Background and Aims The usefulness of coronary venous system mapping has been reported for assessing intramural and epicardial substrates in patients with scar-related ventricular tachycardia (VT). However, there has been little data on mapping from coronary arteries. We investigated the safety and utility of mapping from coronary arteries with a novel over-the-wire multielectrode catheter in scar-related VT patients. Methods Ten consecutive scar-related VT patients with nonischemic cardiomyopathy who underwent mapping from a coronary artery were analyzed. Six patients underwent simultaneous coronary venous mapping. High-density maps were created by combining the left ventricular endocardium and coronary vessels. Results Substrate maps were created during the baseline rhythm with 2,438 points (IQR 2,136–3,490 points), including 329 (IQR 59-508 points) in coronary arteries. Abnormal bipolar electrograms were successfully recorded within coronary arteries close to the endocardial substrate in 7 patients. During VT, isthmus components were recorded within coronary vessels in 3 patients with no discernible isthmus components on endocardial mapping. The ablation terminated the VT from an endocardial site opposite the earliest site in the coronary arteries in 5 patients. Conclusions The transcoronary mapping with an over-the-wire multielectrode catheter can safely record abnormal bipolar electrograms within coronary arteries. Additional mapping data from coronary vessels have the potential to assess three-dimensional ventricular substrates and circuit structures in scar-related VT patients.
{"title":"Transcoronary Mapping with an Over-the-wire Multielectrode Catheter in Scar-related Ventricular Tachycardia Patients","authors":"Takuro Nishimura, Masahiko Goya, Miho Negishi, Takashi Ikenouchi, Tasuku Yamamoto, Iwanari Kawamura, Kentaro Goto, Takatoshi Shigeta, Tomomasa Takamiya, Susumu Tao, Masateru Takigawa, Taishi Yonetsu, Shinsuke Miyazaki, Tetsuo Sasano","doi":"10.1093/europace/euad365","DOIUrl":"https://doi.org/10.1093/europace/euad365","url":null,"abstract":"Background and Aims The usefulness of coronary venous system mapping has been reported for assessing intramural and epicardial substrates in patients with scar-related ventricular tachycardia (VT). However, there has been little data on mapping from coronary arteries. We investigated the safety and utility of mapping from coronary arteries with a novel over-the-wire multielectrode catheter in scar-related VT patients. Methods Ten consecutive scar-related VT patients with nonischemic cardiomyopathy who underwent mapping from a coronary artery were analyzed. Six patients underwent simultaneous coronary venous mapping. High-density maps were created by combining the left ventricular endocardium and coronary vessels. Results Substrate maps were created during the baseline rhythm with 2,438 points (IQR 2,136–3,490 points), including 329 (IQR 59-508 points) in coronary arteries. Abnormal bipolar electrograms were successfully recorded within coronary arteries close to the endocardial substrate in 7 patients. During VT, isthmus components were recorded within coronary vessels in 3 patients with no discernible isthmus components on endocardial mapping. The ablation terminated the VT from an endocardial site opposite the earliest site in the coronary arteries in 5 patients. Conclusions The transcoronary mapping with an over-the-wire multielectrode catheter can safely record abnormal bipolar electrograms within coronary arteries. Additional mapping data from coronary vessels have the potential to assess three-dimensional ventricular substrates and circuit structures in scar-related VT patients.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138684964","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}
Background and Aims Patients with heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) have worse clinical outcomes than those with sinus rhythm (SR). We aim to investigate whether maintaining SR in patients with HFpEF through a strategy such as AF ablation would improve outcomes. Methods This is a cohort study that analyzed 1034 patients (median age 69 [63-76] years, 46.2% [478/1034] female) with HFpEF and AF. Of these, 392 patients who underwent first-time AF ablation were assigned to the ablation group, and the remaining 642 patients, who received only medical therapy, were assigned to the no ablation group. The primary endpoint was a composite of all-cause death or rehospitalization for worsening heart failure. Results After a median follow-up of 39 months, the cumulative incidence of the primary endpoint was significantly lower in the ablation group compared to the no ablation group (adjusted hazard ratio [HR], 0.55 [95% CI, 0.37-0.82], P = 0.003) in the propensity score-matched model. Secondary endpoint analysis showed that the benefit of AF ablation was mainly driven by a reduction in rehospitalization for worsening heart failure (adjusted HR, 0.52 [95% CI, 0.34-0.80], P = 0.003). Patients in the ablation group showed a 33% relative decrease in atrial tachycardia/AF recurrence compared to the no ablation group (adjusted HR, 0.67 [95% CI, 0.54-0.84], P < 0.001). Conclusion Among patients with HFpEF and AF, the strategy of AF ablation to maintain SR was associated with a lower risk of the composite outcome of all-cause death or rehospitalization for worsening heart failure.
{"title":"Ablation for atrial fibrillation improves the outcomes in patients with heart failure with preserved ejection fraction","authors":"Zhonglei Xie, Baozhen Qi, Zimu Wang, Fuhai Li, Chaofeng Chen, Chaofu Li, Shuai Yuan, Shun Yao, Jingmin Zhou, Junbo Ge","doi":"10.1093/europace/euad363","DOIUrl":"https://doi.org/10.1093/europace/euad363","url":null,"abstract":"Background and Aims Patients with heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) have worse clinical outcomes than those with sinus rhythm (SR). We aim to investigate whether maintaining SR in patients with HFpEF through a strategy such as AF ablation would improve outcomes. Methods This is a cohort study that analyzed 1034 patients (median age 69 [63-76] years, 46.2% [478/1034] female) with HFpEF and AF. Of these, 392 patients who underwent first-time AF ablation were assigned to the ablation group, and the remaining 642 patients, who received only medical therapy, were assigned to the no ablation group. The primary endpoint was a composite of all-cause death or rehospitalization for worsening heart failure. Results After a median follow-up of 39 months, the cumulative incidence of the primary endpoint was significantly lower in the ablation group compared to the no ablation group (adjusted hazard ratio [HR], 0.55 [95% CI, 0.37-0.82], P = 0.003) in the propensity score-matched model. Secondary endpoint analysis showed that the benefit of AF ablation was mainly driven by a reduction in rehospitalization for worsening heart failure (adjusted HR, 0.52 [95% CI, 0.34-0.80], P = 0.003). Patients in the ablation group showed a 33% relative decrease in atrial tachycardia/AF recurrence compared to the no ablation group (adjusted HR, 0.67 [95% CI, 0.54-0.84], P &lt; 0.001). Conclusion Among patients with HFpEF and AF, the strategy of AF ablation to maintain SR was associated with a lower risk of the composite outcome of all-cause death or rehospitalization for worsening heart failure.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138684548","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 : 2023-12-13DOI: 10.1093/europace/euad364
Giacomo Mugnai, Michal Farkowski, Luca Tomasi, Laurent Roten, Federico Migliore, Carlo de Asmundis, Giulio Conte, Serge Boveda, Julian K R Chun
Introduction Limited data are available regarding venous thromboembolism (VTE), specifically deep vein thrombosis (DVT) and pulmonary embolism (PE), following right-sided ablations and electrophysiological (EP) studies. Compared to left-sided procedures, no guidelines on antithrombotic management strategies for the prevention of DVT and PE are available. The main purpose of the present European Heart Rhythm Association (EHRA) survey is to report the current management of right-sided EP procedures, focusing on anticoagulation and prevention of VTE. Methods and Results An online survey was conducted using the EHRA infrastructure. A total of 244 participants answered a 19-items questionnaire on the periprocedural management of EP studies and right-sided catheter ablations. The right femoral vein is the most common access for EP studies and right-sided procedures. An ultrasound-guided approach is employed by more than 2/3 of respondents. Intravenous heparin is not commonly given by the majority of participants. About 1/3 of participants (34%) routinely prescribe VTE prophylaxis during (mostly aspirin and low molecular weight heparin) and 1/4 of respondents (25%) commonly prescribe VTE prophylaxis after discharge (mostly aspirin). Of note, respectively 13% and 9% of participants observed at least one DVT and one PE related to right-sided ablation or EP study within the last year in their center. Conclusions The present survey shows that only a minority of operators routinely gives intraprocedural intravenous heparin and prescribes VTE prophylaxis after right-sided EP procedures. Compared to left-sided procedures like AF ablation, there are no consistent systematic antithrombotic management strategies.
