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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.
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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
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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.
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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.
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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.
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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.
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Kueffer T, Bordignon S, Neven K, Blaauw Y, Hansen J, Adelino R, Ouss A, Füting A, Roten L, Mulder BA, Ruwald MH, Mené R, van der Voort P, Reinsch N, Boveda S, Albrecht EM, Schneider CW, Chun KRJ, Schmidt B, Reichlin T. Durability of Pulmonary Vein Isolation Using Pulsed-Field Ablation: Results From the Multicenter EU-PORIA Registry. JACC Clin Electrophysiol 2024; 10:698-708. [PMID: 38340118 DOI: 10.1016/j.jacep.2023.11.026] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Pulsed-field ablation (PFA) is a novel nonthermal ablation technology with high procedural safety and efficiency for pulmonary vein isolation (PVI). Premarket data showed high PVI durability during mandatory remapping studies. Data on lesion durability in real-world patients with clinically indicated redo procedures are scarce. OBJECTIVES This study sought to report PVI durability rates in patients undergoing a clinically indicated redo procedure after an index PVI using PFA. METHODS Patients from 7 European centers undergoing an index PVI using PFA were included the EU-PORIA (European Real-world Outcomes With Pulsed Field Ablation in Patients With Symptomatic Atrial Fibrillation) registry. In patients with subsequent left atrial redo procedures due to arrhythmia recurrence, 3-dimensional electroanatomical maps were acquired. PVI durability was assessed on a per-vein and per-patient level, and sites of reconnections and predictors of lesion durability were identified. RESULTS Of 1,184 patients (62% paroxysmal atrial fibrillation) undergoing an index PVI using PFA, 272 (23%) had an arrhythmia recurrence. Of these, 144 (53%) underwent a left atrial redo procedure a median of 7 (Q1-Q3: 5-10) months after the first ablation. Three-dimensional electroanatomical maps identified 404 of 567 pulmonary veins (71%) with durable isolation. In 54 patients (38%), all pulmonary veins were durably isolated. Prior operator experience with cryoballoon ablation was associated with a higher PVI durability compared to operators with only point-by-point radiofrequency experience (76% vs 60%; P < 0.001). Neither the operators' cumulative experience in atrial fibrillation ablation (≤5 vs >5 years) nor the size of the PFA device used (31 mm vs 35 mm) had an impact on subsequent lesion durability (both P > 0.50). CONCLUSIONS In 144 patients with arrhythmia recurrence after PFA PVI, durable isolation was observed in 71% of the pulmonary veins during the redo procedure, and 38% of all patients showed durable isolation of all veins.
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Affiliation(s)
- Thomas Kueffer
- Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Kars Neven
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany; Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Yuri Blaauw
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jim Hansen
- Arrhythmia Unit, Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark
| | - Raquel Adelino
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
| | - Alexandre Ouss
- Heart Center Catharina Hospital, Eindhoven, the Netherlands
| | - Anna Füting
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany; Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Laurent Roten
- Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bart A Mulder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martin H Ruwald
- Arrhythmia Unit, Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark
| | - Roberto Mené
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
| | | | - Nico Reinsch
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany; Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
| | | | | | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany; Universitätsklinikum Frankfurt, Medizinische Klinik 3- Klinik für Kardiologie, Frankfurt, Germany
| | - Tobias Reichlin
- Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland.
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5
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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.
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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.
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6
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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.
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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
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7
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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.
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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.
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8
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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.
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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
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Sultan A, Futyma P, Metzner A, Anic A, Richter S, Roten L, Badertscher P, Conte G, Chun JKR. Management of ventricular tachycardias: insights on centre settings, procedural workflow, endpoints, and implementation of guidelines-results from an EHRA survey. Europace 2024; 26:euae030. [PMID: 38363995 PMCID: PMC10872712 DOI: 10.1093/europace/euae030] [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] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/24/2024] [Indexed: 02/18/2024] Open
Abstract
Ventricular tachycardia (VT), and its occurrence, is still one of the main reasons for sudden cardiac death and, therefore, for increased mortality and morbidity foremost in patients with structural heart [Kahle A-K, Jungen C, Alken F-A, Scherschel K, Willems S, Pürerfellner H et al. Management of ventricular tachycardia in patients with ischaemic cardiomyopathy: contemporary armamentarium. Europace 2022;24:538-51]. Catheter ablation has become a safe and effective treatment option in patients with recurrent VT [Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N et al. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Heart Rhythm 2020;17:e2-154]. Previous and current guidelines provide guidance on indication for VT ablation and risk assessment and evaluation of underlying disease. However, no uniform recommendation is provided regarding procedural strategies, timing of ablation, and centre setting. Therefore, these specifics seem to differ largely, and recent data are sparse. This physician-based European Heart Rhythm Association survey aims to deliver insights on not only infrastructural settings but also procedural specifics, applied technologies, ablation strategies, and procedural endpoints. Therefore, these findings might deliver a real-world scenario of VT management and potentially are of guidance for other centres.
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Affiliation(s)
- Arian Sultan
- Department of Electrophysiology, Heart Centre University Hospital Cologne, Germany
| | - Piotr Futyma
- St. Joseph’s Heart Rhythm Centre, Rzeszów, Poland
- Medical College, University of Rzeszów, Rzeszów, Poland
| | - Andreas Metzner
- Department of Cardiology, University Heart and Vascular Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Centre Split, Spilt, Croatia
| | - Sergio Richter
- Division of Electrophysiology, Department of Internal Medicine and Cardiology, Heart Centre Dresden, University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Laurent Roten
- Inselspital-Bern University Hospital, Department of Electrophysiology University of Bern, Bern, Switzerland
| | - Patrick Badertscher
- Inselspital-Bern University Hospital, Department of Electrophysiology University of Bern, Bern, Switzerland
| | - Giulio Conte
- Division of Cardiology, Cardiocentro Ticino (CCT), Lugano, Switzerland
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
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10
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Turagam MK, Neuzil P, Schmidt B, Reichlin T, Neven K, Metzner A, Hansen J, Blaauw Y, Maury P, Arentz T, Sommer P, Anic A, Anselme F, Boveda S, Deneke T, Willems S, van der Voort P, Tilz R, Funasako M, Scherr D, Wakili R, Steven D, Kautzner J, Vijgen J, Jais P, Petru J, Chun J, Roten L, Füting A, Lemoine MD, Ruwald M, Mulder BA, Rollin A, Lehrmann H, Fink T, Jurisic Z, Chaumont C, Adelino R, Nentwich K, Gunawardene M, Ouss A, Heeger CH, Manninger M, Bohnen JE, Sultan A, Peichl P, Koopman P, Derval N, Kueffer T, Reinsch N, Reddy VY. Impact of Left Atrial Posterior Wall Ablation During Pulsed-Field Ablation for Persistent Atrial Fibrillation. JACC Clin Electrophysiol 2024:S2405-500X(24)00030-6. [PMID: 38430087 DOI: 10.1016/j.jacep.2024.01.017] [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: 01/09/2024] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) alone is insufficient to treat many patients with persistent atrial fibrillation (PersAF). Adjunctive left atrial posterior wall (LAPW) ablation with thermal technologies has revealed lack of efficacy, perhaps limited by the difficulty in achieving lesion durability amid concerns of esophageal injury. OBJECTIVES This study aims to compare the safety and effectiveness of PVI + LAPW ablation vs PVI in patients with PersAF using pulsed-field ablation (PFA). METHODS In a retrospective analysis of the MANIFEST-PF (Multi-National Survey on the Methods, Efficacy, and Safety on the Post-approval Clinical Use of Pulsed Field Ablation) registry, we studied consecutive PersAF patients undergoing post-approval treatment with a pentaspline PFA catheter. The primary effectiveness outcome was freedom from any atrial arrhythmia of ≥30 seconds. Safety outcomes included the composite of acute and chronic major adverse events. RESULTS Of the 547 patients with PersAF who underwent PFA, 131 (24%) received adjunctive LAPW ablation. Compared to PVI-alone, patients receiving adjunctive LAPW ablation were younger (65 vs 67 years of age, P = 0.08), had a lower CHA2DS2-VASc score (2.3 ± 1.6 vs 2.6 ± 1.6, P = 0.08), and were more likely to receive electroanatomical mapping (48.1% vs 39.0%, P = 0.07) and intracardiac echocardiography imaging (46.1% vs 17.1%, P < 0.001). The 1-year Kaplan-Meier estimate for freedom from atrial arrhythmias was not statistically different between groups in the full (PVI + LAPW: 66.4%; 95% CI: 57.6%-74.4% vs PVI: 73.1%; 95% CI: 68.5%-77.2%; P = 0.68) and propensity-matched cohorts (PVI + LAPW: 71.7% vs PVI: 68.5%; P = 0.34). There was also no significant difference in major adverse events between the groups (2.2% vs 1.4%, respectively, P = 0.51). CONCLUSIONS In patients with PersAF undergoing PFA, as compared to PVI-alone, adjunctive LAPW ablation did not improve freedom from atrial arrhythmia at 12 months.
