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Aborted coumel sign: a novel diagnostic marker for arrhythmia mechanism recognition. 流产库梅尔征:心律失常机制识别的新型诊断标记。
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-29 DOI: 10.1007/s10840-024-01937-1
Alberto Alfie, Gustavo Costa
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引用次数: 0
Ultrasound-guided versus fluoroscopy-guided axillary vein puncture for cardiac implantable electronic device implantation: a meta-analysis enrolling 1257 patients. 在超声波引导下与荧光镜引导下进行腋静脉穿刺以植入心脏植入式电子装置:一项纳入 1257 例患者的荟萃分析。
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-24 DOI: 10.1007/s10840-024-01932-6
Giampaolo Vetta, Antonio Parlavecchio, Jennifer Wright, Michele Magnocavallo, Lorenzo Marcon, Ioannis Doundoulakis, Roberto Scacciavillani, Antonio Sorgente, Luigi Pannone, Alexandre Almorad, Juan Sieira, Charles Audiat, Kazutaka Nakasone, Gezim Bala, Erwin Ströker, Ingrid Overeinder, Pietro Rossi, Andrea Sarkozy, Gian-Battista Chierchia, Carlo de Asmundis, Domenico Giovanni Della Rocca

Introduction: Ultrasound-guided (Echo-AVP) and Fluoroscopy-guided Axillary Vein Puncture (Fluoro-AVP) are both acknowledged as safe and effective techniques for transvenous implantation of leads for cardiac implantable electronic devices (CIEDs). Nonetheless, it is still debated which of the two techniques has a better safety and efficacy profile. Therefore, we performed a meta-analysis to evaluate the efficacy and safety of Echo-AVP versus Fluoro-AVP for CIEDs implantation.

Methods: We systematically searched Medline, Embase and Cochrane electronic databases up to May 15th, 2024, for studies that evaluated the efficacy and safety of Echo-AVP and Fluoro-AVP reporting at least one clinical outcome of interest. The primary efficacy endpoint was acute procedural success and the primary safety endpoint was a composite endpoint of pneumothorax, pocket hematoma/bleeding, pocket infection and inadvertent arterial puncture. The effect size was estimated using a random-effect model as Odds Ratio (OR) and Mean Difference (MD) with relative 95% Confidence Interval (CI).

Results: Overall, 4 studies were included, which enrolled 1257 patients (Echo-AVP: 373 patients; Fluoro-AVP: 884 patients). Echo-AVP led to a significant reduction in the primary safety endpoint (OR: 0.41; p = 0.0009), risk of inadvertent arterial puncture (OR: 0.29; p = 0.003) and fluoroscopy time ( MD: -105.02; p = 0.008). No differences were found between Echo-AVP and Fluoro-AVP for acute procedural success (OR: 0.77; p = 0.27), pneumothorax (OR: 0.66; p = 0.60), pocket hematoma/bleeding (OR: 0.68; p = 0.30), pocket infection (OR: 0.66; p = 0.60), procedural time (MD: 1.99; p = 0.65), success rate at first attempt (OR: 1.25; p = 0.34) and venous access time (MD: -0. 25; p = 0.99).

Conclusion: Echo-AVP proved to reduce significantly the primary safety endpoint, inadvertent arterial puncture and fluoroscopy time compared to Fluoro-AVP.

