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Chew DS, Sacks NC, Emden MR, Cyr PL, Sherwood R, Pokorney SD. Catheter ablation for supraventricular tachycardia and health resource utilization and expenditures: A propensity-matched cohort study. Int J Cardiol 2024; 403:131831. [PMID: 38331201 DOI: 10.1016/j.ijcard.2024.131831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/13/2024] [Accepted: 02/01/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Few data are available regarding temporal patterns of health resource utilization (HRU) and expenditures among patients undergoing catheter ablation for paroxysmal supraventricular tachycardia (PSVT). This study aimed to describe expenditures and HRU in patients with PSVT who underwent catheter ablation compared to a matched cohort of patients on medical therapy alone. METHODS Using a large US administrative database, we identified adult patients (age 18 to 65 years) with a new PSVT diagnosis between 2008 and 2016. Propensity-score matching was used to assemble a PSVT cohort treated with ablation or medical therapy alone (N = 2556). Longitudinal trends in HRU and expenditures in the 3-years preceding and following PSVT diagnosis were compared. RESULTS There were no significant differences in expenditures between groups except within the first year after PSVT diagnosis: $48,004 ablation vs. $17,560 medical therapy (p < 0.001). This difference was driven by procedural expenditures, where the mean cost of catheter ablation was $32,057 ± SD 26,737. In Years 2 and 3 post-ablation, HRU and expenditures decreased to the levels associated with the medical therapy group, although fewer ablation patients required any prescription for beta-blockers, calcium channel blockers, or anti-arrhythmic drugs (32% ablation vs. 42% medical therapy group, p < 0.001). CONCLUSION Catheter ablation reduces medication burden in PSVT, yet health resource use and expenditures were similar beyond 2 years post-ablation when compared to PSVT patients on medical therapy alone. Additional studies are required to better understand drivers of these sustained health expenditures, and barriers to achieving cost-savings for a potentially curative procedure.
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Affiliation(s)
- Derek S Chew
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Naomi C Sacks
- Precision Health Economics and Outcomes Research, Boston, MA, USA; Tufts University School of Medicine, Boston, MA, USA
| | - Maia R Emden
- Precision Health Economics and Outcomes Research, Boston, MA, USA
| | - Philip L Cyr
- Precision Health Economics and Outcomes Research, Boston, MA, USA; College of Health and Human Services, University of North Carolina, Charlotte, NC, USA
| | | | - Sean D Pokorney
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
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2
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Ablation of Atrioventricular Nodal Re-Entrant Tachycardia Combining Irrigated Flexible-Tip Catheters and Three-Dimensional Electroanatomic Mapping: Long-Term Outcomes. J Cardiovasc Dev Dis 2021; 8:jcdd8060061. [PMID: 34070511 PMCID: PMC8229404 DOI: 10.3390/jcdd8060061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Transcatheter ablation is the standasrd treatment for atrioventricular nodal re-entrant tachycardia (AVNRT). However, different techniques are available. Data about the use of irrigated flexible-tip catheters and three-dimensional electroanatomical mapping (3D EAM) for AVNRT ablation are scant. The aim of this study was to evaluate in long-term follow-up efficacy and safety of a novel approach for AVNRT treatment. Methods: This is a cohort single arm study with long-term follow-up. Patients with AVNRT were treated with catheter ablation by means of irrigated flexible-tip catheters combined with 3D EAM. Results: One-hundred-and-fifty patients were enrolled and followed-up for a median of 38 months (minimum 12, maximum 74). Acute procedural success rate was 96.7% (145/150 patients). During follow-up, 11 patients had arrhythmia recurrences (7.3%). No patient developed atrioventricular conduction block with need for pacemaker implantation (0%). Fourteen patients died during follow-up (9.3%). Conclusions: Acute procedural success and long-term follow-up show that AVNRT could be safely and effectively treated with irrigated flexible-tip catheters and 3D EAM.
