95% CI: 0.46-1.60; p = .626), or all-cause mortality (AHR: 4.48; 95% CI: 0.59-34.07; p = .147) between the very elderly and the younger cohort. CONCLUSION In this registry analysis, catheter ablation of AF appears similarly effective and safe in patients 80 years or older when compared to a younger cohort.
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Affiliation(s)
- Omar M. Aldaas
- Division of Cardiac Electrophysiology at the University of California San Diego Health SystemLa JollaCaliforniaUSA
| | - Douglas Darden
- Division of Cardiac Electrophysiology at the University of California San Diego Health SystemLa JollaCaliforniaUSA
| | - Praneet S. Mylavarapu
- Division of Cardiac Electrophysiology at the University of California San Diego Health SystemLa JollaCaliforniaUSA
| | - Amer M. Aldaas
- A. T. Still University School of Osteopathic MedicineMesaArizonaUSA
| | - Frederick T. Han
- Division of Cardiac Electrophysiology at the University of California San Diego Health SystemLa JollaCaliforniaUSA
| | - Kurt S. Hoffmayer
- Division of Cardiac Electrophysiology at the University of California San Diego Health SystemLa JollaCaliforniaUSA
| | - David Krummen
- Division of Cardiac Electrophysiology at the University of California San Diego Health SystemLa JollaCaliforniaUSA
| | - Gordon Ho
- Division of Cardiac Electrophysiology at the University of California San Diego Health SystemLa JollaCaliforniaUSA
| | - Farshad Raissi
- Division of Cardiac Electrophysiology at the University of California San Diego Health SystemLa JollaCaliforniaUSA
| | - Gregory K. Feld
- Division of Cardiac Electrophysiology at the University of California San Diego Health SystemLa JollaCaliforniaUSA
| | - Jonathan C. Hsu
- Division of Cardiac Electrophysiology at the University of California San Diego Health SystemLa JollaCaliforniaUSA
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Aldaas OM, Malladi C, Aldaas AM, Han FT, Hoffmayer KS, Krummen D, Ho G, Raissi F, Birgersdotter-Green U, Feld GK, Hsu JC. Safety and acute efficacy of catheter ablation for atrial fibrillation with pulsed field ablation vs thermal energy ablation: A meta-analysis of single proportions. Heart Rhythm O2 2023; 4:599-608. [PMID: 37936671 PMCID: PMC10626185 DOI: 10.1016/j.hroo.2023.09.003] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Background Pulsed field ablation (PFA) has emerged as a novel energy source for the ablation of atrial fibrillation (AF) using ultrarapid electrical pulses to induce cell death via electroporation. Objective The purpose of this study was to compare the safety and acute efficacy of ablation for AF with PFA vs thermal energy sources. Methods We performed an extensive literature search and systematic review of studies that evaluated the safety and efficacy of ablation for AF with PFA and compared them to landmark clinical trials for ablation of AF with thermal energy sources. Freeman-Tukey double arcsine transformation was used to establish variance of raw proportions followed by the inverse with the random-effects model to combine the transformed proportions and generate the pooled prevalence and 95% confidence interval (CI). Results We included 24 studies for a total of 5203 patients who underwent AF ablation. Among these patients, 54.6% (n = 2842) underwent PFA and 45.4% (n = 2361) underwent thermal ablation. There were significantly fewer periprocedural complications in the PFA group (2.05%; 95% CI 0.94-3.46) compared to the thermal ablation group (7.75%; 95% CI 5.40-10.47) (P = .001). When comparing AF recurrence up to 1 year, there was a statistically insignificant trend toward a lower prevalence of recurrence in the PFA group (14.24%; 95% CI 6.97-23.35) compared to the thermal ablation group (25.98%; 95% CI 15.75-37.68) (P = .132). Conclusion Based on the results of this meta-analysis, PFA was associated with lower rates of periprocedural complications and similar rates of acute procedural success and recurrent AF with up to 1 year of follow-up compared to ablation with thermal energy sources.
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Affiliation(s)
- Omar M. Aldaas
- Section of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, California
| | - Chaitanya Malladi
- Section of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, California
| | - Amer M. Aldaas
- T. Still University School of Osteopathic Medicine, Mesa, Arizona
| | - Frederick T. Han
- Section of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, California
| | - Kurt S. Hoffmayer
- Section of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, California
| | - David Krummen
- Section of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, California
| | - Gordon Ho
- Section of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, California
| | - Farshad Raissi
- Section of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, California
| | - Ulrika Birgersdotter-Green
- Section of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, California
| | - Gregory K. Feld
- Section of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, California
| | - Jonathan C. Hsu
- Section of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, California
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Verma A, Feld GK, Cox JL, Dewland TA, Babkin A, De Potter T, Raju N, Haissaguerre M. Combined pulsed field ablation with ultra-low temperature cryoablation: A preclinical experience. J Cardiovasc Electrophysiol 2023; 34:2124-2133. [PMID: 36218014 DOI: 10.1111/jce.15701] [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: 04/24/2022] [Revised: 08/19/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Combining pulsed field ablation (PFA) with ultra-low temperature cryoablation (ULTC) represents a novel energy source which may create more transmural cardiac lesions. We sought to assess the feasibility of lesions created by combined cryoablation and pulsed field ablation (PFCA) versus PFA alone. METHODS Ablations were performed using a custom PFA generator, ULTC console, and an ablation catheter with insertable stylets. PFA was delivered in a biphasic, bipolar train. PFCA precooled the tissue for 30 s followed by a concurrent PFA train. Benchtop testing using Schlieren imaging and microbubble volume assessment were used to compare PFA and PFCA. PFA and PFCA lesions using pre-optimized and optimized ablation protocols were studied in 6 swine. Pre and post-ECGs were recorded for each ablation and a gross necropsy was performed at 14 days. RESULTS Consistent with benchtop comparisons of heat and microbubble generation, PFA deliveries in the animals were accompanied by muscle contractions and significant microbubbles (Grade 2-3) visible on intracardiac echo while neither occurred during PFCA at higher voltage levels. Both PFA and PFCA acutely eliminated or highly attenuated (>80%) local atrial electrograms. Histology of PFA and PFCA lesions indicated depth up to 6-7 mm and nearly all lesions were transmural. Optimized PFCA produced wider cavotricuspid isthmus lesions with evidence of tissue selectivity. CONCLUSION A novel technology combining PFA and ULTC into one energy source demonstrated in-vivo feasibility for PFCA ablation. PFCA had a more favorable thermal profile and did not produce muscle contraction or microbubbles while extending lesion depth beyond cryoablation.
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Affiliation(s)
- Atul Verma
- McGill University Health Centre, Division of Cardiology, Montreal, Quebec, Canada
| | - Gregory K Feld
- Division of Cardiology, University of California San Diego, La Jolla, California, USA
| | - James L Cox
- Division of Cardiac Surgery, Northwestern University, Chicago, Illinois, USA
| | - Thomas A Dewland
- Division of Cardiology, University of California San Francisco, San Francisco, California, USA
| | | | - Tom De Potter
- Division of Cardiology, Cardiovascular Center, OLV Aalst, Aalst, Belgium
| | - Narayan Raju
- Pathology Research Laboratory, San Francisco, California, USA
| | - Michel Haissaguerre
- Division of Cardiology, Centre Hospitalier Universitaire Bordeaux, Pessac, France
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Aldaas OM, Darden D, Mylavarapu PS, Han FT, Hoffmayer KS, Krummen D, Ho G, Raissi F, Feld GK, Hsu JC. Association of isoproterenol infusion during catheter ablation of atrial fibrillation with outcomes: insights from the UC San Diego AF Ablation Registry. J Interv Card Electrophysiol 2023; 66:1243-1252. [PMID: 36508065 PMCID: PMC10258224 DOI: 10.1007/s10840-022-01448-x] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/03/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND High-dose isoproterenol infusion is a useful provocative maneuver to elicit triggers of atrial fibrillation (AF) during ablation. We evaluated whether the use of isoproterenol infusion to elicit triggers of AF after ablation is associated with differential outcomes. METHODS We performed a retrospective study of all patients who underwent de novo radiofrequency catheter ablation of AF enrolled in the University of California, San Diego AF Ablation Registry. The primary outcome was freedom from atrial arrhythmias on or off antiarrhythmic drugs (AAD). RESULTS Of 314 patients undergoing AF ablation, 235 (74.8%) received isoproterenol while 79 (25.2%) did not. Among those who received isoproterenol, 11 (4.7%) had additional triggers identified. There were no statistically significant differences in procedure time (p = 0.432), antiarrhythmic drug use (p = 0.289), procedural complications (p = 0.279), recurrences of atrial arrhythmias on or off AAD [adjusted hazard ratio (AHR) 0.92 (95% CI 0.58-1.46); p = 0.714], all-cause hospitalizations [AHR 1.00 (95% CI 0.60-1.67); p = 0.986], or all-cause mortality [AHR 0.14 (95% CI 0.01-3.52); p = 0.229] between groups. CONCLUSIONS In this registry analysis, use of isoproterenol is safe but was not associated with a reduction in recurrence of atrial arrhythmias.
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Affiliation(s)
- Omar M Aldaas
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Douglas Darden
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Praneet S Mylavarapu
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Frederick T Han
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Kurt S Hoffmayer
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - David Krummen
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Gordon Ho
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Farshad Raissi
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Gregory K Feld
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Jonathan C Hsu
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA.
