Diagnostic Catheterization Research Articles

Appropriateness of angiography for suspected coronary artery disease

The aim of this study was to assess the appropriate use of diagnostic catheterizations (DC) for the patients with suspected coronary artery disease performed in Iran. The Electronic Health Record System database and manual review of files were utilised to collect data between 2012 and 2014. Patients were categorized in three groups as appropriate, uncertain, and inappropriate usage of DC and the logistic regression was used to investigate the relationships between variables. One-quarter of the 2458 angiographies were rated as inappropriate, out of which 99% had no previous stress test. The rate of inappropriate DC between various hospitals were approximately the same. The regression showed that some risk factors (Sex, high cholesterol, smoking, chronic heart failure, renal failure, diabetes) were significantly associated with inappropriate rate.

Characteristics and Outcomes of Patients With History of CABG Undergoing Cardiac Catheterization Via the Radial Versus Femoral Approach.

The aims of this study were to examine rates of radial artery access in post-coronary artery bypass grafting (CABG) patients undergoing diagnostic catherization and/or percutaneous coronary intervention (PCI), whether operators with higher procedural volumes and higher percentage radial use were more likely to perform diagnostic catherization and/or PCI via the radial approach in post-CABG patients, and clinical and procedural outcomes in post-CABG patients who undergo diagnostic catherization and/or PCI via the radial or femoral approach. There are limited data comparing outcomes of patients with prior CABG undergoing transradial or transfemoral diagnostic catheterization and/or PCI. Using the National Cardiovascular Data Registry CathPCI Registry, all diagnostic catheterizations and PCIs performed in patients with prior CABG from July 1, 2009, to March 31, 2018 (n=1,279,058, 1,173 sites) were evaluated. Temporal trends in transradial access were examined, and mortality, bleeding, vascular complications, and procedural metrics were compared between transradial and transfemoral access. The rate of transradial access increased from 1.4% to 18.7% over the study period. Transradial access was associated with decreased mortality (adjusted odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.75 to 0.91), decreased bleeding (OR: 0.57; 95%CI: 0.51 to 0.63), decreased vascular complications (OR: 0.38; 95%CI: 0.30 to 0.47), increased PCI procedural success (OR: 1.11; 95%CI: 1.06 to 1.16; p<0.0001), and significantly decreased contrast volume across all procedure types. Transradial access was associated with shorter fluoroscopy time for PCI-only procedures but longer fluoroscopy time for diagnostic procedures plus ad hoc PCI and diagnostic procedures only. Operators with a higher rate of transradial access in non-CABG patients were more likely to perform transradial access in patients with prior CABG. The rate of transradial artery access in patients with prior CABG undergoing diagnostic catheterization and/or PCI has increased over the past decade in the United States, and it was more often performed by operators using a transradial approach in non-CABG patients. Compared with transfemoral access, transradial access was associated with improved clinical outcomes in patients with prior CABG.

Digital Subtraction Angiography a Door Opener for Neurosurgical Residents who want to Perform Neurointerventional Procedures

Digital subtraction angiography (DSA) has been a fluoroscopic golden investigative tool to know the vascular angiography of the brain and spinal cord. The technique in performing this procedure exposes residents in accessing the major vessels, branches of the arch of aorta, selective angiography and diagnosing different vascular anomalies of brain and spine. They are also exposed to the knowledge of different diagnostic catheters, its manipulation, use of dye and radiation exposure and safety. We would like to share our experience in training and disseminating the knowledge of digital subtraction angiography to the residents.

Diagnosis of Primary Cardiac T-cell Lymphoma: Feasibility and Safety of Endomyocardial Biopsy Guided by Pre-acquired Cardiovascular Magnetic Resonance.