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Etaee F, Elayi CS, Catanzarro J, Delisle B, Ogunbayo G, Di Biase L, Natale A, Darrat Y. Gender associated disparities in atrioventricular nodal reentrant tachycardia: A review article. J Cardiovasc Electrophysiol 2021; 32:1772-1777. [PMID: 33969588 DOI: 10.1111/jce.15078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/24/2021] [Accepted: 05/01/2021] [Indexed: 12/21/2022]
Abstract
Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common sustained supraventricular arrhythmias. An understanding of gender-related differences in AVNRT epidemiology, diagnosis, treatment, outcome, and complications can help guide a more effective diagnosis and treatment of the condition. The study aimed to perform a review of the available literature regarding all aspects of gender-related differences of AVNRT. We focused on all aspects of gender-related differences regarding AVNRT between men and women. A literature search was performed using Google Scholar, PubMed, Springer, Ovid, and Science Direct. Many investigations have demonstrated that the prevalence of AVNRT exhibited a twofold women-to-men predominance. The potential mechanism behind this difference due to sex hormones and autonomic tone. Despite being more common in women, there is a delay in offering and performing the first-line therapy (catheter ablation) compared to men. There were no significant gender-related discrepancies in patients who underwent ablation therapy for AVNRT, regarding the acute success rate of the procedure, long-term success rate, and recurrence of AVNRT. AVNRT is more common in women due to physiological factors such as sex hormones and autonomic tone. Catheter ablation is equally safe and efficacious in men and women; however, the time between the onset of symptoms and ablation is significantly prolonged in women. It is important for the medical community to be aware of this discrepancy and to strive to eliminate such disparities that are not related to patients' choices.
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Affiliation(s)
- Farshid Etaee
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, Texas, USA.,Department of Internal Medicine, Yale University, New Haven, Connecticut, USA
| | - Claude S Elayi
- Department of Cardiology, Saint Joseph Hospital CHI Commonspirit, Lexington, Kentucky, USA
| | - John Catanzarro
- Department of Cardiology, University of Florida - Jacksonville, Jacksonville, Florida, USA
| | - Brian Delisle
- Saha Cardiovascular Research Center, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Gbolahan Ogunbayo
- Gill Heart Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Luigi Di Biase
- Department of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Yousef Darrat
- Department of Cardiology, Saint Joseph Hospital CHI Commonspirit, Lexington, Kentucky, USA
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4
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Persistence of Palpitations After Slow Pathway Modification for AVNRT in Young People. Pediatr Cardiol 2021; 42:590-596. [PMID: 33394109 PMCID: PMC8479320 DOI: 10.1007/s00246-020-02519-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
Symptoms are the most common indication for ablation in children with atrioventricular nodal reentrant tachycardia (AVNRT). After the procedure, patients may continue to report palpitations. The objective of this study was to quantify the risk and duration of palpitations after pediatric slow pathway modification as well as demographic and technical associations. This was a retrospective review of consecutive patients at a pediatric center who underwent slow pathway modification for AVNRT from 2012 to 2018. Patients with a prior ablation attempt or congenital heart disease were excluded. Palpitations were documented in 35% of patients after ablation. Neither post-ablation echo beats nor other evidence of residual dual AV nodal physiology were associated with a higher risk of post-ablation palpitations. Of the 35 patients with post-ablation palpitations, the median time to resolution of palpitations was 48 months. Acute procedural success was achieved in all 100 cases. There were two recurrences of AVNRT during long-term follow-up and one instance of ectopic atrial tachycardia (3% SVT recurrence). Palpitations after AVNRT ablation occurred in approximately one-third of cases, despite a low recurrence of true arrhythmia. Prior to ablation, patients and families should be counseled that post-ablation palpitations are common and AVNRT recurrence is rare.
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Matteucci F, Maesen B, De Asmundis C, Parise G, Micali LR, Tuijthof G, Gerits P, Vernooy K, Maessen JG, La Meir M, Gelsomino S. New Biparietal Bipolar Catheter Prototype for Hybrid Atrial Fibrillation Ablation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:181-187. [PMID: 33410714 PMCID: PMC8108111 DOI: 10.1177/1556984520981025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Objective To evaluate the size and depth of linear lesions by in vitro testing with a custom-made radio frequency biparietal bipolar ablation catheter in a single-stage setting. Methods A custom-made catheter was created to generate linear lesions around the left atrium and pulmonary veins of an ex vivo pig. Two frames were made, 1 epicardial and 1 endocardial. A continuous copper braid electrode and an alignment system consisting of 2 parallel rows of neodymium magnets were embedded in a flexible plastic support. After 24 hours of formalin conservation, samples of the left atrium of a freshly slaughtered pig were sliced in a cryotome, thus obtaining a sequence of 100-µm thick layers extending from the endocardial to the epicardial side. After being digitized through a scanner, these layers were evaluated using morphometric computer software. For each slice, we evaluated the maximum length of the lesions, the maximum epicardial length, the maximum endocardial length, the total area of the lesion, and the total volume. Results Forty transmural lesions from 40 specimens were obtained. The results were the following (the number in parenthesis is the interquartile range in mm): lesion maximum length (LMAX) was 7.297 mm (0.006), epicardial maximum length (LEPI) was 7.291 mm (0.014), and endocardial maximum length was 7.291 mm (0.018). The total area and total volume were 1018.50 ± 36.51 mm2 and 101.85 ± 3.65 mm3, respectively. Conclusions Our prototype showed very promising results. The next step will be to enhance the design for clinical application.
