EP Europace最新文献

{"title":"Longer and better lives for patients with atrial fibrillation: the 9th AFNET/EHRA consensus conference","authors":"Dominik Linz, Jason G Andrade, Elena Arbelo, Giuseppe Boriani, Guenter Breithardt, A John Camm, Valeria Caso, Jens Cosedis Nielsen, Mirko De Melis, Tom De Potter, Wolfgang Dichtl, Søren Zoega Diederichsen, Dobromir Dobrev, Nicolas Doll, David Duncker, Elke Dworatzek, Lars Eckardt, Christoph Eisert, Larissa Fabritz, Michal Farkowski, David Filgueiras-Rama, Andreas Goette, Eduard Guasch, Guido Hack, Stéphane Hatem, Karl Georg Haeusler, Jeff S Healey, Hein Heidbuechel, Ziad Hijazi, Lucas H Hofmeister, Leif Hove-Madsen, Thomas Huebner, Stefan Kääb, Dipak Kotecha, Katarzyna Malaczynska-Rajpold, José Luis Merino, Andreas Metzner, Lluís Mont, Ghulam Andre Ng, Michael Oeff, Abdul Shokor Parwani, Helmut Puererfellner, Ursula Ravens, Michiel Rienstra, Prashanthan Sanders, Daniel Scherr, Renate Schnabel, Ulrich Schotten, Christian Sohns, Gerhard Steinbeck, Daniel Steven, Tobias Toennis, Stylianos Tzeis, Isabelle C van Gelder, Roderick H van Leerdam, Kevin Vernooy, Manish Wadhwa, Reza Wakili, Stephan Willems, Henning Witt, Stef Zeemering, Paulus Kirchhof","doi":"10.1093/europace/euae070","DOIUrl":"https://doi.org/10.1093/europace/euae070","url":null,"abstract":"Aims Recent trial data demonstrate beneficial effects of active rhythm management in patients with atrial fibrillation (AF) and support the concept that a low arrhythmia burden is associated with a low risk of AF-related complications. The aim of this document is to summarize the key outcomes of the 9th AFNET/EHRA Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Methods and results Eighty-three international experts met in Münster for 2 days in September 2023. Key findings are as follows: (i) Active rhythm management should be part of the default initial treatment for all suitable patients with AF. (ii) Patients with device-detected AF have a low burden of AF and a low risk of stroke. Anticoagulation prevents some strokes and also increases major but non-lethal bleeding. (iii) More research is needed to improve stroke risk prediction in patients with AF, especially in those with a low AF burden. Biomolecules, genetics, and imaging can support this. (iv) The presence of AF should trigger systematic workup and comprehensive treatment of concomitant cardiovascular conditions. (v) Machine learning algorithms have been used to improve detection or likely development of AF. Cooperation between clinicians and data scientists is needed to leverage the potential of data science applications for patients with AF. Conclusions Patients with AF and a low arrhythmia burden have a lower risk of stroke and other cardiovascular events than those with a high arrhythmia burden. Combining active rhythm control, anticoagulation, rate control, and therapy of concomitant cardiovascular conditions can improve the lives of patients with AF.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140566279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accurate diagnosis of apical hypertrophic cardiomyopathy using explainable advanced ECG analysis","authors":"Rebecca K Hughes, George D Thornton, James W Malcolmson, Iain Pierce, Shafik Khoury, Amanda Hornell, Kristopher Knott, Gabriella Captur, James C Moon, Todd T Schlegel, Martin Ugander","doi":"10.1093/europace/euae093","DOIUrl":"https://doi.org/10.1093/europace/euae093","url":null,"abstract":"Background and aims Typical electrocardiogram (ECG) features of apical hypertrophic cardiomyopathy (ApHCM) include tall R waves and deep or giant T-wave inversion in the precordial leads, but these features are not always present. The ECG is used as the gatekeeper to cardiac imaging for diagnosis. We tested whether explainable advanced ECG (A-ECG) could accurately diagnose ApHCM. Methods A-ECG analysis was