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A review of the contemporary use of inotropes in patients with heart failure. 心力衰竭患者肌注药物的当代使用回顾。
IF 2.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 Epub Date: 2023-12-26 DOI: 10.1097/HCO.0000000000001115
Radhika Neicheril, David Snipelisky

Purpose of review: The role of inotropes has evolved with its use now expanding over multiple indications including cardiogenic shock, low cardiac output states, bridging therapy to transplant or mechanical support, and palliative care. There remains no consensus as to the recommended inotrope for the failing heart. We aim to provide an overview of the recent literature related to inotrope therapy and its application in patients with advanced heart failure and hemodynamic compromise.

Recent findings: In this review, we outline various clinical scenarios that warrant the use of inotrope therapy and the associated recommendations. There remains no mortality benefit with inotrope use. Per American Heart Association recommendations, the choice of the inotropic agent should be guided by parameters such as blood pressure, concurrent arrhythmias, and availability of the medication. Outcome variability remains a heightened concern with inpatient inotropic use in both hemodynamically stable and unstable patients. Finally, inotropic use in palliative care continues to be a recommendation for symptom control and improvement in functional status when the appropriate social support is present for the patient.

Summary: In summary, the ideal inotropic agent remains at the discretion of the clinical provider. Different clinical scenarios may favor one agent over another based on the type of cardiogenic shock and mechanism of action of the inotrope. A future shift towards characterizing inotrope use based on subgroup cardiogenic shock profiles may be seen, however further studies are needed to better understand these phenotypes. Inotrope therapy remains a keystone to bridging to advanced therapies and palliative care.

回顾的目的:肌力药物的作用在不断演变,其使用范围现已扩大到多种适应症,包括心源性休克、低心输出量状态、移植或机械支持的桥接治疗以及姑息治疗。对于心脏衰竭患者推荐使用的肌力药物,目前仍未达成共识。我们旨在概述有关肌力药物治疗及其在晚期心衰和血流动力学受损患者中应用的最新文献:在这篇综述中,我们概述了需要使用肌注疗法的各种临床情况以及相关建议。使用肌注药物对死亡率仍无益处。根据美国心脏协会的建议,应根据血压、并发心律失常和药物可用性等参数选择肌力药物。对于血流动力学稳定和不稳定的住院患者使用肌力药物,结果的可变性仍然是一个值得高度关注的问题。最后,在姑息治疗中使用肌力药物仍是一项建议,以控制症状并改善患者的功能状态,前提是患者有适当的社会支持。根据心源性休克的类型和肌力药物的作用机制,不同的临床情况可能会选择不同的药物。未来可能会根据亚组心源性休克的特征来确定肌力药物的使用,但要更好地了解这些表型还需要进一步的研究。肌注治疗仍然是通向先进疗法和姑息治疗的关键。
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引用次数: 0
Simulating mitral repair: lessons learned. 模拟二尖瓣修复:经验教训。
IF 2.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-02-03 DOI: 10.1097/hco.0000000000001106
Abigail White, Anna Zarzycki, Gianluigi Bisleri
With the growing complexity of cardiac surgical cases, increased focus on patient safety, and minimally invasive techniques, simulation-based training has experienced a renaissance. This review highlights important elements of simulation-based training, focusing specifically on available simulators for mitral valve repair and the uses for simulation.
随着心脏外科手术病例的复杂性不断增加、对患者安全的重视程度不断提高以及微创技术的发展,模拟培训也经历了一次复兴。本综述重点介绍了模拟培训的重要内容,特别关注二尖瓣修复术的可用模拟器和模拟的用途。
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引用次数: 0
Radiofrequency lesion formation prediction with contact force versus local impedance. 接触力与局部阻抗的射频损伤形成预测。
IF 2.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-01-01 Epub Date: 2023-10-09 DOI: 10.1097/HCO.0000000000001095
Ziad F Issa

Purpose of review: Safe and effective radiofrequency (RF) myocardial ablation requires real-time monitoring of lesion formation. Here, we review conventional and novel approaches proposed to guide titration of RF energy application.

