Journal of Interventional Cardiac Electrophysiology最新文献

{"title":"Is day-case surgical procedure safe for MICRA leadless pacemaker implantation?","authors":"Lin-Thiri Toon, Mohammed ElRefai, Mohamed Abouelasaad, Roopa Patil, John Paisey, Arthur Yue, Paul Roberts","doi":"10.1007/s10840-024-01907-7","DOIUrl":"10.1007/s10840-024-01907-7","url":null,"abstract":"<p><strong>Background: </strong>MICRA implantation is not commonly done as a day-case procedure. Elective leadless pacemakers are implanted routinely in our centre.</p><p><strong>Objective: </strong>To assess whether the day-case MICRA procedure is safe.</p><p><strong>Methods: </strong>We retrospectively collected data from all patients undergoing elective MICRA implantation at our centre between May 2014 and Nov 2022 (n = 81). Two patient groups were stratified: those planned to be discharged on the same day (SD, n = 52) and those planned to be observed overnight after the procedure (ON, n = 29). Patient demographics, size of the sheath used, type of MICRA device, and rate of complications were recorded. In patients with successful implants (n = 80), device function at discharge and first routine follow-up were evaluated.</p><p><strong>Results: </strong>There were 58% males in the SD group and 45% in the ON group. Median age was 49 years in the SD and 67 years in the ON. Among patients who were planned as a day case, 8 patients had to stay in the hospital but for < 48 h: 2 due to minor groin bleeding, 1 due to patient's request despite fit to discharge, 4 due to the procedure carried out later in the day, and 1 for observation due to procedural complexity. MICRA implantation was successful in 80 patients. The rate of the major complications was 2% in the SD group and 7% in the ON group (p = 0.223), and none of the co-morbidities assessed showed an association with any complications. Device parameters at the follow-up were available in 76 patients. The rate of patients with low and stable PCT at follow-up was also 98% in the SD group and 96% in the ON group.</p><p><strong>Conclusions: </strong>Day case MICRA procedure can be performed safely in an appropriately selected patient population.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"117-123"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mid-term clinical outcomes of left bundle branch area pacing compared to accurate right ventricular septal pacing.","authors":"Yousaku Okubo, Takumi Sakai, Shogo Miyamoto, Yukimi Uotani, Naoto Oguri, Motoki Furutani, Shunsuke Miyauchi, Sho Okamura, Takehito Tokuyama, Yukiko Nakano","doi":"10.1007/s10840-024-01890-z","DOIUrl":"10.1007/s10840-024-01890-z","url":null,"abstract":"<p><strong>Background: </strong>Although left bundle branch area pacing (LBBAP) reportedly results in fewer adverse outcomes after implantation than conventional stylet-guided right ventricular septal pacing (RVSP), previous studies have not compared LBBAP with accurate RVSP using a delivery catheter. The aim of this study was to compare clinical outcomes between LBBAP and accurate RVSP among patients with atrioventricular block (AVB).</p><p><strong>Methods: </strong>This single-center observational study enrolled 160 patients requiring RV pacing due to symptomatic AVB between September 2018 and December 2021. Primary composite outcomes included all-cause death, hospitalization due to heart failure (HF), and upgrading to biventricular pacing. Secondary composite outcomes included any procedural and postprocedural complications.</p><p><strong>Results: </strong>Overall, 160 patients were analyzed (LBBAP, n = 81; RVSP, n = 79). No significant differences in baseline characteristics were observed between the two groups. The RV pacing burden at 1 year after implantation was 90.8% ± 20.4% and 86.2% ± 22.6%, respectively (p = 0.21). During a mean follow-up of 840 ± 369 days, the incidence of the primary outcome was significantly lower with LBBAP (4.9%) compared to RVSP (22.8%) (Log-rank p = 0.02). There was no significant difference in the incidence of the secondary outcome between the two groups (3.7% vs. 5.1%, p = 0.65). In the multivariate analysis, baseline QRS duration, RV pacing burden, and LBBAP were independently associated with the primary outcome (baseline QRS duration: hazard ratio [HR], 1.01; 95% confidence interval [CI], 1.00-1.02; p < 0.001; RV pacing burden: HR, 1.01; 95% CI, 1.00-1.02; p < 0.001; LBBAP: HR, 0.45; 95% CI, 0.31-0.64; p < 0.001).</p><p><strong>Conclusion: </strong>In patients requiring frequent RV pacing, LBBAP was associated with reduced adverse clinical outcome compared to accurate RVSP using a delivery catheter.