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Europace : European Pacing,... Aug 2023This review article reflects how publications in EP Europace have contributed to advancing the science of management of arrhythmic disease in children and adult patients... (Review)
Review
This review article reflects how publications in EP Europace have contributed to advancing the science of management of arrhythmic disease in children and adult patients with congenital heart disease within the last 25 years. A special focus is directed to congenital atrioventricular (AV) block, the use of pacemakers, cardiac resynchronization therapy devices, and implantable cardioverter defibrillators in the young with and without congenital heart disease, Wolff-Parkinson-White syndrome, mapping and ablation technology, and understanding of cardiac genomics to untangle arrhythmic sudden death in the young.
Topics: Adult; Humans; Child; Heart Defects, Congenital; Heart; Wolff-Parkinson-White Syndrome; Cardiac Resynchronization Therapy Devices; Death, Sudden
PubMed: 37622573
DOI: 10.1093/europace/euad155 -
Journal of Arrhythmia Aug 2023Evidence on the impact of obesity on catheter ablation for ventricular tachycardia (VT) is scarce.
BACKGROUND
Evidence on the impact of obesity on catheter ablation for ventricular tachycardia (VT) is scarce.
METHOD AND RESULTS
We queried the Nationwide Readmissions Database to determine the hospital outcomes and procedural complications of VT ablation among the obese and nonobese populations. Obesity was associated with a more prolonged length of stay ( < .01), higher cost of hospitalization ( < .01), and higher rates of pericardial effusion or hemopericardium ( = .05) and vascular complications ( = .05). There was no significant difference in early mortality, 30-day readmissions, and other procedural complications.
CONCLUSION
VT ablation could be performed relatively safely among patients with obesity.
PubMed: 37560290
DOI: 10.1002/joa3.12892 -
BMC Cardiovascular Disorders Feb 2024This umbrella review synthesizes data from 17 meta-analyses investigating the comparative outcomes of catheter ablation (CA) and medical treatment (MT) for atrial... (Review)
Review
This umbrella review synthesizes data from 17 meta-analyses investigating the comparative outcomes of catheter ablation (CA) and medical treatment (MT) for atrial fibrillation (AF). Outcomes assessed were mortality, risk of hospitalization, AF recurrence, cardiovascular events, pulmonary vein stenosis, major bleeding, and changes in left ventricular ejection fraction (LVEF) and MLHFQ score. The findings indicate that CA significantly reduces overall mortality and cardiovascular hospitalization with high strength of evidence. The risk of AF recurrence was notably lower with CA, with moderate strength of evidence. Two associations reported an increased risk of pulmonary vein stenosis and major bleeding with CA, supported by high strength of evidence. Improved LVEF and a positive change in MLHFQ were also associated with CA. Among patients with AF and heart failure, CA appears superior to MT for reducing mortality, improving LVEF, and reducing cardiovascular rehospitalizations. In nonspecific populations, CA reduced mortality and improved LVEF but had higher complication rates. Our findings suggest that CA might offer significant benefits in managing AF, particularly in patients with heart failure. However, the risk of complications, including pulmonary vein stenosis and major bleeding, is notable. Further research in understudied populations may help refine these conclusions.
Topics: Humans; Atrial Fibrillation; Catheter Ablation; Heart Failure; Hemorrhage; Randomized Controlled Trials as Topic; Stenosis, Pulmonary Vein; Stroke Volume; Treatment Outcome; Ventricular Function, Left; Meta-Analysis as Topic
PubMed: 38424483
DOI: 10.1186/s12872-023-03670-5 -
Journal of Interventional Cardiac... Oct 2023Ventricular tachycardia (VT) is associated with significantly increased morbidity and mortality. Catheter ablation (CA) in line with an implantable...
BACKGROUND
Ventricular tachycardia (VT) is associated with significantly increased morbidity and mortality. Catheter ablation (CA) in line with an implantable cardioverter-defibrillator (ICD) is highly effective in VT management; however, it is unknown if CA should be considered as first-line therapy. The aim of this study is to verify the efficacy and safety of CA as first-line therapy for the first VT presentation (as adjunctive to ICD insertion), compared to initial ICD insertion and anti-arrhythmic drug (AAD) therapy.
METHODS
Data from patients with the first presentation for VT from January 2017 to January 2021 was reviewed. Patients were classified as "ablation first" vs "ICD first" groups and compared the clinical outcomes between groups.
