Pub Date : 2022-05-26DOI: 10.1161/CIRCEP.122.010975
C. Gianni, Javier E. Sanchez, Qiong Chen, D. D. Della Rocca, S. Mohanty, C. Trivedi, A. Al‐Ahmad, M. Bassiouny, J. Burkhardt, G. Gallinghouse, R. Horton, P. Hranitzky, Jorge Romero, L. Di Biase, Mario J. Garcia, A. Natale
Background: Following left atrial appendage (LAA) electrical isolation, the decision on whether to continue oral anticoagulation after successful atrial fibrillation ablation is based on the study of its mechanical function on transesophageal echocardiography (TEE). In this cohort, LAA contraction is absent and the incorrect interpretation of emptying flow velocities can lead to unwanted clinical sequelae. Methods: One hundred and sixty consecutive TEE exams performed to evaluate the LAA mechanical function following its electrical isolation were reviewed by an experienced operator blinded to the original diagnosis of LAA dysfunction. The rate of diagnostic discrepancy in the assessment LAA dysfunction and its clinical implications were evaluated. Results: Diagnostic discrepancy with misclassification of the LAA mechanical function occurred 36% (58/160) of TEE exams. In most cases (57/58), such discrepancy was observed in the setting of an incorrect original diagnosis of a normal LAA mechanical function despite absent/reduced or inconsistent LAA contraction. This main source of this wrong diagnosis was the wrong interpretation of passive LAA flows (34/57; 60%), followed by failure to identify dissociated firing (15/57; 26%). In rare cases (8/57; 14%), velocities of surrounding structures were interpreted as LAA flow due to misplacement of the pulsed-wave Doppler sample volume. Following LAA isolation, the proportion of patients who experienced a cerebrovascular event while off oral anticoagulation due to the misclassification of their LAA mechanical function was 70% (7/10 [95% CI, 40%–89%]). Conclusions: Underdiagnosis of LAA mechanical dysfunction is common in TEEs performed following LAA electrical isolation, and it is associated with an increased risk of cerebrovascular events owing to oral anticoagulation discontinuation despite absent/reduced LAA contraction. Careful review of the TEE exam by an operator with specific expertise in LAA imaging and familiar with the functional implications of LAA isolation is necessary before interrupting oral anticoagulation in this cohort.
{"title":"Transesophageal Echocardiography Following Left Atrial Appendage Electrical Isolation: Diagnostic Pitfalls and Clinical Implications","authors":"C. Gianni, Javier E. Sanchez, Qiong Chen, D. D. Della Rocca, S. Mohanty, C. Trivedi, A. Al‐Ahmad, M. Bassiouny, J. Burkhardt, G. Gallinghouse, R. Horton, P. Hranitzky, Jorge Romero, L. Di Biase, Mario J. Garcia, A. Natale","doi":"10.1161/CIRCEP.122.010975","DOIUrl":"https://doi.org/10.1161/CIRCEP.122.010975","url":null,"abstract":"Background: Following left atrial appendage (LAA) electrical isolation, the decision on whether to continue oral anticoagulation after successful atrial fibrillation ablation is based on the study of its mechanical function on transesophageal echocardiography (TEE). In this cohort, LAA contraction is absent and the incorrect interpretation of emptying flow velocities can lead to unwanted clinical sequelae. Methods: One hundred and sixty consecutive TEE exams performed to evaluate the LAA mechanical function following its electrical isolation were reviewed by an experienced operator blinded to the original diagnosis of LAA dysfunction. The rate of diagnostic discrepancy in the assessment LAA dysfunction and its clinical implications were evaluated. Results: Diagnostic discrepancy with misclassification of the LAA mechanical function occurred 36% (58/160) of TEE exams. In most cases (57/58), such discrepancy was observed in the setting of an incorrect original diagnosis of a normal LAA mechanical function despite absent/reduced or inconsistent LAA contraction. This main source of this wrong diagnosis was the wrong interpretation of passive LAA flows (34/57; 60%), followed by failure to identify dissociated firing (15/57; 26%). In rare cases (8/57; 14%), velocities of surrounding structures were interpreted as LAA flow due to misplacement of the pulsed-wave Doppler sample volume. Following LAA isolation, the proportion of patients who experienced a cerebrovascular event while off oral anticoagulation due to the misclassification of their LAA mechanical function was 70% (7/10 [95% CI, 40%–89%]). Conclusions: Underdiagnosis of LAA mechanical dysfunction is common in TEEs performed following LAA electrical isolation, and it is associated with an increased risk of cerebrovascular events owing to oral anticoagulation discontinuation despite absent/reduced LAA contraction. Careful review of the TEE exam by an operator with specific expertise in LAA imaging and familiar with the functional implications of LAA isolation is necessary before interrupting oral anticoagulation in this cohort.