Multimodality imaging of a cardiac mass lesion may raise suspicion of a primitive cardiac lymphoma (PCL). However, a definitive diagnosis requires histopathological confirmation. This report describes the methodology we used to perform biopsy sampling of a cardiac mass lesion affecting a 45-year-old man. In order to increase endomyocardial biopsy diagnostic accuracy, we used pre-acquired cardiac magnetic resonance (CMR) images to guide the bioptome on a cardiac site overtly infiltrated by the suspected tumour. The right ventricular outflow tract was identified as the target site for biopsy sampling. To reduce the risk of the procedure, the biopsy was performed at a safe distance from the tip of a diagnostic quadripolar catheter positioned at the level of the pulmonary valve, previously identified by pacing manoeuvres. The reported approach demonstrated safety and diagnostic accuracy, allowing the identification of an extremely rare PCL subtype of T-cell origin. Biopsy sampling of a suspected tumour may be safely and accurately performed using pre-acquired CMR images to guide the bioptome on the target site. Multimodal imaging techniques capable of tissue characterization may raise suspicion of a primary cardiac lymphoma (PCL).However, the final diagnosis of PCL can be confirmed only by histological examination of a tissue sample.Biopsy sampling of the mass lesion may be accurately guided by previously acquired cardiac magnetic resonance images.

Routine surveillance of patients post Fontan palliation: lessons learnt from cardiac catheterisation

BackgroundThere is no consensus on the clinical utility of ‘routine’ diagnostic cardiac catheterisation in patients with Fontan palliation in the absence of symptoms or haemodynamic lesions.ObjectiveWe sought to evaluate whether diagnostic cardiac catheterisation for a variety of indications led to a change in the clinical management of patients with a Fontan circulation.MethodsAll adult patients (≥16 years) with Fontan palliation undergoing diagnostic cardiac catheterisation at our institution from 2016 to 2019 were included retrospectively. Patients undergoing electrophysiological studies were excluded as haemodynamic measurements were not taken. Routine cardiac catheterisation at our institution is considered in adult patients who have not had a diagnostic cardiac catheter for more than 5 years.ResultsThirty-eight patients, mean age 27 ± 7 years, 60% NYHA I, 31% NYHA II, 8% NYHA III, at mean duration post Fontan of 20 ± 6 years, lateral tunnel (LT) n = 20, extracardiac (EC) n = 14 and atriopulmonary (AP) n = 4, underwent 41 diagnostic cardiac catheterisation procedures. Indication for cardiac catheterisation was as follows: haemodynamic lesion identified on cross-sectional imaging in 12; routine catheterisation in 9; cyanosis in 8; dyspnoea in 8; significant liver stiffness on ultrasound hepatic elastography in 2; and arrhythmia in 2. Of the 9 patients undergoing routine diagnostic catheterisation, 3 had not had any diagnostic catheterisation since their Fontan completion and, in the remaining six, the mean time lapsed since the last diagnostic catheter was 8 ± 3 years. The diagnostic catheterisation led to a recommended change in clinical management on 24 occasions (59%): catheter intervention in 17 (40%); surgery in 4 (10%); medication change in 3 (17%); and transplant referral in 2 (5%). The clinical indications that led to changes in clinical management were: cyanosis (8/8), dyspnoea (7/8), haemodynamic lesions on cross-sectional imaging (8/11) and arrhythmia (1/2). None of the 9 patients listed for routine diagnostic catheterisation or as a result of findings on ultrasound hepatic elastography had a recommended change in clinical management.ConclusionDiagnostic cardiac catheterisation frequently leads to changes in the clinical management of patients with Fontan palliation presenting with dyspnoea, cyanosis, and for further evaluation of potential haemodynamic lesions identified on cross-sectional imaging. Routine cardiac catheterisation in the absence of the above indications had limited impact on clinical management in our cohort.

Percutaneous Coronary Interventions in Patients Supported with Left Ventricular Assist Devices

<h3>Purpose</h3> More than half of patients with advanced heart failure (HF) requiring left ventricular assist device (LVAD) support have severe ischemic cardiomyopathy, yet the incidence, indications, and outcomes of coronary interventions in the LVAD population are unknown. The objective of this study was to describe outcomes of percutaneous coronary interventions (PCI) in LVAD patients. <h3>Methods</h3> Using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS), we identified LVAD patients who underwent diagnostic coronary angiography from 2015-2017. The index admission for LVAD implantation was excluded. Baseline characteristics and in-hospital outcomes of those who underwent PCI vs. diagnostic catheterization only were described. <h3>Results</h3> A total of 33,456 admissions for LVAD patients were identified. Coronary catheterization was performed in 3,830 admissions (11.5%) and 260 of these resulted in PCI (6.8%). Overall, patients were more commonly men (77.3%), white (62.3%), with a high burden of comorbidities based on Elixhauser index ≥3 (99.3%). Acute myocardial infarction (AMI) (83%) was the most common indication for PCI; 35.6% were identified as a ST-elevation MI and 40% presented with or developed cardiogenic shock. Among patients undergoing PCI, the median length-of-stay was 6 days (IQR 4-10) and in-hospital mortality was 15.4%. Among patients undergoing diagnostic catheterization only, the median length-of-stay was 10 days (IQR 5-18) and in-hospital mortality was 4.3%. Other in-hospital outcomes are described in <b>Table 1</b>. <h3>Conclusion</h3> Although PCI procedures are uncommon in LVAD patients, they may be appropriately performed in severe AMI cases. PCI in LVAD patients is associated with significantly high in-hospital mortality. Further studies are warranted to better characterize the risk and outcomes of CAD progression in LVAD patients, as well as the utility of PCI in this complex population.