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Affiliation(s)
- Francesco Matteucci
- 118066 Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bart Maesen
- 118066 Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands.,5211 Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands
| | - Carlo De Asmundis
- 60201 Cardiothoracic Department, Brussels University Hospital, Brussels, Belgium
| | - Gianmarco Parise
- 118066 Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Linda Renata Micali
- 118066 Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Gabrielle Tuijthof
- 5211 IDEE Engineering, Maastricht University, Maastricht, The Netherlands
| | - Peter Gerits
- 118066 Maastricht Instruments BV, Maastricht, The Netherlands
| | - Kevin Vernooy
- 5211 Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands
| | - Jos G Maessen
- 118066 Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands.,5211 Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands
| | - Mark La Meir
- 118066 Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands.,60201 Cardiothoracic Department, Brussels University Hospital, Brussels, Belgium
| | - Sandro Gelsomino
- 118066 Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands.,60201 Cardiothoracic Department, Brussels University Hospital, Brussels, Belgium
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Poptani V, Jayaram AA, Jain S, Samanth J. A study of narrow QRS tachycardia with emphasis on the clinical features, ECG, electrophysiology/radiofrequency ablation. Future Cardiol 2020; 17:137-148. [PMID: 32915064 DOI: 10.2217/fca-2020-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) are the most common forms of paroxysmal regular supraventricular tachycardias. Materials & methods: The clinical, ECG and electrophysiological findings of 121 patients with narrow QRS tachycardia were evaluated prospectively. Results: A total of 75 (62%) of the patients had AVNRT while 46 (38%) had AVRT. Pounding sensation in the neck (40 vs 15.2%; p = 0.004), presynope (26.7 vs 56.5%; p = 0.001) identifiable P wave after QRS complex (25.3 vs 73.9%; p = 0.001), pseudo r'/s waves (45.3 vs 4.3%; p = 0.001), limb leads ST-T changes (34.7 vs 60.9%; p = 0.004) were the significant changes observed. A total of 94.7% of AVNRT and 87% of AVRT could be diagnosed correctly considering both clinical and ECG criteria. Conclusion: Pounding sensation in the neck and presyncope along with ECG features like identifiable P wave after QRS complex, pseudo r'/s waves and limb lead ST-T changes very accurately differentiate AVNRT and AVRT.
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Affiliation(s)
- Vishal Poptani
- Ex-Assistant Professor, Department of Cardiology, U N Mehta Institute of Cardiology & Research Centre, Ahmadabad, Gujarath, India 380016
| | - Ashwal Adamane Jayaram
- Associate Professor, Department of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India 576106
| | - Sharad Jain
- Professor, Department of Cardiology, U N Mehta Institute of Cardiology & Research Centre, Ahmadabad, Gujarath, India 380016
| | - Jyothi Samanth
- Assistant Professor, Department of Cardiovascular Technology, School of Allied Health Science (SOAHS), Manipal Academy of Higher Education, Manipal, India 576104
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Symptomatic arrhythmias after catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT): results from the German Ablation Registry. Clin Res Cardiol 2019; 109:858-868. [PMID: 31784903 DOI: 10.1007/s00392-019-01576-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In atrioventricular nodal reentrant tachycardia (AVNRT), catheter ablation is considered as first-line therapy. Despite high success rates, some patients present with arrhythmia recurrence or develop other types of arrhythmias over time. OBJECTIVE To assess the incidence of symptomatic arrhythmias after initially successful AVNRT ablation and to analyze their clinical implications in a real-world cohort. METHODS We included 2,795 patients from the German Ablation Registry undergoing first ablation of AVNRT between 01/2007 and 01/2010. In patients alive at long-term follow-up, patient-specific characteristics and long-term follow-up data were compared between patients with (group A) and without (group B) any symptomatic arrhythmia during follow-up. RESULTS Symptomatic arrhythmias occurred in 17.2% of patients during a mean follow-up of 678 days after AVNRT ablation. The patients with symptomatic arrhythmias were more often female and suffered from structural heart disease. Arrhythmia occurrence was clinically relevant regarding symptoms and patient satisfaction. Serious adverse events including stroke, transient ischemic attack, pacemaker implantation, as well as continued use of antiarrhythmic medication occurred more often in group A. A second ablation procedure was performed in 26% of symptomatic patients to optimize the symptomatic outcome, whereas cardiovascular events or patient satisfaction were not further improved. CONCLUSION During long-term follow-up, one out of six patients experienced symptomatic arrhythmias after AVNRT ablation, associated with an increase of serious adverse events. A subset of patients required medical or interventional antiarrhythmic therapy, possibly attributable to the co-existence of other arrhythmias. Screening for arrhythmic and cardiac co-morbidity before and after ablation may support comprehensive therapy planning and outcome.
