1
|
Baldinger SH, Burren D, Noti F, Servatius H, Seiler J, Madaffari A, Asatryan B, Tanner H, Reichlin T, Haeberlin A, Roten L. Patient characteristics, predictors and outcome of pacemaker patients upgraded to an implantable cardioverter defibrillator. Pacing Clin Electrophysiol 2024. [PMID: 38655610 DOI: 10.1111/pace.14988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 03/10/2024] [Accepted: 04/04/2024] [Indexed: 04/26/2024]
Abstract
AIMS Pacemaker (PM) patients may require a subsequent upgrade to an implantable cardioverter defibrillator (ICD). Limited data exists on this patient population. We sought to characterize this population, to assess predictors for ICD upgrade, and to report the outcome. METHODS From our prospective PM and ICD implantation registry, all patients who underwent PM and/or ICD implantations at our center were analyzed. Patient characteristics and outcomes of PM patients with subsequent ICD upgrade were compared to age- and sex-matched patients with de novo ICD implantation, and to PM patients without subsequent upgrade. RESULTS Of 1'301 ICD implantations, 60 (5%) were upgraded from PMs. Median time from PM implantation to ICD upgrade was 2.6 years (IQR 1.3-5.4). Of 2'195 PM patients, 28 patients underwent subsequent ICD upgrades, corresponding to an estimated annual incidence of an ICD upgrade of at least 0.33%. Lower LVEF (p = .05) and male sex (p = .038) were independent predictors for ICD upgrade. Survival without death, transplant and LVAD implantation were worse both for upgraded ICD patients compared to matched patients with de novo ICD implantation (p = .05), as well as for PM patients with subsequent upgrade compared to matched PM patients not requiring an upgrade (p = .036). CONCLUSIONS One of 20 ICD implantations are upgrade of patients with a PM. At least one of 30 PM patients will require an ICD upgrade in the following 10 years. Predictors for ICD upgrade are male sex and lower LVEF at PM implantation. Upgraded patients have worse outcomes.
Collapse
Affiliation(s)
- Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Désirée Burren
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
2
|
Kueffer T, Stettler R, Maurhofer J, Madaffari A, Stefanova A, Iqbal SUR, Thalmann G, Kozhuharov NA, Galuszka O, Servatius H, Haeberlin A, Noti F, Tanner H, Roten L, Reichlin T. Pulsed-field vs cryoballoon vs radiofrequency ablation: Outcomes after pulmonary vein isolation in patients with persistent atrial fibrillation. Heart Rhythm 2024:S1547-5271(24)02372-5. [PMID: 38614191 DOI: 10.1016/j.hrthm.2024.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Pulsed-field ablation (PFA) has shown promising data in terms of safety and procedural efficiency for pulmonary vein isolation (PVI), with similar long-term outcomes compared to radiofrequency ablation (RFA) and cryoballoon ablation (CBA) in patients with paroxysmal atrial fibrillation (AF). OBJECTIVE The purpose of this study was to compare the procedural and long-term outcomes in patients with persistent AF undergoing PVI using PFA, CBA, or RFA. METHODS Consecutive patients with persistent AF undergoing first PVI with PFA, CBA, or RFA were included. Patients underwent 7-day Holter electrocardiography at 3, 6, and 12 months postablation. The primary outcome was recurrence of any atrial arrhythmia after a 90-day blanking period. Safety outcomes included the composite of in-hospital major adverse events. RESULTS A total of 533 patients with persistent AF underwent PVI using PFA (n = 214), CBA (n = 190), or RFA (n = 129). Procedures with PFA guided by fluoroscopy were shorter than those with CBA (median 60 minutes; interquartile range [IQR] 53-80 minutes vs 84 minutes; IQR 68-101 minutes; P ≤ .001), and procedures with PFA in combination with 3-dimensional electroanatomic mapping were shorter than those with RFA (median 101 minutes; IQR 85-126 minutes vs 171 minutes; IQR 141-204 minutes; P < .001). Acute safety events occurred in 2.3%, 2.6%, and 0.8% in the PFA, CBA, and RFA groups, respectively (P = .545). The 1-year confounder-adjusted estimate for freedom from atrial arrhythmias was 62.1% for CBA, 55.3% for PFA, and 48.3% for RFA (CBA vs PFA: P = .79; CBA vs RFA: P = .009; PFA vs RFA: P = .010). CONCLUSION In patients with persistent AF undergoing first PVI, 1-year confounder-adjusted outcomes are better with PFA and CBA than with RFA.
Collapse
Affiliation(s)
- Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; SITEM Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Robin Stettler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Maurhofer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anita Stefanova
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Salik Ur Rehman Iqbal
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gregor Thalmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nikola A Kozhuharov
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Oskar Galuszka
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; SITEM Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| |
Collapse
|
3
|
Kueffer T, Stefanova A, Madaffari A, Seiler J, Thalmann G, Kozhuharov N, Maurhofer J, Galuszka O, Haeberlin A, Noti F, Servatius H, Tanner H, Roten L, Reichlin T. Pulmonary vein isolation durability and lesion regression in patients with recurrent arrhythmia after pulsed-field ablation. J Interv Card Electrophysiol 2024; 67:503-511. [PMID: 37523023 PMCID: PMC11015999 DOI: 10.1007/s10840-023-01608-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND A novel multipolar pulsed-field ablation (PFA) catheter has recently been introduced for pulmonary vein isolation (PVI). Pre-market data showed high rates for PVI-durability during mandatory remapping studies. OBJECTIVE To present post-market data in patients with recurrent arrhythmias. METHODS Consecutive patients undergoing a redo procedure after an index PFA PVI using a bipolar-biphasic PFA system were included. 3-D electro-anatomical maps (3D-EAM) on redo procedure were compared to the 3D-EAM acquired after ablation during the index procedure. PVI durability was assessed on a per-vein and per-patient level and the sites of reconnections were identified. Furthermore, lesion extent around veins with durable isolation was compared to study lesion regression. RESULTS Of 341 patients treated with a PFA PVI, 29 (8.5%) underwent a left atrial redo ablation due to arrhythmia recurrence. At the end of the index procedure, 110/112 veins (98%, four common ostia) were isolated. On redo procedures performed a median of 6 months after the first ablation, 3D-EAM identified 69/110 (63%) PVs with durable isolation. In 6 (21%) patients, all PVs were durably isolated. Reconnections were more often found on the right-sided veins and on the anterior aspects of the upper veins. Only minor lesion regression was observed between the index and redo procedure (a median of 3 mm (0 - 9.5) on the posterior wall). CONCLUSION In patients with arrhythmia recurrence after PFA PVI using a first-generation PFA device, durable isolation was observed in 63% of the veins and 21% of the patients showed durable isolation of all previously isolated veins.
Collapse
Affiliation(s)
- Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Anita Stefanova
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Gregor Thalmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Nikola Kozhuharov
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Jens Maurhofer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Oskar Galuszka
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland.
| |
Collapse
|
4
|
Galuszka OM, Baldinger SH, Servatius H, Seiler J, Madaffari A, Kozhuharov N, Thalmann G, Kueffer T, Muehl A, Maurhofer J, Haeberlin A, Noti F, Tanner H, Reichlin T, Roten L. Durability of CLOSE-Guided Pulmonary Vein Isolation in Persistent Atrial Fibrillation: A Prospective Remapping Study. JACC Clin Electrophysiol 2024:S2405-500X(24)00172-5. [PMID: 38639700 DOI: 10.1016/j.jacep.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Recurrence of paroxysmal atrial fibrillation (AF) following pulmonary vein isolation (PVI) is presumably caused by pulmonary vein (PV) reconnections. However, there is little data available on the durability of PVI and incidence of arrhythmia recurrence in patients with persistent AF. OBJECTIVES To evaluate the lesion durability by means of an a priori planned remapping procedure in patients with persistent AF undergoing CLOSE-guided PVI. METHODS In a prospective study, we included patients with symptomatic, persistent AF undergoing CLOSE-guided radiofrequency ablation. Irrespective of AF recurrence, a redo procedure was mandated 6 months following the index procedure to evaluate PV reconnections. The outcome of AF ablation was based on clinical recurrence and 7-day Holter electrocardiogram 3 and 6 months after the index procedure and 3, 6, and 12 months after the redo procedure. RESULTS Of 30 patients included, 26 (81% men; median age 68 years) underwent the planned remapping study a median of 6 months after the index procedure, whereas 4 patients without recurrence refused a repeat procedure. In total, 78 of 102 (76%) PVs showed durable isolation and 15 patients (58%) presented complete isolation of all PVs. Beyond the blanking period, 6 of 26 patients (23%) had arrhythmia recurrence before the redo procedure. Recurrence had occurred in 33% of patients with complete isolation of all veins and in 9% of patients with PV reconnections (P = 0.197). After re-PVI in patients with PV reconnections and additional ablation in patients with recurrence but durable PVI, 17 of 26 patients (65%) were free of arrhythmia after 12 months. CONCLUSIONS In patients with persistent AF, CLOSE-guided PVI resulted in durable rate of PVI on a per-vein and per-patient level of 76% and 58%, respectively. Arrhythmia recurrence was numerically higher in patients with durable PVI compared with patients without.
Collapse
Affiliation(s)
- Oskar M Galuszka
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nikola Kozhuharov
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gregor Thalmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Aline Muehl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Maurhofer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| |
Collapse
|
5
|
Chollet L, Iqbal SUR, Wittmer S, Thalmann G, Madaffari A, Kozhuharov N, Galuszka O, Küffer T, Gräni C, Brugger N, Servatius H, Noti F, Haeberlin A, Roten L, Tanner H, Reichlin T. Impact of atrial fibrillation phenotype and left atrial volume on outcome after pulmonary vein isolation. Europace 2024; 26:euae071. [PMID: 38597211 PMCID: PMC11004789 DOI: 10.1093/europace/euae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/12/2024] [Indexed: 04/11/2024] Open
Abstract
AIMS Pulmonary vein isolation (PVI) is increasingly performed in patients with atrial fibrillation (AF). Both AF phenotype and left atrial (LA) volume have been shown to influence ablation outcome. The inter-relationship of the two is incompletely understood. We aimed to investigate the impact of AF phenotype vs. LA volume on outcome after PVI. METHODS AND RESULTS In a retrospective analysis of a prospective registry of patients undergoing a first PVI, the association of AF phenotype and LA volume index (LAVI) was assessed as well as their impact on AF recurrence during follow-up. Overall, 476 patients were enrolled (median age 63 years, 29% females, 65.8% paroxysmal AF). Obesity, hypertension, chronic kidney disease, and heart failure were all significantly more frequent in persistent AF. After 1 year, single-procedure, freedom from arrhythmia recurrence was 61.5%. Patients with paroxysmal AF had better outcomes compared with patients with persistent AF (65.6 vs. 52.7%, P = 0.003), as had patients with no/mild vs. moderate/severe LA dilation (LAVI <42 mL/m2 67.1% vs. LAVI ≥42 mL/m2 53%, P < 0.001). The combination of both parameters refined prediction of 1-year recurrence (P < 0.001). After adjustment for additional clinical risk factors in multivariable Cox proportional hazard analysis, both AF phenotype and LAVI ≥42 mL/m2 contributed significantly towards the prediction of 1-year recurrence. CONCLUSION Atrial fibrillation phenotype and LA volume are independent predictors of outcome after PVI. Persistent AF with no/mild LA dilation has a similar risk of recurrence as paroxysmal AF with a moderate/severe LA dilation and should be given similar priority for ablation.
Collapse
Affiliation(s)
- Laurève Chollet
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Salik ur Rehman Iqbal
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Severin Wittmer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Gregor Thalmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Nikola Kozhuharov
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Oskar Galuszka
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Thomas Küffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| |
Collapse
|
6
|
Maurhofer J, Kueffer T, Madaffari A, Stettler R, Stefanova A, Seiler J, Thalmann G, Kozhuharov N, Galuszka O, Servatius H, Haeberlin A, Noti F, Tanner H, Roten L, Reichlin T. Pulsed-field vs. cryoballoon vs. radiofrequency ablation: a propensity score matched comparison of one-year outcomes after pulmonary vein isolation in patients with paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2024; 67:389-397. [PMID: 37776355 PMCID: PMC10902096 DOI: 10.1007/s10840-023-01651-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/14/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Pulsed-field ablation (PFA) has shown favourable data in terms of safety and procedural efficiency for pulmonary vein isolation (PVI). We sought to compare procedural and 1-year follow-up data of patients with paroxysmal atrial fibrillation (AF) undergoing PVI using PFA, cryoballoon ablation (CBA) and radiofrequency ablation (RFA). METHODS Consecutive patients with paroxysmal AF undergoing a first PVI with PFA at our institution were included. For comparison, patients with paroxysmal AF undergoing a first PVI with CBA and RFA were selected using a 1:2:2 propensity score matching. The PFA group followed the standard 32-applications lesion-set protocol, the CBA group a time-to-effect plus 2-min strategy, and the RFA group the CLOSE protocol. Patients were followed with 7d-Holter ECGs 3, 6, and 12 months after ablation. The primary endpoint was recurrence of atrial tachyarrhythmia (ATa) following a blanking period of 3 months. RESULTS A total of 200 patients were included (PFA n = 40; CBA n = 80; RFA n = 80). Median procedure times were shortest with CBA (75 min) followed by PFA (94 min) and RFA (182 min; p < 0.001). Fluoroscopy dose was lowest with RFA (1.6Gycm2) followed by PFA (5.0Gycm2) and CBA (5.7Gycm2; p < 0.001). After a 1-year follow-up, freedom from ATa recurrence was 85.0% with PFA, 66.2% with CBA and 73.8% with RFA (p = 0.12 PFA vs. CBA; p = 0.27 PFA vs. RFA). CONCLUSION In a propensity score matched analysis of patients with paroxysmal AF, freedom from any ATa 1 year after PVI using PFA was favourable and at least as good as for PVI with CBA or RFA.
