Publications
183 results found
Rydman R, Shiina Y, Diller GP, et al., 2017, Major adverse events and atrial tachycardia in Ebstein’s anomaly by cardiovascular magnetic resonance, Heart, Vol: 104, Pages: 37-44, ISSN: 1468-201X
Objectives Patients with Ebstein’s anomaly of the tricuspid valve (EA) are at risk of tachyarrhythmia, congestive heart failure and sudden cardiac death. We sought to determine the value of cardiovascular magnetic resonance (CMR) for predicting these outcomes. Methods Seventy-nine consecutive adult patients (aged 37±15 years) with unrepaired EA underwent CMR and were followed prospectively for a median 3.4 (range 0.4-10.9) years for clinical outcomes, namely major adverse cardiovascular events (MACE: sustained ventricular tachycardia/heart failure hospital admission/cardiac transplantation/death) and first-onset atrial tachyarrhythmia (AT).Results CMR-derived variables associated with MACE (n=6) were right ventricular (RV) or left ventricular (LV) ejection fraction (EF) (HR 2.06[95%CI 1.168-3.623],p=0.012 and HR 2.35[95%CI 1.348-4.082],p=0.003, respectively), LV stroke volume index (HR 2.82[95%CI 1.212-7.092],p=0.028) and cardiac index (HR 1.71[95%CI 1.002-1.366],p=0.037);all remained significant when tested solely for mortality. Prior history of AT (HR 11.16[95%CI 1.30-95.81],p=0.028) and NYHA-class >2 (HR 7.66[95%CI 1.54-38.20],p=0.013) were also associated with MACE; AT preceded all but one MACE events suggesting its potential role as an early marker of adverse outcome (p=0.011). CMR variables associated with first-onset AT (n=17;21.5%) included RVEF (HR 1.55[95%CI 1.103-2.160],p=0.011)],total R/L volume index (HR 1.18[95%CI 1.06-1.32],p=0.002), RV/LV end diastolic volume ratio (HR 1.55[95%CI 1.14-2.10],p=0.005) and apical septal leaflet displacement/total LV septal length (HR 1.03[95%CI 1.00-1.07],p=0.041); the latter two combined enhanced risk prediction (HR 6.12[95% CI 1.67-22.56],p=0.007). Conclusion CMR-derived indices carry prognostic information regarding MACE and first-onset AT amongst adults with unrepaired EA. CMR may be included in the periodic surveillance of these patients.
Yang G, Zhuang X, Khan H, et al., 2017, A fully automatic deep learning method for atrial scarring segmentation from late gadolinium-enhanced MRI images, 2017 IEEE 14th International Symposium on Biomedical Imaging, Publisher: IEEE, Pages: 844-848, ISSN: 1945-7928
Precise and objective segmentation of atrial scarring (SAS) is a prerequisite for quantitative assessment of atrial fibrillation using non-invasive late gadolinium-enhanced (LGE) MRI. This also requires accurate delineation of the left atrium (LA) and pulmonary veins (PVs) geometry. Most previous studies have relied on manual segmentation of LA wall and PVs, which is a tedious and error-prone procedure with limited reproducibility. There are many attempts on automatic SAS using simple thresholding, histogram analysis, clustering and graph-cut based approaches; however, in general, these methods are considered as unsupervised learning thus subject to limited segmentation accuracy. In this study, we present a fully-automated multi-atlas based whole heart segmentation method to derive the LA and PVs geometry objectively that is followed by a fully automatic deep learning method for SAS. Our deep learning method consists of a feature extraction step via super-pixel over-segmentation and a supervised classification step via stacked sparse auto-encoders. We demonstrate the efficacy of our method on 20 clinical LGE MRI scans acquired from a longstanding persistent atrial fibrillation cohort. Both quantitative and qualitative results show that our fully automatic method obtained accurate segmentation results compared to the manual segmentation based ground truths.
