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Folli F, Centofanti L, Magnani S, Tagliabue E, Bignotto M, La Sala L, Pontiroli AE. Obesity effect on newly diagnosed and recurrent post-ablation atrial fibrillation: a systematic review and meta-analysis. J Endocrinol Invest 2024; 47:1051-1066. [PMID: 37962809 DOI: 10.1007/s40618-023-02225-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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND AND AIMS The role of overweight and obesity in the development of atrial fibrillation (AF) is well established; however, the differential effect on the occurrence and recurrence of AF remains uncertain. The aim of this review is to compare the effect of underweight and varying degrees of obesity on onset of AF and in recurrent post-ablation AF, and, when possible, in relation to sex. METHODS A systematic literature search was conducted in PubMed, Embase, and Cochrane Library from inception to January 31, 2023. Studies reporting frequency of newly-diagnosed AF and of recurrent post-ablation AF in different BMI categories, were included. 3400 records were screened and 50 met the inclusion criteria. Standardized data search and abstraction were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement. Data were extracted from the manuscripts and were analyzed using a random effect model. The outcome was the occurrence of AF in population studies and in patients undergoing ablation. RESULTS Data from 50 studies were collected, of which 27 for newly-diagnosed AF and 23 for recurrent post-ablation AF, for a total of 15,134,939 patients, of which 15,115,181 in studies on newly-diagnosed AF and 19,758 in studies on recurrent post-ablation AF. Compared to normal weight, the increase in AF was significant (p < 0.01) for overweight, obese, and morbidly obese patients for newly-diagnosed AF, and for obese and morbidly obese patients for recurrent post-ablation AF. Newly-diagnosed AF was more frequent in obese female than obese male patients. CONCLUSION The effect of increased BMI was greater on the onset of AF, and obese women were more affected than men.
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Affiliation(s)
- F Folli
- Department of Health Sciences, University of Milan, Via A. Di Rudinì 8, 20142, Milan, Italy.
| | - L Centofanti
- Department of Health Sciences, University of Milan, Via A. Di Rudinì 8, 20142, Milan, Italy
| | - S Magnani
- Division of Cardiology, Ospedale San Paolo, 20142, Milan, Italy
| | - E Tagliabue
- Laboratory of Cardiovascular and Dysmetabolic Diseases, PST-Via Fantoli 18/15, 20138, Milan, Italy and Value-Based Healthcare Unit, IRCCS MultiMedica, 20099, Sesto San Giovanni, Milan, Italy
| | - M Bignotto
- Department of Health Sciences, University of Milan, Via A. Di Rudinì 8, 20142, Milan, Italy
| | - L La Sala
- Laboratory of Cardiovascular and Dysmetabolic Diseases, PST-Via Fantoli 18/15, 20138, Milan, Italy and Value-Based Healthcare Unit, IRCCS MultiMedica, 20099, Sesto San Giovanni, Milan, Italy
| | - A E Pontiroli
- Department of Health Sciences, University of Milan, Via A. Di Rudinì 8, 20142, Milan, Italy.
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Okumus NK, Zeitler EP, Moustafa A, Iglesias M, Khanna R, Rong Y, Karim S. Three-year incidence of pacemaker implantation in patients with atrial fibrillation and sinus node dysfunction receiving ablation versus antiarrhythmic drugs. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01790-2. [PMID: 38632136 DOI: 10.1007/s10840-024-01790-2] [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: 01/11/2024] [Accepted: 03/13/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Sinus node dysfunction (SND) is commonly seen in patients with atrial fibrillation (AF). The purpose of this study was to compare the incidence of pacemaker implantation among patients with SND and AF treated with catheter ablation (CA) versus anti-arrhythmic drugs (AADs). METHODS The 2013-2022 Optum Clinformatics database, an administrative claims database for commercially insured individuals in the United States (US), was used for this study. Patients with AF and SND and a history of at least one AAD prescription were identified and classified into CA or AAD cohorts based on subsequent treatment received. Inverse probability treatment weighting was applied to balance socio-demographic and clinical characteristics between the cohorts. Weighted Cox regression modeling was used to evaluate the differential risk of incident permanent pacemaker (PPM) implantation. Sub-analyses were performed by AF type (paroxysmal versus persistent). RESULTS A total of 1206 patients in the AAD cohort and 1624 patients in the CA cohort were included. Study cohorts were well-balanced post-weighting. The incidence rate of PPM implantation (per 1000 person-year) was 55.8 for the CA cohort and 117.8 for the AAD cohort. Regression analysis demonstrated that the CA cohort had 42% lower risk of incident PPM implantation than those treated with AADs (hazard ratio [HR], 0.58; 95% CI, 0.46-0.72, p < 0.001). CA-treated patients had lower risks of PPM implantation versus AAD-treated patients among those with paroxysmal AF (HR, 0.48; 95% CI, 0.34-0.69, p < 0.001) and persistent AF (HR, 0.57; 95% CI, 0.40-0.81, p = 0.002). CONCLUSIONS Patients with AF and SND treated with CA have significantly lower risks of incident PPM implantation compared with those treated with an AAD.
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Affiliation(s)
| | | | | | - Maximiliano Iglesias
- Franchise Health Economics and Market Access, Johnson & Johnson, Irvine, CA, USA
| | - Rahul Khanna
- Medical Device Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, NJ, USA
| | - Yiran Rong
- Medical Device Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, NJ, USA
| | - Saima Karim
- Heart and Vascular Institute, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Dr, Cleveland, OH, USA.
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Iacopino S, Fabiano G, Sorrenti PF, Filannino P, Artale P, Colella J, Statuto G, Di Vilio A, Campagna G, Peluso G, Fabiano E, Cecchini F, Speziale G, Petretta A. Utility of an innovative cloud-based storage software for ablation redo procedures: Initial experience. Heart Rhythm O2 2024; 5:246-250. [PMID: 38690141 PMCID: PMC11056462 DOI: 10.1016/j.hroo.2024.03.003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Affiliation(s)
- Saverio Iacopino
- Electrophysiology Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Gennaro Fabiano
- Electrophysiology Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | | | - Pasquale Filannino
- Electrophysiology Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Paolo Artale
- Electrophysiology Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Jacopo Colella
- Electrophysiology Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Giovanni Statuto
- Electrophysiology Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Alessandro Di Vilio
- Electrophysiology Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Giuseppe Campagna
- Electrophysiology Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Gianluca Peluso
- Electrophysiology Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Emmanuel Fabiano
- Electrophysiology Department, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Federico Cecchini
- Electrophysiology Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Giuseppe Speziale
- Electrophysiology Department, Anthea Hospital, GVM Care & Research, Bari, Italy
- Electrophysiology Department, San Carlo di Nancy Hospital, GVM Care & Research, Rome, Italy
| | - Andrea Petretta
- Electrophysiology Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
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Lu J, Xu F, Song B, Liu X, Yu H, Zhang Y. Zero-fluoroscopy transseptal puncture guided by right atrial high-density precision mapping. Heart Rhythm O2 2024; 5:194-197. [PMID: 38560373 PMCID: PMC10980922 DOI: 10.1016/j.hroo.2024.02.003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Affiliation(s)
- Jun Lu
- Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Fengqiang Xu
- Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bingxue Song
- Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xin Liu
- Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Haichu Yu
- Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yingying Zhang
- Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, China
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Robaye B, Deceuninck O, Blommaert D, Godeaux V, Dormal F, Collet B, Ballant E, Huys F, Purnode P, Xhaët O. Method, safety, and outcomes of persistent AF ablation without a circular mapping catheter: 3 years experience of a Belgian Tertiary Centre. Acta Cardiol 2024:1-8. [PMID: 38334112 DOI: 10.1080/00015385.2022.2135240] [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: 08/06/2021] [Accepted: 10/06/2022] [Indexed: 02/10/2024]
Abstract
BACKGROUND We aimed to share our methods and experience of persistent AF ablation without a circular mapping catheter (CMC), thereby avoiding femoral venous and transseptal punctures, decreasing the cost of the procedure, and possibly reducing the duration of the procedure and fluoroscopy time. METHODS We report our experience with 261 persistent AF ablations performed without a CMC over the past 3 years. RESULTS The procedures were performed with no apparent loss of efficacy or safety. Freedom from recurrence was defined as a 1-year absence of AF/atrial flutter (AFL) episodes >30 s, beyond the 3-month blanking period. At 1 year, 72% of the patients were free from arrythmias. CONCLUSIONS Persistent AF ablation is feasible without a CMC, reducing the need for venous and transseptal punctures and the cost of the procedure. We suggest that prospective studies should aim to characterise the reduction in procedure and fluoroscopy times as a result of this technique.
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Affiliation(s)
- Benoit Robaye
- Service de Cardiologie, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Olivier Deceuninck
- Service de Cardiologie, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
- Department of Cardiology, CHR Namur, Namur, Belgium
| | - Dominique Blommaert
- Service de Cardiologie, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Veronique Godeaux
- Service de Cardiologie, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Fabien Dormal
- Service de Cardiologie, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Benoit Collet
- Service de Cardiologie, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Elisabeth Ballant
- Service de Cardiologie, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Florence Huys
- Service de Cardiologie, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Philippe Purnode
- Service de Cardiologie, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Olivier Xhaët
- Service de Cardiologie, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
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Sonoda K, Fukushima T, Takei A, Otsuka K, Hata S, Shinboku H, Muroya T, Maemura K. Association between left atrial low-voltage area and induction and recurrence of macroreentrant atrial tachycardia in pulmonary vein isolation for atrial fibrillation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01760-8. [PMID: 38321306 DOI: 10.1007/s10840-024-01760-8] [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: 10/30/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND The relationship between induction and recurrence due to atrial tachycardia (AT) and left atrial (LA) matrix progression after atrial fibrillation (AF) ablation remains unclear. METHODS One hundred fifty-two consecutive patients with paroxysmal and persistent AF who underwent pulmonary vein isolation (PVI) and cavo-tricuspid isthmus (CTI) ablation and achieved sinus rhythm before the procedure were classified into three groups according to the AT pattern induced after the procedure: group N (non-induced), F (focal pattern), and M (macroreentrant pattern) in 3D mapping. RESULTS The total rate of AT induction was 19.7% (30/152) in groups F (n = 13) and M (n = 17). Patients in group M were older than those in groups N and F, with higher CHADS2/CHA2DS2-VASc values, left atrial enlargement, and low-voltage area (LVA) size of LA. The receiver operating characteristic curve determined that the cut-off LVA for macroreentrant AT induction was 8.8 cm2 (area under the curve [AUC]: 0.86, 95% confidence interval [CI]: 0.75-0.97). The recurrence of AT at 36 months in group N was 4.1% (5/122), and at the second ablation, all patients had macroreentrant AT. Patients with AT recurrence in group N had a wide LVA at the first ablation, and the cut-off LVA for AT recurrence was 6.5 cm2 (AUC 0.94, 95%CI 0.88-0.99). Adjusted multivariate analysis showed that only LVA size was associated with the recurrence of macroreentrant AT (odds ratio 1.21, 95%CI 1.04-1.51). CONCLUSIONS It is important to develop a therapeutic strategy based on the LVA size to suppress the recurrence of AT in these patients.
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Affiliation(s)
- Koichiro Sonoda
- Department of Cardiology, Sasebo City General Hospital, 9-3 Hirase-cho, Sasebo, 857-8511, Japan.
| | - Tadatomo Fukushima
- Department of Cardiology, Sasebo City General Hospital, 9-3 Hirase-cho, Sasebo, 857-8511, Japan
| | - Asumi Takei
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kaishi Otsuka
- Department of Cardiology, Sasebo City General Hospital, 9-3 Hirase-cho, Sasebo, 857-8511, Japan
| | - Shiro Hata
- Department of Cardiology, Sasebo City General Hospital, 9-3 Hirase-cho, Sasebo, 857-8511, Japan
| | - Hiroki Shinboku
- Department of Cardiology, Sasebo City General Hospital, 9-3 Hirase-cho, Sasebo, 857-8511, Japan
| | - Takahiro Muroya
- Department of Cardiology, Sasebo City General Hospital, 9-3 Hirase-cho, Sasebo, 857-8511, Japan
| | - Koji Maemura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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Khaykin M, Khaykin Y, Sadek M. Direct-wire electrocautery: A novel technique to facilitate transseptal access in cryoablation. Heart Rhythm 2024; 21:122-123. [PMID: 37865381 DOI: 10.1016/j.hrthm.2023.10.016] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 10/23/2023]
Affiliation(s)
- Michael Khaykin
- Division of Cardiology, Southlake Regional Health Center, Newmarket, Ontario, Canada
| | - Yaariv Khaykin
- Division of Cardiology, Southlake Regional Health Center, Newmarket, Ontario, Canada
| | - Mouhannad Sadek
- Division of Cardiology, Southlake Regional Health Center, Newmarket, Ontario, Canada.
