Publications
177 results found
Betts TR, Good WW, Melki L, et al., 2023, Treatment of pathophysiologic propagation outside of the pulmonary veins in retreatment of atrial fibrillation patients: RECOVER AF study., Europace
AIMS: RECOVER AF evaluated the performance of whole-chamber non-contact charge-density mapping to guide the ablation of non-pulmonary vein (PV) targets in persistent atrial fibrillation (AF) patients following either a first or second failed procedure. METHODS AND RESULTS: RECOVER AF was a prospective, non-randomized trial that enrolled patients scheduled for a first or second ablation retreatment for recurrent AF. The PVs were assessed and re-isolated if necessary. The AF maps were used to guide the ablation of non-PV targets through elimination of pathologic conduction patterns (PCPs). Primary endpoint was freedom from AF on or off antiarrhythmic drugs (AADs) at 12 months. Patients undergoing retreatment with the AcQMap System (n = 103) were 76% AF-free at 12 months [67% after single procedure (SP)] on or off AADs (80% free from AF on AADs). Patients who had only received a pulmonary vein isolation (PVI) prior to study treatment of non-PV targets with the AcQMap System were 91% AF-free at 12 months (83% SP). No major adverse events were reported. CONCLUSION: Non-contact mapping can be used to target and guide the ablation of PCPs beyond the PVs in persistent AF patients returning for a first or second retreatment with 76% freedom from AF at 12 months. The AF freedom was particularly high, 91% (43/47), for patients enrolled having only a prior de novo PVI, and freedom from all atrial arrhythmias for this cohort was 74% (35/47). These early results are encouraging and suggest that guiding individualized targeted ablation of PCPs may therefore be advantageous to target at the earliest opportunity in patients with persistent AF.
O'Connor M, Shi R, Kramer DB, et al., 2023, Conduction system pacing learning curve: Left bundle pacing compared to His bundle pacing., Int J Cardiol Heart Vasc, Vol: 44, ISSN: 2352-9067
INTRODUCTION: Conduction system pacing (CSP), consisting of His bundle pacing (HBP) or left bundle branch area pacing (LBBAP) is a rapidly developing field. These pacing techniques result in single lead left ventricular resynchronisation. Understanding of the associated learning curve of the two techniques is an important consideration for new implanters/implanting centres. METHODS: We conducted a review of the first 30 cases of both HBP and LBBAP at The Royal Brompton Hospital. The procedural duration and fluoroscopy time were used as surrogates for the learning curve of each technique. RESULTS: Patient characteristics were similar in HBP and LBBAP groups; LV ejection fraction (46% vs 54%, p = 0.08), pre-procedural QRS duration (119 ms vs 128 ms, p = 0.32).Mean procedural duration was shorter for LBBAP than for HBP (87 vs 107mins, p = 0.04) and the drop in procedural duration was more marked in LBBAP, plateauing and remaining low at 80mins after the initial 10 cases. Fluoroscopic screening time mirrored procedural duration (8 min vs 16 min, p < 0.01). DISCUSSION/CONCLUSION: Our data suggest that the CSP learning curve was shorter for LBBAP than for HBP and appears to plateaux after the first 10 cases, however the HBP learning curve is longer with continued improvement over the first 30 cases. The shorter learning curve of LBBAP in conjunction with the superior electrical parameters and simplified programming mean the establishment of a CSP program is potentially easier with LBBAP compared to with HBP.
O'Connor M, Riad O, Shi R, et al., 2022, Left bundle branch area pacing in congenital heart disease, EUROPACE, ISSN: 1099-5129
Zakeri R, Ahluwalia N, Tindale A, et al., 2022, Long-term outcomes following catheter ablation versus medical therapy in patients with persistent atrial fibrillation and heart failure with reduced ejection fraction, EUROPEAN JOURNAL OF HEART FAILURE, Vol: 25, Pages: 77-86, ISSN: 1388-9842
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- Citations: 1
Bodagh N, Malaczynska-Rajpold K, Eysenck W, et al., 2022, Left Bundle Area Pacing for Tachycardia-Bradycardia Syndrome in a Patient With Dextrocardia., JACC Case Rep, Vol: 4, Pages: 1213-1217
We present the case of an 81-year-old woman with a background of situs inversus with dextrocardia who was successfully treated for tachycardia-bradycardia syndrome with left bundle area pacing. This report describes how this approach can circumvent the limitations of other pacing approaches to optimize patient outcomes. (Level of Difficulty: Intermediate.).
