المؤلفون: Mohamed Diab, Daniel J. Cantillon, John Rickard, Mina K. Chung, Mandeep Bhargava, Erika Hutt, Thomas Callahan, Oussama M. Wazni, Jad A. Ballout, Niraj Varma, Walid Saliba, Bryan Baranowski, Patrick J. Tchou, Thomas Dresing, Ayman A. Hussein, Khaldoun G. Tarakji, David O. Martin, Mohamed Kanj

المصدر: Circulation: Arrhythmia and Electrophysiology. 13

مصطلحات موضوعية: Male, medicine.medical_specialty, Databases, Factual, medicine.medical_treatment, Ablation of atrial fibrillation, Hemorrhage, Unnecessary Procedures, Risk Assessment, Risk Factors, Left atrial, Thromboembolism, Physiology (medical), Internal medicine, Atrial Fibrillation, medicine, Humans, Atrial Appendage, In patient, Prospective Studies, Registries, cardiovascular diseases, Stroke, Aged, Ohio, business.industry, Atrial fibrillation, Middle Aged, medicine.disease, Ablation, Treatment Outcome, Atrial Flutter, Pulmonary Veins, Catheter Ablation, cardiovascular system, Cardiology, Feasibility Studies, Female, Cardiology and Cardiovascular Medicine, business, Echocardiography, Transesophageal, Atrial flutter, Factor Xa Inhibitors

الوصف: Background: Many centers continue to routinely perform transesophageal echocardiograms before atrial fibrillation (AF) ablation procedures in patients treated with direct oral anticoagulants (DOACs). One study suggested that the procedures could be done without transesophageal echocardiogram but used intracardiac echocardiography imaging of the appendage from the right ventricular outflow. This study aimed to assess the safety of ablation for AF without transesophageal echocardiogram screening or intracardiac echocardiography imaging of the appendage in DOAC compliant patients. Methods: All patients undergoing AF ablation at the Cleveland Clinic (2011–2018) were enrolled in a prospectively maintained data registry. All consecutive patients presenting with AF or atrial flutter on DOAC were included. Periprocedural thromboembolic complications were assessed. Results: A total of 900 patients were included. Their median CHA 2 DS 2 -VASc score was 2 (interquartile range 1–3). All were on DOACs (333 rivaroxaban, 285 dabigatran, 281 apixaban, and 1 edoxaban). Thromboembolic complications occurred in 4 patients (0.3%): 2 ischemic strokes, 1 transient ischemic attack without residual deficit, and 1 splenic infarct; all with no further complications. Bleeding complications occurred in 5 patients (0.4%): 2 pericardial effusions (1 intraoperative, 1 after 30 days, both drained), 3 groin hematomas (1 of them due to needing heparin for venous thrombosis, none required interventions). No patients required emergent surgeries. Conclusions: In DOAC compliant patients who present for ablation in AF/atrial flutter, the procedures could be performed without transesophageal echocardiogram screening or intracardiac echocardiography imaging of the appendage; with low risk of complications.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1c69eda50dbebe59eab7037bebc69be4
https://doi.org/10.1161/circep.119.008301

المؤلفون: Ayman A. Hussein, Thomas Dresing, Niraj Varma, Walid Saliba, Jad A. Ballout, Bruce D. Lindsay, Mohamed Diab, David O. Martin, Mohamed Kanj, Patrick J. Tchou, Oussama M. Wazni, John Rickard, Mark Niebauer, Mandeep Bhargava, Bryan Baranowski, Mina K. Chung, Khaldoun G. Tarakji, Thomas Callahan, Daniel J. Cantillon

المصدر: Circ Arrhythm Electrophysiol

مصطلحات موضوعية: Male, medicine.medical_specialty, Time Factors, Radiofrequency ablation, medicine.medical_treatment, Drug Resistance, Shock, Cardiogenic, Catheter ablation, Ventricular tachycardia, Article, Ventricular Function, Left, law.invention, Extracorporeal Membrane Oxygenation, Refractory, Heart Rate, Recurrence, Risk Factors, law, Physiology (medical), Internal medicine, medicine, Humans, Assisted Circulation, Hospital Mortality, Registries, Aged, Retrospective Studies, business.industry, Cardiogenic shock, Stroke Volume, Recovery of Function, Middle Aged, Ablation, medicine.disease, Treatment Outcome, Concomitant, Heart failure, Ventricular Fibrillation, Catheter Ablation, Tachycardia, Ventricular, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Anti-Arrhythmia Agents

