Pub Date : 2025-02-01DOI: 10.1016/j.hrthm.2024.07.096
Yang Yang MD , Mengmeng Li MD , Chenxi Jiang MD, Ribo Tang MD, Caihua Sang MD, Wei Wang MD, Xin Zhao MD, Changyi Li MD, Songnan Li MD, Xueyuan Guo MD, Changqi Jia MD, Man Ning MD, Li Feng MD, PhD, Dan Wen MD, Hui Zhu MD, Yuexin Jiang MD, Tong Liu MD, Fang Liu MD, Deyong Long MD, Jianzeng Dong MD, Changsheng Ma MD
Background
Although the electrocardiographic and electrophysiological properties of ventricular arrhythmias (VAs) from the vicinity of the lateral tricuspid annulus (TA) have been reported in previous studies, their precise site of origin have not been addressed.
Objective
The purpose of this study was to describe the precise origin of lateral TA-VA and the relevant anatomy.
Methods
Consecutive patients with idiopathic lateral TA-VAs were reviewed and analyzed. Three-dimensional mapping system combined with intracardiac echocardiography (ICE) was used for anatomic reconstruction, mapping, and ablation.
Results
During the study period, 63 patients with lateral TA-VAs were included. Under ICE view, a prominent enfoldment structure was observed under the valve along the lateral TA. The muscular bundle was documented in all patients (100%) within the subvalvular enfoldment with an average number and diameter of 4 ± 2 and 4.10 ± 0.73 mm, respectively. Initial ablation was attempted via the anterograde approach in 15 patients but succeeded in none. To reach the ventricular side of the TA, the catheter needed to enter the ventricular chamber and retroflexed toward the atrial side with a reverse curve. The earliest activation site was found at the valvular end of muscular bundles in 51 of the 63 patients (80.9%) with a local activation time of –26.78 ± 4.63 ms. The VAs were eliminated after an average of 4 ± 2 seconds of ablation.
Conclusion
The ventricular side adjacent to the lateral TA exhibits a subvalvular enfoldment-like structure, which is rich in muscular bundles and serves as the origin of TA-VAs in most patients. To reach the origins, a reverse technique is required.
{"title":"Idiopathic ventricular arrhythmia originating from the vicinity of lateral tricuspid annulus: The precise origin and anatomic concerns","authors":"Yang Yang MD , Mengmeng Li MD , Chenxi Jiang MD, Ribo Tang MD, Caihua Sang MD, Wei Wang MD, Xin Zhao MD, Changyi Li MD, Songnan Li MD, Xueyuan Guo MD, Changqi Jia MD, Man Ning MD, Li Feng MD, PhD, Dan Wen MD, Hui Zhu MD, Yuexin Jiang MD, Tong Liu MD, Fang Liu MD, Deyong Long MD, Jianzeng Dong MD, Changsheng Ma MD","doi":"10.1016/j.hrthm.2024.07.096","DOIUrl":"10.1016/j.hrthm.2024.07.096","url":null,"abstract":"<div><h3>Background</h3><div>Although the electrocardiographic and electrophysiological properties of ventricular arrhythmias (VAs) from the vicinity of the lateral tricuspid annulus (TA) have been reported in previous studies, their precise site of origin have not been addressed.</div></div><div><h3>Objective</h3><div>The purpose of this study was to describe the precise origin of lateral TA-VA and the relevant anatomy.</div></div><div><h3>Methods</h3><div>Consecutive patients with idiopathic lateral TA-VAs were reviewed and analyzed. Three-dimensional mapping system combined with intracardiac echocardiography (ICE) was used for anatomic reconstruction, mapping, and ablation.</div></div><div><h3>Results</h3><div>During the study period, 63 patients with lateral TA-VAs were included. Under ICE view, a prominent enfoldment structure was observed under the valve along the lateral TA. The muscular bundle was documented in all patients (100%) within the subvalvular enfoldment with an average number and diameter of 4 ± 2 and 4.10 ± 0.73 mm, respectively. Initial ablation was attempted via the anterograde approach in 15 patients but succeeded in none. To reach the ventricular side of the TA, the catheter needed to enter the ventricular chamber and retroflexed toward the atrial side with a reverse curve. The earliest activation site was found at the valvular end of muscular bundles in 51 of the 63 patients (80.9%) with a local activation time of –26.78 ± 4.63 ms. The VAs were eliminated after an average of 4 ± 2 seconds of ablation.</div></div><div><h3>Conclusion</h3><div>The ventricular side adjacent to the lateral TA exhibits a subvalvular enfoldment-like structure, which is rich in muscular bundles and serves as the origin of TA-VAs in most patients. To reach the origins, a reverse technique is required.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 2","pages":"Pages 503-509"},"PeriodicalIF":5.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.hrthm.2024.07.021
Mate Vamos MD, PhD , Elod-Janos Zsigmond MD, PhD , Mauro Biffi MD , Flora Diana Gausz MD , Nora Keller PharmD , Peter Kupo MD, PhD , Tamas Szili-Torok MD, PhD , Matteo Ziacchi MD , Alexander P. Benz MD , Raphael Spittler MD, MSc , Anna Vagvolgyi MD, PhD
Background
The subcutaneous implantable cardioverter-defibrillator (S-ICD) has emerged as an alternative to transvenous systems for prevention of sudden cardiac death. However, concerns have been raised regarding its efficacy and safety in obese individuals.
