Arrhythmia Surgery Research Articles

Low Levels of Adropin Predict Adverse Clinical Outcomes in Outpatients with Newly Diagnosed Prediabetes after Acute Myocardial Infarction.

Adropin-a multifunctional peptide with tissue-protective capacity that regulates energy homeostasis, sensitivity to insulin and inflammatory response-seems to show an inverse association with the presence of cardiovascular and renal diseases, obesity and diabetes mellitus in the general population. The purpose of the study is to elucidate whether adropin may be a plausible predictive biomarker for clinical outcomes in post-ST elevation of myocardial infarction (STEMI) patients with newly diagnosed prediabetes according to the American Diabetes Association criteria. A total of 1214 post-STEMI patients who received percutaneous coronary intervention were identified in a local database of the private hospital "Vita Center" (Zaporozhye, Ukraine). Between November 2020 and June 2024, we prospectively enrolled 498 patients with prediabetes in this open prospective cohort study and followed them for 3 years. The combined clinical endpoint at follow-up was defined as cardiovascular death due to acute myocardial infarction, heart failure, sudden death due to arrhythmia or cardiac surgery, and/or all-cause death. We identified 126 clinical events and found that serum levels of adropin < 2.15 ng/mL (area under the curve = 0.836; 95% confidence interval = 0.745-0.928; sensitivity = 84.9%; specificity = 72.7%; likelihood ratio = 3.11; p = 0.0001) predicted clinical outcomes. Multivariate logistic regression showed that a Gensini score ≥ 32 (Odds ratio [OR] = 1.07; p = 0.001), adropin ≤ 2.15 ng/mL (OR = 1.18; p = 0.001), use of SGLT2i (OR = 0.94; p = 0.010) and GLP-1 receptor agonist (OR = 0.95; p = 0.040) were independent predictors of clinical outcome. Kaplan-Meier plots showed that patients with lower adropin levels (≤2.15 ng/mL) had worse clinical outcomes compared to patients with higher adropin levels (>2.15 ng/mL). In conclusion, low levels of adropin (≤2.15 ng/mL) independently predicted clinical outcomes in post-STEMI patients with newly detected prediabetes and improved the discriminative ability of the Gensini score for 3-year follow-up events. Future clinical studies are needed to clarify whether adropin is a promising molecule to be incorporated into conventional risk scores for the prediction of MACCEs after STEMI.

HART: Deep learning-informed lifespan heart failure risk trajectories

BackgroundHeart failure (HF) results in persistent risk and long-term comorbidities. This is particularly true for patients with lifelong HF sequelae of cardiovascular disease such as patients with congenital heart disease (CHD). PurposeWe developed hART (heart failure Attentive Risk Trajectory), a deep-learning model to predict HF trajectories in CHD patients. MethodshART is designed to capture the contextual relationships between medical events within a patient’s history. It is trained to predict future HF risk by using the masked self-attention mechanism that forces it to focus only on the most relevant segments of the past medical events. ResultsTo demonstrate the utility of hART, we used a large cohort containing healthcare administrative data from the Quebec CHD database (137,493 patients, 35-year follow-up). hART achieves an area under the precision-recall of 28% for HF risk prediction, which is 33% improvement over existing methods. Patients with severe CHD lesion showed a consistently elevated predicted HF risks throughout their lifespan, and patients with genetic syndromes exhibited elevated HF risks until the age of 50. The impact of the birth condition decreases on long-term HF risk. The timing of interventions such as arrhythmia surgery had varying impacts on the lifespan HF risk among the individuals. Arrhythmic surgery performed at a younger age had minimal long-term effects on HF risk, while surgeries during adulthood had a significant lasting impact. ConclusionTogether, we show that hART can detect meaningful lifelong HF risk in CHD patients by capturing both long and short-range dependencies in their past medical events.

Surgery for Cardiac Arrhythmias: Past, Present, Future.