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"26 1","pages":"e010975"},"PeriodicalIF":0.0,"publicationDate":"2022-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88597789","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}
Pub Date : 2022-05-02DOI: 10.1161/CIRCEP.122.011033
Utkarsh Kohli, E. Saarel, Maully J. Shah
{"title":"Extreme Left Ventricular Hypertrophy in Pediatric Hypertrophic Cardiomyopathy: Good News or Bad News?","authors":"Utkarsh Kohli, E. Saarel, Maully J. Shah","doi":"10.1161/CIRCEP.122.011033","DOIUrl":"https://doi.org/10.1161/CIRCEP.122.011033","url":null,"abstract":"","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"62 1","pages":"101161CIRCEP122011033"},"PeriodicalIF":0.0,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79642253","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}
Pub Date : 2022-05-01DOI: 10.1161/CIRCEP.121.010075
G. Norrish, T. Ding, E. Field, E. Cervi, L. Ziółkowska, I. Olivotto, D. Khraiche, G. Limongelli, A. Anastasakis, R. Weintraub, E. Biagini, L. Ragni, T. Prendiville, Sophie Duignan, K. McLeod, M. Ilina, A. Fernández, C. Marrone, R. Bökenkamp, A. Baban, P. Kubuš, P. Daubeney, G. Sarquella-Brugada, Sergi César, S. Klaassen, T. Ojala, V. Bhole, C. Medrano, O. Uzun, Elspeth Brown, F. Gran, G. Sinagra, F. Castro, G. Stuart, G. Vignati, H. Yamazawa, R. Barriales-Villa, L. García-Guereta, S. Adwani, K. Linter, T. Bharucha, P. García-Pavía, A. Siles, T. B. Rasmussen, M. Calcagnino, Caroline B. Jones, H. De Wilde, T. Kubo, T. Felice, A. Popoiu, J. Mogensen, S. Mathur, F. Centeno, Z. Reinhardt, S. Schouvey, Costas O'Mahony, R. Omar, Perry M. Elliott, J. Kaski
Background: Maximal left ventricular wall thickness (MLVWT) is a risk factor for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). In adults, the severity of left ventricular hypertrophy has a nonlinear relationship with SCD, but it is not known whether the same complex relationship is seen in childhood. The aim of this study was to describe the relationship between left ventricular hypertrophy and SCD risk in a large international pediatric HCM cohort. Methods: The study cohort comprised 1075 children (mean age, 10.2 years [±4.4]) diagnosed with HCM (1–16 years) from the International Paediatric Hypertrophic Cardiomyopathy Consortium. Anonymized, noninvasive clinical data were collected from baseline evaluation and follow-up, and 5-year estimated SCD risk was calculated (HCM Risk-Kids). Results: MLVWT Z score was <10 in 598 (58.1%), ≥10 to <20 in 334 (31.1%), and ≥20 in 143 (13.3%). Higher MLVWT Z scores were associated with heart failure symptoms, unexplained syncope, left ventricular outflow tract obstruction, left atrial dilatation, and nonsustained ventricular tachycardia. One hundred twenty-two patients (71.3%) with MLVWT Z score ≥20 had coexisting risk factors for SCD. Over a median follow-up of 4.9 years (interquartile range, 2.3–9.3), 115 (10.7%) had an SCD event. Freedom from SCD event at 5 years for those with MLVWT Z scores <10, ≥10 to <20, and ≥20 was 95.6%, 87.4%, and 86.0, respectively. The estimated SCD risk at 5 years had a nonlinear, inverted U-shaped relationship with MLVWT Z score, peaking at Z score +23. The presence of coexisting risk factors had a summative effect on risk. Conclusions: In children with HCM, an inverted U-shaped relationship exists between left ventricular hypertrophy and estimated SCD risk. The presence of additional risk factors has a summative effect on risk. While MLVWT is important for risk stratification, it should not be used either as a binary variable or in isolation to guide implantable cardioverter defibrillator implantation decisions in children with HCM.
