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Safety and effectiveness of very high-power short duration ablation in patients with atrial fibrillation: early results. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Pulmonary vein isolation (PVI) is at the forefront of treatment methods of rhythm control in patients with atrial fibrillation (AF) (1). The novel contact-force sensing catheter, QDot MicroTM (Biosense Webster) was designed to improve effectiveness of AF ablation and allow better time management due to shorter procedure time. It is a very high power-short duration (vHP-SD) catheter optimized for high density mapping and temperature control, which enables the application of high energy (up to 90W, 4s) (2).
Purpose
The aim of the study was to compare the QDot MicroTM catheter with the ThermoCool SmarttouchTM SF catheter with regard to the effectiveness and safety of PVI ablation.
Methods
It is a single center, cross-sectional, observational study enrolling 101 consecutive patients suffering from symptomatic paroxysmal or persistent AF, referred for first catheter ablation between 16 December 2019 and 03 December 2021. In 47 procedures (mean age 54 years; 70% male; 77% paroxysmal) the QDot Micro catheter was used (vHP-SD group; Qmode+ 90W, 4s), whereas the remaining 54 patients (mean age 57 years; 70% male; 67% paroxysmal) were treated with the ThermoCool SmarttouchTM SF catheter (control group, Ablation Index guided ablation). The primary endpoint was freedom from AF at 3-months after ablation. The secondary endpoints included the amount of opioids administered as well as the incidence of early-onset treatment-emergent adverse events (TEAEs).
Results
AF recurrence was documented in 14.9% patients in vHP-SD group and in 31.5% patients in control group (p=0.06). The mean dose of remifentanil was reported to be lower during Qmode+ catheter-based PVI (0.50 (0.40–0.60) vs. 0.70 (0.55–0.90) mg; p<0.001). There was no statistically significant difference in TEAEs between both groups (6.3 vs. 0%; p=0.10). One severe adverse event (cerebral vascular incident 2 days after PVI – due to thrombus in the left ventricle) was observed in vHP-SD group.
Conclusions
This study suggests that the vHP-SD ablation is safe and enables sedative-analgesic medications demand reduction during procedure. vHP-SD mode may enhance the success rate of catheter-based PVI, however further research is needed to provide additional evidence of its superiority.
Funding Acknowledgement
Type of funding sources: None.
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Evaluation of the feasibility and accuracy of remote mobile app-based self-reported atrial fibrillation risk factor assessment in patients with atrial fibrillation: TeleCheck-AF results. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Previously, we introduced the TeleCheck-AF approach, which is an on-demand mobile health (mHealth) infrastructure incorporating mobile app-based heart rate and rhythm monitoring as well as mobile app-based self-reported atrial fibrillation (AF) risk factor assessment to allow comprehensive remote AF management through teleconsultation. Herein, we evaluated the feasibility and accuracy of remote mobile app-based self-reported AF risk factor assessment in AF patients.
Methods
In our University Medical Center, 545 patients were managed within the TeleCheck-AF project by an on-demand heart rate and rhythm mHealth infrastructure through teleconsultation. Patients were asked to fill in a short mobile app-based 10-item questionnaire related to AF risk factors. A reminder to complete the questionnaire automatically popped-up after the following four heart rate and rhythm recordings. Furthermore, patient's medical history was retrieved from the electronic health records (EHRs).
Results
Out of 545 patients, 542 (99.4%) patients (217 female, age 67 (59–72) years) completed the mobile app-based 10-item questionnaire and were included in this analysis. The number of patients with diabetes mellitus was similar in the EHRs and mobile app-based questionnaire (both 11.3%, p=1.000). There was no significant difference in the number of patients who had a medical history of transient ischemic attack (TIA)/cerebrovascular accident (CVA) and artery disease (coronary artery disease and peripheral artery disease) in the EHRs and mobile app-based questionnaire (11.4% vs 12.2%, p=0.608 and 14.8% vs 13.3%, p=0.366, respectively). Heart failure was more frequently reported in the mobile app-based questionnaire compared to the EHRs (33.4% vs 14.0%, p<0.001). A total of 260 (48.0%) patients had a diagnosis of hypertension verified in EHRs and only 239 (44.1%) patients reported hypertension in the mobile app-based questionnaire (p=0.044). There was no significant difference in number of patients with CHA2DS2-VASc-score ≥2 between the EHRs and mobile app-based questionnaire (64.2% vs 66.1%, p=0.275). The accuracy of mobile app-based assessment of diabetes mellitus was 85.4%, of TIA/CVA 78.9%, of artery disease 60.9%, of heart failure 78.8%, and of hypertension 89.3%.