Ladouceur M, Van De Bruaene A, Kauling R, et al., 2022, A new score for life-threatening ventricular arrhythmias and sudden cardiac death in adults with transposition of the great arteries and a systemic right ventricle, EUROPEAN HEART JOURNAL, Vol: 43, Pages: 2685-+, ISSN: 0195-668X
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- Citations: 4
Schleberger R, Schwarzl JM, Moser J, et al., 2022, The impact of ultra-high-density mapping on long-term outcome after catheter ablation of ventricular tachycardia, SCIENTIFIC REPORTS, Vol: 12, ISSN: 2045-2322
Mehta VS, O'Brien H, Elliott MK, et al., 2022, Machine learning-derived major adverse event prediction of patients undergoing transvenous lead extraction: Using the ESC EHRA EORP European lead extraction ConTRolled ELECTRa registry, HEART RHYTHM, Vol: 19, Pages: 885-893, ISSN: 1547-5271
Griffiths S, Behar JM, Kramer DB, et al., 2022, The long-term outcomes of cardiac implantable electronic devices implanted via the femoral route, Pacing and Clinical Electrophysiology, Vol: 45, Pages: 481-490, ISSN: 0147-8389
BACKGROUND: Conventional superior access for cardiac implantable electronic devices (CIEDs) is not always possible and femoral CIEDs (F-CIED) are an alternative option when leadless systems are not suitable. The long-term outcomes and extraction experiences with F-CIEDs, in particular complex F-CIED (ICD/CRT devices), remain poorly understood. METHODS: Patients referred for F-CIEDs implantation between 2002 and 2019 at two tertiary centers were included. Early complications were defined as ≤30 days following implant and late complications >30 days. RESULTS: Thirty-one patients (66% male; age 56 ± 20 years; 35% [11] patients with congenital heart disease) were implanted with F-CIEDs (10 ICD/CRT and 21 pacemakers). Early complications were observed in 6.5% of patients: two lead displacements. Late complications at 6.8 ± 4.4 years occurred in 29.0% of patients. This was higher with complex F-CIED compared to simple F-CIED (60.0% vs. 14.3%, p = .02). Late complications were predominantly generator site related (n = 8, 25.8%) including seven infections/erosions and one generator migration. Eight femoral generators and 14 leads (median duration in situ seven [range 6-11] years) were extracted without complication. CONCLUSIONS: Procedural success with F-CIEDs is high with clinically acceptable early complication rates. There is a notable risk of late complications, particularly involving the generator site of complex devices following repeat femoral procedures. Extraction of chronic F-CIED in experienced centers is feasible and safe.
O'Connor M, Ho SY, McCarthy KP, et al., 2022, Left bundle pacing in transposition of the great arteries with previous atrial redirection operation., HeartRhythm Case Rep, Vol: 8, Pages: 176-179, ISSN: 2214-0271
Jun C, Zhang H, Mohiaddin R, et al., 2022, Adaptive hierarchical dual consistency for semi-supervised left atrium segmentation on cross-domain data, IEEE Transactions on Medical Imaging, Vol: 41, Pages: 420-433, ISSN: 0278-0062
Semi-supervised learning provides great significance in left atrium (LA) segmentation model learning with insufficient labelled data. Generalising semi supervised learning to cross-domain data is of high importance to further improve model robustness. However, the widely existing distribution difference and sample mismatch between different data domains hinder the generalisation of semi-supervised learning. In this study, we alleviate these problems by proposing an Adaptive Hier10 archical Dual Consistency (AHDC) for the semi-supervised LA segmentation on cross-domain data. The AHDC mainlyconsists of a Bidirectional Adversarial Inference module (BAI) and a Hierarchical Dual Consistency learning module (HDC). The BAI overcomes the difference of distributions and the sample mismatch between two different domains. It mainly learns two mapping networks adversarially to obtain two matched domains through mutual adaptation. The HDC investigates a hierarchical dual learning paradigm for cross-domain semi-supervised segmentation based on the obtained matched domains. It mainly builds two dual modelling networks for mining the complementary information in both intra-domain and inter-domain. For the intra domain learning, a consistency constraint is applied to the dual-modelling targets to exploit the complementary modelling information. For the inter-domain learning, a consistency constraint is applied to the LAs modelled by two dual modelling networks to exploit the complementary knowl28 edge among different data domains. We demonstrated the performance of our proposed AHDC on four 3D late gadolinium enhancement cardiac MR (LGE-CMR) datasets fromdifferent centres and a 3D CT dataset. Compared to otherstate-of-the-art methods, our proposed AHDC achievedhigher segmentation accuracy, which indicated its capability in the cross-domain semi-supervised LA segmentation.