There is a rich history of surgery for cardiac arrhythmias, spanning from atrial fibrillation and Wolff-Parkinson-White syndrome to inappropriate sinus tachycardia and ventricular tachycardia. This review describes the history of these operations, their evolution over time, and the current state of practice. We devote considerable time to the discussion of atrial fibrillation, the most common cardiac arrhythmia addressed by surgeons. We discuss ablation of atrial fibrillation as a stand-alone operation and as a concomitant operation performed at the time of cardiac surgery. We also discuss the emergence of newer procedures to address atrial fibrillation in the past decade, such as the convergent procedure and totally thoracoscopic ablation, and their outcomes relative to historic approaches such as the Cox maze procedure.

Clinical impact of permanent pacemaker implantation following surgical ablation of atrial fibrillation concomitant to mitral valve surgery: a multicenter study

Abstract Background Permanent pacemaker (PPM) implantation is a common adverse event following arrhythmia surgery. However, the epidemiology and clinical impact of PPM has been shown in only few studies in heterogeneous population, and the results are controversial. Purpose The present study aimed to investigate the clinical impact of PPM implantation following surgical ablation of atrial fibrillation (AF) concomitant to mitral valve (MV) surgery. Methods We identified 721 patients (aged 60.2±11.0 years, 437 females) who underwent surgical ablation of AF along with MV repair or replacement at five representative institutions in Korea between 2005 and 2017. Of these, 56 had PPM implanted (PPM group) and the remainder (n=665) did not receive a PPM (No-PPM group). The clinical outcomes were compared between the groups, and multivariable Cox proportional hazard analysis with time-varying covariate was conducted to determine the impact of PPM implantation on mortality and stroke. Results The patients in the PPM group were older, and had a higher CHAD2S2-VASc score than those in the No-PPM group (Table). During follow-up of 68.3 months (interquartile range 44.5-105.4 months), no significant survival difference was evident between the groups, however, the PPM group presented a significantly higher incidence of stroke than No-PPM group (p&amp;lt;0.001) (Figure). On time-varying multivariable analysis, the PPM was not a risk factor for mortality (hazard ratio [HR], 0.44; 95% confidence interval [CI], 0.18-1.08; p=0.072), however, old age (HR, 1.10; 95% CI, 1.07-1.13; p&amp;lt;0.001), chronic kidney disease (HR, 1.61; 95% CI, 1.01-2.58; p=0.046) and previous cardiac surgery (HR, 1.86; 95% CI, 1.01-3.21; p=0.027) were independent predictors of mortality in this subset of patients. The only significant risk factor for stroke was CHAD2S2-VASc score (HR, 1.27; 95% CI, 1.01-1.61; p=0.044), and PPM was not associated with risk of stroke (HR, 1.87; 95% CI, 0.71-4.90; p=0.202). Conclusion PPM implantation following surgical ablation of AF concomitant to MV surgery was not associated with an increased risk of mortality or stroke. This study result provides a supporting evidence for an active attempt in surgical ablation despite of inherent risk of PPM implantation.

Outcomes of mitral valve replacement with complete annular decalcification.

This study aimed to examine the clinical outcomes of mitral valve replacement (MVR) in patients with severe mitral annular calcification (MAC) who required extensive decalcification and mitral annular reconstruction. We reviewed 15 patients with severe MAC who underwent MVR between January 2016 and May 2022. In all cases, the calcified mitral annulus was resected completely using a Cavitron Ultrasound Surgical Aspirator, and a new annulus was created using bovine pericardium. In the acute postoperative phase, strict afterload reduction therapy using an intra-aortic balloon pump (IABP) was administered. The mean age of patients was 73 ± 8 years, and 13 (86.7%) were women. Concomitant aortic valve replacement was performed in 11 (73.3%) patients, tricuspid annuloplasty in 9 (60.0%), coronary artery bypass grafting in 1 (6.7%), and arrhythmia surgery in 7 (46.7%). The mean aortic cross-clamp and cardiopulmonary bypass times were 143 ± 32 min and 175 ± 34 min, respectively. In 13 patients, an IABP was used for 2 or 3 days postoperatively. There were no in-hospital deaths, left ventricular ruptures, or other MAC-related complications. Postoperative echocardiography revealed no paravalvular leakages. Our strategy for managing severe MAC is safe and reproducible even in relatively high-risk patients. Afterload reduction using an IABP in the acute postoperative phase may reduce the risk of fatal complications after extensive decalcification and mitral annular reconstruction.

