Background
Contrast computed tomography (CT) is a useful tool for the detection of intracardiac thrombi. We aimed to assess the accuracy of the late‐phase prone‐position contrast CT (late‐pCT) for ...thrombus detection in patients with persistent or long‐standing persistent atrial fibrillation (AF).
Methods
Early and late‐phase pCT were performed in 300 patients with persistent or long‐standing AF. If late‐pCT did not show an intracardiac contrast defect (CD), catheter ablation (CA) was performed. Immediately before CA, intracardiac echocardiography (ICE) from the left atrium was performed to confirm thrombus absence and the estimation of the blood velocity of the left atrial appendage (LAA). For patients with CDs on late‐pCT, CA performance was delayed, and late‐pCT was performed again after several months following oral anticoagulant alterations or dosage increases.
Results
Of the 40 patients who exhibited CDs in the early phase of pCT, six showed persistent CDs on late‐pCT. In the remaining 294 patients without CDs on late‐pCT, the absence of a thrombus was confirmed by ICE during CA. In all six patients with CD‐positivity on late‐pCT, the CDs vanished under the same CT conditions after subsequent anticoagulation therapy, and CA was successfully performed. Furthermore, the presence of residual contrast medium in the LAA on late‐pCT suggested a decreased blood velocity in the LAA ( ≤ 15 cm/s) (sensitivity = 0.900 and specificity = 0.621).
Conclusions
Late‐pCT is a valuable tool for the assessment of intracardiac thrombi and LAA dysfunction in patients with persistent or long‐standing persistent AF before CA.
Full text
Available for:
BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Background
Recent studies have shown the improvement in long‐term effectiveness with standardized pulmonary vein isolation (PVI) aimed at creating durable and contiguous lesions with VISITAG SURPOINT ...(VS) in paroxysmal atrial fibrillation (PAF).
Objective
We aimed to assess efficacy of PVI alone strategy using VS in non‐PAF patients and evaluate factors associated with corresponding clinical outcomes.
Methods
Consecutive patients who underwent PVI for persistent/long‐standing persistent AF between May 2017 to July 2019 were studied retrospectively. PVI was performed with 30–50 W guided by VS (posterior target: 400–500, anterior target: 500). Left atrial voltage maps were created during atrial pacing after PVI.
Results
A total of 140 patients (119 males, age 62 ± 10 years, long‐standing persistent AF: 35) were included and followed for median of 454 days. No adverse events were reported in any patients during periprocedural and follow‐up period of up to 28 months. Kaplan–Meier analysis estimated that freedom from atrial tachycardia or AF (AT/AF) without antiarrhythmics at 1‐year was 70%. Radiofrequency delivery with higher power was associated with increased first‐pass isolation rate, but not with freedom from AT/AF. In multivariate analysis, long‐standing persistent AF and % low‐voltage zone (%LVZ) were independent predictors of clinical outcome. The best cut‐off value of %LVZ for predicting AT/AF recurrence was 3.24%. Freedom from AT/AF was 88% in patients with persistent AF and %LVZ < 3.24%, while 27% in those with long‐standing persistent AF and %LVZ ≥ 3.24%.
Conclusions
PVI alone using VS was associated with excellent 1‐year success in patients with persistent AF and %LVZ < 3.24%, but was insufficient in those with long‐standing persistent AF and/or %LVZ ≥ 3.24%.
Full text
Available for:
BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Background: Transvenous lead extractions have been performed using 40-Hz laser sheaths. Recently, a new 80-Hz laser sheath became available, but only a few reports have compared the effectiveness of ...the 40- and 80-Hz laser sheaths. Methods and Results: This study included 215 patients. Lead extractions using only laser sheaths were analyzed. The clinical characteristics, extraction parameters, and extraction tools were evaluated. The procedures were performed with 40-Hz sheaths in 150 patients (group 1: 270 leads) and 80-Hz sheaths in 65 (group 2: 99 leads). No statistically significant differences were observed in the clinical parameters except for sex. The mean implant duration was 95.3±86.0 and 78.2±56.8 months in groups 1 and 2, respectively (P=0.07). The respective mean laser time and number of laser pulses were 48.5±52.1 and 48.1±56.1 s (P=0.96) and 2,035.0±2,384.0 and 3,955.1±2,339.3 pulses (P<0.0001). Complete removal was achieved for 97.4% of the leads and in 98.0% in both groups (P=0.38). Major complications occurred in 2.0% and 3.1% of the patients in groups 1 and 2, respectively (P=0.94). Conclusions: Transvenous lead extraction using high-frequency laser sheaths was as highly successful as with low-frequency laser sheaths in Japanese patients.
