Europace最新文献

{"title":"Addressing SARS-CoV-2 viroporins with antiarrhythmic drugs.","authors":"Meye Bloothooft, Niels Voigt, Teun P de Boer","doi":"10.1093/europace/euae254","DOIUrl":"https://doi.org/10.1093/europace/euae254","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":"26 10","pages":""},"PeriodicalIF":7.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11481343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bipolar radiofrequency ablation of refractory ventricular arrhythmias: results from a multicentre network.","authors":"Piotr Futyma, Arian Sultan, Łukasz Zarębski, Guram Imnadze, Vera Maslova, Stefano Bordignon, Maria Kousta, Sven Knecht, Nikola Pavlović, Petr Peichl, Evgeny Lian, Thomas Kueffer, Daniel Scherr, Michael Pfeffer, Paweł Moskal, Gabriel Cismaru, Bor Antolič, Paweł Wałek, Shaojie Chen, Martin Martinek, Georgios Kollias, Michael Derndorfer, Sebastian Seidl, Boris Schmidt, Jakob Lüker, Daniel Steven, Philipp Sommer, Marek Jastrzębski, Josef Kautzner, Tobias Reichlin, Christian Sticherling, Helmut Pürerfellner, Andres Enriquez, Jonas Wörmann, Julian K R Chun","doi":"10.1093/europace/euae248","DOIUrl":"10.1093/europace/euae248","url":null,"abstract":"<p><strong>Aims: </strong>Advanced ablation strategies are needed to treat ventricular tachycardia (VT) and premature ventricular complexes (PVC) refractory to standard unipolar radiofrequency ablation (Uni-RFA). Bipolar radiofrequency catheter ablation (Bi-RFA) has emerged as a treatment option for refractory VT and PVC. Multicentre registry data on the use of Bi-RFA in the setting of refractory VT and PVC are lacking. The aim of this Bi-RFA registry is to determine its real-world safety, feasibility, and efficacy in patients with refractory VT/PVC.</p><p><strong>Methods and results: </strong>Consecutive patients undergoing Bi-RFA at 16 European centres for recurring VT/PVC after at least one standard Uni-RFA were included. Second ablation catheter was used instead of a dispersive patch and was positioned at the opposite site of the ablation target. Between March 2021 and August 2024, 91 patients underwent 94 Bi-RFA procedures (74 males, age 62 ± 13, and prior Uni-RFA range 1-8). Indications were recurrence of PVC (n = 56), VT (n = 20), electrical storm (n = 13), or PVC-triggered ventricular fibrillation (n = 2). Procedural time was 160 ± 73 min, Bi-RFA time 426 ± 286 s, and mean Uni-RFA time 819 ± 697 s. Elimination of clinical VT/PVC was achieved in 67 (74%) patients and suppression of VT/PVC in a further 10 (11%) patients. In the remaining 14 patients (15%), no effect on VT/PVC was observed. Three major complications occurred: coronary artery occlusion, atrioventricular block, and arteriovenous fistula. Follow-up lasted 7 ± 8 months. Nineteen patients (61%) remained VT free. ≥80% PVC burden reduction was achieved in 45 (78%).</p><p><strong>Conclusion: </strong>These real-world registry data indicate that Bi-RFA appears safe, is feasible, and is effective in the majority of patients with VT/PVC.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early rapid local impedance drop is associated with acute lesion efficacy during pulmonary vein isolation.","authors":"Péter Perge, Nikola Petrovic, Zoltán Salló, Katalin Piros, Vivien Klaudia Nagy, Pál Ábrahám, István Osztheimer, Béla Merkely, László Gellér, Nándor Szegedi","doi":"10.1093/europace/euae260","DOIUrl":"10.1093/europace/euae260","url":null,"abstract":"<p><strong>Aims: </strong>The predictive role of local impedance (LI) drop in lesion formation using a novel contact force sensing ablation catheter was recently described. The purpose of our current study was to assess the temporal characteristics of LI drop during ablation and its correlation with acute lesion efficacy.