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Affiliation(s)
- Mohit K Turagam
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Petr Neuzil
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czech Republic
| | - Boris Schmidt
- MVZ CCB Frankfurt und Main-Taunus GbR, Frankfurt, Germany
| | - Tobias Reichlin
- Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kars Neven
- Department of Medicine, Witten/Herdecke University, Witten, Germany; Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
| | - Andreas Metzner
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jim Hansen
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Yuri Blaauw
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France; I2MC, INSERM UMR 1297, Toulouse, France
| | - Thomas Arentz
- Department of Cardiology and Angiology, Medical Center and Faculty of Medicine-University of Freiburg, Freiburg, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split, Croatia
| | | | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France; Universitair Ziekenhuis VUB, Brussels, Belgium
| | - Tom Deneke
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | | | | | - Roland Tilz
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Moritoshi Funasako
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czech Republic; Neuron Medical, Brno, Czech Republic
| | - Daniel Scherr
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Duisburg, Germany
| | - Daniel Steven
- Heart Center University Hospital of Cologne, Department for Electrophysiology, Cologne, Germany
| | - Josef Kautzner
- IKEM-Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Johan Vijgen
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium
| | - Pierre Jais
- IHU LIRYC, CHU Bordeaux, University of Bordeaux, Pessac, France
| | - Jan Petru
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czech Republic
| | - Julian Chun
- MVZ CCB Frankfurt und Main-Taunus GbR, Frankfurt, Germany
| | - Laurent Roten
- Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna Füting
- Department of Medicine, Witten/Herdecke University, Witten, Germany; Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
| | - Marc D Lemoine
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Ruwald
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Bart A Mulder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Heiko Lehrmann
- Department of Cardiology and Angiology, Medical Center and Faculty of Medicine-University of Freiburg, Freiburg, Germany
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Zrinka Jurisic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split, Croatia
| | | | - Raquel Adelino
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France; Universitair Ziekenhuis VUB, Brussels, Belgium
| | - Karin Nentwich
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | | | | | - Christian-Hendrik Heeger
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Martin Manninger
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jan-Eric Bohnen
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Duisburg, Germany
| | - Arian Sultan
- Heart Center University Hospital of Cologne, Department for Electrophysiology, Cologne, Germany
| | - Petr Peichl
- IKEM-Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Pieter Koopman
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium
| | - Nicolas Derval
- IHU LIRYC, CHU Bordeaux, University of Bordeaux, Pessac, France
| | - Thomas Kueffer
- Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nico Reinsch
- Department of Medicine, Witten/Herdecke University, Witten, Germany; Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
| | - Vivek Y Reddy
- Icahn School of Medicine at Mount Sinai, New York, New York, USA; Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czech Republic.
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11
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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.
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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
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12
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Berte B, Pürerfellner H, Roten L, Rissotto S, Mahida S, Reichlin T, Kobza R. Combined complex electrophysiological interventions due to improved standardization and efficiency: proof of concept. Europace 2023; 26:euae014. [PMID: 38227808 PMCID: PMC10810277 DOI: 10.1093/europace/euae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/18/2024] Open
Affiliation(s)
- Benjamin Berte
- Heart Center, Hirslanden St Anna, Zentralstrasse 1, 6003 Lucerne, Switzerland
| | | | - Laurent Roten
- Cardiology Department, Inselspital Bern, Bern, Switzerland
| | | | - Saagar Mahida
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - Richard Kobza
- Heart Center, Hirslanden St Anna, Zentralstrasse 1, 6003 Lucerne, Switzerland
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13
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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.
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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
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14
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Mugnai G, Farkowski M, Tomasi L, Roten L, Migliore F, de Asmundis C, Conte G, Boveda S, Chun JKR. Prevention of venous thromboembolism in right heart-sided electrophysiological procedures: results of an European Heart Rhythm Association survey. Europace 2023; 26:euad364. [PMID: 38091971 PMCID: PMC10754160 DOI: 10.1093/europace/euad364] [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: 10/09/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023] Open
Abstract
Limited data are available regarding venous thromboembolism (VTE), specifically deep vein thrombosis (DVT) and pulmonary embolism (PE), following right-sided ablations and electrophysiological (EP) studies. Compared to left-sided procedures, no guidelines on antithrombotic management strategies for the prevention of DVT and PE are available. The main purpose of the present European Heart Rhythm Association (EHRA) survey is to report the current management of right-sided EP procedures, focusing on anticoagulation and prevention of VTE. An online survey was conducted using the EHRA infrastructure. A total of 244 participants answered a 19-items questionnaire on the periprocedural management of EP studies and right-sided catheter ablations. The right femoral vein is the most common access for EP studies and right-sided procedures. An ultrasound-guided approach is employed by more than 2/3 of respondents. Intravenous heparin is not commonly given by the majority of participants. About 1/3 of participants (34%) routinely prescribe VTE prophylaxis during (mostly aspirin and low molecular weight heparin) and 1/4 of respondents (25%) commonly prescribe VTE prophylaxis after discharge (mostly aspirin). Of note, respectively 13% and 9% of participants observed at least one DVT and one PE related to right-sided ablation or EP study within the last year in their center. The present survey shows that only a minority of operators routinely gives intraprocedural intravenous heparin and prescribes VTE prophylaxis after right-sided EP procedures. Compared to left-sided procedures like atrial fibrillation (AF) ablation, there are no consistent systematic antithrombotic management strategies.
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Affiliation(s)
- Giacomo Mugnai
- Division of Cardiology, Cardio-Thoracic Department, School of Medicine, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy
| | - Michal Farkowski
- Department of Cardiology, Ministry of Interior and Administration National Medical Institute, Warsaw, Poland
| | - Luca Tomasi
- Division of Cardiology, Cardio-Thoracic Department, School of Medicine, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University Hospital of Padova, Padova, Italy
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Giulio Conte
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt Am Main, Germany
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15
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Turagam MK, Neuzil P, Schmidt B, Reichlin T, Neven K, Metzner A, Hansen J, Blaauw Y, Maury P, Arentz T, Sommer P, Anic A, Anselme F, Boveda S, Deneke T, Willems S, van der Voort P, Tilz R, Funasako M, Scherr D, Wakili R, Steven D, Kautzner J, Vijgen J, Jais P, Petru J, Chun J, Roten L, Füting A, Lemoine MD, Ruwald M, Mulder BA, Rollin A, Lehrmann H, Fink T, Jurisic Z, Chaumont C, Adelino R, Nentwich K, Gunawardene M, Ouss A, Heeger CH, Manninger M, Bohnen JE, Sultan A, Peichl P, Koopman P, Derval N, Kueffer T, Reddy VY. Clinical Outcomes by Sex After Pulsed Field Ablation of Atrial Fibrillation. JAMA Cardiol 2023; 8:1142-1151. [PMID: 37910101 PMCID: PMC10620676 DOI: 10.1001/jamacardio.2023.3752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/10/2023] [Indexed: 11/03/2023]
Abstract
Importance Previous studies evaluating the association of patient sex with clinical outcomes using conventional thermal ablative modalities for atrial fibrillation (AF) such as radiofrequency or cryoablation are controversial due to mixed results. Pulsed field ablation (PFA) is a novel AF ablation energy modality that has demonstrated preferential myocardial tissue ablation with a unique safety profile. Objective To compare sex differences in patients undergoing PFA for AF in the Multinational Survey on the Methods, Efficacy, and Safety on the Postapproval Clinical Use of Pulsed Field Ablation (MANIFEST-PF) registry. Design, Setting, and Participants This was a retrospective cohort study of MANIFEST-PF registry data, which included consecutive patients undergoing postregulatory approval treatment with PFA to treat AF between March 2021 and May 2022 with a median follow-up of 1 year. MANIFEST-PF is a multinational, retrospectively analyzed, prospectively enrolled patient-level registry including 24 European centers. The study included all consecutive registry patients (age ≥18 years) who underwent first-ever PFA for paroxysmal or persistent AF. Exposure PFA was performed on patients with AF. All patients underwent pulmonary vein isolation and additional ablation, which was performed at the discretion of the operator. Main Outcomes and Measures The primary effectiveness outcome was freedom from clinically documented atrial arrhythmia for 30 seconds or longer after a 3-month blanking period. The primary safety outcome was the composite of acute (<7 days postprocedure) and chronic (>7 days) major adverse events (MAEs). Results Of 1568 patients (mean [SD] age, 64.5 [11.5] years; 1015 male [64.7%]) with AF who underwent PFA, female patients, as compared with male patients, were older (mean [SD] age, 68 [10] years vs 62 [12] years; P < .001), had more paroxysmal AF (70.2% [388 of 553] vs 62.4% [633 of 1015]; P = .002) but had fewer comorbidities such as coronary disease (9% [38 of 553] vs 15.9% [129 of 1015]; P < .001), heart failure (10.5% [58 of 553] vs 16.6% [168 of 1015]; P = .001), and sleep apnea (4.7% [18 of 553] vs 11.7% [84 of 1015]; P < .001). Pulmonary vein isolation was performed in 99.8% of female (552 of 553) and 98.9% of male (1004 of 1015; P = .90) patients. Additional ablation was performed in 22.4% of female (124 of 553) and 23.1% of male (235 of 1015; P = .79) patients. The 1-year Kaplan-Meier estimate for freedom from atrial arrhythmia was similar in male and female patients (79.0%; 95% CI, 76.3%-81.5% vs 76.3%; 95% CI, 72.5%-79.8%; P = .28). There was also no significant difference in acute major AEs between groups (male, 1.5% [16 of 1015] vs female, 2.5% [14 of 553]; P = .19). Conclusion and Relevance Results of this cohort study suggest that after PFA for AF, there were no significant sex differences in clinical effectiveness or safety events.
