Background Enlarged left atrium is an established predictor of atrial fibrillation recurrence after pulmonary vein isolation but arrhythmia recurrence is also observed in patients with normal anatomy of the left atrium. The aim of the study is to evaluate arrhythmia recurrence predictors in patients with normal anatomy of the left atrium. Methods The study included 182 patients with normal anatomy of the left atrium who underwent pulmonary vein isolation using catheter ablation. Various parameters were also compared, including age, gender, history of arrhythmia, arterial hypertension, concomitant coronary pathology, echocardiography findings, such as mitral valve and tricuspid valve regurgitation and procedure parameters, between patients with and without relapses. Statistical analysis was performed using the IBM SPSS Statistics‐19 software. Results Transthoracic echocardiography was performed by independent specialists with extensive experience. Trans‐esophageal echocardiography was performed before each ablation procedure. Standard trans‐septal puncture was performed under fluoroscopic control. Radiofrequency ablation was performed in the ipsilateral pulmonary vein antrum with a wide capture of nearby lung tissue. Conclusions It was concluded that the tricuspid valve regurgitation and arterial hypertension correlate with atrial fibrillation recurrence after pulmonary vein isolation in patients with normal left atrial anatomy.
Funding Acknowledgements Type of funding sources: None. Background Leadless pacemakers (L-PM) are a new safe alternative technology for pacing the right ventricle. However, not enough information is available on their potential benefits for quality of life (QoL) in patients with L-PM. The purpose of the study was the quality of life comparison of patients with L-PM and conventional pacemakers (C-PM). Methods The study included patients who underwent implantation of a single-chamber pacemaker from December 2018 to March 2022. We used the SF-36 Questionnaire to assess quality of life at baseline and after 6 and 12 months of follow-up. We also used a questionnaire consisting of 10 specific questions related to the implantation procedure. Results Total of 32 patients were included (16 L-PM; 16 C-PM). There were no differences in baseline characteristics between groups (L-PM vs. C-PM), except for age (47.5 vs. 57.3 years; P = 0.012) and diabetes 28% vs. 21%; P = 0.021). Baseline SF-36 did not differ between groups. After 6 months of follow-up, patients in the L-PM group showed significantly higher scores on physical function (47 vs 32; P<0.001), physical role (53 vs 37; P=0.004) and mental health (67 vs 52; P=0.017), even after adjusting for covariates. Pacemaker-related discomfort and physical limitations were significantly lower in the L-PM group. Conclusion L-PM is associated with a better quality of life than C-PM, both in terms of physical and mental health. Patients who underwent L-PM implantation reported less procedure-related discomfort, physical limitations, and anxiety.
Funding Acknowledgements Type of funding sources: None. Background Right ventricular apical (RVA) pacing deleterious effects on left ventricular ejection fraction (LVEF) had been demonstrated. Non-apical pacing, such as right ventricular mid-septal (RVMS) and His Bundle pacing, appear as practical alternatives. Our purpose is to evaluate the effect of alternate sites of right ventricular (RV) pacing on left ventricular (LV) function and hemodynamics in patients with bradyarrhythmias. Methods We observed 118 patients (age 58±27 years, 64% men) with AV block III, who underwent permanent dual chamber pacemaker implantation. To 72 patients RV lead has implanted the middle area of RV septum (RVMS) and 46 patients’ RV lead has been implanted traditionally to the right ventricular apex (RVA). Color tissue velocity imaging was performed to analyze time to peak systolic velocity (Ts) in a 12 segment model of the LV for each pacing site. Measurements included standard deviation of time to peak systolic velocity (SD-Ts) for all segments, the maximal difference in Ts between any 2/6 basal (Ts-B), any 2/6 mid segments (Ts-M) and maximal Ts difference between any 2/12 segments (Ts-12). Stroke volume was estimated using Doppler velocity time integral (TVI) in the left ventricular outflow tract (LVOT). QRS width for each site was recorded. Measurements were observed by transthoracic echocardiography and electrocardiography before and 12 months after implantation. Results Ts-12 was significantly higher with RVA - pacing (107 ms, p=0.003) compared to RVMS - pacing (81 ms) sites. SD-Ts were significantly higher with RVA - pacing (38.5 ms, p=0.01) than RVMS - pacing (28.7 ms). QRS duration was the longest for RVA - pacing (157 ms) while significantly shorter RVMS - pacing (115 ms, p<0.001). LVOT VTI was significantly higher for RVMS - pacing than for RVA (p=0.0014) pacing. Conclusions Right ventricular mid-septal pacing may reduce electro-mechanical dyssynchrony compared to RVA pacing and RVMS – pacing to effect better LV function and hemodynamics than RVA pacing in patients with permanent pacemaker implantation.
Introduction: Pulmonary vein isolation is the primary goal in treating patients with paroxysmal atrial fibrillation using catheter ablation. This study's purpose is a comparative assessment of the efficacy and safety of two strategies for catheter treatment in patients with persistent atrial fibrillation. Patients and methods: The study included 127 patients with persistent atrial fibrillation during the last six months before inclusion in the study. The average follow-up period was 24 months. Results: The primary efficacy endpoint (death, cerebrovascular event, or serious complications associated with treatment) occurred in 15 patients in the cryoballoon ablation group and 14 patients in the radiofrequency ablation group. The Kaplan-Meier survival estimates were 30% and 28%, and the risk ratio 0.96 and 95% of the confidence interval. Conclusions: The treatment in patients with persistent atria fibrillation, using catheter ablation with contact force control catheter treatment with the pulmonary vein isolation, was more efficient.
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