As situs ambiguus can cause sinus bradycardia in young patients, the best timing for pacemaker implantation is controversial when the patient is a fertile female.
Full text
Available for:
FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Aim: Oral anticoagulants (OACs) reduce the risk of ischemic stroke but may increase the risk of major bleeding in patients with non-valvular atrial fibrillation (NVAF). Various risk scores, such as ...HAS-BLED, ATRIA, ORBIT, and DOAC, have been proposed to assess the risk of major bleeding in patients with NVAF receiving OACs. However, limited data are available regarding bleeding risk stratification in Japanese patients with NVAF.Methods: Of the 16,098 NVAF patients from the J-RISK AF study, the combined data of the five major AF registries in Japan (J-RHYTHM Registry, Fushimi AF Registry, Shinken Database, Keio interhospital Cardiovascular Studies, and Hokuriku-Plus AF Registry), we analyzed 11,539 patients receiving OACs (median age, 71 years old; women, 29.6%; median CHA2DS2-VASc score, 3).Results: During the 2-year follow-up period, major bleeding occurred in 274 patients (1.3% per patient-year). In a multivariate Cox proportional hazards analysis, an advanced age, hypertension (systolic blood pressure ≥ 150 mmHg), bleeding history, anemia, thrombocytopenia, and concomitant antiplatelet agents were significantly associated with a higher incidence of major bleeding. We developed a novel risk stratification system, HED-EPA2-B3 score, which had a better predictive performance for major bleeding (C-statistics 0.67, 95% confidence interval, 0.63-0.70) than the HAS-BLED (0.64, 0.60-0.67, P for difference 0.02) and ATRIA (0.63, 0.60-0.66, P for difference ＜0.01) scores. Furthermore, it was non-significantly higher than the ORBIT (0.65, 0.62-0.68, P for difference 0.07) and DOAC (0.65, 0.62-0.68, P for difference 0.17) scores.Conclusion: Our novel risk stratification system, the HED-EPA2-B3 score, may be useful for identifying Japanese patients receiving OACs at a risk of major bleeding.
Introduction
Several studies have revealed that second‐generation cryoballoon (CB)‐based pulmonary vein (PV) isolation is noninferior to radiofrequency (RF)‐based PV isolation for patients with ...drug‐refractory paroxysmal atrial fibrillation (AF). However, electrophysiological differences in repeat ablation remain unclear.
Methods and Results
This study examined electrophysiological differences during the repeat ablation between patients who first underwent RF catheter ablation and CB ablation; PV durability and non‐PV AF foci were assessed for these patients. We enrolled 919 and 491 patients who underwent CB ablation (CB group) and RF catheter ablation (RF group), respectively, for paroxysmal AF between January 2013 and June 2017 at our institution. PV isolation using RF ablation involved the left atrium (LA) antrum and part of the LA posterior wall. After 2 years of follow‐up, 62 and 80 patients in the CB and RF groups, respectively, underwent repeat ablation. PV reconnections were more frequent in the RF group than in the CB group (left superior PV: 46.2% and 14.5%, P < .001; left inferior PV: 35.0% and 11.2%,
P = .001; right superior PV: 40.0% and 22.6%,
P = .031; right inferior PV: 36.2% and 19.4%,
P = .039; PVs: 39.8% and 16.9%,
P < .001). LA AF foci were more frequent in the CB group than in the RF group (27.4% and 7.5%;
P = .002). Other non‐PV foci were prevalent in both groups.
Conclusion
Fewer LA‐PV reconnections occurred with CB ablation. However, extensive PV isolation may eliminate many LA AF foci.
Full text
Available for:
BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Purpose
Progress of balloon devices for pulmonary vein (PV) isolation in atrial fibrillation (AF) has been remarkable. However, these techniques were specialized in pulmonary vein treatment; ...predicting non-PV foci in advance is important to decide the treatment strategy. In this study, we investigate the predictors for paroxysmal AF.
Methods
Subjects were consecutive paroxysmal AF patients who underwent high-dose isoproterenol provocation after PV isolation in the first session. The PV group (
n
= 102) and non-PV group (
n
= 222) were defined as the patients with and without non-PV ablation, respectively. Non-PV ablation was performed when frequent repetitive premature atrial contractions or triggered AF occurred spontaneously or by isoproterenol provocation. Predictors of non-PV origin in paroxysmal AF patients were examined using clinical characteristics and preoperative echocardiography.