导言:超声引导下的腋静脉穿刺(Echo-AVP)和透视引导下的腋静脉穿刺(Fluoro-AVP)都是公认的安全有效的经静脉植入心脏植入式电子设备(CIED)导联的技术。然而,这两种技术中哪种技术的安全性和有效性更好仍存在争议。因此,我们进行了一项荟萃分析,以评估回声-AVP 与荧光-AVP 用于 CIEDs 植入的有效性和安全性:我们系统地检索了Medline、Embase和Cochrane电子数据库(截至2024年5月15日)中对回声-AVP和荧光-AVP的有效性和安全性进行评估的研究,这些研究至少报告了一项相关的临床结果。主要疗效终点是急性手术成功率,主要安全性终点是气胸、腔袋血肿/出血、腔袋感染和意外动脉穿刺的复合终点。效应大小采用随机效应模型估算,即:比值比(OR)和平均差(MD),以及相对的95%置信区间(CI):共纳入了 4 项研究,1257 名患者参与了研究(回声-AVP:373 名患者;荧光-AVP:884 名患者)。Echo-AVP 显著降低了主要安全终点(OR:0.41;p = 0.0009)、意外动脉穿刺风险(OR:0.29;p = 0.003)和透视时间(MD:-105.02;p = 0.008)。在急性手术成功率(OR:0.77;p = 0.27)、气胸(OR:0.66;p = 0.60)、术袋血肿/出血(OR:0.68;p = 0.30)、袋内感染(OR:0.66;P = 0.60)、手术时间(MD:1.99;P = 0.65)、首次尝试成功率(OR:1.25;P = 0.34)和静脉通路时间(MD:-0.25;P = 0.99):结论:事实证明,与氟AVP相比,回声AVP能显著减少主要安全终点、意外动脉穿刺和透视时间。
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引用次数: 0
Early insights on adverse events associated with PulseSelect™ and FARAPULSE™: analysis of the MAUDE database. 关于 PulseSelect™ 和 FARAPULSE™ 相关不良事件的早期见解:MAUDE 数据库分析。
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-23 DOI: 10.1007/s10840-024-01935-3
Pragyat Futela, Gurukripa N Kowlgi, Christopher V DeSimone, Ammar M Killu, Konstantinos C Siontis, Peter A Noseworthy, Suraj Kapa, Abhishek J Deshmukh
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引用次数: 0
Outcomes of leadless pacemaker implantation in the United States based on sex. 美国无导线起搏器植入术的性别结果。
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-22 DOI: 10.1007/s10840-024-01936-2
Muhammad Zia Khan, Bandar Alyami, Waleed Alruwaili, Amanda T Nguyen, Melody Mendez, William E Leon, Justin Devera, Hafiz Muhammad Sohaib Hayat, Abdullah Naveed, Zain Ul Abideen Asad, Siddharth Agarwal, Sudarshan Balla, Douglas Darden, Muhammad Bilal Munir

Background: To determine differences in baseline characteristics and outcomes of leadless pacemaker implantation based on sex.

Methods: For the purpose of this study, data were extracted from the National Inpatient Sample database for years 2016-2020. The study group was then stratified based on sex. Baseline characteristics and in-hospital outcomes including complications were then analyzed in each group. Multivariable logistic regression models were created to analyze the association of sex with important outcomes of mortality, major complications (defined as pericardial effusion requiring intervention and any vascular complication), prolonged length of stay (defined as > 6 days), and increased cost of hospitalization (defined as median cost > 34,098$) after leadless pacemaker implantation.

Results: A total of 29,000 leadless pacemakers (n in women = 12,960, 44.7%) were implanted during our study period. Women were found to have an increased burden of co-morbidities as compared to men. In the adjusted analysis, the likelihood of mortality (aOR 1.27, 95% CI 1.14-1.43), major complications (aOR 1.07, 95% CI 0.98-1.18), prolonged length of stay (aOR 1.09, 95% CI 1.04-1.15), and increased hospitalization cost (aOR 1.14, 95% CI 1.08-1.20) were higher in women as compared to men after leadless pacemaker implantation.

Conclusion: Important and significant differences exist in leadless pacemaker implantation in women as compared to men. These findings highlight the need for evaluating etiologies behind such differences with a goal of improving outcomes in all patients after leadless pacemaker implantation.