Objective
The purpose of this study was to perform a meta-analysis to evaluate the efficacy and safety of the S-ICD in patients with obesity by assessing the relationship between body mass index (BMI) and clinical outcomes.
Methods
A comprehensive search of multiple databases was conducted for English-language peer-reviewed studies reporting clinical outcomes in S-ICD recipients with (BMI ≥30 kg/m2) and without obesity (BMI <30 kg/m2). Data on preimplantation screening failure, defibrillation testing, complications, appropriate and inappropriate shocks, and survival were analyzed using standard, random-effects, meta-analytical techniques.
Results
Twenty-nine studies involving 20,486 patients were included. There was no statistically significant difference in mean BMI values of patients with failed or successful preimplantation screening (mean difference –0.60 kg/m2; 95% confidence interval [CI] –2.06 to 0.86). Obesity was associated with higher rates of failed defibrillation testing at ≤65 J (odds ratio [OR] 2.16; 95% CI 1.39–3.35), and malpositioning/suboptimal positioning occurred more frequently in obese compared to nonobese patients (OR 3.37; 95% CI 1.76–6.44). Increased BMI as a continuous variable (per increase in 1 kg/m2 BMI) was associated with elevated defibrillation thresholds (OR 1.05; 95% CI 1.03–1.08); higher risk of complications (hazard ratio [HR] 1.04; 95% CI 1.02–1.05); a trend toward an increased number of appropriate shocks (HR 1.02; 95% CI 1.00–1.04); and no significant increase in the risk of inappropriate shocks (HR 1.01; 95% CI 0.99–1.03).
Conclusion
This meta-analysis underscores the importance of considering obesity in S-ICD implantation decisions. Although S-ICD remains effective in obese patients, attention to potential technical challenges and higher complication rates is warranted.
背景：皮下植入式心律转复除颤器（S-ICD）已成为预防心脏性猝死的经静脉系统的替代方案。然而，人们对其在肥胖者中的疗效和安全性表示担忧：本荟萃分析旨在通过评估体重指数（BMI）与临床结果之间的关系，评估 S-ICD 对肥胖患者的疗效和安全性：我们对多个数据库进行了全面检索，以寻找报道肥胖（体重指数≥30 kg/m2）和非肥胖（体重指数2）S-ICD接受者临床疗效的英文同行评审研究。采用标准随机效应荟萃分析技术对植入前筛查失败、除颤测试、并发症、适当和不适当电击以及存活率等数据进行了分析：共纳入 29 项研究，涉及 20,486 名患者。植入前筛查失败或成功患者的平均体重指数值在统计学上没有明显差异（平均差异为-0.60 kg/m2，95% CI为-2.06至0.86）。肥胖与≤65J除颤测试失败率较高有关（OR 2.16，95% CI 1.39-3.35），与非肥胖患者相比，肥胖患者的定位不良/不理想发生率更高（OR 3.37，95% CI 1.76-6.44）。作为一个连续变量，体重指数的增加（体重指数每增加 1 kg/m2 ）与除颤阈值升高（OR 1.05，95% CI 1.03-1.08）、并发症风险升高（HR 1.04，95% CI 1.02-1.05）、适当电击次数增加（HR 1.02，95% CI 1.00-1.04）的趋势相关，而不适当电击的风险没有显著增加（HR 1.01，95% CI 0.99-1.03）：这项荟萃分析强调了在决定是否植入 S-ICD 时考虑肥胖因素的重要性。虽然 S-ICD 对肥胖患者仍然有效，但需要注意潜在的技术挑战和较高的并发症发生率。
{"title":"Efficacy and safety of the subcutaneous implantable cardioverter-defibrillator in patients with and without obesity: A meta-analysis","authors":"Mate Vamos MD, PhD , Elod-Janos Zsigmond MD, PhD , Mauro Biffi MD , Flora Diana Gausz MD , Nora Keller PharmD , Peter Kupo MD, PhD , Tamas Szili-Torok MD, PhD , Matteo Ziacchi MD , Alexander P. Benz MD , Raphael Spittler MD, MSc , Anna Vagvolgyi MD, PhD","doi":"10.1016/j.hrthm.2024.07.021","DOIUrl":"10.1016/j.hrthm.2024.07.021","url":null,"abstract":"<div><h3>Background</h3><div>The subcutaneous implantable cardioverter-defibrillator (S-ICD) has emerged as an alternative to transvenous systems for prevention of sudden cardiac death. However, concerns have been raised regarding its efficacy and safety in obese individuals.</div></div><div><h3>Objective</h3><div>The purpose of this study was to perform a meta-analysis to evaluate the efficacy and safety of the S-ICD in patients with obesity by assessing the relationship between body mass index (BMI) and clinical outcomes.</div></div><div><h3>Methods</h3><div>A comprehensive search of multiple databases was conducted for English-language peer-reviewed studies reporting clinical outcomes in S-ICD recipients with (BMI ≥30 kg/m<sup>2</sup>) and without obesity (BMI <30 kg/m<sup>2</sup>). Data on preimplantation screening failure, defibrillation testing, complications, appropriate and inappropriate shocks, and survival were analyzed using standard, random-effects, meta-analytical techniques.</div></div><div><h3>Results</h3><div>Twenty-nine studies involving 20,486 patients were included. There was no statistically significant difference in mean BMI values of patients with failed or successful preimplantation screening (mean difference –0.60 kg/m<sup>2</sup>; 95% confidence interval [CI] –2.06 to 0.86). Obesity was associated with higher rates of failed defibrillation testing at ≤65 J (odds ratio [OR] 2.16; 95% CI 1.39–3.35), and malpositioning/suboptimal positioning occurred more frequently in obese compared to nonobese patients (OR 3.37; 95% CI 1.76–6.44). Increased BMI as a continuous variable (per increase in 1 kg/m<sup>2</sup> BMI) was associated with elevated defibrillation thresholds (OR 1.05; 95% CI 1.03–1.08); higher risk of complications (hazard ratio [HR] 1.04; 95% CI 1.02–1.05); a trend toward an increased number of appropriate shocks (HR 1.02; 95% CI 1.00–1.04); and no significant increase in the risk of inappropriate shocks (HR 1.01; 95% CI 0.99–1.03).</div></div><div><h3>Conclusion</h3><div>This meta-analysis underscores the importance of considering obesity in S-ICD implantation decisions. Although S-ICD remains effective in obese patients, attention to potential technical challenges and higher complication rates is warranted.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 2","pages":"Pages 375-387"},"PeriodicalIF":5.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.hrthm.2024.07.099
