Introduction: Pulmonary vein isolation (PVI) procedures increase the potential thromboembolic ris... more Introduction: Pulmonary vein isolation (PVI) procedures increase the potential thromboembolic risk. 1 The aim of this study was to compare the effect of radiofrequency (RF) ablation and cryoablation on platelet reactivity (PR) in patients with atrial fibrillation (AF). Patients and Methods: We analyzed PR levels using Multiplate function analyzer in 63 consecutive patients undergoing PVI procedures in our institution. Blood samples were drawn just before the procedure and on the following day. Fourty six (46) and seventeen (17) patients underwent cryoablation and RF ablation, respectively. There was no difference in demographics and baseline platelet parameters (platelet count, MPV and PR) between patients in RF and cryo group. ASPI, ADP and TRAPtest were used to-assess multiple pathways of platelet activation. Results: One day after the procedure mean PR droped from baseline levels in both study groups. The observed delta was more expressed in the cryo group for all three PR tests but only ADPtest showed statistically significant difference in PR (Figure 1).
Background: An advanced interatrial block (aIAB) is seen on the ECG as the combination of a P wav... more Background: An advanced interatrial block (aIAB) is seen on the ECG as the combination of a P wave duration >120 ms and biphasic P wave morphology in the inferior leads. It is considered a marker of an electromechanically dysfunctional left atrium (LA) and hence a risk factor for supraventricular arrhythmias and heart failure (HF). 1 The aim of our pilot study is to explore aIAB as a potential marker for determining a clinically relevant subgroup of HF patients. Patients and Methods: An echocardiogram and a surface ECG were performed on a total of 51 HF patients in sinus rhythm (31 (61%) with HF with preserved ejection fraction (HFpEF), 20 (39%) with HF with reduced ejection fraction (HFrEF)) diagnosed per the current guidelines, and 20 sex-matched healthy controls. Echocardiographic parameters of LA structure and function were measured. ECG measurements were performed digitally with an electronic calliper. Results: Prevalence of aIAB was 11% (n=8) in the studied group, significantly greater in HFpEF patients, compared to HFrEF patients and healthy controls (88% vs. 0% vs. 12%, p=0.025, Figure 1). The HFpEF patients formed an aIAB HFpEF subgroup (n=7) that was compared to two control groups, both without P wave duration >120 ms or biphasic P wave morphology in the inferior leads: age-and sex-matched HFpEF patients (n=7) and sex-matched healthy controls (n=12). Based on this subanalysis, the aIAB patients had a significantly higher occurrence of paroxysmal atrial fibrillation (healthy controls vs. HFpEF controls vs. aIAB: 0% vs. 43% vs. 86%, p<0.0001, Table 1). This subgroup also had the largest LA volumes (26.6 (18.7, 29.6) vs. 37.6 (32.7, 54.1) vs. 46.4 (41.4, 50.6) ml/m2, healthy controls vs. HFpEF controls vs. aIAB, respectively, p<0.0001, Table 1) and lowest LA ejection fraction (57.8 (46.4, 66.7) % vs. 39.7 (31.0, 41.3) % vs. 34.6 (31.8, 44.6) %, healthy controls vs. HFpEF controls vs. aIAB, respectively, p=0.004, Table 1). Conclusion: This pilot study relates aIAB to the HFpEF part of the HF spectrum. Significant differences in LA structural and functional characteristics suggest that aIAB may be a useful parameter for determining a clinically relevant subgroup of HFpEF patients, however an analysis of a larger patient cohort would be required to further establish these findings.
Rad Hrvatske akademije znanosti i umjetnosti, 2022
Ventricular arrhythmias are common complication associated with left ventricular assist devices (... more Ventricular arrhythmias are common complication associated with left ventricular assist devices (LVAD). We present a challenging case of a 57-year-old male LVAD recipient who developed ventricular tachycardia refractory to antiarrhythmic drugs and device therapy in the early postoperative period and was eventually successfully treated with radiofrequency catheter ablation. Ventricular arrhythmias were successfully mapped, eliminated with ablation, and remained non-inducible. is case demonstrates that ventricular arrhythmia catheter ablation can be feasible, e ective, and safe in LVAD recipients with a scar-related electrical storm even days after LVAD implantation. Although optimal treatment strategy in this patient population still needs to be de ned, catheter ablation should be considered in LVAD recipients with ventricular arrhythmias refractory to antiarrhythmic drugs and device therapy representing a treatment of last resort.
