623 results on '"Zei, Paul C."'
Search Results
302. PO-644-08 VIRTUAL ATRIAL FIBRILLATION PATIENT EDUCATION LED BY ALLIED PROFESSIONALS IS PREFERRED BY PATIENTS AND LEADS TO HIGH PARTICIPATION RATES AND IMPROVED VIRTUAL CARE ACCEPTANCE.
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Shea, Julie B., Sauer, William H., Sauer, Katherine, Sharma, Esseim, Chang, David, Batnyam, Uyanga, Kapur, Sunil, Tadros, Thomas M., Tedrow, Usha B., Zei, Paul C., Piazza, Gregory, Fanikos, John, Romero, Jorge, Antman, Elliott, and Koplan, Bruce A.
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- 2022
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303. Effects on Ion Permeation with Hydrophobic Substitutions at a Residue in Shaker S6 That Interacts with a Signature Sequence Amino Acid
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ZEI, PAUL C., primary, OGIELSKA, EVA M., additional, HOSHI, TOSHINORI, additional, and ALDRICH, RICHARD W., additional
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- 1999
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304. Transseptal approach versus retrograde aortic approach in mapping and ablation of ventricular arrhythmias from anterolateral papillary muscles.
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Jiang, Chen‐Xi, Li, Shao‐Long, Li, Meng‐Meng, Tang, Ri‐Bo, Sang, Cai‐Hua, Wang, Wei, Dong, Jian‐Zeng, Long, De‐Yong, Zei, Paul C., and Ma, Chang‐Sheng
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RESEARCH funding , *DESCRIPTIVE statistics , *VENTRICULAR arrhythmia , *MYOCARDIUM , *CATHETER ablation - Abstract
Introduction: The anterior and lateral position of the anterolateral papillary muscle (ALPM) has found to be reached with better catheter stability and less mechanical bumping via the transseptal (TS) compared to the retrograde aortic (RA) approach. The aim of this study is to compare the TS and RA approaches on mapping and ablation of ventricular arrhythmias (VAs) arising from ALPMs. Methods: Thirty‐two patients with ALPM‐VAs undergoing mapping and ablation via the TS approach were included and compared with 31 patients via the RA approach within the same period. Acute success was compared, as well as other outcomes including misinterpreted mapping results due to bumping, radiofrequency (RF) attempts, procedural time and success rate at 12‐month follow‐up. Results: Acute success was achieved in more cases in the TS group (96.4% vs. 72.0%, p =.020). During activation mapping, bump‐provoked premature ventricular complexes (PVCs) misinterpreted as clinical PVCs were more common in the RA group (30.0% vs. 58.3%, p =.036), leading to more RF attempts (3.5 ± 2.7 vs. 7.2 ± 6.8, p =.006). Suppression of VAs were finally achieved in the unsuccessful cases by changing to the alternative approach, but the procedural time was significantly less in the TS group (90.0 ± 33.0 vs. 113.7 ± 41.1 min, p =.027) with less need to change the approach, although follow‐up success rates were similar (75.0% vs. 71.0%, p =.718). Conclusion: A TS rather than RA approach as the initial approach appears to facilitate mapping and ablation of ALPM‐VAs, specifically by decreasing the possibility of misleading mapping results caused by bump‐provoked PVC, and increase the acute success rate thereby. [ABSTRACT FROM AUTHOR]
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- 2024
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305. Contributors
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Agarwal, Sandeep K., Ahmann, Frederick R., Al-Ansari, Essam, Alexander, Erik K., Alpert, Elaine J., Antic, Nenad, Antman, Elliott M., Asmal, Mohammed, Baber, Usman, Baggish, Aaron L., Baghdadi, Homeira, Baltodano, Juan Diego, Barrisford, Glen W., Bell, Iris R., Bishop, Jeanne E., Bonaca, Marc P., Bordelon, Yvette M., Byron, Jessica, Cannon, Christopher P., Carney, Shari, Carusi, Daniela, Chen, Sherleen, Cho, Michael, Chou, Sherry, Cleary, Lynn, Curosh, Nancy A., Currier, Paul, Lemos, James A. De, Dharmadhikari, Ashwin, DiBernardo, Allitia B., Dickerson, Bradford C., Eastwood, Gregory L., Eckart, Robert E., Erstad, Brian L., Fajardo, Laurie L., Fang, James C., Fangman, John J.W., Fennerty, M. Brian, Fromson, John A., Fuchs, Deborah, Gallagher, Diana, Gelenberg, Alan J., Gibson, David W., Gilchrest, Barbara A., Gonzales-Osete, Guillermo, Gornik, Heather L., II, Harry L. Greene, Greer, David M., Greifer, Kristyn M., Hammond, Sarah P., Helfgott, Simon, Hochberg, Leigh R., Hoffman, Risa, Houtchens, Maria K., Hruczkowski, Tomaz, Jaffe, Philip E., Johnsen, Alyssa, Johnson, William P., Karabanow, Anthony, Karimi-Shah, Banu A., Katz, Michael D., Kaufman, Richard M., Kaufmann, Lisa, Kesari, Santosh, Khosla, Megan Tamburini, Kim, Peter, Klompas, Michael, Kreisle, William H., Kritek, Patricia, Lemcke, Dawn, Levine, Norman, López, Ana Maria, Lowry, Philip A., Magee, Colm C., Mahadevan, Daruka, Marshall, Lorna A., Matthias, Kathryn R., McDermott, David, McMahon, Graham T., Mielniczuk, Lisa M., Miller, Hugh S., Milligan, Tracey A., Misiaszek, John, Modiano, Manuel, Monach, Paul A., Moore, Janet, Morrow, David A., Muramoto, Myra L., Mushlin, Stuart B., Nasseri, Amir, Nesbitt, William H., Ning, MingMing, Noss, Erika, Ojikutu, Bisola, O'Neil, Cynthia A., Palley, Steven, Pappoe, Lamioko Shika, Patel, Mahesh J., Persky, Daniel O., Pickett, Christopher, Plank, Rebeca M., Partridge, Ann, Portlock, Carol S., Potter, Rebecca L., Reed, Caitlin, Reiman, Eric M., Rifkin, Robert M., Robles, Terra A., Rohr-Kirchgraber, Theresa, Rominski, Jason M., Rowland-Seymour, Anastasia, Roxby, Alison C., Ruiz, George, Sabatine, Marc S., Sampliner, Richard E., Samuelson, Robert N., Sander, Susan Fisk, Saud, Bipin, Scharf, Mark J., Schwartz, Gail L., Scirica, Benjamin M., Scott, Michael E., Sharma, Sunita, Singh, Ajay K., Singh, Micheal, Smith, Marsha, Stankovic, Ana R., Steele, Graeme, Stepkovitch, Khatuna, Szmuilowicz, Emily Deborah, Taetle, Raymond, Tedrow, Usha B., Thomas, Sheeba K., Trujillo, M. Angelo, Tucker, J. Kevin, Walsh, Ronan J., Wang, Michael, Weber, Donna M., Weisenthal, Robert W., Williams, Steven B., Wiviott, Stephen D., Worobey, Cynthia Cooper, Wright, Alexi, Yeo, David, Yialamas, Maria A., Zandi-Nejad, Kambiz, Zane, Richard D., Zei, Paul C., and Zimetbaum, Peter
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- 2010
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306. Utility of a Cloud Based Lesion Data Collection Software to Record, Monitor, and Analyze an Ablation Strategy
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Kreidieh, Omar, Whitaker, John, Thurber, Clinton J., Amit, Mati, Tsoref, Liat, Goldberg, Stanislav, Yungher, Don, Steiger, Nathaniel, Tadros, Thomas M., Kapur, Sunil, Koplan, Bruce A., Tedrow, Usha B., Sauer, William H., and Zei, Paul C.
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- 2022
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307. Noninvasive Ablation of Ventricular Tachycardia.
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Zei, Paul C., Maguire, Patrick, and Haruo Tomoda
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ARRHYTHMIA , *CATHETER ablation , *ELECTROCARDIOGRAPHY , *VENTRICULAR tachycardia , *TREATMENT effectiveness - Published
- 2018
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308. P5-51: Changes in dominant frequency of right atrial and coronary sinus electrograms during progressive ablation to identify patients with potential fibrillation drivers outside the left atrium
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Miyazaki, Hidekazu, Stevenson, William G., Field, Michael E., Hruczkowki, Tomasz W., Zei, Paul C., Tedrow, Usha, and Epstein, Laurence M.
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- 2006
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309. Noninvasive Cardiac Radioablation for Ventricular Arrhythmias.
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Sharp, Alexander J., Mak, Raymond, and Zei, Paul C.
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Purpose of Review: In this review, we describe the general principles and clinical use of stereotactic radioablation (SR) and its specific application to the treatment of malignant cardiac ventricular arrhythmias, or stereotactic arrhythmia radioablation (STAR). The principles of STAR, and the unmet needs in cardiac arrhythmia ablation are described. The basic pathophysiology of radioablative effect on cardiac tissues, the clinical experience to date, and future directions are discussed.Recent Findings: Basic preclinical research has demonstrated in large animal models (porcine, canine) that delivery of SR energy to cardiac targets, specifically left atrial ablation for atrial fibrillation, results in physiologic and histopathologic evidence of treatment effect without evidence of harm. Clinical treatments delivering SR to ventricular and atrial targets for ventricular tachycardia (VT) and atrial fibrillation (AF) have demonstrated clinical response without evidence of obvious harm or complication thus far.Summary: In the nascent but exciting field of stereotactic radioablation for treatment of cardiac arrhythmias, preclinical evidence has demonstrated treatment effect without to date risk of significant collateral injury. In limited clinical experience treating both ventricular and atrial arrhythmias, clinical benefit in arrhythmia reduction without notable risk of complication has been observed. Further basic mechanistic research, refinement of delivery approaches, and further clinical experience are all anticipated and needed. [ABSTRACT FROM AUTHOR]
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- 2019
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310. Predictors of first pass isolation of the pulmonary veins in real world ablations: An analysis of 2671 patients from the REAL‐AF registry.
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Kreidieh, Omar, Hunter, Tina D., Goyal, Sandeep, Varley, Allyson L., Thorne, Christopher, Osorio, Jose, Silverstein, Josh, Varosy, Paul, Metzl, Mark, Leyton‐Mange, Jordan, Singh, David, Rajendra, Anil, Moretta, Antonio, and Zei, Paul C.
