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Journal of Cardiovascular... Nov 2021Combined ablation and left atrial appendage closure (LAAC) is an alternative for atrial fibrillation patients with a high risk of stroke. However, the long-term outcomes... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Combined ablation and left atrial appendage closure (LAAC) is an alternative for atrial fibrillation patients with a high risk of stroke. However, the long-term outcomes of this combined procedure remain elusive.
METHODS
PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from the establishment of databases to 1 January 2021. Studies on the long-term (defined as a mean follow-up of approximately 12 months or longer) efficacy and safety outcomes of combined ablation and LAAC were included.
RESULTS
A total of 16 studies comprising 1428 patients were enrolled. The pooled long-term freedom rate from atrial arrhythmia was 0.66 (95% confidence interval [CI]: 0.59-0.71), long-term successful rate sealing of LAAC was 1.00 (95% CI: 1.00-1.00), and ischemic stroke/transient ischemic attack/systemic embolism during follow-up was 0.01 (95% CI: 0.00-0.02). Meanwhile, of the periprocedural adverse events, phrenic nerve palsy, intracoronary air embolus, device embolization, and periprocedural death had a rate of 0.00 (95% CI: 0.00-0.00), procedure-related bleeding events of 0.03 (95% CI: 0.02-0.04), and pericardial effusion requiring or not requiring intervention of 0.00 (95% CI: 0.00-0.01). Moreover, for the long-term adverse events, device dislocation, intracranial bleeding, pericardial effusion requiring or not requiring intervention, and all-cause mortality had a rate of 0.00 (95% CI: 0.00-0.00), device embolization of 0.01 (95% CI: 0.00-0.01), and other bleeding events of 0.01 (95% CI: 0.00-0.03).
CONCLUSION
This meta-analysis suggests that the combined atrial ablation and LAAC is an effective and safe strategy with long-term benefits.
Topics: Atrial Appendage; Atrial Fibrillation; Cardiac Surgical Procedures; Catheter Ablation; Humans; Stroke; Treatment Outcome
PubMed: 34453379
DOI: 10.1111/jce.15230 -
Clinical Neurophysiology : Official... Jan 2020To assess the prognostic value of phrenic nerve conduction (PNC) in amyotrophic lateral sclerosis (ALS). (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To assess the prognostic value of phrenic nerve conduction (PNC) in amyotrophic lateral sclerosis (ALS).
METHODS
We conducted a systematic review to identify studies reporting on PNC, and mortality and/or forced vital capacity (FVC) in patients with ALS. We searched Medline, EMBASE, and Web of Science. Two independent authors selected studies and extracted data. Risk of bias was assessed using the QUIPS tool. Hazard-ratios and correlation coefficients were pooled using a random effects generic inverse-variance model. Evidence quality was evaluated with GRADE.
RESULTS
In the pooled analysis, patients with CMAP-amplitude equal or below 0.4 mV are 2.021 more likely to die over the studied period (95%CI 1.161-3.522; I = 55.9%; 338 participants). CMAP-amplitude showed a moderate positive correlation with FVC (r = 0.400, 95%CI = 0.226-0.550; I = 69.77%; 381 participants). However, there was a weak negative correlation between CMAP-latency and FVC (r = -0.235; 95%CI = -0.447 to -0.024; I = 15.92%; 112 participants).
CONCLUSIONS
There is moderate-quality evidence that CMAP-amplitude of the PNC is correlated with FVC. Results favour a predictive value for mortality, but the risk of bias is high.
SIGNIFICANCE
PNC is a simple test that should be considered to assess respiratory function in ALS, especially in patients with bulbar involvement or cognitive impairment.
Topics: Amyotrophic Lateral Sclerosis; Female; Humans; Male; Middle Aged; Neural Conduction; Observational Studies as Topic; Phrenic Nerve; Prognosis; Publication Bias; Vital Capacity
PubMed: 31760209
DOI: 10.1016/j.clinph.2019.10.016 -
JTCVS Open Sep 2021Both catheter and surgical ablation strategies offer effective treatments of atrial fibrillation (AF). The hybrid (joint surgical and catheter) ablation for AF is an...
