Abhinav Sehgal, Arati Gangadharan, Herman A Carneiro, Graham Peigh, Jessica Charron, Graham Lohrmann, Mahmoud Elsayed, Jayson Baman, Anna Pfenniger, Kaustubha Patil, Alexandru Chicos, Rishi Arora, Susan S Kim, Albert Lin, Rod Passman, Bradley P Knight, Nishant Verma
{"title":"Safety and feasibility of intravenous sotalol loading for the prevention of ventricular arrhythmias.","authors":"Abhinav Sehgal, Arati Gangadharan, Herman A Carneiro, Graham Peigh, Jessica Charron, Graham Lohrmann, Mahmoud Elsayed, Jayson Baman, Anna Pfenniger, Kaustubha Patil, Alexandru Chicos, Rishi Arora, Susan S Kim, Albert Lin, Rod Passman, Bradley P Knight, Nishant Verma","doi":"10.1007/s10840-024-01829-4","DOIUrl":"10.1007/s10840-024-01829-4","url":null,"abstract":"<p><strong>Background: </strong>The use of intravenous (IV) sotalol loading following recent U.S. Food and Drug Administration (FDA) approval of a 1-day loading protocol has reduced the obligatory 3-day hospital stay for sotalol initiation when given orally. Several studies have recently demonstrated the safety and feasibility of IV loading for patients with atrial arrhythmias. However, there is a paucity of data on the feasibility and safety of IV sotalol loading for patients with ventricular arrhythmias. This study aims to assess the safety, feasibility, and length of stay (LOS) outcomes of IV sotalol loading for the prevention of ventricular arrhythmias.</p><p><strong>Methods: </strong>A retrospective analysis was performed of all patients undergoing IV sotalol loading and oral sotalol initiation for ventricular arrhythmias, or IV sotalol loading for atrial arrhythmias between August 2021 and December 2023 at Northwestern University. Baseline characteristics, success of sotalol initiation/loading, changes in heart rate (HR) and QT/QTc, safety, and LOS were compared between patients undergoing sotalol loading/initiation for ventricular arrhythmias (IV vs. PO) and between patients undergoing IV sotalol loading for ventricular arrhythmias vs. for atrial arrhythmias.</p><p><strong>Results: </strong>A total of 28 patients underwent sotalol loading/initiation for ventricular arrhythmias (N = 15 IV and N = 13 PO) and 41 patients underwent IV sotalol loading for atrial arrhythmias. Baseline characteristics of congestive heart failure history and left ventricular ejection fraction were worse in the ventricular arrhythmias group. There was no significant difference in the successful completion of IV sotalol loading for ventricular arrhythmias compared to oral sotalol initiation for ventricular arrhythmias or IV sotalol loading for atrial arrhythmias (86.7% vs. 92.3% vs. 90.2%, p = 0.88). There was a significant increase in ΔQTc following IV sotalol infusion for ventricular arrhythmias compared to following PO sotalol initiation for ventricular arrhythmias (46.4 ± 29.2 ms vs. 8.9 ± 32.6 ms, p = 0.004) and following IV sotalol infusion for atrial arrhythmias (46.4 ± 29.2 ms vs. 24.0 ± 25.1 ms, p = 0.018). ΔHR following IV sotalol infusion for ventricular arrhythmias was similar to ΔHR following PO sotalol initiation for ventricular arrhythmias and ΔHR following IV sotalol infusion for atrial arrhythmias (- 7.5 ± 8.7 bpm vs. - 8.5 ± 13.9 bpm vs. - 8.3 ± 13.2 bpm, p = 0.87). There were no significant differences in discontinuation for QTc prolongation (6.7% vs. 1.7% vs. 2.4%, p = 0.64) and bradycardia (13.3% vs. 7.7% vs. 9.8%, p = 0.88) between IV sotalol loading for ventricular arrhythmias, PO sotalol initiation for ventricular arrhythmias, and IV sotalol loading for atrial arrhythmias. There were no instances of hypotension, life-threatening ventricular arrhythmias, heart failure, or death. Length of stay was significantly shorter for IV sotalol loading c","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"1647-1655"},"PeriodicalIF":2.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140957838","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}
Masaki Hashimoto, Kenichiro Yamagata, Jun Yokota, Izumi Tanikawa, Katsuhito Fujiu
{"title":"Denki buro: a Japanese electric bath in public space causing inappropriate ICD shock.","authors":"Masaki Hashimoto, Kenichiro Yamagata, Jun Yokota, Izumi Tanikawa, Katsuhito Fujiu","doi":"10.1007/s10840-024-01832-9","DOIUrl":"10.1007/s10840-024-01832-9","url":null,"abstract":"","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"1501-1503"},"PeriodicalIF":2.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283928","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":"Cardioembolic stroke in cardiac amyloidosis is a formidable challenge.","authors":"De-Gang Mo","doi":"10.1007/s10840-024-01865-0","DOIUrl":"10.1007/s10840-024-01865-0","url":null,"abstract":"","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"1477-1478"},"PeriodicalIF":2.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498183","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}
Jamario Skeete, Jonathan S Gordon, Lincoln Kavinksy, Henry D Huang, Tolga Aksu
{"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":" ","pages":""},"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}
Olatunde Ola, S Michael Gharacholou, Abhishek J Deshmukh, Arturo M Valverde, Christopher G Scott, Alexander T Lee, Freddy Del-Carpio Munoz
{"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":" ","pages":""},"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}
Fabrizio Drago, Francesco Flore, Rita Blandino, Aurelio Secinaro, Ilaria Cazzoli, Cristina Raimondo, Corrado Di Mambro
{"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":" ","pages":""},"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}
Linlin Wang, Xiangwei Ding, Weizhu Ju, Hongwu Chen, Kai Gu, Mingfang Li, Minglong Chen, Gang Yang
{"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> < 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":"403 1","pages":""},"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}
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
{"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 > 0.05), as was AF burden (20% vs 16%, p > 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 > 0.05). QoL pre/post ablation was also similar (p > 0.05). On multivariate analysis, history of AAD was not predictive of AF recurrence(p > 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":"10 1","pages":""},"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}