EP Europace最新文献

{"title":"Real-world experience on implantation and atrial signal detection of a SC ICD with atrial sensing capability: The MATRIX study","authors":"G. Maglia, A. Bollmann, D. Theuns, D. Bar-Lev, I. Anguera, FA Ayala Paredes, M. Arnold, J. Geller, B. Merkely, KM Dyrda, C. Perings, S. Ploux, J. Meyhoefer, T. Timmel, G. Hindricks","doi":"10.1093/europace/euac053.469","DOIUrl":"https://doi.org/10.1093/europace/euac053.469","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Private company. Main funding source(s): BIOTRONIK, Berlin, Germany\u0000 \u0000 \u0000 \u0000 A single-lead implantable cardioverter-defibrillator (ICD) with atrial sensing dipole (the DX ICD system) can potentially give additive information concerning atrial diagnostics in patients requiring only a single-chamber ICD. We therefore report the real-world experience from large DX registry on implantation, atrial signal quality and detection and the long-term stability of the atrial signal.\u0000 \u0000 \u0000 \u0000 The prospective, single-arm MATRIX (Management and Detection of Atrial Tachyarrhythmias in Patients Implanted With BIOTRONIK DX Systems, NCT01774357) registry study effectively enrolled 2041 patients at 119 sites in 24 countries. All patients had a DX system implanted for a single-chamber ICD indication for primary or secondary prevention of sudden cardiac death. Patients were followed for 24 months including remote monitoring. Implantation and follow-up data are reported for the whole patient set. For the analyses on atrial sensing amplitude values, remotely transmitted device measurements of patients without history of long-standing persistent or permanent AF at baseline were used.\u0000 \u0000 \u0000 \u0000 The mean follow-up period was 677±173 days. Implantation took place at 15±22 days before enrollment. Baseline and implantation data are shown in the table. Implantation procedure and lead insertion were rated as \"easy\" or \"very easy\" in 91.0% and 96.3% of assessments, respectively. At implantation, the investigators rated the quality of the atrial sensing amplitude as \"sufficient\" in 97% of the assessed cases. At enrollment (12-month/24-month follow-up), the atrial signal quality and detection were rated as \"good\" or \"excellent\" in 92.3% (89.8%/89.9%) and 92.4% (90.1%/91.3%) of assessments, respectively. For 1841 patients (90.2%), remotely transmitted device information was received. The median (mean ± SD, IQR) transmission rate was 92.5% (85.4±18.2%, 81.4-97.3%). 1746 patients (85.5%) matched the inclusion criteria for the quantitative analyses on atrial sensing. 95.6% of available RA sensing amplitude values were ≥1 mV. Based on each patient’s overall median value, the median (mean ± SD, IQR) RA sensing amplitude was 4.6 mV (4.4±2.0 mV, 2.8-6.2 mV). The time course of patient median values stratified by month is shown in the figure.\u0000 \u0000 \u0000 \u0000 The study followed 2041 patients implanted with the DX ICD system for two years. In the vast majority of cases, investigators rated implantation as (very) easy and the atrial signal over 24 months as good/excellent. According to daily, automatic Home Monitoring data, the overall mean P-wave amplitude remained stable throughout the whole follow-up. The MATRIX study demonstrated functionality and clinical utility of the DX concept in an unselected, real-life setting.\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":"82163246","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":"Evaluation of electrocardiographic repolarization parameters in patients with polycystic ovary syndrome","authors":"A. Orosz, L. Szabó, A. Vagvolgyi, S. Magony, Szabolcs Nyiraty, B. Tóth, F. Pesei, GY Abraham, A. Nemes, C. Lengyel, T. Várkonyi, I. Baczkó","doi":"10.1093/europace/euac053.606","DOIUrl":"https://doi.org/10.1093/europace/euac053.606","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research, Development and Innovation Office\u0000 \u0000 \u0000 \u0000 Polycystic ovary syndrome (PCOS) is a multifactorial, endocrine disease associated with metabolic disturbances (e.g. hyperinsulinemia, insulin resistance) and increased cardiovascular risk. Recent data strongly suggest that different QT variability parameters characterizing cardiac repolarization instability represent novel markers in proarrhythmic risk assessment.\u0000 \u0000 \u0000 \u0000 In the present study we investigated ECG repolarization parameters, including QT variability parameters in patients with polycystic ovary syndrome.