Journal of interventional cardiology最新文献

Background: This study aimed at comparing the safety and long-term outcomes pertaining to delayed left atrial appendage closure (LAAC) after catheter ablation (CA).

Methods: The retrospective analysis in the study included 474 patients who received LAAC at our center between July 2017 and April 2024. Procedure- and device-related complications, major adverse events (MAEs), and recurrence of atrial fibrillation (AF) were compared among the CA + LAAC, Delayed-LAAC, and LAAC-only groups.

Results: The Delayed-LAAC group did not report device-related thrombus (DRT) formation, and the CA + LAAC group presented obviously lower DRT incidence versus the LAAC-only group (0.7% vs. 7.1%, p = 0.02). Both CA + LAAC and Delayed-LAAC groups exhibited obviously lower stroke events rate versus the LAAC-only group (4.6% and 2% vs. 13.7%, p = 0.02). And all three groups demonstrated low rates of bleeding events (9.8% and 6% vs. 3.4%, p = 0.25) and all-cause death (1.9% and 2% vs. 5.2%, p = 0.23). The Delayed-LAAC group showed dramatically lower AF recurrence rate relative to the CA + LAAC group (16% vs. 35.2%, p = 0.006). In the multivariate Cox regression analysis, delayed LAAC (hazard ratio (HR) = 0.43, 95% confidence interval (CI): 0.20–0.93, and p = 0.03) and paroxysmal AF (HR = 0.56, 95% CI: 0.38–0.83, and p = 0.003) were protective factors. Patients with persistent AF and who once had been diagnosed with coronary heart disease (HR = 1.56, 95% CI: 1.11–2.21, and p = 0.01) were more likely to experience AF recurrence. Further subgroup analysis showed similar results.

Conclusions: The Delayed-LAAC is as safe and feasible as the combination procedure. However, Delayed-LAAC was associated with lower AF recurrence rate.

Background: Congenital heart disease (CHD) is one of the most common birth defects globally, and catheter-based interventions have become essential in its management. However, nationwide epidemiological data on CHD interventions remain limited. This study aims to analyze nationwide epidemiological trends in catheter-based CHD interventions among pediatric and adult populations in Korea.

Methods: We analyzed the National Health Insurance Service database from 2002 to 2018 to identify patients who underwent catheter-based interventions for CHD.

Results: A total of 18,800 CHD interventions were performed during the study period, with female patients accounting for 60.4% of cases. The most common intervention was atrial septal defect (ASD) device closure (35.3%), followed by patent ductus arteriosus (PDA) device closure (29.5%), balloon pulmonary valvuloplasty, and balloon pulmonary angioplasty. Intervention patterns varied by age, with PDA device closure being most frequent in infants and children, while ASD device closure dominated among adults. The overall number of CHD interventions increased significantly over the study period, with a marked rise among adults following the inclusion of ASD closure in national health insurance coverage in 2009.

Conclusions: CHD interventions in Korea have increased substantially over time, with a notable shift toward adult patients. ASD device closure was the most frequently performed procedure, especially after its inclusion in national health insurance coverage. These findings highlight the growing need for adult CHD care and underscore the critical role of healthcare policies in shaping intervention trends.

Background: Coronary lesions with significant angulation or tortuosity pose unique challenges during intervention due to limited access and maneuverability. The SuperCross microcatheter (SCM) is specifically designed to navigate through these angulated vessels and facilitate the successful crossing of side branches.

Objectives: The objective of this article is to formulate and discuss recommendations for the primary use of SCM in coronary intervention involving complex coronary anatomy.

Methods: From January 2021 to December 2023, a total of 43 patients underwent treatment at our single center utilizing SCM techniques. The duration of the treatment period was categorized into two distinct phases: primary use and secondary use of SCM.

Results: The average age of the patients was 68.5 ± 10.6 years, with a predominance of male patients. The primary diagnosis consisted of unstable angina. Due to limited accessibility and maneuverability, there were frequent attempts made at the ostium of the left circumflex artery (30.2%), diagonal branch ostium (27.9%), and obtuse marginal branch ostium (14.0%). However, three cases failed to successfully navigate through highly angulated lesions.

