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Point-by-Point Pulsed Field Ablation Using a Multimodality Generator and a Contact Force-Sensing Ablation Catheter: Comparison With Radiofrequency Ablation in a Remapped Chronic Swine Heart. 使用多模态发生器和接触式力感应消融导管的逐点脉冲场消融:与射频消融在重测慢性猪心脏中的比较。
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-01 Epub Date: 2023-11-23 DOI: 10.1161/CIRCEP.123.012344
Luigi Di Biase, Jacopo Marazzato, Fengwei Zou, Aung Lin, Vito Grupposo, Nilarun Chowdhuri, Jennifer Maffre, Salman Farshchi-Heydari, Tushar Sharma, Christopher Beeckler, Assaf Govari, Rahul Bhardwaj, Sanghamitra Mohanty, Andrea Natale, Hiroshi Nakagawa, Xiaodong Zhang

Background: Pulsed field ablation (PFA) has emerged as an alternative to radiofrequency ablation. However, data on focal point-by-point PFA are scarce. The aim of this study was to compare lesion durability and collateral damage between focally delivered unipolar/biphasic PFA versus radiofrequency in swine.

Methods: Eighteen swine were randomized to low-dose PFA, high-dose PFA, and radiofrequency using a multimodality generator. Radiofrequency delivered by market-available generator served as control group. A contact force-sensing catheter was used to focally deliver PFA/radiofrequency at the pulmonary veins and other predefined sites in the atria. Animals were remapped postprocedurally and 28 days postablation to test lesion durability followed by gross necroscopy and histology.

Results: All targeted sites were successfully ablated (contact force value, 13.9±4.1 g). Follow-up remapping showed persistent pulmonary vein isolation in all animals (100%) with lesion durability at nonpulmonary vein sites proven in most (98%). Regardless of the energy source used, the lesion size was similar across the study groups. Transmurality was achieved in 95% of targeted sites and 100% at pulmonary veins. On histology, PFA animals showed more mature scar formation than their radiofrequency counterpart without myocardial necrosis or inflammation. Finally, no sign of collateral damage was observed in any of the groups.

Conclusions: In a randomized preclinical study, focally delivered unipolar/biphasic PFA guided by contact force values was associated with durable lesions on chronic remapping and with mature scar formation on histology without signs of collateral injury on necroscopy. Further studies are needed to investigate the long-term feasibility of this new approach to atrial fibrillation treatment.

背景:脉冲场消融(PFA)已成为射频消融的替代方案。然而,关于逐点PFA的数据很少。本研究的目的是比较猪局部单极/双相PFA与射频PFA的损伤持久性和附带损伤。方法:18头猪随机分为低剂量PFA组、高剂量PFA组和多模态发生器射频组。市场上可用的发电机提供的射频作为对照组。使用接触式力感导管在肺静脉和心房其他预定位置局部传递PFA/射频。术后和消融后28天对动物进行重新定位,以测试病变的持久性,然后进行大体坏死镜检查和组织学检查。结果:所有目标部位均成功消融(接触力值,13.9±4.1 g)。随访重测显示所有动物(100%)持续肺静脉分离,大多数动物(98%)证实非肺静脉部位病变持久。无论使用何种能量来源,整个研究组的病变大小都是相似的。95%的靶部位和100%的肺静脉均实现了通透性。在组织学上,PFA动物比射频动物显示更成熟的瘢痕形成,没有心肌坏死或炎症。最后,在任何组中都没有观察到附带损害的迹象。结论:在一项随机临床前研究中,由接触力值引导的局部单极/双相PFA与慢性重定位的持久病变和组织学上的成熟瘢痕形成有关,在坏死镜检查中没有附带损伤的迹象。这种治疗心房颤动的新方法的长期可行性需要进一步的研究。
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引用次数: 0
Genetic Atrial Cardiomyopathies: Common Features, Specific Differences, and Broader Relevance to Understanding Atrial Cardiomyopathy. 遗传性心房心肌病:共同特征,特定差异,以及与理解心房心肌病更广泛的相关性。
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-01 Epub Date: 2023-11-29 DOI: 10.1161/CIRCEP.123.003750
Edouard Marcoux, Deanna Sosnowski, Sandro Ninni, Martin Mackasey, Julia Cadrin-Tourigny, Jason D Roberts, Morten Salling Olesen, Diane Fatkin, Stanley Nattel