背景:旨在确定无导线起搏器植入术的基线特征和结果与性别的差异:目的:确定基于性别的无引线起搏器植入的基线特征和结果差异:本研究从全国住院患者抽样数据库中提取了 2016-2020 年的数据。然后根据性别对研究组进行分层。然后分析各组的基线特征和院内结局(包括并发症)。建立多变量逻辑回归模型,分析性别与无引线起搏器植入术后死亡率、主要并发症(定义为需要介入治疗的心包积液和任何血管并发症)、住院时间延长(定义为大于 6 天)和住院费用增加(定义为费用中位数大于 34,098 美元)等重要结果的相关性:研究期间共植入了 29,000 个无引线起搏器(女性为 12,960 个,占 44.7%)。与男性相比,女性的并发症负担更重。在调整分析中,与男性相比,女性在无引线起搏器植入术后的死亡率(aOR 1.27,95% CI 1.14-1.43)、主要并发症(aOR 1.07,95% CI 0.98-1.18)、住院时间延长(aOR 1.09,95% CI 1.04-1.15)和住院费用增加(aOR 1.14,95% CI 1.08-1.20)的可能性更高:结论:与男性相比,女性在无引线起搏器植入方面存在重要且显著的差异。结论:在无导线起搏器植入术中,女性与男性存在重要且显著的差异,这些发现强调了评估这些差异背后病因的必要性,目的是改善所有无导线起搏器植入术患者的预后。
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引用次数: 0
Sex differences in leadless pacemakers: pacing is still not a woman's world. 无引线心脏起搏器的性别差异:起搏仍不是女人的世界。
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-22 DOI: 10.1007/s10840-024-01934-4
Nicholas O Palmeri, Margot Yopes, Daniel Alyesh, Sri Sundaram
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引用次数: 0
Surveillance of esophageal injury after atrial fibrillation catheter ablation. 监测心房颤动导管消融术后的食管损伤。
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-22 DOI: 10.1007/s10840-024-01922-8
Alberto Pereira Ferraz, Cristiano Faria Pisani, Esteban Wisnivesky Rocca Rivarola, Tan Chen Wu, Francisco Carlos da Costa Darrieux, Rafael Alvarenga Scanavacca, Carina Abigail Hardy, Muhieddine Omar Chokr, Denise Tessariol Hachul, Maurício Ibrahim Scanavacca

Aims: Atrial-esophageal fistula following ablation procedures for atrial fibrillation (AF) remains a major concern. There is no standardized approach to minimize the risk and morbidity of this serious complication. The objective of this study was to present the 7-year experience of systematic endoscopic surveillance of esophageal injury after AF catheter ablation.

Methods: This was a retrospective single-center registry of systematic endoscopic evaluations after consecutive AF ablation procedures performed from 2016 to 2022.

Results: A total of 677 AF ablation procedures with controlled esophagogastroduodenoscopy (EGD) were analyzed during that period. Most patients were male (71%) with paroxysmal AF (71%). Radiofrequency with electroanatomical mapping was the main ablation approach for 633 patients (93.5%). Esophageal temperature monitoring was performed using a single sensor in 220 patients (34.3%) and a multisensor probe in 296 patients (46%). Most of the patients presented no esophageal lesions (75,7%). Severe lesions (Kansas-city-classification KCC 2B) were found in 46 (6.8%) of them, requiring a new EGD in 7 days. KCC2B lesions were persistent in 3 patients, 2 of whom had ulcers during healing and 1 patient with a deep ulcer of 10 mm who was admitted to the hospital and underwent fasting and parenteral nutrition. The ulcer healed in the second week after the procedure. Both esophageal temperature monitoring strategies were equivalent at preventing thermal lesions. Additionally, a greater left atrium (LA) was associated with a lower incidence of esophageal ulcer (P = 0.028). Most of the lesions spontaneously healed.

Conclusion: The incidence of esophageal injury after ablation was 24.3%. Most (72%) were mild lesions that required no therapeutic intervention. A larger left atrium (LA) was correlated with a lower incidence of thermal lesions. Early endoscopy can help diagnose severe esophageal lesions and may provide additional information for the surveillance of esophageal injury after AF ablation.