Conclusions: The utilization of SCM techniques offers distinct advantages in managing complex coronary anatomies, particularly when dealing with highly angulated vessels observed in bifurcation or chronic total occlusion scenarios, as well as facilitating antegrade dissection for re-entry into the true lumen.

Background and Aims: Breast cancer (BC) is the leading cause of cancer in women. Female interventional cardiologists are potentially at a higher risk of developing BC due to occupational radiation exposure. This survey aimed at understanding radiation safety and awareness in current clinical practice, and the occurrence of BC, among female interventional cardiologists.

Methods: A survey was conducted worldwide among 64 cardiac laboratories from September 2022 to December 2022.

Results: 195 physicians (mean age 41.0 ± 7.4 years) completed the survey: 33 (16.9%) reported being exposed to X-ray for less than five years, 78 (40%) between five and ten years and 84 (43.1%) for more than ten years; 13 (6.7%) reported performing less than 50 interventional procedures/year, 52 (26.7%) between 50 and 100 and 130 (66.6%) more than 100 procedures/year. 126 physicians reported wearing three or more radiation dosimeters; 72 reported not using tableside X-ray shielding to protect themselves from direct and scattered radiation. BC occurred in four (2.1%) physicians, all of whom worked in the electrophysiology laboratory for a relatively long time (one with 5–10 years of exposure and three with more than ten years; mean age at cancer presentation was 46.5 ± 3.7 years). All tumours were left-sided BC.

Conclusions: This survey provides a snapshot of occupational radiation exposure of female interventional cardiologists. BC is a possible professional threat in addition to its real-life epidemiology, with a negative impact on women’s lives in interventional laboratories. All possible efforts should be made to eliminate radiation exposure among interventional laboratory workers.

Introduction and Objectives: Coronary artery perforation (CAP) is a rare but potentially fatal complication of percutaneous coronary intervention (PCI). Although its management is well-studied in tertiary care settings, little is known about the incidence and treatment patterns at district general hospitals (DGHs), which this study explored.

Materials and Methods: A single-centre analysis of all PCI procedures in a DGH between January 2011 and December 2023 was performed. Patients’ records were examined for procedure details and endpoints, which included pericardiocentesis, emergency cardiac surgery and secondary coronary artery bypass grafting. The endpoints also included in-hospital and one-year mortalities.

Results: During the study period, there were 13,480 PCIs, of which 31 (0.23%) were complicated by CAP. Males composed 65%, and the mean age was 69.9 ± 10 years. The most common perforation type was Ellis II in 45% of patients, and the left anterior ascending artery (LAD) was most affected in 55% of patients. An echocardiogram was done in all patients and showed tamponade physiology in 16%, in all of whom pericardiocentesis was performed. Other CAP treatments included balloon tamponade in 65%, covered stent in 42%, fat embolisation in 10% and emergency surgery and coiling in 6% each. Inpatient mortality occurred in three patients (10%), with no one-year mortalities. Long-term complications were not observed in the study.

Conclusion: CAP remains a rare, potentially lethal complication of PCI in a DGH setting, with an incidence, pattern and treatments similar to those of high-volume PCI teaching centres. Early recognition and proper management are crucial.

Objective: To compare left ventricular (LV) and aortic (AO) pressures obtained using fluid-filled and high-fidelity solid-state pressure catheters in subjects undergoing left heart catheterization.

Materials and Methods: Twenty subjects scheduled for a left heart catheterization were enrolled and 18 subjects completed this IRB-approved study. LV and AO pressures were obtained using fluid-filled pressure catheter (standard-of-care) and high-fidelity solid-state pressure catheter synchronously. Pressure tracings were analyzed to measure LV systolic (LVSP), LV minimum-diastolic (LVMDP), LV end-diastolic (LVEDP), AO systolic (AOSP), and AO diastolic (AODP) pressures. Isovolumic contraction and relaxation rates (peak ± dp/dt) were derived from the pressure waveforms. Repeated measures of variance, post hoc tests with Bonferroni corrections, and Bland–Altman plots were used for comparisons.