Boyalla V, Harling L, Snell A, et al., 2022, Biomarkers as predictors of recurrence of atrial fibrillation post ablation: an updated and expanded systematic review and meta-analysis, CLINICAL RESEARCH IN CARDIOLOGY, Vol: 111, Pages: 680-691, ISSN: 1861-0684
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- Citations: 2
Malaczynska-Rajpold K, Jarman J, Shi R, et al., 2022, Beyond pulmonary vein isolation for persistent atrial fibrillation: sequential high-resolution mapping to guide ablation, JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY, Vol: 65, Pages: 53-62, ISSN: 1383-875X
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- Citations: 2
Shi R, Zaman JAB, Chen Z, et al., 2022, Novel aggregated multiposition noncontact mapping of atrial tachycardia in humans: From computational modeling to clinical validation, HEART RHYTHM, Vol: 19, Pages: 61-69, ISSN: 1547-5271
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- Citations: 1
Chen J, Yang G, Khan H, et al., 2022, JAS-GAN: generative adversarial network based joint atrium and scar segmentations on unbalanced atrial targets, IEEE Journal of Biomedical and Health Informatics, Vol: 26, Pages: 103-114, ISSN: 2168-2194
Automated and accurate segmentation of the left atrium (LA) and atrial scars from late gadolinium-enhanced cardiac magnetic resonance (LGE CMR) images are in high demand for quantifying atrial scars. The previous quantification of atrial scars relies on a two-phase segmentation for LA and atrial scars due to their large volume difference (unbalanced atrial targets). In this paper, we propose an inter-cascade generative adversarial network, namely JAS-GAN, to segment the unbalanced atrial targets from LGE CMR images automatically and accurately in an end-to-end way. Firstly, JAS-GAN investigates an adaptive attention cascade to automatically correlate the segmentation tasks of the unbalanced atrial targets. The adaptive attention cascade mainly models the inclusion relationship of the two unbalanced atrial targets, where the estimated LA acts as the attention map to adaptively focus on the small atrial scars roughly. Then, an adversarial regularization is applied to the segmentation tasks of the unbalanced atrial targets for making a consistent optimization. It mainly forces the estimated joint distribution of LA and atrial scars to match the real ones. We evaluated the performance of our JAS-GAN on a 3D LGE CMR dataset with 192 scans. Compared with state-of-the-art methods, our proposed approach yielded better segmentation performance (Average Dice Similarity Coefficient (DSC) values of 0.946 and 0.821 for LA and atrial scars, respectively), which indicated the effectiveness of our proposed approach for segmenting unbalanced atrial targets.