الوصف: Background: There is paucity of data regarding radiofrequency ablation for ventricular tachycardia (VT) in patients with cardiogenic shock and concomitant VT refractory to antiarrhythmic drugs on mechanical support. Methods: Patients undergoing VT ablation at our center were enrolled in a prospectively maintained registry and screened for the current study (2010–2017). Results: All 21 consecutive patients with cardiogenic shock and concomitant refractory ventricular arrhythmia undergoing bailout ablation due to inability to wean off mechanical support were included. Median age was 61 years, 86% were men, median left ventricular ejection fraction was 20%, 81% had ischemic cardiomyopathy, and PAINESD score was 18±5. The type of mechanical support in place before the procedure was intra-aortic balloon pump in 14 patients (67%), Impella CP in 2, extracorporeal membrane oxygenation in 2, extracorporeal membrane oxygenation and intra-aortic balloon pump in 2, and extracorporeal membrane oxygenation and Impella CP in 1. Endocardial voltage maps showed myocardial scar in 19 patients (90%). The clinical VTs were inducible in 13 patients (62%), whereas 6 patients had premature ventricular contraction–induced ventricular fibrillation/VT (29%), and VT could not be induced in 2 patients (9%). Activation mapping was possible in all 13 with inducible clinical VTs. Substrate modification was performed in 15 patients with scar (79%). After ablation and scar modification, the arrhythmia was noninducible in 19 patients (91%). Seventeen (81%) were eventually weaned off mechanical support successfully, but 6 (29%) died during the index admission from persistent cardiogenic shock. Patients who had ventricular arrhythmia and cardiogenic shock on presentation had a trend toward lower in-hospital mortality compared with those who presented with cardiogenic shock and later developed ventricular arrhythmia. Conclusions: Bailout ablation for refractory ventricular arrhythmia in cardiogenic shock allowed successful weaning from mechanical support in a large proportion of patients. Mortality remains high, but the majority of patients were discharged home and survived beyond 1 year.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f22fb2268fcc13288857f3c52106224c
https://doi.org/10.1161/circep.119.007669

المؤلفون: John Rickard, Ayman A. Hussein, Oussama M. Wazni, Bruce D. Lindsay, Amr F. Barakat, Thomas Dresing, Mandeep Bhargava, Mohamed Kanj, Thomas Callahan, Pejman Raeisi-Giglou, Patrick J. Tchou, Bryan Baranowski, Khaldoun G. Tarakji, Walid Saliba, Daniel J. Cantillon

المصدر: Circulation. Arrhythmia and electrophysiology. 11(5)

مصطلحات موضوعية: Male, medicine.medical_specialty, Percutaneous, Time Factors, Computed Tomography Angiography, medicine.medical_treatment, Constriction, Pathologic, 030204 cardiovascular system & hematology, Severity of Illness Index, Pulmonary vein, 03 medical and health sciences, 0302 clinical medicine, Recurrence, Risk Factors, Physiology (medical), Atrial Fibrillation, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Registries, Pulmonary vein stenosis, Stroke, Aged, Ohio, business.industry, Endovascular Procedures, Atrial fibrillation, Phlebography, Middle Aged, medicine.disease, Ablation, Surgery, Stenosis, Treatment Outcome, Catheter Ablation, Pulmonary Veno-Occlusive Disease, Female, Stents, Cardiology and Cardiovascular Medicine, business, Complication

