Pub Date : 2025-01-01DOI: 10.1016/j.jacep.2024.09.033
Kate M. Bourne BSc , Kavithra Karalasingham BHSc , Tanya Siddiqui MBBS, MPhil , Aishani Patel BSc , Derek Exner MD, MPH , Robert Sheldon MD, PhD , Satish R. Raj MD, MSCI
Background
Compression garments reduce heart rate and symptoms in patients with postural orthostatic tachycardia syndrome in an acute laboratory setting. Patients taking medications controlling heart rate have less benefit from compression than those not on medications. The effectiveness of commercially available garments in a community-based setting, with and without medication use, is not known.
Objectives
The authors sought to evaluate commercially available compression tights in a community-based setting both with, and without, medications modulating heart rate, using a clinical trial with 2 before–after protocols conducted in a randomized crossover fashion.
Methods
Participants (N = 26) held medications during protocol #1 and took medications as normal during protocol #2. For each, participants completed 4, 10-minute active stand tests in the morning (AM) and afternoon (PM) with the garments on (ON) and off (OFF) (AM-OFF, AM-ON, PM-ON, and PM-OFF). Heart rate (Holter monitor) and symptoms (Vanderbilt Orthostatic Symptom Score [VOSS]) were measured for each standing test.
Results
Protocol #1: Standing heart rate was reduced (105 [99-116] beats/min vs 119 [105-130] beats/min; P < 0.001) and symptoms improved (P < 0.001), during AM-ON vs AM-OFF. Standing heart rate (P = 0.04) and symptoms (P = 0.004) increased when compression was removed after several hours. Protocol #2: Standing heart rate was reduced (84 [77-90] beats/min vs 89 [84-100] beats/min; P < 0.001), and symptoms improved (P = 0.03), during AM-ON vs AM-OFF. Standing heart rate (P = 0.02) and symptoms (P < 0.001) increased when compression was removed after several hours.
Conclusions
Commercially available compression tights reduced heart rate and symptoms both acutely and after several hours of use. This additional benefit persisted whether concomitant medications were used. (Compression Garments in the Community With POTS [COM-COM-POTS]; NCT04881318)
{"title":"A Community-Based Trial of Commercially Available Compression Tights in Patients With Postural Orthostatic Tachycardia Syndrome","authors":"Kate M. Bourne BSc , Kavithra Karalasingham BHSc , Tanya Siddiqui MBBS, MPhil , Aishani Patel BSc , Derek Exner MD, MPH , Robert Sheldon MD, PhD , Satish R. Raj MD, MSCI","doi":"10.1016/j.jacep.2024.09.033","DOIUrl":"10.1016/j.jacep.2024.09.033","url":null,"abstract":"<div><h3>Background</h3><div>Compression garments reduce heart rate and symptoms in patients with postural orthostatic tachycardia syndrome in an acute laboratory setting. Patients taking medications controlling heart rate have less benefit from compression than those not on medications. The effectiveness of commercially available garments in a community-based setting, with and without medication use, is not known.</div></div><div><h3>Objectives</h3><div>The authors sought to evaluate commercially available compression tights in a community-based setting both with, and without, medications modulating heart rate, using a clinical trial with 2 before–after protocols conducted in a randomized crossover fashion.</div></div><div><h3>Methods</h3><div>Participants (N = 26) held medications during protocol #1 and took medications as normal during protocol #2. For each, participants completed 4, 10-minute active stand tests in the morning (AM) and afternoon (PM) with the garments on (ON) and off (OFF) (AM-OFF, AM-ON, PM-ON, and PM-OFF). Heart rate (Holter monitor) and symptoms (Vanderbilt Orthostatic Symptom Score [VOSS]) were measured for each standing test.