Journal of Interventional Cardiac Electrophysiology最新文献

Atrial arrhythmias, including atrial fibrillation (AF), are a major contributor to cardiovascular morbidity and mortality. Early detection and effective management are critical to mitigating adverse outcomes such as stroke, heart failure, and overall mortality. Wearable devices have emerged as promising tools for monitoring, detecting, and managing atrial arrhythmias near-continuously. This comprehensive analysis explores these wearable technologies' current role and capabilities for clinicians' daily practice. Despite challenges related to data accuracy, privacy, patient compliance, and integration with healthcare systems, ongoing advancements hold significant promise for the future. Continued research and development are essential to fully realize the potential of wearables in improving clinical outcomes for patients with atrial arrhythmias.

Background: The conventional mapping approach for the atrioventricular accessory pathway (AP) involves point-by-point mapping to identify the connection sites of the AP to the atria or ventricle and accurate interpretation of local electrograms. Omnipolar mapping technology (OMT) explains how vector and wave speed are produced by using both unipolar and bipolar signals to obtain omnipolar signals, directions, and conduction velocity. The aim of this study is to verify the effectiveness of OMT for catheter ablation of AP.

Methods: The study enrolled 68 patients who underwent catheter ablation of APs between January 2018 and December 2023, of which 35 (OMT group) underwent high-resolution omnipolar mapping and 33 underwent radiofrequency ablation (RF) with a conventional approach (conventional group). The background characteristics and procedural details of these groups were compared.

Results: All patients achieved acute success. Any arrhythmia recurrence was observed in one and three patients in the OMT and conventional groups, respectively (p = 0.0501). In the OMT group, AP elimination by the first RF applications (77.1% vs. 48.4%, p = 0.0143), the number of RF applications for eliminating AP (median [IQR]; 1.1 [1.0-3.0] vs. 4.4 [1.0-7.0], p = 0.0012), procedure time (median [IQR], min; 80.1 [72.2-92.7] vs. 112.0 [95.1-125.4], p < 0.01), fluoroscopy time (median [IQR], min; 12.0 [9.5-15.2] vs. 19.8 [13.6-28.1], p < 0.01), and fluoroscopy dose (median [IQR], mGy; 60.9 [45.0-83.5] vs. 129.0 [80.5-360.2], p < 0.01) were significantly lower than in the conventional group. No complications associated with mapping and ablation procedures were observed.

Conclusions: The OMT was useful for ablating APs and reducing the number of RF applications and radiation exposure.

Background: Slow activation areas, characterized by decreased conduction velocities in the left atrium, are commonly observed in patients with persistent atrial fibrillation (PeAF). However, it remains unclear whether the ablation of slow activation areas combined with pulmonary vein isolation (PVI) improves clinical outcomes in these patients.

Methods: This single-center retrospective study included patients who underwent catheter ablation for PeAF. A total of 78 consecutive patients were included in the PVI + SAA group, while another 78 patients who underwent PVI with/without the roof line, matched 1:1 by propensity score, served as the control group. Slow activation area was defined as ≥ 4 10 ms-step isochrones within 10 mm distance. The endpoint was AF recurrence, atrial flutter, or atrial tachycardia (AT) lasting > 30 s after the blanking period.

Results: The mean mapping time was 10 ± 3 min in the PVI + SAA group. Slow activation areas were identified in 37 of the 78 patients, predominantly located in the anterior wall and often overlapping with the low-voltage areas. The proportion of atrial arrhythmia-free patients was significantly higher in the PVI + SAA group compared to the PVI group (Log-rank P = 0.024; hazard ratio [HR]: 0.40; 95% confidence interval [CI]: 0.19-0.85). Subgroup analysis showed no significant difference in AT/AF recurrence rates between patients who underwent additional ablation of slow activation area and those without identified slow activation areas in the PVI + SAA group (Log-rank P = 0.73; HR: 1.20; 95% CI: 0.42-3.42).

Conclusions: Slow activation areas can be efficiently identified using isochronal mapping. Targeted ablation of slow activation areas helps reduce AT/AF recurrence in patients with PeAF.

Pulmonary vein (PV) variations are commonly detected by preoperative imaging modalities in catheter ablation for atrial fibrillation. However, rare variations that have not been previously reported exist. The present case is the first reported instance of three PVs originating from a common trunk. Contrast-enhanced cardiac computed tomography revealed that the left superior, left inferior, and right inferior PVs originated from the common trunk. Additionally, 3-dimensional electroanatomical mapping revealed interesting findings, showing that the three PVs and their common trunk were scarred areas prior to catheter ablation. The rare common PV may have no arrhythmogenic substrate in the PV antrum or common trunk.

Background: Patients with transposition of the great arteries (TGA) who undergo atrial switch procedures may develop symptomatic atrial arrhythmias necessitating ablation. We present a single-centre retrospective analysis of a novel approach using jugular access for catheter ablation in this unique patient population.

