152 results found
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%  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.
Sarkozy A, Vijgen J, De Potter T, et al., 2022, An early multicenter experience of the novel high-density star-shaped mapping catheter in complex arrhythmias, JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY, ISSN: 1383-875X
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, ISSN: 1383-875X
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
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
Obika BD, Dolezova N, Ponzo S, et al., 2021, Implementation of a mHealth solution to remotely monitor patients on a cardiac surgical waiting list: service evaluation, JAMIA OPEN, Vol: 4
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
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
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
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
Gue YX, Kanji R, Markides V, et al., 2020, Angiotensin Converting Enzyme 2 May Mediate Disease Severity In COVID-19, AMERICAN JOURNAL OF CARDIOLOGY, Vol: 130, Pages: 161-162, ISSN: 0002-9149
Shi R, Chen Z, Butcher C, et al., 2020, Diverse activation patterns during persistent atrial fibrillation by noncontact charge-density mapping of human atrium, JOURNAL OF ARRHYTHMIA, Vol: 36, Pages: 692-702, ISSN: 1880-4276
Shi R, Parikh P, Chen Z, et al., 2020, Validation of Dipole Density Mapping During Atrial Fibrillation and Sinus Rhythm in Human Left Atrium, JACC-CLINICAL ELECTROPHYSIOLOGY, Vol: 6, Pages: 171-181, ISSN: 2405-500X
Karim N, Ho SY, Nicol E, et al., 2020, The left atrial appendage in humans: structure, physiology, and pathogenesis, EUROPACE, Vol: 22, Pages: 5-18, ISSN: 1099-5129
Butcher C, Sohaib S, Shun-Shin M, et al., 2019, High Precision Acute Haemodynamic Evaluation of Personalisation of Endocardial Left Ventricular Pacing Site in Patients With Heart Failure, Scientific Sessions of the American-Heart-Association, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322
Gue YX, Spinthakis N, Markides V, et al., 2019, Patients with atrial fibrillation exhibit a systemic prothrombotic state attributable to impaired endogenous fibrinolysis, Congress of the European-Society-of-Cardiology (ESC) / World Congress of Cardiology, Publisher: OXFORD UNIV PRESS, Pages: 2948-2948, ISSN: 0195-668X
Shi R, Pope MTB, Boyalla V, et al., 2019, Core to block: a new ablation strategy for treating persistent atrial fibrillation, Congress of the European-Society-of-Cardiology (ESC) / World Congress of Cardiology, Publisher: OXFORD UNIV PRESS, Pages: 573-573, ISSN: 0195-668X
Karim N, Marinelli A, Cantor E, et al., 2019, Safety of atrial fibrillation catheter ablation in the elderly, Congress of the European-Society-of-Cardiology (ESC) / World Congress of Cardiology, Publisher: OXFORD UNIV PRESS, Pages: 1775-1775, ISSN: 0195-668X
Shi R, Chen Z, Butcher C, et al., 2019, Diverse activation patterns during persistent atrial fibrillation characterised by dipole density non-contact mapping, Congress of the European-Society-of-Cardiology (ESC) / World Congress of Cardiology, Publisher: OXFORD UNIV PRESS, Pages: 2354-2354, ISSN: 0195-668X
Corden B, Jarman J, Whiffin N, et al., 2019, Association between titin truncating variants and life-threatening cardiac arrhythmias in patients with dilated cardiomyopathy and implantable defibrillator, JAMA Network Open, Vol: 2, Pages: 1-12, ISSN: 2574-3805
Importance There is a need for better arrhythmic risk stratification in nonischemic dilated cardiomyopathy (DCM). Titin-truncating variants (TTNtvs) in the TTN gene are the most common genetic cause of DCM and may be associated with higher risk of arrhythmias in patients with DCM.Objective To determine if TTNtv status is associated with the development of life-threatening ventricular arrhythmia and new persistent atrial fibrillation in patients with DCM and implanted cardioverter defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) devices.Design, Setting, and Participants This retrospective, multicenter cohort study