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"55-63"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of conduction system pacing compared to biventricular pacing in patients with mid-range ejection fraction.","authors":"Jiaojiao Tang, Nathan W Kong, Andrew Beaser, Zaid Aziz, Srinath Yeshwant, Cevher Ozcan, Roderick Tung, Gaurav A Upadhyay","doi":"10.1007/s10840-024-01882-z","DOIUrl":"10.1007/s10840-024-01882-z","url":null,"abstract":"<p><strong>Background: </strong>There is a paucity of data comparing conduction system pacing (CSP) to biventricular pacing (BiVP) in patients with heart failure (HF) with mid-range left ventricular ejection fraction (LVEF).</p><p><strong>Objective: </strong>Compare the clinical outcomes of patients with mid-range LVEF undergoing CSP versus BiVP.</p><p><strong>Methods: </strong>Patients with mid-range LVEF (> 35 to 50%) undergoing CSP or BiVP were retrospectively identified. Lead performance, LVEF, HF hospitalization, and clinical composite outcome including upgrade to cardiac resynchronization therapy and mortality were compared.</p><p><strong>Results: </strong>A total of 36 patients (20 BiVP, 16 CSP--14 His bundle pacing, 4 left bundle branch area pacing) were analyzed. The mean age was 73 ± 15, 44% were female, and the mean LVEF was 42 ± 5%. Procedural and fluoroscopy time was comparable between the two groups. QRS duration was significantly shorter for the CSP group compared to the BiVP group (P < 0.001). During a mean follow-up of 47 ± 36 months, no significant differences were found in thresholds or need for generator change due to early battery depletion. LVEF improved in both groups (41.5 ± 4.5% to 53.9 ± 10.9% BiVP, P < 0.001; 41.6 ± 5.3% to 52.5 ± 8.3% CSP, P < 0.001). There were no significant differences in HF hospitalizations (P = 0.71) or clinical composite outcomes (P = 0.07).</p><p><strong>Conclusion: </strong>Among patients with HF with moderately reduced ejection fraction, CSP appears associated with similar improvements in LVEF and had similar clinical outcomes as BiVP in mid-term follow-up.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"111-116"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995862","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":"Implantation of a permanent pacemaker following orthotopic heart transplantation: a systematic review and meta-analysis.","authors":"Patavee Pajareya, Sathapana Srisomwong, Noppachai Siranart, Ponthakorn Kaewkanha, Yanisa Chumpangern, Narut Prasitlumkum, Jakrin Kewcharoen, Ronpichai Chokesuwattanaskul, Nithi Tokavanich","doi":"10.1007/s10840-024-01909-5","DOIUrl":"10.1007/s10840-024-01909-5","url":null,"abstract":"<p><strong>Background: </strong>Orthotopic heart transplant (OHT) is among the final armamentariums for end-stage heart disease. Many patients who have had OHT require a post-transplant permanent pacemaker (PPM) implantation due to an abnormal conduction system. We aimed to evaluate the risk of mortality and acute rejection in patients with OHT who had received PPM compared to patients without PPM and to determine predictors for PPM placement in this population.</p><p><strong>Methods: </strong>We comprehensively searched for studies from MEDLINE, EMBASE, and Cochrane databases from inception to September 2023. Inclusion criteria focused on patients who had undergone OHT and PPM implantation post-transplant. Data from each study were combined using a random-effects model. Results were expressed as relative risk (RR) or odd ratios (OR) with a 95% confidence interval (CI).</p><p><strong>Results: </strong>A total of 9 studies were included in this meta-analysis incorporating a total of 54,848 patients (3.3% had PPM). The pooled all-cause mortality rate among patients with PPM post-OHT was 26% (95% CI: 19-33%, I² = 1%). There were no differences between post-heart transplant patients with PPM and those without PPM in risk of all-cause mortality (RR 0.76, 95% CI: 0.43-1.34; I² = 45%) and acute rejection (RR 1.22, 95% CI: 0.74-2.00, I² = 59%). Bi-atrial anastomosis was associated with an increased risk of PPM implantation post-OHT (OR 7.74, 95% CI: 3.55-16.91, I² = 0%), while pre-OHT mechanical circulatory support (MCS) was associated with a decreased risk of PPM implantation post-OHT (OR 0.45, 95% CI 0.27-0.76, I² = 0%).