Recent findings: Conventional monitoring modalities, such as ablation electrode temperature, generator impedance, and tissue electrophysiological properties have been of limited value in predicting efficacy and safety of ablation. Therefore, several input-driven indices have been proposed to improve the quality and durability of RF ablation lesion while maintaining safety. These metrics predominantly incorporate RF power output, duration of RF application, and firmness and stability of electrode-tissue contact. More recently, novel catheters have enabled measuring local impedance at the catheter-tissue interface, which has been found valuable for real-time monitoring of RF lesion formation.

Summary: It is likely that using the combination of multiple metrics would be required to improve the quality and safety of RF lesions, but further investigation is still required.

综述目的:安全有效的射频(RF)心肌消融术需要实时监测病变的形成。在这里,我们回顾了为指导射频能量应用的滴定而提出的传统和新方法。最近的发现:传统的监测模式,如消融电极温度、发生器阻抗和组织电生理特性,在预测消融的疗效和安全性方面的价值有限。因此,已经提出了几个输入驱动的指标来提高射频消融损伤的质量和耐久性,同时保持安全性。这些指标主要包括RF功率输出、RF应用的持续时间以及电极-组织接触的牢固性和稳定性。最近,新型导管已经能够测量导管-组织界面处的局部阻抗,这对于实时监测RF损伤的形成是有价值的。总结:可能需要使用多种指标的组合来提高射频损伤的质量和安全性,但仍需进一步研究。
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引用次数: 0
2023 Update on equity, diversity, and inclusion in Canadian cardiac surgery. 2023加拿大心脏外科的公平性、多样性和包容性更新。
IF 2.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-01-01 Epub Date: 2023-11-07 DOI: 10.1097/HCO.0000000000001101
Lina A Elfaki, Rosalind Groenewoud, Akachukwu Nwakoby, Areeba Zubair, Raj Verma, Bobby Yanagawa

Purpose of review: Despite efforts to diversify the medical field, cardiac surgery remains amongst the least diverse specialties. Specifically, the percentage of women and racial minorities has remained low in past few decades. This may impact prospective trainee recruitment and surgical care. This paper highlights recent efforts that aim to promote diversity and inclusion of the Canadian cardiac surgical workforce.

Recent findings: Formal programs have been established to support students at different stages of training. In 2022, the Canadian Society for Cardiac Surgery has released an equity, diversity, and inclusion statement to summarize the current state and the strategic goals to accomplish a more just working environment. At the local level, the University of Toronto Next Surgeon high school pilot program, provided low-income, women, and racial minority students mentorship and experiential exposure to our field. Also, the University of Toronto, scholarships funded summer research with cardiac surgeons for women, as well as Black and Indigenous medical students.

Summary: Tangible efforts that target high school, undergraduate, and medical students are underway to promote equity and diversity of cardiac surgeons in Canada. Future studies that evaluate the gaps and identify bottlenecks could better guide interventions at institutions across the country.

综述目的:尽管努力使医疗领域多样化,但心脏外科仍然是最不多样化的专业之一。具体而言,在过去几十年中,妇女和少数种族的比例一直很低。这可能会影响未来的实习生招聘和外科护理。本文重点介绍了最近为促进加拿大心脏外科工作人员的多样性和包容性所做的努力。最近的发现:已经建立了正式的项目来支持处于不同训练阶段的学生。2022年,加拿大心脏外科学会发布了一份公平、多样性和包容性声明,总结了当前的状况和实现更公正工作环境的战略目标。在地方一级,多伦多大学Next Surgeon高中试点项目为低收入、女性和少数族裔学生提供了指导,并让他们体验我们的领域。此外,多伦多大学的奖学金资助了女性心脏外科医生以及黑人和土著医学生的夏季研究。摘要:针对高中生、本科生和医学生的切实努力正在进行中,以促进加拿大心脏外科医生的公平性和多样性。未来评估差距和确定瓶颈的研究可以更好地指导全国各机构的干预措施。
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引用次数: 0
Advances in cardiac pacing with leadless pacemakers and conduction system pacing. 无引线起搏器心脏起搏和传导系统起搏的进展。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-01-01 Epub Date: 2023-09-21 DOI: 10.1097/HCO.0000000000001092
Sulaiman Somani, Albert J Rogers

Purpose of review: The field of cardiac pacing has undergone significant evolution with the introduction and adoption of conduction system pacing (CSP) and leadless pacemakers (LLPMs). These innovations provide benefits over conventional pacing methods including avoiding lead related complications and achieving more physiological cardiac activation. This review critically assesses the latest advancements in CSP and LLPMs, including their benefits, challenges, and potential for future growth.

