Research

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10 pages, 733 KiB

Open AccessArticle

Impact of Systematic Use of Intracardiac Ultrasound during Transseptal Catheterization in the Electrophysiology Laboratory

by Nicola Bottoni, Paolo Donateo, Luca Rossi, Michele Malagù, Luca Tomasi, Fabio Quartieri, Andrea Biagi, Matteo Iori, Giacomo Mugnai, Antonella Battista, Stefano Cló, Michele Brignole and Matteo Bertini

J. Cardiovasc. Dev. Dis. 2023, 10(2), 62; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd10020062 - 02 Feb 2023

Cited by 2 | Viewed by 1335

Abstract

Aims: To explore the impact of the use of intracardiac echocardiography (ICE) in the ablation of supraventricular arrhythmias requiring transseptal catheterization (TSC), whilst analyzing the reduction in periprocedural complications and complications specifically related to TSC. Methods: A retrospective multicenter study collecting data from [...] Read more.

Aims: To explore the impact of the use of intracardiac echocardiography (ICE) in the ablation of supraventricular arrhythmias requiring transseptal catheterization (TSC), whilst analyzing the reduction in periprocedural complications and complications specifically related to TSC. Methods: A retrospective multicenter study collecting data from consecutive atrial fibrillation (AF) and supraventricular ablation procedures that required TSC was performed in five Italian centers. Based on physician discretion, TSC was performed with or without ICE. Periprocedural complications, separating all complications from complications directly related to TSC, were collected. Independent predictors of periprocedural complications and TSC-related complications were investigated. Results: A total of 2181 TSCs were performed on 1862 patients at five Italian centers from 2006 to 2021, in 76% of cases by AF ablation and in 24% by ablation of other arrhythmias with a circuit in the left atrium. Overall, 1134 (52%) procedures were performed with ICE support and 1047 (48%) without ICE. A total of 67 (3.1%) complications were detected, 19 (1.7%) in the ICE group and 48 (4.6%) in the no ICE group, p < 0.001. A total of 42 (1.5%) complications directly related to TSC: 0.9% in the ICE group and 3.1% in the no ICE group (p < 0.001). The independent predictors of all complications were age (OR 1,02 95% C.I 1.00–1.05; p = 0.036), TSC with the use of ICE (OR 0.27 95% C.I 0.15–0.46; p < 0.001) and AF ablation (OR 2,25 95%C.I 1.05–4.83; p = 0.037). The independent predictors for TSC complications were age (OR 1.03 95% C.I 1.01–1.06; p = 0.013) and TSC with the use of ICE (OR 0.24 95% C.I 0.11–0.49; p < 0.001). Conclusions: ICE reduced periprocedural and TSC-related complications during electrophysiological procedures for ablation of left atrial arrhythmias. Full article

(This article belongs to the Special Issue Modern Approach to Complex Arrhythmias)

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11 pages, 1612 KiB

Open AccessArticle

Three-Dimensional Electro-Anatomical Mapping and Myocardial Work Performance during Spontaneous Rhythm, His Bundle Pacing and Right Ventricular Pacing: The EMPATHY Study

by Michele Malagù, Francesco Vitali, Rodolfo Francesco Massafra, Laura Sofia Cardelli, Rita Pavasini, Gabriele Guardigli, Claudio Rapezzi and Matteo Bertini

J. Cardiovasc. Dev. Dis. 2022, 9(11), 377; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9110377 - 02 Nov 2022

Cited by 4 | Viewed by 1464

Abstract

Background. His bundle pacing (HBP) has emerged as an alternative site to right ventricular pacing (RVP) with encouraging outcomes. To date, no study has investigated the systematic approach of three-dimensional electroanatomic mapping (3D-EAM) to guide HBP implantation and to evaluate myocardial activation timing. [...] Read more.

