-
PloS One 2018Growing evidence suggests that second-generation cryoballoon ablation (2G-CB) is effective in patients with persistent atrial fibrillation (PerAF). The cornerstone of... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Growing evidence suggests that second-generation cryoballoon ablation (2G-CB) is effective in patients with persistent atrial fibrillation (PerAF). The cornerstone of atrial fibrillation (AF) ablation is pulmonary vein isolation (PVI). The purpose of this study was to summarize the available data on the safety and mid-term (≥ 12 months) effectiveness of a 'PVI-only' strategy vs. a 'PVI-plus' strategy using 2G-CB in patients with PerAF.
METHODS
We searched the PubMed, EMBASE and Cochrane library databases for studies on 2G-CB for PerAF. Group analysis was based on the ablation approach: 'PVI-only' versus 'PVI-plus', the latter of which involved PVI plus other substrate modifications. Studies showing clinical success rates at a follow-up (FU) of ≥ 12 months were included. Complication rates were also assessed. Data were analyzed by applying a fixed effects model.
RESULTS
A total of 879 patients from 5 studies were analyzed. After a mid-term FU of 27 months, the overall success rate of 2G-CB for PerAF was 66.1%. In the 'PVI-plus' group, the success rate was 73.8%. In the 'PVI-only' group, the success rate was 53.6%. No heterogeneity was noted among studies (I2 = 0.0%, P = 0.82). Complications occurred in 5.2% of patients (P = 0.93), and the rate of phrenic nerve (PN) injury was 2.8% (P = 0.14). Vascular assess complications were the most frequent at 1.6% (P = 0.33). No death or myocardial infarction was reported.
CONCLUSION
'PVI-plus' involving 2G-CB seems to be safe and effective for treating PerAF.
Topics: Aged; Atrial Fibrillation; Cardiac Surgical Procedures; Catheter Ablation; Cryosurgery; Female; Humans; Male; Middle Aged; Postoperative Complications; Pulmonary Veins; Recurrence; Risk Factors; Treatment Outcome
PubMed: 30359452
DOI: 10.1371/journal.pone.0206362 -
Frontiers in Cardiovascular Medicine 2022Persistent left superior vena cava (PLSVC) is the most common form of thoracic venous abnormality. Catheter ablation (CA) for atrial fibrillation (AF) can be complicated...
INTRODUCTION
Persistent left superior vena cava (PLSVC) is the most common form of thoracic venous abnormality. Catheter ablation (CA) for atrial fibrillation (AF) can be complicated by the existence of PLSVC, which could act as an important arrhythmogenic mechanism in AF.
METHODS AND RESULTS
We reported a case series of patients with PLSVC who underwent CA for AF at our center between 2018 and 2021. A systematic search was also performed on PubMed, EMBASE, and Web of Science for research reporting CA for AF in patients with PLSVC. Sixteen patients with PLSVC were identified at our center. Ablation targeting PLSVC was performed in 5 patients in the index procedures and in four patients receiving redo procedures. One patient experienced acute procedure failure. After a median follow-up period of 15 months, only 6 (37.5%) patients remained free from AF/atrial tachycardia (AT) after a single procedure. In the systematic review, 11 studies with 167 patients were identified. Based on the included studies, the estimated prevalence of PLSVC in patients undergoing CA for AF was 0.7%. Ablation targeting PLSVC was performed in 121 (74.7%) patients. Major complications in patients with PLSVC receiving AF ablation procedure included four cases of cardiac tamponades (2%), three cases of cardiac effusion (1.5%), one case of ischemic stroke, and three cases of phrenic nerve injury (1.5%) (one left phrenic nerve and two right phrenic nerve). Pooled analysis revealed that after a median follow-up period of 15.6 months (IQR 12.0-74.0 months), the long-term AF/AT-free rate was 70.6% (95% CI 62.8-78.4%, = 0.0%) (Central illustration). Different ablation strategies for PLSVC were summarized and discussed in the systematic review.
CONCLUSION
In patients with PLSVC, recurrence of atrial arrhythmia after CA for AF is relatively common. Ablation aiming for PLSVC isolation is necessitated in most patients. The overall risk of procedural complications was within an acceptable range.