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Affiliation(s)
- Mohit K. Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Petr Neuzil
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia
| | - Boris Schmidt
- Medizinisches Versorgungszentrum Cardioangiologisches Centrum Bethanien Frankfurt und Main-Taunus GbR, Frankfurt, Germany
| | - Tobias Reichlin
- Inselspital—Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kars Neven
- Department of Medicine, Witten/Herdecke University, Witten, Germany
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
| | - Andreas Metzner
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jim Hansen
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Yuri Blaauw
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
- I2MC Institute, INSERM UMR 1297, Toulouse, France
| | - Thomas Arentz
- Department of Cardiology and Angiology, Medical Center and Faculty of Medicine—University of Freiburg, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum North Rhine Westfalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split, Croatia
| | | | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
- Universitair Ziekenhuis, Brussels, Belgium
| | - Tom Deneke
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | | | - Pepijn van der Voort
- Catharina Hospital, Eindhoven, the Netherlands instead of Catharina Ziekenhuis Eindhoven, the Netherlands
| | - Roland Tilz
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Moritoshi Funasako
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia
- Neuron Medical, Brno, Czech Republic
| | - Daniel Scherr
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Duisburg, Germany
| | - Daniel Steven
- Heart Center University Hospital of Cologne, Department for Electrophysiology, Cologne, Germany
| | - Josef Kautzner
- IKEM—Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Johan Vijgen
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium
| | - Pierre Jais
- IHU LIRYC—Institute Des Maladies Du Rythme Cardiaque, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Jan Petru
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia
| | - Julian Chun
- Medizinisches Versorgungszentrum Cardioangiologisches Centrum Bethanien Frankfurt und Main-Taunus GbR, Frankfurt, Germany
| | - Laurent Roten
- Inselspital—Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna Füting
- Department of Medicine, Witten/Herdecke University, Witten, Germany
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
| | - Marc D. Lemoine
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Ruwald
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Bart A. Mulder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Heiko Lehrmann
- Department of Cardiology and Angiology, Medical Center and Faculty of Medicine—University of Freiburg, Germany
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum North Rhine Westfalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Zrinka Jurisic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split, Croatia
| | | | - Raquel Adelino
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
- Universitair Ziekenhuis, Brussels, Belgium
| | - Karin Nentwich
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | | | - Alexandre Ouss
- Catharina Hospital, Eindhoven, the Netherlands instead of Catharina Ziekenhuis Eindhoven, the Netherlands
| | - Christian-Hendrik Heeger
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Martin Manninger
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jan-Eric Bohnen
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Duisburg, Germany
| | - Arian Sultan
- Heart Center University Hospital of Cologne, Department for Electrophysiology, Cologne, Germany
| | - Petr Peichl
- IKEM—Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Pieter Koopman
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium
| | - Nicolas Derval
- IHU LIRYC—Institute Des Maladies Du Rythme Cardiaque, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Thomas Kueffer
- Inselspital—Bern University Hospital, University of Bern, Bern, Switzerland
| | - Vivek Y. Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia
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16
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Meinel TR, Triulzi CB, Kaesmacher J, Mujanovic A, Pasi M, Leung LY, Kent DM, Sui Y, Seiffge D, Bücke P, Umarova R, Arnold M, Roten L, Nguyen TN, Wardlaw J, Fischer U. Management of covert brain infarction survey: A call to care for and trial this neglected population. Eur Stroke J 2023; 8:1079-1088. [PMID: 37427426 PMCID: PMC10683731 DOI: 10.1177/23969873231187444] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Covert brain infarction (CBI) is highly prevalent and linked with stroke risk factors, increased mortality, and morbidity. Evidence to guide management is sparse. We sought to gain information on current practice and attitudes toward CBI and to compare differences in management according to CBI phenotype. METHODS We conducted a web-based, structured, international survey from November 2021 to February 2022 among neurologists and neuroradiologists. The survey captured respondents' baseline characteristics, general approach toward CBI and included two case scenarios designed to evaluate management decisions taken upon incidental detection of an embolic-phenotype and a small-vessel-disease phenotype. RESULTS Of 627 respondents (38% vascular neurologists, 24% general neurologists, and 26% neuroradiologists), 362 (58%) had a partial, and 305 (49%) a complete response. Most respondents were university hospital senior faculty members experienced in stroke, mostly from Europe and Asia. Only 66 (18%) of respondents had established institutional written protocols to manage CBI. The majority indicated that they were uncertain regarding useful investigations and further management of CBI patients (median 67 on a slider 0-100, 95% CI 35-81). Almost all respondents (97%) indicated that they would assess vascular risk factors. Although most would investigate and treat similarly to ischemic stroke for both phenotypes, including initiating antithrombotic treatment, there was considerable diagnostic and therapeutic heterogeneity. Less than half of respondents (42%) would assess cognitive function or depression. CONCLUSIONS There is a high degree of uncertainty and heterogeneity regarding management of two common types of CBI, even among experienced stroke physicians. Respondents were more proactive regarding the diagnostic and therapeutic management than the minimum recommended by current expert opinions. More data are required to guide management of CBI; meantime, more consistent approaches to identification and consistent application of current knowledge, that also consider cognition and mood, would be promising first steps to improve consistency of care.
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Affiliation(s)
- Thomas R Meinel
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Camilla B Triulzi
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Adnan Mujanovic
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Marco Pasi
- University of Lille, Inserm, CHU Lille, U1172-Lille Neuroscience & Cognition (LilNCog), Lille, France
| | - Lester Y Leung
- Department of Neurology, Tufts Medical Center, Boston, MA, USA
| | - David M Kent
- Predictive Analytics and Comparative Effectiveness Center, Tufts Medical Center, Boston, MA, USA
| | - Yi Sui
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, China
- Department of Neurology, Shenyang First People’s Hospital, Shenyang Brain Institute, Shenyang, China
| | - David Seiffge
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp Bücke
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roza Umarova
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thanh N Nguyen
- Neurology and Radiology, Boston Medical Center, Boston, MA, USA
| | - Joanna Wardlaw
- Division of Neuroimaging Sciences, Brain Research Imaging Centre, Centre for Clinical Brain Sciences, UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK
| | - Urs Fischer
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
- Neurology, Basel University Hospital, University of Basel, Basel, Switzerland
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17
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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).
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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.
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18
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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.
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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
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Bourquin L, Küffer T, Asatryan B, Badertscher P, Baldinger SH, Knecht S, Seiler J, Spies F, Servatius H, Kühne M, Noti F, Osswald S, Haeberlin A, Tanner H, Roten L, Reichlin T, Sticherling C. Validation of a clinical model for predicting left versus right ventricular outflow tract origin of idiopathic ventricular arrhythmias. Pacing Clin Electrophysiol 2023; 46:1186-1196. [PMID: 37616339 DOI: 10.1111/pace.14809] [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: 05/16/2022] [Revised: 07/26/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Prediction of the chamber of origin in patients with outflow tract ventricular arrhythmias (OTVA) remains challenging. A clinical risk score based on age, sex and presence of hypertension was associated with a left ventricular outflow tract (LVOT) origin. We aimed to validate this clinical score to predict an LVOT origin in patients with OTVA. METHODS In a two-center observational cohort study, unselected patients undergoing catheter ablation (CA) for OTVA were enrolled. All procedures were performed using an electroanatomical mapping system. Successful ablation was defined as a ≥80% reduction of the initial overall PVC burden after 3 months of follow-up. Patients with unsuccessful ablation were excluded from this analysis. RESULTS We included 187 consecutive patients with successful CA of idiopathic OTVA. Mean age was 52 ± 15 years, 102 patients (55%) were female, and 74 (40%) suffered from hypertension. A LVOT origin was found in 64 patients (34%). A score incorporating age, sex and presence of hypertension reached 73% sensitivity and 67% specificity for a low (0-1) and high (2-3) score, to predict an LVOT origin. The combination of one ECG algorithm (V2 S/V3 R-index) with the clinical score resulted in a sensitivity and specificity of 81% and 70% for PVCs with R/S transition at V3 . CONCLUSION The published clinical score yielded a lower sensitivity and specificity in our cohort. However, for PVCs with R/S transition at V3, the combination with an existing ECG algorithm can improve the predictability of LVOT origin.
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Affiliation(s)
- Luc Bourquin
- 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
| | - Babken Asatryan
- 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
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Knecht
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Jens Seiler
- 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
| | - Helge Servatius
- 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
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Osswald
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Andreas Haeberlin
- 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 and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
- 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
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20
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Mahmoudi K, Galea R, Elhadad S, Temperli F, Sebag F, Gräni C, Rezine Z, Roten L, Landolff Q, Brugger N, Masri A, Räber L, Amabile N. Computed Tomography Scan Evidence for Left Atrial Appendage Short-Term Remodeling Following Percutaneous Occlusion: Impact of Device Oversizing. J Am Heart Assoc 2023; 12:e030037. [PMID: 37609989 PMCID: PMC10547351 DOI: 10.1161/jaha.123.030037] [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: 03/01/2023] [Accepted: 07/11/2023] [Indexed: 08/24/2023]
Abstract
Background The interrelationships between left atrial appendage (LAA) dimensions and device following implantation are unknown. We aimed to analyze the impact of Watchman device implantation on LAA dimensions following its percutaneous closure and potential predictors of remodeling. Methods and Results All consecutive LAA closure procedures performed at 2 centers between November 2017 and December 2020 were included in the WATCH-DUAL (Watchman 2.5 Versus Watchman FLX in a Dual-Center Left Atrial Appendage Closure Cohort) registry. This study included patients who had pre- and postintervention computed tomography scan analysis. The LAA and device dimensions were measured in a centralized core lab by 3-dimensional computed tomography scan reconstruction methods, focusing on the device landing zone. This analysis included 104 patients (age, 76.0 [range, 72.0-83.0] years; 72% men; 53% Watchman FLX; 47% Watchman 2.5). The baseline characteristics were comparable between Watchman 2.5 and Watchman FLX groups, except for the higher use of oversizing in the latter group. The median delay for computed tomography control was 49 (range, 43-64) days. The landing zone area (median, 446 [range, 363-523] versus 290 [222-366] mm2; P<0.001) and minimal diameter (median, 23.0 [range, 20.7-24.8] versus 16.7 [14.7-19.4] mm; P<0.001) significantly increased after implantation. The absolute (median, 157 [range, 98-220] versus 85 [18-148] mm2, P<0.001) and relative (median, 50% [range, 32%-79%] versus 26% [4%-50%]; P<0.001) increases in landing zone area were more pronounced in patients with oversized device. Baseline LAA dimensions were smaller, landing zone eccentricity larger, and oversized device more frequent in patients with significant overexpansion compared with the others. Conclusions LAA dimensions increased at the site of the Watchman prosthesis after implantation, suggesting a local positive remodeling after the procedure. This phenomenon was more pronounced in the case of oversized devices.
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Affiliation(s)
- Khalil Mahmoudi
- Cardiology DepartmentInstitut Mutualiste MontsourisParisFrance
| | - Roberto Galea
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | - Simon Elhadad
- Cardiology Department, Centre Hospitalier Marne la Vallée, JossignyFrance
| | - Fabrice Temperli
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | - Frederic Sebag
- Cardiology DepartmentInstitut Mutualiste MontsourisParisFrance
| | - Christoph Gräni
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | - Zhor Rezine
- Cardiology Department, Centre Hospitalier Marne la Vallée, JossignyFrance
| | - Laurent Roten
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | | | - Nicolas Brugger
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | - Alaa Masri
- Cardiology DepartmentInstitut Mutualiste MontsourisParisFrance
| | - Lorenz Räber
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | - Nicolas Amabile
- Cardiology DepartmentInstitut Mutualiste MontsourisParisFrance
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21
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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.