Comparison of one-catheter strategy versus conventional two-catheter strategy on the volume of radiological contrast and diagnostic coronary catheterization performance by transradial access: A systematic review and meta-analysis of randomized clinical trials

Background One-catheter strategy, based in multipurpose catheters, allows exploring both coronary arteries with a single catheter. This strategy could simplify coronary catheterization and reduce the volume of contrast administration, by reducing radial spasm. To date, observational studies showed greater benefits regarding contrast consumption and catheterization performance than controlled trials. The aim of this work is to perform the first systematic review and meta-analysis of randomized clinical trials (RCT) to adequately quantify the benefits of one-catheter strategy, with multipurpose catheters, over conventional two-catheter strategy on contrast consumption, and catheterization performance. Methods A search in PubMed, CINALH, and CENTRAL databases was conducted to identify randomized trials comparing one-catheter and two-catheter strategies. The primary outcome was volume of iodinated contrast administrated. Secondary endpoints, evaluating coronary catheterization performance included: arterial spasm, fluoroscopy time, and procedural time. Results Five RCT were included for the final analysis, with a total of 1599 patients (802 patients with one-catheter strategy and 797 patients with two-catheter strategy). One-catheter strategy required less administration of radiological contrast (difference in means [DiM] [95% confidence interval (CI)]; -3.831 mL [-6.165 mL to -1.496 mL], p = 0.001) as compared to two-catheter strategy. Furthermore, less radial spasm (odds ratio [95% CI], 0.484 [0.363 to 0.644], p < 0.001) and less procedural time (DiM [95% CI], -72.471 s [-99.694 s to -45.249 s], p < 0.001) were observed in one-catheter strategy. No differences on fluoroscopy time were observed. Conclusions One-catheter strategy induces a minimal reduction on radiological contrast administration but improves coronary catheterization performance by reducing arterial spasm and procedural time as compared to conventional two-catheter strategy.

Pulmonary hypertension in fibrosing idiopathic interstitial pneumonia: Uncertainties, challenges and opportunities

Pulmonary hypertension is a serious complication of chronic fibrosing idiopathic interstitial pneumonia (PH-fIIP) leading to greater morbidity and mortality. The pathophysiologic basis for PH in fIIP is not completely understood, but microvascular rarefaction may play a key role. Severe hypoxemia and reduced diffusion capacity are characteristic. Doppler echocardiography has limited diagnostic utility and right heart catheterization is required to confirm the diagnosis. Lung volumes can be minimally affected, and radiographic findings can be subtle, making the distinction from pulmonary arterial hypertension challenging. Several randomized controlled trials of pulmonary arterial hypertension targeted therapies have recently been completed. Endothelin-receptor antagonists have shown either no benefit or harm. Sildenafil may have some favorable short-term effects but does not appear to impact long-term outcomes. Riociguat treatment increased hospitalizations and mortality. A recent trial of inhaled treprostinil demonstrated improved exercise capacity, but the impact on long-term morbidity and mortality are unknown. Currently, the only viable option for improved survival is lung transplantation. Early referral is imperative to optimize post-transplant outcomes.

