Pub Date : 2025-01-01Epub Date: 2024-09-07DOI: 10.1007/s10840-024-01912-w
Teiichi Yamane, Tetsuo Sasano, Hirofumi Tomita, Daisetsu Aoyama, Shinsuke Miyazaki, Masateru Takigawa, Masaomi Kimura, Taihei Itoh, Seigo Yamashita, Jada M Selma, Jeffrey Cerkvenik, Atul Verma, Hiroshi Tada
Background: Pulsed field ablation (PFA), a novel treatment for atrial fibrillation (AF), has yet to be evaluated in a Japanese cohort.
Methods: In this sub-analysis of the PULSED AF trial, 12-month outcomes of paroxysmal AF (PAF) and persistent AF (PsAF) patients treated with PFA in four Japan centers were assessed. After a 90-day blanking period, primary efficacy was determined via freedom from a composite endpoint of acute procedural failure, arrhythmia recurrence, or antiarrhythmic drug escalation over 1 year. Patient improvement was evaluated via two quality of life (QoL) surveys (AFEQT and EQ-5D) at baseline and 12 months.
Results: The analysis included 32 patients, 16 PAF and 16 PsAF, with PAF patients averaging 61.1 ± 10.6 years and PsAF patients averaging 62.8 ± 11.5 years of age. Females made up 31% of PAF and 25% of PsAF cohorts. Acute pulmonary vein isolation was achieved in 100% of both cohorts. The primary efficacy success rate at 12 months was 75.0% for PAF and 56.3% for PsAF patients. No primary safety events occurred. The mean AFEQT score significantly increased for both PAF (25.9 points, p < 0.0001) and PsAF (13.2 points, p = 0.0002) patients, while the EQ-5D-5L score improved significantly for PAF (0.12 points, p = 0.048) patients but not for PsAF (0.04 points, p = 0.08) patients.
Conclusions: Similar to outcomes in the global cohort, ablation with the PulseSelect™ PFA catheter was efficient, effective, and safe in a Japanese population, resulting in improved QoL for PAF and PsAF patients.
{"title":"Safety, efficacy, and quality of life outcomes of pulsed field ablation in Japanese patients with atrial fibrillation: results from the PULSED AF trial.","authors":"Teiichi Yamane, Tetsuo Sasano, Hirofumi Tomita, Daisetsu Aoyama, Shinsuke Miyazaki, Masateru Takigawa, Masaomi Kimura, Taihei Itoh, Seigo Yamashita, Jada M Selma, Jeffrey Cerkvenik, Atul Verma, Hiroshi Tada","doi":"10.1007/s10840-024-01912-w","DOIUrl":"10.1007/s10840-024-01912-w","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation (PFA), a novel treatment for atrial fibrillation (AF), has yet to be evaluated in a Japanese cohort.</p><p><strong>Methods: </strong>In this sub-analysis of the PULSED AF trial, 12-month outcomes of paroxysmal AF (PAF) and persistent AF (PsAF) patients treated with PFA in four Japan centers were assessed. After a 90-day blanking period, primary efficacy was determined via freedom from a composite endpoint of acute procedural failure, arrhythmia recurrence, or antiarrhythmic drug escalation over 1 year. Patient improvement was evaluated via two quality of life (QoL) surveys (AFEQT and EQ-5D) at baseline and 12 months.</p><p><strong>Results: </strong>The analysis included 32 patients, 16 PAF and 16 PsAF, with PAF patients averaging 61.1 ± 10.6 years and PsAF patients averaging 62.8 ± 11.5 years of age. Females made up 31% of PAF and 25% of PsAF cohorts. Acute pulmonary vein isolation was achieved in 100% of both cohorts. The primary efficacy success rate at 12 months was 75.0% for PAF and 56.3% for PsAF patients. No primary safety events occurred. The mean AFEQT score significantly increased for both PAF (25.9 points, p < 0.0001) and PsAF (13.2 points, p = 0.0002) patients, while the EQ-5D-5L score improved significantly for PAF (0.12 points, p = 0.048) patients but not for PsAF (0.04 points, p = 0.08) patients.</p><p><strong>Conclusions: </strong>Similar to outcomes in the global cohort, ablation with the PulseSelect™ PFA catheter was efficient, effective, and safe in a Japanese population, resulting in improved QoL for PAF and PsAF patients.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov Identifier: NCT04198701.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"149-157"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-08-27DOI: 10.1007/s10840-024-01898-5
Jeanne du Fay de Lavallaz, Jackson J Liang
{"title":"Noninvasive programmed stimulation after ventricular tachycardia ablation: gazing into a crystal ball to predict recurrences?","authors":"Jeanne du Fay de Lavallaz, Jackson J Liang","doi":"10.1007/s10840-024-01898-5","DOIUrl":"10.1007/s10840-024-01898-5","url":null,"abstract":"","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"27-28"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2023-09-05DOI: 10.1007/s10840-023-01625-6