Conclusion
Patient self-reported AF risk factors by a remote mobile app-based assessment is feasible and may be useful for future digital trials and comprehensive remote AF management through teleconsultation.
Funding Acknowledgement
Type of funding sources: None.
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The photoplethysmography dictionary: practical guidance on signal interpretation and clinical scenarios from TeleCheck-AF. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
During the coronavirus disease 2019 (COVID-19) pandemic, numerous centres in Europe used on-demand photoplethysmography (PPG) technology to remotely assess heart rate and rhythm in conjunction with teleconsultations within the TeleCheck-AF project.
Purpose
To develop an educational structured stepwise practical guide on how to interpret PPG signals and to study typical clinical scenarios how on-demand PPG was used in the TeleCheck-AF project.
Methods
During an online conference, the structured stepwise practical guide on how to interpret PPG signals was discussed and further refined during an internal review process. We provide the number of respective PPG recordings and number of patients managed within a clinical scenario during the TeleCheck-AF project.
Results
To interpret PPG recordings, we introduce a structured stepwise practical guide and provide representative PPG recordings. In the TeleCheck-AF project, 2522 subjects collected 90.616 recordings. The majority of these recordings was classified by the PPG algorithm as sinus rhythm (57.6%), followed by atrial fibrillation (AF) (23.6%). In 9.7% of recordings the quality was too low to interpret. Other observed rhythms were tachycardia (1.4%), extra systoles (4.7%), bigeminy episodes (1.8%), trigeminy episodes (0.6%) and atrial flutter (0.2%). The most frequent clinical scenario where PPG technology was used in the TeleCheck-AF project was follow-up after AF ablation (1110 patients) followed by heart rate and rhythm assessment around (tele)consultation (966 patients), sometimes including remote PPG-guided adaption of rate or rhythm control. 275 patients were followed around cardioversion, either (semi-)acute or elective. Other possible scenarios are assessment of palpitations, assessment of symptom-rhythm correlation and monitoring during up-titration of heart failure medication.
Conclusion
We introduce a newly developed structured stepwise practical guide on PPG signal interpretation developed based on presented experiences from TeleCheck-AF. The present clinical scenarios for the use of on-demand PPG technology derived from the TeleCheck-AF project will help to implement PPG technology in the management of arrhythmia patients.
Funding Acknowledgement
Type of funding sources: None. TeleCheck-AF clinical scenariosClassification of PPG recordings
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Clinical characteristics and risk profile of patients with atrial fibrillation with mid-range ejection fraction, insights from the Polish part of EORP-AF Long-Term General Registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) comprises a wide range of patients (pts), from those with preserved to those with reduced left ventricular ejection fraction (LVEF). According to 2016 ESC guidelines, pts with LVEF in the range of 40–49% represent a “grey area”, which is defined as heart failure with mid-range ejection fraction (HFmrEF). Not much is known about the clinical characteristics of AF pts with mid-range ejection fraction.
Purpose
To determine the potential differences in the clinical characteristics, risk profile, and the outcomes of AF with moderate systolic dysfunction, measured by LVEF.
Methods
The EURObservational Research Programme on AF (EORP-AF) Long-Term General Registry analyzed consecutive AF patients who have presented to cardiologists in 250 centers from 27 European countries, including 25 centers from Poland. We analyzed data collected at baseline and at a 1-year follow-up visit from 568 Polish patients included in 25 Polish centers in the years 2013–2016. Pts were divided into three groups based on LVEF: the preserved LVEF (pEF) group (LVEF ≥50%), the mid-range LVEF (mrEF) group (40–49%), and the reduced LVEF (rEF) group (<40%).
Results
117/568 pts with rEF represented 20,6%, 105/568 mrEF 18,5% and 346/568 pEF 60,9% of the whole analyzed group. With regard to the most typical risk factors, the mrEF population appeared between rEF and pEF, presenting a moderate risk profile with the exception of hypertension, which was the most common in the mrEF group. While permanent AF was the most common in the rEF group and paroxysmal in the pEF pts, pts with mrEF had a higher rate of long-lasting persistent AF. Taking into account the risk factors profile, surprisingly, pts with AF and mrEF more often presented with dyspnea/shortnes of breath (mrEF 38,1% vs. rEF 18,8% vs. pEF 22,5%; p=0,001) and fatigue (mrEF 38,1% vs. rEF 23,9% vs. pEF 25,4%; p=0,025). AF pts with mrEF also had the highest thrombo-embolic risk estimated with the CHA2DS2-VASc score (mrEF 4 [2–5], n=105; rEF 3 [2–5], n=117, pEF 3 [2–4], n=346, p=0.005). However, this did not translate into the highest number of thromboembolic events after one year which did not significantly differ (mrEF 10.5%, rEF 15.4%, pEF 11.3%, p=0.30) between the three groups.