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Keyt LK, Atwood T, Bruggeman A, Mundt AJ, Feld GK, Krummen DE, Ho G. Successful Noninvasive 12-Lead ECG Mapping-Guided Radiotherapy of Inaccessible Ventricular Tachycardia Substrate Due to Mechanical Valves. JACC Case Rep 2023; 15:101870. [PMID: 37283824 PMCID: PMC10240275 DOI: 10.1016/j.jaccas.2023.101870] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/21/2023] [Accepted: 04/13/2023] [Indexed: 06/08/2023]
Abstract
In patients presenting with refractory ventricular tachycardia (VT) and aortic and mitral mechanical prosthetic valves, traditional catheter ablation is challenging. We describe a case in which a novel noninvasive computational electrocardiogram mapping algorithm localized VT sources originating from substrate near the mechanical valves, in which stereotactic ablative radiotherapy eliminated VT in 1.5-year follow-up. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Lucas K. Keyt
- Department of Medicine, Division of Cardiology, University of California-San Diego, La Jolla, California, USA
| | - Todd Atwood
- Department of Radiation Medicine and Applied Sciences, University of California-San Diego, La Jolla, California, USA
| | - Andrew Bruggeman
- Department of Radiation Medicine and Applied Sciences, University of California-San Diego, La Jolla, California, USA
| | - Arno J. Mundt
- Department of Radiation Medicine and Applied Sciences, University of California-San Diego, La Jolla, California, USA
| | - Gregory K. Feld
- Department of Medicine, Division of Cardiology, University of California-San Diego, La Jolla, California, USA
| | - David E. Krummen
- Department of Medicine, Division of Cardiology, University of California-San Diego, La Jolla, California, USA
| | - Gordon Ho
- Department of Medicine, Division of Cardiology, University of California-San Diego, La Jolla, California, USA
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Darden D, Aldaas O, Du C, Munir MB, Feld GK, Pothineni NVK, Gopinathannair R, Lakkireddy D, Curtis JP, Freeman JV, Akar JG, Hsu JC. In-hospital complications associated with pulmonary vein isolation with adjunctive lesions: the NCDR AFib Ablation Registry. Europace 2023; 25:euad124. [PMID: 37184436 PMCID: PMC10228609 DOI: 10.1093/europace/euad124] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/26/2022] [Accepted: 03/29/2023] [Indexed: 05/16/2023] Open
Abstract
AIMS No prior study has been adequately powered to evaluate real-world safety outcomes in those receiving adjunctive ablation lesions beyond pulmonary vein isolation (PVI). We sought to evaluate characteristics and in-hospital complications among patients undergoing PVI with and without adjunctive lesions. METHODS AND RESULTS Patients in the National Cardiovascular Data Registry AFib Ablation Registry undergoing first-time atrial fibrillation (AF) ablation between 2016 and 2020 were identified and stratified into paroxysmal (PAF) and persistent AF, and separated into PVI only, PVI + cavotricuspid isthmus (CTI) ablation, and PVI + adjunctive (superior vena cava isolation, coronary sinus, vein of Marshall, atypical atrial flutter lines, other). Adjusted odds of adverse events were calculated using multivariable logistic regression. A total of 50 937 patients [PAF: 30 551 (60%), persistent AF: 20 386 (40%)] were included. Among those with PAF, there were no differences in the adjusted odds of complications between PVI + CTI or PVI + adjunctive when compared with PVI only. Among persistent AF, PVI + adjunctive was associated with a higher risk of any complication [3.0 vs. 4.5%, odds ratio (OR) 1.30, 95% confidence interval (CI) 1.07-1.58] and major complication (0.8 vs. 1.4%, OR 1.56, 95% CI 1.10-2.21), while no differences were observed in PVI + CTI compared with PVI only. Overall, there was high heterogeneity in adjunctive lesion type, and those receiving adjunctive lesions had a higher comorbidity burden. CONCLUSION Additional CTI ablation was common without an increased risk of complications. Adjunctive lesions other than CTI are commonly performed in those with more comorbidities and were associated with an increased risk of complications in persistent AF, although the current analysis is limited by high heterogeneity in adjunctive lesion set type.
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Affiliation(s)
- Douglas Darden
- Kansas City Heart Rhythm Institute, 5100 W 110th St, Suite 200, Overland Park, KS, USA
| | - Omar Aldaas
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, CA 92037, USA
| | - Chengan Du
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Muhammad Bilal Munir
- Division of Cardiology, Department of Medicine, University of California Davis, Sacramento, CA, USA
| | - Gregory K Feld
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, CA 92037, USA
| | | | - Rakesh Gopinathannair
- Kansas City Heart Rhythm Institute, 5100 W 110th St, Suite 200, Overland Park, KS, USA
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute, 5100 W 110th St, Suite 200, Overland Park, KS, USA
| | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - James V Freeman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Joseph G Akar
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Jonathan C Hsu
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, CA 92037, USA
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Toomu A, Han FT, Ho G, Fox SR, Sung K, Hoffmayer KS, Hsu JC, Shabari FR, Feld GK, Krummen DE. CLINICAL IMPACT OF FORWARD-SOLUTION ECG MAPPING ON PROCEDURE DURATION AND FLUOROSCOPY USE DURING CATHETER ABLATION PROCEDURES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00486-2] [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: 03/06/2023]
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11
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Birs AS, Darden D, Adler ED, Feld GK. Refractory coronary vasospasm and recurrent cardiac arrest. BMJ Case Rep 2023; 16:16/1/e253884. [PMID: 36631170 PMCID: PMC9835876 DOI: 10.1136/bcr-2022-253884] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
We present a case of recurrent vasospasm as an uncommon cause of ventricular fibrillation in a young female patient who was found to have a genetic mutation of unknown significance in the desmoplakin (DSP) gene and ultimately required an implantable cardiac defibrillator and percutaneous coronary intervention. Refractory vasospasm as a cause of chest pain and cardiac arrest may be under-recognised. In this manuscript, we highlight the natural history of refractory vasospasm, treatment considerations including medical therapy, implantable cardiac defibrillator and percutaneous coronary intervention. Lastly, we explore the potential correlation between the DSP mutation and her clinical presentation and the growing importance of genetic testing in unexplained cardiac arrest.
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Affiliation(s)
- Antoinette S Birs
- Department of Cardiology, UC San Diego Health System, La Jolla, California, USA
| | - Douglas Darden
- Department of Cardiology, UC San Diego Health System, La Jolla, California, USA
| | - Eric D Adler
- Department of Cardiology, UC San Diego Health System, La Jolla, California, USA
| | - Gregory K Feld
- Department of Cardiology, UC San Diego Health System, La Jolla, California, USA
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12
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Srivatsa UN, Varyani R, Kini P, Srinivas N, Garg A, Yegya-Raman S, Park J, Srivathsan K, Tisma-Dupanovic S, Reddy M, Nordsieck E, Wijetunga M, Airey K, Abedin M, Nannapaneni N, Freedman RA, Scott Wall T, Swarna US, Birgersdotter-Green U, Feld GK, Dash P. Knowledge exchange-Working together across the globe. Heart Rhythm O2 2022; 3:871-873. [PMID: 36588994 PMCID: PMC9795277 DOI: 10.1016/j.hroo.2022.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Uma N. Srivatsa
- Address reprint requests and correspondence: Dr Uma N. Srivatsa, Division of Cardiovascular Medicine, University of California Davis Medical Center, 4860 Y St, Ste 2820, Sacramento, CA 95817.
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13
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Krummen DE, Villongco CT, Ho G, Schricker AA, Field ME, Sung K, Kacena KA, Martinson MS, Hoffmayer KS, Hsu JC, Raissi F, Feld GK, McCulloch AD, Han FT. Forward-Solution Noninvasive Computational Arrhythmia Mapping: The VMAP Study. Circ Arrhythm Electrophysiol 2022; 15:e010857. [PMID: 36069189 PMCID: PMC9509662 DOI: 10.1161/circep.122.010857] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The accuracy of noninvasive arrhythmia source localization using a forward-solution computational mapping system has not yet been evaluated in blinded, multicenter analysis. This study tested the hypothesis that a computational mapping system incorporating a comprehensive arrhythmia simulation library would provide accurate localization of the site-of-origin for atrial and ventricular arrhythmias and pacing using 12-lead ECG data when compared with the gold standard of invasive electrophysiology study and ablation. METHODS The VMAP study (Vectorcardiographic Mapping of Arrhythmogenic Probability) was a blinded, multicenter evaluation with final data analysis performed by an independent core laboratory. Eligible episodes included atrial and ventricular: tachycardia, fibrillation, pacing, premature atrial and ventricular complexes, and orthodromic atrioventricular reentrant tachycardia. Mapping system results were compared with the gold standard site of successful ablation or pacing during electrophysiology study and ablation. Mapping time was assessed from time-stamped logs. Prespecified performance goals were used for statistical comparisons. RESULTS A total of 255 episodes from 225 patients were enrolled from 4 centers. Regional accuracy for ventricular tachycardia and premature ventricular complexes in patients without significant structural heart disease (n=75, primary end point) was 98.7% (95% CI, 96.0%-100%; P<0.001 to reject predefined H0 <0.80). Regional accuracy for all episodes (secondary end point 1) was 96.9% (95% CI, 94.7%-99.0%; P<0.001 to reject predefined H0 <0.75). Accuracy for the exact or neighboring segment for all episodes (secondary end point 2) was 97.3% (95% CI, 95.2%-99.3%; P<0.001 to reject predefined H0 <0.70). Median spatial accuracy was 15 mm (n=255, interquartile range, 7-25 mm). The mapping process was completed in a median of 0.8 minutes (interquartile range, 0.4-1.4 minutes). CONCLUSIONS Computational ECG mapping using a forward-solution approach exceeded prespecified accuracy goals for arrhythmia and pacing localization. Spatial accuracy analysis demonstrated clinically actionable results. This rapid, noninvasive mapping technology may facilitate catheter-based and noninvasive targeted arrhythmia therapies. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT04559061.
