Pub Date : 2022-05-18DOI: 10.1093/europace/euac053.046
B. Steinhauer, J. Spicher, S. Aerschmann, N. Ambord, J. Bartkowiak, H. Servatius, F. Noti, J. Seiler, S. Baldinger, A. Haeberlin, Antonio Madaffari, H. Tanner, T. Reichlin, L. Roten, S. Duetschler
Type of funding sources: None. Implantation of an implantable cardiac monitor (ICM) is a simple and straightforward procedure. However, with a growing demand for such implants, workload significantly increases. In January 2020, we established a completely nurse-led ICM implantation service (N-IMPLANT) with a standard operating procedure. The present study aimed to analyze the safety, efficacy, and patient satisfaction of N-IMPLANT compared to implantation of ICMs by a physician (P-IMPLANT). Consenting patients implanted with an ICM were included in a prospective registry, which collects patient characteristics, procedural and remote monitoring data. All patients were followed-up by phone interview four weeks after ICM implantation and a standardized questionnaire was completed. Of 321 patients implanted with an ICM (median age 67 years; 33% women), 189 (59%) were N-IMPLANT. Significantly more N-IMPLANT were performed in the outpatient clinic compared to P-IMPLANT (94% vs. 10%; p<0.001). For wound closure, N-IMPLANT used wound glue in 65 (34%) and a single subcutaneous stitch in 124 patients (66%). Two N-IMPLANT patients experienced vaso-vagal reaction during implantation, whereas no adverse events occurred during P-IMPLANT (p=0.51). Two-hundred and fifty-two patients (79%) completed the questionnaire. We found no difference between N-IMPLANT and P-IMPLANT regarding pain after implant, analgesic use, wound closure after 2 weeks and presence and size of patient reported hematoma (see Table). Duration of pain was longer after P-IMPLANT. All N-IMPLANT patients indicated to be satisfied with the implant procedure. Three patients were dissatisfied with P-IMPLANT for the following reasons: ongoing pain at implant site; discomfort at implant site; and too numerous people present during the implant procedure. In three N-IMPLANT (2%) the ICM was explanted prematurely. The reasons for explantation were infection (with reimplantation of another ICM), discomfort at implant site and attempt to avoid interferences during magnetic resonance tomography in one patient each. One P-IMPLANT (1%) was explanted prematurely because of ICM malfunction. Nurse-led implantation of cardiac monitors is effective without compromising patient safety and has excellent patient satisfaction. N-IMPLANT is a suitable model to reduce the workload of physicians.
{"title":"Nurse-led compared to physician-led implant of cardiac monitors","authors":"B. Steinhauer, J. Spicher, S. Aerschmann, N. Ambord, J. Bartkowiak, H. Servatius, F. Noti, J. Seiler, S. Baldinger, A. Haeberlin, Antonio Madaffari, H. Tanner, T. Reichlin, L. Roten, S. Duetschler","doi":"10.1093/europace/euac053.046","DOIUrl":"https://doi.org/10.1093/europace/euac053.046","url":null,"abstract":"Type of funding sources: None. Implantation of an implantable cardiac monitor (ICM) is a simple and straightforward procedure. However, with a growing demand for such implants, workload significantly increases. In January 2020, we established a completely nurse-led ICM implantation service (N-IMPLANT) with a standard operating procedure. The present study aimed to analyze the safety, efficacy, and patient satisfaction of N-IMPLANT compared to implantation of ICMs by a physician (P-IMPLANT). Consenting patients implanted with an ICM were included in a prospective registry, which collects patient characteristics, procedural and remote monitoring data. All patients were followed-up by phone interview four weeks after ICM implantation and a standardized questionnaire was completed. Of 321 patients implanted with an ICM (median age 67 years; 33% women), 189 (59%) were N-IMPLANT. Significantly more N-IMPLANT were performed in the outpatient clinic compared to P-IMPLANT (94% vs. 10%; p<0.001). For wound closure, N-IMPLANT used wound glue in 65 (34%) and a single subcutaneous stitch in 124 patients (66%). Two N-IMPLANT patients experienced vaso-vagal reaction during implantation, whereas no adverse events occurred during P-IMPLANT (p=0.51). Two-hundred and fifty-two patients (79%) completed the questionnaire. We found no difference between N-IMPLANT and P-IMPLANT regarding pain after implant, analgesic use, wound closure after 2 weeks and presence and size of patient reported hematoma (see Table). Duration of pain was longer after P-IMPLANT. All N-IMPLANT patients indicated to be satisfied with the implant procedure. Three patients were dissatisfied with P-IMPLANT for the following reasons: ongoing pain at implant site; discomfort at implant site; and too numerous people present during the implant procedure. In three N-IMPLANT (2%) the ICM was explanted prematurely. The reasons for explantation were infection (with reimplantation of another ICM), discomfort at implant site and attempt to avoid interferences during magnetic resonance tomography in one patient each. One P-IMPLANT (1%) was explanted prematurely because of ICM malfunction. Nurse-led implantation of cardiac monitors is effective without compromising patient safety and has excellent patient satisfaction. N-IMPLANT is a suitable model to reduce the workload of physicians.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81854363","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}
Pub Date : 2022-05-18DOI: 10.1093/europace/euac053.578
J. Fernstad, E. Svennberg, P. Aberg, K. Kemp-Gudmundsdottir, A. Jansson, M. Rosenqvist, J. Engdahl
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Vinnova - The Swedish Agency for Innovation Systems. Region Stockholm Innovation Fund. Devices for long-term and ambulatory recording of heart rhythm have limited availability within health care systems worldwide, potentially leading to missed diagnoses and limitations in peri-procedural heart rhythm management. As smartphones are becoming ubiquitous the availability of heart rhythm diagnostics and management of atrial fibrillation (AF) using smartphone photoplethysmography (PPG) compared to electrocardiography (ECG) is increasing. Previous validation studies of smartphone-PPG applications have all been performed under supervision in healthcare settings. In addition, no previous study has validated smartphone-PPG compared to simultaneous ECG recordings, with manual heart rhythm interpretation of the PPG recordings nor have they included patients with atrial flutter (AFL). The aim of this study was to validate a novel smartphone-PPG method for heart rhythm diagnostics in patients with AF and/or AFL when in use unsupervised in an ambulatory setting. Unselected patients undergoing direct current cardioversion at a University Hospital for treatment of AF or AFL were asked to perform one-minute heart rhythm recordings post-treatment at least twice daily for 30 days in their home environment. All included were provided with an unmodified iPhone 7 smartphone running the CORAI Heart Monitor PPG application simultaneously with a single-lead ECG recording (KardiaMobile). PPG and ECG recordings were interpreted independently by two readers. In total 280 patients, with median age of 69.0 years (31% women) were included from November 2018 to July 2020 and registered 18 005 simultaneous PPG and ECG recordings. Of the PPG recordings 96.9% had sufficient quality for diagnosis compared to 95.1% of the ECG recordings (p < 0.001). Precardioversion ECG recordings were interpreted as AF in 82.1%, AFL in 14.3% and as having insufficient quality for diagnosis in 3.6% of the patients. After removal of recordings with insufficient quality 69.7% of ECG recordings were interpreted as sinus rhythm, 28.2% as AF and 2.1 % as AFL. Manual interpretation of the PPG recordings diagnosed AF/AFL (sensitivity) in 97.7% and sinus rhythm (specificity) in 99.4% of the recordings compared to manually interpreted ECG recordings, with an overall accuracy of 98.9%. Results excluding recordings interpreted as AFL on ECG or PPG diagnosed AF (sensitivity) in 99.0% and sinus rhythm (specificity) in 99.7% of the recordings, with an overall accuracy of 99.5%. A novel smartphone-PPG method can be used by patients unsupervised in their home environment for accurate heart rhythm diagnostics of AF and AFL with high sensitivity and specificity.