Atrial cardiomyopathy is a condition that causes electrical and contractile dysfunction of the atria, often along with structural and functional changes. Atrial cardiomyopathy most commonly occurs in conjunction with ventricular dysfunction, in which case it is difficult to discern the atrial features that are secondary to ventricular dysfunction from those that arise as a result of primary atrial abnormalities. Isolated atrial cardiomyopathy (atrial-selective cardiomyopathy [ASCM], with minimal or no ventricular function disturbance) is relatively uncommon and has most frequently been reported in association with deleterious rare genetic variants. The genes involved can affect proteins responsible for various biological functions, not necessarily limited to the heart but also involving extracardiac tissues. Atrial enlargement and atrial fibrillation are common complications of ASCM and are often the predominant clinical features. Despite progress in identifying disease-causing rare variants, an overarching understanding and approach to the molecular pathogenesis, phenotypic spectrum, and treatment of genetic ASCM is still lacking. In this review, we aim to analyze the literature relevant to genetic ASCM to understand the key features of this rather rare condition, as well as to identify distinct characteristics of ASCM and its arrhythmic complications that are related to specific genotypes. We outline the insights that have been gained using basic research models of genetic ASCM in vitro and in vivo and correlate these with patient outcomes. Finally, we provide suggestions for the future investigation of patients with genetic ASCM and improvements to basic scientific models and systems. Overall, a better understanding of the genetic underpinnings of ASCM will not only provide a better understanding of this condition but also promises to clarify our appreciation of the more commonly occurring forms of atrial cardiomyopathy associated with ventricular dysfunction.

心房心肌病是一种引起心房电和收缩功能障碍的疾病,通常伴有结构和功能改变。房性心肌病最常与心室功能障碍合并发生,在这种情况下,很难区分继发于心室功能障碍的心房特征和由原发性心房异常引起的心房特征。孤立性心房心肌病(心房选择性心肌病;心房选择性心肌病(心房选择性心肌病,伴有轻微或无心室功能障碍)相对罕见,且常与有害的罕见遗传变异相关。所涉及的基因可以影响负责各种生物功能的蛋白质,不一定局限于心脏,也涉及心外组织。心房扩大和心房颤动是ASCM的常见并发症,往往是主要的临床特征。尽管在识别致病的罕见变异方面取得了进展,但对遗传性ASCM的分子发病机制、表型谱和治疗仍缺乏全面的理解和方法。在这篇综述中,我们旨在分析与遗传性ASCM相关的文献,以了解这种相当罕见的疾病的关键特征,并确定ASCM的独特特征及其与特定基因型相关的心律失常并发症。我们概述了在体外和体内使用遗传ASCM的基础研究模型所获得的见解,并将这些与患者预后相关联。最后,我们对今后遗传性ASCM患者的调查和基础科学模型和系统的完善提出了建议。总的来说,更好地了解ASCM的遗传基础不仅可以更好地了解这种疾病,而且还有望澄清我们对与心室功能障碍相关的更常见的心房心肌病形式的认识。
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引用次数: 0
Effects of Intraluminal Content on Esophageal Lesion Formation During Radiofrequency Catheter Ablation: Preliminary Data. 射频导管消融过程中腔内内容物对食管病变形成的影响:初步数据。
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-01 Epub Date: 2023-11-16 DOI: 10.1161/CIRCEP.123.012404
Fabrizio Assis, Harikrishna Tandri, Rushil Shah, Christopher Batich, Parag Karmarkar, Akhilesh Gonuguntla, Michele Dill, Ekin C Uzunoglu, John N Catanzaro
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引用次数: 0
Ventricular Preexcitation in Hypertrophic Cardiomyopathy: Dove or a Hawk? 肥厚型心肌病的心室预激:鸽子还是鹰?
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-11-01 Epub Date: 2023-11-03 DOI: 10.1161/CIRCEP.123.012543
Henry Chubb, Anne M Dubin
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引用次数: 0
Hypertrophic Cardiomyopathy and Ventricular Preexcitation in the Young: Cause and Accessory Pathway Characteristics. 年轻人肥厚性心肌病和心室预先兴奋:病因学和副通路特征。
IF 9.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-11-01 Epub Date: 2023-10-25 DOI: 10.1161/CIRCEP.123.012191
Robert Przybylski, Sakethram Saravu Vijayashankar, Edward T O'Leary, Robyn J Hylind, Jennifer Noon, Audrey Dionne, Elizabeth S DeWitt, Vassilios J Bezzerides, Dominic J Abrams