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Affiliation(s)
- David E. Krummen
- Department of Medicine, University of California San Diego, La Jolla
- Veterans Affairs San Diego Healthcare System, San Diego
| | | | - Gordon Ho
- Department of Medicine, University of California San Diego, La Jolla
- Veterans Affairs San Diego Healthcare System, San Diego
| | | | | | - Kevin Sung
- Department of Medicine, University of California San Diego, La Jolla
| | | | | | - Kurt S. Hoffmayer
- Department of Medicine, University of California San Diego, La Jolla
- Veterans Affairs San Diego Healthcare System, San Diego
| | - Jonathan C. Hsu
- Department of Medicine, University of California San Diego, La Jolla
| | - Farshad Raissi
- Department of Medicine, University of California San Diego, La Jolla
| | - Gregory K. Feld
- Department of Medicine, University of California San Diego, La Jolla
| | - Andrew D. McCulloch
- Department of Medicine, University of California San Diego, La Jolla
- Department of Bioengineering, University of California San Diego, La Jolla
| | - Frederick T. Han
- Department of Medicine, University of California San Diego, La Jolla
- Veterans Affairs San Diego Healthcare System, San Diego
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Darden D, Peterson PN, Xin X, Munir MB, Minges KE, Goldenberg I, Poole JE, Feld GK, Birgersdotter-Green U, Curtis JP, Hsu JC. Temporal trends and long-term outcomes among recipients of cardiac resynchronization therapy with defibrillator in the United States, 2011-2015: Insights from the National Cardiovascular Data Registry. Heart Rhythm O2 2022; 3:405-414. [PMID: 36097450 PMCID: PMC9463686 DOI: 10.1016/j.hroo.2022.03.004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Contemporary data on national trends and outcomes in cardiac resynchronization therapy with defibrillator (CRT-D) recipients following the 2012 updated guidelines has not been studied. Objectives This study assessed the trends in long-term outcomes among CRT-D Medicare-aged recipients implanted in 2011-2015. Methods Patients aged ≥65 years undergoing de novo CRT-D implantation in the National Cardiovascular Data Implantable Cardiac Defibrillator Registry from 2011-2015 with follow-up through 2017 using Medicare data were included and stratified by year of implant. Patient characteristics, in-hospital outcomes, and outcomes up to 2 years following implant were evaluated. Results Among 53,174 patients (aged 75.6-6.4 years, 29.7% women) implanted with CRT-D from 2011 to 2015, there was an increase in implantations based on guideline-concordant recommendations (81.0% to 84.7%, P < .001). Compared to 2011, in-hospital procedural complications decreased in 2015 (3.9% vs 2.9%; adjusted odds ratio, 0.76, 95% confidence interval, 0.66-0.88, P < .001), driven in part by decreased lead dislodgement (1.4% vs 1.0%). After multivariable adjustment, there was a lower risk of all-cause hospitalization, cardiovascular hospitalization, and mortality at 2-year follow-up in 2015 as compared to 2011, while there were no differences in heart failure hospitalizations at follow-up. Conclusion Among Medicare beneficiaries receiving CRT-D from 2011 to 2015, there was an increase in implantations based on guideline-concordant recommendations. Furthermore, there has been a reduction in in-hospital complications and long-term outcomes, including cardiovascular hospitalization, all-cause hospitalization, and mortality; however, there has been no difference in the risk of heart failure hospitalization after adjustment.
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Affiliation(s)
- Douglas Darden
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Pamela N. Peterson
- Division of Cardiology, Denver Health Medical Center, Denver, Colorado
- University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Xin Xin
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Muhammad Bilal Munir
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Karl E. Minges
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Ilan Goldenberg
- Division of Cardiology, University of Rochester Medical Center, Rochester, New York
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York
| | - Jeanne E. Poole
- University of Washington School of Medicine, Seattle, Washington
| | - Gregory K. Feld
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Ulrika Birgersdotter-Green
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Jeptha P. Curtis
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jonathan C. Hsu
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
- Address reprint requests and correspondence: Dr Jonathan C. Hsu, Associate Professor of Medicine, University of California San Diego, 9452 Medical Center Dr, MC7411, La Jolla, CA 92037.
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Hoffmayer KS, Han FT, Hsu JC, Feld GK, Scheinman MM. Exercise-induced arrhythmias. Heart Rhythm 2022; 19:1214-1216. [DOI: 10.1016/j.hrthm.2021.09.012] [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] [Received: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 11/15/2022]
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16
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Margolin E, Lin A, Ho G, Han FT, Pretorius V, Adler E, Feld GK, Hsu JC, Hong KN. PO-653-08 EFFECT OF VT ABLATION ON TIME BETWEEN VT STORM AND HEART TRANSPLANT. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.260] [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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17
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Krummen DE, Villongco CT, Ho G, Schricker AA, Field ME, Sung K, Kacena KA, Martnson MS, Hoffmayer KS, Hsu JC, Shabari FR, Feld GK, McCulloch AD, Han FT. CE-520-04 FORWARD-SOLUTION COMPUTATIONAL ARRHYTHMIA SOURCE MAPPING: THE VMAP STUDY. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.106] [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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18
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Feld GK. Alternative Approaches for Ablation of the Mitral Isthmus for Treatment of Atrial Fibrillation. JACC Clin Electrophysiol 2022; 8:377-379. [PMID: 35331433 DOI: 10.1016/j.jacep.2021.12.003] [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] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 10/18/2022]
Affiliation(s)
- Gregory K Feld
- Department of Medicine, Division of Cardiology, Cardiac Electrophysiology Section, University of California-San Diego Health System, La Jolla, California, USA.
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19
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Dharmavaram G, Killeen J, Chan T, Birgersdotter-Green U, Hoffmayer KS, Han FT, Ho G, Raissi F, Krummen DE, Feld GK, Hsu JC. ROUTINE DEVICE INTERROGATION IN THE EMERGENCY DEPARTMENT INCREASES ATRIAL FIBRILLATION DETECTION AND ELECTROPHYSIOLOGY FOLLOW-UP. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01109-3] [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: 10/18/2022]
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20
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Bhuta S, Hsu J, S Hoffmayer K, Mello M, Savides T, Bashti M, Hunter J, Lewis K, K Feld G. Intraluminal Esophageal Temperature Monitoring Using the Circa S-Cath™ Temperature Probe to Guide Left Atrial Ablation in Patients with Atrial Fibrillation. J Atr Fibrillation 2021; 13:2386. [PMID: 34950319 DOI: 10.4022/jafib.2386] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/20/2020] [Accepted: 06/29/2020] [Indexed: 11/10/2022]
Abstract
Introduction Radiofrequency catheter ablation is a common treatment for atrial fibrillation (AF), during which thermal esophageal injury may rarely occur and lead to an atrio-esophageal fistula. Therefore, we studied the utility of the Circa S-Cath™ multi-sensor luminal esophageal temperature (LET) probe to prevent esophageal thermal injury. Methods and Results Thirty-six patients, enrolled prospectively, underwent circumferential or segmental pulmonary vein isolation for treatment of AF. A maximum ablation electrode temperature of 42ºC was programmed for automatic power delivery cutoff. In addition, energy delivery was manually discontinued when the maximum LET on any sensor of the probe rose abruptly (i.e. ˃0.2ºC) or exceeded 39º C. Esophagoscopy was performed immediately after ablation in 18 patients (with the temperature probe still in place) and at approximately 24 hours after ablation in 18 patients. Esophageal lesions were classified as likely traumatic or thermally related. Of the 36 patients enrolled in the study, 21 had persistent and 15 had paroxysmal AF, average LVEF 57±16% and CHA2DS2VASc score 1.6±1.2 (range 0-4). Average maximum LET was 37.8±1.4ºC, power delivery 31.1±8 watts and ablation electrode temperature 36.4±4.1ºC. Average maximum contact force was 44.5±20.5 grams where measured. Only 1 patient (<3%) had an esophageal lesion that could potentially represent thermal injury and 4 patients (11.1%) had minor traumatic mechanical injury. Conclusions LET guided titration of power and duration of energy application, using an insulated multi-sensor esophageal temperature probe, is associated with a low risk of esophageal thermal injury during AF ablation. In only rare cases, LET monitoring resulted in the need to manipulate the esophagus to avoid unacceptable temperature rises, that could not be achieved by adjustment of power and duration of energy application.