</p><p><strong>Conclusion: </strong>There were no significant differences in all-cause mortality or acute rejection between post-OHT recipients who required PPM compared to those who did not receive PPM. Further, bi-atrial anastomosis portended the need for PPM implantation, while MCS was associated with a decreased occurrence of PPM.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"167-177"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072955","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":"Omnipolar mapping for increased precision in atrial fibrillation ablation.","authors":"Shivaraj Patil, Abhishek Deshmukh, Christopher V DeSimone","doi":"10.1007/s10840-024-01917-5","DOIUrl":"10.1007/s10840-024-01917-5","url":null,"abstract":"","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"29-30"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132969","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":"Incidence and risk factors for first and recurrent ICD shock therapy in patients with an implantable cardioverter defibrillator.","authors":"Diana My Frodi, Søren Zöga Diederichsen, Lucas Yixi Xing, Daniel Camillo Spona, Peter Karl Jacobsen, Niels Risum, Jesper Hastrup Svendsen","doi":"10.1007/s10840-024-01873-0","DOIUrl":"10.1007/s10840-024-01873-0","url":null,"abstract":"<p><strong>Background: </strong>Advances in medical treatment and outcomes in implantable cardioverter-defibrillator (ICD) recipients incentivize a need for improved candidate selection and identification of risk factors for ICD therapy. We examined contemporary rates of and risk factors for ICD therapy.</p><p><strong>Methods: </strong>Patients with ICD for primary (PP) or secondary prevention (SP), implanted between January 2010 and December 2020, were followed for appropriate and inappropriate incident and recurrent shock.</p><p><strong>Results: </strong>Overall, 2998 patients (mean age 61.8 ± 12.7 years, 20% female, 73% ICD carriers, and 47.1% SP) were analyzed with a median follow-up of 4.3 (interquartile range (IQR) 2.1-7.4) years. A total of 426/2998 (14.2%) patients had shock; 364/2998 (12.1%) had appropriate and 82/2998 (2.7%) inappropriate shock, with annualized event rates of 2.34 (2.11-2.59) and 0.49 (0.39-0.61) per 100 person-years, respectively. Of those with shock, 133/364 (36.5%) experienced recurrent appropriate shock and 8/364 (2.2%) received recurrent inappropriate shock, with event rates of 10.57 (8.85-12.53) and 0.46 (0.20-0.92), respectively. In multivariable analyses, female sex was associated with a reduced risk of incident appropriate shock (hazard ratio 0.69 [95% confidence interval 0.52; 0.91]). Of other variables, only revascularization status was associated with recurrent appropriate shock in PP, and CRT-D with recurrent appropriate shock in the overall cohort.</p><p><strong>Conclusion: </strong>One in eight ICD recipients received appropriate shock 2-7 years after guideline-directed implantation. More than one-third of patients with a first shock experienced recurrent shock. Few clinical variables showed potential in predicting shocks, illustrating a need for more advanced tools to select candidates for implantation.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"125-139"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing pulsed field ablation with very high-power and high-power short-duration radiofrequency ablation for atrial fibrillation: a systematic review and meta-analysis.","authors":"Elísio Bulhões, Roberto A S V Mazetto, Antunes L Vanio, Maria L R Defante, Luanna Feitoza, Camila Guida, Henry Huang","doi":"10.1007/s10840-024-01970-0","DOIUrl":"https://doi.org/10.1007/s10840-024-01970-0","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation is a key treatment for atrial fibrillation (AF), with high-power, very high-power short-duration and pulsed field ablation (PFA) being efficient options. However, direct comparisons between these techniques are lacking.</p><p><strong>Objective: </strong>We performed a systematic review and meta-analysis, which included predominantly observational studies (four retrospective and one prospective study), to compare PFA and High-power short-duration (HPSD) and very high-power short-duration (vHPSD) radiofrequency (RF) ablation in patients with AF.</p><p><strong>Methods: </strong>We searched PubMed, Embase and Cochrane Central. Outcomes of interest included: Arrhythmia-free survival (AF, atrial flutter, and atrial tachycardia recurrences 30 s during follow-up after a 1-month blanking period), procedure time, fluoroscopy time, fluoroscopy dose, complications overall. Statistical analysis was performed using the R program (version 4.3.2). Heterogeneity was assessed with I² statistics.