O'Connor M, Gatzoulis M, Wong T, 2021, Conduction system pacing in adults with congenital heart disease, International Journal of Cardiology Congenital Heart Disease, Vol: 6, Pages: 100288-100288, ISSN: 2666-6685
Haldar S, Khan HR, Boyalla V, et al., 2021, Thoracoscopic surgical ablation versus catheter ablation as first-line treatment for long-standing persistent atrial fibrillation: the CASA-AF RCT, Efficacy and Mechanism Evaluation, Vol: 8, Pages: 1-122, ISSN: 2050-4365
<jats:sec id="abs1-1"> <jats:title>Background</jats:title> <jats:p>Standalone thoracoscopic surgical ablation may be more effective than catheter ablation in patients with long-standing persistent atrial fibrillation.</jats:p> </jats:sec> <jats:sec id="abs1-2"> <jats:title>Objectives</jats:title> <jats:p>To determine whether or not surgical ablation is clinically superior to catheter ablation as the first-line treatment strategy in long-standing persistent atrial fibrillation.</jats:p> </jats:sec> <jats:sec id="abs1-3"> <jats:title>Design</jats:title> <jats:p>This was a prospective, multicentre, randomised control trial.</jats:p> </jats:sec> <jats:sec id="abs1-4"> <jats:title>Setting</jats:title> <jats:p>Four NHS tertiary centres in England.</jats:p> </jats:sec> <jats:sec id="abs1-5"> <jats:title>Participants</jats:title> <jats:p>Adults with long-standing persistent atrial fibrillation, who had European Heart Rhythm Association symptom scores > 2 and who were naive to previous catheter ablation or thoracic/cardiac surgery.</jats:p> </jats:sec> <jats:sec id="abs1-6"> <jats:title>Interventions</jats:title> <jats:p>Minimally invasive thoracoscopic surgical ablation and conventional catheter ablation (control intervention).</jats:p> </jats:sec> <jats:sec id="abs1-7"> <jats:title>Mai
Hind M, Wong T, 2021, Atrial Fibrillation, Obstructive Sleep Apnea, and Continuous Positive Airway Pressure: No Easy Fix, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 204, Pages: 503-505, ISSN: 1073-449X
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- Citations: 1
Gandjbakhch E, Laredo M, Berruezo A, et al., 2021, Outcomes after catheter ablation of ventricular tachycardia without implantable cardioverter-defibrillator in selected patients with arrhythmogenic right ventricular cardiomyopathy, EUROPACE, Vol: 23, Pages: 1428-1436, ISSN: 1099-5129
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- Citations: 2
Griffiths S, Behar JM, Li W, et al., 2021, Cerebral protection device for transvenous lead extraction in a patient with an intracardiac shunt, International Journal of Cardiology Congenital Heart Disease, Vol: 4, Pages: 100138-100138, ISSN: 2666-6685
Simard T, Jung RG, Lehenbauer K, et al., 2021, Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 78, Pages: 297-313, ISSN: 0735-1097
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- Citations: 31
Ali AN, Riad O, Tawfik M, et al., 2021, Newer generation cryoballoon vs. contact force-sensing radiofrequency ablation catheter in the ablation of paroxysmal atrial fibrillation., Herzschrittmacherther Elektrophysiol, Vol: 32, Pages: 236-243
BACKGROUND: Catheter ablation for atrial fibrillation (AF) has become an effective treatment to control symptoms. The second generation cryoballoon (CB) was designed for more efficient and homogenous freeze. Radiofrequency (RF) ablation catheters using three-dimensional electroanatomical mapping with the use of contact-force radiofrequency (CF RF) technology has achieved good results in several studies. OBJECTIVES: To compare the efficacy and safety of second-generation CB ablation in contrast to CF RF ablation in the ablation of paroxysmal AF. METHODS: A total of 81 consecutive patients suffering from paroxysmal AF underwent pulmonary vein isolation (PVI) either by the second generation cryoballoon (n = 44) or a contact force-sensing RF catheter (n = 37). The study was conducted at Ain Shams University Hospitals and Royal Brompton & Harefield NHS trust. Baseline data, procedural data and patient follow up-at 3, 6 and 12 months-were collected and analysed. RESULTS: The mean age was 53.8 ± 15 years in the CB group and 62.4 ± 12 years in the RF group, females representing 40.9% and 48.6% respectively. The baseline characteristics were comparable, but the CB group had less left atrial diameter and more left ventricular ejection fraction. The CB procedure was shorter (94.4 ± 39.3 vs. 140.8 ± 44.3 min, p < 0.0001), with longer fluoroscopy time (30 vs. 15.1 min, p = 0.047). Procedural complications were comparable between the two groups (CB 4.6%, CF RF 2.7%, p = 0.411). After 1 year, the recurrence rate in the CB group was similar to RF (27.3% vs. 27% respectively, p = 0.980). CONCLUSION: Second-generation CB ablation of paroxysmal AF has similar efficacy and safety to contact force-sensing RF catheters, with shorter procedure times and more fluoroscopy.