Background: The cause of hypertrophic cardiomyopathy (HCM) in the young is highly varied. Ventricular preexcitation (preexcitation) is well recognized, yet little is known about the specificity for any cause and the characteristics of the responsible accessory pathways (AP).

Methods: Retrospective cohort study of patients <21 years of age with HCM/preexcitation from 2000 to 2022. The cause of HCM was defined as isolated HCM, storage disorder, metabolic disease, or genetic syndrome. Atrioventricular AP (true AP) were distinguished from fasciculoventricular fibers (FVF) using standard invasive electrophysiology study criteria. AP were defined as high risk if any of the following were <250 ms: shortest preexcited RR interval in atrial fibrillation, shortest paced preexcited cycle length, or anterograde AP effective refractory period.

Results: We identified 345 patients with HCM and 28 (8%) had preexcitation (isolated HCM, 10/220; storage disorder, 8/17; metabolic disease, 5/19; and genetic syndrome, 5/89). Six (21%) patients had clinical atrial fibrillation (1 with shortest preexcited RR interval <250 ms). Twenty-two patients underwent electrophysiology study which identified 23 true AP and 16 FVF. Preexcitation was exclusively FVF mediated in 8 (36%) patients. Five (23%) patients had AP with high-risk conduction properties (including ≥1 patient in each etiologic group). Multiple AP were seen in 8 (36%) and AP plus FVF in 10 (45%) patients. Ablation was acutely successful in 13 of 14 patients with recurrence in 3. One procedure was complicated by complete heart block after ablation of a high-risk midseptal AP. There were significant differences in QRS amplitude and delta wave amplitude between groups. There were no surface ECG features that differentiated AP from FVF.

Conclusions: Young patients with HCM and preexcitation have a high likelihood of underlying storage disease or metabolic disease. Nonisolated HCM should be suspected in young patients with large QRS and delta wave amplitudes. Surface ECG is not adequate to discriminate preexcitation from a benign FVF from that secondary to potentially life-threatening AP.

背景:年轻人肥厚型心肌病(HCM)的病因多种多样。心室预激(precition)是公认的,然而,对任何病因的特异性和责任副通路(AP)的特征知之甚少。方法:对患者的回顾性队列研究结果:我们确定了345名HCM患者,28名(8%)有预激(孤立的HCM,10/220;储存障碍,8/17;代谢性疾病,5/19;遗传综合征,5/89)。6名(21%)患者出现临床心房颤动(1具有最短的预激RR间期结论:患有HCM和预激的年轻患者很有可能患上潜在的储存性疾病或代谢性疾病。QRS和德尔塔波振幅较大的年轻患者应怀疑是非孤立性HCM。表面心电图不足以区分预激与良性FVF以及继发于潜在危及生命的AP。
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引用次数: 0
Natriuretic Peptide Receptor B Protects Against Atrial Fibrillation by Controlling Atrial cAMP Via Phosphodiesterase 2. 利钠肽受体B通过磷酸二酯酶2控制心房cAMP保护心房颤动。
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-11-01 Epub Date: 2023-11-07 DOI: 10.1161/CIRCEP.123.012199
Tristan W Dorey, Yingjie Liu, Hailey J Jansen, Loryn J Bohne, Martin Mackasey, Logan Atkinson, Shuvam Prasai, Darrell D Belke, Ali Fatehi-Hassanabad, Paul W M Fedak, Robert A Rose

