Journal of Interventional Cardiac Electrophysiology最新文献

{"title":"Fluoroscopy-free cardioneuroablation for functional bradycardia: a single-center experience.","authors":"Parnia Abolhassan Choubdar, Megan Gruber, Jose Carlos Pachon-M, Stephen Manu, Mansour Razminia, John Clark","doi":"10.1007/s10840-024-01926-4","DOIUrl":"https://doi.org/10.1007/s10840-024-01926-4","url":null,"abstract":"<p><strong>Background: </strong>Cardioneuroablation (CNA) is an emerging treatment for cardioinhibitory syncope and functional AV block. This study aimed to evaluate the safety and efficacy of a fluoroless CNA approach using three-dimensional mapping and extracardiac vagal stimulation (ECVS).</p><p><strong>Methods: </strong>This prospective observational study included 22 patients (mean age 21 years) with clinically significant functional bradycardia who underwent fluoroless CNA. Procedural success was defined as elimination or significant attenuation of the vagal response to ECVS.</p><p><strong>Results: </strong>CNA was successfully performed in all patients with a mean procedure time of 251 min. Fluoroscopy was avoided in 91% of cases. At a mean follow-up of 11.4 months, 77% of patients remained symptom-free. Among pacemaker patients, 90% did not require further pacing, and 6/10 (60%) have had their pacemakers turned off. No complications were seen during the procedure.</p><p><strong>Conclusions: </strong>Fluoroscopy-free CNA is a safe and effective treatment for functional bradycardia, offering high procedural success rates and favorable symptom-free outcomes while minimizing radiation exposure.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invasive management of atrial tachycardias using a novel lattice-tip catheter combining high-density mapping and dual ablation properties: initial real-world experience.","authors":"Ourania Kariki, Panagiotis Mililis, Athanasios Saplaouras, Theodoros Efremidis, Stylianos Dragasis, Konstantinos P Letsas, Michael Efremidis","doi":"10.1007/s10840-024-01928-2","DOIUrl":"https://doi.org/10.1007/s10840-024-01928-2","url":null,"abstract":"<p><strong>Background: </strong>Invasive management of atrial tachycardias(ATs) requires proper diagnosis of the mechanism followed by elimination of the responsible substrate. A novel lattice-tip catheter with both high-density mapping and dual ablation properties(radiofrequency-RF/pulsed field ablation-PFA) has been recently introduced for catheter ablation of atrial fibrillation. We present the first study to assess its performance in the management of ATs (diagnostic and therapeutic).</p><p><strong>Methods: </strong>Patients with documented ATs were selected. Activation mapping was used for the establishment of the AT mechanism. Confirmation with entrainment was performed, whenever appropriate. Accuracy of the activation mapping in diagnosis, acute ablation efficacy, and procedural characteristics were the study endpoints.</p><p><strong>Results: </strong>Twenty patients were included (12 cavotricuspid isthmus-dependent atrial flutters, 5 mitral flutters, 2 roof flutters, and 2 focal ATs). Proper diagnosis was established by activation mapping in all cases. The mean mapping time was 7.85 ± 3.06 min with 296.82 ± 150.9 mean mapping points/minute. The mean ablation time was 54.25 ± 42.97 s. Conversion to sinus rhythm during ablation was achieved in all cases with the exception of a roof flutter that converted to mitral flutter and a case of a parahisian AT in which ablation was not attempted. Patients that received ablation did not experience any arrhythmia recurrence in a mean follow up of 4.14 ± 0.91 months. No major or minor complications occurred.</p><p><strong>Conclusion: </strong>The lattice-tip catheter and its dedicated electroanatomical mapping system provided sufficiently detailed activation mapping for the diagnosis of the AT mechanism. The delivered lesions were highly effective acutely, with no adverse events. However, limitations exist and should be acknowledged.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peak frequency mapping in Brugada Syndrome.","authors":"Paulo Medeiros, Pedro A Sousa, Carolina Saleiro, Natália António, Patrícia Alves, João Ferreira, Luís Elvas, Lino Gonçalves","doi":"10.1007/s10840-024-01925-5","DOIUrl":"https://doi.org/10.1007/s10840-024-01925-5","url":null,"abstract":"","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The potato model: A root of all pulsed field ablation experimentation?","authors":"Martin van Zyl, Christopher V DeSimone","doi":"10.1007/s10840-024-01924-6","DOIUrl":"https://doi.org/10.1007/s10840-024-01924-6","url":null,"abstract":"","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardioneuroablation for the management of neurally mediated syncope, sinus bradycardia, and atrioventricular block.","authors":"Jamario Skeete, Jonathan S Gordon, Lincoln Kavinksy, Henry D Huang, Tolga Aksu","doi":"10.1007/s10840-024-01923-7","DOIUrl":"https://doi.org/10.1007/s10840-024-01923-7","url":null,"abstract":"<p><p>Through several decades of medical advances, we have improved our understanding of the role of the autonomic nervous system in the production of a myriad of clinical cardiac conditions such as vasovagal syncope, situational syncope, carotid sinus hypersensitivity, vagally mediated sinus bradycardia, and atrioventricular block. While typically not associated with mortality, these common clinical entities may result in significant patient symptoms and morbidity and are