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Sulke N, Dulai R, Freemantle N, Sugihara C, Podd S, Eysenck W, Lewis M, Hyde J, Veasey RA, Furniss SS. Long Term outcomes of percutaneous atrial fibrillation ablation in patients with continuous monitoring. Pacing Clin Electrophysiol 2021; 44:1176-1184. [PMID: 34028066 DOI: 10.1111/pace.14282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 05/09/2021] [Accepted: 05/16/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION There is limited data using continuous monitoring to assess outcomes of atrial fibrillation (AF) ablation. This study assessed long-term outcomes of AF ablation in patients with implantable cardiac devices. METHODS 207 patients (mean age 68.1 ± 9.5, 50.3% men) undergoing ablation for symptomatic AF were followed up for a mean period of 924.5 ± 636.7 days. Techniques included The Pulmonary Vein Ablation Catheter (PVAC) (59.4%), cryoablation (17.4%), point by point (14.0%) and The Novel Irrigated Multipolar Radiofrequency Ablation Catheter (nMARQ) (9.2%). RESULTS 130 (62.8%) patients had paroxysmal AF (PAF) and 77 (37.2%) persistent AF. First ablation and repeat ablation reduced AF burden significantly (relative risk 0.91, [95% CI 0.89 to 0.94]; P <0.0001 and 0.90, [95% CI, 0.86-0.94]; P <0.0001). Median AF burden in PAF patients reduced from 1.05% (interquartile range [IQR], 0.1%-8.70%) to 0.10% ([IQR], 0%-2.28%) at one year and this was maintained out to four-years. Persistent AF burden reduced from 99.9% ([IQR], 51.53%-100%) to 0.30% ([IQR], 0%-77.25%) at one year increasing to 87.3% ([IQR], 4.25%-100%) after four years. If a second ablation was required, point-by-point ablation achieved greater reduction in AF burden (relative risk, 0.77 [95% CI, 0.65-0.91]; P <0.01). CONCLUSION Ablation reduces AF burden both acutely and in the long-term. If a second ablation was required the point-by-point technique achieved greater reductions in AF burden than "single-shot" technologies. Persistent AF burden increased to near pre ablation levels by year 4 suggesting a different mechanism from PAF patients where this increase did not occur.
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Affiliation(s)
- Neil Sulke
- Cardiology Research Department, East Sussex Hospitals NHS Trust, Eastbourne District General Hospital, Eastbourne, United Kingdom
| | - Rajdip Dulai
- Cardiology Research Department, East Sussex Hospitals NHS Trust, Eastbourne District General Hospital, Eastbourne, United Kingdom
| | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
| | - Conn Sugihara
- Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, United Kingdom
| | - Steven Podd
- The Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - William Eysenck
- Cardiology Research Department, East Sussex Hospitals NHS Trust, Eastbourne District General Hospital, Eastbourne, United Kingdom
| | - Michael Lewis
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Jonathan Hyde
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Rick A Veasey
- Cardiology Research Department, East Sussex Hospitals NHS Trust, Eastbourne District General Hospital, Eastbourne, United Kingdom
| | - Stephen S Furniss
- Cardiology Research Department, East Sussex Hospitals NHS Trust, Eastbourne District General Hospital, Eastbourne, United Kingdom
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Juliá J, Bokhari F, Uuetoa H, Derejko P, Traykov VB, Gwizdala A, Sebag FA, Hegbom F, Anfinsen OG, AlQubbany A, Bardyszewski A, Gul EE, Geleva V, Kirubakaran S, Podd S, Babu GG, Balasubramaniam R, Lim PB, Wright M, Veasey R, Mann I, Hildick-Smith D, McCready J, Silberbauer J. A New Era in Epicardial Access for the Ablation of Ventricular Arrhythmias: The Epi-Co 2 Registry. JACC Clin Electrophysiol 2020; 7:85-96. [PMID: 33478716 DOI: 10.1016/j.jacep.2020.07.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This multicenter registry aimed to assess the reproducibility and safety of intentional coronary vein exit and carbon dioxide insufflation to facilitate subxiphoid epicardial access in the setting of ventricular tachycardia ablation. BACKGROUND Epicardial ablation for ventricular tachycardia is not a widespread technique due to the significant potential complications associated with subxiphoid puncture. The first experience in 12 patients showed that intentional coronary vein exit and carbon dioxide insufflation was technically feasible. METHODS A branch of the coronary sinus was cannulated by means of a diagnostic JR4 coronary catheter. Intentional perforation at the distal portion of that branch was performed with a high tip load 0.014-inch angioplasty wire. A microcatheter was advanced over the wire into the pericardial space. Carbon dioxide was then insufflated into the pericardial space, allowing direct visualization of the anterior pericardial space to facilitate subxiphoid puncture. RESULTS Intentional coronary vein exit was attempted in 102 consecutive patients in 16 different centers and successfully completed in 101 patients. Significant pericardial adhesions were confirmed in 3 patients, preventing carbon dioxide insufflation and epicardial ablation. None of the punctures were complicated with inadvertent right ventricular puncture or damage to a coronary artery. Significant bleeding (>80 ml) due to coronary vein exit occurred in 5 patients, without hemodynamic compromise. None of the patients required surgery. CONCLUSIONS Coronary vein exit and carbon dioxide insufflation can be safely and reproducibly achieved to facilitate subxiphoid pericardial access in the setting of ventricular tachycardia ablation.
