Journal of Cardiovascular Electrophysiology最新文献

英文中文

Multielectrode Radiofrequency Balloon Catheter for Paroxysmal Atrial Fibrillation: Results From the Global, Multicenter, STELLAR Study 多电极射频球囊导管治疗阵发性心房颤动：来自全球、多中心、STELLAR研究的结果。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology

Pub Date : 2024-12-16 DOI: 10.1111/jce.16524

Sandeep K. Goyal, Carlo Pappone, Massimo Grimaldi, Sung W. Lee, Stavros Mountantonakis, J. Brian DeVille, Venkata S. Sagi, Chen-Yang Jiang, Haseeb Jafri, Alan P. Wimmer, Li-Qun Wu, Srinivas Dukkipati, Haroon Rashid, Hugh Calkins, Moussa Mansour, Javier Roman-Gonzalez, Andrea Natale, Giuseppe Ciconte, Arash Aryana, STELLAR investigators

Introduction

The safety and efficacy of paroxysmal atrial fibrillation (PAF) ablation with the HELIOSTAR multielectrode radiofrequency (RF) balloon catheter have been demonstrated in European studies; data from elsewhere are lacking. This prospective, multicenter study conducted in the United States, Italy, and China investigated the safety and efficacy of pulmonary vein isolation (PVI) using HELIOSTAR in drug-refractory symptomatic PAF.

Methods

The primary effectiveness endpoint (PEE) was 12-month freedom from documented atrial fibrillation/atrial flutter/atrial tachycardia plus freedom from acute procedural failure, nonstudy catheter failure, repeat ablation failure, direct current cardioversion (DCCV), and Class I/III antiarrhythmic drug (AAD) failure. The primary safety endpoint was the occurrence of early-onset primary adverse events (PAEs). Cerebral magnetic resonance imaging (MRI) and cardiac computed tomography were performed in a patient subset to assess silent cerebral lesions (SCLs) and severe pulmonary vein (PV) stenosis, respectively.

Results

Across 36 centers, 257 eligible subjects in the main phase had the study catheter inserted. Acute PVI was achieved in all subjects, with the majority (94.1%) using the balloon catheter only. In 67.7% and 92.2% of subjects, respectively, PEE and freedom from repeat ablation were met; clinical success rate was 77.7%. The PAE rate was 5.1%. One of 15 (6.7%) subjects with MRI showed a new SCL at 1 month postablation, which resolved at 3 months. Clinically meaningful improvements in Atrial Fibrillation Effect on QualiTy-of-life scores were seen at 3 months and were sustained to 12 months postablation, and accompanied with reduction of Class I/III AAD use and DCCV.

Conclusion

STELLAR confirmed the safety and efficacy of the HELIOSTAR catheter for PVI, with clinically meaningful improvements in quality of life in patients with drug-refractory symptomatic PAF. Most PVIs were achieved without focal touch-up, and > 90% of patients were free from repeat ablation at 12 months.

Trial Registration

ClinicalTrials.gov Identifier: NCT03683030.

导读：在欧洲的研究中，HELIOSTAR多电极射频球囊导管消融阵发性心房颤动（PAF）的安全性和有效性已经得到证实；其他地方的数据缺乏。这项在美国、意大利和中国开展的前瞻性多中心研究探讨了HELIOSTAR肺静脉隔离（PVI）治疗难治性症状性PAF的安全性和有效性。方法：主要疗效终点（PEE）为12个月无房颤/心房扑动/房性心动过速，无急性手术失败、非研究导管失败、重复消融失败、直流心律转复（DCCV）和I/III类抗心律失常药物（AAD）失败。主要安全性终点是早发性主要不良事件（PAEs）的发生。在患者亚组中分别进行脑磁共振成像（MRI）和心脏计算机断层扫描，以评估无症状脑病变（SCLs）和严重肺静脉（PV）狭窄。结果：在36个中心，257名符合条件的受试者在主要阶段插入了研究导管。所有受试者均达到急性PVI，其中大多数（94.1%）仅使用球囊导管。在67.7%和92.2%的受试者中，PEE和不再重复消融分别得到满足；临床成功率77.7%。PAE率为5.1%。15例（6.7%）MRI患者中有1例在消融后1个月出现新的SCL， 3个月消退。心房颤动对生活质量评分的影响在消融后3个月和持续到12个月有临床意义的改善，并伴有I/III级AAD使用和DCCV的减少。结论：STELLAR证实了HELIOSTAR导管治疗PVI的安全性和有效性，对难治性症状性PAF患者的生活质量有临床意义的改善。大多数PVIs是在没有局部补片的情况下实现的，并且90%的患者在12个月时没有重复消融。试验注册：ClinicalTrials.gov标识符：NCT03683030。