Andrew Andreae MD , Eric Black-Maier MD , Kelly Arps MD , Elizabeth Kobe MD , Trevor Johnson MS , Peter Shrader MS , DaJuanicia Holmes MS , Emily Towery RN, BSN , Albert Sun MD , Daniel J. Friedman MD , Jason Koontz MD , Jacob Schroder MD , Carmelo Milano MD , Michel G. Khouri MD , Jason N. Katz MD, MHS , Richa Agarwal MD , Stuart D. Russell MD , Sean Pokorney MD , James Daubert MD, FHRS , Jonathan Piccini MD, MHS, FHRS
Background
Implantable cardioverter-defibrillator (ICD) shocks are a common complication after left ventricular assist device (LVAD) implantation; however, data on their frequency and causes are limited.
Objective
The purpose of this study was to define the incidence, programming, patient characteristics, and factors associated with appropriate and inappropriate ICD shocks in persons with LVADs.
Methods
We performed a retrospective review at Duke University Hospital of all LVAD recipients implanted between January 1, 2013, to June 30, 2019, with a preexisting ICD. ICD shocks were adjudicated by the treating physician and a second reviewer for the purpose of this study.
Results
Among 421 patients with an ICD in situ undergoing LVAD implant, 147 (33.9%) had at least 1 shock after LVAD implantation. Among 134 patients with complete device history, a total of 330 shock episodes occurred: 255 (77.3%) appropriate and 75 (22.7%) inappropriate. Etiologies for inappropriate shocks included supraventricular tachycardia (n = 66 [20.0%]), physiological oversensing (n = 1 [0.3%]), and nonphysiological oversensing (n = 8 [2.4%]) including LVAD electromagnetic interference (n = 1 [0.3%]). ICD programming with shorter detection delay (P <.001) and absence of antitachycardia pacing programming (P = .001) in high-rate zones was seen more commonly in inappropriate shock than appropriate shock.
Conclusions
The rate of inappropriate shocks in LVAD recipients is very high and most often is due to supraventricular arrhythmias. LVAD electromagnetic interference is a rare cause of ICD shock. Implementation of current consensus American Heart Association recommendations for LVAD programming with long detection delays and high rate cutoffs may help prevent inappropriate ICD shocks.
{"title":"Appropriate and inappropriate ICD shocks in patients with LVADs: Prevalence, associated factors, and etiologies","authors":"Andrew Andreae MD , Eric Black-Maier MD , Kelly Arps MD , Elizabeth Kobe MD , Trevor Johnson MS , Peter Shrader MS , DaJuanicia Holmes MS , Emily Towery RN, BSN , Albert Sun MD , Daniel J. Friedman MD , Jason Koontz MD , Jacob Schroder MD , Carmelo Milano MD , Michel G. Khouri MD , Jason N. Katz MD, MHS , Richa Agarwal MD , Stuart D. Russell MD , Sean Pokorney MD , James Daubert MD, FHRS , Jonathan Piccini MD, MHS, FHRS","doi":"10.1016/j.hrthm.2024.07.099","DOIUrl":"10.1016/j.hrthm.2024.07.099","url":null,"abstract":"<div><h3>Background</h3><div>Implantable cardioverter-defibrillator (ICD) shocks are a common complication after left ventricular assist device (LVAD) implantation; however, data on their frequency and causes are limited.</div></div><div><h3>Objective</h3><div>The purpose of this study was to define the incidence, programming, patient characteristics, and factors associated with appropriate and inappropriate ICD shocks in persons with LVADs.</div></div><div><h3>Methods</h3><div>We performed a retrospective review at Duke University Hospital of all LVAD recipients implanted between January 1, 2013, to June 30, 2019, with a preexisting ICD. ICD shocks were adjudicated by the treating physician and a second reviewer for the purpose of this study.</div></div><div><h3>Results</h3><div>Among 421 patients with an ICD <em>in situ</em> undergoing LVAD implant, 147 (33.9%) had at least 1 shock after LVAD implantation. Among 134 patients with complete device history, a total of 330 shock episodes occurred: 255 (77.3%) appropriate and 75 (22.7%) inappropriate. Etiologies for inappropriate shocks included supraventricular tachycardia (n = 66 [20.0%]), physiological oversensing (n = 1 [0.3%]), and nonphysiological oversensing (n = 8 [2.4%]) including LVAD electromagnetic interference (n = 1 [0.3%]). ICD programming with shorter detection delay (<em>P</em> <.001) and absence of antitachycardia pacing programming (<em>P</em> = .001) in high-rate zones was seen more commonly in inappropriate shock than appropriate shock.</div></div><div><h3>Conclusions</h3><div>The rate of inappropriate shocks in LVAD recipients is very high and most often is due to supraventricular arrhythmias. LVAD electromagnetic interference is a rare cause of ICD shock. Implementation of current consensus American Heart Association recommendations for LVAD programming with long detection delays and high rate cutoffs may help prevent inappropriate ICD shocks.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 2","pages":"Pages 394-402"},"PeriodicalIF":5.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.hrthm.2024.07.094