{"title":"Validation of a novel smartphone-based photoplethysmographic method for ambulatory heart rhythm diagnostics","authors":"J. Fernstad, E. Svennberg, P. Aberg, K. Kemp-Gudmundsdottir, A. Jansson, M. Rosenqvist, J. Engdahl","doi":"10.1093/europace/euac053.578","DOIUrl":"https://doi.org/10.1093/europace/euac053.578","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Vinnova - The Swedish Agency for Innovation Systems.\u0000 Region Stockholm Innovation Fund.\u0000 \u0000 \u0000 \u0000 Devices for long-term and ambulatory recording of heart rhythm have limited availability within health care systems worldwide, potentially leading to missed diagnoses and limitations in peri-procedural heart rhythm management. As smartphones are becoming ubiquitous the availability of heart rhythm diagnostics and management of atrial fibrillation (AF) using smartphone photoplethysmography (PPG) compared to electrocardiography (ECG) is increasing. Previous validation studies of smartphone-PPG applications have all been performed under supervision in healthcare settings. In addition, no previous study has validated smartphone-PPG compared to simultaneous ECG recordings, with manual heart rhythm interpretation of the PPG recordings nor have they included patients with atrial flutter (AFL).\u0000 \u0000 \u0000 \u0000 The aim of this study was to validate a novel smartphone-PPG method for heart rhythm diagnostics in patients with AF and/or AFL when in use unsupervised in an ambulatory setting.\u0000 \u0000 \u0000 \u0000 Unselected patients undergoing direct current cardioversion at a University Hospital for treatment of AF or AFL were asked to perform one-minute heart rhythm recordings post-treatment at least twice daily for 30 days in their home environment. All included were provided with an unmodified iPhone 7 smartphone running the CORAI Heart Monitor PPG application simultaneously with a single-lead ECG recording (KardiaMobile). PPG and ECG recordings were interpreted independently by two readers.\u0000 \u0000 \u0000 \u0000 In total 280 patients, with median age of 69.0 years (31% women) were included from November 2018 to July 2020 and registered 18 005 simultaneous PPG and ECG recordings. Of the PPG recordings 96.9% had sufficient quality for diagnosis compared to 95.1% of the ECG recordings (p < 0.001). Precardioversion ECG recordings were interpreted as AF in 82.1%, AFL in 14.3% and as having insufficient quality for diagnosis in 3.6% of the patients. After removal of recordings with insufficient quality 69.7% of ECG recordings were interpreted as sinus rhythm, 28.2% as AF and 2.1 % as AFL. Manual interpretation of the PPG recordings diagnosed AF/AFL (sensitivity) in 97.7% and sinus rhythm (specificity) in 99.4% of the recordings compared to manually interpreted ECG recordings, with an overall accuracy of 98.9%. Results excluding recordings interpreted as AFL on ECG or PPG diagnosed AF (sensitivity) in 99.0% and sinus rhythm (specificity) in 99.7% of the recordings, with an overall accuracy of 99.5%.\u0000 \u0000 \u0000 \u0000 A novel smartphone-PPG method can be used by patients unsupervised in their home environment for accurate heart rhythm diagnostics of AF and AFL with high sensitivity and specificity.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84577291","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}
Pub Date : 2022-05-18DOI: 10.1093/europace/euac053.366
J. Mueller, K. Nentwich, A. Berkovitz, P. Halbfass, E. Ene, K. Sonne, G. Simu, I. Chakarov, T. Deneke
Type of funding sources: None. Data about VT ablation in patients with electrical storm (ES) is limited. This study sought to compare the prognostic outcome of patients undergoing VT ablation after electrical storm with and without a septal substrate on mortality, VT recurrence rates, rehospitalization rates and major adverse cardiac events (MACE). In this large single-centre study patients presenting with ES and undergoing VT ablation were included from June 2018 to April 2021. Patients with septal substrate were compared to patients without septal substrate. The primary prognostic outcome was cardiovascular mortality, secondary endpoints were VT recurrence rates, rehospitalization rates and MACE all after a median follow-up of 22 months. A total of 108 patients underwent a first VT ablation due to electrical storm and were included (65 ± 13 years; 86% male; 45% ischemic cardiomyopathy). Cardiovascular risk factors were equally distributed among both groups (all p>0.05). Major complications occurred in 11% of all patients with increased postinterventional third degree AV blocks among patients with septal substrate (9% vs 0%; p=0.062). Noninducibility of the clinical VT was achieved in 98% of all patients without a septal substrate and in 91% of all patients with a septal substrate (p=0.136). Noninducibility of any VT was achieved in 88% without a septal substrate and in 66% with a septal substrate (p=0.011). However, in non-invasive programmed stimulation before hospital discharge VT inducibility did not differ among both groups (p>0.05). After 1 year and a median of 22 months follow-up, patients with septal substrate died significantly more often due to cardiovascular causes (25% vs. 7%; log-rank p=0.021). In univariate analysis cardiovascular mortality for ES patients with septal substrate was 3.9 fold higher (HR 3.979; CI 95% 1.124 – 14.092; p=0.032). Independent predictors of adverse outcome in multivariable regression analysis were presence of septal substrate (HR 4.836; p=0.026) and increased numbers of VTs inducible during VT ablation (HR 1.635; p=0.007). VT recurrence during follow-up was 59% and equally distributed among both groups (log rank p=0.911). Rehospitalization rates (log rank p=0.532) and rates of MACE (log rank p=0.463) were equal. Presence of a septal substrate is associated with adverse long-term cardiovascular mortality in patients admitted for VT ablation after electrical storm. Despite decreased ablation success in these patients VT recurrence rates were not increased during follow-up.