Introduction: The so called "zero fluoro" or "apron less" approach is getting more popular in the... more Introduction: The so called "zero fluoro" or "apron less" approach is getting more popular in the electrophysiology labs 1. The main concern of this strategy is its safety. We aimed to demonstrate the feasibility of zero-fluoro approach for the repeat atrial fibrillation (AF) procedures after initial cryoballoon ablation (CB). Patients and Methods: We have performed a retrospective study on patients that have undergone repeat pulmonary vein isolation (PVI) procedures in our institution since we started the zero-fluoro program in 2020. All patients received CB ablation for the initial procedure. Procedures were performed under conscious sedation with the help of intracardiac echo (ICE) and 3D mapping system, without the use of fluoroscopy. Right-sided femoral vein was used for the two introducers. A single transseptal puncture was performed guided by ICE. Steerable sheath was used and high-density voltage map of left atrium (LA) was created to evaluate the pulmonary vein (PV) reconnections. Contact-sensing radiofrequency ablation (RF) ablation catheters were used to reisolate the reconnected veins and in the case of no reconnections, posterior wall isolation was performed. Results: We have analyzed in total 38 patients (74% male, 59.3±0.3 years old), 53% of which suffered from paroxysmal AF. The mean left ventricular ejection fraction was 61.6±7.0% and mean LA diameter was 42.0±5.2 mm. In two (5.2%) patients RF energy was required to cross the intraatrial septum. In one patient (2.7%) conversion to fluoroscopy was required because of demanding transseptal puncture. The mean procedure time was 98.1.3±26.4 min and the mean RF time was 821 sec±420 sec. The mean of 1.25±0.893 veins were reconnected per patient and 10 patients (26.3%) did not have PV reconnections. In all patients successful PV/PW isolation was performed confirmed by entry and exit block. No periprocedural complications were observed. Conclusion: In our cohort of patients, zero-fluoro approach for repeat PVI procedures ablation proved to be feasible and safe. Conversion to fluoroscopy was needed infrequently for more difficult transseptal procedures.
Cryoballoon (CB) is an established technology for atrial fibrillation (AF) ablation and is usuall... more Cryoballoon (CB) is an established technology for atrial fibrillation (AF) ablation and is usually performed using solely fluoroscopy. We aimed to study the feasibility of three-dimensional rotational angiography (3DRA) as intra-procedural imaging in CB ablation. Analyzed data were retrospectively collected from patients that underwent second generation CB ablation from February 2015 to August 2017. We studied 68 consecutive patients that received 3DRA (3DRA group). Sixtysix patients who received conventional X-ray imaging served as a control group. 3DRA was performed via an introducer placed in the left atrium. Angiographic images were segmented and fused with live fluoroscopy to guide the ablation. We have analyzed 134 CB patients (73.8% male, 56.9 ± 11.4 years). Paroxysmal AF was present in 77.6% of patients. 3DRA was successfully performed in all 3DRA group patients. The mean procedure time was significantly shorter in the control group (82.4 ± 26.3 min) than in the 3DRA group (121.1 ± 21.4 min) (p < 0.0001). Total radiation dose (419.3 ± 317.9 vs 998.3 ± 673 mGy, p < 0.0001) and contrast administration (83.2 ± 22.3 mL vs 191.6 ± 33.4 mL, p < 0.0001) were significantly lower in control group. There was no significant difference in 2-year success rate, 35.2% of patients had AF recurrence in the 3DRA group and 30.3% in the control group (p = 0.584). Major complications occurred in 2.9% and 1.5% of patients in 3DRA group and control group, respectively (p = 1.000). 3DRA is a feasible method of intra-procedural imaging to guide CB ablation. However, it prolongs procedure time, increases radiation dose and contrast administration with no significant effect on procedure outcomes and complication rates.
