首页 > 最新文献

Circulation: Arrhythmia and Electrophysiology最新文献

英文 中文
Coronary Sinus Metabolite 12,13-diHOME Is a Novel Biomarker for Left Atrial Remodeling in Patients With Atrial Fibrillation 冠状窦代谢物 12,13-diHOME 是心房颤动患者左心房重塑的新型生物标记物
Pub Date : 2024-05-01 DOI: 10.1161/circep.123.012486
Xixiang Tang, Jiafu Wang, Xiaolan Ouyang, Qian Chen, Ruimin Dong, Yanting Luo, Junlin Zhong, Zhuoshan Huang, Long Peng, Xujing Xie, Jieming Zhu, Zhenda Zheng, Suhua Li
BACKGROUND:12,13-dihydroxy-9Z-octadecenoic acid (12,13-diHOME) has shown potential in protecting against heart disease, but its relationship with atrial fibrillation (AF) remains unknown.METHODS:Coronary sinus (CS) and femoral vein blood samplings were synchronously collected from AF and non-AF subjects (paroxysmal supraventricular tachycardia or idiopathic premature ventricular complexes) who underwent catheter ablation. First, untargeted metabolomic profiling was performed in a discovery cohort (including 12 AF and 12 non-AF subjects) to identify the most promising CS or femoral vein metabolite. Then, the selected metabolite was further measured in a validation cohort (including 119 AF and 103 non-AF subjects) to confirm its relationship with left atrium remodeling and 1-year postablation recurrence of AF. Finally, the biological function of the selected metabolite was validated in a rapid-paced cultured HL-1 atrial cardiomyocytes model.RESULTS:Metabolomic analysis identified CS 12,13-diHOME as the most pronounced change metabolite correlated with left atrium remodeling in the discovery cohort. In the validation cohort, CS 12,13-diHOME was significantly lower in patients with AF than non-AF controls (84.32±20.13 versus 96.24±23.56 pg/mL; P<0.01), and associated with worse structural, functional, and electrical remodeling of left atrium. Multivariable regression analyses further demonstrated that decreased CS 12,13-diHOME was an independent predictor of 1-year postablation recurrence of AF (odds ratio, 0.754 [95% CI, 0.648–0.920]; P=0.005). Biological function validations showed that 12,13-diHOME treatment significantly protect the cell viability, improved the expression of MHC (myosin heavy chain) and L-type calcium channel α1c, and attenuated mitochondrial damage in the rapid-paced cultured HL-1 cardiomyocytes model.CONCLUSIONS:CS metabolite 12,13-diHOME is decreased in patients with AF and can serve as a novel biomarker for left atrium remodeling.
背景:12,13-二羟基-9Z-十八碳烯酸(12,13-diHOME)具有预防心脏病的潜力,但它与心房颤动(房颤)的关系仍不清楚。方法:对接受导管消融术的房颤和非房颤受试者(阵发性室上性心动过速或特发性室性早搏)同步采集冠状窦(CS)和股静脉血样本。首先,在发现队列(包括 12 名房颤受试者和 12 名非房颤受试者)中进行非靶向代谢组学分析,以确定最有希望的 CS 或股静脉代谢物。然后,在验证队列(包括 119 名房颤受试者和 103 名非房颤受试者)中进一步测定所选代谢物,以确认其与左心房重塑和消融术后 1 年房颤复发的关系。结果:在发现队列中,代谢组学分析发现 CS 12,13-diHOME 是与左心房重塑相关的最明显变化代谢物。在验证队列中,房颤患者的 CS 12,13-diHOME 明显低于非房颤对照组(84.32±20.13 对 96.24±23.56 pg/mL;P<0.01),并与左心房结构、功能和电重塑恶化有关。多变量回归分析进一步表明,CS 12,13-diHOME的降低是消融术后1年房颤复发的独立预测因素(几率比0.754 [95% CI, 0.648-0.920];P=0.005)。生物功能验证显示,12,13-diHOME 治疗可显著保护细胞活力,改善 MHC(肌球蛋白重链)和 L 型钙通道 α1c 的表达,并减轻快节奏培养的 HL-1 心肌细胞模型的线粒体损伤。
{"title":"Coronary Sinus Metabolite 12,13-diHOME Is a Novel Biomarker for Left Atrial Remodeling in Patients With Atrial Fibrillation","authors":"Xixiang Tang, Jiafu Wang, Xiaolan Ouyang, Qian Chen, Ruimin Dong, Yanting Luo, Junlin Zhong, Zhuoshan Huang, Long Peng, Xujing Xie, Jieming Zhu, Zhenda Zheng, Suhua Li","doi":"10.1161/circep.123.012486","DOIUrl":"https://doi.org/10.1161/circep.123.012486","url":null,"abstract":"BACKGROUND:12,13-dihydroxy-9Z-octadecenoic acid (12,13-diHOME) has shown potential in protecting against heart disease, but its relationship with atrial fibrillation (AF) remains unknown.METHODS:Coronary sinus (CS) and femoral vein blood samplings were synchronously collected from AF and non-AF subjects (paroxysmal supraventricular tachycardia or idiopathic premature ventricular complexes) who underwent catheter ablation. First, untargeted metabolomic profiling was performed in a discovery cohort (including 12 AF and 12 non-AF subjects) to identify the most promising CS or femoral vein metabolite. Then, the selected metabolite was further measured in a validation cohort (including 119 AF and 103 non-AF subjects) to confirm its relationship with left atrium remodeling and 1-year postablation recurrence of AF. Finally, the biological function of the selected metabolite was validated in a rapid-paced cultured HL-1 atrial cardiomyocytes model.RESULTS:Metabolomic analysis identified CS 12,13-diHOME as the most pronounced change metabolite correlated with left atrium remodeling in the discovery cohort. In the validation cohort, CS 12,13-diHOME was significantly lower in