资金来源类型:无。关于电风暴(ES)患者室速消融的数据有限。本研究旨在比较有和没有间隔底物的电风暴后行室速消融患者的预后结果，包括死亡率、室速复发率、再住院率和主要心脏不良事件(MACE)。在这项大型单中心研究中，2018年6月至2021年4月期间纳入了出现ES并接受VT消融的患者。将有间隔底物的患者与没有间隔底物的患者进行比较。主要预后指标为心血管死亡率，次要终点为房颤复发率、再住院率和MACE，均为中位随访22个月后。108例患者因电风暴首次行房室消融术，时间为(65±13年;男性86%;45%缺血性心肌病)。两组心血管危险因素分布均匀(p>0.05)。在有间隔底物的患者中，所有介入后三度房室传导阻滞增加的患者中有11%发生了主要并发症(9% vs 0%;p = 0.062)。98%没有间隔底物的患者和91%有间隔底物的患者实现了临床室速无诱导性(p=0.136)。没有间隔底物的患者达到88%，而有间隔底物的患者达到66% (p=0.011)。然而，在出院前无创程序性刺激下，两组间的VT诱导性无差异(p>0.05)。经过1年和中位22个月的随访，有间隔底物的患者死于心血管原因的几率明显更高(25% vs. 7%;log-rank p = 0.021)。单因素分析中，有间隔底物的ES患者心血管死亡率高出3.9倍(HR 3.979;Ci 95% 1.124 - 14.092;p = 0.032)。在多变量回归分析中，不良结果的独立预测因子是存在间隔底物(HR 4.836;p=0.026)，室速消融诱导的室速数增加(HR 1.635;p = 0.007)。随访期间室速复发率为59%，两组间分布均匀(log rank p=0.911)。再住院率(log rank p=0.532)和MACE率(log rank p=0.463)相等。室间隔底物的存在与电风暴后室间隔消融患者不良的长期心血管死亡率相关。尽管这些患者的消融成功率降低，但随访期间室速复发率并未增加。
{"title":"Prognosis of patients with and without septal substrate after VT ablation due to electrical storm","authors":"J. Mueller, K. Nentwich, A. Berkovitz, P. Halbfass, E. Ene, K. Sonne, G. Simu, I. Chakarov, T. Deneke","doi":"10.1093/europace/euac053.366","DOIUrl":"https://doi.org/10.1093/europace/euac053.366","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Data about VT ablation in patients with electrical storm (ES) is limited. This study sought to compare the prognostic outcome of patients undergoing VT ablation after electrical storm with and without a septal substrate on mortality, VT recurrence rates, rehospitalization rates and major adverse cardiac events (MACE).\u0000 \u0000 \u0000 \u0000 In this large single-centre study patients presenting with ES and undergoing VT ablation were included from June 2018 to April 2021. Patients with septal substrate were compared to patients without septal substrate. The primary prognostic outcome was cardiovascular mortality, secondary endpoints were VT recurrence rates, rehospitalization rates and MACE all after a median follow-up of 22 months.\u0000 \u0000 \u0000 \u0000 A total of 108 patients underwent a first VT ablation due to electrical storm and were included (65 ± 13 years; 86% male; 45% ischemic cardiomyopathy). Cardiovascular risk factors were equally distributed among both groups (all p>0.05). Major complications occurred in 11% of all patients with increased postinterventional third degree AV blocks among patients with septal substrate (9% vs 0%; p=0.062). Noninducibility of the clinical VT was achieved in 98% of all patients without a septal substrate and in 91% of all patients with a septal substrate (p=0.136). Noninducibility of any VT was achieved in 88% without a septal substrate and in 66% with a septal substrate (p=0.011). However, in non-invasive programmed stimulation before hospital discharge VT inducibility did not differ among both groups (p>0.05). After 1 year and a median of 22 months follow-up, patients with septal substrate died significantly more often due to cardiovascular causes (25% vs. 7%; log-rank p=0.021). In univariate analysis cardiovascular mortality for ES patients with septal substrate was 3.9 fold higher (HR 3.979; CI 95% 1.124 – 14.092; p=0.032). Independent predictors of adverse outcome in multivariable regression analysis were presence of septal substrate (HR 4.836; p=0.026) and increased numbers of VTs inducible during VT ablation (HR 1.635; p=0.007). VT recurrence during follow-up was 59% and equally distributed among both groups (log rank p=0.911). Rehospitalization rates (log rank p=0.532) and rates of MACE (log rank p=0.463) were equal.\u0000 \u0000 \u0000 \u0000 Presence of a septal substrate is associated with adverse long-term cardiovascular mortality in patients admitted for VT ablation after electrical storm. Despite decreased ablation success in these patients VT recurrence rates were not increased during follow-up.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84875529","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}
Pub Date : 2022-05-18DOI: 10.1093/europace/euac053.397
CG Pestrea, AI Gherghina, FO Ortan
Type of funding sources: None. Permanent His bundle pacing is currently considered the most physiological form of cardiac pacing. The main benefit of the procedure, compared to right ventricular pacing, is encountered in atrioventricular block, where a high burden of ventricular pacing is expected. One of the limits of His bundle pacing is a distal conduction abnormality in the His-Purkinje system. Nevertheless, there is published data that shows the possibility of conduction system capture even in these patients. This retrospective study evaluated the feasibility of permanent His bundle pacing in patients with second or third degree AV block, taking into account the level of block : suprahisian vs. infrahisian. 45 patients with second or third degree AV block with an attempt at permanent His bundle pacing and an available intraprocedural hisian electrogram for review were included. The procedure went as follows: a lead delivery system including a preformed 3D shaped sheath and a lumenless lead with a fixed exposed helix was placed at the septal atrioventricular junction. Careful mapping was performed until a His bundle signal was recorded. At that site, the pacing response was evaluated at variable pacing outputs. The procedural criteria for success was conduction system capture (selective or non-selective) with an amplitude of less than 2,5V/1ms. If the criteria was met, the lead was fixed, an atrial lead was placed and both connected to a dual-chamber pacemaker. The periprocedural characteristics and those at the three-months follow-up were noted. 28 patients (62,2%) were diagnosed with suprahisian block, with a procedural success rate of 89 % and 17 (37,8%) with infrahisian block, with a procedural success rate of 59%. QRS duration was 96,4±21,6 ms in those with suprahisian block vs. 119,4±23,8 ms in those with infrahisian block (p=0,0027). There was no significant statistical difference regarding acute His bundle pacing thresholds (1,13±0,63 V/1ms vs. 1,25±0,76 V/1ms, p= 0,66), ventricular sensing (3,46±1,5 mV vs. 3,21±1,6 mV, p= 0,68) and fluoroscopy time (12,75±8,3 min vs. 10,78±9,5 min, p= 0,57) between suprahisian and infrahisian block. Also, the paced QRS duration was similar between the two groups (86,9±13,4 ms vs. 82±14,7 ms, p= 0,38) and narrower than the baseline complex. The three-months follow-up showed stable pacing and sensing parameters, without other procedural or lead related complications. In atrioventricular block, permanent His bundle pacing achieves atrioventricular resynchronization, while maintaining rapid and synchronous biventricular depolarization. As expected, in suprahisian blocks the success rate is superior to infrahisian blocks. Nevertheless, in a significant proportion of the latter cases, His bundle pacing can recrute the intrinsic conduction system.