</div></div><div><h3>Results</h3><div>Protocol #1: Standing heart rate was reduced (105 [99-116] beats/min vs 119 [105-130] beats/min; <em>P</em> < 0.001) and symptoms improved (<em>P</em> < 0.001), during AM-ON vs AM-OFF. Standing heart rate (<em>P</em> = 0.04) and symptoms (<em>P</em> = 0.004) increased when compression was removed after several hours. Protocol #2: Standing heart rate was reduced (84 [77-90] beats/min vs 89 [84-100] beats/min; <em>P</em> < 0.001), and symptoms improved (<em>P</em> = 0.03), during AM-ON vs AM-OFF. Standing heart rate (<em>P</em> = 0.02) and symptoms (<em>P</em> < 0.001) increased when compression was removed after several hours.</div></div><div><h3>Conclusions</h3><div>Commercially available compression tights reduced heart rate and symptoms both acutely and after several hours of use. This additional benefit persisted whether concomitant medications were used. (Compression Garments in the Community With POTS [COM-COM-POTS]; <span><span>NCT04881318</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 1","pages":"Pages 179-190"},"PeriodicalIF":8.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jacep.2024.06.017
Jeff S. Healey MD, PhD, FHRS , Robert G. Hart MD , Richard P. Whitlock MD , John Eikelboom MBBS, MSc , Salim Yusuf MD , William F. McIntyre MD, PhD , Alex P. Benz MD , Paul Dorian MDCM , Chris Granger MD
{"title":"Stuart J. Connolly, MD, April 9, 1949–June 2, 2024","authors":"Jeff S. Healey MD, PhD, FHRS , Robert G. Hart MD , Richard P. Whitlock MD , John Eikelboom MBBS, MSc , Salim Yusuf MD , William F. McIntyre MD, PhD , Alex P. Benz MD , Paul Dorian MDCM , Chris Granger MD","doi":"10.1016/j.jacep.2024.06.017","DOIUrl":"10.1016/j.jacep.2024.06.017","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 1","pages":"Pages 255-257"},"PeriodicalIF":8.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jacep.2024.09.018
Rose Crowley Bmed, MD , David Chieng MBBS, PhD , Louise Segan MBBS , Jeremy William MBBS , Hariharan Sugumar MBBS, PhD , Sandeep Prabhu MBBS, PhD , Aleksandr Voskoboinik MBBS, PhD , Liang-Han Ling MBBS, PhD , Joseph B. Morton MBBS, PhD , Geoffrey Lee MBBS, PhD , Alex J. McLellan MBBS, PhD , Michael Wong MBBS, PhD , Rajeev K. Pathak MBBS, PhD , Laurence Sterns MD , Matthew Ginks MD , Prashanthan Sanders MBBS, PhD , Peter M. Kistler MBBS, PhD , Jonathan M. Kalman MBBS, PhD
Background
Many patients with persistent atrial fibrillation (PsAF) have progressed from an initial paroxysmal phenotype; however, there are patients in whom atrial fibrillation (AF) is persistent at diagnosis. Relatively little is known about this subgroup, but prior observational studies have suggested these patients have worse outcomes with ablation.
Objectives
This study sought to: 1) assess demographic and electrophysiologic characteristics of patients with PsAF at first diagnosis compared with those with who have progressed from paroxysmal atrial fibrillation (PAF); and 2) assess the impact of pattern of AF at diagnosis on recurrence post ablation.
Methods
CAPLA (Catheter Ablation for persistent atrial fibrillation: A Multicentre randomised trial of Pulmonary vein isolation [PVI] vs PVI with posterior Left Atrial wall isolation [PWI]) was a multicenter trial that randomized patients with PsAF to PVI plus PWI or PVI alone. Follow-up was 12 months. Outcomes were assessed after a 3-month blanking period.
Results
A total of 334 patients were included (median age 65.6 years, 23.1% female), 194 (58.1%) had PsAF at first AF diagnosis and 140 (41.9%) had PAF. Patients with PsAF at diagnosis were younger (age 64.0 vs 67.7 years, P = 0.005), had higher rates of heart failure (P < 0.001), and lower left ventricular ejection fraction (54.5%, IQR: 40%-60% vs 60%, IQR: 50%-61%, P = 0.007). AF recurrence occurred in 85 (43.8%) with PsAF at diagnosis and 70 (50%) with PAF at diagnosis. PsAF at diagnosis was not associated with risk of recurrence on univariable (HR: 0.802; 95% CI: 0.585-1.101; P = 0.173) or multivariable analysis (HR: 0.922; 95% CI: 0.647-1.312; P = 0.650). Median AF burden was 0% in both groups (P = 0.125). There was no difference in left atrial size (P = 0.337) or bipolar voltage (P = 0.579) between the groups.
