Journal of Interventional Cardiac Electrophysiology最新文献

Background: In patients with ventricular arrhythmias (VA) admitted via the emergency department (ED), immediate catheter ablation (CA-VA) might be indicated to stabilize patients. However, the unstable condition of these patients may increase periprocedural risk. This study evaluated the periprocedural safety of immediate CA-VA in patients admitted via the ED.

Methods and results: In total, 223 ED patients who underwent immediate CA-VA from 01/2017 to 12/2022 (mean age 66 ± 13 years, 19% female, 55% heart failure, 59% coronary artery disease) were analyzed in terms of in-hospital outcomes (periprocedural death, pericardial tamponade, thromboembolic events, major bleedings). To address differences to elective patients, ED patients were compared with 784 elective CA-VA patients (mean age 59 ± 15 years, 34% female, 20% heart failure, 33% coronary artery disease, all p < 0.001): ED patients experienced higher rates of periprocedural complications (6.3% vs. 2.0%, p = 0.002) driven by thromboembolic events (2.2% vs. 0.4%, p = 0.02). Life-threatening complications were not different between groups (cardiac tamponade: 2.2% vs. 1.4%, p = 0.56; stroke: 0.9% vs. 0.4%, p = 0.67). Seven ED patients (3.1%) died unrelated to the procedure during hospitalization vs. none in the elective CA-VA group. Emergency admission (OR 3.07, 95% CI 1.48-6.38), age (OR 2.12, 95% CI 1.22-3.70), and heart failure (OR 1.99, 95% CI 0.96-4.15) were independently associated with periprocedural complications and overall death during hospitalization.

Conclusion: Patients with VA admitted via the ED were older, sicker, and more often presented with ventricular tachycardia than elective CA-VA patients. Immediate CA-VA was associated with higher rates of periprocedural complications, driven by thromboembolic events; however, no procedure-related death occurred.

Background: Catheter ablation using radiofrequency (RF) energy is an established treatment for ventricular tachycardia (VT). Tissue temperature is a key determinant of successful lesion creation, and yet, it is difficult to measure during conventional RF ablation because of the cooling effect of high-flow rate saline irrigation. The TRAC-VT study evaluated the safety and efficacy of a novel irrigated RF ablation system modulating power based on real-time tissue temperature.

Methods: Patients with sustained monomorphic VT and structural heart disease (SHD) were enrolled. Catheter ablation was performed in temperature-control mode (irrigation 8 ml/min, temperature set-points 55 or 60 °C, and power output ≤ 50 W), with RF applications for ≤ 45 s. The primary safety endpoint was a composite of cardiovascular-specific serious procedure-related adverse events within 30 days post-ablation. The primary effectiveness endpoint was acute success (i.e., non-inducibility of all clinically relevant VTs).

Results: Thirty-eight patients were enrolled with monomorphic VT (age 68 ± 12 years and 84% male), with an average of 1.7 ± 1.2 VTs targeted per patient. In total, 41 ± 23 RF applications per patient were delivered. Acute procedural success was 100% (95% CI, 91-100%). No primary safety endpoints were observed. Six-month follow-up was completed in 92% of patients with 81% (95% CI, 65-91%) freedom from sustained or treated VT. A repeat ablation was performed in three patients.

Conclusions: Ablation of VT in SHD, using a temperature-controlled irrigated RF catheter, was safe and effective with a low rate of VT recurrence at 6 months.

Introduction: Pulsed field ablation (PFA) is a non-thermal energy source for catheter ablation associated with shorter procedure time, less risk of esophageal injury, and less dependence on absolute catheter stability compared with radiofrequency ablation. Limited data are available on performing the procedure with deep sedation (DS) as an alternative to general anesthesia (GA) utilizing endotracheal intubation.

Methods: Patients who underwent PFA using DS between March and August 2024 were retrospectively included. DS was administered by anesthesia staff, consisting of propofol, dexmedetomidine, fentanyl, and midazolam, at the discretion of the practitioner. The primary endpoint was the rate of airway complications or requirement for conversion to GA. Secondary endpoints were the rate of acute procedural success, total time in the EP lab, procedure time, and non-procedure time.

Results: A total of 100 patients (mean age 71.9 ± 11.6 years, BMI 30.1 ± 7.1, 51% females) were included in the analysis. There were no instances of airway complications or conversion from DS to GA. There was a 100% rate of acute isolation of pulmonary veins. The average total time in the lab was 149.7 ± 44.7 min, consisting of a mean procedure time of 98.3 ± 40.5 min and a non-procedure time of 51.4 ± 12.2 min.

Conclusions: In this study conducted at a single health system, DS for PFA was feasible and associated with no instances of airway complications nor conversion to GA. The findings may not apply to patients with moderate or severe obstructive sleep apnea or other pulmonary diseases.