资金来源类型:无。他束起搏目前被认为是最生理的心脏起搏形式。与右心室起搏相比，该手术的主要好处是在房室传导阻滞中遇到，在房室传导阻滞中，心室起搏的负担很高。希氏束起搏的限制之一是希氏-浦肯野系统的远端传导异常。然而，已发表的数据显示，即使在这些患者中，传导系统捕获也是可能的。本回顾性研究评估永久性His束起搏对二度或三度房室传导阻滞患者的可行性，并考虑阻滞程度:肌上阻滞vs.肌下阻滞。我们纳入了45例二度或三度房室传导阻滞的患者，这些患者尝试进行永久性he束起搏，并获得术中脑电图以供复查。手术过程如下:在室间隔房室连接处放置一个铅输送系统，包括一个预制的3D形状护套和一个固定暴露螺旋的无管铅。进行了仔细的测绘，直到他的束信号被记录下来。在该部位，以不同的起搏输出评估起搏反应。成功的程序标准是传导系统捕获(选择性或非选择性)，幅度小于2.5 v /1ms。如果符合标准，则固定导联，放置心房导联，并将其连接到双室起搏器。记录围手术期及随访3个月的特征。28例(62.2%)被诊断为肌上阻滞，手术成功率为89%;17例(37.8%)被诊断为肌下阻滞，手术成功率为59%。上肌阻滞组QRS持续时间为96,4±21,6 ms，下肌阻滞组为119,4±23,8 ms (p=0,0027)。在急性His束起搏阈值(1,13±0,63 V/1ms vs. 1,25±0,76 V/1ms, p= 0,66)、心室感觉(3,46±1,5 mV vs. 3,21±1,6 mV, p= 0,68)和透视时间(12,75±8,3 min vs. 10,78±9,5 min, p= 0,57)上肌和下肌阻滞之间无显著统计学差异。此外，两组间节律性QRS持续时间相似(86,9±13,4 ms vs. 82±14,7 ms, p= 0,38)，且比基线复合物窄。3个月随访显示起搏和传感参数稳定，无其他手术或导联相关并发症。在房室传导阻滞中，永久性His束起搏实现房室再同步，同时保持快速和同步的双室去极化。正如预期的那样，在上层区块中，成功率优于底层区块。然而，在后一种情况下，他的束起搏可以调动内在传导系统。
{"title":"Permanent his bundle pacing in suprahisian versus infrahisian atrioventricular block . A single center experience","authors":"CG Pestrea, AI Gherghina, FO Ortan","doi":"10.1093/europace/euac053.397","DOIUrl":"https://doi.org/10.1093/europace/euac053.397","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Permanent His bundle pacing is currently considered the most physiological form of cardiac pacing. The main benefit of the procedure, compared to right ventricular pacing, is encountered in atrioventricular block, where a high burden of ventricular pacing is expected. One of the limits of His bundle pacing is a distal conduction abnormality in the His-Purkinje system. Nevertheless, there is published data that shows the possibility of conduction system capture even in these patients. This retrospective study evaluated the feasibility of permanent His bundle pacing in patients with second or third degree AV block, taking into account the level of block : suprahisian vs. infrahisian.\u0000 \u0000 \u0000 \u0000 45 patients with second or third degree AV block with an attempt at permanent His bundle pacing and an available intraprocedural hisian electrogram for review were included. The procedure went as follows: a lead delivery system including a preformed 3D shaped sheath and a lumenless lead with a fixed exposed helix was placed at the septal atrioventricular junction. Careful mapping was performed until a His bundle signal was recorded. At that site, the pacing response was evaluated at variable pacing outputs. The procedural criteria for success was conduction system capture (selective or non-selective) with an amplitude of less than 2,5V/1ms. If the criteria was met, the lead was fixed, an atrial lead was placed and both connected to a dual-chamber pacemaker. The periprocedural characteristics and those at the three-months follow-up were noted.\u0000 \u0000 \u0000 \u0000 28 patients (62,2%) were diagnosed with suprahisian block, with a procedural success rate of 89 % and 17 (37,8%) with infrahisian block, with a procedural success rate of 59%. QRS duration was 96,4±21,6 ms in those with suprahisian block vs. 119,4±23,8 ms in those with infrahisian block (p=0,0027). There was no significant statistical difference regarding acute His bundle pacing thresholds (1,13±0,63 V/1ms vs. 1,25±0,76 V/1ms, p= 0,66), ventricular sensing (3,46±1,5 mV vs. 3,21±1,6 mV, p= 0,68) and fluoroscopy time (12,75±8,3 min vs. 10,78±9,5 min, p= 0,57) between suprahisian and infrahisian block. Also, the paced QRS duration was similar between the two groups (86,9±13,4 ms vs. 82±14,7 ms, p= 0,38) and narrower than the baseline complex. The three-months follow-up showed stable pacing and sensing parameters, without other procedural or lead related complications.\u0000 \u0000 \u0000 \u0000 In atrioventricular block, permanent His bundle pacing achieves atrioventricular resynchronization, while maintaining rapid and synchronous biventricular depolarization. As expected, in suprahisian blocks the success rate is superior to infrahisian blocks. Nevertheless, in a significant proportion of the latter cases, His bundle pacing can recrute the intrinsic conduction system.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85648905","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}
Pub Date : 2022-05-18DOI: 10.1093/europace/euac053.100
O. Krahnefeld, T. Agdirlioglu, P. Poley, J. Weil
Type of funding sources: None. Catheter ablation (CA) with radiofrequency (RF) energy using the CLOSE protocol has proven safety and efficacy in a large prospective multicenter study (1) with a rate of pericardial tamponade (PT) as low as 0.9%, thus with lower PT risk than reported by previous register data for PVI (2). PT may still become hazardous in the era of uninterrupted anticoagulation and may require urgent surgical repair. Steam pop is the major cause of PT during PVI with RF ablation and is usually preceded by steep impedance rise measured between tissue and tip of the RF catheter. The STOCKERT SMARTABLATE RF Generator as a core part of technology for CLOSE protocol guided PVI offers the opportunity to automatically stop RF energy delivery within 0.5 seconds if catheter impedance rises above a predefined value: impedance spike cut off (ISCO). The standard – manufacturer recommended – value for ISCO is 50 Ohms per 0.5 seconds. To investigate the effect of reduced ISCO during CLOSE protocol guided catheter ablation of AF on the occurrence of acute PT and pericardial effusion (PE) in a large single center series. We performed CLOSE protocol guided PVI procedures using Biosense Webster CARTO PRIME 3D navigation system, Smarttouch SF ablation catheter, VIZIGO steerable sheath, invasive blood pressure measurement via radial artery. We changed the STOCKERT SMARTABLATE generator settings to ISCO of 25 Ohms per 0.5 seconds. Cut off during ablation by ISCO led the operator to reduce contact force, angulation/orientation of catheter/steerable sheath, changing to jet ventilation if mechanical ventilation was present. A retrospective analysis of all procedures was performed. Investigation for PT by echocardiography was performed for every drop < 90mmHg systolic blood pressure, immediately after and one day post ablation. Statistical analysis was performed on the evaluable population. During 31 months of observation we performed 627 CLOSE protocol guided procedures: 409 PVI only, 218 PVI with additional ablations (cavotricuspid isthmus, slow pathway, additional LA lines, ethanol ablation of vein of marshall). We observed 3 (0.5%) PT immediately at the end of the procedure and no additional relevant PE the day after CA. Of the 3 PT, one patient needed urgent surgical repair and two were managed conservatively with pericardiocentesis and retransfusion. CLOSE protocol guided PVI is a very effective and safe intervention for treatment of AF. In the multicentre VISITAX trial, the rate of PT was reported with 3 events per 329 patients (0.9%). By reducing ISCO to 25 Ohms per 0.5 seconds, we could half the rate of PT found in the VISITAX trial. The generator cut off at ISCO of 25 Ohms per 0.5 seconds indicates a potentially dangerous position for ablation. Our data are limited due to the retrospective monocentric design and therefore the aformentioned approach should be evaluated prospectively.
