Journal of Interventional Cardiac Electrophysiology最新文献

Background: The time from the initial diagnosis of atrial fibrillation (AF) to the index ablation procedure, known as diagnosis-to-ablation time (DAT), is a modifiable risk factor that is correlated to affect the recurrence of AF. The objective of this meta-analysis was to examine the correlation between diagnosis-to-ablation time and AF recurrence.

Methods: A systematic search was performed in PubMed, Google Scholar, and Cochrane Library from database inception till June 2024. Studies reporting diagnosis-to-ablation time and its relation with AF recurrence were included. The primary analysis evaluated outcomes segregated by DAT ≤ 1 year versus > 1 year. Random-effects model with the Mantel-Haenszel method was used to evaluate AF recurrence.

Results: Of the 9177 articles, only 6 observational studies got through the inclusion criteria with a total participant count of 14,862. DAT of greater than 1 year was associated with increased risk of AF recurrence in all the included studies while DAT of ≤ 1 year was correlated with lower risk of AF recurrence (RR, 0.76 (95% CI, 0.73-0.79); P < 0.01). Similarly, DAT of ≤ 3 years was correlated with lower AF recurrence risk (RR, 0.82 (95% CI, 0.79-0.85); P < 0.01).

Conclusion: Evidence from observational cohorts suggests that the optimum time for ablation in AF patients is less than 1 year and a DAT of ≤ 1 year is linked to 24% lower chances of recurrence in AF patients, compared to DAT of ≥ 1 year.

Background: Risk scores have been used to assess stroke risk in atrial fibrillation (AF) for reducing ischemic stroke and bleeding risk. Information gain ratio (IGR) is an entropy-based parameter that shows which clinical score is more informative for prediction of the clinical endpoint.

Objective: Herein, we aimed to generate and validate a stroke risk score based on the TuRkish Atrial Fibrillation (TRAF) data.

Methods: We used a split-sample approach to develop and internally validate the new stroke risk score. Based on multivariate logistic regression analysis, we generated CHADS-F in the anticoagulation naïve TRAF cohort (274,631 patients). CHADS-F stands for Cardiac failure (1 point), hypertension (1 point), age (≥ 65-69 = 1 point, ≥ 70-74 = 2 points ≥ 75 = 3 points), diabetes (1 point), stroke (2 points), and older female (1 point) (≥ 65). External validation was performed in the "Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF)" Registry. Informative capacity and accuracy of the CHADS-F score was compared with CHADS₂ and CHA₂DS₂-VASc scores.

Results: In anticoagulation naïve cohort, CHADS-F (IGR for all cohort: 0.7526) outperforms both the CHADS₂ (IGR for all cohort: 0.6340) and CHA₂DS₂-VASc (IGR for all cohort: 0.6969) in terms of the IGR for ischemic stroke and systemic embolism. Receiver operating characteristic curves revealed highest accuracy for the CHADS-F score [area under curve for CHADS-F: 0.743, CHADS₂: 0.722, and CHA₂DS₂-VASc: 0.722]. CHADS-F had good discriminative abilities at predicting clinical endpoints in the GARFIELD-AF registry.

Conclusion: The CHADS-F score had higher informative capacity and accuracy than the current CHADS₂ and CHA₂DS₂-VASc scores for predicting stroke and systemic embolism.

Background: In some patients who receive a cardiac resynchronization therapy (CRT) device, the left ventricular ejection fraction (LVEF) does not improve.

Methods: We analyzed patients enrolled in the REVERSE, MADIT-CRT, and BLOCK-HF trials, restricting the analysis to those who received CRT. Characteristics of patients with or without improved LVEF were compared using two sample t-tests and Pearson's chi-square tests. Kaplan-Meier survival curves were constructed to display time-to-event data. A log-rank test was used to compare event rates for patients with or without improved LVEF. Mixed effects Cox Proportional-Hazards models adjusting for covariates were used to analyze time to death or heart failure hospitalization (HFH) and time to death.

Results: Of 1065 included patients, 75% (802) were men, 87% (793) were White, 11% (118) were Black, and 7% (72) were Hispanic. LVEF improved in 910 (85%) patients and did not in 155 (15%). Patients with an improved LVEF were less likely to have ischemic cardiomyopathy (ICM) (54% vs 76%; p = 0.004), more likely to have LBBB (73% vs 53%; p = < 0.001), and had longer QRS duration (159 vs 150 ms; p = < 0.001). In adjusted analyses, improved LVEF was associated with a longer time to HFH or death (HR 0.40; 95% CI 0.26-0.62; p < 0.001) or death alone (HR 0.27; 95% CI 0.15-0.48; p < 0.001).

Conclusions: Patients with improvement in LVEF post-CRT implantation are less likely to have ICM and more likely to have LBBB and a longer QRS interval. Improvement in LVEF was associated with better outcomes.

Background: Single chamber atrial pacing (AAI) provides a disease-specific treatment for sick sinus syndrome (SSS) but has largely been replaced by DDD pacing. With the advent of leadless atrial pacemakers (PM), there is growing interest in long-term follow-up data in patients with SSS and an AAI pacemaker.

Purpose: To assess the incidence of system upgrade in patients treated with AAI-PM for SSS during long-term follow-up.

Methods: This is an analysis of prospectively enrolled patients undergoing implantation of an AAI-PM. Wenckebach block point (WBP) was measured at implantation and serially during follow up.