导言：关于静脉血栓栓塞症（VTE），特别是右侧消融术和电生理（EP）研究后的深静脉血栓形成（DVT）和肺栓塞（PE），现有数据有限。与左侧手术相比，目前尚无预防深静脉血栓和肺栓塞的抗血栓管理策略指南。本次欧洲心脏节律协会（EHRA）调查的主要目的是报告目前右侧 EP 手术的管理情况，重点是抗凝和预防 VTE。方法和结果 利用欧洲心脏节律协会的基础设施开展了一项在线调查。共有 244 名参与者回答了一份包含 19 个项目的调查问卷，内容涉及 EP 研究和右侧导管消融术的围手术期管理。右股静脉是 EP 研究和右侧手术最常见的入路。超过三分之二的受访者采用超声引导方法。大多数参与者并不常用静脉注射肝素。约 1/3 的受访者（34%）在住院期间常规处方 VTE 预防药物（主要是阿司匹林和低分子量肝素），1/4 的受访者（25%）在出院后通常处方 VTE 预防药物（主要是阿司匹林）。值得注意的是，分别有 13% 和 9% 的参与者观察到，在他们所在的中心，去年至少有一次深静脉血栓和一次 PE 与右侧消融术或 EP 研究有关。结论 本次调查显示，只有少数操作者会在右侧 EP 术后常规给予术中静脉注射肝素并开具 VTE 预防处方。与房颤消融术等左侧手术相比，目前还没有一致的系统性抗血栓管理策略。
{"title":"Prevention of venous thromboembolism after right heart-sided electrophysiological procedures: results of an EHRA survey","authors":"Giacomo Mugnai, Michal Farkowski, Luca Tomasi, Laurent Roten, Federico Migliore, Carlo de Asmundis, Giulio Conte, Serge Boveda, Julian K R Chun","doi":"10.1093/europace/euad364","DOIUrl":"https://doi.org/10.1093/europace/euad364","url":null,"abstract":"Introduction Limited data are available regarding venous thromboembolism (VTE), specifically deep vein thrombosis (DVT) and pulmonary embolism (PE), following right-sided ablations and electrophysiological (EP) studies. Compared to left-sided procedures, no guidelines on antithrombotic management strategies for the prevention of DVT and PE are available. The main purpose of the present European Heart Rhythm Association (EHRA) survey is to report the current management of right-sided EP procedures, focusing on anticoagulation and prevention of VTE. Methods and Results An online survey was conducted using the EHRA infrastructure. A total of 244 participants answered a 19-items questionnaire on the periprocedural management of EP studies and right-sided catheter ablations. The right femoral vein is the most common access for EP studies and right-sided procedures. An ultrasound-guided approach is employed by more than 2/3 of respondents. Intravenous heparin is not commonly given by the majority of participants. About 1/3 of participants (34%) routinely prescribe VTE prophylaxis during (mostly aspirin and low molecular weight heparin) and 1/4 of respondents (25%) commonly prescribe VTE prophylaxis after discharge (mostly aspirin). Of note, respectively 13% and 9% of participants observed at least one DVT and one PE related to right-sided ablation or EP study within the last year in their center. Conclusions The present survey shows that only a minority of operators routinely gives intraprocedural intravenous heparin and prescribes VTE prophylaxis after right-sided EP procedures. Compared to left-sided procedures like AF ablation, there are no consistent systematic antithrombotic management strategies.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138684542","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 : 2023-12-13DOI: 10.1093/europace/euad361
Lars Eckardt, Florian Doldi, Omar Anwar, Nele Gessler, Katharina Scherschel, Ann-Kathrin Kahle, Aenne S von Falkenhausen, Raffael Thaler, Julian Wolfes, Andreas Metzner, Christian Meyer, Stephan Willems, Julia Köbe, Philipp Sebastian Lange, Gerrit Frommeyer, Karl-Heinz Kuck, Stefan Kääb, Gerhard Steinbeck, Moritz F Sinner
Objective and Background In-hospital complications of catheter ablation for atrial fibrillation (AF), atrial flutter (AFL), and ventricular tachycardia (VT) may be overestimated by analyses of administrative data. Methods We determined the incidences of in-hospital mortality, major bleeding, and stroke around AF, AFL, and VT ablations in four German tertiary centers between 2005-2020. All cases were coded by the G-DRG- and OPS-systems. Uniform code search terms were applied defining both the types of ablations for AF, AFL, and VT and the occurrence of major adverse events including femoral vascular complications, iatrogenic tamponade, stroke, and in-hospital death. Importantly, all complications were individually reviewed based on patient-level source records. Results Overall, 43,031 ablations were analyzed (30,361 AF; 9,364 AFL; 3,306 VT). The number of ablations/year more than doubled from 2005 (n=1569) to 2020 (n=3317) with 3 times and 2.5 times more AF and VT ablations in 2020 (n=2404 and n=301, resp.) as compared to 2005 (n=817 and n=120, resp.), but a rather stable number of AFL ablations (n=554 vs. n=612). Major periprocedural complications occurred in 594 (1.4%) patients. Complication rates were 1.1% (n=325) for AF, 1.0% (n=95) for AFL, and 5.3% (n=175) for VT. With an increase in complex AF/VT procedures the overall complication rate significantly increased (0.76% in 2005 vs. 1.81% in 2020; p=0.004). but remained low over time. Following patient-adjudication, all in-hospital cardiac tamponades (0.7%) and strokes (0.2%) were related to ablation. Major femoral vascular complications requiring surgical intervention occurred in 0.4% of all patients. The in-hospital mortality rate adjudicated to be ablation-related was lower than the coded mortality rate: AF: 0.03% vs. 0.04%; AFL: 0.04% vs. 0.14%; VT: 0.42% vs. 1.48%. Conclusion Major adverse events are low and comparable after catheter ablation for AFL and AF (around 1.0%), whereas they are five times higher for VT ablations. In the presence of an increase in complex ablations procedures a moderate but significant increase in overall complications from 2005-2020 was observed. Individual case analysis demonstrated a lower than coded ablation-related in-hospital mortality. This highlights the importance of individual case adjudication when analyzing administrative data.