Jose Osorio MD, FHRS , Daniela Hincapie MD , Allyson L. Varley PhD , Joshua R. Silverstein MD, FHRS , Carlos D. Matos MD , Amit J. Thosani MD, FHRS , Christopher Thorne PhD , Benjamin D’Souza MD, FHRS , Isabella Alviz MD , Mohamed Gabr MD , Anil Rajendra MD, FHRS , Saumil Oza MD , Dinesh Sharma MD, MPH, FHRS , Carolina Hoyos MD , Matthew J. Singleton MD, FHRS , Chinmaya Mareddy MD , Alejandro Velasco MD , Paul C. Zei MD, PhD, FHRS , William H. Sauer MD, FHRS , Jorge E. Romero MD, FHRS
Background
High-frequency, low-tidal volume (HFLTV) ventilation increases the efficacy and efficiency of radiofrequency catheter ablation (RFCA) of paroxysmal atrial fibrillation. Whether those benefits can be extrapolated to RFCA of persistent atrial fibrillation (PeAF) is undetermined.
Objective
The purpose of this study was to evaluate whether using HFLTV ventilation during RFCA in patients with PeAF is associated with improved procedural and long-term clinical outcomes compared to standard ventilation (SV).
Methods
In this prospective multicenter registry (REAL-AF), patients who had undergone pulmonary vein isolation (PVI) + posterior wall isolation (PWI) for PeAF using either HFLTV ventilation or SV were included. The primary efficacy outcome was freedom from all-atrial arrhythmias at 12 months. Secondary outcomes included procedural and long-term clinical outcomes and complications.
Results
A total of 210 patients were included (HFLTV=95 vs. SV=115) in the analysis. There were no differences in baseline characteristics between the groups. Procedural time (80 [66–103.5] minutes vs 110 [85–141] minutes; P <.001), total radiofrequency (RF) time (18.73 [13.93–26.53] minutes vs 26.15 [20.30–35.25] minutes; P <.001), and pulmonary vein RF time (11.35 [8.78–16.69] minutes vs 18 [13.74–24.14] minutes; P <.001) were significantly shorter using HFLTV ventilation compared with SV. Freedom from all-atrial arrhythmias was significantly higher with HFLTV ventilation compared with SV (82.1% vs 68.7%; hazard ratio 0.41; 95% confidence interval [0.21–0.82]; P = .012), indicating a 43% relative risk reduction and a 13.4% absolute risk reduction in all-atrial arrhythmia recurrence. There was no difference in long-term procedure-related complications between the groups (HFLTV 1.1% vs SV 0%, P = .270).
Conclusion
In patients undergoing RFCA with PVI + PWI for PeAF, the use of HFLTV ventilation was associated with higher freedom from all-atrial arrhythmias at 12-month follow-up, with significantly shorter procedural and RF times compared to SV, while reporting a similar safety profile.
{"title":"High-frequency low-tidal volume ventilation improves procedural and long-term clinical outcomes in persistent atrial fibrillation ablation: Prospective multicenter registry","authors":"Jose Osorio MD, FHRS , Daniela Hincapie MD , Allyson L. Varley PhD , Joshua R. Silverstein MD, FHRS , Carlos D. Matos MD , Amit J. Thosani MD, FHRS , Christopher Thorne PhD , Benjamin D’Souza MD, FHRS , Isabella Alviz MD , Mohamed Gabr MD , Anil Rajendra MD, FHRS , Saumil Oza MD , Dinesh Sharma MD, MPH, FHRS , Carolina Hoyos MD , Matthew J. Singleton MD, FHRS , Chinmaya Mareddy MD , Alejandro Velasco MD , Paul C. Zei MD, PhD, FHRS , William H. Sauer MD, FHRS , Jorge E. Romero MD, FHRS","doi":"10.1016/j.hrthm.2024.07.094","DOIUrl":"10.1016/j.hrthm.2024.07.094","url":null,"abstract":"<div><h3>Background</h3><div>High-frequency, low-tidal volume (HFLTV) ventilation increases the efficacy and efficiency of radiofrequency catheter ablation (RFCA) of paroxysmal atrial fibrillation. Whether those benefits can be extrapolated to RFCA of persistent atrial fibrillation (PeAF) is undetermined.</div></div><div><h3>Objective</h3><div>The purpose of this study was to evaluate whether using HFLTV ventilation during RFCA in patients with PeAF is associated with improved procedural and long-term clinical outcomes compared to standard ventilation (SV).</div></div><div><h3>Methods</h3><div>In this prospective multicenter registry (REAL-AF), patients who had undergone pulmonary vein isolation (PVI) + posterior wall isolation (PWI) for PeAF using either HFLTV ventilation or SV were included. The primary efficacy outcome was freedom from all-atrial arrhythmias at 12 months. Secondary outcomes included procedural and long-term clinical outcomes and complications.</div></div><div><h3>Results</h3><div>A total of 210 patients were included (HFLTV=95 vs. SV=115) in the analysis. There were no differences in baseline characteristics between the groups. Procedural time (80 [66–103.5] minutes vs 110 [85–141] minutes; <em>P</em> <.001), total radiofrequency (RF) time (18.73 [13.93–26.53] minutes vs 26.15 [20.30–35.25] minutes; <em>P</em> <.001), and pulmonary vein RF time (11.35 [8.78–16.69] minutes vs 18 [13.74–24.14] minutes; <em>P</em> <.001) were significantly shorter using HFLTV ventilation compared with SV. Freedom from all-atrial arrhythmias was significantly higher with HFLTV ventilation compared with SV (82.1% vs 68.7%; hazard ratio 0.41; 95% confidence interval [0.21–0.82]; <em>P</em> = .012), indicating a 43% relative risk reduction and a 13.4% absolute risk reduction in all-atrial arrhythmia recurrence. There was no difference in long-term procedure-related complications between the groups (HFLTV 1.1% vs SV 0%, <em>P</em> = .270).</div></div><div><h3>Conclusion</h3><div>In patients undergoing RFCA with PVI + PWI for PeAF, the use of HFLTV ventilation was associated with higher freedom from all-atrial arrhythmias at 12-month follow-up, with significantly shorter procedural and RF times compared to SV, while reporting a similar safety profile.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 2","pages":"Pages 432-442"},"PeriodicalIF":5.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Data on transvenous (TV) lead–associated superior vena cava (SVC) syndrome are limited. The management of this problem might require a multidisciplinary approach, often involving transvenous lead extraction (TLE) followed by angioplasty and stenting.