often characterized by a frustrating treatment course with a paucity of effective strategies. In recent years, there has been increased interest in the management of these conditions via direct modulation of the parasympathetic component of the autonomic nervous system. This is achieved by targeting the ganglionated plexus central to the pathogenesis of these conditions via cardioneuroablation. The primary role of this strategy is evolving and serves to augment traditional treatment strategies such as lifestyle modification and pharmacotherapy. In this review, we examine the principles governing the role of cardioneuroablation in select populations with vasovagal syncope, sinus dysfunction, and atrioventricular block including the evolving evidence in this exciting field while keeping in mind the need for robust clinical studies examining the long-term effectiveness and safety.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of atrial fibrillation ablation in community hospitals with and without onsite cardiothoracic surgery availability.","authors":"Olatunde Ola, S Michael Gharacholou, Abhishek J Deshmukh, Arturo M Valverde, Christopher G Scott, Alexander T Lee, Freddy Del-Carpio Munoz","doi":"10.1007/s10840-024-01920-w","DOIUrl":"https://doi.org/10.1007/s10840-024-01920-w","url":null,"abstract":"<p><strong>Background: </strong>Limited data exist on outcomes of atrial fibrillation (AF) catheter ablation based on hospital setting and, specifically, the availability of onsite cardiothoracic surgery (CTS). We aimed to describe the characteristics and outcomes of catheter ablation for AF performed at a facility with and without CTS.</p><p><strong>Methods: </strong>This was a retrospective study of consecutive patients who underwent catheter ablation for AF at hospital with (CTS) and without cardiothoracic surgery (N-CTS) from January 2011 through December 2019. Clinical and procedural characteristics, complications, and 1-year outcomes, including clinical events and AF recurrence, were collected.</p><p><strong>Results: </strong>There were 326 unique patients who underwent an index AF ablation procedure: 206 CTS patients and 120 N-CTS patients. There were no differences in overall cardiac complications (2.5% vs. 5.8%), including mapping catheter entrapment requiring open-heart surgery (0% vs. 0.5%), pericardial effusion requiring pericardiocentesis (0.8% vs. 0.5%), hemopericardium (1.7% vs. 0.5%), acute myocardial infarction (0% vs. 1.0%), and sinus node injury (0% versus 0.5%) (all P values > .05) between N-CTS and CTS patients. Likewise, overall noncardiac complications (20.7% vs. 19.8%, P = .85), including bleeding, cerebrovascular accident, and phrenic or vagus nerve injury, were similar between N-CTS and CTS hospitals. Also, 1-year cumulative Kaplan-Meier estimates of overall AF recurrence (11.6% vs. 16.4%; log-rank P = 0.21; HR 1.47; 95% CI, 0.79-2.74) were not statistically significant between N-CTS and CTS hospitals.</p><p><strong>Conclusion: </strong>Catheter ablation procedure is safe and effective regardless of onsite CTS presence, and there were no significant differences between the two hospital settings.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT-scan-guided-irrigated trans-catheter ablation of epicardial accessory pathways in the coronary sinus: safety and feasibility in pediatric patients.","authors":"Fabrizio Drago, Francesco Flore, Rita Blandino, Aurelio Secinaro, Ilaria Cazzoli, Cristina Raimondo, Corrado Di Mambro","doi":"10.1007/s10840-024-01921-9","DOIUrl":"https://doi.org/10.1007/s10840-024-01921-9","url":null,"abstract":"<p><strong>Background: </strong>The most common site of epicardial APs is posterior-septal, and ablation from the coronary sinus (CS) or its main tributaries is needed. However, particularly in children, it can carry a considerable risk of complications, such as coronary artery (CA) injury, CS damage, and perforation. This study aims to assess the efficacy and safety of computed tomography (CT)-scan-guided-irrigated trans-catheter (TC) ablation of epicardial APs through the CS in children.</p><p><strong>Methods: </strong>Twenty-four children (19 males; mean age 13.8 ± 2.6) with posterior-septal and left posterior epicardial APs who underwent an endocavitary electrophysiological study (EPS) and TC ablation from the CS were enrolled in this study. All patients underwent a CT scan to visualize the CS and its branches and their proximity to the CAs before the ablation. Clinical, electrophysiological and follow-up data were collected.</p><p><strong>Results: </strong>Acute success rate was 87.5% (21 out of 24 procedures). No complications occurred. In 16 (66.7%) patients, the ablation site was detected at the proximal CS, in two (8.3%) patients in the mid-proximal CS and in six (25%) in the middle cardiac vein (MCV). Ablation was achieved using an irrigated radiofrequency (RF) catheter in all patients and without the use of fluoroscopy in 20 patients (83.3%). Over a median follow-up of 15.1 months (IQR 2.5-32.3), no recurrences or complications occurred.</p><p><strong>Conclusion: </strong>Epicardial posterior-septal and left posterior APs, in the area of CS or MCV, can be definitively eliminated in most children using CT-scan-guided electro-anatomical mapping and transvenous irrigated RF ablation.