{"title":"Major In-Hospital Complications after Catheter Ablation of Cardiac Arrhythmias - Individual Case Analysis of 43,031 Procedures","authors":"Lars Eckardt, Florian Doldi, Omar Anwar, Nele Gessler, Katharina Scherschel, Ann-Kathrin Kahle, Aenne S von Falkenhausen, Raffael Thaler, Julian Wolfes, Andreas Metzner, Christian Meyer, Stephan Willems, Julia Köbe, Philipp Sebastian Lange, Gerrit Frommeyer, Karl-Heinz Kuck, Stefan Kääb, Gerhard Steinbeck, Moritz F Sinner","doi":"10.1093/europace/euad361","DOIUrl":"https://doi.org/10.1093/europace/euad361","url":null,"abstract":"Objective and Background In-hospital complications of catheter ablation for atrial fibrillation (AF), atrial flutter (AFL), and ventricular tachycardia (VT) may be overestimated by analyses of administrative data. Methods We determined the incidences of in-hospital mortality, major bleeding, and stroke around AF, AFL, and VT ablations in four German tertiary centers between 2005-2020. All cases were coded by the G-DRG- and OPS-systems. Uniform code search terms were applied defining both the types of ablations for AF, AFL, and VT and the occurrence of major adverse events including femoral vascular complications, iatrogenic tamponade, stroke, and in-hospital death. Importantly, all complications were individually reviewed based on patient-level source records. Results Overall, 43,031 ablations were analyzed (30,361 AF; 9,364 AFL; 3,306 VT). The number of ablations/year more than doubled from 2005 (n=1569) to 2020 (n=3317) with 3 times and 2.5 times more AF and VT ablations in 2020 (n=2404 and n=301, resp.) as compared to 2005 (n=817 and n=120, resp.), but a rather stable number of AFL ablations (n=554 vs. n=612). Major periprocedural complications occurred in 594 (1.4%) patients. Complication rates were 1.1% (n=325) for AF, 1.0% (n=95) for AFL, and 5.3% (n=175) for VT. With an increase in complex AF/VT procedures the overall complication rate significantly increased (0.76% in 2005 vs. 1.81% in 2020; p=0.004). but remained low over time. Following patient-adjudication, all in-hospital cardiac tamponades (0.7%) and strokes (0.2%) were related to ablation. Major femoral vascular complications requiring surgical intervention occurred in 0.4% of all patients. The in-hospital mortality rate adjudicated to be ablation-related was lower than the coded mortality rate: AF: 0.03% vs. 0.04%; AFL: 0.04% vs. 0.14%; VT: 0.42% vs. 1.48%. Conclusion Major adverse events are low and comparable after catheter ablation for AFL and AF (around 1.0%), whereas they are five times higher for VT ablations. In the presence of an increase in complex ablations procedures a moderate but significant increase in overall complications from 2005-2020 was observed. Individual case analysis demonstrated a lower than coded ablation-related in-hospital mortality. This highlights the importance of individual case adjudication when analyzing administrative data.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138684768","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 : 2023-12-10DOI: 10.1093/europace/euad354
Stijn Dupulthys, Karl Dujardin, Wim Anné, Peter Pollet, Maarten Vanhaverbeke, David McAuliffe, Pieter-Jan Lammertyn, Louise Berteloot, Nathalie Mertens, Peter De Jaeger
Background and Aims Guidelines recommend opportunistic screening for atrial fibrillation (AF), using a 30-second single-lead electrocardiogram (ECG) recorded by a wearable device. Since many patients have paroxysmal AF, identification of patients at high risk presenting in sinus rhythm may increase the yield of subsequent long-term cardiac monitoring. The aim is evaluating an AI-algorithm trained on 10-second single-lead ECG with or without risk factors to predict AF. Methods This retrospective study used 13479 ECGs from AF-patients in sinus rhythm around time of diagnosis and 53916 age- and sex-matched control ECGs, augmented with seventeen risk factors extracted from electronic health records. AI models were trained and compared using one- or twelve-lead ECGs, with or without risk factors. Model bias was evaluated by age- and sex-stratification of results. Random forest models identified the most relevant risk factors. Results The single-lead model achieved an AUC of 0.74, which increased to 0.76 by adding six risk factors (95% confidence interval: 0.74-0.79). This model matched the performance of a twelve-lead model. Results are stable for both sexes, over ages ranging from 40 to 90 years. Out of seventeen clinical variables, six were sufficient for optimal accuracy of the model: hypertension, heart failure, valvular disease, history of myocardial infarction, age and sex. Conclusions An AI model using a single-lead sinus rhythm ECG and six risk factors can identify patients with concurrent AF with similar accuracy as a 12-lead ECG-AI model. An age- and sex matched dataset leads to an unbiased model with consistent predictions across age groups.