Background: Fibrillatory wave amplitude (fWA) on 12-lead ECG predicts the outcome of ablation in atrial fibrillation (AF). We hypothesized that changes in fWA following wide circumferential isolation of pulmonary veins (WPVI) in persistent AF (peAF) is a better predictor of ablation outcome compared to baseline fWA.

Methods: Eighty-nine patients (sustained peAF 7 ± 7 months) underwent a first-time WPVI. Sixty-second ECG signals devoid of QRST waves were recorded at baseline and at the end of the WPVI (endWPVI). fWA for each ECG lead and mean fWA (meanfWA) across the 12-lead ECG were computed. Patients with recurrence after the index WPVI underwent a redo to ensure complete PVI. The primary endpoint was long-term AF freedom OFF antiarrhythmics drugs (AADs) after one or two WPVI (SUCCESS group). The FAILURE group was defined as AF recurrence post-redo.

Results: Over a mean follow-up of 35 ± 10 months, freedom from AF OFF AADs was achieved in 61% (SUCCESS group), while 29% had AF recurrence after redo WPVI (FAILURE group). The SUCCESS group showed significantly higher fWA values in ECG leads V₁, V₄, and V₅ at baseline (p < 0.05), as well as in leads III, aVL, aVF, and V₄, and in meanfWA at endWPVI (p < 0.05) compared to the FAILURE group. A baseline mean fWA ≥ 0.044 mV or a decrease in mean fWA ≤ 11% following WPVI predicted long-term sinus rhythm restoration with a sensitivity of 81% and a specificity of 69% (p < 0.05).

Conclusion: Low fWA values and a significant reduction in fWA following WPVI are associated with a high risk of AF recurrence in patients with peAF.

Background: Pulmonary vein isolation (PVI) is a cornerstone of AF ablation. Posterior wall isolation (PWI) has become a frequently used adjunct to PVI. While there is data to suggest that PVI alone does not negatively impact left atrial function, the effect of PWI on left atrial mechanical function has not been definitively determined. Our aim was to determine if PVI plus PWI using a cryoballoon impacted left atrial mechanical function as measured by cardiac MRI.

Methods: We studied 28 patients who underwent ablation for AF. Fourteen patients had PVI alone and 14 patients had PVI plus PWI. All patients had cardiac magnetic resonance (CMR) before and after ablation. The primary outcome was change in LA ejection fraction (LAEF) as measured by CMR.

Results: There were no statistically significant differences in the average patient age, height, weight, type of AF, or frequency of concomitant diseases between groups. No statistically significant differences in LAEF, LA max volume, LA min volume, or LA stroke volume were identified between baseline and follow up CMRs for the PVI only group nor the PVI plus PWI group. When utilizing linear regression analysis to compare change in LAEF, LA max volume, LA min volume, and LA stroke volume before and after ablation between groups, no statistically significant differences were identified.

Conclusion: Cardiac MRI did not demonstrate a significant change in left atrial mechanical function as measured by left atrial ejection fraction after pulmonary vein isolation alone nor after PVI plus posterior wall isolation.

Background: Patients undergoing atrial fibrillation (AF) catheter ablation may require redo procedures involving pulmonary vein (PV) re-isolation and/or ablation of extra-PV sites. Pulsed field ablation (PFA) offers a highly selective energy source for cardiac tissue, with the potential to reduce collateral damage to adjacent structures. This study aimed to evaluate the feasibility and efficacy of redo ablation using a pentaspline PFA system.

Methods: Patients undergoing redo procedures with a pentaspline PFA system at three international centers were enrolled. A workflow was established based on rhythm at presentation: sinus rhythm (Group 1), atrial flutter/atrial tachycardia (Group 2), or AF (Group 3). Propensity score matching was used for comparison between PFA- and RF-based redo ablations.

Results: A total of 117 patients were included (Group 1: 64, Group 2: 18, Group 3: 35). PV re-isolation was required in 71.9% and 72.2% of Group 1 and 2 patients, respectively. PFA terminated all cases of non-cavotricuspid isthmus dependent flutter and 45.7% of cases of AF. One major complication (0.9%; frontal cerebral hematoma) was documented. Freedom from atrial tachyarrhythmias at 12 months was 78.3% (95% CI 69.6-84.8%) without statistically significant differences among groups (Group 1: 85.7%; Group 2: 77%; Group 3: 65.5%; p = 0.053). PFA led to similar arrhythmia freedom compared to RF, but with significantly shorter procedural and dwelling times.

Conclusion: The adoption of a pentaspline PFA system for repeat ablation procedures was feasible, safe, and effective at 1-year follow-up. No clinical differences were observed between PFA and RF; however, redo PFA cases were significantly shorter.