Fatima M Ezzeddine, Ammar M Killu, Abhishek J Deshmukh, Freddy Del-Carpio Munoz
{"title":"Inappropriate shocks due to P-wave oversensing in a patient with a subcutaneous implantable cardioverter-defibrillator.","authors":"Fatima M Ezzeddine, Ammar M Killu, Abhishek J Deshmukh, Freddy Del-Carpio Munoz","doi":"10.1007/s10840-023-01625-6","DOIUrl":"10.1007/s10840-023-01625-6","url":null,"abstract":"","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"1-4"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10162562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-06-21DOI: 10.1007/s10840-024-01839-2
André Rivera, Marcelo Antonio Pinheiro Braga, Caique M P Ternes, Douglas Mesadri Gewehr, Felipe Villa Martignoni, Alexander Dal Forno, Andrew H Locke, André d'Avila
The efficacy and safety of hybrid ablation (HA) for patients with non-paroxysmal atrial fibrillation (AF) remain unclear. PubMed, Embase, Cochrane, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) comparing HA (endo-epicardial ablation) versus endocardial ablation (EA) for patients with persistent/long-standing persistent AF. Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled. Our meta-analysis included 3 RCTs comprising 358 patients, of whom 233 (65.1%) were randomized to HA. Compared with EA, HA reduced the recurrence of atrial tachyarrhythmias (RR 0.53; 95% CI 0.41-0.69; p < 0.01) but had no subgroup interaction according to AF type (p = 0.90). There was no significant difference in major adverse events (RR 1.22; 95% CI 0.46-3.25; p = 0.68). Trial sequential analysis indicates that the observed effects can be deemed conclusive. In conclusion, in patients with persistent/long-standing persistent AF, HA substantially reduced the recurrence of atrial tachyarrhythmias. Notably, patients with long-standing persistent AF may benefit more from this ablation strategy.
混合消融术(HA)对非阵发性房颤(AF)患者的疗效和安全性仍不明确。我们在 PubMed、Embase、Cochrane 和 ClinicalTrials.gov 等网站上检索了对持续/长期存在的房颤患者进行 HA(心内膜消融)与心内膜消融(EA)比较的随机对照试验(RCT)。对风险比 (RR) 和 95% 置信区间 (CI) 进行了汇总。我们的荟萃分析纳入了 3 项研究,共 358 名患者,其中 233 人(65.1%)随机接受了 HA 治疗。与 EA 相比,HA 降低了房性快速性心律失常的复发率(RR 0.53; 95% CI 0.41-0.69; p
{"title":"Hybrid ablation for persistent/long-standing persistent atrial fibrillation: a meta-analysis and trial sequential analysis of randomized controlled trials.","authors":"André Rivera, Marcelo Antonio Pinheiro Braga, Caique M P Ternes, Douglas Mesadri Gewehr, Felipe Villa Martignoni, Alexander Dal Forno, Andrew H Locke, André d'Avila","doi":"10.1007/s10840-024-01839-2","DOIUrl":"10.1007/s10840-024-01839-2","url":null,"abstract":"<p><p>The efficacy and safety of hybrid ablation (HA) for patients with non-paroxysmal atrial fibrillation (AF) remain unclear. PubMed, Embase, Cochrane, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) comparing HA (endo-epicardial ablation) versus endocardial ablation (EA) for patients with persistent/long-standing persistent AF. Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled. Our meta-analysis included 3 RCTs comprising 358 patients, of whom 233 (65.1%) were randomized to HA. Compared with EA, HA reduced the recurrence of atrial tachyarrhythmias (RR 0.53; 95% CI 0.41-0.69; p < 0.01) but had no subgroup interaction according to AF type (p = 0.90). There was no significant difference in major adverse events (RR 1.22; 95% CI 0.46-3.25; p = 0.68). Trial sequential analysis indicates that the observed effects can be deemed conclusive. In conclusion, in patients with persistent/long-standing persistent AF, HA substantially reduced the recurrence of atrial tachyarrhythmias. Notably, patients with long-standing persistent AF may benefit more from this ablation strategy.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"159-163"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141436946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-11-21DOI: 10.1007/s10840-024-01949-x
Alex Scripcariu, Serge Boveda, Robin Richard-Vitton, Stephane Combes, Jean Paul Albenque, Nicolas Combes, Quentin Voglimacci-Stephanopoli
We present two cases of patients with inaccessible femoral veins referred for ablation of paroxysmal atrial fibrillation (AF) who underwent Jugular access pulmonary vein isolation (PVI) with the pentaspline pulsed field ablation system. To our knowledge, there is only one other case reported of usage of this system via a superior approach by Mol et al. (Journal of Interventional Cardiac Electrophysiology (2023) 66:835-836).