\u0000 \u0000 \u0000 \u0000 Fifty-five PCOS patients (age: 29±6 years) and 55 age-matched healthy volunteers (age: 29±10 years) were enrolled in the study. Five-minute 12-lead resting electrocardiograms were recorded, the ECGs were digitized and evaluated off-line using the Cardiosys-A01 system (Cardiosys-A01). The following parameters were determined: the frequency corrected QT interval (QTc) using Bazett’s, Fridericia, Framingham and the Hodges formulas; QT dispersion (QTd) and T wave peak-to-end distance (Tpeak-Tend). Among QT variability parameters we analyzed the QT variance (QTv), the QT variability index (QTVI), the short-term beat-to-beat QT and RR interval variability (STV-QT, STV-RR) based on constructed Poincaré plots and the variability ratio (VR).\u0000 \u0000 \u0000 \u0000 The RR interval did not differ significantly in PCOS patients compared to controls (821±129 ms vs. 847±99 ms), however the QT interval (373±30 ms vs. 391±27 ms, p<0.01), the QTc calculated with Bazett’s, Framingham, Fridericia and Hodges correction formulas (QTc Bazett’s: 413±18 ms vs. 426±21 ms, p<0.01) and the Tpeak-Tend intervals were significantly shorter (76±10 ms vs. 83±12 ms, p<0.01). The QTd, QTv, and STV-RR did not differ significantly. However, the VR (0.3±0.4 vs. 0.2±0.2, p<0.05), the QTVI (-0,9±0.5 vs. -1,3±0.4, p<0.001), and importantly, the STV-QT were significantly higher in PCOS patients compared to controls (4.0±0.9 ms vs. 3.2±0.9 ms, p<0.0001).\u0000 \u0000 \u0000 \u0000 Some of the alterations in repolarization parameters and the significant increase in the short-term beat-to-beat QT interval variability and the QT variability index may indicate increased repolarization instability in patients with polycystic ovary syndrome compared to age-matched controls, however, further studies are needed to establish the exact relation of this finding to increased arrhythmia propensity in this population.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82105343","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":"In-silico optimisation of ICD defibrillation efficacy by modifying lead/can configurations using a cohort of high-resolution whole-torso heart models","authors":"S. Qian, S. Monaci, C. Mendonca-Costa, F. Campos, P. Gemmell, S. Zaidi, R. Rajani, J. Whitaker, C. Rinaldi, M. Bishop","doi":"10.1093/europace/euac053.449","DOIUrl":"https://doi.org/10.1093/europace/euac053.449","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Medical Research Council, UK\u0000 \u0000 \u0000 \u0000 ICD is an effective direct therapy against VT/VF by applying a strong electrical shock across the heart between the shocking coil and can. Conventionally, patients will have a shocking coil inside the right ventricle (RV) and a can at the upper left chest. However, due to infections or other conditions, the can may need to place towards the right chest. The placement of the RV coil may also vary in different cases, for example avoiding scar. However, it is unclear how defibrillation efficacy may be altered by these unavoidable modifications to conventional lead/can configurations and whether optimisation may be possible.\u0000 \u0000 \u0000 \u0000 To compare defibrillation efficacy of modifications of ICD configurations in a cohort of whole-torso models.\u0000 \u0000 \u0000 \u0000 A cohort of 15 whole torso models was generated from high resolution CT data and contrast CT cardiac scans, including 5 dilated cardiomyopathy (DCM), 5 hypertrophic cardiomyopathy (HCM) and 5 structurally normal patients (Fig A). Transvenous ICDs were represented by a shocking coil inside the RV (near apex) and a (ground) can at the upper left chest as default settings. Configurations were then varied by moving the can to the right chest, moving the RV coil up the mid-septum or adding extra grounds (Superior Vena Cava (SVC) coil, coronary sinus (CS) coil (Fig A)). Defibrillation-strength shocks were applied to all models (Fig B). DFTs and mean electrical field were evaluated across the whole heart as well as specific LV, RV, RV insertion regions, along with overall impedance.\u0000 \u0000 \u0000 \u0000 Shifting the can from left to right significantly increased DFT for the whole heart (23 J vs 15 J, P=0.03) and LV (25 J vs 17 J, P=0.03) (Fig C) and reduced the mean electrical field. Moving the RV coil further up the septum did not significantly alter DFT (Fig D), but did reduce mean electrical field for all regions and reduce impedance significantly. Additional separate coils significantly reduced DFT for all regions (Fig D) by increasing mean electrical field, whilst adding both coils significantly reduced DFT the most (whole heart: 15 J vs 6 J, P=0.03) (Fig E). Impedance was increased significantly by adding SVC coil, but reduced significantly by adding CS coil. Adding both coils increased impedance slightly.