Introduction: The so called "zero fluoro" or "apron less" approach is getting more popular in the... more Introduction: The so called "zero fluoro" or "apron less" approach is getting more popular in the electrophysiology labs 1. The main concern of this strategy is its safety. We aimed to demonstrate the feasibility of zero-fluoro approach for the repeat atrial fibrillation (AF) procedures after initial cryoballoon ablation (CB). Patients and Methods: We have performed a retrospective study on patients that have undergone repeat pulmonary vein isolation (PVI) procedures in our institution since we started the zero-fluoro program in 2020. All patients received CB ablation for the initial procedure. Procedures were performed under conscious sedation with the help of intracardiac echo (ICE) and 3D mapping system, without the use of fluoroscopy. Right-sided femoral vein was used for the two introducers. A single transseptal puncture was performed guided by ICE. Steerable sheath was used and high-density voltage map of left atrium (LA) was created to evaluate the pulmonary vein (PV) reconnections. Contact-sensing radiofrequency ablation (RF) ablation catheters were used to reisolate the reconnected veins and in the case of no reconnections, posterior wall isolation was performed. Results: We have analyzed in total 38 patients (74% male, 59.3±0.3 years old), 53% of which suffered from paroxysmal AF. The mean left ventricular ejection fraction was 61.6±7.0% and mean LA diameter was 42.0±5.2 mm. In two (5.2%) patients RF energy was required to cross the intraatrial septum. In one patient (2.7%) conversion to fluoroscopy was required because of demanding transseptal puncture. The mean procedure time was 98.1.3±26.4 min and the mean RF time was 821 sec±420 sec. The mean of 1.25±0.893 veins were reconnected per patient and 10 patients (26.3%) did not have PV reconnections. In all patients successful PV/PW isolation was performed confirmed by entry and exit block. No periprocedural complications were observed. Conclusion: In our cohort of patients, zero-fluoro approach for repeat PVI procedures ablation proved to be feasible and safe. Conversion to fluoroscopy was needed infrequently for more difficult transseptal procedures.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Introduction: Pulmonary vein isolation (PVI) procedures increase the potential thromboembolic ris... more Introduction: Pulmonary vein isolation (PVI) procedures increase the potential thromboembolic risk. 1 The aim of this study was to compare the effect of radiofrequency (RF) ablation and cryoablation on platelet reactivity (PR) in patients with atrial fibrillation (AF). Patients and Methods: We analyzed PR levels using Multiplate function analyzer in 63 consecutive patients undergoing PVI procedures in our institution. Blood samples were drawn just before the procedure and on the following day. Fourty six (46) and seventeen (17) patients underwent cryoablation and RF ablation, respectively. There was no difference in demographics and baseline platelet parameters (platelet count, MPV and PR) between patients in RF and cryo group. ASPI, ADP and TRAPtest were used to-assess multiple pathways of platelet activation. Results: One day after the procedure mean PR droped from baseline levels in both study groups. The observed delta was more expressed in the cryo group for all three PR tests but only ADPtest showed statistically significant difference in PR (Figure 1).