</p><p><strong>Methods and results: </strong>Point-by-point pulmonary vein isolation was performed. The efficacy of applications was determined by pacing along the circular ablation line and assessing loss of capture. Local impedance, contact force, and catheter position data with high resolution were analysed and compared in successful and unsuccessful applications. Five hundred and fifty-nine successful and 84 unsuccessful applications were analysed. The successful applications showed higher baseline LI (P < 0.001) and larger LI drop during ablation (P < 0.001, for all). In case of unsuccessful applications, after a moderate but significant drop from baseline to the 2 s time point (153 vs. 145 Ω, P < 0.001), LI did not change further (P = 0.99). Contradictorily, in case of successful applications, the LI significantly decreased further (baseline-2 s-10 s: 161-150-141 Ω, P < 0.001 for all). The optimal cut-point for the LI drop indicating unsuccessful application was <9 Ω at the 4-s time point [AUC = 0.73 (0.67-0.76), P < 0.001]. Failing to reach this cut-point predicted unsuccessful applications [OR 3.82 (2.34-6.25); P < 0.001].</p><p><strong>Conclusion: </strong>A rapid and enduring drop of the LI may predict effective lesion formation, while slightly changing or unchanged LI is associated with unsuccessful applications. A moderate LI drop during the first 4 s of radiofrequency application predicts ineffective radiofrequency delivery.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11493088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravascular haemolysis and acute kidney injury following atrial fibrillation ablation: a report using two different systems for pulsed field ablation.","authors":"Maarten A J De Smet, Clara François, Benjamin De Becker, Rene Tavernier, Jean-Benoît le Polain de Waroux, Sébastien Knecht, Mattias Duytschaever","doi":"10.1093/europace/euae251","DOIUrl":"10.1093/europace/euae251","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11493093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multielectrode catheter-based pulsed field ablation of persistent and long-standing persistent atrial fibrillation.","authors":"Domenico G Della Rocca, Antonio Sorgente, Luigi Pannone, María Cespón-Fernández, Giampaolo Vetta, Alexandre Almorad, Gezim Bala, Alvise Del Monte, Erwin Ströker, Juan Sieira, Ioannis Doundoulakis, Sahar Mouram, Charles Audiat, Cinzia Monaco, Sanghamitra Mohanty, Roberto Scacciavillani, Lorenzo Marcon, Kazutaka Nakasone, Wael Zaher, Ingrid Overeinder, Serge Boveda, Mark La Meir, Andrea Natale, Andrea Sarkozy, Carlo de Asmundis, Gian-Battista Chierchia","doi":"10.1093/europace/euae246","DOIUrl":"10.1093/europace/euae246","url":null,"abstract":"<p><strong>Aims: </strong>Rhythm control of non-paroxysmal atrial fibrillation (AF) is significantly more challenging, as a result of arrhythmia perpetuation promoting atrial substrate changes and AF maintenance. We describe a tailored ablation strategy targeting multiple left atrial (LA) sites via a pentaspline pulsed field ablation (PFA) catheter in persistent AF sustained beyond 6 months (PerAF > 6 m) and long-standing persistent AF (LSPAF).</p><p><strong>Methods and results: </strong>The ablation protocol included the following stages: pulmonary vein antral and posterior wall isolation plus anterior roof line ablation (Stage 1); electrogram-guided substrate ablation (Stage 2); atrial tachyarrhythmia regionalization and ablation (Stage 3). Seventy-two [age:68 ± 10years, 61.1%males; AF history: 25 (18-45) months] patients with PerAF > 6 m (52.8%) and LSPAF (47.2%) underwent their first PFA via the FarapulseTM system. LA substrate ablation (Stage 1 and 2) led to AF termination in 95.8% of patients. AF organized into a left-sided atrial flutter (AFlu) in 46 (74.2%) patients. The PFA catheter was used to identify LA sites showing diastolic, low-voltage electrograms and entrainment from its splines was performed to confirm the pacing site was inside the AFlu circuit. Left AFlu termination was achieved in all cases via PFA delivery. Total procedural and LA dwell times were 112 ± 25 min and 59 ± 22 min, respectively. Major complications occurred in 2 (2.8%) patients. Single-procedure success rate was 74.6% after 14.9 ± 2.7 months of follow-up; AF-free survival was 89.2%.</p><p><strong>Conclusion: </strong>In our cohort, PFA-based AF substrate ablation led to AF termination in 95.8% of cases. Very favourable clinical outcomes were observed during >1 year of follow-up.