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ATRIAL fibrillation diagnosis , *ARRHYTHMIA diagnosis , *PULMONARY veins , *BODY mass index , *LOGISTIC regression analysis , *SCARS , *TREATMENT effectiveness , *MULTIVARIATE analysis , *DESCRIPTIVE statistics , *LONGITUDINAL method , *ATRIAL fibrillation , *STATISTICS , *RESEARCH , *SLEEP apnea syndromes , *RESPIRATORY measurements , *CATHETER ablation , *DIABETES , *COMORBIDITY , *OBESITY - Abstract
Introduction: During atrial fibrillation ablation (AFA), achievement of first pass isolation (FPI) reflects effective lesion formation and predicts long‐term freedom from arrhythmia recurrence. We aim to determine the clinical and procedural predictors of pulmonary vein FPI. Methods: We reviewed AFA procedures in a multicenter prospective registry of AFA (REAL‐AF). A multivariate ordinal logistic regression, weighted by inverse proceduralist volume, was used to determine predictors of FPI. Results: A total of 2671 patients were included with 1806 achieving FPI in both vein sides, 702 achieving FPI in one, and 163 having no FPI. Individually, age, left atrial (LA) scar, higher power usage (50 W), greater posterior contact force, ablation index >350 posteriorly, Vizigo™ sheath utilization, nonstandard ventilation, and high operator volume (>6 monthly cases) were all related to improved odds of FPI. Conversely sleep apnea, elevated body mass index (BMI), diabetes mellitus, LA enlargement, antiarrhythmic drug use, and center's higher fluoroscopy use were related to reduced odds of FPI. Multivariate analysis showed that BMI > 30 (OR 0.78 [0.64–0.96]) and LA volume (OR per mL increase = 1.00 [0.99–1.00]) predicted lower odds of achieving FPI, whereas significant left atrial scarring (>20%) was related to higher rates of FPI. Procedurally, the use of high power (50 W) (OR 1.32 [1.05–1.65]), increasing force posteriorly (OR 2.03 [1.19–3.46]), and nonstandard ventilation (OR 1.26 [1.00–1.59]) predicted higher FPI rates. At a site level, high procedural volume (OR 1.89 [1.48–2.41]) and low fluoroscopy centers (OR 0.72 [0.61–0.84]) had higher rates of FPI. Conclusion: FPI rates are affected by operator experience, patient comorbidities, and procedural strategies. These factors may be postulated to impact acute lesion formation. [ABSTRACT FROM AUTHOR]
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- 2024
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311. Is the Wearable Cardioverter-Defibrillator the Answer for Early Post-Myocardial Infarction Patients at Risk for Sudden Death?: Mind the Gap ∗.
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Zei, Paul C.
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- 2013
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312. Lesion Quality and Safety Maintained as Trainees Develop Catheter Handling Skills and Progress to Independence: Analysis of Cloud-Based Device Data.
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Whitaker, John, Hunter, Tina D., Carsey, Jane, Sharma, Esseim, Verry, Josselyn, Yungher, Don, Goldberg, Stanislav, Kreidieh, Omar, Thurber, Clinton, Steiger, Nathaniel, Chang, David, Batnyam, Uyanga, McClennen, Seth, Kapur, Sunil, Tadros, Thomas, Sauer, William H., Koplan, Bruce, Tedrow, Usha, and Zei, Paul C.
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CATHETER ablation , *SCHOLARSHIPS , *PULMONARY veins , *DATA management , *PHYSICIANS - Abstract
Introduction: Detailed data stored by an ablation mapping system may be a valuable adjunctive training tool. This study was undertaken to assess whether procedural data from a cloud-based smart storage and data analytics system reflects differences between procedures involving fellows at different training stages. Methods: Data from atrial ablations involving a fellow in the first 3 months of year 1 (Y1) or year 2 (Y2) of an EP fellowship program were compared. Results: Mean contact force, catheter stability, ablation index and time between consecutive lesions were similar between Y2 vs. Y1. Y2 fellows performed 92.5% vs. 84.8% of cavotricuspid isthmus (CTI) lesions (P=0.4760), 67.5% vs. 61.8% of left pulmonary vein (PV) lesions (P=0.6795), and 72.1% vs. 63.4% of right PV lesions (P=0.5258) compared to Y1 fellows. Y2 fellows completed independent CTI isolation in 88.2% vs. 52.9% of cases compared to Y1 fellows (P=0.0570). In the 31 procedures where both PV and CTI ablations were performed, Y2 fellows completed the full procedure independently more often than Y1 fellows (40.0% vs. 6.3%, P=0.0373). Y2 fellows also had higher rates of independently achieving first pass PV isolation (17.4% vs. 0.0%, P=0.0497). Conclusion: Analysis of procedural data from a cloud-based smart storage system demonstrates that under careful supervision, procedural parameters at a lesion level, attainment of clinical endpoints and procedural safety are not affected by level of experience of trainee involved. Procedural data demonstrates increasing independence with progression through training and may be a valuable adjunct to training, allowing monitoring of technical skill development. [ABSTRACT FROM AUTHOR]
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- 2023
313. Cost of cardiac stereotactic body radioablation therapy versus catheter ablation for treatment of ventricular tachycardia.
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Wei, Chen, Boeck, Michelle, Qian, Pierre C., Vivenzio, Todd, Elizee, Zoe, Bredfeldt, Jeremy S., Kaplan, Robert S., Tedrow, Usha, Mak, Raymond, and Zei, Paul C.
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TIME , *CATHETER ablation , *RETROSPECTIVE studies , *COST control , *VENTRICULAR tachycardia , *HOSPITAL care , *RADIOSURGERY , *LONGITUDINAL method - Abstract
Aims: To compare the cost of cardiac stereotactic body radioablation therapy (SBRT) versus catheter ablation for treating ventricular tachycardia (VT). Background: Cardiac SBRT is a novel way of treating refractory VT that may be less costly than catheter ablation, owing to its noninvasive, outpatient nature. However, the true costs of either procedure are not well described, which could help inform a more appropriate reimbursement for cardiac SBRT than simply cross‐indexing existing procedural rates. Methods: Process maps were derived for the full patient care cycle of both procedures using time‐driven activity‐based costing. Step‐by‐step timestamps were collected prospectively from a 10‐patient SBRT cohort and retrospectively from a 59‐patient catheter ablation cohort. Individual costs were estimated by multiplying timestamps with capacity cost rates (CCRs) for personnel, space, equipment, consumable, and indirect resources. These were summed into total cost, which for cardiac SBRT was compared with current catheter ablation and single‐fraction lung SBRT reimbursements, both potential reference rates for cardiac SBRT. Results: The direct and total procedural costs of cardiac SBRT ($7549 and $10,621) were 49% and 54% less than those of VT ablation ($14,707 and $23,225). These costs were significantly different from current reimbursement for catheter ablation ($22,692) and lung SBRT ($6329). After including hospitalization expenses (≥$15,000), VT ablation costs at least $27,604 more to furnish than cardiac SBRT. Conclusions: Time‐driven activity‐based costing (TDABC) can be a helpful tool for assessing healthcare costs, including novel treatment approaches. In addition to its clinical benefits, cardiac SBRT may provide significant cost reduction opportunities for treatment of VT. [ABSTRACT FROM AUTHOR]
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- 2022
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314. 28 - Timing Cycles of Implantable Devices
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Wang, Paul J., Al-Ahmad, Amin, Hsia, Henry H., Zei, Paul C., Turakhia, Mintu P., and Perez, Marco V.
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315. 24 - Ablation of Atriofascicular “Mahaim Fiber” Accessory Pathways and Variants
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Chen, Henry, Al-Ahmad, Amin, Hsia, Henry H., Turakhia, Mintu, Zei, Paul C., and Wang, Paul J.
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316. Atrial Fibrillation and Catheter Ablation.
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Antman, Elliott M, Leopold, Jane A, Sauer, William H, and Zei, Paul C
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ATRIAL fibrillation , *CATHETER ablation , *TREATMENT effectiveness - Abstract
The article reviews the classification and diagnosis of atrial fibrillation video.
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- 2022
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317. Contributors
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Al-Ahmad, Amin, Auricchio, Angelo, Baranowski, Bryan, Bardy, Gust, Belott, Peter H., Berecki-Gisolf, Janneke, Berne, Paola, Brugada, Josep, Chung, Mina K., Cooper, Joshua M., Crespi, Ann M., Crossley, George H., III, Donahue, J. Kevin, Dosdall, Derek J., Ellenbogen, Kenneth A., Epstein, Andrew E., Epstein, Laurence M., Exner, Derek V., Gillberg, Jeffrey M., Gillis, Anne M., Grace, Andrew A., Halperin, Henry, Haqqani, Haris M., Hayes, David, Hood, Margaret, Hsia, Henry H., Ideker, Raymond E., Israel, Carsten W., Kantharia, Bharat K., Kaszala, Karoly, Kay, G. Neal, Khairy, Paul, Kramer, Daniel B., Kutalek, Steven P., Lampert, Rachel, Lau, Chu-Pak, Lee, Kathy L., Love, Charles J., Maisel, William H., Nazarian, Saman, Niebauer, Mark J., Perez, Marco V., Pickett, Robert Andrew, Pogwizd, Stephen M., Prinzen, Frits W., Regoli, François, Reynolds, Dwight W., Riley, Michael P., Rorvick, Anthony, Saarel, Elizabeth Vickers, Saxon, Leslie A., Schmidt, Craig L., Serwer, Gerald A., Sheldon, Robert S., Shepard, Richard B., Shetty, Ira, Siu, Chung-Wah, Skarstad, Paul M., Smith, Warren M., Stambler, Bruce S., Strik, Marc, Sweeney, Michael O., Swerdlow, Charles D., Talwar, Sandeep, Tchou, Patrick J., Tse, Hung-Fat, Turakhia, Mintu P., Untereker, Darrel F., Varma, Niraj, Walcott, Gregory P., Wang, Paul J., Wazni, Oussama, Wilkoff, Bruce L., Worley, Seth J., and Zei, Paul C.