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引用次数: 0

Echocardiographic Predictors of Ventricular Arrhythmias in Patients With Left Ventricular Assist Devices and Implantable Cardioverter-Defibrillator 超声心动图预测左心室辅助装置和植入式心律转复除颤器患者的室性心律失常。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology

Pub Date : 2024-12-16 DOI: 10.1111/jce.16539

Elena Efimova, Samira Zeynalova, Sandra Eifert, Alexey Dashkevich, Michael Andrew Borger, Anna L. Meyer, Jens Garbade, Angeliki Darma, Kerstin Bode, Arash Arya

Aim

To evaluate the predictive value of preoperative echocardiographic parameters for occurrence of VAs in patients with preexisting ICD undergoing LVAD implantation.

Methods and Results

All consecutive patients (n = 264) with previous ICD who underwent LVAD surgery between May 2011 and December 2019 at our institution were included. The patients were predominantly male (89%) with NICM (59%) and a mean age of 59 ± 10 years. All LVADs were continuous flow device (154 HVAD, 21 HeartMate II, and 89 HeartMate 3). A total of 102 (39%) patients had VAs in the first year after LVAD implantation. We compared echocardiographic parameters in patients with and without VAs before LVAD, at 1 month and 1 year after LVAD implantation. Increased pre-LVEDD ≥ 72 mm predicted the occurrence of VAs after LVAD implantation for ICM patients (HR: 2.9, 95% confidence interval (CI): [1.3–6.6], p = 0.012), while a larger pre-RVEDD ≥ 46 mm was predictive in NICM patients (HR: 2.8, (CI): [1.4–5.9], p = 0.004). Moreover, a larger RVEDD at 1 year after LVAD was highly associated with VAs in the first year after LVAD implantation (50 ± 10 vs. 45 ± 8 mm, p = 0.001). All patients demonstrated a significant decrease in LVEDD as well as a reduction in severity of mitral and tricuspid regurgitation during 1 year after LVAD implantation, reflecting left ventricular unloading through the LVAD.

Conclusions

Larger left and right ventricular diameters before LVAD predict the occurrence of VAs after LVAD implantation in ICM and NICM patients. Persistent RV remodeling post-LVAD is also associated with VAs.

目的：评估术前超声心动图参数对接受 LVAD 植入术的既往有 ICD 患者发生 VAs 的预测价值：纳入2011年5月至2019年12月期间在我院接受LVAD手术的所有既往患有ICD的连续患者（n = 264）。患者主要为男性（89%），NICM（59%），平均年龄（59 ± 10）岁。所有 LVAD 均为持续流装置（154 台 HVAD、21 台 HeartMate II 和 89 台 HeartMate 3）。共有 102 名（39%）患者在植入 LVAD 后第一年出现 VAs。我们比较了植入 LVAD 前、植入 LVAD 1 个月后和植入 LVAD 1 年后有 VAs 和无 VAs 患者的超声心动图参数。对于 ICM 患者，LVEDD 前值增大≥ 72 mm 预测 LVAD 植入后 VAs 的发生（HR：2.9，95% 置信区间 (CI)：[1.3-6.6]，p = 0.012），而对于 NICM 患者，RVEDD 前值增大≥ 46 mm 预测 VAs 的发生（HR：2.8，(CI)：[1.4-5.9]，p = 0.004）。此外，LVAD 术后 1 年时 RVEDD 较大与 LVAD 植入术后第一年的 VAs 高度相关（50 ± 10 vs. 45 ± 8 mm，p = 0.001）。所有患者在植入 LVAD 1 年后，LVEDD 均显著下降，二尖瓣和三尖瓣反流的严重程度也有所减轻，这反映了通过 LVAD 进行的左心室卸载：结论：植入 LVAD 前较大的左心室和右心室直径可预测 ICM 和 NICM 患者植入 LVAD 后 VA 的发生。LVAD术后持续的RV重塑也与VA有关。

