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Journal of Arrhythmia Jun 2024High-power ablation has been widely used in atrial fibrillation (AF). However, there were many studies observed the outcomes of the short-term follow-up. This study aims...
OBJECTIVE
High-power ablation has been widely used in atrial fibrillation (AF). However, there were many studies observed the outcomes of the short-term follow-up. This study aims to the long-term results of high-power ablation guided by ablation index (AI) in patients with AF.
METHODS
Analysis of patients with AF, who first received high-power (40-50 W) ablation, to pulmonary vein isolation (PVI) in the Second Hospital of Shanxi Medical University from May 2020 to March 2022. All patients were managed perioperatively according to the routine treatment procedures. High-power ablation was conducted under the guidance of our conventional power AI and baseline data, first-pass PVI rate, ablation time, operative time, and long-term surgical success rate were analyzed.
RESULTS
A total of 83 patients with atrial fibrillation were enrolled in the study, with an average age of 61.62 ± 9.04 years, 47 male patients, and 49 paroxysmal atrial fibrillation. All patients achieved PVI, and the rate of first pass was 82%. The ablation time of the left atrial was 28.54 ± 9.11 min. There were no serious complications related to ablation, and only a small amount of pericardial effusion was found in 4 patients. During the follow-up period of 26.36 ± 6.11 months, 8 patients were lost to follow-up and the overall success rate was 84%, including 91% for paroxysmal AF and 71% for persistent AF.
CONCLUSION
High-power ablation long-term results appear a high freedom atrial arrhythmia, but further expanded samples are needed for controlled studies.
PubMed: 38939788
DOI: 10.1002/joa3.13035 -
Journal of Arrhythmia Jun 2024Uncoupling of the endocardial bundles in the left atrium was suggested during modified posterior wall isolation. Although this fact may not be observed because of the...
Uncoupling of the endocardial bundles in the left atrium was suggested during modified posterior wall isolation. Although this fact may not be observed because of the possible bridging conduction by epicardial bundles in humans, partially failed transmural ablation in the atrial roof may have iatrogenically unveiled this fact.
PubMed: 38939781
DOI: 10.1002/joa3.13046 -
Journal of Arrhythmia Jun 2024Hyperuricemia (HU) has been reported to be associated with a high incidence of atrial fibrillation (AF). However, the relationship between HUA and recurrent AF after...
BACKGROUND
Hyperuricemia (HU) has been reported to be associated with a high incidence of atrial fibrillation (AF). However, the relationship between HUA and recurrent AF after catheter ablation (CA) is unclear.
METHODS
Four hundred consecutive AF patients (paroxysmal/persistent AF [PAF/PsAF]: 200/200) who underwent the initial CA were retrospectively enrolled. HU was defined as serum uric acid (SUA) level >7.0 mg/dL. We measured SUA levels 1 day before (pre-CA) and 1 month after CA (post-CA). A second-generation 28 mm cryoballoon was used for pulmonary vein isolation (PVI) for PAF, while PVI plus linear ablation (roof and mitral isthmus lines) by radiofrequency catheter was conducted for PsAF.
RESULTS
During 57 ± 24 months of follow-up, AF recurred in 16% and 42% in PAF and PsAF patients ( < .0001). Pre-CA SUA level in PsAF was significantly higher than that in PAF (6.5 ± 1.3 vs. 5.8 ± 1.3 mg/dL, < .001). SUA level was significantly decreased after CA in both PAF and PsAF (5.8 ± 1.3 vs. 5.6 ± 1.3 mg/dL; < .01 and 6.5 ± 1.3 vs. 6.1 ± 1.2 mg/dL; < .0001, respectively). The association between pre-/post-CA HU and recurrent AF was not identified in PAF, while the incidence of post-CA HU was significantly higher in patients with recurrent AF than those without in PsAF (36% vs. 15%, < .001). In multivariable analysis, longer AF duration and the presence of post-CA HU were identified as independent predictors of AF recurrence in PsAF (OR:1.01, 95%CI:1.003-1.011, = .0001 and OR:2.77, 95%CI:1.333-5.755, = .007, respectively).
CONCLUSIONS
SUA level was significantly higher in PsAF than PAF patients. The presence of post-CA HU was strongly related to AF recurrence in PsAF patients.
PubMed: 38939774
DOI: 10.1002/joa3.13030 -
Journal of Arrhythmia Jun 2024Periesophageal vagal nerve injury (PNI) is an unpredictable and serious complication of atrial fibrillation (AF) ablation. We aimed to identify the factors associated...