Conclusions
In the CAPLA cohort of patients, pattern of AF at first diagnosis did not influence post-ablation rate of AF recurrence or AF burden. (Catheter Ablation for persistent atrial fibrillation: A Multicentre randomised trial of Pulmonary vein isolation [PVI] vs PVI with posterior Left Atrial wall isolation [PWI]; ACTRN12616001436460)
{"title":"Persistent Atrial Fibrillation Phenotypes and Ablation Outcomes","authors":"Rose Crowley Bmed, MD , David Chieng MBBS, PhD , Louise Segan MBBS , Jeremy William MBBS , Hariharan Sugumar MBBS, PhD , Sandeep Prabhu MBBS, PhD , Aleksandr Voskoboinik MBBS, PhD , Liang-Han Ling MBBS, PhD , Joseph B. Morton MBBS, PhD , Geoffrey Lee MBBS, PhD , Alex J. McLellan MBBS, PhD , Michael Wong MBBS, PhD , Rajeev K. Pathak MBBS, PhD , Laurence Sterns MD , Matthew Ginks MD , Prashanthan Sanders MBBS, PhD , Peter M. Kistler MBBS, PhD , Jonathan M. Kalman MBBS, PhD","doi":"10.1016/j.jacep.2024.09.018","DOIUrl":"10.1016/j.jacep.2024.09.018","url":null,"abstract":"<div><h3>Background</h3><div>Many patients with persistent atrial fibrillation (PsAF) have progressed from an initial paroxysmal phenotype; however, there are patients in whom atrial fibrillation (AF) is persistent at diagnosis. Relatively little is known about this subgroup, but prior observational studies have suggested these patients have worse outcomes with ablation.</div></div><div><h3>Objectives</h3><div>This study sought to: 1) assess demographic and electrophysiologic characteristics of patients with PsAF at first diagnosis compared with those with who have progressed from paroxysmal atrial fibrillation (PAF); and 2) assess the impact of pattern of AF at diagnosis on recurrence post ablation.</div></div><div><h3>Methods</h3><div>CAPLA (Catheter Ablation for persistent atrial fibrillation: A Multicentre randomised trial of Pulmonary vein isolation [PVI] vs PVI with posterior Left Atrial wall isolation [PWI]) was a multicenter trial that randomized patients with PsAF to PVI plus PWI or PVI alone. Follow-up was 12 months. Outcomes were assessed after a 3-month blanking period.</div></div><div><h3>Results</h3><div>A total of 334 patients were included (median age 65.6 years, 23.1% female), 194 (58.1%) had PsAF at first AF diagnosis and 140 (41.9%) had PAF. Patients with PsAF at diagnosis were younger (age 64.0 vs 67.7 years, <em>P</em> = 0.005), had higher rates of heart failure (<em>P</em> < 0.001), and lower left ventricular ejection fraction (54.5%, IQR: 40%-60% vs 60%, IQR: 50%-61%, <em>P</em> = 0.007). AF recurrence occurred in 85 (43.8%) with PsAF at diagnosis and 70 (50%) with PAF at diagnosis. PsAF at diagnosis was not associated with risk of recurrence on univariable (HR: 0.802; 95% CI: 0.585-1.101; <em>P</em> = 0.173) or multivariable analysis (HR: 0.922; 95% CI: 0.647-1.312; <em>P</em> = 0.650). Median AF burden was 0% in both groups (<em>P</em> = 0.125). There was no difference in left atrial size (<em>P</em> = 0.337) or bipolar voltage (<em>P</em> = 0.579) between the groups.</div></div><div><h3>Conclusions</h3><div>In the CAPLA cohort of patients, pattern of AF at first diagnosis did not influence post-ablation rate of AF recurrence or AF burden. (Catheter Ablation for persistent atrial fibrillation: A Multicentre randomised trial of Pulmonary vein isolation [PVI] vs PVI with posterior Left Atrial wall isolation [PWI]; <span><span>ACTRN12616001436460</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 1","pages":"Pages 10-18"},"PeriodicalIF":8.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jacep.2024.09.040
Matthew Yee BA , James W. Salazar MD, MAS , Julianne Wojciak MS , W. Patrick Devine MD, PhD , Ellen Moffatt MD , Zian H. Tseng MD, MAS
{"title":"TTN Variants, Dilated Cardiomyopathy, and Arrhythmic Causes by Autopsy Among Countywide Sudden Deaths","authors":"Matthew Yee BA , James W. Salazar MD, MAS , Julianne Wojciak MS , W. Patrick Devine MD, PhD , Ellen Moffatt MD , Zian H. Tseng MD, MAS","doi":"10.1016/j.jacep.2024.09.040","DOIUrl":"10.1016/j.jacep.2024.09.040","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 1","pages":"Pages 213-216"},"PeriodicalIF":8.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jacep.2024.09.022
Xiaolei Wang MD , Jie Yu MD , Cheng Wang MD , Yanjie Li MD , Xumin Hou MD , Lan Ma MD , Ben He MD, PhD , Yunshan Cao MD, PhD , Xin Pan MD
Background
Pulmonary vein stenting is effective for severe pulmonary vein stenosis, which is limited by restenosis. The assessment and management of in-stent restenosis (ISR) are inadequate, and follow-up outcomes after reintervention remain unknown.