{"title":"Pulsed-field ablation of atrial fibrillation using the Farapulse system through the jugular vein: a case series of two patients.","authors":"Alex Scripcariu, Serge Boveda, Robin Richard-Vitton, Stephane Combes, Jean Paul Albenque, Nicolas Combes, Quentin Voglimacci-Stephanopoli","doi":"10.1007/s10840-024-01949-x","DOIUrl":"10.1007/s10840-024-01949-x","url":null,"abstract":"<p><p>We present two cases of patients with inaccessible femoral veins referred for ablation of paroxysmal atrial fibrillation (AF) who underwent Jugular access pulmonary vein isolation (PVI) with the pentaspline pulsed field ablation system. To our knowledge, there is only one other case reported of usage of this system via a superior approach by Mol et al. (Journal of Interventional Cardiac Electrophysiology (2023) 66:835-836).</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"5-8"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-08-30DOI: 10.1007/s10840-024-01913-9
Poggi Sara, Strisciuglio Teresa, Iuliano Assunta, Spiniello Giorgio, Schillaci Vincenzo, Arestia Alberto, Shopova Gergana, Salito Armando Mariano, Marano Giovanni, La Rocca Vincenzo, Agresta Alessia, Ricciolino Riccardo, Cosimo Damiano Di Candia, Tommaso Infusino, Marco Micillo, De Simone Antonio, Solimene Francesco, Stabile Giuseppe
Background: Very high-power short-duration (vHPSD) temperature-controlled radiofrequency ablation (vHPSD) may reduce ablation times and improve patient tolerability, permitting pulmonary vein (PV) isolation under mild conscious sedation. We evaluated of the anesthetic drugs use and patients' pain experience during vHPSD PV isolation.
Methods: Fifty-eight patients, with paroxysmal and persistent atrial fibrillation (AF), treated with QDot Micro catheter and vHPSD (90 w for 4 s) (vHPSD group), were compared with the last 33 patients treated with a surround flow contact force-sensing catheter guided by the ablation index (450 anteriorly at 50 W, 330 posteriorly at 40 W) (AI group). Anesthetic drugs use was compared as well as pain experience, measured using a 0-10 scale.
Results: All PVs were acutely isolated. Procedural time (78 ± 10 min vs 84 ± 12 min, p = 0.012), fluoroscopy time (369 ± 139 s vs 441 ± 172 s, p = 0.03), and RF time in the vHPSD group (8.3 ± 2.1 min) were shorter than in the AI group (25 ± 11 min, p < 0.001). Only 4 patients experienced an access site-related vascular complication (groin hematoma). Midazolam was required in 36 (62%) vHPSD group patients vs 31 (94%) AI group patients (p < 0.001). Fentanyl was required in 4 (7%) vHPSD group patients vs 25 (76%) AI group patients (p < 0.001). No patients required general anesthesia. Twenty-two (38%) vHPSD group patients underwent PV isolation without any anesthetic drug. Pain experience was significantly lower in vHPSD group (4.9 ± 2 vs 6.6 ± 1.8, p < 0.001).
Conclusions: vHPSD radiofrequency ablation for PVI can be performed under conscious sedation using only benzodiazepine in most of patients without compromising patient pain experience.