目的:心房颤动(房颤)消融术后的心房食管瘘仍是一个主要问题。目前还没有标准化的方法来最大限度地降低这一严重并发症的风险和发病率。本研究旨在介绍房颤导管消融术后系统性内镜监测食管损伤的 7 年经验:这是一项回顾性单中心登记,对 2016 年至 2022 年连续进行房颤消融术后的系统性内镜评估进行登记:在此期间,共分析了 677 例房颤消融手术,并进行了受控食管胃十二指肠镜检查(EGD)。大多数患者为男性(71%),阵发性房颤(71%)。633名患者(93.5%)的主要消融方法是射频消融和电解剖图绘制。220 名患者(34.3%)使用单传感器进行食管温度监测,296 名患者(46%)使用多传感器探头进行食管温度监测。大多数患者没有食管病变(75.7%)。其中 46 名患者(6.8%)出现严重病变(堪萨斯城市分级 KCC 2B),需要在 7 天内重新进行胃肠造影检查。有 3 名患者的 KCC2B 病变持续存在,其中 2 人在愈合过程中出现溃疡,1 名患者的溃疡深达 10 毫米,需要入院接受禁食和肠外营养治疗。溃疡在术后第二周愈合。两种食管温度监测策略在预防热损伤方面效果相当。此外,左心房(LA)越大,食管溃疡发生率越低(P = 0.028)。大多数病变可自行愈合:结论:消融术后食管损伤的发生率为 24.3%。结论:消融术后食管损伤发生率为 24.3%,大部分(72%)为轻微损伤,无需治疗干预。左心房(LA)越大,热损伤的发生率越低。早期内镜检查有助于诊断严重的食管病变,并可为房颤消融术后食管损伤的监测提供更多信息。
{"title":"Surveillance of esophageal injury after atrial fibrillation catheter ablation.","authors":"Alberto Pereira Ferraz, Cristiano Faria Pisani, Esteban Wisnivesky Rocca Rivarola, Tan Chen Wu, Francisco Carlos da Costa Darrieux, Rafael Alvarenga Scanavacca, Carina Abigail Hardy, Muhieddine Omar Chokr, Denise Tessariol Hachul, Maurício Ibrahim Scanavacca","doi":"10.1007/s10840-024-01922-8","DOIUrl":"https://doi.org/10.1007/s10840-024-01922-8","url":null,"abstract":"<p><strong>Aims: </strong>Atrial-esophageal fistula following ablation procedures for atrial fibrillation (AF) remains a major concern. There is no standardized approach to minimize the risk and morbidity of this serious complication. The objective of this study was to present the 7-year experience of systematic endoscopic surveillance of esophageal injury after AF catheter ablation.</p><p><strong>Methods: </strong>This was a retrospective single-center registry of systematic endoscopic evaluations after consecutive AF ablation procedures performed from 2016 to 2022.</p><p><strong>Results: </strong>A total of 677 AF ablation procedures with controlled esophagogastroduodenoscopy (EGD) were analyzed during that period. Most patients were male (71%) with paroxysmal AF (71%). Radiofrequency with electroanatomical mapping was the main ablation approach for 633 patients (93.5%). Esophageal temperature monitoring was performed using a single sensor in 220 patients (34.3%) and a multisensor probe in 296 patients (46%). Most of the patients presented no esophageal lesions (75,7%). Severe lesions (Kansas-city-classification KCC 2B) were found in 46 (6.8%) of them, requiring a new EGD in 7 days. KCC2B lesions were persistent in 3 patients, 2 of whom had ulcers during healing and 1 patient with a deep ulcer of 10 mm who was admitted to the hospital and underwent fasting and parenteral nutrition. The ulcer healed in the second week after the procedure. Both esophageal temperature monitoring strategies were equivalent at preventing thermal lesions. Additionally, a greater left atrium (LA) was associated with a lower incidence of esophageal ulcer (P = 0.028). Most of the lesions spontaneously healed.</p><p><strong>Conclusion: </strong>The incidence of esophageal injury after ablation was 24.3%. Most (72%) were mild lesions that required no therapeutic intervention. A larger left atrium (LA) was correlated with a lower incidence of thermal lesions. Early endoscopy can help diagnose severe esophageal lesions and may provide additional information for the surveillance of esophageal injury after AF ablation.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467638","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}
引用次数: 0
Ablating-by-LAW thickness: a get out of jail free card for point-to-point AF ablation? 按法律厚度消融:点对点房颤消融的免罪金牌?
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-22 DOI: 10.1007/s10840-024-01930-8
David B DeLurgio
{"title":"Ablating-by-LAW thickness: a get out of jail free card for point-to-point AF ablation?","authors":"David B DeLurgio","doi":"10.1007/s10840-024-01930-8","DOIUrl":"https://doi.org/10.1007/s10840-024-01930-8","url":null,"abstract":"","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467634","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}
引用次数: 0
Clinical relevance of left atrial structural remodeling and non-pulmonary vein foci in atrial fibrillation. 心房颤动中左心房结构重塑和非肺静脉病灶的临床意义。
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-16 DOI: 10.1007/s10840-024-01931-7
Atsuhiko Yagishita, Susumu Sakama, Kazuma Iimura, Kyong Hee Lee, Kengo Ayabe, Mari Amino, Yuji Ikari, Koichiro Yoshioka

Background: The mechanistic role of left atrial (LA) structural remodeling as a non-pulmonary vein (PV) trigger in the initiation of atrial fibrillation (AF) remains uncertain. This study is aimed at prospectively evaluating the association between non-PV triggers and LA structural remodeling.