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons from ablation responses to preferential wavefront in typical atrial flutter","authors":"Linlin Wang, Xiangwei Ding, Weizhu Ju, Hongwu Chen, Kai Gu, Mingfang Li, Minglong Chen, Gang Yang","doi":"10.1007/s10840-024-01911-x","DOIUrl":"https://doi.org/10.1007/s10840-024-01911-x","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>The heterogeneous conduction properties through the cavotricuspid isthmus (CTI) in typical atrial flutter (AFL) have not yet been well elucidated.</p><h3 data-test=\"abstract-sub-heading\">Objective</h3><p>We sought to investigate preferential conduction through the CTI and the efficacy of ablation targeting preferential wavefront (PW) guided by ultra-high-resolution mapping.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>In retrospective study, 28 patients were enrolled. Wavefront propagation patterns through the CTI and ablation responses at the location of PW were evaluated. In the following prospective study, 23 patients with predominant PW across the CTI were enrolled and assigned to the arm of PW prior ablation and the arm of conventional ablation.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Five activation patterns were noticed in the retrospective study. The termination sites were exactly located at the PW in 18 of 28 patients (64.3%). The width of the PW in direct termination group was significantly narrower than that in the CL prolongation before termination group (16.6 ± 1.0 mm vs. 23.3 ± 3.4 mm, respectively, <i>p</i> = 0.025). In the prospective study, the voltage of PW region was significantly higher than non-PW regions both from unipolar and bipolar mapping. 21 of 23 patients (91.3%) were terminated at PW. AFL could no longer be induced immediately after termination. The time from radiofrequency application to AFL termination and to achieve bidirectional conduction block was significantly shorter in PW prior ablation arm than that in conventional ablation group (<i>p</i> &lt; 0.05).</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Ablation targeting the PW first could be more efficient to terminate typical AFL and to achieve the endpoint of bidirectional conduction block.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142208338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct-to-catheter ablation versus second line catheter ablation for persistent atrial fibrillation: Effect on arrhythmia recurrence, AF burden, early left atrium remodeling and quality of life","authors":"Hadi Younes, Besim Ademi, Eli Tsakiris, Han Feng, Amitabh C. Pandey, Mario Mekhael, Charbel Noujaim, Chanho Lim, Lilas Dagher, Abdel Hadi El Hajjar, Ghassan Bidaoui, Mayana Bsoul, Ala Assaf, Swati Rao, Christian Mahnkopf, Ghaith Shamaileh, Omar Kreidieh, Abboud Hassan, Yinshuo Liu, Yishi Jia, Francisco T. Polo, Nassir F. Marrouche, Eoin Donnellan","doi":"10.1007/s10840-024-01916-6","DOIUrl":"https://doi.org/10.1007/s10840-024-01916-6","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Catheter ablation has obtained class 1 indication in ablation of young, healthy patients with symptomatic paroxysmal atrial fibrillation (AF). Anti-arrhythmic drugs (AADs) remain first-line therapy before ablating persistent AF (PersAF). We sought to evaluate the efficacy of a direct-to-catheter ablation approach against catheter ablation post AADs in PersAF.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>In this DECAAF II subanalysis, patients were stratified into two subgroups: ‘Direct-to-catheter’ group comprising patients who had not received AADs prior to ablation, and’second-line ablation’ group, comprising patients who had been on any AAD therapy at any time before ablation. Patients were followed over 18 months. The primary outcome was AF recurrence. Secondary outcomes included AF burden, quality of life (QoL) that assessed by the AFSS and SF-36 scores, and changes in the left atrial volume index (LAVI) assessed by LGE-MRI scans.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The analysis included 815 patients, with 279 classified as’direct-to-catheter’ group and 536 classified as’Second-line ablation’ group. The primary outcome was similar between both groups (44.8% vs 44.4%, p &gt; 0.05), as was AF burden (20% vs 16%, p &gt; 0.05). Early remodeling, reflected by LAVI reduction, was similar between the groups (9.1 [1.6—18.0] in the second-line ablation group and 9.5 [2.5—19.7] in the direct-to-catheter group, p &gt; 0.05). QoL pre/post ablation was also similar (p &gt; 0.05). On multivariate analysis, history of AAD was not predictive of AF recurrence(p &gt; 0.05).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Prior AAD therapy demonstrated minimal impact on atrial remodeling and QoL improvement, in addition to limited benefit on AF recurrence and burden post-ablation in patients with PersAF. Additional studies are warranted to explore the efficacy of catheter ablation as a first-line therapy in PersAF.</p><h3 data-test=\"abstract-sub-heading\">Graphical Abstract</h3>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142208337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided femoral venipuncture for catheter ablation of atrial fibrillation","authors":"Jana Hašková, Josef Kautzner, Petr Peichl, Predrag Stojadinovič, Bashar Aldhoon, Peter Štiavnický, Eva Borišincová, Jiří Plášek, Robert Čihák, Dan Wichterle","doi":"10.1007/s10840-024-01918-4","DOIUrl":"https://doi.org/10.1007/s10840-024-01918-4","url":null,"abstract":"","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142226441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}