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Moustafa A, Elzanaty A, Karim S, Eltahawy E, Maraey A, Kahaly O, Chacko P. Mortality post in-patient catheter ablation of atrial fibrillation in rural versus urban areas: Insights from national inpatient sample database. Curr Probl Cardiol 2024; 49:102183. [PMID: 37913928 DOI: 10.1016/j.cpcardiol.2023.102183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 10/28/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND A growing body of evidence is supportive of early atrial fibrillation (AF) ablation to maintain sinus rhythm. Disparities in health care between rural and urban areas in the United States are well known. Catheter ablation (CA) of AF is a complex procedure and its outcomes among rural versus urban areas has not been studied in the past. METHODS The national inpatient sample database 2016-2020 was queried for all hospitalization with the primary diagnosis of AF who underwent AF catheter ablation at the index hospitalization. Then, hospitalizations were stratified into rural versus urban. The primary outcome was in-hospital mortality. Secondary outcomes were total hospitalization costs and likelihood for longer length of stay. RESULTS A total of 78,735 patients underwent inpatient CA of AF between January 2016 and December 2020, mean age was 68.5 ± 11 with 44 % being females. 27,180 (35 %) CA were performed in rural areas, while the remaining CA 51,555 (65 %) were done in urban areas. While, there was very low risk of mortality, patients who underwent CA in rural areas had more comorbidities and also was associated with a 79 % increase in post-procedural in-hospital mortality compared with urban areas (aOR 1.79, 0.8 % vs 0.4 %, CI: 1.15-2.78, P < 0.01). CA of AF in rural areas had a longer length of hospital stay (aOR 1.11, 4.21 vs 3.79 days, 95 % CI: 1.02-1.2, P = 0.02), lower overall cost compared with urban areas (49,698 ± 1251 vs. $53,252 ± 1339, P = 0.03). Multivariate regression analysis showed end stage renal disease and congestive heart failure were independent risk factors associated with increase in post CA in-hospital mortality exceeding two-fold. CONCLUSION Inpatient CA of AF in rural areas was associated with higher in-hospital mortality, longer length of stay and a lower overall cost when compared with urban areas.
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Affiliation(s)
| | - Ahmed Elzanaty
- Division of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA
| | - Saima Karim
- Division of Cardiovascular Medicine, Heart and Vascular Institute, MetroHealth Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Ehab Eltahawy
- Division of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA
| | - Ahmed Maraey
- Division of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA
| | - Omar Kahaly
- Division of Cardiovascular Medicine, Promedica- Toledo Hospital, Toledo, OH, USA
| | - Paul Chacko
- Division of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA
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Sairaku A, Hashimoto K, Nakano Y. A Novel Hemostatic Belt Allowing Ambulation Soon After Atrial Fibrillation Ablation. J Cardiovasc Transl Res 2023; 16:1439-1446. [PMID: 37526899 DOI: 10.1007/s12265-023-10417-2] [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: 12/31/2022] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
We aimed to develop a hemostatic device with physiological evidence that allows ambulation soon after atrial fibrillation (AF) ablation. We measured right femoral vein pressure in 57 participants to clarify why groin post-venipuncture rebleeding often occurs during the transition from supine to sitting under compression bandage application and found that it increased more than threefold when raising the upper body (8.6 ± 4.1 to 27.6 ± 6.9 mmHg; P < 0.001). Based on that data, we created a novel hemostatic belt. Its capability test including 25 participants demonstrated that the belt gave much higher compression pressures on the right groin while sitting than the compression bandage (59.5 ± 14.9 vs. 8.1 ± 4 mmHg; P < 0.001), achieving pressures above the maximum femoral vein pressure in 92% of participants. A randomized trial comparing the belt with compression bandage in 74 AF patients demonstrated that the belt reduced time to ambulation without any rebleeding (340 [92.5-360] vs. 360 [360-360] min; P < 0.001) and satisfied more patients. The novel hemostatic belt provided a much higher compression pressure on the right groin during the sitting position than the conventional compression bandage, achieving a pressure above the maximum femoral vein pressure in 92% of the participants.
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Affiliation(s)
- Akinori Sairaku
- Department of Cardiology, Cardiovascular Center, National Hospital Organization Higashihiroshima Medical Center, 513 Jike, Saijo-cho, Higashihiroshima, 739-0041, Japan.
- Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, Onomichi, Japan.
| | - Koji Hashimoto
- Hiroshima Prefectural Technology Research Institute, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Doshi SK, Di Biase L, Shah K, Alcazar J, Ziv-Ari M, Brem E, Farshchi-Heydari S. Preclinical experience using 4-dimensional intracardiac echocardiography with CARTO integration. Heart Rhythm O2 2023; 4:823-825. [PMID: 38204463 PMCID: PMC10774664 DOI: 10.1016/j.hroo.2023.11.013] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Affiliation(s)
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York
| | - Kruti Shah
- Biosense Webster, Inc., Irvine, California
| | | | | | - Erez Brem
- Biosense Webster, Inc., Irvine, California
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Abdulsalam NM, Sridhar AM, Tregoning DM, He BJ, Jafarvand M, Mehri A, Afroze T, Chahine Y, Ko CW, Akoum N. Esophageal luminal temperature monitoring using a multi-sensor probe lowers the risk of esophageal injury in cryo and radiofrequency catheter ablation for atrial fibrillation. J Interv Card Electrophysiol 2023; 66:1827-1835. [PMID: 36745324 DOI: 10.1007/s10840-023-01492-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/22/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Esophageal luminal temperature monitoring is a commonly used strategy to reduce esophageal thermal injury in catheter ablation for atrial fibrillation (AFib). OBJECTIVES We sought to compare the incidence of endoscopically detected esophageal lesions (EDEL) between two commonly used esophageal luminal temperature probes. METHODS Consecutive patients undergoing ablation with esophageal luminal temperature monitoring and upper endoscopy within 24 h after ablation were included. RESULTS Four hundred forty-five patients (64 ± 10 years, 44% female) were included. Esophageal temperature monitoring was done with a single-sensor probe in 213 (48%) and multi-sensor probe in 232 (52%). Cryoballoon (CB) ablation was performed in 118 (27%) and radiofrequency (RF) ablation in 327 (73%) of patients. EDEL was present in 94 (22.9%) of which 85 were mild, 8 were moderate, and 1 was severe, and none progressed to atrial-esophageal fistula. The use of the multi-sensor probe during CB ablation was associated with a reduction in EDEL compared to single sensor (6.8% vs 24.3%; P = 0.016). Similarly, in the RF ablation group, EDEL was present in 19.5% of the multi-sensor group vs 32.8% in the single-sensor group (P = 0.001). Logistic regression showed that multi-sensor probe use was associated with reduction in EDEL with an odds ratio of 0.23 in CB ablation (P = 0.024) and 0.44 for RF ablation (P = 0.001). CONCLUSIONS Esophageal luminal temperature monitoring during AFib ablation using a multi-sensor probe was associated with a significant reduction in EDEL compared to a single-sensor probe.
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Affiliation(s)
- Nashwa M Abdulsalam
- Division of Cardiology, PeaceHealth Southwest Medical Center, 400 NE Mother Jospeh PI, WA, 98664, Vancouver, USA.
| | - Arun M Sridhar
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Deanna M Tregoning
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Beixin J He
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Mahbod Jafarvand
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Avin Mehri
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Tanzina Afroze
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Yaacoub Chahine
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Cynthia W Ko
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Nazem Akoum
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
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Baudo M, Rosati F, Di Bacco L, D'Alonzo M, Benussi S, Muneretto C. Left Atrium Volume Reduction Procedure Concomitant With Cox-Maze Ablation in Patients Undergoing Mitral Valve Surgery: A Meta-Analysis of Clinical and Rhythm Outcomes. Heart Lung Circ 2023; 32:1386-1393. [PMID: 37821261 DOI: 10.1016/j.hlc.2023.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/11/2023] [Accepted: 09/10/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The management of an enlarged left atrium (LA) in mitral valve (MV) disease with atrial fibrillation (AF) is still being debated. It has been postulated that a reduction in LA size may improve patient outcomes. This meta-analysis aimed to assess rhythm and clinical outcomes of combined surgical AF treatment with or without LA volume reduction (LAVR) in patients undergoing MV surgery. METHODS A systematic review was performed and all available literature to May 2022 was included. The primary endpoint was analysis of early and late mortality and rhythm outcomes. Secondary outcomes included early and late cerebrovascular accident (CVA) and permanent pacemaker implantation. RESULTS The search strategy yielded 2,808 potentially relevant articles, and 19 papers were eventually included. The pooled estimated rate of 30-day mortality was 3.76% (95% CI 2.52-5.56). The incidence rate of late mortality and late cardiac-related mortality was 1.75%/year (95% CI 0.63-4.84) and 1.04%/year (95% CI 0.31-3.53), respectively. At subgroup analysis when comparing the surgical procedure with and without AF ablation, the ablation subgroup showed a significantly lower rate of postoperative CVA (p<0.0001) and higher restoration to sinus rhythm at discharge (p=0.0124), with only a trend of lower AF recurrence at 1 year (p=0.0608). At univariable meta-regression, reintervention was significantly associated with higher late mortality (p=0.0033). CONCLUSION In enlarged LA undergoing MV surgery, LAVR combined with AF ablation showed a trend of improved rhythm outcomes when compared with AF ablation without LAVR. Each LAVR technique has its advantages and disadvantages, which must be managed accordingly.
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Affiliation(s)
- Massimo Baudo
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy.
| | - Fabrizio Rosati
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Lorenzo Di Bacco
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Michele D'Alonzo
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Stefano Benussi
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Claudio Muneretto
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
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13
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Skeete J, Huang HD, Kenigsberg D. Prospective study of zero-fluoroscopy laser balloon pulmonary vein isolation for the management of atrial fibrillation. J Interv Card Electrophysiol 2023; 66:1669-1677. [PMID: 36738388 DOI: 10.1007/s10840-023-01477-0] [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: 07/30/2022] [Accepted: 01/10/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND In recent years, there has been increased focus on the development of safe and effective strategies to minimize and ultimately eliminate fluoroscopy use in the electrophysiology lab due to the inherent risks to patients and staff associated with this imaging source. However, studies examining these innovative fluoroless strategies for pulmonary vein isolation (PVI) using catheters without direct 3D mapping system integration are lacking. We sought to develop a method to perform zero-fluoroscopy laser balloon PVI for patients with atrial fibrillation (AF), and to test the safety and efficacy of this approach. METHODS We developed a standardized method for performing PVI using the X3 laser balloon (LB) system, 3-dimensional electroanatomic mapping (3D-EAM) and intracardiac echocardiography (ICE) in a cohort of patients with symptomatic AF. The primary endpoint of the study was the ability to perform PVI without the use of fluoroscopy. Secondary outcomes were rate of successful transseptal puncture on first attempt, first pass isolation of target PVs, mean procedural time, active laser time to achieve PVI, need for use of supplemental energy sources, and procedural complication rates. RESULTS Two hundred consecutive patients undergoing PVI were recruited in the study. In the zero-fluoroscopy group, LB PVI was successfully performed in 100% of participants (n = 100) without the need for fluoroscopy. Transseptal access was achieved in 100% of cases on the first attempt. Successful first pass PVI was achieved in 360 of the 387 pulmonary veins attempted (93%). Mean procedural time was 68.2 ± 16.2 min in the zero-fluoroscopy group versus 67.5 ± 17.0 min in the conventional fluoroscopy group. PVI was able to be achieved in 100% of cases in both groups without need for use of supplemental energy sources. In the zero-fluoroscopy group there were minimal complications, with 3% of all cases having groin complications and 1 patient with a pericardial effusion noted post-procedure which was managed conservatively. CONCLUSIONS We demonstrated that successful zero-fluoroscopy LB PVI could be performed at a single high-volume center by experienced operators in an effective manner, without significant complications.