Methods: A total of 517 patients undergoing catheter ablation for AF were included. After PV isolation, a standardized protocol was implemented to reveal non-PV triggers, which included burst pacing into AF followed by cardioversion during isoproterenol infusion. If pacing-induced atrial tachycardia (AT) was observed, mapping and catheter ablation were performed.

Results: The mean percentage of LA low-voltage area (LVA) < 0.5 mV incrementally increased during right atrial pacing among the no induction (n = 470), AF (n = 21), and AT (n = 26) groups (2.6 ± 5.7%, 5.5 ± 6.4%, and 18.0 ± 21.5%, respectively; P < 0.001). In the AF induction group, non-PV foci originated from the left atrium in 13 of 25 foci (52%), and 8 of 13 LA non-PV foci (62%) were located in the septal region. All except 1 focus originated from the non-LVA < 0.5 mV (8%), but 8 of the 13 LA foci originated from the LVA < 1.0 mV (62%). There were no differences in AF recurrence among the groups (log-rank, P = 0.160).

Conclusion: The majority of non-PV foci in the LA originated outside regions with advanced structural remodeling, thus suggesting the limited effectiveness of adjunctive ablation guided by the LVA < 0.5 mV during sinus rhythm in eliminating non-PV triggers.

背景:左心房(LA)结构重塑作为非肺静脉(PV)触发因素在房颤(AF)起始中的机制作用仍不确定。本研究旨在前瞻性地评估非 PV 触发因素与 LA 结构重塑之间的关联:方法:共纳入 517 名接受房颤导管消融术的患者。方法:共纳入了 517 名接受房颤导管消融术的患者,在进行 PV 隔离后,执行标准化方案以揭示非 PV 触发器,包括对房颤进行脉冲起搏,然后在输注异丙托品醇期间进行心脏复律。如果观察到起搏诱发的房性心动过速(AT),则进行绘图和导管消融:LA 低电压区(LVA)的平均百分比LA 中的大多数非低电压灶来自结构重塑较晚的区域,这表明以低电压区为指导的辅助消融效果有限。
{"title":"Clinical relevance of left atrial structural remodeling and non-pulmonary vein foci in atrial fibrillation.","authors":"Atsuhiko Yagishita, Susumu Sakama, Kazuma Iimura, Kyong Hee Lee, Kengo Ayabe, Mari Amino, Yuji Ikari, Koichiro Yoshioka","doi":"10.1007/s10840-024-01931-7","DOIUrl":"https://doi.org/10.1007/s10840-024-01931-7","url":null,"abstract":"<p><strong>Background: </strong>The mechanistic role of left atrial (LA) structural remodeling as a non-pulmonary vein (PV) trigger in the initiation of atrial fibrillation (AF) remains uncertain. This study is aimed at prospectively evaluating the association between non-PV triggers and LA structural remodeling.</p><p><strong>Methods: </strong>A total of 517 patients undergoing catheter ablation for AF were included. After PV isolation, a standardized protocol was implemented to reveal non-PV triggers, which included burst pacing into AF followed by cardioversion during isoproterenol infusion. If pacing-induced atrial tachycardia (AT) was observed, mapping and catheter ablation were performed.</p><p><strong>Results: </strong>The mean percentage of LA low-voltage area (LVA) < 0.5 mV incrementally increased during right atrial pacing among the no induction (n = 470), AF (n = 21), and AT (n = 26) groups (2.6 ± 5.7%, 5.5 ± 6.4%, and 18.0 ± 21.5%, respectively; P < 0.001). In the AF induction group, non-PV foci originated from the left atrium in 13 of 25 foci (52%), and 8 of 13 LA non-PV foci (62%) were located in the septal region. All except 1 focus originated from the non-LVA < 0.5 mV (8%), but 8 of the 13 LA foci originated from the LVA < 1.0 mV (62%). There were no differences in AF recurrence among the groups (log-rank, P = 0.160).</p><p><strong>Conclusion: </strong>The majority of non-PV foci in the LA originated outside regions with advanced structural remodeling, thus suggesting the limited effectiveness of adjunctive ablation guided by the LVA < 0.5 mV during sinus rhythm in eliminating non-PV triggers.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467635","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}
引用次数: 0
Volumetric lesion analysis and validation of various bipolar configurations in radiofrequency ablation of ventricular myocardium in a bovine model. 在牛模型中对射频消融心室心肌的各种双极配置进行容积病灶分析和验证。
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-14 DOI: 10.1007/s10840-024-01927-3
Saikiran Kakarla, UmaShankar Pr, Sabari Saravanan, Narayanan Namboodiri

Background: The bipolar radiofrequency ablation(B-RFA) strategy was increasingly used to target deep intramural re-entrant foci responsible for the arrhythmia not ablated by conventional unipolar RFA / sequential unipolar RFA. Lesional characteristics of various bipolar configurations were largely unknown.