Objectives
This study aimed to assess the prognosis and management of pulmonary vein ISR and determine whether the modified stent-in-stent strategy is superior to balloon angioplasty (BA) in treating ISR.
Methods
The authors conducted a prospective observational study on patients with severe pulmonary vein stenosis post radiofrequency ablation for atrial fibrillation.
Results
A total of 107 patients with 174 severely stenosed veins underwent successful stenting. Forty-three veins among 36 patients experienced ISR (24.7%, 43 of 174). Veins developing ISR had smaller diameter stents (7.8 ± 0.8 mm vs 9.2 ± 0.7 mm; P = 0.008). Restenosis veins were assigned to BA group or stent-in-stent group. Success rate was 95.7% for BA and 90.0% for stent-in-stent. Twelve veins experienced recurrent ISR, including 2 in stent-in-stent group (11.1%, 2 of 18) and 10 in BA group (45.5%, 10 of 22). The risk of recurrent stenosis was significantly lower in veins treated with the stent-in-stent method than with BA (HR: 0.21; 95% CI: 0.07-0.64; P = 0.02). Patients in the stent-in-stent group had greater exercise endurance and better World Health Organization cardiac functional class compared with BA group (F = 7.2; P < 0.05; and F = 4.4; P < 0.05, respectively) at 6- and 12-month follow-ups.
Conclusions
Our modified stent-in-stent implantation approach is superior to BA for treating pulmonary vein ISR, by reducing recurrent restenosis rate and improving exercise endurance.
{"title":"Prognosis and Management of Recurrent Stenosis After Pulmonary Vein Stenting","authors":"Xiaolei Wang MD , Jie Yu MD , Cheng Wang MD , Yanjie Li MD , Xumin Hou MD , Lan Ma MD , Ben He MD, PhD , Yunshan Cao MD, PhD , Xin Pan MD","doi":"10.1016/j.jacep.2024.09.022","DOIUrl":"10.1016/j.jacep.2024.09.022","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary vein stenting is effective for severe pulmonary vein stenosis, which is limited by restenosis. The assessment and management of in-stent restenosis (ISR) are inadequate, and follow-up outcomes after reintervention remain unknown.</div></div><div><h3>Objectives</h3><div>This study aimed to assess the prognosis and management of pulmonary vein ISR and determine whether the modified stent-in-stent strategy is superior to balloon angioplasty (BA) in treating ISR.</div></div><div><h3>Methods</h3><div>The authors conducted a prospective observational study on patients with severe pulmonary vein stenosis post radiofrequency ablation for atrial fibrillation.</div></div><div><h3>Results</h3><div>A total of 107 patients with 174 severely stenosed veins underwent successful stenting. Forty-three veins among 36 patients experienced ISR (24.7%, 43 of 174). Veins developing ISR had smaller diameter stents (7.8 ± 0.8 mm vs 9.2 ± 0.7 mm; <em>P</em> = 0.008). Restenosis veins were assigned to BA group or stent-in-stent group. Success rate was 95.7% for BA and 90.0% for stent-in-stent. Twelve veins experienced recurrent ISR, including 2 in stent-in-stent group (11.1%, 2 of 18) and 10 in BA group (45.5%, 10 of 22). The risk of recurrent stenosis was significantly lower in veins treated with the stent-in-stent method than with BA (HR: 0.21; 95% CI: 0.07-0.64; <em>P</em> = 0.02). Patients in the stent-in-stent group had greater exercise endurance and better World Health Organization cardiac functional class compared with BA group (<em>F</em> = 7.2; <em>P</em> < 0.05; and <em>F</em> = 4.4; <em>P</em> < 0.05, respectively) at 6- and 12-month follow-ups.</div></div><div><h3>Conclusions</h3><div>Our modified stent-in-stent implantation approach is superior to BA for treating pulmonary vein ISR, by reducing recurrent restenosis rate and improving exercise endurance.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 1","pages":"Pages 46-55"},"PeriodicalIF":8.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jacep.2024.09.038
Lukas Urbanek MD , Gunnar H. Heine MD , Claudia Reddavid MD , Jacqueline Saw MD , Iwanari Kawamura MD , Vivek Y. Reddy MD , Roberto Galea MD , Lorenz Räber MD, PhD , Alexander Sedaghat MD , Domenico G. Della Rocca MD , Andrea Natale MD , Gaetano Fassini MD , Claudio Tondo MD , Shephal K. Doshi MD , Dorothy S. Peng BS , Ralph Stephan von Bardeleben MD , Felix Kreidel MD , Boris Schmidt MD
Background
The net benefit of oral anticoagulation in patients with end-stage renal disease on hemodialysis (HD) is uncertain. In recent years, left atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation; however, there is scant evidence of LAAC in patients on HD.