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Affiliation(s)
- Jamario Skeete
- Section of Electrophysiology, Division of Cardiology, Rush University Medical Center, 1717 W, Congress Parkway, Kellogg, Suite 320, Chicago, IL, 60612, USA.
| | - Henry D Huang
- Section of Electrophysiology, Division of Cardiology, Rush University Medical Center, 1717 W, Congress Parkway, Kellogg, Suite 320, Chicago, IL, 60612, USA
| | - David Kenigsberg
- Cardiac Electrophysiology, Florida Heart Rhythm Specialists, Fort Lauderdale, FL, USA
- Cardiac Electrophysiology, Fort Lauderdale Heart and Rhythm Surgical Center, Fort Lauderdale, FL, USA
- Cardiac Electrophysiology, Westside Regional Medical Center, Plantation, FL, USA
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14
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Mahajan A, Girman C, Subzposh FA, Vijayaraman P. Novel automated "score mapping" of diaphragmatic compound motor action potential for the early detection of phrenic nerve injury during cryoablation. Heart Rhythm 2023; 20:1339-1340. [PMID: 37352947 DOI: 10.1016/j.hrthm.2023.06.012] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 06/25/2023]
Affiliation(s)
- Ankit Mahajan
- Division of Cardiac Electrophysiology, Geisinger Heart Institute, Wilkes-Barre, Pennsylvania
| | | | - Faiz Ali Subzposh
- Division of Cardiac Electrophysiology, Geisinger Heart Institute, Wilkes-Barre, Pennsylvania
| | - Pugazhendhi Vijayaraman
- Division of Cardiac Electrophysiology, Geisinger Heart Institute, Wilkes-Barre, Pennsylvania.
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Mills EW, Antman EM, Javaheri S. Breathless nights and heart flutters: Understanding the relationship between obstructive sleep apnea and atrial fibrillation. Heart Rhythm 2023; 20:1267-1273. [PMID: 37127146 DOI: 10.1016/j.hrthm.2023.04.022] [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: 04/11/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/03/2023]
Abstract
There is an extraordinary and increasing global burden of atrial fibrillation (AF) and obstructive sleep apnea (OSA), two conditions that frequently accompany one another and that share underlying risk factors. Whether a causal pathophysiologic relationship connects OSA to the development and/or progression of AF, or whether shared risk factors promote both conditions, is unproven. With increasing recognition of the importance of controlling AF-related risk factors, numerous observational studies now highlight the potential benefits of OSA treatment in AF-related outcomes. Physicians are regularly faced with caring for this important and increasing population of patients despite a paucity of clinical guidance on the topic. Here, we review the clinical epidemiology and pathophysiology of AF and OSA with a focus on key clinical studies and major outstanding questions that should be addressed in future studies.
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Affiliation(s)
- Eric W Mills
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Elliott M Antman
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sogol Javaheri
- Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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16
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Brandt RR, Stöbe S, Ewers A, Helfen A. [Echocardiography in cardiac arrhythmias]. Herzschrittmacherther Elektrophysiol 2023; 34:256-264. [PMID: 37584761 DOI: 10.1007/s00399-023-00956-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/19/2023] [Indexed: 08/17/2023]
Abstract
Echocardiography plays a key role in planning and guidance of electrophysiological procedures. After exclusion of structural heart disease, echocardiography provides insight into the extent of left atrial remodeling by determining left atrial metrics. This "biomarker" is associated with the risk of new-onset atrial fibrillation and predictive of atrial fibrillation recurrence after ablation. Transesophageal echocardiography is necessary to exclude left atrial thrombi and is able to guide a transseptal puncture. In case of a rare but life-threatening cardiac tamponade, an echocardiographic-guided pericardiocentesis ensures quick and effective treatment. Left ventricular ejection fraction and deformation analysis determined by echocardiography are established methods for risk stratification in patients with systolic dysfunction and used to guide pharmacological and device therapy.
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Affiliation(s)
- Roland R Brandt
- Abteilung für Kardiologie, Kerckhoff Klinik GmbH, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland.
| | - Stephan Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Aydan Ewers
- Medizinische Universitätsklinik II - Kardiologie und Angiologie, BG Universitätsklinikum Bergmannsheil Bochum, Bürkle de la Camp-Platz 1, 44789, Bochum, Deutschland
| | - Andreas Helfen
- Abteilung für Kardiologie, Katholische St. Paulus Gesellschaft, St.-Marien-Hospital Lünen, Altstadtstr. 23, 44534, Lünen, Deutschland
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17
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Leiva O, Alam U, Bohart I, Yang EH. Interventional Cardio-Oncology: Unique Challenges and Considerations in a High-Risk Population. Curr Treat Options Oncol 2023:10.1007/s11864-023-01110-2. [PMID: 37296366 PMCID: PMC10356652 DOI: 10.1007/s11864-023-01110-2] [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] [Accepted: 05/09/2023] [Indexed: 06/12/2023]
Abstract
OPINION STATEMENT Patients with cancer are at risk of developing cardiovascular disease (CVD) including atherosclerotic heart disease (AHD), valvular heart disease (VHD), and atrial fibrillation (AF). Advances in percutaneous catheter-based treatments, including percutaneous coronary intervention (PCI) for AHD, percutaneous valve replacement or repair for VHD, and ablation and left atrial appendage occlusion devices (LAAODs) for AF, have provided patients with CVD significant benefit in the recent decades. However, trials and registries investigating outcomes of these procedures often exclude patients with cancer. As a result, patients with cancer are less likely to undergo these therapies despite their benefits. Despite the inclusion of cancer patients in randomized clinical trial data, studies suggest that cancer patients derive similar benefits of percutaneous therapies for CVD compared with patients without cancer. Therefore, percutaneous interventions for CVD should not be withheld in patients with cancer, as they may still benefit from these procedures.
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Affiliation(s)
- Orly Leiva
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Usman Alam
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Isaac Bohart
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Eric H Yang
- Division of Cardiology, Department of Medicine, UCLA Cardio-Oncology Program, University of California at Los Angeles, 100 Medical Plaza, Suite 630, Los Angeles, CA, 90095, USA.
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Taylor J, Assaf SN, Assaf AN, Heidel E, Mahlow W, Baljepally R. Obstructive Sleep Apnea as a Predictor of Inducible Atrial Flutter During Pulmonary Vein Isolation in Patients With Atrial Fibrillation: Clinical Significance and Follow-Up Outcomes. Cardiol Res 2023; 14:183-191. [PMID: 37304914 PMCID: PMC10257505 DOI: 10.14740/cr1491] [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: 03/09/2023] [Accepted: 05/01/2023] [Indexed: 06/13/2023] Open
Abstract
Background Atrial fibrillation (AF) and atrial flutter (AFL) often coexist in patients and may lead to severe symptoms and complications. Despite their coexistence, prophylactic cavotricuspid isthmus (CTI) ablation has failed to reduce the incidence of recurrent AF or new onset AFL. In contrast, the presence of inducible AFL during pulmonary vein isolation (PVI) has been shown to be predictive of symptomatic AFL during follow-up. However, the potential role of obstructive sleep apnea (OSA) as a predictor of inducible AFL during PVI in patients with AF remains unclear. Therefore, this study aimed to examine the potential role of OSA as a predictor of inducible AFL during PVI in patients with AF and reexamine the clinical significance of inducible AFL during PVI in terms of recurrent AFL or AF during follow-up. Methods We conducted a single-center, non-randomized retrospective study on patients who underwent PVI between October 2013 and December 2020. A total of 192 patients were included in the study after screening 257 patients for exclusion criteria, which included a previous history of AFL or previous PVI or Maze procedure. All patients underwent a transesophageal echocardiogram (TEE) prior to their ablation to rule out a left atrial appendage thrombus. The PVI was performed using both fluoroscopic and electroanatomic mapping derived from intracardiac echocardiography. After the confirmation of PVI, additional electrophysiology (EP) testing was performed. AFL was classified as typical or atypical based on the origin and activation pattern. Descriptive and frequency statistics were performed to describe the demographic and clinical characteristics of the sample, and Chi-square and Fisher's exact tests were used to compare independent groups on categorical outcomes. Logistic regression analysis was performed to adjust for confounding variables. The study was approved by the Institutional Review Board, and informed consent was waived given the retrospective nature of the study. Results Of the 192 patients included in the study, 52% (n = 100) had inducible AFL after PVI, with 43% (n = 82) having typical right AFL. Bivariate analysis showed statistically significant differences between the groups for OSA (P = 0.04) and persistent AF (P = 0.047) when examining the outcome of any inducible AFL. Similarly, only OSA (P = 0.04) and persistent AF (P = 0.043) were significant when examining the outcome of typical right AFL. Multivariate analysis showed that only OSA was significantly associated with any inducible AFL after controlling for other variables (adjusted odds ratio (AOR) = 1.92, 95% confidence interval (CI): 1.003 - 3.69, P = 0.049). Of the 100 patients with inducible AFL, 89 underwent additional ablation for AFL prior to completion of their procedure. At 1 year, the rates of recurrence for AF, AFL, and either AF or AFL were 31%, 10%, and 38%, respectively. There was no significant difference in the rates of recurrence of AF, AFL, or either AF/AFL at 1 year when accounting for the presence of inducible AFL or the efficacy of additional AFL ablation. Conclusions In conclusion, our study found a high incidence of inducible AFL during PVI, particularly among patients with OSA. However, the clinical significance of inducible AFL in relation to the recurrence rates of AF or AFL at 1-year post-PVI remains unclear. Our findings suggest that successful ablation of inducible AFL during PVI may not provide clinical benefit in reducing AF or AFL recurrence. To establish the clinical significance of inducible AFL during PVI in various patient populations, further prospective studies with larger sample sizes and longer follow-up periods are necessary.
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Affiliation(s)
- John Taylor
- The University of Tennessee Graduate School of Medicine, Knoxville, TN 37920, USA
| | - Sohiub N. Assaf
- The University of Tennessee Graduate School of Medicine, Knoxville, TN 37920, USA
| | - Abdallah N. Assaf
- The University of Tennessee Graduate School of Medicine, Knoxville, TN 37920, USA
| | - Eric Heidel
- Department of Surgery, University of Tennesse, Knoxville, TN 37920, USA
| | - William Mahlow
- The University of Tennessee Graduate School of Medicine, Knoxville, TN 37920, USA
- Division of Cardiology, University of Tennessee Medical Center Knoxville, Knoxville, TN 37920, USA
| | - Raj Baljepally
- The University of Tennessee Graduate School of Medicine, Knoxville, TN 37920, USA
- Division of Cardiology, University of Tennessee Medical Center Knoxville, Knoxville, TN 37920, USA
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Meinhardt C, List S, Chamieh AE, Fehrendt H, Meves V, Mohamed M, Müller J, Deneke T, Geismann C, Elsässer A, Arlt A, Halbfass P. High prevalence of incidental endoscopic findings at routine endoscopy after atrial fibrillation ablation: Do we need a screening endoscopy for the upper gastrointestinal tract in the general population? Eur J Intern Med 2023; 111:54-62. [PMID: 36797118 DOI: 10.1016/j.ejim.2023.02.011] [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: 11/19/2022] [Revised: 01/07/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION High-power short-duration ablation (HPSD) is an effective therapy for atrial fibrillation with thermal esophageal injury as a rare but relevant side effect. AIM AND METHODS In this retrospective single-center analysis we evaluated the incidence and relevance of ablation-induced findings and the prevalence of ablation-independent incidental gastrointestinal findings. For 15 months all patients undergoing ablation were screened by postablation esophagogastroduodenoscopy. Pathological findings were followed up and treated if necessary. RESULTS 286 consecutive patients (66±10 years; 54.9% male) were included. 19.6% of patients showed ablation-associated alterations (10.8% esophageal lesions, 10.8% gastroparesis, 1.7% both findings). Logistic multivariable regression analysis confirmed an influence of lower BMI on the occurrence of RFA-associated endoscopic findings (OR 0.936, 95% CI 0.878-0.997, p<0.05). 48.3% of patients demonstrated incidental gastrointestinal findings. In 1.0% neoplastic lesions were present, 9.4% showed precancerous lesions and in 4.2% neoplastic lesions of unknown dignity were found requiring further diagnostics or therapy. 18.1% of patients demonstrated findings associated with a potentially increased risk of bleeding under anticoagulation. Patients with clinically relevant incidental findings were significantly more often male, 68.8% vs. 49.5% (p<0.01). CONCLUSION HPSD ablation is safe, no devasting complication occurred in any patient. It resulted in 19.6% ablation-induced thermal injury whereas incidental findings of the upper GI tract were found in 48.3% of patients. Due to the high prevalence of 14.7% of findings requiring further diagnostics, therapy, or surveillance in a cohort that is mimicking the general population, screening endoscopy of the upper GI tract seems to be reasonable in the general population.