Objective: To investigate the lesional geometry in relation to various factors to determine the most effective ablation strategy that minimises steam pops and achieves transmurality. To assess the temperatures at the return electrode.

Methods: A custom-made validated ex-vivo bipolar ablation model was used to assess lesion formation. The myocardial sample was placed between two ablation catheters in four different orientations. Lesions were created using different power (30 W, 40 W, 50 W) and time settings(30, 40 and 50 s) with different catheter orientations. Data was analysed using binary logistic regression and multiple linear regression.

Results: Among 107 lesions, The volume of the active catheter lesion (266 +/- 137 mm^3) significantly differed from their return electrode counterparts (130 +/- 91.8 mm^3) (p < 0.001), and the temperatures at the return electrode end were lower than at the active electrode (p = 0.004). Higher power and longer duration application led to more frequent steam pops (p < 0.001), while true parallel configuration resulted in fewer steam pops (p < 0.001).

Conclusion: A custom model without ground electrode temperature monitoring is safe and cost-effective. The safest strategy is a true parallel configuration with an inter-electrode distance of at least 15 mm and a power of 30 W to 40 W, which generates lower steam pops and better transmurality.

背景:双极射频消融(B-RFA)策略越来越多地被用于针对传统单极射频消融(RFA)或序贯单极射频消融(RFA)无法消融的导致心律失常的深部室内再电位病灶。各种双极配置的病变特征在很大程度上是未知的:研究病变几何形状与各种因素的关系,以确定最有效的消融策略,最大限度地减少蒸汽爆裂并实现透射性。评估回流电极的温度:使用定制的经验证的体外双极消融模型来评估病变的形成。心肌样本以四个不同的方向放置在两个消融导管之间。使用不同的功率(30 瓦、40 瓦、50 瓦)和时间设置(30 秒、40 秒和 50 秒)以及不同的导管方向形成病变。数据采用二元逻辑回归和多元线性回归进行分析:在 107 个病灶中,主动导管病灶的体积(266 +/- 137 mm^3)与回流电极病灶的体积(130 +/- 91.8 mm^3)有显著差异(p):无接地电极温度监测的定制模型既安全又经济。最安全的策略是采用真正的平行配置,电极间距至少为 15 mm,功率为 30 W 至 40 W,这样可产生较低的蒸汽爆裂和更好的透射性。
{"title":"Volumetric lesion analysis and validation of various bipolar configurations in radiofrequency ablation of ventricular myocardium in a bovine model.","authors":"Saikiran Kakarla, UmaShankar Pr, Sabari Saravanan, Narayanan Namboodiri","doi":"10.1007/s10840-024-01927-3","DOIUrl":"https://doi.org/10.1007/s10840-024-01927-3","url":null,"abstract":"<p><strong>Background: </strong>The bipolar radiofrequency ablation(B-RFA) strategy was increasingly used to target deep intramural re-entrant foci responsible for the arrhythmia not ablated by conventional unipolar RFA / sequential unipolar RFA. Lesional characteristics of various bipolar configurations were largely unknown.</p><p><strong>Objective: </strong>To investigate the lesional geometry in relation to various factors to determine the most effective ablation strategy that minimises steam pops and achieves transmurality. To assess the temperatures at the return electrode.</p><p><strong>Methods: </strong>A custom-made validated ex-vivo bipolar ablation model was used to assess lesion formation. The myocardial sample was placed between two ablation catheters in four different orientations. Lesions were created using different power (30 W, 40 W, 50 W) and time settings(30, 40 and 50 s) with different catheter orientations. Data was analysed using binary logistic regression and multiple linear regression.</p><p><strong>Results: </strong>Among 107 lesions, The volume of the active catheter lesion (266 +/- 137 mm^3) significantly differed from their return electrode counterparts (130 +/- 91.8 mm^3) (p < 0.001), and the temperatures at the return electrode end were lower than at the active electrode (p = 0.004). Higher power and longer duration application led to more frequent steam pops (p < 0.001), while true parallel configuration resulted in fewer steam pops (p < 0.001).</p><p><strong>Conclusion: </strong>A custom model without ground electrode temperature monitoring is safe and cost-effective. The safest strategy is a true parallel configuration with an inter-electrode distance of at least 15 mm and a power of 30 W to 40 W, which generates lower steam pops and better transmurality.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467639","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}
引用次数: 0
Fluoroscopy-free cardioneuroablation for functional bradycardia: a single-center experience. 治疗功能性心动过缓的无透视心脏神经消融术:单中心经验。
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-10 DOI: 10.1007/s10840-024-01926-4
Parnia Abolhassan Choubdar, Megan Gruber, Jose Carlos Pachon-M, Stephen Manu, Mansour Razminia, John Clark