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引用次数: 0

A Supraventricular Tachycardia With the Atrial Interval Variability: What Is the Mechanism? 室上性心动过速伴房间期变异性：其机制是什么？

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology

Pub Date : 2024-12-12 DOI: 10.1111/jce.16536

Atsushi Doi, Kazuya Sugioka, Takuya Tsukamoto, Sawa Tanaka, Naoko Takaoka, Toshiharu Iwamura, Takahiko Kawarabayashi, Daiju Fukuda

引用次数: 0

A Giant Left Atrial Appendage Aneurysm With Incessant Atrial Tachycardia 巨大左心房附件动脉瘤伴持续性房性心动过速。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology

Pub Date : 2024-12-12 DOI: 10.1111/jce.16529

Hui-Qiang Wei, Yumei Xue, Shulin Wu, Hongtao Liao

Introduction

Left atrial appendage aneurysm (LAAA) is a rare congenital cardiac anomaly that involves the progressive dilatation of the left atrial appendage (LAA), predisposing the patient to serious complications such as atrial tachyarrhythmias, life-threatening systemic thromboembolism, and cardiac dysfunction.

Methods and Results

We described a case of a 36-year-old woman with incessant atrial tachycardia (AT) originating from LAAA, which surgical intervention successfully terminated AT after attempted ablation failed. The AT terminated after the LAA was excised. There was no recurrence at the follow-up period of 3 months.

Conclusion

We present and discuss the management of rare incessant AT arising from giant LAAA where the localization was confirmed on electroanatomic mapping. LAA resection via video-assisted thoracoscopic surgery is minimally invasive approach to manage the LAAA AT, uniformly considered safe and successful.

左心房附件动脉瘤（LAAA）是一种罕见的先天性心脏异常，涉及左心房附件（LAA）的进行性扩张，使患者容易出现严重的并发症，如心房性心动过速、危及生命的全身血栓栓塞和心功能障碍。方法和结果：我们描述了一例36岁女性因LAAA引起的不间断房性心动过速（AT），在尝试消融失败后手术成功终止了AT。LAA切除后AT终止。随访3个月无复发。结论：我们报告并讨论了罕见的由巨大LAAA引起的连续AT的处理方法，并在电解剖图上确定了定位。通过电视胸腔镜手术切除LAA是治疗LAAA AT的微创方法，被一致认为是安全和成功的。

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引用次数: 0

The Pitfalls of Capture/Fusion Beats: Diagnostic Challenges in Wide QRS Complex Tachycardia 捕获/融合节拍的陷阱：宽QRS复杂心动过速的诊断挑战。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology

Pub Date : 2024-12-12 DOI: 10.1111/jce.16538

Ryuta Watanabe, Koichi Nagashima, Yuji Wakamatsu, Shu Hirata, Moyuru Hirata, Masanaru Sawada, Yuji Saito, Sayaka Kurokawa, Yasuo Okumura

引用次数: 0

Efficacy and Safety of High-Power Short-Duration Ablation for Cavo-Tricuspid Isthmus With a Flexible-Tip Temperature-Controlled Power Regulation Catheter Performed by Electrophysiology Trainees 电生理学学员使用柔性尖端温控功率调节导管进行高功率短时间消融cav -三尖峡部的有效性和安全性。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology

Pub Date : 2024-12-11 DOI: 10.1111/jce.16516

Hidehiro Iwakawa, Masateru Takigawa, Kosuke Nakada, Tasuku Yamamoto, Takashi Ikenouchi, Mayumi Masumura, Miho Negishi, Iwanari Kawamura, Kentaro Goto, Takatoshi Shigeta, Takuro Nishimura, Tomomasa Takamiya, Susumu Tao, Shinsuke Miyazaki, Masahiko Goya, Hiroyuki Watanabe, Tetsuo Sasano

Introduction

The suitability of high-power short-duration (HPSD) cavo-tricuspid isthmus ablation (CTI-Abl) for electrophysiology (EP) trainees, as well as the underlying mechanisms of its efficacy, remain unknown. The aim of this study was to clarify the efficacy and safety of HPSD CTI-Abl performed by EP trainees and assess lesion characteristics between HPSD and moderate-power long duration (MPLD) ablations.