patients with AF than non-AF controls (84.32±20.13 versus 96.24±23.56 pg/mL; <i>P</i>&lt;0.01), and associated with worse structural, functional, and electrical remodeling of left atrium. Multivariable regression analyses further demonstrated that decreased CS 12,13-diHOME was an independent predictor of 1-year postablation recurrence of AF (odds ratio, 0.754 [95% CI, 0.648–0.920]; <i>P</i>=0.005). Biological function validations showed that 12,13-diHOME treatment significantly protect the cell viability, improved the expression of MHC (myosin heavy chain) and L-type calcium channel α1c, and attenuated mitochondrial damage in the rapid-paced cultured HL-1 cardiomyocytes model.CONCLUSIONS:CS metabolite 12,13-diHOME is decreased in patients with AF and can serve as a novel biomarker for left atrium remodeling.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"97 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140833504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of Contact Force on Pulsed Field Ablation Outcomes Using Focal Point Catheter 接触力对焦点导管脉冲场消融结果的影响
Pub Date : 2024-05-01 DOI: 10.1161/circep.123.012723
Arwa Younis, Pasquale Santangeli, Kara Garrott, Eric Buck, Chadi Tabaja, Sojin Y. Wass, Lauren Lehn, Ryan Kleve, Ayman A. Hussein, Shady Nakhla, Hiroshi Nakagawa, Tyler Taigen, Mohamed Kanj, Jakub Sroubek, Walid I. Saliba, Oussama M. Wazni
BACKGROUND:Conventional focal radiofrequency catheters may be modified to enable multiple energy modalities (radiofrequency or pulsed field [PF]) with the benefit of contact force (CF) feedback, providing greater flexibility in the treatment of arrhythmias. Information on the impact of CF on lesion formation in PF ablations remains limited.METHODS:An in vivo study was performed with 8 swine using an investigational dual-energy CF focal catheter with local impedance. Experiment I: To evaluate atrial lesion formation, contiguity, and width, a point-by-point approach was used to create an intercaval line. The distance between the points was prespecified at 4±1 mm. Half of the line was created with radiofrequency energy, whereas the other half utilized PF (single 2.0 kV application with a proprietary waveform). Experiment II: To evaluate single application lesion dimensions with a proprietary waveform, discrete ventricular lesions were performed with PFA (single 2.0 kV application) with targeted levels of CF: low, 5 to 15 g; medium, 20 to 30 g; and high, 35 to 45 g. Following 1 week of survival, animals underwent endocardial/epicardial remapping, and euthanasia to enable histopathologic examination.RESULTS:Experiment I: Both energy modalities resulted in a complete intercaval line of transmural ablation. PF resulted in significantly wider lines than radiofrequency: minimum width, 14.9±2.3 versus 5.0±1.6 mm; maximum width, 21.8±3.4 versus 7.3±2.1 mm, respectively; P<0.01 for each. Histology confirmed transmural lesions with both modalities. Experiment II: With PF, lesion depth, width, and volume were larger with higher degrees of CF (depth: r=0.82, P<0.001; width: r=0.26, P=0.052; and volume: r=0.55, P<0.001), with depth increasing at a faster rate than width. The mean depths were as follows: low (n=17), 4.3±1.0 mm; medium (n=26), 6.4±1.2 mm; and high (n=14), 9.1±1.4 mm.CONCLUSIONS:Using the same focal point CF-sensing catheter, a novel PF ablation waveform with a single application resulted in transmural atrial lesions that were significantly wider than radiofrequency. Lesion depth showed a significant positive correlation with CF with depths of 6.4 mm at moderate CF.
背景:传统的病灶射频导管经改良后可采用多种能量模式(射频或脉冲场[PF]),并可获得接触力(CF)反馈,从而为心律失常的治疗提供更大的灵活性。方法:使用带局部阻抗的双能量 CF 局灶导管对 8 头猪进行了体内研究。实验 I:为评估心房病灶的形成、毗连性和宽度,采用逐点法创建腔间线。点与点之间的距离预先设定为 4±1 毫米。该线的一半使用射频能量,另一半使用 PF(使用专有波形的 2.0 kV 单次应用)。实验二:为了评估使用专有波形的单次应用病变尺寸,使用 PFA(单次 2.0 千伏应用)进行离散的心室病变,CF 目标水平为:低,5 至 15 克;中,20 至 30 克;高,35 至 45 克。存活 1 周后,对动物进行心内膜/心外膜重绘,然后安乐死,以便进行组织病理学检查。结果:实验 I:两种能量模式都能形成完整的腔间跨壁消融线。射频消融术的消融线明显比射频消融术宽:最小宽度分别为 14.9±2.3 mm 对 5.0±1.6 mm;最大宽度分别为 21.8±3.4 mm 对 7.3±2.1 mm;P<均为 0.01。两种模式的组织学检查都证实了跨膜病变。实验二:使用 PF 时,CF 度越高,病变深度、宽度和体积越大(深度:r=0.82,P<0.001;宽度:r=0.26,P=0.052;体积:r=0.55,P<0.001),深度的增加速度快于宽度。平均深度如下:低(n=17),4.3±1.0 mm;中(n=26),6.4±1.2 mm;高(n=14),9.1±1.4 mm。病变深度与 CF 呈显著正相关,中度 CF 时病变深度为 6.4 毫米。