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318. Contributors
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Al-Ahmad, Amin, Anderson, Robert H., Arora, Rishi, Badhwar, Nitish, Banchs, Javier E., Benezet-Mazuecos, Juan, Bhakta, Deepak, Buch, Eric, Cabrera, José A., Calkins, Hugh, Callans, David J., Chang, Shih-Lin, Chen, Henry, Chen, Shih-Ann, Crawford, Thomas, Das, Mithilesh K., Dixit, Sanjay, Doshi, Shephal K., Dubuc, Marc, Dukkipati, Srinivas, Ernst, Sabine, Farré, Jerónimo, Feld, Gregory K., Fisher, Westby G., Forclaz, Andrei, Gonzalez, Mario D., Haines, David E., Haïssaguerre, Michel, Haqqani, Haris M., Higa, Satoshi, Hocini, Mélèze, Hoppe, Bobbi, Hsia, Henry H., Hung, Lynne, Jadidi, Amir, Jaïs, Pierre, Kadish, Alan, Kalman, Jonathan M., Keane, David, Khairy, Paul, Klein, George J., Knecht, Sebastien, Krahn, Andrew D., Lai, Ling-Ping, Lee, Byron K., Lerman, Bruce B., Lin, David, Lin, Kuo-Hung, Lin, Yenn-Jiang, Linton, Nick, Lo, Li-Wei, Marchlinski, Francis E., Markowitz, Steven M., Miller, John M., Miyazaki, Shinsuke, Morton, Joseph B., Nault, Isabelle, Nogami, Akihiko, Olgin, Jeffrey E., Oral, Hakan, Petrellis, Basilios, Reddy, Vivek Y., Rivera, Jaime, Ro, Alexander S., Rosso, Raphael, Rubio, José M., Sánchez-Quintana, Damián, Sanders, Prashanthan, Saul, J. Philip, Scanavacca, Mauricio, Shah, Ashok, Shivkumar, Kalyanam, Skanes, Allan C., Soejima, Kyoko, Sosa, Eduardo, Srivatsa, Uma, Tai, Ching-Tai, Taneja, Taresh, Turakhia, Mintu, Van Hare, George F., Walsh, Edward P., Wang, Paul J., Wright, Matthew, Yadav, Anil V., Yee, Raymond, and Zei, Paul C.
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319. One-year mortality and causes of death after stereotactic radiation therapy for refractory ventricular arrhythmias: A systematic review and pooled analysis.
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Benali K, Zei PC, Lloyd M, Kautzner J, Guenancia C, Ninni S, Rigal L, Simon A, Bellec J, Vlachos K, Sacher F, Hammache N, Sellal JM, de Crevoisier R, Da Costa A, and Martins R
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- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Arrhythmias, Cardiac mortality, Arrhythmias, Cardiac diagnosis, Arrhythmias, Cardiac physiopathology, Disease Progression, Heart Failure mortality, Heart Failure diagnosis, Heart Failure physiopathology, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Cause of Death, Radiosurgery adverse effects, Radiosurgery mortality
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Patients treated with cardiac stereotactic body radiation therapy (radioablation) for refractory ventricular arrhythmias are patients with advanced structural heart disease and significant comorbidities. However, data regarding 1-year mortality after the procedure are scarce. This systematic review and pooled analysis aimed at determining 1-year mortality after cardiac radioablation for refractory ventricular arrhythmias and investigating leading causes of death in this population. MEDLINE/EMBASE databases were searched up to January 2023 for studies including patients undergoing cardiac radioablation for the treatment of refractory ventricular arrhythmias. Quality of included trials was assessed using the NIH Tool for Case Series Studies (PROSPERO CRD42022379713). A total of 1,151 references were retrieved and evaluated for relevance. Data were extracted from 16 studies, with a total of 157 patients undergoing cardiac radioablation for refractory ventricular arrhythmias. Pooled 1-year mortality was 32 % (95 %CI: 23-41), with almost half of the deaths occurring within three months after treatment. Among the 157 patients, 46 died within the year following cardiac radioablation. Worsening heart failure appeared to be the leading cause of death (52 %), although non-cardiac mortality remained substantial (41 %) in this population. Age≥70yo was associated with a significantly higher 12-month all-cause mortality (p<0.022). Neither target volume size nor radiotherapy device appeared to be associated with 1-year mortality (p = 0.465 and p = 0.199, respectively). About one-third of patients undergoing cardiac stereotactic body radiation therapy for refractory ventricular arrhythmias die within the first year after the procedure. Worsening heart failure appears to be the leading cause of death in this population., (Copyright © 2023. Published by Elsevier Inc.)
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- 2024
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320. Lesion characteristics using high-frequency low-tidal volume ventilation versus standard ventilation during ablation of paroxysmal atrial fibrillation.
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Qian X, Zei PC, Osorio J, Hincapie D, Gabr M, Peralta A, Miranda-Arboleda AF, Koplan BA, Hoyos C, Matos CD, Lopez-Cabanillas N, Steiger NA, Velasco A, Alviz I, Kapur S, Tadros TM, Tedrow UB, Sauer WH, and Romero JE
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- Humans, Female, Male, Retrospective Studies, Middle Aged, Treatment Outcome, Aged, Time Factors, Action Potentials, Databases, Factual, Atrial Fibrillation surgery, Atrial Fibrillation physiopathology, Atrial Fibrillation diagnosis, Catheter Ablation adverse effects, Pulmonary Veins surgery, Pulmonary Veins physiopathology, Heart Rate
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Introduction: High-frequency low-tidal-volume (HFLTV) ventilation during radiofrequency catheter ablation (RFCA) for paroxysmal atrial fibrillation (PAF) has been shown to be superior to standard ventilation (SV) in terms of procedural efficiency, acute and long-term clinical outcomes. Our study aimed to compare ablation lesions characteristics utilizing HFLTV ventilation versus SV during RFCA of PAF., Methods: A retrospective analysis was conducted on patients who underwent pulmonary vein isolation (PVI) for PAF between August 2022 and March 2023, using high-power short-duration ablation. Thirty-five patients underwent RFCA with HFLTV ventilation and were matched with another cohort of 35 patients who underwent RFCA with SV. Parameters including ablation duration, contact force (CF), impedance drop, and ablation index were extracted from the CARTONET database for each ablation lesion., Results: A total of 70 patients were included (HFLTV = 35/2484 lesions, SV = 35/2830 lesions) in the analysis. There were no differences in baseline characteristics between the groups. While targeting the same ablation index, the HFLTV ventilation group demonstrated shorter average ablation duration per lesion (12.3 ± 5.0 vs. 15.4 ± 8.4 s, p < .001), higher average CF (17.0 ± 8.5 vs. 10.5 ± 4.6 g, p < .001), and greater impedance reduction (9.5 ± 4.6 vs. 7.7 ± 4.1 ohms, p < .001). HFLTV ventilation group also demonstrated shorter total procedural time (61.3 ± 25.5 vs. 90.8 ± 22.8 min, p < .001), ablation time (40.5 ± 18.6 vs. 65.8 ± 22.5 min, p < .001), and RF time (15.3 ± 4.8 vs. 22.9 ± 9.7 min, p < .001)., Conclusion: HFLTV ventilation during PVI for PAF was associated with improved ablation lesion parameters and procedural efficiency compared to SV., (© 2024 Wiley Periodicals LLC.)
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- 2024
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321. Improved all-cause mortality with left bundle branch area pacing compared to biventricular pacing in cardiac resynchronization therapy: a meta-analysis.
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Diaz JC, Gabr M, Tedrow UB, Duque M, Aristizabal J, Marin J, Niño C, Bastidas O, Koplan BA, Hoyos C, Matos CD, Hincapie D, Pacheco-Barrios K, Alviz I, Steiger NA, Kapur S, Tadros TM, Zei PC, Sauer WH, and Romero JE
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- Humans, Bundle-Branch Block therapy, Bundle-Branch Block mortality, Hospitalization statistics & numerical data, Risk Assessment, Stroke Volume physiology, Survival Rate, Treatment Outcome, Cardiac Resynchronization Therapy methods, Cause of Death, Heart Failure mortality, Heart Failure therapy
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Background: Left bundle branch area pacing (LBBAP) has emerged as a physiological alternative pacing strategy to biventricular pacing (BIVP) in cardiac resynchronization therapy (CRT). We aimed to assess the impact of LBBAP vs. BIVP on all-cause mortality and heart failure (HF)-related hospitalization in patients undergoing CRT., Methods: Studies comparing LBBAP and BIVP for CRT in patients with HF with reduced left ventricular ejection fraction (LVEF) were included. The coprimary outcomes were all-cause mortality and HF-related hospitalization. Secondary outcomes included procedural and fluoroscopy time, change in QRS duration, and change in LVEF., Results: Thirteen studies (12 observational and 1 RCT, n = 3239; LBBAP = 1338 and BIVP = 1901) with a mean follow-up duration of 25.8 months were included. Compared to BIVP, LBBAP was associated with a significant absolute risk reduction of 3.2% in all-cause mortality (9.3% vs 12.5%, RR 0.7, 95% CI 0.57-0.86, p < 0.001) and an 8.2% reduction in HF-related hospitalization (11.3% vs 19.5%, RR 0.6, 95% CI 0.5-0.71, p < 0.00001). LBBAP also resulted in reductions in procedural time (mean weighted difference- 23.2 min, 95% CI - 42.9 to - 3.6, p = 0.02) and fluoroscopy time (- 8.6 min, 95% CI - 12.5 to - 4.7, p < 0.001) as well as a significant reduction in QRS duration (mean weighted difference:- 25.3 ms, 95% CI - 30.9 to - 19.8, p < 0.00001) and a greater improvement in LVEF of 5.1% (95% CI 4.4-5.8, p < 0.001) compared to BIVP in the studies that reported these outcomes., Conclusion: In this meta-analysis, LBBAP was associated with a significant reduction in all-cause mortality as well as HF-related hospitalization when compared to BIVP. Additional data from large RCTs is warranted to corroborate these promising findings., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2024
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322. Relative contribution of contact force to lesion depth using high-power short-duration radiofrequency applications.
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Steiger N, McClennen L, Bilenker J, Elst LV, Matos C, Gracia E, Nauffal V, Zei PC, Romero JE, and Sauer WH
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- Humans, Animals, Atrial Fibrillation physiopathology, Atrial Fibrillation surgery, Catheter Ablation methods
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Competing Interests: Disclosures The authors have no conflicts of interest to disclose.