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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.
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Schmidt B, Bordignon S, Neven K, Reichlin T, Blaauw Y, Hansen J, Adelino R, Ouss A, Füting A, Roten L, Mulder BA, Ruwald MH, Mené R, van der Voort P, Reinsch N, Kueffer T, Boveda S, Albrecht EM, Schneider CW, Chun KRJ. EUropean real-world outcomes with Pulsed field ablatiOn in patients with symptomatic atRIAl fibrillation: lessons from the multi-centre EU-PORIA registry. Europace 2023; 25:euad185. [PMID: 37379528 PMCID: PMC10320231 DOI: 10.1093/europace/euad185] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 05/23/2023] [Indexed: 06/30/2023] Open
Abstract
AIMS Pulsed field ablation (PFA) is a new, non-thermal ablation modality for pulmonary vein (PV) isolation in patients with atrial fibrillation (AF). The multi-centre EUropean Real World Outcomes with Pulsed Field AblatiOn in Patients with Symptomatic AtRIAl Fibrillation (EU-PORIA) registry sought to determine the safety, efficacy, and learning curve characteristics for the pentaspline, multi-electrode PFA catheter. METHODS AND RESULTS All-comer AF patients from seven high-volume centres were consecutively enrolled. Procedural and follow-up data were collected. Learning curve effects were analysed by operator ablation experience and primary ablation modality. In total, 1233 patients (61% male, mean age 66 ± 11years, 60% paroxysmal AF) were treated by 42 operators. In 169 patients (14%), additional lesions outside the PVs were performed, most commonly at the posterior wall (n = 127). Median procedure and fluoroscopy times were 58 (interquartile range: 40-87) and 14 (9-21) min, respectively, with no differences due to operator experience. Major complications occurred in 21/1233 procedures (1.7%) including pericardial tamponade (14; 1.1%) and transient ischaemic attack or stroke (n = 7; 0.6%), of which one was fatal. Prior cryoballoon users had less complication. At a median follow-up of 365 (323-386) days, the Kaplan-Meier estimate of arrhythmia-free survival was 74% (80% for paroxysmal and 66% for persistent AF). Freedom from arrhythmia was not influenced by operator experience. In 149 (12%) patients, a repeat procedure was performed due to AF recurrence and 418/584 (72%) PVs were durably isolated. CONCLUSION The EU-PORIA registry demonstrates a high single-procedure success rate with an excellent safety profile and short procedure times in a real-world, all-comer AF patient population.
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Affiliation(s)
- Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
- Universitätsklinikum Frankfurt, Medizinische Klinik 3- Klinik für Kardiologie, Theodor-Stern-Kai 7, Frankfurt, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - Kars Neven
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
- Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Tobias Reichlin
- Inselspital—Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yuri Blaauw
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jim Hansen
- Arrhythmia Unit, Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark
| | - Raquel Adelino
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
| | - Alexandre Ouss
- Heart Center Catharina Hospital, Eindhoven, The Netherlands
| | - Anna Füting
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
- Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Laurent Roten
- Inselspital—Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bart A Mulder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin H Ruwald
- Arrhythmia Unit, Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark
| | - Roberto Mené
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
| | | | - Nico Reinsch
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
- Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Thomas Kueffer
- Inselspital—Bern University Hospital, University of Bern, Bern, Switzerland
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
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23
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Nozica N, Asatryan B, Aur S, Clement JB, Schwerzmann M, Guan F, Pascale P, Gass M, Duru F, Reichlin T, Pruvot E, Wolber T, Roten L. Arrhythmias and Clinical Outcomes in a Swiss Multicenter Cohort of Patients With Dextro-Transposition of the Great Arteries and Atrial Switch. J Am Heart Assoc 2023:e028956. [PMID: 37345794 DOI: 10.1161/jaha.122.028956] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Background Data on the incidence of arrhythmias, associated cardiac interventions, and outcome in patients with dextro-transposition of the great arteries and atrial switch are scarce. Methods and Results In this multicenter analysis, we included adult patients with dextro-transposition of the great arteries and atrial switch regularly followed up at 3 Swiss tertiary care hospitals. The primary outcome was a composite of left ventricular assist device, heart transplantation, and death. The secondary outcome was occurrence of ventricular tachycardia, ventricular fibrillation, or sudden cardiac death. We identified 207 patients (34% women; median age at last follow-up, 35 years) with dextro-transposition of the great arteries and atrial switch. Arrhythmias occurred in 97 patients (47%) at a median age of 22 years. A pacemaker or an implantable cardioverter-defibrillator was implanted in 39 (19%) and 13 (6%) patients, respectively, and 33 (16%) patients underwent a total of 51 ablation procedures to target 60 intra-atrial re-entry tachycardias, 4 atrioventricular nodal re-entry tachycardias, and 1 atrial fibrillation. The primary outcome occurred in 21 patients (10%), and the secondary outcome occurred in 18 patients (9%); both were more common in patients with concomitant ventricular septum defect than in those without (hazard ratio [HR], 3.06 [95% CI, 1.29-7.27], P=0.011; and HR, 3.62 [95% CI, 1.43-9.18], P=0.007, respectively). Conclusions In patients with dextro-transposition of the great arteries and atrial switch reaching adulthood, arrhythmias occur in almost half of patients, and associated rhythm interventions are frequent. One-tenth of those patients do not survive until the age of 35 years free from left ventricular assist device or heart transplantation, and the outcome is worse in patients with concomitant ventricular septum defect.
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Affiliation(s)
- Nikolas Nozica
- 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
| | - Stefania Aur
- Department of Cardiology Centre Hospitalier Universitaire Vaudois University of Lausanne Lausanne Switzerland
| | - Judith Bouchardy Clement
- Department of Cardiology Centre Hospitalier Universitaire Vaudois University of Lausanne Lausanne Switzerland
| | - Markus Schwerzmann
- Department of Cardiology, Inselspital Bern University Hospital University of Bern Bern Switzerland
| | - Fu Guan
- Department of Cardiology Zurich University Hospital University of Zurich Zurich Switzerland
| | - Patrizio Pascale
- Department of Cardiology Centre Hospitalier Universitaire Vaudois University of Lausanne Lausanne Switzerland
| | - Matthias Gass
- Department of Cardiology Zurich University Hospital University of Zurich Zurich Switzerland
- Department of Cardiology University Children's Hospital Zurich Zurich Switzerland
| | - Firat Duru
- Department of Cardiology Zurich University Hospital University of Zurich Zurich Switzerland
- Center for Integrative Human Physiology University of Zurich Zurich Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern University Hospital University of Bern Bern Switzerland
| | - Etienne Pruvot
- Department of Cardiology Centre Hospitalier Universitaire Vaudois University of Lausanne Lausanne Switzerland
| | - Thomas Wolber
- Department of Cardiology Zurich University Hospital University of Zurich Zurich Switzerland
- Center for Integrative Human Physiology University of Zurich Zurich Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital Bern University Hospital University of Bern Bern Switzerland
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24
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Turagam MK, Neuzil P, Schmidt B, Reichlin T, Neven K, Metzner A, Hansen J, Blaauw Y, Maury P, Arentz T, Sommer P, Anic A, Anselme F, Boveda S, Deneke T, Willems S, van der Voort P, Tilz R, Funasako M, Scherr D, Wakili R, Steven D, Kautzner J, Vijgen J, Jais P, Petru J, Chun J, Roten L, Füting A, Lemoine MD, Ruwald M, Mulder BA, Rollin A, Lehrmann H, Fink T, Jurisic Z, Chaumont C, Adelino R, Nentwich K, Gunawardene M, Ouss A, Heeger CH, Manninger M, Bohnen JE, Sultan A, Peichl P, Koopman P, Derval N, Kueffer T, Rahe G, Reddy VY. Safety and Effectiveness of Pulsed Field Ablation to Treat Atrial Fibrillation: One-Year Outcomes From the MANIFEST-PF Registry. Circulation 2023. [PMID: 37199171 DOI: 10.1161/circulationaha.123.064959] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Pulsed field ablation is a novel nonthermal cardiac ablation modality using ultra-rapid electrical pulses to cause cell death by a mechanism of irreversible electroporation. Unlike the traditional ablation energy sources, pulsed field ablation has demonstrated significant preferentiality to myocardial tissue ablation, and thus avoids certain thermally mediated complications. However, its safety and effectiveness remain unknown in usual clinical care. METHODS MANIFEST-PF (Multi-National Survey on the Methods, Efficacy, and Safety on the Post-Approval Clinical Use of Pulsed Field Ablation) is a retrospective, multinational, patient-level registry wherein patients at each center were prospectively included in their respective center registries. The registry included all patients undergoing postapproval treatment with a multielectrode 5-spline pulsed field ablation catheter to treat atrial fibrillation (AF) between March 1, 2021, and May 30, 2022. The primary effectiveness outcome was freedom from clinical documented atrial arrhythmia (AF/atrial flutter/atrial tachycardia) of ≥30 seconds on the basis of electrocardiographic data after a 3-month blanking period (on or off antiarrhythmic drugs). Safety outcomes included the composite of acute (<7 days postprocedure) and latent (>7 days) major adverse events. RESULTS At 24 European centers (77 operators) pulsed field ablation was performed in 1568 patients with AF: age 64.5±11.5 years, female 35%, paroxysmal/persistent AF 65%/32%, CHA2DS2-VASc 2.2±1.6, median left ventricular ejection fraction 60%, and left atrial diameter 42 mm. Pulmonary vein isolation was achieved in 99.2% of patients. After a median (interquartile range) follow-up of 367 (289-421) days, the 1-year Kaplan-Meier estimate for freedom from atrial arrhythmia was 78.1% (95% CI, 76.0%-80.0%); clinical effectiveness was more common in patients with paroxysmal AF versus persistent AF (81.6% versus 71.5%; P=0.001). Acute major adverse events occurred in 1.9% of patients. CONCLUSIONS In this large observational registry of the postapproval clinical use of pulsed field technology to treat AF, catheter ablation using pulsed field energy was clinically effective in 78% of patients with AF.