Methods

Study 1: CTI-Abl was performed by first- to fourth-year EP trainees in consecutive 113 patients (67 ± 11 years, 27.2% female). Study cohort was historically divided into three groups: MPLD (30–35 W for up to 30 s) using TactiCath (TC-MPLD, N = 38) and MPLD and HPSD (50 W for 12 s) using TactiFlex (TF-MPLD, N = 23; TF-HPSD, N = 52). Primary endpoint was first-pass bidirectional isthmus block (BIB). Study 2: lesion geometries created by each ablation strategy were compared using an ex-vivo model.

Results

Study 1: TF-HPSD ablation strategy demonstrated a higher success rate of first-pass BIB than MPLD protocol (TC-MPLD, 58%; TF-MPLD, 48%; TF-HPSD, 94%, p < 0.001), without any complications. TF-HPSD group was associated with shorter total procedure and RF application times, as well as fewer ablation points and gaps, compared to the MPLD groups. Study 2: TF-HPSD created greater lesion surface length, width, and area than MPLD strategies.

Conclusion

HPSD CTI-Abl performed by EP trainees using TactiFlex SE catheter demonstrated a higher first-pass BIB rate, shorter total procedure and RF application times, and fewer ablation points and gaps compared to the conventional method, without increasing complication rates.

高功率短时间（HPSD） cav -三尖瓣峡部消融（CTI-Abl）对电生理（EP）受训者的适用性及其疗效的潜在机制尚不清楚。本研究的目的是阐明由EP学员进行的HPSD CTI-Abl的有效性和安全性，并评估HPSD和中功率长时间（MPLD）消融之间的病变特征。方法：研究1：连续113例（67±11岁，27.2%为女性）的1 - 4年EP学员进行CTI-Abl。研究队列历来分为三组：使用TactiCath （TC-MPLD, N = 38）的MPLD （30-35 W，持续30 s）和使用tactical flex （TF-MPLD, N = 23）的MPLD和HPSD (50 W，持续12 s)；Tf-hpsd, n = 52)。主要终点为首次通过双向峡部阻滞（BIB）。研究2：使用离体模型比较每种消融策略产生的病变几何形状。结果：研究1:TF-HPSD消融策略比MPLD方案显示出更高的首次BIB成功率(TC-MPLD, 58%；TF-MPLD, 48%;结论：与传统方法相比，EP培训生使用tactical flex SE导管进行HPSD CTI-Abl具有更高的首次通过BIB率，更短的总手术过程和RF应用时间，更少的消融点和间隙，且未增加并发症发生率。

{"title":"Efficacy and Safety of High-Power Short-Duration Ablation for Cavo-Tricuspid Isthmus With a Flexible-Tip Temperature-Controlled Power Regulation Catheter Performed by Electrophysiology Trainees","authors":"Hidehiro Iwakawa, Masateru Takigawa, Kosuke Nakada, Tasuku Yamamoto, Takashi Ikenouchi, Mayumi Masumura, Miho Negishi, Iwanari Kawamura, Kentaro Goto, Takatoshi Shigeta, Takuro Nishimura, Tomomasa Takamiya, Susumu Tao, Shinsuke Miyazaki, Masahiko Goya, Hiroyuki Watanabe, Tetsuo Sasano","doi":"10.1111/jce.16516","DOIUrl":"10.1111/jce.16516","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The suitability of high-power short-duration (HPSD) cavo-tricuspid isthmus ablation (CTI-Abl) for electrophysiology (EP) trainees, as well as the underlying mechanisms of its efficacy, remain unknown. The aim of this study was to clarify the efficacy and safety of HPSD CTI-Abl performed by EP trainees and assess lesion characteristics between HPSD and moderate-power long duration (MPLD) ablations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Study 1: CTI-Abl was performed by first- to fourth-year EP trainees in consecutive 113 patients (67 ± 11 years, 27.2% female). Study cohort was historically divided into three groups: MPLD (30–35 W for up to 30 s) using TactiCath (TC-MPLD, <i>N</i> = 38) and MPLD and HPSD (50 W for 12 s) using TactiFlex (TF-MPLD, <i>N</i> = 23; TF-HPSD, <i>N</i> = 52). Primary endpoint was first-pass bidirectional isthmus block (BIB). Study 2: lesion geometries created by each ablation strategy were compared using an ex-vivo model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Study 1: TF-HPSD ablation strategy demonstrated a higher success rate of first-pass BIB than MPLD protocol (TC-MPLD, 58%; TF-MPLD, 48%; TF-HPSD, 94%, <i>p</i> < 0.001), without any complications. TF-HPSD group was associated with shorter total procedure and RF application times, as well as fewer ablation points and gaps, compared to the MPLD groups. Study 2: TF-HPSD created greater lesion surface length, width, and area than MPLD strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>HPSD CTI-Abl performed by EP trainees using TactiFlex SE catheter demonstrated a higher first-pass BIB rate, shorter total procedure and RF application times, and fewer ablation points and gaps compared to the conventional method, without increasing complication rates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"36 2","pages":"367-375"},"PeriodicalIF":2.3,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Feasibility and Clinical Efficacy of Focal Pulsed Field Ablation in Patients With Non-Pulmonary Vein Triggered Atrial Arrhythmia From the Superior Caval Vein 上腔静脉局部脉冲场消融治疗非肺静脉诱发心房心律失常的可行性及临床疗效。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology

Pub Date : 2024-12-10 DOI: 10.1111/jce.16510

Ahmad Keelani, Obaida Alothman, Georgi Borisov, Markus Frommhold, Lorenzo Bartoli, Hytham Abdelwahab, Gabriele D'Ambrosio, Sultan Al Shehri, Santi Raffa, J. Christoph Geller

Introduction

In patients with atrial arrhythmias originating from the superior vena cava (SVC), the use of radiofrequency energy to isolate the SVC is associated with a significant risk of injury both to the phrenic nerve and the sinus node. Pulsed field ablation (PFA) may overcome the disadvantages of thermal energy and improve both ablation efficacy and safety.

Objective

We report the feasibility, safety, and clinical efficacy of focal monopolar PFA in patients with the origin of their atrial arrhythmia in the SVC.

Methods

Nine patients (7 men, age 66 ± 8 years) with SVC-induced paroxysmal AF (n = 3), persistent AF (n = 5), or frequent premature atrial beats (n = 1) underwent SVC isolation using focal monopolar PFA.

Results

Acute circumferential SVC isolation was achieved in all cases, using 22 Ampere (A) or 25 A in areas with or without phrenic capture, respectively. The safety profile was excellent: two patients had transient sinus arrest and two had transient phrenic nerve stunning. Sinus node and phrenic nerve function recovered during the procedure, and no permanent damage was observed at follow-up. Coronary vasospasm occurred (and quickly resolved after injection of nitroglycerin) in one patient during additional ablation of a focal atrial tachycardia at the coronary sinus ostium. Kidney function remained stable before and after ablation in all patients.

Conclusions

In this patient cohort with SVC-triggered atrial arrhythmia, isolation using focal monopolar PFA was feasible, effective, and safe. No permanent injury to the phrenic nerve or sinus node was observed.

在源自上腔静脉（SVC）的房性心律失常患者中，使用射频能量隔离SVC与膈神经和窦房结损伤的显著风险相关。脉冲场烧蚀（PFA）可以克服热能烧蚀的缺点，提高烧蚀效率和安全性。目的：我们报道局灶单极PFA治疗心房心律失常的可行性、安全性和临床疗效。方法：9例（男性7例，年龄66±8岁）SVC诱发的阵发性房颤（n = 3）、持续性房颤（n = 5）或频繁早搏（n = 1）采用局灶单极PFA分离SVC。结果：所有病例均实现了急性周向SVC隔离，分别在有或没有膈膜捕获的区域使用22安培(A)或25 A。安全性非常好：两名患者有短暂性窦性骤停，两名患者有短暂性膈神经休克。术中窦结及膈神经功能恢复，随访未见永久性损伤。1例患者在冠状窦口灶性房性心动过速的附加消融过程中发生冠状动脉血管痉挛（注射硝酸甘油后迅速消退）。所有患者消融前后肾功能均保持稳定。结论：在svc诱发的心房心律失常患者队列中，采用局灶单极PFA隔离是可行、有效和安全的。膈神经及窦结未见永久性损伤。

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引用次数: 0

Brugada Phenocopy Induced by BRAF and MEK Inhibitors in a Lung Adenocarcinoma BRAF和MEK抑制剂在肺腺癌中诱导Brugada表型

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology

Pub Date : 2024-12-10 DOI: 10.1111/jce.16533

Leonardo Portolan, Alessandro Ruzzarin, Francesca Vassanelli, Flavio Ribichini, Giacomo Mugnai

Management of patients with drug-induced type 1 Brugada pattern is complex and controversial. We report the case of a 66-year-old man affected by metastatic lung adenocarcinoma with type 1 Brugada phenocopy at electrocardiogram (ECG) after initiation of an oncological therapy with BRAF and MEK inhibitors.