PubMed: 36337869
DOI: 10.3389/fcvm.2022.1015540 -
Cureus Nov 2023Diaphragmatic paralysis (DP), whether unilateral or bilateral, often leads to extended recovery and more severe complications, particularly in neonates and infants... (Review)
Review
Diaphragmatic paralysis (DP), whether unilateral or bilateral, often leads to extended recovery and more severe complications, particularly in neonates and infants undergoing congenital heart surgery. This condition's impact is most pronounced after single-ventricle palliative procedures. Tracheostomy prevalence is rising in pediatric patients with congenital heart disease (CHD) despite its association with high resource utilization and in-hospital mortality. This study examines the reported incidence of diaphragmatic paralysis and timing of tracheostomy in pediatric patients undergoing surgery for congenital heart disease in the literature and a retrospective analysis of cases in our institution between 2018 and 2023, offering insights for prospective management. An electronic search of PubMed databases retrieved 10 studies on pediatric tracheostomy and 11 studies on DP. Our retrospective analysis included 15 patients, of whom 10 underwent tracheostomy, four underwent diaphragmatic plication, and one underwent both. Postoperative tracheostomy had an 11.8% mortality rate in our systematic review, rising to 40% in our observational study. Diaphragm repair and early diagnosis can reduce morbidity, prevent complications, and improve patients' quality of life.
PubMed: 37954631
DOI: 10.7759/cureus.48648 -
Journal of Cardiovascular... Sep 2021In May 2020, a novel cryoballoon system (POLARx; Boston Scientific) became available for catheter ablation of atrial fibrillation (AF). The design of the cryoballoon is... (Meta-Analysis)
Meta-Analysis
Comparison of procedural efficacy, balloon nadir temperature, and incidence of phrenic nerve palsy between two cryoballoon technologies for pulmonary vein isolation: A systematic review and meta-analysis.
INTRODUCTION
In May 2020, a novel cryoballoon system (POLARx; Boston Scientific) became available for catheter ablation of atrial fibrillation (AF). The design of the cryoballoon is comparable to the Arctic Front Advance Pro (AFA-Pro; Medtronic), but it is more compliant during freezing. We compared the procedural efficacy, biophysical parameters, and risk of phrenic nerve palsy (PNP) between the two cryoballoons.
METHODS
Embase, MEDLINE, Web of Science, Cochrane, and Google Scholar databases were searched until June 1, 2021 for relevant studies comparing POLARx versus AFA-Pro in patients undergoing pulmonary vein isolation (PVI) for AF.
RESULTS
A total of four studies, involving 310 patients were included. There was no difference between the two groups for outcomes regarding procedural efficacy: acute PVI (odds ratio [OR]: 0.43; 95% confidence interval [CI]: 0.06 to 3.03; p = .40), procedure time (mean difference [MD]: 8.15 min; 95% CI: -8.09 to 24.39; p = .33), fluoroscopy time (MD: 1.32 min; 95% CI: -1.61 to 4.25; p = .38) and ablation time (MD: 1.00 min; 95% CI: -0.20 to 2.20; p = .10). The balloon nadir temperature was lower for all individual pulmonary veins (PV) in POLARx compared with AFA-Pro (MD: -9.74°C, -9.98°C, -6.72°C, -7.76°C, for left superior PV, left inferior PV, right superior PV, and right inferior PV, respectively; all p < .001). The incidence of PNP was similar between groups (OR: 0.79; 95% CI: 0.22 to 2.85; p = .72).
CONCLUSION
In AF patients undergoing PVI, POLARx and AFA-Pro had a similar procedural efficacy. Balloon nadir temperatures were lower with POLARx, however, the incidence of PNP was similar.
Topics: Atrial Fibrillation; Catheter Ablation; Cryosurgery; Humans; Incidence; Paralysis; Phrenic Nerve; Pulmonary Veins; Temperature; Treatment Outcome
PubMed: 34289198
DOI: 10.1111/jce.15182 -
Kardiologia Polska Jan 2020Clinical outcomes of catheter ablation for persistent atrial fibrillation (AF) remain discouraging. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Clinical outcomes of catheter ablation for persistent atrial fibrillation (AF) remain discouraging.
AIM
This meta‑analysis aimed to compare cryoballoon ablation (CBA) with radiofrequency ablation (RFA) for persistent AF.