RESULTS
One hundred and eighty-four consecutive patients presented with VT; 34 underwent CA as first-line therapy prior to ICD insertion, and 150 had ICD insertion/AAD therapy as first-line. During the median follow-up of 625 days, patients who underwent CA as first-line therapy had significantly higher ventricular arrhythmia (VA)-free survival (91% vs 59%, log-rank P = 0.002) and composite of VA recurrence, cardiovascular hospitalization, transplant, and death (84% vs 54%, log-rank P = 0.01) compared to those who did not undergo CA. Multivariate analysis revealed that first-line CA was the only protective predictor of VA recurrence (hazard ratio (HR) 0.20, P = 0.003). There were 3 (9%) peri-procedural complications with no peri-procedural deaths.
CONCLUSION
Real-world data supports the efficacy and safety of CA as first-line therapy at the time of the first VT hospitalization, compared to the initial ICD implant and AAD therapy.
Topics: Humans; Treatment Outcome; Tachycardia, Ventricular; Defibrillators, Implantable; Electric Countershock; Catheter Ablation
PubMed: 36754908
DOI: 10.1007/s10840-023-01483-2 -
Journal of Arrhythmia Apr 2024
PubMed: 38586841
DOI: 10.1002/joa3.12991 -
Clinical Research in Cardiology :... Dec 2023Patients with Brugada syndrome (BrS) may experience recurrent ventricular arrhythmias (VAs). Catheter ablation is becoming an emerging paradigm for treatment of BrS.
BACKGROUND
Patients with Brugada syndrome (BrS) may experience recurrent ventricular arrhythmias (VAs). Catheter ablation is becoming an emerging paradigm for treatment of BrS.
OBJECTIVE
To assess the efficacy and safety of catheter ablation in BrS in an updated systematic review.
METHODS
We comprehensively searched the databases of Pubmed/Medline, EMBASE, and Cochrane Central Register of Controlled Trials from inception to 11th of August 2021.
RESULTS
Fifty-six studies involving 388 patients were included. A substrate-based strategy was used in 338 cases (87%), and a strategy of targeting premature ventricular complex (PVCs)/ventricular tachycardias (VTs) that triggered ventricular fibrillation (VF) in 47 cases (12%), with combined abnormal electrogram and PVC/VT ablation in 3 cases (1%). Sodium channel blocker was frequently used to augment the arrhythmogenic substrate in 309/388 cases (80%), which included a variety of agents, of which ajmaline was most commonly used. After ablation procedure, the pooled incidence of non-inducibility of VA was 87.1% (95% confidence interval [CI], 73.4-94.3; I = 51%), and acute resolution of type I ECG was seen in 74.5% (95% CI [52.3-88.6]; I = 75%). Over a weighted mean follow up of 28 months, 7.6% (95% CI [2.1-24]; I = 67%) had recurrence of type I ECG either spontaneously or with drug challenge and 17.6% (95% CI [10.2-28.6]; I = 60%) had recurrence of VA.
CONCLUSION
Catheter ablation appears to be an efficacious strategy for elimination of arrhythmias or substrate associated with BrS. Further study is needed to identify which patients stand to benefit, and optimal provocation protocol for identifying ablation targets.
Topics: Humans; Brugada Syndrome; Ventricular Fibrillation; Ventricular Premature Complexes; Catheter Ablation; Tachycardia, Ventricular; Treatment Outcome; Electrocardiography
PubMed: 35451610
DOI: 10.1007/s00392-022-02020-3 -
The American Journal of Cardiology Aug 2023Endocardial-epicardial (Endo-epi) catheter ablation (CA) has been shown to reduce the rate of ventricular arrhythmia (VA) ablation in patients with structural heart... (Meta-Analysis)
Meta-Analysis Review
Endocardial-Epicardial Catheter Ablation Versus Endocardial Catheter Ablation Alone for Ventricular Arrhythmia in Patients With Structural Heart Disease (Meta-Analysis of Reconstructed Time-to-Event Data).