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Affiliation(s)
- Justo Juliá
- Sussex Cardiac Centre, Brighton, United Kingdom.
| | - Fayez Bokhari
- King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Hasso Uuetoa
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pawel Derejko
- Medicover Hospital, Warsaw, Poland; Department of Cardiac Arrhythmias, National Institute of Cardiology, Warsaw, Poland
| | | | - Adrian Gwizdala
- First Department of Cardiology, University of Medical Sciences, Poznan, Poland
| | | | - Finn Hegbom
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | | | | | | | - Valeri Geleva
- Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | | | - Steven Podd
- Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | | | | | | | | | - Rick Veasey
- Eastbourne District General Hospital, Eastbourne, United Kingdom
| | - Ian Mann
- Sussex Cardiac Centre, Brighton, United Kingdom
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Kiedrowicz RM, Podd S, O'Neill M. Focal automaticity manifesting as incessant right atrial tachycardia. Heart Rhythm 2015; 13:999-1000. [PMID: 26690064 DOI: 10.1016/j.hrthm.2015.12.014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Radoslaw Marek Kiedrowicz
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, St. Thomas' Hospital, London, United Kingdom.
| | - Steven Podd
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, St. Thomas' Hospital, London, United Kingdom
| | - Mark O'Neill
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, St. Thomas' Hospital, London, United Kingdom; Division of Imaging Sciences and Biomedical Engineering, King's College London, Rayne Institute, St. Thomas' Hospital, London, United Kingdom
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Podd S, Hunt J, Sulke N. Home Orthostatic Training in Elderly Patients with Vasovagal Syncope - A Prospective Randomised Controlled Trial. Eur Cardiol 2015; 10:123-127. [PMID: 30310437 DOI: 10.15420/ecr.2015.10.2.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aim: The aim of this study was to assess the effect of home orthostatic training (HOT) on autonomic reflexes in elderly patients with vasovagal syncope (VVS). Methods: Design and Setting: A single-blind randomised control trial was conducted at Eastbourne District General Hospital, East Sussex NHS Trust. Patients: Individuals with recurrent syncope underwent tilt-table testing between August 2007 and October 2009.Those with at least two syncopal episodes and tilt-test proven VVS were recruited. Participants were divided into those aged >65 years (O65) and those aged <65 years (U65). Interventions: Patients in the O65 group were randomised 1:1 to receive active HOT (O65+) or sham HOT (O65-). The U65 group received active HOT. Participants performed HOT/sham HOT and recorded their training and symptoms. Patients had a repeat tilt test at 3 months. Outcome Measures: Time to syncope at repeat tilt-table testing, low-frequency heart rate variability (LF-HRV), high-frequency heart rate variability (HF-HRV), mean upslope baroreflex sensitivity (BRS) and mean downslope BRS were assessed. Results: A total of 106 patients with recurrent syncope underwent tilt-table testing. Of these, 45 consecutive patients (30 in the O65 group and 15 in the U65 group) were recruited. Two, one and three patients withdrew or were lost-to-follow-up in the O65+, O65-, and U65 groups, respectively. Symptomatic benefit occurred in four (31 %) of the O65+, four (29 %) of the O65-, and six (50 %) of the U65. None of the autonomic measures changed significantly in any group. No difference was seen with HF-HRV, LF-HRV mean upslope BRS and mean downslope BRS. Fifty per-cent of the O65+ group stopped training because of back pain. Time constraint (25 %) was the most common reason for cessation in the U65 group. Conclusions: Despite good tilt training compliance, no improvement in autonomic measures in any group was shown. The most common reason for cessation of training was back pain in the elderly groups. This study does not support the use of HOT in elderly patients.