{"title":"Relationship Between Maximal Left Ventricular Wall Thickness and Sudden Cardiac Death in Childhood Onset Hypertrophic Cardiomyopathy","authors":"G. Norrish, T. Ding, E. Field, E. Cervi, L. Ziółkowska, I. Olivotto, D. Khraiche, G. Limongelli, A. Anastasakis, R. Weintraub, E. Biagini, L. Ragni, T. Prendiville, Sophie Duignan, K. McLeod, M. Ilina, A. Fernández, C. Marrone, R. Bökenkamp, A. Baban, P. Kubuš, P. Daubeney, G. Sarquella-Brugada, Sergi César, S. Klaassen, T. Ojala, V. Bhole, C. Medrano, O. Uzun, Elspeth Brown, F. Gran, G. Sinagra, F. Castro, G. Stuart, G. Vignati, H. Yamazawa, R. Barriales-Villa, L. García-Guereta, S. Adwani, K. Linter, T. Bharucha, P. García-Pavía, A. Siles, T. B. Rasmussen, M. Calcagnino, Caroline B. Jones, H. De Wilde, T. Kubo, T. Felice, A. Popoiu, J. Mogensen, S. Mathur, F. Centeno, Z. Reinhardt, S. Schouvey, Costas O'Mahony, R. Omar, Perry M. Elliott, J. Kaski","doi":"10.1161/CIRCEP.121.010075","DOIUrl":"https://doi.org/10.1161/CIRCEP.121.010075","url":null,"abstract":"Background: Maximal left ventricular wall thickness (MLVWT) is a risk factor for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). In adults, the severity of left ventricular hypertrophy has a nonlinear relationship with SCD, but it is not known whether the same complex relationship is seen in childhood. The aim of this study was to describe the relationship between left ventricular hypertrophy and SCD risk in a large international pediatric HCM cohort. Methods: The study cohort comprised 1075 children (mean age, 10.2 years [±4.4]) diagnosed with HCM (1–16 years) from the International Paediatric Hypertrophic Cardiomyopathy Consortium. Anonymized, noninvasive clinical data were collected from baseline evaluation and follow-up, and 5-year estimated SCD risk was calculated (HCM Risk-Kids). Results: MLVWT Z score was <10 in 598 (58.1%), ≥10 to <20 in 334 (31.1%), and ≥20 in 143 (13.3%). Higher MLVWT Z scores were associated with heart failure symptoms, unexplained syncope, left ventricular outflow tract obstruction, left atrial dilatation, and nonsustained ventricular tachycardia. One hundred twenty-two patients (71.3%) with MLVWT Z score ≥20 had coexisting risk factors for SCD. Over a median follow-up of 4.9 years (interquartile range, 2.3–9.3), 115 (10.7%) had an SCD event. Freedom from SCD event at 5 years for those with MLVWT Z scores <10, ≥10 to <20, and ≥20 was 95.6%, 87.4%, and 86.0, respectively. The estimated SCD risk at 5 years had a nonlinear, inverted U-shaped relationship with MLVWT Z score, peaking at Z score +23. The presence of coexisting risk factors had a summative effect on risk. Conclusions: In children with HCM, an inverted U-shaped relationship exists between left ventricular hypertrophy and estimated SCD risk. The presence of additional risk factors has a summative effect on risk. While MLVWT is important for risk stratification, it should not be used either as a binary variable or in isolation to guide implantable cardioverter defibrillator implantation decisions in children with HCM.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"86 1 1","pages":"e010075 - e010075"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82783380","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}
Pub Date : 2022-05-01DOI: 10.1161/CIRCEP.121.007955
Philip L. Mar, Piotr Horbal, M. Chung, J. Dukes, M. Ezekowitz, Dhanunjaya Lakkireddy, G. Lip, Mike Miletello, P. Noseworthy, J. Reiffel, J. Tisdale, B. Olshansky, R. Gopinathannair