الوصف: Background: Pulmonary vein (PV) stenosis remains a feared complication of atrial fibrillation ablation. Little is known about outcomes in patients with severe PV stenosis, especially about repeat ablations. Methods: In 10 368 patients undergoing atrial fibrillation ablation (2000–2015), computed tomography scans were obtained 3 to 6 months after ablation. The clinical outcomes in severe PV stenosis were determined. RESULTS: Severe PV stenosis was diagnosed in 52 patients (0.5%). This involved mostly the left superior PV (51% of severely stenosed veins). Percutaneous interventions were performed in 43 patients, and complications occurred in 5: 3 PV ruptures, 1 stroke, and 1 phrenic injury. Over a median follow-up of 25 months, 41 (79%) patients remained arrhythmia free. Repeat ablation was performed in 15 patients (7 from the main series and 8 from prior ablation at other institutions); of whom 10 had PV stents in place. Conduction recovery was noted in all but 2 of the stenosed or stented PVs, and areas with recovery were targeted with antral ablation. Lasso entrapment within stents occurred in 2 patients but eventually freed without complications. After redo ablation, preplanned stenting was performed in 3 patients and computed tomographic scans showed progression of concomitant stenoses in 1 patient (moderate to severe). No procedure-related deaths occurred. Conclusions: The incidence of severe PV stenosis is low but remains associated with significant morbidity. In patients with recurrent arrhythmia, conduction recovery at the stenosed or stented veins is common. Care must be taken to ablate antrally to avoid stenosis progression. In patients with prior PV stents, we suggest to avoid using Lasso.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::ebedcd62b365d12fce2b22bedf9ef442
https://pubmed.ncbi.nlm.nih.gov/29986948

المؤلفون: David D. Spragg, Andreas S. Barth, John Rickard, Joseph E. Marine, Hugh Calkins, Gordon F. Tomaselli, Jonathan Chrispin, Hiroshi Ashikaga, Ronald D. Berger, Sunil Sinha, Jane E. Crosson, Harikrishna Tandri, Satish Misra, Aravindan Kolandaivelu

المصدر: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 20(4)

مصطلحات موضوعية: Tachycardia, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Catheter ablation, 030204 cardiovascular system & hematology, Workflow, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Recurrence, Risk Factors, Physiology (medical), Internal medicine, medicine, Humans, Tachycardia, Atrioventricular Nodal Reentry, Anesthesia, 030212 general & internal medicine, Practice Patterns, Physicians', Retrospective Studies, business.industry, Retrospective cohort study, Cardiac Ablation, Ablation, Treatment Outcome, Cohort, Cardiology, Catheter Ablation, Re entrant, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Complication, Electrophysiologic Techniques, Cardiac

الوصف: Aims Historical studies of ablation of atrioventricular nodal re-entrant tachycardia (AVNRT) have shown high long-term success rates and low complication rates. The potential impact of several recent practice trends has not been described. This study aims to characterize recent clinical practice trends in AVNRT ablation and their associated success rates and complications. Methods and results Patients undergoing initial ablation of AVNRT between 1 July 2005 and 30 June 2015 were included in this study. Patient demographics and procedural data were abstracted from procedure reports. Follow-up data, including AVNRT recurrence and complications, was evaluated through electronic medical record review. In total, 877 patients underwent catheter ablation for AVNRT. By the last recorded year, three-dimension (3D) electroanatomical mapping (EAM) was used in 36.2%, 43.2% included anaesthesia, and 23.1% utilized irrigated catheters. Long-term procedural success was 95.5%. The use of anaesthesia, 3D EAM, and irrigated ablation catheters were not associated with differences in success. The presence of an atrial 'echo' or 'AH' jump at the end of an acutely successful procedure was not associated with long-term recurrence (P = 0.18, P = 0.15, respectively). Complications, including AV block requiring a pacemaker (0.4%), were uncommon. Conclusion In a large, contemporary cohort, catheter ablation for AVNRT remains highly successful with low complications rates. The increased use of anaesthesia as well as modern mapping and ablation tools were not associated with changes in clinical outcomes. Further prospective evaluation of such contemporary practices is warranted given the lack of evidence to support their escalating use.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::abd8deee2fe4736b9d9c18b409bffc32
https://pubmed.ncbi.nlm.nih.gov/28541507

المؤلفون: Oussama M. Wazni, Patrick J. Tchou, Bryan Baranowski, Mariam Diab, Thomas Dresing, Walid Saliba, Mohamed Kanj, Ayman A. Hussein, David O. Martin, Mingyuan Shao, Wahaj Aman, Bruce D. Lindsay, Khaldoun G. Tarakji, Ali H. Hakim, John Rickard, Mandeep Bhargava, Thomas Callahan, Mohamed Bassiouny

المصدر: Circulation. Arrhythmia and electrophysiology. 9(2)