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Affiliation(s)
- Mohit K Turagam
- Icahn School of Medicine at Mount Sinai, New York, NY (M.K.T., V.Y.R.)
| | - Petr Neuzil
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia (P.N., M.F., J.P., V.Y.R.)
| | - Boris Schmidt
- MVZ CCB Frankfurt und Main-Taunus GbR, Frankfurt, Germany (B.S., J.C.)
- Universitair Ziekenhuis VUB, Brussels, Belgium (S.B., R.A.)
| | - Tobias Reichlin
- Inselspital-Bern University Hospital, University of Bern, Switzerland (T.R., L.R., T.K.)
| | - Kars Neven
- Department of Medicine, Witten/Herdecke University, Germany (K. Neven, A.F., G.R.)
- Department of Electrophysiology, Alfried Krupp Hospital, EssenGermany (K. Neven, A.F.)
| | - Andreas Metzner
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Germany (A.M., M.D.L.)
| | - Jim Hansen
- Copenhagen University Hospital, Denmark (J.H., M.R.)
| | - Yuri Blaauw
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (Y.B., B.A.M.)
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France (P.M., A.R.)
- I2MC, INSERM UMR 1297, ToulouseFrance (P.M.)
| | - Thomas Arentz
- Department of Cardiology and Angiology, Medical Center and Faculty of Medicine- University of Freiburg, Germany (T.A., H.L.)
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany (P.S., T.F.)
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Center Split, Croatia (A.A., Z.J.)
| | - Frederic Anselme
- Department of Medicine, Witten/Herdecke University, Germany (K. Neven, A.F., G.R.)
- Department of Electrophysiology, Alfried Krupp Hospital, EssenGermany (K. Neven, A.F.)
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France (S.B., R.A.)
| | - Tom Deneke
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany (T.D., K. Nentwich)
| | | | - Pepijn van der Voort
- Department of Cardiology, Catharina Ziekenhuis Eindhoven, The Netherlands (P.v.d.V., A.O.)
| | - Roland Tilz
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany (R.T., C.-H.H.)
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (R.T., C.-H.H.)
| | - Moritoshi Funasako
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia (P.N., M.F., J.P., V.Y.R.)
- Neuron Medical, Brno, Czech Republic (M.F.)
| | - Daniel Scherr
- Medical University of Graz, Austria (D. Scherr, M.M.)
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Germany (R.W., J.-E.B.)
| | - Daniel Steven
- Heart Center University Hospital of Cologne, Department for Electrophysiology, Germany (D. Steven, A.S.)
| | - Josef Kautzner
- IKEM-Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K., P.P.)
| | - Johan Vijgen
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium (J.V., P.K.)
| | - Pierre Jais
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia (P.N., M.F., J.P., V.Y.R.)
| | - Jan Petru
- 2I HU LIRYC, CHU Bordeaux, University of Bordeaux, France (P.J., N.D.)
| | - Julian Chun
- MVZ CCB Frankfurt und Main-Taunus GbR, Frankfurt, Germany (B.S., J.C.)
| | - Laurent Roten
- Inselspital-Bern University Hospital, University of Bern, Switzerland (T.R., L.R., T.K.)
| | - Anna Füting
- Department of Cardiology, Rouen Hospital, France (F.A., C.C.)
| | - Marc D Lemoine
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Germany (A.M., M.D.L.)
| | - Martin Ruwald
- Copenhagen University Hospital, Denmark (J.H., M.R.)
| | - Bart A Mulder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (Y.B., B.A.M.)
| | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, Toulouse, France (P.M., A.R.)
- Universitair Ziekenhuis VUB, Brussels, Belgium (S.B., R.A.)
| | - Heiko Lehrmann
- Department of Cardiology and Angiology, Medical Center and Faculty of Medicine- University of Freiburg, Germany (T.A., H.L.)
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany (P.S., T.F.)
| | - Zrinka Jurisic
- Department for Cardiovascular Diseases, University Hospital Center Split, Croatia (A.A., Z.J.)
| | | | - Raquel Adelino
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France (S.B., R.A.)
| | - Karin Nentwich
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany (T.D., K. Nentwich)
| | | | - Alexandre Ouss
- Department of Cardiology, Catharina Ziekenhuis Eindhoven, The Netherlands (P.v.d.V., A.O.)
| | - Christian-Hendrik Heeger
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany (R.T., C.-H.H.)
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (R.T., C.-H.H.)
| | | | - Jan-Eric Bohnen
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Germany (R.W., J.-E.B.)
| | - Arian Sultan
- Heart Center University Hospital of Cologne, Department for Electrophysiology, Germany (D. Steven, A.S.)
| | - Petr Peichl
- IKEM-Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K., P.P.)
| | - Pieter Koopman
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium (J.V., P.K.)
| | - Nicolas Derval
- 2I HU LIRYC, CHU Bordeaux, University of Bordeaux, France (P.J., N.D.)
| | - Thomas Kueffer
- Inselspital-Bern University Hospital, University of Bern, Switzerland (T.R., L.R., T.K.)
| | - Gilbert Rahe
- Department of Medicine, Witten/Herdecke University, Germany (K. Neven, A.F., G.R.)
- Department of Pulmonology, Gastroenterology and Internal Medicine, Alfried Krupp Hospital, Essen, Germany (G.R.)
| | - Vivek Y Reddy
- Icahn School of Medicine at Mount Sinai, New York, NY (M.K.T., V.Y.R.)
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia (P.N., M.F., J.P., V.Y.R.)
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25
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Tilz RR, Schmidt V, Pürerfellner H, Maury P, Chun KJ, Martinek M, Sohns C, Schmidt B, Mandel F, Gandjbakhch E, Laredo M, Gunawardene MA, Willems S, Beiert T, Borlich M, Iden L, Füting A, Spittler R, Gaspar T, Richter S, Schade A, Kuniss M, Neumann T, Francke A, Wunderlich C, Shin DI, Grosse Meininghaus D, Foresti M, Bonsels M, Reek D, Wiegand U, Bauer A, Metzner A, Eckardt L, Popescu SȘ, Krahnefeld O, Sticherling C, Kühne M, Nguyen DQ, Roten L, Saguner AM, Linz D, van der Voort P, Mulder BA, Vijgen J, Almorad A, Guenancia C, Fauchier L, Boveda S, De Greef Y, Da Costa A, Jais P, Derval N, Milhem A, Jesel L, Garcia R, Poty H, Khoueiry Z, Seitz J, Laborderie J, Mechulan A, Brigadeau F, Zhao A, Saludas Y, Piot O, Ahluwalia N, Martin C, Chen J, Antolic B, Leventopoulos G, Özcan EE, Yorgun H, Cay S, Yalin K, Botros MS, Mahmoud AT, Jędrzejczyk-Patej E, Inaba O, Okumura K, Ejima K, Khakpour H, Boyle N, Catanzaro JN, Reddy V, Mohanty S, Natale A, Blessberger H, Yang B, Stevens I, Sommer P, Veltmann C, Steven D, Vogler J, Kuck KH, Merino JL, Keelani A, Heeger CH. A worldwide survey on incidence, management and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: The POTTER-AF study. Eur Heart J 2023:7123667. [PMID: 37062040 DOI: 10.1093/eurheartj/ehad250] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/25/2023] [Accepted: 04/14/2023] [Indexed: 04/17/2023] Open
Abstract
AIMS Oesophageal fistula represents a rare but dreadful complication of atrial fibrillation catheter ablation. Data on its incidence, management and outcome are sparse. METHODS AND RESULTS This international multicenter registry investigates the characteristics of oesophageal fistulae after treatment of atrial fibrillation by catheter ablation. A total of 553,729 catheter ablation procedures (radiofrequency: 62.9%, cryoballoon: 36.2%, other modalities: 0.9%) were performed at 214 centers in 35 countries. In 78 centers 138 patients (0.025%, radiofrequency: 0.038%, cryoballoon: 0.0015% (p<0.0001)) were diagnosed with an oesophageal fistula. Periprocedural data were available for 118 patients (85.5%). Following catheter ablation, the median time to symptoms and the median time to diagnosis were 18 (7.75, 25; range: 0-60) days and 21 (15, 29.5; range: 2-63) days, respectively. The median time from symptom onset to oesophageal fistula diagnosis was 3 (1, 9; range: 0-42) days. The most common initial symptom was fever (59.3%). The diagnosis was established by chest computed tomography in 80.2% of patients. Oesophageal surgery was performed in 47.4% and direct endoscopic treatment in 19.8%, and conservative treatment in 32.8% of patients. The overall mortality was 65.8%. Mortality following surgical (51.9%) or endoscopic treatment (56.5%) was significantly lower as compared to conservative management (89.5%) (odds ratio 7.463 (2.414, 23.072) p<0.001). CONCLUSIONS Oesophageal fistula after catheter ablation of atrial fibrillation is rare and occurs mostly with the use of radiofrequency energy rather than cryoenergy. Mortality without surgical or endoscopic intervention is exceedingly high.