Background: An advanced interatrial block (aIAB) is seen on the ECG as the combination of a P wav... more Background: An advanced interatrial block (aIAB) is seen on the ECG as the combination of a P wave duration >120 ms and biphasic P wave morphology in the inferior leads. It is considered a marker of an electromechanically dysfunctional left atrium (LA) and hence a risk factor for supraventricular arrhythmias and heart failure (HF). 1 The aim of our pilot study is to explore aIAB as a potential marker for determining a clinically relevant subgroup of HF patients. Patients and Methods: An echocardiogram and a surface ECG were performed on a total of 51 HF patients in sinus rhythm (31 (61%) with HF with preserved ejection fraction (HFpEF), 20 (39%) with HF with reduced ejection fraction (HFrEF)) diagnosed per the current guidelines, and 20 sex-matched healthy controls. Echocardiographic parameters of LA structure and function were measured. ECG measurements were performed digitally with an electronic calliper. Results: Prevalence of aIAB was 11% (n=8) in the studied group, significantly greater in HFpEF patients, compared to HFrEF patients and healthy controls (88% vs. 0% vs. 12%, p=0.025, Figure 1). The HFpEF patients formed an aIAB HFpEF subgroup (n=7) that was compared to two control groups, both without P wave duration >120 ms or biphasic P wave morphology in the inferior leads: age-and sex-matched HFpEF patients (n=7) and sex-matched healthy controls (n=12). Based on this subanalysis, the aIAB patients had a significantly higher occurrence of paroxysmal atrial fibrillation (healthy controls vs. HFpEF controls vs. aIAB: 0% vs. 43% vs. 86%, p<0.0001, Table 1). This subgroup also had the largest LA volumes (26.6 (18.7, 29.6) vs. 37.6 (32.7, 54.1) vs. 46.4 (41.4, 50.6) ml/m2, healthy controls vs. HFpEF controls vs. aIAB, respectively, p<0.0001, Table 1) and lowest LA ejection fraction (57.8 (46.4, 66.7) % vs. 39.7 (31.0, 41.3) % vs. 34.6 (31.8, 44.6) %, healthy controls vs. HFpEF controls vs. aIAB, respectively, p=0.004, Table 1). Conclusion: This pilot study relates aIAB to the HFpEF part of the HF spectrum. Significant differences in LA structural and functional characteristics suggest that aIAB may be a useful parameter for determining a clinically relevant subgroup of HFpEF patients, however an analysis of a larger patient cohort would be required to further establish these findings.
Rad Hrvatske akademije znanosti i umjetnosti, 2022
Ventricular arrhythmias are common complication associated with left ventricular assist devices (... more Ventricular arrhythmias are common complication associated with left ventricular assist devices (LVAD). We present a challenging case of a 57-year-old male LVAD recipient who developed ventricular tachycardia refractory to antiarrhythmic drugs and device therapy in the early postoperative period and was eventually successfully treated with radiofrequency catheter ablation. Ventricular arrhythmias were successfully mapped, eliminated with ablation, and remained non-inducible. is case demonstrates that ventricular arrhythmia catheter ablation can be feasible, e ective, and safe in LVAD recipients with a scar-related electrical storm even days after LVAD implantation. Although optimal treatment strategy in this patient population still needs to be de ned, catheter ablation should be considered in LVAD recipients with ventricular arrhythmias refractory to antiarrhythmic drugs and device therapy representing a treatment of last resort.
Introduction: The so called "zero fluoro" or "apron less" approach is getting more popular in the... more Introduction: The so called "zero fluoro" or "apron less" approach is getting more popular in the electrophysiology labs 1. The main concern of this strategy is its safety. We aimed to demonstrate the feasibility of zero-fluoro approach for the repeat atrial fibrillation (AF) procedures after initial cryoballoon ablation (CB). Patients and Methods: We have performed a retrospective study on patients that have undergone repeat pulmonary vein isolation (PVI) procedures in our institution since we started the zero-fluoro program in 2020. All patients received CB ablation for the initial procedure. Procedures were performed under conscious sedation with the help of intracardiac echo (ICE) and 3D mapping system, without the use of fluoroscopy. Right-sided femoral vein was used for the two introducers. A single transseptal puncture was performed guided by ICE. Steerable sheath was used and high-density voltage map of left atrium (LA) was created to evaluate the pulmonary vein (PV) reconnections. Contact-sensing radiofrequency ablation (RF) ablation catheters were used to reisolate the reconnected veins and in the case of no reconnections, posterior wall isolation was performed. Results: We have analyzed in total 38 patients (74% male, 59.3±0.3 years old), 53% of which suffered from paroxysmal AF. The mean left ventricular ejection fraction was 61.6±7.0% and mean LA diameter was 42.0±5.2 mm. In two (5.2%) patients RF energy was required to cross the intraatrial septum. In one patient (2.7%) conversion to fluoroscopy was required because of demanding transseptal puncture. The mean procedure time was 98.1.3±26.4 min and the mean RF time was 821 sec±420 sec. The mean of 1.25±0.893 veins were reconnected per patient and 10 patients (26.3%) did not have PV reconnections. In all patients successful PV/PW isolation was performed confirmed by entry and exit block. No periprocedural complications were observed. Conclusion: In our cohort of patients, zero-fluoro approach for repeat PVI procedures ablation proved to be feasible and safe. Conversion to fluoroscopy was needed infrequently for more difficult transseptal procedures.