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Affiliation(s)
- Sapan Bhuta
- Division of Cardiology, Cardiac Electrophysiology Program, and the Division of Gastroenterology, UCSD Health System, University of California, San Diego
| | - Jonathan Hsu
- Division of Cardiology, Cardiac Electrophysiology Program, and the Division of Gastroenterology, UCSD Health System, University of California, San Diego
| | - Kurt S Hoffmayer
- Division of Cardiology, Cardiac Electrophysiology Program, and the Division of Gastroenterology, UCSD Health System, University of California, San Diego
| | - Michael Mello
- Division of Cardiology, Cardiac Electrophysiology Program, and the Division of Gastroenterology, UCSD Health System, University of California, San Diego
| | - Thomas Savides
- Division of Cardiology, Cardiac Electrophysiology Program, and the Division of Gastroenterology, UCSD Health System, University of California, San Diego
| | - Malek Bashti
- Division of Cardiology, Cardiac Electrophysiology Program, and the Division of Gastroenterology, UCSD Health System, University of California, San Diego
| | - Jessica Hunter
- Division of Cardiology, Cardiac Electrophysiology Program, and the Division of Gastroenterology, UCSD Health System, University of California, San Diego
| | - Kathryn Lewis
- Division of Cardiology, Cardiac Electrophysiology Program, and the Division of Gastroenterology, UCSD Health System, University of California, San Diego
| | - Gregory K Feld
- Division of Cardiology, Cardiac Electrophysiology Program, and the Division of Gastroenterology, UCSD Health System, University of California, San Diego
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Ho G, Atwood TF, Bruggeman AR, Moore KL, McVeigh E, Villongco CT, Han FT, Hsu JC, Hoffmayer KS, Raissi F, Lin GY, Schricker A, Woods CE, Cheung JP, Taira AV, McCulloch A, Birgersdotter-Green U, Feld GK, Mundt AJ, Krummen DE. Computational ECG mapping and respiratory gating to optimize stereotactic ablative radiotherapy workflow for refractory ventricular tachycardia. Heart Rhythm O2 2021; 2:511-520. [PMID: 34667967 PMCID: PMC8505208 DOI: 10.1016/j.hroo.2021.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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] [Indexed: 02/08/2023] Open
Abstract
Background Stereotactic ablative radiotherapy (SAbR) is an emerging therapy for refractory ventricular tachycardia (VT). However, the current workflow is complicated, and the precision and safety in patients with significant cardiorespiratory motion and VT targets near the stomach may be suboptimal. Objective We hypothesized that automated 12-lead electrocardiogram (ECG) mapping and respiratory-gated therapy may improve the ease and precision of SAbR planning and facilitate safe radiation delivery in patients with refractory VT. Methods Consecutive patients with refractory VT were studied at 2 hospitals. VT exit sites were localized using a 3-D computational ECG algorithm noninvasively and compared to available prior invasive mapping. Radiotherapy (25 Gy) was delivered at end-expiration when cardiac respiratory motion was ≥0.6 cm or targets were ≤2 cm from the stomach. Results In 6 patients (ejection fraction 29% ± 13%), 4.2 ± 2.3 VT morphologies per patient were mapped. Overall, 7 out of 7 computational ECG mappings (100%) colocalized to the identical cardiac segment when prior invasive electrophysiology study was available. Respiratory gating was associated with smaller planning target volumes compared to nongated volumes (71 ± 7 vs 153 ± 35 cc, P < .01). In 2 patients with inferior wall VT targets close to the stomach (6 mm proximity) or significant respiratory motion (22 mm excursion), no GI complications were observed at 9- and 12-month follow-up. Implantable cardioverter-defibrillator shocks decreased from 23 ± 12 shocks/patient to 0.67 ± 1.0 (P < .001) post-SAbR at 6.0 ± 4.9 months follow-up. Conclusions A workflow including computational ECG mapping and protocol-guided respiratory gating is feasible, is safe, and may improve the ease of SAbR planning. Studies to validate this workflow in larger populations are required.
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Affiliation(s)
- Gordon Ho
- Department of Medicine-Cardiology, University of California San Diego, La Jolla, California
| | - Todd F Atwood
- Department of Radiation Medicine, University of California San Diego, La Jolla, California
| | - Andrew R Bruggeman
- Department of Radiation Medicine, University of California San Diego, La Jolla, California
| | - Kevin L Moore
- Department of Radiation Medicine, University of California San Diego, La Jolla, California
| | - Elliot McVeigh
- Department of Bioengineering, University of California San Diego, La Jolla, California
| | | | - Frederick T Han
- Department of Medicine-Cardiology, University of California San Diego, La Jolla, California
| | - Jonathan C Hsu
- Department of Medicine-Cardiology, University of California San Diego, La Jolla, California
| | - Kurt S Hoffmayer
- Department of Medicine-Cardiology, University of California San Diego, La Jolla, California
| | - Farshad Raissi
- Department of Medicine-Cardiology, University of California San Diego, La Jolla, California
| | - Grace Y Lin
- Department of Pathology, University of California San Diego, La Jolla, California
| | - Amir Schricker
- Department of Cardiac Electrophysiology, Mills-Peninsula Medical Center, Sutter Health, Burlingame, California
| | - Christopher E Woods
- Department of Cardiac Electrophysiology, Mills-Peninsula Medical Center, Sutter Health, Burlingame, California
| | - Joey P Cheung
- Department of Radiation Oncology, Mills-Peninsula Medical Center, Sutter Health, Burlingame, California
| | - Al V Taira
- Department of Radiation Oncology, Mills-Peninsula Medical Center, Sutter Health, Burlingame, California
| | - Andrew McCulloch
- Department of Bioengineering, University of California San Diego, La Jolla, California
| | | | - Gregory K Feld
- Department of Medicine-Cardiology, University of California San Diego, La Jolla, California
| | - Arno J Mundt
- Department of Radiation Medicine, University of California San Diego, La Jolla, California
| | - David E Krummen
- Department of Medicine-Cardiology, University of California San Diego, La Jolla, California
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Aldaas OM, Darden D, Mylavarapu PS, Han FT, Hoffmayer KS, Krummen D, Ho G, Raissi F, Feld GK, Hsu JC. B-PO05-104 UTILITY OF ISOPROTERENOL INFUSION DURING CATHETER ABLATION OF ATRIAL FIBRILLATION: INSIGHTS FROM THE UC SAN DIEGO AF ABLATION REGISTRY. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.1023] [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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23
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Vanam S, Munir MB, Aldaas OM, Hsu JC, Feld GK, Han FT, Hoffmayer KS, Shabari FRR, Birgersdotter-Green UM, Krummen DE, Ho G. B-PO02-113 MAPPING AND ABLATION OF ELECTRICAL DRIVERS ARE ASSOCIATED WITH DECREASED ATRIAL FIBRILLATION RECURRENCE IN PATIENTS WHO FAILED PRIOR PULMONARY VEIN ISOLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.367] [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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Lin A, Barat M, Aldaas OM, Han FT, Hoffmayer KS, Ho G, Raissi F, Birgersdotter-Green U, Krummen DE, Feld GK, Hsu JC. B-PO03-099 ATRIOVENTRICULAR NODE ABLATION WITH BIVENTRICULAR PACING VERSUS PULMONARY VEIN ISOLATION IN PATIENTS WITH ATRIAL FIBRILLATION AND ADVANCED HEART FAILURE: INSIGHTS FROM THE UC SAN DIEGO AF ABLATION REGISTRY. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.573] [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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Verma A, Feld GK, Haissaguerre M, Cox JL, Dewland TA, Sharma A, Babkin A, Rupp K, Raju N, Ahmed F, De Potter T. B-PO03-095 COMBINED PULSED FIELD ABLATION WITH CRYOABLATION (PFCA): PRE-CLINICAL EXPERIENCE. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.569] [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: 11/16/2022]
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Mylavarapu P, Mahmoud Aldaas O, Darden D, Han FT, Hoffmayer KS, Krummen DE, Ho G, Raissi F, Feld GK, Hsu JC. B-011-06 USING MACHINE LEARNING TO IDENTIFY PATIENTS LIKELY TO REQUIRE REPEAT CATHETER ABLATION FOR ATRIAL FIBRILLATION: INSIGHTS FROM THE UC SAN DIEGO AF ABLATION REGISTRY. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.07.019] [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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Ho G, Atwood T, Bruggeman A, Moore K, McVeigh E, Villongco C, Han F, Hsu JC, Hoffmayer KS, Lin G, Schricker A, Woods C, Cheung J, Taira AV, Feld GK, Mundt AJ, Krummen DE. B-PO02-129 AN EFFICIENT WORKFLOW TO INCREASE THE PRECISION OF NONINVASIVE RADIO-ABLATION OF VENTRICULAR TACHYCARDIA USING COMPUTERIZED ECG MAPPING AND RESPIRATORY GATING. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.383] [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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Affiliation(s)
- Gregory K Feld
- University of California, San Diego Health System, San Diego, California.
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Darden D, Aldaas O, Malladi CL, Mylavarapu PS, Munir MB, Han FT, Hoffmayer KS, Raissi F, Ho G, Krummen D, Feld GK, Hsu JC. Association between early recurrences of atrial tachyarrhythmias and long-term outcomes in patients after repeat atrial fibrillation ablation. J Interv Card Electrophysiol 2021; 64:323-331. [PMID: 33826085 PMCID: PMC9399025 DOI: 10.1007/s10840-021-00987-z] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/26/2021] [Indexed: 11/30/2022]
Abstract
Purpose Early recurrence of atrial tachyarrhythmia (ER) is predictive of late recurrence of atrial tachyarrhythmia (LR) after first-time atrial fibrillation (AF) ablation, but the association in patients undergoing repeat AF ablation is unknown. We aim to determine the incidence and prognostic significance of ER after repeat ablation. Methods A total of 259 consecutive patients (mean age 64 years, 75.3% male) undergoing repeat AF ablation with complete follow-up data were included at a single institution from 2010 to 2015. ER and LR were defined as atrial tachyarrhythmia (AF, atrial flutter or atrial tachycardia) > 30 s within the 3-month blanking period (BP) and after the 3-month BP, respectively. Results ER occurred in 79/259 (30.5%), and LR occurred in 138/259 (53%) at a median follow-up of 1221 (IQR: 523–1712) days. Four-year freedom from LR was 22% and 56% in patients with and without ER, respectively (p < 0.001). After multivariate adjustment, ER was strongly associated with LR, cardioversion post BP, and repeat ablation, but not associated with hospitalization. Compared to those with no ER, there was a higher risk of LR when ER occurred within the first month of the BP [month 1: hazard ratio (HR) 2.32, confidence interval (CI) 1.57–3.74, p < 0.001; month 2: HR 2.01, CI 1.13–3.83, p = 0.02; month 3: HR 1.46, CI 0.5–3.36, p = 0.37], however the prediction of LR based on timing within the BP was poor (area under curve 0.64). Conclusion Following repeat AF ablation, ER is strongly associated with LR, cardioversion post BP, and repeat ablation.
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Affiliation(s)
- Douglas Darden
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Omar Aldaas
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Chaitanya L Malladi
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Praneet S Mylavarapu
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Muhammad Bilal Munir
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Frederick T Han
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Kurt S Hoffmayer
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Farshad Raissi
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Gordon Ho
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - David Krummen
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Gregory K Feld
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Jonathan C Hsu
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA.