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- 2024
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323. Patient selection, ventricular tachycardia substrate delineation and data transfer for stereotactic arrhythmia radioablation. A Clinical Consensus Statement of the European Heart Rhythm Association (EHRA) of the ESC and the Heart Rhythm Society (HRS).
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Zeppenfeld K, Rademaker R, Al-Ahmad A, Carbucicchio C, De Chillou C, Ebert M, Stevenson WG, Ho G, Kautzner J, Sramko M, Lambiase P, Lloyd M, Merino JL, Pruvot E, Sapp J, Schiappacasse L, and Zei PC
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Stereotactic arrythmia radioablation (STAR) is a novel, non-invasive and promising treatment option for ventricular arrythmias (VA). It has been applied in highly selected patients mainly as bail-out procedure, when (multiple) catheter-ablations, together with anti-arrhythmic drugs, were unable to control the VAs. Despite the increasing clinical use there is still limited knowledge of the acute and long-term response of normal and diseased myocardium to STAR. Acute toxicity appeared to be reasonably low but potential late adverse effects may be underreported. Among published studies, the provided methodological information is often limited, and patient selection, target volume definition, methods for determination and transfer of target volume, and techniques for treatment planning and execution differ across studies, hampering pooling of data and comparison across studies. In addition, STAR requires close and new collaboration between clinical electrophysiologists and radiation oncologists, which is facilitated by shared knowledge in each collaborator's area of expertise and a common language. This clinical consensus statement provides uniform definition of cardiac target volumes. It aims to provide advice in patient selection for STAR including etiology specific aspects, and advice in optimal cardiac target volume identification based on available evidence. Safety concerns and the advice for acute and long-term monitoring including the importance of standardized reporting and follow-up are covered by this document. Areas of uncertainty are listed, which require high-quality, reliable pre-clinical and clinical evidence before expansion of STAR beyond clinical scenarios in which proven therapies are ineffective or unavailable., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2024
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324. Cardiac Substructure Radiation Dose and Associations With Tachyarrhythmia and Bradyarrhythmia After Lung Cancer Radiotherapy.
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Atkins KM, Zhang SC, Kehayias C, Guthier C, He J, Gasho JO, Bakhtiar M, Silos KD, Kozono DE, Zei PC, Nohria A, Nikolova AP, and Mak RH
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Background: Arrhythmias are common following radiotherapy for non-small cell lung cancer., Objectives: The aim of this study was to analyze the association of distinct arrhythmia classes with cardiac substructure radiotherapy dose., Methods: A retrospective analysis was conducted of 748 patients with locally advanced non-small cell lung cancer treated with radiotherapy. Cardiac substructure dose parameters were calculated. Receiver-operating characteristic curve analyses for predictors of Common Terminology Criteria for Adverse Events grade ≥3 atrial fibrillation (AF), atrial flutter, non-AF and non-atrial flutter supraventricular tachyarrhythmia (SVT), bradyarrhythmia, and ventricular tachyarrhythmia (VT) or asystole were calculated. Fine-Gray regression models were performed (with noncardiac death as a competing risk)., Results: Of 748 patients, 128 (17.1%) experienced at least 1 grade ≥3 arrhythmia, with a median time to first arrhythmia of 2.0 years (Q1-Q3: 0.9-4.2 years). The 2-year cumulative incidences of each arrhythmia group were 8.0% for AF, 2.7% for atrial flutter, 1.8% for other SVT, 1.4% for bradyarrhythmia, and 1.1% for VT or asystole. Adjusting for baseline cardiovascular risk, pulmonary vein (PV) volume receiving 5 Gy was associated with AF (subdistribution HR [sHR]: 1.04/mL; 95% CI: 1.01-1.08; P = 0.016), left circumflex coronary artery volume receiving 35 Gy with atrial flutter (sHR: 1.10/mL; 95% CI: 1.01-1.19; P = 0.028), PV volume receiving 55 Gy with SVT (sHR: 1.03 per 1%; 95% CI: 1.02-1.05; P < 0.001), right coronary artery volume receiving 25 Gy with bradyarrhythmia (sHR: 1.14/mL; 95% CI: 1.00-1.30; P = 0.042), and left main coronary artery volume receiving 5 Gy with VT or asystole (sHR: 2.45/mL; 95% CI: 1.21-4.97; P = 0.013)., Conclusions: This study revealed pathophysiologically distinct arrhythmia classes associated with radiotherapy dose to discrete cardiac substructures, including PV dose with AF and SVT, left circumflex coronary artery dose with atrial flutter, right coronary artery dose with bradyarrhythmia, and left main coronary artery dose with VT or asystole, guiding potential risk mitigation approaches., Competing Interests: Dr Atkins has received honoraria from OncLive. Dr Mak is a consultant for AstraZeneca, ViewRay, Novartis, Sio Capital Management, and Varian Medical Systems; is an advisory board member for ViewRay and AstraZeneca; and has received grant funding from AstraZeneca and ViewRay. Dr Nohria has received research support from Bristol Myers Squibb; and has received consulting fees from Altathera Pharmaceuticals, AstraZeneca, Bantam Pharmaceuticals, Regeneron Pharmaceuticals, and Takeda Oncology. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)
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- 2024
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325. Evaluation of pulsed field ablation lesion characteristics using an in vitro vegetable model.
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Steiger NA, McClennen L, Bilenker J, Patino C, Matos CD, Sauer KM, Hoyas C, Tedrow UB, Zei PC, Romero JE, and Sauer WH
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Background: In vitro models to evaluate cardiac pulsed field ablation (PFA) have not been well established. We sought to create a standardized vegetable model and staining protocol for assessing unipolar PFA using a surface electrode., Methods: We exposed potato slabs to unipolar PFA in a saline bath using a 3.5 mm electrode catheter and grounding pad connected to a custom-built high-voltage generator. Lesions were clearly visualized after staining with 2,3,5-triphenyltetrazolium chloride (TTC) using a timed protocol to reveal a necrotic center and a periphery of electroporated cells with intact mitochondria., Results: Lesion volume increased linearly with increasing voltage and logarithmically with repetitive PFA applications., Conclusion: The findings observed in this vegetable model using a TTC staining protocol are consistent with findings observed with cardiomyocytes., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2024
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326. Trainee involvement in AF ablation procedures.
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Whitaker J and Zei PC
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- 2024
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327. Consistency of ablations with trainee and increasing independence during fellowship training-Analysis of ablation data by CARTONET.
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Whitaker J, Hunter TD, Carsey J, Thatcher WH, Yungher D, Goldberg S, Kaneko C, Amit M, Kreidieh O, Thurber C, Steiger N, Chang D, Batnyam U, Sharma E, McClennen S, Kapur S, Tadros T, Sauer WH, Koplan B, Tedrow U, and Zei PC
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- Humans, Learning Curve, Electrophysiologic Techniques, Cardiac, Artificial Intelligence, Time Factors, Treatment Outcome, Fellowships and Scholarships, Cardiologists education, Cardiac Electrophysiology education, Cardiac Catheters, Catheter Ablation, Clinical Competence, Atrial Fibrillation surgery, Atrial Fibrillation physiopathology, Atrial Fibrillation diagnosis, Education, Medical, Graduate
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Introduction: Training in clinical cardiac electrophysiology (CCEP) involves the development of catheter handling skills to safely deliver effective treatment. Objective data from analysis of ablation data for evaluating trainee of CCEP procedures has not previously been possible. Using the artificial intelligence cloud-based system (CARTONET), we assessed the impact of trainee progress through ablation procedural quality., Methods: Lesion- and procedure-level data from all de novo atrial fibrillation (AF) and cavotricuspid isthmus (CTI) ablations involving first-year (Y1) or second-year (Y2) fellows across a full year of fellowship was curated within Cartonet. Lesions were automatically assigned to anatomic locations., Results: Lesion characteristics, including contact force, catheter stability, impedance drop, ablation index value, and interlesion time/distance were similar over each training year. Anatomic location and supervising operator significantly affected catheter stability. The proportion of lesion sets delivered independently and of lesions delivered by the trainee increased steadily from the first quartile of Y1 to the last quartile of Y2. Trainee perception of difficult regions did not correspond to objective measures., Conclusion: Objective ablation data from Cartonet showed that the progression of trainees through CCEP training does not impact lesion-level measures of treatment efficacy (i.e., catheter stability, impedance drop). Data demonstrates increasing independence over a training fellowship. Analyses like these could be useful to inform individualized training programs and to track trainee's progress. It may also be a useful quality assurance tool for ensuring ongoing consistency of treatment delivered within training institutions., (© 2024 The Author(s). Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.)
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- 2024
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328. High-frequency low-tidal volume ventilation improves procedural and long-term clinical outcomes in persistent atrial fibrillation ablation: Prospective multicenter registry.
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Osorio J, Hincapie D, Varley AL, Silverstein JR, Matos CD, Thosani AJ, Thorne C, D'Souza B, Alviz I, Gabr M, Rajendra A, Oza S, Sharma D, Hoyos C, Singleton MJ, Mareddy C, Velasco A, Zei PC, Sauer WH, and Romero JE
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Background: High-frequency, low-tidal volume (HFLTV) ventilation increases the efficacy and efficiency of radiofrequency catheter ablation (RFCA) of paroxysmal atrial fibrillation. Whether those benefits can be extrapolated to RFCA of persistent atrial fibrillation (PeAF) is undetermined., Objective: The purpose of this study was to evaluate whether using HFLTV ventilation during RFCA in patients with PeAF is associated with improved procedural and long-term clinical outcomes compared to standard ventilation (SV)., Methods: In this prospective multicenter registry (REAL-AF), patients who had undergone pulmonary vein isolation (PVI) + posterior wall isolation (PWI) for PeAF using either HFLTV ventilation or SV were included. The primary efficacy outcome was freedom from all-atrial arrhythmias at 12 months. Secondary outcomes included procedural and long-term clinical outcomes and complications., Results: A total of 210 patients were included (HFLTV=95 vs. SV=115) in the analysis. There were no differences in baseline characteristics between the groups. Procedural time (80 [66-103.5] minutes vs 110 [85-141] minutes; P <.001), total radiofrequency (RF) time (18.73 [13.93-26.53] minutes vs 26.15 [20.30-35.25] minutes; P <.001), and pulmonary vein RF time (11.35 [8.78-16.69] minutes vs 18 [13.74-24.14] minutes; P <.001) were significantly shorter using HFLTV ventilation compared with SV. Freedom from all-atrial arrhythmias was significantly higher with HFLTV ventilation compared with SV (82.1% vs 68.7%; hazard ratio 0.41; 95% confidence interval [0.21-0.82]; P = .012), indicating a 43% relative risk reduction and a 13.4% absolute risk reduction in all-atrial arrhythmia recurrence. There was no difference in long-term procedure-related complications between the groups (HFLTV 1.1% vs SV 0%, P = .270)., Conclusion: In patients undergoing RFCA with PVI + PWI for PeAF, the use of HFLTV ventilation was associated with higher freedom from all-atrial arrhythmias at 12-month follow-up, with significantly shorter procedural and RF times compared to SV, while reporting a similar safety profile., Competing Interests: Disclosures Dr Osorio, Dr Zei, Dr Sauer, and Dr Romero report consulting and research support from Biosense Webster. Dr Silverstein reports consulting and honoraria from Biosense Webster. Dr D’Souza, Dr Oza, Dr Sharma, and Dr Rajendra report consulting from Biosense Webster. Dr Thosani reports physician education from Biosense Webster. All other authors have no conflicts of interest to disclose., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
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- 2024
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329. Procedural volume and outcomes with atrial fibrillation ablation: A report from the NCDR AFib Ablation Registry.