Recent findings: CSP, especially of the left bundle branch area, enhances ventricular depolarization and cardiac mechanics. Recent studies show CSP to be favorable over traditional pacing in various patient populations, with an increase in its global adoption. Nevertheless, challenges related to lead placement and long-term maintenance persist. Meanwhile, LLPMs have emerged in response to complications from conventional pacemaker leads. Two main types, Aveir and Micra, have demonstrated improved outcomes and adoption over time. The incorporation of new technologies allows LLPMs to cater to broader patient groups, and their integration with CSP techniques offers exciting potential.

Summary: The advancements in CSP and LLPMs present a transformative shift in cardiac pacing, with evidence pointing towards enhanced clinical outcomes and reduced complications. Future innovations and research are likely to further elevate the clinical impact of these technologies, ensuring improved patient care for those with conduction system disorders.

综述目的:随着传导系统起搏(CSP)和无引线起搏器(LLPM)的引入和采用,心脏起搏领域发生了重大发展。这些创新提供了优于传统起搏方法的优势,包括避免与铅相关的并发症和实现更多的生理性心脏激活。这篇综述批判性地评估了CSP和LLPM的最新进展,包括它们的好处、挑战和未来增长的潜力。最近的研究结果:CSP,尤其是左束支区域,增强了心室去极化和心脏力学。最近的研究表明,在各种患者群体中,CSP优于传统起搏,其在全球的应用也在增加。然而,与潜在客户安置和长期维护相关的挑战依然存在。同时,LLPM已经出现,以应对传统起搏器导线的并发症。两种主要类型,Aveir和Micra,随着时间的推移,结果和采用率都有所提高。新技术的结合使LLPM能够满足更广泛的患者群体,并且它们与CSP技术的结合提供了令人兴奋的潜力。总结:CSP和LLPM的进步为心脏起搏带来了变革性的转变,有证据表明其可以提高临床疗效并减少并发症。未来的创新和研究可能会进一步提高这些技术的临床影响,确保改善传导系统疾病患者的护理。
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引用次数: 0
Left atrial appendage closure: the journey today and tomorrow. 左心耳封堵术:今天和明天的旅程。
IF 2.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-01-01 Epub Date: 2023-10-20 DOI: 10.1097/HCO.0000000000001091
Marvin Louis Roy Lu, David Bowers De Lurgio

Purpose of review: This review aims to discuss the rationale behind the development of percutaneous LAAC devices as a treatment option for atrial fibrillation patients ineligible for long-term anticoagulation. The evolution of LAAC, from early experiences and challenges to risk mitigation and improved devices and techniques, will be examined. Furthermore, the review will explore our current understanding of the potential and limitations of LAAC in stroke prevention.

Recent findings: Multiple trials confirm LAAC device safety and efficacy for stroke prevention, but peri-device leak and thrombus remain concerns postimplantation. Even small leaks pose increased stroke risk. While guidelines suggest short-term anticoagulation postimplant; real-world data show equivalent efficacy with dual antiplatelet regimen.

Summary: LAAC device design has evolved and now serve as a viable option for stroke prevention in high-risk atrial fibrillation patients, offering protection in the absence of anticoagulation.