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Darden D, Hsu JC, Tzou WS, von Alvensleben JC, Brooks M, Hoffmayer KS, Brambatti M, Sauer WH, Feld GK, Adler E. Fasciculoventricular and atrioventricular accessory pathways in patients with Danon disease and preexcitation: A multicenter experience. Heart Rhythm 2021; 18:1194-1202. [PMID: 33737230 DOI: 10.1016/j.hrthm.2021.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 10/25/2020] [Revised: 02/23/2021] [Accepted: 03/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Studies have suggested that a fasciculoventricular pathway (FVP) may be the cause of preexcitation in patients with Danon disease, a rare X-linked dominant genetic disorder of hypertrophic cardiomyopathy. OBJECTIVE The purpose of this study was to describe the prevalence of ventricular preexcitation on resting 12-lead electrocardiogram (ECG) in patients with Danon disease and the electrophysiological study (EPS) results of those with preexcitation. METHODS Patients with confirmed Danon disease diagnosed with preexcitation (PR ≤120 ms, delta wave, QRS >110 ms) on ECG were included from a multicenter registry. The incidence of arrhythmias, implantable cardioverter-defibrillator (ICD) procedures, ICD shocks, and EPS results were collected. RESULTS Thirteen of 40 patients (32.5%) with Danon disease were found to have preexcitation (mean age 17.3 years; 38% women). EPS performed in 9 of 13 patients (69%) demonstrated FVP only in 2 (22.2%), extranodal pathway without exclusion of FVP in 2 (22.2%), and both FVP and extranodal pathway in 5 (55.6%). Two patients had malignant accessory pathway (AP) properties. Over median follow-up of 842 days (interquartile range 138-1678), 11 patients (85%) had ICD placement, and 6 (46.1%) underwent heart transplantation. No patients required therapy for ventricular tachycardia, and 2 patients (15%) had paroxysmal atrial fibrillation. CONCLUSION In a large multicenter cohort of patients with Danon disease, there was a high prevalence of FVP and extranodal pathways diagnosed on EPS in those with preexcitation. These findings suggest patients with preexcitation and Danon disease should undergo EPS to assess for FVP and potentially malignant extranodal AP.
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Affiliation(s)
- Douglas Darden
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California.
| | - Jonathan C Hsu
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Wendy S Tzou
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Johannes C von Alvensleben
- Division of Cardiology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Mary Brooks
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Kurt S Hoffmayer
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Michela Brambatti
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - William H Sauer
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gregory K Feld
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Eric Adler
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
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Aldaas OM, Lupercio F, Darden D, Mylavarapu PS, Malladi CL, Han FT, Hoffmayer KS, Krummen D, Ho G, Raissi F, Birgersdotter-Green U, Feld GK, Hsu JC. Meta-analysis of the Usefulness of Catheter Ablation of Atrial Fibrillation in Patients With Heart Failure With Preserved Ejection Fraction. Am J Cardiol 2021; 142:66-73. [PMID: 33290688 DOI: 10.1016/j.amjcard.2020.11.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 12/12/2022]
Abstract
Catheter ablation improves clinical outcomes in atrial fibrillation (AF) patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, the role of catheter ablation in HF with a preserved ejection fraction (HFpEF) is less clear. We performed a literature search and systematic review of studies that compared AF recurrence at one year after catheter ablation of AF in patients with HFpEF versus those with HFrEF. Risk ratio (RR; where a RR <1.0 favors the HFpEF group) and mean difference (MD; where MD <0 favors the HFpEF group) 95% confidence intervals (CI) were measured for dichotomous and continuous variables, respectively. Six studies with a total of 1,505 patients were included, of which 764 (51%) had HFpEF and 741 (49%) had HFrEF. Patients with HFpEF experienced similar recurrence of AF 1 year after ablation on or off antiarrhythmic drugs compared with those with HFrEF (RR 1.01; 95% CI 0.76, 1.35). Fluoroscopy time was significantly shorter in the HFpEF group (MD -5.42; 95% CI -8.51, -2.34), but there was no significant difference in procedure time (MD 1.74; 95% CI -11.89, 15.37) or periprocedural adverse events between groups (RR 0.84; 95% CI 0.54,1.32). There was no significant difference in hospitalizations between groups (MD 1.18; 95% CI 0.90, 1.55), but HFpEF patients experienced significantly less mortality (MD 0.41; 95% CI 0.18, 0.94). In conclusion, based on the results of this meta-analysis, catheter ablation of AF in patients with HFpEF appears as safe and efficacious in maintaining sinus rhythm as in those with HFrEF.
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Aldaas OM, Lupercio F, Lin AY, Han FT, Hoffmayer KS, Raissi F, Ho G, Krummen D, Feld GK, Hsu JC. Ablation of mitral annular flutter ablation utilizing a left atrial anterior line versus a lateral mitral isthmus line: a systematic review and meta-analysis. J Interv Card Electrophysiol 2021; 63:87-95. [PMID: 33538952 PMCID: PMC8333257 DOI: 10.1007/s10840-021-00943-x] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
Abstract
Purpose Mitral annular flutter (MAF) is a common arrhythmia after atrial fibrillation ablation. We sought to compare the efficacy and safety of catheter ablation utilizing either a left atrial anterior wall (LAAW) line or a lateral mitral isthmus (LMI) line. Methods We performed a systematic review for all studies that compared LAAW versus LMI lines. Risk ratio (RR) and mean difference (MD) 95% confidence intervals were measured for dichotomous and continuous variables, respectively. Results Four studies with a total of 594 patients were included, one of which was a randomized control trial. In the LMI ablation group, 40% of patients required CS ablation. There were no significant differences in bidirectional block (RR 1.26; 95% CI, 0.94–1.69) or ablation time (MD −1.5; 95% CI, −6.11–3.11), but LAAW ablation was associated with longer ablation line length (MD 11.42; 95% CI, 10.69–12.14) and longer LAA activation delay (MD 67.68; 95% CI, 33.47–101.89.14) when compared to LMI. There was no significant difference in pericardial effusions (RR 0.36; 95% CI, 0.39–20.75) between groups and more patients were maintained sinus rhythm (RR 1.19; 95% CI, 1.03–1.37, p = 0.02) who underwent LAAW compared to LMI. Conclusion Ablation of mitral annular flutter with a LAAW line compared to a LMI line showed no difference in rates of acute bidirectional block, ablation time, or pericardial effusion. However, LAAW ablation required a longer ablation line length, resulted in greater LAA activation delayed and was associated with more sinus rhythm maintenance, with the added advantage of avoiding ablation in the CS.
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Affiliation(s)
- Omar M Aldaas
- Division of Cardiac Electrophysiology, University of California San Diego Health System, 9452 Medical Center Drive, San Diego, La Jolla, CA, 92037, USA
| | - Florentino Lupercio
- Division of Cardiac Electrophysiology, University of California San Diego Health System, 9452 Medical Center Drive, San Diego, La Jolla, CA, 92037, USA
| | - Andrew Y Lin
- Division of Cardiac Electrophysiology, University of California San Diego Health System, 9452 Medical Center Drive, San Diego, La Jolla, CA, 92037, USA
| | - Frederick T Han
- Division of Cardiac Electrophysiology, University of California San Diego Health System, 9452 Medical Center Drive, San Diego, La Jolla, CA, 92037, USA
| | - Kurt S Hoffmayer
- Division of Cardiac Electrophysiology, University of California San Diego Health System, 9452 Medical Center Drive, San Diego, La Jolla, CA, 92037, USA
| | - Farshad Raissi
- Division of Cardiac Electrophysiology, University of California San Diego Health System, 9452 Medical Center Drive, San Diego, La Jolla, CA, 92037, USA
| | - Gordon Ho
- Division of Cardiac Electrophysiology, University of California San Diego Health System, 9452 Medical Center Drive, San Diego, La Jolla, CA, 92037, USA
| | - David Krummen
- Division of Cardiac Electrophysiology, University of California San Diego Health System, 9452 Medical Center Drive, San Diego, La Jolla, CA, 92037, USA
| | - Gregory K Feld
- Division of Cardiac Electrophysiology, University of California San Diego Health System, 9452 Medical Center Drive, San Diego, La Jolla, CA, 92037, USA
| | - Jonathan C Hsu
- Division of Cardiac Electrophysiology, University of California San Diego Health System, 9452 Medical Center Drive, San Diego, La Jolla, CA, 92037, USA. .,Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California - San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, San Diego, La Jolla, San Diego, CA, 92037, USA.