Transarterial correction of patent ductus arteriosus in small dogs with the Amplatz™ Vascular Plug 4: A pilot study

ObjectivesDetermine if the Amplatz™ Vascular Plug 4 (AVP4) can be used to occlude left-to-right shunting patent ductus arteriosus (PDA) in dogs with inadequate arterial vascular access for the Amplatz Canine Duct Occluder (ACDO). AnimalsSix adolescent dogs with PDA whose femoral artery was too small for insertion of a 4 Fr vascular access sheath. Materials and methodsStandard femoral arterial vascular access and a 4 Fr diagnostic catheter were used to deploy an appropriately sized AVP4 into the PDA of each dog. Successful occlusion was defined as no residual ductal flow and determined by color Doppler echocardiography and angiography. ResultsThe AVP4 was successfully deployed, and complete occlusion of the PDA was achieved in all dogs. There were no complications encountered in any of the dogs. ConclusionsThe AVP4 is a viable option for the correction of PDA in dogs with inadequate arterial vascular access for the ACDO and should be considered as one of the options available for PDA correction in this challenging animal population.

Survey of coronary catheterization laboratory activity in Iran during the coronavirus disease-2019 pandemic.

With the onset of the coronavirus disease-2019 (COVID-19) pandemic, hospitalization and treatment of non-covid patients decreased worldwide. The aim of this study is to evaluate the admission and treatment of patients with coronary artery diseases (CADs) by examining coronary Cath labs activities in some centers of Iran during the COVID-19 period. A retrospective, multi-center survey was conducted in four cites in Iran which participated in National Persian Registry Of CardioVascular diseasE (N-PROVE). Two periods of COVID-19 occurrence peak in Iran were compared with the same date in 2019. Information was collected on the number of diagnostic and therapeutic coronary catheterizations in both stable ischemic heart diseases (SIHDs) and acute coronary syndrome (ACS) settings. In the first peak of COVID-19 pandemic, coronary angiographies and angioplasties decreased by 37 and 38% compared to the same period in 2019, respectively. The most common indication for coronary angiography during this period was ACS [especially ST-Segment Elevation Myocardial Infarction (STEMI)]; however, at the time of peak decrease, the SIHDs were the most. In the second peak of COVID-19 pandemic in Iran, 34% and 27% decrease in diagnostic and therapeutic coronary procedures were seen, respectively. During this period, the number of elective admissions increased, although it was still lower than that in 2019. The tendency to rescue percutaneous coronary intervention increased in most centers during the COVID-19 era, especially in the second peak. A significant reduction in the coronary Cath lab activity has been observed during the COVID-19 pandemic that can indicate an increased risk of cardiovascular mortality and morbidity.

Compare Different Blood Parameters Between Different Types of Cathete in Atherosclerosis Patients with Type 2 Diabetus

Human blood groups ABO (BG) represent an important system in blood transfusion medicine and transplantation, and have a role in the development of heart disease. The current study was conducted with the aim of comparing the types of blood groups and knowing the most affected by atherosclerosis and type 2 diabetes. Our study was consisted of total (n192) population with age range (45-70) years old and overweight in terms of their BMI. The first group included (n64) under Precautinous coronary intervention (PCI) catheterization with atherosclerosis and diabetes type 2. The second group (n64) underwent Diagnostic (DIG) catheterization with diabetes type 2 and without atherosclerosis. The association between blood group types with diabetes type 2 disease and atherosclerosis was investigated. The most prevalent blood group was O+(93.74%) in DIG, (80.84%) in PCI closely followed by group B(49.99%), (44.62%) in DIG and PCI respectively, and group A (43.75%)In both group. Least prevalent blood group was AB (35.25%) in PCI and (12.5%) in DIG group. In conclusion the patients with type O are more likely to have diabetes and atherosclerosis, and those with type B are more likely to develop diabetes. Type A and AB are less likely to develop sclerosis.