Results: A significant main effect of the pressure catheter was noted for LVSP, LVMDP, and AOSP (p ≤ 0.025). The LVSP and AOSP measured with fluid-filled pressure catheters were higher by 6.6 ± 6.9 mmHg and 4.6 ± 5.2 mmHg in comparison to solid-state pressure catheter. In contrast, the LVMDP measurements were 3.5 ± 5.7 mmHg lower than the solid-state pressure catheter measurements. The isovolumic contraction (66.4 ± 116.0 mmHg/s) and relaxation rates (60.5 ± 113.5 mmHg/s) were not significantly different between catheter systems after Bonferroni corrections for multiple comparisons (p ≥ 0.06). The Bland–Altman analysis revealed a bias ranging from 0.8 to 6.6 mmHg.

Conclusions: Differences in LVSP, LVMDP, and AOSP were noted between the catheter systems but not for other pressure values and contraction/relaxation rates. Fluid-filled catheters overestimated true systolic pressures in the left ventricle and aorta.

Trial Registration: ClinicalTrials.gov identifier: NCT03245255

Background: The shorter time to hemostasis in patients who undergo transradial cardiac catheterization may reduce the complications, cause less pain, facilitate early discharge, and improve patient satisfaction.

Objective: This trial aimed to evaluate if SoftSeal-STF (Chitogen Inc., Plymouth, MN) with manual compression alone or in combination with a radial compression device (RCD) would reduce time to hemostasis compared to patients with RCD only (Vasc Band).

Methods: We enrolled 300 patients in four arms, including SoftSeal-STF with manual compression, Vasc Band (standard of care), SoftSeal-STF with TR Band, and SoftSeal-STF with EasyClik. This study was analyzed as an observational study due to modification in the design of a randomized trial. The primary outcome was time to hemostasis; the secondary outcomes were complications before discharge, a 3 day follow-up, and a follow-up office visit (30–45 days postprocedure).

Results: The median time to hemostasis (interquartile range [IQR]) was significantly lower in the SoftSeal-STF + TR Band group and the SoftSeal-STF + EasyClik group than in the Vasc Band group (45 [40–69] minutes vs. 120 [120–124] minutes, p < 0.0001; 44 [40–58.5] minutes vs. 120 [120–124] minutes, p < 0.0001, respectively). The median time to hemostasis (IQR) was not different between SoftSeal-STF + TR Band and SoftSeal-STF + EasyClik (45 [40–69] minutes vs. 44 [40–58.5] minutes, p = 0.3). The median time to hemostasis (IQR) was lowest in the SoftSeal-STF + manual compression group (19 [15–30] minutes), but these patients had more postoperative pain and bruising along with logistic issues within the catheterization lab.

Conclusion: The SoftSeal-STF + RCD is a safe and time-efficient strategy in patients who undergo transradial cardiac catheterization. (Radial Artery Vascular Complication and Resource Utilization [RAVE]).

Trial Registration: ClinicalTrials.gov identifier: NCT03522077

Objective: The results of right-to-left shunt (RLS) assessments are highly influenced by the methods used. This study aimed to compare the effectiveness of contrast transthoracic echocardiography (cTTE) and contrast transcranial Doppler (cTCD) in detecting RLS by conducting them simultaneously, employing the same provocations, timing, contrast-saline mixture, and posture.

Materials and Methods: This study was conducted at the Second Affiliated Hospital, School of Medicine, the Chinese University of Hong Kong, Shenzhen. A total of 237 patients who underwent both cTTE and cTCD simultaneously were included. The differences in RLS detection rates and the degree of shunting between the two examinations were assessed using the chi-square test and Wilcoxon rank-sum test. In addition, the timing of RLS appearance was compared between cTTE and cTCD examinations.

Results: The detection rate of RLS was higher with cTTE compared to cTCD (93.25% vs. 84.81%, X² = 8.64, p = 0.03); the difference was primarily observed in cases where RLS appeared after five cardiac cycles (X² = 17.496, p < 0.001). Regarding the detection of moderate/large shunts, cTTE outperformed cTCD (66.67% vs. 30.38%, X² = 62.468, p < 0.001); the difference in moderate/large shunt detection rates was primarily observed in cases where RLS appeared after five cardiac cycles (X² = 86.361, p < 0.001).