综述目的:本综述旨在讨论开发经皮左心房颤动装置作为不符合长期抗凝条件的心房颤动患者的治疗选择的基本原理。将研究LAAC的演变,从早期的经验和挑战到风险缓解以及改进的设备和技术。此外,这篇综述将探讨我们目前对LAAC在中风预防中的潜力和局限性的理解。最近的研究结果:多项试验证实了LAAC装置预防中风的安全性和有效性,但装置周围渗漏和血栓仍然是植入后的问题。即使是很小的泄漏也会增加中风的风险。而指南建议植入后进行短期抗凝治疗;真实世界的数据显示双重抗血小板方案具有同等疗效。总结:LAAC装置的设计已经发展成为高危心房颤动患者预防中风的可行选择,在没有抗凝的情况下提供保护。
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引用次数: 0
Neurologic impact of atrial fibrillation. 心房颤动对神经系统的影响。
IF 2.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-01-01 Epub Date: 2023-09-07 DOI: 10.1097/HCO.0000000000001093
Daniel R Feldman, Emily P Zeitler

Purpose of review: Cognitive dysfunction is a complex condition that is becoming increasingly more prevalent. There has been growing acknowledgement that individuals with atrial fibrillation are at an increased risk of cognitive dysfunction beyond the association of age with both disorders. The purpose of this review is to explore the potential underlying mechanisms connecting atrial fibrillation and cognitive dysfunction and to examine the existing evidence for potential treatment options.

Recent findings: Many mechanisms have been proposed for the association between cognitive dysfunction and atrial fibrillation. These include cerebral infarction (both micro and macro embolic events), cerebral microbleeds including those secondary to therapeutic anticoagulation, an increased inflammatory state, cerebral hypoperfusion, and a genetic predisposition to both diseases. Treatments designed to target each of these mechanisms have led to mixed results and there are no specific interventions that have definitively led to a reduction in the incidence of cognitive dysfunction.

Summary: The relationship between cognitive dysfunction and atrial fibrillation remains poorly understood. Standard of care currently focuses on reducing risk factors, managing stroke risk, and maintaining sinus rhythm in appropriately selected patients. Further work needs to be conducted in this area to limit the progression of cognitive dysfunction in patients with atrial fibrillation.

回顾的目的:认知功能障碍是一种日益普遍的复杂疾病。越来越多的人认识到,除了年龄与认知功能障碍的关系外,心房颤动患者患认知功能障碍的风险也在增加。本综述旨在探讨心房颤动与认知功能障碍之间的潜在内在机制,并研究潜在治疗方案的现有证据:认知功能障碍与心房颤动之间的关联有许多机制。这些机制包括脑梗塞(微栓塞和大栓塞事件)、脑微出血(包括治疗性抗凝继发出血)、炎症状态加重、脑灌注不足以及这两种疾病的遗传易感性。针对上述每种机制的治疗结果不一,目前还没有特定的干预措施能明确降低认知功能障碍的发病率。摘要:人们对认知功能障碍与心房颤动之间的关系仍然知之甚少。目前的标准治疗重点是减少风险因素、控制中风风险以及在适当选择的患者中维持窦性心律。要限制心房颤动患者认知功能障碍的发展,还需要在这一领域开展进一步的工作。
{"title":"Neurologic impact of atrial fibrillation.","authors":"Daniel R Feldman, Emily P Zeitler","doi":"10.1097/HCO.0000000000001093","DOIUrl":"10.1097/HCO.0000000000001093","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cognitive dysfunction is a complex condition that is becoming increasingly more prevalent. There has been growing acknowledgement that individuals with atrial fibrillation are at an increased risk of cognitive dysfunction beyond the association of age with both disorders. The purpose of this review is to explore the potential underlying mechanisms connecting atrial fibrillation and cognitive dysfunction and to examine the existing evidence for potential treatment options.</p><p><strong>Recent findings: </strong>Many mechanisms have been proposed for the association between cognitive dysfunction and atrial fibrillation. These include cerebral infarction (both micro and macro embolic events), cerebral microbleeds including those secondary to therapeutic anticoagulation, an increased inflammatory state, cerebral hypoperfusion, and a genetic predisposition to both diseases. Treatments designed to target each of these mechanisms have led to mixed results and there are no specific interventions that have definitively led to a reduction in the incidence of cognitive dysfunction.</p><p><strong>Summary: </strong>The relationship between cognitive dysfunction and atrial fibrillation remains poorly understood. Standard of care currently focuses on reducing risk factors, managing stroke risk, and maintaining sinus rhythm in appropriately selected patients. Further work needs to be conducted in this area to limit the progression of cognitive dysfunction in patients with atrial fibrillation.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"33-38"},"PeriodicalIF":2.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10184569","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
Low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol and apolipoprotein B for cardiovascular care. 用于心血管护理的低密度脂蛋白胆固醇、非高密度脂蛋白蛋白胆固醇和载脂蛋白B。
IF 2.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-01-01 Epub Date: 2023-11-06 DOI: 10.1097/HCO.0000000000001100
Selin Bilgic, Allan D Sniderman