Collapse
Affiliation(s)
- Jens Maurhofer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Robin Stettler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anita Stefanova
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gregor Thalmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nikola Kozhuharov
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Oskar Galuszka
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| |
Collapse
|
7
|
Goulouti E, Lam A, Nozica N, Elchinova E, Dernektsi C, Neugebauer F, Branca M, Servatius H, Noti F, Haeberlin A, Thalmann G, Kozhuharov NA, Madaffari A, Tanner H, Reichlin T, Roten L. Incidental Arrhythmias During Atrial Fibrillation Screening With Repeat 7-Day Holter ECGs in a Hospital-Based Patient Population. J Am Heart Assoc 2024; 13:e032223. [PMID: 38348803 PMCID: PMC11010089 DOI: 10.1161/jaha.123.032223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/16/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Screening for atrial fibrillation (AF) may reveal incidental arrhythmias of relevance. The aim of this study was to describe incidental arrhythmias detected during screening for AF in the STAR-FIB (Predicting SilenT AtRial FIBrillation in Patients at High Thrombembolic Risk) cohort study. METHODS AND RESULTS In the STAR-FIB cohort study, we screened hospitalized patients for AF with 3 repeat 7-day Holter ECGs. We analyzed all Holter ECGs for the presence of the following incidental arrhythmias: (1) sinus node dysfunction, defined as sinus pause of ≥3 seconds' duration; (2) second-degree (including Wenckebach) or higher-degree atrioventricular block (AVB); (3) sustained supraventricular tachycardia of ≥30 seconds' duration; and (4) sustained ventricular tachycardia of ≥30 seconds' duration. We furthermore report treatment decisions because of incidental arrhythmias. A total of 2077 Holter ECGs were performed in 794 patients (mean age, 74.7 years; 49% women), resulting in a mean cumulative duration of analyzable ECG signal of 414±136 hours/patient. We found incidental arrhythmias in 94 patients (11.8%). Among these were sinus node dysfunction in 14 patients (1.8%), AVB in 41 (5.2%), supraventricular tachycardia in 42 (5.3%), and ventricular tachycardia in 2 (0.3%). Second-degree AVB was found in 23 patients (2.9%), 2:1 AVB in 10 (1.3%), and complete AVB in 8 (1%). Subsequently, 8 patients underwent pacemaker implantation, 1 for sinus node dysfunction (post-AF conversion pause of 9 seconds) and 7 for advanced AVB. One patient had an implantable cardioverter-defibrillator implanted for syncopal ventricular tachycardia. CONCLUSIONS Incidental arrhythmias were frequently detected during screening for AF in the STAR-FIB study and resulted in device therapy in 1.1% of our cohort patients.
Collapse
Affiliation(s)
- Eleni Goulouti
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Anna Lam
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Nikolas Nozica
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Elena Elchinova
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Chrisoula Dernektsi
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Felix Neugebauer
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | | | - Helge Servatius
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Fabian Noti
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Andreas Haeberlin
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
- Sitem Center for Translational Medicine and Biomedical Entrepreneurship University of Bern Switzerland
| | - Gregor Thalmann
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Nikola Asenov Kozhuharov
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Antonio Madaffari
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Hildegard Tanner
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Tobias Reichlin
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Laurent Roten
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| |
Collapse
|
8
|
Huber AT, Fankhauser S, Wittmer S, Chollet L, Lam A, Maurhofer J, Madaffari A, Seiler J, Servatius H, Haeberlin A, Noti F, Brugger N, von Tengg-Kobligk H, Gräni C, Roten L, Tanner H, Reichlin T. Epicardial adipose tissue dispersion at CT and recurrent atrial fibrillation after pulmonary vein isolation. Eur Radiol 2024:10.1007/s00330-023-10498-2. [PMID: 38197916 DOI: 10.1007/s00330-023-10498-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/03/2023] [Accepted: 11/06/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES Epicardial adipose tissue (EAT) remodeling is associated with atrial fibrillation (AF). Left atrial (LA) EAT dispersion on cardiac CT is a non-invasive imaging biomarker reflecting EAT heterogeneity. We aimed to investigate the association of LA EAT dispersion with AF recurrence after pulmonary vein isolation (PVI). METHODS In a prospective registry of consecutive patients undergoing first PVI, mean EAT attenuation values were measured on contrast-enhanced cardiac CT scans in Hounsfield units (HU) within low (- 195 to - 45 HU) and high (- 44 to - 15 HU) threshold EAT compartments around the left atrium (LA). EAT dispersion was defined as the difference between the mean HU values within the two EAT compartments. Continuous variables were compared between groups using the Mann-Whitney U test and cox proportional hazard models were used to calculate hazard ratios of predictors of 1-year AF recurrence. RESULTS A total of 208 patients were included, 135 with paroxysmal AF and 73 with persistent AF. LA EAT dispersion was significantly larger in patients with persistent compared to paroxysmal AF (52.6 HU vs. 49.9 HU; p = 0.001). After 1 year of follow-up, LA EAT dispersion above the mean (> 50.8 HU) was associated with a higher risk of AF recurrence (HR 2.3, 95% CI 1.5-3.6; p < 0.001). It retained its predictive value when corrected for age, sex, body mass index, LA volume, and AF type (HR 2.8, 95% CI 1.6-4.6; p < 0.001). CONCLUSION A larger LA EAT dispersion on contrast-enhanced cardiac CT scans, reflecting EAT heterogeneity, is independently associated with AF recurrence after PVI. CLINICAL RELEVANCE STATEMENT Based on LA EAT dispersion assessment, a more accurate risk stratification and patient selection may be possible based on a pre-procedural cardiac CT when planning PVI. KEY POINTS • Epicardial adipose tissue (EAT) remodeling is associated with atrial fibrillation (AF). • A larger left atrial EAT dispersion in a pre-procedural cardiac CT was associated with a higher 1-year AF recurrence risk after pulmonary vein isolation. • A pre-procedural cardiac CT with left atrial EAT dispersion assessment may provide a more accurate risk stratification and patient selection for PVI.
Collapse
Affiliation(s)
- Adrian Thomas Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
- Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, University of Lucerne, Lucerne, Switzerland, Lucerne, Switzerland.
| | - Severin Fankhauser
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Severin Wittmer
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Laureve Chollet
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Anna Lam
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Jens Maurhofer
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Hendrik von Tengg-Kobligk
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
9
|
Kueffer T, Tanner H, Madaffari A, Seiler J, Haeberlin A, Maurhofer J, Noti F, Herrera C, Thalmann G, Kozhuharov NA, Reichlin T, Roten L. Posterior wall ablation by pulsed-field ablation: procedural safety, efficacy, and findings on redo procedures. Europace 2023; 26:euae006. [PMID: 38225174 PMCID: PMC10803044 DOI: 10.1093/europace/euae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/08/2024] [Indexed: 01/17/2024] Open
Abstract
AIMS The left atrial posterior wall is a potential ablation target in patients with recurrent atrial fibrillation despite durable pulmonary vein isolation or in patients with roof-dependent atrial tachycardia (AT). Pulsed-field ablation (PFA) offers efficient and safe posterior wall ablation (PWA), but available data are scarce. METHODS AND RESULTS Consecutive patients undergoing PWA using PFA were included. Posterior wall ablation was performed using a pentaspline PFA catheter and verified by 3D-electroanatomical mapping. Follow-up was performed using 7-day Holter ECGs 3, 6, and 12 months after ablation. Recurrence of any atrial arrhythmia lasting more than 30 s was defined as failure. Lesion durability was assessed during redo procedures. Posterior wall ablation was performed in 215 patients (70% males, median age 70 [IQR 61-75] years, 67% redo procedures) and was successful in all patients (100%) by applying a median of 36 (IQR 32-44) PFA lesions. Severe adverse events were cardiac tamponade and vascular access complication in one patient each (0.9%). Median follow-up was 7.3 (IQR 5.0-11.8) months. One-year arrhythmia-free outcome in Kaplan-Meier analysis was 53%. A redo procedure was performed in 26 patients (12%) after a median of 6.9 (IQR 2.4-11) months and showed durable PWA in 22 patients (85%) with only minor lesion regression. Among four patients with posterior wall reconnection, three (75%) presented with roof-dependent AT. CONCLUSION Posterior wall ablation with this pentaspline PFA catheter can be safely and efficiently performed with a high durability observed during redo procedures. The added value of durable PWA for the treatment of atrial fibrillation remains to be evaluated.
Collapse
Affiliation(s)
- Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Jens Maurhofer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claudia Herrera
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gregor Thalmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nikola A Kozhuharov
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
10
|
Maurhofer J, Kueffer T, Knecht S, Madaffari A, Badertscher P, Seiler J, Krisai P, Jufer C, Asatryan B, Heg D, Servatius H, Tanner H, Kühne M, Roten L, Sticherling C, Reichlin T. Comparison of the PolarX and the Arctic Front cryoballoon for pulmonary vein isolation in patients with symptomatic paroxysmal atrial fibrillation (COMPARE CRYO) - Study protocol for a randomized controlled trial. Contemp Clin Trials 2023; 134:107341. [PMID: 37722483 DOI: 10.1016/j.cct.2023.107341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/24/2023] [Accepted: 09/15/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION Single-shot devices are increasingly used for pulmonary vein isolation (PVI) in atrial fibrillation (AF). The Arctic Front cryoballoon (Medtronic) is the most frequently used single-shot technology. A recently developed novel cryoballoon has been introduced (PolarX, Boston Scientific) with the aim to address limitations of the Arctic Front system. METHODS COMPARE CRYO is a multicentre, randomized, controlled trial with blinded endpoint adjudication by an independent clinical events committee. A total of 200 patients with paroxysmal AF undergoing their first PVI are randomized 1:1 between PolarX cryoballoon ablation and Arctic Front cryoballoon ablation. Continuous monitoring during follow-up is performed using an implantable cardiac monitor (ICM) in all patients. The primary endpoint is time to first recurrence of any atrial tachyarrhythmia (AF, atrial flutter, and/or atrial tachycardia) ≥ 120 s between days 91 and 365 post ablation as detected on the (ICM). Procedural safety is assessed by a composite of cardiac tamponade, persistent phrenic nerve palsy >24 h, vascular complications requiring intervention, stroke/transient ischemic attack, atrioesophageal fistula or death occurring during or up to 30 days after the procedure. Key secondary endpoints include (1) procedure and fluoroscopy times, (2) AF burden, (3) proportion of patients with recurrence in the blanking period, (4) proportion of patients undergoing repeat ablation, and (5) quality of life changes at 12 months compared to baseline. CONCLUSION COMPARE CRYO will compare the efficacy and safety of the novel PolarX cryoballoon and the standard-of-practice Arctic Front cryoballoon for first PVI performed in patients with symptomatic paroxysmal AF. TRIAL REGISTRATION (ClinicalTrials.gov ID: NCT04704986).
Collapse
Affiliation(s)
- Jens Maurhofer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Corinne Jufer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| |
Collapse
|
11
|
Steinhauer B, Dütschler S, Spicher J, Aerschmann S, Ambord N, Bartkowiak J, Tawo S, Thalmann G, Servatius H, Noti F, Seiler J, Baldinger S, Haeberlin A, Madaffari A, Tanner H, Reichlin T, Roten L. Patient satisfaction, safety and efficacy of nurse-led compared to physician-led implantation of cardiac monitors. Eur J Cardiovasc Nurs 2023:zvad103. [PMID: 37851866 DOI: 10.1093/eurjcn/zvad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023]
Abstract
AIMS Implantation of an implantable cardiac monitor (ICM) is a simple procedure, but adds significant and increasing workload to the arrhythmia service. In 2020, we established a nurse-led ICM implantation service. We aimed to analyze patient satisfaction, adverse events during implant and ICM re-interventions with nurse-led ICM implantation (N-Implant) compared to physician-led ICM implantation (P-Implant). METHOD AND RESULTS From January 2020 to December 2021 we included all consecutive patients implanted with an ICM in a prospective registry. We collected data on patient characteristics, implant procedure and follow-up. Patients were interviewed by phone four weeks after ICM implantation.Of 321 patients implanted with an ICM (median age 67 years; 33% women), 189 (59%) were N-Implants. More N-Implants were performed in the outpatient clinic compared to P-Implants (95% vs. 8%; p<0.001). Two N-Implant patients experienced vaso-vagal reaction during implantation (1%), whereas no adverse events occurred during P-Implant (p=0.51). 297 patients (93%) completed the questionnaire. Duration of pain was shorter and wound closure after 2 weeks better following N-Implant (p=0.019 and p=0.018). A minor bruise or swelling at the implant site was reported more frequently after N-Implant (p=0.003 and p=0.041). Patient satisfaction was excellent with both N-Implant and P-Implant (99% and 97%; p=0.16). After a median follow-up of 242 days (range 7-725 days), five ICMs (2%) were explanted prematurely, without differences among groups. Reasons for premature explants were local discomfort (n=2), infection, MRI and ICM malfunction. CONCLUSION Nurse-led ICM implantation has excellent patient satisfaction without compromising safety. N-Implant both expands nursing competencies and reduces physician workload.
Collapse
Affiliation(s)
- Barbara Steinhauer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sophie Dütschler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jasmin Spicher
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sarah Aerschmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicole Ambord
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joanna Bartkowiak
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Serlha Tawo
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gregor Thalmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Samuel Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
12
|
Kueffer T, Seiler J, Madaffari A, Mühl A, Asatryan B, Stettler R, Haeberlin A, Noti F, Servatius H, Tanner H, Baldinger SH, Reichlin T, Roten L. Pulsed-field ablation for the treatment of left atrial reentry tachycardia. J Interv Card Electrophysiol 2023; 66:1431-1440. [PMID: 36496543 PMCID: PMC10457215 DOI: 10.1007/s10840-022-01436-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND We describe our initial experience using a multipolar pulsed-field ablation catheter for the treatment of left atrial (LA) reentry tachycardia. METHODS We included all patients with LA reentry tachycardia treated with PFA at our institution between September 2021 and March 2022. The tachycardia mechanism was identified using 3D electro-anatomical mapping (3D-EAM). Subsequently, a roof line, anterior line, or mitral isthmus line was ablated as appropriate. Roof line ablation was always combined with LA posterior wall (LAPW) ablation. Positioning of the PFA catheter was guided by a 3D-EAM system and by fluoroscopy. Bidirectional block across lines was verified using standard criteria. Additional radiofrequency ablation (RFA) was used to achieve bidirectional block as necessary. RESULTS Among 22 patients (median age 70 (59-75) years; 9 females), we identified 27 LA reentry tachycardia: seven roof dependent macro-reentries, one posterior-wall micro-reentry, twelve peri-mitral macro-reentries, and seven anterior-wall micro-reentries. We ablated a total of 20 roof lines, 13 anterior lines, and 6 mitral isthmus lines. Additional RFA was necessary for two anterior lines (15%) and three mitral isthmus lines (50%). Bidirectional block was achieved across all roof lines, 92% of anterior lines, and 83% of mitral isthmus lines. We observed no acute procedural complications. CONCLUSION Ablation of a roof line and of the LAPW is feasible, effective, and safe using this multipolar PFA catheter. However, the catheter is less suited for ablation of the mitral isthmus and the anterior line. A focal pulsed-field ablation catheter may be more effective for ablation of these lines. This study shows the feasibility to ablate linear lesions with a multipolar pulsed-field ablation catheter. 27 left atrial reentry tachycardia were treated in 22 patients.
