Journal of Interventional Cardiac Electrophysiology最新文献

Background: Atrioventricular node ablation (AVNA) and pacemaker implantation enhance prognosis in heart failure patients experiencing rapid ventricular response due to atrial fibrillation. This meta-analysis assessed the clinical benefits of various pacing modalities following AVNA.

Methods: The electrophysiological endpoint was defined as QRS duration, while the echocardiographic endpoint was the change in left ventricular ejection fraction. Secondary endpoints included pacing threshold, mortality rates, and improvements in the 6-min walk test.

Results: This meta-analysis of 13 studies involving 1257 patients suggested that His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) conferred an advantage in narrowing QRS duration compared to biventricular pacing (BVP) (HBP vs BVP OR = - 59.05, 95%CI = - 73.12 to - 44.97; LBBAP vs BVP OR = - 48.64, 95%CI = - 64.05 to - 33.24). The findings of echocardiographic endpoints suggested that LBBAP and HBP emerged as the optimal strategies over RVP (vs HBP OR = - 7.59, 95%CI = - 11.85 to - 3.32; vs LBBAP OR = - 6.58, 95%CI = - 12.08 to - 1.07). LBBAP reduced all-cause mortality compared to BVP (OR = 0.10, 95%CI = 0.01-0.78); however, no significant differences in all-cause mortality were observed between LBBAP and HBP. The pacing threshold of LBBAP was significantly lower than HBP (OR = - 0.40, 95%CI = - 0.57 to - 0.23).

Conclusion: LBBAP not only demonstrated superior clinical outcomes regarding mortality compared to ventricular pacing strategies, but also was associated with a lower pacing threshold than HBP, thereby indicating its potential advantage over HBP in patients undergoing AVNA and subsequent pacemaker implantation.

Background: Short-duration radiofrequency ablation is designed to enhance efficiency of pulmonary vein isolation (PVI). We investigated the performance of a novel stability algorithm (STABILITY +).

Methods: In a prospective, single-center study, consecutive patients undergoing first-time PVI were included. Patients were categorized into four groups: Group 1, Hybrid (anterior, 50 W, 550 AI; posterior, 90 W 4 s) using Viistag; Group 2, Hybrid using STABILITY + ; Group 3, 90 W (anterior and posterior, 90 W 4 s) using Visitag; Group 4, 90 W using STABILITY + . Clinical, procedural and follow-up data were systematically collected.

Results: A total of 268 patients were included. In total, 130 patients had Hybrid ablation while 138 underwent 90-W ablation. Procedure time was comparable in Groups 1, 2, and 3 however was lower in Group 4 (65 min, 65 min, 70 min, 54 min, p < 0.001). RF-time was longer in Group 1 and 2 vs 3 and 4 (11.6 min, 9.7 min, 4.5 min, 5.2 min, p < 0.001). First-pass isolation rates were comparable between all 4 groups (88%, 91%, 83.9%, 90%, p = 0.480). Freedom from arrhythmia at 6 months was also comparable (9%, 9%, 16.6%, 10.4%, p = 0.341). Complications were comparable and low and restricted to vascular access-related complications (2%, 1%, 0%, 2%, p = 0.388).

Conclusions: Irrespective of the mode of ablation, the novel STABILITY + algorithm can be used in PVI ablations without compromising safety and efficiency and has the potential to improve first-pass isolation using 90-W HPSD ablation.

Background: Current treatment strategies for vasovagal syncope (VVS) patients recommended by the guidelines are diverse, but effects of these therapies are still unsatisfactory with respective limitations on the indications. Cardioneuroablation (CNA), an innovative and promising therapy, has shown potently effective against syncopal recurrences in numerous observational studies. Recently, a single-center randomized clinical trial has reported CNA was superior to non-pharmacologic therapy for VVS patients. Therefore, this study is designed to compare the efficacy of CNA with pharmacologic treatment in a multicenter and randomized fashion.

Methods and results: The Cardioneuroablation versus Midodrine in Patients with Vasovagal Syncope (CAMPAIGN) study is an international multicenter, prospective, open-label, randomized controlled trial. The recurrent VVS patients with a positive response to tilt testing despite sufficient conventional treatment will be predominantly enrolled at different medical centers in China, Russia, and Turkey. All eligible participants will be randomized in a ratio of 1:1 to treatment with CNA versus midodrine, and followed up for 12 months after randomization. Approximately 184 subjects are projected to enroll from April 2023 to December 2024 with follow-up until 2025. The primary endpoint is the recurrence rate of syncope at 12 months of follow-up. The secondary endpoints are comprised of quality of life assessed with the Impact of Syncope on Quality of Life, tilt-induced syncope, blood pressure, cardiac deceleration capacity, and heart rate variability.