Purpose of review: Some experts and consensus groups continue to argue that apolipoprotein B (apoB) should not be introduced broadly into clinical care. But, too often, the present approach to clinical care is not succeeding. An important reason for this failure, we believe, is that the conventional approach limits what the expert clinician can accomplish and is too complex, confusing, and contradictory for primary care physicians to apply effectively in their practise.

Recent findings: There are four major reasons that apoB should be measured routinely in clinical care. First, apoB is a more accurate marker of cardiovascular risk than LDL-C or non-HDL-C. Second, the measurement of apoB is standardized whereas the measurements of LDL-C and non-HDL-C are not. Third, with apoB and a conventional lipid panel, all the lipid phenotypes can be simply and accurately distinguished. This will improve the care of the expert. Fourth, apoB, as the single measure to evaluate the success of therapy, would simplify the process of care for primary care physicians.

Summary: By introducing apoB broadly into clinical care, the process of care will be improved for both the expert and the primary care physician, and this will improve the outcomes of care.

综述目的:一些专家和共识团体继续认为,载脂蛋白B(apoB)不应广泛引入临床护理。但是,目前的临床护理方法往往并不成功。我们认为,这种失败的一个重要原因是,传统的方法限制了专业临床医生的能力,而且过于复杂、令人困惑和矛盾,初级保健医生无法在实践中有效应用。最近的发现:有四个主要的原因,apoB应该定期测量在临床护理。首先,apoB是比LDL-C或非HDL-C更准确的心血管风险标志物。其次,apoB的测量是标准化的,而LDL-C和非HDL-C的测量则不是标准化的。第三,使用apoB和传统的脂质组,可以简单准确地区分所有的脂质表型。这将提高专家的护理水平。第四,apoB作为评估治疗成功与否的单一指标,将简化初级保健医生的护理过程。摘要:通过将apoB广泛引入临床护理,专家和初级保健医生的护理过程都将得到改善,这将改善护理结果。
{"title":"Low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol and apolipoprotein B for cardiovascular care.","authors":"Selin Bilgic, Allan D Sniderman","doi":"10.1097/HCO.0000000000001100","DOIUrl":"10.1097/HCO.0000000000001100","url":null,"abstract":"<p><strong>Purpose of review: </strong>Some experts and consensus groups continue to argue that apolipoprotein B (apoB) should not be introduced broadly into clinical care. But, too often, the present approach to clinical care is not succeeding. An important reason for this failure, we believe, is that the conventional approach limits what the expert clinician can accomplish and is too complex, confusing, and contradictory for primary care physicians to apply effectively in their practise.</p><p><strong>Recent findings: </strong>There are four major reasons that apoB should be measured routinely in clinical care. First, apoB is a more accurate marker of cardiovascular risk than LDL-C or non-HDL-C. Second, the measurement of apoB is standardized whereas the measurements of LDL-C and non-HDL-C are not. Third, with apoB and a conventional lipid panel, all the lipid phenotypes can be simply and accurately distinguished. This will improve the care of the expert. Fourth, apoB, as the single measure to evaluate the success of therapy, would simplify the process of care for primary care physicians.</p><p><strong>Summary: </strong>By introducing apoB broadly into clinical care, the process of care will be improved for both the expert and the primary care physician, and this will improve the outcomes of care.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"49-53"},"PeriodicalIF":2.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71489195","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
Perspectives on pulsed field ablation: how to judge endpoints. 脉冲场消融的视角:如何判断终点。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-01-01 Epub Date: 2023-09-11 DOI: 10.1097/HCO.0000000000001094
Valeria Anglesio, Atul Verma

Purpose of review: This review highlights pulse field ablation's (PFA) significance in treating atrial fibrillation. PFA uses short-pulsed electrical fields, offering safety advantages over thermal methods. Multicenter studies' findings on PFA's safety, efficiency, and efficacy, compared with thermal techniques, are discussed.