Objectives
This study aimed to assess the feasibility and safety of LAAC in patients on HD.
Methods
In an international multicenter registry, patients’ baseline characteristics and procedural and follow-up data were recorded from all patients on HD with atrial fibrillation who underwent LAAC.
Results
A total of 147 patients from 9 centers were included. The mean age was 72.6 ± 10.4 years; the mean CHA2DS2-VASc-score was 4.6 ± 1.5, and the mean HAS-BLED-score was 4.7 ± 1.1. Antithrombotic treatment regimens prior to implantation were notably diverse, encompassing more than 12 distinct combinations. Technical successful LAA at first procedure was achieved in 144 of 147 (98%) patients and major complications were observed in 4.7% (7 of 149 procedures). The median follow-up was 427 days (Q1-Q3: 184-797 days), no device-related thrombi were detected, and peridevice leaks ≥5 mm were 1.7% at first imaging control. The most common post-implantation antithrombotic therapy was single antiplatelet therapy with 165.9 patient-years (py). During follow-up of 222.9 py, the annual stroke rate was 0.9%, reflecting an 88% relative risk reduction (P < 0.001) compared to historical data. Similarly, the annual rate of major bleeding was 4.5%, signifying a 55% relative risk reduction (P = 0.023). Throughout follow-up, 29 deaths (19.9%) were recorded.
Conclusions
LAAC in end-stage renal disease patients on HD demonstrated an acceptable safety profile, coupled with a notably low incidence of strokes. This was paralleled by low bleeding rates.
{"title":"Left Atrial Appendage Occlusion in Patients With Atrial Fibrillation and Hemodialysis","authors":"Lukas Urbanek MD , Gunnar H. Heine MD , Claudia Reddavid MD , Jacqueline Saw MD , Iwanari Kawamura MD , Vivek Y. Reddy MD , Roberto Galea MD , Lorenz Räber MD, PhD , Alexander Sedaghat MD , Domenico G. Della Rocca MD , Andrea Natale MD , Gaetano Fassini MD , Claudio Tondo MD , Shephal K. Doshi MD , Dorothy S. Peng BS , Ralph Stephan von Bardeleben MD , Felix Kreidel MD , Boris Schmidt MD","doi":"10.1016/j.jacep.2024.09.038","DOIUrl":"10.1016/j.jacep.2024.09.038","url":null,"abstract":"<div><h3>Background</h3><div>The net benefit of oral anticoagulation in patients with end-stage renal disease on hemodialysis (HD) is uncertain. In recent years, left atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation; however, there is scant evidence of LAAC in patients on HD.</div></div><div><h3>Objectives</h3><div>This study aimed to assess the feasibility and safety of LAAC in patients on HD.</div></div><div><h3>Methods</h3><div>In an international multicenter registry, patients’ baseline characteristics and procedural and follow-up data were recorded from all patients on HD with atrial fibrillation who underwent LAAC.</div></div><div><h3>Results</h3><div>A total of 147 patients from 9 centers were included. The mean age was 72.6 ± 10.4 years; the mean CHA<sub>2</sub>DS<sub>2</sub>-VASc-score was 4.6 ± 1.5, and the mean HAS-BLED-score was 4.7 ± 1.1. Antithrombotic treatment regimens prior to implantation were notably diverse, encompassing more than 12 distinct combinations. Technical successful LAA at first procedure was achieved in 144 of 147 (98%) patients and major complications were observed in 4.7% (7 of 149 procedures). The median follow-up was 427 days (Q1-Q3: 184-797 days), no device-related thrombi were detected, and peridevice leaks ≥5 mm were 1.7% at first imaging control. The most common post-implantation antithrombotic therapy was single antiplatelet therapy with 165.9 patient-years (py). During follow-up of 222.9 py, the annual stroke rate was 0.9%, reflecting an 88% relative risk reduction (<em>P</em> < 0.001) compared to historical data. Similarly, the annual rate of major bleeding was 4.5%, signifying a 55% relative risk reduction (<em>P</em> = 0.023). Throughout follow-up, 29 deaths (19.9%) were recorded.