{"title":"Peri-procedural anesthesia and patient pain experience in pulmonary vein isolation by means of very high-power short-duration radiofrequency ablation.","authors":"Poggi Sara, Strisciuglio Teresa, Iuliano Assunta, Spiniello Giorgio, Schillaci Vincenzo, Arestia Alberto, Shopova Gergana, Salito Armando Mariano, Marano Giovanni, La Rocca Vincenzo, Agresta Alessia, Ricciolino Riccardo, Cosimo Damiano Di Candia, Tommaso Infusino, Marco Micillo, De Simone Antonio, Solimene Francesco, Stabile Giuseppe","doi":"10.1007/s10840-024-01913-9","DOIUrl":"10.1007/s10840-024-01913-9","url":null,"abstract":"<p><strong>Background: </strong>Very high-power short-duration (vHPSD) temperature-controlled radiofrequency ablation (vHPSD) may reduce ablation times and improve patient tolerability, permitting pulmonary vein (PV) isolation under mild conscious sedation. We evaluated of the anesthetic drugs use and patients' pain experience during vHPSD PV isolation.</p><p><strong>Methods: </strong>Fifty-eight patients, with paroxysmal and persistent atrial fibrillation (AF), treated with QDot Micro catheter and vHPSD (90 w for 4 s) (vHPSD group), were compared with the last 33 patients treated with a surround flow contact force-sensing catheter guided by the ablation index (450 anteriorly at 50 W, 330 posteriorly at 40 W) (AI group). Anesthetic drugs use was compared as well as pain experience, measured using a 0-10 scale.</p><p><strong>Results: </strong>All PVs were acutely isolated. Procedural time (78 ± 10 min vs 84 ± 12 min, p = 0.012), fluoroscopy time (369 ± 139 s vs 441 ± 172 s, p = 0.03), and RF time in the vHPSD group (8.3 ± 2.1 min) were shorter than in the AI group (25 ± 11 min, p < 0.001). Only 4 patients experienced an access site-related vascular complication (groin hematoma). Midazolam was required in 36 (62%) vHPSD group patients vs 31 (94%) AI group patients (p < 0.001). Fentanyl was required in 4 (7%) vHPSD group patients vs 25 (76%) AI group patients (p < 0.001). No patients required general anesthesia. Twenty-two (38%) vHPSD group patients underwent PV isolation without any anesthetic drug. Pain experience was significantly lower in vHPSD group (4.9 ± 2 vs 6.6 ± 1.8, p < 0.001).</p><p><strong>Conclusions: </strong>vHPSD radiofrequency ablation for PVI can be performed under conscious sedation using only benzodiazepine in most of patients without compromising patient pain experience.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"141-147"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-08-07DOI: 10.1007/s10840-024-01888-7
Alejandro Vidal Margenat, Som Prabh Singh, Sarah Kondrach, Ellen Condoure, Jeremy Russell, Ramesh Hariharan
Background: There remains an imperative need to accurately map the left atrium in the setting of atrial fibrillation. While the pulmonary vein segmental ostial isolation plays a significant role in atrial fibrillation, clinical attempts to selectively ablate near the pulmonary vein myocardial sleeves have demonstrated a higher recurrence rate of arrhythmia given less precise mapping modalities. However, novel omnipolar mapping technology coupled with Advisor™ HD Grid Mapping Catheter may provide an advantageous profile to map and selectively ablate near the myocardial sleeves.
Methods: This retrospective cohort underwent ablation targeting the pulmonary vein myocardial sleeves with the use of omnipolar mapping technology and later wide area circumferential ablation (WACA) was performed.
Results: The findings of this study demonstrated a few number of lesions were required to achieve all PVI targeting PVMS at 36 (95% CI 32-41) compared to WACA at 81 (95% CI 73-90). PVMS radiofrequency time was shorter at 314 s (95% CI 278-350 s) compared to 799 s (95% CI 692-906 s) for WACA. Mean procedure time to complete PVMS was 59 min (95% CI 53-65) and to complete WACA was 90 min (95% CI 80-100).
Conclusion: Precision ablation near PVMS coupled with omnipolar technology may provide a superior profile in reducing procedure time and number of ablative lesions compared to WACA in the setting of atrial fibrillation with possible similar results. Future investigation using randomized controlled trials can help further support these findings.