Antiarrhythmic drugs (AAD) play an important role in the management of arrhythmias. Drug interactions involving AAD are common in clinical practice. As AADs have a narrow therapeutic window, both pharmacokinetic as well as pharmacodynamic interactions involving AAD can result in serious adverse drug reactions ranging from arrhythmia recurrence, failure of device-based therapy, and heart failure, to death. Pharmacokinetic drug interactions frequently involve the inhibition of key metabolic pathways, resulting in accumulation of a substrate drug. Additionally, over the past 2 decades, the P-gp (permeability glycoprotein) has been increasingly cited as a significant source of drug interactions. Pharmacodynamic drug interactions involving AADs commonly involve additive QT prolongation. Amiodarone, quinidine, and dofetilide are AADs with numerous and clinically significant drug interactions. Recent studies have also demonstrated increased morbidity and mortality with the use of digoxin and other AAD which interact with P-gp. QT prolongation is an important pharmacodynamic interaction involving mainly Vaughan-Williams class III AAD as many commonly used drug classes, such as macrolide antibiotics, fluoroquinolone antibiotics, antipsychotics, and antiemetics prolong the QT interval. Whenever possible, serious drug-drug interactions involving AAD should be avoided. If unavoidable, patients will require closer monitoring and the concomitant use of interacting agents should be minimized. Increasing awareness of drug interactions among clinicians will significantly improve patient safety for patients with arrhythmias.
{"title":"Drug Interactions Affecting Antiarrhythmic Drug Use","authors":"Philip L. Mar, Piotr Horbal, M. Chung, J. Dukes, M. Ezekowitz, Dhanunjaya Lakkireddy, G. Lip, Mike Miletello, P. Noseworthy, J. Reiffel, J. Tisdale, B. Olshansky, R. Gopinathannair","doi":"10.1161/CIRCEP.121.007955","DOIUrl":"https://doi.org/10.1161/CIRCEP.121.007955","url":null,"abstract":"Antiarrhythmic drugs (AAD) play an important role in the management of arrhythmias. Drug interactions involving AAD are common in clinical practice. As AADs have a narrow therapeutic window, both pharmacokinetic as well as pharmacodynamic interactions involving AAD can result in serious adverse drug reactions ranging from arrhythmia recurrence, failure of device-based therapy, and heart failure, to death. Pharmacokinetic drug interactions frequently involve the inhibition of key metabolic pathways, resulting in accumulation of a substrate drug. Additionally, over the past 2 decades, the P-gp (permeability glycoprotein) has been increasingly cited as a significant source of drug interactions. Pharmacodynamic drug interactions involving AADs commonly involve additive QT prolongation. Amiodarone, quinidine, and dofetilide are AADs with numerous and clinically significant drug interactions. Recent studies have also demonstrated increased morbidity and mortality with the use of digoxin and other AAD which interact with P-gp. QT prolongation is an important pharmacodynamic interaction involving mainly Vaughan-Williams class III AAD as many commonly used drug classes, such as macrolide antibiotics, fluoroquinolone antibiotics, antipsychotics, and antiemetics prolong the QT interval. Whenever possible, serious drug-drug interactions involving AAD should be avoided. If unavoidable, patients will require closer monitoring and the concomitant use of interacting agents should be minimized. Increasing awareness of drug interactions among clinicians will significantly improve patient safety for patients with arrhythmias.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"28 1","pages":"e007955"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79439132","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}
Pub Date : 2022-04-27DOI: 10.1161/CIRCEP.121.010666
A. Rosenblatt, C. Ayers, A. Rao, S. Howell, N. Hendren, Ronit H. Zadikany, J. Ebinger, J. Daniels, M. Link, J. D. de Lemos, Sandeep R. Das