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Affiliation(s)
- Christian Meinhardt
- Department of Internal Medicine and Gastroenterology, Carl von Ossietzky University Oldenburg, Germany
| | - Stephan List
- Department of Internal Medicine and Invasive Cardiology, Carl von Ossietzky University Oldenburg, Germany
| | - Alexander Elias Chamieh
- Department of Internal Medicine and Gastroenterology, Carl von Ossietzky University Oldenburg, Germany
| | - Hinrich Fehrendt
- Department of Internal Medicine and Gastroenterology, Carl von Ossietzky University Oldenburg, Germany
| | - Volker Meves
- Department of Internal Medicine and Gastroenterology, Carl von Ossietzky University Oldenburg, Germany
| | - Moustafa Mohamed
- Department of Internal Medicine and Gastroenterology, Carl von Ossietzky University Oldenburg, Germany
| | - Julian Müller
- Department of Invasive Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Thomas Deneke
- Department of Invasive Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Claudia Geismann
- Department of Internal Medicine I, Laboratory of Molecular Gastroenterology & Hepatology, UKSH-Campus Kiel, Germany
| | - Albrecht Elsässer
- Department of Internal Medicine and Invasive Cardiology, Carl von Ossietzky University Oldenburg, Germany
| | - Alexander Arlt
- Department of Internal Medicine and Gastroenterology, Carl von Ossietzky University Oldenburg, Germany.
| | - Philipp Halbfass
- Department of Internal Medicine and Invasive Cardiology, Carl von Ossietzky University Oldenburg, Germany
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Wörmann J, Lüker J, van den Bruck JH, Filipovic K, Erlhöfer S, Scheurlen C, Dittrich S, Schipper JH, Steven D, Sultan A. Pulmonary vein isolation for atrial fibrillation using true high-power short-duration vs. cryoballoon ablation. Clin Res Cardiol 2023:10.1007/s00392-023-02188-2. [PMID: 37009942 DOI: 10.1007/s00392-023-02188-2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/22/2023] [Indexed: 04/04/2023]
Abstract
AIMS Pulmonary vein isolation (PVI) is achievable and effective using radiofrequency (RF) catheter (CA) or cryoballoon (CB) ablation. The newly introduced high RF-power short-duration ablation (HPSD) technique has shown promising results. Data comparing HPSD- to CB-PVI is sparse. We sought to investigate success rates and procedural differences of HPSD-PVI vs. CB-PVI in patients undergoing ablation for PAF and persAF. METHODS Consecutive patients undergoing de novo PVI (HPSD or CB) were included. A power setting of 70W/7 s (70W/5 s at posterior wall) using a flexible tip catheter with enhanced irrigation was considered as true HPSD. Follow-up consisted of out-clinic pts visits, tele-consultation, 48-h Holter ECG, app-based telemonitoring and cardiac implanted electronic devices (CIED) interrogation. RESULTS 721 patients (46 HPSD, 675 CB) were analyzed. In all HPSD (27 persAF [59%]) and CB patients (423 persAF [63%]), PVI was successfully achieved. Procedure duration was significantly longer for HPSD (91 ± 19 min vs. 72 ± 18 min, p < 0.01). Ablation time was similar in both groups (HPSD: 44 ± 19 min vs. CB: 40 ± 17 min; p = 0.347). No major complications occurred in HPSD. For CB-PVI, in 25 (3.7%; p = 0.296) patients, complications occurred. At a follow-up of 290 ± 135 days, arrhythmia-free survival using HPSD was non-inferior to CB-PVI in the Kaplan-Meier survival analysis (p = 0.096). CONCLUSION PVI using HPSD is equally effective and safe to CB-PVI. This analysis revealed a similar arrhythmia-free survival after HPSD and CB with low complication rates. Procedure duration for CB was significantly shorter while LA dwell time excluding mapping was equal. Currently, a prospective trial is conducted to corroborate these findings.
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Affiliation(s)
- Jonas Wörmann
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Jakob Lüker
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jan-Hendrik van den Bruck
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Karlo Filipovic
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Susanne Erlhöfer
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Cornelia Scheurlen
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Sebastian Dittrich
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jan-Hendrik Schipper
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Daniel Steven
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Arian Sultan
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Baudo M, Petruccelli RD, D'Alonzo M, Rosati F, Benussi S, Di Bacco L, Muneretto C. Rhythm outcomes of minimally-invasive off-pump surgical versus catheter ablation in atrial fibrillation: A meta-analysis of reconstructed time-to-event data. Int J Cardiol 2023; 376:62-75. [PMID: 36787869 DOI: 10.1016/j.ijcard.2023.02.008] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/13/2023] [Accepted: 02/06/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND Mid- and long-term rhythm outcomes of catheter ablation (CA) for atrial fibrillation (AF) are reported to be suboptimal. Minimally invasive surgical off-pump ablation (MISOA), including both thoracoscopic and trans-diaphragmatic approaches, has been developed to reduce surgical invasiveness and overcome on-pump surgery drawbacks. We sought to compare the efficacy and safety of MISOA and CA for AF treatment. METHODS A systematic review and meta-analysis of the literature was performed including studies comparing MISOA and CA. The primary endpoint was survival freedom from AF at follow-up after a 3-month blanking period. Subgroup analysis of the primary endpoint was performed according to the type of surgical incision and hybrid approach. RESULTS Freedom from AF at 4 years was 52.1% ± 3.2% vs 29.1% ± 3.5%, between MISOA and CA respectively (log-rank p < 0.001; Hazard Ratio: 0.60 [95%Confidence Interval (CI):0.50-0.72], p < 0.001). At landmark analysis, a significant improvement in rhythm outcomes was observed in the MISOA group after the 5th month of follow-up (2 months from the blanking period). The Odds Ratio between MISOA and CA of postoperative cerebrovascular accident incidence and postoperative permanent pacemaker implant (PPM) were 2.00 (95%CI:0.91-4.40, p = 0.084) and 1.55 (95%CI:0.61-3.95, p = 0.358), respectively. The incidence rate ratio of late CVA between MISOA and CA was 0.86 (95%CI:0.28-2.65, p = 0.787), while for late PPM implant was 0.45 (95%CI:0.11-1.78, p = 0.256). CONCLUSIONS The current meta-analysis suggests that MISOA provides superior rhythm outcomes when compared to CA in terms of sinus rhythm restoration. Despite the rhythm outcome superiority of MISOA, it is associated to higher postoperative complications compared to CA.
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Affiliation(s)
- Massimo Baudo
- Department of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy.
| | | | - Michele D'Alonzo
- Department of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Fabrizio Rosati
- Department of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Stefano Benussi
- Department of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Lorenzo Di Bacco
- Department of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Claudio Muneretto
- Department of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
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Wang J, Zhao X, Ma C. Tortuous treatment process of a complex femoral pseudoaneurysm following atrial fibrillation ablation: a case report. Eur Heart J Case Rep 2023; 7:ytad186. [PMID: 37123648 PMCID: PMC10133992 DOI: 10.1093/ehjcr/ytad186] [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: 12/21/2022] [Revised: 01/17/2023] [Accepted: 04/12/2023] [Indexed: 05/02/2023]
Abstract
Background Although the rate of vascular complications following catheter ablation has been decreasing in the past 10 years, it remains a common and thorny problem in clinical settings. For the majority of iatrogenic pseudoaneurysms (PSAs), non-surgical therapeutic approaches such as ultrasound-guided compression repair (UGCR) and ultrasound-guided thrombin injection (UGTI) have been used as first-line regimens. However, suitable treatment for PSA mainly depends on the characteristics of the PSA. Case summary This report presented the case of a 75-year-old woman who suffered from a beaded multi-chamber femoral PSA combined with arteriovenous fistula between the superficial femoral artery and the common femoral vein following radiofrequency ablation of atrial fibrillation. The treatment process of the PSA was tortuous. After a UGCR attempt, the PSA was not occluded. The UGTI successfully clotted the superficial and middle chambers of the PSA. After repeat UGCR, the residual deep chamber of the PSA was expanded, and the skin deteriorated. The complicated PSA was finally treated with surgical repair. Discussion Appropriate treatment for PSA depends on the anatomical characteristics of the PSA and indications of various treatment measures.
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Affiliation(s)
- Jue Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Disease, Chaoyang District, Beijing 100029, China
| | - Xin Zhao
- Corresponding author. Tel: +86 10 84005363,
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Oliveira M, Sousa L, Trindade A, da Silva N. Single puncture approach guided by transesophageal echocardiography for atrial fibrillation ablation in a patient with prior percutaneous septal closure: case report. Eur Heart J Case Rep 2023; 7:ytad139. [PMID: 37090759 PMCID: PMC10114039 DOI: 10.1093/ehjcr/ytad139] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/11/2022] [Accepted: 03/24/2023] [Indexed: 04/25/2023]
Abstract
Background Atrial septal defect (ASD) is associated with a risk of developing atrial fibrillation (AF) higher than in the general population, even after percutaneous or surgical septal closure. Catheter ablation is an effective treatment strategy for preventing recurrences and reducing the AF burden. However, electrophysiologists are faced with technical difficulties and the risk of complications with the left atrium access in patients with prior ASD percutaneous closure. Case summary We report a case of a patient with highly symptomatic paroxysmal AF, with an ASD, closed percutaneously many years before, who underwent a successful catheter AF ablation, using a single transeptal (TSP) approach guided by transesophageal echocardiography (TEE). Discussion In patients with ASD and an occluder device implanted, there is a potential risk for septal tear during the TSP passage, device dislodgement, or thrombus formation on the device. Atrial fibrillation ablation in this subset of patients has often been protracted and scarcely reported. TEE and intra-cardiac echocardiography have been increasingly used for interventional procedure guidance during AF ablation. As described here, AF ablation using a simplified single TSP guided by TEE is feasible, safe, and effective after device ASD closure.
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Affiliation(s)
| | - Lidia Sousa
- Heart Center, Hospital CUF Tejo, Lisbon, Portugal
- Hospital Santa Marta, CHULC, Lisbon, Portugal
| | - Ana Trindade
- Heart Center, Hospital CUF Tejo, Lisbon, Portugal
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Chakraborty P, Po SS. The role of autonomic denervation in the success of atrial fibrillation ablation: Can pulsed-field ablation provide the answer? Heart Rhythm 2023; 20:341-342. [PMID: 36503178 DOI: 10.1016/j.hrthm.2022.12.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Praloy Chakraborty
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Sunny S Po
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
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25
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Mahmoodi E, Leitch J, Davies A, Leigh L, Oldmeadow C, Dwivedi J, Boyle A, Jackson N. The importance of anaesthesia in atrial fibrillation ablation: Comparing conscious sedation with general anaesthesia. Indian Pacing Electrophysiol J 2023; 23:47-52. [PMID: 36509310 DOI: 10.1016/j.ipej.2022.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/18/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND General anaesthesia (GA) for atrial fibrillation (AF) ablation is often preferred over conscious sedation (CS) to minimize patient discomfort and reduce the risk of map disruption from patient movement but may pose an additional risk to some patients with significant comorbidity or poor cardiac function. METHODS We extracted data for 300 patients who underwent AF ablation between the years 2017 and 2019 and compared the outcomes of AF ablation with CS and GA. RESULTS Compared to the GA group, patients were younger in the CS group (63 versus 66 years, p = 0.02), had less persistent AF (34% versus 46%, p = 0.048) and the left atrial dimension was smaller (41 versus 45 mm, p = 0.01). More patients had cryoballoon ablation (CBA) than radiofrequency (RFA) ablation in the CS than the GA group (88% CB with CS and 56% RF with GA, p < 0.01), frequency of ASA score 3-4 (higher anaesthetic risk) was less for CS than for GA (45% versus 75%, p < 0.01), and procedural duration was shorter for patients who had CS (110 versus 139 min, p < 0.001). Of the patients receiving CS, 127/182 (70%) were planned for same day discharge (SDD) and this occurred in 120 (94%) of those patients. There were no significant differences in complication rates between the groups (5.1% in GA and 6% in CS, p = 0.8). AF type was the only significant predictor of freedom from AF recurrence on multivariate analysis (HR 0.33, 0.13-0.82, p = 0.018). CONCLUSION In this study, the use of CS compared with GA for AF ablation was associated with similar outcomes and complication rates.