P0339 / #936: HIGH RISK FONTAN: A SINGLE CENTER EXPERIENCE IN A MIDDLE INCOME COUNTRY

Aims & Objectives: Patients after Fontan operations are affected by a numerous of complications related to the increased venous pressure. The purpose of this study was to describe adverse events during the early postoperative period as to identify risk factors for a prolonged PICU stay and mortality in a single center in Mexico. Methods: This was a retrospective study. Between 2008 and 2018, we evaluated data of pediatric patients who underwent Fontan procedure to identify variables associated with morbidity and mortality. Results: We had 133 patients with a mean age of 8 years, 111 (84%) of them had previous procedures. Although all patients meet Fontan criteria, almost 85% of them showed some level of pulmonary branch distortion that required surgical intervention. The most common procedure was fenestrated extracardiac conduit in 95.5% and the mean PICU stay was 6.8 days. The most frequent morbidity was pleural effusions, 91.9% present bilateral effusions and in 37.4% persisted for more than 15 days. In 54 patients with hemodynamic instability a diagnostic catheterization was indicated, 48 patients required an intervention. Seventeen patients die (12.5%) and 7 Fontan takedowns were performed, considering the lack of transplant and ventricular assistant device programs in patients with univentricular physiology. Conclusions: Age, weigh and height at the time of the surgery, as a fenestration of 5 mm or smaller in the conduit, were the relevant factors associated with prolonged pleural effusions and poorer outcomes. Probably, late diagnosis and referral of patients to cardiac centers are the reasons of the important prevalence of high-risk Fontan patients.

Does pulsed field ablation regress over time? A quantitative temporal analysis of pulmonary vein isolation

The tissue specificity of pulsed field ablation (PFA) makes it an attractive energy source for pulmonary vein (PV) isolation (PVI). However, beyond each PFA lesion's zone of irreversible electroporation and cell death, there may be a surrounding zone of reversible electroporation and cell injury that could potentially normalize with time. The purpose of this study was to assess whether the level of electrical PVI that is observed acutely after PFA regresses over time. In a clinical trial, patients with paroxysmal atrial fibrillation underwent PVI using a biphasic PFA waveform delivered through a dedicated, variably deployable multielectrode basket/flower catheter. Detailed voltage maps were created using a multispline diagnostic catheter immediately after PFA and again ∼3 months later in a prospective, protocol-specified reassessment procedure. We analyzed 20 patients who underwent PFA with durable PVI and available maps from both time points. To compare the ablated zones, the left- and right-sided PV antral isolation areas and nonablated posterior wall area were quantified and the distances between left and right PV low-voltage edges were measured. A comparison of voltage maps immediately after PFA and at a median of 84 days (interquartile range 69-90 days) later revealed that there was no significant difference in either the left- and right-sided PV antral isolation areas or nonablated posterior wall area. The distances between low-voltage edges on the posterior wall were also not significantly different between the 2 time points. This study demonstrates that the level of PV antral isolation after PFA with a multielectrode PFA catheter persists without regression.

Early results for iCMR in atrial flutter

Abstract Funding Acknowledgements Type of funding sources: None. Background As a standard of care, ablation of typical atrial flutter involves performing cardiac catheterization under x-ray fluoroscopy. The unique ability of magnetic resonance (MR) to provide real-time functional imaging in multiple views without ionizing radiation exposure has the potential to be a powerful tool for diagnostic and interventional procedures. Real-time MR imaging-guided radiofrequency (RF) ablation has been used as a part of clinical trials. Objective To implement the MR imaging-guided RF ablation of typical atrial flutter in the clinical routine. Methods From January to July 2020, 15 consecutive patients with typical atrial flutter have been referred for ablation. Patient preparation, conscious sedation and groin puncture took place inside the 1.5 Tesla MR scanner as a part of an MR-only workflow. The catheter advancement as well as the RF ablation procedure have been performed under direct visualisation of catheters with integrated micro-coils using an interactive sequence with active tip tracking and automatic slice positioning in the plane where the catheter tip has been detected. During catheter advancement a single frontal plane has been used to visualize the passage of the catheter through femoral veins and inferior vena cava. With both diagnostic and ablation catheters in the right atrium, an axial stack of balanced steady-state free precession acquisitions has been acquired and used to reconstruct planes in the short- and long cardiac axis. These have been used to provide a "left- and right anterior oblique" view familiar to an interventional electrophysiologist. The subsequent catheter placement and ablation have been performed under direct visualisation in these two planes (see figure). Results The ablation was successful in 14 patients, one patient had to undergo a conventional procedure on the following day. The mean time to reach right atrium and coronary sinus was 4 [3,5] and 7 [6,10] minutes, respectively. The mean total ablation duration and procedure time was 18 [12,26] and 43 [33,58] minutes, respectively. There were no adverse events. Conclusion The implementation of the MR imaging-guided RF ablation of typical atrial flutter in the clinical routine is feasible and leads to similar success rates and procedure times as the conventional fluoroscopy-based ablation. Abstract Figure.