Objective
The purpose of this study was to describe the management and outcome of TV lead–associated SVC syndrome.
Methods
We retrospectively identified patients with a diagnosis of SVC syndrome and TV leads at Emory Healthcare between 2015 and 2023.
Results
Fifteen patients with lead-related SVC syndrome were identified. The cohort average age was 50 years. Symptoms included swelling of the face, neck, and upper extremities (67%); shortness of breath (53%); and lightheadedness (40%). Patients had an average of 2 ± 0.7 leads crossing the SVC, with a lead dwell time of 9.8 ± 7.5 years. Thirteen patients were managed with TLE, followed by SVC stenting and angioplasty in 10 and angioplasty alone in 2; 1 patient had no intervention after TLE. One patient was managed with anticoagulation, and another had angioplasty and stenting with lead jailing. One patient experienced SVC perforation and cardiac tamponade during SVC stenting, which was managed successfully with a covered stent and pericardiocentesis. Among the 12 patients with TLE and angioplasty ± stenting, 7 underwent reimplantation of a transvenous lead. Two of those patients had symptoms recurrence, and none of the 5 patients without lead reimplantation had recurrence of symptoms.
Conclusion
Lead-related SVC syndrome management requires a multidisciplinary approach often including TLE followed by angioplasty and stenting. Avoiding TV lead reimplantation might help reduce symptoms recurrence.
{"title":"Managing superior vena cava syndrome in patients with cardiac implantable electronic device leads: Strategies and considerations","authors":"Wissam Mekary MD , Elsa Hebbo MD , Anand Shah MD , Stacy Westerman MD , Neal Bhatia MD , Isida Byku MD , Vasilis Babaliaros MD , Adam Greenbaum MD , Faisal M. Merchant MD, FHRS , Mikhael F. El-Chami MD, FHRS","doi":"10.1016/j.hrthm.2024.06.060","DOIUrl":"10.1016/j.hrthm.2024.06.060","url":null,"abstract":"<div><h3>Background</h3><div>Data on transvenous (TV) lead–associated superior vena cava (SVC) syndrome are limited. The management of this problem might require a multidisciplinary approach, often involving transvenous lead extraction (TLE) followed by angioplasty and stenting.</div></div><div><h3>Objective</h3><div>The purpose of this study was to describe the management and outcome of TV lead–associated SVC syndrome.</div></div><div><h3>Methods</h3><div>We retrospectively identified patients with a diagnosis of SVC syndrome and TV leads at Emory Healthcare between 2015 and 2023.</div></div><div><h3>Results</h3><div>Fifteen patients with lead-related SVC syndrome were identified. The cohort average age was 50 years. Symptoms included swelling of the face, neck, and upper extremities (67%); shortness of breath (53%); and lightheadedness (40%). Patients had an average of 2 ± 0.7 leads crossing the SVC, with a lead dwell time of 9.8 ± 7.5 years. Thirteen patients were managed with TLE, followed by SVC stenting and angioplasty in 10 and angioplasty alone in 2; 1 patient had no intervention after TLE. One patient was managed with anticoagulation, and another had angioplasty and stenting with lead jailing. One patient experienced SVC perforation and cardiac tamponade during SVC stenting, which was managed successfully with a covered stent and pericardiocentesis. Among the 12 patients with TLE and angioplasty ± stenting, 7 underwent reimplantation of a transvenous lead. Two of those patients had symptoms recurrence, and none of the 5 patients without lead reimplantation had recurrence of symptoms.</div></div><div><h3>Conclusion</h3><div>Lead-related SVC syndrome management requires a multidisciplinary approach often including TLE followed by angioplasty and stenting. Avoiding TV lead reimplantation might help reduce symptoms recurrence.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 2","pages":"Pages 311-317"},"PeriodicalIF":5.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141537826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.hrthm.2024.07.027
Gianfranco Mitacchione MD, PhD , Marco Schiavone MD , Alessio Gasperetti MD, PhD , Giovanni L. Tripepi MD , Manuel Cerini MD , Elisabetta Montemerlo MD , Alvise Del Monte MD , Luca Bontempi MD , Massimo Moltrasio MD , Alexander Breitenstein MD , Cinzia Monaco MD , Pietro Palmisano MD , Giovanni Rovaris MD , Gian-Battista Chierchia MD , Antonio Dello Russo MD , Mauro Biffi MD , Carlo de Asmundis MD , Patrizio Mazzone MD , Luigi Di Biase MD, PhD , Maurizio Gallieni MD , Giovanni B. Forleo MD, PhD
Background
Limited data are available on leadless pacemaker (LPM) outcomes according to different stages of chronic kidney disease (CKD).