{"title":"Impact of Contact Force on Pulsed Field Ablation Outcomes Using Focal Point Catheter","authors":"Arwa Younis, Pasquale Santangeli, Kara Garrott, Eric Buck, Chadi Tabaja, Sojin Y. Wass, Lauren Lehn, Ryan Kleve, Ayman A. Hussein, Shady Nakhla, Hiroshi Nakagawa, Tyler Taigen, Mohamed Kanj, Jakub Sroubek, Walid I. Saliba, Oussama M. Wazni","doi":"10.1161/circep.123.012723","DOIUrl":"https://doi.org/10.1161/circep.123.012723","url":null,"abstract":"BACKGROUND:Conventional focal radiofrequency catheters may be modified to enable multiple energy modalities (radiofrequency or pulsed field [PF]) with the benefit of contact force (CF) feedback, providing greater flexibility in the treatment of arrhythmias. Information on the impact of CF on lesion formation in PF ablations remains limited.METHODS:An in vivo study was performed with 8 swine using an investigational dual-energy CF focal catheter with local impedance. Experiment I: To evaluate atrial lesion formation, contiguity, and width, a point-by-point approach was used to create an intercaval line. The distance between the points was prespecified at 4±1 mm. Half of the line was created with radiofrequency energy, whereas the other half utilized PF (single 2.0 kV application with a proprietary waveform). Experiment II: To evaluate single application lesion dimensions with a proprietary waveform, discrete ventricular lesions were performed with PFA (single 2.0 kV application) with targeted levels of CF: low, 5 to 15 g; medium, 20 to 30 g; and high, 35 to 45 g. Following 1 week of survival, animals underwent endocardial/epicardial remapping, and euthanasia to enable histopathologic examination.RESULTS:Experiment I: Both energy modalities resulted in a complete intercaval line of transmural ablation. PF resulted in significantly wider lines than radiofrequency: minimum width, 14.9±2.3 versus 5.0±1.6 mm; maximum width, 21.8±3.4 versus 7.3±2.1 mm, respectively; <i>P</i>&lt;0.01 for each. Histology confirmed transmural lesions with both modalities. Experiment II: With PF, lesion depth, width, and volume were larger with higher degrees of CF (depth: r=0.82, <i>P</i>&lt;0.001; width: r=0.26, <i>P</i>=0.052; and volume: r=0.55, <i>P</i>&lt;0.001), with depth increasing at a faster rate than width. The mean depths were as follows: low (n=17), 4.3±1.0 mm; medium (n=26), 6.4±1.2 mm; and high (n=14), 9.1±1.4 mm.CONCLUSIONS:Using the same focal point CF-sensing catheter, a novel PF ablation waveform with a single application resulted in transmural atrial lesions that were significantly wider than radiofrequency. Lesion depth showed a significant positive correlation with CF with depths of 6.4 mm at moderate CF.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140833589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Characteristics of Right-Sided Accessory Pathways Associated With Right Cardiac Veins 与右心静脉相关的右侧辅助通路的特征
Pub Date : 2024-05-01 DOI: 10.1161/circep.123.012513
Yiwei Lai, Mingyang Gao, Qifan Li, Mengmeng Li, Jianghua Zhang, Xuexun Li, Qi Guo, Lihong Huang, Chenxi Jiang, Songnan Li, Xueyuan Guo, Song Zuo, Nian Liu, Wei Wang, Xin Zhao, Caihua Sang, Ribo Tang, Deyong Long, Jianzeng Dong, Changsheng Ma
BACKGROUND:The anatomy of myocardial fibers around the right cardiac veins (RCVs) and their roles in accessory pathways (APs) are rarely reported.METHODS:Six RCV-APs were identified from 566 patients with right-sided APs. Mapping of retrograde atrial activation was performed using CARTO 3 system under orthodromic tachycardia or right ventricular pacing. Venography of RCVs was acquired at the earliest retrograde atrial activation.RESULTS:Patients enrolled had a median age of 30 (11–51) years, 5 of them were male. Venography of RCVs could be classified into 3 distinct patterns based on the identified ventricular branches, right marginal vein only (type I; n=3), both right marginal vein and anterior cardiac veins (type II; n=2), and anterior cardiac vein only (type III; n=1). Patients with type I venography had rS QRS pattern in lead V1, negative delta wave in lead III and negative or isoelectric delta wave in lead aVF. However, patients with type II and III venography had QS QRS patterns in lead V1 and variable patterns of delta wave in inferior leads. Earliest retrograde atrial activation was found at a median of 16.75 (14.60–20.00) mm away from the tricuspid annulus, all with A larger than V. At the earliest retrograde atrial activation, far-field ventricular electrogram was found 30 ms later than QRS onset in 1 patient under sinus rhythm. AP conduction was eliminated by mechanical pressure in 2 and by radiofrequency ablation in 4 at the ostium of the veins colocalizing with the earliest retrograde activation of the right atrium. No recurrence observed during 36 (10–60) months follow-up.CONCLUSIONS:The RCV-AP is a rare form of right-sided APs characterized by atrial insertions distant from the annulus. ECG-speculated ventricular insertion sites conformed to the location of identified RCVs.