Collapse
Affiliation(s)
- Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Aline Mühl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Robin Stettler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
- ARTORG Center, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland.
| |
Collapse
|
13
|
Knecht S, Schlageter V, Badertscher P, Krisai P, Jousset F, Küffer T, Madaffari A, Schaer B, Osswald S, Sticherling C, Kühne M. Atrial substrate characterization based on bipolar voltage electrograms acquired with multipolar, focal and mini-electrode catheters. Europace 2023; 25:euad127. [PMID: 37165671 PMCID: PMC10228606 DOI: 10.1093/europace/euad127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/21/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Bipolar voltage (BV) electrograms for left atrial (LA) substrate characterization depend on catheter design and electrode configuration. AIMS The aim of the study was to investigate the relationship between the BV amplitude (BVA) using four catheters with different electrode design and to identify their specific LA cutoffs for scar and healthy tissue. METHODS AND RESULTS Consecutive high-resolution electroanatomic mapping was performed using a multipolar-minielectrode Orion catheter (Orion-map), a duo-decapolar circular mapping catheter (Lasso-map), and an irrigated focal ablation catheter with minielectrodes (Mifi-map). Virtual remapping using the Mifi-map was performed with a 4.5 mm tip-size electrode configuration (Nav-map). BVAs were compared in voxels of 3 × 3 × 3 mm3. The equivalent BVA cutoff for every catheter was calculated for established reference cutoff values of 0.1, 0.2, 0.5, 1.0, and 1.5 mV. We analyzed 25 patients (72% men, age 68 ± 15 years). For scar tissue, a 0.5 mV cutoff using the Nav corresponds to a lower cutoff of 0.35 mV for the Orion and of 0.48 mV for the Lasso. Accordingly, a 0.2 mV cutoff corresponds to a cutoff of 0.09 mV for the Orion and of 0.14 mV for the Lasso. For healthy tissue cutoff at 1.5 mV, a larger BVA cutoff for the small electrodes of the Orion and the Lasso was determined of 1.68 and 2.21 mV, respectively. CONCLUSION When measuring LA BVA, significant differences were seen between focal, multielectrode, and minielectrode catheters. Adapted cutoffs for scar and healthy tissue are required for different catheters.
Collapse
Affiliation(s)
- Sven Knecht
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Vincent Schlageter
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Florian Jousset
- Boston Scientific, Rhythm Management, Solothurn, Switzerland
| | - Thomas Küffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Beat Schaer
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| |
Collapse
|
14
|
Kueffer T, Madaffari A, Thalmann G, Mühl A, Galuszka O, Baldinger S, Seiler J, Tanner H, Kobza R, Roten L, Berte B, Reichlin T. Eliminating transseptal sheath exchange for pulsed field ablation procedures using a direct over-the-needle transseptal access with the Faradrive sheath. Europace 2023; 25:1500-1502. [PMID: 36892147 PMCID: PMC10105838 DOI: 10.1093/europace/euad060] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/14/2023] [Indexed: 03/10/2023] Open
Abstract
AIMS Pulsed field ablation (PFA) for pulmonary vein isolation (PVI) combines the benefits of high procedural efficacy and safety. Transseptal puncture (TSP) to obtain left atrial (LA) access during PVI remains an important source of complications during LA procedures. For PFA procedures, TSP is generally performed using a standard transseptal sheath that is then exchanged over the wire for a dedicated PFA sheath, which might be a potential source for air embolism. We aimed to prospectively evaluate the feasibility and safety of a simplified workflow using the PFA sheath (Faradrive, Boston Scientific) directly for TSP. METHODS AND RESULTS We prospectively enrolled 100 patients undergoing PVI using PFA at two centres. TSP was performed using the PFA sheath and a standard 98 cm transseptal needle under fluoroscopic guidance. TSP via the PFA sheath was successfully performed in all patients and no complications occurred. The median time from the first groin puncture to the completed LA access was 12 min (IQR 8-16 min). CONCLUSION An over-the-needle TSP directly with the PFA sheath proved feasible and safe in our study. This simplified workflow has the potential to reduce the risk of air embolism, to shorten procedure time, and to reduce cost.
Collapse
Affiliation(s)
- Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, CH-3010 Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, CH-3010 Bern, Switzerland
| | - Gregor Thalmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, CH-3010 Bern, Switzerland
| | - Aline Mühl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, CH-3010 Bern, Switzerland
| | - Oskar Galuszka
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, CH-3010 Bern, Switzerland.,Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Samuel Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, CH-3010 Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, CH-3010 Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, CH-3010 Bern, Switzerland
| | - Richard Kobza
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, CH-3010 Bern, Switzerland
| | - Benjamin Berte
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, CH-3010 Bern, Switzerland
| |
Collapse
|
15
|
Kueffer T, Haeberlin A, Knecht S, Baldinger SH, Madaffari A, Seiler J, Mühl A, Tanner H, Roten L, Reichlin T. Validation of the accuracy of contact force measurement by contemporary force-sensing ablation catheters. J Cardiovasc Electrophysiol 2023; 34:292-299. [PMID: 36490307 DOI: 10.1111/jce.15770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/31/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Contact force sensing catheters are widely used for ablation of cardiac arrhythmias. They allow quantification of catheter-to-tissue contact, which is an important determinant for lesion formation and may reduce the risk of complications. The accuracy of these sensors may vary across the measurement range, catheter-to-tissue angle, and amongst manufacturers. We aim to compare the accuracy and reproducibility of four different force sensing ablation catheters. METHODS A measurement setup containing a heated saline water bath with an integrated force measurement unit was constructed and validated. Subsequently, we investigated four different catheter models, each equipped with a unique measurement technology: Tacticath Quartz (Abbott), AcQBlate Force (Biotronik/Acutus), Stablepoint (Boston Scientific), and Smarttouch SF (Biosense Webster). For each model, the accuracy of three different catheters was measured within the range of 0-60 g and at contact angles of 0°, 30°, 45°, 60°, and 90°. RESULTS In total, 6685 measurements were performed using 4 × 3 catheters (median of 568, interquartile range: 511-606 measurements per catheter). Over the entire measurement-range, the force measured by the catheters deviated from the real force by the following absolute mean values: Tacticath 1.29 ± 0.99 g, AcQBlate Force 2.87 ± 2.37 g, Stablepoint 1.38 ± 1.29 g, and Smarttouch 2.26 ± 2.70 g. For some models, significant under- and overestimation of >10 g were observed at higher forces. Mean absolute errors of all models across the range of 10-40 g were <3 g. CONCLUSION Contact measured by force-sensing catheters is accurate with 1-3 g deviation within the range of 10-40 g. Significant errors can occur at higher forces with potential clinical consequences.
Collapse
Affiliation(s)
- Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aline Mühl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
16
|
Segeroth M, Winkel DJ, Strebel I, Yang S, van der Stouwe JG, Formambuh J, Badertscher P, Cyriac J, Wasserthal J, Caobelli F, Madaffari A, Lopez-Ayala P, Zellweger M, Sauter A, Mueller C, Bremerich J, Haaf P. Pulmonary transit time of cardiovascular magnetic resonance perfusion scans for quantification of cardiopulmonary haemodynamics. Eur Heart J Cardiovasc Imaging 2023:6994365. [PMID: 36662127 PMCID: PMC10364617 DOI: 10.1093/ehjci/jead001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/26/2022] [Indexed: 01/21/2023] Open
Abstract
AIMS Pulmonary transit time (PTT) is the time blood takes to pass from the right ventricle to the left ventricle via pulmonary circulation. We aimed to quantify PTT in routine cardiovascular magnetic resonance imaging perfusion sequences. PTT may help in the diagnostic assessment and characterization of patients with unclear dyspnoea or heart failure (HF). METHODS AND RESULTS We evaluated routine stress perfusion cardiovascular magnetic resonance scans in 352 patients, including an assessment of PTT. Eighty-six of these patients also had simultaneous quantification of N-terminal pro-brain natriuretic peptide (NTproBNP). NT-proBNP is an established blood biomarker for quantifying ventricular filling pressure in patients with presumed HF. Manually assessed PTT demonstrated low inter-rater variability with a correlation between raters >0.98. PTT was obtained automatically and correctly in 266 patients using artificial intelligence. The median PTT of 182 patients with both left and right ventricular ejection fraction >50% amounted to 6.8 s (Pulmonary transit time: 5.9-7.9 s). PTT was significantly higher in patients with reduced left ventricular ejection fraction (<40%; P < 0.001) and right ventricular ejection fraction (<40%; P < 0.0001). The area under the receiver operating characteristics curve (AUC) of PTT for exclusion of HF (NT-proBNP <125 ng/L) was 0.73 (P < 0.001) with a specificity of 77% and sensitivity of 70%. The AUC of PTT for the inclusion of HF (NT-proBNP >600 ng/L) was 0.70 (P < 0.001) with a specificity of 78% and sensitivity of 61%. CONCLUSION PTT as an easily, even automatically obtainable and robust non-invasive biomarker of haemodynamics might help in the evaluation of patients with dyspnoea and HF.
Collapse
Affiliation(s)
- Martin Segeroth
- Department of Radiology and Nuclear Medicine, University Hospital, Basel and University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - David Jean Winkel
- Department of Radiology and Nuclear Medicine, University Hospital, Basel and University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Ivo Strebel
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel and University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Shan Yang
- Department of Research and Analysis, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Jan Gerrit van der Stouwe
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel and University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Jude Formambuh
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel and University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel and University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Joshy Cyriac
- Department of Research and Analysis, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Jakob Wasserthal
- Department of Research and Analysis, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Federico Caobelli
- Department of Radiology and Nuclear Medicine, University Hospital, Basel and University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, University Hospital Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Pedro Lopez-Ayala
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel and University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Michael Zellweger
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel and University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Alexander Sauter
- Department of Radiology and Nuclear Medicine, University Hospital, Basel and University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Christian Mueller
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel and University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Jens Bremerich
- Department of Radiology and Nuclear Medicine, University Hospital, Basel and University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Philip Haaf
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel and University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| |
Collapse
|
17
|
Knecht S, Sticherling C, Roten L, Badertscher P, Krisai P, Chollet L, Küffer T, Spies F, Völlmin G, Madaffari A, Mühl A, Baldinger SH, Servatius H, Tanner H, Osswald S, Reichlin T, Kühne M. Efficacy and safety of a novel cryoballoon ablation system: multicentre comparison of 1-year outcome. Europace 2022; 24:1926-1932. [PMID: 35727739 DOI: 10.1093/europace/euac094] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS The aim of the study was to compare the 1-year efficacy and safety of a novel cryoballoon (NCB) ablation system (POLARx; Boston Scientific) for pulmonary vein isolation (PVI) compared with the standard cryoballoon (SCB) system (Arctic Front, Medtronic). METHODS AND RESULTS Consecutive patients with atrial fibrillation (AF) undergoing PVI using the NCB and the SCB at two centres were included. We report 1-year efficacy after 12 months, short-term safety and hospitalizations within the blanking period, and predictors for AF recurrence. In case of repeat procedures, pulmonary vein (PV) reconnection patterns were characterized. Eighty patients (age 66 ± 10 years, ejection fraction 57 ± 10%, left atrial volume index 39 ± 13 mL/m2, paroxysmal AF in 64%) were studied. After a single procedure and a follow-up of 12 months, 68% in the NCB group and 70% in the SCB group showed no recurrence of AF/atrial tachycardias (P = 0.422). One patient in the NCB group suffered a periprocedural stroke with full recovery. There were no differences regarding hospitalizations during follow-up between the groups. PV reconnection observed during 12 repeat procedures (4 NCB, 8 SCB) pattern was comparable between the groups with more reconnections in the right-sided compared with the left-sided PVs. CONCLUSION In this multicentre study comparing two currently available cryoballoon ablation systems for PVI, no differences were observed in the efficacy and safety during a follow-up of 12 months.
Collapse
Affiliation(s)
- Sven Knecht
- Cardiology/Electrophysiology, University of Basel Hospital, Basel, Switzerland
| | | | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Badertscher
- Cardiology/Electrophysiology, University of Basel Hospital, Basel, Switzerland
| | - Philipp Krisai
- Cardiology/Electrophysiology, University of Basel Hospital, Basel, Switzerland
| | - Laurève Chollet
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Küffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Spies
- Cardiology/Electrophysiology, University of Basel Hospital, Basel, Switzerland
| | - Gian Völlmin
- Cardiology/Electrophysiology, University of Basel Hospital, Basel, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aline Mühl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Osswald
- Cardiology/Electrophysiology, University of Basel Hospital, Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Kühne
- Cardiology/Electrophysiology, University of Basel Hospital, Basel, Switzerland
| |
Collapse
|
18
|
Haeberlin A, Holz A, Seiler J, Baldinger SH, Tanner H, Roten L, Madaffari A, Servatius H, Jenni H, Kadner A, Erdoes G, Reichlin T, Noti F. Impact of a structured institutional lead management programme at a high volume centre for transvenous lead extractions in Switzerland. Cardiovasc Med 2022. [DOI: 10.4414/cvm.2022.02224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
|
19
|
Madaffari A, Brugger N, Grni C, Rimoldi SF, Roten L, Reichlin T. Atrial fibrillation ablation from above. Cardiovasc Med 2022. [DOI: 10.4414/cvm.2022.02205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
| | - Nicolas Brugger
- Inselspital University Hospital Bern Department of Cardiology: Inselspital Universitatsspital Bern Universitatsklinik fur Kardiologie
| | - Christoph Grni
- Inselspital University Hospital Bern Department of Cardiology: Inselspital Universitatsspital Bern Universitatsklinik fur Kardiologie
| | - Stefano F. Rimoldi
- Inselspital University Hospital Bern Department of Cardiology: Inselspital Universitatsspital Bern Universitatsklinik fur Kardiologie
| | - Laurent Roten
- Inselspital University Hospital Bern Department of Cardiology: Inselspital Universitatsspital Bern Universitatsklinik fur Kardiologie
| | - Tobias Reichlin
- Inselspital University Hospital Bern Department of Cardiology: Inselspital Universitatsspital Bern Universitatsklinik fur Kardiologie
| |
Collapse
|
20
|
Gallego Vázquez C, Breuss A, Gnarra O, Portmann J, Madaffari A, Da Poian G. Label noise and self-learning label correction in cardiac abnormalities classification. Physiol Meas 2022; 43. [PMID: 35970176 DOI: 10.1088/1361-6579/ac89cb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/15/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Learning to classify cardiac abnormalities requires large and high-quality labeled datasets, which is a challenge in medical applications. Small datasets from various sources are often aggregated to meet this requirement, resulting in a final dataset prone to label noise owing to inter- and intra-observer variability, and different expertise. It is well known that label noise can affect the performance and generalizability of the trained models. In this work, we explore the impact of label noise and self-learning label correction on the classification of cardiac abnormalities on large heterogeneous datasets of electrocardiogram (ECG) signals. APPROACH A state-of-the-art self-learning multi-class label correction method for image classification is adapted to learn a multi-label classifier for electrocardiogram signals. We evaluated our performance using 5-fold cross-validation on the publicly available PhysioNet/Computing in Cardiology (CinC) 2021 Challenge data, with full and reduced sets of leads. Due to the unknown label noise in the testing set, we tested our approach on the MNIST dataset. We investigated the performance under different levels of structured label noise for both datasets. MAIN RESULTS Under high levels of noise, the cross-validation results of self-learning label correction showed an improvement of approximately 3% in the Challenge score for the PhysioNet/CinC 2021 Challenge dataset and, an improvement in accuracy of 5$\%$ and reduction of the expected calibration error of 0.03 for the MNIST dataset. We demonstrate that self-learning label correction can be used to effectively deal with the presence of unknown label noise, also when using a reduced number of ECG leads.