METHODS
A systematic search of the PubMed, EMBASE, and Cochrane Library databases was performed for studies comparing the outcomes between CBA and RFA. Seven trials including 934 patients were analyzed.
RESULTS
There were no differences between groups in terms of freedom from atrial arrhythmia (risk ratio [RR], 1.04; 95% CI, 0.93-1.15; P = 0.52; I2 = 0%), procedural complications (RR, 0.91; 95% CI, 0.52-1.59; P = 0.74; I2 = 0%), atrial fibrillation or atrial tachycardia relapse during the blanking period (RR, 0.73; 95% CI, 0.50-1.06; P = 0.1; I2 = 9%), repeat ablation (RR, 0.74; 95% CI, 0.45-1.21; P = 0.23; I2 = 62%), and vascular complications (RR, 0.98; 95% CI, 0.42-2.27; P = 0.97; I2 = 0%). Cryoballoon ablation increased the incidence of conversion to sinus rhythm during ablation (RR, 1.69; 95% CI, 1.01-2.83; P = 0.046; I2 = 0%) and phrenic nerve palsy (PNP; RR, 3.05; 95% CI, 0.95-9.8; P = 0.06; I2 = 0%), while RFA increased the risk of cardiac tamponade (RR, 0.27; 95% CI, 0.06-1.25; P = 0.09; I2 = 0%). Subanalyses revealed a lower incidence of recurrent atrial arrhythmia and repeat ablation during CBA without touch‑up RFA in pulmonary vein isolation.
CONCLUSIONS
CBA provides an alternative technique for persistent AF ablation. It might reduce the risk of repeat ablation and cardiac tamponade but increase the risk of PNP.
Topics: Atrial Fibrillation; Catheter Ablation; Cryosurgery; Humans; Pulmonary Veins; Recurrence; Treatment Outcome
PubMed: 31688837
DOI: 10.33963/KP.15048 -
Frontiers in Physiology 2023The pre-Bötzinger complex, situated in the ventrolateral medulla, serves as the central generator for the inspiratory phase of the respiratory rhythm. Evidence strongly...
The pre-Bötzinger complex, situated in the ventrolateral medulla, serves as the central generator for the inspiratory phase of the respiratory rhythm. Evidence strongly supports its pivotal role in generating, and, in conjunction with the post-inspiratory complex and the lateral parafacial nucleus, in shaping the respiratory rhythm. While there remains an ongoing debate concerning the mechanisms underlying these nuclei's ability to generate and modulate breathing, transgenic rodent models have significantly contributed to our understanding of these processes. However, there is a significant knowledge gap regarding the spectrum of transgenic rodent lines developed for studying respiratory rhythm, and the methodologies employed in these models. In this study, we conducted a scoping review to identify commonly used transgenic rodent lines and techniques for studying respiratory rhythm generation and modulation. Following PRISMA guidelines, we identified relevant papers in PubMed and EBSCO on 29 March 2023, and transgenic lines in Mouse Genome Informatics and the International Mouse Phenotyping Consortium. With strict inclusion and exclusion criteria, we identified 80 publications spanning 1997-2022 using 107 rodent lines. Our findings revealed 30 lines focusing on rhythm generation, 61 on modulation, and 16 on both. The primary method was whole-body plethysmography. The main method was hypoglossal/phrenic nerve recordings using the preparation. Additionally, we identified 119 transgenic lines with the potential for investigating the intricate mechanisms underlying respiratory rhythm. Through this review, we provide insights needed to design more effective experiments with transgenic animals to unravel the mechanisms governing respiratory rhythm. The identified transgenic rodent lines and methodological approaches compile current knowledge and guide future research towards filling knowledge gaps in respiratory rhythm generation and modulation.
PubMed: 38179140
DOI: 10.3389/fphys.2023.1295632 -
JACC. Clinical Electrophysiology Mar 2017The goal of this study was to describe short- and long-term outcomes in all patients referred for inappropriate sinus tachycardia ablation, along with the potential...
OBJECTIVES
The goal of this study was to describe short- and long-term outcomes in all patients referred for inappropriate sinus tachycardia ablation, along with the potential complications of the intervention.
BACKGROUND
Sinus node (SN) ablation/modification has been proposed for patients refractory to pharmacological therapy. However, available data derive from limited series.