Objective
The purpose of this study was to investigate differences in the safety and efficacy of LPMs among patients stratified per different stages of renal function.
Methods
Consecutive patients enrolled in the multicenter international i-LEAPER registry (International LEAdless PacemakEr Registry) were analyzed. Patients were divided into 3 groups according to CKD stage. The primary end point was the comparison of LPM-related major complication rate at implantation and during follow-up. Differences in electrical performance were deemed secondary outcomes.
Results
Of the 1748 patients enrolled, 33% were in CKD stage G3a/G3b and 9.4% were in CKD stage G4/G5. Patients with CKD presented cardiovascular comorbidities more frequently. During a median follow-up of 39 months (interquartile range [IQR] 18–59 months), major complication rate did not differ between groups (normal kidney function [NKF] group 1.8% vs CKD stage G3a/G3b group 2.9% vs CKD stage G4/G5 group 2.4%; P = .418). All-cause mortality resulted higher in the CKD stage G4/G5 group than in the NKF group (19.5% vs 9.8%; adjusted hazard ratio 1.9; 95% confidence interval 1.25–2.89; P = .003). LPM electrical performance was comparable between groups, except for patients with CKD who showed a slightly higher pacing threshold during 1-month follow-up (NKF group 0.50 V [IQR 0.35–0.70 V] vs G3a/G3b group 0.56 V [IQR 0.38–0.81 V] vs G4/G5 group 0.51 V [0.38–0.84 V] @ 0.24 ms; P < .001).
Conclusion
In a real-world setting, patients with advanced CKD who underwent LPM implantation were underrepresented. Although all-cause mortality was higher in end-stage CKD, periprocedural complications and LPM performance were overall comparable between NKF and different stages of CKD, except for higher values of pacing threshold in patients with CKD up to first-month follow-up.
{"title":"Leadless pacemakers in patients with different stages of chronic kidney disease: Real-world data from the updated i-LEAPER registry","authors":"Gianfranco Mitacchione MD, PhD , Marco Schiavone MD , Alessio Gasperetti MD, PhD , Giovanni L. Tripepi MD , Manuel Cerini MD , Elisabetta Montemerlo MD , Alvise Del Monte MD , Luca Bontempi MD , Massimo Moltrasio MD , Alexander Breitenstein MD , Cinzia Monaco MD , Pietro Palmisano MD , Giovanni Rovaris MD , Gian-Battista Chierchia MD , Antonio Dello Russo MD , Mauro Biffi MD , Carlo de Asmundis MD , Patrizio Mazzone MD , Luigi Di Biase MD, PhD , Maurizio Gallieni MD , Giovanni B. Forleo MD, PhD","doi":"10.1016/j.hrthm.2024.07.027","DOIUrl":"10.1016/j.hrthm.2024.07.027","url":null,"abstract":"<div><h3>Background</h3><div>Limited data are available on leadless pacemaker (LPM) outcomes according to different stages of chronic kidney disease (CKD).</div></div><div><h3>Objective</h3><div>The purpose of this study was to investigate differences in the safety and efficacy of LPMs among patients stratified per different stages of renal function.</div></div><div><h3>Methods</h3><div>Consecutive patients enrolled in the multicenter international i-LEAPER registry (International LEAdless PacemakEr Registry) were analyzed. Patients were divided into 3 groups according to CKD stage. The primary end point was the comparison of LPM-related major complication rate at implantation and during follow-up. Differences in electrical performance were deemed secondary outcomes.</div></div><div><h3>Results</h3><div>Of the 1748 patients enrolled, 33% were in CKD stage G3a/G3b and 9.4% were in CKD stage G4/G5. Patients with CKD presented cardiovascular comorbidities more frequently. During a median follow-up of 39 months (interquartile range [IQR] 18–59 months), major complication rate did not differ between groups (normal kidney function [NKF] group 1.8% vs CKD stage G3a/G3b group 2.9% vs CKD stage G4/G5 group 2.4%; <em>P</em> = .418). All-cause mortality resulted higher in the CKD stage G4/G5 group than in the NKF group (19.5% vs 9.8%; adjusted hazard ratio 1.9; 95% confidence interval 1.25–2.89; <em>P</em> = .003). LPM electrical performance was comparable between groups, except for patients with CKD who showed a slightly higher pacing threshold during 1-month follow-up (NKF group 0.50 V [IQR 0.35–0.70 V] vs G3a/G3b group 0.56 V [IQR 0.38–0.81 V] vs G4/G5 group 0.51 V [0.38–0.84 V] @ 0.24 ms; <em>P</em> < .001).</div></div><div><h3>Conclusion</h3><div>In a real-world setting, patients with advanced CKD who underwent LPM implantation were underrepresented. Although all-cause mortality was higher in end-stage CKD, periprocedural complications and LPM performance were overall comparable between NKF and different stages of CKD, except for higher values of pacing threshold in patients with CKD up to first-month follow-up.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 2","pages":"Pages 325-331"},"PeriodicalIF":5.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.hrthm.2024.07.103
Alonzo Armani Prata , Eric Katsuyama MD , Pedro Scardini , Vanio Antunes , João Granja , Ana Carolina Coan , Christian Fukunaga , Juan Carlos Pachón Mateos MD, PhD
Background
Cardioneuroablation (CNA) is a novel procedure that shows promising results in reducing syncope recurrence in patients with refractory vasovagal syncope (VVS). However, its effectiveness and safety remain controversial.