{"title":"Single-lead ECG AI model with risk factors detects Atrial Fibrillation during Sinus Rhythm","authors":"Stijn Dupulthys, Karl Dujardin, Wim Anné, Peter Pollet, Maarten Vanhaverbeke, David McAuliffe, Pieter-Jan Lammertyn, Louise Berteloot, Nathalie Mertens, Peter De Jaeger","doi":"10.1093/europace/euad354","DOIUrl":"https://doi.org/10.1093/europace/euad354","url":null,"abstract":"Background and Aims Guidelines recommend opportunistic screening for atrial fibrillation (AF), using a 30-second single-lead electrocardiogram (ECG) recorded by a wearable device. Since many patients have paroxysmal AF, identification of patients at high risk presenting in sinus rhythm may increase the yield of subsequent long-term cardiac monitoring. The aim is evaluating an AI-algorithm trained on 10-second single-lead ECG with or without risk factors to predict AF. Methods This retrospective study used 13479 ECGs from AF-patients in sinus rhythm around time of diagnosis and 53916 age- and sex-matched control ECGs, augmented with seventeen risk factors extracted from electronic health records. AI models were trained and compared using one- or twelve-lead ECGs, with or without risk factors. Model bias was evaluated by age- and sex-stratification of results. Random forest models identified the most relevant risk factors. Results The single-lead model achieved an AUC of 0.74, which increased to 0.76 by adding six risk factors (95% confidence interval: 0.74-0.79). This model matched the performance of a twelve-lead model. Results are stable for both sexes, over ages ranging from 40 to 90 years. Out of seventeen clinical variables, six were sufficient for optimal accuracy of the model: hypertension, heart failure, valvular disease, history of myocardial infarction, age and sex. Conclusions An AI model using a single-lead sinus rhythm ECG and six risk factors can identify patients with concurrent AF with similar accuracy as a 12-lead ECG-AI model. An age- and sex matched dataset leads to an unbiased model with consistent predictions across age groups.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"59 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138572537","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 : 2023-12-07DOI: 10.1093/europace/euad328
Ida Anna Cappello, Luigi Pannone, Domenico Giovanni Della Rocca, Antonio Sorgente, Alvise Del Monte, Sahar Mouram, Giampaolo Vetta, Rani Kronenberger, Robbert Ramak, Ingrid Overeinder, Gezim Bala, Alexandre Almorad, Erwin Ströker, Juan Sieira, Mark La Meir, Dries Belsack, Andrea Sarkozy, Pedro Brugada, Kaoru Tanaka, Gian Battista Chierchia, Ali Gharaviri, Carlo de Asmundis
Aims Catheter ablation (CA) is an established treatment for atrial fibrillation (AF). A computed tomography (CT) may be performed before ablation to evaluate the anatomy of pulmonary veins. The aim of this study is to investigate the prevalence of patients with coronary artery disease (CAD) detected by cardiac CT scan pre-ablation and to evaluate the impact of CAD and revascularization on outcomes after AF ablation. Methods and results All consecutive patients with AF diagnosis, hospitalized at Universitair Ziekenhuis Brussel, Belgium, between 2015 and 2019, were prospectively screened for enrolment in the study. Inclusion criteria were (i) AF diagnosis, (ii) first procedure of AF ablation with cryoballoon CA, and (iii) contrast CT scan performed pre-ablation. A total of 576 consecutive patients were prospectively included and analysed in this study. At CT scan, 122 patients (21.2%) were diagnosed with CAD, of whom 41 patients (7.1%) with critical CAD. At survival analysis, critical CAD at CT scan was a predictor of atrial tachyarrhythmia (AT) recurrence during the follow-up, only in Cox univariate analysis [hazard ratio (HR) = 1.79] but was not an independent predictor in Cox multivariate analysis. At Cox multivariate analysis, independent predictors of AT recurrence were as follows: persistent AF (HR = 2.93) and left atrium volume index (HR = 1.04). Conclusion In patients undergoing CT scan before AF ablation, critical CAD was diagnosed in 7.1% of patients. Coronary artery disease and revascularization were not independent predictors of recurrence; thus, in this patient population, AF ablation should not be denied and can be performed together with CAD treatment.
{"title":"Coronary artery disease in atrial fibrillation ablation: impact on arrhythmic outcomes","authors":"Ida Anna Cappello, Luigi Pannone, Domenico Giovanni Della Rocca, Antonio Sorgente, Alvise Del Monte, Sahar Mouram, Giampaolo Vetta, Rani Kronenberger, Robbert Ramak, Ingrid Overeinder, Gezim Bala, Alexandre Almorad, Erwin Ströker, Juan Sieira, Mark La Meir, Dries Belsack, Andrea Sarkozy, Pedro Brugada, Kaoru Tanaka, Gian Battista Chierchia, Ali Gharaviri, Carlo de Asmundis","doi":"10.1093/europace/euad328","DOIUrl":"https://doi.org/10.1093/europace/euad328","url":null,"abstract":"Aims Catheter ablation (CA) is an established treatment for atrial fibrillation (AF). A computed tomography (CT) may be performed before ablation to evaluate the anatomy of pulmonary veins. The aim of this study is to investigate the prevalence of patients with coronary artery disease (CAD) detected by cardiac CT scan pre-ablation and to evaluate the impact of CAD and revascularization on outcomes after AF ablation. Methods and results All consecutive patients with AF diagnosis, hospitalized at Universitair Ziekenhuis Brussel, Belgium, between 2015 and 2019, were prospectively screened for enrolment in the study. Inclusion criteria were (i) AF diagnosis, (ii) first procedure of AF ablation with cryoballoon CA, and (iii) contrast CT scan performed pre-ablation. A total of 576 consecutive patients were prospectively included and analysed in this study. At CT scan, 122 patients (21.2%) were diagnosed with CAD, of whom 41 patients (7.1%) with critical CAD. At survival analysis, critical CAD at CT scan was a predictor of atrial tachyarrhythmia (AT) recurrence during the follow-up, only in Cox univariate analysis [hazard ratio (HR) = 1.79] but was not an independent predictor in Cox multivariate analysis. At Cox multivariate analysis, independent predictors of AT recurrence were as follows: persistent AF (HR = 2.93) and left atrium volume index (HR = 1.04). Conclusion In patients undergoing CT scan before AF ablation, critical CAD was diagnosed in 7.1% of patients. Coronary artery disease and revascularization were not independent predictors of recurrence; thus, in this patient population, AF ablation should not be denied and can be performed together with CAD treatment.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138562446","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 : 2022-05-18DOI: 10.1093/europace/euac053.431
K. Čurila, P. Jurák, P. Waldauf, J. Halámek, P. Stros, R. Smíšek, F. Plesinger, L. Znojilova, P. Leinveber, I. Viscor, D. Heřman, P. Osmančík, F. Prinzen
Type of funding sources: Public Institution(s). Main funding source(s): Charles University Research Program When pacing in the left septal area, it is not clear where the pacing lead needs to be implanted to obtain the most physiological ventricular activation during pure myocardial pacing. To use UHF-ECG to compare ventricular activation between myocardial pacing of the left septum with and without the possibility to capture the left bundle branch by high output pacing. This was a retrospective study of patients with bradycardia and deep septal myocardial pacing close to LBB (paraLBBP) or deep septal pacing more distant from LBB (DSTP), which both produced a pseudo-right bundle branch morphology in V1. During paraLBBP, left bundle branch capture was feasible during increasing pacing output up to 5V at 0.5 ms, but during DSTP, LBB capture was not possible during high output pacing. Only patients with both paraLBBP and DSTP were analyzed. Paced QRS morphology, presence of LBBpotential, QRSduration, R wave peak time (RWPT) in V5, lead depth in the septum and UHF-ECG parameters of dyssynchrony, i.e., e-DYS as the difference between the first and last ventricular activation and local depolarization durations in precordial leads (V1-V8d) were compared between them. From 119 consecutive bradycardia patients enrolled, we identified 23 with both paraLBBP and DSTP during an implant procedure. On X-ray, a lead tip was placed shallower during DSTP than paraLBBP (12 ± 3 vs. 15 ± 3 mm, p < 0.001). A pseudo right bundle branch block morphology was present in all cases, but LBB potential was more frequently present in paraLBBP (17 of 23) than in DSTP (4 of 36; p < 0.0001). QRSd was not significantly different (146 ± 14 vs. 142 ± 14 ms, p = 0.08), but DSTP had longer V5RWPT (86 ± 11 vs. 83 ± 9 ms; p = 0.03). paraLBBP resulted in larger interventricular dyssynchrony, e-DYS (-20 ± 15 vs. -12 ± 18 ms; p = 0.046), the same V1-6d, but its local depolarization durations in V7 and V8 (V7 and V8d) were shorter compared to DSTP (-5 and -7 ms; p < 0.05). Interventricular dyssynchrony and LV lateral wall depolarization during myocardial pacing of the left septum are dependent on the relation of the leads´ tip to the LBB. Pacing positions closer to the LBB are responsible for bigger interventricular dyssynchrony and more physiological LV lateral wall depolarization.