Endocardial-epicardial (Endo-epi) catheter ablation (CA) has been shown to reduce the rate of ventricular arrhythmia (VA) ablation in patients with structural heart disease (SHD). However, the effectiveness of this technique compared with endocardial (Endo) CA alone remains uncertain. This meta-analysis aims to compare the effectiveness of Endo-epi versus Endo alone in reducing the risk of VA recurrence in patients with SHD. We searched PubMed, Embase, and Cochrane Central Register with a comprehensive strategy. We used reconstructed time-to-event data to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for VA recurrence accompanied by at least one Kaplan-Meier curve for ventricular tachycardia recurrence. Our meta-analysis included 11 studies with a total of 977 patients. Endo-epi had a significantly lower risk of VA recurrence compared with those treated with Endo alone (HR 0.43, 95% CI 0.32 to 0.57, p <0.001). Subgroup analysis based on the type of cardiomyopathy revealed that patients with arrhythmogenic right ventricular cardiomyopathy and ischemic cardiomyopathy (ICM) benefited significantly from Endo-epi in reducing the risk of VA recurrence (HR 0.835, 0.55 to 0.87, p <0.021). However, there was no significant difference with non-ICM (HR 0.440, 0.55 to 0.87, p <0.33). The analysis of conditional survival showed that patients who remained free of VA recurrence for 5 years after the procedure had a very low probability of developing VA recurrence thereafter. In conclusion, Endo-epi CA is more effective than Endo CA alone in reducing the risk of VA recurrence in patients with SHD, especially those with arrhythmogenic right ventricular cardiomyopathy and ICM.
Topics: Humans; Arrhythmogenic Right Ventricular Dysplasia; Treatment Outcome; Heart Diseases; Tachycardia, Ventricular; Cardiomyopathies; Catheter Ablation; Recurrence
PubMed: 37385173
DOI: 10.1016/j.amjcard.2023.05.068 -
Cell & Bioscience Jul 2023Genetics evidences have long linked mosaic loss of Y-chromosome (mLOY) in peripheral leukocytes with a wide range of male age-associated diseases. However, a lack of...
BACKGROUND
Genetics evidences have long linked mosaic loss of Y-chromosome (mLOY) in peripheral leukocytes with a wide range of male age-associated diseases. However, a lack of cellular and molecular mechanistic explanations for this link has limited further investigation into the relationship between mLOY and male age-related disease. Excitingly, Sano et al. have provided the first piece of evidence directly linking mLOY to cardiac fibrosis through mLOY enriched profibrotic transforming growth factor β1 (TGF-β1) regulons in hematopoietic macrophages along with suppressed interleukin-1β (IL-1β) proinflammatory regulons. The results of this novel finding can be extrapolated to other disease related to mLOY, such as cancer, cardiac disease, and age-related macular degeneration.
RESULTS
Sano et al. used a CRISPR-Cas9 gRNAs gene editing induced Y-chromosome ablation mouse model to assess results of a UK biobank prospective analysis implicating the Y-chromosome in male age-related disease. Using this in vivo model, Sano et al. showed that hematopoietic mLOY accelerated cardiac fibrosis and heart failure in male mice through profibrotic pathways. This process was linked to monocyte-macrophage differentiation during hematopoietic development. Mice confirmed to have mLOY in leukocytes, by loss of Y-chromosome genes Kdm5d, Uty, Eif2s3y, and Ddx3y, at similar percentages to the human population were shown to have accelerated rates of interstitial and perivascular fibrosis and abnormal echocardiograms. These mice also recovered poorly from the transverse aortic constriction (TAC) model of heart failure and developed left ventricular dysfunction at higher rates. This was attributed to aberrant proliferation of cardiac MEF-SK4 + fibroblasts promoted by mLOY macrophages enriched in profibrotic regulons and lacking in proinflammatory regulons. These pro-fibrotic macrophages localized to heart and eventually resulted in cardiac fibrosis via enhanced TGF-β1 and suppressed IL-1β signaling. Furthermore, treatment of mLOY mice with TGFβ1 neutralizing antibody was able to improve their cardiac function. This study by Sano et al. was able to provide a causative link between the known association between mLOY and male cardiac disease morbidity and mortality for the first time, and thereby provide a new target for improving human health.
CONCLUSIONS
Using a CRISPR-Cas9 induced Y-chromosome ablation mouse model, Sano et al. has proven mosaic loss of Y-chromosome in peripheral myeloid cells to have a causative effect on male mobility and mortality due to male age-related cardiac disease. They traced the mechanism of this effect to hyper-expression of the profibrotic TGF-β1 and reduced pro-inflammatory IL-1β signaling, attenuation of which could provide another potential strategy in improving outcomes against age-related diseases in men.