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Feld GK, Hsu JC. A simple improvement on existing technology to enhance transseptal puncture and left atrial access using large diameter sheaths for mapping, ablation, and LAA occlusion procedures. J Cardiovasc Electrophysiol 2021; 32:735-736. [PMID: 33476470 DOI: 10.1111/jce.14899] [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] [Received: 01/14/2021] [Accepted: 01/17/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Gregory K Feld
- Division of Cardiology, Department of Medicine, University of California San Diego Health System, California, USA
| | - Jonathan C Hsu
- Division of Cardiology, Department of Medicine, University of California San Diego Health System, California, USA
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Aldaas OM, Malladi CL, Mylavarapu PS, Lupercio F, Darden D, Han FT, Hoffmayer KS, Krummen D, Ho G, Raissi F, Feld GK, Hsu JC. Comparison of Outcomes After Ablation of Atrial Fibrillation in Patients With Heart Failure With Preserved Versus Reduced Ejection Fraction. Am J Cardiol 2020; 136:62-70. [PMID: 32941815 DOI: 10.1016/j.amjcard.2020.09.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/01/2020] [Accepted: 09/08/2020] [Indexed: 12/12/2022]
Abstract
Catheter ablation improves outcomes in atrial fibrillation (AF) patients with heart failure (HF) with reduced ejection fraction (HFrEF). We sought to evaluate the efficacy and safety of catheter ablation of AF in HF patients with a preserved ejection fraction (HFpEF). We performed a retrospective study of all patients who underwent de novo radiofrequency catheter ablation enrolled in the UC San Diego AF Ablation Registry. The primary outcome was recurrence of all atrial arrhythmias on or off antiarrhythmic drugs (AAD). Of 547 total patients, 51 (9.3%) had HFpEF, 40 (7.3%) had HFrEF, and 456 (83.4%) were without HF. There was no difference in recurrence of atrial arrhythmias on or off AAD (Adjusted Hazard Ratio [AHR] 1.92 [95% CI 0.97 to 3.83] for HFpEF vs HFrEF and AHR 0.90 [95% CI 0.59 to 1.39] for HFpEF vs no HF) or off AAD (AHR 1.96 [95% CI 0.99 to 3.90] for HFpEF vs HFrEF and AHR 1.14 [95% CI 0.74 to 1.77] for HFpEF vs no HF). There was also no difference in rates of all-cause hospitalizations (AHR 1.80 [95% CI 0.97 to 3.33] for HFpEF vs HFrEF and AHR 2.05 [95% CI 1.30 to 3.23] for HFpEF vs no HF) or rates of all-cause mortality (AHR 0.53 [95% CI 0.05 to 6.11] for HFpEF vs HFrEF and AHR 2.46 [95% CI 0.34 to 17.92] for HFpEF vs no HF). There were no significant differences in AAD use (p = 0.176) or procedural complications between groups (p = 0.980). In conclusion, there were no significant differences in arrhythmia-free survival between patients with HFpEF and HFrEF that underwent catheter ablation of AF.
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Affiliation(s)
- Omar M Aldaas
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California
| | - Chaitanya L Malladi
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California
| | - Praneet S Mylavarapu
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California
| | - Florentino Lupercio
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California
| | - Douglas Darden
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California
| | - Frederick T Han
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California
| | - Kurt S Hoffmayer
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California
| | - David Krummen
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California
| | - Gordon Ho
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California
| | - Farshad Raissi
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California
| | - Gregory K Feld
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California
| | - Jonathan C Hsu
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California.
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Loring Z, Holmes DN, Matsouaka RA, Curtis AB, Day JD, Desai N, Ellenbogen KA, Feld GK, Fonarow GC, Frankel DS, Hurwitz JL, Knight BP, Joglar JA, Russo AM, Sidhu MS, Turakhia MP, Lewis WR, Piccini JP. Procedural Patterns and Safety of Atrial Fibrillation Ablation: Findings From Get With The Guidelines-Atrial Fibrillation. Circ Arrhythm Electrophysiol 2020; 13:e007944. [PMID: 32703018 DOI: 10.1161/circep.119.007944] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [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: 12/29/2022]
Abstract
BACKGROUND Catheter ablation is an increasingly used treatment for symptomatic atrial fibrillation (AF). However, there are limited prospective, nationwide data on patient selection and procedural characteristics. This study describes patient characteristics, techniques, treatment patterns, and safety outcomes of patients undergoing AF ablation. METHODS A total of 3139 patients undergoing AF ablation between 2016 and 2018 in the Get With The Guidelines-Atrial Fibrillation registry from 24 US centers were included. Patient demographics, medical history, procedural details, and complications were abstracted. Differences between paroxysmal and patients with persistent AF were compared using Pearson χ2 and Wilcoxon rank-sum tests. RESULTS Patients undergoing AF ablation were predominantly male (63.9%) and White (93.2%) with a median age of 65. Hypertension was the most common comorbidity (67.6%), and patients with persistent AF had more comorbidities than patients with paroxysmal AF. Drug refractory, paroxysmal AF was the most common ablation indication (class I, 53.6%) followed by drug refractory, persistent AF (class I, 41.8%). Radiofrequency ablation with contact force sensing was the most common ablation modality (70.5%); 23.7% of patients underwent cryoballoon ablation. Pulmonary vein isolation was performed in 94.6% of de novo ablations; the most common adjunctive lesions included left atrial roof or posterior/inferior lines, and cavotricuspid isthmus ablation. Complications were uncommon (5.1%) and were life-threatening in 0.7% of cases. CONCLUSIONS More than 98% of AF ablations among participating sites are performed for class I or class IIA indications. Contact force-guided radiofrequency ablation is the dominant technique and pulmonary vein isolation the principal lesion set. In-hospital complications are uncommon and rarely life-threatening.
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Affiliation(s)
- Zak Loring
- Duke Clinical Research Institute (Z.L., D.N.H., R.A.M., J.P.P.), Duke University Medical Center.,Division of Cardiology (Z.L., J.P.P.), Duke University Medical Center
| | - DaJuanicia N Holmes
- Duke Clinical Research Institute (Z.L., D.N.H., R.A.M., J.P.P.), Duke University Medical Center
| | - Roland A Matsouaka
- Duke Clinical Research Institute (Z.L., D.N.H., R.A.M., J.P.P.), Duke University Medical Center.,Department of Biostatistics & Bioinformatics, Duke University, Durham, NC (R.A.M.)
| | - Anne B Curtis
- Department of Medicine, University at Buffalo, NY (A.B.C.)
| | - John D Day
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT (J.D.D.)
| | - Nihar Desai
- Cardiovascular Medicine Section, Yale University, New Haven, CT (N.D.)
| | | | - Gregory K Feld
- Department of Medicine, University of California San Diego (G.K.F.)
| | - Gregg C Fonarow
- Department of Medicine, University of California Los Angeles (G.C.F.)
| | - David S Frankel
- Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.S.F.)
| | | | - Bradley P Knight
- Feinberg School of Medicine, Northwestern University, Chicago, IL (B.P.K.)
| | - Jose A Joglar
- Department of Cardiology, University of Texas, Southwestern Medical Center, Dallas (J.A.J.)
| | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, NJ (A.M.R.)
| | | | - Mintu P Turakhia
- VA Palo Alto Health Care System, Palo Alto, CA (M.P.T.).,Center for Digital Health, Stanford University, Stanford, CA (M.P.T.)
| | - William R Lewis
- MetroHealth System Campus, Case Western Reserve University, Cleveland, OH (W.R.L.)
| | - Jonathan P Piccini
- Duke Clinical Research Institute (Z.L., D.N.H., R.A.M., J.P.P.), Duke University Medical Center.,Division of Cardiology (Z.L., J.P.P.), Duke University Medical Center
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Darden D, Hsu JC, Shah S, Hoffmayer K, Feld GK, Han FT. Ventricular Tachycardia Storm Originating From Moderator Band Requiring Extracorporeal Membrane Oxygenation. JACC Case Rep 2020; 2:946-950. [PMID: 34317388 PMCID: PMC8302099 DOI: 10.1016/j.jaccas.2020.05.019] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/13/2020] [Accepted: 04/20/2020] [Indexed: 11/29/2022]
Abstract
A 67-year-old man presented with dizziness secondary to ventricular tachycardia (VT) originating from the moderator band. The VT was refractory to multiple antiarrhythmic medications requiring extracorporeal membrane oxygenation and eventual curative ablation. We highlight a malignant form of idiopathic VT, unique electrocardiogram characteristics, and ablation considerations. (Level of Difficulty: Intermediate.)
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Key Words
- APM, anterior papillary muscle
- ECG, electrocardiogram
- ECMO, extracorporeal membrane oxygenation
- ICD, implantable cardioverter-defibrillator
- MB, moderator band
- PF, Purkinje fibers
- PVC, premature ventricular contraction
- RV, right ventricle
- VA, ventricular arrhythmia
- VF, ventricular fibrillation
- VT, ventricular tachycardia
- ablation
- acute heart failure
- cardiac assist devices
- ventricular tachycardia
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Affiliation(s)
- Douglas Darden
- Division of Cardiology, Department of Medicine, Cardiovascular Institute, University of California San Diego, San Diego, California
| | - Jonathan C Hsu
- Division of Cardiology, Department of Medicine, Cardiovascular Institute, University of California San Diego, San Diego, California
| | - Sanjay Shah
- Division of Cardiology, Department of Medicine, Cardiovascular Institute, University of California San Diego, San Diego, California
| | - Kurt Hoffmayer
- Division of Cardiology, Department of Medicine, Cardiovascular Institute, University of California San Diego, San Diego, California
| | - Gregory K Feld
- Division of Cardiology, Department of Medicine, Cardiovascular Institute, University of California San Diego, San Diego, California
| | - Frederick T Han
- Division of Cardiology, Department of Medicine, Cardiovascular Institute, University of California San Diego, San Diego, California
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Giancaterino S, Nishimura M, Birgersdotter‐Green U, Hoffmayer KS, Han FT, Raissi F, Ho G, Krummen D, Feld GK, Hsu JC. Clinical factors associated with baseline history of atrial fibrillation and subsequent clinical outcomes following initial implantable cardioverter‐defibrillator placement. Pacing Clin Electrophysiol 2020; 43:542-550. [PMID: 32297348 PMCID: PMC7299732 DOI: 10.1111/pace.13919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 01/19/2020] [Revised: 03/28/2020] [Accepted: 04/12/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is frequently present in patients with heart failure (HF) and an implantable cardioverter-defibrillator (ICD). This study aims to identify clinical factors associated with a baseline history of AF in ICD recipients, and compares subsequent clinical outcomes in those with and without a baseline history of AF. METHODS We studied 566 consecutive first-time ICD recipients at an academic center between 2011 and 2018. Logistic regression multivariable analyses were used to identify clinical factors associated with a baseline history of AF at the time of ICD implant. Cox-proportional hazard regression models were constructed for multivariate analysis to examine associations between a baseline history of AF with subsequent clinical outcomes, including ICD therapies, HF readmission, and all-cause mortality. RESULTS Of all patients, 201 (36%) had a baseline history of AF at the time of ICD implant. In multivariate analyses, clinical factors associated with a baseline history of AF included hypertension, valvular heart disease, body weight, PR interval, and serum creatinine level. After multivariate adjustment for potential confounders, a baseline history of AF was associated with an increased risk of anti-tachycardia pacing (HR = 1.84, 95% CI = 1.19-2.85, P = .006), appropriate ICD shocks (HR = 1.80, 95% CI = 1.05-3.09, P = .032), and inappropriate ICD shocks (HR = 3.72, 95% CI = 1.7-7.77, P = .0001), but not other adverse outcomes. CONCLUSION Among first-time ICD recipients, specific clinical characteristics were associated with a baseline history of AF at the time of ICD implant. After adjustment for potential confounders, a baseline history of AF was associated with a higher risk of all ICD therapies in follow-up.