PO-04-157 PREVALENCE AND PREDICTABLE FACTORS OF LATE ARRHYTHMIAS AFTER THE FONTAN COMPLETION

Many patients with highly complex congenital heart disease could survive thanks to the Fontan operation. However, there is growing awareness of its long-term complications, including arrhythmias. This study aims to demonstrate the prevalence of late arrhythmia and identify predictors of developing arrhythmias in Fontan patients with long-term follow-up. We conducted a Retrospective analysis of patients with Fontan surgery between 1979 and 2019 using the Korean multi-center Fontan registry (N=1673). Arrhythmias were presented in 201 patients with a median age of 19.8 years, who were 42% of total atriopulmonary (AP) Fontan, 24% of total lateral tunnel (LT) Fontan, and 6% of total extracardiac conduit (ECC) Fontan. The median follow-up duration since Fontan surgery was 13.6 years. Tachyarrhythmia was developed in 141 patients. The most common tachyarrhythmia was intra-reentrant atrial tachycardia in 70 patients, followed by re-entrant supraventricular tachycardia in 35 patients. Direct cardioversion was performed in 40 patients(28%), and catheter ablation was performed in 22 patients (16%). Twenty-two patients(16%) and 48 (34%) underwent arrhythmia surgery and Fontan conversion each. Bradyarrhythmia occurred in 88 patients, sinus node dysfunction in 54 patients, and high degree atrioventricular block in 34 patients. Most patients required permanent pacemakers. Twenty year-freedom survival from any arrhythmia, tachyarrhythmia and bradyarrhythmia was 81.9% (95% CI, 79.1-84.8), 88% (95% CI, 85.6-90.4), and 91.9% (95% CI, 90.1-93.9), respectively. On multivariable analyses, age at Fontan surgery and left isomerism were significant predictive factors of developing an arrhythmia (HR 1.07 [1.04-1.09], P<0.001, HR 1.81 [1.15-2.82], P=0.01). The patients with ECC Fontan were less likely to develop arrhythmia than AP or LT Fontan. (HR 0.48 [0.35-0.65], P<0.001). The older age at Fontan surgery and non-ECC Fontan patients were highly susceptible to developing tachyarrhythmia( HR 1.1 [1.05-1.20], P<0.001, HR 3.0 [2.01-4.49], P<0.001). For bradyarrhythmia, left isomerism and the longer time after Fontan surgery was identified significant risk factor of developing bradyarrhythmia. (HR 2.29 [1.24-4.25], P=0.008, HR 1.39 [1.01-1.07], P=0.02). Arrhythmia is a significant burden and inevitable complication in Fontan patients during long-term follow-up, especially those who underwent Fontan surgery in old age and non-ECC Fontan patients for tachyarrhythmia.

Risk factors for atrial arrhythmia recurrence after atrial arrhythmia surgery with pulmonary valve replacement

ObjectivesAtrial arrhythmias are a significant cause of late morbidity and mortality in patients after tetralogy of Fallot repair. However, reports on their recurrence following atrial arrhythmia surgery are limited. We aimed to identify the risk factors for atrial arrhythmia recurrence after pulmonary valve replacement (PVR) and arrhythmia surgery. MethodsWe reviewed 74 patients with repaired tetralogy of Fallot who underwent PVR for pulmonary insufficiency at our hospital between 2003 and 2021. Twenty-two patients (mean age, 39 years) underwent PVR and atrial arrhythmia surgery. A modified Cox-maze III was performed in 6 patients with chronic atrial fibrillation, and a right-sided maze was performed in 12 with paroxysmal atrial fibrillation, 3 with atrial flutter, and 1 with atrial tachycardia. Atrial arrhythmia recurrence was defined as any documented sustained atrial tachyarrhythmia requiring intervention. The influence of preoperative parameters on recurrence was assessed with the Cox proportional-hazards model. ResultsThe median follow-up period was 9.2 years (interquartile range, 4.5-12.4). Cardiac death and redo-PVR due to prosthetic valve dysfunction were not observed. Eleven patients had atrial arrhythmia recurrence after discharge. Atrial arrhythmia recurrence-free rates were 68% at 5 years and 51% at 10 years after PVR and arrhythmia surgery. Multivariable analysis revealed that right atrial volume index (hazard ratio, 1.04; 95% confidence interval, 1.01-1.08, P = .009) was a significant risk factor for atrial arrhythmia recurrence after arrhythmia surgery and PVR. ConclusionsPreoperative right atrial volume index was associated with atrial arrhythmia recurrence, which may assist in planning the timing of atrial arrhythmia surgery and PVR.