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8
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Frey MK, Richter B, Gwechenberger M, Marx M, Pezawas T, Schrutka L, Gössinger H. High incidence of atrial fibrillation after successful catheter ablation of atrioventricular nodal reentrant tachycardia: a 15.5-year follow-up. Sci Rep 2019; 9:11784. [PMID: 31409803 PMCID: PMC6692351 DOI: 10.1038/s41598-019-47980-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/23/2019] [Indexed: 11/30/2022] Open
Abstract
Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common type of supraventricular tachycardia. Slow pathway (SP) ablation is the treatment of choice with a high acute success rate and a negligible periprocedural risk. However, long-term outcome data are scarce. The aim of this study was to assess long-term outcome and arrhythmia free survival after SP ablation. In this study, 534 consecutive patients with AVNRT, who underwent SP ablation between 1994 and 1999 were included. During a mean follow-up of 15.5 years, 101 (18.9%) patients died unrelated to the procedure or any arrhythmia. Data were collected by completing a questionnaire and/or contacting patients. Clinical information was obtained from 329 patients (61.6%) who constitute the final study cohort. During the electrophysiological study, sustained 1:1 slow AV nodal pathway conduction was eliminated in all patients. Recurrence of AVNRT was documented in 9 patients (2.7%), among those 7 patients underwent a successful repeat ablation procedure. New-onset atrial fibrillation (AF) was documented in 39 patients (11.9%) during follow-up. Pre-existing arterial hypertension (odds ratio 2.61, 95% CI 1.14–5.97, p = 0.023), age (odds ratio 1.05, 95% CI 1.02–1.09, p = 0.003) and the postinterventional AH interval (odds ratio 1.02, 95% CI 1.00–1.04, p = 0.038) predicted the occurrence of AF. The present long-term observational study after successful SP ablation of AVNRT confirms its clinical value reflected by low recurrence and complication rates. The unexpectedly high incidence of new-onset AF (11.9%) may impact long-term follow-up and requires further clinical attention.