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Affiliation(s)
- Shaun Giancaterino
- Cardiac Electrophysiology Section, Division of Cardiology, Department of MedicineUniversity of California San Diego California
| | - Marin Nishimura
- Cardiac Electrophysiology Section, Division of Cardiology, Department of MedicineUniversity of California San Diego California
| | - Ulrika Birgersdotter‐Green
- Cardiac Electrophysiology Section, Division of Cardiology, Department of MedicineUniversity of California San Diego California
| | - Kurt S. Hoffmayer
- Cardiac Electrophysiology Section, Division of Cardiology, Department of MedicineUniversity of California San Diego California
| | - Frederick T. Han
- Cardiac Electrophysiology Section, Division of Cardiology, Department of MedicineUniversity of California San Diego California
| | - Farshad Raissi
- Cardiac Electrophysiology Section, Division of Cardiology, Department of MedicineUniversity of California San Diego California
| | - Gordon Ho
- Cardiac Electrophysiology Section, Division of Cardiology, Department of MedicineUniversity of California San Diego California
| | - David Krummen
- Cardiac Electrophysiology Section, Division of Cardiology, Department of MedicineUniversity of California San Diego California
| | - Gregory K. Feld
- Cardiac Electrophysiology Section, Division of Cardiology, Department of MedicineUniversity of California San Diego California
| | - Jonathan C. Hsu
- Cardiac Electrophysiology Section, Division of Cardiology, Department of MedicineUniversity of California San Diego California
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Feld GK. Ensuring bidirectional cavotricuspid isthmus conduction block during ablation for typical atrial flutter—A new twist on an old problem. J Cardiovasc Electrophysiol 2020; 31:1658-1660. [DOI: 10.1111/jce.14543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Gregory K. Feld
- Division of Cardiology, Department of Medicine, Clinical Cardiac Electrophysiology Program and CCEP Fellowship Training Program University of California San Diego Health System La Jolla California
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Aldaas OM, Lupercio F, Han FT, Hoffmayer KS, Krummen D, Ho G, Raissi F, Birgersdotter-Green U, Feld GK, Hsu JC. Meta-analysis of Effect of Modest (≥10%) Weight Loss in Management of Overweight and Obese Patients With Atrial Fibrillation. Am J Cardiol 2019; 124:1568-1574. [PMID: 31540665 PMCID: PMC7089802 DOI: 10.1016/j.amjcard.2019.08.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 01/19/2023]
Abstract
Obesity and atrial fibrillation (AF) are growing epidemics with significant overlap in co-morbidities. Multiple smaller studies have evaluated the effects of weight loss and risk factor modification on recurrence of AF, reduction in AF burden and improvement in AF symptom severity. The objective of this study was to determine if a modest weight loss of ≥10% of initial body weight is enough to improve outcomes in overweight or obese patients with established AF. We performed an extensive literature search and systematic review of studies that compared weight loss of ≥10% versus weight loss of less than 10% or weight gain and assessed outcomes including recurrence of AF as determined through a Holter monitor, AF burden and improvement in AF symptom severity. Risk ratio 95% confidence intervals (CI) were measured for dichotomous variables and mean difference (MD) 95% CI were measured for continuous variables, where MD >0 favors the group with ≥10% weight loss. Five studies with a total of 548 patients were included. Patients who lost ≥10% of their initial body weight experienced less recurrence of AF (risk ratio 0.29; 95% CI 0.19 to 0.44) and a larger reduction in reported event frequency (MD 1.74; 95% CI 0.70 to 2.79), episode duration (MD 2.14; 95% CI 0.04 to 4.23), global episode severity (MD 1.89; 95% CI 1.34 to 2.45), and symptom severity (MD 5.36; 95% CI 3.75 to 6.97). In conclusion, weight loss is associated with less risk of recurrent AF, reduction in AF burden, and improvement in AF symptom severity.
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Lupercio F, Lin AY, Aldaas OM, Romero J, Briceno D, Hoffmayer KS, Han FT, Di Biase L, Feld GK, Hsu JC. Role of adjunctive posterior wall isolation in patients undergoing atrial fibrillation ablation: a systematic review and meta-analysis. J Interv Card Electrophysiol 2019; 58:77-86. [DOI: 10.1007/s10840-019-00634-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
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Hsu JC, Birnie D, Stadler RW, Cerkvenik J, Feld GK, Birgersdotter-Green U. Adaptive cardiac resynchronization therapy is associated with decreased risk of incident atrial fibrillation compared to standard biventricular pacing: A real-world analysis of 37,450 patients followed by remote monitoring. Heart Rhythm 2019; 16:983-989. [DOI: 10.1016/j.hrthm.2019.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Indexed: 11/16/2022]
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Lewis K, Dai M, Patton KK, Cha YM, Pollema T, Feld GK, Birgersdotter-Green U, Pretorius V. Lead extraction for reduction of chronic pain related to cardiovascular implantable electronic device. Europace 2019; 21:781-786. [PMID: 30698694 DOI: 10.1093/europace/euy320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/20/2018] [Indexed: 11/12/2022] Open
Abstract
AIMS Chronic pain at the cardiovascular implantable electronic device (CIED) generator or lead insertion site that is not otherwise manageable carries a IIA indication for extraction. However, limited data exist evaluating causes of pain and outcomes of extraction in eliminating pain. A multi-centre retrospective observational study was conducted to evaluate outcomes of patients undergoing device extraction for treatment of chronic device pain. METHODS AND RESULTS Twenty-seven out of 2188 lead extraction candidates (1.3%) met the chronic pain IIA indication for extraction [50 ± 16 years; 14 (51%) women]. Onset, severity, triggers, and pain management were measured before and after extraction. Device type, procedure done (with/without reimplantation), and positive tissue cultures were noted. Pain was reported as constant (n = 14; 50%), intermittent (n = 13; 46%), and movement-triggered (n = 14; 50%). Average severity of pain was seven out of 10 (10 being the worst). Post-extraction, 18 (66%) received freedom from pain, including all patients with poorly formed pockets (n = 2) and subclinical infections (n = 2). Of the 18, 11 underwent reimplantation (61%) without recurrent pain. Nine still had pain (44 ± 17 years; seven women) after extraction. Eight of the nine underwent reimplantation, three on the contralateral chest wall and five ipsilaterally. Pain severity decreased (n = 5), increased (n = 1), or was unchanged (n = 3). CONCLUSION Chronic pain at the CIED generator site can present as chronic or movement-triggered pain, and can be due to subclinical infection or a poorly formed device pocket. Extraction relieved constant and intermittent pain in two-thirds of patients. Extraction appears less successful in eliminating pain in women who undergo subsequent reimplantation.
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Affiliation(s)
- Kathryn Lewis
- Department of Cardiac Electrophysiology, University of California, San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, USA
| | - Mingyan Dai
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, USA
| | - Kristen K Patton
- Division of Cardiology, University of Washington, 1959 NE Pacific St., Seattle, WA, USA
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, USA
| | - Travis Pollema
- Department of Cardiac Electrophysiology, University of California, San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, USA
| | - Gregory K Feld
- Department of Cardiac Electrophysiology, University of California, San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, USA
| | - Ulrika Birgersdotter-Green
- Department of Cardiac Electrophysiology, University of California, San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, USA
| | - Victor Pretorius
- Department of Cardiac Electrophysiology, University of California, San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, USA
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Hoffmayer KS, Krainski F, Shah S, Hunter J, Alegre M, Hsu JC, Feld GK. Randomized controlled trial of Amigo® robotically controlled versus manually controlled ablation of the cavo-tricuspid isthmus using a contact force ablation catheter. J Interv Card Electrophysiol 2018; 51:125-132. [DOI: 10.1007/s10840-018-0319-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/25/2018] [Indexed: 11/29/2022]
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44
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Nishimura M, Sab S, Birgersdotter-Green U, Krummen D, Schricker A, Raissi F, Hoffmayer KS, Feld GK, Hsu JC. Reasons for and predictors of acute hospitalization versus elective outpatient implantable cardioverter-defibrillator implantation and subsequent differential clinical outcomes. J Interv Card Electrophysiol 2017; 50:85-93. [PMID: 28844089 DOI: 10.1007/s10840-017-0283-1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillator (ICD) implantation is often an elective outpatient procedure, but previous studies have shown that approximately 30% are performed during acute hospitalizations. PURPOSE This study aims to identify predictors of acute hospitalization versus elective outpatient ICD implantation and evaluate differential clinical outcomes. METHODS We studied 327 first-time ICD recipients between 2011 and 2015. All patients receiving a primary prevention ICD were optimized on guideline directed medical therapy (GDMT) prior to consideration for device implantation. Using multivariate logistic regression, we examined predictors of ICD implantation during acute hospitalization. Cox proportional hazard regression was used adjusting for patient characteristics to examine associations with clinical outcomes including complications, device therapy, heart failure re-admission, and death. RESULTS Of all patients, 132 (40.3%) underwent ICD implantation during acute hospitalization, most frequently performed for secondary prevention (n = 76, 57.6%). The most common reason for acute hospitalization ICD implantation in primary prevention patients was an indication for pacing (n = 20, 35.7%). In multivariable adjusted models, secondary prevention indication, non-single chamber device, NYHA class IV symptoms, lower diastolic blood pressure, higher BUN, and lower hemoglobin were significant predictors of ICD implantation during an acute hospitalization. In univariate analysis, acute hospitalization ICD implantation was associated with a higher risk of heart failure re-admission (HR = 1.6, 95% CI 1.1-2.4) and mortality (HR = 3.0, 95% CI 1.1-8.0) but no difference in risk of ICD therapy (HR = 1.4, 95% CI 0.9-2.3) or adverse events (HR = 1.1, 95% CI 0.6-2.1). After multivariable adjustment for potential confounders, all outcomes were no different between acute hospitalization versus elective outpatient ICD recipients. CONCLUSIONS Among first-time ICD recipients, specific clinical characteristics predicted acute hospitalization ICD implantation. After adjustment for potential confounders, acute hospitalization ICD implantation was not associated with increased risk of morbidity or mortality.