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11498055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detailed analysis of electrogram peak frequency to guide ventricular tachycardia substrate mapping.","authors":"Joseph Mayer, Jaffar Al-Sheikhli, Maria Niespialowska-Steuden, Ian Patchett, James Winter, Rafaella Siang, Nicolas Lellouche, Karthick Manoharan, Thanh Trung Phan, Justo Juliá Calvo, Andreu Porta-Sánchez, Ivo Roca Luque, John Silberbauer, Tarvinder Dhanjal","doi":"10.1093/europace/euae253","DOIUrl":"10.1093/europace/euae253","url":null,"abstract":"<p><strong>Aims: </strong>Differentiating near-field (NF) and far-field (FF) electrograms (EGMs) is crucial in identifying critical arrhythmogenic substrate during ventricular tachycardia (VT) ablation. A novel algorithm annotates NF-fractionated signals enabling EGM peak frequency (PF) determination using wavelet transformation. This study evaluated the algorithms' effectiveness in identifying critical components of the VT circuit during substrate mapping.</p><p><strong>Methods and results: </strong>A multicentre, international cohort undergoing VT ablation was investigated. VT activation maps were used to demarcate the isthmus zone (IZ). Offline analysis was performed to evaluate the diagnostic performance of low-voltage area (LVA) PF substrate mapping. A total of 30 patients encompassing 198 935 EGMs were included. The IZ PF was significantly higher in sinus rhythm (SR) compared to right ventricular paced (RVp) substrate maps (234 Hz (195-294) vs. 197 Hz (166-220); P = 0.010). Compared to LVA PF, the IZ PF was significantly higher in both SR and RVp substrate maps (area under curve, AUC: 0.74 and 0.70, respectively). The LVA PF threshold of ≥200 Hz was optimal in SR maps (sensitivity 69%; specificity 64%) and RVp maps (sensitivity 60%; specificity 64%) in identifying the VT isthmus. In amiodarone-treated patients (n = 20), the SR substrate map IZ PF was significantly lower (222 Hz (186-257) vs. 303 Hz (244-375), P = 0.009) compared to amiodarone-naïve patients (n = 10). The ≥200 Hz LVA PF threshold resulted in an 80% freedom from VT with a trend towards reduced ablation lesions and radiofrequency times.</p><p><strong>Conclusion: </strong>LVA PF substrate mapping identifies critical components of the VT circuit with an optimal threshold of ≥200 Hz. Isthmus PF is influenced by chronic amiodarone therapy with lower values observed during RV pacing.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11481296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive vs. standard remote monitoring of cardiac resynchronization devices in heart failure patients: results of the ECOST-CRT study.","authors":"Cédric Klein, Claude Kouakam, Arnaud Lazarus, Pascal de Groote, Christophe Bauters, Eloi Marijon, Frédéric Mouquet, Bruno Degand, Yves Guyomar, Jacques Mansourati, Christophe Leclercq, Laurence Guédon-Moreau","doi":"10.1093/europace/euae233","DOIUrl":"https://doi.org/10.1093/europace/euae233","url":null,"abstract":"<p><strong>Aims: </strong>Integrating remote monitoring (RM) into existing healthcare practice for heart failure (HF) patients to improve clinical outcome remains challenging. The ECOST-CRT study compared the clinical outcome of a comprehensive RM scheme including a patient questionnaire capturing signs and symptoms of HF and notifications for HF specific parameters to traditional RM in patients with cardiac resynchronization therapy (CRT) devices.</p><p><strong>Methods and results: </strong>Patients were randomized 1:1 to standard daily RM (notification for technical parameters and ventricular arrhythmias; control group) or comprehensive RM (adding a monthly symptom questionnaire and notifications for biventricular pacing, premature ventricular contraction, atrial arrhythmias; active group). The primary endpoint was all-cause mortality or hospitalization for worsening HF (WHF). Six hundred fifty-two patients (70.4 ± 10.3 years, 73% men, left ventricular ejection fraction 29.1 ± 7.6%, 68% CRT-Defibrillators, 32% CRT-Pacemakers) were enrolled. The COVID-19 pandemic caused an early termination of the study, so the mean follow-up duration was 18 ± 8 months. No statistically significant difference in the primary endpoint was found between the groups [59 (18.3%) control vs. 77 (23.3%) active group; log-rank test P = 0.13]. Among the secondary endpoints, the MLHF questionnaire showed a larger share of patients with improvement of quality of life compared to baseline in the active group (78%) vs. control (61%; P = 0.03).