Jarman JW, Hunter TD, Hussain W, et al., 2017, Mortality, stroke, and heart failure in atrial fibrillation cohorts after ablation versus propensity-matched cohorts, Pragmatic and Observational Research, Vol: 8, Pages: 99-106, ISSN: 1179-7266
Background: We sought to determine from key clinical outcomes whether catheter ablation of atrial fibrillation (AF) is associated with increased survival.Methods and results: Using routinely collected hospital data, ablation patients were matched to two control cohorts using direct and propensity score methodology. Four thousand nine hundred ninety-one ablation patients were matched 1:1 with general AF controls without ablation. Five thousand four hundred seven ablation patients were similarly matched to controls who underwent cardioversion. We examined the rates of ischemic stroke or transient ischemic attack (stroke/TIA), heart failure hospitalization, and death. Matched populations had very similar comorbidity profiles, including nearly identical CHA2DS2-VASc risk distribution (p=0.6948 and p=0.8152 vs general AF and cardioversion cohorts). Kaplan–Meier models showed increased survival after ablation for all outcomes compared with both control cohorts (p<0.0001 for all outcomes vs general AF, p=0.0087 for stroke/TIA, p<0.0001 for heart failure, and p<0.0001 for death vs cardioversion). Cox regression models also showed improved survival after ablation for all outcomes compared with the general AF cohort (hazard ratio [HR]=0.4, 95% confidence interval [95% CI]: 0.3–0.6, p<0.0001 for stroke/TIA; HR=0.4, 95% CI: 0.2–0.6, p<0.0001 for heart failure; HR=0.1, 95% CI: 0.1–0.1, p<0.0001 for death) and the cardioversion cohort (HR=0.6 , 95% CI: 0.4–0.9, p=0.0111 for stroke/TIA; HR=0.4, 95% CI: 0.3–0.6, p<0.0001 for heart failure; HR=0.3, 95% CI:0.2–0.5, p<0.0001 for death).Conclusions: Catheter ablation of AF was associated with very significant reductions in mortality, stroke/TIA, and heart failure compared with a matched general AF population and a matched population who underwent cardioversion. Potential confounding of outcomes was minimized by very tight cohort matching.
Jarman JW, Hunter TD, Hussain W, et al., 2017, Stroke rates before and after ablation of atrial fibrillation and in propensity-matched controls in the UK, Pragmatic and Observational Research, Vol: 8, Pages: 107-118, ISSN: 1179-7266
Background: We sought to determine whether catheter ablation of atrial fibrillation (AF) is associated with reduced occurrence of ischemic cerebrovascular events.Methods and results: Using routinely collected hospital data, ablation patients were matched to two control cohorts via direct and propensity score matching. A total of 4,991 ablation patients were matched 1:1 to general AF controls with no ablation, and 5,407 ablation patients were similarly matched to controls who underwent cardioversion. Yearly rates of ischemic stroke or transient ischemic attack (stroke/TIA) before and after an index date were compared between cohorts. Index date was defined as the first ablation, the first cardioversion, or the second AF event in the general AF cohort. Matched populations had very similar demographic and comorbidity profiles, including nearly identical CHA2DS2-VASc risk distribution (p-values 0.6948 and 0.8152 vs general AF and cardioversion cohorts). Statistical models of stroke/TIA risk in the preindex period showed no difference in annual event rates between cohorts (mean±standard error 0.30% ± 0.08% ablation vs 0.28% ± 0.07% general AF, p=0.8292; 0.37% ± 0.09% ablation vs 0.42% ± 0.08% cardioversion, p=0.5198). Postindex models showed significantly lower annual rates of stroke/TIA in ablation patients compared with each control group over 5 years (0.64% ± 0.11% ablation vs 1.84% ± 0.23% general AF, p<0.0001; 0.82% ± 0.15% ablation vs 1.37% ± 0.18% cardioversion, p=0.0222).Conclusion: Matching resulted in cohorts having the same baseline risks and rates of ischemic cerebrovascular events. After the index date, there were significantly lower yearly event rates in the ablation cohort. These results suggest the divergence in outcome rates stems from variance in the treatment pathways beginning at the index date.