مصطلحات موضوعية: Male, Time Factors, medicine.medical_treatment, Action Potentials, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Radiography, Interventional, Pulmonary vein, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Heart Rate, Recurrence, Risk Factors, Atrial Fibrillation, Sinus rhythm, 030212 general & internal medicine, Prospective Studies, Atrial fibrillation, Middle Aged, Ablation, Treatment Outcome, Anesthesia, Cardiology, Catheter Ablation, Female, Electrical conduction system of the heart, Cardiology and Cardiovascular Medicine, Electrophysiologic Techniques, Cardiac, Anti-Arrhythmia Agents, medicine.medical_specialty, Operative Time, Catheter ablation, Disease-Free Survival, 03 medical and health sciences, Heart Conduction System, Predictive Value of Tests, Physiology (medical), Internal medicine, Heart rate, medicine, Humans, Aged, Ohio, business.industry, medicine.disease, Fluoroscopy, Electrocardiography, Ambulatory, business

الوصف: Background— Achieving long-term successful outcomes with ablation of persistent atrial fibrillation (AF) remains a clinical and procedural challenge. We aimed to assess 2 ablation strategies for persistent AF: pulmonary vein antral isolation (PVAI) in sinus rhythm after direct current cardioversion versus PVAI and ablation targeting complex-fractionated atrial electrograms while in AF. Methods and Results— Between June 2009 and July 2013, patients with continuous persistent AF for ≥3 months were prospectively randomized to either direct current cardioversion before PVAI and posterior wall/septum ablation while in sinus rhythm (group 1), versus same ablation in group 1 in addition to complex-fractionated atrial electrogram ablation while in AF (group 2). The procedural profiles and clinical outcomes of the 2 strategies were compared. Ninety patients were randomized to group 1 (n=46) or group 2 (n=44). There were no differences in baseline characteristics between groups. Over 365 days of follow-up after the index procedure, 16 patients (35%) in group 1 and 13 patients (30%) in group 2 remained arrhythmia-free off antiarrhythmic medications. Over long-term follow-up (median, 867 days), arrhythmia-free survival off antiarrhythmic medications was more likely in group 1 than in group 2 in Kaplan–Meier analysis (Log Rank P =0.04). Group 1 ablation was associated with significantly shorter procedural duration and fluoroscopy time (231±72 versus 273±76 min; P =0.008 and 54 [Q1–Q3: 46–67] versus 66 (Q1–Q3: 53–83] min; P =0.018, respectively). Conclusions— In patients with persistent AF, PVAI in sinus rhythm after direct current cardioversion is associated with higher success and shorter procedural and fluoroscopy times compared with PVAI in AF with additional complex-fractionated atrial electrogram ablation. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT02429648.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::ba70266f4a2f8392ffc1327046e66c2f
https://pubmed.ncbi.nlm.nih.gov/26857909

المؤلفون: Walid Saliba, Mandeep Bhargava, Thomas Dresing, Moustafa Banna, Oussama M. Wazni, Harry M. Lever, Ayman A. Hussein, Mohamed Kanj, Nicholas G. Smedira, Bryan Baranowski, Bruce D. Lindsay, Patrick J. Tchou, JoEllyn M. Abraham, Thomas Callahan, Allan L. Klein, Mohamed Bassiouny, Khaldoun G. Tarakji, Daniel J. Cantillon, A. Marc Gillinov, John Rickard, Mingyuan Shao

المصدر: Heart rhythm. 12(7)

مصطلحات موضوعية: Adult, Male, Reoperation, medicine.medical_specialty, medicine.medical_treatment, Catheter ablation, Postoperative Complications, Interquartile range, Recurrence, Risk Factors, Physiology (medical), Internal medicine, Atrial Fibrillation, Outcome Assessment, Health Care, medicine, Humans, Atrial tachycardia, Aged, Ejection fraction, business.industry, Hypertrophic cardiomyopathy, Atrial fibrillation, Stroke Volume, Cardiomyopathy, Hypertrophic, Middle Aged, medicine.disease, Prognosis, United States, Surgery, Catheter, Pulmonary Veins, Cardiology, Catheter Ablation, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Atrial flutter, Follow-Up Studies