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Affiliation(s)
- Roland Richard Tilz
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Vanessa Schmidt
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
| | | | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Kr Julian Chun
- MVZ CCB am Agaplesion Markus Krankenhaus, Frankfurt a.M., Germany
| | | | - Christian Sohns
- Kliniken für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Boris Schmidt
- MVZ CCB am Agaplesion Markus Krankenhaus, Frankfurt a.M., Germany
| | - Franck Mandel
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Estelle Gandjbakhch
- Sorbonne Université, APHP, Pitié Salpêtrière University Hospital, Cardiology Institute, Paris, France
| | - Mikael Laredo
- APHP, Pitié Salpêtrière University Hospital, Cardiology Institute, Paris, France
| | | | - Stephan Willems
- Klinik für Kardiologie und Internistische Intensivmedizin, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Thomas Beiert
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Martin Borlich
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg), Bad Segeberg, Schleswig-Holstein, Germany
| | - Leon Iden
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg), Bad Segeberg, Schleswig-Holstein, Germany
| | - Anna Füting
- Dept. of Electrophysiology, Alfred Krupp Hospital, EssenGermany
- Dept. Of Medicine, Witten/Herdecke University, Witten, Germany
| | - Raphael Spittler
- Department of Cardiology II/Electrophysiology, Center for Cardiology, University Hospital Mainz, Germany
| | - Thomas Gaspar
- Department of Internal and Cardiovascular Medicine, Herzzentrum Dresden, University Clinic, Technische Universität Dresden, Germany
| | - Sergio Richter
- Department of Internal and Cardiovascular Medicine, Herzzentrum Dresden, University Clinic, Technische Universität Dresden, Germany
| | - Anja Schade
- Department of Interventional Electrophysiology, Helios Hospital Erfurt, Erfurt, Germany
| | - Malte Kuniss
- Dept. of Cardiology Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Thomas Neumann
- Dept. of Cardiology Kerckhoff Heart Center, Bad Nauheim, Germany
| | | | | | - Dong-In Shin
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany
- Faculty of Health, School of Medicine, University Witten/Herdecke, Witten, Germany
| | | | - Mike Foresti
- Kliniken Maria Hilf GmbH, Mönchengladbach, Germany
| | - Marc Bonsels
- Kliniken Maria Hilf GmbH, Mönchengladbach, Germany
| | - David Reek
- University Hospital Augsburg, Department of Cardiology, Augsburg, Germany
| | - Uwe Wiegand
- Sana-Klinikum Remscheid GmbH, Akademisches Lehrkrankenhaus der Universität zu Köln, Remscheid, Germany
| | - Alexander Bauer
- Diak-Klinikum Schwäbisch Hall und Klinikum Crailsheim, Schwäbisch Hall, Germany
| | - Andreas Metzner
- Universitäres Herz- und Gefäßzentrum, Klinik für Kardiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Eckardt
- Department of Cardiology II (Electrophysiology), University Hospital Münster, Germany
| | - Sorin Ștefan Popescu
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
| | | | | | - Michael Kühne
- Deaprtment of Cardiology, University Hospital Basel, Switzerland
| | | | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | | | - Bart A Mulder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Johan Vijgen
- Heart Center Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | | | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Serge Boveda
- Cardiology - Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Y De Greef
- Department of Cardiology, ZNA Heart Centre, Antwerp, Belgium
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Antoine Da Costa
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Pierre Jais
- CHU Bordeaux, Univ. Bordeaux, IHU LIRYC ANR-10-IAHU-04, France
| | - Nicolas Derval
- CHU Bordeaux, Univ. Bordeaux, IHU LIRYC ANR-10-IAHU-04, France
| | | | | | | | | | | | | | | | | | | | | | | | | | - Nikhil Ahluwalia
- Barts Heart Centre, Barts Health NHS Trust, London, UK
- Wiliam Harvey Heart Centre, Queen Mary University of London, UK
| | | | - Jian Chen
- Department of Heart Disease, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Bor Antolic
- Department of Cardiology, University Medical Center Ljubljana, Slovenia
| | | | - Emin Evren Özcan
- Heart Rhythm Management Center, Dokuz Eylul University, Izmir, Turkey
| | - Hikmet Yorgun
- Hacettepe University, Department of Cardiology, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, Division of Arrhythmia and Electrophysiology, University of Health Sciences, Yuksek Ihtisas Cardiovascular Building, Ankara City Hospital, Ankara, Turkey
| | - Kivanc Yalin
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Maichel Sobhy Botros
- Department of critical care medicine, Faculty of medicine, Cairo University, Cairo, Egypt
| | - Ahmed Taher Mahmoud
- Department of critical care medicine, Faculty of medicine, Cairo University, Cairo, Egypt
| | - Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Osamu Inaba
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Japan
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Koichiro Ejima
- Department of Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | | | - Noel Boyle
- UCLA Cardiac Arrhythmia Center, Los Angeles, USA
| | - J N Catanzaro
- University of Florida Health, Jacksonville, Florida, USA
| | - Vivek Reddy
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
- International Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Bing Yang
- Department of Cardiology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Irene Stevens
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
| | - Philipp Sommer
- Kliniken für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | | | - Daniel Steven
- Department for Electrophysiology, Heart Center University Cologne, Cologne, Germany
| | - Julia Vogler
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
| | - Karl-Heinz Kuck
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
| | - José Luis Merino
- La Paz University Hospital, Universidad Autónoma de Madrid, Idipaz, Madrid, Spain
| | - Ahmad Keelani
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
| | - Christian-H Heeger
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
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Castiglione A, Küffer T, Gräni C, Servatius H, Reichlin T, Roten L. Pulsed-Field-Ablation for the Treatment of Atrial Fibrillation in Patients with Congenital Anomalies of Cardiac Veins. J Cardiovasc Electrophysiol 2023; 34:1183-1191. [PMID: 37003265 DOI: 10.1111/jce.15900] [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: 01/19/2023] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Anomalous cardiac veins are not rare and pulmonary vein (PV) isolation for atrial fibrillation (AF) treatment should include these veins. Pulsed-field ablation (PFA) is a novel technology for AF ablation with excellent efficacy and safety profile. In this case series, we describe our first experience of isolation of anomalous cardiac veins using PFA in patients with AF. METHODS We report a series of patients with congenital anomalies of the cardiac veins and AF, treated with PFA. All patients underwent cardiac computed tomography for procedural planning. RESULTS We included five patients (4 males). Anomalous cardiac veins included a connection of a left common ostium to the coronary sinus, a partial and a complete drainage of the right superior PV into the superior vena cava (SVC) with and without additional atrial septal defect, a persistent left SVC and an anomalous posterior PV. All anomalous PVs were isolated using PFA. No phrenic nerve palsy or other complications occurred. PFA of an abnormal right superior PV draining into the distal SVC was possible without affecting the sinus node. After a median of four months, four patients were free of recurrence. One patient had recurrent AF and perimitral reentry tachycardia, probably facilitated by PFA in the mitral isthmus region during isolation of an anomalous connection of the left common ostium to the coronary sinus. CONCLUSIONS Using systematic pre-procedural imaging and 3D-electroanatomic mapping, the currently available PFA system seems well suited, efficient and versatile for the treatment of AF in patients with anomalous cardiac veins. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Alessandro Castiglione
- 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
| | - Christoph Gräni
- 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
| | - 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
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27
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Maurhofer J, Asatryan B, Haeberlin A, Noti F, Roten L, Seiler J, Baldinger SH, Franzeck F, Lam A, Kueffer T, Reichlin T, Tanner H, Servatius H. Acute and Long-term Outcomes of quadripolar IS-4 versus bipolar IS-1 Left Ventricular Leads in Cardiac Resynchronization Therapy: A Retrospective Registry Study. Pacing Clin Electrophysiol 2023; 46:365-375. [PMID: 36912446 DOI: 10.1111/pace.14686] [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: 01/05/2023] [Revised: 02/15/2023] [Accepted: 02/24/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND The implantation procedure of left ventricular (LV) leads and the management of cardiac resynchronization therapy (CRT) patients can be challenging. The IS-4 standard for CRT offers additional pacing vectors compared to bipolar leads (IS-1). IS-4 leads improve procedural outcome and may also result in lower adverse events during follow-up (FU) and improve clinical outcome in CRT patients. Further long-term FU data comparing the two lead designs are necessary. METHODS In this retrospective, single-center study we included adult patients implanted with a CRT-Defibrillator (CRT-D) or CRT-Pacemaker (CRT-P) with a quadripolar (IS-4 group) or bipolar (IS-1 group) LV lead and with available ≥3 years clinical FU. The combined primary endpoint was a combination of predefined, lead-related adverse events. Secondary endpoints were all single components of the primary endpoint. RESULTS Overall, 133 patients (IS-4 n = 66; IS-1 n = 67) with a mean FU of 4.03±1.93 years were included. Lead-related adverse events were less frequent in patients with an IS-4 lead than with an IS-1 lead (n = 8, 12.1% vs. n = 23, 34.3%; p = 0.002). The secondary outcomes showed a lower rate of LV lead deactivation/explantation and LV lead dislodgement/dysfunction (4.5% vs 22.4%; p = 0.003; 4.5% vs. 17.9%; p = 0.015, respectively) in the IS-4 patient group. Less patients suffered from unresolved phrenic nerve stimulation with an IS-4 lead (3.0% vs. 13.4%; p = 0.029). LV lead-related re-interventions were fewer in case of an IS-4 lead (6.1% vs. 17.9%; p = 0.036). CONCLUSION In this retrospective analysis, the IS-4 LV lead is associated with lower lead-related complication rates than the IS-1 lead at long-term FU. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jens Maurhofer
- 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
| | - 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
| | - Laurent Roten
- 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 H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Franzeck
- 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
| | - Thomas Kueffer
- 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
| | - Hildegard Tanner
- 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
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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.
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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
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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.
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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
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Amberger U, Lippert J, Mujanovic A, Beyeler M, Siepen B, Vynckier J, Scutelnic A, Goeldlin M, Seiffge D, Jung S, Gralla J, Arnold M, Kaesmacher J, Reichlin T, Tanner H, Fischer U, Roten L, Meinel TR. Association of Chronic Covert Cerebral Infarctions and White Matter Hyperintensities With Atrial Fibrillation Detection on Post-Stroke Cardiac Rhythm Monitoring: A Cohort Study. J Am Heart Assoc 2022; 11:e026962. [PMID: 36515235 PMCID: PMC9798803 DOI: 10.1161/jaha.122.026962] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background This study was conducted to explore the association of different phenotypes, count, and location of chronic covert brain infarctions (CBIs) with detection of atrial fibrillation (AF) on prolonged post-stroke cardiac rhythm monitoring (PCM). Methods and Results We conducted a cohort single-center study of consecutive first-ever ischemic stroke or transient ischemic attack patients undergoing PCM between January 2015 and December 2017. We blindly rated CBI phenotypes according to established definitions and white matter hyperintensities (WMHs) according to the age-related white matter changes rating scale. We used (multiple) regression models to assess the association of the imaging biomarkers and incident AF on PCM. A total of 795 patients (median [interquartile range]) aged 69 (57-78) years, 41% women, median National Institutes of Health Stroke Scale score 2 (0-5), median PCM duration 14 (7-14) days, and AF detection in 61 patients (7.7%) were included. On univariate analysis, WMHs (per point odds ratio, 1.35 [95% CI, 1.03-1.78]) but not CBIs (odds ratio, 0.90 [95% CI, 0.52-1.56]) were associated with AF detection. Neither CBI phenotype, count, nor location were associated with AF detection. After adjustment for age, hypertension, and stroke severity, neither increasing WMHs (per point adjusted odds ratio, 0.85 [95% CI, 0.60-1.20]) nor CBIs (adjusted odds ratio, 0.60 [95% CI, 0.33-1.09]) were independently associated with AF detection. Conclusions Although WMHs and CBIs represent surrogate biomarkers of vascular risk factors, neither WMHs nor CBIs, including their phenotypes, count, and location, were independently associated with AF detection on PCM. In patients with manifest ischemic stroke or transient ischemic attack, the presence of imaging biomarkers of chronic ischemic injury does not seem promising to further refine prediction tools for AF detection on PCM.