Recent findings: The review encompasses major PFA systems utilized in multicenter studies: penta-spline, circular, and lattice catheters. These studies affirm PFA's safety, with minimal complications like esophageal injury, phrenic nerve complications, and pulmonary vein stenosis. PFA also demonstrates procedural efficiency benefits because of rapid pulse delivery. However, PFA's efficacy appears on par with thermal ablation, showing similar rates of atrial arrhythmia recurrence during follow-up periods. The studies explore diverse postablation monitoring strategies, underscoring the necessity for standardized monitoring or consistent transformation of arrhythmia data.

Summary: In conclusion, PFA marks a promising era for atrial fibrillation treatment with improved safety and efficiency. Efficacy is comparable to thermal methods, though technology advancements could alter this. PFA's potential as a safer and faster alternative positions it as a dominant atrial fibrillation ablation technology. Careful analysis and standardized monitoring are vital to assess PFA's potential and clinical implications.

综述的目的:本综述强调了脉冲场消融术(PFA)在治疗心房颤动方面的重要意义。脉冲场消融术使用短脉冲电场,与热疗方法相比具有安全优势。与热疗技术相比,多中心研究对脉冲场消融的安全性、效率和疗效进行了讨论:最新研究结果:本综述涵盖了多中心研究中使用的主要 PFA 系统:五叉形、圆形和格子导管。这些研究肯定了 PFA 的安全性,其食道损伤、膈神经并发症和肺静脉狭窄等并发症极少。由于脉冲输送迅速,PFA 还能提高手术效率。不过,PFA 的疗效似乎与热消融相当,在随访期间显示出相似的房性心律失常复发率。这些研究探讨了不同的消融后监测策略,强调了标准化监测或心律失常数据一致性转换的必要性。其疗效与热疗方法不相上下,但技术的进步可能会改变这一状况。作为一种更安全、更快速的替代方法,PFA 的潜力使其成为心房颤动消融技术的主流。仔细分析和标准化监测对于评估 PFA 的潜力和临床意义至关重要。
{"title":"Perspectives on pulsed field ablation: how to judge endpoints.","authors":"Valeria Anglesio, Atul Verma","doi":"10.1097/HCO.0000000000001094","DOIUrl":"10.1097/HCO.0000000000001094","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review highlights pulse field ablation's (PFA) significance in treating atrial fibrillation. PFA uses short-pulsed electrical fields, offering safety advantages over thermal methods. Multicenter studies' findings on PFA's safety, efficiency, and efficacy, compared with thermal techniques, are discussed.</p><p><strong>Recent findings: </strong>The review encompasses major PFA systems utilized in multicenter studies: penta-spline, circular, and lattice catheters. These studies affirm PFA's safety, with minimal complications like esophageal injury, phrenic nerve complications, and pulmonary vein stenosis. PFA also demonstrates procedural efficiency benefits because of rapid pulse delivery. However, PFA's efficacy appears on par with thermal ablation, showing similar rates of atrial arrhythmia recurrence during follow-up periods. The studies explore diverse postablation monitoring strategies, underscoring the necessity for standardized monitoring or consistent transformation of arrhythmia data.</p><p><strong>Summary: </strong>In conclusion, PFA marks a promising era for atrial fibrillation treatment with improved safety and efficiency. Efficacy is comparable to thermal methods, though technology advancements could alter this. PFA's potential as a safer and faster alternative positions it as a dominant atrial fibrillation ablation technology. Careful analysis and standardized monitoring are vital to assess PFA's potential and clinical implications.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"27-32"},"PeriodicalIF":2.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10609986","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
Reconsideration of the definition of blanking period and significance of early recurrences after catheter ablation of atrial fibrillation. 心房颤动导管消融术后空白期定义及早期复发意义的再思考。
IF 2.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-01-01 Epub Date: 2023-09-18 DOI: 10.1097/HCO.0000000000001096
Songnan Wen, Yu Liao, Tejas S Khurana, Rong Bai

Purpose of review: Early recurrence of atrial tachyarrhythmia (ERAT) during blanking period (BP) is not uncommon after catheter ablation of AF. Current guidelines and consensus statements recommend conservative treatment of ERAT. This review summarized recent studies, underlying mechanism and clinical managements of ERAT, and proposed a reconsideration of the definition and clinical significance of BP.