</div></div><div><h3>Conclusions</h3><div>LAAC in end-stage renal disease patients on HD demonstrated an acceptable safety profile, coupled with a notably low incidence of strokes. This was paralleled by low bleeding rates.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 1","pages":"Pages 71-82"},"PeriodicalIF":8.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jacep.2024.09.035
Ehsan Jafree MD , Michael O’Quinn MD, PhD , Pouria Shoureshi MD , Brianna Rose BA , Li Wang PhD , Na Nguyen BS , Tam Nguyen MD, PhD , Kenneth J. Dormer PhD , Kytai T. Nguyen PhD , Anindita Das PhD , Mohammed Quader MD, PhD , Vigneshwar Kasirajan MD , Karoly Kaszala MD, PhD , Kenneth A. Ellenbogen MD , Jose F. Huizar MD , Alex Y. Tan MD
Background
The mechanisms underlying postoperative atrial fibrillation (POAF) remain unclear.
Objectives
The aim of this study was to test the hypothesis that targeted chemical ganglionated plexi (GP) modulation of all major left atrial–pulmonary vein GP using novel nanoformulated calcium chloride (nCaCl2) can reverse postoperative neuroelectrical remodeling by suppressing vagosympathetic nerve activity and the localized inflammatory process, both critical substrates of POAF.
Methods
In a novel canine model of POAF with serial thoracopericardiotomies, sympathetic nerve activity (SNA), vagal nerve activity (VNA) and GP nerve activity (GPNA) were recorded; spontaneous and in vivo AF vulnerability were assessed; and atrial and circulating inflammatory markers and norepinephrine (NE) were measured to determine the neuroelectrical remodeling that promotes POAF and its subsequent modulation with nCaCl2 GP treatment (n = 6) vs saline sham controls (n = 6).
Results
The first 3 postpericardiotomy weeks demonstrated increased plasma C-reactive protein (P = 0.034) and NE (P = 0.033), decreased atrial effective refractory period (P = 0.002), and increased AF vulnerability (P = 0.0008). Subsequent nCaCl2 GP treatment reversed atrial effective refractory period remodeling 6 weeks later (P < 0.001) and decreased AF vulnerability (P = 0.0002) and spontaneous AF burden (P = 0.03). nCaCl2 GP treatment acutely (3 days) and chronically (6 weeks) suppressed GPNA (P = 0.008 and P = 0.04), SNA (P = 0.048 and P = 0.041), and VNA (P = 0.041 and P = 0.046) and increased mean RR interval (P = 0.046 and P = 0.034). In sham controls, the opposite changes occurred (increased GPNA [P = 0.035 and P = 0.02], SNA [P = 0.048 and P = 0.042], and VNA [P = 0.041 and P = 0.042] and decreased mean RR interval [P = 0.041 and P = 0.046]). Plasma NE (P = 0.044), left atrial interleukin-6 (P = 0.008), nerve growth factor (P < 0.001), and sympathetic nerve levels (P < 0.001) were reduced, along with apoptosis of GP neurons in the nCaCl2 GP group.
Conclusions
Targeted GP modulation with nCaCl2 durably suppresses POAF by inducing apoptosis of GP neurons and inhibiting GP and vagosympathetic nerve activity. This exerts a localized anti-inflammatory effect to reverse the proarrhythmic neural-electrical remodeling following thoracopericardiotomy without myocardial damage or compensatory neural regrowth.