\u0000 \u0000 \u0000 \u0000 Although a right-sided can increases DFT by over 50%, additional leads (grounds) may mitigate this increase by increasing mean electrical field. Moving the RV coil closer to the mid-septum reduces DFT slightly, but also reduces mean electrical field and impedance significantly.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"145 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82269281","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":"Safety and efficacy of direct oral anticoagulants in patients with atrial fibrillation on concomitant treatment with dronedarone","authors":"R. Vio, P. China, E. Marras, A. Cutolo, R. Valle, G. Grassi, S. Saccà, A. Chinellato, S. Themistoclakis","doi":"10.1093/europace/euac053.291","DOIUrl":"https://doi.org/10.1093/europace/euac053.291","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 The use of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) is associated with bleedings. Interactions with dronedarone may increase this risk, but data on concomitant treatment of DOACs with dronedarone are limited.\u0000 \u0000 \u0000 \u0000 The primary endpoint was to compare the survival free from the composite endpoint of clinically relevant bleeding, thromboembolic event and all-cause death, between AF patients on treatment with dronedarone and different DOACs. The secondary endpoints were to compare the survival free from i) clinically relevant bleeding and ii) clinically relevant major bleeding.\u0000 \u0000 \u0000 \u0000 A retrospective study was conducted at our Local Health Unit, from January 1st 2016 to December 31st 2020. The population included AF patients with concomitant prescriptions of DOACs and dronedarone. Patients were divided into 4 groups (rivaroxaban, apixaban, edoxaban, dabigatran). Clinically relevant major bleedings were defined as fatal bleeding or bleeding leading to transfusion of ≥2 units of blood. Clinically relevant non-major bleedings were defined as any sign of hemorrhage that does not fit the criteria for major bleeding but does lead to hospitalization or emergency room admission. Thromboembolic events were defined as ischemic stroke, transient ischemic attack (TIA), and systemic embolism.\u0000 \u0000 \u0000 \u0000 165 patients were included: 46/165 (28%) on rivaroxaban, 66/165 (40%) on apixaban, 45/165 (27%) on edoxaban, and 8/165 (5%) on dabigatran (Fig.1). Over a median follow-up of 339 days, 14/165 (8%) met the primary composite endpoint: 8/165 (5%) had clinically relevant bleedings, of which 1/165 (0.6%) was a clinically relevant major bleeding (i.e., fatal spontaneous intracerebral hemorrhage), 2/165 (1%) had TIAs, and 5/165 (3%) died. We found no difference in survival free from the primary composite endpoint and from clinically relevant bleeding between groups (p=0.19 and p=0.69, respectively) (Fig. 2A-B). However, survival free from clinically relevant major bleeding was significantly lower in dabigatran users (p=0.003) (Fig. 2C). At a secondary analysis, DOACs contraindicated by 2015 EHRA guide (dabigatran, edoxaban 60 mg), and not by 2018/2021 EHRA guides (rivaroxaban, dabigatran, edoxaban 60 mg), were associated with lower survival from either clinically relevant bleeding or clinically relevant major bleeding (p=0.03 and p<0.001, respectively).\u0000 \u0000 \u0000 \u0000 In our study on patients on concomitant treatment with DOACs and dronedarone, there was no difference in survival free from the primary composite endpoint and from clinically relevant bleeding between groups of coadministration. However, survival free from clinically relevant major bleeding was significantly lower in dabigatran users. DOACs contraindicated by 2015 EHRA guide (and not by the latest 2018/2021 EHRA guides) are associated with lower survival from either clinically relevant bleeding or clinically relevant major bleeding.\u0000","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":"76211751","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":"Diagnostic yield of a portable electrocardiographic device versus 24-hours conventional holter monitoring in the diagnosis of arrhythmic events","authors":"N. Torres González, L. Alvarez-Acosta, D. Valdivia-Miranda, V. Barreto-Caceres, A. Iriarte-Plasencia, P. Cappellesso, V. Ramos Reyes, S. Hernandez Castellano, A. Quijada Fumero, A. Lorenzo Gonzalez, JS Hernandez-Afonso","doi":"10.1093/europace/euac053.570","DOIUrl":"https://doi.org/10.1093/europace/euac053.570","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 The study of palpitations, presyncope or dizziness constitutes an important part of the cardiology consultations. These symptoms are nonspecific most of times, and with the usual diagnostic tools (24-hour Holter mainly) it is difficult to reach an accurate diagnosis, since episodes occur erratically once or a few times a month. The Kardia® electrocardiographic monitoring device is a diagnostic tool that allows the patient to self-perform ECG based on symptoms and send it for later review and interpretation by a cardiologist.