Late outcome of coronary artery bypass grafting with or without mitral repair for moderate or moderate-severe ischemic mitral regurgitation.

Operative indication of the additional mitral repair for moderate ischemic mitral regurgitation (MR) in the setting of coronary artery bypass grafting (CABG) is still unclear. This study was designed as the nation-wide multi-center retrospective analysis with additional survival data. CABGs without past heart surgery registered in 2014 and 2015 were included. Concomitant surgery other than tricuspid or arrhythmia surgery, mitral replacement, and off-pump cases, was excluded. Grade 1 or 4 MR, and ejection fraction < 20 or > 50 were excluded. Additional questionnaire was sent to each hospital, regarding the pathology of MR and clinical outcomes. Additional data were registered between May 28, 2021 and Dec 31, 2021, and the primary outcomes were all-death and cardiac death. The secondary outcomes were heart failure and cerebrovascular event requiring admission, mitral re-intervention. Patients underwent on-pump CABG (CABG only group 221 cases) and CABG with mitral repair (CABG + Mitral repair group 276 cases) were enrolled. After Propensity score matching, 362 cases (CABG only 181cases vs CABG + mitral repair 181 cases) were matched. Cox regression model showed no statistical difference in the long-term survival between CABG alone group and combined procedure group (p = 0.52). Cardiac death (p = 1.00), heart failure (p = 0.68), and cerebrovascular event (p -0.80) requiring admission were not different between groups as well. The incidence of mitral re-intervention was very few (2 cases in CABG only group, 4 cases in CABG + mitral repair group). In patients with moderate ischemic MR, additional mitral repair to CABG did not improve long-term survival, freedom from heart failure, or cerebrovascular event.

Permanent pacemaker implantation after valve and arrhythmia surgery in patients with preoperative atrial fibrillation.

Among patients referred for cardiac surgery, atrial fibrillation (AF) is a common comorbidity and a risk factor for postoperative arrhythmias (eg, sinus node dysfunction, atrioventricular heart block), including those requiring permanent pacemaker (PPM) implantation. The purpose of this study was to evaluate the prevalence and long-term survival of postoperative PPM implantation in patients with preoperative AF who underwent valve surgery with or without concomitant procedures. Presented analysis pertains to the HEIST (HEart surgery In atrial fibrillation and Supraventricular Tachycardia) registry. During the study period, 11,949 patients underwent valvular (aortic, mitral, or tricuspid valve replacement or repair) surgery and/or surgical ablation (SA) and were stratified according to postoperative PPM status. PPM implantation after surgery was necessary in 2.5% of patients, with significant variation depending on the type of surgery (from 1.1% in mitral valve repair to 3.3% in combined mitral and tricuspid valve surgery). In a multivariate logistic regression model, tricuspid intervention (P <.001), cardiopulmonary bypass time (P = .024), and endocarditis (P = .014) were shown to be risk factors for PPM. Over long-term follow-up, PPM was not associated with increased mortality compared to no PPM (hazard ratio 0.96; 95% confidence interval 0.77-1.19; P = .679). SA was not associated with PPM implantation. However, SA improved survival regardless of PPM status (log rank P <.001). In patients with preoperative AF, the need for PPM implantation after valve surgery or SA is not an infrequent outcome, with SA not affecting its prevalence but actually improving long-term survival.