Recent findings: Recent studies have shown that the entity of ERAT in the very early phase of BP (i.e., first 4 weeks of the 3-month period) is different from those ERATs occurring late which is strongly associated with the late recurrence of atrial tachyarrhythmia. The optimal BP duration suggested by clinical observation ranges from 21 to 58 days. Using antiarrhythmic drugs and early electrical cardioversion are the effective management for ERAT, whereas re-ablation is a reasonable strategy although remains controversial.

Summary: The definition of BP with a shorter duration, that is, 1 month instead of 3 months post AF ablation, is supported by the observations of latest clinical studies. Recurrent atrial tachyarrhythmia beyond the 1-month time frame is associated with higher risk of late recurrence and may warrant repeat ablation. A revisit to the guideline recommendation on management of ERAT is needed to change clinical practice.

综述目的:心房颤动导管消融术后,心房快速性心律失常(ERAT)在空白期(BP)早期复发并不罕见。目前的指南和共识声明建议对ERAT进行保守治疗。这篇综述总结了ERAT的最新研究、潜在机制和临床管理,并提出了对BP的定义和临床意义的重新思考。最近的发现:最近的研究表明,ERAT在BP的早期阶段(即前4 3个月周期的几周)不同于那些晚发的ERAT,后者与心房快速性心律失常的晚发复发密切相关。临床观察建议的最佳血压持续时间为21-58 天。使用抗心律失常药物和早期电复律是治疗ERAT的有效方法,而再次消融是一种合理的策略,尽管仍有争议。摘要:持续时间较短的BP的定义,即1 月而不是3 最新临床研究的观察结果支持了房颤消融术后数月的疗效。超过1个月的复发性房性快速性心律失常与晚期复发的风险较高相关,可能需要重复消融。需要重新审视ERAT管理指南建议,以改变临床实践。
{"title":"Reconsideration of the definition of blanking period and significance of early recurrences after catheter ablation of atrial fibrillation.","authors":"Songnan Wen, Yu Liao, Tejas S Khurana, Rong Bai","doi":"10.1097/HCO.0000000000001096","DOIUrl":"10.1097/HCO.0000000000001096","url":null,"abstract":"<p><strong>Purpose of review: </strong>Early recurrence of atrial tachyarrhythmia (ERAT) during blanking period (BP) is not uncommon after catheter ablation of AF. Current guidelines and consensus statements recommend conservative treatment of ERAT. This review summarized recent studies, underlying mechanism and clinical managements of ERAT, and proposed a reconsideration of the definition and clinical significance of BP.</p><p><strong>Recent findings: </strong>Recent studies have shown that the entity of ERAT in the very early phase of BP (i.e., first 4 weeks of the 3-month period) is different from those ERATs occurring late which is strongly associated with the late recurrence of atrial tachyarrhythmia. The optimal BP duration suggested by clinical observation ranges from 21 to 58 days. Using antiarrhythmic drugs and early electrical cardioversion are the effective management for ERAT, whereas re-ablation is a reasonable strategy although remains controversial.</p><p><strong>Summary: </strong>The definition of BP with a shorter duration, that is, 1 month instead of 3 months post AF ablation, is supported by the observations of latest clinical studies. Recurrent atrial tachyarrhythmia beyond the 1-month time frame is associated with higher risk of late recurrence and may warrant repeat ablation. A revisit to the guideline recommendation on management of ERAT is needed to change clinical practice.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"15-19"},"PeriodicalIF":2.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41141513","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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Current Opinion in Cardiology
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