Background: New-onset atrial fibrillation (AF) in patients hospitalized with COVID-19 has been reported and associated with poor clinical outcomes. We aimed to understand the incidence of and outcomes associated with new-onset AF in a diverse and representative US cohort of patients hospitalized with COVID-19. Methods: We used data from the American Heart Association COVID-19 Cardiovascular Disease Registry. Patients were stratified by the presence versus absence of new-onset AF. The primary and secondary outcomes were in-hospital mortality and major adverse cardiovascular events (MACE; cardiovascular death, myocardial infarction, stroke, cardiogenic shock, and heart failure). The association of new-onset AF and the primary and secondary outcomes was evaluated using Cox proportional-hazards models for the primary time to event analyses. Results: Of the first 30 999 patients from 120 institutions across the United States hospitalized with COVID-19, 27 851 had no history of AF. One thousand five hundred seventeen (5.4%) developed new-onset AF during their index hospitalization. New-onset AF was associated with higher rates of death (45.2% versus 11.9%) and MACE (23.8% versus 6.5%). The unadjusted hazard ratio for mortality was 1.99 (95% CI, 1.81–2.18) and for MACE was 2.23 (95% CI, 1.98–2.53) for patients with versus without new-onset AF. After adjusting for demographics, clinical comorbidities, and severity of disease, the associations with death (hazard ratio, 1.10 [95% CI, 0.99–1.23]) fully attenuated and MACE (hazard ratio, 1.31 [95% CI, 1.14–1.50]) partially attenuated. Conclusions: New-onset AF was common (5.4%) among patients hospitalized with COVID-19. Almost half of patients with new-onset AF died during their index hospitalization. After multivariable adjustment for comorbidities and disease severity, new-onset AF was not statistically significantly associated with death, suggesting that new-onset AF in these patients may primarily be a marker of other adverse clinical factors rather than an independent driver of mortality. Causality between the MACE composites and AF needs to be further evaluated.
{"title":"New-Onset Atrial Fibrillation in Patients Hospitalized With COVID-19: Results From the American Heart Association COVID-19 Cardiovascular Registry","authors":"A. Rosenblatt, C. Ayers, A. Rao, S. Howell, N. Hendren, Ronit H. Zadikany, J. Ebinger, J. Daniels, M. Link, J. D. de Lemos, Sandeep R. Das","doi":"10.1161/CIRCEP.121.010666","DOIUrl":"https://doi.org/10.1161/CIRCEP.121.010666","url":null,"abstract":"Background: New-onset atrial fibrillation (AF) in patients hospitalized with COVID-19 has been reported and associated with poor clinical outcomes. We aimed to understand the incidence of and outcomes associated with new-onset AF in a diverse and representative US cohort of patients hospitalized with COVID-19. Methods: We used data from the American Heart Association COVID-19 Cardiovascular Disease Registry. Patients were stratified by the presence versus absence of new-onset AF. The primary and secondary outcomes were in-hospital mortality and major adverse cardiovascular events (MACE; cardiovascular death, myocardial infarction, stroke, cardiogenic shock, and heart failure). The association of new-onset AF and the primary and secondary outcomes was evaluated using Cox proportional-hazards models for the primary time to event analyses. Results: Of the first 30 999 patients from 120 institutions across the United States hospitalized with COVID-19, 27 851 had no history of AF. One thousand five hundred seventeen (5.4%) developed new-onset AF during their index hospitalization. New-onset AF was associated with