Concomitant arrhythmia surgery should be a standard procedure in AF patients undergoing cardiac surgery.

Concomitant arrhythmia surgery should be a standard procedure in AF patients undergoing cardiac surgery.

Patient-activated anti-tachycardia pacing in adult congenital heart disease.

IntroductionIn adults with congenital heart disease, intra‐atrial reentrant tachycardia (IART) is a common arrhythmia that causes significant morbidity and mortality. One treatment option for IART is antitachycardia pacing. Atrial antitachycardia pacing algorithms deliver therapy for IART with ≥2:1 conduction, but most algorithms will not recognize IART with 1:1 conduction. Temporary Patient Activated Rx (TPARx) is Medtronic software that can be installed in antitachycardia pacemakers allowing patients to deliver therapies on demand for IART with 1:1 conduction.MethodsRetrospective chart review at a single institution of all patients who had TPARx installed into their pacemaker.ResultsFour adults with single ventricle congenital heart disease and IART underwent Fontan conversion, arrhythmia surgery, and placement of an epicardial dual‐chamber antitachycardia pacemaker. They had recurrent IART with a long cycle length and 1:1 conduction that failed to trigger antitachycardia pacing therapies. TPARx software was programmed into their pacemakers to allow recognition and treatment of IART with 1:1 conduction. Mean follow‐up duration after TPARx programming was 4.9 years. Each patient received at least one successful antitachycardia pacing therapy via TPARx – range 0.4–26 treated IART episodes per year. There were no atrial or ventricular arrhythmias induced with antitachycardia pacing. Two patients were able to discontinue anticoagulation after TPARx installation.ConclusionThis series demonstrates the use of TPARx software as part of a long‐term IART management strategy in select patients with IART who have failed more conventional therapies.

Structure and function of the ventricular tachycardia isthmus.

Catheter ablation of postinfarction reentrant ventricular tachycardia (VT) has received renewed interest owing to the increased availability of high-resolution electroanatomic mapping systems that can describe the VT circuits in greater detail, and the emergence and need to target noninvasive external beam radioablation. These recent advancements provide optimism for improving the clinical outcome of VT ablation in patients with postinfarction and potentially other scar-related VTs. The combination of analyses gleaned from studies in swine and canine models of postinfarction reentrant VT, and in human studies, suggests the existence of common electroanatomic properties for reentrant VT circuits. Characterizing these properties may be useful for increasing the specificity of substrate mapping techniques and for noninvasive identification to guide ablation. Herein, we describe properties of reentrant VT circuits that may assist in elucidating the mechanisms of onset and maintenance, as well as a means to localize and delineate optimal catheter ablation targets.

Preliminary Results of Cryoablation for Surgical Treatment of Arrhythmias in Adults With Congenital Heart Disease.

Background: Arrhythmias in adult congenital heart disease (ACHD) are responsible for the majority of hospital admissions and 20–25% of late deaths. Since need for further cardiac operations is frequent in ACHD, concomitant arrhythmia surgery represents a strategic treatment modality.Material and Methods: A two-center retrospective study was undertaken on cryoablation of supraventricular arrhythmias in 25 conescutive ACHD patients (16/9, M/F, median age 38.5 years, IQR 38–60) operated between 01/2017 and 12/2020. Nineteen (76%) had undergone one or more previous cardiac operations and 8 (32%) one or more trans-catheter ablations. Indications included Fontan conversion in seven patients, septal defect repair in 6, pulmonary valve replacement in 10 and tricuspid surgery in 2. Open-heart cryoablation included: 4 cavotricuspid isthmus ablations, 19 right-sided Maze for atrial tachycardia/flutter, and 2 Cox-Maze III for atrial fibrillation.Results: There were 2 (8%) hospital deaths, unrelated to cryoablation, due to low cardiac output syndrome. There were no intraoperative complications related to cryoablation. Seven (28%) patients required pace-maker implantation due to post-operative atrioventricular block. All patients were discharged on oral antiarrhythmic and anticoagulantion for 6 months. After a median follow-up of 14 months (IQR 7–27) no late mortality was observed. At follow-up, 16/23 (69%) patients are in stable sinus rhythm, 12 without anti-arrhythmic therapy. Two (8.6%) patients had relapse of arrhythmia. Freedom from arrhythmia was 90.9% and cumulative risk of recurrence was 9.6%.Conclusions: Intraoperative cryoablation is safe and effective procedure. Surgical treatment of arrhythmias should always be considered in ACHD, whenever further open-heart repair is needed.