performed on standard resting 12-lead ECGs in patients with ApHCM (n = 75 overt, n = 32 relative [<15mm hypertrophy]), a subgroup of which underwent cardiovascular magnetic resonance, n = 92), and comparator subjects (n = 2449), including healthy volunteers (n = 1672), patients with coronary artery disease (n = 372), left ventricular electrical remodelling (n = 108), ischemic (n = 114) or non-ischemic cardiomyopathy (n = 57), and asymmetrical septal hypertrophy (ASH) HCM (n = 126). Results Multivariable logistic regression identified four A-ECG measures that together discriminated ApHCM from other diseases with high accuracy (area under the receiver operating characteristics curve (AUC) [bootstrapped 95% confidence interval] 0.982 [0.965–0.993]. Linear discriminant analysis also diagnosed ApHCM with high accuracy (AUC 0.989 [0.986–0.991]). Conclusion Explainable A-ECG has excellent diagnostic accuracy for ApHCM, even when the hypertrophy is relative, with A-ECG analysis providing incremental diagnostic value over imaging alone. The electrical (ECG) and anatomical (wall thickness) disease features do not completely align, suggesting future diagnostic and management strategies may incorporate both features.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"198 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140566149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of a circular-shaped pulsed field ablation catheter with magnetic sensors for pulmonary vein isolation: a multi-centre clinical study report","authors":"Yan Wang, Heng Li Lai, Qi Chen, Hao Liu, Qi Ming Liu, Wei Bin Huang, Yu Tao, Qingmei Xiong, Ning Zhou, Chunxia Zhao, Jie Qiu, Ziqin Xu, Dao Wen Wang","doi":"10.1093/europace/euae068","DOIUrl":"https://doi.org/10.1093/europace/euae068","url":null,"abstract":"Aims A few studies have reported the effect and safety of pulsed field ablation (PFA) catheters for ablating atrial fibrillation (AF), which were mainly based on basket-shaped or flower-shaped designs. However, the clinical application of a circular-shaped multi-electrode catheter with magnetic sensors is very limited. To study the efficacy and safety of a PFA system in patients with paroxysmal AF using a circular-shaped multi-electrode catheter equipped with magnetic sensors for pulmonary vein isolation (PVI). Methods and results A novel proprietary bipolar PFA system was used for PVI, which utilized a circular-shaped multi-electrode catheter with magnetic sensors and allowed for three-dimensional model reconstruction, mapping, and ablation in one map. To evaluate the efficacy, efficiency, and safety of this PFA system, a prospective, multi-centre, single-armed, pre-market clinical study was performed. From July 2021 to December 2022, 151 patients with paroxysmal AF were included and underwent PVI. The study examined procedure time, immediate success rate, procedural success rate at 12 months, and relevant complications. In all 151 patients, all the pulmonary veins were acutely isolated using the studied system. Pulsed field ablation delivery was 78.4 ± 41.8 times and 31.3 ± 16.7 ms per patient. Skin-to-skin procedure time was 74.2 ± 29.8 min, and fluoroscopy time was 13.1 ± 7.6 min. The initial 11 (7.2%) cases underwent procedures with deep sedation anaesthesia, and the following cases underwent local anaesthesia. In the initial 11 cases, 4 cases (36.4%) presented transient vagal responses, and the rest were all successfully preventatively treated with atropine injection and rapid fluid infusion. No severe complications were found during or after the procedure. During follow-up, 3 cases experienced atrial flutter, and 11 cases had AF recurrence. The estimated 12-month Kaplan–Meier of freedom from arrhythmia was 88.4%. Conclusion The PFA system, comprised of a circular PFA catheter with magnetic sensors, could rapidly achieve PVI under three-dimensional guidance and demonstrated excellent safety with comparable effects.