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Affiliation(s)
- Ulfrid Amberger
- Stroke Research Center Bern, Department of Neurology, InselspitalBern University Hospital, University of BernSwitzerland
| | - Julian Lippert
- Stroke Research Center Bern, Department of Neurology, InselspitalBern University Hospital, University of BernSwitzerland
| | - Adnan Mujanovic
- Stroke Research Center Bern, Department of Neurology, InselspitalBern University Hospital, University of BernSwitzerland,Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of BernSwitzerland
| | - Morin Beyeler
- Stroke Research Center Bern, Department of Neurology, InselspitalBern University Hospital, University of BernSwitzerland
| | - Bernhard Siepen
- Stroke Research Center Bern, Department of Neurology, InselspitalBern University Hospital, University of BernSwitzerland
| | - Jan Vynckier
- Stroke Research Center Bern, Department of Neurology, InselspitalBern University Hospital, University of BernSwitzerland
| | - Adrian Scutelnic
- Stroke Research Center Bern, Department of Neurology, InselspitalBern University Hospital, University of BernSwitzerland
| | - Martina Goeldlin
- Stroke Research Center Bern, Department of Neurology, InselspitalBern University Hospital, University of BernSwitzerland
| | - David Seiffge
- Stroke Research Center Bern, Department of Neurology, InselspitalBern University Hospital, University of BernSwitzerland
| | - Simon Jung
- Stroke Research Center Bern, Department of Neurology, InselspitalBern University Hospital, University of BernSwitzerland
| | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of BernSwitzerland
| | - Marcel Arnold
- Stroke Research Center Bern, Department of Neurology, InselspitalBern University Hospital, University of BernSwitzerland
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of BernSwitzerland
| | - Tobias Reichlin
- Department of Cardiology, InselspitalBern University Hospital, and University of BernSwitzerland
| | - Hildegard Tanner
- Department of Cardiology, InselspitalBern University Hospital, and University of BernSwitzerland
| | - Urs Fischer
- Stroke Research Center Bern, Department of Neurology, InselspitalBern University Hospital, University of BernSwitzerland,Department of NeurologyBasel University Hospital, University of BaselSwitzerland
| | - Laurent Roten
- Department of Cardiology, InselspitalBern University Hospital, and University of BernSwitzerland
| | - Thomas Raphael Meinel
- Stroke Research Center Bern, Department of Neurology, InselspitalBern University Hospital, University of BernSwitzerland
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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.
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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
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Zwimpfer L, Aeschbacher S, Krisai P, Coslovsky M, Springer A, Paladini RE, Girod M, Hufschmid J, Knecht S, Badertscher P, Beer JH, Bonati LH, Zuern CS, Roten L, Reichlin T, Sticherling C, Conen D, Osswald S, Kühne M. Neurocognitive function in patients with atrial fibrillation undergoing pulmonary vein isolation. Front Cardiovasc Med 2022; 9:1000799. [PMID: 36505379 PMCID: PMC9732530 DOI: 10.3389/fcvm.2022.1000799] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022] Open
Abstract
Background Atrial fibrillation (AF) is associated with cognitive dysfunction. However, neurocognitive function in AF patients undergoing pulmonary vein isolation (PVI) has not been well studied. The aim of this analysis is to compare neurocognitive function in patients who did or did not undergo PVI. Materials and methods We used data from the Swiss Atrial Fibrillation Cohort study (Swiss-AF), a prospective, observational, multicenter study in Switzerland. Patients with documented AF were enrolled and data of 1,576 patients without history of PVI and with complete information on PVI status and neurocognitive function were used. Information on PVI was collected at baseline and during 1 year of follow-up. Neurocognitive testing was performed at baseline and after 1 year of follow-up, using the Montreal Cognitive Assessment (MoCA), trail making test (TMT) A and B, digit symbol substitution test (DSST) and semantic fluency test (SFT). To investigate the association of PVI with neurocognitive function, we use propensity score matching (1:3) and inverse probability of treatment weighting (IPTW). Results The mean age of this population was 74 ± 8 years, 27.1% were women. Overall, 88 (5.5%) patients underwent PVI during 1 year of follow-up. Using ITPW (n = 1576), PVI was weakly associated with the MoCA score after adjusting for time since PVI, baseline MoCA score and other covariates (β (95%CI) 1.19 (0.05; 2.32), p = 0.04). In the propensity matched comparison (n = 352), there was no significant association between PVI and the MoCA score (β (95%CI) 1.04 (-0.19; 2.28), p = 0.1). There were no significant associations between PVI and cognitive function when using the TMT A and B, DSST or SFT independent of the method used. Conclusion In this population of AF patients, there was no consistent evidence of an association between PVI and neurocognitive function. Clinical trial registration [https://clinicaltrials.gov/], identifier [NCT02105844].
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Affiliation(s)
- Leon Zwimpfer
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - Stefanie Aeschbacher
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - Philipp Krisai
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - Michael Coslovsky
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland,Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Anne Springer
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - Rebecca E. Paladini
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - Marc Girod
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - Janik Hufschmid
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - Sven Knecht
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - Patrick Badertscher
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - Jürg H. Beer
- Department of Medicine, Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Zürich, Switzerland
| | - Leo H. Bonati
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland,Reha Rheinfelden, Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland,Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christine S. Zuern
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, 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
| | - Christian Sticherling
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Stefan Osswald
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - Michael Kühne
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland,*Correspondence: Michael Kühne,
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Galea R, Roten L, Siontis GCM, Brugger N, Windecker S, Räber L. Percutaneous left atrial appendage closure with superior vascular access. EUROINTERVENTION 2022; 18:e695-e696. [PMID: 35924340 PMCID: PMC10241274 DOI: 10.4244/eij-d-22-00435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/12/2022] [Indexed: 10/09/2023]
Affiliation(s)
- Roberto Galea
- 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
| | - Georgios C M Siontis
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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34
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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
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35
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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
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Prudat Y, Luca A, Yazdani S, Derval N, Jaïs P, Roten L, Berte B, Pruvot E, Vesin JM, Pascale P. Evaluation and optimization of novel extraction algorithms for the automatic detection of atrial activations recorded within the pulmonary veins during atrial fibrillation. BMC Med Inform Decis Mak 2022; 22:225. [PMID: 36031620 PMCID: PMC9420290 DOI: 10.1186/s12911-022-01969-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background and objective The automated detection of atrial activations (AAs) recorded from intracardiac electrograms (IEGMs) during atrial fibrillation (AF) is challenging considering their various amplitudes, morphologies and cycle length. Activation time estimation is further complicated by the constant changes in the IEGM active zones in complex and/or fractionated signals. We propose a new method which provides reliable automatic extraction of intracardiac AAs recorded within the pulmonary veins during AF and an accurate estimation of their local activation times.
Methods First, two recently developed algorithms were evaluated and optimized on 118 recordings of pulmonary vein IEGM taken from 35 patients undergoing ablation of persistent AF. The adaptive mathematical morphology algorithm (AMM) uses an adaptive structuring element to extract AAs based on their morphological features. The relative-energy algorithm (Rel-En) uses short- and long-term energies to enhance and detect the AAs in the IEGM signals. Second, following the AA extraction, the signal amplitude was weighted using statistics of the AA sequences in order to reduce over- and undersensing of the algorithms. The detection capacity of our algorithms was compared with manually annotated activations and with two previously developed algorithms based on the Teager–Kaiser energy operator and the AF cycle length iteration, respectively. Finally, a method based on the barycenter was developed to reduce artificial variations in the activation annotations of complex IEGM signals. Results The best detection was achieved using Rel-En, yielding a false negative rate of 0.76% and a false positive rate of only 0.12% (total error rate 0.88%) against expert annotation. The post-processing further reduced the total error rate of the Rel-En algorithm by 70% (yielding to a final total error rate of 0.28%). Conclusion The proposed method shows reliable detection and robust temporal annotation of AAs recorded within pulmonary veins in AF. The method has low computational cost and high robustness for automatic detection of AAs, which makes it a suitable approach for online use in a procedural context.
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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%.
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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
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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.