Results: We included 178 patients (58% female, median age at implantation 77 [71-83] years). The median follow-up duration was 6.5 [2.0-9.7] years. Twenty-three patients (13%) received a system upgrade to a DDD system, corresponding to a yearly upgrade rate of 2.0%. Median time to system upgrade was 5.2 [1.6-8.7] years. Reasons for system upgrade were higher-degree AVB (39%), atrial arrhythmias (35%), low WBP (17%), and syncope (9%). Median WBP at implantation was 130 [120-140] bpm, showing a significant decline over time in the upgrade-group compared to the rest of the cohort with 103 [91-130] bpm vs. 130 [120-130] bpm (p = 0.011).

Conclusion: In this cohort of patients undergoing AAI-PM implantation for SSS, upgrade to a DDD system was low during long-term follow-up. Therefore, AAI pacing for the treatment of SSS may be considered a patient-tailored treatment option, especially in light of novel leadless pacing therapies.

Background: Skin antisepsis plays a key role in the prevention of cardiac implantable electronic device (CIED) infections. Moreover, skin antisepsis by chlorhexidine-alcohol has not yet been fully evaluated.

Objectives: This single-center controlled study sought (1) to conduct a prospective observational analysis comparing two antiseptic skin preparations over two similar consecutive time periods, one conducted over a 1-year period using a povidone-iodine-alcohol solution (group I) and the other over the following year with a chlorhexidine-alcohol solution (group II) and (2) to determine real-life CIED infection predictive factors using the Prevention of Arrhythmia Device Infection Trial (PADIT) score.

Methods and results: CIED implantations were performed in 1689 patients. A total of 17 patients (1.01%) developed a CIED infection. Long-term follow-up (16 ± 13 months) revealed no significant differences between groups: infections were observed in 9/844 patients (1.07%) in group I versus 8/845 patients (0.95%) in group II (p = 0.99). Univariate and multivariate logistic regression analyses were performed to identify infectious risk factors. Adjusted odds ratios (ORs) and hazard ratios (HRs) were calculated. Univariate analyses revealed that infection occurrence was positively correlated with acute heart failure (OR: 3.55; 95%CI [1.24-9.37]; p = 0.01 and HR: 3.37; 95% CI [1.28-8.87]; p = 0.014), renal failure (OR: 2.71; 95% CI [0.88-8.42]; p = 0.08 and HR: 2.99; 95% CI [0.97-9.17]; p = 0.05), use of temporary pacing before the implantation procedure (OR: 4.45; 95% CI [1.003-20.3]; p = 0.04 and HR: 4.35; 95% CI [0.99-19.05]; p = 0.05), PADIT score (OR: 1.3; 95% CI [1.064-1.54]; p = 0.009 and HR: 1.27; 95% CI [1.052-1.53]; p = 0.013), and PADIT score ≥ 5 (OR: 4.185; 95% CI [1.6-10.9]; p = 0.003 and HR: 3.91; 95% CI [1.51-10.149]; p = 0.005). No clear significant difference was found regarding the antiseptic skin preparation choice (OR: 0.88; 95% CI [0.34-2.3]; p = 0.8 and HR: 1.11; 95% CI [0.416-2.98]; p = 0.82). In multivariate analysis, the PADIT score ≥ 5 (OR: 3.18; 95% CI [1.125-8.99]; p = 0.003 and HR: 3.052; 95% CI [1.089-8.55]; p = 0.034) and use of temporary pacing before the implantation procedure (OR: 8.44; 95% CI [1.68-42.34]; p = 0.01 and HR: 8.49; 95% CI [1.732-41.69]; p = 0.008) were negatively correlated with the device infection risk.

Conclusion: This study found that chlorhexidine-alcohol and povidone-iodine-alcohol solutions displayed similar antiseptic effects regarding CIED infection prevention. Both use of temporary pacing before the implantation procedure and PADIT score ≥ 5 correlated with the device infection risk.

Background: Dilated cardiomyopathy (DCM) and cardiac sarcoidosis (CS) manifest unique late gadolinium enhancement (LGE) patterns on cardiac magnetic resonance (CMR), indicative of different myocardial scar distributions. However, the overlap in these patterns due to their lack of specificity complicates differentiation. This study introduces a novel quantitative method employing z-score analysis of LGE-CMR intensity to objectively compare the spatial distribution of LGE intensity between DCM and CS.

Methods: This retrospective study included 22 NICM patients (13 DCM, 9 CS) who underwent CMR before electrophysiology study from November 2018 to May 2023. LGE images were delineated into sub-endocardial, mid-myocardial, and sub-epicardial layers across anterior, lateral, inferior, and septal walls using the AHA 17-segment model. CMR signal intensities were standardized to z-scores (z = (x - μ)/σ), with x as the signal intensity for a specific myocardial segment, and μ and σ as the mean and SD for all LV myocardial segments, to map regional intensity variations.

Results: Compared to DCM, CS patients exhibited significantly higher CMR signal intensity z-scores in the septum (β = 0.32, p = 0.009), particularly in the endocardial third of the right ventricular (RV) side (β = 0.56, p = 0.001). A z-score greater than 0.40 in this area was associated with a CS diagnosis, with an area under the ROC curve of 0.692 in fivefold cross-validation.

Conclusion: Patients with CS exhibit higher affinity for contrast in the septum, particularly on the RV endocardium. Standardized analysis of CMR signal intensities provides a novel, quantitative method for distinguishing CS from DCM, with the former exhibiting higher CMR signal intensity z-scores in the septum.