背景:有关右心静脉(RCV)周围心肌纤维的解剖结构及其在附属通路(AP)中的作用的报道很少。在正交性心动过速或右室起搏的情况下,使用 CARTO 3 系统绘制了逆行性心房激活图。结果:入选患者的中位年龄为 30(11-51)岁,其中 5 人为男性。根据已识别的心室分支,RCV静脉造影可分为3种不同类型:仅右缘静脉(I型;n=3)、右缘静脉和心脏前静脉(II型;n=2)以及仅心脏前静脉(III型;n=1)。I 型静脉造影患者的 V1 导联出现 rS QRS 模式,III 导联出现负三角波,aVF 导联出现负三角波或等电三角波。然而,Ⅱ型和Ⅲ型静脉造影患者的 V1 导联出现 QS QRS 模式,下导联出现不同模式的三角波。最早的逆行性心房激活出现在距离三尖瓣环中位 16.75(14.60-20.00)毫米处,所有患者的 A 均大于 V。在最早的逆行性心房激活时,发现 1 名窦性心律患者的远场心室电图比 QRS 开始晚 30 毫秒。2 名患者通过机械加压消除了 AP 传导,4 名患者通过射频消融消除了最早逆行激活右心房的静脉血管。结论:RCV-AP 是一种罕见的右侧心房颤动,其特点是心房插入部位远离瓣环。心电图推测的心室插入位置与确定的RCV位置一致。
{"title":"Characteristics of Right-Sided Accessory Pathways Associated With Right Cardiac Veins","authors":"Yiwei Lai, Mingyang Gao, Qifan Li, Mengmeng Li, Jianghua Zhang, Xuexun Li, Qi Guo, Lihong Huang, Chenxi Jiang, Songnan Li, Xueyuan Guo, Song Zuo, Nian Liu, Wei Wang, Xin Zhao, Caihua Sang, Ribo Tang, Deyong Long, Jianzeng Dong, Changsheng Ma","doi":"10.1161/circep.123.012513","DOIUrl":"https://doi.org/10.1161/circep.123.012513","url":null,"abstract":"BACKGROUND:The anatomy of myocardial fibers around the right cardiac veins (RCVs) and their roles in accessory pathways (APs) are rarely reported.METHODS:Six RCV-APs were identified from 566 patients with right-sided APs. Mapping of retrograde atrial activation was performed using CARTO 3 system under orthodromic tachycardia or right ventricular pacing. Venography of RCVs was acquired at the earliest retrograde atrial activation.RESULTS:Patients enrolled had a median age of 30 (11–51) years, 5 of them were male. Venography of RCVs could be classified into 3 distinct patterns based on the identified ventricular branches, right marginal vein only (type I; n=3), both right marginal vein and anterior cardiac veins (type II; n=2), and anterior cardiac vein only (type III; n=1). Patients with type I venography had rS QRS pattern in lead V<sub>1</sub>, negative delta wave in lead III and negative or isoelectric delta wave in lead aVF. However, patients with type II and III venography had QS QRS patterns in lead V<sub>1</sub> and variable patterns of delta wave in inferior leads. Earliest retrograde atrial activation was found at a median of 16.75 (14.60–20.00) mm away from the tricuspid annulus, all with A larger than V. At the earliest retrograde atrial activation, far-field ventricular electrogram was found 30 ms later than QRS onset in 1 patient under sinus rhythm. AP conduction was eliminated by mechanical pressure in 2 and by radiofrequency ablation in 4 at the ostium of the veins colocalizing with the earliest retrograde activation of the right atrium. No recurrence observed during 36 (10–60) months follow-up.CONCLUSIONS:The RCV-AP is a rare form of right-sided APs characterized by atrial insertions distant from the annulus. ECG-speculated ventricular insertion sites conformed to the location of identified RCVs.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"1234 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140833590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prognostic Impact of Sinus Rhythm in Atrial Fibrillation Patients: Separating Rhythm Outcomes From Randomized Strategy Findings From the CABANA Trial 心房颤动患者窦性心律的预后影响:将心律结果与 CABANA 试验的随机策略结果区分开来
Pub Date : 2024-04-17 DOI: 10.1161/circep.123.012697
T. Jared Bunch, Jeanne E. Poole, Adam P. Silverstein, Kerry L. Lee, Hussein R. Al-Khalidi, Gerhard Hindricks, Alexander Romanov, Evgeny Pokushalov, Tristram D. Bahnson, Melanie Daniels, Jonathan P. Piccini, Daniel B. Mark, Douglas L. Packer, for the CABANA Investigators
BACKGROUND:Clinically detected atrial fibrillation (AF) is associated with a significant increase in mortality and other adverse cardiovascular events. Since the advent of effective methods for AF rhythm control, investigators have attempted to determine how much these adverse prognostic AF effects could be mitigated by the restoration of sinus rhythm (SR) and whether the method used mattered.METHODS:The CABANA trial (Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation) randomized 2204 AF patients to ablation versus drug therapy, of which 1240 patients were monitored in follow-up using the CABANA ECG rhythm monitoring system. To assess the prognostic benefits of SR, we performed a prespecified analysis using Cox survival modeling with heart rhythm as a time-dependent variable and a randomized treatment group as a stratification factor.RESULTS:In the 1240 patient study cohort, 883 (71.2%) had documented AF at some point during their postblanking follow-up. Among the 883 patients, 671 (76.0%) experienced AF within the first year of postblanking follow-up, and 212 (24.0%) experienced their first AF after ≥1 year of postblanking follow-up. The primary CABANA end point (death, disabling stroke, serious bleeding, or cardiac arrest) occurred in 95 (10.8%) of the 883 patients with documented AF and in 29 (8.1%) of the 357 patients with no AF recorded during follow-up. In multivariable time-dependent analysis, the presence of SR (compared with non-SR) was associated with a significantly reduced risk of the primary end point (adjusted hazard ratio, 0.57 [95% CI, 0.38–0.85]; P=0.006; independent of treatment strategy [ablation versus drugs]). Corresponding results for all-cause mortality were adjusted hazard ratio of 0.59 [95% CI, 0.35–1.01]; P=0.053).CONCLUSIONS:In patients in the CABANA trial with detailed long-term rhythm follow-up, increased time in SR was associated with a clinically consequential decreased in mortality and other adverse prognostic events. The predictive value of SR was independent of the therapeutic approach responsible for reducing the burden of detectable AF.REGISTRATION:URL: https://clinicaltrials.gov; Unique Identifier: NCT00911508