{"title":"Impedance spike cut-off enhances safety of CLOSE-protocol guided ablation of atrial fibrillation","authors":"O. Krahnefeld, T. Agdirlioglu, P. Poley, J. Weil","doi":"10.1093/europace/euac053.100","DOIUrl":"https://doi.org/10.1093/europace/euac053.100","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Catheter ablation (CA) with radiofrequency (RF) energy using the CLOSE protocol has proven safety and efficacy in a large prospective multicenter study (1) with a rate of pericardial tamponade (PT) as low as 0.9%, thus with lower PT risk than reported by previous register data for PVI (2). PT may still become hazardous in the era of uninterrupted anticoagulation and may require urgent surgical repair. Steam pop is the major cause of PT during PVI with RF ablation and is usually preceded by steep impedance rise measured between tissue and tip of the RF catheter. The STOCKERT SMARTABLATE RF Generator as a core part of technology for CLOSE protocol guided PVI offers the opportunity to automatically stop RF energy delivery within 0.5 seconds if catheter impedance rises above a predefined value: impedance spike cut off (ISCO). The standard – manufacturer recommended – value for ISCO is 50 Ohms per 0.5 seconds.\u0000 \u0000 \u0000 \u0000 To investigate the effect of reduced ISCO during CLOSE protocol guided catheter ablation of AF on the occurrence of acute PT and pericardial effusion (PE) in a large single center series.\u0000 \u0000 \u0000 \u0000 We performed CLOSE protocol guided PVI procedures using Biosense Webster CARTO PRIME 3D navigation system, Smarttouch SF ablation catheter, VIZIGO steerable sheath, invasive blood pressure measurement via radial artery. We changed the STOCKERT SMARTABLATE generator settings to ISCO of 25 Ohms per 0.5 seconds. Cut off during ablation by ISCO led the operator to reduce contact force, angulation/orientation of catheter/steerable sheath, changing to jet ventilation if mechanical ventilation was present. A retrospective analysis of all procedures was performed. Investigation for PT by echocardiography was performed for every drop < 90mmHg systolic blood pressure, immediately after and one day post ablation. Statistical analysis was performed on the evaluable population.\u0000 \u0000 \u0000 \u0000 During 31 months of observation we performed 627 CLOSE protocol guided procedures: 409 PVI only, 218 PVI with additional ablations (cavotricuspid isthmus, slow pathway, additional LA lines, ethanol ablation of vein of marshall). We observed 3 (0.5%) PT immediately at the end of the procedure and no additional relevant PE the day after CA. Of the 3 PT, one patient needed urgent surgical repair and two were managed conservatively with pericardiocentesis and retransfusion.\u0000 \u0000 \u0000 \u0000 CLOSE protocol guided PVI is a very effective and safe intervention for treatment of AF. In the multicentre VISITAX trial, the rate of PT was reported with 3 events per 329 patients (0.9%). By reducing ISCO to 25 Ohms per 0.5 seconds, we could half the rate of PT found in the VISITAX trial. The generator cut off at ISCO of 25 Ohms per 0.5 seconds indicates a potentially dangerous position for ablation. Our data are limited due to the retrospective monocentric design and therefore the aformentioned approach should be evaluated prospectively.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76915130","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}
Pub Date : 2022-05-18DOI: 10.1093/europace/euac053.164
J. Huang, Y. Lip, M.Z Wu, Q. Ren, H. Tse, K. Yiu
Type of funding sources: None. Heart failure (HF) is common in patients with nonvalvular atrial fibrillation (NVAF) which is associated with excess morbidity and mortality. Notably, the presence of diabetes increases risk of HF in patients with NVAF. The association between pre-diabetes and risk of HF was nonetheless unexplored in this population. The present study aimed to evaluate whether pre-diabetes was associated with an increased risk of HF in patients with NVAF. Using a previously validated territory-wide electronic health record database, patients with newly diagnosed NVAF from 2010 to 2018 were included to evaluate for risk of HF upon competing risk regression with Cox proportional-hazard model adjustment. Patients were divided into 3 groups according to their baseline glycemic status: (1) type 2 diabetes, (2) pre-diabetes, and (3) normoglycemia. In the pre-diabetes group, the subsequent risk of HF was further evaluated according to the changes of glycemic status at two years following index date. Among 65,994 NVAF patients (mean age 75.7 years, 48.5% female), 27,706 (42.0%) were normoglycemic, 10,926 (16.6%) had pre-diabetes, and 27,312 (41.4%) had diabetes at baseline. Over a median follow-up of 7.1 years, 7,203 (26%) normoglycemic patients, 3,168 (29%) pre-diabetic patients, and 8,745 (32%) diabetic patients developed HF (Log rank test, P<0.001). Pre-diabetes was associated with an increased risk of HF compared with normoglycemic patients (subdistribution Hazard Ratio (SHR) = 1.09, 95% confidence interval (CI): 1.04-1.14) and diabetes conferred the highest risk amongst three groups (SHR=1.19, 95%CI: 1.15-1.24). In patients with pre-diabetes at baseline, 873 (8.0%) progressed to diabetes and 1204 (11%) resolved to normoglycemia at 2 years. Compared to those who remained pre-diabetic, patients who progressed to diabetes had a higher risk of HF (SHR = 1.23, 95% CI :1.05-1.44), whereas those who resolved to normoglycemia incurred a lower risk (SHR = 0.80, 95% CI :0.68-0.94). Pre-diabetes was independently associated with an increased risk of HF in patients with NVAF. Pre-diabetic patients who progressed to diabetes at 2 years experienced an increased risk of HF, whereas those who resolved to normoglycemia reduced risk of HF, as compared to those who remained pre-diabetic. These findings highlight the importance of strict blood glucose control in reducing the risk of HF in patients with atrial fibrillation.