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"198 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140566274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation","authors":"Stylianos Tzeis, Edward P Gerstenfeld, Jonathan Kalman, Eduardo B Saad, Alireza Sepehri Shamloo, Jason G Andrade, Chirag R Barbhaiya, Tina Baykaner, Serge Boveda, Hugh Calkins, Ngai-Yin Chan, Minglong Chen, Shih-Ann Chen, Nikolaos Dagres, Ralph J Damiano, Tom De Potter, Isabel Deisenhofer, Nicolas Derval, Luigi Di Biase, Mattias Duytschaever, Katia Dyrda, Gerhard Hindricks, Meleze Hocini, Young-Hoon Kim, Mark la Meir, Jose Luis Merino, Gregory F Michaud, Andrea Natale, Isabelle Nault, Santiago Nava, Takashi Nitta, Mark O’Neill, Hui-Nam Pak, Jonathan P Piccini, Helmut Pürerfellner, Tobias Reichlin, Luis Carlos Saenz, Prashanthan Sanders, Richard Schilling, Boris Schmidt, Gregory E Supple, Kevin L Thomas, Claudio Tondo, Atul Verma, Elaine Y Wan, Daniel Steven, Michael-Joseph Agbayani, T Jared Bunch, Aman Chugh, Juan Carlos Díaz, James V Freeman, Carina Abigail Hardy, Hein Heidbuchel, Sofian Johar, Dominik Linz, Bart Maesen, Peter A Noseworthy, Seil Oh, Andreu Porta-Sanchez, Tatjana Potpara, Gerardo Rodriguez-Diez, Frederic Sacher, Piotr Suwalski, Serge A Trines","doi":"10.1093/europace/euae043","DOIUrl":"https://doi.org/10.1093/europace/euae043","url":null,"abstract":"In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140566145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Three-dimensional Electroanatomic Mapping for Epicardial Access: Needle Tracking, Elctrographic Characteristics and Clinical Application","authors":"Ronghui Yu, Nian Liu, Binquan You, Haixiong Wang, Yanfei Ruan, Songnan Wen, Peter J Weiss, Michael Zawaneh, Wilber Su, Roderick Tung, Xin Zhao, Wei Wang, Ribo Tang, Rong Bai","doi":"10.1093/europace/euae089","DOIUrl":"https://doi.org/10.1093/europace/euae089","url":null,"abstract":"Background and Aims Pericardiocentesis is usually completed under fluoroscopy. The electroanatomic mapping (EAM) system allows visualizing puncture needle tip (NT) while displaying the electrogram recorded from NT, making it possible to obtain epicardial access (EA) independent of fluoroscopy. This study was designed to establish and validate a technique by which EA is obtained under guidance of 3-dimensional (3D) EAM combined with NT electrogram. Methods 3D shell of the heart was generated and the NT was made trackable in the EAM system. Unipolar NT electrogram was continuously monitored. Penetration into pericardial sac was determined by an increase in NT potential amplitude and an injury current. A long guidewire of which the tip was also visible in the EAM system was advanced to confirm EA. Results EA was successfully obtained without complication in 13 pigs and 22 patients. In the animals, NT potential amplitude was 3.2± 1.0 mV when it was located in mediastinum, 5.2±1.6 mV when in contact with fibrous pericardium and 9.8±2.8 mV after penetrating into pericardial sac (all p≤0.001). In human subjects, it measured 1.54±0.40 mV, 3.61±1.08 mV and 7.15±2.88 mV respectively (all p<0.001). Fluoroscopy time decreased in every 4-5 cases (64±15, 23±17 and 0 second for animals 1-4, 5-8, 9-13 respectively, p=0.01; 44±23, 31±18; 4±7 seconds for patients 1-7, 8-14, 15-22 respectively, p<0.001). In 5 pigs and 7 patients, EA was obtained without X-ray exposure. Conclusions By tracking NT in the 3D EAM system and continuously monitoring the NT electrogram, it is feasible and safe to obtain EA with minimum or no fluoroscopic guidance.