The latest medical research on Clinical Cardiac Electrophysiology

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about clinical cardiac electrophysiology gathered by our medical AI research bot.

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Prognostic score model based on six m6A-related autophagy genes for predicting survival in esophageal squamous cell carcinoma.

Clinical Laboratory

Prognostic signatures based on autophagy genes have been proposed for esophageal squamous cell carcinoma (ESCC). Autophagy genes are closely associated with m6A genes. Our purpose is to identify m6A-related autophagy genes in ESCC and develop a survival prediction model.

Differential expression analyses for m6A genes and autophagy genes were performed based on TCGA and HADd databases followed by constructing a co-expression network. Uni-variable Cox regression analysis was performed for m6A-related autophagy genes. Using the optimal combination of feature genes by LASSO Cox regression model, a prognostic score (PS) model was developed and subsequently validated in an independent dataset.

The differential expression of 13 m6A genes and 107 autophagy genes was observed between ESCC and normal samples. The co-expression network contained 13 m6A genes and 96 autophagy genes. Of the 12 m6A-related autophagy genes that were significantly related to survival, DAPK2, DIRAS3, EIF2AK3, ITPR1, MAP1LC3C, and TP53 were used to construct a PS model, which split the training set into two risk groups with significant different survival ratios (p = 0.015, 1-year, 3-year, and 5-year AUC = 0.873, 0.840, and 0.829). Consistent results of GSE53625 dataset confirmed predictive ability of the model (p = 0.024, 1-year, 3-year, and 5-year AUC = 0.793, 0.751, and 0.744). The six-gene PS score was an independent prognostic factor from clinical factors (HR, 2.362; 95% CI, 1.390-7.064; p-value = 0.012).

Our study recommends 6 m6A-related autophagy genes as promising prognostic biomarkers and develops a PS model to predict survival in ESCC.

Simultaneous narrow and wide QRS complex tachycardia: Misdiagnosis or Missed diagnosis?

Journal of Cardiovascular Magnetic Resonance

Tachycardia-induced tachycardia, or so-called double tachycardia, appears to be a relatively rare condition. Regardless of the mechanism, this case...

Case report: Epicardial Ligation of the Left Atrial Appendage in a Patient with an inaccessible left atrial cavity.

Journal of Cardiovascular Magnetic Resonance

It has been shown that endocardial occlusion of the left atrial appendage (LAA) is equally effective in preventing embolic events compared to oral ...

Short-Term Natural Course of Esophageal Thermal Injury After Ablation for Atrial Fibrillation.

Journal of Cardiovascular Magnetic Resonance

To provide insight into the short-term natural history of esophageal thermal injury (ETI) after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) by esophagogastroduodenoscopy (EGD).

We screened patients who underwent RFCA for AF and EGD based on esophageal late gadolinium enhancement (LGE) in post ablation MRI. Patients with ETI diagnosed with EGD were included. We defined severity of ETI according to Kansas City classification (KCC): type 1: erythema; type 2: ulcers (2a: superficial; 2b deep); type 3 perforation (3a: perforation; 3b: perforation with atrioesophageal fistula). Repeated EGD was performed within 1-14 days after the last EGD if recommended and possible until any certain healing signs (visible reduction in size without deepening of ETI or complete resolution) were observed.

ETI was observed in 62 of 378 patients who underwent EGD after RFCA. Out of these 62 patients with ETI, 21% (13) were type 1, 50% (31) were type 2a and 29% (18) were type 2b at the initial EGD. All esophageal lesions, but one type 2b lesion that developed into an atrioesophageal fistula (AEF), showed signs of healing in repeated EGD studies within 14 days after the procedure. The one type 2b lesion developing into an AEF showed an increase in size and ulcer deepening in repeat EGD 8 days after the procedure.

We found that all ETI which didn't progress to AEF presented healing signs within 14 days after the procedure and that worsening ETI might be an early signal for developing esophageal perforation. This article is protected by copyright. All rights reserved.

Durable pulmonary vein isolation with diffuse posterior left atrial ablation using low-flow, median power, short-duration strategy.

Journal of Cardiovascular Magnetic Resonance

To target posterior wall isolation (PWI) in atrial fibrillation (AF) ablation, diffuse ablation theoretically confers a lower risk of conduction recovery compared to box set. We sought to assess the safety and efficacy of diffuse PWI with low-flow, medium-power, and short-duration (LF-MPSD) ablation, and evaluate the PVI and PWI durability among patients undergoing repeat ablations.

