Intraprocedural Complications Research Articles

Outcomes of ventricular tachycardia ablation with intracardiac echocardiography-a retrospective cohort study of the national inpatient sample

Abstract Background Intracardiac echocardiography (ICE) is being increasingly used in VT ablation. Sparse literature indicates that ICE reduces repeat VT ablation and VT-related admissions (1). Objective To determine if ICE reduced procedural complications, mortality, length of stay, and hospitalization costs in VT ablation. Methods Utilizing the National Inpatient Sample (NIS) of the years 2016 to 2020, we compared the differences between patients who had VT ablation with and without ICE. We used multivariable logistic and linear regression models as appropriate to determine if ICE was associated with improved outcomes as defined above. Results We included 15,480 hospitalizations (95% CI 14,513-16,446) with VT ablations. ICE was used in 1815 (11.7%) of the patients. The mortality rate was 2.2%(95% CI 1.1-4.3) in the ICE group and 3.2% (95% CI 2.6-3.9) in the non-ICE group, and composite complications rate was 18.4% (95% CI 14.7-22.7) in the ICE group and 19.2% (17.7-20.8) in the non-ICE group. On univariate and multivariate analysis, ICE was not associated with a decrease in mortality, composite complications, or hospitalization charges but with a reduction in length of stay (Tables 1 and 2). ICE was associated with sepsis on univariate analysis but not on multivariate analysis (aOR 0.51, 95% CI 0.26-1.00, P=0.051) Conclusion Our study demonstrates that ICE was not associated with a reduction in mortality or complications in VT ablation but was associated with a slightly shorter length of stay. Although our observational study did not demonstrate a major benefit with ICE, given the multiple advantages of ICE in VT ablations, such as real-time recognition of myocardial substrate, identification of anatomical structures to guide ablation, and prompt recognition of intra-procedural complications, we recommend randomized controlled studies to evaluate the efficacy of ICE(2). Our study is limited by its retrospective nature and reliance on ICD codes for data extraction.

The use of balloon guide catheters during venous sinus stenting: A case series.

Venous sinus stenting (VSS) is a safe and effective treatment strategy for pulsatile tinnitus (PT) and idiopathic intracranial hypertension (IIH). Although complications are rare, the morbidity associated with the complications is high. Navigating through the venous sinuses poses unique challenges to the interventionalist. There is limited literature regarding device selection to maximize safety and efficiency. We report on the safety and advantages of using a balloon guide catheter (BGC) for venous access in VSS. Retrospective analysis of all patients undergoing VSS using a BGC over a three-month period. A total of 22 patients were included in the analysis (median age 35; 21 female). The indication for treatment was PT in 10 patients and IIH in 12 patients. The BGC was navigated into the sigmoid and transverse sinuses, enabling successful delivery of the stent in all cases. The BGC balloon was inflated 23 times for navigating past tortuosity or obstructions, and for anchoring. There were no intraprocedural complications. The use of BGC in VSS is safe and feasible. BGCs have features that can be utilized to overcome the unique challenges encountered during VSS.

Echocardiography-guided percutaneous closure of oval-shaped secundum atrial septal defects

BackgroundAn atrial septal defect (ASD) is considered oval-shaped when its shortest diameter is less than 75% of the longest diameter. Research on percutaneous closure of oval-shaped ASDs is limited, with no known reports of non-fluoroscopic closure for this population.ObjectiveTo assess the effectiveness of non-fluoroscopic percutaneous closure for oval-shaped ASDs.MethodsThis single-center retrospective study evaluates patients undergoing non-fluoroscopic percutaneous closure of oval-shaped ASDs, defined by the shortest to longest diameter ratio < 0.75, a circular index of 1.33, or ultrasound visualization of an oval shape. Device size was chosen to be 0–4 mm larger than the defect’s longest diameter, based on transthoracic and transesophageal ultrasound measurements.ResultsWe identified 78 patients (33.3% children, 20.5% males) with a mean age of 27.4 ± 16.3 years and a mean weight of 46.8 ± 19.8 kg. The mean longest diameter and mean shortest diameter of ASDs were 23.3 ± 6.8 mm and 15.8 ± 5 mm, respectively. The mean ratio of the shortest to longest diameter was 0.7 ± 0.1. Percutaneous closure was not attempted in 7/78 (9%) patients. Three out of 71 (4.2%) procedures were fluoroscopy-guided upfront due to technical difficulties, and 5/71 (7%) were converted to fluoroscopy-guided closure. Overall procedural success rate was 98.6% (70/71) including 63/71 (88.7%) performed with zero fluoroscopy. Mean device size was 26.5 ± 7.1 mm. Mean procedural time was 45.3 ± 22.6 min. Eleven intraprocedural complications occurred including 6 arrhythmias, 3 pericardial effusions, and 2 device dislodgements.ConclusionTranscatheter closure of oval-shaped ASD is safe and feasible. Echocardiography is adequate for adequate operative guidance.