Conclusion: During the synchronous provocation testing, cTTE demonstrated superior performance over cTCD in detecting RLS and moderate/large RLS, particularly when RLS appeared after five cardiac cycles following full right atrial opacification.

Background: Transradial coronary intervention has been shown to be both safe and effective, with several benefits, such as limited access to site complications and earlier patient discharge. Radial compression devices, on the other hand, add to the total expense of the procedure and have not been adequately compared to traditional compressive dressings. The purpose of this study is to compare the safety and efficacy of elastic compressive dressing with gauze swabs and crepe bandages to balloon compression devices with the TR Band (Terumo) for maintaining radial hemostasis following cardiac procedures.

Method: A total of 402 patients were randomly assigned to receive either a TR band or an elastic compressive dressing for radial hemostasis following cardiac intervention in a prospective, partially blinded, randomized clinical study. The main outcome was the hemostasis time and the occurrence of hematoma. Patient satisfaction, postprocedure pain, vascular problems, and the cost of the compression device used were all secondary outcomes.

Results: The two groups had similar baseline characteristics and procedural data. The majority of patients (79%) were very satisfied with both hemostasis techniques. The elastic dressing group achieved hemostasis significantly faster than the TR band group (83.8 ± 142.8 min vs. 116.3 ± 122.7, p = 0.017). Significant differences in the incidence of hematoma (8% elastic dressing vs. 18.4% TR band, p = 0.003) and postprocedural pain (0.84 ± 1.2 elastic dressing vs. 1.39 ± 1.4 TR band, p ≤ 0.001) were observed. The incidence of early radial artery occlusion was higher in the elastic dressing group (7 patients) than in the TR band group (2 patients), although the difference was not statistically significant (p = 0.09). Finally, the TR band was significantly more expensive than the elastic dressing used in the trial.

Conclusion: Elastic compressive dressings are a safe, low-cost, and effective alternative to TR band. They decrease hemostasis time, enhance patient comfort, and reduce both the number and size of hematomas. When compared to the TR band, these dressings have a similar rate of radial artery patency at discharge.

Trial Registration: ClinicalTrials.gov identifier: NCT05409716

Background: Gender differences exist in atrial fibrillation (AF) regarding epidemiology, mechanisms, management, and outcomes. There are limited data regarding gender-specific outcomes after pulmonary vein isolation (PVI) including AF recurrence, physical activity, and health-related quality of life.

Methods: In this secondary analysis of a randomized controlled trial (BE-ACTION study: investigating 200 patients with paroxysmal or persistent AF undergoing PVI), a gender-specific analysis of the primary endpoint (recurrence of atrial arrhythmia > 30s, additional ablation procedure, or new onset of antiarrhythmic drugs) was performed. Quality of life was assessed using the AFEQT and SF-36 questionnaires, while physical activity was measured via step counts recorded at baseline, 6 months, and 12 months. The Mann–Whitney U test and Fisher exact test were used to compare continuous and categorical variables, respectively.

Results: 33.5% were women. Women and men were comparable in demographics, comorbidities, and steps per day before and after PVI. There was no statistically significant difference in the primary composite endpoint between women (37.3%) and men (25.6%) (p = 0.085). Before PVI, women had lower quality of life scores than men (median AFEQT scores: 43.5 points [25^th to 75^th percentiles 25.9–63.9] vs. 62.0 points [47.2–76.4], respectively, p < 0.001) as well as in the physical (40.22 points [33.98–46.69] vs. 46.30 points [39.21–51.60], p = 0.002) and mental domains (42.33 points [27.34–51.59] vs. 49.59 points [36.02–55.64], p = 0.001) of the SF-36 questionnaire. The overall improvement in the quality of life was significant for both men and women (p < 0.001). Using AFEQT, women exhibited lower quality of life scores compared to men at 6 months post-PVI (p = 0.001); however, this difference was no longer statistically significant at 12 months (p = 0.077).

Conclusion: These data emphasize the importance of AF recurrence after PVI and motivate future research to explore the causes and clinical consequences of a gender gap in quality of life in women after PVI.

Trial Registration: BE-ACTION Study ClinicalTrials.gov identifier: DRKS00012914