recruited 148 patients with or without TTNtvs who had nonischemic DCM and ICD or CRT-D devices from secondary and tertiary cardiology clinics in the United Kingdom from February 1, 2011, to June 30, 2016, with a median (interquartile range) follow-up of 4.2 (2.1-6.5) years. Exclusion criteria were ischemic cardiomyopathy, primary valve disease, congenital heart disease, or a known or likely pathogenic variant in the lamin A/C gene. Analyses were performed February 1, 2017, to May 31, 2017.Main Outcome and Measures The primary outcome was time to first device-treated ventricular tachycardia of more than 200 beats/min or first device-treated ventricular fibrillation. Secondary outcome measures included time to first development of persistent atrial fibrillation.Results Of 148 patients recruited, 117 adult patients with nonischemic DCM and an ICD or CRT-D device (mean [SD] age, 56.9 [12.5] years; 76 [65.0%] men; 106 patients [90.6%] with primary prevention indications) were included. Having a TTNtv was associated with a higher risk of receiving appropriate ICD therapy (shock or antitachycardia pacing) for ventricular tachycardia or fibrillation (hazard ratio [HR], 4.9; 95% CI, 2.2-10.7; P < .001). This association was independent of all covariates, including midwall fibrosis measured by late gadolinium enhanc
Khan H, Haldar S, Boyalla V, et al., 2019, Left atrial reverse remodelling is not associated with improved success in treatment of long standing persistent atrial fibrillation, Publisher: OXFORD UNIV PRESS, Pages: 250-250, ISSN: 2047-2404
Shi R, Parikh P, Chen Z, et al., 2019, DIPOLE DENSITY MAPPING OF ATRIAL FIBRILLATION AND SINUS RHYTHM IN THE HUMAN LEFT ATRIUM: A CLINICAL VALIDATION STUDY, 68th Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), Publisher: ELSEVIER SCIENCE INC, Pages: 326-326, ISSN: 0735-1097
Shi R, Chen Z, Kontogeorgis A, et al., 2019, EPICARDIAL VENTRICULAR TACHYCARDIA ABLATION GUIDED BY A NOVEL HIGH-RESOLUTION CONTACT MAPPING SYSTEM: A MULTICENTRE STUDY, 68th Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), Publisher: ELSEVIER SCIENCE INC, Pages: 325-325, ISSN: 0735-1097
Mantziari L, Butcher C, Shi R, et al., 2019, Characterization of the mechanism and substrate of atrial tachycardia using ultra-high-density mapping in adults with congenital heart disease: Impact on clinical outcomes, Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease, Vol: 8, ISSN: 2047-9980
BackgroundAtrial tachycardia (AT) is common in patients with adult congenital heart disease and is challenging to map and ablate. We used ultra‐high‐density mapping to characterize the AT mechanism and investigate whether substrate characteristics are related to ablation outcomes.Methods and ResultsA total of 50 ATs were mapped with ultra‐high‐density mapping in 23 procedures. Patients were followed up for up to 12 months. Procedures were classified to group A if there was 1 single AT induced (n=12) and group B if there were ≥2 ATs induced (n=11 procedures). AT mechanism per procedure was macro re‐entry (n=10) and localized re‐entry (n=2) in group A and multiple focal (n=6) or multiple macro re‐entry (n=5) in group B. Procedure duration, low voltage area (0.05–0.5 mV), and low voltage area indexed for volume were higher in group B (159 [147–180] versus 412 [352–420] minutes, P<0.001, 22.6 [12.2–29.8] versus 54.2 [51.1–61.6] cm2, P=0.014 and 0.17 [0.12–0.21] versus 0.26 [0.23–0.27] cm2/mL, P=0.024 accordingly). Dense scar (<0.05 mV) and atrial volume were similar between groups. Acute success and freedom from arrhythmia recurrence were worse in group B (100% versus 77% P=0.009 and 11.3, CI 9.8–12.7 versus 4.9, CI 2.2–7.6 months, log rank P=0.004). Indexed low voltage area ≥0.24 cm2/mL could predict recurrence with 100% sensitivity and 77% specificity (area under the curve 0.923, P=0.007).ConclusionsLarger low voltage area but not dense scar is associated with the induction of multiple focal or re‐entry ATs, which are subsequently associated with longer procedure duration and worse acute and midterm clinical outcomes.
