Journal of Invasive Cardiology最新文献

Background: Operator radiation exposure (ORE) is one of the most adverse occupational hazards faced by interventional cardiologists. The presence of subclavian tortuosity can influence ORE.

Methods: This single-center retrospective study compared the cumulative radiation (CR) exposure in μSv and normalized radiation exposure (CR/DAP) of the primary operator during cardiac catheterization of all patients with subclavian tortuosity from left (LRA) and right radial artery approaches (RRA). ORE was measured at 4 anatomical locations: thorax, abdomen, left eye, and right eye.

Results: CR dose was significantly higher in the RRA group than in the LRA group at the left eye (P = .004), right eye (P = .01), thorax (P = .01) and abdomen (P = .01). CR/DAP dose was significantly higher in the RRA group than in the LRA group at the left eye (P = .04) and right eye (P = .03).

Conclusions: In cases with subclavian tortuosity, the LRA was associated with less CR to the operator than the RRA. The LRA was also associated with less CR/DAP that persisted at the anatomical location of the left eye. The authors recommend operators have time thresholds to exchange for appropriate catheters in patients with subclavian tortuosity. Furthermore, operators should consider time thresholds to change access sites to avoid potential procedural complications and excessive fluoroscopic times.

Objectives: Leadless pacemakers provide an alternative to transvenous pacing in patients at risk for lead- and pocket-related complications. While the femoral vein is the standard route of implantation, certain anatomical or clinical factors may make this approach technically challenging. The objective of this study was to evaluate the feasibility and safety of AVEIR (Abbott) implantation through the right internal jugular (RIJ) vein in patients in whom the femoral approach was not feasible.

Methods: The authors report a single-center case series of patients who underwent AVEIR implantation using the RIJ vein. Procedural techniques, periprocedural management, and early clinical outcomes were reviewed.

Results: Eight patients (8 VR and 1 DR) underwent successful implantation through the RIJ approach. Device deployment was accomplished with stable electrical parameters and without acute complications.

Conclusions: This case series demonstrates that AVEIR implantation via the RIJ is both technically feasible and safe. These findings expand access strategies for leadless pacing and may provide a foundation for future applications of conduction system pacing using superior venous routes.

Objectives: Large language models (LLMs) have the potential to assist in complex decision making for interventional cardiology (IC). However, their comparative performance in providing clinical recommendations remains uncertain. In this blinded model‑comparison study, the authors evaluated and compared the quality of recommendations produced by 6 LLMs for complex IC cases.

Methods: Twenty detailed and complex clinical cases focusing on coronary artery disease (n=10) and structural heart disease (n=10) were developed. Six LLMs were tested: default ChatGPT (ChatGPTd), ChatGPT with European Society of Cardiology guidelines (ChatGPT-gl), ChatGPT with internet search enabled (ChatGPTi), Gemini (Google), Mistral 7B (Mistral AI), and Perplexity AI (Perplexity AI, Inc.). Only the ordering of anonymized outputs was randomized to ensure blinding. Five expert ICs independently assessed the anonymized and randomized responses using a 0 to 10 scale for appropriateness, accuracy, relevance, clarity, and clinical utility, generating a composite score. Statistical analysis was performed using a mixed linear model.

Results: Six hundred blinded evaluations (20 cases x 6 models x 5 raters) were analyzed, yielding an overall composite score of 7.1 (95% CI, 7.0-7.2). Performance significantly varied across LLMs (P less than .001), with ChatGPTi (7.8 [7.5-8.0]) and ChatGPT-gl (7.7 [7.4-7.9]) outperforming others. ChatGPTd (6.9 [6.6-7.3]), Mistral 7B (7.0 [6.7-7.3]), and Perplexity AI (7.0 [6.7-7.3]) performed moderately, while Gemini had the lowest score (6.3 [6.0-6.7]). These differences were consistent across all scoring dimensions (P less than .001). Case type did not affect LLM performance (P = .900).

Conclusions: LLMs show promise in IC decision making, but their performance remains suboptimal. Maximizing their potential requires systematic integration of web search capabilities and guideline-based knowledge retrieval.