Cryoballoon (CB) is an established technology for atrial fibrillation (AF) ablation and is usuall... more Cryoballoon (CB) is an established technology for atrial fibrillation (AF) ablation and is usually performed using solely fluoroscopy. We aimed to study the feasibility of three-dimensional rotational angiography (3DRA) as intra-procedural imaging in CB ablation. Analyzed data were retrospectively collected from patients that underwent second generation CB ablation from February 2015 to August 2017. We studied 68 consecutive patients that received 3DRA (3DRA group). Sixtysix patients who received conventional X-ray imaging served as a control group. 3DRA was performed via an introducer placed in the left atrium. Angiographic images were segmented and fused with live fluoroscopy to guide the ablation. We have analyzed 134 CB patients (73.8% male, 56.9 ± 11.4 years). Paroxysmal AF was present in 77.6% of patients. 3DRA was successfully performed in all 3DRA group patients. The mean procedure time was significantly shorter in the control group (82.4 ± 26.3 min) than in the 3DRA group (121.1 ± 21.4 min) (p < 0.0001). Total radiation dose (419.3 ± 317.9 vs 998.3 ± 673 mGy, p < 0.0001) and contrast administration (83.2 ± 22.3 mL vs 191.6 ± 33.4 mL, p < 0.0001) were significantly lower in control group. There was no significant difference in 2-year success rate, 35.2% of patients had AF recurrence in the 3DRA group and 30.3% in the control group (p = 0.584). Major complications occurred in 2.9% and 1.5% of patients in 3DRA group and control group, respectively (p = 1.000). 3DRA is a feasible method of intra-procedural imaging to guide CB ablation. However, it prolongs procedure time, increases radiation dose and contrast administration with no significant effect on procedure outcomes and complication rates.
Introduction: The so called "zero fluoro" or "apron less" approach is getting more popular in the... more Introduction: The so called "zero fluoro" or "apron less" approach is getting more popular in the electrophysiology labs 1. The main concern of this strategy is its safety. We aimed to demonstrate the feasibility of zero-fluoro approach for the repeat atrial fibrillation (AF) procedures after initial cryoballoon ablation (CB). Patients and Methods: We have performed a retrospective study on patients that have undergone repeat pulmonary vein isolation (PVI) procedures in our institution since we started the zero-fluoro program in 2020. All patients received CB ablation for the initial procedure. Procedures were performed under conscious sedation with the help of intracardiac echo (ICE) and 3D mapping system, without the use of fluoroscopy. Right-sided femoral vein was used for the two introducers. A single transseptal puncture was performed guided by ICE. Steerable sheath was used and high-density voltage map of left atrium (LA) was created to evaluate the pulmonary vein (PV) reconnections. Contact-sensing radiofrequency ablation (RF) ablation catheters were used to reisolate the reconnected veins and in the case of no reconnections, posterior wall isolation was performed. Results: We have analyzed in total 38 patients (74% male, 59.3±0.3 years old), 53% of which suffered from paroxysmal AF. The mean left ventricular ejection fraction was 61.6±7.0% and mean LA diameter was 42.0±5.2 mm. In two (5.2%) patients RF energy was required to cross the intraatrial septum. In one patient (2.7%) conversion to fluoroscopy was required because of demanding transseptal puncture. The mean procedure time was 98.1.3±26.4 min and the mean RF time was 821 sec±420 sec. The mean of 1.25±0.893 veins were reconnected per patient and 10 patients (26.3%) did not have PV reconnections. In all patients successful PV/PW isolation was performed confirmed by entry and exit block. No periprocedural complications were observed. Conclusion: In our cohort of patients, zero-fluoro approach for repeat PVI procedures ablation proved to be feasible and safe. Conversion to fluoroscopy was needed infrequently for more difficult transseptal procedures.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
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