BACKGROUND
Both catheter and surgical ablation strategies offer effective treatments of atrial fibrillation (AF). The hybrid (joint surgical and catheter) ablation for AF is an emerging rhythm control strategy. We sought to determine the efficacy and safety of hybrid ablation of AF.
METHODS
Systematic review and meta-analysis interrogating PubMed, EMBASE, and Cochrane databases from January 1, 1991, to November 30, 2017, using the following search terms: "Cox-maze," "mini-maze," "ablation methods (including radiofrequency, cryoablation, cryomaze)," and "surgery." Included studies required ablation procedures to be hybrid and report rhythm follow-up.
RESULTS
We included 925 patients with AF (38% persistent, 51% longstanding persistent) from 22 single-center studies (mean follow-up of 19 months). The surgical lesion set consisted of pulmonary vein isolation (n = 11) or box lesion (n = 11) with variable additional linear ablation. This was followed by sequential (n = 9), staged (n = 9), or combination (n = 4) catheter-based ablation to ensure isolation of pulmonary veins and to facilitate additional ablation or consolidation of surgically ablated lines. Overall, sinus rhythm maintenance was 79.4% (95% confidence interval [CI], 72.4-85.7] and 70.7% (95% CI, 62.2-78.7) with and without antiarrhythmic drugs, respectively at 19 ± 25 (range, 6-128) months. The use of the bipolar AtriCure Synergy system and left atrial appendage exclusion conferred superior rhythm outcome without antiarrhythmic drugs ( ≤ .01). The overall complication rate was 6.5% (95% CI, 3.4-10.2): mortality 0.2% (95% CI, 0-0.9); stroke 0.3% (95% CI, 0-1.1); reoperation for bleeding 1.6% (95% CI, 0.6-3.0); permanent pacing ~0% (95% CI, 0-0.5); conversion to sternotomy 0.3% (95% CI, 0-1.1); atrioesophageal fistula ~0% (95% CI, 0-0.5); and phrenic nerve injury 0.3% (95% CI, 0-1.1).
CONCLUSIONS
Hybrid ablation therapy for AF demonstrates favorable rhythm outcome with acceptable complication rates.
PubMed: 36003726
DOI: 10.1016/j.xjon.2021.07.005 -
Journal of Interventional Cardiac... Jun 2021Phrenic and hypoglossal nerve pacing therapies have shown benefit in sleep apnea. We sought to analyze the role of pacing therapies in sleep apnea and their impact on... (Meta-Analysis)
Meta-Analysis
PURPOSE
Phrenic and hypoglossal nerve pacing therapies have shown benefit in sleep apnea. We sought to analyze the role of pacing therapies in sleep apnea and their impact on heart failure.
METHODS
A comprehensive literature search in PubMed and Google Scholar from inception to August 5, 2019, was performed. A meta-analysis was performed using fixed effects model to calculate mean difference (MD) with 95% confidence interval (CI).
RESULTS
Six studies were eligible and included 626 patients, of whom 334 were in the control arm and 393 were in the experimental arm. Phrenic nerve pacing (MD - 23.20 events/h, 95% CI - 27.96 to - 18.44, p < 0.00001) and hypoglossal nerve pacing (MD - 20.24 events/h, 95% CI - 23.22 to - 17.27, p < 0.00001) were associated with improvements in apnea-hypopnea index (AHI). Phrenic nerve pacing was associated with a trend towards improvements in left ventricular ejection fraction (MD 3.95%, 95% CI - 0.04 to 7.94, p = 0.05). Hypoglossal and phrenic nerve pacing were associated with improvements in the quality of life as assessed by improvements in Epworth sleepiness scale (MD 3.71 points, 95% CI 2.89 to 4.54, p < 0.00001).
CONCLUSIONS
Our analysis suggests that phrenic and hypoglossal nerve pacing improves AHI and quality of life with a trend towards improvement in left ventricular ejection fraction, especially in central sleep apnea. Complications were high but future refinement in technology will likely improve clinical outcomes and minimize complications.
