Heart rhythm最新文献

Background: Pulsed field ablation (PFA) for paroxysmal atrial fibrillation (AF) has been gaining worldwide acceptance because of its efficacy and safety. A variable loop circular catheter (VLCC, VARIPULSE, Biosense Webster, Inc) for PFA recently launched in Japan, includes a tissue proximity indication (TPI) feature to monitor catheter-tissue contact via impedance. However, the role of TPI during pulmonary vein isolation (PVI) is unclear.

Objective: This study aims to evaluate TPI feasibility during PVI and its relationship with acute pulmonary vein (PV) reconnection.

Methods: Twenty-one patients with paroxysmal AF underwent PFA (at least 4 ablations per PV) using the VLCC. We evaluated the association between TPI-positive site percentages, voltage, left atrial wall thickness on ADAS 3D software (Adas3D Medical SL, Barcelona Spain), and acute PVI failure sites.

Results: Four of 21 patients (8 failure sites) experienced PVI failure after primary PFA. Failure sites had significantly lower TPI-positive site percentages (0 ± 0% vs 63 ± 27%, P < .001) and higher voltage (3.57 ± 1.35 mV vs 2.06 ± 1.42 mV, P = .003) but not PV wall thickness. We found that a left atrial bipolar voltage amplitude ≥2.24 mV was determinants of PV gaps with an area under the curve of 0.83 calculating receiver operating characteristic curves. TPI-positive site percentages increased significantly (58 ± 29% to 64 ± 26%, P = .009), whereas PV gaps decreased from 3 of 28 PVs (11%) to 2 of 54 PVs (4%, P = .332) between the first 7 and last 14 cases.

Conclusion: Acute PVI failure was significantly associated with poor tissue contact and higher voltage. However, acute PVI failure can be prevented with improved TPI-based contact information.

Background: The assessment of left ventricular (LV) systolic function and quantification of LV ejection fraction (LVEF) in patients with atrial fibrillation (AF) can be difficult. We previously demonstrated that LV volume changes over the 100 ms of systole (LVEF_100ms) can be used as a measure of LV systolic function.

Objective: We sought to evaluate the applicability of LVEF_100ms in patients with AF.

Methods: We screened patients with AF who underwent prospective systolic electrocardiogram-triggered cardiac computed tomography from January 2015 to June 2023. The correlation between LVEF_100ms and echocardiography-derived LVEF was assessed. Patients were categorized into 3 groups on the basis of echocardiographic LVEF (≤40%, 40%-55%, and ≥55%), and LVEF_100ms was compared among these groups. Receiver operating characteristic curve analysis and Cox proportional hazards models were used to determine the optimal LVEF_100ms cutoff for predicting LVEF ≤ 40% and major adverse cardiovascular events (MACE), defined as a composite of cardiac death, myocardial infarction, heart failure hospitalization, and stroke.

Results: Of the total 123 patients, 62 (50.4%) had an LVEF of ≥55%, 40 (32.5%) had an LVEF of 40%-50%, and 21 (17.1%) had an LVEF of ≤40%. LVEF_100ms correlated with echocardiography-derived LVEF (P < .001) and differed significantly among groups (P < .001). LVEF_100ms ≤ 3.3% predicted LVEF ≤ 40% (area under the curve 0.809; sensitivity 87%; specificity 67%). Patients with an LVEF_100ms of ≤3.3% had a higher rate of MACE than did those without (P = .030), and LVEF_100ms ≤ 3.3% was an independent predictor of MACE.

Conclusion: LVEF_100ms can provide a useful indicator of LV dysfunction in patients with AF undergoing prospective electrocardiogram-triggered cardiac computed tomography.