Methods: A 5-year retrospective analysis was conducted on patients referred for atrial arrhythmia ablation following atrial switch procedures. Procedures were performed by experienced operators, and data on patient demographics, procedural characteristics, and outcomes were collected. Statistical analysis was performed to compare outcomes between jugular and femoral access groups.

Results: Jugular access (N = 9) and femoral access (N = 13) cohorts were comparable in age, gender distribution, and clinical characteristics. Procedural success rates were high in both groups, with no significant difference in recurrence rates. Jugular access demonstrated a comparatively safe profile compared to femoral access.

Discussion: The jugular approach offers a viable alternative to femoral access for atrial arrhythmia ablation in patients with atrial switch procedures. The trajectory from the internal jugular vein to the baffle is straightforward, reducing vascular complications. Success rates and procedural times were comparable, highlighting the feasibility and safety of the jugular approach. The option for rapid post-procedural mobilisation adds to its appeal.

Conclusion: Atrial arrhythmia ablation with jugular access in patients with atrial switch procedures is safe and effective, providing an alternative in cases where femoral access may pose challenges. This approach warrants consideration in the management of atrial arrhythmias in this unique patient population.

Background: Little data exists regarding the optimal antithrombotic strategy during S-ICD implantation to prevent pocket hematomas. This study explores the association between perioperative antithrombotic management and the occurrence of pocket hematoma following S-ICD implantation.

Methods: All patients who underwent de novo S-ICD implantation between February 2009 and January 2023 at Amsterdam UMC were included. Data was collected retrospectively from electronic patient records. Clinically significant pocket hematomas were defined as an accumulation of blood at the pocket site within 30 days after implantation.

Results: A total of 347 patients were included of which 224 (64.6%) patients used antithrombotic therapy pre-implantation. The median age at implantation was 50 years (IQR 36-61 years), 33.4% of the patients were female, and the majority of implants were intermuscular (90.2%). A total of 18 patients (5.2%) developed a clinically significant pocket hematoma. There were significantly more pocket hematomas in patients with continued vitamin K antagonists (VKA) compared to patients with interrupted VKA (27.3% (6/22) vs. 4.3% (2/47), respectively, p = 0.01), and continuation of VKA was an independent predictor for pocket hematoma formation in the VKA group (p = 0.04). Moreover, continuation of dual antiplatelet therapy (DAPT) with ticagrelor was associated with significantly more pocket hematomas post-implantation compared to continuation of DAPT with clopidogrel (4/12 vs. 1/28, respectively, p = 0.02).

Conclusion: Continuation of VKA during S-ICD implantation was associated with an increased risk of pocket hematoma formation compared to interruption of VKA. This supports the need for specific perioperative antithrombotic therapy guidelines for S-ICD implantations to reduce the risk of pocket hematomas.

Introduction: Mutations in EMD are related to an increased risk of ventricular arrhythmias and sudden cardiac death. There is a lack of data concerning ventricular arrhythmia ablation in Emery-Dreifuss patients.

Methods and results: We present a case of successful ablation of a short-coupled ventricular ectopy (VE) triggering recurrent ventricular fibrillation (VF) episodes in a EMD patient with an intraseptal substrate. Our approach combined substrate ablation with ICD-guided pacemapping.

Conclusion: VF ablation of Purkinje triggers may be an alternative treatment for patients with dilated cardiomyopathy and recurrent ICD shocks due to VF induced by monomorphic VE.

Background: The relationship between premature ventricular contractions (PVC) and right ventricular (RV) function is not widely known. Left ventricular (LV) dysfunction due to PVC is known as PVC-induced cardiomyopathy (PIC) and suppressing the PVC substrate would improve LV function. The effect of PVC ablation on changes in RV function in patients with subtle RV subclinical dysfunction remains unknown.

Objective: Understanding the alterations in RV function parameters after PVC ablation.

Method: Basic and speckle-tracking echocardiography has been performed on 42 individuals with symptomatic idiopathic outflow tract PVC before and 1 month after a successful ablation.

Result: At the baseline of the study, there were 26 patients with RV subclinical dysfunction and 16 patients without RV dysfunction. Patients with RV subclinical dysfunction exhibited significantly higher PVC burden and QRS complex duration than those with normal RV function (p < 0.05). A PVC burden ≥ 21% (OR 9.11, 1.54-53.87, p = 0.015) and a QRS complex duration ≥ 138 ms (OR 5.74, 1.07-30.90, p = 0.042) were independently associated with RV subclinical dysfunction. In both groups, measurements of RV subclinical function before and after ablation, specifically by free wall longitudinal strain (FWLS) and global longitudinal strain (GLS), demonstrated significant changes. These improvements were more pronounced in the group with RV dysfunction (FWLS 9.7 ± 4.0, p < 0.001; GLS 7.5 ± 4.2, p < 0.001). Lower initial FWLS and GLS before ablation emerged as significant parameters in the multivariate analysis for the improvement of RV function post-ablation.

Conclusion: Patients with RV subclinical dysfunction had higher PVC burden and wider QRS duration. Patients with idiopathic outflow tract PVC with RV subclinical dysfunction may experience improvements in RV function after successful PVC ablation.