Objective
We performed an updated meta-analysis evaluating CNA efficacy and safety in patients with refractory VVS.
Methods
PubMed, Embase, and Cochrane databases were systematically searched for CNA studies in patients with refractory VVS. Our primary efficacy end point was syncope recurrence, and our safety end point was periprocedural complications. Prespecified subgroup analyses were performed for (1) the ganglionated plexus (GP) targeting method and (2) the GP location of ablation.
Results
We included 27 observational studies and 1 randomized controlled trial encompassing 1153 patients with refractory VVS who underwent CNA. The median age was 39.6 years, and follow-up was 21.4 months. The overall weighted rate of syncope recurrence after CNA was 5.94% (95% confidence interval [CI] 3.37%–9.01%; I2 = 64%), and the rate of periprocedural complications was 0.99% (95% CI 0.14%–2.33%; I2 = 0%). Our prespecified subgroup analysis using the GP targeting method and GP ablation location showed a higher prevalence of syncope recurrence in the electroanatomic mapping subgroup (6.21%; 95% CI 2.93%–10.28%; I2 = 0%) and in the right atrium approach (15.78%; 95% CI 3.61%–33.14%; I2 = 65.2%).
Conclusion
This study supports the efficacy and safety of CNA in preventing syncope recurrence in patients with VVS. Furthermore, the electroanatomic mapping method of GP targeting and the right atrium approach were associated with a higher syncope recurrence rate than other methods.
{"title":"Cardioneuroablation in patients with vasovagal syncope: An updated systematic review and meta-analysis","authors":"Alonzo Armani Prata , Eric Katsuyama MD , Pedro Scardini , Vanio Antunes , João Granja , Ana Carolina Coan , Christian Fukunaga , Juan Carlos Pachón Mateos MD, PhD","doi":"10.1016/j.hrthm.2024.07.103","DOIUrl":"10.1016/j.hrthm.2024.07.103","url":null,"abstract":"<div><h3>Background</h3><div>Cardioneuroablation (CNA) is a novel procedure that shows promising results in reducing syncope recurrence in patients with refractory vasovagal syncope (VVS). However, its effectiveness and safety remain controversial.</div></div><div><h3>Objective</h3><div>We performed an updated meta-analysis evaluating CNA efficacy and safety in patients with refractory VVS.</div></div><div><h3>Methods</h3><div>PubMed, Embase, and Cochrane databases were systematically searched for CNA studies in patients with refractory VVS. Our primary efficacy end point was syncope recurrence, and our safety end point was periprocedural complications. Prespecified subgroup analyses were performed for (1) the ganglionated plexus (GP) targeting method and (2) the GP location of ablation.</div></div><div><h3>Results</h3><div>We included 27 observational studies and 1 randomized controlled trial encompassing 1153 patients with refractory VVS who underwent CNA. The median age was 39.6 years, and follow-up was 21.4 months. The overall weighted rate of syncope recurrence after CNA was 5.94% (95% confidence interval [CI] 3.37%–9.01%; I<sup>2</sup> = 64%), and the rate of periprocedural complications was 0.99% (95% CI 0.14%–2.33%; I<sup>2</sup> = 0%). Our prespecified subgroup analysis using the GP targeting method and GP ablation location showed a higher prevalence of syncope recurrence in the electroanatomic mapping subgroup (6.21%; 95% CI 2.93%–10.28%; I<sup>2</sup> = 0%) and in the right atrium approach (15.78%; 95% CI 3.61%–33.14%; I<sup>2</sup> = 65.2%).</div></div><div><h3>Conclusion</h3><div>This study supports the efficacy and safety of CNA in preventing syncope recurrence in patients with VVS. Furthermore, the electroanatomic mapping method of GP targeting and the right atrium approach were associated with a higher syncope recurrence rate than other methods.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 2","pages":"Pages 526-535"},"PeriodicalIF":5.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.hrthm.2024.07.111
Robin A. Bertels MD , Janneke A.E. Kammeraad MD, PhD , Nan van Geloven PhD , Luc H. Filippini MD , Roel L.F. van der Palen MD, PhD , Ramon O. Tak MD , Stefan Frerich MD , Ward Vanagt MD, PhD , Jan J.B. Rehbock MD , Ingmar Knobbe MD , Irene M. Kuipers MD, PhD , Marta de Riva MD, PhD , Katja Zeppenfeld MD, PhD , Nico A. Blom MD, PhD
Background
Frequent premature ventricular contractions (PVCs) in children are usually considered benign. Symptoms and left ventricular dysfunction are indications for treatment with antiarrhythmic drugs.