Background. His bundle pacing (HBP) has emerged as an alternative site to right ventricular pacing (RVP) with encouraging outcomes. To date, no study has investigated the systematic approach of three-dimensional electroanatomic mapping (3D-EAM) to guide HBP implantation and to evaluate myocardial activation timing. Furthermore, studies reporting a comprehensive assessment of the ventricular function, using myocardial work (MW) evaluation are lacking. Objectives. (1) To evaluate the systematic use of the 3D-EAM as a guide to HBP; (2) to assess the electrical and mechanical activations with high-density mapping, comparing spontaneous ventricular activation (SVA), HBP and RVP; (3) to assess the myocardial function through speckle-tracking echocardiography (STE) and MW analysis in SVA, HBP and RVP. Methods. 3D-EAM was performed in consecutive patients undergoing HBP implantation with a low use of fluoroscopy. All patients were systematically evaluated with high-density mapping, MW and STE. Results. Fifteen patients were enrolled, of whom three had an implant failure (20%). RV activation time was not statistically different between SVA and HBP (103 vs. 104 ms, p = 0.969) but was significantly higher in RVP (133 ms, p = 0.011 vs. SVA and p = 0.001 vs HBP). Global constructive work was significantly lower during RVP (1191 mmHg%) than during SVA and HBP (1648 and 1505 mmHg%, p = 0.011 and p = 0.008, respectively) and did not differ between SVA and HBP (p = 0.075). Conclusions. 3D-EAM and MW evaluation showed that HBP was comparable to the physiological SVA in terms of activation time and cardiac performance. Compared to both SVA and HBP, RVP was associated with a worse activation timing and ventricular efficiency. Full article

(This article belongs to the Special Issue Modern Approach to Complex Arrhythmias)

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9 pages, 690 KiB

Open AccessArticle

Pulmonary Vein Isolation in Obese Compared to Non-Obese Patients: Real-Life Experience from a Large Tertiary Center

by Julian Wolfes, Daniel Hoppe, Christian Ellermann, Kevin Willy, Benjamin Rath, Patrick Leitz, Fatih Güner, Julia Köbe, Philipp S. Lange, Lars Eckardt and Gerrit Frommeyer

J. Cardiovasc. Dev. Dis. 2022, 9(8), 275; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9080275 - 17 Aug 2022

Cited by 2 | Viewed by 1390

Abstract

1. Introduction: Pulmonary vein isolation (PVI) is an established procedure used to achieve rhythm control in atrial fibrillation (AF). In obese patients (pts), in whom AF occurs more frequently, a reduced effectiveness of PVI has been observed. Therefore, this study’s aim was to [...] Read more.

1. Introduction: Pulmonary vein isolation (PVI) is an established procedure used to achieve rhythm control in atrial fibrillation (AF). In obese patients (pts), in whom AF occurs more frequently, a reduced effectiveness of PVI has been observed. Therefore, this study’s aim was to compare the long-term efficacy of PVI between obese and non-obese patients. 2. Methods: We enrolled 111 consecutive pts with a body mass index (BMI) of >30 kg/m² undergoing PVI from our large registry. Procedural data and outcomes were compared with a matched group of 115 non-obese PVI pts and the long-term outcomes were analyzed. 3. Results: Overall follow-up duration was 314 patient-years in the obese and 378 patient-years in the non-obese group. The follow-up rate was 71% in the obese and 76% in the non-obese group. In both groups, their AF-characteristics did not differ significantly, while known risk factors were significantly more prevalent in the obese group. Procedural characteristics were similar in both groups. During follow-up, the obese pts demonstrated significant weight loss compared to the non-obese pts, while at the same time, the overall recurrence rate during follow-up did not differ significantly between both groups (obese: 39.2% and non-obese: 43.7%). PVI related and long-term complications were comparable between both groups. In the univariate analysis, obesity was not found to be associated with an increased AF recurrence risk. 4. Conclusion: These real-life data demonstrate that obese pts may not show higher AF recurrence rates after PVI compared to pts with normal body weight. Furthermore, PVI was found to be safe and effective in obese patients; thus, a BMI alone may not be a criterion for refusal of PVI. Full article

(This article belongs to the Special Issue Modern Approach to Complex Arrhythmias)

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Review

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16 pages, 23289 KiB

Open AccessReview

The Atrioventricular Conduction Axis Revisited for the 21st Century

by Damian Sanchez-Quintana, Andrew C. Cook, Yolanda Macias, Diane E. Spicer and Robert H. Anderson

J. Cardiovasc. Dev. Dis. 2023, 10(11), 471; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd10110471 - 19 Nov 2023

Cited by 1 | Viewed by 1372

Abstract

Although first described in the final decade of the 19th century, the axis responsible for atrioventricular conduction has long been the source of multiple controversies. Some of these continue to reverberate. When first described by His, for example, many doubted the existence of [...] Read more.

