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Safety, efficacy, and quality of life outcomes of pulsed field ablation in Japanese patients with atrial fibrillation: results from the PULSED AF trial. 日本心房颤动患者脉冲场消融术的安全性、疗效和生活质量:PULSED 心房颤动试验的结果。
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 Epub Date: 2024-09-07 DOI: 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.

Clinical trial registration: ClinicalTrials.gov Identifier: NCT04198701.

背景:脉冲场消融术(PFA)是治疗心房颤动(AF)的一种新型疗法,但尚未在日本人群中进行评估:在这项 PULSED 心房颤动试验的子分析中,对日本四个中心接受脉冲场消融术治疗的阵发性房颤(PAF)和持续性房颤(PsAF)患者的 12 个月疗效进行了评估。经过 90 天的空白期后,主要疗效通过 1 年内无急性手术失败、心律失常复发或抗心律失常药物升级等复合终点来确定。在基线和12个月时,通过两项生活质量(QoL)调查(AFEQT和EQ-5D)评估患者的改善情况:分析包括 32 名患者,其中 16 名 PAF 患者和 16 名 PsAF 患者,PAF 患者平均年龄(61.1 ± 10.6)岁,PsAF 患者平均年龄(62.8 ± 11.5)岁。在 PAF 和 PsAF 患者中,女性分别占 31% 和 25%。两组患者中,100% 实现了急性肺静脉隔离。在 12 个月的主要疗效成功率方面,PAF 患者为 75.0%,PsAF 患者为 56.3%。未发生主要安全性事件。PAF(25.9 分,p < 0.0001)和 PsAF(13.2 分,p = 0.0002)患者的平均 AFEQT 得分均显著增加,而 PAF(0.12 分,p = 0.048)患者的 EQ-5D-5L 得分显著改善,但 PsAF(0.04 分,p = 0.08)患者的 EQ-5D-5L 得分没有改善:与全球队列的结果相似,在日本人群中使用 PulseSelect™ PFA 导管进行消融是高效、有效和安全的,从而改善了 PAF 和 PsAF 患者的 QoL:临床试验注册:ClinicalTrials.gov Identifier:临床试验注册:ClinicalTrials.gov Identifier:NCT04198701。
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引用次数: 0
Noninvasive programmed stimulation after ventricular tachycardia ablation: gazing into a crystal ball to predict recurrences? 室性心动过速消融术后的无创程序化刺激:用水晶球预测复发?
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 Epub Date: 2024-08-27 DOI: 10.1007/s10840-024-01898-5
Jeanne du Fay de Lavallaz, Jackson J Liang
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引用次数: 0
Inappropriate shocks due to P-wave oversensing in a patient with a subcutaneous implantable cardioverter-defibrillator. 使用皮下植入式心律转复除颤器的病人因p波敏感过度而引起的不适当电击。
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 Epub Date: 2023-09-05 DOI: 10.1007/s10840-023-01625-6
Fatima M Ezzeddine, Ammar M Killu, Abhishek J Deshmukh, Freddy Del-Carpio Munoz
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引用次数: 0
Hybrid ablation for persistent/long-standing persistent atrial fibrillation: a meta-analysis and trial sequential analysis of randomized controlled trials. 针对持续性/长期持续性心房颤动的混合消融术:随机对照试验的荟萃分析和试验顺序分析。
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 Epub Date: 2024-06-21 DOI: 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
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引用次数: 0
Localized three-dimensional reentrant ventricular tachycardia visualized by high-density mapping in arrhythmogenic right ventricular cardiomyopathy. 致心律失常性右室心肌病患者通过高密度图谱观察到的局部三维返流性室速。
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 Epub Date: 2024-08-07 DOI: 10.1007/s10840-024-01892-x
Tetsuma Kawaji, Saki Yamano, Misaki Naka, Masashi Kato, Takafumi Yokomatsu, Shinji Miki
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引用次数: 0
Pulsed-field ablation of atrial fibrillation using the Farapulse system through the jugular vein: a case series of two patients. 使用 Farapulse 系统通过颈静脉对心房颤动进行脉冲场消融:两名患者的病例系列。
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 Epub Date: 2024-11-21 DOI: 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).