Objective
This study aimed to evaluate the efficacy of flecainide vs metoprolol in reducing PVCs in children.
Methods
A randomized open-label crossover trial was conducted of children with a PVC burden of >15% on Holter monitoring successively treated with metoprolol and flecainide, or vice versa, with a drug-free interval of at least 2 weeks. Holter measurements were repeated before and after the start of the antiarrhythmic drug.
Results
Sixty patients were screened; 19 patients could be included. Median age was 13.9 years (interquartile range, 5.5 years). Mean baseline PVC burden was 21.7% (n = 18; SD ± 14.0) before the start of flecainide and 21.2% (n = 17; SD ± 11.5) before the start of metoprolol. In a mixed model analysis, the estimated mean reduction in PVC burden was 10.6 percentage points (95% CI, 5.8–15.3) for flecainide and 2.4 percentage points (95% CI,2.7–7.5) for metoprolol, with a significant difference of 8.2 percentage points (95% CI, 0.86–15.46; P = .031). Exploratory analysis revealed that 9 of 18 patients treated with flecainide and 1 of 17 patients treated with metoprolol had a reduction to a PVC burden below 5%. No discriminating factors between flecainide responders and nonresponders were found; the mean plasma level was not significantly different (0.34 mg/L vs 0.52 mg/L; P = .277).
Conclusion
In children with frequent PVCs, flecainide led to a significantly greater reduction of PVC burden compared with metoprolol. Flecainide was effective in only a subgroup of patients, which appears to be unrelated to the plasma level.
{"title":"ECTOPIC trial: The efficacy of flEcainide Compared To metOprolol in reducing Premature ventrIcular Contractions: A randomized open-label crossover study in pediatric patients","authors":"Robin A. Bertels MD , Janneke A.E. Kammeraad MD, PhD , Nan van Geloven PhD , Luc H. Filippini MD , Roel L.F. van der Palen MD, PhD , Ramon O. Tak MD , Stefan Frerich MD , Ward Vanagt MD, PhD , Jan J.B. Rehbock MD , Ingmar Knobbe MD , Irene M. Kuipers MD, PhD , Marta de Riva MD, PhD , Katja Zeppenfeld MD, PhD , Nico A. Blom MD, PhD","doi":"10.1016/j.hrthm.2024.07.111","DOIUrl":"10.1016/j.hrthm.2024.07.111","url":null,"abstract":"<div><h3>Background</h3><div>Frequent premature ventricular contractions (PVCs) in children are usually considered benign. Symptoms and left ventricular dysfunction are indications for treatment with antiarrhythmic drugs.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the efficacy of flecainide vs metoprolol in reducing PVCs in children.</div></div><div><h3>Methods</h3><div>A randomized open-label crossover trial was conducted of children with a PVC burden of >15% on Holter monitoring successively treated with metoprolol and flecainide, or vice versa, with a drug-free interval of at least 2 weeks. Holter measurements were repeated before and after the start of the antiarrhythmic drug.</div></div><div><h3>Results</h3><div>Sixty patients were screened; 19 patients could be included. Median age was 13.9 years (interquartile range, 5.5 years). Mean baseline PVC burden was 21.7% (n = 18; SD ± 14.0) before the start of flecainide and 21.2% (n = 17; SD ± 11.5) before the start of metoprolol. In a mixed model analysis, the estimated mean reduction in PVC burden was 10.6 percentage points (95% CI, 5.8–15.3) for flecainide and 2.4 percentage points (95% CI,2.7–7.5) for metoprolol, with a significant difference of 8.2 percentage points (95% CI, 0.86–15.46; <em>P</em> = .031). Exploratory analysis revealed that 9 of 18 patients treated with flecainide and 1 of 17 patients treated with metoprolol had a reduction to a PVC burden below 5%. No discriminating factors between flecainide responders and nonresponders were found; the mean plasma level was not significantly different (0.34 mg/L vs 0.52 mg/L; <em>P</em> = .277).</div></div><div><h3>Conclusion</h3><div>In children with frequent PVCs, flecainide led to a significantly greater reduction of PVC burden compared with metoprolol. Flecainide was effective in only a subgroup of patients, which appears to be unrelated to the plasma level.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 2","pages":"Pages 536-543"},"PeriodicalIF":5.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.hrthm.2024.07.119
Hasan S. Alarouri MD, Gerardo V. Lo Russo MD, Mohamad Alkhouli MD, MBA
{"title":"Reply to the Editor — Investigating hemodynamic uncertainties in left atrial appendage occlusion","authors":"Hasan S. Alarouri MD, Gerardo V. Lo Russo MD, Mohamad Alkhouli MD, MBA","doi":"10.1016/j.hrthm.2024.07.119","DOIUrl":"10.1016/j.hrthm.2024.07.119","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 2","pages":"Pages 588-589"},"PeriodicalIF":5.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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