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Affiliation(s)
- M K Frey
- Department of Cardiology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - B Richter
- Department of Cardiology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - M Gwechenberger
- Department of Cardiology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - M Marx
- Department of Pediatric Cardiology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - T Pezawas
- Department of Cardiology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - L Schrutka
- Department of Cardiology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - H Gössinger
- Department of Cardiology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Kusterer N, Morales G, Butt M, Darrat Y, Parrott K, Ogunbayo G, Bidwell K, Patel R, Delisle B, Czarapata M, Elayi CS. Junctional ectopic rhythm after AVNRT ablation: An underrecognized complication. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:182-193. [DOI: 10.1111/pace.13260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/21/2017] [Accepted: 11/09/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Nathan Kusterer
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Gustavo Morales
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Muhammad Butt
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Yousef Darrat
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Kevin Parrott
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Gbolahan Ogunbayo
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Katrina Bidwell
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Ripa Patel
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Brian Delisle
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Melissa Czarapata
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Claude S. Elayi
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
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10
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Brembilla-Perrot B, Sellal JM, Olivier A, Villemin T, Beurrier D, Vincent J, Manenti V, de Chillou C, Bozec E, Girerd N. Influence of advancing age on clinical presentation, treatment efficacy and safety, and long-term outcome of inducible paroxysmal supraventricular tachycardia without pre-excitation syndromes: A cohort study of 1960 patients included over 25 years. PLoS One 2018; 13:e0187895. [PMID: 29304037 PMCID: PMC5755731 DOI: 10.1371/journal.pone.0187895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 10/27/2017] [Indexed: 11/18/2022] Open
Abstract
AIM To investigate the influence of increasing age on clinical presentation, treatment and long-term outcome in patients with inducible paroxysmal supraventricular tachycardia (SVT) without pre-excitation syndromes. METHODS Clinical and electrophysiological study (EPS) data, as well as long-term clinical outcome (mean follow-up 2.4±4.0 years) were collected in patients referred for regular tachycardia with inducible SVT during EPS without pre-excitation. RESULTS Among 1960 referred patients, 301 patients (15.4%) were aged ≥70 (70-97). In this subset, anticoagulants were prescribed in 49 patients following an erroneous diagnosis of atrial tachycardia and 14 were previously erroneously diagnosed with ventricular tachycardia because of wide QRS. Ablation was performed more frequently in patients ≥70 despite more frequent failure and complications. During follow-up, higher risks of AF, stroke, pacemaker implantation and death were observed in patients ≥70 whereas SVT recurrences were similar in both age groups. In multivariable analysis, age ≥70 was independently associated with higher risks of SVT-related adverse events prior to ablation (OR = 1.93, 1.41-2.62, p<0.001), conduction disturbances (OR = 11.27, 5.89-21.50, p<0.001), history of AF (OR = 2.18, 1.22-3.90, p = 0.009) and erroneous diagnosis at baseline (OR = 9.14, 5.93-14.09, p<0.001) as well as high rates of procedural complications (OR = 2.13, 1.19-3.81, p = 0.01) and ablation failure (OR = 1.68, 1.08-2.62, p = 0.02). In contrast, age ≥70 was not significantly associated with a higher risk of AF in multivariable analysis. CONCLUSIONS A sizeable proportion of patients with inducible SVT without pre-excitation syndromes are elderly. These patients exhibit higher risks of erroneous tachycardia diagnosis prior to EPS as well as failure and/or complication of ablation, but similar risk of SVT recurrence. These results support performing transesophageal EPS in most patients and intracardiac EPS in selected patients. EPS may furthermore prove useful in elderly patients with regular tachycardia, mainly by avoiding treatment based on an erroneous diagnosis.
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Affiliation(s)
| | - Jean Marc Sellal
- Department of Cardiology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Arnaud Olivier
- Department of Cardiology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Thibaut Villemin
- Department of Cardiology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Daniel Beurrier
- Department of Cardiology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Julie Vincent
- Department of Cardiology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Vladimir Manenti
- Department of Cardiology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Christian de Chillou
- Department of Cardiology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Erwan Bozec
- INSERM, Centre d’Investigations Cliniques 1433, Nancy, France
- INSERM, Unité 1116, Nancy, France
- Faculté de médecine, Université de Lorraine, Nancy, France
- CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France
- INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France
| | - Nicolas Girerd
- Department of Cardiology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
- INSERM, Centre d’Investigations Cliniques 1433, Nancy, France
- INSERM, Unité 1116, Nancy, France
- Faculté de médecine, Université de Lorraine, Nancy, France
- CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France
- INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France
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11