Performance and Safety of the Extravascular Implantable Cardioverter-Defibrillator Through Long-Term Follow-Up: Final Results From the Pivotal Study.

Substernal lead placement of the extravascular implantable cardioverter-defibrillator (EV ICD) permits both defibrillation at thresholds similar to those seen with transvenous ICDs and effective antitachycardia pacing (ATP), while avoiding the vasculature and associated complications. The global Pivotal study has shown the EV ICD system to be safe and effective through 6 months, but long-term experience has yet to be published. We aim to report the performance and safety of the EV ICD system throughout the study. The EV ICD Pivotal study was a prospective, global, single-arm, pre-market clinical study. Individuals with a class I or IIa indication for a single-chamber ICD per guidelines were enrolled. Freedom from major system- or procedure-related complications, as well as appropriate and inappropriate therapy rates, were assessed through 3 years using the Kaplan-Meier method. Anti-tachycardia pacing success was calculated using simple proportions. An implant was attempted in 316 patients [25.3% female, 53.8±13.1 years old, 81.6% primary prevention, LVEF 38.9%±15.4%]. Of 299 patients with a successful implant, 24 experienced 82 spontaneous arrhythmic episodes that were appropriately treated with either ATP only (38, 46.3%), shock only (34, 41.5%), or both (10, 12.2%) for a Kaplan-Meier-estimated rate of first any appropriate therapy of 9.2% at 3 years. Antitachycardia pacing was successful in 77.1% (37/48) of episodes, and ATP usage significantly increased from discharge to last follow-up visit (P<0.0001). Shock therapy was successful in 100% (27/27) of discrete, spontaneous ventricular arrhythmias. The inappropriate shock rates at 1 and 3 years were 9.8% and 17.5%, respectively, with P-wave oversensing the predominant cause. No major intraprocedural complications were reported and the estimated freedom from system- or procedure-related major complications was 91.9% at 1 year and 89.0% at 3 years. The most common major complications were lead dislodgement (10 events; n=9 patients, 2.8%), postoperative wound or device pocket infection (n=8, 2.5%), and device inappropriate shock delivery (n=4, 1.3%). Twenty-four system revisions were performed as a result of major complications related to the EV ICD system or procedure. From implant to study completion, the EV ICD Pivotal study demonstrated that a single integrated system with an extravascular lead placed in the substernal space maintains high ATP success, effective defibrillation, and a consistent safety profile.

Evaluation of a novel central venous access port for direct catheter insertion without a peel-away sheath.

This study retrospectively evaluated the feasibility and safety of implanting a newly developed central venous access port (CV-port) that allows catheter insertion into a vein without the use of a peel-away sheath, with a focus on its potential to minimize risks associated with conventional implantation methods. All procedures were performed using a new device (P-U CelSite Port™ MS; Toray Medical, Tokyo, Japan) under ultrasound guidance. The primary endpoint was the implantation success rate. The secondary endpoints were the safety and risk factors for infection in the early postprocedural period (< 30days). We assessed 523 CV-port implantations performed in a cumulative total of 523 patients (240 men and 283 women; mean age, 61.6 ± 13.1years; range, 18-85years). All implantations were successfully performed using an inner guide tube and over-the-wire technique through 522 internal jugular veins and one subclavian vein. The mean procedural time was 33.2 ± 10.9min (range 15-112min). Air embolism, rupture/perforation of the superior vena cava, or hemothorax did not occur during catheter insertion. Eleven (2.1%) intraprocedural complications occurred, including Grade I arrhythmia (n = 8) and subcutaneous bleeding (n = 1), Grade II arrhythmia (n = 1), and Grade IIIa pneumothorax (n = 1). Furthermore, 496 patients were followed up for ≥ 30days. Six early postprocedural complications were encountered (1.1%), including Grade IIIa infection (n = 4), catheter occlusion (n = 1), and skin necrosis due to subcutaneous leakage of trabectedin (n = 1). These six CV-ports were withdrawn, and no significant risk factors for infection in the early postprocedural period were identified. The implantation of this CV-port device demonstrated comparable success and complication rates to conventional devices, with the added potential benefit of eliminating complications associated with the use of a peel-away sheath.

Intraoperative Challenges in Endovascular Treatment for Ruptured Intracranial Aneurysms

In aneurysmal subarachnoid hemorrhage, the highest therapeutic priority is to ensure immediate hemostasis without intraprocedural complications. This article outlines the possible intraoperative coil embolization complications for ruptured intracranial aneurysms and discuss strategies for their prevention and treatment.