{"title":"Pre-diabetes increases the risk of heart failure among patients with nonvalvular atrial fibrillation","authors":"J. Huang, Y. Lip, M.Z Wu, Q. Ren, H. Tse, K. Yiu","doi":"10.1093/europace/euac053.164","DOIUrl":"https://doi.org/10.1093/europace/euac053.164","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Heart failure (HF) is common in patients with nonvalvular atrial fibrillation (NVAF) which is associated with excess morbidity and mortality. Notably, the presence of diabetes increases risk of HF in patients with NVAF. The association between pre-diabetes and risk of HF was nonetheless unexplored in this population.\u0000 \u0000 \u0000 \u0000 The present study aimed to evaluate whether pre-diabetes was associated with an increased risk of HF in patients with NVAF.\u0000 \u0000 \u0000 \u0000 Using a previously validated territory-wide electronic health record database, patients with newly diagnosed NVAF from 2010 to 2018 were included to evaluate for risk of HF upon competing risk regression with Cox proportional-hazard model adjustment. Patients were divided into 3 groups according to their baseline glycemic status: (1) type 2 diabetes, (2) pre-diabetes, and (3) normoglycemia. In the pre-diabetes group, the subsequent risk of HF was further evaluated according to the changes of glycemic status at two years following index date.\u0000 \u0000 \u0000 \u0000 Among 65,994 NVAF patients (mean age 75.7 years, 48.5% female), 27,706 (42.0%) were normoglycemic, 10,926 (16.6%) had pre-diabetes, and 27,312 (41.4%) had diabetes at baseline. Over a median follow-up of 7.1 years, 7,203 (26%) normoglycemic patients, 3,168 (29%) pre-diabetic patients, and 8,745 (32%) diabetic patients developed HF (Log rank test, P<0.001). Pre-diabetes was associated with an increased risk of HF compared with normoglycemic patients (subdistribution Hazard Ratio (SHR) = 1.09, 95% confidence interval (CI): 1.04-1.14) and diabetes conferred the highest risk amongst three groups (SHR=1.19, 95%CI: 1.15-1.24). In patients with pre-diabetes at baseline, 873 (8.0%) progressed to diabetes and 1204 (11%) resolved to normoglycemia at 2 years. Compared to those who remained pre-diabetic, patients who progressed to diabetes had a higher risk of HF (SHR = 1.23, 95% CI :1.05-1.44), whereas those who resolved to normoglycemia incurred a lower risk (SHR = 0.80, 95% CI :0.68-0.94).\u0000 \u0000 \u0000 \u0000 Pre-diabetes was independently associated with an increased risk of HF in patients with NVAF. Pre-diabetic patients who progressed to diabetes at 2 years experienced an increased risk of HF, whereas those who resolved to normoglycemia reduced risk of HF, as compared to those who remained pre-diabetic. These findings highlight the importance of strict blood glucose control in reducing the risk of HF in patients with atrial fibrillation.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81019409","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}
Pub Date : 2022-05-18DOI: 10.1093/europace/euac053.299
H. Mengjin
Type of funding sources: None. We aimed to test the optimal duration of dual antiplatelet therapy (DAPT) on long-term clinical outcomes after implantation of drug-eluting stents (DES). We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Web of Science through November 8th, 2021 to identify randomized controlled trials (RCT) assessing the duration of DAPT in patients receiving DES. Efficacy of all DAPT strategies was reported as pooled odd ratios (OR) with 95% credible interval (CrI) to summarize the effect of each strategy tested. We identified 24 RCTs containing 81405 patients. In comparison with 12-month DAPT, 3-month DAPT followed by P2Y12 inhibitor monotherapy could reduce net clinical events (OR: 0.72; CrI: 0.55-0.94) and major bleeding (OR: 0.57; CrI: 0.34-1.00) without increasing ischeamic events (OR: 0.93; CrI: 0.68-1.29). Although >12-month DAPT was associated with a lower risk of myocardial infarction (OR: 0.67; CrI: 0.51-0.93), yet the risk of major bleeding (OR: 1.70; CrI: 1.10-2.70) was also increased, which is more strongly related to all-cause death than ischeamic events. Moreover, the benefits of 3-month DAPT (P2Y12 Inhibitor) were consistent for male patients with acute coronary disease, young age, complex lesion, single vessel disease, low body mass index, without diabetes. Among patients treated with DES, 3-month DAPT followed by P2Y12 inhibitor monotherapy could reduce the risk of net clinical events without increasing ischeamic events. DAPT beyond one year reduced myocardial infarction at the expense of increased major bleeding. Taken together, 3-month DAPT followed by P2Y12 inhibitor monotherapy may be the optimal strategy for patients receiving DES.
{"title":"The optimal duration of dual antiplatelet therapy after PCI with drug-eluting stent: a systematic review and Bayesian network meta-analysis","authors":"H. Mengjin","doi":"10.1093/europace/euac053.299","DOIUrl":"https://doi.org/10.1093/europace/euac053.299","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 We aimed to test the optimal duration of dual antiplatelet therapy (DAPT) on long-term clinical outcomes after implantation of drug-eluting stents (DES).\u0000 \u0000 \u0000 \u0000 We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Web of Science through November 8th, 2021 to identify randomized controlled trials (RCT) assessing the duration of DAPT in patients receiving DES. Efficacy of all DAPT strategies was reported as pooled odd ratios (OR) with 95% credible interval (CrI) to summarize the effect of each strategy tested.\u0000 \u0000 \u0000 \u0000 We identified 24 RCTs containing 81405 patients. In comparison with 12-month DAPT, 3-month DAPT followed by P2Y12 inhibitor monotherapy could reduce net clinical events (OR: 0.72; CrI: 0.55-0.94) and major bleeding (OR: 0.57; CrI: 0.34-1.00) without increasing ischeamic events (OR: 0.93; CrI: 0.68-1.29). Although >12-month DAPT was associated with a lower risk of myocardial infarction (OR: 0.67; CrI: 0.51-0.93), yet the risk of major bleeding (OR: 1.70; CrI: 1.10-2.70) was also increased, which is more strongly related to all-cause death than ischeamic events. Moreover, the benefits of 3-month DAPT (P2Y12 Inhibitor) were consistent for male patients with acute coronary disease, young age, complex lesion, single vessel disease, low body mass index, without diabetes.\u0000 \u0000 \u0000 \u0000 Among patients treated with DES, 3-month DAPT followed by P2Y12 inhibitor monotherapy could reduce the risk of net clinical events without increasing ischeamic events. DAPT beyond one year reduced myocardial infarction at the expense of increased major bleeding. Taken together, 3-month DAPT followed by P2Y12 inhibitor monotherapy may be the optimal strategy for patients receiving DES.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78580650","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}
Pub Date : 2022-05-18DOI: 10.1093/europace/euac053.186
Jamol Uzokov, B. Alyavi, D. Payziev, O. Mukhitdinova, D. Orziev
Type of funding sources: None. Metabolic syndrome is widely discussed lately and it is consists of several components, which in turns exaggerates the development of the cardiovascular disease and rhythm disorders. Atrial fibrillation (AF) is considered one of the common type of heart rhythm disorders. Effects of metabolic syndrome components on outcomes of catheter ablation in AF remain poorly understood. Assess the influence of metabolic syndrome and its components on short-term outcomes of catheter ablation on atrial fibrillation. We carried out a retrospective analysis of 120 patients who underwent atrial fibrillation ablation for the first time. 60 out of them were diagnosed with concomitant MetS (Group I) whereas 60 without MetS (Group II). Clinical outcomes, cardiovascular and all caused hospitalizations, procedural complications, AF recurrence, ischemic stroke were assessed. All endpoints were assessed at least 12 months after the catheter ablation. Median CHA2DS2-VASc were higher in Group I than Group II (2.2 (1-4) vs. 1.9 (1-3), P<0.05). Patients with MetS tended to have larger median diameter of left atrial than those without it (4.3 vs. 4.0, P<0.05). Cardiovascular and all cause hospitalizations did not differ in two groups (P>0.05). Median total radiofrequency duration (59.0 min vs. 61 min, P>0.05) and procedural complications (P>0.05) did not significantly differ between groups. AF recurrence in 12 months tended to be higher in Group I than Group II (9.0 vs.5.0, P>0.05). There were not statistically significant changes between groups in terms of ischemic stroke (1.0 vs. 1.0, P>0.05). Using multivariate regression analysis, among MetS components abdominal obesity (1.7 (1.1-2.1), P<0.05) hypertension (1.5 (1.1-1.9), P<0.05) were positively correlated with AF recurrence whilst median left atrial diameter was only correlated with hypertension (1.6 (1.1-2.0), P<0.05) after adjusting other risk factors. AF recurrence in short-term period of catheter ablation in AF higher in patients with MetS. Further studies with large amount of patients are required along with assessment in long-term period.