</p><p><strong>Conclusion: </strong>The study does not support the notion that comprehensive RM, when compared to standard RM, in HF patients with CRT improves the clinical outcome of all-cause mortality or WHF hospitalizations. However, this study was underpowered due to an early termination and further trials are required.</p><p><strong>Registration: </strong>Clinical Trials.gov Identifier: NCT03012490.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":"26 10","pages":""},"PeriodicalIF":7.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel systematic processing of cardiac magnetic resonance imaging identifies target regions associated with infarct-related ventricular tachycardia.","authors":"Alba Ramos-Prada, Andrés Redondo-Rodríguez, Ivo Roca-Luque, Andreu Porta-Sánchez, Rachel M A Ter Bekke, Jorge G Quintanilla, Javier Sánchez-González, Rafael Peinado, Jose Luis Merino, Matthijs Cluitmans, Robert J Holtackers, Manuel Marina-Breysse, Carlos Galán-Arriola, Daniel Enríquez-Vázquez, Sara Vázquez-Calvo, José Manuel Alfonso-Almazán, Gonzalo Pizarro, Borja Ibáñez, Juan José González-Ferrer, Ricardo Salgado-Aranda, Victoria Cañadas-Godoy, David Calvo, Julián Pérez-Villacastín, Nicasio Pérez-Castellano, David Filgueiras-Rama","doi":"10.1093/europace/euae244","DOIUrl":"10.1093/europace/euae244","url":null,"abstract":"<p><strong>Aims: </strong>There is lack of agreement on late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging processing for guiding ventricular tachycardia (VT) ablation. We aim at developing and validating a systematic processing approach on LGE-CMR images to identify VT corridors that contain critical VT isthmus sites.</p><p><strong>Methods and results: </strong>This is a translational study including 18 pigs with established myocardial infarction and inducible VT undergoing in vivo characterization of the anatomical and functional myocardial substrate associated with VT maintenance. Clinical validation was conducted in a multicentre series of 33 patients with ischaemic cardiomyopathy undergoing VT ablation. Three-dimensional LGE-CMR images were processed using systematic scanning of 15 signal intensity (SI) cut-off ranges to obtain surface visualization of all potential VT corridors. Analysis and comparisons of imaging and electrophysiological data were performed in individuals with full electrophysiological characterization of the isthmus sites of at least one VT morphology. In both the experimental pig model and patients undergoing VT ablation, all the electrophysiologically defined isthmus sites (n = 11 and n = 19, respectively) showed overlapping regions with CMR-based potential VT corridors. Such imaging-based VT corridors were less specific than electrophysiologically guided ablation lesions at critical isthmus sites. However, an optimized strategy using the 7 most relevant SI cut-off ranges among patients showed an increase in specificity compared to using 15 SI cut-off ranges (70 vs. 62%, respectively), without diminishing the capability to detect VT isthmus sites (sensitivity 100%).</p><p><strong>Conclusion: </strong>Systematic imaging processing of LGE-CMR sequences using several SI cut-off ranges may improve and standardize procedure planning to identify VT isthmus sites.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intermittent ventricular preexcitation in children: not always a low-risk condition.","authors":"Marie Laure Yammine, Pietro Paolo Tamborrino, Francesco Flore, Corrado Di Mambro, Vincenzo Pazzano, Sara Di Marzio, Fabrizio Drago","doi":"10.1093/europace/euae250","DOIUrl":"10.1093/europace/euae250","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11481285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Outcomes of catheter ablation in high-risk patients with Brugada syndrome refusing an implantable cardioverter defibrillator implantation.","authors":"","doi":"10.1093/europace/euae249","DOIUrl":"10.1093/europace/euae249","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":"26 10","pages":""},"PeriodicalIF":7.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}