Prevention of Oculocardiac Reflex by Premedication With Low Dose I/V Ketamine during Strabismus Surgery

Background: OCR commonly occurs during strabismus surgery, producing bradycardia, arrhythmias and even cardiac arrest after manipulation of orbital structures. Ketamine is NMDA receptor antagonist and acts as an analgesic. Aim: To determine the effect of ketamine premedication on prevention of OCR during strabismus surgery. Study design: Randomized control trial Methodology: 60 patients were randomly divided into two groups i.e., Ketamine 0.75mg/kg (Group K) and control (Group C). Group K patients were premedicated with 0.75mg/kg ketamine while Group C patients did not receive any premedication. Heart rate and ECG were observed 30 sec before and continuously after traction on extraocular muscles was applied upto end of surgery for bradycardia and arrhythmias. Percentage change in HR and presence of arrhythmias was documented. All the data was collected using case report form and analyzed using SPSS version 15. Results: In Group C, 15(50%) cases had arrhythmias while in Group K, only 4(13.33%) cases had arrhythmias. Mean HR in Group C was 118.77±6.92/min and in Group K was 101.57±15.65/min. In Group C, oculocardiac reflex was present in 23(76.7%) cases and in Group K, OCR was present in 6 (20%) cases and prevented in 24 (80%) cases. Conclusion: Premedication with 0.75mg/kg IV ketamine significantly reduces the occurrence of oculocardiac reflex during strabismus surgery. Keywords: Ketamine, Oculocardiac Reflex, Premedication, Prevention, Strabismus

Patient-reported quality of life after stand-alone and concomitant arrhythmia surgery: a systematic review and meta-analysis.

OBJECTIVESPatient-reported quality of life (QOL) has become an important endpoint for arrhythmia surgery for atrial fibrillation (AF). While studies specifically evaluating the effect of arrhythmia surgery on QOL are scarce, we aimed to summarize current evidence of QOL following concomitant and stand-alone arrhythmia surgery for AF.METHODSAll studies reporting on QOL using questionnaires from patients undergoing arrhythmia surgery for AF, both stand-alone and concomitant, were included in this systematic review. A meta-analysis was performed on inter-study heterogeneity of changes in QOL on 9 of 12 included studies that used the Short-Form 36 tool and meta-regression based on rhythm outcome after 1 year was executed. Finally, differences in QOL following stand-alone arrhythmia surgery and concomitant procedures were evaluated.RESULTSOverall, QOL scores improved 1 year after surgical ablation for AF evaluated by several questionnaires. In stand-alone arrhythmia procedures, meta-regression showed significant improvements in those who were in sinus rhythm compared to those in AF after 1 year. This association between an improved QOL and the procedural effectiveness was also suggested in concomitant procedures. However, when comparing QOL of patients undergoing cardiac surgery with and without add-on surgical ablation for AF, only the variable ‘physical role’ demonstrated a significant improvement.CONCLUSIONSIn patients with AF, QOL improves after both stand-alone and concomitant arrhythmia surgery. In the concomitant group, this improvement can be attributed to both the cardiac procedure itself as well as the add-on arrhythmia surgery. However, both in stand-alone and concomitant procedures, the improvement in QOL seems to be related to the effectiveness of the procedure to maintain sinus rhythm after 12 months.

Atrial heat shock protein levels are associated with early postoperative and persistence of atrial fibrillation.

