Brian Zenger, Scott Rizzi, Benjamin A Steinberg, Ravi Ranjan, T Jared Bunch
{"title":"This is Your Brain, and This is Your Brain on Atrial Fibrillation: The Roles of Cardiac Malperfusion Events and Vascular Dysfunction in Cognitive Impairment.","authors":"Brian Zenger, Scott Rizzi, Benjamin A Steinberg, Ravi Ranjan, T Jared Bunch","doi":"10.15420/aer.2022.29","DOIUrl":"https://doi.org/10.15420/aer.2022.29","url":null,"abstract":"<p><p>AF is an independent and strong predictor of long-term cognitive decline. However, the mechanism for this cognitive decline is difficult to define and likely multifactorial, leading to many different hypotheses. Examples include macro- or microvascular stroke events, biochemical changes to the blood-brain barrier related to anticoagulation, or hypo-hyperperfusion events. This review explores and discusses the hypothesis that AF contributes to cognitive decline and dementia through hypo-hyperperfusion events occurring during cardiac arrhythmias. We briefly explain several brain perfusion imaging techniques and further examine the novel findings associated with changes in brain perfusion in patients with AF. Finally, we discuss the implications and areas requiring more research to further understand and treat patients with cognitive decline related to AF.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"12 ","pages":"e01"},"PeriodicalIF":3.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5a/f6/aer-12-e01.PMC9945461.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10073142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Venkatesh Ravi, Jeffrey Winterfield, Jackson Liang, Timothy Larsen, Cicely Dye, David Sanders, Jamario Skeete, Josh Payne, Richard G Trohman, Tolga Aksu, Parikshit S Sharma, Henry D Huang
{"title":"Solving the Reach Problem: A Review of Present and Future Approaches for Addressing Ventricular Arrhythmias Arising from Deep Substrate.","authors":"Venkatesh Ravi, Jeffrey Winterfield, Jackson Liang, Timothy Larsen, Cicely Dye, David Sanders, Jamario Skeete, Josh Payne, Richard G Trohman, Tolga Aksu, Parikshit S Sharma, Henry D Huang","doi":"10.15420/aer.2022.28","DOIUrl":"https://doi.org/10.15420/aer.2022.28","url":null,"abstract":"<p><p>Ventricular tachycardia (VT) is a significant cause of morbidity and mortality in patients with ischaemic and non-ischaemic cardiomyopathies. In most patients, the primary strategy of VT catheter ablation is based on the identification of critical components of reentry circuits and modification of abnormal substrate which can initiate reentry. Despite technological advancements in catheter design and improved ability to localise abnormal substrates, putative circuits and site of origins of ventricular arrhythmias (VAs), current technologies remain inadequate and durable success may be elusive when the critical substrate is deep or near to critical structures that are at risk of collateral damage. In this article, we review the available and potential future non-surgical investigational approaches for treatment of VAs and discuss the viability of these modalities.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"12 ","pages":"e04"},"PeriodicalIF":3.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fa/df/aer-12-e04.PMC10433105.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10105516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ganglionic Plexus Ablation: A Step-by-step Guide for Electrophysiologists and Review of Modalities for Neuromodulation for the Management of Atrial Fibrillation.","authors":"Tolga Aksu, Jamario R Skeete, Henry H Huang","doi":"10.15420/aer.2022.37","DOIUrl":"https://doi.org/10.15420/aer.2022.37","url":null,"abstract":"<p><p>As the most common sustained arrhythmia, AF is a complex clinical entity which remains a difficult condition to durably treat in the majority of patients. Over the past few decades, the management of AF has focused mainly on pulmonary vein triggers for its initiation and perpetuation. It is well known that the autonomic nervous system (ANS) has a significant role in the <i>milieu</i> predisposing to the triggers, perpetuators and substrate for AF. Neuromodulation of ANS - ganglionated plexus ablation, vein of Marshall ethanol infusion, transcutaneous tragal stimulation, renal nerve denervation, stellate ganglion block and baroreceptor stimulation - constitute an emerging therapeutic approach for AF. The purpose of this review is to summarise and critically appraise the currently available evidence for neuromodulation modalities in AF.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"12 ","pages":"e02"},"PeriodicalIF":3.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ba/a9/aer-12-e02.PMC9945432.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10793687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Primer on Machine Learning in Electrophysiology.","authors":"Shane E Loeffler, Natalia Trayanova","doi":"10.15420/aer.2022.43","DOIUrl":"https://doi.org/10.15420/aer.2022.43","url":null,"abstract":"<p><p>Artificial intelligence has become ubiquitous. Machine learning, a branch of artificial intelligence, leads the current technological revolution through its remarkable ability to learn and perform on data sets of varying types. Machine learning applications are expected to change contemporary medicine as they are brought into mainstream clinical practice. In the field of cardiac arrhythmia and electrophysiology, machine learning applications have enjoyed rapid growth and popularity. To facilitate clinical acceptance of these methodologies, it is important to promote general knowledge of machine learning in the wider community and continue to highlight the areas of successful application. The authors present a primer to provide an overview of common supervised (least squares, support vector machine, neural networks and random forest) and unsupervised (k-means and principal component analysis) machine learning models. The authors also provide explanations as to how and why the specific machine learning models have been used in arrhythmia and electrophysiology studies.