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Kattel S, Tan Z, Lin Z, Mszar R, Sanders P, Zeitler EP, Zei PC, Bunch TJ, Mansour M, Akar J, Curtis JP, Friedman DJ, and Freeman JV
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Background: The association of hospital and physician procedure volume with outcome has not been well evaluated for atrial fibrillation (AF) ablation in contemporary practice., Objective: This study aimed to determine the association between hospital and physician AF ablation volume and procedural success (isolation of all pulmonary veins) and major adverse events (MAEs)., Methods: Procedures reported to the National Cardiovascular Data Registry AFib Ablation Registry between July 2019 and June 2022 were included. Hospital and physician procedural volumes were annualized and stratified into quartiles to compare outcomes. Three-level hierarchical (patient, hospital, and physician) models were used to assess the procedural volume-outcome relationship., Results: A total of 70,296 first-time AF ablations at 186 US hospitals were included. Overall, procedural success and MAE rates were 98.5% and 1.0%, respectively. With hospital volume (Q4) as a reference, the likelihood of procedural success was lower for Q1 (odds ratio [OR], 0.44; 95% CI, 0.29-0.68), Q2 (OR, 0.50; 95% CI, 0.33-0.75), and Q3 (OR, 0.60; 95% CI, 0.40-0.89); the results were similarly significant for physician volume. With MAE for hospitals, there was an inverse procedural volume relationship for Q1 (OR, 1.78; 95% CI, 1.26-2.52) but not for Q2 (OR, 1.06; 95% CI, 0.77-1.46) or Q3 (OR, 1.19; 95% CI, 0.89-1.58) and similarly for physicians in Q1 and Q2 but not in Q3. An adjusted MAE ≤1% was predicted by an annual volume of approximately 190 for hospitals and 60 for physicians., Conclusion: In this national cohort, hospital and physician AF ablation procedural volumes were directly related to acute procedural success and inversely related to rates of MAE., Competing Interests: Disclosures Dr Freeman reports advisory board/consulting fees from Boston Scientific, Medtronic, Biosense Webster, and PaceMate; and equity in PaceMate. Dr Zeitler reports nonfinancial research support from Biosense Webster, Boston Scientific, and Sanofi; travel/speaking for Abbott, Biosense Webster, Medtronic, and Philips; and advisory board/consulting fees from Biosense Webster and Medtronic. Dr Zei reports consulting fees from Biosense Webster, Abbott, Volta Medical, and Medtronic. Dr Sanders served on the advisory board of Medtronic, Abbott, Boston Scientific, PaceMate, and CathRx; the University of Adelaide, Australia has received on his behalf lecture, research funding, and/or consulting fees from Medtronic, Abbott, Boston Scientific, and Becton-Dickenson., (Published by Elsevier Inc.)
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- 2024
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330. Sex Differences in Left Bundle Branch Area Pacing Versus Biventricular Pacing for Cardiac Resynchronization Therapy.
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Tedrow UB, Miranda-Arboleda AF, Sauer WH, Duque M, Koplan BA, Marín JE, Aristizabal JM, Niño CD, Bastidas O, Martinez JM, Hincapie D, Hoyos C, Matos CD, Lopez-Cabanillas N, Steiger NA, Tadros TM, Zei PC, Diaz JC, and Romero JE
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- Humans, Female, Male, Aged, Prospective Studies, Middle Aged, Sex Factors, Registries, Treatment Outcome, Hospitalization statistics & numerical data, Aged, 80 and over, Stroke Volume physiology, Cardiac Resynchronization Therapy methods, Heart Failure therapy, Heart Failure physiopathology, Bundle-Branch Block therapy, Bundle-Branch Block physiopathology
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Background: Women respond more favorably to biventricular pacing (BIVP) than men. Sex differences in atrioventricular and interventricular conduction have been described in BIVP studies. Left bundle branch area pacing (LBBAP) offers advantages due to direct capture of the conduction system. We hypothesized that men could respond better to LBBAP than BIVP., Objectives: This study aims to describe the sex differences in response to LBBAP vs BIVP as the initial cardiac resynchronization therapy (CRT)., Methods: In this multicenter prospective registry, we included patients with left ventricular ejection fraction ≤35% and left bundle branch block or a left ventricular ejection fraction ≤40% with an expected right ventricular pacing exceeding 40% undergoing initial CRT with LBBAP or BIVP. The composite primary outcome was heart failure-related hospitalization and all-cause mortality. The primary safety outcome included all procedure-related complications., Results: There was no significant difference in the primary outcome when comparing men and women receiving LBBAP (P = 0.46), whereas the primary outcome was less frequent in women in the BIVP group than men treated with BIVP (P = 0.03). The primary outcome occurred less frequently in men undergoing LBBAP (29.9%) compared to those treated with BIVP (46.5%) (P = 0.004). In women, the incidence of the primary endpoint was 24.14% in the LBBAP group and 36.2% in the BIVP group; however, this difference was not statistically significant (P = 0.23). Complication rates remained consistent across all groups., Conclusions: Men and women undergoing LBBAP for CRT had similar clinical outcomes. Men undergoing LBBAP showed a lower risk of heart failure-related hospitalizations and all-cause mortality compared to men undergoing BIVP, whereas there was no difference between LBBAP and BIVP in women., Competing Interests: Funding Support and Author Disclosures Dr Diaz has received speaker honoraria and has been a proctor for Medtronic for conduction system pacing. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2024
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331. Feasibility, Efficacy, and Safety of Fluoroless Ablation of VT in Patients With Structural Heart Disease.
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Enriquez A, Sadek M, Hanson M, Yang J, Matos CD, Neira V, Marchlinski F, Miranda-Arboleda A, Orellana-Cáceres JJ, Alviz I, Hoyos C, Gabr M, Batnyam U, Tedrow UB, Zei PC, Sauer WH, and Romero JE
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- Humans, Male, Female, Aged, Middle Aged, Fluoroscopy, Echocardiography, Treatment Outcome, Cardiomyopathies surgery, Cardiomyopathies complications, Catheter Ablation methods, Catheter Ablation adverse effects, Feasibility Studies, Tachycardia, Ventricular surgery
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Background: Catheter ablation of ventricular tachycardia (VT) typically requires radiation exposure with its potential adverse health effects. A completely fluoroless ablation approach is achievable using a combination of electroanatomical mapping and intracardiac echocardiography. Nonetheless, data in patients undergoing VT ablation are limited., Objectives: This study aimed to determine the feasibility, efficacy, and safety of VT ablation in patients with structural heart disease using a zero-fluoroscopy approach., Methods: This multicenter study included consecutive patients with ischemic and nonischemic cardiomyopathy undergoing fluoroless VT ablation. Patients requiring epicardial access or coronary angiography were excluded., Results: Between 2017 and 2023 a total of 198 patients (aged 66.4 ± 13.4 years, 76% male, 48% ischemic) were included. Most patients (95.4%) underwent left ventricular (LV) mapping and/or ablation, which was conducted via transseptal route in 54.5% (n = 103), via retrograde aortic route in 43.4% (n = 82), and using a combined approach in 2.1% (n = 4). Two-thirds of patients had a cardiac device, including a biventricular device in 15%; 2 patients had a LV assist device, and 1 patient had a mechanical aortic valve prosthesis. The mean total procedural time was 211 ± 70 minutes, and the total radiofrequency time was 30 ± 22 minutes. During a follow-up period of 22 ± 18 months, the freedom from VT recurrence was 80%, and 7.6% of patients underwent a repeated ablation. Procedural-related complications occurred in 6 patients (3.0%)., Conclusions: Fluoroless ablation of VT in structural heart disease is feasible, effective, and safe when epicardial mapping/ablation is not required., Competing Interests: Funding Support and Author Disclosures This study was supported by the Mark Marchlinski E.P. Research Fund, and the Winkleman Family Fund in Cardiac Innovation. The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2024
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332. Real-world data of radiofrequency catheter ablation in paroxysmal atrial fibrillation: Short- and long-term clinical outcomes from the prospective multicenter REAL-AF Registry.