背景:在心房颤动的情况下,准确绘制左心房地图仍是当务之急。虽然肺静脉节段性骨膜隔离在心房颤动中起着重要作用,但临床尝试选择性消融肺静脉心肌套管附近的心律失常,结果表明,在不太精确的映射模式下,心律失常的复发率较高。然而,新型全极映射技术与 Advisor™ HD 网格映射导管结合使用,可为映射和选择性消融心肌套管附近的心律失常提供有利条件:该回顾性队列使用全极映射技术对肺静脉心肌袖进行了消融,随后进行了大面积环形消融(WACA):研究结果表明,与 WACA 的 81 次(95% CI 73-90)相比,针对 PVMS 的全部 PVI(36 次(95% CI 32-41))需要的病变次数更少。PVMS 射频时间较短,为 314 秒(95% CI 278-350 秒),而 WACA 为 799 秒(95% CI 692-906 秒)。完成 PVMS 的平均手术时间为 59 分钟(95% CI 53-65),完成 WACA 的平均手术时间为 90 分钟(95% CI 80-100):结论:与 WACA 相比,PVMS 附近的精确消融结合全极技术在减少心房颤动的手术时间和消融病灶数量方面可能更胜一筹,而且效果可能相似。未来采用随机对照试验进行的研究将有助于进一步证实这些发现。
{"title":"Targeting pulmonary vein myocardial sleeves with omnipolar mapping can reduce radiofrequency applications and procedure time: a proof-of-concept study.","authors":"Alejandro Vidal Margenat, Som Prabh Singh, Sarah Kondrach, Ellen Condoure, Jeremy Russell, Ramesh Hariharan","doi":"10.1007/s10840-024-01888-7","DOIUrl":"10.1007/s10840-024-01888-7","url":null,"abstract":"<p><strong>Background: </strong>There remains an imperative need to accurately map the left atrium in the setting of atrial fibrillation. While the pulmonary vein segmental ostial isolation plays a significant role in atrial fibrillation, clinical attempts to selectively ablate near the pulmonary vein myocardial sleeves have demonstrated a higher recurrence rate of arrhythmia given less precise mapping modalities. However, novel omnipolar mapping technology coupled with Advisor™ HD Grid Mapping Catheter may provide an advantageous profile to map and selectively ablate near the myocardial sleeves.</p><p><strong>Methods: </strong>This retrospective cohort underwent ablation targeting the pulmonary vein myocardial sleeves with the use of omnipolar mapping technology and later wide area circumferential ablation (WACA) was performed.</p><p><strong>Results: </strong>The findings of this study demonstrated a few number of lesions were required to achieve all PVI targeting PVMS at 36 (95% CI 32-41) compared to WACA at 81 (95% CI 73-90). PVMS radiofrequency time was shorter at 314 s (95% CI 278-350 s) compared to 799 s (95% CI 692-906 s) for WACA. Mean procedure time to complete PVMS was 59 min (95% CI 53-65) and to complete WACA was 90 min (95% CI 80-100).</p><p><strong>Conclusion: </strong>Precision ablation near PVMS coupled with omnipolar technology may provide a superior profile in reducing procedure time and number of ablative lesions compared to WACA in the setting of atrial fibrillation with possible similar results. Future investigation using randomized controlled trials can help further support these findings.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"83-91"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-07-30DOI: 10.1007/s10840-024-01877-w
Gregory Cunn, Apoor Patel, Kristie Coleman, Eric Dulmovits, Nicholas Skipitaris, Laurence Epstein, Stavros Mountantonakis, Stuart Beldner
Background: Vein of Marshall (VoM) ethanol ablation has a proven benefit in patients with persistent atrial fibrillation (AF) undergoing index procedure; however, its role in repeat ablation is unknown. We sought to evaluate the benefit of empiric VoM ethanol ablation in addition to posterior wall isolation (PWI) during the repeat procedure in patients with durable pulmonary vein (PV) isolation from prior ablation.
Methods: Twenty-three patients (age 67.1 + / - 7.4, 74% males) who received empiric VoM ethanol infusion in addition to PWI were matched for age, gender, ejection fraction, and left atrial size with forty-six patients receiving empiric PWI alone. All patients in the study group underwent additional ablation on mitral isthmus to complete the lateral mitral isthmus line. Additional ablation was based on program and trigger stimulation. Primary outcome was freedom from AF after a blanking period of 3 months by qualification of symptoms, EKG, wearable, or implantable monitor or device.