资金来源类型:公共机构。当起搏在左间隔区域时，在纯心肌起搏时，起搏导联需要植入何处才能获得最大的生理心室激活尚不清楚。采用超高频心电图(UHF-ECG)比较高输出起搏可捕获左束支和不捕获左中隔心肌起搏时的心室激活情况。这是一项回顾性研究，心动过缓和深间隔心肌起搏靠近LBB (paraLBBP)或深间隔起搏远离LBB (DSTP)的患者，这两种情况都在V1区产生伪右束支形态。在paraLBBP期间，在0.5 ms时将起搏输出增加到5V时，左束分支捕获是可行的，但在DSTP期间，在高输出起搏时不可能捕获LBB。我们只分析了同时患有paraLBBP和DSTP的患者。比较两组间节律性QRS形态、lbbb电位存在、qr饱和度、V5区R波峰值时间(RWPT)、中隔导联深度、非同步化的UHF-ECG参数，即首末次心室激活差值e-DYS和心前导联局部去极化持续时间(V1-V8d)。从连续纳入的119例心动过缓患者中，我们确定了23例在植入过程中同时患有paraLBBP和DSTP。在x线上，DSTP期间铅头的位置比palbbp更浅(12±3比15±3 mm, p < 0.001)。所有病例均存在伪右束分支阻滞形态，但LBB电位在paraLBBP(23例中有17例)比DSTP(36例中有4例)更常见;P < 0.0001)。QRSd差异无统计学意义(146±14比142±14 ms, p = 0.08)，但DSTP的V5RWPT更长(86±11比83±9 ms;P = 0.03)。副bbp导致更大的室间不同步，e-DYS(-20±15 vs -12±18 ms;p = 0.046)， V1-6d相同，但V7和V8的局部去极化持续时间(V7和V8d)比DSTP短(-5和-7 ms;P < 0.05)。左中隔心肌起搏期间的室间非同步化和左室侧壁去极化取决于导联尖端与左室的关系。起搏位置越靠近LBB，室间非同步化越严重，左室侧壁去极化越生理性。
{"title":"Left ventricular septal pacing: how deep is enough?","authors":"K. Čurila, P. Jurák, P. Waldauf, J. Halámek, P. Stros, R. Smíšek, F. Plesinger, L. Znojilova, P. Leinveber, I. Viscor, D. Heřman, P. Osmančík, F. Prinzen","doi":"10.1093/europace/euac053.431","DOIUrl":"https://doi.org/10.1093/europace/euac053.431","url":null,"abstract":"Type of funding sources: Public Institution(s). Main funding source(s): Charles University Research Program When pacing in the left septal area, it is not clear where the pacing lead needs to be implanted to obtain the most physiological ventricular activation during pure myocardial pacing. To use UHF-ECG to compare ventricular activation between myocardial pacing of the left septum with and without the possibility to capture the left bundle branch by high output pacing. This was a retrospective study of patients with bradycardia and deep septal myocardial pacing close to LBB (paraLBBP) or deep septal pacing more distant from LBB (DSTP), which both produced a pseudo-right bundle branch morphology in V1. During paraLBBP, left bundle branch capture was feasible during increasing pacing output up to 5V at 0.5 ms, but during DSTP, LBB capture was not possible during high output pacing. Only patients with both paraLBBP and DSTP were analyzed. Paced QRS morphology, presence of LBBpotential, QRSduration, R wave peak time (RWPT) in V5, lead depth in the septum and UHF-ECG parameters of dyssynchrony, i.e., e-DYS as the difference between the first and last ventricular activation and local depolarization durations in precordial leads (V1-V8d) were compared between them. From 119 consecutive bradycardia patients enrolled, we identified 23 with both paraLBBP and DSTP during an implant procedure. On X-ray, a lead tip was placed shallower during DSTP than paraLBBP (12 ± 3 vs. 15 ± 3 mm, p < 0.001). A pseudo right bundle branch block morphology was present in all cases, but LBB potential was more frequently present in paraLBBP (17 of 23) than in DSTP (4 of 36; p < 0.0001). QRSd was not significantly different (146 ± 14 vs. 142 ± 14 ms, p = 0.08), but DSTP had longer V5RWPT (86 ± 11 vs. 83 ± 9 ms; p = 0.03). paraLBBP resulted in larger interventricular dyssynchrony, e-DYS (-20 ± 15 vs. -12 ± 18 ms; p = 0.046), the same V1-6d, but its local depolarization durations in V7 and V8 (V7 and V8d) were shorter compared to DSTP (-5 and -7 ms; p < 0.05). Interventricular dyssynchrony and LV lateral wall depolarization during myocardial pacing of the left septum are dependent on the relation of the leads´ tip to the LBB. Pacing positions closer to the LBB are responsible for bigger interventricular dyssynchrony and more physiological LV lateral wall depolarization.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"123 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73523227","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 : 2022-05-18DOI: 10.1093/europace/euac053.593
A. Lyon, WB Van Ham, S. Van Der Voorn, J. Heijman, F. Kirkels, A. Vink, A. Te Riele, J. Lumens, T. V. van Veen
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NWO - ZonMw (VIDI grant 016.176.340 to JL) Dutch Heart Foundation (ERA-CVD JTC2018 grant 2018T094; Dr. Dekker Program grant 2015T082 to JL) The Netherlands Cardio Vascular Research Initiative (CVON): the Dutch Heart Foundation, Dutch Federation of University Medical Center, the Netherlands Organization for Health Research and Development and the Royal Netherlands Academy of Sciences (CVON-eDETECT 2015-12 and CVON-PREDICT2 2018-30 to TvV). Patients with arrhythmogenic cardiomyopathy (ACM), an inherited progressive cardiac disease, mostly remain asymptomatic until the occurrence of life-threatening arrhythmias. Previous research identified disturbed calcium handling as a potential disease-initiating mechanism [1], but how this translates to arrhythmogenesis and cardiac mechanical dysfunction remains unknown. To characterize disturbed molecular regulators of intracellular calcium (Ca2+) handling in patients with ACM and predict their effects on action potential (AP), calcium transient (CaT) and tension development in both left and right ventricles (LV, RV) using a computer model of cellular electromechanics. We performed gene expression (qPCR) and protein level (Western blot) analysis using LV and RV tissue samples obtained from 5 ACM patients who underwent heart transplant and 5 controls with no history of cardiac disease. Changes in protein levels were implemented in our recent human electromechanical cardiomyocyte computer model [2]. CaT, AP and tension traces were simulated and compared to control. Clinical data (age, sex, genetics, ECG, echocardiography) were related to the simulation outcome. Measured protein levels varied significantly between the 5 patients and between individual LV and RV samples. Exemplary results for one ACM patient are shown in the figure below. In the LV, AP duration was shorter than control (221ms vs. 255ms), CaT peak was increased (0.52µM vs. 0.39µM) but CaT amplitude was reduced due to increased diastolic Ca2+ (0.26µM vs. 0.060µM). Relaxation was also impaired, as shown by a longer CaT and tension duration (965ms vs. 640ms), and an increased diastolic tension (10mN vs. 4.8mN). In the RV, AP duration was shortened, and CaT and tension peak were lower than in the LV (0.37µM and 13.6mN). Diastolic levels were elevated compared to control, and CaT and tension development were prolonged. This can be related to the measured Ca2+ changes: in the LV, a lower activity of the sodium-calcium exchanger (NCX) (22% of control) and SERCA pump (52%) combined with an increased ryanodine receptor (RyR) activity (96%) may impair the extrusion of Ca2+, leading to accumulation of Ca2+ and increased diastolic Ca2+ levels. In the RV, milder changes in NCX (48% of control) and RyR (11%) may explain the larger Ca2+ extrusion, leading to lower CaT peak and diastolic levels. The patient showed a normal LV size, a severely