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26
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Winkle RA, Mead RH, Engel G, Salcedo J, Brodt C, Barberini P, Lebsack C, Kong MH, Kalantarian S, Patrawala RA. Very long term outcomes of atrial fibrillation ablation. Heart Rhythm 2023; 20:680-688. [PMID: 36764350 DOI: 10.1016/j.hrthm.2023.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 01/10/2023] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Little is known about the very long term durability of atrial fibrillation (AF) ablation. OBJECTIVE The purpose of this study was to evaluate very long term AF ablation outcomes. METHODS We followed 5200 patients undergoing 7145 ablation procedures. We evaluated outcomes after single and multiple ablation procedures for paroxysmal (PAF; 33.6%), persistent (PeAF; 56.4%), and long-standing (LsAF; 9.9%) AF. We compared 3 ablation eras by initial ablation catheter: early (101 patients) using solid big tip (SBT) catheters (October 2003 to December 2005), intermediate (2143 patients) using open irrigated tip (OIT) catheters (December 2005 to August 2016), and contemporary (2956 patients) using contact force (CF) catheters (March 2014 to December 2021). RESULTS AF freedom at 5, 10, and 15 years was as follows: initial ablation: PAF 67.8%, 56.3%, 47.6%; PeAF 46.6%, 35.6%, 26.5%; and LsAF 30.4%, 18.0%, 3.4%; final ablation: PAF 80.3%, 72.6%, 62.5%; PeAF 60.1%, 50.2%, 42.5%; and LsAF 43.4%, 32.0%, 20.6%. For PAF and PeAF, CF ablation procedures were better than OIT ablation procedures (P < .0001) and both were better than SBT ablation procedures (P < .001). LsAF had no outcome improvement over the eras. The 8-year success rate after final ablation for CF, OIT, and SBT catheter eras was as follows: PAF 79.1%, 71.8%, 60.0%; PeAF 55.9%, 50.7%, 38.0%; and LsAF 42.7%, 36.2%, 31.8%. Highest AF recurrence was in the first 2 years, with a 2- to 15-year recurrence of 2%/yr. Success predictors after initial and final ablation procedures were younger age, smaller left atrium, shorter AF duration, male sex, less persistent AF, lower CHA2DS2-VASc score, fewer drugs failed, and more recent catheter era. CONCLUSION After year 2, there is 2%/yr recurrence rate for all AF types. Ablation success is best in the CF catheter era, intermediate in the OIT era, and worst in the SBT era. Over the ablation eras, outcomes improved for PAF and PeAF but not for LsAF. We should follow patients indefinitely after ablation. We need an understanding of how to better ablate more persistent AF.
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Affiliation(s)
- Roger A Winkle
- Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, East Palo Alto, California; Sequoia Hospital, Redwood City, California.
| | - R Hardwin Mead
- Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, East Palo Alto, California; Sequoia Hospital, Redwood City, California
| | - Gregory Engel
- Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, East Palo Alto, California; Sequoia Hospital, Redwood City, California
| | - Jonathan Salcedo
- Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, East Palo Alto, California; Sequoia Hospital, Redwood City, California
| | - Chad Brodt
- Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, East Palo Alto, California; Sequoia Hospital, Redwood City, California
| | - Patricia Barberini
- Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, East Palo Alto, California; Sequoia Hospital, Redwood City, California
| | - Cynthia Lebsack
- Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, East Palo Alto, California; Sequoia Hospital, Redwood City, California
| | - Melissa H Kong
- Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, East Palo Alto, California; Sequoia Hospital, Redwood City, California
| | - Shadi Kalantarian
- Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, East Palo Alto, California; Sequoia Hospital, Redwood City, California
| | - Rob A Patrawala
- Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, East Palo Alto, California; Sequoia Hospital, Redwood City, California
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Tanese N, Almorad A, Pannone L, Defaye P, Jacob S, Kilani MB, Chierchia G, Venier S, Cardin C, Jacon P, Combes S, Deschamps E, Menè R, de Asmundis C, Boveda S. Outcomes after cryoballoon ablation of paroxysmal atrial fibrillation with the PolarX or the Arctic front advance pro: a prospective multicentre experience. Europace 2023; 25:873-879. [PMID: 36695332 PMCID: PMC10062287 DOI: 10.1093/europace/euad005] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [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: 09/18/2022] [Accepted: 12/28/2022] [Indexed: 01/26/2023] Open
Abstract
AIMS The aim of this study was to compare procedural efficacy and safety, including 1-year freedom from AF recurrence, between the novel cryoballoon system PolarX (Boston Scientific) and the Arctic Front Advance Pro (AFA-Pro) (Medtronic), in patients with paroxysmal AF undergoing PVI. METHODS AND RESULTS This multicentre prospective observational study included 267 consecutive patients undergoing a first cryoablation procedure for paroxysmal AF (137 PolarX, 130 AFA-Pro). KM curves with the log-rank test was used to compare the 1-year freedom from AF recurrence between both groups. Multivariate Cox model was performed to evaluate whether the type of procedure (PolarX vs. AFA-Pro) had an impact on the occurrence of AF recurrences after adjustment on potentially confounding factors. The PolarX reaches lower temperatures than the AFA-Pro (LSPV 52 ± 5, vs. 59 ± 6; LIPV 49 ± 6 vs. 56 ± 6; right superior pulmonary vein: 49 ± 6 vs. 57 ± 7; right inferior pulmonary vein: 52 ± 6 vs. 59 ± 6; P < 0.0001). A higher rate of transient phrenic nerve palsy was found in patients treated with the PolarX system (15% vs. 7%, P = 0.05). After a mean follow-up of 15 ± 5 months, 20 patients (15%) had recurrences in AFA-Pro group and 27 patients (19%) in PolarX group (P = 0.35). Based on survival analysis, no significant difference was observed between both groups with a 12-month free of recurrence survival of 91.2% (85.1-95.4%) vs. 83.7% (76.0%-89.1%) (log-rank test P = 0.11). In multivariate Cox model hazard ratio of recurrence for PolarX vs. AFA-Pro was not significant [HR = 1.6 (0.9-2.8), P = 0.12]. CONCLUSION PolarX and AFA-Pro have comparable efficacy and safety profiles for pulmonary veins isolation in paroxysmal atrial fibrillation.
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Affiliation(s)
- Nikita Tanese
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France.,IRCCS San Raffaele Hospital, Milan, Italy
| | - Alexandre Almorad
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Luigi Pannone
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Pascal Defaye
- Arrythmia Departement University Hospital of Grenoble-Alpes and Grenoble Alpes University, Grenboble, France
| | - Sophie Jacob
- Laboratory of epidemiology, Institute of Radiation Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Mouna Ben Kilani
- Arrythmia Departement University Hospital of Grenoble-Alpes and Grenoble Alpes University, Grenboble, France
| | - Gianbattista Chierchia
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Sandrine Venier
- Arrythmia Departement University Hospital of Grenoble-Alpes and Grenoble Alpes University, Grenboble, France
| | | | - Peggy Jacon
- Arrythmia Departement University Hospital of Grenoble-Alpes and Grenoble Alpes University, Grenboble, France
| | | | - Elodie Deschamps
- Arrythmia Departement University Hospital of Grenoble-Alpes and Grenoble Alpes University, Grenboble, France
| | - Roberto Menè
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
| | - Carlo de Asmundis
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France.,Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
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28
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Schade A, Costello-Boerrigter L, Deneke T, Steinborn F, Chapran M, Vathie K, Milisavljevic N, Franz M, Surber R, Assani M, Hamo H, Khshfeh M, Lauten A, Mattea V. Oesophageal safety in voltage-guided atrial fibrillation ablation using ablation index or contact force only: a prospective comparison. Europace 2022; 24:1909-1916. [PMID: 35851917 DOI: 10.1093/europace/euac103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS Left atrial ablation using radiofrequency (RF) is associated with endoscopically detected thermal oesophageal lesions (EDELs). The aim of this study was to compare EDEL occurrence after conventional contact force-guided (CFG) RF ablation vs. an ablation index-guided (AIG) approach in clinical routine of voltage-guided ablation (VGA). Predictors of EDEL were also assessed. METHODS AND RESULTS This study compared CFG (n = 100) with AIG (n = 100) in consecutive atrial fibrillation ablation procedures, in which both pulmonary vein isolation and VGA were performed. In the AIG group, AI targets were ≥500 anteriorly and ≥350-400 posteriorly. Upper endoscopy was performed after ablation.The CFG and AIG groups had comparable baseline characteristics. The EDEL occurred in 6 and 5% (P = 0.86) in the CFG and AIG groups, respectively. Category 2 lesions occurred in 4 and 2% (P = 0.68), respectively. All EDEL healed under proton pump inhibitor therapy. The AI > 520 was the only predictor of EDEL [odds ratio (OR) 3.84; P = 0.039]. The more extensive Category 2 lesions were predicted by: AI max > 520 during posterior ablation (OR 7.05; P = 0.042), application of posterior or roof lines (OR 5.19; P = 0.039), existence of cardiomyopathy (OR 4.93; P = 0.047), and CHA2DS2-VASc score (OR 1.71; P = 0.044). The only Category 2 lesion with AI max < 520 (467) occurred in a patient with low body mass index. CONCLUSIONS Both methods were comparable with respect to clinical complications and EDEL. In consideration of previous reconnection data and our study results regarding oesophageal safety, optimal AI target range might be between 400 and 450.
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Affiliation(s)
- Anja Schade
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Lisa Costello-Boerrigter
- Department of Cardiology and Center for Clinical Studies, Central Clinic Bad Berka, Robert-Koch-Alle 9, 99438 Bad Berka, Germany
| | - Thomas Deneke
- Department of Cardiology II/Interventional Electrophysiology, Rhoen-Klinikum Campus Bad Neustadt, Von-Guttenberg Str. 11, 97616 Bad Neustadt, Germany
| | - Frank Steinborn
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Mykhaylo Chapran
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Koroush Vathie
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Nemanja Milisavljevic
- Department of Internal Medicine 2, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Marcus Franz
- Department of Internal Medicine I/Cardiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Ralf Surber
- Department of Internal Medicine I/Cardiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Mohamad Assani
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Hussam Hamo
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Muhammed Khshfeh
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Alexander Lauten
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Violeta Mattea
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
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Nowak B, Schmidt B, Chen S, Urbanek L, Bordignon S, Schaack D, Tohoku S, Chun J. [Metabolic syndrome and atrial fibrillation]. Herzschrittmacherther Elektrophysiol 2022; 33:367-372. [PMID: 36131155 DOI: 10.1007/s00399-022-00898-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/01/2022] [Indexed: 06/15/2023]
Abstract
Metabolic syndrome is defined by the simultaneous occurrence of the cardiovascular risk factors obesity, hypertension, diabetes and dyslipidemia. Overweight, in particular, is continuously increasing in many countries. In this respect, metabolic syndrome is a strong risk factor for atrial fibrillation. Only few data are available on the influence of obesity on antiarrhythmic drugs. Sodium channel blockers, in particular, appear to show a reduced effectiveness. Direct oral anticoagulants can be used for anticoagulation in obese patients. With a body weight > 140 kg, a plasma level measurement is recommended. Severe overweight reduces the chances of successful ablation treatment and leads to more complications. Consistent treatment of the metabolic syndrome, and in particular weight reduction, can significantly improve the risk and the frequency of atrial fibrillation, the associated symptoms and the success of treatment for maintaining cardiac rhythm.
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Affiliation(s)
- Bernd Nowak
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt a.M., Deutschland.
| | - Boris Schmidt
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt a.M., Deutschland
| | - Shaojie Chen
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt a.M., Deutschland
| | - Lukas Urbanek
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt a.M., Deutschland
| | - Stefano Bordignon
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt a.M., Deutschland
| | - David Schaack
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt a.M., Deutschland
| | - Shota Tohoku
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt a.M., Deutschland
| | - Julian Chun
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt a.M., Deutschland
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Elliott MK, de Vere F, Mehta VS, Wijesuriya N, Strocchi M, Rajani R, Niederer S, Rinaldi CA. Rate or Rhythm Control in CRT (RHYTHMIC): Study rationale and protocol. Heart Rhythm O2 2022; 3:681-687. [PMID: 36589918 PMCID: PMC9795294 DOI: 10.1016/j.hroo.2022.09.001] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Atrial fibrillation (AF) has several detrimental effects on heart failure patients treated with cardiac resynchronization therapy (CRT). These include suboptimal biventricular pacing and the loss of atrioventricular (AV) synchrony. AV node ablation improves biventricular pacing and clinical outcomes in large observational studies. However, restoration of sinus rhythm with AF ablation may have additional benefits. Objectives To compare the effects of AV node ablation and AF ablation on echocardiographic and symptomatic outcomes in patients with CRT and suboptimal biventricular pacing. Methods RHYTHMIC is a multicenter prospective randomized controlled trial. Seventy patients will be recruited and randomized to each ablation strategy in a 1:1 ratio. Key inclusion criteria include a previous CRT implant (with atrial lead) for dyssynchronous heart failure, and biventricular pacing <95% secondary to AF. Patients with permanent AF will be excluded. Results Patients will undergo baseline assessment including transthoracic echocardiography (TTE), device check, blood tests, electrocardiogram (ECG), 6-minute walk test, and symptom questionnaire. They will then undergo either AV node ablation or AF ablation according to their allocated group. Follow-up will occur at 1 week (TTE and ECG) and at 6 months (repeat of baseline investigations). The primary endpoint will be change in left ventricular ejection fraction on TTE. Conclusion This is the first randomized controlled trial comparing AV node ablation and AF ablation in patients with CRT. We anticipate it will provide valuable insight into the management of this frequently encountered clinical scenario in a challenging patient cohort.