Boutou AK, Franks R, Mohan D, et al., 2017, Exercise-induced changes in QT interval are smaller in COPD patients and have no impact on mortality, European Respiratory Journal, Vol: 49, ISSN: 0903-1936
Midha D, Chen Z, Jones DG, et al., 2017, Pacing in congenital heart disease - A four-decade experience in a single tertiary centre, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 241, Pages: 177-181, ISSN: 0167-5273
Betts TR, Leo M, Panikker S, et al., 2017, Percutaneous Left Atrial Appendage Occlusion Using Different Technologies in the United Kingdom: A Multicenter Registry, CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Vol: 89, Pages: 484-492, ISSN: 1522-1946
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- Citations: 27
Zakeri R, Van Wagoner DR, Calkins H, et al., 2017, The burden of proof: The current state of atrial fibrillation prevention and treatment trials, HEART RHYTHM, Vol: 14, Pages: 763-782, ISSN: 1547-5271
Jones DG, Markides V, Chow AW, et al., 2017, Characterization and consistency of interactions of triggers and substrate at the onset of paroxysmal atrial fibrillation., Europace, Vol: 19, Pages: 1454-1462, ISSN: 1099-5129
Aims: Initiating mechanisms of atrial fibrillation (AF) remain poorly understood, involving complex interaction between triggers and the atrial substrate. This study sought to classify the transitional phenomena, hypothesizing that there is consistency within and between patients in trigger-substrate interaction during transition to AF. Methods and results: Non-contact left atrial (LA) mapping was performed in 17 patients undergoing ablation for paroxysmal AF. All had spontaneous ectopy. Left atrial activation from the first ectopic to established AF was examined offline to characterize the initiating and transitional sequence of activation. In 57 fully mapped spontaneous AF initiations in 8 patients, all involved interaction of pulmonary venous/LA triggers with a septopulmonary line of block (SP-LOB) also evident in sinus rhythm, by 4 different transitional mechanisms characterized by (i) continuous focal firing: AF resulted from fragmentation of each ectopic wavefront through gaps in the SP-LOB and persisted only while focal firing continued (n = 18/32%) (ii) transient focal firing, wavefront fragmentation at the SP-LOB produced wavelet re-entry that persisted after cessation of an initiating ectopic source (n = 12/21%), (iii) of two separate interacting ectopic foci (n = 15/26%), or from (iv) transiently stable macroreentry (n = 12/21%), around the SP-LOB extending to the LA roof, resulting in progressive wavefront fragmentation. It was found that 79 ± 22% of each of the initiations in individual patients showed the same triggering mechanism. Conclusion: Onset of paroxysmal AF can be described by discrete mechanistic categories, all involving interaction of ectopic activity with a common SP-LOB. Within/between-patient consistency of initiations suggests constancy of the interacting triggers and substrate, and supports the concept of mechanistically tailored treatment.
Yang G, Zhuang X, Khan H, et al., 2017, Differentiation of Pre-ablation and Post-ablation Late Gadolinium-enhanced Cardiac MRI Scans of Longstanding Persistent Atrial Fibrillation Patients
Yang G, Zhuang X, Khan H, et al., 2017, Multi-atlas Propagation based Left Atrium Segmentation Coupled with Super-voxel based Pulmonary Veins Delineation in Late Gadolinium-enhanced Cardiac MRI
Chen Z, Kontogeorgis A, Uebing A, et al., 2016, Threading the eye of a needle: successful implantation of defibrillator leads through a stent strut after treatment for complex superior vena cava obstruction., JACC: Clinical Electrophysiology, Vol: 3, Pages: 528-529, ISSN: 2405-5018
Panikker S, Lord J, Jarman JWE, et al., 2016, Outcomes and costs of left atrial appendage closure from randomized controlled trial and real-world experience relative to oral anticoagulation, EUROPEAN HEART JOURNAL, Vol: 37, Pages: 3470-3482A, ISSN: 0195-668X
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- Citations: 22
Viswanathan K, Mantziari L, Butcher C, et al., 2016, Evaluation of a novel high-resolution mapping system for catheter ablation of ventricular arrhythmias., Heart Rhythm, Vol: 14, Pages: 176-183, ISSN: 1547-5271