</p><p><strong>Results: </strong>Our meta-analysis included 1,255 patients from 5 studies, with a mean age ranging from 63 to 68 years. Among them, 554 (45.2%) underwent pulsed field ablation (PFA) and 701 (55.8%) received high/very high potential short-duration ablation. PFA improved arrhythmia-free survival (RR 1.05; 95% CI 1.002-1.120; P = 0.004; I² = 0%) and reduced procedure time (MD -29.95 min; 95% CI -30.90 to -29.00; P < 0.01; I² = 0%). However, PFA increased fluoroscopy time (MD 6.33 min; 95% CI 1.65 to 11.01; P < 0.01; I² = 98%) and showed no significant difference in overall complications (RR 0.88; 95% CI 0.38-2.02; P = 0.756; I² = 47%), cardiac tamponade (RR 1.62; 95% CI 0.27-9.85; P = 0.599; I² = 40%), or stroke/transient ischemic attack (TIA) incidence (RR 0.64; 95% CI 0.15-2.80; P = 0.555; I² = 0%). PFA was associated with a reduced need for redo procedures (RR 0.66; 95% CI 0.45-0.97; P = 0.036; I² = 0%) and did not significantly affect the fluoroscopy dose (MD 896.86 mGy·cm²; 95% CI -1269.44 to 3063.15; P = 0.42; I² = 39%).</p><p><strong>Conclusion: </strong>In this meta-analysis, PFA was associated with improved arrhythmia-free survival and reduced procedure time, although it resulted in increased fluoroscopy time. PFA and high/very high power short-duration ablation yielded similar outcomes regarding overall complications, cardiac tamponade, and stroke/TIA incidence. Both techniques demonstrated comparable efficacy in treating atrial fibrillation.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909734","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":"Long-term impact of atrial fibrillation catheter ablation on heart failure with preserved ejection fraction.","authors":"Harsh Patel, Rezwan Munshi, Aakash Sheth, Siddharth Agarwal, Freddy Del-Carpio Munoz, Guru Kowlgi, Christopher V DeSimone, Mohamed Rafa Labedi, Sourbha Dani, Abhishek Deshmukh","doi":"10.1007/s10840-024-01939-z","DOIUrl":"https://doi.org/10.1007/s10840-024-01939-z","url":null,"abstract":"<p><strong>Background: </strong>The efficacy of catheter ablation as a treatment approach for patients with concurrent atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) has been inadequately investigated.</p><p><strong>Objective: </strong>This study's objective was to assess the effectiveness of atrial fibrillation ablation (AFA) in patients with heart failure with preserved ejection fraction.</p><p><strong>Methods: </strong>Utilizing the TriNetX research network, we identified individuals aged 18 and older with atrial fibrillation (AF) and concurrent heart failure with preserved ejection fraction (HFpEF) from January 1, 2010, to June 1, 2021. Patients were further classified based on their catheter ablation procedure, using Current Procedural Terminology codes. Following propensity-score matching, each cohort consisted of 9440 patients. The primary endpoint was all-cause mortality at two years and secondary outcomes during the 2-year follow-up encompassing readmissions for heart failure, AF, and stroke.</p><p><strong>Results: </strong>In propensity-matched cohort, patients with AF and HFpEF who underwent AFA plus medical therapy had significantly lower all-cause mortality at two years than those who did not undergo AFA (hazard ratio (HR): 0.37, 95% CI: 0.34-0.40; P < 0.001) even after matching antiarrhythmic medications. At two years, secondary outcomes including HF readmissions (HR: 0.86 95% CI: 0.84-0.89; P < 0.001) and stroke readmissions (HR: 0.66 95% CI: 0.59-0.73; P < 0.001) were lower in the AFA group.</p><p><strong>Conclusion: </strong>AFA amongst AF patients with concomitant HFpEF showed a significant reduction in all-cause mortality. It also leads to significant reductions in readmissions due to HF and ischemic stroke at two years.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877149","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":"Image quality assessment and automation in late gadolinium-enhanced MRI of the left atrium in atrial fibrillation patients.","authors":"Benjamin Orkild, K M Arefeen Sultan, Eugene Kholmovski, Eugene Kwan, Erik Bieging, Alan Morris, Greg Stoddard, Rob S MacLeod, Shireen Elhabian, Ravi Ranjan, Ed DiBella","doi":"10.1007/s10840-024-01971-z","DOIUrl":"10.1007/s10840-024-01971-z","url":null,"abstract":"<p><strong>Background: </strong>Late gadolinium-enhanced (LGE) MRI has become a widely used technique to non-invasively image the left atrium prior to catheter ablation. However, LGE-MRI images are prone to variable image quality, with quality metrics that do not necessarily correlate to the image's diagnostic quality. In this study, we aimed to define consistent clinically relevant metrics for image and diagnostic quality in 3D LGE-MRI images of the left atrium, have multiple observers assess LGE-MRI image quality to identify key features that measure quality and intra/inter-observer variabilities, and train and test a CNN to assess image quality automatically.