We retrospectively studied patients undergoing LF-MPSD ablation for AF (PVI + diffuse PWI) between 8/2017 and 12/2019. Clinical characteristics were collected. Kaplan-Meier survival analysis was performed to study AF/atrial flutter (AFL) recurrence. Ablation data were analyzed in patients who underwent a repeat AF/AFL ablation.

Of the 463 patients undergoing LF-MPSD AF ablation (PVI alone, or PVI + diffuse PWI), 137 patients had PVI + diffuse PWI. Acute PWI with complete electrocardiogram elimination was achieved in 134 (97.8%) patients. Among the 126 patients with consistent follow up, 38 (30.2%) patients had AF/AFL recurrence during a median duration of 14 months. Eighteen patients underwent a repeat AF/AFL ablation after PVI + diffuse PWI, and 16 (88.9%) patients had durable PVI, in contrast to 10 of 45 (23.9%) patients who had redo ablation after LF-MPSD PVI alone. Seven patients (38.9%) had durable PWI, while 11 patients had partial electrical recovery at the posterior wall. The median percentage of area without electrical activity at the posterior wall was 70.7%. Conduction block across the posterior wall was maintained in 16 (88.9%) patients.

There was a high rate of PVI durability in patients undergoing diffuse PWI and PVI. Partial posterior wall electrical recovery was common but conduction block across the posterior wall was maintained in most patients. This article is protected by copyright. All rights reserved.

Can All Stakeholders Benefit from Same Day Discharge Following Catheter Ablation of Atrial Fibrillation?

Journal of Cardiovascular Magnetic Resonance

Same-day discharge after AF ablation procedure is becoming the preferred trend. Vascular closure devices use have shortened the post-procedural bed...

Initial experience of left bundle branch area pacing using stylet-driven pacing leads: a multicenter study.

Journal of Cardiovascular Magnetic Resonance

Left bundle branch area pacing (LBBAP) has been performed exclusively using lumen-less pacing leads (LLL) with fixed helix design. This registry study explores the safety and feasibility of LBBAP using stylet-driven leads (SDL) with extendable helix design in a multicenter patient population.

This study prospectively enrolled consecutive patients who underwent LBBAP for bradycardia pacing or heart failure indications at eight Belgian hospitals. LBBAP was attempted using SDL (Solia S60, Biotronik) delivered through dedicated delivery sheath (Selectra3D). Implant success, complications, procedural and pacing characteristics were recorded at implant and follow-up.

The study enrolled 353 patients (mean age 76±39 years, 43% female). The mean number of implants per center was 25 (range 5-162). Overall, LBBAP with SDL was successful in 334/353 (94%), varying from 93 to 100% among centers. Pacing response was labeled as left bundle branch pacing in 73%, whereas 27% were labeled as myocardial capture. Mean paced QRS duration and stimulus to left ventricular activation time measured 126±21ms and 74±17. SDL LBBAP resulted in low pacing thresholds (0.6±0.4V at 0.4ms), which remained stable at 12 months follow-up (0.7±0.3, p=0.291). Lead revisions for SDL LBBAP occurred in 5(1.4%) patients occurred during a mean follow up of 9±5 months. Five (1.4%) septal coronary artery fistulas and 8(2%) septal perforations occurred, none of them causing persistent ventricular septal defects.

The use of SDL to achieve LBBAP is safe and feasible, characterized by high implant success in low and high volume centers, low complication rates, and stable low pacing thresholds. This article is protected by copyright. All rights reserved.

Characteristics of Successful Reactive Atrial-based Antitachycardia Pacing in Patients with Cardiac Implantable Electronic Devices: History of Catheter Ablation of Atrial Fibrillation as a Predictor of High Treatment Efficacy.

Journal of Cardiovascular Magnetic Resonance

Reactive atrial-based antitachycardia pacing (rATP) in patients with cardiac implantable electronic devices (CIEDs) suppresses the progression of atrial fibrillation (AF) to the persistent form. However, the clinical factors associated with successful rATP treatment are unknown. This study aimed to examine the predictors of high rATP efficacy in patients with CIEDs.

The data of 101,325 rATP-treated atrial tachyarrhythmia (AT/AF) episodes in 51 patients, obtained through remote monitoring and device interrogation, were analyzed. The study population was divided into the high and low efficacy groups based on the overall median success rate of rATP. Clinical characteristics were compared between the two groups.