higher rates of death (45.2% versus 11.9%) and MACE (23.8% versus 6.5%). The unadjusted hazard ratio for mortality was 1.99 (95% CI, 1.81–2.18) and for MACE was 2.23 (95% CI, 1.98–2.53) for patients with versus without new-onset AF. After adjusting for demographics, clinical comorbidities, and severity of disease, the associations with death (hazard ratio, 1.10 [95% CI, 0.99–1.23]) fully attenuated and MACE (hazard ratio, 1.31 [95% CI, 1.14–1.50]) partially attenuated. Conclusions: New-onset AF was common (5.4%) among patients hospitalized with COVID-19. Almost half of patients with new-onset AF died during their index hospitalization. After multivariable adjustment for comorbidities and disease severity, new-onset AF was not statistically significantly associated with death, suggesting that new-onset AF in these patients may primarily be a marker of other adverse clinical factors rather than an independent driver of mortality. Causality between the MACE composites and AF needs to be further evaluated.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"54 1","pages":"e010666"},"PeriodicalIF":0.0,"publicationDate":"2022-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88490658","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}
Pub Date : 2022-04-26DOI: 10.1161/CIRCEP.121.010707
Tetsuma Kawaji, T. Aizawa, Shun Hojo, Akihiro Kushiyama, H. Yaku, Kenji Nakatsuma, Kazuhisa Kaneda, Masashi Kato, Takafumi Yokomatsu, S. Miki
{"title":"Concomitant Spatiotemporal Electrogram Dispersion and Low Voltage During Atrial Fibrillation Is Associated With Refractory Atrial Fibrillation After Catheter Ablation.","authors":"Tetsuma Kawaji, T. Aizawa, Shun Hojo, Akihiro Kushiyama, H. Yaku, Kenji Nakatsuma, Kazuhisa Kaneda, Masashi Kato, Takafumi Yokomatsu, S. Miki","doi":"10.1161/CIRCEP.121.010707","DOIUrl":"https://doi.org/10.1161/CIRCEP.121.010707","url":null,"abstract":"","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"25 1","pages":"101161CIRCEP121010707"},"PeriodicalIF":0.0,"publicationDate":"2022-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84022933","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}
Pub Date : 2022-04-26DOI: 10.1161/CIRCEP.122.011032
T. Richardson, Arvindh N Kanagasundram, W. Stevenson
{"title":"Plumbing the Depths of Intramural Ventricular Arrhythmias: The Surface May Not Always Reveal What Lies Below.","authors":"T. Richardson, Arvindh N Kanagasundram, W. Stevenson","doi":"10.1161/CIRCEP.122.011032","DOIUrl":"https://doi.org/10.1161/CIRCEP.122.011032","url":null,"abstract":"","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"38 1","pages":"101161CIRCEP122011032"},"PeriodicalIF":0.0,"publicationDate":"2022-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90868611","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}
Pub Date : 2022-04-26DOI: 10.1161/CIRCEP.122.010895
Kristie M. Coleman, G. Atteya, D. Varrias, Elliot Wolf, Amarbir Bhullar, Nikhil Sharma, Moussa Saleh, K. Bhasin, N. Bernstein, N. Skipitaris, S. Mountantonakis
{"title":"Voltage Map Guided Nonocclusive Balloon Cryoablation to Achieve Antral Pulmonary Vein Isolation.","authors":"Kristie M. Coleman, G. Atteya, D. Varrias, Elliot Wolf, Amarbir Bhullar, Nikhil Sharma, Moussa Saleh, K. Bhasin, N. Bernstein, N. Skipitaris, S. Mountantonakis","doi":"10.1161/CIRCEP.122.010895","DOIUrl":"https://doi.org/10.1161/CIRCEP.122.010895","url":null,"abstract":"","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"139 1","pages":"101161CIRCEP122010895"},"PeriodicalIF":0.0,"publicationDate":"2022-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74901983","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}
Pub Date : 2022-04-26DOI: 10.1161/CIRCEP.121.010693