Collapse
Affiliation(s)
- Cristina Gallego Vázquez
- Health Sciences and Technology, ETH Zürich D-HEST, Sonneggstrasse 3, Zurich, Zürich, 8092, SWITZERLAND
| | - Alexander Breuss
- Health Sciences and Technology, ETH Zurich Institute of Robotics and Intelligent Systems, Sonnegstrasse 3, Zurich, 8092, SWITZERLAND
| | - Oriella Gnarra
- Health Sciences and Technology, ETH Zürich D-HEST, Sonnegstrasse 3, Zurich, Zürich, 8092, SWITZERLAND
| | - Julian Portmann
- Computer Science, ETH Zürich, Universitätstrasse 6, Zurich, Zürich, 8092, SWITZERLAND
| | - Antonio Madaffari
- Inselspital Universitätsspital Bern Universitätsklinik für Kardiologie, Freiburgstrasse 18, Bern, Bern, 3010, SWITZERLAND
| | - Giulia Da Poian
- Health Sciences and Technologie, ETH Zürich D-HEST, Sonnegstrasse 3, Zurich, Zürich, 8092, SWITZERLAND
| |
Collapse
|
21
|
Kueffer T, Baldinger SH, Servatius H, Madaffari A, Seiler J, Mühl A, Franzeck F, Thalmann G, Asatryan B, Haeberlin A, Noti F, Tanner H, Roten L, Reichlin T. Validation of a multipolar pulsed-field ablation catheter for endpoint assessment in pulmonary vein isolation procedures. Europace 2022; 24:1248-1255. [PMID: 35699395 DOI: 10.1093/europace/euac044] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS To validate the performance of a multipolar pulsed-field ablation (PFA) catheter compared to a standard pentaspline 3D-mapping catheter for endpoint assessment of pulmonary vein isolation (PVI). PFA for PVI using single-shot devices combines the benefits of high procedural efficacy and safety. A newly available multipolar PFA catheter allows real-time recording of pulmonary vein (PV) signals during PVI. METHODS AND RESULTS Patients undergoing first PVI using PFA with the standard ablation protocol (eight applications per PV) were studied. Entrance and exit block (10 V/2 ms) were assessed using the PFA catheter. Subsequently, a high-density 3D electroanatomical bipolar voltage map (3D-EAM) was constructed using a standard pentaspline 3D-mapping catheter. Additional PFA applications were delivered only after confirmation of residual PV connection by 3D-EAM. In 56 patients, 213 PVs were targeted for ablation. Acute PVI was achieved in 100% of PVs: in 199/213 (93%) PVs with the standard ablation protocol alone and in the remaining 14 PVs after additional PFA applications. The accuracy of PV assessment with the PFA catheter after the standard ablation protocol was 91% (194/213 veins). In 5/213 (2.3%) PVs, the PFA catheter incorrectly indicated PV-isolation. In 14/213 (6.6%), the PFA catheter incorrectly indicated residual PV-conduction due to high-output pace-capture. Lowering the output to 5 V/1 ms reduced this observation to 0.9% (2/213) and increased the overall accuracy to 97% (206/213). CONCLUSION A novel multipolar PFA catheter allows reliable endpoint assessment for PVI. Due to its design, far-field sensing and high-output pace-capture can occur. Lowering the pacing output increases the accuracy from 91 to 97%.
Collapse
Affiliation(s)
- Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Aline Mühl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Florian Franzeck
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Gregor Thalmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| |
Collapse
|
22
|
Huber AT, Fankhauser S, Chollet L, Wittmer S, Lam A, Baldinger S, Madaffari A, Seiler J, Servatius H, Haeberlin A, Noti F, Brugger N, von Tengg-Kobligk H, Gräni C, Roten L, Tanner H, Reichlin T. The Relationship between Enhancing Left Atrial Adipose Tissue at CT and Recurrent Atrial Fibrillation. Radiology 2022; 305:56-65. [PMID: 35670718 DOI: 10.1148/radiol.212644] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background The association of epicardial adipose tissue (EAT) and its metabolic activity with atrial fibrillation (AF) is an area of active investigation. Left atrial (LA) enhancing EAT (e-EAT) at cardiac CT may be a noninvasive surrogate marker for the metabolic activity of EAT. Purpose To determine the relationship between LA e-EAT and recurrence after AF ablation. Materials and Methods In a secondary analysis of a prospective registry of consecutive patients (from July 2018 to December 2019) undergoing first AF ablation, total and LA EAT were segmented on preprocedural noncontrast- and contrast-enhanced cardiac CT scans. LA e-EAT volume fraction was defined as the LA EAT volume difference between the noncontrast- and contrast-enhanced scan divided by the total LA EAT volume on the noncontrast-enhanced scan (threshold values, -15 HU to -195 HU). Continuous variables were compared between groups by using the Mann-Whitney U test. Cox proportional hazard models were used to calculate hazard ratios of predictors of 1-year AF recurrence. Results A total of 212 patients (mean age, 64 years; 159 men) who underwent a first AF ablation were included (paroxysmal AF, 64%; persistent AF, 36%). The LA EAT volume was higher in patients with persistent versus paroxysmal AF (50 cm3 [IQR, 37-72] vs 37 [IQR, 27-49]; P < .001), but no difference was found for LA e-EAT (P = .09). After 1 year of follow-up, AF recurrence rate was 77 of 212 (36%). LA e-EAT above the mean (>33%) was associated with a higher risk of AF recurrence (hazard ratio [HR], 2.1; 95% CI: 1.3, 3.3; P < .01). In a multivariable Cox regression analysis, LA e-EAT retained its predictive value when corrected for sex, age, AF phenotype, LA volume index, and LA EAT volume (HR, 1.9; 95% CI: 1.1, 3.1; P = .02). Conclusion Left atrial enhancing epicardial adipose tissue was independently associated with recurrence after atrial fibrillation ablation. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Stojanovska in this issue.
Collapse
Affiliation(s)
- Adrian Thomas Huber
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Severin Fankhauser
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Laurève Chollet
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Severin Wittmer
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Anna Lam
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Samuel Baldinger
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Antonio Madaffari
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Jens Seiler
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Helge Servatius
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Andreas Haeberlin
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Fabian Noti
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Nicolas Brugger
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Hendrik von Tengg-Kobligk
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Christoph Gräni
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Laurent Roten
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Hildegard Tanner
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Tobias Reichlin
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| |
Collapse
|
23
|
Haeberlin A, Bartkowiak J, Brugger N, Tanner H, Wan E, Baldinger SH, Seiler J, Madaffari A, Thalmann G, Servatius H, Roten L, Noti F, Reichlin T. Evolution of tricuspid valve regurgitation after implantation of a leadless pacemaker - a single center experience, systematic review and meta-analysis. J Cardiovasc Electrophysiol 2022; 33:1617-1627. [PMID: 35614867 PMCID: PMC9545011 DOI: 10.1111/jce.15565] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/12/2022] [Accepted: 05/22/2022] [Indexed: 11/29/2022]
Abstract
Introduction Conventional transvenous pacemaker leads may interfere with the tricuspid valve leaflets, tendinous chords, and papillary muscles, resulting in significant tricuspid valve regurgitation (TR). Leadless pacemakers (LLPMs) theoretically cause less mechanical interference with the tricuspid valve apparatus. However, data on TR after LLPM implantation are sparse and conflicting. Our goal was to investigate the prevalence of significant TR before and after LLPM implantation. Methods Patients who received a leadless LLPM (Micra™ TPS, Medtronic) between May 2016 and May 2021 at our center were included in this observational study if they had at least a pre‐ and postinterventional echocardiogram (TTE). The evolution of TR severity was assessed. Following a systematic literature review on TR evolution after implantation of a LLPM, data were pooled in a random‐effects meta‐analysis. Results We included 69 patients (median age 78 years [interquartile range (IQR) 72–84 years], 26% women). Follow‐up duration between baseline and follow‐up TTE was 11.4 months (IQR 3.5–20.1 months). At follow‐up, overall TR severity was not different compared to baseline (p = .49). Six patients (9%) had new significant TR during follow‐up after LLPM implantation, whereas TR severity improved in seven patients (10%). In the systematic review, we identified seven additional articles that investigated the prevalence of significant TR after LLPM implantation. The meta‐analysis based on 297 patients failed to show a difference in significant TR before and after LLPM implantation (risk ratio 1.22, 95% confidence interval 0.97–1.53, p = .11). Conclusion To date, there is no substantial evidence for a significant change in TR after implantation of a LLPM.
Collapse
Affiliation(s)
- Andreas Haeberlin
- Dept. of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Switzerland
| | - Joanna Bartkowiak
- Dept. of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Dept. of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Dept. of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Elaine Wan
- Div. of Cardiology, Dept. of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - Samuel H Baldinger
- Dept. of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Dept. of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Dept. of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gregor Thalmann
- Dept. of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Dept. of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Dept. of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Dept. of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Dept. of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
24
|
Kueffer T, Seiler J, Madaffari A, Muehl A, Noti F, Haeberlin A, Servatius H, Tanner H, Baldinger S, Reichlin T, Roten L. Multipolar pulsed-field ablation for the treatment of left atrial reentry tachycardia. Europace 2022. [DOI: 10.1093/europace/euac053.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
A multipolar pulsed field ablation (PFA) catheter was recently introduced for pulmonary vein isolation and combines the benefits of high procedural efficacy and safety. It may also be used to treat left atrial (LA) reentry tachycardia.
Purpose
To describe our initial experience using a multipolar PFA catheter for the treatment of LA reentry tachycardia.
Methods
We included all patients with LA reentry tachycardia treated with a multipolar PFA catheter at our institution. Using 3D electro-anatomical mapping (3D-EAM), we identified the tachycardia mechanism and applied linear lesions either at the left atrial roof, mitral isthmus or on the anterior wall, as appropriate. Positioning of the PFA catheter was verified by integration into 3D-EAM. Applications were performed using 2.0kV with the catheter in basket or flower configuration, depending on ablation site. Bidirectional block across linear lesions was verified using standard criteria. Additional focal radiofrequency ablation (RFA) was used to achieve bidirectional block if necessary.
Results
We treated 17 LA reentry tachycardia with a multipolar PFA catheter in 13 patients (median age 69 (59-73) years; 5 females). The tachycardia mechanism was identified as roof-dependent in five, peri-mitral in eight and anterior scar-related in four cases. PFA lesion sets consisted of 12 posterior wall isolations (i.e. roof lines), four mitral isthmus lines (MIL) and eight anterior lines. For ablation of the mitral side of the anterior line, we always used the PFA catheter in basket configuration, while we targeted the posterior wall and the superior side of the anterior line exclusively with the catheter in flower configuration. To ablate the MIL we used both flower and basket configurations. Three roof-dependent, six peri-mitral, and four anterior scar-related tachycardias were successfully terminated by PFA (76%). Additional RFA was necessary for two MIL, two anterior lines and no roof line (17%). Finally, we achieved bidirectional block across all lines. PFA triggered, vagal-mediated and reversible AV block was observed in one case. Otherwise, there were no acute procedural complications.
Conclusion
Linear lesion sets are feasible and safe using a multipolar PFA catheter. Posterior wall isolation by PFA for the treatment of roof-dependent LA reentry tachycardia is highly efficient while anterior lines and MIL remain challenging and may need complementary RFA or a PFA catheter designed for focal or linear ablations.
Collapse
Affiliation(s)
- T Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - J Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A Muehl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - F Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - H Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - H Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - T Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - L Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
25
|
Kueffer T, Seiler J, Madaffari A, Muehl A, Stettler R, Asatryan B, Haeberlin A, Noti F, Servatius H, Tanner H, Baldinger SH, Roten L, Reichlin T. Pulsed field ablation of atrial fibrillation: recurrence rate after first pulmonary vein isolation and first insights into durability at redo procedures. Europace 2022. [DOI: 10.1093/europace/euac053.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Pulsed field ablation (PFA) is newly available for pulmonary vein isolation (PVI) and combines the benefits of high procedural efficacy and safety. Independent data on the recurrence-rate of atrial fibrillation (AF) after PVI and on PVI durability during redo procedures are scarce.
Purpose
We report data on the recurrence rate of AF after first PVI using PFA and first insights into findings of PVI durability during redo procedures.
Methods
Consecutive AF patients undergoing a first PFA PVI at our center between May 2021 and August 2021 were included. PVI was verified by 3D-electroanatomical mapping (3D-EAM), and additional PFA lesions were applied when necessary until all PV were isolated. Seven-day Holter ECGs were performed at 3 and 6 months after ablation. After a blanking period of 3 months, episodes of AF/AT lasting more than 30 seconds were considered as AF-recurrence.
Results
41 Patients, median age 69 (interquartile range 62-73) years, 24% female, 56% persistent AF, underwent first PVI by PFA. All PVs were successfully isolated using a multipolar PFA catheter. Median total procedure time including 3D-EAM was 104 (85-121) min. Total fluoroscopy time and dose were 26 (19-30) min and 671 (323-1248) Gym2. Acute complications occurred in 1 (2.4%) patient (cardiac tamponade requiring drainage). Early recurrence of AF during the blanking period occurred in 1 (2.4%) patient. Median follow-up time was 107 (91-152) days. Recurrence of AF after the blanking period was detected in 5 (12%) patients, 1 (6%) in paroxysmal AF and 4 (17%) in persistent AF patients, respectively. Redo procedures in 3 (7.3%) patients with AF recurrence confirmed durable isolation of 12/12 (100%) pulmonary veins and showed no evidence of PFA lesion regression.