{"title":"Targeted Ganglionated Plexi Ablation With Nanoformulated Calcium Suppresses Postoperative AF Via Vagosympatholytic and Anti-Inflammatory Effects","authors":"Ehsan Jafree MD , Michael O’Quinn MD, PhD , Pouria Shoureshi MD , Brianna Rose BA , Li Wang PhD , Na Nguyen BS , Tam Nguyen MD, PhD , Kenneth J. Dormer PhD , Kytai T. Nguyen PhD , Anindita Das PhD , Mohammed Quader MD, PhD , Vigneshwar Kasirajan MD , Karoly Kaszala MD, PhD , Kenneth A. Ellenbogen MD , Jose F. Huizar MD , Alex Y. Tan MD","doi":"10.1016/j.jacep.2024.09.035","DOIUrl":"10.1016/j.jacep.2024.09.035","url":null,"abstract":"<div><h3>Background</h3><div>The mechanisms underlying postoperative atrial fibrillation (POAF) remain unclear.</div></div><div><h3>Objectives</h3><div>The aim of this study was to test the hypothesis that targeted chemical ganglionated plexi (GP) modulation of all major left atrial–pulmonary vein GP using novel nanoformulated calcium chloride (nCaCl<sub>2</sub>) can reverse postoperative neuroelectrical remodeling by suppressing vagosympathetic nerve activity and the localized inflammatory process, both critical substrates of POAF.</div></div><div><h3>Methods</h3><div>In a novel canine model of POAF with serial thoracopericardiotomies, sympathetic nerve activity (SNA), vagal nerve activity (VNA) and GP nerve activity (GPNA) were recorded; spontaneous and in vivo AF vulnerability were assessed; and atrial and circulating inflammatory markers and norepinephrine (NE) were measured to determine the neuroelectrical remodeling that promotes POAF and its subsequent modulation with nCaCl<sub>2</sub> GP treatment (n = 6) vs saline sham controls (n = 6).</div></div><div><h3>Results</h3><div>The first 3 postpericardiotomy weeks demonstrated increased plasma C-reactive protein (<em>P</em> = 0.034) and NE (<em>P</em> = 0.033), decreased atrial effective refractory period (<em>P</em> = 0.002), and increased AF vulnerability (<em>P</em> = 0.0008). Subsequent nCaCl<sub>2</sub> GP treatment reversed atrial effective refractory period remodeling 6 weeks later (<em>P</em> < 0.001) and decreased AF vulnerability (<em>P</em> = 0.0002) and spontaneous AF burden (<em>P</em> = 0.03). nCaCl<sub>2</sub> GP treatment acutely (3 days) and chronically (6 weeks) suppressed GPNA (<em>P</em> = 0.008 and <em>P</em> = 0.04), SNA (<em>P</em> = 0.048 and <em>P</em> = 0.041), and VNA (<em>P</em> = 0.041 and <em>P</em> = 0.046) and increased mean RR interval (<em>P</em> = 0.046 and <em>P</em> = 0.034). In sham controls, the opposite changes occurred (increased GPNA [<em>P</em> = 0.035 and <em>P</em> = 0.02], SNA [<em>P</em> = 0.048 and <em>P</em> = 0.042], and VNA [<em>P</em> = 0.041 and <em>P</em> = 0.042] and decreased mean RR interval [<em>P</em> = 0.041 and <em>P</em> = 0.046]). Plasma NE (<em>P</em> = 0.044), left atrial interleukin-6 (<em>P</em> = 0.008), nerve growth factor (<em>P</em> < 0.001), and sympathetic nerve levels (<em>P</em> < 0.001) were reduced, along with apoptosis of GP neurons in the nCaCl<sub>2</sub> GP group.</div></div><div><h3>Conclusions</h3><div>Targeted GP modulation with nCaCl<sub>2</sub> durably suppresses POAF by inducing apoptosis of GP neurons and inhibiting GP and vagosympathetic nerve activity. This exerts a localized anti-inflammatory effect to reverse the proarrhythmic neural-electrical remodeling following thoracopericardiotomy without myocardial damage or compensatory neural regrowth.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 1","pages":"Pages 56-70"},"PeriodicalIF":8.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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