Topics: Humans; Quality of Life; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Stroke Volume; Ventricular Function, Left
PubMed: 32445012
DOI: 10.1007/s10840-020-00760-8 -
Open Heart Jan 2022The limited availability of balloon sizes for cryoballoon leads to anatomical limitations for pulmonary vein (PV) isolation. We conducted a comprehensive systematic...
BACKGROUND
The limited availability of balloon sizes for cryoballoon leads to anatomical limitations for pulmonary vein (PV) isolation. We conducted a comprehensive systematic analysis on procedural success rate, atrial fibrillation (AF) recurrence rate and complications of cryoballoon ablation in association with the anatomy of the left atrium and PV based on preprocedural CT to gain insights into proper treatments of patients with AF using cryoballoon.
METHOD
A systematic search of literature databases, including PubMed, Web of Science and Cochrane Library, from the inception of each database through February 2021 was conducted. Search keywords included 'atrial fibrillation', 'cryoballoon ablation' and 'anatomy'.
RESULTS
Overall, 243 articles were identified. After screening, 16 articles comprising 1396 patients were included (3, 5 and 8 for acute success, AF recurrence and complications, respectively). Regarding acute success and AF recurrences, thinner width of the left lateral ridge, higher PV ovality, PV ostium-bifurcation distance, shorter distance from the non-coronary cusp to inferior PVs, shallower angle of right PVs against the atrial septum and larger right superior PV (RSPV) were associated with poor outcomes. Regarding complications, shorter distance between the RSPV ostium and the right phrenic nerve, larger RSPV-left atrium angle, larger RSPV area and smaller right carina width were associated with incidences of phrenic nerve injury.
CONCLUSION
This study elucidated several key anatomical features of PVs possibly affecting acute success, AF recurrence and complications in patients with AF using cryoballoon ablation. CT analysis has helped to describe benefits and anatomical limitations for cryoballoon ablation.
Topics: Cryosurgery; Heart Atria; Humans; Pulmonary Veins; Recurrence; Surgery, Computer-Assisted; Tomography, X-Ray Computed
PubMed: 34992156
DOI: 10.1136/openhrt-2021-001724 -
Neurosurgery Jan 2022Traumatic brachial plexus injuries (BPIs) often lead to devastating upper extremity deficits. Treatment frequently prioritizes restoring elbow flexion through transfer... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Traumatic brachial plexus injuries (BPIs) often lead to devastating upper extremity deficits. Treatment frequently prioritizes restoring elbow flexion through transfer of various donor nerves; however, no consensus identifies optimal donor nerve sources.
OBJECTIVE
To complete a meta-analysis to assess donor nerves for restoring elbow flexion after partial and total BPI (TBPI).
METHODS
Original English language articles on nerve transfers to restore elbow flexion after BPI were included. Using a random-effects model, we calculated pooled, weighted effect size of the patients achieving a composite motor score of ≥M3, with subgroup analyses for patients achieving M4 strength and with TBPI. Meta-regression was performed to assess comparative efficacy of each donor nerve for these outcomes.
RESULTS
Comparison of the overall effect size of the 61 included articles demonstrated that intercostal nerves and phrenic nerves were statistically superior to contralateral C7 (cC7; P = .025, <.001, respectively) in achieving ≥M3 strength. After stratification by TBPI, the phrenic nerve was still superior to cC7 in achieving ≥M3 strength (P = .009). There were no statistical differences among ulnar, double fascicle, or medial pectoral nerves in achieving ≥M3 strength. Regarding M4 strength, the phrenic nerve was superior to cC7 (P = .01) in patients with TBPI and the ulnar nerve was superior to the medial pectoral nerve (P = .036) for partial BPI.
CONCLUSION
Neurotization of partial BPI or TBPI through the intercostal nerve or phrenic nerve may result in functional advantage over cC7. In patients with upper trunk injuries, neurotization using ulnar, median, or double fascicle nerve transfers has similarly excellent functional recovery.