Results: The study group had a higher average BMI (35.07 + / - 8.98 vs. 30.85 + / - 5.65, p = 0.033) and rate of persistent AF (83.0% vs. 54.3%, p = 0.029) versus the control. The 1-year AF-free survival for the study and control groups was 20 (86.96%) and 28 (60.1%) patients (p = 0.027). Cox proportional hazard regression analysis showed a significant reduction in AF recurrence in the study group (HR 0.25, 95% CI 0.073-0.843, p = 0.026).
Conclusion: Among patients undergoing repeat catheter ablation for recurrent AF with durably isolated PVs, the addition of VoM ethanol infusion increased the likelihood of remaining free from AF at 12 months.
背景:马歇尔静脉(VoM)乙醇消融术已证实对接受指数手术的持续性心房颤动(AF)患者有益,但其在重复消融术中的作用尚不清楚。我们试图评估经验性 VoM 乙醇消融术与后壁隔离术(PWI)在重复消融术中对先前消融术进行了持久肺静脉(PV)隔离的患者的益处:23 名患者(年龄 67.1 + / - 7.4,74% 为男性)在接受 PWI 的同时接受了经验性 VoM 乙醇灌注,他们的年龄、性别、射血分数和左心房大小与 46 名仅接受经验性 PWI 的患者相匹配。研究组的所有患者都接受了二尖瓣峡部的额外消融术,以完成二尖瓣峡部侧线的消融。附加消融术以程序和触发刺激为基础。根据症状、心电图、可穿戴或植入式监测仪或设备的鉴定,主要结果为空白期3个月后无房颤:研究组的平均体重指数(35.07 + / - 8.98 vs. 30.85 + / - 5.65,p = 0.033)和持续房颤率(83.0% vs. 54.3%,p = 0.029)均高于对照组。研究组和对照组的无房颤 1 年生存率分别为 20 例(86.96%)和 28 例(60.1%)(p = 0.027)。Cox比例危险回归分析显示,研究组房颤复发率显著降低(HR 0.25,95% CI 0.073-0.843,p = 0.026):结论:在因复发性房颤接受重复导管消融术且存在持久隔离的上下肢房室的患者中,加用VoM乙醇输注可增加12个月后保持无房颤的可能性。
{"title":"Vein of Marshall ethanol infusion for recurrent atrial fibrillation in patients with durably isolated pulmonary veins.","authors":"Gregory Cunn, Apoor Patel, Kristie Coleman, Eric Dulmovits, Nicholas Skipitaris, Laurence Epstein, Stavros Mountantonakis, Stuart Beldner","doi":"10.1007/s10840-024-01877-w","DOIUrl":"10.1007/s10840-024-01877-w","url":null,"abstract":"<p><strong>Background: </strong>Vein of Marshall (VoM) ethanol ablation has a proven benefit in patients with persistent atrial fibrillation (AF) undergoing index procedure; however, its role in repeat ablation is unknown. We sought to evaluate the benefit of empiric VoM ethanol ablation in addition to posterior wall isolation (PWI) during the repeat procedure in patients with durable pulmonary vein (PV) isolation from prior ablation.</p><p><strong>Methods: </strong>Twenty-three patients (age 67.1 + / - 7.4, 74% males) who received empiric VoM ethanol infusion in addition to PWI were matched for age, gender, ejection fraction, and left atrial size with forty-six patients receiving empiric PWI alone. All patients in the study group underwent additional ablation on mitral isthmus to complete the lateral mitral isthmus line. Additional ablation was based on program and trigger stimulation. Primary outcome was freedom from AF after a blanking period of 3 months by qualification of symptoms, EKG, wearable, or implantable monitor or device.</p><p><strong>Results: </strong>The study group had a higher average BMI (35.07 + / - 8.98 vs. 30.85 + / - 5.65, p = 0.033) and rate of persistent AF (83.0% vs. 54.3%, p = 0.029) versus the control. The 1-year AF-free survival for the study and control groups was 20 (86.96%) and 28 (60.1%) patients (p = 0.027). Cox proportional hazard regression analysis showed a significant reduction in AF recurrence in the study group (HR 0.25, 95% CI 0.073-0.843, p = 0.026).</p><p><strong>Conclusion: </strong>Among patients undergoing repeat catheter ablation for recurrent AF with durably isolated PVs, the addition of VoM ethanol infusion increased the likelihood of remaining free from AF at 12 months.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"65-71"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-08-09DOI: 10.1007/s10840-024-01867-y
Marco Valerio Mariani, Marta Palombi, Jean Pierre Jabbour, Nicola Pierucci, Pietro Cipollone, Agostino Piro, Cristina Chimenti, Fabio Miraldi, Carmine Dario Vizza, Carlo Lavalle
Background: The long-term success rate of pulmonary vein isolation (PVI) is suboptimal due to the presence of non-pulmonary vein (PV) foci that can trigger atrial fibrillation (AF) in up to 11%. Among non-PV triggers, the superior vena cava (SVC) is a major site of origin of ectopic beats initiating AF.
