Journal of Interventional Cardiac Electrophysiology最新文献

Background: Preprocedural cardiac magnetic resonance (CMR) imaging is crucial for identifying ventricular scar areas, borderline zones, and potential reentry channels. This study aimed to evaluate the impact of late gadolinium enhancement (LGE) core and borderline mass on the acute and long-term outcomes of ventricular tachycardia (VT) ablation in patients with structural heart disease (SHD).

Methods and results: A total of 204 consecutive patients underwent CMR before scheduled VT ablation. Of these, 38 were excluded due to incomplete LGE quantification caused by device-related imaging artifacts, and 19 had no detectable left ventricular (LV) LGE, resulting in a final cohort of 147 patients with positive LGE (median age 64 years, 57% with non-ischemic cardiomyopathy [NICM], median left ventricular ejection fraction 38%, 61% with defibrillators). Patients with ischemic cardiomyopathy (ICM) had higher LV mass (86 vs. 75 g, P = 0.005) and LGE core mass (21 vs. 12 g, P = 0.001) compared to NICM patients, while borderline LGE mass was similar (2.9 vs. 2.5 g, P = 0.240). ICM patients more frequently presented with transmural inferior scars, whereas NICM patients exhibited more diffuse, non-transmural LGE patterns, particularly in the inferolateral, inferoseptal, and anteroseptal regions. Post-ablation, 28 patients (19%) remained acutely inducible (with clinical VT in two), and 53 patients (36%) experienced VT recurrence within a 20-month follow-up period. Neither high LGE core mass nor borderline mass predicted VT inducibility or recurrence. Most patients with clinical deterioration had NICM with septal involvement.

Conclusion: In patients with SHD undergoing VT ablation, neither high LGE core mass nor borderline mass was predictive of postprocedural VT inducibility or recurrence.

Background: Studies have shown a correlation between greater cardiorespiratory fitness (CRF) and lower risk of incident and recurrent atrial fibrillation (AF). Transthoracic echocardiographic (TTE) parameters correlate to CRF and risk of AF. However, there is scarce data regarding the interplay of CRF, echocardiographic parameters, and AF ablation outcomes. Our study sought to investigate how CRF and echocardiographic parameters impact AF ablation outcomes.

Methods: We evaluated the Mayo Clinic Cardiorespiratory Exercise database from January 1, 2013, through December 31, 2017, to include all patients who underwent cardiopulmonary exercise testing and an AF ablation in temporal proximity.

Results: A total of 205 patients (mean age 61.2 years, 74% male) were included for analysis. Fitness was calculated with peak VO2 when available and exercise time when VO2 was not available. Lower baseline fitness correlated to larger left atrial volumes, lower medial mitral e' values, and higher E/e' ratios. Lower baseline fitness correlated to higher risk of AF recurrence post-ablation in a simple model, but lost significance when multiple variables were accounted for. Lower baseline fitness also correlated to a higher AF burden post-ablation at one year.

Conclusions: Lower baseline CRF likely correlates to more malignant and difficult to treat AF. Lower fitness also correlated to larger left atria and TTE parameters suggestive of diastolic dysfunction.

Background: Treatment of PAF with PVI is the gold standard approach. Recently, esophageal cooling has been shown to significantly reduce the risk of esophageal injury during thermal ablation. This study investigated outcomes of HPSD before and after instituting esophageal cooling.

Methods: In this natural experiment, we enrolled 346 consecutive patients with PAF undergoing initial ablation using HPSD, 143 patients immediately prior to and 203 patients immediately after switching from luminal esophageal monitoring (LET arm) to esophageal cooling with ensoETM (ensoETM arm). The primary endpoint was time-to-atrial arrhythmia recurrence.

Results: The procedure times were significantly faster with ensoETM (82.9 ± 27 vs 112 ± 49 min, p < 0.0001). At a median follow-up of 10.3 ± 3.4 months, the atrial arrhythmia recurrence rate did not significantly differ between LET and ensoETM arms (25.2% vs 30.0%, p = 0.3202). Kaplan-Meier analysis showed no significant difference in the overall atrial arrhythmia recurrence (log-rank, p = 0.3780). Statistical analysis of all notable comorbidities revealed no significant association with procedural outcomes.

Conclusion: In patients with PAF undergoing an initial ablation procedure with HPSD, esophageal cooling led to significantly faster procedures, with no decrease in efficacy.

Background: Subcutaneous implantable cardioverter-defibrillators (S-ICD) are an alternative to transvenous ICDs for patients without a need for cardiac pacing. Obese patients have been proposed to be at higher risk for conversion failure with S-ICDs due to subcutaneous fat underneath the device. Optimal device positioning may promote equivalent outcomes between obese and non-obese patients by minimizing the effects of excess adipose tissue.

Methods: A retrospective analysis of patients undergoing defibrillation testing at the time of S-ICD implantation was performed. The primary endpoint was the rate of successful conversion of ventricular fibrillation (VF) at the time of implant. The secondary endpoint was shock impedance.

Results: A total of 184 patients were included in the study. The rate of successful conversion of VF was 90.3% for obese patients (n = 72) and 96.4% for non-obese patients (n = 112) (p = 0.086). Compared to non-obese patients, obese patients had a higher mean PRAETORIAN score (78.5 ± 58.1 vs. 48.8 ± 35.5, p < 0.001) and higher measured mean impedance (82.0 ohms ± 26.5 vs. 69.8 ohms ± 19.3, p < 0.001). Patients with a PRAETORIAN score < 90 all had successful defibrillation testing regardless of BMI.

Conclusions: In this study, a PRAETORIAN score < 90 was associated with a 100% success rate of defibrillation testing following S-ICD implantation regardless of patient body mass index (BMI). Thus, the impact of obesity on impedance and the risk of failed shocks may be minimized with close attention to implantation technique to achieve a low PRAETORIAN score.

Background: Pulsed field ablation (PFA) and high-power short-duration radiofrequency ablation (HPSD) are emerging techniques for treating atrial fibrillation (AF), offering promising results compared to cryoballoon ablation (CBA). This network meta-analysis aims to evaluates the efficacy and safety of PFA, HPSD, and CBA.

Method: PubMed, Scopus and Cochrane Central Register of Controlled Trials were systematically searched for relevant studies until October 2024. The primary outcome is freedom from atrial arrhythmia. A random-effects model was used for data synthesis, and P-scores were employed for outcome ranking. Point estimation (odd ratios) was calculated for comparisons.

Results: Eighteen studies were included in our network meta-analysis, involving 7,071 atrial fibrillation patients. Among them, 2,023 (29%), 3,725 (53%), and 1,323 (18%) patients underwent PFA, CBA, and HPSD, respectively. PFA demonstrated a higher freedom from atrial arrhythmia, with an odds ratio (OR) of 3.63 (95% CI: 2.95-4.46) compared to CBA and 1.89 (95% CI: 1.47-2.43) compared to HPSD. However, PFA was associated with a higher risk of complications (OR = 6.54, 95% CI: 2.13-20.00) compared to CBA, while HPSD showed an insignificant association with a lower risk of complications compared to CBA (OR = 0.61, 95% CI: 0.15-2.42). PFA had the shortest procedural time (P-score: 100%), while HPSD had the longest (P-score: 0%). In contrast, HPSD had the shortest fluoroscopic time, with P-scores of 100%, 46%, and 3% for HPSD, PFA, and CBA, respectively.

Conclusion: PFA demonstrated higher efficacy but also a higher risk of complications compared to HPSD and CBA. HPSD showed greater efficacy with comparable safety to CBA.