Background: β-AR (β-adrenergic receptor) stimulation regulates atrial electrophysiology and Ca2+ homeostasis via cAMP-dependent mechanisms; however, enhanced β-AR signaling can promote atrial fibrillation (AF). CNP (C-type natriuretic peptide) can also regulate atrial electrophysiology through the activation of NPR-B (natriuretic peptide receptor B) and cGMP-dependent signaling. Nevertheless, the role of NPR-B in regulating atrial electrophysiology, Ca2+ homeostasis, and atrial arrhythmogenesis is incompletely understood.

Methods: Studies were performed using atrial samples from human patients with AF or sinus rhythm and in wild-type and NPR-B-deficient (NPR-B+/-) mice. Studies were conducted in anesthetized mice by intracardiac electrophysiology, in isolated mouse atrial preparations using high-resolution optical mapping, in isolated mouse and human atrial myocytes using patch-clamping and Ca2+ imaging, and in mouse and human atrial tissues using molecular biology.

Results: Atrial NPR-B protein levels were reduced in patients with AF, and NPR-B+/- mice were more susceptible to AF. Atrial cGMP levels and PDE2 (phosphodiesterase 2) activity were reduced in NPR-B+/- mice leading to larger increases in atrial cAMP in the presence of the β-AR agonist isoproterenol. NPR-B+/- mice displayed larger increases in action potential duration and L-type Ca2+ current in the presence of isoproterenol. This resulted in the occurrence of spontaneous sarcoplasmic reticulum Ca2+ release events and delayed afterdepolarizations in NPR-B+/- atrial myocytes. Phosphorylation of the RyR2 (ryanodine receptor) and phospholamban was increased in NPR-B+/- atria in the presence of isoproterenol compared with the wildtypes. C-type natriuretic peptide inhibited isoproterenol-stimulated L-type Ca2+ current through PDE2 in mouse and human atrial myocytes.

Conclusions: NPR-B protects against AF by preventing enhanced atrial responses to β-adrenergic receptor agonists.