资金来源类型:无。代谢综合征是近年来被广泛讨论的疾病，它由几个组成部分组成，这些组成部分反过来又加剧了心血管疾病和节律障碍的发展。心房颤动(AF)被认为是一种常见的心律失常。代谢综合征成分对房颤导管消融结果的影响尚不清楚。评估代谢综合征及其组成部分对房颤导管消融短期预后的影响。我们对120例首次房颤消融患者进行了回顾性分析。其中60人被诊断为伴有MetS(第一组)，而60人没有MetS(第二组)。临床结果，心血管和所有引起的住院，手术并发症，房颤复发，缺血性卒中进行评估。所有终点在导管消融后至少12个月进行评估。I组中位CHA2DS2-VASc高于II组(2.2(1-4)比1.9 (1-3)，P0.05)。中位总射频持续时间(59.0 min vs 61 min, P>0.05)和手术并发症(P>0.05)组间差异无统计学意义。12个月房颤复发率I组高于II组(9.0 vs 5.0, P>0.05)。缺血性卒中发生率组间比较差异无统计学意义(1.0 vs 1.0, P>0.05)。多因素回归分析显示，调整其他危险因素后，腹型肥胖(1.7 (1.1-2.1)，P<0.05)、高血压(1.5 (1.1-1.9)，P<0.05)与AF复发呈正相关，而左心房中径仅与高血压(1.6 (1.1-2.0)，P<0.05)相关。房颤导管消融短期内房颤复发率在met患者中较高。需要对大量患者进行进一步研究，并进行长期评估。
{"title":"Short-term outcomes of catheter ablation in atrial fibrillation in patients with metabolic syndrome","authors":"Jamol Uzokov, B. Alyavi, D. Payziev, O. Mukhitdinova, D. Orziev","doi":"10.1093/europace/euac053.186","DOIUrl":"https://doi.org/10.1093/europace/euac053.186","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Metabolic syndrome is widely discussed lately and it is consists of several components, which in turns exaggerates the development of the cardiovascular disease and rhythm disorders. Atrial fibrillation (AF) is considered one of the common type of heart rhythm disorders. Effects of metabolic syndrome components on outcomes of catheter ablation in AF remain poorly understood.\u0000 \u0000 \u0000 \u0000 Assess the influence of metabolic syndrome and its components on short-term outcomes of catheter ablation on atrial fibrillation.\u0000 \u0000 \u0000 \u0000 We carried out a retrospective analysis of 120 patients who underwent atrial fibrillation ablation for the first time. 60 out of them were diagnosed with concomitant MetS (Group I) whereas 60 without MetS (Group II). Clinical outcomes, cardiovascular and all caused hospitalizations, procedural complications, AF recurrence, ischemic stroke were assessed. All endpoints were assessed at least 12 months after the catheter ablation.\u0000 \u0000 \u0000 \u0000 Median CHA2DS2-VASc were higher in Group I than Group II (2.2 (1-4) vs. 1.9 (1-3), P<0.05). Patients with MetS tended to have larger median diameter of left atrial than those without it (4.3 vs. 4.0, P<0.05). Cardiovascular and all cause hospitalizations did not differ in two groups (P>0.05). Median total radiofrequency duration (59.0 min vs. 61 min, P>0.05) and procedural complications (P>0.05) did not significantly differ between groups. AF recurrence in 12 months tended to be higher in Group I than Group II (9.0 vs.5.0, P>0.05). There were not statistically significant changes between groups in terms of ischemic stroke (1.0 vs. 1.0, P>0.05). Using multivariate regression analysis, among MetS components abdominal obesity (1.7 (1.1-2.1), P<0.05) hypertension (1.5 (1.1-1.9), P<0.05) were positively correlated with AF recurrence whilst median left atrial diameter was only correlated with hypertension (1.6 (1.1-2.0), P<0.05) after adjusting other risk factors.\u0000 \u0000 \u0000 \u0000 AF recurrence in short-term period of catheter ablation in AF higher in patients with MetS. Further studies with large amount of patients are required along with assessment in long-term period.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"262 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76262331","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}
Pub Date : 2022-05-18DOI: 10.1093/europace/euac053.461
A. Milman, E. Nof, R. Beinart, E. Regev, M. Rav Acha, V. Kutyifa, B. Merkely, M. Biffi, YM Cha, T. Ovdat, R. Klempfner, M. Glikson
Type of funding sources: Foundation. Main funding source(s): Maurice Kahn Foundation via the Mayo- Sheba Collaboration Fund. The need for intraoperative defibrillation testing (DFT) during implant and/or replacement of implantable cardioverter-defibrillators (ICDs) has been a matter of debate for many years. This debate was put to rest by the Simple and the Nordic ICD trials, and the practice of testing during new implantations has practically been nearly abandoned. Nevertheless, induction of VF for testing purposes (VFT) may still have an important role in selective populations at risk for defibrillation failure, who were not included in the SIMPLE and Nordic trials. One such population includes those who undergo device replacements. Old registries demonstrated an increased incidence of significant findings in VFT during replacements. In the present study, we sought to test this observation. Evaluate frequency of significant findings and the safety of VFT in subjects undergoing device replacement. A prospective observational multi-center study of VFT included consecutive patients undergoing ICD generator replacement in 5 centers in Israel, Europe, and the US. All centers followed the same VFT protocol. The primary outcome was defined as failure to terminate induced VF with a single shock at 10 Joules below the maximal capacity of the device. Secondary outcomes included complications of VFT. Patients were followed-up at 1 month and 6 months post-procedure. Data collection included documentation of any peri-operative complications and clinical endpoints (occurrence of appropriate shock, inappropriate shocks, lead failure, need for re-intervention, and infection). A total of 92 patients were eligible, and consented for the study, of which 84 underwent DFT during battery replacement. The median age was 68 years and 79.8% were male subjects. Induction of VF was successful in all 84 patients as well as VFT with a successful conversion on first attempt. During follow up one patient had two appropriate ICD shock events. In four patients, the ICD programming was changed. None suffered an inappropriate shock. There was no evidence of lead malfunction. A total of two deaths occurred, none of which were related to the device. The present study found VFT was not associated with complications in patients undergoing ICD/CRTD generator replacement but produced no clinically important information.