资金来源类型:公共拨款-仅限国家预算。主要资助来源:NWO - ZonMw (VIDI资助016.176.340给JL)荷兰心脏基金会(ERA-CVD JTC2018资助2018T094;荷兰心血管研究计划(CVON):荷兰心脏基金会、荷兰大学医学中心联合会、荷兰卫生研究与发展组织和荷兰皇家科学院(CVON- edetect 2015-12和CVON- predict2 2018-30)。心律失常性心肌病(ACM)是一种遗传性进行性心脏病，大多数患者在发生危及生命的心律失常之前都没有症状。先前的研究发现，钙处理紊乱是一种潜在的疾病启动机制，但这如何转化为心律失常和心脏机械功能障碍仍不清楚。表征ACM患者细胞内钙(Ca2+)处理的干扰分子调节因子，并使用细胞电力学计算机模型预测其对左、右心室(LV、RV)动作电位(AP)、钙瞬态(CaT)和张力发展的影响。我们对5名接受心脏移植的ACM患者和5名无心脏病史的对照组的左室和右室组织样本进行了基因表达(qPCR)和蛋白水平(Western blot)分析。在我们最近的人类机电心肌细胞计算机模型[2]中实现了蛋白质水平的变化。模拟CaT、AP和张力轨迹，并与对照组进行比较。临床数据(年龄、性别、遗传学、心电图、超声心动图)与模拟结果相关。测量的蛋白水平在5名患者之间以及LV和RV个体样本之间存在显著差异。一个ACM患者的示例性结果如下图所示。在左室，AP持续时间比对照组短(221ms vs. 255ms)， CaT峰值增加(0.52µM vs. 0.39µM)，但由于舒张期Ca2+增加(0.26µM vs. 0.060µM)， CaT振幅降低。松弛也受损，表现为CaT和张力持续时间较长(965ms vs. 640ms)，舒张张力增加(10mN vs. 4.8mN)。RV组AP持续时间缩短，CaT和张力峰均低于LV组(0.37µM和13.6mN)。与对照组相比，舒张水平升高，CaT和张力发展延长。这可能与测量到的Ca2+变化有关:在左室中，钠钙交换器(NCX)(22%的对照组)和SERCA泵(52%)的活性较低，再加上ryanodine受体(RyR)活性的增加(96%)，可能会损害Ca2+的挤压，导致Ca2+的积累和舒张期Ca2+水平的增加。在右心室，NCX(对照组的48%)和RyR(11%)的轻微变化可能解释了较大的Ca2+挤压，导致较低的CaT峰值和舒张水平。患者左室大小正常，右室严重扩张，左室分数缩短较差，提示心室僵硬度增加，与模拟显示的潜在舒张受损一致。通过将ACM患者的蛋白质水平数据整合到细胞电力学的计算模型中，我们量化了患者特异性Ca2+处理变化的机电效应。这项工作的未来全心脏扩展有可能识别和理解ACM患者的心律失常机制。
{"title":"Computational modeling identifies the cellular electromechanical effects of disrupted intracellular calcium handling in arrhythmogenic cardiomyopathy patients","authors":"A. Lyon, WB Van Ham, S. Van Der Voorn, J. Heijman, F. Kirkels, A. Vink, A. Te Riele, J. Lumens, T. V. van Veen","doi":"10.1093/europace/euac053.593","DOIUrl":"https://doi.org/10.1093/europace/euac053.593","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NWO - ZonMw (VIDI grant 016.176.340 to JL) Dutch Heart Foundation (ERA-CVD JTC2018 grant 2018T094; Dr. Dekker Program grant 2015T082 to JL) The Netherlands Cardio Vascular Research Initiative (CVON): the Dutch Heart Foundation, Dutch Federation of University Medical Center, the Netherlands Organization for Health Research and Development and the Royal Netherlands Academy of Sciences (CVON-eDETECT 2015-12 and CVON-PREDICT2 2018-30 to TvV).\u0000 \u0000 \u0000 \u0000 Patients with arrhythmogenic cardiomyopathy (ACM), an inherited progressive cardiac disease, mostly remain asymptomatic until the occurrence of life-threatening arrhythmias. Previous research identified disturbed calcium handling as a potential disease-initiating mechanism [1], but how this translates to arrhythmogenesis and cardiac mechanical dysfunction remains unknown.\u0000 \u0000 \u0000 \u0000 To characterize disturbed molecular regulators of intracellular calcium (Ca2+) handling in patients with ACM and predict their effects on action potential (AP), calcium transient (CaT) and tension development in both left and right ventricles (LV, RV) using a computer model of cellular electromechanics.\u0000 \u0000 \u0000 \u0000 We performed gene expression (qPCR) and protein level (Western blot) analysis using LV and RV tissue samples obtained from 5 ACM patients who underwent heart transplant and 5 controls with no history of cardiac disease. Changes in protein levels were implemented in our recent human electromechanical cardiomyocyte computer model [2]. CaT, AP and tension traces were simulated and compared to control. Clinical data (age, sex, genetics, ECG, echocardiography) were related to the simulation outcome.\u0000 \u0000 \u0000 \u0000 Measured protein levels varied significantly between the 5 patients and between individual LV and RV samples. Exemplary results for one ACM patient are shown in the figure below. In the LV, AP duration was shorter than control (221ms vs. 255ms), CaT peak was increased (0.52µM vs. 0.39µM) but CaT amplitude was reduced due to increased diastolic Ca2+ (0.26µM vs. 0.060µM). Relaxation was also impaired, as shown by a longer CaT and tension duration (965ms vs. 640ms), and an increased diastolic tension (10mN vs. 4.8mN). In the RV, AP duration was shortened, and CaT and tension peak were lower than in the LV (0.37µM and 13.6mN). Diastolic levels were elevated compared to control, and CaT and tension development were prolonged. This can be related to the measured Ca2+ changes: in the LV, a lower activity of the sodium-calcium exchanger (NCX) (22% of control) and SERCA pump (52%) combined with an increased ryanodine receptor (RyR) activity (96%) may impair the extrusion of Ca2+, leading to accumulation of Ca2+ and increased diastolic Ca2+ levels. In the RV, milder changes in NCX (48% of control) and RyR (11%) may explain the larger Ca2+ extrusion, leading to lower CaT peak and diastolic levels. The patient showed a normal LV size, a severely ","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"81 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73633852","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 : 2022-05-18DOI: 10.1093/europace/euac053.567
L. Leenknegt, K. Zeppenfeld, A. Panfilov, H. Dierckx