背景:β-AR(β-肾上腺素能受体)刺激通过cAMP依赖性机制调节心房电生理和Ca2+稳态;然而,增强的β-AR信号可以促进心房颤动(AF)。CNP(C型钠尿肽)还可以通过激活NPR-B(钠尿肽受体B)和cGMP依赖性信号传导来调节心房电生理。然而,NPR-B在调节心房电生理、Ca2+稳态和心房心律失常发生中的作用尚不完全清楚。方法:使用心房颤动或窦性心律患者的心房样本以及野生型和NPR-B缺陷(NPR-B+/-)小鼠的心房样本进行研究。通过心内电生理在麻醉小鼠中、使用高分辨率光学标测在分离的小鼠心房制剂中、使用膜片钳和Ca2+成像在分离的鼠和人心房肌细胞中以及使用分子生物学在小鼠和人心房组织中进行研究。结果:房颤患者的心房NPR-B蛋白水平降低,而NPR-B+/-小鼠对房颤更敏感。在β-AR激动剂异丙肾上腺素存在的情况下,NPR-B+/-小鼠的心房cGMP水平和磷酸二酯酶2活性降低,导致心房cAMP增加更大。NPR-B+/-小鼠在异丙肾上腺素存在下表现出动作电位持续时间和L型Ca2+电流的较大增加。这导致NPR-B+/-心房肌细胞发生自发肌浆网Ca2+释放事件和延迟后去极化。与野生型相比,在异丙肾上腺素存在的情况下,NPR-B+/-心房中RyR2(ryanodine受体)和磷铵的磷酸化增加。在小鼠和人心房肌细胞中,C型钠尿肽通过PDE2抑制异丙肾上腺素刺激的L型Ca2+电流。结论:NPR-B通过防止心房对β-肾上腺素能受体激动剂的反应增强来预防房颤。
{"title":"Natriuretic Peptide Receptor B Protects Against Atrial Fibrillation by Controlling Atrial cAMP Via Phosphodiesterase 2.","authors":"Tristan W Dorey, Yingjie Liu, Hailey J Jansen, Loryn J Bohne, Martin Mackasey, Logan Atkinson, Shuvam Prasai, Darrell D Belke, Ali Fatehi-Hassanabad, Paul W M Fedak, Robert A Rose","doi":"10.1161/CIRCEP.123.012199","DOIUrl":"10.1161/CIRCEP.123.012199","url":null,"abstract":"<p><strong>Background: </strong>β-AR (β-adrenergic receptor) stimulation regulates atrial electrophysiology and Ca<sup>2+</sup> homeostasis via cAMP-dependent mechanisms; however, enhanced β-AR signaling can promote atrial fibrillation (AF). CNP (C-type natriuretic peptide) can also regulate atrial electrophysiology through the activation of NPR-B (natriuretic peptide receptor B) and cGMP-dependent signaling. Nevertheless, the role of NPR-B in regulating atrial electrophysiology, Ca<sup>2+</sup> homeostasis, and atrial arrhythmogenesis is incompletely understood.</p><p><strong>Methods: </strong>Studies were performed using atrial samples from human patients with AF or sinus rhythm and in wild-type and NPR-B-deficient (NPR-B<sup>+/-</sup>) mice. Studies were conducted in anesthetized mice by intracardiac electrophysiology, in isolated mouse atrial preparations using high-resolution optical mapping, in isolated mouse and human atrial myocytes using patch-clamping and Ca<sup>2+</sup> imaging, and in mouse and human atrial tissues using molecular biology.</p><p><strong>Results: </strong>Atrial NPR-B protein levels were reduced in patients with AF, and NPR-B<sup>+/-</sup> mice were more susceptible to AF. Atrial cGMP levels and PDE2 (phosphodiesterase 2) activity were reduced in NPR-B<sup>+/-</sup> mice leading to larger increases in atrial cAMP in the presence of the β-AR agonist isoproterenol. NPR-B<sup>+/-</sup> mice displayed larger increases in action potential duration and L-type Ca<sup>2+</sup> current in the presence of isoproterenol. This resulted in the occurrence of spontaneous sarcoplasmic reticulum Ca<sup>2+</sup> release events and delayed afterdepolarizations in NPR-B<sup>+/-</sup> atrial myocytes. Phosphorylation of the RyR2 (ryanodine receptor) and phospholamban was increased in NPR-B<sup>+/-</sup> atria in the presence of isoproterenol compared with the wildtypes. C-type natriuretic peptide inhibited isoproterenol-stimulated L-type Ca<sup>2+</sup> current through PDE2 in mouse and human atrial myocytes.</p><p><strong>Conclusions: </strong>NPR-B protects against AF by preventing enhanced atrial responses to β-adrenergic receptor agonists.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e012199"},"PeriodicalIF":8.4,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71478713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Nanosecond Pulsed Electric Field Ablation With a Bipolar Clamp Creates Durable Transmural Lesions in Cardiac Tissue. 用双极夹进行的纳秒脉冲电场消融在心脏组织中产生持久的跨壁损伤。
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-11-01 Epub Date: 2023-11-03 DOI: 10.1161/CIRCEP.123.012300
Federica Serra, Jonathan M Philpott, Johanna U Neuber, Emily Shih, James C Etheridge, Frency Varghese, Gregory D Rushing, Christian W Zemlin
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引用次数: 0
No Effect of Continued Antiarrhythmic Drug Treatment on Top of Optimized Pulmonary Vein Isolation in Patients With Persistent Atrial Fibrillation: Results From the POWDER-AF2 Trial. 持续性心房颤动患者在优化肺静脉隔离的基础上继续抗心律失常药物治疗无效果:粉末-AF2试验的结果。
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-11-01 Epub Date: 2023-11-03 DOI: 10.1161/CIRCEP.123.012043
Anthony Demolder, Louisa O'Neill, Milad El Haddad, Daniel Scherr, Johan Vijgen, Michael Wolf, Benjamin Berte, Felipe Bisbal, Arne Johannessen, Maximo Rivero-Ayerza, Tom De Potter, Benjamin De Becker, Jean-Benoît le Polain de Waroux, Sebastien Knecht, Rene Tavernier, Mattias Duytschaever