背景:临床发现的心房颤动(房颤)与死亡率和其他不良心血管事件的显著增加有关。方法:CABANA 试验(心房颤动导管消融与抗心律失常药物治疗)将 2204 名心房颤动患者随机分为消融与药物治疗两组,其中 1240 名患者使用 CABANA 心电图节律监测系统进行随访监测。为了评估 SR 的预后益处,我们使用 Cox 生存模型进行了预先指定的分析,将心律作为时间依赖变量,随机治疗组作为分层因素。在这 883 名患者中,有 671 人(76.0%)在分组后随访的第一年内出现房颤,212 人(24.0%)在分组后随访≥1 年后首次出现房颤。在有房颤记录的 883 例患者中,有 95 例(10.8%)出现了 CABANA 主要终点(死亡、致残性中风、严重出血或心脏骤停),在随访期间没有房颤记录的 357 例患者中,有 29 例(8.1%)出现了 CABANA 主要终点。在多变量时间依赖性分析中,出现 SR(与非 SR 相比)与主要终点风险显著降低相关(调整后危险比为 0.57 [95% CI, 0.38-0.85]; P=0.006;与治疗策略[消融与药物]无关)。结论:在 CABANA 试验中,对患者进行了详细的长期心律随访,SR 时间的延长与死亡率和其他不良预后事件的临床减少有关。SR的预测价值与减少可检测到的房颤负担的治疗方法无关。注册:URL:https://clinicaltrials.gov;唯一标识符:NCT00911508:NCT00911508
{"title":"Prognostic Impact of Sinus Rhythm in Atrial Fibrillation Patients: Separating Rhythm Outcomes From Randomized Strategy Findings From the CABANA Trial","authors":"T. Jared Bunch, Jeanne E. Poole, Adam P. Silverstein, Kerry L. Lee, Hussein R. Al-Khalidi, Gerhard Hindricks, Alexander Romanov, Evgeny Pokushalov, Tristram D. Bahnson, Melanie Daniels, Jonathan P. Piccini, Daniel B. Mark, Douglas L. Packer, for the CABANA Investigators","doi":"10.1161/circep.123.012697","DOIUrl":"https://doi.org/10.1161/circep.123.012697","url":null,"abstract":"BACKGROUND:Clinically detected atrial fibrillation (AF) is associated with a significant increase in mortality and other adverse cardiovascular events. Since the advent of effective methods for AF rhythm control, investigators have attempted to determine how much these adverse prognostic AF effects could be mitigated by the restoration of sinus rhythm (SR) and whether the method used mattered.METHODS:The CABANA trial (Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation) randomized 2204 AF patients to ablation versus drug therapy, of which 1240 patients were monitored in follow-up using the CABANA ECG rhythm monitoring system. To assess the prognostic benefits of SR, we performed a prespecified analysis using Cox survival modeling with heart rhythm as a time-dependent variable and a randomized treatment group as a stratification factor.RESULTS:In the 1240 patient study cohort, 883 (71.2%) had documented AF at some point during their postblanking follow-up. Among the 883 patients, 671 (76.0%) experienced AF within the first year of postblanking follow-up, and 212 (24.0%) experienced their first AF after ≥1 year of postblanking follow-up. The primary CABANA end point (death, disabling stroke, serious bleeding, or cardiac arrest) occurred in 95 (10.8%) of the 883 patients with documented AF and in 29 (8.1%) of the 357 patients with no AF recorded during follow-up. In multivariable time-dependent analysis, the presence of SR (compared with non-SR) was associated with a significantly reduced risk of the primary end point (adjusted hazard ratio, 0.57 [95% CI, 0.38–0.85]; <i>P</i>=0.006; independent of treatment strategy [ablation versus drugs]). Corresponding results for all-cause mortality were adjusted hazard ratio of 0.59 [95% CI, 0.35–1.01]; <i>P</i>=0.053).CONCLUSIONS:In patients in the CABANA trial with detailed long-term rhythm follow-up, increased time in SR was associated with a clinically consequential decreased in mortality and other adverse prognostic events. The predictive value of SR was independent of the therapeutic approach responsible for reducing the burden of detectable AF.REGISTRATION:URL: https://clinicaltrials.gov; Unique Identifier: NCT00911508","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140617268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Trends Favoring an Anatomical Approach to Radiofrequency Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating From the Left Ventricular Summit 采用解剖学方法射频导管消融源自左心室峰的特发性室性心律失常的发展趋势
Pub Date : 2024-04-17 DOI: 10.1161/circep.123.012548
Takumi Yamada, G. Neal Kay
BACKGROUND:Epicardial radiofrequency catheter ablation (RFCA) of idiopathic ventricular arrhythmias (VAs) originating from the left ventricular summit (LVS) is challenging because of the anatomic barriers. On the other hand, RFCA at the endocardial sites near the earliest epicardial activation site of LVS-VAs (anatomic approach) has proven successful. The evolving trends in the approaches and outcomes of RFCA of LVS-VAs at a single center were evaluated.METHODS:We studied 88 consecutive patients with idiopathic LVS-VAs at our institute from 2009 to 2019. These patients were divided into 3 periods: 2009 to 2012 (early), 2013 to 2015 (middle), and 2016 to 2019 (recent). The data were compared among the 3 periods.RESULTS:The RFCA success rate did not significantly change from the early-to-middle period but significantly increased from the middle-to-recent period (P=0.0315). The transpericardial approach usage significantly decreased over the 3 periods. The anatomic approach usage significantly increased over the 3 periods. The use of the transpericardial approach did not affect the RFCA outcomes over the 3 periods. The success rate of the anatomic RFCA tended to increase from the early-to-middle period and significantly increased from the middle-to-recent period (P=0.0412). The number of endocardial locations where RFCA was successful increased over the 3 periods.CONCLUSIONS:Over the 10-year period, the transpericardial approach became decreasingly performed, whereas the anatomic approach became increasingly performed with a satisfactory improvement in the RFCA outcomes of LVS-VAs. The anatomic RFCA became more successful by identifying more and various endocardial locations as target sites.