Endovascular treatment of iatrogenic superior mesenteric arteriovenous fistula resulting in recurrent abdominal ascites

Superior mesenteric arteriovenous fistulas (AVFs) are rare and are usually caused by previous bowel surgery or blunt abdominal trauma. Patients may be asymptomatic, have non-specific symptoms of abdominal pain, nausea and vomiting or present with symptoms of portal hypertension; some patients may present years after initial surgery or trauma. Traditionally, superior mesenteric AVFs are treated by surgical ligation. However, percutaneous endovascular treatment has become increasingly popular in recent years. Different options of endovascular treatment include coil embolisation, covered stent and vascular plugs. There is a risk of coil migration with coil embolisation and covered stents may cause abnormal vessel straightening. Vascular plugs allow the fistula to be treated with fewer devices and have minimal risk of migration. Newer devices such as microvascular plugs have the added advantage of being able to be delivered through microcatheters or diagnostic catheters. The smaller profile of the microvascular plug also allows it to navigate through tortuous vessels. We report a case of a 77-year-old patient presenting with recurrent abdominal ascites three years after small bowel resection. CT and angiogram demonstrated a superior mesenteric AVF, which was successfully treated with a combination of microvascular plug and coil. He remained relatively asymptomatic four months after treatment.

Comparison of pathologist review protocols for cytologic detection of prostatic and urothelial carcinomas in canines: A bi-institutional retrospective study of 298 cases.

Urothelial carcinoma, also known as transitional cell carcinoma, is the most common primary bladder tumour in dogs, and can also involve the prostate gland. Cytology is a common diagnostic tool utilized for dogs with bladder or prostate gland lesions. The objectives of this retrospective study were to compare the sensitivity and specificity of cytologic evaluation for urothelial or prostatic carcinoma between two institutions with different cytology review protocols as well as determine if certain collection methods resulted in higher cytologic accuracy. A total of 298 cases met inclusion criteria. The overall sensitivity and specificity for institution 1 were 91.8% and 50%, respectively, compared to 31.1% and 97.4%, respectively, for institution 2. When the urine sample review protocol at institution 2 was matched to that of institution 1, sensitivity and specificity were more similar to institution 1 (71.2% and 88.9%, respectively). Our results show that the sensitivity and specificity of cytology are affected by screening and review protocols implemented by different institutions. The data also demonstrate that sensitivity and specificity vary by collection method. Diagnostic catheterization had the highest performance: of the 11 cases between two institutions, it had 100% sensitivity and specificity. In contrast, examination of urine sediment not collected via diagnostic catheterization had low sensitivity and specificity that varied greatly by institution. In summary, cytologic interpretation should be undertaken with consideration given to both processing and collection protocols.

Severe myocardial ischemia in a patient with diabetes mellitus and left bundle branch block

We present the case of a 69-year-old woman with diabetes mellitus, left bundle branch block, and obesity who develops cardiogenic shock after undergoing myocardial perfusion imaging and diagnostic left heart catheterization, but prior to coronary revascularization. This case highlights the risk of cardiac decompensation awaiting surgery in patients with multivessel coronary artery disease. It also emphasizes the subtleties involved in imaging patients with diabetes mellitus and left bundle branch block, as well as the risk of developing complete heart block in the setting of ischemia with underlying conduction disease.

A multicenter study of anorectal pressures and rectal sensation measured with portable manometry in healthy women and men.

The equipment and methods for performing anorectal manometry and biofeedback therapy are different and not standardized. Normal values are influenced by age and sex. Our aims were to generate reference values, examine effects of gender and age, and compare anorectal pressures measured with diagnostic and biofeedback catheters and a portable manometry system. In this multicenter study, anorectal pressures at rest, during squeeze, and evacuation were measured with diagnostic and biofeedback catheters using Mcompass™ portable device in healthy subjects. Balloon expulsion time and rectal sensation were evaluated. The effects of age and gender were assessed. The final dataset comprised 108 (74 women) of 124 participants with normal rectal balloon expulsion time (less than 60s). During squeeze, anal resting pressure increased by approximately twofold in women and threefold in men. During evacuation, anal pressure exceeded rectal pressure in 87 participants (diagnostic catheter). The specific rectoanal pressures (e.g., resting pressure) were significantly correlated and not different between diagnostic and biofeedback catheters. With the diagnostic catheter, the anal squeeze pressure and rectal pressure during evacuation were greater in men than women (p≤0.02). Among women, women aged 50years and older had lower anal resting pressure; rectal pressure and the rectoanal gradient during evacuation were greater in older than younger women (p≤0.01). Anal and rectal pressures measured with diagnostic and biofeedback manometry catheters were correlated and not significantly different. Pressures were influenced by age and sex, providing reference values in men and women.