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"86 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140566278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of atrial fibrillation phenotype and left atrial volume on outcome after pulmonary vein isolation","authors":"Laurève Chollet, Salik ur Rehman Iqbal, Severin Wittmer, Gregor Thalmann, Antonio Madaffari, Nikola Kozhuharov, Oskar Galuszka, Thomas Küffer, Christoph Gräni, Nicolas Brugger, Helge Servatius, Fabian Noti, Andreas Haeberlin, Laurent Roten, Hildegard Tanner, Tobias Reichlin","doi":"10.1093/europace/euae071","DOIUrl":"https://doi.org/10.1093/europace/euae071","url":null,"abstract":"Aims Pulmonary vein isolation (PVI) is increasingly performed in patients with atrial fibrillation (AF). Both AF phenotype and left atrial (LA) volume have been shown to influence ablation outcome. The inter-relationship of the two is incompletely understood. We aimed to investigate the impact of AF phenotype vs. LA volume on outcome after PVI. Methods and results In a retrospective analysis of a prospective registry of patients undergoing a first PVI, the association of AF phenotype and LA volume index (LAVI) was assessed as well as their impact on AF recurrence during follow-up. Overall, 476 patients were enrolled (median age 63 years, 29% females, 65.8% paroxysmal AF). Obesity, hypertension, chronic kidney disease, and heart failure were all significantly more frequent in persistent AF. After 1 year, single-procedure, freedom from arrhythmia recurrence was 61.5%. Patients with paroxysmal AF had better outcomes compared with patients with persistent AF (65.6 vs. 52.7%, P = 0.003), as had patients with no/mild vs. moderate/severe LA dilation (LAVI <42 mL/m2 67.1% vs. LAVI ≥42 mL/m2 53%, P < 0.001). The combination of both parameters refined prediction of 1-year recurrence (P < 0.001). After adjustment for additional clinical risk factors in multivariable Cox proportional hazard analysis, both AF phenotype and LAVI ≥42 mL/m2 contributed significantly towards the prediction of 1-year recurrence. Conclusion Atrial fibrillation phenotype and LA volume are independent predictors of outcome after PVI. Persistent AF with no/mild LA dilation has a similar risk of recurrence as paroxysmal AF with a moderate/severe LA dilation and should be given similar priority for ablation.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140566280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First-in-Human Clinical Series of a Novel Conformable Large-Lattice Pulsed Field Ablation Catheter for Pulmonary Vein Isolation","authors":"Vivek Y Reddy, Elad Anter, Petr Peichl, Gediminas Rackauskas, Jan Petru, Moritoshi Funasako, Jacob S Koruth, Germanas Marinskis, Mohit Turagam, Audrius Aidietis, Josef Kautzner, Andrea Natale, Petr Neuzil","doi":"10.1093/europace/euae090","DOIUrl":"https://doi.org/10.1093/europace/euae090","url":null,"abstract":"Background/Aims Pulsed field ablation (PFA) has significant advantages over conventional thermal ablation of atrial fibrillation (AF). This first-in-human, single-arm trial to treat paroxysmal AF (PAF) assessed the efficiency, safety, pulmonary vein isolation (PVI) durability and one-year clinical effectiveness of an 8-Fr, large-lattice, conformable single-shot PFA catheter together with a dedicated electroanatomical mapping system. Methods After rendering the PV anatomy, the PFA catheter delivered monopolar, biphasic pulse trains (5-6 secs per application; ∼4 applications per PV). Three waveforms were tested: PULSE1, PULSE2 and PULSE3. Follow-up included ECGs, Holters at 6 and 12 months, and symptomatic and scheduled transtelephonic monitoring. The primary and secondary efficacy endpoints were acute PVI and post-blanking atrial arrhythmia recurrence, respectively. Invasive remapping was conducted ∼75 days post-ablation. Results At three centers, PVI was performed by five operators in 85 patients using PULSE1 (n=30), PULSE2 (n=20), and PULSE3 (n=35). Acute PVI was achieved in 100% of PVs using 3.9±1.4 PFA applications per PV. Overall procedure, transpired ablation, PFA