Background: Cardioneuroablation (CNA) is an emerging treatment for cardioinhibitory syncope and functional AV block. This study aimed to evaluate the safety and efficacy of a fluoroless CNA approach using three-dimensional mapping and extracardiac vagal stimulation (ECVS).

Methods: This prospective observational study included 22 patients (mean age 21 years) with clinically significant functional bradycardia who underwent fluoroless CNA. Procedural success was defined as elimination or significant attenuation of the vagal response to ECVS.

Results: CNA was successfully performed in all patients with a mean procedure time of 251 min. Fluoroscopy was avoided in 91% of cases. At a mean follow-up of 11.4 months, 77% of patients remained symptom-free. Among pacemaker patients, 90% did not require further pacing, and 6/10 (60%) have had their pacemakers turned off. No complications were seen during the procedure.

Conclusions: Fluoroscopy-free CNA is a safe and effective treatment for functional bradycardia, offering high procedural success rates and favorable symptom-free outcomes while minimizing radiation exposure.

背景:心脏神经消融术(CNA)是治疗心抑制性晕厥和功能性房室传导阻滞的一种新兴疗法。本研究旨在评估使用三维映射和心外迷走神经刺激(ECVS)的无氟 CNA 方法的安全性和有效性:这项前瞻性观察研究纳入了 22 名接受无氟 CNA 治疗的临床显著功能性心动过缓患者(平均年龄 21 岁)。程序成功的定义是对 ECVS 的迷走神经反应消失或显著减弱:所有患者均成功实施了 CNA,平均手术时间为 251 分钟。91%的病例避免了透视检查。在平均 11.4 个月的随访中,77% 的患者仍无症状。在心脏起搏器患者中,90%的患者不需要继续起搏,6/10(60%)的患者已经关闭了心脏起搏器。手术期间未出现并发症:无透视 CNA 是治疗功能性心动过缓的一种安全有效的方法,手术成功率高,无症状效果好,同时最大限度地减少了辐射暴露。
{"title":"Fluoroscopy-free cardioneuroablation for functional bradycardia: a single-center experience.","authors":"Parnia Abolhassan Choubdar, Megan Gruber, Jose Carlos Pachon-M, Stephen Manu, Mansour Razminia, John Clark","doi":"10.1007/s10840-024-01926-4","DOIUrl":"https://doi.org/10.1007/s10840-024-01926-4","url":null,"abstract":"<p><strong>Background: </strong>Cardioneuroablation (CNA) is an emerging treatment for cardioinhibitory syncope and functional AV block. This study aimed to evaluate the safety and efficacy of a fluoroless CNA approach using three-dimensional mapping and extracardiac vagal stimulation (ECVS).</p><p><strong>Methods: </strong>This prospective observational study included 22 patients (mean age 21 years) with clinically significant functional bradycardia who underwent fluoroless CNA. Procedural success was defined as elimination or significant attenuation of the vagal response to ECVS.</p><p><strong>Results: </strong>CNA was successfully performed in all patients with a mean procedure time of 251 min. Fluoroscopy was avoided in 91% of cases. At a mean follow-up of 11.4 months, 77% of patients remained symptom-free. Among pacemaker patients, 90% did not require further pacing, and 6/10 (60%) have had their pacemakers turned off. No complications were seen during the procedure.</p><p><strong>Conclusions: </strong>Fluoroscopy-free CNA is a safe and effective treatment for functional bradycardia, offering high procedural success rates and favorable symptom-free outcomes while minimizing radiation exposure.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391105","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}
引用次数: 0
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Journal of Interventional Cardiac Electrophysiology
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