</p><p><strong>Methods: </strong>We identified four image quality categories that impact fibrosis assessment in LGE-MRI images and trained individuals to score 50 consecutive pre-ablation atrial fibrillation LGE-MRI scans from the University of Utah hospital image database. The trained individuals then scored 146 additional scans, which were used to train a convolutional neural network (CNN) to assess diagnostic quality.</p><p><strong>Results: </strong>There was excellent agreement among trained observers when scoring LGE-MRI scans, with inter-rater reliability scores ranging from 0.65 to 0.76 for each category. When the quality scores were converted to a binary diagnostic/non-diagnostic, the CNN achieved a sensitivity of <math><mrow><mn>0.80</mn> <mo>±</mo> <mn>0.06</mn></mrow> </math> and a specificity of <math><mrow><mn>0.56</mn> <mo>±</mo> <mn>0.10</mn></mrow> </math> .</p><p><strong>Conclusion: </strong>The use of a training document with reference examples helped raters achieve excellent agreement in their quality scores. The CNN gave a reasonably accurate classification of diagnostic or non-diagnostic 3D LGE-MRI images of the left atrium, despite the use of a relatively small training set.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872226","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":"Very high-power short-duration radiofrequency ablation in patients with typical atrial flutter: rationale and design of the FASD-HP randomized trial.","authors":"Laura Valverde Soria, Jorge Toquero, Thomas Brouzet, Laura García Cano, Ana García Barrios, Melodie Segura Domínguez, Gloria A Hermón Ramírez, Raquel Ajo Ferrer, María Ajo Ferrer, Celia María Andreu Concha, Vicente Arrarte Esteban, Angel Sánchez Barbié, Juan Gabriel Martínez-Martínez, Alicia Ibáñez Criado, José Luis Ibáñez Criado","doi":"10.1007/s10840-024-01969-7","DOIUrl":"https://doi.org/10.1007/s10840-024-01969-7","url":null,"abstract":"<p><strong>Background: </strong>The aim of cavotricuspid isthmus (CTI)-dependent flutter ablation is the bidirectional conduction block of the CTI. Very-high-power short-duration (vHPSD) radiofrequency ablation aims to minimize conductive heating and increase resistive heating to create shallower but wider lesions in a very short time, while reducing the risk of collateral tissue damage. Experimental studies have shown that it produces effective transmural lesions with an equal or better safety profile compared to conventional parameters. There are published and ongoing trials studying long-term outcomes of this technique for pulmonary vein isolation, but there is a lack of evidence regarding its use in flutter ablation.</p><p><strong>Methods and results: </strong>Multicenter 1:1 randomized, single-blind study. Two CTI ablation strategies are compared: (1) conventional treatment arm consisting of 25-40-W applications of unlimited duration until reaching the minimum value of one of the currently accepted lesion markers (Ablation Index > 500 at the anterior half of the CTI and > 400 at the posterior half with CARTO3 system); (2) experimental treatment arm consisting of CTI block using point-by-point applications of very-high-power (90 W) short duration (4 s). The primary objective is to evaluate the non-inferiority of the efficacy and safety of vHPSD ablation in patients undergoing typical flutter ablation. Secondary objectives include comparison of total radiofrequency time, number of applications, number of steam pops, percentage of reconnections, procedure duration, pain during the procedure, and time to flutter recurrence.</p><p><strong>Conclusions: </strong>The FASD-HP trial is the first clinical trial to investigate the non-inferiority of CTI ablation with vHPSD in patients with typical atrial flutter.</p><p><strong>Clinical trial registration number: </strong>The study was registered at http://www.</p><p><strong>Clinicaltrials: </strong>gov (NCT05777850) on March 21, 2023.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872235","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}