Early detection and staging of atrial fibrillation (AF) is of importance for clinical management. Serum (bio)markers, such as heat shock proteins (HSP), may enable AF staging and identify patients at risk for AF recurrence and postoperative AF (PoAF). This study evaluates the relation between serum and atrial tissue HSP levels, stages of AF, AF recurrence after treatment, and PoAF from patients undergoing cardiothoracic surgery. Patients without (control) and with paroxysmal, persistent (PerAF), or longstanding persistent (LSPerAF) AF were included. HSPB1, HSPA1, HSPB7, and HSPD1 levels were measured in serum obtained prior to and post intervention. HSPB1, HSPA1, HSPA5, HSPD1, HSPB5, and pHSF1 levels were measured in left and/or right atrial appendages (respectively, LAA and RAA). In RAA, HSPA5 levels were significantly lower in LSPerAF and HSPD1 levels significantly higher in PerAF patients compared to controls. In RAA of controls who developed PoAF, HSPA1 and HSPA5 levels were significantly higher compared to those without PoAF. Also, HSPB1 RAA levels were lower and HSPA5 LAA levels higher in patients undergoing arrhythmia surgery who developed AF recurrence within 1 week after surgery compared to patients who did not. HSPA5 RAA and HSPD1 RAA and LAA levels are altered in persistent stages of AF. RAA HSPA1 and HSPA5 levels associate with development of PoAF. Additionally, HSPB1 RAA and HSPA5 LAA levels can predict AF recurrence in patients who underwent arrhythmia surgery. Nevertheless, HSP levels in serum cannot discriminate AF stages from controls, nor predict PoAF or AF recurrence after treatment.

Excision of a rare cardiac tumor aided by endocardial electroanatomical mapping

Glomus tumors are rare benign soft tissue lesions, most commonly found on the skin. They are an extremely rare cause of the cardiac tumor. We report a case of right atrial glomus tumor excised using a novel technique utilizing cardiac electroanatomical mapping techniques ordinarily used for arrhythmia surgery.

Unexpected effects of new COVID-19 infection in arrhythmia surgery

The article presents two clinical cases of patients with a fatal outcome after a coronavirus infection. The first patient had sepsis and purulonecrotic phlegmon complication after radiofrequency ablation of the cavatricuspid isthmus. The second one had a complication in the form of the esophageal rupture in the middle third after transesophageal echocardiography.

JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias.

JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias.

Does cardiac arrhythmia surgery improve a patient"s quality of life? a systematic review and meta-analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background Although one-year success of arrhythmia surgery for atrial fibrillation (AF) has long been defined as freedom from supraventricular tachyarrhythmia, patient-reported quality of life (QOL) has become increasingly important. Purpose We aimed to analyze current evidence of QOL following both concomitant and stand-alone arrhythmia surgery for AF. Methods Studies reporting on QOL of patients undergoing arrhythmia surgery for AF, stand-alone or concomitant, who provided essential data for the analysis, were included in this systematic review. A meta-analysis was performed on inter-study heterogeneity of changes in QOL in 9 of 12 included studies who used the Short-Form (SF) 36 tool. The metric standardized mean difference (SMD) was used to compare one year outcomes with baseline scores per variable of the SF-36 QOL questionnaire (total patients n = 545). Finally, meta-regression based on rhythm outcome after one year and add-on arrhythmia surgery as covariate were performed. Results QOL scores improved one year after surgical ablation for AF, evaluated by several questionnaires. In standalone arrhythmia procedures, meta-regression showed a significant improvement between the QOL and the procedural effectiveness after one year (Physical Functioning p = 0.015, Role Physical p = 0.006, General Health p = 0.002, Social Functioning p = 0.043. Forest plot Physical Functioning: SMD = 1.105; heterogeneity: I²=90.6%, p &amp;lt; 0.001). While this association was also suggested in concomitant procedures, only the variable Physical Role demonstrated a significant improvement when comparing QOL of cardiac surgery with and without add-on surgical AF ablation (p = 0.037). Conclusion Arrhythmia surgery for AF improves QOL. Both in standalone and concomitant procedures, the improvement in QOL seems to be related to the procedural effectiveness to maintain sinus rhythm after 12 months. Abstract Figure. SF-36 variable Physical Functioning