Jarman JWE, Hussain W, Wong T, et al., 2018, Resource use and clinical outcomes in patients with atrial fibrillation with ablation versus antiarrhythmic drug treatment, BMC Cardiovascular Disorders, Vol: 18, ISSN: 1471-2261
BackgroundThe objective of our study was to compare resource use and clinical outcomes among atrial fibrillation (AF) patients who underwent catheter ablation versus antiarrhythmic drug (AAD) treatment.MethodsA retrospective cohort design using the Clinical Practice Research Data-Hospital Episode Statistics linkage data from England (2008–2013) was used. Patients undergoing catheter ablation treatment for AF were indexed to the date of first procedure. AAD patients with at least two different AAD drugs were indexed to the first fill of the second AAD. Patients were matched using 1:1 propensity matching. Primary endpoints including inpatient and outpatient visits were compared between ablation and AAD cohorts in the 4 months-1 year period after index. Secondary endpoints including heart failure, stroke, cardioversion, mortality, and a composite outcome were compared for the 4 months-3 years post-index period in the two groups. Cox-proportional hazards models were estimated for clinical outcomes comparison.ResultsA total of 558 patients were matched in the two groups for resource utilization comparison. The average number of cardiovascular (CV)-related outpatient visits in the 4–12 months post-index period were significantly lower in the ablation group versus the AAD group (1.76 vs 3.57, p < .0001). There was no significant difference in all-cause and CV-related inpatient visits and all-cause outpatient visits among the two groups. For secondary endpoints comparison, 615 matched patients in each group emerged. Ablation patients had 38% lower risk of heart failure (hazard ratio [HR] 0.62, p = 0.0318), 50% lower risk of mortality (HR 0.50, p = 0.0082), and 43% lower risk of experiencing a composite outcome (HR 0.57, p = 0.0009) as compared to AAD treatment cohort.ConclusionAF ablation was associated with significantly lower CV-related outpatient visits, and lower risk of heart failure and mortality v
Shi R, Chen Z, Kontogeorgis A, et al., 2018, Epicardial ventricular tachycardia ablation guided by a novel high-resolution contact mapping system: a multicenter study, Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease, Vol: 7, ISSN: 2047-9980
Background Mapping using a multipolar catheter with small and closely spaced electrodes has been shown to improve the validity of electrograms to identify endocardial critical sites of reentry isthmus and foci of earliest activation. However, the feasibility, safety, and clinical outcome of using such technology to guide epicardial ventricular tachycardia (VT) ablation has not been reported. Methods and Results Thirty-three consecutive patients from 5 high-volume centers were studied. These patients had 43 epicardial maps using a novel 64-pole mini-basket catheter to guide VT ablation. Activation maps with 17 832 points per map (interquartile range: 7621-32 497 points per map) were acquired in 11 patients with tolerated VT (7 focal, 4 reentry). Substrate maps with 40149 points per map (interquartile range: 20926-49391 points per map) were acquired in 30 patients. Local abnormal ventricular activities were consistently demonstrated at the substrate regions of interest. Epicardial ablation was performed in 31 of 33 patients, with acute VT termination in 10 of 11 patients (91%). Complete elimination of local abnormal ventricular activities was achieved in 25 of 31 patients. At a median follow-up of 10 months (interquartile range: 4-14 months), 64% (7/11) of patients who had acute termination of VT and 55% (11/20) of those who had substrate modification alone were free of VT. There was no immediate complication following epicardial procedure. Conclusions Epicardial VT ablation guided by a mini-basket catheter is feasible and safe. Complete reentry VT circuits and foci of earliest activation were identified in all inducible stable VT. The longer term clinical outcome of ablation guided by this novel mapping technology utilizing small and closely spaced electrodes will have to be determined with a larger study.
Wong C, Zakeri R, Khan H, et al., 2018, Long-Term Outcomes Following Catheter Ablation in Patients With Atrial Fibrillation and Heart Failure: 7-Year Follow-Up of the ARC-HF Trial, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322
Ibrahim M, Panikker S, Lim E, et al., 2018, Relevance of electrical connectivity between the coronary sinus and the left atrial appendage for the intentional electrical isolation of the left atrial appendage in treating persistent atrial fibrillation: insights from the LEIO-AF study, HeartRhythm Case Reports, Vol: 4, Pages: 420-424, ISSN: 2214-0271
Catheter ablation is an accepted therapeutic option for paroxysmal atrial fibrillation (AF), but its role is less certain in patients with persistent AF.1 The difference in response to pulmonary vein (PV) isolation (PVI) between paroxysmal and persistent forms of AF may arise because of triggers from non-PV sites or alterations in atrial substrate favoring maintenance of AF that are unaffected by PVI alone.2 In support of this statement, adjunctive ablation of certain sites (including the superior vena cava, ligament of Marshall [LOM], crista terminalis, coronary sinus [CS], posterior wall of the left atrium [LA], and left atrial appendage [LAA]) as well as more widespread ablation aimed at modifying substrate has been shown to improve the success of catheter ablation of persistent AF.In the case of the LAA, the BELIEF study (Effect of Empirical Left Atrial Appendage Isolation on Long-term Procedure Outcome in Patients With Persistent or Long-standing Persistent Atrial Fibrillation Undergoing Catheter Ablation)3 recently showed that in patients with long-standing persistent AF, empirical electrical isolation of the LAA together with extensive atrial ablation markedly improved freedom from AF at 1 year compared to an extensive atrial ablation strategy alone. However, electrical isolation of the LAA can be challenging and is sometimes impossible to achieve. This may be partly because the electrical connections of the LAA are not completely understood.Here we report 2 patients showing that the CS can be an important electrical conduit to the LAA.
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.