背景:由于解剖障碍,对源于左心室顶部(LVS)的特发性室性心律失常(VAs)进行心外膜射频导管消融(RFCA)具有挑战性。另一方面,在 LVS-VAs 的最早心外膜激活点附近的心内膜部位进行 RFCA(解剖方法)已被证明是成功的。方法:我们研究了 2009 年至 2019 年在我院连续就诊的 88 例特发性 LVS-VA 患者。这些患者被分为 3 个时期:2009 年至 2012 年(早期)、2013 年至 2015 年(中期)和 2016 年至 2019 年(近期)。结果:从早期到中期,RFCA 成功率没有显著变化,但从中期到近期,RFCA 成功率显著上升(P=0.0315)。经心包途径的使用率在三个时期内明显下降。解剖方法的使用率在这三个时期明显增加。经心包途径的使用在 3 个时期内均未影响 RFCA 的结果。解剖型 RFCA 的成功率从早期到中期呈上升趋势,从中期到晚期则显著上升(P=0.0412)。结论:10 年间,经心包入路的手术越来越少,而解剖入路的手术越来越多,LVS-VAs 的 RFCA 结果得到了令人满意的改善。通过确定更多不同的心内膜位置作为靶点,解剖型 RFCA 取得了更大的成功。
{"title":"Trends Favoring an Anatomical Approach to Radiofrequency Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating From the Left Ventricular Summit","authors":"Takumi Yamada, G. Neal Kay","doi":"10.1161/circep.123.012548","DOIUrl":"https://doi.org/10.1161/circep.123.012548","url":null,"abstract":"BACKGROUND:Epicardial radiofrequency catheter ablation (RFCA) of idiopathic ventricular arrhythmias (VAs) originating from the left ventricular summit (LVS) is challenging because of the anatomic barriers. On the other hand, RFCA at the endocardial sites near the earliest epicardial activation site of LVS-VAs (anatomic approach) has proven successful. The evolving trends in the approaches and outcomes of RFCA of LVS-VAs at a single center were evaluated.METHODS:We studied 88 consecutive patients with idiopathic LVS-VAs at our institute from 2009 to 2019. These patients were divided into 3 periods: 2009 to 2012 (early), 2013 to 2015 (middle), and 2016 to 2019 (recent). The data were compared among the 3 periods.RESULTS:The RFCA success rate did not significantly change from the early-to-middle period but significantly increased from the middle-to-recent period (<i>P</i>=0.0315). The transpericardial approach usage significantly decreased over the 3 periods. The anatomic approach usage significantly increased over the 3 periods. The use of the transpericardial approach did not affect the RFCA outcomes over the 3 periods. The success rate of the anatomic RFCA tended to increase from the early-to-middle period and significantly increased from the middle-to-recent period (<i>P</i>=0.0412). The number of endocardial locations where RFCA was successful increased over the 3 periods.CONCLUSIONS:Over the 10-year period, the transpericardial approach became decreasingly performed, whereas the anatomic approach became increasingly performed with a satisfactory improvement in the RFCA outcomes of LVS-VAs. The anatomic RFCA became more successful by identifying more and various endocardial locations as target sites.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140617269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
First Pulmonary Vein Isolation Using LINAC-Based Stereotactic Arrhythmia Radioablation. 基于linac的立体定向心律失常放射消融术第一肺静脉隔离。
Pub Date : 2022-06-01 DOI: 10.1161/CIRCEP.122.010880
A. Di Monaco, F. Gregucci, I. Bonaparte, F. Troisi, A. Surgo, D. Di Molfetta, N. Vitulano, F. Quadrini, R. Carbonara, E. Ludovico, M. P. Ciliberti, A. Fiorentino, M. Grimaldi
{"title":"First Pulmonary Vein Isolation Using LINAC-Based Stereotactic Arrhythmia Radioablation.","authors":"A. Di Monaco, F. Gregucci, I. Bonaparte, F. Troisi, A. Surgo, D. Di Molfetta, N. Vitulano, F. Quadrini, R. Carbonara, E. Ludovico, M. P. Ciliberti, A. Fiorentino, M. Grimaldi","doi":"10.1161/CIRCEP.122.010880","DOIUrl":"https://doi.org/10.1161/CIRCEP.122.010880","url":null,"abstract":"","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"8 1","pages":"CIRCEP122010880"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82275138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Characterization of Phrenic Nerve Response to Pulsed Field Ablation 膈神经对脉冲场消融反应的表征
Pub Date : 2022-06-01 DOI: 10.1161/CIRCEP.121.010127
Brian T. Howard, D. Haines, A. Verma, N. Kirchhof, N. Barka, Birce Onal, M. Stewart, Daniel C. Sigg
Background: Phrenic nerve palsy is a well-known complication of cardiac ablation, resulting from the application of direct thermal energy. Emerging pulsed field ablation (PFA) may reduce the risk of phrenic nerve injury but has not been well characterized. Methods: Accelerometers and continuous pacing were used during PFA deliveries in a porcine model. Acute dose response was established in a first experimental phase with ascending PFA intensity delivered to the phrenic nerve (n=12). In a second phase, nerves were targeted with a single ablation level to observe the effect of repetitive ablations on nerve function (n=4). A third chronic phase characterized assessed histopathology of nerves adjacent to ablated cardiac tissue (n=6). Results: Acutely, we observed a dose-dependent response in phrenic nerve function including reversible stunning (R2=0.965, P<0.001). Furthermore, acute results demonstrated that phrenic nerve function responded to varying levels of PFA and catheter proximity placements, resulting in either: no effect, effect, or stunning. In the chronic study phase, successful isolation of superior vena cava at a dose not predicted to cause phrenic nerve dysfunction was associated with normal phrenic nerve function and normal phrenic nerve histopathology at 4 weeks. Conclusions: Proximity of the catheter to the phrenic nerve and the PFA dose level were critical for phrenic nerve response. Gross and histopathologic evaluation of phrenic nerves and diaphragms at a chronic time point yielded no injury. These results provide a basis for understanding the susceptibility and recovery of phrenic nerves in response to PFA and a need for appropriate caution in moving beyond animal models.