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"12 ","pages":"e06"},"PeriodicalIF":3.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/19/2b/aer-12-e06.PMC10323871.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9812536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Defibrillation Threshold Testing for Right-sided Device Implants: A Review to Inform Shared Decision-making, in Association with the British Heart Rhythm Society.","authors":"Michael Tb Pope, John R Paisey, Paul R Roberts","doi":"10.15420/aer.2022.38","DOIUrl":"https://doi.org/10.15420/aer.2022.38","url":null,"abstract":"Prevention of sudden death using ICDs requires the reliable delivery of a high-energy shock to successfully terminate VF. Until more recently, the device implant procedure included conducting defibrillation threshold (DFT) testing involving VF induction and shock delivery to ensure efficacy. Large clinical trials, including SIMPLE and NORDIC ICD, have subsequently demonstrated that this is unnecessary, with a practice of omitting DFT testing having no impact on subsequent clinical outcomes. However, these studies specifically excluded patients requiring devices implanted on the right side, in whom the shock vector is significantly different and smaller studies suggest a higher DFT. In this review, the data regarding the use of DFT testing, focusing on right-sided implants, and the results of a survey of current UK practice are presented. In addition, a strategy of shared decision-making when it comes to deciding on the use of DFT testing during right-sided ICD implant procedures is proposed.","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"12 ","pages":"e10"},"PeriodicalIF":3.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a3/0d/aer-12-e10.PMC10326664.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9815178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Atrial Transseptal Catheterisation: Challenging Scenarios and Techniques to Overcome Them.","authors":"Maiwand Mirwais, Pasquale Santangeli","doi":"10.15420/aer.2022.25","DOIUrl":"https://doi.org/10.15420/aer.2022.25","url":null,"abstract":"<p><p>Atrial transseptal catheterisation is a fundamental skill of any interventional electrophysiologist. In this review, various scenarios that pose unique challenges to atrial transseptal catheterisation are discussed. These scenarios include post-surgical or congenital malformations of the interatrial septum, presence of interatrial septal closure devices, absent or obstructed inferior vena cava and complex congenital heart disease after palliative surgery. Transseptal catheterisation in all of the above situations is feasible and can be performed safely with the aid of dedicated tools and specific techniques.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"12 ","pages":"e23"},"PeriodicalIF":3.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ea/a6/aer-12-e23.PMC10466273.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10127552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Prophylactic Cavotricuspid Isthmus Ablation in Atrial Fibrillation without Documented Typical Atrial Flutter: A Systematic Review and Meta-analysis.","authors":"Yoga Waranugraha, Ardian Rizal, Mohammad Saifur Rohman, Chia-Ti Tsai, Fu-Chun Chiu","doi":"10.15420/aer.2021.37","DOIUrl":"https://doi.org/10.15420/aer.2021.37","url":null,"abstract":"<p><p><b>Background:</b> The advantage of prophylactic cavotricuspid isthmus (CTI) ablation for AF patients without documented atrial flutter is still unclear. The present study aimed to evaluate the role of prophylactic CTI ablation in this population. <b>Methods:</b> A systematic review and meta-analysis study was conducted. The overall effects estimation was conducted using random effects models. The pooled effects were presented as the risk difference and standardised mean difference for dichotomous and continuous outcomes, respectively. <b>Results:</b> A total of 1,476 patients from four studies were included. The risk of atrial tachyarrhythmias following a successful catheter ablation procedure was greater in the pulmonary vein isolation + CTI ablation group than pulmonary vein isolation alone group (34.8% versus 28.2%; risk difference 0.08; 95% CI [0.00-0.17]; p=0.04). Prophylactic CTI ablation was associated with a higher recurrent AF rate (33.8% versus 27.1%; risk difference 0.07; 95% CI [0.01-0.13]; p=0.02). Additional prophylactic CTI ablation to pulmonary vein isolation significantly increased the radio frequency application time (standardised mean difference 0.52; 95% CI [0.04-1.01]; p=0.03). <b>Conclusion:</b> This study suggested that prophylactic CTI ablation was an ineffective and inefficient approach in AF without documented typical atrial flutter patients.