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Affiliation(s)
- Marin Nishimura
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Dr, 3rd Fl, Rm 3E-417, La Jolla, CA, 92037, USA
| | - Shiv Sab
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Dr, 3rd Fl, Rm 3E-417, La Jolla, CA, 92037, USA
| | - Ulrika Birgersdotter-Green
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Dr, 3rd Fl, Rm 3E-417, La Jolla, CA, 92037, USA
| | - David Krummen
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Dr, 3rd Fl, Rm 3E-417, La Jolla, CA, 92037, USA
| | - Amir Schricker
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Dr, 3rd Fl, Rm 3E-417, La Jolla, CA, 92037, USA
| | - Farshad Raissi
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Dr, 3rd Fl, Rm 3E-417, La Jolla, CA, 92037, USA
| | - Kurt S Hoffmayer
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Dr, 3rd Fl, Rm 3E-417, La Jolla, CA, 92037, USA
| | - Gregory K Feld
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Dr, 3rd Fl, Rm 3E-417, La Jolla, CA, 92037, USA
| | - Jonathan C Hsu
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Dr, 3rd Fl, Rm 3E-417, La Jolla, CA, 92037, USA.
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Khan F, Feld GK, Schricker A, Han FT, Hoffmayer KS, Hsu JC. A surgeon with symptomatic ventricular tachycardia while operating and exacerbated by left lateral decubitus position: Too much of a stretch? HeartRhythm Case Rep 2017; 3:210-214. [PMID: 28491804 PMCID: PMC5419809 DOI: 10.1016/j.hrcr.2017.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Faris Khan
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California
| | - Gregory K Feld
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California
| | - Amir Schricker
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California
| | - Frederick T Han
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Utah, Salt Lake City, Utah
| | - Kurt S Hoffmayer
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California
| | - Jonathan C Hsu
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California
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Salcedo JD, Pretorius VG, Hsu JC, Lalani GG, Schricker AA, Hebsur SM, McGARRY TJ, Hunter JA, Lewis KE, Krummen DE, Feld GK, Birgersdotter-Green U. Compatibility of Radiofrequency Surgical Sponge Detection Technology with Cardiac Implantable Electronic Devices and Temporary Pacemakers. Pacing Clin Electrophysiol 2016; 39:1254-1260. [PMID: 27550834 DOI: 10.1111/pace.12938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/13/2016] [Accepted: 08/18/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Radiofrequency (RF) technology has improved detection of retained surgical sponges with a reported 100% sensitivity and specificity. However, the potential for interactions of the RF signals emitted by the detection system with cardiac implantable electronic devices (CIEDs) or temporary pacemakers may limit its use in those patients with these devices. This study investigated whether RF detection technology causes interference or clinically significant changes in the programmed settings of implanted pacemakers and defibrillators or temporary epicardial pacemakers. METHODS Fifty patients who were scheduled either for CIED removal or placement of a temporary epicardial pacemaker (at the time of open heart surgery) were recruited for this study. Device settings and measurements from separate interrogations before and after scanning with the RF detection system were compared. For the temporary pacemakers, we observed for any changes in hemodynamics or signs of pacing interference. RESULTS Twenty (40%) pacemakers, 20 (40%) implantable cardioverter defibrillators, and 10 (20%) temporary pacemakers were analyzed in this study. During scanning, no signal interference was detected in any permanent device, and there were no significant changes in programmed settings after scanning with the RF detection system. However, pacing inhibition was detected with temporary pacing systems when programmed to a synchronous mode (DDD). CONCLUSIONS RF detection technology can be safely used to scan for retained surgical sponges in patients with permanent CIEDs and temporary pacemakers set to asynchronous mode.
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Affiliation(s)
- Jonathan D Salcedo
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
| | - Victor G Pretorius
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
| | - Jonathan C Hsu
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
| | - Gautam G Lalani
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
| | - Amir A Schricker
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
| | - Shrinivas M Hebsur
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
| | - Thomas J McGARRY
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
| | - Jessica A Hunter
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
| | - Kathryn E Lewis
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
| | - David E Krummen
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
| | - Gregory K Feld
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
| | - Ulrika Birgersdotter-Green
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
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Schricker AA, Feld GK, Tsimikas S. Retrieval of a detached transseptal sheath tip from a right pulmonary artery branch following catheter ablation. Catheter Cardiovasc Interv 2015; 86:1131-5. [DOI: 10.1002/ccd.25957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/19/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Amir A. Schricker
- Division of Cardiovascular Disease; Vascular Medicine Program; University of California San Diego Medical Center, Sulpizio Family Cardiovascular Center; La Jolla California
| | - Gregory K. Feld
- Division of Cardiovascular Disease; Vascular Medicine Program; University of California San Diego Medical Center, Sulpizio Family Cardiovascular Center; La Jolla California
| | - Sotirios Tsimikas
- Division of Cardiovascular Disease; Vascular Medicine Program; University of California San Diego Medical Center, Sulpizio Family Cardiovascular Center; La Jolla California
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DeMaria AN, Adler ED, Bax JJ, Ben-Yehuda O, Feld GK, Greenberg BH, Hall JL, Hlatky MA, Lew WYW, Lima JAC, Mahmud E, Maisel AS, Narayan SM, Nissen SE, Sahn DJ, Tsimikas S. Highlights of the year in JACC 2013. J Am Coll Cardiol 2014; 63:570-602. [PMID: 24524815 DOI: 10.1016/j.jacc.2014.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - Eric D Adler
- Cardiology Division, UCSD Medical Center, San Diego, California
| | - Jeroen J Bax
- Leiden University Medical Center, Leiden, the Netherlands
| | | | - Gregory K Feld
- Cardiology Division, UCSD Medical Center, San Diego, California
| | | | | | | | | | | | - Ehtisham Mahmud
- Cardiology Division, UCSD Medical Center, San Diego, California
| | - Alan S Maisel
- Veterans Affairs Medical Center, San Diego, California
| | | | | | - David J Sahn
- Department of Pediatric Cardiology, Oregon Health and Science University, Portland, Oregon
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Feld GK. Radiofrequency catheter ablation of Type 1 atrial flutter using a large-tip electrode catheter and high-power radiofrequency energy generator. Expert Rev Med Devices 2014; 1:187-92. [PMID: 16293039 DOI: 10.1586/17434440.1.2.187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent studies have demonstrated a high degree of efficacy of 8 mm electrode-tipped or saline-irrigated-tip catheters for ablation of atrial flutter (AFL). These catheters have a theoretical advantage as they produce a large ablation lesion. However, large-tip ablation catheters have a larger surface area and require a higher power radiofrequency (RF) generator with up to 100 W capacity to produce adequate ablation temperatures (50-60 degrees C). The potential advantages of a large-tip ablation catheter and high-power RF generator include the need for fewer energy applications, shorter procedure and fluoroscopy times, and greater efficacy. Therefore, the safety and efficacy of AFL ablation using 8 or 10 mm electrode catheters and a 100-W RF generator was studied using the Boston Scientific, Inc., EPT-1000 XP cardiac ablation system. There were 169 patients, aged 61 +/- 12 years involved. Acute end points were bidirectional isthmus block and no inducible AFL. Following ablation, patients were seen at 1, 3 and 6 months, with event monitoring performed weekly and for any symptoms. Three quality of life surveys were completed during follow-up. Acute success was achieved in 158 patients (93%), with 12 +/- 11 RF energy applications. The efficacy of 8 and 10 mm electrodes did not differ significantly. The number of RF energy applications (10 +/- 8 vs. 14 +/- 8) and ablation time (0.5 +/- 0.4 vs. 0.8 +/- 0.6 h) were less with 10 mm compared with 8 mm electrodes (p < 0.01). Of 158 patients with acute success, 42 were not evaluated at 6 months due to study exclusions. Of the 116 patients evaluated at 6 months, 112 (97%) had no AFL recurrence. Of those without AFL recurrence at 6 months, 95 and 93% were free of symptoms at 12 and 24 months, respectively. Ablation of AFL improved quality of life scores (p < 0.05) and reduced anti-arrhythmic and rate control drug use (p < 0.05). Complications occurred in six out of 169 patients (3.6%) but there were no deaths. It was concluded that ablation of AFL with 8 or 10 mm electrode catheters and a high-power RF generator was safe, effective and improved quality of life. The number and duration of RF applications was lower with 10 mm compared with 8 mm electrode catheters.
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Affiliation(s)
- Gregory K Feld
- Cardiac Electrophysiology Program, University of California San Diego, 200 West Arbor Drive, 8411, San Diego, CA 92103, USA.
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Feld GK, Yao B. Evaluation of the safety and effectiveness of the CryoMedix cryoablation catheter system for the treatment of atrial flutter and fibrillation. J Interv Card Electrophysiol 2013; 39:37-44. [DOI: 10.1007/s10840-013-9847-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 10/01/2013] [Indexed: 11/30/2022]
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