الوصف: Background Limited data exist regarding the outcome of atrial fibrillation (AF) surgery and catheter ablation in patients with hypertrophic cardiomyopathy (HCM). Objective The purpose of this study was to evaluate the safety and efficacy of nonpharmacologic treatment of AF in HCM. Methods One hundred forty-seven patients (46 female, age 55 ± 11 years, ejection fraction [EF] 58% ± 8%) with symptomatic paroxysmal (58%), persistent (31%), and long-standing persistent AF (11%) refractory to antiarrhythmic drugs who presented for their first catheter ablation (n = 79) or AF surgery (n = 68) were included. Results After follow-up of 35 months (interquartile range 13, 60), 29% of patients who underwent catheter ablation and 51% of those who had undergone AF surgery had no documented recurrent atrial arrhythmia after a single procedure. Repeat ablation was performed in 55% of patients with recurrent arrhythmia in the catheter group and 24% in the surgery group, increasing the success rate to 39% and 53%, respectively, after 1 or more procedures. Predictors of success after the first procedure in a multivariable setting included higher baseline EF and male gender. Persistent or long-standing AF and log of AF duration were associated with lower success. Major complications occurred in 6% of the catheter ablation group and 18% of the AF surgery group. During follow-up, 16 patients died (9 in catheter group, 7 in surgery group) and 1 underwent heart replacement. Lower baseline EF and older age were independently associated with death. Conclusion Catheter ablation and AF surgery are associated with symptomatic improvement in HCM patients. However, long-term success is lower and complications are higher than previously reported.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::39480aa9407efca2e36629d0243993b3
https://pubmed.ncbi.nlm.nih.gov/25814420

المؤلفون: Stefan L. Zimmerman, Ronald D. Berger, Esra Gucuk Ipek, Eunice Yang, Hugh Calkins, Hiroshi Ashikaga, Saman Nazarian, Jonathan Chrispin, Joseph E. Marine, David D. Spragg, John Rickard, Mohammadali Habibi

المصدر: Europace. :euw019

مصطلحات موضوعية: Gadolinium DTPA, Male, medicine.medical_treatment, Contrast Media, 030204 cardiovascular system & hematology, Ventricular Function, Left, 0302 clinical medicine, Risk Factors, Atrial Fibrillation, Odds Ratio, Prospective Studies, Registries, 030212 general & internal medicine, Prospective cohort study, Ejection fraction, medicine.diagnostic_test, Atrial fibrillation, Stroke volume, Middle Aged, Magnetic Resonance Imaging, Predictive value of tests, embryonic structures, Catheter Ablation, Cardiology, Atrial Function, Left, Female, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Catheter ablation, 03 medical and health sciences, Clinical Research, Predictive Value of Tests, Cardiac magnetic resonance imaging, Physiology (medical), Internal medicine, medicine, Humans, Heart Atria, cardiovascular diseases, Aged, business.industry, Stroke Volume, Magnetic resonance imaging, Atrial Remodeling, medicine.disease, Fibrosis, Logistic Models, Multivariate Analysis, Linear Models, business

الوصف: Aims This study aims to examine the association of clinical co-morbidities with the presence of left atrial (LA) late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR). Previous studies have established the severity of LA LGE to be associated with atrial fibrillation (AF) recurrence following AF ablation. We sought to determine whether baseline clinical characteristics were associated with LGE extent among patients presenting for an initial AF ablation. Methods and results The cohort consisted of 179 consecutive patients with no prior cardiac ablation procedures who underwent pre-procedure LGE-CMR. The extent of LA LGE for each patient was calculated using the image intensity ratio, normalized to the mean blood pool intensity, corresponding to a bipolar voltage ≤0.3 mV. The association of LGE extent with baseline clinical characteristics was examined using non-parametric and multivariable models. The mean age of the cohort was 60.9 ± 9.6 years and 128 (72%) were male. In total, 56 (31%) patients had persistent AF. The mean LA volume was 118.4 ± 41.6 mL, and the mean LA LGE extent was 14.1 ± 10.4%. There was no association with any clinical variables with LGE extent by quartiles in the multivariable model. Extent of LGE as a continuous variable was positively, but weakly associated with LA volume in a multivariable model adjusting for age, body mass index, AF persistence, and left ventricular ejection fraction (1.5% scar/mL, P = 0.038). Conclusion In a cohort of patients presenting for initial AF ablation, the presence of pre-ablation LA LGE extent was weakly, but positively associated with increasing LA volume.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9d7666eaa51e99d36713e717d78f1cba
https://doi.org/10.1093/europace/euw019