BACKGROUND
Periesophageal vagal nerve injury (PNI) is an unpredictable and serious complication of atrial fibrillation (AF) ablation. We aimed to identify the factors associated with symptomatic PNI.
METHODS
This study included 1391 patients who underwent ablation index-guided pulmonary vein isolation (PVI) using the CARTO system. The target ablation index was set at 550, except for the left atrial (LA) posterior wall near the esophagus, where radiofrequency (RF) power and duration were limited. Ten patients (0.72%) were diagnosed with symptomatic PNI. We randomly selected 40 patients without PNI (1:4 ratio) matched based on age, sex, body mass index, LA diameter, type of AF, and esophageal location. We measured the shortest distance from the RF lesions to the esophagus (LED) and classified the RF lesions according to the LED into four groups: 0-5, 5-10, 10-15, and 15-20 mm. We conducted a comparative analysis of classified RF lesions between patients with PNI ( = 10) and those without ( = 40).
RESULTS
The contact force at LED 0-5 mm was significantly higher in patients with PNI than in those without (14.6 ± 1.7 vs. 12.0 ± 2.9 g; = .01). Multivariate logistic analysis revealed that the independent factor for PNI was contact force at an LED of 0-5 mm (odds ratio: 1.506; 95% confidence interval: 1.053-2.153; = .025).
CONCLUSIONS
The symptomatic PNI was significantly associated with a higher contact force near the esophagus. Strategies for regulating contact force near the esophagus may aid in the prevention of PNI.
PubMed: 38939771
DOI: 10.1002/joa3.13036 -
Journal of Arrhythmia Jun 2024
Editorial to: Where is the gap after a 90 W/4 s very high-power short-duration ablation of atrial fibrillation?: Association with the left atrial-pulmonary vein voltage and wall thickness.
PubMed: 38939767
DOI: 10.1002/joa3.13019 -
Journal of Arrhythmia Jun 2024
PubMed: 38939765
DOI: 10.1002/joa3.13057 -
Journal of Arrhythmia Jun 2024The concept of ablation index (AI) was introduced to evaluate radiofrequency (RF) ablation lesions. It is calculated from power, contact force (CF), and RF duration....
BACKGROUND
The concept of ablation index (AI) was introduced to evaluate radiofrequency (RF) ablation lesions. It is calculated from power, contact force (CF), and RF duration. However, other factors may also affect the quality of ablation lesions. To examine the difference in RF lesions made during sinus rhythm (SR) and atrial fibrillation (AF).
METHODS
Sixty patients underwent index pulmonary vein isolation during SR ( = 30, SR group) or AF ( = 30, AF group). All ablations were performed with a power of 50 W, a targeted CF of 5-15 g, and AI of 400-450 using Thermocool Smarttouch SF. The CF, AI, RF duration, temperature rise (Δtemp), impedance drop (Δimp), and the CF stability of each ablation point quantified as the standard deviation of the CF (CF-SD) were compared between the two groups.
RESULTS
A total of 3579 ablation points were analyzed, which included 1618 and 1961 points in the SR and the AF groups, respectively. Power, average CF, RF duration per point, and the resultant AI (389 ± 59 vs. 388 ± 57) were similar for the two rhythms. However, differences were seen in the CF-SD (3.5 ± 2.2 vs. 3.8 ± 2.1 g, < .01), Δtemp (3.8 ± 1.3 vs. 4.0 ± 1.3°C, < .005), and Δimp (10.3 ± 5.8 vs. 9.4 ± 5.4 Ω, < .005).
CONCLUSIONS
Despite similar AI, various RF parameters differed according to the underlying atrial rhythm. Ablation delivered during SR demonstrated less CF variability and temperature increase and greater impedance drop than during AF.
PubMed: 38939764
DOI: 10.1002/joa3.13025 -
JACC. Advances Sep 2023Data on the association between atrial fibrillation (AF) and venous thromboembolism (VTE) are controversial.
BACKGROUND
Data on the association between atrial fibrillation (AF) and venous thromboembolism (VTE) are controversial.
OBJECTIVES
The purpose of this study was to investigate the risk of VTE in patients with AF according to the time from AF diagnosis.