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Osorio J, Miranda-Arboleda AF, Velasco A, Varley AL, Rajendra A, Morales GX, Hoyos C, Matos C, Thorne C, D'Souza B, Silverstein JR, Metzl MD, Hebsur S, Costea AI, Kang S, Sellers M, Singh D, Salam T, Nazari J, Ro AS, Mazer S, Moretta A, Oza SR, Magnano AR, Sackett M, Dukes J, Patel P, Goyal SK, Senn T, Newton D, Romero JE, and Zei PC
- Abstract
Background: The safety and long-term efficacy of radiofrequency (RF) catheter ablation (CA) of paroxysmal atrial fibrillation (PAF) has been well established. Contemporary techniques to optimize ablation delivery, reduce fluoroscopy use, and improve clinical outcomes have been developed., Objective: The purpose of this study was to assess the contemporary real-world practice approach and short and long-term outcomes of RF CA for PAF through a prospective multicenter registry., Methods: Using the REAL-AF (Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation; ClincalTrials.gov Identifier: NCT04088071) Registry, patients undergoing RF CA to treat PAF across 42 high-volume institutions and 79 experienced operators were evaluated. The procedures were performed using zero or reduced fluoroscopy, contact force sensing catheters, wide area circumferential ablation, and ablation index as a guide with a target of 380-420 for posterior and 500-550 for anterior lesions. The primary efficacy outcome was freedom from all-atrial arrhythmia recurrence at 12 months., Results: A total of 2470 patients undergoing CA from January 2018 to December 2022 were included. Mean age was 65.2 ±11.14 years, and 44% were female. Most procedures were performed without fluoroscopy (71.5%), with average procedural and total RF times of 95.4 ± 41.7 minutes and 22.1±11.8 minutes, respectively. At 1-year follow-up, freedom from all-atrial arrhythmias was 81.6% with 89.7% of these patients off antiarrhythmic drugs. No significant difference was identified comparing pulmonary vein isolation vs pulmonary vein isolation plus ablation approaches. The complication rate was 1.9%., Conclusion: Refinement of RF CA to treat PAF using contemporary tools, standardized protocols, and electrophysiology laboratory workflows resulted in excellent short- and long-term clinical outcomes., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
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- 2024
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333. Use of intracardiac echocardiography in vein of Marshall ethanol infusion for ablation of persistent atrial fibrillation.
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Ding X, Wang L, Liu Q, Chen S, Jiang R, Yu L, Zhang P, Lin J, Sun Y, Sheng X, Fu G, Zei PC, and Jiang C
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- Humans, Ethanol, Coronary Vessels diagnostic imaging, Heart Atria, Echocardiography, Atrial Fibrillation diagnostic imaging, Atrial Fibrillation surgery, Catheter Ablation methods
- Abstract
Background: Few methods have been reported to demonstrate real-time effects during vein of Marshall (VOM) ethanol infusion in persistent atrial fibrillation (PeAF)., Objective: This study was to evaluate the impact of left atrial (LA) monitoring using intracardiac echocardiography (ICE) during VOM ethanol infusion., Methods: Seventy-four consecutive patients with PeAF who underwent VOM ethanol infusion followed by radiofrequency (RF) ablation were included. Patients with findings on ICE consistent with echogenic streaming in the LA and with increased myocardial local echogenicity along the VOM area were placed into one group (group A) and those without into the other group (group B). Outcomes between the 2 groups were compared., Results: Forty-six patients (62%) were placed into group A. A new ethanol-induced low-voltage area in group A was larger than that in group B (8.5 cm
2 [5.5-10.2 cm2 ] and 4.0 cm2 (2.4-6.3 cm2 ]; P < .001). The RF ablation time required to achieve MI block was reduced in group A patients (263.0 seconds [196.0-351.0 seconds] vs 417.0 seconds [315.0-709.5 seconds] in group B patients; P < .001). MI block was achieved in 46 patients (100%) via an endocardial approach in group A and 27 patients (96.4%) in group B (extra coronary sinus ablation in 4 patients). One patient developed clinically significant pericardial effusions and required pericardiocentesis in group B., Conclusion: Presence of increased myocardial local echogenicity at the ridge and consistent echogenic streaming in the LA detected by ICE-based imaging during VOM ethanol infusion suggests increased ablated tissue in that region and lower RF ablation time during ablation for PeAF., Competing Interests: Disclosures The authors have no conflicts to disclose, (Copyright © 2023 Heart Rhythm Society. All rights reserved.)- Published
- 2024
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334. Diagnosis and Management of Paroxysmal Supraventricular Tachycardia.
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Peng G and Zei PC
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- Adult, Child, Female, Humans, Male, Adenosine administration & dosage, Adenosine therapeutic use, Administration, Intravenous, Anti-Arrhythmia Agents administration & dosage, Anti-Arrhythmia Agents therapeutic use, Cardiomyopathies etiology, Catheter Ablation, Electrocardiography, Valsalva Maneuver, Electric Countershock, Tachycardia, Ventricular complications, Tachycardia, Ventricular diagnosis, Tachycardia, Ventricular therapy
- Abstract
Importance: Paroxysmal supraventricular tachycardia (PSVT), defined as tachyarrhythmias that originate from or conduct through the atria or atrioventricular node with abrupt onset, affects 168 to 332 per 100 000 individuals. Untreated PSVT is associated with adverse outcomes including high symptom burden and tachycardia-mediated cardiomyopathy., Observations: Approximately 50% of patients with PSVT are aged 45 to 64 years and 67.5% are female. Most common symptoms include palpitations (86%), chest discomfort (47%), and dyspnea (38%). Patients may rarely develop tachycardia-mediated cardiomyopathy (1%) due to PSVT. Diagnosis is made on electrocardiogram during an arrhythmic event or using ambulatory monitoring. First-line acute therapy for hemodynamically stable patients includes vagal maneuvers such as the modified Valsalva maneuver (43% effective) and intravenous adenosine (91% effective). Emergent cardioversion is recommended for patients who are hemodynamically unstable. Catheter ablation is safe, highly effective, and recommended as first-line therapy to prevent recurrence of PSVT. Meta-analysis of observational studies shows single catheter ablation procedure success rates of 94.3% to 98.5%. Evidence is limited for the effectiveness of long-term pharmacotherapy to prevent PSVT. Nonetheless, guidelines recommend therapies including calcium channel blockers, β-blockers, and antiarrhythmic agents as management options., Conclusion and Relevance: Paroxysmal SVT affects both adult and pediatric populations and is generally a benign condition. Catheter ablation is the most effective therapy to prevent recurrent PSVT. Pharmacotherapy is an important component of acute and long-term management of PSVT.
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- 2024
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335. Left Bundle Branch Pacing vs Left Ventricular Septal Pacing vs Biventricular Pacing for Cardiac Resynchronization Therapy.
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Diaz JC, Tedrow UB, Duque M, Aristizabal J, Braunstein ED, Marin J, Niño C, Bastidas O, Lopez Cabanillas N, Koplan BA, Hoyos C, Matos CD, Hincapie D, Velasco A, Steiger NA, Kapur S, Tadros TM, Zei PC, Sauer WH, and Romero JE
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- Humans, Prospective Studies, Heart Conduction System, Heart Ventricles, Electrocardiography, Cardiac Resynchronization Therapy adverse effects, Heart Failure
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Background: Left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) are considered to be acceptable as LBBAP strategies. Differences in clinical outcomes between LBBP and LVSP are yet to be determined., Objectives: The purpose of this study was to compare the outcomes of LBBP vs LVSP vs BIVP for CRT., Methods: In this prospective multicenter observational study, LBBP was compared with LVSP and BIVP in patients undergoing CRT. The primary composite outcome was freedom from heart failure (HF)-related hospitalization and all-cause mortality. Secondary outcomes included individual components of the primary outcome, postprocedural NYHA functional class, and electrocardiographic and echocardiographic parameters., Results: A total of 415 patients were included (LBBP: n = 141; LVSP: n = 31; BIVP: n = 243), with a median follow-up of 399 days (Q1-Q3: 249.5-554.8 days). Freedom from the primary composite outcomes was 76.6% in the LBBP group and 48.4% in the LVSP group (HR: 1.37; 95% CI: 1.143-1.649; P = 0.001), driven by a 31.4% absolute increase in freedom from HF-related hospitalizations (83% vs 51.6%; HR: 3.55; 95% CI: 1.856-6.791; P < 0.001) without differences in all-cause mortality. LBBP was also associated with a higher freedom from the primary composite outcome compared with BIVP (HR: 1.43; 95% CI: 1.175-1.730; P < 0.001), with no difference between LVSP and BIVP., Conclusions: In patients undergoing CRT, LBBP was associated with improved outcomes compared with LVSP and BIVP, while outcomes between BIVP and LVSP are similar., Competing Interests: Funding Support and Author Disclosures Dr Diaz has received speaker honoraria from and is a proctor for Medtronic for LBBAP. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2024
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336. Understanding Lesion Creation Biophysics and Improved Lesion Assessment during Radiofrequency Catheter Ablation. The Perfect Combination to Achieve Durable Lesions in Atrial Fibrillation Ablation.
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Gracia E, Miranda-Arboleda AF, Hoyos C, Matos CD, Osorio J, Romero JE, and Zei PC
- Abstract
Atrial fibrillation (AF) is a prevalent arrhythmia, while pulmonary vein isolation (PVI) has become a cornerstone in its treatment. The creation of durable lesions is crucial for successful and long-lasting PVI, as inconsistent lesions lead to reconnections and recurrence after ablation. Various approaches have been developed to assess lesion quality and transmurality in vivo , acting as surrogates for improved lesion creation and long-term outcomes utilizing radiofrequency (RF) energy. This review manuscript examines the biophysics of lesion creation and different lesion assessment techniques that can be used daily in the electrophysiology laboratory when utilizing RF energy. These methods provide valuable insights into lesion effectiveness, facilitating optimized ablation procedures and reducing atrial arrhythmia recurrences. However, each approach has its limitations, and a combination of techniques is recommended for comprehensive lesion assessment during AF catheter ablation. Future advancements in imaging techniques, such as magnetic Resonance Imaging (MRI), optical coherence tomography, and photoacoustic imaging, hold promise in further enhancing lesion evaluation and guiding treatment strategies., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 The Author(s). Published by IMR Press.)
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- 2024
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337. High-Power Short-Duration Ablation of Paroxysmal and Persistent Atrial Fibrillation.
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Hoyos C, Matos CD, Miranda-Arboleda AF, Patino C, Hincapie D, Osorio J, Zei PC, and Romero JE
- Abstract
Catheter ablation has become a cornerstone in atrial fibrillation (AF) therapy, improving freedom from all-atrial arrhythmias, as well as outperforming antiarrhythmic drugs in alleviating AF-related symptoms, reducing hospitalizations, and enhancing quality of life. Nevertheless, the success rate of traditional radiofrequency ablation (RFA) methods remains less than ideal. To address these issues, refinement in RFA strategies has been developed to improve efficacy and laboratory efficiency during pulmonary vein isolation (PVI). High-power short-duration (HPSD) RFA has emerged as a safe strategy to reduce the time required to produce durable lesions. This article reviews critical aspects of HPSD ablation in the management of both paroxysmal and persistent AF, covering aspects such as effectiveness, safety, procedural intricacies, and the underlying biophysics., Competing Interests: Dr. Romero is a paid consultant and has received grant support from Biosense Webster (BWI-IIS-535) for an investigator-initiated study (The PLEA Trial NCT04216667). Neither honoraria nor payments were made for authorship. The remaining authors declare no conflict of interest., (Copyright: © 2023 The Author(s). Published by IMR Press.)