Conclusion
AF recurrence rates after PVI by means of PFA are low. Durable isolation of 12/12 pulmonary veins (100%) and no evidence of PFA lesion regression was observed during redo procedures in patients with AF recurrence.
Collapse
Affiliation(s)
- T Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - J Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A Muehl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - R Stettler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - B Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - F Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - H Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - H Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - SH Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - L Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - T Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
26
|
Steinhauer B, Spicher J, Aerschmann S, Ambord N, Bartkowiak J, Servatius H, Noti F, Seiler J, Baldinger S, Haeberlin A, Madaffari A, Tanner H, Reichlin T, Roten L, Duetschler S. Nurse-led compared to physician-led implant of cardiac monitors. Europace 2022. [DOI: 10.1093/europace/euac053.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction
Implantation of an implantable cardiac monitor (ICM) is a simple and straightforward procedure. However, with a growing demand for such implants, workload significantly increases. In January 2020, we established a completely nurse-led ICM implantation service (N-IMPLANT) with a standard operating procedure.
Purpose
The present study aimed to analyze the safety, efficacy, and patient satisfaction of N-IMPLANT compared to implantation of ICMs by a physician (P-IMPLANT).
Method
Consenting patients implanted with an ICM were included in a prospective registry, which collects patient characteristics, procedural and remote monitoring data. All patients were followed-up by phone interview four weeks after ICM implantation and a standardized questionnaire was completed.
Results
Of 321 patients implanted with an ICM (median age 67 years; 33% women), 189 (59%) were N-IMPLANT. Significantly more N-IMPLANT were performed in the outpatient clinic compared to P-IMPLANT (94% vs. 10%; p<0.001). For wound closure, N-IMPLANT used wound glue in 65 (34%) and a single subcutaneous stitch in 124 patients (66%). Two N-IMPLANT patients experienced vaso-vagal reaction during implantation, whereas no adverse events occurred during P-IMPLANT (p=0.51). Two-hundred and fifty-two patients (79%) completed the questionnaire. We found no difference between N-IMPLANT and P-IMPLANT regarding pain after implant, analgesic use, wound closure after 2 weeks and presence and size of patient reported hematoma (see Table). Duration of pain was longer after P-IMPLANT. All N-IMPLANT patients indicated to be satisfied with the implant procedure. Three patients were dissatisfied with P-IMPLANT for the following reasons: ongoing pain at implant site; discomfort at implant site; and too numerous people present during the implant procedure. In three N-IMPLANT (2%) the ICM was explanted prematurely. The reasons for explantation were infection (with reimplantation of another ICM), discomfort at implant site and attempt to avoid interferences during magnetic resonance tomography in one patient each. One P-IMPLANT (1%) was explanted prematurely because of ICM malfunction.
Conclusion
Nurse-led implantation of cardiac monitors is effective without compromising patient safety and has excellent patient satisfaction. N-IMPLANT is a suitable model to reduce the workload of physicians.
Collapse
Affiliation(s)
- B Steinhauer
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - J Spicher
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - S Aerschmann
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - N Ambord
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - J Bartkowiak
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - H Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - F Noti
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - J Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - S Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - A Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - A Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - H Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - T Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - L Roten
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - S Duetschler
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| |
Collapse
|
27
|
Kueffer T, Haeberlin A, Knecht S, Baldinger SH, Servatius H, Madaffari A, Seiler J, Muehl A, Franzeck F, Asatryan B, Noti F, Tanner H, Roten L, Reichlin T. Comparison of the accuracy of contact force measurement in four commercially available force-sensing ablation catheters. Europace 2022. [DOI: 10.1093/europace/euac053.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Contact force-sensing catheters are widely used for ablation of cardiac arrhythmias. They allow precise quantification of catheter-to-tissue contact, which is an important determinant of lesion size and durability. Moreover, contact force information reduces the risk for cardiac perforation and is used for estimation of lesion size. However, the accuracy of contact force sensors across different manufacturers has not been validated independently.
Objective
To compare the accuracy and reproducibility of different force sensing catheters used in cardiac electrophysiology procedures.
Methods
A force measurement setup containing a heated saline water bath and a catheter fixation mechanism was constructed. The setup allows to accurately measure forces applied to a platform with the catheter. We studied four different catheter models, equipped with the following, unique force-measurement technologies (figure 1): 1) multiple-fiber optical sensor; 2) single-fiber optical sensor; 3) inductive sensor; and 4) magnetic field sensors. For each model, we assessed three catheters. Repeated measurements within the force range of 0g to 60g and at electrode-tissue contact angles of 0°, 45°, and 90° were performed and validated against the force measurement unit of our measurement setup.
Results
For each catheter, at least 500 measurements at different contact forces (equally distributed across the measurement range of 0 to 60 grams) were performed. Correlation of measured-force to real-force was ρSpearman=0.99 for MFOS, ρSpearman=0.98 for SFOS, ρSpearman=0.99 for IS, and ρSpearman=0.98 for MFS. MFS and SFOS showed a higher variance for high forces and increased intra-catheter variability compared to MFOS and IS. IS overestimated higher contact force at 0° and 30°. MFS and SFOS underestimated contact force for higher forces at 30° and 45° (figure 2). Within a clinical range of 5g to 40g, the catheters reached the following root-mean-square-error, independent of contact angle: MFOS 0.88g ±0.68g, SFOS 2.15g ±1.74g, IS 0.88g ±0.72g, and MFS 1.13g ±1.01g.
Conclusion
Measured contact by force-sensing catheters correlates well with true exerted electrode-tissue force. Despite an excellent overall correlation, some technologies may be prone to significant errors at higher forces (>10g under-/overestimation of true contact force) with potential clinical consequences related to increased risk of perforation.
Collapse
Affiliation(s)
- T Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S Knecht
- University Hospital Basel, Basel, Switzerland
| | - SH Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - H Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - J Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A Muehl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - F Franzeck
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - B Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - F Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - H Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - L Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - T Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
28
|
Kueffer T, Baldinger SH, Servatius H, Madaffari A, Seiler J, Muehl A, Franzeck F, Thalmann G, Asatryan B, Haeberlin A, Noti F, Tanner H, Roten L, Reichlin T. Validation of a multipolar pulsed field ablation catheter for endpoint assessment in pulmonary vein isolation procedures. Europace 2022. [DOI: 10.1093/europace/euac053.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): FP7/2007-2013, №602299, EU-CERT-ICD
Objective
To validate the performance of a multipolar PFA catheter compared to a standard pentaspline 3D-mapping catheter for endpoint assessment of PVI.
Background
Pulsed field ablation (PFA) for pulmonary vein isolation (PVI) using single-shot devices combines the benefits of high procedural efficacy and safety. A newly available multipolar PFA catheter allows real-time recording of pulmonary vein (PV) signals during PVI.
Methods
Patients undergoing first PVI using PFA with the standard ablation protocol (8 applications per PV) were studied. Entrance- and exit-block (10V/2ms) were assessed using the PFA catheter. Subsequently, a high-density bipolar voltage 3D electro-anatomical map (3D-EAM) was constructed using a standard pentaspline 3D-mapping catheter. Additional PFA applications were delivered only after confirmation of residual PV-connection by 3D-EAM.
Results
In 56 patients, 213 PVs were targeted for ablation. Acute PVI was achieved in 100% of PVs: in 199/213 (93%) PVs with the standard ablation protocol alone and in the remaining 14 PVs after additional PFA applications. Accuracy of PV assessment with the PFA catheter after the standard ablation protocol was 91% (194/213 veins). In 5/213 (2.3%) PVs, the PFA catheter incorrectly indicated PV-isolation. In 14/213 (6.6%) the PFA catheter incorrectly indicated residual PV-conduction due to high-output pace-capture. When the output was reduced to 5V/1ms, pace-capture was reduced to 0.9% (2/213).
Conclusion
A novel multipolar PFA catheter allows reliable endpoint assessment for PVI. Due to its design, far-field sensing and high-output pace-capture can occur, which may require adjustment of standard pacing outputs for verification of exit-block.
Collapse
Affiliation(s)
- T Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - SH Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - H Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - J Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A Muehl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - F Franzeck
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - G Thalmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - B Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - F Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - H Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - L Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - T Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
29
|
Servatius H, Kueffer T, Baldinger SH, Asatryan B, Seiler J, Tanner H, Novak J, Noti F, Haeberlin A, Madaffari A, Muehl A, Branca M, Duetschler S, Reichlin T, Roten L. Electrophysiological differences of deep sedation with dexmedetomidine versus propofol. Europace 2022. [DOI: 10.1093/europace/euac053.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Dexmedetomidine and propofol are commonly used drugs for deep sedation during cardiovascular interventions. Patients undergoing these interventions often have impaired sinus node function or atrioventricular (AV) conduction disease. Anesthetics used for deep sedation may further compromise sinus node function and AV nodal conduction, and thereby interfere with the intervention.
Purpose
To compare the electrophysiological effects of dexmedetomidine and propofol on the function of the sinus node and AV conduction.
Methods
We randomized patients undergoing first atrial fibrilation ablation 1:1 to deep sedation by dexmedetomidine (DEX group) versus propofol (PRO group), according to a standardized protocol. At the end of the ablation procedure with the patients still deeply sedated and hemodynamically stable, we conducted a standard electrophysiological study and assessed sinus node function, properties of AV conduction and atrial refractoriness.
Results
Of 160 patients (65±11 years old; 32% female) included into the study, 80 patients were randomized to the DEX and PRO group each. Procedure duration (128±59 minutes) and sedation depth, as assessed by the "Modified Observer’s Assessment of Alertness/Sedation" score (median 3; interquartile range 2, 3), was not different among groups. DEX group patients received a mean of 231±111 mcg of dexmedetomidine and PRO group patients a mean of 657±356 mg of propofol. The table shows the results of the electrophysiological study. DEX group patients had lower sinus rate and longer unadjusted sinus node recovery time (SNRT) at pacing cycle lengths of 600, 500 and 400 ms. However, both corrected (SNRT-RR) and normalized (SNRT/RR) SNRT did not differ among groups. Compared to PRO group patients, AV nodal conduction was slower in DEX group patients as evidenced by longer PR and AH intervals, and a higher Wenckebach cycle length and AV node effective refractory period (ERP) was observed. Conduction properties in the His-Purkinje system were not different among groups, as QRS width and HV interval were similar. An arrhythmia, mainly atrial fibrillation, was induced in 33 patients (21%) during the electrophysiological study, without differences among groups.
Conclusions
Sinus rate and AV conduction are slower during deep sedation with dexmedetomidine compared to propofol. These differences in electrophysiological effects need to be taken into account when using these anesthetics during cardiovascular interventions.
Collapse
Affiliation(s)
- H Servatius
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - T Kueffer
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - SH Baldinger
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - B Asatryan
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - J Seiler
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - H Tanner
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - J Novak
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - F Noti
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - A Haeberlin
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - A Madaffari
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - A Muehl
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - M Branca
- CTU Bern, University of Bern, Bern, Switzerland
| | - S Duetschler
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - T Reichlin
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - L Roten
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| |
Collapse
|
30
|
Baldinger SH, Burren D, Noti F, Servatius H, Seiler J, Madaffari A, Asatryan B, Tanner H, Reichlin T, Haeberlin A, Roten L. Patient characteristics, predictors and outcome of pacemaker patients upgraded to an implantable cardioverter defibrillator. Europace 2022. [DOI: 10.1093/europace/euac053.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Pacemaker (PM) patients may require a later upgrade to an implantable cardioverter-defibrillator (ICD). Limited data exists on this patient population. We sought to characterize this population, to assess predictors for ICD upgrade, and to report the outcome.
Methods
From our prospective PM and ICD implantation registry, all patients who underwent PM and/or ICD implantations at our center were analyzed. Patient characteristics and outcome of PM patients with subsequent ICD upgrade were compared to age- and sex-matched patients with de novo ICD implantation, and to PM patients without later upgrade.
Results
Of 1’301 ICD implantations, 60 (5%) were upgrades from PMs. Median time from PM implantation to ICD upgrade was 2.6 years (IQR 1.3-5.4) Of 2’195 PM patients, 28 patients underwent subsequent ICD upgrade, corresponding to an estimated annual incidence of an ICD upgrade of at least 0.33%. Lower LVEF (p=0.05) and male sex (p=0.038) were independent predictors for ICD upgrade. Transplant- and LVAD-free survival was worse both for upgraded ICD patients compared to matched patients with de novo ICD implantation (p=0.05; Figure, panel A), as well as for PM patients with later upgrade compared to matched PM patients not requiring an upgrade (p=0.036; Figure, panel B).
Conclusions
One of twenty ICD implantations are upgrades of patients with a PM. At least one of 30 PM patients will require an ICD upgrade in the following 10 years. Predictors for ICD upgrade are male sex and lower LVEF at PM implantation. Upgraded patients have worse outcome.
Collapse
Affiliation(s)
- SH Baldinger
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - D Burren
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - F Noti
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - H Servatius
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - J Seiler
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - A Madaffari
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - B Asatryan
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - H Tanner
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - T Reichlin
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - A Haeberlin
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - L Roten
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| |
Collapse
|
31
|
Neugebauer F, Noti F, Van Gool S, Roten L, Baldinger SH, Seiler J, Madaffari A, Servatius H, Ryser A, Tanner H, Reichlin T, Haeberlin A. Diagnostic reliability of AV synchrony self-diagnostics in leadless VDD pacemakers. Europace 2022. [DOI: 10.1093/europace/euac053.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Leadless pacemakers (PMs) capable of atrio-ventricular (AV) synchronous pacing have been introduced recently. These devices provide mechanical atrial sensing by detection of the atrial contraction via an accelerometer. Atrial tracking may be disturbed by external influences such as body motions and higher heart rates in real life. To track the amount of AV synchronous pacing, the device statistic classifies all sensed and paced QRS complexes according to presumed AV synchrony. The reliability of this self-diagnostics to estimate the true degree of AV synchrony, however, is insufficiently studied.
Purpose
To investigate the informative value of the device statistics offered by leadless VDD PMs regarding true AV snychrony.