METHODS
Systematic review of MEDLINE (PubMed), Embase, Cumulative Index to Nursing and Allied Health Literature (EBSCO host), Cochrane Central Register of Controlled Trials (2020) in the Cochrane Library, and World Health Organization Global Index Medicus databases and meta-analysis of observational studies. The risk of VTE, deep vein thrombosis (DVT) and pulmonary embolism (PE) was analyzed according to the time of AF onset: 1) short (≤3 months); 2) medium (≤6 months); and 3) long (>6 months) time groups.
RESULTS
Eight studies were included with 4,170,027 patients, of whom 650,828 with AF. In the short-term group, AF was associated with the highest risk of either PE (HR: 9.62; 95% CI: 7.07-13.09; I = 0%) or DVT (HR: 6.18; 95% CI: 4.51-8.49, I = 0%). Even if to a lesser extent, AF was associated with a higher risk of VTE (HR: 3.69; 95% CI: 1.65-8.27; I = 79%), DVT (HR: 1.75; 95% CI: 1.43-2.14; I = 0%), and PE (HR: 4.3; 95% CI: 1.61-11.47; I = 68%) in the up to 6 months and long-term risk group >6 months groups (HR: 1.39; 95% CI: 1.00-1.92; I = 72%) and PE (HR: 1.08; 95% CI: 1.00-1.16; I = 0%).
CONCLUSIONS
The risk of VTE is highest in the first 3 to 6 months after AF diagnosis and decreases over time. The early initiation of anticoagulation in patients with AF may reduce the risk of VTE.
PubMed: 38939492
DOI: 10.1016/j.jacadv.2023.100555 -
Cureus May 2024Pulmonary embolism (PE) is a life-threatening condition resulting from the obstruction of pulmonary arteries by blood clots, usually originating from deep veins....
Pulmonary embolism (PE) is a life-threatening condition resulting from the obstruction of pulmonary arteries by blood clots, usually originating from deep veins. Symptoms of PE might vary from nothing to sudden death. Clinically, individuals may present very differently. When a diagnosis of PE is suspected, any possible life-saving intervention must be implemented because survival from cardiac arrest following PE is often quite low. Although there are not many randomized controlled trials that provide guidelines for treating suspected PE in cardiac arrest victims, the few published case reports and other minor studies suggest that thrombolysis and other therapies are associated with good outcomes. We report a patient with PE who presented in cardiac arrest with its clinical, electrographic, and radiologic findings, along with the appropriate therapy chosen based on hemodynamic stability. It is important to intervene early to prevent severe complications and improve the patient's outcomes.
PubMed: 38939235
DOI: 10.7759/cureus.61213 -
Open Veterinary Journal May 2024Exercise-induced pulmonary hemorrhage (EIPH) is one of the most commonly diagnosed disorders in racehorses. Many EIPH risk factors such as breed, age, high or low...
BACKGROUND
Exercise-induced pulmonary hemorrhage (EIPH) is one of the most commonly diagnosed disorders in racehorses. Many EIPH risk factors such as breed, age, high or low environmental temperature, and distance of the race have been studied in racehorses.
AIM
The aim of this study was to study the relationship between EIPH and the presence of jugular vein thrombose in racehorses.
METHODS
Forty-eight thoroughbred racehorses randomly selected from animals with exercise intolerance due to respiratory disorders were enrolled in the present study. Clinical and tracheobronchoscopy examinations were done for EIPH grading. In addition, both jugular veins were examined using ultrasonography for vein thrombosis.
RESULTS
It was noted during endoscopy that many cases suffered from laryngeal paralysis, and we were not able to assess the degree of laryngeal paralysis under sedation. About 40% of horses with exercise intolerance suffered from EIPH of varying degrees. Most cases of jugular vein thrombosis were of the chronic type, as local heat and pain were not observed. About 42% of the exercise-intolerant horses had jugular vein thrombose with most jugular vein thrombosis on the left side. Combined jugular veins thrombose and EIPH were found in about 25% of exercise intolerance horses, while 17% showed jugular vein thrombose without EIPH, and 41% showed no EIPH with the absence of jugular vein thrombose.
CONCLUSION
The present study revealed that jugular vein thrombosis may cause disorders-associated damage to the vessels and anatomical structures close to it, such as the trachea causing EIPH.
Topics: Animals; Horses; Horse Diseases; Jugular Veins; Physical Conditioning, Animal; Hemorrhage; Risk Factors; Male; Venous Thrombosis; Female; Lung Diseases
PubMed: 38938431
DOI: 10.5455/OVJ.2024.v14.i5.4