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- 2023
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338. 50-W vs 40-W During High-Power Short-Duration Ablation for Paroxysmal Atrial Fibrillation: A Multicenter Prospective Study.
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Costea A, Diaz JC, Osorio J, Matos CD, Hoyos C, Goyal S, Te C, D'Souza B, Rastogi M, Lopez-Cabanillas N, Ibanez LC, Thorne C, Varley AL, Zei PC, Sauer WH, and Romero JE
- Subjects
- Humans, Prospective Studies, Neoplasm Recurrence, Local etiology, Time Factors, Atrial Fibrillation, Cryosurgery, Catheter Ablation adverse effects
- Abstract
Background: High-power short-duration (HPSD) radiofrequency ablation of atrial fibrillation (AF) increases first-pass pulmonary vein isolation (PVI) and freedom from atrial arrhythmias while decreasing procedural time. However, the optimal power setting in terms of safety and efficacy has not been determined., Objectives: This study compared the procedural characteristics and clinical outcomes of 50-W vs 40-W during HPSD ablation of paroxysmal AF., Methods: Patients from the REAL-AF prospective multicenter registry (Real-World Experience of Catheter Ablation for Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation) undergoing HPSD ablation of paroxysmal AF, either using 50-W or 40-W, were included. The primary efficacy outcome was freedom from all-atrial arrhythmias. The primary safety outcome was the occurrence of any procedural complication at 12 months. Secondary outcomes included procedural characteristics, AF-related symptoms, and the occurrence of transient ischemic attack or stroke at 12 months., Results: A total of 383 patients were included. Freedom from all-atrial arrhythmias at 12 months was 80.7% in the 50-W group and 77.3% in the 40-W group (Log-rank P = 0.387). The primary safety outcome occurred in 3.7% of patients in the 50-W group vs 2.8% in the 40-W group (P = 0.646). The 50-W group had a higher rate of first-pass PVI (82.3% vs 76.2%; P = 0.040) as well as shorter procedural (67 minutes [IQR: 54-87.5 minutes] vs 93 minutes [IQR: 80.5-111 minutes]; P < 0.001) and radiofrequency ablation times (15 minutes [IQR: 11.4-20 minutes] vs 27 minutes [IQR: 21.5-34.6 minutes]; P < 0.001) than the 40-W group., Conclusions: There was no significant difference in freedom from all-atrial arrhythmias or procedural safety outcomes between 50-W and 40-W during HPSD ablation of paroxysmal AF. The use of 50-W was associated with a higher rate of first-pass PVI as well as shorter procedural times., Competing Interests: Funding Support and Author Disclosures The REAL-AF registry is funded through an investigator-initiated research grant (PI: Dr Osorio) from Biosense Webster Inc (NCT04088071). Drs Osorio, Zei, and Romero have received consulting and research support from Biosense Webster. Dr D’Souza has received consulting support from Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2023
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339. Pulsed Field Ablation of Atrial Fibrillation: A Comprehensive Review.
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Matos CD, Hoyos C, Miranda-Arboleda AF, Diaz JC, Hincapie D, Patino C, Hernadez RH, Zei PC, Romero JE, and Osorio J
- Abstract
Pulsed-field ablation (PFA) has emerged as a promising nonthermal ablation alternative for treating atrial fibrillation (AF). By delivering ultra-rapid high-energy electrical pulses, PFA induces irreversible electroporation, selectively targeting myocardial tissue while sparing adjacent structures from thermal or other damage. This article provides a comprehensive review of multiple pre-clinical studies, clinical studies, and clinical trials evaluating the safety, efficacy, and long-term outcomes of PFA in various settings and patient populations. Overall, the reviewed evidence highlights PFA's potential as a revolutionary ablation strategy for AF treatment. Offering comparable procedural efficacy to conventional ablation methods, PFA distinguishes itself with shorter procedure times and reduced risks of complications such as phrenic nerve palsy and potential esophageal injury. While further research is warranted to establish long-term efficacy, PFA's distinct advantages and evolving clinical evidence suggest a promising future for this novel nonthermal ablation approach. As PFA continues to advance, it has the potential to transform AF ablation procedures, providing a safer alternative for patients with atrial fibrillation., Competing Interests: Dr. Zei, Dr. Romero, and Dr. Osorio report consulting and research support from Biosense Webster. Dr. Romero reports consulting for Boston Scientific. Neither honoraria nor payments were made for authorship., (Copyright: © 2023 The Author(s). Published by IMR Press.)
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- 2023
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340. Measured temperatures using uninterrupted and interrupted sequences of radiofrequency applications in a phantom gel model: implications for esophageal injury.
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Steiger N, Qian PC, Foley G, Bomma T, Kreidieh O, Whitaker J, Thurber CJ, Koplan BA, Tadros TM, Kapur S, Zei PC, Tedrow UB, Romero J, and Sauer WH
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- 2023
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341. Chinese expert consensus on the construction of the fluoroless cardiac electrophysiology laboratory and related techniques.
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Jiang C, Ma C, Chen S, Chen S, Jiang C, Jiang R, Ju W, Long D, Li D, Li J, Liu Q, Ma W, Pu X, Wang R, Wang Y, Yi F, Zou C, Zhang J, Zhang X, Zhao Y, Zei PC, Biase LD, Chang D, Cai H, Chen L, Chen M, Fu G, Fu H, Fan J, Gui C, Jiang T, Liu S, Li X, Li Y, Shu M, Wang Y, Xu J, Xie R, Xia Y, Xue Y, Yang P, Yuan Y, Zhong J, and Zhu W
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- Humans, Cardiac Electrophysiology, Treatment Outcome, Catheter Ablation methods, Electrophysiologic Techniques, Cardiac methods, Surgery, Computer-Assisted methods
- Abstract
Transcatheter radiofrequency ablation has been widely introduced for the treatment of tachyarrhythmias. The demand for catheter ablation continues to grow rapidly as the level of recommendation for catheter ablation. Traditional catheter ablation is performed under the guidance of X-rays. X-rays can help display the heart contour and catheter position, but the radiobiological effects caused by ionizing radiation and the occupational injuries worn caused by medical staff wearing heavy protective equipment cannot be ignored. Three-dimensional mapping system and intracardiac echocardiography can provide detailed anatomical and electrical information during cardiac electrophysiological study and ablation procedure, and can also greatly reduce or avoid the use of X-rays. In recent years, fluoroless catheter ablation technique has been well demonstrated for most arrhythmic diseases. Several centers have reported performing procedures in a purposefully designed fluoroless electrophysiology catheterization laboratory (EP Lab) without fixed digital subtraction angiography equipment. In view of the lack of relevant standardized configurations and operating procedures, this expert task force has written this consensus statement in combination with relevant research and experience from China and abroad, with the aim of providing guidance for hospitals (institutions) and physicians intending to build a fluoroless cardiac EP Lab, implement relevant technologies, promote the standardized construction of the fluoroless cardiac EP Lab., (© 2023 Wiley Periodicals LLC.)
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- 2023
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342. Performance of the REAL-AF Same-Day Discharge Protocol in Patients Undergoing Catheter Ablation of Atrial Fibrillation.
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Rajendra A, Osorio J, Diaz JC, Hoyos C, Rivera E, Matos CD, Costea A, Varley AL, Thorne C, Hoskins M, Goyal S, Oza S, Magnano A, D'Souza B, Silverstein J, Metzl M, Zei PC, and Romero JE
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- Humans, Patient Discharge, Stroke Volume, Treatment Outcome, Ventricular Function, Left, Atrial Fibrillation, Catheter Ablation
- Abstract
Background: Same-day discharge (SDD) after catheter ablation of atrial fibrillation (AF) has been widely adopted. Nevertheless, planned SDD has been performed by using subjective criteria rather than standardized protocols., Objectives: The goal of this study was to determine the efficacy and safety of the previously described SDD protocol in a prospective multicenter study., Methods: Using the REAL-AF (Real-world Experience of Catheter Ablation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation) SDD protocol eligibility criteria (stable anticoagulation, no bleeding history, left ventricular ejection fraction >40%, no pulmonary disease, no procedures within 60 days, and body mass index <35 kg/m
2 ), operators prospectively determined whether patients undergoing ablation of AF were candidates for SDD (SDD vs non-SDD groups). Successful SDD was achieved if the patient met the protocol discharge criteria. The primary efficacy endpoint was the success rate of SDD. The primary safety endpoints were readmission rates as well as acute and subacute complications. The secondary endpoints included procedural characteristics and freedom from all-atrial arrhythmias., Results: A total of 2,332 patients were included. The REAL-AF SDD protocol identified 1,982 (85%) patients as potential candidates for SDD. The primary efficacy endpoint was achieved in 1,707 (86.1%) patients. The readmission rate for SDD vs non-SDD group was similar (0.8% vs 0.9%; P = 0.924). The SDD group had a lower acute complication rate than the non-SDD group (0.8% vs 2.9%; P < 0.001), and there was no difference in the subacute complication rate between groups (P = 0.513). Freedom from all-atrial arrhythmias was comparable between groups (P = 0.212)., Conclusions: In this large, multicenter prospective registry, the use of a standardized protocol showed the safety of SDD after catheter ablation of paroxysmal and persistent AF. (Real-world Experience of Catheter Ablation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation [REAL-AF]; NCT04088071)., Competing Interests: Funding Support and Author Disclosures This work was supported by Biosense Webster, Inc. The REAL-AF registry is funded through an investigator-initiated research grant (Principal Investigator: Dr. Osorio) from Biosense Webster Inc. The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)- Published
- 2023
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343. High-Frequency Low-Tidal Volume Ventilation Improves Long-Term Outcomes in AF Ablation: A Multicenter Prospective Study.