BACKGROUND: The mapping of ventricular arrhythmias in humans using a minibasket 64-electrode catheter paired with a novel automatic mapping system (Rhythmia) has not been evaluated. OBJECTIVE: The purpose of this study was to evaluate the safety and efficacy of mapping ventricular arrhythmias and clinical outcomes after ablation using this system. METHODS: Electroanatomic maps for ventricular arrhythmias were obtained during 20 consecutive procedures in 19 patients (12 with ventricular tachycardia [VT] and 2 with ventricular ectopy [VE]). High-density maps were acquired using automatic beat acceptance and automatic system annotation of electrograms. RESULTS: Forty-seven electroanatomic maps (including 3 right ventricular and 9 epicardial maps) were obtained. Left ventricular endocardial mapping by transseptal (n = 13) and/or transaortic (n = 11) access was safe with no complications related to the minibasket catheter. VT substrate maps (n = 14; median 10,184 points) consistently demonstrated late potentials with high resolution. VT activation maps (n = 25; median 6401 points) obtained by automatic annotation included 7 complete maps (covering ≥90% of the tachycardia cycle length) in 5 patients in whom the entire VT circuit was accurately visualized. VE timing maps (n = 8) successfully localized the origin of VEs in all, with all accepted beats consistent with clinical VEs. Over a median follow-up of 10 months, no arrhythmia recurrence was noted in 75% after VT ablation and 86% after VE ablation. CONCLUSION: In this first human experience for ventricular arrhythmias using this system, ultra-high-density maps were created rapidly and safely, with a reliable automatic annotation of VT and consistent recording of abnormal electrograms. Medium-term outcomes after ablation were encouraging. Further larger studies are needed to validate these findings.
Panikker S, Jarman JWE, Virmani R, et al., 2016, Response by Panikker et al to letter regarding article, "Left atrial appendage electrical isolation and concomitant device occlusion to treat persistent atrial fibrillation: a first-in-human safety, feasibility, and efficacy study", Circulation-Arrhythmia and Electrophysiology, Vol: 9, ISSN: 1941-3149
Jones DG, Haldar SK, Donovan J, et al., 2016, Biomarkers in persistent AF and heart failure: impact of catheter ablation compared with rate control, PACE-Pacing and Clinical Electrophysiology, Vol: 39, Pages: 926-934, ISSN: 0147-8389
BackgroundTo investigate the effects of catheter ablation and rate control strategies on cardiac and inflammatory biomarkers in patients with heart failure and persistent atrial fibrillation (AF).MethodsPatients were recruited from the ARC-HF trial (catheter Ablation vs Rate Control for management of persistent AF in Heart Failure, NCT00878384), which compared ablation with rate control for persistent AF in heart failure. B-type natriuretic peptide (BNP), midregional proatrial natriuretic peptide (MR-proANP), apelin, and interleukin-6 (IL-6) were assayed at baseline, 3 months, 6 months, and 12 months. The primary end point, analyzed per-protocol, was changed from baseline at 12 months.ResultsOf 52 recruited patients, 24 ablation and 25 rate control subjects were followed to 12 months. After 1.2 ± 0.5 procedures, sinus rhythm was present in 22 (92%) ablation patients; under rate control, rate criteria were achieved in 23 (96%) of 24 patients remaining in AF. At 12 months, MR-proANP fell significantly in the ablation arm (–106.0 pmol/L, interquartile range [IQR] –228.2 to –60.6) compared with rate control (–28.7 pmol/L, IQR –69 to +9.5, P = 0.028). BNP showed a similar trend toward reduction (P = 0.051), with no significant difference in apelin (P = 0.13) or IL-6 (P = 0.68). Changes in MR-proANP and BNP correlated with peak VO2 and ejection fraction, and MR-proANP additionally with quality-of-life score.ConclusionsCatheter ablation, compared with rate control, in patients with heart failure and persistent AF was associated with significant reduction in MR-proANP, which correlated with physiological and symptomatic improvement. Ablation-based rhythm control may induce beneficial cardiac remodeling, unrelated to changes in inflammatory state. This may have prognostic implications, which require confirmation by event end point studies.