Shi R, Chen Z, Pope MTB, et al., 2021, Individualized ablation strategy to treat persistent atrial fibrillation: Core-to-boundary approach guided by charge-density mapping, HEART RHYTHM, Vol: 18, Pages: 862-870, ISSN: 1547-5271
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- Citations: 10
Maclean E, Simon R, Ang R, et al., 2021, A multi-center experience of ablation index for evaluating lesion delivery in typical atrial flutter, PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, Vol: 44, Pages: 1039-1046, ISSN: 0147-8389
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- Citations: 3
Griffiths S, Behar JM, Lascelles K, et al., 2021, The fatal consequence of inappropriate therapy in a single VF zone primary prevention defibrillator, PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, Vol: 44, Pages: 740-743, ISSN: 0147-8389
Schwarzl JM, Schleberger R, Kahle A-K, et al., 2021, Specific electrogram characteristics impact substrate ablation target area in patients with scar-related ventricular tachycardia-insights from automated ultrahigh-density mapping, JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Vol: 32, Pages: 376-388, ISSN: 1045-3873
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- Citations: 5
Ma Y, Zaman JAB, Shi R, et al., 2021, Spectral characterization and impact of stepwise ablation protocol including LAA electrical isolation on persistent AF, PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, Vol: 44, Pages: 318-326, ISSN: 0147-8389
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- Citations: 1
Boyalla V, Jarman JWE, Markides V, et al., 2021, Internationally validated score to predict the outcome of non-paroxysmal atrial fibrillation ablation: the 'FLAME score', OPEN HEART, Vol: 8, ISSN: 2053-3624
Haldar S, Khan HR, Boyalla V, et al., 2020, Catheter ablation vs. thoracoscopic surgical ablation in long-standing persistent atrial fibrillation: CASA-AF randomized controlled trial., European Heart Journal, Vol: 41, Pages: 4471-4480, ISSN: 0195-668X
AIMS: Long-standing persistent atrial fibrillation (LSPAF) is challenging to treat with suboptimal catheter ablation (CA) outcomes. Thoracoscopic surgical ablation (SA) has shown promising efficacy in atrial fibrillation (AF). This multicentre randomized controlled trial tested whether SA was superior to CA as the first interventional strategy in de novo LSPAF. METHODS AND RESULTS: We randomized 120 LSPAF patients to SA or CA. All patients underwent predetermined lesion sets and implantable loop recorder insertion. Primary outcome was single procedure freedom from AF/atrial tachycardia (AT) ≥30 s without anti-arrhythmic drugs at 12 months. Secondary outcomes included clinical success (≥75% reduction in AF/AT burden); procedure-related serious adverse events; changes in patients' symptoms and quality-of-life scores; and cost-effectiveness. At 12 months, freedom from AF/AT was recorded in 26% (14/54) of patients in SA vs. 28% (17/60) in the CA group [OR 1.128, 95% CI (0.46-2.83), P = 0.83]. Reduction in AF/AT burden ≥75% was recorded in 67% (36/54) vs. 77% (46/60) [OR 1.13, 95% CI (0.67-4.08), P = 0.3] in SA and CA groups, respectively. Procedure-related serious adverse events within 30 days of intervention were reported in 15% (8/55) of patients in SA vs. 10% (6/60) in CA, P = 0.46. One death was reported after SA. Improvements in AF symptoms were greater following CA. Over 12 months, SA was more expensive and provided fewer quality-adjusted life-years (QALYs) compared with CA (0.78 vs. 0.85, P = 0.02). CONCLUSION: Single procedure thoracoscopic SA is not superior to CA in treating LSPAF. Catheter ablation provided greater improvements in symptoms and accrued significantly more QALYs during follow-up than SA. CLINICAL TRIAL REGISTRATION: ISRCTN18250790 and ClinicalTrials.gov: NCT02755688.
Wu J-T, Zaman JAB, Yakupoglu HY, et al., 2020, Catheter Ablation of Atrial Fibrillation in Patients With Functional Mitral Regurgitation and Left Ventricular Systolic Dysfunction, FRONTIERS IN CARDIOVASCULAR MEDICINE, Vol: 7, ISSN: 2297-055X
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- Citations: 7
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