Methods
We prospectively included all patients who received a leadless VDD PM between 07/2020 and 05/2021 at our center in this observational study. During the regular outpatient follow-ups, device interrogation was performed, which included evaluation of the PM statistics. True AV synchrony (defined as a QRS complex preceded by a p-wave within 300ms) was analyzed repeatedly during follow-up using Holter ECGs.
Results
We analysed 34 Holter ECGs from 20 outpatients (816 hours of ECG in total). Patients had a median age of 80 years (interquartile range 76-86 years), 55% were females. For Holter ECG sequences that showed high degree or complete AV-Block (>80% ventricular pacing), the percentage of paced beats that were presumed to be AV synchronous by the device statistic (ratio "AM-VP"/total VP) correlated well with AV synchrony as assessed using Holter-ECGs (Kendall’s τ=0.312, p<0.001). AV synchrony in the Holter ECG was different in patients with <66.6% presumed AV synchrony than in patients with >66.6% presumed AV synchrony (p<0.001, figure). For Holter ECG sequences with mostly preserved intrinsic AV conduction (<20% ventricular pacing), the ratio "AM-VP"/total VP was not predictive for true AV synchrony (Kendall’s τ=0.07, p=n.s.). In this situation, however, "VS only" (Kendall’s τ=0.110, p=0.005) correlated with true AV synchrony (due to AV conduction mode switch) and "VP only" showed an inverse correlation with AV synchrony (Kendall’s τ=-0.215, p<0.001).
Conclusion
Leadless PMs provide device statistics that show a correlation with true AV synchrony. The clinical setting as well as the device programming (e.g. AV conduction mode switch) significantly influence the predictive value of the different parameters of the device’s statistics.
Collapse
Affiliation(s)
- F Neugebauer
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - F Noti
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - S Van Gool
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - L Roten
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - SH Baldinger
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - J Seiler
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - A Madaffari
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - H Servatius
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - A Ryser
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - H Tanner
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - T Reichlin
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - A Haeberlin
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| |
Collapse
|
32
|
Baldinger SH, Servatius H, Seiler J, Madaffari A, Kueffer T, Muehl A, Asatryan B, Haeberlin A, Noti F, Tanner H, Reichlin T, Roten L. Durability of CLOSE-guided pulmonary vein isolation in persistent atrial fibrillation - First results from a prospective remapping study. Europace 2022. [DOI: 10.1093/europace/euac053.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The CLOSE protocol for pulmonary vein isolation (CLOSE-PVI) combines ablation index and inter-lesion distance (≤6 mm) targets. CLOSE-PVI has been shown to result in high clinical success rates. Data on durability of PVI after CLOSE-PVI mainly derive from repeat procedures in paroxysmal atrial fibrillation (AF) patients with recurrent AF.
Purpose
We sought to assess the incidence of pulmonary vein (PV) reconnections during a staged redo procedure performed independently of AF recurrence 6 months after CLOSE-PVI in patients with persistent AF.
Methods
In this prospective, single-center study, patients with symptomatic persistent AF (EHRA score >1) undergoing AF ablation were included. Close-PVI was performed during the index procedure. A blanking period of 3 months was applied. Seven-day Holter ECGs were performed at 3 and 6 months post ablation. All patients underwent a staged redo procedure including high-density voltage mapping of the left atrium at 6 months after the index procedure.
Results
Overall, 20 patients were included (median age: 68 years [IQR 63-71]; 20% women; median duration of persistent AF: 8 months [IQR 5-15]; median LAVI 45 ml/m2 [IQR 43-53]). All PVs were successfully isolated with CLOSE-PVI during the index procedure. Four patients (20%) had AF recurrence. The redo procedure was performed after a median of 6.1 months (IQR 5.6-7.3). Of 80 PVs, 71 (89%) were still isolated. No patient had a common ostium. Reconnections were observed in 3 left superior (15%), in one left inferior (5%), in one right superior (5%) and in 4 right inferior (20%) PVs. Fourteen patients (74%) had completely isolated PVs. Two of four patients with AF recurrence (50%) and 12 of 16 patients without AF recurrence (75%) had completely isolated PVs (p=0.33).
Conclusions
CLOSE-PVI achieves durable PVI after 6 months in the majority of patients with persistent AF. In half of persistent AF patients with recurrence after CLOSE-PVI, all PVs are still isolated. These patients may need adjunctive ablation.
Collapse
Affiliation(s)
- SH Baldinger
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - H Servatius
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - J Seiler
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - A Madaffari
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - T Kueffer
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - A Muehl
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - B Asatryan
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - A Haeberlin
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - F Noti
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - H Tanner
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - T Reichlin
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - L Roten
- Bern University Hospital, Inselspital, Bern, Switzerland
| |
Collapse
|
33
|
Servatius H, Raab S, Asatryan B, Haeberlin A, Branca M, de Marchi S, Brugger N, Nozica N, Goulouti E, Elchinova E, Lam A, Seiler J, Noti F, Madaffari A, Tanner H, Baldinger SH, Reichlin T, Wilhelm M, Roten L. Differences in Atrial Remodeling in Hypertrophic Cardiomyopathy Compared to Hypertensive Heart Disease and Athletes' Hearts. J Clin Med 2022; 11:jcm11051316. [PMID: 35268407 PMCID: PMC8910879 DOI: 10.3390/jcm11051316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Hypertrophic cardiomyopathy (HCM), hypertensive heart disease (HHD) and athletes’ heart share an increased prevalence of atrial fibrillation. Atrial cardiomyopathy in these patients may have different characteristics and help to distinguish these conditions. Methods: In this single-center study, we prospectively collected and analyzed electrocardiographic (12-lead ECG, signal-averaged ECG (SAECG), 24 h Holter ECG) and echocardiographic data in patients with HCM and HHD and in endurance athletes. Patients with atrial fibrillation were excluded. Results: We compared data of 27 patients with HCM (70% males, mean age 50 ± 14 years), 324 patients with HHD (52% males, mean age 75 ± 5.5 years), and 215 endurance athletes (72% males, mean age 42 ± 7.5 years). HCM patients had significantly longer filtered P-wave duration (153 ± 26 ms) and PR interval (191 ± 48 ms) compared to HHD patients (144 ± 16 ms, p = 0.012 and 178 ± 31, p = 0.034, respectively) and athletes (134 ± 14 ms, p = 0.001 and 165 ± 26 ms, both p < 0.001, respectively). HCM patients had a mean of 4.9 ± 16 premature atrial complexes per hour. Premature atrial complexes per hour were significantly more frequent in HHD patients (27 ± 86, p < 0.001), but not in athletes (2.7 ± 23, p = 0.639). Left atrial volume index (LAVI) was 43 ± 14 mL/m2 in HCM patients and significantly larger than age- and sex-corrected LAVI in HHD patients 30 ± 10 mL/m2; p < 0.001) and athletes (31 ± 9.5 mL/m2; p < 0.001). A borderline interventricular septum thickness ≥13 mm and ≤15 mm was found in 114 (35%) HHD patients, 12 (6%) athletes and 3 (11%) HCM patients. Conclusions: Structural and electrical atrial remodeling is more advanced in HCM patients compared to HHD patients and athletes.
Collapse
Affiliation(s)
- Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
- Correspondence: ; Tel.: +41-31-664-17-01
| | - Simon Raab
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Mattia Branca
- CTU Bern, University of Bern, 3010 Bern, Switzerland;
| | - Stefano de Marchi
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Nikolas Nozica
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Eleni Goulouti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Elena Elchinova
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Anna Lam
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Samuel H. Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| |
Collapse
|
34
|
Neugebauer F, Noti F, van Gool S, Roten L, Baldinger SH, Seiler J, Madaffari A, Servatius H, Ryser A, Tanner H, Reichlin T, Haeberlin A. Leadless atrio-ventricular synchronous pacing in an outpatient setting - early lessons learned on factors affecting atrio-ventricular synchrony. Heart Rhythm 2021; 19:748-756. [PMID: 34971817 DOI: 10.1016/j.hrthm.2021.12.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Leadless pacemakers (PMs) capable of atrio-ventricular (AV) synchronous pacing have recently been introduced. Initial feasibility studies were promising, but limited to just a few minutes of AV synchronous pacing. Real-world long-term data on AV synchrony and programming adjustments affecting AV synchrony in outpatients are lacking. OBJECTIVE To investigate AV synchrony and influences of PM programming adjustments in outpatients with leadless VDD PMs. METHODS All patients who received a leadless VDD PM (Micra™ AV, Medtronic, US) between 07/2020 and 05/2021 at our center were included in this observational study. AV synchrony was assessed repeatedly postoperatively and during follow-up using Holter ECG recordings. AV synchrony was defined as a QRS complex preceded by a p-wave within 300ms. The impact of programming changes during follow-up on AV synchrony was studied. RESULTS 816 hours of Holter ECG from 20 outpatients were analyzed. During predominantly paced episodes (≥80% ventricular pacing), median AV synchrony was 91% (IQR 34-100%) when patients had sinus rates 50-80/min. Median AV synchrony was lower when patients had sinus rates >80/min (33%, IQR 29-46%, p<0.001). During a stepwise optimization protocol, AV synchrony could be improved (p<0.038). Multivariate analysis showed that a shorter maximum A3 window end (p<0.001), a lower A3 threshold (p=0.046), and minimum A4 threshold (p<0.001) improved AV synchrony. CONCLUSION Successful VDD pacing in the outpatient setting during higher sinus rates is more difficult to achieve than can be presumed based on the initial feasibility studies. The devices often require multiple reprogramming to maximize AV sequential pacing.
Collapse
Affiliation(s)
- Felix Neugebauer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan van Gool
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian Ryser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland.
| |
Collapse
|
35
|
Servatius H, Küffer T, Baldinger SH, Asatryan B, Seiler J, Tanner H, Novak J, Lam A, Noti F, Haeberlin A, Madaffari A, Sweda R, Mühl A, Branca M, Dütschler S, Erdoes G, Stüber F, Theiler L, Reichlin T, Roten L. Dexmedetomidine versus Propofol for Operator-Directed Nurse-Administered Procedural Sedation during Catheter Ablation of Atrial Fibrillation: a Randomized Controlled Study. Heart Rhythm 2021; 19:691-700. [PMID: 34971816 DOI: 10.1016/j.hrthm.2021.12.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/02/2021] [Accepted: 12/23/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Operator-directed nurse-administered (ODNA) sedation with propofol is the preferred sedation technique for catheter ablation of atrial fibrillation (AF) in many centers. OBJECTIVE We aimed to investigate whether Dexmedetomidine, an α2-adrenergic receptor agonist, is superior to propofol. METHODS We randomized 160 consecutive patients undergoing first AF ablation to ODNA sedation by dexmedetomidine (DEX group) versus propofol (PRO group), according to a standardized protocol. Patients were unaware of treatment allocation. The primary endpoint was a composite of inefficient sedation, termination/change of sedation protocol or procedure abortion, hypercapnia (transcutaneous CO2 >55 mmHg), hypoxemia (SpO2 <90%) or intubation, prolonged hypotension (systolic blood pressure <80 mmHg), and sustained bradycardia necessitating cardiac pacing. Secondary endpoints were the components of the primary endpoint and patient satisfaction with procedural sedation, as assessed by a standardized questionnaire the day following ablation. RESULTS The primary endpoint occurred in 15 DEX group and 25 PRO group patients (19% vs. 31%; p=0.068). Hypercapnia was significantly more frequent in PRO group patients (29% vs. 10%; p=0.003). There was no significant difference among the other components of the primary endpoint, no procedure was aborted. Patient satisfaction was significantly better in PRO group patients (visual analog scale 0-100; median 100 in PRO group vs. median 93 in DEX group; p<0.001). CONCLUSION Efficacy of ODNA sedation with dexmedetomidine was not different to propofol. Hypercapnia occurs less frequent with dexmedetomidine, but patient satisfaction is better with propofol sedation. In selected patients, dexmedetomidine may be used as an alternative to propofol for ODNA sedation during AF ablation. (ClinicalTrials.gov number NCT03844841).
Collapse
Affiliation(s)
- Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Küffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jan Novak
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna Lam
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Romy Sweda
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aline Mühl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Sophie Dütschler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gabor Erdoes
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Frank Stüber
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Lorenz Theiler
- Department of Anaesthesiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| |
Collapse
|
36
|
Frey SM, Brantner P, Gehweiler J, Madaffari A, Zellweger MJ, Haaf P. 3D-printed visualization of a double right coronary artery with intra-atrial course. Int J Cardiovasc Imaging 2021; 38:709-710. [PMID: 34714465 PMCID: PMC8926975 DOI: 10.1007/s10554-021-02451-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 12/15/2022]
Affiliation(s)
| | | | | | | | | | - Philip Haaf
- University Hospital Basel, Basel, Switzerland.
| |
Collapse
|
37
|
Wittmer S, Chollet L, Baldinger S, Servatius H, Seiler J, Madaffari A, Kueffer T, Muehl A, Asatryan B, Lam A, Noti F, Haeberlin A, Roten L, Tanner H, Reichlin T. Impact of clinical risk factor profile vs. atrial fibrillation phenotype on outcome after pulmonary vein isolation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
Catheter ablation for atrial fibrillation (AF) is increasingly performed. Both clinical risk factors as well as the AF phenotype have been shown to influence ablation outcomes. The inter-relationship of the two however is incompletely understood.
Methods
In a retrospective analysis of a prospective registry of patients undergoing a first pulmonary vein isolation, the association of 8 predefined clinical risk factors (age >70 years, female gender, hypertension, BMI >30 kg/m2, coronary artery disease, heart failure, chronic kidney disease (CKD; eGFR<60ml/min/1.73m2) and diabetes mellitus) and the AF phenotype (paroxysmal vs. persistent AF) were assessed as well as their impact on AF recurrence during follow-up.
Results
Overall, 715 patients were enrolled (median age 63 years, 27% females, 69% paroxysmal AF). The prevalence of obesity, hypertension, heart failure and CKD was significantly higher in persistent AF, while female gender was more prevalent in paroxysmal AF. After 2 years of follow-up, overall freedom from recurrence was 46%, and was higher in paroxysmal AF compared to persistent AF (54.1% vs. 29.1%, p<0.001). Of the clinical risk factors, obesity (p=0.02), CKD (p=0.01) and heart failure (p=0.01) were significantly associated with lower arrhythmia-free survival, and there was a trend for hypertension and coronary artery disease (both p<0.2). A risk score composed of those 5 factors was associated with recurrences in patients with paroxysmal AF (p=0.04, Figure 1), but not in those with persistent AF (p=0.85, Figure 2).