\u0000 \u0000 \u0000 \u0000 We compared the diagnostic yield of the conventional 24-hour Holter monitor versus the Kardia® device in patients undergoing a cardiology study.\u0000 \u0000 \u0000 \u0000 We conducted a prospective cohort study in 36 patients referred to the cardiology consultation due to palpitations or presyncope. In all of them, a 24-hour Holter was carried out, according to the usual protocol, and then a KardiaMobile® 6L device was given for a month. They received training to perform an ECG (six limb leads) and use the mobile application. The quantitative variables are expressed as means and standard deviation and the qualitative values as percentages.\u0000 \u0000 \u0000 \u0000 The study included 36 patients, of which 66.7% were women and 33.3% men, mean age of 44.2±14.3 years. The most frequent clinical symptom was palpitations (88.9%). Regarding the 24-hour Holter, only 22.2% of patients felt the symptoms for which they consulted during the day they wore it. Only in 19.4% the etiological diagnosis was reached through this method. Regarding the KardiaMobile® device, 72.2% of patients presented symptoms during the month of follow-up. Through the records obtained with this device, the diagnosis was reached in 52.8% of the cases, taking into account that if the patient reported having symptoms at the time the ECG was performed, if the ECG was normal, it was considered a diagnostic success, since the non-cardiological cause of the symptom was demonstrated. The diagnosis implied a therapeutic approach in 30.6% of cases: antiarrhythmic drugs were started in 8 patients, and 4 electrophysiological studies were indicated: in 3 patients for AVRNT ablation and in 1 patient for sustained ventricular tachycardias. Table1 shows a summary of the results.\u0000 \u0000 \u0000 \u0000 Despite the limited number of patients, in our study, the 30-day recording with portable KardiaMobile® monitoring system showed statistically significant superiority (p <0.05) compared to the conventional 24-hour Holter monitor in the etiological diagnosis of palpitations and dizziness in a selected group of patients.\u0000 It must be borne in mind that this is a relatively young population and the study needs to be extended to a larger number of patients to generalize these conclusions. The main limitation of the KardiaMobile® device is that it requires minimal skills in terms of using a smartphone, so this tool is not extensible to any patient profile.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87867464","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":"Identification of electrical rotational activity in noisy cardiac tissue recordings using a deep neural network","authors":"T. De Coster, N. Kudryashova, G. Derevyanko, A. D. de Vries, D. Pijnappels, A. Panfilov","doi":"10.1093/europace/euac053.620","DOIUrl":"https://doi.org/10.1093/europace/euac053.620","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Deep learning is increasingly used in modern biomedical research and applications due to the substantial availability of large clinical datasets. These approaches are invaluable in tasks involving noisy imaging data, such as tumour segmentation in histological images. In cardiology, a deep learning approach could be helpful in real-time tracking of the sources of arrhythmia, i.e. electrical rotational activity in the heart. However, the existing optical or electrophysiological recordings that could be used for training such a model are recorded under highly variable conditions and are not always annotated, thereby requiring data augmentation.\u0000 \u0000 \u0000 \u0000 To use deep neural networks trained on synthetic data to obtain concise (low dimensional) representations of noisy optical mapping recordings of cardiac arrhythmias and rapidly locate spiral wave centres.