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Osorio J, Zei PC, Díaz JC, Varley AL, Morales GX, Silverstein JR, Oza SR, D'Souza B, Singh D, Moretta A, Metzl MD, Hoyos C, Matos CD, Rivera E, Magnano A, Salam T, Nazari J, Thorne C, Costea A, Thosani A, Rajendra A, and Romero JE
- Subjects
- Humans, Prospective Studies, Treatment Outcome, Tidal Volume, Neoplasm Recurrence, Local surgery, Atrial Fibrillation, Catheter Ablation adverse effects, Catheter Ablation methods
- Abstract
Background: High-frequency, low-tidal-volume (HFLTV) ventilation is a safe and simple strategy to improve catheter stability and first-pass isolation during pulmonary vein (PV) isolation. However, the impact of this technique on long-term clinical outcomes has not been determined., Objectives: This study sought to assess acute and long-term outcomes of HFLTV ventilation compared with standard ventilation (SV) during radiofrequency (RF) ablation of paroxysmal atrial fibrillation (PAF)., Methods: In this prospective multicenter registry (REAL-AF), patients undergoing PAF ablation using either HFLTV or SV were included. The primary outcome was freedom from all-atrial arrhythmia at 12 months. Secondary outcomes included procedural characteristics, AF-related symptoms, and hospitalizations at 12 months., Results: A total of 661 patients were included. Compared with those in the SV group, patients in the HFLTV group had shorter procedural (66 [IQR: 51-88] minutes vs 80 [IQR: 61-110] minutes; P < 0.001), total RF (13.5 [IQR: 10-19] minutes vs 19.9 [IQR: 14.7-26.9] minutes; P < 0.001), and PV RF (11.1 [IQR: 8.8-14] minutes vs 15.3 [IQR: 12.4-20.4] minutes; P < 0.001) times. First-pass PV isolation was higher in the HFLTV group (66.6% vs 63.8%; P = 0.036). At 12 months, 185 of 216 (85.6%) in the HFLTV group were free from all-atrial arrhythmia, compared with 353 of 445 (79.3%) patients in the SV group (P = 0.041). HLTV was associated with a 6.3% absolute reduction in all-atrial arrhythmia recurrence, lower rate of AF-related symptoms (12.5% vs 18.9%; P = 0.046), and hospitalizations (1.4% vs 4.7%; P = 0.043). There was no significant difference in the rate of complications., Conclusions: HFLTV ventilation during catheter ablation of PAF improved freedom from all-atrial arrhythmia recurrence, AF-related symptoms, and AF-related hospitalizations with shorter procedural times., Competing Interests: Funding Support and Author Disclosures The REAL-AF registry is funded through an investigator-initiated research grant (Dr Osorio, principal investigator) from Biosense Webster. Drs Osorio and Zei have received consulting and research support from Biosense Webster. Dr Silverstein has received consulting and honoraria from Biosense Webster. Drs D’Souza, Metzl, Salam, Rajendra, and Romero have received consulting from Biosense Webster. Dr Thosani reports physician education from Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2023
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344. 10-year single center experience of catheter ablation of focal atrial tachycardia.
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Whitaker J, Steiger N, Romero J, Kapur S, Tadros T, Sauer WH, Zei PC, Tedrow U, and Koplan B
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- Humans, Treatment Outcome, Tachycardia surgery, Tachycardia, Supraventricular surgery, Tachycardia, Ectopic Atrial surgery, Catheter Ablation methods, Cardiomyopathies surgery, Atrial Fibrillation surgery
- Abstract
Background: Focal atrial tachycardias (ATs) represent 5-15% of sustained supraventricular tachycardias (SVTs). Characteristic distribution of sites of origin and detailed electrophysiologic characterization of AT from specific sites of origin (SOO) have been described. Acute success and recurrence are less favorable than for other SVTs. In this series, we present our experience of focal AT ablation over a 10-year period., Methods: We undertook a retrospective review of an electronically maintained database of all patients undergoing AT ablation at our institution between January 2011 and December 2020. Demographic, procedural, and outcomes data were reviewed., Results: A total of 293 distinct atrial tachycardias were treated during 279 procedures in 256 patients, including 207 first AT ablations. Acutely successful AT suppression was achieved in 91% of first-time ablations. Acute success was dependent on SOO of AT with lowest rates of acute suppression in the para-Hisian region and the crista terminalis (CT). The most common reason for failure to acutely suppress the AT was proximity to a critical structure (phrenic nerve, sinus node, and AV node). 8.9% of patients in this series presented with a tachycardia-mediated cardiomyopathy (TCM). 48% of TCM patients underwent an ablation attempt during an acute medical admission. Among the TCM group, median LV ejection fraction increased from 25% (range 10-50%) to 55% (range 35-65%) with successful treatment of AT. Five patients undergoing a repeat procedure had planned pericardial access for displacement of the phrenic nerve to permit ablation of the AT, which was successful in all cases. Among patients without a pre-existing diagnosis of AF, peri-procedural AF was not associated with a higher incidence of a subsequent diagnosis of AF (odds ratio 1.169, 95% CI 0.4058-3.475, p = 0.7628). Median duration of follow-up was 832 days. By Kaplan-Meier estimate, recurrence-free survival was 78% (95% CI 67-88%)., Conclusions: In this series, focal AT ablation is associated with good acute results and a low rate of complications, but outcomes remain less favorable than previously reported for other forms of SVT., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2023
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345. Left Atrial Calcification After Catheter Ablation for Atrial Fibrillation: The Medusa Atrium?
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Zei PC
- Subjects
- Humans, Heart Atria diagnostic imaging, Heart Atria surgery, Atrial Fibrillation surgery, Atrial Appendage surgery, Catheter Ablation adverse effects
- Abstract
Competing Interests: Funding Support and Author Disclosures Dr Zei has received research support from Biosense Webster and Abbott; has received consulting fees from Biosense Webster Abbott, Afferra/Medtronic, and Varian; and has equity with Afferra/Medtronic.
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- 2023
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346. Effect of Extracellular Matrix Envelopes on Shock Impedance in Patients With Subcutaneous Implantable Cardioverter-Defibrillators.
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Sharma E, Wang W, Tadros TM, Koplan BA, Zei PC, Maytin M, Romero J, Tedrow U, Sauer W, and Kapur S
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- Humans, Electric Impedance, Arrhythmias, Cardiac, Ventricular Fibrillation, Defibrillators, Implantable
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- 2023
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347. Ventricular Conduction Velocity Following Multimodal Ablation Including Stereotactic Body Radiation Therapy for Refractory Ventricular Tachycardia.
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Whitaker J, Bredfeldt J, Williams SE, Qian P, Chang D, Mak RH, Cochet H, Sauer W, Zei PC, and Tedrow U
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- Humans, Heart Ventricles, Tachycardia, Ventricular surgery
- Published
- 2023
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348. Practice Patterns of Operators Participating in the Real-World Experience of Catheter Ablation for Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation (REAL-AF) Registry.
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Kreidieh O, Varley AL, Romero J, Singh D, Silverstein J, Thosani A, Varosy P, Hebsur S, Godfrey BE, Schrappe G, Justice L, Zei PC, and Osorio J
- Subjects
- Humans, Recurrence, Treatment Outcome, Registries, Atrial Fibrillation surgery, Catheter Ablation methods, Pulmonary Veins surgery, Heart Diseases
- Abstract
Background: The Real-World Experience of Catheter Ablation for Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation (REAL-AF) is a multicenter prospective registry of atrial fibrillation (AF) ablation. We sought to describe the baseline workflows of REAL-AF operators., Methods: REAL-AF enrolls high volume minimum fluoroscopy radiofrequency ablators. A 150 item questionnaire was administered to participating operators. Responses were analyzed using standard methods., Results: Forty-two respondents had a mean 178.2 ± 89.2 yearly AF ablations, with 42.4 ± 11.9% being paroxysmal (PAF). Most operators performed ablation with uninterrupted or minimally interrupted anticoagulation (66.7% and 28.6%). Left atrial appendage (LAA) thrombus was most commonly ruled out with transesophageal echocardiography (33.3% and 42.9% for PAF and persistent AF). Consistent with registry design, radiofrequency energy (92.1% ± 18.8% of cases) and zero fluoroscopy ablation (73.8% goal 0 fluoroscopy) were common. The majority of operators relied on index-guided ablation (90.5%); Mean Visitag surpoint targets were higher anteriorly vs posteriorly (508.3 ± 49.8 vs 392.3 ± 37.0, p < 0.01), but power was similar. There was considerable heterogeneity related to gaps in current knowledge, such as lesion delivery targets and sites of extra-pulmonary vein ablation (most common was the posterior wall followed by the roof). Peri-procedural risk factor management of obesity, hypertension, and sleep apnea was common. There was a mean of 3.0 ± 1.2 follow-up visits at 12 months., Conclusions: REAL-AF operators were high volume low fluoroscopy "real world" operators with good follow-up and adherence to known best-practices. There was disagreement related to knowledge gaps in guidelines., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2022
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349. Atrial Fibrillation - What Is It and How Is It Treated?
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Antman EM, Leopold JA, Sauer WH, and Zei PC
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- Humans, Anticoagulants therapeutic use, Stroke etiology, Stroke prevention & control, Atrial Fibrillation complications, Atrial Fibrillation diagnosis, Atrial Fibrillation therapy
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- 2022
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350. Intracardiac echocardiography Chinese expert consensus.
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Jingquan Z, Deyong L, Huimin C, Hua F, Xuebin H, Chenyang J, Yan L, Xuebin L, Min T, Zulu W, Yumei X, Jinlin Z, Wei Z, Xiaochun Z, Daxin Z, Yun Z, Changsheng M, Zei PC, and Di Biase L
- Abstract
In recent years, percutaneous catheter interventions have continuously evolved, becoming an essential strategy for interventional diagnosis and treatment of many structural heart diseases and arrhythmias. Along with the increasing complexity of cardiac interventions comes ever more complex demands for intraoperative imaging. Intracardiac echocardiography (ICE) is well-suited for these requirements with real-time imaging, real-time monitoring for intraoperative complications, and a well-tolerated procedure. As a result, ICE is increasingly used many types of cardiac interventions. Given the lack of relevant guidelines at home and abroad and to promote and standardize the clinical applications of ICE, the members of this panel extensively evaluated relevant research findings, and they developed this consensus document after discussions and correlation with front-line clinical work experience, aiming to provide guidance for clinicians and to further improve interventional cardiovascular diagnosis and treatment procedures., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Jingquan, Deyong, Huimin, Hua, Xuebin, Chenyang, Yan, Xuebin, Min, Zulu, Yumei, Jinlin, Wei, Xiaochun, Daxin, Yun, Changsheng, Zei and Di Biase.)
- Published
- 2022
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