During a follow-up period of 28.6±8.6 months, the median success rate was 43.7% (31.5-64.9%). The prevalence of a history of catheter ablation of AF was significantly higher in the high efficacy group than in the low efficacy group (73.0% vs. 44.0%, p=0.048) and was the only independent predictor of high rATP efficacy (odds ratio, 3.45; p=0.038). The rATP success rate in patients with (n=30) and without (n=21) a history of catheter ablation was 53.9% (40.0-67.5%) and 36.4% (22.2-47.7%), respectively (p=0.012). The effect of rATP after ablation was more pronounced in patients with long cycle length episodes (≥75% of AT/AF sequences having a cycle length of 200-449 ms) (67.3% [46.0-73.6%] vs. 30.6% [18.1-60.3%], p=0.027). The high efficacy group had a significantly lower incidence of AT/AF lasting ≥1, ≥7, and ≥30 days than the low efficacy group.

rATP combined with catheter ablation therapy is effective in suppressing AT/AF. This article is protected by copyright. All rights reserved.

Patient-reported Outcomes and Costs Associated with Vascular Closure and Same-Day Discharge following Atrial Fibrillation Ablation.

Journal of Cardiovascular Magnetic Resonance

We aimed to measure patient reported outcomes (PROs) and costs associated with same day discharge (SDD) for AF ablation and vascular closure device implantation in clinical practice.

PROs were prospectively measured in 50 AF ablation patients, comparing complete vascular device closure (n=25) versus manual compression hemostasis (n=25). Health-system costs for SDD patients receiving vascular device closure were compared to matched controls with one-night stays who did not receive any closure device.

Prospectively-enrolled patients receiving vascular device closure for AF ablation had mean age of 65 years, 17% were female, with a mean CHA2 DS2 -VASc score 3. Mean number of venous sheaths was higher among patients receiving vascular device closure (3.8 vs. 3.1,p<0.001), and there was 1 case of re-bleeding in a patient receiving vascular closure device (no other complications). Same-day discharge rates (76% vs. 8.3%,p<0.001), patient satisfaction with bedrest time (8.5 vs. 6,p=0.004) and with pain (8 vs. 5.1,p=0.009) were significantly better among patients receiving vascular closure. In matched analyses of health-system costs, patients with vascular closure had mean age 66, 32% were female, and mean CHA2 DS2 -VASc score was 2 (p=NS vs. controls). SDD with vascular closure was associated with significantly lower facility, pharmacy, and disposable costs, but higher implant costs. Overall costs for ablation were not significantly different (mean difference 1.10%, 95% CI -3.03-5.42).

Vascular closure for AF ablation improves patient experience in routine care. Use of vascular closure and SDD after AF ablation reduces several components of healthcare system costs, without an overall increase. This article is protected by copyright. All rights reserved.

Left Atrial Posterior Wall Isolation - The Conundrum of Safety versus Efficacy.

Journal of Cardiovascular Magnetic Resonance

The study by Worck et al. raises interesting findings with regard to left atrial posterior wall ablation. The utility of ablation at the CRZ - whic...

Posterior Wall Isolation in Persistent Atrial Fibrillation Feasibility, Safety, Durability and Efficacy.

Journal of Cardiovascular Magnetic Resonance

Posterior wall isolation (PWI) added to pulmonary vein isolation (PVI) is increasingly used despite limited evidence of clinical benefit. We investigated the feasibility, durability, and efficacy of index-procedure PVI + PWI radio frequency ablation (RFA) in patients with persistent atrial fibrillation (PeAF).

Twenty-four patients with PeAF participated in the prospective PeAF-Box study and underwent RFA with wide area circumferential ablation (WACA), roof- and inferior lines to achieve PVI + PWI at index procedure. Follow-up included monitoring by an implantable cardiac monitor (ICM), esophagoscopy and mandated invasive lesion-reassessment at six months. PWI was achieved at minor procedural cost in all patients following PVI. In 33% of patients a median of three ablations in the narrow zone between the center of the posterior wall (PW) and the posterior right carina was pivotal for swift achievement of PWI. At the 6-months reassessment procedure 85% (95% CI: 77-92%) of pulmonary veins (PV´s) and 46% (95% CI: 26-67%) of PW´s remained durably isolated. AF recurred in 25% and was associated with PV-reconnection (P = 0.02) but not PW-reconnection (P = 0.27). AF-burden was 0% (IQR: 0% to 0%) overall and after recurrence 1% (IQR: 0 % - 7 %) CONCLUSION: Index procedure PVI + PWI for PeAF was feasible when recognizing that limited ablation in a PW center-to-right-carina zone was required in a subset of patients. Despite limited chronic PWI durability this strategy was followed by low AF-burden. A PVI + PWI strategy appears promising in ablation for PeAF. This article is protected by copyright. All rights reserved.

Uncommon output-dependent paced QRS morphology transition during left bundle branch pacing.

Pacing Clin Electrophysiol

We report a patient who underwent left bundle branch pacing (LBBP) because of intermittent complete heart block. During unipolar pacing at a deep s...