Type of funding sources: Foundation. Main funding source(s): FWO-Flanders, KU Leuven internal starting grant Cardiac electrograms (EGMs) are one of the most important recordings obtained during electroanatomical voltage mapping and lie at the basis for planning most clinical electrophysiological interventions. Despite its widespread use, the relation of EGM shape and amplitude to the underlying excitation patterns and properties of cardiac tissue is not completely understood. Recent clinical studies [1] have provided important new guidelines on the relation between EGM amplitudes and the thickness of myocardial walls. The aim of this study is to quantify the effect of the wall thickness on EGM amplitudes and duration using analytical and in-silico approaches. We study bipolar EGMs both in-silico and analytically in a homogeneous slab of cardiac tissue (70 x 70 x L mm), where L = 2, 5, or 10 mm, with parallel fiber direction. Simulations were performed using the cardiac electrophysiology simulator openCARP [2]. Cardiac cells were described by the ten Tusscher-Panfilov 2006 model (TP06) [4] with epicardial tissue parameters. A plane wave propagating along the fiber direction was initiated. The extracellular voltage at 147 points arranged in a hemisphere around a point was measured to study the effect of bipolar electrode orientation (see Fig. 1A [3]). In addition, we developed an analytical approach to obtain an EGM, using an equivalent dipole representation of the depolarization wavefront and analytical evaluation of the corresponding integrals. Fig. 1B and 1C show the dependency of the EGM properties on the electrode orientation, as represented by the angles α (incidence angle) and β (angle between electrode and propagation direction) [3]. Solid lines represent data from a state-of-the-art numerical methodology, the dashed lines show our analytical estimations. Both the peak-to-peak amplitude and EGM width are well approximated by our theory for all orientations of the electrodes. Fig. 2 shows how the EGM is influenced by the myocardial wall thickness L. Both the amplitude and the duration are in good agreement with our theory. We observe that the amplitude as well as the width increase with the slab thickness, confirming the result in [1] but also delivering an accurate analytical expression for this change. It may thus allow to discriminate effects of thickness and other factors affecting the EGMs, such as substrate abnormalities, for example. We developed an analytical approach which can correctly describe the amplitude, duration, and shape of the depolarization part of the EGM. Our theory agrees with the previous in-silico and clinical studies on the influence of catheter orientation [3,5], and wall thickness [1,3]. Subsequent work in this direction is expected to provide better guidelines for clinical interpretation of EGMs, accounting for the effects of the thickness of myocardial wall in the characterizat
经费来源类型:基金会。心脏电图(EGMs)是电解剖电压测绘过程中获得的最重要的记录之一，是规划大多数临床电生理干预措施的基础。尽管它被广泛使用，但EGM的形状和振幅与心脏组织的潜在兴奋模式和特性的关系尚未完全了解。最近的临床研究为EGM振幅与心肌壁厚度之间的关系提供了重要的新指导。本研究的目的是利用分析和计算机方法量化壁厚对EGM振幅和持续时间的影响。我们在心脏组织的均匀板(70 x 70 x L mm)中进行了双极EGMs的硅质和解析性研究，其中L = 2、5或10 mm，具有平行纤维方向。使用心脏电生理模拟器openCARP[2]进行模拟。用10只Tusscher-Panfilov 2006模型(TP06)[4]描述心肌细胞，并记录心外膜组织参数。产生沿光纤方向传播的平面波。为了研究双极电极取向对细胞外电压的影响(见图1A[3])，我们测量了围绕一个点呈半球排列的147个点的细胞外电压。此外，我们开发了一种解析方法来获得EGM，使用去极化波前的等效偶极子表示和相应积分的解析计算。图1B和1C显示了EGM性能与电极方向的关系，用α(入射角)和β(电极与传播方向之间的夹角)[3]表示。实线表示最先进的数值方法的数据，虚线表示我们的分析估计。我们的理论可以很好地近似于电极所有方向的峰间振幅和EGM宽度。图2显示了心肌壁厚l对EGM的影响，其振幅和持续时间都与我们的理论很好地吻合。我们观察到振幅和宽度随着板坯厚度的增加而增加，证实了[1]的结果，但也为这种变化提供了准确的分析表达式。因此，它可以区分厚度和影响egm的其他因素的影响，例如衬底异常。我们开发了一种能够正确描述EGM去极化部分的振幅、持续时间和形状的分析方法。我们的理论与之前关于导管定向[3,5]和管壁厚度[1,3]影响的计算机和临床研究一致。该方向的后续工作有望为egm的临床解释提供更好的指导，考虑心肌壁厚度在心律失常底物表征中的作用。
{"title":"Insights into the intracardiac electrogram from analytical and numerical modelling","authors":"L. Leenknegt, K. Zeppenfeld, A. Panfilov, H. Dierckx","doi":"10.1093/europace/euac053.567","DOIUrl":"https://doi.org/10.1093/europace/euac053.567","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Foundation. Main funding source(s): FWO-Flanders, KU Leuven internal starting grant\u0000 \u0000 \u0000 \u0000 Cardiac electrograms (EGMs) are one of the most important recordings obtained during electroanatomical voltage mapping and lie at the basis for planning most clinical electrophysiological interventions. Despite its widespread use, the relation of EGM shape and amplitude to the underlying excitation patterns and properties of cardiac tissue is not completely understood. Recent clinical studies [1] have provided important new guidelines on the relation between EGM amplitudes and the thickness of myocardial walls. The aim of this study is to quantify the effect of the wall thickness on EGM amplitudes and duration using analytical and in-silico approaches.\u0000 \u0000 \u0000 \u0000 We study bipolar EGMs both in-silico and analytically in a homogeneous slab of cardiac tissue (70 x 70 x L mm), where L = 2, 5, or 10 mm, with parallel fiber direction. Simulations were performed using the cardiac electrophysiology simulator openCARP [2]. Cardiac cells were described by the ten Tusscher-Panfilov 2006 model (TP06) [4] with epicardial tissue parameters. A plane wave propagating along the fiber direction was initiated. The extracellular voltage at 147 points arranged in a hemisphere around a point was measured to study the effect of bipolar electrode orientation (see Fig. 1A [3]). In addition, we developed an analytical approach to obtain an EGM, using an equivalent dipole representation of the depolarization wavefront and analytical evaluation of the corresponding integrals.\u0000 \u0000 \u0000 \u0000 Fig. 1B and 1C show the dependency of the EGM properties on the electrode orientation, as represented by the angles α (incidence angle) and β (angle between electrode and propagation direction) [3]. Solid lines represent data from a state-of-the-art numerical methodology, the dashed lines show our analytical estimations. Both the peak-to-peak amplitude and EGM width are well approximated by our theory for all orientations of the electrodes.\u0000 Fig. 2 shows how the EGM is influenced by the myocardial wall thickness L. Both the amplitude and the duration are in good agreement with our theory. We observe that the amplitude as well as the width increase with the slab thickness, confirming the result in [1] but also delivering an accurate analytical expression for this change. It may thus allow to discriminate effects of thickness and other factors affecting the EGMs, such as substrate abnormalities, for example.\u0000 \u0000 \u0000 \u0000 We developed an analytical approach which can correctly describe the amplitude, duration, and shape of the depolarization part of the EGM. Our theory agrees with the previous in-silico and clinical studies on the influence of catheter orientation [3,5], and wall thickness [1,3]. Subsequent work in this direction is expected to provide better guidelines for clinical interpretation of EGMs, accounting for the effects of the thickness of myocardial wall in the characterizat","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"307 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74158716","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 : 2022-05-18DOI: 10.1093/europace/euac053.144