Topics: Brachial Plexus; Brachial Plexus Neuropathies; Elbow; Elbow Joint; Humans; Nerve Transfer; Range of Motion, Articular; Recovery of Function; Treatment Outcome; Ulnar Nerve
PubMed: 34982869
DOI: 10.1227/NEU.0000000000001737 -
Clinical Autonomic Research : Official... Jun 2023With contemporaneous advances in congenital central hypoventilation syndrome (CCHS), recognition, confirmatory diagnostics with PHOX2B genetic testing, and conservative... (Review)
Review
PURPOSE
With contemporaneous advances in congenital central hypoventilation syndrome (CCHS), recognition, confirmatory diagnostics with PHOX2B genetic testing, and conservative management to reduce the risk of early morbidity and mortality, the prevalence of identified adolescents and young adults with CCHS and later-onset (LO-) CCHS has increased. Accordingly, there is heightened awareness and need for transitional care of these patients from pediatric medicine into a multidisciplinary adult medical team. Hence, this review summarizes key clinical and management considerations for patients with CCHS and LO-CCHS and emphasizes topics of particular importance for this demographic.
METHODS
We performed a systematic review of literature on diagnostics, pathophysiology, and clinical management in CCHS and LO-CCHS, and supplemented the review with anecdotal but extensive experiences from large academic pediatric centers with expertise in CCHS.
RESULTS
We summarized our findings topically for an overview of the medical care in CCHS and LO-CCHS specifically applicable to adolescents and adults. Care topics include genetic and embryologic basis of the disease, clinical presentation, management, variability in autonomic nervous system dysfunction, and clarity regarding transitional care with unique considerations such as living independently, family planning, exposure to anesthesia, and alcohol and drug use.
CONCLUSIONS
While a lack of experience and evidence exists in the care of adults with CCHS and LO-CCHS, a review of the relevant literature and expert consensus provides guidance for transitional care areas.
Topics: Child; Humans; Adolescent; Young Adult; Homeodomain Proteins; Transitional Care; Mutation; Transcription Factors
PubMed: 36403185
DOI: 10.1007/s10286-022-00908-8 -
Child's Nervous System : ChNS :... Dec 2023Contralateral C7 (CC7) nerve transfer is a reconstructive option in the upper limb when there are limited donor options. Promising results have been reported in the... (Review)
Review
PURPOSE
Contralateral C7 (CC7) nerve transfer is a reconstructive option in the upper limb when there are limited donor options. Promising results have been reported in the adult population but its role in Brachial Plexus Birth Injury (BPBI) is unclear. A major concern with this technique is the potential impact on the contralateral, unaffected limb. Our aim was to review the available literature on the use of this transfer in BPBI, to determine the incidence of short- and long-term deficits at the donor site.
METHODS
The relevant literature was identified from searches of Embase, Ovid Emcare and Ovid MEDLINE, for combinations of terms relating to CC7 nerve transfer and BPBI.
RESULTS
Seventy-five patients were included in this review, from the eight papers that were eligible for inclusion, from a total of 16 papers identified. Patient age ranged from three to 93 months and the shortest follow-up period was six months. Post-operative motor deficits at the donor site included reduced range of shoulder abduction; triceps weakness; and phrenic nerve palsy. All motor deficits recovered within six months. The only sensory deficit reported was reduced sensation in the median nerve distribution which, in all cases, resolved within four weeks. Finally, synchronous donor limb motion and sensation were reported in 46.6% of patients.
CONCLUSION
CC7 nerve transfer in BPBI appears to have few long-term donor limb complications. Sensory and motor deficits are reportedly transient. The impact of synchronous motion and sensation on upper limb function in this patient cohort is not yet known.
