Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
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J Interv Card Electrophysiol · Oct 2021
Randomized Controlled Trial Multicenter StudyLeft atrial posterior wall isolation in conjunction with pulmonary vein isolation using cryoballoon for treatment of persistent atrial fibrillation (PIVoTAL): study rationale and design.
There is growing evidence in support of pulmonary vein isolation (PVI) with concomitant posterior wall isolation (PWI) for the treatment of patients with symptomatic persistent atrial fibrillation (persAF). However, there is limited data on the safety and efficacy of this approach using the cryoballoon. ⋯ The PIVoTAL is a prospective, randomized controlled trial designed to evaluate the outcomes of PVI alone versus PVI+PWI using the cryoballoon, in patients with symptomatic persAF. We hypothesize that PVI+PWI will prove to be superior to PVI alone for prevention of AF recurrence.
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J Interv Card Electrophysiol · Aug 2021
Posterior box isolation as an adjunctive ablation strategy with the second-generation cryoballoon for paroxysmal atrial fibrillation: a comparison with standard cryoballoon pulmonary vein isolation.
The purpose of the study was to evaluate the impact of left atrial posterior wall isolation (LAPWI) in addition to pulmonary vein isolation (PVI) vs PVI alone, performed using CB-A, in patients with PAF on a midterm follow-up of 12 months. ⋯ LAPW ablation in addition to PVI by the means of CB-A does not seem to reduce the risk of AF recurrence if compared with the standard PVI on a midterm follow-up of 12 months.
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J Interv Card Electrophysiol · Jun 2021
ReviewThe electrocardiogram characteristics and pacing parameters of permanent left bundle branch pacing: a systematic review and meta-analysis.
Recent advances in conduction system pacing have led to the use of left bundle branch pacing (LBBP), which has potential advantages over His bundle pacing (HBP). For example, LBBP engages the electrical activation through the left bundle branch, produces ventricular electrical synchrony, and avoids the weakness of HBP such as lead instability, higher threshold, and early battery depletion. This pacing modality has been considered an attractive mode to achieve normal physiological pacing. However, as a new technology, LBBP is still in the stage of clinical exploration and lacks adequate evaluation. This study aims to investigate the electrocardiogram characteristics, pacing parameters, the safety, and the effectiveness of LBBP. ⋯ Permanent LBBP has shown promising results for pacemaker-indicated patients in small observational studies. Good electrical synchronization, high success rates, and stable pacemaker lead parameters suggested significant advantages of LBBP in physiological pacing. Randomized controlled trials are needed to assess the efficacy of LBBP in patients.
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J Interv Card Electrophysiol · Apr 2021
Surviving sudden cardiac arrest-successes, challenges, and opportunities.
Sudden cardiac arrest (SCA) is the most common cause of death in the world. This manuscript highlights the various challenges in prevention and early management of SCA and also discusses the current state of SCA awareness. The manuscript also outlines the various national and international initiatives in improving SCA awareness and their impact on improving outcomes in SCA. ⋯ Finally, the manuscript describes future directions including harnessing technology with voice command and artificial intelligence to allow lay person deliver effective CPR, to improve EMS response times, and to allow wider CPR knowledge dissemination in schools and places of employment. Future research should be focused on optimizing SCA outcomes among vulnerable populations and minorities. Advancements in resuscitation science and use of big data for improvement of EMS services will improve outcomes in SCA.
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J Interv Card Electrophysiol · Apr 2021
Randomized Controlled Trial Multicenter StudyRationale and study design for ablation of paroxysmal atrial fibrillation guided by ablation index: a multi-center, prospective randomized trial (PAF-AI trial).
Pulmonary vein isolation (PVI) has become the cornerstone of atrial fibrillation (AF) ablation, but long-term success rates remains suboptimal, due in large part to late PV reconnection and insufficient ostial substrate modification. ⋯ PAF-AI trial compares the effectiveness and safety of two different strategies of PVI in patients with PAF, AI-guided PVI versus more established CF-guided PVI. This prospective, multi-center, randomized controlled trial, with comparative data evaluating procedural and long-term follow-up results, aims to evaluate the impact of AI-guided strategy on AF ablation compared with the current standard of care RF ablation approach.