Background: In patients with persistent atrial fibrillation (PersAF), catheter ablation aiming for pulmonary vein isolation (PVI) is associated with moderate clinical effectiveness. We investigated the benefit of continuing previously ineffective class 1C or 3 antiarrhythmic drug therapy (ADT) in the setting of a standardized PVI-only ablation strategy.

Methods: In this multicenter, randomized controlled study, patients with PersAF (≥7 days and <12 months) despite ADT were prospectively randomized 1:1 to PVI with ADT continued versus discontinued beyond the blanking period (ADT ON versus ADT OFF). Standardized catheter ablation was performed aiming for durable isolation with stable, contiguous, and optimized radio frequency applications encircling the pulmonary veins (CLOSE protocol). Clinical visits and 1-to-7-day Holter were performed at 3, 6, and 12 months. The primary end point was any documented atrial tachyarrhythmia lasting >30 seconds beyond 3 months. Prospectively defined secondary end points included repeat ablations, unscheduled arrhythmia-related visits, and quality of life among groups.

Results: Of 200 PersAF patients, 98 were assigned to ADT OFF and 102 to ADT ON. The longest atrial fibrillation episode qualifying for PersAF was 28 (10-90) versus 30 (11-90) days. Clinical characteristics and procedural characteristics were similar. Recurrence of atrial tachyarrhythmia was comparable in both groups (20% OFF versus 21.2% ON). No differences were observed in repeat ablations and unscheduled arrhythmia-related visits. Marked improvement in quality of life was observed in both groups.

Conclusions: In patients with PersAF, there is no benefit in continuing previously ineffective ADT beyond the blanking period after catheter ablation. The high success rate of PVI-only might be explained by the high rate of durable isolation after optimized PVI and the early stage of PersAF (POWDER-AF2).

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03437356.

背景:在持续性心房颤动(PersAF)患者中,针对肺静脉隔离(PVI)的导管消融具有中等的临床疗效。我们研究了在标准化仅PVI消融策略的背景下,继续进行先前无效的1C或3类抗心律失常药物治疗(ADT)的益处。方法:在这项多中心、随机对照研究中,PersAF患者(3个月后≥7天30秒)。前瞻性定义的次要终点包括重复消融、计划外心律失常相关访视和组间生活质量。结果:在200名PersAF患者中,98名患者被分为ADT OFF,102名患者被分配为ADT ON。符合PersAF条件的最长心房颤动发作时间为28(10-90)天,而非30(11-90)天。临床特征和手术特征相似。两组房性快速性心律失常的复发率相当(分别为20%和21.2%)。在重复消融和计划外心律失常相关访视中未观察到差异。两组患者的生活质量均有明显改善。结论:在PersAF患者中,在导管消融后的空白期之后继续进行先前无效的ADT没有任何益处。仅PVI的高成功率可以通过优化PVI后的高持久隔离率和PersAF(粉末-AF2)的早期阶段来解释。注册:URL:https://www.Clinicaltrials:政府;唯一标识符:NCT03437356。
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引用次数: 0
Reversible Pulsed Electrical Fields as an In Vivo Tool to Study Cardiac Electrophysiology: The Advent of Pulsed Field Mapping. 可逆脉冲电场作为研究心脏电生理学的体内工具:脉冲场标测的出现。
IF 9.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-10-01 Epub Date: 2023-09-20 DOI: 10.1161/CIRCEP.123.012018
Jacob S Koruth, Petr Neuzil, Iwanari Kawamura, Kenji Kuroki, Jan Petru, Gediminas Rackauskas, Moritoshi Funasako, Audrius Aidietis, Vivek Y Reddy