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Moak JP. Look and you shall find: Perils along the road after slow pathway ablation for AV nodal reentry tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:194-196. [PMID: 29266362 DOI: 10.1111/pace.13261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 12/05/2017] [Accepted: 12/10/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Jeffrey P Moak
- Division of Cardiology, Children's National Health System, Washington, DC, USA
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12
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Follow-up of children or teenagers with paroxysmal supraventricular tachycardia, but without pre-excitation syndrome. Arch Cardiovasc Dis 2017; 110:599-606. [DOI: 10.1016/j.acvd.2017.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 11/15/2022]
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13
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Katritsis DG, Zografos T, Katritsis GD, Giazitzoglou E, Vachliotis V, Paxinos G, Camm AJ, Josephson ME. Catheter ablation vs. antiarrhythmic drug therapy in patients with symptomatic atrioventricular nodal re-entrant tachycardia: a randomized, controlled trial. Europace 2017; 19:602-606. [PMID: 28431060 DOI: 10.1093/europace/euw064] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To conduct a randomized trial in order to guide the optimum therapy of symptomatic atrioventricular nodal re-entrant tachycardia (AVNRT). METHODS AND RESULTS Patients with at least one symptomatic episode of tachycardia per month and an electrophysiologic diagnosis of AVNRT were randomly assigned to catheter ablation or chronic antiarrhythmic drug (AAD) therapy with bisoprolol (5 mg od) and/or diltiazem (120-300 mg od). All patients were properly educated to treat subsequent tachycardia episodes with autonomic manoeuvres or a 'pill in the pocket' approach. The primary endpoint of the study was hospital admission for persistent tachycardia cardioversion, during a follow-up period of 5 years. Sixty-one patients were included in the study. In the ablation group, 1 patient was lost to follow-up, and 29 were free of arrhythmia or conduction disturbances at a 5-year follow-up. In the AAD group, three patients were lost to follow-up. Of the remainder, 10 patients (35.7%) continued with initial therapy, 11 patients (39.2%) remained on diltiazem alone, and 7 patients (25%) interrupted their therapy within the first 3 months following randomization, and subsequently developed an episode requiring cardioversion. During a follow-up of 5 years, 21 patients in the AAD group required hospital admission for cardioversion. Survival free from the study endpoint was significantly higher in the ablation group compared with the AAD group (log-rank test, P < 0.001). CONCLUSIONS Catheter ablation is the therapy of choice for symptomatic AVNRT. Antiarrhythmic drug therapy is ineffective and not well tolerated.
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Affiliation(s)
- Demosthenes G Katritsis
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Rd, Baker 4, Boston, MA 02215, USA
- Athens Euroclinic, Athens, Greece
| | | | | | | | | | | | - A John Camm
- St George's University of London, London, UK
| | - Mark E Josephson
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Rd, Baker 4, Boston, MA 02215, USA
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Wu T, Wu D, Wu Q, Zou B, Huang X, Cheng X, Wu Y, Hong K, Li P. Effect and mechanism of Irbesartan on occurrence of ventricular arrhythmias in rats with myocardial ischemia through connexin43 (cx43). ASIAN PAC J TROP MED 2016; 9:1007-1012. [DOI: 10.1016/j.apjtm.2016.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/20/2016] [Accepted: 07/19/2016] [Indexed: 10/21/2022] Open
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15
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Brembilla-Perrot B, Olivier A, Sellal JM, Manenti V, Brembilla A, Villemin T, Admant P, Beurrier D, Bozec E, Girerd N. Influence of advancing age on clinical presentation, treatment efficacy and safety, and long-term outcome of pre-excitation syndromes: a retrospective cohort study of 961 patients included over a 25-year period. BMJ Open 2016; 6:e010520. [PMID: 27188807 PMCID: PMC4874160 DOI: 10.1136/bmjopen-2015-010520] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES There are very little data on pre-excitation syndrome (PS) in the elderly. We investigated the influence of advancing age on clinical presentation, treatment and long-term outcome of PS. SETTING Single-centre retrospective study of patient files. PARTICIPANTS In all, 961 patients (72 patients ≥60 years (mean 68.5±6), 889 patients <60 years (mean 30.5±14)) referred for overt pre-excitation and indication for electrophysiological study (EPS) were followed for 5.3±5 years. Usual care included 24 h Holter monitoring, echocardiography and EPS. Patients underwent accessory pathway (AP) ablation if necessary. PRIMARY AND SECONDARY OUTCOME MEASURES Occurrence of atrial fibrillation (AF) or procedure-induced adverse event. RESULTS Electrophysiological data and recourse to AP ablation (43% vs 48.5%, p=0.375) did not significantly differ between the groups. Older patients more often had symptomatic forms (81% vs 63%, p=0.003), history of spontaneous AF (8% vs 3%, p=0.01) or adverse presentation (poorly tolerated arrhythmias: 18% vs 7%, p=0.0009). In multivariable analysis, patients ≥60 years had a significantly higher risk of history of AF (OR=4.2, 2.1 to 8.3, p=0.001) and poorly tolerated arrhythmias (OR=3.8, 1.8 to 8.1, p=0.001). Age ≥60 years was associated with an increased major AP ablation complication risk (10% vs 1.9%, p=0.006). During follow-up, occurrence of AF (13.9% vs 3.6%, p<0.001) and incidence of poorly tolerated tachycardia (4.2% vs 0.6%, p=0.001) were more frequent in patients ≥60 years, although frequency of ablation failure or recurrence was similar (20% vs 15.5%, p=0.52). In multivariable analysis, patients ≥60 years had a significantly higher risk of AF (OR=2.9, 1.2 to 6.8, p≤0.01). CONCLUSIONS In this retrospective monocentre study, patients ≥60 years referred for PS work up appeared at higher risk of AF and adverse presentation, both prior and after the work up. These results suggest that, in elderly patients, the decision for EPS and AP ablation should be discussed in light of their suspected higher risk of events and ablation complications. However, these findings should be further validated in future prospective multicentre studies.