Shin-Yi Lin, C. Kuo, L. Ho, Yen‐Bin Liu, Chih-Fen Huang, Sung-Chun Tang, J. Jeng
{"title":"Association Between Apixaban Concentration and Clinical Outcomes in Asians With Atrial Fibrillation.","authors":"Shin-Yi Lin, C. Kuo, L. Ho, Yen‐Bin Liu, Chih-Fen Huang, Sung-Chun Tang, J. Jeng","doi":"10.1161/CIRCEP.121.010693","DOIUrl":"https://doi.org/10.1161/CIRCEP.121.010693","url":null,"abstract":"","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"50 1","pages":"101161CIRCEP121010693"},"PeriodicalIF":0.0,"publicationDate":"2022-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73565397","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}
Pub Date : 2022-04-01DOI: 10.1161/CIRCEP.121.010663
A. Bortone, J. Albenque, F. D. Ramirez, M. Haïssaguerre, S. Combes, M. Constantin, Guillaume Laborie, G. Brault-Noble, É. Marijon, P. Jaïs, T. Pambrun
Background: Fifty-watt radiofrequency applications have proven to be safe and efficient for pulmonary vein isolation (PVI). However, as PV reconnection still occurs and ablation catheter instability significantly contributes to suboptimal lesion formation, a new ablation catheter capable of delivering 90 W for 4 seconds only has been developed with the aim of improving PVI outcomes. In this setting, we sought to determine whether 90 W applications create transmural lesions without collateral damage experimentally and whether they can safely improve PVI procedures clinically compared with 50 W settings. Methods: Experimentally, individual lesions were created in vivo in the right atrium of 6 swine with 90 W-4 seconds applications using the SmartTouch-SF catheter in a power-controlled mode (3 animals) or the QDOT-MICRO catheter in a temperature-controlled mode (3 animals). Clinically, PVI was performed in a homogenous population of 150 consecutive paroxysmal atrial fibrillation patients using CARTO and the QDOT-MICRO catheter in a temperature-controlled mode (75 patients 50 W-ablation index-guided and 75 patients 90 W-4 seconds). Results: Mostly, (94.9%) experimental lesions were transmural in the thin-walled right atrium of swine. However, collateral damage was observed with both catheters in 17.9% of lesions. Clinically, 90 W procedures had a lower first-pass PVI rate (49% versus 81%, P<10−4) and a higher acute PV reconnection rate (21% versus 5%, P=0.004) than 50 W procedures, whereas total procedural duration (62 versus 66 minutes, P=0.09), 1-year sinus rhythm maintenance (88% versus 90%, P=0.6) and safety (1 tamponade per group) were similar in both groups. Conclusions: Experimentally, using the QDOT-MICRO catheter, 90 W-4 seconds lesions are mostly transmural in the thin-walled right atrium of swine (median depth 1.87 mm) with a moderate lesion diameter of 6.62 mm but retain the potential for collateral damage. Clinically, 90 W-4 seconds applications are associated with a lower first-pass PVI rate and a higher acute PV reconnection rate than 50 W applications but similar safety outcomes and effectiveness at 1 year.
背景:50瓦射频应用已被证明是安全有效的肺静脉隔离(PVI)。然而，由于PV重连仍然会发生，消融导管的不稳定性显著导致病变形成不理想，为了改善PVI结果，一种新的消融导管能够在4秒内提供90w的能量。在这种情况下，我们试图确定90w是否会在实验中产生无附带损伤的跨壁病变，以及与50w设置相比，它们是否可以安全地改善临床PVI手术。方法:实验中，使用SmartTouch-SF导管在功率控制模式下(3只动物)或QDOT-MICRO导管在温度控制模式下(3只动物)，在6头猪的右心房进行90 W-4秒的应用，在体内形成单个病变。临床上，在150例连续阵发性心房颤动患者中使用CARTO和QDOT-MICRO导管在温控模式下进行PVI(75例患者50 w -消融指数引导，75例患者90 W-4秒)。结果:猪右心房薄壁病变多为跨壁病变(94.9%)。然而，17.9%的病变观察到两根导管的附带损伤。临床上，90w手术比50w手术具有更低的首次通过PVI率(49%比81%，P<10−4)和更高的急性PV重连率(21%比5%，P=0.004)，而两组的总手术时间(62比66分钟，P=0.09)、1年窦性心律维持(88%比90%，P=0.6)和安全性(每组1次填塞)相似。结论:在实验中，使用QDOT-MICRO导管，90 W-4秒的病变主要是跨壁的猪右心房薄壁病变(中位深度1.87 mm)，中度病变直径为6.62 mm，但保留了附带损伤的可能性。临床上，90w -4秒的应用与50w的应用相比，具有较低的首次通过PV率和较高的急性PV重新连接率，但在1年的安全性和有效性相似。
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