Background: During electrophysiological mapping of tachycardias, putative target sites are often only truly confirmed to be vital after observing the effect of ablation. This lack of mapping specificity potentiates inadvertent ablation of innocent cardiac tissue not relevant to the arrhythmia. But if myocardial excitability could be transiently suppressed at critical regions, their suitability as targets could be conclusively determined before delivering tissue-destructive ablation lesions. We studied whether reversible pulsed electric fields (PFREV) could transiently suppress electrical conduction, thereby providing a means to dissect tachycardia circuits in vivo.

Methods: PFREV energy was delivered from a 9-mm lattice-tip catheter to the atria of 12 swine and 9 patients, followed by serial electrogram assessments. The effects on electrical conduction were explored in 5 additional animals by applying PFREV to the atrioventricular node: 17 low-dose (PFREV-LOW) and 10 high-dose (PFREV-HIGH) applications. Finally, in 3 patients manifesting spontaneous tachycardias, PFREV was applied at putative critical sites.

Results: In animals, the immediate post-PFREV electrogram amplitudes diminished by 74%, followed by 78% recovery by 5 minutes. Similarly, in patients, a 69.9% amplitude reduction was followed by 84% recovery by 3 minutes. Histology revealed only minimal to no focal, superficial fibrosis. PFREV-LOW at the atrioventricular node resulted in transient PR prolongation and transient AV block in 59% and 6%, while PFREV-HIGH caused transient PR prolongation and transient AV block in 30% and 50%, respectively. The 3 tachycardia patients had atypical atrial flutters (n=2) and atrioventricular nodal reentrant tachycardia. PFREV at putative critical sites reproducibly terminated the tachycardias; ablation rendered the tachycardias noninducible and without recurrence during 1-year follow-up.

Conclusions: Reversible electroporation pulses can be applied to myocardial tissue to transiently block electrical conduction. This technique of pulsed field mapping may represent a novel electrophysiological tool to help identify the critical isthmus of tachycardia circuits.

背景:在心动过速的电生理标测过程中,通常只有在观察消融效果后,才能真正确认假定的靶位点是至关重要的。这种缺乏标测特异性的情况会导致无意中消融与心律失常无关的无辜心脏组织。但是,如果心肌兴奋性可以在关键区域被短暂抑制,那么在进行组织破坏性消融损伤之前,就可以最终确定其作为靶点的适用性。我们研究了可逆脉冲电场(PFREV)是否能瞬时抑制导电,从而为体内解剖心动过速回路提供了一种方法。方法:将PFREV能量从9mm格子尖端导管输送到12头猪和9名患者的心房,然后进行系列心电图评估。通过将PFREV应用于房室结,在另外5只动物中探讨了对导电的影响:17只低剂量(PFREV-low)和10只高剂量(PFREV-high)。最后,在3例表现为自发性心动过速的患者中,在假定的关键部位应用PFREV。结果:在动物中,PFREV后即刻的电图振幅降低了74%,随后在5分钟内恢复了78%。同样,在患者中,振幅降低69.9%,随后在3分钟内恢复84%。组织学检查显示仅有轻微或无局灶性浅表纤维化。房室结处的PFREV-LOW导致59%和6%的患者出现短暂PR延长和短暂AV阻滞,而PFREV-HIGH分别导致30%和50%的患者出现暂时PR延长和暂时AV阻滞。3例心动过速患者出现非典型心房颤动(n=2)和房室结折返性心动过速。PFREV在假定的关键位点可重复地终止心动过速;消融使心动过速在1年的随访中不易发生,也不会复发。结论:可逆电穿孔脉冲可以应用于心肌组织,短暂阻断电传导。这种脉冲场标测技术可能代表一种新的电生理工具,有助于识别心动过速回路的关键峡部。
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引用次数: 0
Retrieval of Chronically Implanted Dual-chamber Leadless Pacemakers in an Ovine Model. 在绵羊模型中回收长期植入的双腔无导线起搏器。
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-10-01 Epub Date: 2023-09-28 DOI: 10.1161/CIRCEP.123.012232
Rajesh S Banker, Marian K Rippy, Nicole Cooper, Petr Neužil, Derek V Exner, Devi G Nair, Daniel F Booth, David Ligon, Nima Badie, Mark Krans, Kenji Ando, Reinoud E Knops, James E Ip, Rahul N Doshi, Mayer Rashtian, Vivek Y Reddy