catheter dwell and fluoroscopy times were 56.5±21.6, 10.0 ± 6.0, 19.1±9.3 and 5.7±3.9 min, respectively. No pre-defined primary safety events occurred. Upon remapping, PVI durability was 90% and 99% on a per vein basis for the total and PULSE3 cohort, respectively. The Kaplan-Meier estimate of one-year freedom from atrial arrhythmias was 81.8% (95% CI 70.2-89.2%) for the total, and 100% (95% CI 80.6-100%) for the PULSE3 cohort. Conclusion PVI utilizing a conformable single-shot PFA catheter to treat PAF was efficient, safe, and effective, with durable lesions demonstrated upon remapping.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140566268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Same-day discharge after atrial fibrillation ablation under a nurse-coordinated standardized protocol","authors":"Teresa Espinosa, Anna Farrus, Montserrat Venturas, Alba Cano, Sara Vazquez-Calvo, Margarida Pujol-Lopez, Frida Eulogio-Valenzuela, Jean-Baptiste Guichard, Pasquale V Falzone, Freddy R Graterol, Xavier Freixa, Jose M Tolosana, Eduard Guasch, Andreu Porta-Sanchez, Elena Arbelo, Josep Brugada, Marta Sitges, Lluis Mont, lvo Roca-Luque, Till F Althoff","doi":"10.1093/europace/euae083","DOIUrl":"https://doi.org/10.1093/europace/euae083","url":null,"abstract":"Background and aims Same-day discharge (SDD) after atrial fibrillation (AF) ablation is an effective means to spare healthcare resources. However, safety remains a concern, and besides structural adaptations, SDD requires more efficient logistics and coordination. Therefore, we implemented a streamlined, nurse-coordinated SDD program following a standardized protocol. Methods As dedicated SDD coordinator a nurse specialized in ambulatory cardiac interventions was in charge of the full SDD protocol, including eligibility, patient-flow, in-hospital logistics, patient education and discharge as well as early post-discharge follow-up by smartphone-based virtual visits. Patients planned for AF ablation were eligible if LVEF ≥35%, basic support at home and accessibility of the hospital within 60min were warranted. Results 420 consecutive patients were screened by the SDD coordinator of whom 331 were eligible for SDD. Reasons for exclusion were living remotely (29, 6.9%), lack of support at home (19, 4.5%) or LVEF <35% (17, 4.0%). Of the eligible patients 300 (91%) were successfully discharged the same day. There was no major post-SDD complication. Rates of unplanned medical attention (19, 6.3%) and 30d-readmission (5, 1.6%) were extremely low and driven by femoral access site complications. Those were significantly reduced upon introduction of compulsory ultrasound-guided puncture after the initial 150 SDD patients (p=0.0145). Standardized SDD-coordination resulted in efficient workflows and reduced the total workload of the medical staff. Conclusions SDD after AF ablation following a nurse-coordinated standardized protocol is safe and efficient. The concept of ambulatory cardiac intervention nurses functioning as dedicated coordinators may be key in the forthcoming transition of hospitals to SDD. Ultrasound-guided femoral puncture virtually eliminated relevant femoral access site complications and should be a prerequisite for SDD.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140566322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Area-weighted unipolar voltage to predict heart failure outcomes in patients with ischaemic cardiomyopathy and ventricular tachycardia","authors":"Robert Rademaker, Yoshi Kimura, Marta de Riva Silva, Hans C Beukers, Sebastiaan R D Piers, Adrianus P Wijnmaalen, Olaf M Dekkers, Katja Zeppenfeld","doi":"10.1093/europace/euad346","DOIUrl":"https://doi.org/10.1093/europace/euad346","url":null,"abstract":"Aims Patients with ischaemic cardiomyopathy (ICM) referred for catheter ablation of ventricular tachycardia (VT) are at