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Affiliation(s)
- Mark K. Elliott
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Felicity de Vere
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Vishal S. Mehta
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Marina Strocchi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Ronak Rajani
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Christopher A. Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
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31
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Nasso G, Lorusso R, Di Bari N, Condello I, Agró FE, Fiore F, Bonifazi R, Santarpino G, Speziale G. Hybrid approach for long-standing persistent atrial fibrillation: immediate versus staged treatment. J Cardiothorac Surg 2022; 17:274. [PMID: 36289547 PMCID: PMC9609243 DOI: 10.1186/s13019-022-02019-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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background The hybrid approach has become the most effective treatment option for restoring sinus rhythm and reducing the risk of atrial fibrillation (AF) recurrence. However, several issues remain to be clearly defined, including the appropriate timing of the staged procedure and the most effective strategy. Methods Over a 12-year period of activity, we performed 609 AF ablation procedures via a right mini-thoracotomy. From this general population, 60 patients underwent a hybrid procedure with catheter ablation performed at least 4 weeks after the surgical procedure to confirm if effective complete electrical isolation of pulmonary veins was achieved. In 20 patients, the second stage procedure was performed during the same hospitalization due to patient’s electrical instability. The results obtained in immediate versus staged patients were compared. Results All patients were discharged after the first stage procedure in sinus rhythm. The 20 immediate patients had a shorter hospital stay compared with the staged patients, in whom the two hospitalizations resulted in a longer hospital stay (immediate 5.5 ± 1.6 days versus staged 8.7 ± 1.4, P < 0.001). A significantly higher number of immediate patients had an associated ablation of the Bachmann’s bundle (n = 16 in the immediate group [80%] versus n = 14 in the staged group [45%]; P = 0.001). After a mean follow-up of 74 months, there was no significant difference in the risk of AF relapse between groups (immediate 1/20 [5%] versus staged 7/40 [17.5%]; P = 0.18). Conclusion The hybrid approach for the treatment of AF was safe and effective in immediate restoring sinus rhythm and in its maintenance at follow-up. Our preliminary results show that both immediate and staged procedures show similar efficacy but this result is strongly influenced by the concomitant ablation of the Bachmann’s bundle, which appears to be the most important component of the treatment strategy in order to reduce the risk of recurrent AF.
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Affiliation(s)
- Giuseppe Nasso
- grid.513136.30000 0004 1785 1004Department of Cardiac Surgery, Anthea Hospital, GVM Care&Research, Via Camillo Rosalba, 35/38, 70124 Bari, Italy
| | - Roberto Lorusso
- grid.412966.e0000 0004 0480 1382Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, Netherlands ,grid.5012.60000 0001 0481 6099Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| | - Nicola Di Bari
- grid.513136.30000 0004 1785 1004Department of Cardiac Surgery, Anthea Hospital, GVM Care&Research, Via Camillo Rosalba, 35/38, 70124 Bari, Italy
| | - Ignazio Condello
- grid.513136.30000 0004 1785 1004Department of Cardiac Surgery, Anthea Hospital, GVM Care&Research, Via Camillo Rosalba, 35/38, 70124 Bari, Italy
| | - Felice Eugenio Agró
- grid.9657.d0000 0004 1757 5329Department od Anaesthesiology, Campus Bio-Medico University, Rome, Italy
| | - Flavio Fiore
- grid.513136.30000 0004 1785 1004Department of Cardiac Surgery, Anthea Hospital, GVM Care&Research, Via Camillo Rosalba, 35/38, 70124 Bari, Italy
| | - Raffaele Bonifazi
- grid.513136.30000 0004 1785 1004Department of Cardiac Surgery, Anthea Hospital, GVM Care&Research, Via Camillo Rosalba, 35/38, 70124 Bari, Italy
| | - Giuseppe Santarpino
- grid.411489.10000 0001 2168 2547Department of Experimental and Clinical Medicine, “Magna Graecia” University, Catanzaro, Italy ,grid.511981.5Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany ,Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care&Research, Lecce, Italy
| | - Giuseppe Speziale
- grid.513136.30000 0004 1785 1004Department of Cardiac Surgery, Anthea Hospital, GVM Care&Research, Via Camillo Rosalba, 35/38, 70124 Bari, Italy
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Melby DP, Tholakanahalli VN, Itah R, Abdelhadi R, Sengupta J, Gornick CC, Moore J, Pai M, Benditt DG. Ripple Frequency Determined via a Novel Algorithm Is Associated With Atrial Fibrillation Termination and Freedom From Atrial Fibrillation. Heart Rhythm O2 2022; 3:665-72. [PMID: 36589915 DOI: 10.1016/j.hroo.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Persistent atrial fibrillation (AF) is a complex arrhythmia, and attaining freedom from AF with ablation has been challenging. Objectives This study evaluated a novel CARTO software algorithm based on the CARTO Ripple map for AF termination and 18-month freedom from AF. Methods Consecutive patients who underwent first-time ablation for persistent AF were included. A high-density Ripple map was created using a Pentaray catheter. Following PVI, ablation was performed at locations with rapid Ripple activations, a protocol previously described by us. Patients were followed for 18 months to assess rhythm outcomes. A retrospective analysis was performed using the CARTO Ripple frequency software algorithm. The Ripple frequency algorithm quantifies amplitude changes in the bipolar electrogram. Results A total of 115 AF maps were analyzed from 84 patients (mean age 65.9 years, 63.1% men). The top quartile of Ripple frequency corresponded to a visual reference with 96.7% sensitivity and 91.1% specificity. AF terminated during ablation in 88.1% of patients: pulmonary vein antrum alone (14.9%) or pulmonary vein plus nonantral sites (85.1%). The top quartile of Ripple frequency was present in nonantral areas associated with AF termination with 90.2% sensitivity and 86.5% specificity. After 14.0 ± 6.5 months and 1.2 ± 0.4 ablations, 78 (92.9%) of 84 patients were free of AF, and 79.8% were free of any atrial arrhythmia. Conclusion A novel algorithm for automated analysis of CARTO Ripple frequency demonstrated good sensitivity and specificity for detecting atrial regions in persistent AF in which ablation is associated with frequent AF termination and freedom from AF during follow-up.
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Freedman BL, Yang S, Shim D, d'Avila A, Waks JW, Tung P. Feasibility and safety of same-day discharge and shortened bedrest after atrial fibrillation ablation. J Interv Card Electrophysiol 2022; 65:209-217. [PMID: 35633430 PMCID: PMC9142825 DOI: 10.1007/s10840-022-01255-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/13/2022] [Indexed: 11/24/2022]
Abstract
Background While initial studies suggest that same-day discharge or shortened bedrest may be feasible for some patients following atrial fibrillation (AF) ablation, the risks and benefits of this approach remain unclear for patients undergoing hemostasis with figure-of-eight (FO8) suture technique. Methods We prospectively evaluated access site bleeding, length of hospitalization, urinary catheterization, and other clinical outcomes in patients undergoing AF ablation with 3 hours of bedrest between April and May 2021, and compared them to a control group that had undergone AF ablation with 6 hours of bedrest from April to July 2019. FO8 sutures were used for hemostasis in all patients. Independent risk factors for bleeding and urinary catheterization were determined using multiple logistic regression. Results Same-day discharge was achieved in 74% of patients in the 3-hour bedrest group compared to 7% of patients in the 6-hour bedrest group (p < 0.001). There were no differences between 3-hour and 6-hour bedrest groups in the rates of serious adverse events (2% vs. 1%, p = 0.45) or rehospitalizations or ED visits (1% vs. 3%, p = 0.45) within 30 days of ablation. The 3-hour bedrest group showed a non-significant trend toward more access site bleeding (15% vs. 8%, p = 0.10), but had a significant reduction in urinary catheterization (27% vs. 64%, p < 0.001) and opioid analgesia use (20% vs. 33%, p = 0.04). Conclusions Same-day discharge after 3 hours of bedrest is safe and feasible following AF ablation and is not associated with higher rates of complications or rehospitalizations at 30 days. Reduced bedrest resulted in decreased opioid analgesia and urinary catheterization. Supplementary Information The online version contains supplementary material available at 10.1007/s10840-022-01255-4.
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Affiliation(s)
- Benjamin L Freedman
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Shu Yang
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - David Shim
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.,Division of Cardiology, Veterans Affairs Portland Health Care, Portland, OR, USA
| | - Andre d'Avila
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Jonathan W Waks
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Patricia Tung
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
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Butt MU, Okumus N, Jabri A, Thomas C, Tarabichi Y, Karim S. Early versus late Catheter Ablation of Atrial Fibrillation and Risk of Permanent Pacemaker Implantation in patients with underlying Sinus Node Dysfunction. J Am Heart Assoc 2022; 11:e023333. [PMID: 35535620 PMCID: PMC9496447 DOI: 10.1161/jaha.121.023333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Atrial fibrillation (AF) is associated with anatomical and electrical remodeling. Some patients with AF have concomitant sick sinus syndrome and may need permanent pacemaker (PPM) implantation. Association between catheter ablation of AF timing and need for PPM in sick sinus syndrome has not been assessed. Methods and Results We used pooled electronic health data to perform retrospective cross‐sectional analysis of 66, 595 patients with AF and sick sinus syndrome to assess the need of PPM implantation temporally, with AF performed divided into earlier within 5 years (group 1), 5 to 10 years (group 2), or beyond 10 years (group 3) of diagnosis. PPM implantation was lowest among those who had catheter ablation within 5 years of sick sinus syndrome diagnosis: group 1 versus group 2 (18.15% versus 27.21%) and group 1 versus group 3 (18.15% versus 27.22%). Interestingly, there was no difference in risk of PPM between group 2 and group 3 (27.21% versus 27.22%; odds ratio [OR], 1.00 [95% CI, 0.85–1.20]). Conclusions Even after controlling known risk factors that increase the need for pacemaker implantation, timing of AF ablation was the strongest predictor for need for PPM. Patients adjusted OR of PPM was lower if patients had catheter ablation within 5 years of diagnosis compared with later than 5 years (adjusted OR, 0.64 [95% CI, 0.59–0.70]).
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Affiliation(s)
| | - Nazli Okumus
- Heart and Vascular InstituteMetroHealth Medical Center/Case Western Reserve UniversityClevelandOH
| | - Ahmad Jabri
- Heart and Vascular InstituteMetroHealth Medical Center/Case Western Reserve UniversityClevelandOH
| | - Charles Thomas
- Health Education CampusCase Western Reserve UniversityClevelandOH
| | - Yasir Tarabichi
- Division of PulmonaryCritical Care, and Sleep MedicineMetroHealth Medical Center/Case Western Reserve UniversityClevelandOH
| | - Saima Karim
- Department of CardiologyNew York University Langone HealthNew YorkNY
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Tavazzi L, Maggioni AP, Rapezzi C, Ferrari R. Heart failure and catheter ablation of atrial fibrillation: Navigating the difficult waters of heart failure phenotypes. Eur J Intern Med 2022; 99:13-18. [PMID: 35241349 DOI: 10.1016/j.ejim.2022.02.021] [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: 10/29/2021] [Revised: 02/07/2022] [Accepted: 02/16/2022] [Indexed: 11/03/2022]
Abstract
The use of catheter ablation of atrial fibrillation (AFA) is increasing and it has now been extended to include higher risk patients with heart failure (HF), based on evidence from observational studies and meta-analyses of randomized controlled trials (RCTs) indicating it as safe and beneficial in terms of quality of life, AF recurrence and hospital readmissions in the short-to-middle term. However, the RCTs so far have been relatively small with short follow-up, and few larger trials with long follow-up inconclusive about hard outcomes for large patient crossover undermining the robustness of the results. Importantly, most RCTs involved HF patients with reduced left ventricular ejection fraction (HFrEF). In contrast, most observational studies show that the majority of ablated HF patients in clinical practice have a preserved ejection fraction (HFpEF), a condition representing roughly half of all HF patients. This article provides an overview of the available scientific evidence in this clinical field and examines the current guideline recommendations. In the absence of robust evidence-based research, the recommendations on AFA in HF may be inconsistent or abstain from taking firm positions, particularly regarding AFA in HFpEF. There is need for clinical research in such a surprisingly orphan setting, in parallel with the current attempts to sort out the knotty question of the HF phenotypes, in particular, again, of the HFpEF phenotypes.