Although first described in the final decade of the 19th century, the axis responsible for atrioventricular conduction has long been the source of multiple controversies. Some of these continue to reverberate. When first described by His, for example, many doubted the existence of the bundle we now name in his honour, while Kent suggested that multiple pathways crossed the atrioventricular junctions in the normal heart. It was Tawara who clarified the situation, although many of his key definitions have not universally been accepted. In key studies in the third decade of the 20th century, Mahaim then suggested the presence of ubiquitous connections that provided “paraspecific” pathways for atrioventricular conduction. In this review, we show the validity of these original investigations, based on our own experience with a large number of datasets from human hearts prepared by serial histological sectioning. Using our own reconstructions, we show how the atrioventricular conduction axis can be placed back within the heart. We emphasise that newly emerging techniques will be key in providing the resolution to map cellular detail to the gross evidence provided by the serial sections. Full article

(This article belongs to the Special Issue Modern Approach to Complex Arrhythmias)

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14 pages, 888 KiB

Open AccessReview

Mapping of Neuro-Cardiac Electrophysiology: Interlinking Epilepsy and Arrhythmia

by Sidhartha G. Senapati, Aditi K. Bhanushali, Simmy Lahori, Mridula Sree Naagendran, Shreya Sriram, Arghyadeep Ganguly, Mounika Pusa, Devanshi N. Damani, Kanchan Kulkarni and Shivaram P. Arunachalam

J. Cardiovasc. Dev. Dis. 2023, 10(10), 433; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd10100433 - 18 Oct 2023

Cited by 1 | Viewed by 2235

Abstract

The interplay between neurology and cardiology has gained significant attention in recent years, particularly regarding the shared pathophysiological mechanisms and clinical comorbidities observed in epilepsy and arrhythmias. Neuro-cardiac electrophysiology mapping involves the comprehensive assessment of both neural and cardiac electrical activity, aiming to [...] Read more.

The interplay between neurology and cardiology has gained significant attention in recent years, particularly regarding the shared pathophysiological mechanisms and clinical comorbidities observed in epilepsy and arrhythmias. Neuro-cardiac electrophysiology mapping involves the comprehensive assessment of both neural and cardiac electrical activity, aiming to unravel the intricate connections and potential cross-talk between the brain and the heart. The emergence of artificial intelligence (AI) has revolutionized the field by enabling the analysis of large-scale data sets, complex signal processing, and predictive modeling. AI algorithms have been applied to neuroimaging, electroencephalography (EEG), electrocardiography (ECG), and other diagnostic modalities to identify subtle patterns, classify disease subtypes, predict outcomes, and guide personalized treatment strategies. In this review, we highlight the potential clinical implications of neuro-cardiac mapping and AI in the management of epilepsy and arrhythmias. We address the challenges and limitations associated with these approaches, including data quality, interpretability, and ethical considerations. Further research and collaboration between neurologists, cardiologists, and AI experts are needed to fully unlock the potential of this interdisciplinary field. Full article

(This article belongs to the Special Issue Modern Approach to Complex Arrhythmias)

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15 pages, 2563 KiB

Open AccessReview

Trigger and Substrate Mapping and Ablation for Ventricular Fibrillation in the Structurally Normal Heart

by Simon Christie, Sami Idris, Richard G. Bennett, Marc W. Deyell, Thomas Roston and Zachary Laksman

J. Cardiovasc. Dev. Dis. 2023, 10(5), 200; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd10050200 - 02 May 2023

Cited by 3 | Viewed by 1619

Abstract

Sudden cardiac death (SCD) represents approximately 50% of all cardiovascular mortality in the United States. The majority of SCD occurs in individuals with structural heart disease; however, around 5% of individuals have no identifiable cause on autopsy. This proportion is even higher in [...] Read more.

Sudden cardiac death (SCD) represents approximately 50% of all cardiovascular mortality in the United States. The majority of SCD occurs in individuals with structural heart disease; however, around 5% of individuals have no identifiable cause on autopsy. This proportion is even higher in those <40 years old, where SCD is particularly devastating. Ventricular fibrillation (VF) is often the terminal rhythm leading to SCD. Catheter ablation for VF has emerged as an effective tool to alter the natural history of this disease among high-risk individuals. Important advances have been made in the identification of several mechanisms involved in the initiation and maintenance of VF. Targeting the triggers of VF as well as the underlying substrate that perpetuates these lethal arrhythmias has the potential to eliminate further episodes. Although important gaps remain in our understanding of VF, catheter ablation has become an important option for individuals with refractory arrhythmias. This review outlines a contemporary approach to the mapping and ablation of VF in the structurally normal heart, specifically focusing on the following major conditions: idiopathic ventricular fibrillation, short-coupled ventricular fibrillation, and the J-wave syndromes—Brugada syndrome and early-repolarization syndrome. Full article