Topics: Adult; Humans; Infant; Child, Preschool; Child; Nerve Transfer; Treatment Outcome; Brachial Plexus; Spinal Nerves; Brachial Plexus Neuropathies; Birth Injuries
PubMed: 37368067
DOI: 10.1007/s00381-023-06047-3 -
Journal of Interventional Cardiac... Mar 2022The purpose of this systematic review and meta-analysis was to evaluate the feasibility and safety of a same-day discharge protocol following pulmonary vein isolation... (Meta-Analysis)
Meta-Analysis
PURPOSE
The purpose of this systematic review and meta-analysis was to evaluate the feasibility and safety of a same-day discharge protocol following pulmonary vein isolation (PVI).
METHODS
PubMed and Embase were systematically investigated from the inception to 20 July 2020. Studies on safety and feasibility of PVI for atrial fibrillation (AF) were included. Study-specific estimates were combined using one-group meta-analysis with a random-effects model.
RESULTS
Seven observational studies investigating the safety and feasibility of same-day discharge protocols were identified. Of a total of 3656 patients who have undergone PVI for AF, the overall complication rate was 0.80% (95% confidence interval [CI], 0.20-1.40%). The readmission within 30-day following same-day discharge protocol occurred at a pooled rate of 3.6% (95% CI, 0.0-8.4%). Frequent complications following the procedure were complications related to vascular access (0.38%; 95% CI, 0.18-0.58%), and phrenic nerve injury (0.19%; 95% CI, 0.05-0.33%). The reported complications in SDD group were mainly based on results among patients without perioperative complications.
CONCLUSIONS
The introduction of same-day discharge strategies might be safe and feasible in selected patients given the reported complication and re-admission rates in the current practice. Further prospective studies are needed to confirm these findings.
Topics: Atrial Fibrillation; Catheter Ablation; Feasibility Studies; Humans; Patient Discharge; Pulmonary Veins; Treatment Outcome
PubMed: 33630213
DOI: 10.1007/s10840-021-00967-3 -
Europace : European Pacing,... Jan 2022To conduct a systematic review and meta-analysis to compare the effectiveness and safety of cryoballoon ablation of atrial fibrillation (AF) performed using a single... (Meta-Analysis)
Meta-Analysis
To conduct a systematic review and meta-analysis to compare the effectiveness and safety of cryoballoon ablation of atrial fibrillation (AF) performed using a single freeze strategy in comparison to an empiric double ('bonus') freeze strategy. We systematically searched MEDLINE, EMBASE, and CENTRAL databases from inception to 12 July 2020, for prospective and retrospective studies of patients undergoing cryoballoon for paroxysmal or persistent AF comparing a single vs. bonus freeze strategy. The main outcome was atrial arrhythmia-free survival and eligible studies required at least 12 months of follow-up; the primary safety outcome was a composite of all complications. Study quality was assessed using the Cochrane risk of bias tool and the Newcastle-Ottawa Scale. Thirteen studies (3 randomized controlled trials and 10 observational studies) comprising 3163 patients were eligible for inclusion (64% males, 71.5% paroxysmal AF, mean CHA2DS2-VASc score 1.3 ± 0.9). There was no significant difference in pooled effectiveness between single freeze strategy compared to double freeze strategy [relative risk (RR) 1.03; 95% confidence interval (CI): 0.98-1.07; I2 = 0%]. Single freeze procedures were associated with a significantly lower adverse event rate (RR 0.72; 95% CI: 0.53-0.98; I2 = 0%) and shorter average procedure time (90 ± 27 min vs. 121 ± 36 min, P < 0.001). A trend for lower risk of persistent phrenic nerve palsy was observed (RR 0.61; 95% CI: 0.37-1.01; I2 = 0%). The quality of included studies was moderate/good, with no evidence of significant publication bias. Single freeze strategy for cryoballoon of AF is as effective as an empiric double ('bonus') freeze strategy while appearing safer and probably quicker (PROSPERO registration number CRD42020158696).
Topics: Atrial Fibrillation; Catheter Ablation; Cryosurgery; Female; Humans; Male; Prospective Studies; Pulmonary Veins; Randomized Controlled Trials as Topic; Retrospective Studies; Treatment Outcome
PubMed: 34297839
DOI: 10.1093/europace/euab133