Anatolian Journal of Cardiology最新文献

Background: Atrial tachycardia (AT) is a commonly encountered rhythm disorder and most patients require catheter ablation. In this study, the aim was to evaluate the outcomes of catheter ablation in patients with symptomatic AT, define acute and long-term outcomes, and determine the clinical and electrophysiological features that affect these outcomes.

Methods: A total of 666 (mean age: 55 ± 16, gender: 344 (51.7%) female) symptomatic patients with AT were enrolled. Activation mapping was performed using 3-dimensional electroanatomical mapping as well as entrainment mapping when needed. Atrial tachyarrhythmia (ATa) recurrence was defined as the presence of atrial fibrillation or AT (≥ 30 seconds) detected by electrocardiogram, Holter, or implantable device interrogation.

Results: Macroreentry was the primary mechanism in right and left atrium (70.2% and 52.8%, respectively). Cavotricuspid isthmus dependent macroreentry was the most frequent mechanism in right ATs, whereas perimitral reentry and roof-dependent macroreentry were the most common mechanisms in left ATs. Acute procedural success was 96.3% after catheter ablation. Freedom from ATa was 72.8% after index procedure and 84.5% after multiple procedures during a mean follow-up of 39 ± 23 months. In multivariable Cox regression analysis, history of atrial fibrillation [HR: 2.43, 95% confidence interval (CI): 1.78-3.30; P < .001], previous cardiac surgery (HR: 1.68, 95% CI: 1.22-2.30; P = .001) and moderate to severe tricuspid regurgitation (HR: 1.47, 95% CI: 1.08-2.01; P = .014) were significant predictors of ATa recurrence.

Conclusion: The findings demonstrated that catheter ablation of tachycardia has a high acute success rate and favorable long-term outcomes in patients with symptomatic AT.

Background: Transcatheter closure approaches of ventricular septal defects (VSDs) include anterograde through the right ventricle using an arteriovenous loop and retrograde transarterial approach. This systematic review assesses the outcomes and complications associated with transcatheter closure of VSD through a retrograde approach.

Methods: PubMed was searched for articles in English on retrograde closure of VSD from 2006 to 2024. The pooled estimates of success and complication rates were done by the random effects model.

Results: A total of 11 publications comprising 482 patients with variable types of VSD were included in this analysis. The pooled estimate of success was 89.3% (95% CI: 0.84-0.93). The most common complication is residual shunt pooled estimated is 7.1% (95% CI: 0.02-0.20). Others included valvular lesions pooled estimate is 6.4% (95% CI: 0.02-0.14), arrhythmias pooled estimate is 5.5% (95% CI: 0.02-0.12), conduction abnormalities pooled estimate rate is 5.3% (95% CI: 0.01-0.13), and death pooled estimated rate is 2.8% (95% CI: 0.08-0.07).

Conclusion: This analysis suggests that transcatheter retrograde closure of VSD is safe and effective with promising results. The limitations of this study are difficulties in analyzing the types of devices and VSDs individually. Clear inclusion and exclusion criteria including the patient's age, weight, VSD type, and other features must be considered before proceeding with this approach.

Background: Myval is a balloon-expandable valve (BEV) used in transcatheter aortic valve implantation (TAVI) with distinguished features. Data comparing Myval with contemporary transcatheter heart valves (THVs) is limited. The authors performed a meta-analysis of studies comparing Myval with contemporary THVs (Sapien series and Evolut series).

Methods: The authors searched PubMed, EMBASE, and Cochrane databases. The primary composite endpoint of early safety (freedom from death and major complications) and other outcomes were extracted as defined by the Valve Academic Research Consortium 3 (VARC 3). The authors computed risk ratios (RRs) with 95% CIs using a Mantel-Haenszel method with a random-effects model with Review Manager (Cochrane Collaboration).

Results: Six studies with 2084 patients were included. Myval had better early safety at 30 days as per VARC 3 (RR 1.12; 95% CI: 1.02-1.22; P = .01) and lower need for permanent pacemaker implantation (PPI) (RR 0.62; 95% CI: 0.45-0.86; P = .004). Other outcomes were comparable in both groups. Vis-à-vis Evolut, Myval had better 30-day device success and lower rates of moderate or severe paravalvular leak (PVL) in addition to better early safety and lower need for PPI. Subgroup analyses of Myval with Sapien showed non-inferiority of Myval.

Conclusion: Myval showed better safety and lower need for PPI and may become a promising alternative for concurrent THVs.