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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
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Ekanem E, Reddy VY, Schmidt B, Reichlin T, Neven K, Metzner A, Hansen J, Blaauw Y, Maury P, Arentz T, Sommer P, Anic A, Anselme F, Boveda S, Deneke T, Willems S, van der Voort P, Tilz R, Funasako M, Scherr D, Wakili R, Steven D, Kautzner J, Vijgen J, Jais P, Petru J, Chun J, Roten L, Füting A, Rillig A, Mulder BA, Johannessen A, Rollin A, Lehrmann H, Sohns C, Jurisic Z, Savoure A, Combes S, Nentwich K, Gunawardene M, Ouss A, Kirstein B, Manninger M, Bohnen JE, Sultan A, Peichl P, Koopman P, Derval N, Turagam MK, Neuzil P. Multi-national survey on the methods, efficacy, and safety on the post-approval clinical use of pulsed field ablation (MANIFEST-PF). Europace 2022; 24:1256-1266. [PMID: 35647644 PMCID: PMC9435639 DOI: 10.1093/europace/euac050] [Citation(s) in RCA: 110] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 01/11/2023] Open
Abstract
AIMS Pulsed field ablation (PFA) is a novel atrial fibrillation (AF) ablation modality that has demonstrated preferential tissue ablation, including no oesophageal damage, in first-in-human clinical trials. In the MANIFEST-PF survey, we investigated the 'real world' performance of the only approved PFA catheter, including acute effectiveness and safety-in particular, rare oesophageal effects and other unforeseen PFA-related complications. METHODS AND RESULTS This retrospective survey included all 24 clinical centres using the pentaspline PFA catheter after regulatory approval. Institution-level data were obtained on patient characteristics, procedure parameters, acute efficacy, and adverse events. With an average of 73 patients treated per centre (range 7-291), full cohort included 1758 patients: mean age 61.6 years (range 19-92), female 34%, first-time ablation 94%, paroxysmal/persistent AF 58/35%. Most procedures employed deep sedation without intubation (82.1%), and 15.1% were discharged same day. Pulmonary vein isolation (PVI) was successful in 99.9% (range 98.9-100%). Procedure time was 65 min (38-215). There were no oesophageal complications or phrenic nerve injuries persisting past hospital discharge. Major complications (1.6%) were pericardial tamponade (0.97%) and stroke (0.4%); one stroke resulted in death (0.06%). Minor complications (3.9%) were primarily vascular (3.3%), but also included transient phrenic nerve paresis (0.46%), and TIA (0.11%). Rare complications included coronary artery spasm, haemoptysis, and dry cough persistent for 6 weeks (0.06% each). CONCLUSION In a large cohort of unselected patients, PFA was efficacious for PVI, and expressed a safety profile consistent with preferential tissue ablation. However, the frequency of 'generic' catheter complications (tamponade, stroke) underscores the need for improvement.
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Affiliation(s)
| | - Vivek Y Reddy
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,Cardiology Department, Na Homolce Hospital, Homolka Hospital, Roentgenova 37/2, 15030 Praha 5 Prague, Czech Republic
| | - Boris Schmidt
- MVZ CCB Frankfurt und Main-Taunus GbR, Frankfurt, Germany
| | - Tobias Reichlin
- Inselspital—Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kars Neven
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany,Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Andreas Metzner
- University Heart and Vascular Center, University of Hamburg, Hamburg, Germany
| | - Jim Hansen
- Copenhagen University Hospital, Copenhagen, Denmark
| | - Yuri Blaauw
- Universitair Medish Groningen, Groningen, The Netherlands
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France,I2MC, INSERM UMR 1297, Toulouse, France
| | | | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split, Croatia
| | | | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France,Universitair Ziekenhuis VUB, Brussels, Belgium
| | - Tom Deneke
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | | | - Pepijn van der Voort
- Department of Cardiology, Catharina Ziekenhuis Eindhoven, Eindhoven, The Netherlands
| | - Roland Tilz
- Department of Rhythmology, University Heart Center, Lubeck, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany,LANS Cardio, Hamburg, Germany
| | - Moritoshi Funasako
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Roentgenova 37/2, 15030 Praha 5 Prague, Czech Republic,Neuron Medical, Brno, Czech Republic
| | | | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Duisburg, Germany
| | | | - Josef Kautzner
- IKEM—Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Johan Vijgen
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium
| | - Pierre Jais
- IHU LIRYC, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Jan Petru
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Roentgenova 37/2, 15030 Praha 5 Prague, Czech Republic
| | - Julian Chun
- MVZ CCB Frankfurt und Main-Taunus GbR, Frankfurt, Germany
| | - Laurent Roten
- Inselspital—Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna Füting
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany,Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Andreas Rillig
- University Heart and Vascular Center, University of Hamburg, Hamburg, Germany
| | - Bart A Mulder
- Universitair Medish Groningen, Groningen, The Netherlands
| | | | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | | | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Zrinka Jurisic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split, Croatia
| | | | - Stephanes Combes
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France,Universitair Ziekenhuis VUB, Brussels, Belgium
| | - Karin Nentwich
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | | | - Alexandre Ouss
- Department of Cardiology, Catharina Ziekenhuis Eindhoven, Eindhoven, The Netherlands
| | - Bettina Kirstein
- Department of Rhythmology, University Heart Center, Lubeck, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany,LANS Cardio, Hamburg, Germany
| | | | - Jan Eric Bohnen
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Duisburg, Germany
| | | | - Petr Peichl
- IKEM—Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Pieter Koopman
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium
| | - Nicolas Derval
- IHU LIRYC, CHU Bordeaux, University of Bordeaux, Bordeaux, France
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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.
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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
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Tanner H, Goulouti E, Lam A, Elchinova E, Nozica N, Servatius H, Noti F, Seiler J, Baldinger SH, Haeberlin A, Franzeck F, Asatryan B, Reichlin T, Roten L. Gender gap in study inclusion: Insights from the STAR-FIB cohort study. Europace 2022. [DOI: 10.1093/europace/euac053.153] [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: Foundation. Main funding source(s): Swiss National Science Foundation Swiss Heart Foundation
Background
The underrepresentation of women in cardiovascular clinical trials is well described but cannot be fully explained by sex-specific differences in the prevalence of cardiovascular diseases. Data on potential sex- and gender-related differences in study exclusion reasons are scarce.
The STAR-FIB cohort study aimed to estimate the age and sex-specific prevalence of screening-detected atrial fibrillation (AF) in 800 hospitalized patients aged 65-84 years using serial seven-day ECGs. Recruitment for study inclusion was stratified by sex (female/male, as stated in the patient’s records) and age (four age bands, ≥65 to <70, ≥70 to <75, ≥75 to <80, and ≥80 to <85 years), and was truncated for each subgroup after the inclusion of 100 participants.
Purpose
To assess sex and gender differences in patient recruitment for inclusion in the STAR-FIB cohort study.
Methods
A screening log containing sex-category, age, and reasons for exclusion was maintained. Exclusion criteria are shown in the figure. For the purpose of the present study, an explorative analysis of all exclusion criteria with respect to sex category was done.
Results
Overall, 11’470 patients were identified for eligibility, 795 patients (49% women; mean age 75 years) were enrolled, and 10’675 patients (52% women vs. 48% men, p =0.13) were not enrolled. The two major exclusion reasons were unwillingness to participate, which was more frequent in women (27.9% of women vs. 18.4% of men, p < 0.01), and the presence of clinical AF, which was more prevalent in men (27.1% of men vs. 20.5 % of women, p < 0.01). A detailed analysis of all exclusion criteria analysed by sex category is provided in the figure.
Conclusions
Clinical AF was more frequent in men, in accordance with the well described sex-driven (biological) higher prevalence of AF in men. In contrast, we found a higher percentage of women unwilling to participate in this study, which may represent a more gender-based (sociocultural) phenomenon. A further exploration of these findings should be performed and may help to identify and potentially overcome modifiable obstacles for study participation.
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Affiliation(s)
- H Tanner
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - E Goulouti
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - A Lam
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - E Elchinova
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - N Nozica
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - H Servatius
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - F Noti
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - J Seiler
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - SH Baldinger
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - A Haeberlin
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - F Franzeck
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - B Asatryan
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - T Reichlin
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - L Roten
- Bern University Hospital, Cardiology, Bern, Switzerland
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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.
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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
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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.
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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
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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.
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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
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45
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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.
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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
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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.
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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
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Goulouti E, Lam A, Nozica N, Elchinova E, Spirito A, Servatius H, Noti F, Seiler J, Baldinger S, Haeberlin A, Babken A, Franzeck F, Tanner H, Reichlin T, Roten L. Incidental arrhythmias during atrial fibrillation screening in a hospital-based patient population. Europace 2022. [DOI: 10.1093/europace/euac053.032] [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.
Introduction
Screening for atrial fibrillation may reveal other, incidental arrhythmias of relevance. We sought to describe such incidental arrhythmias in the prospective STARFIB cohort study, which screened for silent atrial fibrillation in hospitalized patients aged 65-84 years.
Method
Patients included in the STARFIB cohort study had up to three 7-day Holter ECGs, performed in two-month intervals. We analysed all the 7-day Holter ECGs of study participants for the presence of one of the following incidental arrhythmias: 1) sick-sinus-syndrome (SSS), defined as sinus arrest of ≥3 seconds duration; 2) second or higher degree atrioventricular block (AVB); 3) sustained atrial tachycardia of ≥30 seconds duration (AT); and 4) sustained ventricular tachycardia of ≥30 seconds duration (VT).
Results
A total of 2’077 Holter ECGs were performed in 794 patients (mean age 74.7 years; 49% females), resulting in a mean cumulative duration of an analyzable ECG signal of 414±136 hours per patient. We found incidental arrhythmias in 94 patients (11.8%). Among these were SSS in 14 patients (1.8%), AVB in 41 (5.2%), AT in 41 (5.2%), and VT in two (0.3%). The median pause duration in SSS was 4 seconds and SSS resulted in pacemaker implantation in one patient with a pause of 9 seconds duration. The most severe type of AVB found per patient was second degree AVB type Wenkebach in 23 patients (2.9%), second degree AVB type Mobitz or 2:1 AV conduction in 10 patients (1.3%) and complete AVB in 8 (1%; maximum pause 18 seconds). AVB led to pacemaker implantation in 9 patients (1.1%). The median duration and heart rate of AT was 2.2 minutes and 144 bpm, respectively. Initiation of betablocker therapy was recommended in 3 patients (0.4%) due to symptomatic AT. The duration and heart rate of VT was 3 minutes at 216 bpm in one patient and 38 seconds at 150 bpm in another. The former patient with VT experienced syncope and an ICD was implanted, whereas in the latter the betablocker dose was increased. One patient died from a non-cardiac cause during a Holter ECG, which showed progressive bradycardia and finally asystole.
Conclusion
Incidental arrhythmias were frequently discovered during screening for atrial fibrillation and resulted in device therapy in 1.4% of our cohort patients.
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Affiliation(s)
- E Goulouti
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - A Lam
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - N Nozica
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - E Elchinova
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - A Spirito
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - H Servatius
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - F Noti
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - J Seiler
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - S Baldinger
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - A Haeberlin
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - A Babken
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - F Franzeck
- 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
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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.
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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
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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.
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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
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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.
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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
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