背景:膈神经麻痹是众所周知的心脏消融术的并发症,是由直接热能的应用引起的。新兴的脉冲场消融(PFA)可能降低膈神经损伤的风险,但尚未得到很好的表征。方法:在猪PFA模型分娩过程中使用加速计和连续起搏。在第一个实验阶段,PFA浓度升高(n=12)传递到膈神经,建立了急性剂量反应。在第二阶段,神经以单一消融水平为目标,观察重复消融对神经功能的影响(n=4)。第三个慢性期以消融心脏组织附近神经的组织病理学特征为特征(n=6)。结果:急性时,我们观察到膈神经功能的剂量依赖性反应,包括可逆性休克(R2=0.965, P<0.001)。此外,急性结果表明膈神经功能对不同水平的PFA和导管邻近放置有反应,导致:无效果、有效果或休克。在慢性研究阶段,成功分离上腔静脉的剂量预计不会导致膈神经功能障碍,与4周时膈神经功能和膈神经组织病理学正常相关。结论:导管与膈神经的距离和PFA剂量水平对膈神经反应至关重要。大体和组织病理学评估膈神经和膈在一个慢性时间点没有发现损伤。这些结果为理解PFA对膈神经的易感性和恢复提供了基础,并为在动物模型之外的应用提供了适当的谨慎。
{"title":"Characterization of Phrenic Nerve Response to Pulsed Field Ablation","authors":"Brian T. Howard, D. Haines, A. Verma, N. Kirchhof, N. Barka, Birce Onal, M. Stewart, Daniel C. Sigg","doi":"10.1161/CIRCEP.121.010127","DOIUrl":"https://doi.org/10.1161/CIRCEP.121.010127","url":null,"abstract":"Background: Phrenic nerve palsy is a well-known complication of cardiac ablation, resulting from the application of direct thermal energy. Emerging pulsed field ablation (PFA) may reduce the risk of phrenic nerve injury but has not been well characterized. Methods: Accelerometers and continuous pacing were used during PFA deliveries in a porcine model. Acute dose response was established in a first experimental phase with ascending PFA intensity delivered to the phrenic nerve (n=12). In a second phase, nerves were targeted with a single ablation level to observe the effect of repetitive ablations on nerve function (n=4). A third chronic phase characterized assessed histopathology of nerves adjacent to ablated cardiac tissue (n=6). Results: Acutely, we observed a dose-dependent response in phrenic nerve function including reversible stunning (R2=0.965, P<0.001). Furthermore, acute results demonstrated that phrenic nerve function responded to varying levels of PFA and catheter proximity placements, resulting in either: no effect, effect, or stunning. In the chronic study phase, successful isolation of superior vena cava at a dose not predicted to cause phrenic nerve dysfunction was associated with normal phrenic nerve function and normal phrenic nerve histopathology at 4 weeks. Conclusions: Proximity of the catheter to the phrenic nerve and the PFA dose level were critical for phrenic nerve response. Gross and histopathologic evaluation of phrenic nerves and diaphragms at a chronic time point yielded no injury. These results provide a basis for understanding the susceptibility and recovery of phrenic nerves in response to PFA and a need for appropriate caution in moving beyond animal models.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"29 1","pages":"e010127 - e010127"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87094848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 16
Relationship Between Early and Late Recurrences After Catheter Ablation for Atrial Tachycardia in Patients With a History of Atrial Fibrillation. 有房颤病史的患者心房心动过速导管消融后早期和晚期复发的关系。
Pub Date : 2022-05-27 DOI: 10.1161/CIRCEP.121.010727
A. Kahle, C. Jungen, K. Scherschel, F. Alken, C. Meyer
{"title":"Relationship Between Early and Late Recurrences After Catheter Ablation for Atrial Tachycardia in Patients With a History of Atrial Fibrillation.","authors":"A. Kahle, C. Jungen, K. Scherschel, F. Alken, C. Meyer","doi":"10.1161/CIRCEP.121.010727","DOIUrl":"https://doi.org/10.1161/CIRCEP.121.010727","url":null,"abstract":"","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"54 2 1","pages":"101161CIRCEP121010727"},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77911089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Intraoperative Ventricular Tachycardia Ablation During Left Ventricular Assist Device Implantation in High-Risk Heart Failure Patients. 高危心力衰竭患者左心室辅助装置植入术中室性心动过速消融。
Pub Date : 2022-05-26 DOI: 10.1161/CIRCEP.121.010660
S. Tankut, I. Gošev, A. Yoruk, A. Younis, S. McNitt, M. Bjelic, H. Vidula, I-Hul Wu, M. Aktas, I. Goldenberg, David T. Huang
{"title":"Intraoperative Ventricular Tachycardia Ablation During Left Ventricular Assist Device Implantation in High-Risk Heart Failure Patients.","authors":"S. Tankut, I. Gošev, A. Yoruk, A. Younis, S. McNitt, M. Bjelic, H. Vidula, I-Hul Wu, M. Aktas, I. Goldenberg, David T. Huang","doi":"10.1161/CIRCEP.121.010660","DOIUrl":"https://doi.org/10.1161/CIRCEP.121.010660","url":null,"abstract":"","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"7 1","pages":"101161CIRCEP121010660"},"PeriodicalIF":0.0,"publicationDate":"2022-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78577222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
5S Study: Safe and Simple Single Shot Pulmonary Vein Isolation With Pulsed Field Ablation Using Sedation 5S研究:安全、简单的单针肺静脉隔离与镇静脉冲场消融
Pub Date : 2022-05-26 DOI: 10.1161/CIRCEP.121.010817
B. Schmidt, S. Bordignon, S. Tohoku, Shaojie Chen, F. Bologna, L. Urbanek, F. Pansera, Matthias Ernst, K. J. Chun