Conclusion
Clinical risk factors predict outcome after pulmonary vein isolation in patients with paroxysmal, but not persistent AF. This is likely due to a strong association of those risk factors with the occurrence of persistent AF.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Collapse
Affiliation(s)
- S Wittmer
- Inselspital - University of Bern, Bern, Switzerland
| | - L Chollet
- Inselspital - University of Bern, Bern, Switzerland
| | - S Baldinger
- Inselspital - University of Bern, Bern, Switzerland
| | - H Servatius
- Inselspital - University of Bern, Bern, Switzerland
| | - J Seiler
- Inselspital - University of Bern, Bern, Switzerland
| | - A Madaffari
- Inselspital - University of Bern, Bern, Switzerland
| | - T Kueffer
- Inselspital - University of Bern, Bern, Switzerland
| | - A Muehl
- Inselspital - University of Bern, Bern, Switzerland
| | - B Asatryan
- Inselspital - University of Bern, Bern, Switzerland
| | - A Lam
- Inselspital - University of Bern, Bern, Switzerland
| | - F Noti
- Inselspital - University of Bern, Bern, Switzerland
| | - A Haeberlin
- Inselspital - University of Bern, Bern, Switzerland
| | - L Roten
- Inselspital - University of Bern, Bern, Switzerland
| | - H Tanner
- Inselspital - University of Bern, Bern, Switzerland
| | - T Reichlin
- Inselspital - University of Bern, Bern, Switzerland
| |
Collapse
|
38
|
Schaerli N, Badertscher P, Spies F, Madaffari A, Osswald S, Sticherling C, Kühne M, Knecht S. A Simplified Method to Detect Phrenic Nerve Injury During Cryoballoon Ablation of Atrial Fibrillation Using Lead aVF of the Surface ECG. Circ Arrhythm Electrophysiol 2021; 14:e009986. [PMID: 34397268 DOI: 10.1161/circep.121.009986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nicolas Schaerli
- Department of Cardiology/Electrophysiology (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB) (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology/Electrophysiology (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB) (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland
| | - Florian Spies
- Department of Cardiology/Electrophysiology (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB) (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland
| | - Antonio Madaffari
- Department of Cardiology/Electrophysiology (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB) (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology/Electrophysiology (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB) (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology/Electrophysiology (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB) (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology/Electrophysiology (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB) (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology/Electrophysiology (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB) (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland
| |
Collapse
|
39
|
Auberson C, Badertscher P, Madaffari A, Malushi M, Bourquin L, Spies F, Aeschbacher S, Fahrni G, Kaiser C, Jeger R, Osswald S, Sticherling C, Kuehne M, Knecht S. Non-invasive predictors for infranodal conduction delay in patients with left bundle branch block after transcatheter aortic valve replacement. Europace 2021. [DOI: 10.1093/europace/euab116.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Left bundle branch block (LBBB) is the most common conduction disorder after transcatheter aortic valve replacement (TAVR) with an increased risk of atrioventricular (AV) block. The aim of the current study was to identify non-invasive predictors for infranodal conduction delay in patients with LBBB.
Methods
We analyzed consecutive patients undergoing TAVR with pre-existing or new-onset LBBB between August 2014 and August 2020. His ventricular (HV) interval measurement was performed on day 1 after TAVR. Baseline, procedural, as well as surface and intracardiac electrocardiographic parameters were included. Infranodal conduction delay was defined as HV interval >55 ms.
Results
Of 825 patients screened after TAVR, 151 patients (82 ± 6 years, 39% male) with LBBB were included. Among these, infranodal conduction delay was observed in 25%. ΔPR (difference in PR interval after and before TAVR), PR and QRS duration after TAVR were significantly longer in the group with HV prolongation. In a multivariate analysis in patients with sinus rhythm (n = 131), ΔPR (OR per 10 ms increase: 1.52; 95% CI: 1.19-2.01; p = 0.002) was the only independent factor associated with infranodal conduction delay. The AUC of the ROC curve was 0.724 (95% CI) for ΔPR. A change in PR interval by 20 ms yielded a sensitivity of 26% and specificity of 83% with a positive predictive value of 45% and a negative predictive value of 84% to predict HV prolongation.
Conclusions
Simple analysis of surface ECG and a calculated ΔPR <20ms can be used as predictor for the absence of infranodal conduction delay in post-TAVR patients with LBBB. Abstract Figure HV
Collapse
Affiliation(s)
- C Auberson
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - P Badertscher
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - A Madaffari
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - M Malushi
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - L Bourquin
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - F Spies
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - S Aeschbacher
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - G Fahrni
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - C Kaiser
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - R Jeger
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - S Osswald
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - C Sticherling
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - S Knecht
- University Hospital Basel, Cardiology, Basel, Switzerland
| |
Collapse
|
40
|
Badertscher P, Knecht S, Madaffari A, Spies F, Osswald S, Schaer B, Sticherling C, Kuehne M. Efficacy and safety of a high power short duration ablation-index guided protocol for pulmonary vein isolation using a single catheter. Europace 2021. [DOI: 10.1093/europace/euab116.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Catheter ablation for atrial fibrillation (AF) is the most common performed electrophysiological procedure. The cost of this procedure remains high.
Purpose
To improve health care utilization, we aimed to compare the efficacy and safety of a minimalistic, streamlined single radiofrequency catheter ablation approach using high power short duration ablation-index guided protocol (HPSD) vs. a standard single catheter protocol.
Methods
A circular mapping catheter free PVI with a single transseptal puncture was performed in 91 patients. A CARTO fast anatomical map was performed with the ablation catheter. Pacing maneuvers were used to confirm exit block. Procedural characteristics and success rates were compared using HPSD- vs. a standard ablation-protocol. Freedom from recurrence was defined as a 1-year absence of AF episodes > 30 s, beyond the 3-month-blanking-period.
Results
Using the HPSD-protocol the median procedure, map and RF ablation time were significantly shorter in the HPSD group compared to the standard group, 84 (IQR 76-100) vs. 118 minutes (IQR 104-141), 12 (IQR 10-16) vs. 18 minutes (IQR 15-21) and 1036 (898-1184) vs. 1949 seconds (IQR 1693-2261), respectively, P < .001 for all. First-pass-PVI was achieved using the HPSD-protocol in 23 patients (74%) and the standard-protocol in 30 patients (53%), p = 0.08. Localization of conduction gaps are illustrated for the HPSD-protocol and the standard-protocol in Figure 1. The residual gap was identified using the ablation catheter only in all patients. No procedural complication were observed. At 12 months follow-up, 60 (89.6%) patients remained free from AF with no differences between groups.
Conclusions
A minimalistic, CMC-free HPSD-guided PVI approach is very efficient, safe, likely cost-saving, and associated with excellent clinical outcomes at 1 year. Abstract Figure 1
Collapse
Affiliation(s)
- P Badertscher
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - S Knecht
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - A Madaffari
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - F Spies
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - S Osswald
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - B Schaer
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - C Sticherling
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| |
Collapse
|
41
|
Lam A, Küffer T, Hunziker L, Nozica N, Asatryan B, Franzeck F, Madaffari A, Haeberlin A, Mühl A, Servatius H, Seiler J, Noti F, Baldinger SH, Tanner H, Windecker S, Reichlin T, Roten L. Efficacy and safety of ethanol infusion into the vein of Marshall for mitral isthmus ablation. J Cardiovasc Electrophysiol 2021; 32:1610-1619. [PMID: 33928711 DOI: 10.1111/jce.15064] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/31/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Chemical ablation by retrograde infusion of ethanol into the vein of Marshall (VOM-EI) can facilitate the achievement of mitral isthmus block. This study sought to describe the efficacy and safety of this technique. METHODS AND RESULTS Twenty-two consecutive patients (14 males, median age 71 years) with attempted VOM-EI for mitral isthmus ablation were included in the study. VOM-EI was successfully performed with a median of 4 ml of 96% ethanol in 19 patients (86%) and the mitral isthmus was successfully blocked in all (100%). Touch up endocardial and/or epicardial ablation after VOM-EI was necessary for 12 patients (63%). Perimitral flutter was present in 12 patients (63%) during VOM-EI and terminated or slowed by VOM-EI in 4 and 3 patients, respectively. The low-voltage area of the mitral isthmus region increased from 3.1 cm2 (interquartile range [IQR] 0-7.9) before to 13.2 cm2 (IQR: 8.2-15.0) after VOM-EI and correlated significantly with the volume of ethanol injected (p = .03). Median high-sensitive cardiac troponin-T increased significantly from 330 ng/L (IQR: 221-516) the evening of the procedure to 598 ng/L (IQR: 382-769; p = .02) the following morning. A small pericardial effusion occurred in three patients (16%), mild pericarditis in one (5%), and uneventful VOM dissection in two (11%). After a median follow-up of 3.5 months (IQR: 3.0-11.0), 10 of 18 patients (56%) with VOM-EI and available follow-up had arrhythmia recurrence. Repeat ablation was performed in five patients (50%) and peri-mitral flutter diagnosed in three (60%). CONCLUSION VOM-EI is feasible, safe, and effective to achieve acute mitral isthmus block.
Collapse
Affiliation(s)
- Anna Lam
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Thomas Küffer
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Lukas Hunziker
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Nikolas Nozica
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Florian Franzeck
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Aline Mühl
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| |
Collapse
|
42
|
Asatryan B, Seiler J, Bourquin L, Knecht S, Servatius H, Madaffari A, Baldinger SH, Badertscher P, Küffer T, Spies F, Tanner H, Kühne M, Osswald S, Roten L, Sticherling C, Reichlin T. Pre-procedural arrhythmia burden and the outcome of catheter ablation of idiopathic premature ventricular complexes. Pacing Clin Electrophysiol 2021; 44:703-710. [PMID: 33675240 DOI: 10.1111/pace.14211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/22/2021] [Accepted: 02/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Radiofrequency catheter ablation of idiopathic premature ventricular complexes (PVCs) is an effective method for eliminating symptoms and preventing/reversing arrhythmia-induced cardiomyopathy. One reason for procedural failure is low PVC frequency during the procedure. We aimed to investigate the relation between pre-procedural PVC burden and outcome of idiopathic PVC catheter ablation. METHODS Patients who underwent idiopathic PVC ablation between 2013 and 2019 at two tertiary referral centers were retrospectively included. All procedures were performed using irrigated-tip ablation catheters and a 3D electro-anatomical mapping system. Sustained ablation success was defined as a ≥80% reduction of pre-procedural PVC burden determined by 24h-Holter at follow-up. RESULTS Overall, 254 patients (median age 54 years [IQR 42-64]; 47% male) were enrolled. The median pre-ablation PVC-burden was 22% (IQR 11-31%), which was reduced to a post-ablation PVC burden of 0.3% (IQR 0-4%) after a median of 90 days. Sustained ablation success was achieved in 182 patients (72%). Pre-procedural PVC burden did not differ between patients with sustained ablation success and recurrence during follow-up (median 21% vs. 22%, p = .76). When assessed in pre-ablation PVC-burden groups of ≤5%, 6-15%, 16-30%, and ≥31%, sustained ablation success was achieved in 67%, 75%, 71%, and 72%, respectively, with no significant difference (p = .89). Sustained ablation outcome for PVC-burden ≤5% versus >5% showed no difference either (67% vs. 72%, p = .52). CONCLUSIONS Pre-procedural Holter-determined PVC burden does not predict the outcome of idiopathic PVC ablation. Thus, catheter ablation may be a reasonable first choice also for patients with symptomatic yet rare PVCs.
Collapse
Affiliation(s)
- Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luc Bourquin
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Badertscher
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Thomas Küffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Spies
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Kühne
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Sticherling
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
43
|
Spies F, Madaffari A, Voellmin G, Krisai P, Schaerli N, Reichlin T, Osswald S, Sticherling C, Kuhne M, Knecht S. Empirical superior vena cava isolation in patients undergoing redo- catheter ablation procedure after recurrence of atrial fibrillation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Extra pulmonary vein (PV) foci may trigger AF recurrence after an initially successful PVI. Superior vena cava (SVC) catheter ablation (CA) may therefore offer a treatment target in order to improve success rates.
Purpose
The purpose of this study was to evaluate the potential benefit of empirical SVC isolation in addition to PVI in patients undergoing a second CA after index PVI.
Methods
We retrospectively analyzed consecutive patients scheduled for a second CA because of a recurrence of symptomatic AF. Redo-CA was performed with a 3D electroanatomic mapping system and point-by-point ablation using RF energy in the range between 25 W and 30 W. In case of persistent isolation of all PVs, only SVCI was performed. In case of reconnection of vein(s), a wider antral re-isolation was performed. Redo-PVI (PVI-group) or Redo-PVI plus SVC isolation (SVCI) (PVIplusSVCI-group) were performed at the discretion of the operator. No additional targets were allowed. The endpoint of all procedures was elimination of the PV signals confirmed by a circular mapping catheter at the level of the PV ostium and elimination of all signals in the SVC in case of SVCI. Recurrence of AF during a follow-up of 12 months is presented.
Results
We analyzed 191 patients (age 61±10 years, 30% female, BMI 27±5 kg/m2, LVEF 56±9%, PLAX 41±7 mm, paroxysmal 61%). Whereas 148 (78%) patients underwent Redo-PVI only, 31 patients (16%) underwent PVI plus SVCI, and in 12 patients (6%) SVCI only was performed. Baseline characteristics did not differ significantly between the two groups. In the PVI-group, 79% were recurrence-free compared to 65% (see Kaplan-Meier curve: log rank p=0.011) in the PVIplusSVCI-group. The RF time of the PVI group focusing on the wide antral re-isolation of vein(s) was significantly higher than for the PVIplusSVCI-group (819±494 s versus 458±444 s; p<0.001).
Conclusion
Additional empirical SVCI at redo-PVI in patients with symptomatic AF recurrence does not lead to an increase in freedom from AF recurrence. Focusing on an additional “wider antral” re-isolation may be more effective.