药物致1型Brugada型患者的治疗是一个复杂而有争议的问题。我们报告了一例66岁男性转移性肺腺癌患者，在接受BRAF和MEK抑制剂的肿瘤治疗后，心电图显示1型Brugada表型。

引用次数: 0

Incidence and Predictors of Adverse Events Among Patients Awaiting Left Atrial Appendage Closure. 等待左心耳闭合的患者不良事件的发生率及预测因素。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology

Pub Date : 2024-12-09 DOI: 10.1111/jce.16502

Justin Pieper, Sapan Bhuta, Michael Poliner, Brian J Hansen, Chad C Ward, Salvatore J Savona, Ralph S Augostini, Steven J Kalbfleisch, Muhammad R Afzal, Mahmoud Houmsse, Emile G Daoud, John D Hummel

Background: There is a paucity of data regarding the optimal timing of left atrial appendage closure (LAAC) and whether scheduling delays increase the risk for adverse outcomes.

Objectives: This study sought to assess the incidence and predictors of adverse events among patients awaiting LAAC.

Methods: This single-center retrospective study assessed all patients who underwent LAAC from January 2017 to March 2020. The primary study endpoints were the rate and characteristics of adverse events occurring from the time of initial shared decision to pursue LAAC until the time of LAAC. Adverse events were defined as clinically significant bleeding or anemia, thromboembolic complications, or death. Patients were censored after successful closure or the first adverse event.

Results: Two hundred and sixty-five patients underwent LAAC with demographics notable for age 73.5 ± 8.1 years, 98 (37%) females, left ventricular ejection fraction 52.3% ± 10.4%, CHA₂DS₂-VASc 4.8 ± 1.4, and HAS-BLED 3.2 ± 1.2. Median time from shared decision to insurance approval and insurance approval to LAAC were 18 (IQR 28) and 44 (IQR 40) days, respectively. Seventeen (6%) patients suffered an adverse event, including 15 (88%) cases of bleeding or anemia and 2 (12%) cases of thromboembolism. Multivariate analysis demonstrated that increased time to LAAC (odds ratio [OR] 1.31, 95% confidence interval [CI] [1.15, 1.50], p < 0.001) and higher HAS-BLED score (OR 1.67, CI [1.11, 2.59], p = 0.017) were associated with significantly increased risk for adverse events.

Conclusion: Prolonged time to LAAC and higher HAS-BLED score portend an increased risk for adverse events while awaiting LAAC. Expedited closure is warranted in high-risk patients.

背景：关于左心耳关闭（LAAC）的最佳时间以及时间延迟是否会增加不良后果的风险的数据缺乏。目的：本研究旨在评估等待LAAC的患者不良事件的发生率和预测因素。方法：这项单中心回顾性研究评估了2017年1月至2020年3月期间接受LAAC治疗的所有患者。主要研究终点是从最初共同决定进行LAAC时到LAAC时发生的不良事件的发生率和特征。不良事件定义为临床显著出血或贫血、血栓栓塞并发症或死亡。患者在成功闭合或首次不良事件后被审查。结果：265例患者行LAAC，年龄73.5±8.1岁，女性98例（37%），左室射血分数52.3%±10.4%,CHA2DS2-VASc 4.8±1.4,ha - bled 3.2±1.2。从共同决策到保险批准和保险批准到LAAC的中位时间分别为18 （IQR 28）和44 （IQR 40）天。17例（6%）患者出现不良事件，包括15例（88%）出血或贫血，2例（12%）血栓栓塞。多因素分析显示，等待LAAC的时间延长（优势比[OR] 1.31, 95%可信区间[CI] [1.15, 1.50], p）。结论：等待LAAC的时间延长和较高的ha - bled评分预示着等待LAAC期间不良事件发生的风险增加。在高危患者中加速关闭是必要的。

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引用次数: 0

Unique Feature of Catheter Ablation for Tachyarrhythmia in Pediatric Patients 导管消融治疗小儿快速心律失常的独特特点。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology

Pub Date : 2024-12-08 DOI: 10.1111/jce.16527

Naoya Kataoka, Teruhiko Imamura

引用次数: 0

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