Results
In the multivariate logistic regression analysis, female sex, body mass index (BMI < 23.8), absence of hypertension, and higher ratio of mitral early diastolic peak (E-wave) to early diastolic mitral annulus peak (e’) velocity (E/e’ > 8.44) were significant independent predictors of non-PV foci (hazard ratio 2.04, 1.88, 3.63, and 2.33; 95% confidence interval 1.17–3.55, 1.05–3.39, 1.72–7.67, and 1.34–4.05;
p
= 0.011, 0.035, < 0.001, and 0.003, respectively). If a patient had these four factors, non-PV was detected with 96.8% specificity.
Conclusion
Female sex, lower BMI, absence of hypertension, and higher E/e’ were significant indicators of non-PV foci in patients with paroxysmal AF. Reviewing these factors in advance may be useful for selecting a device to perform pulmonary vein isolation.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background
The incidence, predictors, and clinical impact of lead break during transvenous lead extraction (TLE) were previously unknown.
Methods
We included consecutive patients who underwent TLE ...between September 2013 and July 2019 at our institute. Lead break during removal was defined as lead stretching and becoming misshapen, as assessed by fluoroscopy.
Results
A total of 246 patients underwent TLE for 501 leads. At a patient level, complete success was achieved in 226 patients (91.9%). At a lead level, 481 leads (96.0%) were completely removed and 101 leads (20.1%) were broken during the procedure. Of 392 identified pacemaker leads, 71 (18.3%) were broken during the TLE procedure. A multivariable analysis confirmed high lead age (odds ratio OR 1.12, 95% confidence interval (CI) 1.07‐1.17; P < .001), passive leads (OR 2.29 95% CI 1.09‐4.80; P = .028), coradial leads (OR 3.45 95% CI 1.72‐6.92; P < .001), and insulators made of nonpolyurethane (OR 2.38 95% CI 1.03‐5.26; P = .04) as predictors of lead break. Broken leads needed longer procedure times and were associated with a higher rate of cardiac tamponade.
Conclusions
Lead age, coradial bipolar leads, passive leads, and leads without polyurethane insulation were predictors of lead break and could increase the difficulty of lead extraction.
The extraction of cardiac implantable electronic device leads due to infections, malfunctions, and recalls is common, and can lead to complications such as lead break resulting in incomplete lead removal and cardiac tamponade. We found that older lead age, co‐radial leads, passive leads, and non‐polyurethane leads were independent predictors of lead break during extraction. These findings will guide clinicians to make appropriate choices of procedure and take greater care when these risk factors are present.
Full text
Available for:
FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Purpose
The size of the distal electrode and the method of measuring local impedance (LI) are different between the IntellaNav MiFi-OI™ (MiFi-OI) and IntellaNav STABLE POINT™ (SP) catheters. We ...investigated the impact of these differences on LI, efficacy, and safety of radiofrequency (RF) applications.
Methods
RF applications at a range of powers (30 W, 40 W, and 50 W), contact forces (10 g and 20 g), and durations (10–120 s) were performed in excised porcine hearts (
N
= 48). LI variation was defined by δLI-drop (= initial LI − post-RF LI) and %LI-drop (= δLI-drop/initial LI) × 100, and the relationship between lesion characteristics and LI variation was compared.
Results
A total of 576 lesions were examined. Although absolute δLI-drop during RF applications was significantly larger for the SP than MiFi-OI catheter (4731–65ohm for SP vs 3724–51ohm for MiFi-OI,
p
< 0.0001), %LI-drop was similar (23.3 15.5–30.6% in SP vs 24.917.3–32.5% in MiFi-OI,
p
= 0.10). Although lesions produced by both catheters were similarly correlated with LI variation, the SP catheter produced generally larger lesions (depth; 5.0 3.7–6.1mm vs 4.7 3.3–6.0mm,
p
= 0.06; surface areas, 46.9 36.8–58.8mm
2
vs 44.7 34.3–55.5mm
2
,
p
= 0.02; volume, 321 165–533mm
3
vs 265141–471mm
3
,
p
= 0.02). Steam pops were similarly observed with both catheters. In both catheters, %LI-drop was superior to δLI-drop in correlation to lesion size (
p
< 0.0001) and in predicting steam pops (
p
< 0.01).
Conclusions
Although no difference in safety profile is observed between MiFi-OI and SP catheters, the SP catheter produces larger lesions. %LI-drop is superior to δLI-drop in correlation to lesion size and in predicting steam pops as well as in normalizing the difference between catheters.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
PDF