A. Aro, J. Haukka, O. Halminen, J. Putaala, M. Linna, P. Mustonen, J. Hartikainen, J. Airaksinen, M. Lehto
Type of funding sources: Foundation. Main funding source(s): Sigrid Juselius Foundation Atrial fibrillation (AF) is recognized as a major public health problem due to increased mortality, morbidity and risk of stroke. Advanced age and burden of other comorbidities are potential contributors to AF development and adverse outcomes. Clinical risk factor based CHA2DS2-VASc score is widely used to assess thromboembolic risk in AF, but mortality risk associated with different CHA2DS2-VASc scores is not established. Using data from a nationwide AF registry study including comorbidities and outcomes of unselected AF patients, we wanted to study whether CHA2DS2-VASc score could be useful in estimating prognosis in newly diagnosed AF patients. New-onset AF patients in Finland 2007-2017 were identified from comprehensive national registries. Comorbidities were gathered from individualized registry data on drug reimbursements and from ICD-10 diagnoses during hospitalizations and outpatient visits in primary and specialist care. These were used to create CHA2DS2-VASc risk score for each AF patient at cohort entry, including data on heart failure, hypertension, age, diabetes, stroke, vascular disease and sex. Patients were followed until the end of 2018 from the causes of death registry, which records every death in the country. All-cause mortality in each CHA2DS2-VASc category per 1000 person-years was determined, and relative risk (RR) of death according to the CHA2DS2-VASc category was calculated. A total of 229 357 patients with new-onset AF (mean age 73.2 ± 13.2 years, 50.0% female) were identified. Distribution of CHA2DS2-VASc score among these individuals is shown in Table. Mortality increased significantly with rising CHA2DS2-VASc risk score points, as demonstrated in Table. Compared to CHA2DS2-VASc 0, those with 2 points had a RR 2.9 (95%CI 2.7-3.1), 3 points RR 5.0 (4.7-5.3), 4 points RR 8.0 (7.5-8.4), 5 points RR 11.0 (10.4-11.7) and >5 points RR 14.8 (14.0-15.7) for all-cause mortality. In new-onset AF, mortality increased drastically with increasing age and comorbidities as depicted in the CHA2DS2-VASc score. Besides assessing thromboembolic risk, CHA2DS2-VASc score seems to be useful in estimating survival of AF patients.
{"title":"CHA2DS2-VASc score and the risk of death in atrial fibrillation","authors":"A. Aro, J. Haukka, O. Halminen, J. Putaala, M. Linna, P. Mustonen, J. Hartikainen, J. Airaksinen, M. Lehto","doi":"10.1093/europace/euac053.144","DOIUrl":"https://doi.org/10.1093/europace/euac053.144","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Foundation. Main funding source(s): Sigrid Juselius Foundation\u0000 \u0000 \u0000 \u0000 Atrial fibrillation (AF) is recognized as a major public health problem due to increased mortality, morbidity and risk of stroke. Advanced age and burden of other comorbidities are potential contributors to AF development and adverse outcomes. Clinical risk factor based CHA2DS2-VASc score is widely used to assess thromboembolic risk in AF, but mortality risk associated with different CHA2DS2-VASc scores is not established.\u0000 \u0000 \u0000 \u0000 Using data from a nationwide AF registry study including comorbidities and outcomes of unselected AF patients, we wanted to study whether CHA2DS2-VASc score could be useful in estimating prognosis in newly diagnosed AF patients.\u0000 \u0000 \u0000 \u0000 New-onset AF patients in Finland 2007-2017 were identified from comprehensive national registries. Comorbidities were gathered from individualized registry data on drug reimbursements and from ICD-10 diagnoses during hospitalizations and outpatient visits in primary and specialist care. These were used to create CHA2DS2-VASc risk score for each AF patient at cohort entry, including data on heart failure, hypertension, age, diabetes, stroke, vascular disease and sex. Patients were followed until the end of 2018 from the causes of death registry, which records every death in the country. All-cause mortality in each CHA2DS2-VASc category per 1000 person-years was determined, and relative risk (RR) of death according to the CHA2DS2-VASc category was calculated.\u0000 \u0000 \u0000 \u0000 A total of 229 357 patients with new-onset AF (mean age 73.2 ± 13.2 years, 50.0% female) were identified. Distribution of CHA2DS2-VASc score among these individuals is shown in Table. Mortality increased significantly with rising CHA2DS2-VASc risk score points, as demonstrated in Table. Compared to CHA2DS2-VASc 0, those with 2 points had a RR 2.9 (95%CI 2.7-3.1), 3 points RR 5.0 (4.7-5.3), 4 points RR 8.0 (7.5-8.4), 5 points RR 11.0 (10.4-11.7) and >5 points RR 14.8 (14.0-15.7) for all-cause mortality.\u0000 \u0000 \u0000 \u0000 In new-onset AF, mortality increased drastically with increasing age and comorbidities as depicted in the CHA2DS2-VASc score. Besides assessing thromboembolic risk, CHA2DS2-VASc score seems to be useful in estimating survival of AF patients.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"32 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75289024","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}
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