Background: The clinical utilization of leadless pacemakers (LPs) as an alternative to traditional transvenous pacemakers is likely to increase with the advent of dual-chamber LP systems. Since device retrieval to allow LP upgrade or replacement will become an important capability, the first such dual-chamber, helix-fixation LP system (Aveir DR; Abbott, Abbott Park, IL) was specifically designed to allow catheter-based retrieval. In this study, the preclinical performance and safety of retrieving chronically implanted dual-chamber LPs was evaluated.

Methods: Atrial and ventricular LPs were implanted in the right atrial appendage and right ventricular apex of 9 healthy ovine subjects. After ≈2 years, the LPs were retrieved using a dedicated transvenous retrieval catheter (Aveir Retrieval Catheter; Abbott) by snaring, docking, and unscrewing from the myocardium. Comprehensive necropsy/histopathology studies were conducted to evaluate device- and procedure-related outcomes.

Results: At a median of 1.9 years postimplant (range, 1.8-2.6), all 18 of 18 (100%) LPs were retrieved from 9 ovine subjects without complications. The median retrieval procedure duration for both LPs, from first-catheter-in to last-catheter-out, was 13.3 minutes (range, 2.5-36.4). Postretrieval, all right atrial, and right ventricular implant sites demonstrated minimal tissue disruption, with intact fibrous tissue limited to the distal device body. No significant device-related trauma, perforation, pericardial effusion, right heart or tricuspid valve injury, or chronic pulmonary thromboembolism were observed at necropsy.

Conclusions: This preclinical study demonstrated the safe and effective retrieval of chronically implanted, helix-fixation, dual-chamber LP systems, paving the way for clinical studies of LP retrieval.

背景:随着双腔LP系统的出现,无引线起搏器(LP)作为传统经静脉起搏器的替代品的临床应用可能会增加。由于能够升级或更换LP的装置回收将成为一项重要功能,因此第一个这样的双腔螺旋固定LP系统(Aveir DR;Abbott,Abbott Park,IL)专门设计用于基于导管的回收。在本研究中,评估了回收长期植入的双腔LPs的临床前性能和安全性。方法:在9例健康绵羊的右心耳和右心室尖部植入心房和心室LPs。≈2年后,使用专用经静脉取出导管(Aveir retrieval catheter;Abbott)通过从心肌上圈套、对接和拧下来取出LPs。进行了全面的尸检/组织病理学研究,以评估器械和手术相关的结果。结果:在植入后1.9年的中位数(范围1.8-2.6),从9名绵羊受试者中回收了18个(100%)LP中的全部18个,没有并发症。从第一根导管插入到最后一根导管取出,两个LP的中位取出程序持续时间为13.3分钟(范围2.5-36.4)。取出后,所有右心房和右心室植入部位的组织破坏最小,完整的纤维组织仅限于远端装置体。尸检时未观察到明显的装置相关创伤、穿孔、心包积液、右心或三尖瓣损伤或慢性肺血栓栓塞。结论:该临床前研究证明了长期植入、螺旋固定、双腔LP系统的安全有效回收,为LP回收的临床研究铺平了道路。
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Circulation. Arrhythmia and electrophysiology
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