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":" ","pages":"e10"},"PeriodicalIF":3.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/37/44/aer-11-e10.PMC9277616.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40514366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical Relevance of Sinus Rhythm Mapping to Quantify Electropathology Related to Atrial Fibrillation.","authors":"Mathijs S van Schie, Natasja Ms de Groot","doi":"10.15420/aer.2022.03","DOIUrl":"https://doi.org/10.15420/aer.2022.03","url":null,"abstract":"<p><p>Progression of AF is accompanied by structural and electrical remodelling, resulting in complex electrical conduction disorders. This is defined as electropathology and it increases with the progression of AF. The severity of electropathology, thus, defines the stage of AF and is a major determinant of effectiveness of AF therapy. As specific features of AF-related electropathology are still unknown, it is essential to first quantify the electrophysiological properties of atrial tissue and then to examine the inter- and intra-individual variation during normal sinus rhythm. Comparison of these parameters between patients with and without a history of AF unravels quantified electrophysiological features that are specific to AF patients. This can help to identify patients at risk for early onset or progression of AF. This review summarises current knowledge on quantified features of atrial electrophysiological properties during sinus rhythm and discusses its relevance in identifying AF-related electropathology.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":" ","pages":"e11"},"PeriodicalIF":3.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d6/2b/aer-11-e11.PMC9277615.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40514368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ablation Lesion Assessment with MRI.","authors":"Lluís Mont, Ivo Roca-Luque, Till F Althoff","doi":"10.15420/aer.2021.63","DOIUrl":"10.15420/aer.2021.63","url":null,"abstract":"<p><p>Late gadolinium enhancement (LGE) MRI is capable of detecting not only native cardiac fibrosis, but also ablation-induced scarring. Thus, it offers the unique opportunity to assess ablation lesions non-invasively. In the atrium, LGE-MRI has been shown to accurately detect and localise gaps in ablation lines. With a negative predictive value close to 100% it can reliably rule out pulmonary vein reconnection non-invasively and thus may avoid unnecessary invasive repeat procedures where a pulmonary vein isolation only approach is pursued. Even LGE-MRI-guided repeat pulmonary vein isolation has been demonstrated to be feasible as a standalone approach. LGE-MRI-based lesion assessment may also be of value to evaluate the efficacy of ventricular ablation. In this respect, the elimination of LGE-MRI-detected arrhythmogenic substrate may serve as a potential endpoint, but validation in clinical studies is lacking. Despite holding great promise, the widespread use of LGE-MRI is still limited by the absence of standardised protocols for image acquisition and post-processing. In particular, reproducibility across different centres is impeded by inconsistent thresholds and internal references to define fibrosis. Thus, uniform methodological and analytical standards are warranted to foster a broader implementation in clinical practice.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"11 1","pages":"e02"},"PeriodicalIF":2.6,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9014705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43229788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Preprocedural Discrimination of Posteroseptal Accessory Pathways Ablated from the Right Endocardium from Those Requiring a Left-sided or Epicardial Coronary Venous Approach.","authors":"Mathieu Lebloa, Patrizio Pascale","doi":"10.15420/aer.2021.55","DOIUrl":"https://doi.org/10.15420/aer.2021.55","url":null,"abstract":"<p><p>The success of radiofrequency catheter ablation of the accessory pathway (AP) depends on the accurate localisation of the bypass tract. In that respect, posteroseptal or inferior paraseptal APs often pose a diagnostic challenge because of the complex anatomy at the crux of the four cardiac chambers. Considering the differences in procedure risks and success rate depending on the need for a left-sided approach or a coronary sinus ablation, an accurate anticipation of the precise location of inferior paraseptal APs is critical to inform the consent process and guide the initial mapping strategy. Here, the preprocedural clues to discriminate APs that can be ablated from the right atrium, from those requiring a left-sided or epicardial coronary venous approach, are reviewed. Both manifest and concealed APs will be considered and, following the diagnostic process made by the operator before interpretation of the intra-cardiac signals, each of the following aspects will be addressed: clinical context and initial probability; and 12-lead ECG analysis during baseline ECG with manifest AP, maximal preexcitation, and orthodromic reciprocating tachycardia.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":" ","pages":"e07"},"PeriodicalIF":3.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/46/af/aer-11-e07.PMC9194913.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40224944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}