Safety, effectiveness, and quality of life following pulmonary vein isolation with a multi-electrode radiofrequency balloon catheter in paroxysmal atrial fibrillation: 1-year outcomes from SHINE.

AimsTo evaluate the safety and effectiveness of a compliant multi-electrode radiofrequency balloon catheter (RFB) used with a multi-electrode diagnostic catheter for pulmonary vein isolation (PVI).Methods and resultsThis prospective, multicentre, single-arm study was conducted at six European sites and enrolled patients with symptomatic paroxysmal atrial fibrillation. The primary effectiveness endpoint was entrance block in treated pulmonary veins (PVs) after adenosine/isoproterenol challenge. The primary safety endpoint was the occurrence of primary adverse events (PAEs) within 7 days. Cerebral magnetic resonance imaging and neurological assessments were performed pre- and post-ablation in a subset of patients. Atrial arrhythmia recurrence was assessed over 12 months via transtelephonic and Holter monitoring. Quality of life was assessed by the Atrial Fibrillation Effect on Quality of Life (AFEQT) questionnaire. Of 85 patients undergoing ablation per study protocol, PV entrance block was achieved in all (one PV required touch-up with a focal catheter). Acute reconnection of ≥1 PVs after adenosine/isoproterenol challenge was observed in 9.3% (30/324) of PVs ablated. Post-ablation, silent cerebral lesions were detected in 9.7% (3/31) of patients assessed, all of which was resolved at 1-month follow-up. One patient experienced a PAE (retroperitoneal bleed). Freedom from documented symptomatic and all arrhythmia was 72.2% and 65.8% at 12 months. Four patients (4.7%) underwent repeat ablation. Significant improvements in all AFEQT subscale scores were seen at 6 and 12 months. ConclusionPVI with the novel RFB demonstrated favourable safety and effectiveness, with low repeat ablation rate and clinically meaningful improvement in quality of life.ClinicalTrials.gov Registration NumberNCT03437733.

COMPARISON OF INTRAVENOUS VERSUS INTR-ARTERIAL HEPARIN FOR THE PREVENTION OF RADIAL ARTERY OCCLUSION DURING TRANSRADIAL CORONARY ARTERY CATHETHERIZATION

Objective: To determine the relative efficacy of intravenous heparin as compared to intra-arterial heparin used during transradial coronary angiography for the prevention of radial artery occlusion.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Study was conducted at the Department of Cardiology, AFIC/NIHD Rawalpindi, Pakistan, from Jul 2019 to Dec 2019.&#x0D; Methodology: A total number of 144 patients were considered for the study using the consecutive sampling technique who were undergoing diagnostic coronary angiography. Patients were divided into the intra-arterial group (n=72) who received 50 IU/kg of unfractionated heparin (maximal dose 5,000 U) intra-arterially, and an intravenous group (n=72) received the similar dose through intravenous route. All patients were administered 100 mcg of nitroglycerin to minimize radial artery spasm. Coronary Angiography was performedusing a 6F introducer sheath and diagnostic catheters. Early radial artery occlusion (RAO) at 24 hours after the procedure was detected by performing the plethysmographic (reverse Barbeau’s) and doppler USG evaluation. Chronic RAO was assessed 30 days after the procedure by performing the same tests. Data was collected through a predesigned proforma and analyzed using SPSS 23. A p-value of less than 0.05 was considered as significant.&#x0D; Results: Early RAO was found in 4 (5.6%) of the patients from the intra-arterial groupand 5 (6.9%) of the intravenous group. The difference was found to be statistically insignificant (p-value 0.731). Chronic RAO was observed in 3 (4.4%) of the intra-arterial group as compared to 4 (6%) of the intravenous group. This difference was also statistically insignificant (p-value 0.683) for chronic RAO.&#x0D; Conclusion: Intra-arterial and intravenous heparin administration providedsimilar efficacy to prevent RAO.