Kaplan-Meier Survival Curves for Recurre
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- F Spies
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - A Madaffari
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - G Voellmin
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - P Krisai
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - N Schaerli
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - T Reichlin
- Bern University Hospital, Inselspital, Cardiology, Bern, Switzerland
| | - S Osswald
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - C Sticherling
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - M Kuhne
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - S Knecht
- University Hospital Basel, Cardiology, Basel, Switzerland
| |
Collapse
|
44
|
Madaffari A, Rivetti L, Kühne M, Knecht S, Osswald S, Sticherling C. Ventricular tachycardia catheter ablation after repaired tetralogy of Fallot: how to overcome an electrical short circuit. Europace 2020; 22:1687. [PMID: 33175985 DOI: 10.1093/europace/euaa167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/13/2020] [Accepted: 05/23/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Antonio Madaffari
- Department of Cardiology and the Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Luigi Rivetti
- Department of Cardiology and the Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology and the Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology and the Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology and the Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology and the Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| |
Collapse
|
45
|
Schaerli N, Knecht S, Spies F, Madaffari A, Osswald S, Sticherling C, Kuehne M. A simple method to detect phrenic nerve impairment during cryoballoon ablation of atrial fibrillation using aVF in the standard surface ECG. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Phrenic nerve palsy (PNP) is the most common complication in cryoballoon ablation of atrial fibrillation. Monitoring techniques such as compound motor action potential (CMAP) measurements using additional leads, or catheters positioned in the subdiaphragmatic hepatic vein or the esophagus have demonstrated to be effective to prevent PNP.
Purpose
This study investigates the safety and feasibility of a simple monitoring strategy using the lead aVF of the standard surface 12 lead ECG for CMAP monitoring to prevent PNP.
Methods
In 263 continuous patients undergoing cryoballoon ablation, a decapolar catheter was placed in the right subclavian vein to stimulate the phrenic nerve during ablation of the right sided pulmonary veins (12V@2.9 ms at 60 bpm). Capture was continuously monitored using the CMAP potential in the inferior aVF lead of the surface ECG and manually by palpation of the abdominal movement. The freeze was terminated early if the amplitude of the aVF signal decrease by >25% in three consecutive beats or if the diaphragmatic contraction decreased.
Results
Phrenic nerve injury documented by a reduction of the signal in aVF was observed in 13 of the 263 patients (5%) during freezes of the right superior pulmonary vein. Reduced diaphragmatic contraction detected by palpation of the abdomen was never observed without previous reduced amplitude in the surface aVF signal and was therefore never the trigger to stop a freeze. In patients with phrenic nerve injury, the mean initial amplitude was 1mV (SD ±0.3mV) and the mean minimal amplitude was 0.3mV (SD ±0.2mV). Mean time to recovery of the aVF amplitude was 160 seconds. Twelve patients (4.6%) showed complete recovery whereas one patient (0.4%) showed only partial recovery, as demonstrated in a sniff test at the end of the procedure. This patient showed no clinical signs of phrenic nerve palsy the following day, and full recovery was demonstrated in a sniff test 3 months later.
Conclusion
Monitoring of CMAP using the aVF signal from a standard 12-lead ECG during phrenic nerve stimulation to reduce the incidence of phrenic nerve palsy is safe and feasible. This technique is readily available during every standard ablation without placing additional electrodes and more sensitive than manual palpation.
aVF signal before and during ablation
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- N Schaerli
- University Hospital Basel, Department of Cardiology and Cardiovascular Research Institute (CRIB), Basel, Switzerland
| | - S Knecht
- University Hospital Basel, Department of Cardiology and Cardiovascular Research Institute (CRIB), Basel, Switzerland
| | - F Spies
- University Hospital Basel, Department of Cardiology and Cardiovascular Research Institute (CRIB), Basel, Switzerland
| | - A Madaffari
- University Hospital Basel, Department of Cardiology and Cardiovascular Research Institute (CRIB), Basel, Switzerland
| | - S Osswald
- University Hospital Basel, Department of Cardiology and Cardiovascular Research Institute (CRIB), Basel, Switzerland
| | - C Sticherling
- University Hospital Basel, Department of Cardiology and Cardiovascular Research Institute (CRIB), Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Department of Cardiology and Cardiovascular Research Institute (CRIB), Basel, Switzerland
| |
Collapse
|
46
|
Meyre PB, Sticherling C, Spies F, Aeschbacher S, Blum S, Voellmin G, Madaffari A, Conen D, Osswald S, Kühne M, Knecht S. C-reactive protein for prediction of atrial fibrillation recurrence after catheter ablation. BMC Cardiovasc Disord 2020; 20:427. [PMID: 32993521 PMCID: PMC7526257 DOI: 10.1186/s12872-020-01711-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/22/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Inflammation plays an important role in the initiation and progression of atrial fibrillation (AF), but data about the relationship between subclinical inflammation and recurrence of AF after catheter ablation remains poorly studied. We aimed to assess whether plasma levels of C-reactive protein (CRP) are associated with long-term AF recurrence following catheter ablation. METHODS Prior to the intervention, plasma CRP concentrations were measured in patients who underwent first catheter ablation for AF. AF recurrence was evaluated after 12 months and defined as any AF episode longer than 30 s recorded on either 12-lead electrocardiogram, 24-h Holter or 7-day Holter monitoring. Multivariable adjusted Cox models were constructed to examine the association of CRP levels and AF recurrence. RESULTS Of the 711 patients (mean age: 61 years, 25% women) included in this study, 247 patients (35%) experienced AF recurrence after ablation. Patients who were in the highest CRP quartile had a higher rate of recurrent AF compared to those who were in the lowest quartile (53.4 vs. 33.1% at 1 year of follow-up; P = 0.004). The adjusted hazard ratios (aHR) of recurrent AF across increasing quartiles of CRP were 1.0 (reference), 1.26 (95% confidence interval [CI], 0.86-1.84), 1.15 (95% CI, 0.78-1.70) and 1.60 (95% CI, 1.10-2.34) (P trend = 0.015). A similar effect was observed when CRP was analyzed as continuous variable (aHR per unit increase, 1.21; 95% CI, 1.05-1.39; P = 0.009). When a predefined CRP cut-off of 3 mg/l was applied, patients with CRP levels of 3 mg/l or above had a higher risk of AF recurrence than those with levels below (aHR, 1.44; 95% CI, 1.06-1.95; P = 0.019). CONCLUSIONS Increasing pre-interventional CRP levels are associated with a higher risk of AF recurrence in patients undergoing catheter ablation for AF. TRAIL REGISTRATION ClinicalTrials.gov identifier, NCT03718364.
Collapse
Affiliation(s)
- Pascal B Meyre
- Division of Cardiology, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
| | - Christian Sticherling
- Division of Cardiology, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Florian Spies
- Division of Cardiology, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Stefanie Aeschbacher
- Division of Cardiology, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Steffen Blum
- Division of Cardiology, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Gian Voellmin
- Division of Cardiology, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Antonio Madaffari
- Division of Cardiology, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - David Conen
- Division of Cardiology, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Stefan Osswald
- Division of Cardiology, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Michael Kühne
- Division of Cardiology, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Sven Knecht
- Division of Cardiology, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
47
|
Krisai P, Streicher O, Meyre P, Haemmerle P, Steiner F, Reddiess P, Zeljkovic I, Pavlovic N, Ammann P, Roten L, Reichlin T, Madaffari A, Kuehne M, Novak J, Sticherling C. P993Incidence of atrial fibrillation early after cavotricuspid isthmus ablation. Europace 2020. [DOI: 10.1093/europace/euaa162.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is a common finding in patients undergoing cavotricuspid isthmus ablation for isthmus dependent right atrial flutter (RAF). Little is known about the time of its occurrence.
Purpose
We aimed to investigate the incidence of AF early after RAF ablation in a well-defined, prospective cohort.
Methods
A total of 255 participants with RAF ablation from 5 centers and at least one completed follow-up were included. Structured clinical follow-up was performed at 3, 6 and 12 months including a 24 hour Holter-ECG. The endpoint was incidence of AF detected clinically or by Holter-ECG. Risk factors associated with the occurrence of AF were assessed using separate, univariate Cox proportional-hazards models.
Results
Mean age was 67 years, 80% were male and previous episodes of AF were known in 40%. Over a mean follow-up of 7.4 (±4.4) months AF was detected in 35 (13.7%) participants after RAF ablation (Figure A). After 3, 6 and 12 months AF was detected in 18 (7.1%), 30 (11.7%) and 34 (13.3%) patients. No difference in the incidence of AF after RAF ablation was found comparing patients with and without a history of AF (log-rank p value = 0.44) (Figure B). Comparing patients with and without AF during follow-up, there was no difference in age (68 vs 66 years, p = 0.36), sex (69 vs 81% male, p = 0.08), prior heart failure (29 vs 19%, p = 0.20), hypertension (43 vs 38%, p = 0.56) or left atrial volume (46.6 vs 39.6 ml, p = 0.10), but patients with previous AF had a lower left ventricular ejection fraction (LVEF) (45.7 vs 52.3%, p = 0.02). In separate, univariate Cox proportional-hazards models only increasing LVEF (Hazard ratio 0.97, 95% confidence interval (0.95; 0.99, p = 0.02)) was associated with a lower risk of incident AF after RAF ablation, but no other risk factor.
Conclusions
AF occurred in 13.7% of patients early after cavotricuspid isthmus ablation for RAF. There was no difference in the occurrence of AF between patients with and without previously known episodes of AF. Only impaired LVEF was associated with AF occurrence.
Abstract Figure
Collapse
Affiliation(s)
- P Krisai
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - O Streicher
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - P Meyre
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - P Haemmerle
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - F Steiner
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - P Reddiess
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - I Zeljkovic
- University of Zagreb School of Medicine, KBC Sestre Milosrdnice, Zagreb, Croatia
| | - N Pavlovic
- University of Zagreb School of Medicine, KBC Sestre Milosrdnice, Zagreb, Croatia
| | - P Ammann
- Cantonal Hospital St. Gallen, Cardiology department, St Gallen, Switzerland
| | - L Roten
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - T Reichlin
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - A Madaffari
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - J Novak
- Cantonal Hospital Solothurn, Herz- und Nierenzentrum Aare AG, Solothurn, Switzerland
| | - C Sticherling
- University Hospital Basel, Cardiology, Basel, Switzerland
| |
Collapse
|
48
|
Knecht S, Schaer B, Reichlin T, Spies F, Madaffari A, Vischer A, Fahrni G, Jeger R, Kaiser C, Osswald S, Sticherling C, Kühne M. Electrophysiology Testing to Stratify Patients With Left Bundle Branch Block After Transcatheter Aortic Valve Implantation. J Am Heart Assoc 2020; 9:e014446. [PMID: 32089049 PMCID: PMC7335581 DOI: 10.1161/jaha.119.014446] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Left bundle branch block (LBBB) is common after transcatheter aortic valve implantation (TAVI) and is an indicator of subsequent high-grade atrioventricular block (HAVB). No standardized protocol is available to identify LBBB patients at risk for HAVB. The aim of the current study was to evaluate the safety and efficacy of an electrophysiology study tailored strategy in patients with LBBB after TAVI. Methods and Results We prospectively analyzed consecutive patients with LBBB after TAVI. An electrophysiology study was performed to measure the HV-interval the day following TAVI. In patients with normal His-ventricular (HV)-interval ≤55 ms, a loop recorder was implanted (ILR-group), whereas pacemaker implantation was performed in patients with prolonged HV-interval >55 ms (PM-group). The primary end point was occurrence of HAVB during a follow-up of 12 months. Secondary end points were symptoms, hospitalizations, adverse events because of device implantation or electrophysiology study, and death. Of 373 patients screened after TAVI, 56 patients (82±6 years, 41% male) with LBBB were included. HAVB occurred in 4 of 41 patients (10%) in the ILR-group and in 8 of 15 patients (53%) in the PM-group (P<0.001). We did not identify other predictors for HAVB than the HV interval. The negative predictive value for the cut-off of HV 55 ms to detect HAVB was 90%. No HAVB-related syncope occurred in the 2 groups. Conclusions An electrophysiology study tailored strategy to LBBB after TAVI with a cut-off of HV >55 ms is a feasible and safe approach to stratify patients with regard to developing HAVB during a follow-up of 12 months.
Collapse
Affiliation(s)
- Sven Knecht
- Cardiology/Electrophysiology University Hospital Basel University Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University Basel Basel Switzerland
| | - Beat Schaer
- Cardiology/Electrophysiology University Hospital Basel University Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University Basel Basel Switzerland
| | - Tobias Reichlin
- Cardiology/Electrophysiology University Hospital Basel University Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University Basel Basel Switzerland.,Department of Cardiology Inselspital Bern University Hospital University of Bern Switzerland
| | - Florian Spies
- Cardiology/Electrophysiology University Hospital Basel University Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University Basel Basel Switzerland
| | - Antonio Madaffari
- Cardiology/Electrophysiology University Hospital Basel University Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University Basel Basel Switzerland
| | - Annina Vischer
- Medical Outpatient Department University Hospital Basel University Basel Basel Switzerland
| | - Gregor Fahrni
- Cardiology/Electrophysiology University Hospital Basel University Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University Basel Basel Switzerland
| | - Raban Jeger
- Cardiology/Electrophysiology University Hospital Basel University Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University Basel Basel Switzerland
| | - Christoph Kaiser
- Cardiology/Electrophysiology University Hospital Basel University Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University Basel Basel Switzerland
| | - Stefan Osswald
- Cardiology/Electrophysiology University Hospital Basel University Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University Basel Basel Switzerland
| | - Christian Sticherling
- Cardiology/Electrophysiology University Hospital Basel University Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University Basel Basel Switzerland
| | - Michael Kühne
- Cardiology/Electrophysiology University Hospital Basel University Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University Basel Basel Switzerland
| |
Collapse
|
49
|
Madaffari A, Krisai P, Kühne M, Osswald S. Ablation of typical atrial flutter guided by the paced PR interval on the surface electrocardiogram: Authors' reply. Europace 2020; 22:171. [PMID: 31713597 DOI: 10.1093/europace/euz305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Antonio Madaffari
- Department of Cardiology, and the Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, Basel, Switzerland
| | - Philipp Krisai
- Department of Cardiology, and the Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, and the Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, and the Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, Basel, Switzerland
| |
Collapse
|
50
|
Knecht S, Haaf P, Spies F, Madaffari A, Kühne M, Sticherling C. Gadolinium based contrast agent-free cardiac magnetic resonance imaging for the assessment of heart anatomy. A feasibility study. ACTA ACUST UNITED AC 2019; 73:510-512. [PMID: 31843495 DOI: 10.1016/j.rec.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Sven Knecht
- Cardiology/Electrophysiology Department, University Hospital Basel, University Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland.
| | - Philip Haaf
- Cardiology/Electrophysiology Department, University Hospital Basel, University Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland
| | - Florian Spies
- Cardiology/Electrophysiology Department, University Hospital Basel, University Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland
| | - Antonio Madaffari
- Cardiology/Electrophysiology Department, University Hospital Basel, University Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland
| | - Michael Kühne
- Cardiology/Electrophysiology Department, University Hospital Basel, University Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland
| | - Christian Sticherling
- Cardiology/Electrophysiology Department, University Hospital Basel, University Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland
| |
Collapse
|