(This article belongs to the Special Issue Modern Approach to Complex Arrhythmias)

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12 pages, 2546 KiB

Open AccessEditor’s ChoiceReview

Moderator Band and Ventricular Tachycardia: Structural or Functional Substrate?

by Federico Landra, Carmine Marallo, Amato Santoro, Simone Taddeucci, Maria Cristina Tavera, Claudia Baiocchi and Alberto Palazzuoli

J. Cardiovasc. Dev. Dis. 2023, 10(4), 159; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd10040159 - 06 Apr 2023

Viewed by 4136

Abstract

The moderator band (MB) is an intracavitary structure of the right ventricle composed of muscular fibers encompassing specialized Purkinje fibers, separated each other by collagen and adipose tissue. In the last decades, premature ventricular complexes originating within the Purkinje network have been implicated [...] Read more.

The moderator band (MB) is an intracavitary structure of the right ventricle composed of muscular fibers encompassing specialized Purkinje fibers, separated each other by collagen and adipose tissue. In the last decades, premature ventricular complexes originating within the Purkinje network have been implicated in the genesis of life-threatening arrhythmias. However, right Purkinje network arrhythmias have been much less reported in the literature compared to the left counterpart. The MB has unique anatomical and electrophysiological properties, which may account for its arrhythmogenicity and may be responsible for a significant portion of idiopathic ventricular fibrillation. MB embodies autonomic nervous system cells, with important implications in arrhythmogenesis. Some idiopathic ventricular arrhythmias, defined as the absence of any identifiable structural heart disorder, can begin from this site. Due to these complex structural and functional peculiarities strictly interplayed each other, it is arduous to determine the precise mechanism underlying MB arrhythmias. MB-related arrhythmias should be differentiated from other right Purkinje fibers arrhythmias because of the opportunity for intervention and the unusual site for the ablation poorly described in the literature. In the current paper, we report the characteristics and electrical properties of the MB, their involvement in arrhythmogenesis, clinical and electrophysiological peculiarities of MB-related arrhythmias, and current treatment options. Full article

(This article belongs to the Special Issue Modern Approach to Complex Arrhythmias)

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10 pages, 830 KiB

Open AccessEditor’s ChoiceReview

Targeted Atrial Fibrillation Therapy and Risk Stratification Using Atrial Alternans

by Neha Muthavarapu, Anmol Mohan, Sharanya Manga, Palak Sharma, Aditi Kishor Bhanushali, Ashima Yadav, Devanshi Narendra Damani, Pierre Jais, Richard D. Walton, Shivaram P. Arunachalam and Kanchan Kulkarni

J. Cardiovasc. Dev. Dis. 2023, 10(2), 36; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd10020036 - 20 Jan 2023

Cited by 2 | Viewed by 2001

Abstract

Atrial fibrillation (AF) is the most persistent arrhythmia today, with its prevalence increasing exponentially with the rising age of the population. Particularly at elevated heart rates, a functional abnormality known as cardiac alternans can occur prior to the onset of lethal arrhythmias. Cardiac [...] Read more.

Atrial fibrillation (AF) is the most persistent arrhythmia today, with its prevalence increasing exponentially with the rising age of the population. Particularly at elevated heart rates, a functional abnormality known as cardiac alternans can occur prior to the onset of lethal arrhythmias. Cardiac alternans are a beat-to-beat oscillation of electrical activity and the force of cardiac muscle contraction. Extensive evidence has demonstrated that microvolt T-wave alternans can predict ventricular fibrillation vulnerability and the risk of sudden cardiac death. The majority of our knowledge of the mechanisms of alternans stems from studies of ventricular electrophysiology, although recent studies offer promising evidence of the potential of atrial alternans in predicting the risk of AF. Exciting preclinical and clinical studies have demonstrated a link between atrial alternans and the onset of atrial tachyarrhythmias. Here, we provide a comprehensive review of the clinical utility of atrial alternans in identifying the risk and guiding treatment of AF. Full article

(This article belongs to the Special Issue Modern Approach to Complex Arrhythmias)

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