Bartus K, Gafoor S, Tschopp D, et al., 2016, Left atrial appendage ligation with the next generation LARIAT<SUP>+</SUP> suture delivery device: Early clinical experience, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 215, Pages: 244-247, ISSN: 0167-5273
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- Citations: 21
Jones S, Lumens J, Sohaib SMA, et al., 2016, Cardiac Resynchronisation Therapy: mechanisms of action and scope for further improvement in cardiac function, Europace, Vol: 19, Pages: 1178-1186, ISSN: 1532-2092
BackgroundCardiac resynchronisation therapy(CRT) may exert its beneficial hemodynamic effect by improving ventricular synchrony and improving atrioventricular(AV) timing.Aims To establish the relative importance of the mechanisms through which CRT improves cardiac function and explore the potential for additional improvements with improved ventricular resynchronisation. Methods We performed simulations using the CircAdapt haemodynamic model and performed haemodynamic measurements while adjusting AV delay, at low and high heart rates, in 87 patients with CRT devices. We assessed QRS duration, presence of fusion and haemodynamic response.ResultsThe simulations suggest intrinsic PR interval and the magnitude of reduction in ventricular activation determine the relative importance of the mechanisms of benefit. For example, if PR interval is 201ms and LV activation time is reduced by 25ms (typical for current CRT methods) then AV delay optimisation is responsible for 69% of overall improvement. Reducing LV activation time by an additional 25ms produced an additional 2.6mmHg increase in BP (30% of effect size observed with current CRT).In the clinical population, ventricular fusion significantly shortened QRS duration (∆-27±23ms, P <0.001), and, improved SBP (mean 2.5 mmHg increase). Ventricular Fusion was present in 69% of patients, yet in 40% of patients with fusion, shortening AV delay (to a delay where fusion was not present) produced the optimal haemodynamic response.ConclusionsImproving LV preloading by shortening AV delay is an important mechanism through which cardiac function is improved with CRT. There is substantial scope for further improvement if methods for delivering more efficient ventricular resynchronisation can be developed.
Panikker S, Jarman JWE, Virmani R, et al., 2016, Left Atrial Appendage Electrical Isolation and Concomitant Device Occlusion to Treat Persistent Atrial Fibrillation A First-in-Human Safety, Feasibility, and Efficacy Study, CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, Vol: 9, ISSN: 1941-3149
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- Citations: 70
Rydman R, Shiina Y, Diller G-P, et al., 2016, MORTALITY AND VT IN EBSTEIN'S ANOMALY OF THE TRICUSPID VALVE: A PROSPECTIVE CARDIOVASCULAR MAGNETIC RESONANCE STUDY, Annual Meeting of the British-Congenital-Cardiac-Association, Publisher: BMJ PUBLISHING GROUP, Pages: A27-A27, ISSN: 1355-6037
Ullah W, Schilling RJ, Wong T, 2016, Contact force and atrial fibrillation ablation., Journal of Atrial Fibrillation, Vol: 8, Pages: 1-7, ISSN: 1941-6911
Catheters able to measure the force and vector of contact between the catheter tip and myocardium are now available. Pre-clinical work has established that the degree of contact between the radiofrequency ablation catheter and myocardium correlates with the size of the delivered lesion. Excess contact is associated with steam pops and perforation. Catheter contact varies within the left atrium secondary to factors including respiration, location, atrial rhythm and the trans-septal catheter delivery technology used. Compared with procedures performed without contact force (CF)-sensing, the use of this technology has, in some studies, been found to improve complication rates, procedure and fluoroscopy times, and success rates. However, for each of these parameters there are also studies suggesting a lack of difference from the availability of CF data. Nevertheless, CF-sensing technology has been adopted as a standard of care in many institutions. It is likely that use of CF-sensing technology will allow for the optimization of each individual radiofrequency application to maximize efficacy and procedural safety. Recent work has attempted to define what these optimal targets should be, and approaches to do this include assessing for sites of pulmonary vein reconnection after ablation, or comparing the impedance response to ablation. Based on such work, it is apparent that factors including mean CF, force time integral (the area under the force-time curve) and contact stability are important determinants of ablation efficacy. Multicenter prospective randomized data are lacking in this field and required to define the CF parameters required to produce optimal ablation.