{"title":"Intraoperative defibrillation testing during replacements of implantable cardioverter-defibrillators: The Simpler trial","authors":"A. Milman, E. Nof, R. Beinart, E. Regev, M. Rav Acha, V. Kutyifa, B. Merkely, M. Biffi, YM Cha, T. Ovdat, R. Klempfner, M. Glikson","doi":"10.1093/europace/euac053.461","DOIUrl":"https://doi.org/10.1093/europace/euac053.461","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Foundation. Main funding source(s): Maurice Kahn Foundation via the Mayo- Sheba Collaboration Fund.\u0000 \u0000 \u0000 \u0000 The need for intraoperative defibrillation testing (DFT) during implant and/or replacement of implantable cardioverter-defibrillators (ICDs) has been a matter of debate for many years. This debate was put to rest by the Simple and the Nordic ICD trials, and the practice of testing during new implantations has practically been nearly abandoned.\u0000 Nevertheless, induction of VF for testing purposes (VFT) may still have an important role in selective populations at risk for defibrillation failure, who were not included in the SIMPLE and Nordic trials. One such population includes those who undergo device replacements. Old registries demonstrated an increased incidence of significant findings in VFT during replacements. In the present study, we sought to test this observation.\u0000 \u0000 \u0000 \u0000 Evaluate frequency of significant findings and the safety of VFT in subjects undergoing device replacement.\u0000 \u0000 \u0000 \u0000 A prospective observational multi-center study of VFT included consecutive patients undergoing ICD generator replacement in 5 centers in Israel, Europe, and the US. All centers followed the same VFT protocol. The primary outcome was defined as failure to terminate induced VF with a single shock at 10 Joules below the maximal capacity of the device. Secondary outcomes included complications of VFT. Patients were followed-up at 1 month and 6 months post-procedure. Data collection included documentation of any peri-operative complications and clinical endpoints (occurrence of appropriate shock, inappropriate shocks, lead failure, need for re-intervention, and infection).\u0000 \u0000 \u0000 \u0000 A total of 92 patients were eligible, and consented for the study, of which 84 underwent DFT during battery replacement. The median age was 68 years and 79.8% were male subjects. Induction of VF was successful in all 84 patients as well as VFT with a successful conversion on first attempt. During follow up one patient had two appropriate ICD shock events. In four patients, the ICD programming was changed. None suffered an inappropriate shock. There was no evidence of lead malfunction. A total of two deaths occurred, none of which were related to the device.\u0000 \u0000 \u0000 \u0000 The present study found VFT was not associated with complications in patients undergoing ICD/CRTD generator replacement but produced no clinically important information.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82986704","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}
Pub Date : 2022-05-18DOI: 10.1093/europace/euac053.225
K. Neven, A. Fueting, D. Hoewel, L. Brokkaar, G. Rahe, N. Reinsch
Type of funding sources: None. Catheter ablation for AF using thermal energy can cause collateral damage. Pulsed field ablation (PFA) is a novel nonthermal energy source. Only a few small clinical studies have been published. We report on the first “real-world” experience with PVI using PFA for paroxysmal AF. Pre and post ablation, phrenic nerve function was assessed. A high-density LA bipolar voltage map was created. All PVs were individually isolated using a steerable sheath and a pentaspline over-the-wire PFA catheter. After ablation, mapping was repeated to assess lesion formation. In 30 patients (63 years; 47% male), uncomplicated PFA was performed, with all PVs isolated. Procedure time was 116 min. PFA catheter LA dwell time was 29 min. Fluoroscopy time was 26 min. (All values are median). In 1 patient with roof dependent flutter, a roof line was intentionally created. In 2 patients, unintentional bidirectional mitral isthmus block was created. There was no phrenic nerve or esophageal damage. In 1 patient, pericardial drainage after cardiac tamponade was performed. In-hospital stay, and 30-day follow-up were uneventful. After 90 days, 97% of patients were in sinus rhythm. PVI using PFA for paroxysmal AF in a “real-world” setting is safe and feasible. Procedure and ablation times are short. Atrial ablation lines can easily be created. Unintentional ablation of atrial tissue can occur, accurate catheter alignment to the PV ostium and PV axis should be ensured. Figure: Postero-anterior view of a LA bipolar voltage 3D map. Left panel: pre ablation. Magenta areas in the PVs are conducting (>0,5 mV). Right panel: post ablation. Non-magenta (<0,5 mV) and red (<0,1 mV) areas in the PVs are ablated and electrically silent.
{"title":"First real-world experience with pulmonary vein isolation using pulsed field ablation for paroxysmal atrial fibrillation","authors":"K. Neven, A. Fueting, D. Hoewel, L. Brokkaar, G. Rahe, N. Reinsch","doi":"10.1093/europace/euac053.225","DOIUrl":"https://doi.org/10.1093/europace/euac053.225","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Catheter ablation for AF using thermal energy can cause collateral damage. Pulsed field ablation (PFA) is a novel nonthermal energy source. Only a few small clinical studies have been published.\u0000 \u0000 \u0000 \u0000 We report on the first “real-world” experience with PVI using PFA for paroxysmal AF.\u0000 \u0000 \u0000 \u0000 Pre and post ablation, phrenic nerve function was assessed. A high-density LA bipolar voltage map was created. All PVs were individually isolated using a steerable sheath and a pentaspline over-the-wire PFA catheter. After ablation, mapping was repeated to assess lesion formation.\u0000 \u0000 \u0000 \u0000 In 30 patients (63 years; 47% male), uncomplicated PFA was performed, with all PVs isolated. Procedure time was 116 min. PFA catheter LA dwell time was 29 min. Fluoroscopy time was 26 min. (All values are median). In 1 patient with roof dependent flutter, a roof line was intentionally created. In 2 patients, unintentional bidirectional mitral isthmus block was created. There was no phrenic nerve or esophageal damage. In 1 patient, pericardial drainage after cardiac tamponade was performed. In-hospital stay, and 30-day follow-up were uneventful. After 90 days, 97% of patients were in sinus rhythm.\u0000 \u0000 \u0000 \u0000 PVI using PFA for paroxysmal AF in a “real-world” setting is safe and feasible. Procedure and ablation times are short. Atrial ablation lines can easily be created. Unintentional ablation of atrial tissue can occur, accurate catheter alignment to the PV ostium and PV axis should be ensured.\u0000 Figure: Postero-anterior view of a LA bipolar voltage 3D map. Left panel: pre ablation. Magenta areas in the PVs are conducting (>0,5 mV). Right panel: post ablation. Non-magenta (<0,5 mV) and red (<0,1 mV) areas in the PVs are ablated and electrically silent.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79867147","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}
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