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Affiliation(s)
| | - Arnaud Olivier
- Department of Cardiology, CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Jean-Marc Sellal
- Department of Cardiology, CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Vladimir Manenti
- Department of Cardiology, CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Alice Brembilla
- Department of Epidemiology, CHU of Besançon, Besançon, France
| | - Thibaut Villemin
- Department of Cardiology, CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | | | - Daniel Beurrier
- Department of Cardiology, CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Erwan Bozec
- INSERM, Centre d'Investigations Cliniques 1433, Université de Lorraine, CHU de Nancy, Institut Lorrain du cœur et des vaisseaux and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, Vandoeuvre-lès-Nancy, France
| | - Nicolas Girerd
- INSERM, Centre d'Investigations Cliniques 1433, Université de Lorraine, CHU de Nancy, Institut Lorrain du cœur et des vaisseaux and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, Vandoeuvre-lès-Nancy, France
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16
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Brembilla-Perrot B, Bénichou M, Brembilla A, Bozec E, Dorlet S, Sellal JM, Olivier A, Manenti V, Villemin T, Beurrier D, Moulin-Zinsch A, De Chillou C, Girerd N. AV nodal reentrant tachycardia or AV reentrant tachycardia using a concealed bypass tract-related adverse events. Int J Cardiol 2015; 199:84-9. [DOI: 10.1016/j.ijcard.2015.07.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/26/2015] [Accepted: 07/10/2015] [Indexed: 11/27/2022]
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17
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Risk and outcome after ablation of isthmus-dependent atrial flutter in elderly patients. PLoS One 2015; 10:e0127672. [PMID: 26000772 PMCID: PMC4441372 DOI: 10.1371/journal.pone.0127672] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/17/2015] [Indexed: 11/19/2022] Open
Abstract
Purpose of the research To study the influence of age on the clinical presentation and long-term outcome of patients referred for atrial flutter (AFL) ablation. Age-related differences have been reported regarding the prognosis of arrhythmias. Methods A total of 1187 patients with a mean age 65±12 years consecutively referred for AFL ablation were retrospectively analyzed in the study. Results 445 (37.5%) patients were aged ≥70 (range 70 to 93) among which 345 were aged 70 to 79 years (29.1%) and 100 were aged ≥80 (8.4%). In multivariable analysis, AFL-related rhythmic cardiomyopathy and presentation with 1/1 AFL were less frequent (respectively adjusted OR = 0.44, 0.27–0.74, p = 0.002 and adjusted OR = 0.29, 0.16–0.52, p<0.0001). AFL ablation-related major complications were more frequent in patients ≥70 although remained lower than 10% (7.4% in ≥70 vs. 4.2% in <70, adjusted OR = 1.74, 1.04–2.89, p = 0.03). After 2.1±2.7 years, AFL recurrence was less frequent in patients ≥70 (adjusted OR = 0.54, 0.37–0.80, p = 0.002) whereas atrial fibrillation (AF) occurrence was as frequent in the 70–79 and ≥80 age subsets. As expected, cardiac mortality was higher in older patients. Patients aged ≥80 also had a low probability of AFL recurrence (5.0%) and AF onset (19.0%). Conclusions Older patients represent 37.5% of patients referred for AFL ablation and displayed a <10% risk of ablation-related complications. Importantly, AFL recurrences were less frequent in patients ≥70 while AF occurrence was as frequent as in patients <70. Similar observations were made in patients ≥80 years. AFL ablation appears to be safe and efficient and should not be ruled out in elderly patients.
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