Conclusion: A prospective and multicenter clinical trial to compare outcomes of CNA with drug therapy is still lacking. The CAMPAIGN study will provide outcome-based evidence for VVS treatment strategy.

Trial registration: Clinicaltrials.gov: NCT05803148 (Date: March 9, 2023).

Background: Ibrutinib, a Bruton's tyrosine kinase (BTK) inhibitor, is used in the treatment of B-cell malignancies (e.g., chronic lymphocytic leukemia [CLL]). Initial risk stratification of ibrutinib-associated atrial fibrillation (IAAF) may inform atrial fibrillation (AF) surveillance strategies. The performance of existing AF risk scores to predict incident AF among patients newly treated with ibrutinib is unknown.

Methods: We conducted a single-center retrospective study of all patients without a history of AF who were treated with ibrutinib (2012-2016). Patient demographics were compared between cohorts by the presence of IAAF within 24 months of treatment initiation. First, the predictive ability of established AF risk models was assessed. Secondly, univariate and multivariate analyses were used to create a new IAAF risk model which was compared to established AF risk models by area under the curve (AUC) analysis.

Results: Of 167 patients (66 ± 11 years, 70% male), 24 (14.4%) developed incident IAAF (mean time to IAAF, 7.1 ± 6.3 months). Univariate analysis showed that hypertension (HTN), diabetes (DM), systolic heart failure (HFrEF), and obstructive sleep apnea (OSA) were associated with IAAF. Logistic regression analysis of variables of interest and those with p < 0.1 on univariate analysis demonstrated that left atrial diameter (LAD) > 43 mm and obstructive sleep apnea were independently associated with IAAF. Existing AF risk scores had reasonable performance (AUC, 0.68-0.72). A new simple clinical risk score was developed: OSA 5 points, HFrEF 3 points, DM 2 points, and hyperlipidemia 2 points. This simple IAAF risk score achieved a numerically greater AUC than that of established risk models (AUC = 0.77). There was no statistically significant difference in the AUC performance between risk scores.

Conclusion: Among 167 ibrutinib naïve patients, risk factors for incident AF development resemble those of the general population. However, common AF risk models have moderate predictive ability. Large validation studies are needed to confirm the superior IAAF predictive ability of this simple risk score and investigate the incremental predictive value of echocardiographic variables.

Background: There are various diagnostic manoeuvres to distinguish between atrial tachycardia (AT), atrio-ventricular nodal re-entrant tachycardia (AVNRT) and orthodromic re-entrant tachycardia (ORT) when assessing a narrow complex supraventricular tachycardia (SVT) in the electrophysiology (EP) laboratory. These manoeuvres are commonly used in combination to come to a diagnosis due to the inability of a single test to be able to reliably differentiate between the arrhythmias.

Objective: To determine whether a single captured His-synchronous simultaneous extra-stimulus in the atrium and ventricle ("Double Capture") can reliably distinguish the mechanism of a narrow complex SVT.

Methods: At a single institution, we reviewed the data on patients in whom this maneuver was performed as part of their routine electrophysiology study and analyzed the intracardiac recordings. There were 44 patients who underwent routine electrophysiology studies for narrow complex SVTs and the maneuver was attempted. If the simultaneous extra-stimuli was delivered when the His was refractory and captured both the atrium (A) and ventricle (V), the earliest signal was assessed to attempt to differentiate the mechanism.

Results: Double Capture was attempted in 44 patients of which six were excluded due to incorrect timing or inadequate electrogram recordings. Of the 38 remaining patients who either had AVNRT or ORT (no atrial tachycardias were included), "Double Capture" was achieved in 29 patients (76%). In patients in whom "Double Capture" occurred, reproducible termination of the tachyarrhythmia with "Double Capture" corresponded with ORT (n = 7). In patients with "Double Capture" with a His signal as the first signal post, and ongoing tachycardia, this typically corresponded with a diagnosis of AVNRT (n = 20), though there were two exceptions with ORT (n = 2).

Conclusion: In this small study, "Double Capture" of the A and V during a sustained narrow complex SVT without change to the tachycardia or His interval timings was able to confirm AVNRT with a specificity of 78% and ORT with a specificity of 100%. This maneuver may be especially helpful to confirm bystander pathways or assess septal pathways.