Lazoura O, Ismail TF, Pavitt C, et al., 2016, A low-dose, dual-phase cardiovascular CT protocol to assess left atrial appendage anatomy and exclude thrombus prior to left atrial intervention, INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING, Vol: 32, Pages: 347-354, ISSN: 1569-5794
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- Citations: 32
Wynn GJ, Panikker S, Morgan M, et al., 2016, Biatrial linear ablation in sustained nonpermanent AF: Results of the substrate modification with ablation and antiarrhythmic drugs in nonpermanent atrial fibrillation (SMAN-PAF) trial, HEART RHYTHM, Vol: 13, Pages: 399-406, ISSN: 1547-5271
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- Citations: 33
Lim E, Wong T, 2016, Is non-sustained ventricular tachycardia a predictor of sudden death in adults with congenital heart disease?, International Journal of Cardiology, Vol: 207, Pages: 264-265, ISSN: 1874-1754
Giannakidis A, Nyktari E, Keegan J, et al., 2015, Rapid automatic segmentation of abnormal tissue in late gadolinium enhancement cardiovascular magnetic resonance images for improved management of long-standing persistent atrial fibrillation., Biomedical Engineering Online, Vol: 14, ISSN: 1475-925X
BACKGROUND: Atrial fibrillation (AF) is the most common heart rhythm disorder. In order for late Gd enhancement cardiovascular magnetic resonance (LGE CMR) to ameliorate the AF management, the ready availability of the accurate enhancement segmentation is required. However, the computer-aided segmentation of enhancement in LGE CMR of AF is still an open question. Additionally, the number of centres that have reported successful application of LGE CMR to guide clinical AF strategies remains low, while the debate on LGE CMR's diagnostic ability for AF still holds. The aim of this study is to propose a method that reliably distinguishes enhanced (abnormal) from non-enhanced (healthy) tissue within the left atrial wall of (pre-ablation and 3 months post-ablation) LGE CMR data-sets from long-standing persistent AF patients studied at our centre. METHODS: Enhancement segmentation was achieved by employing thresholds benchmarked against the statistics of the whole left atrial blood-pool (LABP). The test-set cross-validation mechanism was applied to determine the input feature representation and algorithm that best predict enhancement threshold levels. RESULTS: Global normalized intensity threshold levels T PRE = 1 1/4 and T POST = 1 5/8 were found to segment enhancement in data-sets acquired pre-ablation and at 3 months post-ablation, respectively. The segmentation results were corroborated by using visual inspection of LGE CMR brightness levels and one endocardial bipolar voltage map. The measured extent of pre-ablation fibrosis fell within the normal range for the specific arrhythmia phenotype. 3D volume renderings of segmented post-ablation enhancement emulated the expected ablation lesion patterns. By comparing our technique with other related approaches that proposed different threshold levels (although they also relied on reference regions from within the LABP) for segmenting enhancement in LGE CMR data-sets of AF patients, we illustra
Butcher C, Mareev Y, Markides V, et al., 2015, Cardiac Resynchronization Therapy Update: Evolving Indications, Expanding Benefit?, CURRENT CARDIOLOGY REPORTS, Vol: 17, ISSN: 1523-3782
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- Citations: 4
Mantziari L, Butcher C, Kontogeorgis A, et al., 2015, Utility of a novel rapid high-resolution mapping system in the catheter ablation of arrhythmias: an initial human experience of mapping the atria and the left ventricle., JACC: Clinical Electrophysiology, Vol: 1, Pages: 411-420, ISSN: 2405-5018
OBJECTIVES: This study sought to assess the clinical efficacy, safety, and clinical utility of a novel electroanatomical mapping system. BACKGROUND: A new mapping system capable of rapidly acquiring detailed maps based on automatic annotation of thousands of points was recently released for clinical use. This is the first description of its utility in humans. METHODS: The first consecutive 20 cases (7 atrial tachycardia, 8 atrial fibrillation, 3 ventricular tachycardia, and 2 ventricular ectopic beat ablations) were analyzed. The system uses a bidirectional deflectable basket catheter with 64 closely spaced mini-electrodes. It automatically accepts and annotates electrograms when a number of predefined criteria are met. RESULTS: Thirty right atrial maps were acquired in 11 (4 to 15) min, consisting of 7,220 (3,467 to 10,947) points, 22 left atrial maps in 11 (6 to 19) min, consisting of 7,818 (4,379 to 12,262) points and 10 left ventricular maps in 37 (14 to 43) min, consisting of 8,709 (2,605 to 15,514) points. The mini-basket catheter could reach all areas of interest without deflectable sheaths. No embolic events, bleeding complications, or endocardial structure damage were observed. Correction of the automatic annotation was performed in 0.02% of points in 4 of 62 maps. The system revealed re-entry circuits of atrial tachyarrhythmias, identified gaps on linear lesions, and identified and correctly annotated the clinical ventricular ectopic beats and channels of slow conduction within ventricular scar. CONCLUSIONS: The novel automatic mapping system was rapid, safe, and efficacious in mapping a variety of cardiac arrhythmias in humans. Further clinical research is needed to optimize its use in the ablation of complex arrhythmias.
