Journal: Circ Arrhythm Electrophysiol

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Abstract

Pulsed Field Ablation vs Radiofrequency Ablation: Esophageal Injury in a Novel Model.

Koruth JS, Kuroki K, Kawamura I, Brose R, ... Dukkipati SR, Reddy VY

- Pulsed field ablation (PFA) can be myocardium-selective, potentially sparing the esophagus during left atrial ablation. In an in vivo porcine esophageal injury model, we compared the effects of newer biphasic PFA with radiofrequency ablation (RFA).- In 10 animals, under general anesthesia, the lower esophagus was deflected towards the inferior vena cava (IVC) using an esophageal deviation balloon, and ablation was performed from within the IVC at areas of esophageal contact. Four discrete esophageal sites were targeted in each animal: 6 animals received 8 PFA applications/site (2 kV, multispline catheter), and 4 animals received 6 clusters of irrigated RFA applications (30W x 30 seconds, 3.5mm catheter). All animals were survived to 25 days, sacrificed and the esophagus submitted for pathological examination, including 10 discrete histological sections/esophagus.- The animals weight increased by 13.7±6.2 and 6.8±6.3 % (p=0.343) in the PFA and RFA cohorts, respectively. No PFA animals (0 of 6, 0%) developed abnormal in-life observations, but 1 of 4 RFA animals (25%) developed fever and dyspnea. On necropsy, no PFA animals (0 of 6, 0%) demonstrated esophageal lesions. In contrast, esophageal injury occurred in all RFA animals (4 of 4, 100%; p=0.005): a mean of 1.5 mucosal lesions/animal (length - 21.8±8.9 mm, width - 4.9±1.4 mm) were observed, including one esophago-pulmonary fistula, and deep esophageal ulcers in the other animals. Histological examination demonstrated tissue necrosis surrounded by acute and chronic inflammation and fibrosis. The necrotic RFA lesions involved multiple esophageal tissue layers with evidence of arteriolar medial thickening and fibrosis of peri-esophageal nerves. Abscess formation and full-thickness esophageal wall disruptions were seen in areas of perforation/fistula.- In this novel porcine model of esophageal injury, biphasic PFA induced no chronic histopathological esophageal changes, while RFA demonstrated a spectrum of esophageal lesions including fistula and deep esophageal ulcers and abscesses.



Circ Arrhythm Electrophysiol: 23 Jan 2020; epub ahead of print
Koruth JS, Kuroki K, Kawamura I, Brose R, ... Dukkipati SR, Reddy VY
Circ Arrhythm Electrophysiol: 23 Jan 2020; epub ahead of print | PMID: 31977250
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Abstract

The Left Atrial Appendage Morphology Improves Prediction of Stagnant Flow and Stroke Risk in Atrial Fibrillation.

Yaghi S, Chang A, Ignacio G, Scher E, ... Atalay M, Song C

The left atrial appendage (LAA) is the most common site of thrombus formation in patients with atrial fibrillation. Therefore, better knowledge of the morphology, physiology, and function of the LAA may provide a better estimate of stroke risk. The LAA morphology is currently classified into 4 categories: chicken-wing (CW), windsock, cauliflower, and cactus. Chicken-wing is the most common and carries lower risk. This classification system, however, lacks consistent inter-rater reliability and correlation with stroke risk.



Circ Arrhythm Electrophysiol: 26 Jan 2020; epub ahead of print
Yaghi S, Chang A, Ignacio G, Scher E, ... Atalay M, Song C
Circ Arrhythm Electrophysiol: 26 Jan 2020; epub ahead of print | PMID: 31986073
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Abstract

Impedance in the Diagnosis of Lead Malfunction.

Swerdlow CD, Koneru JN, Gunderson B, Kroll MW, Ploux S, Ellenbogen KA

Impedance is the ratio of voltage to current in an electrical circuit. Cardiac implantable electronic devices measure impedance to assess the structural integrity electrical performance of leads, typically using subthreshold pulses. We review determinants of impedance, how it is measured, variation in clinically-measured pacing and high-voltage impedance, and impedance trends as a diagnostic for lead failure and lead-device connection problems. We consider the differential diagnosis of abnormal impedance and the approach to the challenging problem of a single, abnormal impedance measurement. Present impedance provides a specific but insensitive diagnostic. For pacing circuits, we review the complementary roles of impedance and more sensitive oversensing diagnostics. Shock circuits lack a sensitive diagnostic. This deficiency is particularly important for insulation breaches, which may go undetected and present with short circuits during therapeutic shocks. We consider new methods for measuring impedance that may increase sensitivity for insulation breaches.



Circ Arrhythm Electrophysiol: 26 Jan 2020; epub ahead of print
Swerdlow CD, Koneru JN, Gunderson B, Kroll MW, Ploux S, Ellenbogen KA
Circ Arrhythm Electrophysiol: 26 Jan 2020; epub ahead of print | PMID: 31985260
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Abstract

Persistent Asthma is Associated with Increased Risk for Incident Atrial Fibrillation in the Multi-Ethnic Study of Atherosclerosis (MESA).

Tattersall MC, Dasiewicz AS, McClelland RL, Gepner AD, ... Hamdan MH, Stein JH

- Asthma and atrial fibrillation (AF) share an underlying inflammatory pathophysiology. We hypothesized that persistent asthmatics are at higher risk for developing AF and that this association would be attenuated by adjustment for baseline markers of systemic inflammation.- The Multi-Ethnic Study of Atherosclerosis is a prospective longitudinal study of adults free of cardiovascular disease at baseline. Presence of asthma was determined at exam 1. Persistent asthma was defined as asthma requiring use of controller medications. Intermittent asthma was defined as asthma without use of controller medications. Participants were followed for a median of 12.9 (interquartile range 10-13.6) years for incident AF. Multivariable Cox regression models were used to assess associations of asthma subtype and AF.- The 6,615 participants were a mean (standard deviation) 62.0 (10.2) years old, (47% male, 27% African-American, 12% Chinese, 22% Hispanic). AF incidence rates were 0.11 [95% CI 0.01, 0.12] events/10 person-years for non-asthmatics, 0.11 [95% CI 0.08, 0.14] events/10 person-years for intermittent asthmatics, and 0.19 [95% CI 0.12, 0.49] events/10 person-years for persistent asthmatics (log-rank p=0.008). In risk-factor adjusted models, persistent asthmatics had a greater risk of incident AF (hazard ratio [HR] 1.49 [95% CI 1.03-2.14], p=0.03). Interleukin 6 (IL-6, HR 1.26 [95% CI 1.13-1.42]), tumor necrosis factor-α receptor 1 (TNF-α R1, HR 1.09 [95% CI 1.08-1.11]) and D-Dimer (HR 1.10 [95% CI 1.02-1.20]) predicted incident AF, but the relationship between asthma and incident AF was not attenuated by adjustment for any inflammation marker (IL-6, C-reactive protein, TNF-α R1, D-dimer, fibrinogen).- In a large multiethnic cohort with nearly 13 years follow-up, persistent asthma was associated with increased risk for incident AF. This association was not attenuated by adjustment for baseline inflammatory biomarkers.



Circ Arrhythm Electrophysiol: 03 Feb 2020; epub ahead of print
Tattersall MC, Dasiewicz AS, McClelland RL, Gepner AD, ... Hamdan MH, Stein JH
Circ Arrhythm Electrophysiol: 03 Feb 2020; epub ahead of print | PMID: 32013555
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This program is still in alpha version.