\u0000 \u0000 \u0000 \u0000 To overcome the lack of experimental training data, a digital twin of a neonatal rat ventricular cardiomyocyte monolayer was used to create a large synthetic training dataset of noiseless spiral wave recordings. Spiral wave centres were detected and labelled by making use of classical algorithms which are proven to work well on noiseless data. After labelling the centres, noise was added to the spiral wave recordings to simulate realistic experimental measurements. Subsequently, these data were fed into three different deep learning architectures: 1) a variational auto-encoder (VAE) to denoise optical mapping recordings of cardiac arrhythmias in an unsupervised manner, 2) a convolutional neural network (CNN) to detect the spiral centres, and 3) a combination of both to denoise the recording and detect centres simultaneously.\u0000 \u0000 \u0000 \u0000 After training on synthetic datasets, each architecture could accurately predict what it was designed for (noiseless wave fronts, spiral centres including chirality, or both) on both synthetic and experimental data. These spiral centre detection results were compared with 5 classical methods of denoising and spiral centre detection for accuracy and speed. Our method was as accurate as the best performing yet slow classical algorithm, which can only detect centres after observing a full rotation cycle (~300ms). At the same time, it was as fast as the fastest classical method, needing only 30ms after enabling the algorithm to detect spiral wave centres. This allows quasi-real-time tracking of arrhythmic sources.\u0000 \u0000 \u0000 \u0000 This study reveals that modern deep learning strategies in combination with synthetic simulation datasets can be used on experimental measurements to aid in the development of new technologies, here applied to the detection of spiral wave centres in optical mapping recordings of cardiac arrhythmias. Given the combination of speed and accuracy at which these algorithms produce results, further exploration and refinement may improve the identification of targets for catheter ablation, thereby potentially improvi","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87566460","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":"Fifty-fifty - a comparison of two 50 watts high power short duration protocols using temperature- versus power- controlled radiofrequency ablation for atrial fibrillation","authors":"D. Guckel, L. Bergau, M. Braun, M. El Hamriti, P. Lucas, K. Isgandarova, T. Fink, V. Sciacca, M. Khalaph, G. Imnadze, P. Sommer, C. Sohns","doi":"10.1093/europace/euac053.216","DOIUrl":"https://doi.org/10.1093/europace/euac053.216","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Radiofrequency-guided catheter ablation (RFCA) is an established treatment option for atrial fibrillation (AF). New approaches applying higher than usual energy levels for shorter periods (high power short duration, HPSD) to improve lesion quality have been reported. The novel DiamondTemp (DT) catheter allows for temperature-guided high power RFCA. Data on a direct comparison of the two emerging RFCA approaches are lacking.\u0000 \u0000 \u0000 \u0000 This observational single center study aimed to compare the efficacy, safety and characteristics of the novel DT catheter to an ablation index (AI) guided 50 W high power short duration (HPSD) ablation protocol using a conventional force-sensing equipped ablation catheter with surround-flow.\u0000 \u0000 \u0000 \u0000 A total number of 101 patients undergoing RFA for AF were included. 33 patients treated with the DT catheter (50 W, 9 sec), were compared to 69 consecutive patients undergoing AI-guided AF ablation (AI anterior 550; AI posterior 400) with an open-irrigated catheter adherent to a 50 W HPSD protocol. Procedural data and recurrence rates were documented. Follow-up examinations were scheduled after 3, 6 and 12 months.\u0000 \u0000 \u0000 \u0000 Acute procedural success was achieved in all patients (n=101, 100%). DT-guided AF ablation was associated with a significantly longer mean procedure duration (98.8±30.1min vs. 78.2±25.6, p=0.002*). PVI using the DT ablation catheter required significantly more RF applications (75.4±30.8min vs. 61.3±14.1, p=0.019*). Total RF duration was significantly lower in the DT group (792.1±311.2sec vs. 1035.5±287.2sec, p<0.001*) as well as fluoroscopy time (4.6±2.1min vs.5.5±2.5min, p<0.006*) and dose (183.8±178.1yGym2 vs. 295.8±247.5yGym2, p<0.013*). Procedure related mayor complications occurred in 1 patient from the DT group (acute stroke; 3%) and in no patients from the HPSD cohort. Early recurrence was reported from 4 patients treated with the DT catheter (12%) compared to 8 patients undergoing HPSD RFA (12 %) (p=1.000).