Al Halabi S, Qintar M, Hussein A, et al., 2015, Catheter Ablation for Atrial Fibrillation in Heart Failure Patients: A Meta-Analysis of Randomized Controlled Trials., JACC Clin Electrophysiol, Vol: 1, Pages: 200-209, ISSN: 2405-500X
BACKGROUND: Rhythm control with antiarrhythmic drugs (AADs) is not superior to rate control in patients with heart failure (HF) and atrial fibrillation (AF), but AF ablation may be more successful at achieving rhythm control than AADs. However, risks for both ablation and AADs are likely higher and success rates lower in patients with HF. OBJECTIVE: To compare rate control versus AF catheter ablation strategies in patients with AF and HF. METHODS: We conducted a meta-analysis of trials which randomized HF patients (LVEF<50%) with AF to a rate control or AF catheter ablation strategy and reported change in LVEF, quality of life, 6-minute walk test, or peak oxygen consumption. Study quality and heterogenity were assessed using Jadad scores and Cochran's Q statistics, respectively. Mantel Haenszel relative risks and mean differences were calculated using random effect models. RESULTS: Four trials (N=224) met inclusion criteria; 82.5% (n=185) had persistent AF. AF ablation was associated with an increase in LVEF (mean difference 8.5%; 95%CI 6.4,10.7%; P<0.001) compared to rate control. AF ablation was superior in improving quality of life by Minnesota Living with Heart Failure (MLWHF) questionnaire scores (mean difference -11.9; 95%CI -17.1, -6.6; P<0.001). Peak oxygen consumption and 6-minute walk distance increased in AF ablation compared to rate control patients (mean difference 3.2; 95%CI 1.1,5.2; P=0.003; mean difference 34.8; 95%CI 2.9, 66.7; P = 0.03, respectively). In the persistent AF subgroup LVEF and MLWHF were significantly improved with AF ablation. Major adverse event rates (RR 1.3; 95% CI, 0.4, 3.9; p=0.64) were not significantly different. No significant heterogeneity was evident. CONCLUSIONS: In patients with HF and AF, AF catheter ablation is superior to rate control in improving LVEF, quality of life and functional capacity. Prior to accepting a rate control strategy in HF patients with persistent or drug refractory AF, consideration should b
Khwanda A, Rosen SD, Cohen A, et al., 2015, ECG ABNORMALITIES IN PATIENTS ON ANTIPSYCHOTIC MEDICATION: MORE TO IT THAN QT PROLONGATION, British-Cardiac-Society (BCS) Annual Conference on Hearts and Genes, Publisher: BMJ PUBLISHING GROUP, Pages: A35-A35, ISSN: 1355-6037
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Rydman R, Gatzoulis MA, Ho SY, et al., 2015, Systemic Right Ventricular Fibrosis Detected by Cardiovascular Magnetic Resonance Is Associated With Clinical Outcome, Mainly New-Onset Atrial Arrhythmia, in Patients After Atrial Redirection Surgery for Transposition of the Great Arteries, CIRCULATION-CARDIOVASCULAR IMAGING, Vol: 8, ISSN: 1941-9651
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- Citations: 38
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