Objective: To compare data from randomized controlled trials (RCTs) assessing PVI + empiric SVC isolation (SVCI) versus PVI alone in terms of AF recurrence, procedure-related complications, and fluoroscopic and procedural times.
Methods: A search of online scientific libraries (from inception to April 1, 2024) was performed. Four RCTs were considered eligible for the meta-analysis totaling 600 patients of whom 287 receiving PVI + SVCI and 313 receiving PVI alone.
Results: In the overall population, SVCI + PVI was associated with a non-significant reduction of AF recurrence at follow-up (0.66 [0.43;1.00], p = 0.05, I2 0%). In patients with paroxysmal AF (PAF), a significant reduction of AF recurrence was related to SVCI + PVI (11.7%) as compared to PVI alone (19.9%) (0.54 [0.32;0.92], p = 0.02, I2 0%). No statistical differences were found among the groups in terms of fluoroscopic (3.31 [- 0.8;7.41], p = 0.11, I2 = 91%), procedural times (5.69 [- 9.78;21.16], p = 0.47, I2 = 81%), and complications (1.06 [0.33;3.44], p = 0.92, I2 = 0%).
Conclusion: The addition of SVCI to PVI in patients in PAF is associated with a significant lower rate of AF recurrence at follow-up, without increasing complication rates and procedural and fluoroscopy times.
{"title":"Usefulness of empiric superior vena cava isolation in paroxysmal atrial fibrillation ablation: a meta-analysis of randomized clinical trials.","authors":"Marco Valerio Mariani, Marta Palombi, Jean Pierre Jabbour, Nicola Pierucci, Pietro Cipollone, Agostino Piro, Cristina Chimenti, Fabio Miraldi, Carmine Dario Vizza, Carlo Lavalle","doi":"10.1007/s10840-024-01867-y","DOIUrl":"10.1007/s10840-024-01867-y","url":null,"abstract":"<p><strong>Background: </strong>The long-term success rate of pulmonary vein isolation (PVI) is suboptimal due to the presence of non-pulmonary vein (PV) foci that can trigger atrial fibrillation (AF) in up to 11%. Among non-PV triggers, the superior vena cava (SVC) is a major site of origin of ectopic beats initiating AF.</p><p><strong>Objective: </strong>To compare data from randomized controlled trials (RCTs) assessing PVI + empiric SVC isolation (SVCI) versus PVI alone in terms of AF recurrence, procedure-related complications, and fluoroscopic and procedural times.</p><p><strong>Methods: </strong>A search of online scientific libraries (from inception to April 1, 2024) was performed. Four RCTs were considered eligible for the meta-analysis totaling 600 patients of whom 287 receiving PVI + SVCI and 313 receiving PVI alone.</p><p><strong>Results: </strong>In the overall population, SVCI + PVI was associated with a non-significant reduction of AF recurrence at follow-up (0.66 [0.43;1.00], p = 0.05, I<sup>2</sup> 0%). In patients with paroxysmal AF (PAF), a significant reduction of AF recurrence was related to SVCI + PVI (11.7%) as compared to PVI alone (19.9%) (0.54 [0.32;0.92], p = 0.02, I<sup>2</sup> 0%). No statistical differences were found among the groups in terms of fluoroscopic (3.31 [- 0.8;7.41], p = 0.11, I<sup>2</sup> = 91%), procedural times (5.69 [- 9.78;21.16], p = 0.47, I<sup>2</sup> = 81%), and complications (1.06 [0.33;3.44], p = 0.92, I<sup>2</sup> = 0%).</p><p><strong>Conclusion: </strong>The addition of SVCI to PVI in patients in PAF is associated with a significant lower rate of AF recurrence at follow-up, without increasing complication rates and procedural and fluoroscopy times.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"93-100"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}