\u0000 \u0000 \u0000 \u0000 Temperature- and power- controlled AF ablation using 50 W was safe and effective. AI-guided HPSD ablation resulted in significantly shorter procedure times with significantly fewer RF applications for PVI, whereas total RF duration and fluoroscopy times were significantly higher in this cohort. Further studies are needed to confirm this initial observation.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"126 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87723370","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":"Ambulatory pulmonary vein isolation workflow using suture-mediated vascular closure devices: a prospective observational cohort study","authors":"D. Fabbricatore, N. Mileva, C. Valeriano, D. Buytaert, P. Paolisso, P. Geelen, T. D. De Potter","doi":"10.1093/europace/euac053.099","DOIUrl":"https://doi.org/10.1093/europace/euac053.099","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Cardiovascular Abbott D. Fabbricatore is supported by a research grant from the CardioPaTh PhD Program\u0000 \u0000 \u0000 \u0000 Pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF) is an increasingly performed procedure worldwide, presenting an attractive opportunity for performing it in a day care setting.[1] The main reason for delayed discharge are the potential vascular complications that may occur.[2–5] There is still a lack of knowledge considering the usage of vascular closure devices in the electrophysiological field.\u0000 \u0000 \u0000 \u0000 The aim of the study was to evaluate feasibility, safety, and efficacy of a suture-mediated vascular closure device in ambulatory management after PVI.\u0000 \u0000 \u0000 \u0000 Prospective single-centre cohort study on 50 patients admitted for PVI from January 2020 to May 2021. At the end of the procedure, a suture-mediated vascular closure system was used for each vascular access. The feasibility of an ambulatory PVI strategy was assessed as the percentage of patients being able to be discharged the same day of the procedure. Outcomes were defined as acute rate of vascular device closure performance, postprocedural time to haemostasis, time to ambulation and time to discharge. Vascular complications, analysed on the total number of patients enrolled, were assessed during the 30-days follow-up.\u0000 \u0000 \u0000 \u0000 A total of 48/50 (96%) patients were discharged at the same day of the procedure. Haemostasis was reached within 1 minute after the deployment of the device in 30 patients (60%). During the post-operative stay, two patients had minor bleeding without necessity of intervention and one patient was kept in supine position until an ultrasound evaluation resulted negative. Mean and median time to be deemed suitable for discharge in the 48 patients who reached the primary endpoint were 4:55 (±00:54) and 4:48 (2:50-7:30) hours respectively. Mean and median time to discharge were 5:48 (± 1:03) and 5:51 (3:38-7:57) hours respectively. Patient satisfaction was queried and resulted excellent. No major vascular complications were observed during 30-days follow up. Minor complications occurred in 4 patients and were three minor superficial haematomas (<6 cm) and one transient access site related nerve injury.\u0000 \u0000 \u0000 \u0000 The use of a closure device for femoral venous accesses after PVI led to a safe discharge of patients within 6 hours from the intervention in 96% of the population. The ambulatory management described in the abstract could be useful for minimizing the overcrowding of healthcare facilities and reduce the post-operative recovery time and management. Additionally, patients were satisfied with the treatment received. Randomised trials are needed for further evaluate the efficacy of this approach.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86130097","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":"Thawing plateau time indicating the duration of phase transition from ice to water is the strongest predictor for long-term durable pulmonary vein isolation after cryoablation for atrial fibrillation","authors":"L. Shi, SY Chu, Yc Wang, E. Solheim, P. Schuster, J. Chen","doi":"10.1093/europace/euac053.258","DOIUrl":"https://doi.org/10.1093/europace/euac053.258","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Foundation. Main funding source(s): Helse Vest, Norway (LBS), and the Research Council of Norway (SYC).\u0000 \u0000 \u0000 \u0000 Cryoballoon ablation is an important method for pulmonary vein (PV) isolation in treatment of atrial fibrillation (AF). Previous studies have shown that thawing time, but not freezing time or temperature, impacts PV reconnection during long-term follow-up. However, it is unknown whether the entire or only part of the thawing stage plays a critical role.