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Affiliation(s)
- Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care&Research, Cotignola (RA), Italy.
| | - Aldo P Maggioni
- Maria Cecilia Hospital, GVM Care&Research, Cotignola (RA), Italy; Centro Studi ANMCO, Firenze, Italy
| | - Claudio Rapezzi
- Maria Cecilia Hospital, GVM Care&Research, Cotignola (RA), Italy; Azienda Ospedaliero-Universitaria di Ferrara "Arcispedale S. Anna", Cona, Ferrara, Italy
| | - Roberto Ferrari
- Scientific Department, Medical Trial Analysis, Lugano, Switzerland
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Cay S, Kara M, Ozcan F, Ozeke O, Aksu T, Aras D, Topaloglu S. Propafenone use in coronary artery disease patients undergoing atrial fibrillation ablation. J Interv Card Electrophysiol 2022. [PMID: 35366133 DOI: 10.1007/s10840-022-01186-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/15/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Antiarrhythmic drugs (AADs) are frequently used after atrial fibrillation (AF) ablation. Class IC AAD use after AF ablation in patients with coronary artery disease (CAD) is uncertain. The aim was to evaluate propafenone use in CAD patients undergoing AF ablation and to compare propafenone with amiodarone regarding ventricular arrhythmia and mortality. METHODS In this retrospective, longitudinal cohort study, consecutive patients with mild to moderate CAD, undergoing AF ablation and receiving either propafenone (study group, n = 263) or amiodarone (control group, n = 499) in the blanking period, were included. After propensity score matching, 212 patients in each group were compared for the primary outcome defined as a composite of ventricular arrhythmic events, which included sudden cardiac death, sustained ventricular tachycardia or fibrillation, or non-sustained ventricular tachycardia (NSVT). Cardiovascular and non-cardiovascular mortality were evaluated as secondary outcomes. RESULTS Baseline variables of the study and control groups were well matched after propensity score matching. At 12-month follow up, 20 patients (4.7%) (11 in propafenone group and 9 in amiodarone group) experienced the primary outcome measure of NSVT (Gray test p = 0.645). No sustained ventricular tachycardia, ventricular fibrillation, sudden cardiac death, or cardiovascular mortality were observed. On multivariable competing analysis, age and diabetes but not propafenone use (hazard ratio 1.017; p = 0.804) were found to be independent and significant predictors of the primary outcome measure. CONCLUSION Propafenone use after AF ablation in patients with mild to moderate CAD had a safety profile similar to amiodarone and was not associated with major arrhythmic events.
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Iqbal AM, Li KY, Aznaurov SG, Lugo RM, Venkataraman R, Gautam S. Catheter ablation for atrial fibrillation can be safely performed without invasive hemodynamic monitoring: A multi-center study. J Interv Card Electrophysiol 2022. [PMID: 35182273 DOI: 10.1007/s10840-022-01151-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Arterial invasive monitoring is the most common method in the USA for hemodynamic monitoring during atrial fibrillation (AF) ablation. Although studies have shown favorable comparison between non-invasive and invasive hemodynamic monitoring (IHM) in non-cardiac procedures under general anesthesia, limited data is available for complex cardiac procedures such as AF ablation in the USA. With progressive improvement in AF ablation procedural safety, particularly with routine use of intracardiac echocardiography (ICE) to monitor for pericardial effusion, it is unclear if invasive hemodynamic monitoring provides any advantage over non-invasive methods. Therefore, the purpose of this study is to determine whether noninvasive hemodynamic monitoring is non-inferior to invasive hemodynamic monitoring during AF ablation under general anesthesia in patients without major cardiac structural abnormality. METHODS A multi-center retrospective data of AF ablation from July 2019 to December 2020 was extracted. A total of three hundred and sixty-two patients (362) were included, which were divided into group A (non-invasive hemodynamic monitoring) and group B (invasive hemodynamic monitoring). The primary outcome was to compare procedural safety between the two groups. RESULTS Out of 362 patients, 184 (51%) received non-invasive and 178 (49%) received invasive hemodynamic monitoring with similar baseline characteristics. There was no significant difference between the two groups in complication rates (groin hematoma, pericardial effusion, cardiac tamponade). Mean procedure time was longer in group B with 3.35% arterial site discomfort. Urgent arterial access was required in only 1 patient in group A. CONCLUSION This retrospective multicenter study strongly suggests that catheter ablation for atrial fibrillation under general anesthesia can be safely performed with noninvasive hemodynamic monitoring without requiring arterial access, with potential benefit in procedural duration and cost.
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Kadado AJ, Gobeil K, Fakhoury F, Pervaiz A, Chalhoub F. Very low tidal volume, high-frequency ventilation in atrial fibrillation ablation: a systematic review. J Interv Card Electrophysiol 2022; 64:539-543. [PMID: 35029769 DOI: 10.1007/s10840-022-01123-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/06/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Ventilation strategies in atrial fibrillation ablation affect procedure outcomes by influencing catheter stability. Studies have highlighted favorable atrial fibrillation (AF) ablation outcomes with the use of high-frequency jet ventilation (HFJV) which has been shown to improve lesion durability, energy delivery, and tissue contact. However, this mode of ventilation is not readily available. In this systematic review, we highlight the available data on the use of very low tidal volume, high-frequency ventilation using standard ventilators that aim to provide settings similar to HFJV during AF ablations. METHODS Using a combination of search terms in databases and manual searches in bibliographies of identified articles, we reviewed all published data reported in the English language on the use of very low tidal volume with high-frequency ventilation during atrial fibrillation ablation. RESULTS A total of 4 manuscripts were identified; 3 cohort studies and 1 case report. The utilization of standard ventilators with a high-frequency, very low tidal volume ventilation strategy appears to closely mimic the catheter stability benefits that HFJV ventilators provide. Across the 3 cohort identified studies, the use of this ventilation strategy was associated with improved catheter stability, tissue contact, and a decrease in radiofrequency time. No increased risk was identified compared to standard ventilation. CONCLUSION With a purpose of limiting thoracic excursion and cardiac movement, limited and sparse studies have shown improved outcomes with a very low tidal volume, high-frequency ventilation strategy. Additional studies are needed to solidify this easily accessible and widely available mode of ventilation.
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Affiliation(s)
- Anis John Kadado
- Department of Cardiology, UMass Chan Medical School-Baystate, 759 Chestnut Street, Springfield, MA, 01199, USA.
| | - Kyle Gobeil
- Department of Cardiology, UMass Chan Medical School-Baystate, 759 Chestnut Street, Springfield, MA, 01199, USA
| | - Fadi Fakhoury
- Department of Anesthesiology and Pain Management, Centre Hospitalo-Universitaire Caremeau, Nimes, France
| | - Abdullah Pervaiz
- Department of Cardiology, UMass Chan Medical School-Baystate, 759 Chestnut Street, Springfield, MA, 01199, USA
| | - Fadi Chalhoub
- Department of Cardiology, UMass Chan Medical School-Baystate, 759 Chestnut Street, Springfield, MA, 01199, USA
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Lozano Granero C, Franco E, Matía Francés R, Hernández-Madrid A, Sánchez-Pérez I, Zamorano Gómez JL, Moreno J. Impact of power and contact force on index-guided radiofrequency lesions in an ex vivo porcine heart model. J Interv Card Electrophysiol 2022; 63:687-697. [PMID: 34997886 DOI: 10.1007/s10840-021-01110-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/27/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Lesion size index (LSI) and ablation index (AI) are markers of lesion quality that incorporate power, contact force (CF) and time in a weighted formula to estimate lesion size. Although accurate predicting lesion depth in vitro, their precision in lesion size estimation has not been well established for certain power and CF settings. We conducted an experimental ex vivo study to analyse the effect of power and CF in size and morphology of ablation lesions in a porcine heart model. METHODS Twenty-four sets of 10 perpendicular epicardial radiofrequency applications were performed with two commercially available catheters (TactiCath, Sensor Enabled; and SmartTouch) on porcine left ventricle submerged in 37 °C saline, combining different power (25, 30, 35, 40, 50 and 60 W) and CF (10 and 20 g) settings, and aiming at a lower (LSI/AI of 5/400) or higher (LSI/AI of 6/550) index. After each application, lesions were cross-sectioned and measured. RESULTS Four hundred eighty lesions were performed. For a given target index and CF, significant differences in lesion volume and depth with different power were observed with both catheters, generally with smaller lesions using higher power. Lesions performed with CF of 10 g were particularly smaller with TactiCath compared to SmartTouch; lesions with CF of 20 g aiming a low LSI/AI were, however, bigger; lesions with CF of 20 g aiming a high LSI/AI were similar. In general, high-power lesions were wider and shallower than low-power lesions, especially with SmartTouch. CONCLUSION Size and morphology of index-guided radiofrequency lesions varied significantly with different power and CF settings.
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Affiliation(s)
- Cristina Lozano Granero
- Cardiology Department, Arrhythmia Unit, University Hospital Ramón Y Cajal, M-607, km 9100, 28034, Madrid, Spain.
| | - Eduardo Franco
- Cardiology Department, Arrhythmia Unit, University Hospital Ramón Y Cajal, M-607, km 9100, 28034, Madrid, Spain
| | - Roberto Matía Francés
- Cardiology Department, Arrhythmia Unit, University Hospital Ramón Y Cajal, M-607, km 9100, 28034, Madrid, Spain
| | - Antonio Hernández-Madrid
- Cardiology Department, Arrhythmia Unit, University Hospital Ramón Y Cajal, M-607, km 9100, 28034, Madrid, Spain
| | - Inmaculada Sánchez-Pérez
- Paediatric Cardiology Department, Arrhythmia Unit, University Hospital Ramón Y Cajal, M-607, km 9100, 28034, Madrid, Spain
| | | | - Javier Moreno
- Cardiology Department, Arrhythmia Unit, University Hospital Ramón Y Cajal, M-607, km 9100, 28034, Madrid, Spain
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Leung LWM, Akhtar Z, Sheppard MN, Louis-Auguste J, Hayat J, Gallagher MM. Preventing esophageal complications from atrial fibrillation ablation: A review. Heart Rhythm O2 2022; 2:651-664. [PMID: 34988511 PMCID: PMC8703125 DOI: 10.1016/j.hroo.2021.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Atrioesophageal fistula is a life-threatening complication of ablation treatment for atrial fibrillation. Methods to reduce the risk of esophageal injury have evolved over the last decade, and diagnosis of this complication remains difficult and therefore challenging to treat in a timely manner. Delayed diagnosis leads to treatment occurring in the context of a critically ill patient, contributing to the poor prognosis associated with this complication. The associated mortality risk can be as high as 70%. Recent important advances in preventative techniques are explored in this review. Preventative techniques used in current clinical practice are discussed, which include high-power short-duration ablation, esophageal temperature probe monitoring, cryotherapy and laser balloon technologies, and use of proton pump inhibitors. A lack of randomized clinical evidence for the effectiveness of these practical methods are found. Alternative methods of esophageal protection has emerged in recent years, including mechanical deviation of the esophagus and esophageal temperature control (esophageal cooling). Although these are fairly recent methods, we discuss the available evidence to date. Mechanical deviation of the esophagus is due to undergo its first randomized study. Recent randomized study on esophageal cooling has shown promise of its effectiveness in preventing thermal injuries. Lastly, novel ablation technology that may be the future of esophageal protection, pulsed field ablation, is discussed. The findings of this review suggest that more robust clinical evidence for esophageal protection methods is warranted to improve the safety of atrial fibrillation ablation.
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Affiliation(s)
- Lisa W M Leung
- Department of Cardiology, St George's Hospital NHS Foundation Trust, London, United Kingdom
| | - Zaki Akhtar
- Department of Cardiology, St George's Hospital NHS Foundation Trust, London, United Kingdom
| | - Mary N Sheppard
- Cardiac Pathology Unit, St. George's University of London, London, United Kingdom
| | - John Louis-Auguste
- Department of Gastroenterology, St George's Hospital NHS Foundation Trust, London, United Kingdom
| | - Jamal Hayat
- Department of Gastroenterology, St George's Hospital NHS Foundation Trust, London, United Kingdom
| | - Mark M Gallagher
- Department of Cardiology, St George's Hospital NHS Foundation Trust, London, United Kingdom
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Kronenberger R, Mana F, Chierchia GB, La Meir M. A novel hybrid technique for the repair of an atrioesophageal fistula post-atrial radiofrequency ablation. Eur J Cardiothorac Surg 2021; 61:958-959. [PMID: 34652427 DOI: 10.1093/ejcts/ezab448] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 08/24/2021] [Accepted: 09/10/2021] [Indexed: 11/14/2022] Open
Abstract
An atrioesophageal fistula is an uncommon complication of atrial ablation with a mortality rate of 40-100%. Uniform treatment guidelines have yet to be established. Herein, we illustrate the successful surgical management of an atrioesophageal fistula, avoiding the need for an oesophageal surgical intervention by sealing and clipping of the oesophagus. This novel single-step hybrid approach combining cardiac surgical and gastroenterological techniques provides a less aggressive strategy with potentially a more favourable prognosis.