METHODS
The electronic databases MEDLINE, Embase, CINAHL, Cochrane, and Scopus were systematically searched (January 1, 1995-December 31, 2015). Studies were screened according to predefined inclusion and exclusion criteria.
RESULTS
A total of 153 patients were included. Their mean age was 35.18 ± 10.02 years, and 139 (90.8%) were female. All patients had failed to respond to maximum tolerated doses of pharmacological therapy (3.5 ± 2.4 drugs). Mean baseline heart rates averaged 101.3 ± 16.4 beats/min according to electrocardiography and 104.5 ± 13.5 beats/min according to 24-h Holter monitoring. Two electrophysiological strategies were used, SN ablation and SN modification, with the latter being used more. Procedural acute success (using variably defined pre-determined endpoints) was 88.9%. Consistently, all groups reported high-output pacing from the ablation catheter to confirm absence of phrenic nerve stimulation before radiofrequency delivery. Need of pericardial access varied between 0% and 76.9%. Thirteen patients (8.5%) experienced severe procedural complications, and 15 patients (9.8%) required implantation of a pacemaker. At a mean follow-up interval of 28.1 ± 12.6 months, 86.4% of patients demonstrated successful outcomes. The symptomatic recurrence rate was 19.6%, and 29.8% of patients continued to receive antiarrhythmic drug therapy after procedural intervention.
CONCLUSIONS
Inappropriate sinus tachycardia ablation/modification achieves acute success in the vast majority of patients. Complications are fairly common and diverse. However, symptomatic relief decreases substantially over longer follow-up periods, with a corresponding high recurrence rate.
Topics: Adult; Anti-Arrhythmia Agents; Body Surface Potential Mapping; Catheter Ablation; Electrocardiography; Electrocardiography, Ambulatory; Electrophysiologic Techniques, Cardiac; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pacemaker, Artificial; Pericardium; Phrenic Nerve; Recurrence; Sinoatrial Node; Tachycardia, Sinus; Treatment Outcome
PubMed: 29759520
DOI: 10.1016/j.jacep.2016.09.014 -
Frontiers in Cardiovascular Medicine 2021Catheter ablation has become a well-established indication for long-term rhythm control in atrial fibrillation (AF) patients refractory to anti-arrhythmic drugs (AADs)....
Catheter Ablation vs. Anti-Arrhythmic Drugs as First-Line Treatment in Symptomatic Paroxysmal Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.
Catheter ablation has become a well-established indication for long-term rhythm control in atrial fibrillation (AF) patients refractory to anti-arrhythmic drugs (AADs). Efficacy and safety of AF catheter ablation (AFCA) before AADs failure are, instead, questioned. The aim of the study was to perform a systematic review and meta-analysis of randomized clinical trials (RCTs) comparing first-line AFCA with AADs in symptomatic patients with paroxysmal AF. We performed a random-effects meta-analysis of binary outcome events comparing AFCA with AADs in rhythm control-naïve patients. The primary outcomes, also stratified by the type of ablation energy (radiofrequency or cryoenergy), were (1) recurrence of atrial tachyarrhythmias and (2) recurrence of symptomatic atrial tachyarrhythmias. The secondary outcomes included adverse events. Six RCTs were included in the analysis. AFCA was associated with lower recurrences of atrial tachyarrhythmias [relative risk (RR) 0.58, 95% confidence interval (CI) 0.46-0.72], consistent across the two types of ablation energy (radiofrequency, RR 0.50, 95% CI 0.28-0.89; cryoenergy, RR 0.60, 95% CI 0.50-0.72; -value for subgroup differences: 0.55). Similarly, AFCA was related to less symptomatic arrhythmic recurrences (RR 0.46, 95% CI 0.27-0.79). Overall, adverse events did not differ. A trend toward increased periprocedural cardiac tamponade or phrenic nerve palsy was observed in the AFCA group, while more atrial flutter episodes with 1:1 atrioventricular conduction and syncopal events were reported in the AAD group. First-line rhythm control therapy with AFCA, independent from the adopted energy source (radiofrequency or cryoenergy), reduces long-term arrhythmic recurrences in patients with symptomatic paroxysmal AF compared with AADs.
PubMed: 34095254
DOI: 10.3389/fcvm.2021.664647