Conclusions
The risk factor profile of AF pts with mrEF was milder than for those with rEF and more severe than for pEF pts. AF pts with mrEF more often presented HF symptoms. Their estimated thrombo-embolic risk was higher but the number of events in the one year follow-up did not significantly differ between groups.
Funding Acknowledgement
Type of funding source: None
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P1384Radiation safety and electrophysiologists: radiation protection status. Europace 2020. [DOI: 10.1093/europace/euaa162.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
Ionizing radiation is typically used during variety electrophysiological (EP) procedures, although it may contribute to deterministic effects especially for staff.
PURPOSE
The purpose of this study was to perform an analysis of EP operators’ radiation protective devices for occupational exposure.
METHODS
Data reported herein were gathered from international, multi-site, prospective, Go 4 Zero Fluoroscopy registry. The registry encompassed 25 European EP centers, and up to 5 operators from each center. The presence of operators’ X-ray protection tools was examined to determine the level of operators’ protection. Additionally, the tests included availability of measures to decrease radiation output and exposure control measures. Finally, the analysis of correlation between the X-ray protection and degree of operators’ experience (<5, 5-15,>15 years) as well as number of procedures performed per month (1-9, 10-19, 20-39, >40 procedures/month) was performed.
RESULTS
Our analysis included 95 operators (median age: 39 years, 85% of male, median training time: 5 years). The whole study group performed annually medical examinations due to radiation exposure and 56% of them received dosimetry reports once a month, 5% - once every 3 months, and 39% - once a year. Irrespectively of experience or number of performed procedures the most frequently used X-ray protection tools (used by >80% of group) were lead apron, thyroid shields, screen below the table, glass in the lab, and least often (used by < 6% of group) – protective gloves and cabin. The most often exposure control measures used were chest (95%) followed by collar (31%), ring (24%) and eye (7%) dosimeters. The inverse correlation between level of experience and measures to decrease radiation output was observed (collimation: 84%, 80% and 78%; minimizing the tube-to intensifier distance: 100%, 93% and 91% of operators with <5, 5-15 and >15 years of experience, respectively). There were not observed differences between type of radiation protection equipment and operators’ level of experience or number of procedures. Additionally, there were no differences between male and female operators regarding protective equipment, expect eyeglasses or cabin that were more often used by men. Operators who were protected by >4 X-ray protection tools were exposed for higher radiation levels as compared to those protected by <4 X-ray protection tools (median [IQR] radiation exposure: 0.6 [0.2-1.1] vs 0.2 [0.1-0.2] mSv per month, p < 0.0001; 1.1 [0.1-12.0] vs 0.5 [0.1-1.1] mSv per year, p < 0.0001). There were no differences between the type of (universitary vs non-universitary) or institution’s localization (Eastern vs Central vs Western Europe) and used protective equipment.
CONCLUSIONS
Both proper radiation protective equipment, and regular medical examination due to professional exposure are mandatory to reduce radiation exposure in practice.
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P3579Differences between randomized controlled clinical trials and real-world atrial fibrillation patients treated with oral anticoagulants - do we treat the same patients? Results from the CRAFT study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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550 Efficacy of short term pharmacological treatment in patients after radiofrequency ablation due to focal atrial fibrillation — preliminary results. Europace 2005. [DOI: 10.1016/eupace/7.supplement_1.120-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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P-255 Clinical assessment of the preliminary results of the short tilt test with low dose of isoproterenol. Europace 2003. [DOI: 10.1016/eupace/4.supplement_2.b126-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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P-254 Clinical assessment of the preliminary results of the short tilt test with adenosine. Europace 2003. [DOI: 10.1016/eupace/4.supplement_2.b126-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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P-256 Hemodynamic curves characteristic during first minute of tilting in vasovagal patients. Europace 2003. [DOI: 10.1016/eupace/4.supplement_2.b126-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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