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Affiliation(s)
| | - Fazia Mana
- Gastroenterology Department, St. Jan, Brussels, Belgium
| | | | - Mark La Meir
- Department of Cardiac Surgery, UZ Brussel, Brussels, Belgium
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Jabri A, Deutch Z, Butt M, Soltero-Mariscal E, Finkelhor R, Aneja A, Karim S. A diagnostic dilemma upon discovery of a left atrial mass using an intracardiac echocardiogram. HeartRhythm Case Rep 2021; 7:507-509. [PMID: 34434696 PMCID: PMC8377274 DOI: 10.1016/j.hrcr.2021.06.004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ahmad Jabri
- Heart and Vascular Institute, MetroHealth Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Zachary Deutch
- Heart and Vascular Institute, MetroHealth Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Muhammad Butt
- Heart and Vascular Institute, MetroHealth Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Enrique Soltero-Mariscal
- Heart and Vascular Institute, MetroHealth Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Robert Finkelhor
- Heart and Vascular Institute, MetroHealth Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Ashish Aneja
- Heart and Vascular Institute, MetroHealth Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Saima Karim
- Heart and Vascular Institute, MetroHealth Medical Center/Case Western Reserve University, Cleveland, Ohio
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Sridhar AR, Varma N. Significance of electrical activity in the right superior pulmonary vein post-isolation and relationship to superior vena cava potentials. J Interv Card Electrophysiol 2021. [PMID: 34292462 DOI: 10.1007/s10840-021-01032-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE After antral pulmonary vein isolation (PVI), electrical potentials may persist deep in the right superior pulmonary vein (RSPV). Whether these potentials signify true pulmonary vein potential (PVP) (implying inadequate RSPV isolation) or are far-field potentials (FFP) from the superior vena cava (SVC) is unclear. Here, we attempt to assess the incidence of persistent potentials in RSPV post-isolation and methods to differentiate PVP from FFP. METHODS Following PVI, we mapped the RSPV and the SVC with simultaneously placed catheters. We recorded the incidence of SVC potentials, RSPV potentials, and distance between the 2 structures. When RSPV potentials were present, we assessed (1) relationship to SVC potentials, (2) RSPV-SVC distance, and (3) responses on pacing from either site. RESULTS Among 43 consecutive post-PVI patients, 39 (91%) patients had SVC electrical activity but only 10 had persistent RSPV potentials. Of these, 2/10 had true PVP, and 8 were FFP from SVC. Bipolar electrogram morphology did not differentiate PVP from FFP, but low-amplitude (5 mA) SVC pacing was an effective maneuver. However, high-amplitude (≥ 10 mA) pacing from SVC and/or RSPV could result in far-field capture of the other site even when RSPV was devoid of electrical activity. Average RSPV-SVC distance was 15.9 mm. CONCLUSIONS Persistent RSPV potentials occur rarely post-PVI despite the close proximity to electrically active SVC. When present, true PVP can be differentiated from FFP by low-amplitude pacing from SVC. Bipolar EGM morphology and high-amplitude pacing are unreliable at differentiating these potentials.
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Sairaku A, Morishima N, Amioka M, Maeda J, Watanabe Y, Nakano Y. Does atrial fibrillation ablation worsen preexisting anemia? Another anemia paradox in DOAC era. J Cardiol 2021; 78:382-387. [PMID: 34256966 DOI: 10.1016/j.jjcc.2021.06.007] [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: 03/24/2021] [Revised: 06/11/2021] [Accepted: 06/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is a concern about worsening anemia after atrial fibrillation (AF) ablation in anemic patients. We aimed to clarify whether or not patients with anemia who are on an oral anticoagulant therapy are more likely to lose blood after AF ablation. METHODS We studied AF patients in 3 cardiovascular centers who skipped a single dose of a direct oral anticoagulant prior to the ablation, and compared the drop in the hemoglobin level 24 hours after the procedure and bleeding complications between the patients with and without preexisting anemia. RESULTS We identified 183 (15.7%) patients with anemia at baseline out of 1163 patients. The reduction in the hemoglobin level (-0.39±0.71 vs. -0.93±0.9 g/dL; p<0.001) was smaller in the anemic than non-anemic patients. A fall in the hemoglobin level of ≥2 g/dL, which is a guideline-defined significant hemoglobin drop, was less common in anemic patients (1.6% vs. 11.3%; p<0.001). A female gender [odds ratio (OR) 1.62, confidence interval (CI) 1.07-2.45; p=0.02], persistent or long-standing persistent versus paroxysmal AF (OR 1.67, CI 1.13-2.49; p=0.01), ORBIT score ≥3 (OR 3.5, CI 1.34-8.94; p=0.01), and preexisting anemia (OR 0.02, CI 0.004-0.14; p<0.001) were independently associated with the fall in the hemoglobin level of ≥2 g/dL. No difference was noted in the rate of major bleeding complications (1.6% vs. 1.2%; p=0.72). CONCLUSIONS Paradoxically, patients with preexisting anemia may be less likely to lose blood following AF ablation.
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Affiliation(s)
- Akinori Sairaku
- Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, Onomichi, Japan; Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
| | - Nobuyuki Morishima
- Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, Onomichi, Japan
| | - Michitaka Amioka
- Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, Onomichi, Japan
| | - Junji Maeda
- Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, Onomichi, Japan
| | - Yoshikazu Watanabe
- Department of Cardiology, Cardiovascular Center, Hiroshima General Hospital, Hatsukaichi, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Sakhy S, Didier R, Blain M, Leclercq T, Maza M, Artus A, Issa R, Zeller M, Cochet A, Cottin Y, Laurent G. No impact of sub-clinical coronary artery disease identified by cardiac CT scan on the recurrence of atrial fibrillation after a single ablation procedure. J Interv Card Electrophysiol 2021. [PMID: 34240293 DOI: 10.1007/s10840-021-01018-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Performing a cardiac CT scan before ablation provides a better understanding of the anatomical variations of the left atrium and pulmonary veins, as well as an analysis of coronary anatomy and the calcium score. The aim of the present study was to determine whether the CT characteristics of patients with unknown CAD have an impact on recurrence of AF. METHODS This monocentric retrospective study included patients with AF who had undergone cardiac CT prior to a single ablation. RESULTS Among the 229 patients included in the study, 70 (30.5%) presented AF recurrence between 3 and 12 months after a single ablation. The prevalence of CAD confirmed by CT coronary angiogram and the coronary calcium score were similar in the two groups. Patients with recurrent atrial fibrillation had a significantly higher LAVI evaluated by CT scan than patients without recurrence. The ROC curve determined an optimal LAVI threshold of 49 mL/m2. In multivariate analysis, the LAVI measured by CT scan was independently associated with the risk of AF recurrence. CONCLUSIONS Our study confirms that CAD is not a predictor of AF recurrence after a single ablation, unlike the LAVI. Further studies are necessary to re-evaluate the long-term conclusions of this work.
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Pecha S. Can we predict the risk for atrial fibrillation recurrence after concomitant surgical atrial fibrillation ablation and should this influence our treatment strategy? Eur J Cardiothorac Surg 2021; 59:1225-1226. [PMID: 34007985 DOI: 10.1093/ejcts/ezab022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Simon Pecha
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Germany
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Gianni C, Anannab A, Della Rocca DG, Salwan A, MacDonald B, Quintero Mayedo A, Mohanty S, Trivedi C, Di Biase L, Natale A. Recurrent Atrial Fibrillation with Isolated Pulmonary Veins: What to Do. Card Electrophysiol Clin 2021; 12:209-217. [PMID: 32451105 DOI: 10.1016/j.ccep.2020.02.001] [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] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
When patients have symptomatic recurrent atrial tachyarrhythmias after 2 months following pulmonary vein antral isolation, a repeat ablation should be considered. Patients might present with isolated pulmonary veins posterior wall. In these patients, posterior wall isolation is extended, and non-pulmonary vein triggers are actively sought and ablated. Moreover, in those with non-paroxysmal atrial fibrillation or a known higher prevalence of non-pulmonary vein triggers, empirical isolation of the superior vena cava, coronary sinus, and/or left atrial appendage might be performed. In this review, we will focus on ablation of non-pulmonary vein triggers, summarizing our current approach for their mapping and ablation.
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Affiliation(s)
- Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.
| | - Alisara Anannab
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Electrophysiology Unit, Department of Cardiovascular Interventions, Central Chest Institute of Thailand, Nonthaburi, Thailand
| | | | - Anu Salwan
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Bryan MacDonald
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | | | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Dell Medical School, University of Texas, Austin, TX, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; HCA National Medical Director of Cardiac Electrophysiology, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA; MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Stauber A, Kornej J, Hilbert S, Dagres N, Bollmann A, Hindricks G, Sommer P. Subjective assessment of complexity and prognosis after pulmonary vein isolation as significant predictor for procedural success. J Interv Card Electrophysiol 2021. [PMID: 34089173 DOI: 10.1007/s10840-021-01005-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Subjective estimation of recurrence after atrial fibrillation ablation is an important tool in clinical use. The aim of this study is to evaluate (1) if the subjective complexity of an atrial fibrillation ablation procedure is correlated with rhythm stability and (2) if the subjective prognosis of the operator has a predictive value. METHODS We prospectively enrolled patients admitted for ablation of atrial fibrillation. Two scores were given immediately after the procedure by the operator: the complexity and the prognosis scores. With routine follow-ups, we tried to evaluate the correlation between the subjective scores and measured outcome. RESULTS The study population included 611 patients (63 ± 10 years, 37% females, 61% persistent AF). During follow-up (FU) (median 24, IQR 7-36 months), recurrences occurred in 44% patients. Both scores (prognosis and complexity) correlated significantly with age, persistent AF, LA diameter, procedural characteristics, and recurrences. On multivariable analysis, complexity (OR 1.304, 95%CI 1.016-1.675, p = 0.037) and prognosis (OR 1.443, 95%CI 1.080-1.982, p = 0.013) scores remained significant predictors for arrhythmia recurrences. On ROC analysis, both scores showed significant predictive value for rhythm outcomes after catheter ablation (AUC 0.599 and 0.613, both p < 0.001 for complexity and prognosis scores, respectively). CONCLUSIONS Complexity and prognosis scores are significant predictors for arrhythmia recurrences after AF catheter ablations and even independent when competing with simple risk factors.
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Gianni C, Sanchez JE, Della Rocca DG, Al-Ahmad A, Horton RP, Di Biase L, Natale A. Intracardiac Echocardiography to Guide Catheter Ablation of Atrial Fibrillation. Card Electrophysiol Clin 2021; 13:303-311. [PMID: 33990269 DOI: 10.1016/j.ccep.2021.03.009] [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: 10/21/2022]
Abstract
Intracardiac echocardiography (ICE) is a valuable tool and should be standard of care in any modern electrophysiology laboratory. Through real-time imaging of cardiac anatomy, ICE is used to guide electrophysiology procedures and monitor for complications. This article is a short overview of the application of real-time ICE imaging during atrial fibrillation ablation procedures.
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Affiliation(s)
- Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | | | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Montefiore Medical Center, Bronx, NY, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; HCA National Medical Director of Cardiac Electrophysiology, Nashville, TN, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA; MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Wintrich J, Pavlicek V, Millenaar D, Ukena C. Mapping of an atrial tachycardia after Epicor™ high-intensity focused ultrasound ablation: A case report. J Electrocardiol 2021; 67:19-22. [PMID: 34000613 DOI: 10.1016/j.jelectrocard.2021.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Surgical techniques, such as the application of high-intensity focused ultrasound (HIFU), can be used for pulmonary vein isolation (PVI). CASE SUMMARY We report a case of a 73-year old patient, in whom HIFU failed to achieve PVI but promoted the occurrence of a scar-related atrial tachycardia (AT). Voltage mapping of the left atrium revealed multiple gaps along the ablation line. Coherent mapping with visualization of velocity vectors allowed the correct interpretation and the targeted ablation of the AT. DISCUSSION Cardiac surgery can promote scar-related AT. The coherent mapping function could simplify the mapping of scar-related AT in the future.
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Affiliation(s)
- Jan Wintrich
- Department of Internal Medicine III, Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Saarland University, Homburg, Saar, Germany.
| | - Valérie Pavlicek
- Department of Internal Medicine III, Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Saarland University, Homburg, Saar, Germany
| | - Dominic Millenaar
- Department of Internal Medicine III, Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Saarland University, Homburg, Saar, Germany
| | - Christian Ukena
- Department of Internal Medicine III, Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Saarland University, Homburg, Saar, Germany
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