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Affiliation(s)
- Steven Podd
- Eastbourne District General Hospital, East Sussex, United Kingdom
| | - Jacqueline Hunt
- Eastbourne District General Hospital, East Sussex, United Kingdom
| | - Neil Sulke
- Eastbourne District General Hospital, East Sussex, United Kingdom
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Hammersley D, Podd S, Gomes A, Thomson C, Keeble T, Dooley M, Hildick-Smith D. Feasibility of Left Atrial Appendage Occlusion Without Preprocedural Transesophageal Echocardiography or CT Scanning. J Invasive Cardiol 2015; 27:E297-E301. [PMID: 26477044] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To assess the success rate and safety outcomes of left atrial appendage occlusion (LAAO) procedures in a cohort of patients who had not undergone preprocedural imaging. BACKGROUND LAAO patients usually undergo imaging with either transesophageal echocardiography (TEE) or computed tomography (CT) prior to the procedure itself. This preprocedural imaging may not be necessary. METHODS The procedural success and major complication rates were assessed in a cohort of 52 patients who underwent LAAO without preprocedural imaging. RESULTS Mean patient age was 75 ± 8 years. Median CHA2DS2-VASc score was 4 and median HASBLED score was 3. The LAAO procedure was successful in 51/52 cases (98.1%). In 1 case, the LAAO procedure did not proceed because the LAA was too large for the available occlusion devices. No patient had left atrial appendage thrombus, despite the fact that only 4 patients were taking oral anticoagulation therapy at the time. Major complications occurred in 2/52 cases (3.8%), both due to vascular injuries causing pseudoaneurysm formation. CONCLUSION LAAO in this series was not adversely affected by lack of preprocedural imaging. Omitting preprocedural imaging reduces risk attributable to the modality, reduces patient inconvenience and discomfort, reduces cost, and does not appear to significantly reduce the proportion of patients who can undergo a successful procedure. Further larger studies are warranted.
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Affiliation(s)
| | | | | | | | | | | | - David Hildick-Smith
- Royal Sussex Cardiac Centre, Brighton Department of Cardiology, Brighton, BN2 5BE, United Kingdom.
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Montoro Lopez M, Iniesta Manjavacas A, De Torres Alba F, Lopez Fernandez T, De Celix MCGR, Gomez De Diego J, Ramirez U, Mesa J, Moreno Yanguela M, Lopez Sendon J, Shiina Y, Ernst S, Gatzoulis M, Li W, Cameli M, De Vito R, Di Giovanni A, Lisi M, Focardi M, Giacomin E, Bigio E, Mondillo S, Szymczyk E, Lipiec P, Michalski B, Szymczyk K, Rotkiewicz A, Wozniakowski B, Stefanczyk L, Kasprzak J, Luo X, Fang F, Lee AP, Lam Y, Sanderson JE, Kwong JS, Yu C, Nasis A, Moir S, Meredith I, Mottram P, Van Zalen J, Podd S, Raju P, Mcintosh R, Beale L, Brickley G, Sturridge L, Patel N, Lloyd G, Esteban Martinez F, Ariza Canete J, Casanova Martin M, Ciudad Caballero M, Trapiello Gonzalez L, Herrera Gutierrez N, Matei F, Beladan C, Popescu B, Calin A, Rosca M, Curea F, Calin C, Ginghina C, Baronaite-Dudoniene K, Vaskelyte JJ, Puodziukynas A, Smalinskas V, Urbonaite L, Botezatu CD, Enache R, Rosca M, Beladan CC, Calin A, Gurzun MM, Ginghina C, Popescu BA, Ercan S, Kervancioglu S, Davutoglu V, Cakici M, Ozkur A, Oylumlu M, Sari I, Faustino A, Paiva L, Providencia R, Trigo J, Botelho A, Costa M, Leitao-Marques A, Al Barjas M, Alwis L, Sonoda L, Balan K, Alqaseer M, Jelani A, Niaz K, Andres Lahuerta A, Igual Munoz B, Alonso Fernandez P, Maceira A, Cano O, Osca J, Sancho-Tello M, Jimenez Carreno R, De Munoz YR, De Ros JO, Bonanad Lozano C, Lopez-Lereu M, Monmeneu J, Estornell J, Igual Munoz B, Maceira A, Chaustre F, Sanchis J, Badr Eslam R, Pfaffenberger S, Marzluf B, Frey M, Bartko P, Babayev J, Kammerlander A, Maurer G, Mascherbauer J. Club 35 Poster session Friday 7 December: Dobutamine stress echo. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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