PubMed: 37488646
DOI: 10.1186/s13578-023-01075-7 -
Europace : European Pacing,... Jun 2024We aimed to assess the acute and midterm efficacy of premature ventricular contraction (PVC) ablation guided by multielectrode and point-by-point (PbP) mapping.
AIMS
We aimed to assess the acute and midterm efficacy of premature ventricular contraction (PVC) ablation guided by multielectrode and point-by-point (PbP) mapping.
METHODS AND RESULTS
This is a retrospective, international multicentre study of consecutive patients referred for PVC ablation in 10 hospital centres from January 2017 to December 2021. Based on the mapping approach, two cohorts were identified: the 'Multipolar group', where a dedicated high-density mapping catheter was employed, and the 'PbP group', where mapping was performed with the ablation catheter. Procedural endpoints, safety, and acute (procedural) and midterm efficacies were assessed. Of the 698 patients included in this study, 592 received activation mapping [46% males, median age of 55 (41-65) years]-248 patients in the Multipolar group and 344 patients in the PbP group. A higher number of activation points [432 (217-843) vs. 95 (42-185), P < 0.001], reduced mapping time (40 ± 38 vs. 61 ± 50 min, P < 0.001), and shorter procedure time (124 ± 60 vs. 143 ± 63 min, P < 0.001) were reported in the Multipolar group. Both groups had high acute success rates (84.7% with Multipolar mapping vs. 81.3% with PbP mapping, P = 0.63), as well as midterm efficacy (83.4% vs. 77.4%, P = 0.08), with no significant differences in the risk of adverse events (6.0% vs. 3.5%, P = 0.24). However, for left-sided PVC ablation specifically, there was a higher midterm efficacy in the Multipolar group (80.7% vs. 69.5%, P = 0.04), with multipolar mapping being an independent predictor of success [adjusted OR = 2.231 (95% CI, 1.476-5.108), P = 0.02].
CONCLUSION
The acute and midterm efficacies of PVC ablation are high with both multipolar and PbP mapping, although the former allows for quicker procedures and may potentially improve the outcomes of left-sided PVC ablation.
Topics: Humans; Ventricular Premature Complexes; Male; Middle Aged; Female; Catheter Ablation; Retrospective Studies; Aged; Adult; Treatment Outcome; Electrophysiologic Techniques, Cardiac
PubMed: 38818846
DOI: 10.1093/europace/euae148 -
Europace : European Pacing,... Aug 2023Brugada Syndrome (BrS) is a cardiogenetic disease known for its association with sudden cardiac death (SCD) in individuals with structurally normal hearts. The...
BACKGROUND
Brugada Syndrome (BrS) is a cardiogenetic disease known for its association with sudden cardiac death (SCD) in individuals with structurally normal hearts. The prevalence of BrS is higher in males, who also face a greater risk of SCD. Its higher prevalence and worse outcome in male subjects may be due to testosterone effects on ion channels expression and function. The influence of testosterone on cardiac action potentials, both genomically and non-genomically, underscores its potential role in unmasking the syndrome and triggering life-threatening arrhythmias. Notably, testosterone replacement therapy (TRT), used for hypogonadism and gender reassignment, has been linked to BrS unmasking. The role of epicardial ablation in symptomatic BrS patients where hormonal therapy cannot be discontinued is unknown.
METHODS AND RESULTS
In this study we describe the first two cases of substrate mapping and ablation in BrS patients experiencing arrhythmic events while on TRT. In both cases, high-density epicardial mapping revealed abnormal areas of prolonged and fragmented electrograms in the right ventricular (RV) outflow tract and anterior wall. These abnormalities were completely abolished by radiofrequency ablation (RFA). After ablation, both patients showed a persistent normalization of the ECG and were free from ventricular arrhythmias at follow-up, despite ongoing TRT.
CONCLUSION
RFA can be considered as a therapeutic option in symptomatic BrS patients with a high-risk profile who cannot discontinue TRT, being essential for restoring their normal physiology or preserving their sexual identity. As testosterone use is increasing, further studies are warranted to define a standardized diagnostic and therapeutic strategy in this specific subset of BrS patients.
Topics: Humans; Male; Testosterone; Brugada Syndrome; Arrhythmias, Cardiac; Death, Sudden, Cardiac; Heart
PubMed: 37655650
DOI: 10.1093/europace/euad254