我们介绍了两例无法进入股静脉的阵发性心房颤动(房颤)消融患者,他们接受了使用五棘脉冲场消融系统的颈静脉入路肺静脉隔离术(PVI)。据我们所知,目前仅有 Mol 等人的一例报告(《介入性心脏电生理学杂志》(2023 年)66:835-836)报道了通过高级方法使用该系统的情况。
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引用次数: 0
Peri-procedural anesthesia and patient pain experience in pulmonary vein isolation by means of very high-power short-duration radiofrequency ablation. 通过超高功率短时射频消融术隔离肺静脉的围手术期麻醉和患者疼痛体验。
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 Epub Date: 2024-08-30 DOI: 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.

背景:极高功率短持续时间(vHPSD)温控射频消融术(vHPSD)可缩短消融时间并改善患者耐受性,允许在轻度清醒镇静状态下进行肺静脉(PV)隔离。我们对 vHPSD 肺静脉隔离术中麻醉药物的使用和患者的疼痛体验进行了评估:58名阵发性和持续性心房颤动(房颤)患者接受了QDot Micro导管和vHPSD(90瓦,4秒)治疗(vHPSD组),并与最后33名接受消融指数引导的环流接触力感应导管(前方450,50瓦,后方330,40瓦)治疗的患者(AI组)进行了比较。对麻醉药物的使用以及疼痛体验进行了比较,疼痛体验采用 0-10 级评分:结果:所有上皮细胞均被急性分离。vHPSD 组的手术时间(78 ± 10 分钟 vs 84 ± 12 分钟,P = 0.012)、透视时间(369 ± 139 秒 vs 441 ± 172 秒,P = 0.03)和射频时间(8.3 ± 2.1 分钟)均短于 AI 组(25 ± 11 分钟,P = 0.012)。
{"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}
引用次数: 0
Targeting pulmonary vein myocardial sleeves with omnipolar mapping can reduce radiofrequency applications and procedure time: a proof-of-concept study. 利用全极映射锁定肺静脉心肌套管可减少射频应用和手术时间:一项概念验证研究。
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 Epub Date: 2024-08-07 DOI: 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}
引用次数: 0
Vein of Marshall ethanol infusion for recurrent atrial fibrillation in patients with durably isolated pulmonary veins. 马歇尔静脉乙醇输注治疗持久孤立肺静脉患者的复发性心房颤动。
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 Epub Date: 2024-07-30 DOI: 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}
引用次数: 0
Usefulness of empiric superior vena cava isolation in paroxysmal atrial fibrillation ablation: a meta-analysis of randomized clinical trials. 经验性上腔静脉隔绝术在阵发性心房颤动消融术中的实用性:随机临床试验荟萃分析。
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 Epub Date: 2024-08-09 DOI: 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.

背景:肺静脉隔离术(PVI)的长期成功率并不理想,这是因为非肺静脉(PV)病灶的存在可诱发高达 11% 的心房颤动(AF)。在非肺静脉触发因素中,上腔静脉(SVC)是引发房颤的异位搏动的主要起源部位:目的:从房颤复发、手术相关并发症、透视和手术时间等方面,比较随机对照试验(RCT)中评估 PVI + 经验性 SVC 隔离术(SVCI)与单纯 PVI 的数据:方法:对在线科学图书馆(从开始到 2024 年 4 月 1 日)进行了检索。有四项研究被认为符合荟萃分析的条件,共计600名患者,其中287名患者接受了PVI+SVCI,313名患者仅接受了PVI:结果:在总体人群中,SVCI + PVI 与随访时房颤复发率的降低无显著相关性(0.66 [0.43;1.00], p = 0.05, I2 0%)。在阵发性房颤(PAF)患者中,与单纯 PVI(19.9%)相比,SVCI + PVI(11.7%)显著降低了房颤复发率(0.54 [0.32;0.92],p = 0.02,I2 0%)。在透视时间(3.31 [- 0.8;7.41], p = 0.11, I2 = 91%)、手术时间(5.69 [- 9.78;21.16], p = 0.47, I2 = 81%)和并发症(1.06 [0.33;3.44], p = 0.92, I2 = 0%)方面,各组间未发现统计学差异:结论:PAF 患者在 PVI 的基础上加用 SVCI 可显著降低随访时的房颤复发率,且不会增加并发症发生率、手术时间和透视时间。
{"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}
引用次数: 0
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Journal of Interventional Cardiac Electrophysiology
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