risk for end-stage heart failure (HF) due to adverse remodelling. Local unipolar voltages (UV) decrease with loss of viable myocardium. A UV parameter reflecting global viable myocardium may predict prognosis. We evaluate if a newly proposed parameter, area-weighted unipolar voltage (awUV), can predict HF-related outcomes [HFO; HF death/left ventricular (LV) assist device/heart transplant] in ICM. Methods and results From endocardial voltage maps of consecutive patients with ICM referred for VT ablation, awUV was calculated by weighted interpolation of local UV. Associations between clinical and mapping parameters and HFO were evaluated and validated in a second cohort. The derivation cohort consisted of 90 patients [age 68 ±8 years; LV ejection fraction (LVEF) 35% interquartile range (IQR) (24–40)] and validation cohort of 60 patients [age 67 ± 9, LVEF 39% IQR (29–45)]. In the derivation cohort, during a median follow-up of 45 months [IQR (34–83)], 36 (43%) patients died and 23 (26%) had HFO. Patients with HFO had lower awUV [4.51 IQR (3.69–5.31) vs. 7.03 IQR (6.08–9.2), P < 0.001]. A reduction in awUV [optimal awUV (5.58) cut-off determined by receiver operating characteristics analysis] was a strong predictor of HFO (3-year HFO survival 97% vs. 57%). The cut-off value was confirmed in the validation cohort (2-year HFO-free survival 96% vs. 60%). Conclusion The newly proposed parameter awUV, easily available from routine voltage mapping, may be useful at identifying ICM patients at high risk for HFO.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139679890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘Single-shot’ pulmonary vein isolation using a novel lotos pulsed field ablation catheter: a preclinical evaluation of the feasibility, safety and 30-day efficacy","authors":"Sijia Pu, Fangzhou Liu, Yuhan Chen, Cihua Luo, Peng Li, Yanlin Chen, Lu Fu, Huiyi Liu, Xingdong Ye, Shulin Wu, Yumei Xue, Weidong Lin","doi":"10.1093/europace/euad362","DOIUrl":"https://doi.org/10.1093/europace/euad362","url":null,"abstract":"Aims Pulsed field ablation (PFA) is emerging as a nonthermal, tissue-specific technique for pulmonary vein isolation (PVI) in atrial fibrillation therapy. This preclinical study aimed to investigate the feasibility and safety of PVI using a novel PFA system including a nanosecond-scale PFA generator, a novel lotos PFA catheter, and a customized 12-French steerable sheath. Methods and Results A total of 11 Yorkshire swine were included in this study, with 4 in the acute cohort and 7 in the chronic cohort. Under general anesthesia, transseptal puncture and pulmonary vein (PV) angiography was initially performed. The PFA catheter was navigated to position at the right and left PV antrum after the electroanatomic reconstruction of left atrium. Biphasic PFA applications were performed on PVs in both the spindle-shaped and lotos-shaped poses. PVI and PFA-associated safety was assessed 30 minutes after ablation in both cohorts and 30 days later in the chronic cohort. Detailed necropsy and histopathology were performed. Additional intracardiac echocardiography and coronary angiogram were evaluated for safety. All target pulmonary veins (n = 20) were successfully isolated on the first attempt. No spasm of coronary artery or microbubble was seen during the procedure. Eleven of 12 PVs (91.6%) remained isolation at 30-day invasive study. No evidence of PV stenosis was observed in any targets. However, transient diaphragm capture occurred in 17.6%. Histopathological examinations showed no evidence of collateral injury. Conclusion This study provides scientific evidence demonstrating the safety and efficacy of the novel PFA catheter and system for single-shot PVI, which shows great potential.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138741681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}