Background: Pulsed field ablation represents an energy source specific for ablation of cardiac arrhythmias including atrial fibrillation. The aim of the study was to describe the adoption and the process of streamlining procedures with a new ablation technology. Methods: All-comer atrial fibrillation patients (n=191; mean age 69±12 years) underwent catheter ablation with a pulsed field ablation ablation device exclusively using analog-sedation. In the validation phase (n=25), device electrogram quality was compared with a circular mapping catheter to assess pulmonary vein isolation and esophageal temperature monitoring was used. In the streamline phase (n=166), a single-catheter approach was implemented. Postprocedural cerebral magnetic resonance imaging was performed in 53 patients. In 52 patients, esophageal endoscopy was performed at day 1 after the procedure. Follow-up was performed using 72 hours Holter ECGs. Results: On a pulmonary vein basis, pulmonary vein isolation rate was 100% including a single shot isolation rate of 99.5%. The electrogram information of the pulsed field ablation catheter and the circular mapping catheter were 100% congruent. Neither esophageal temperature rises nor esophageal thermal injury were observed. Two minor strokes occurred, presumable due to air embolism during catheter exchanges through the large bore sheath (13.8 F ID). In the streamline phase, reduced procedure times (46±14 versus 38±13 minutes, P=0.004), no further strokes and a low incidence of silent cerebral injury (10/53 patients; 19%) were noted. During short-term follow-up, 17/191 patients (9%) had a atrial tachyarrhythmia recurrence. Conclusions: The pulsed field ablation device allows for simple and safe simple single shot pulmonary vein isolation using standard sedation protocols. Procedural speed and efficacy are remarkable and streamlining measures have added safety.
背景:脉冲场消融是包括心房颤动在内的心律失常消融的一种特殊能量来源。本研究的目的是描述一种新的消融技术的采用和简化程序的过程。方法:全角性心房颤动患者191例;平均年龄69±12岁)采用脉冲场消融术进行导管消融术。在验证阶段(n=25),将设备电图质量与圆形测图导管进行比较,以评估肺静脉隔离,并使用食管温度监测。流线期(n=166)采用单导管入路。对53例患者行术后脑磁共振成像。52例患者在术后第1天进行食管内镜检查。随访采用72小时动态心电图。结果:以肺静脉为基础,肺静脉分离率100%,其中单针分离率99.5%。脉冲场消融导管与圆形测图导管的电图信息100%一致。未见食管温度升高,也未见食管热损伤。发生了两例轻微中风,可能是由于在通过大口径护套交换导管时发生空气栓塞(13.8 F ID)。在流线期,手术时间缩短(46±14分钟vs 38±13分钟,P=0.004),无进一步卒中,无症状脑损伤发生率低(10/53例;19%)。在短期随访中,191例患者中有17例(9%)再次发生房性心动过速。结论:脉冲场消融术装置允许使用标准镇静方案进行简单、安全的单次肺静脉隔离。程序速度和效率显著,精简措施增加了安全性。
{"title":"5S Study: Safe and Simple Single Shot Pulmonary Vein Isolation With Pulsed Field Ablation Using Sedation","authors":"B. Schmidt, S. Bordignon, S. Tohoku, Shaojie Chen, F. Bologna, L. Urbanek, F. Pansera, Matthias Ernst, K. J. Chun","doi":"10.1161/CIRCEP.121.010817","DOIUrl":"https://doi.org/10.1161/CIRCEP.121.010817","url":null,"abstract":"Background: Pulsed field ablation represents an energy source specific for ablation of cardiac arrhythmias including atrial fibrillation. The aim of the study was to describe the adoption and the process of streamlining procedures with a new ablation technology. Methods: All-comer atrial fibrillation patients (n=191; mean age 69±12 years) underwent catheter ablation with a pulsed field ablation ablation device exclusively using analog-sedation. In the validation phase (n=25), device electrogram quality was compared with a circular mapping catheter to assess pulmonary vein isolation and esophageal temperature monitoring was used. In the streamline phase (n=166), a single-catheter approach was implemented. Postprocedural cerebral magnetic resonance imaging was performed in 53 patients. In 52 patients, esophageal endoscopy was performed at day 1 after the procedure. Follow-up was performed using 72 hours Holter ECGs. Results: On a pulmonary vein basis, pulmonary vein isolation rate was 100% including a single shot isolation rate of 99.5%. The electrogram information of the pulsed field ablation catheter and the circular mapping catheter were 100% congruent. Neither esophageal temperature rises nor esophageal thermal injury were observed. Two minor strokes occurred, presumable due to air embolism during catheter exchanges through the large bore sheath (13.8 F ID). In the streamline phase, reduced procedure times (46±14 versus 38±13 minutes, P=0.004), no further strokes and a low incidence of silent cerebral injury (10/53 patients; 19%) were noted. During short-term follow-up, 17/191 patients (9%) had a atrial tachyarrhythmia recurrence. Conclusions: The pulsed field ablation device allows for simple and safe simple single shot pulmonary vein isolation using standard sedation protocols. Procedural speed and efficacy are remarkable and streamlining measures have added safety.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"12 1","pages":"e010817"},"PeriodicalIF":0.0,"publicationDate":"2022-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87268653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 30
期刊
Circulation: Arrhythmia and Electrophysiology
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1