\u0000 \u0000 \u0000 \u0000 This study aimed to clarify the relationship between the durability of PV isolation and the time of phase transition from ice to water indicated by thawing plateau (TP) time during a cryoballoon ablation.\u0000 \u0000 \u0000 \u0000 In this retrospective study, 241 PVs from 71 patients who underwent a repeat AF ablation 526 (IQR: 412, 675) days after a cryoballoon ablation were analyzed. The predictive value of procedural parameters for the durability of PV isolation were evaluated. Definitions of different phases of the temperature-time curve are shown in Figure 1. TP Time is defined as the time from 0 to 10°C inside the balloon in the thawing period (the plateau on the curve).\u0000 \u0000 \u0000 \u0000 Reconnection was observed in 101 (41.9%) PVs of 53 patients (74.6%). Durable PV isolation was associated with significantly longer TP Time compared with PV reconnection (26.0 vs. 11.0 s, P<0.001). The proportion of durable PV isolations increased with TP Time in a dose-proportional manner (Figure 2). The cut point for PV reconnection was TP Time <15 s with a positive predictive value of 82.1% (sensitivity=63.4%, specificity=90.0%) while for durable PV isolation the cut point was TP Time >25 s with a positive predictive value of 84.6% (sensitivity=55.0%, specificity=86.1%). After the analysis of multivariable logistic regression, location of PV (P<0.01), and TP Time (P<0.05) were shown as independent predictors for durable PV isolation. None of nadir temperature, initial cooling time, effective freezing time, initial thawing time, or late warming time was independent predictor. Accumulated TP Time for all PVs showed a positive linear correlation with the plasma level of troponin T (ρ=0.624, P<0.01).\u0000 \u0000 \u0000 \u0000 TP Time is an independent predictor for the durability of PV isolation, and it presents in a dose-proportional manner. TP Time <15 s predicts long-term reconnection while TP Time >25 s predicts durable PV isolation.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"43 5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86058763","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":"Lead complications after cardiac surgery in danish patients with cardiac implantable electronic devices: a nationwide nested case-control study","authors":"M. Frausing, J. Nielsen, J. Johansen, OD Jorgensen, J. Kristensen, T. Olsen, C. Gerdes, M. Kronborg","doi":"10.1093/europace/euac053.528","DOIUrl":"https://doi.org/10.1093/europace/euac053.528","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Karen Elise Jensen’s Foundation\u0000 \u0000 \u0000 \u0000 Manipulation of the heart during cardiac surgery in patients with cardiac implantable electronic devices (CIEDs) may result in lead damage or -displacement, but whether cardiac surgery truly infers an excess risk of lead failure is not known.\u0000 \u0000 \u0000 \u0000 The objective of this study was to examine risk of lead complications as a result of cardiac surgery in CIED patients.\u0000 \u0000 \u0000 \u0000 We conducted a nationwide nested case-control study. Our source population comprised all patients ≥18 of age who underwent a de novo CIED implantation in Denmark between 1998 and 2017. Only patients who were alive and event-free at six months after implantation were eligible for inclusion in the case-control study. Cases were defined as incident lead complications resulting in a revision procedure, and were matched 1:30 to controls using risk set sampling. We used conditional logistic regression to estimate incidence rate ratios (IRRs) for the association between cardiac surgery and lead complications.\u0000 \u0000 \u0000 \u0000 Our population consisted of 61,869 de novo CIED patient. We identified 1324 incident cases of lead complications and 39,708 time-matched controls. 1036 cases and controls underwent cardiac surgery during follow-up; 61 cases (4.5%) and 975 controls (2.5%). Risk of lead-related reoperation was highest within the first six months of cardiac surgery (IRR 10.1, 95% CI 6.5-15.6, adjusted IRR 11.0, 95% CI 7-17.4). At one year, we observed no association between cardiac surgery and lead complications (IRR: 1.0, 95% CI 0.7-1.5 and adjusted IRR: 1.1, 95% CI 0.7-1.6).\u0000 \u0000 \u0000 \u0000 Cardiac surgery was associated with a substantial risk of lead complications in patients with de novo CIEDs. Manipulation of the heart including cannulation of the right atrium is a likely explanation for the subsequent lead problems.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86242176","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}