Perioperative Anesthetic Considerations for Catheter-Based Pulmonary Vein Interventions in Fibrosing Mediastinitis

IntroductionFibrosing mediastinitis is a rare disease characterized by abnormal proliferation of fibrous tissue, causing compression, and narrowing of the airway, blood vessels and other mediastinal structures, including the pulmonary veins. Catheter based interventions are available palliative strategies. Due to the complex nature of the disease and the profound respiratory and hemodynamic sequela that may ensue, anesthetic management requires meticulous interdisciplinary planning. MethodsWe performed a retrospective descriptive study including patients with Fibrosing Mediastinitis undergoing catheter-based interventions for pulmonary vein stenosis from January 2020 to April 2024. A total of fourteen patients underwent chart review and we reported patient sex, preprocedural pulmonary artery pressures, comorbidities, lung isolation strategies, intra-procedural anesthestic complications, post procedural ICU admissions and length of stayResults: All patients underwent pulmonary vasculature angioplasty, with or without stent placement, under general anesthesia with lung isolation capabilities and echocardiogram guidance. 11 of 18 (61%) cases were uncomplicated. 4 of 18 (22%) required unanticipated postoperative ICU care, 2 (11%) in the setting of pulmonary hemorrhage, one due to hypoxic respiratory failure, and one due to difficult airway. One patient developed self-limiting postoperative hemoptysis in two different occasions and one patient developed a vascular access related complication. Mean hospital length of stay (LOS) was 2.6 days (0-13 days) and mean ICU LOS was 1.75 days (1-4 days). One patient presented 6-weeks postoperatively with massive hemoptysis likely secondary to PV rupture and passed away following a protracted ICU course. ConclusionPatients with FM can achieve successful intraprocedural outcomes by ensuring a comprehensive understanding of the disease, addressing significant anesthetic concerns and considerations, and engaging a multi-disciplinary team.

Anatomical Flow Diversion by Hybrid Strategy for Intractable Large Cerebral Aneurysms.

Flow diverters (FDs) provide curative endovascular treatment for wide-necked sidewall aneurysms. The efficacy of FDs for bifurcation or branching sidewall aneurysms is probably limited. We used anatomical flow diversion (AFD) for intractable large cerebral aneurysms. We report our experiences with AFD. The concept of AFD is the transformation from the bifurcation or branching sidewall type to the nonbranching sidewall type. Linearization of the parent artery by stenting, intentional branch occlusion, and aneurysmal coil embolization were performed. Furthermore, bypass surgery is performed for patients intolerant to branch occlusions. We evaluated the clinical outcomes of intractable aneurysms treated with AFD. AFD was performed in seven unruptured large aneurysms. Aneurysmal locations were the top of the basilar artery (BA), BA-superior cerebellar artery (SCA), internal carotid artery (IC)-posterior communicating artery (PcomA), and IC terminal. The mean dome diameter was 17.0 ± 4.6 mm. Six patients underwent bypass surgery. The occluded branches were the PCA + SCA, PcomA, and anterior cerebral artery (ACA) A1. An FD was used in three patients and a neck bridge stent in four patients. No intraprocedural complications occurred. Two postprocedural ischemic complications occurred in one patient. Six (86%) patients demonstrated a modified Rankin Scale (mRS) 0 at the 3-month follow-up, and one with an ischemic complication showed an mRS 5. Complete occlusion of all aneurysms was maintained with a median follow-up duration of 60 months. AFD is useful for intractable large cerebral aneurysms with high curability, although safety verification is required.

Medical malpractice claims and state medical board complaints among United States neurointerventionalists

BackgroundSurgeons are at high risk for malpractice claims, which can significantly impact physician quality of life and risk of burnout. There are few published data reporting the incidence, outcomes, and...

Clinical and subclinical microemboli following neuroangiography in children

BackgroundTo assess the frequency, imaging appearances, and risk factors of brain microemboli following pediatric neuroangiography, as assessed by early diffusion-weighted MRI imaging (DWI).MethodsThis single-center, retrospective analysis investigated early DWI post-pediatric...

Clinical Outcome of Pipeline Embolization Device with and without Coil to Treat Intracranial Aneurysm: A Systematic Review and Meta-Analysis.

The use of a Pipeline Embolization Device (PED) in combination with coils (PEDC) to treat intracranial aneurysms remains unclear as to whether it offers significant benefits for the patients since the results have varied. This study aimed to investigate the clinical outcome of PEDC compared to PED in treating intracranial aneurysms. We systematically searched the articles from PubMed, Web of Science, and the Cochrane Library databases published before January 25, 2024. We selected studies comparing PEDC vs. PED to treat intracranial aneurysms. Patients treated with PEDC but using dense coiling were excluded from the study. The clinical outcomes observed in this meta-analysis were intraprocedural complications, postoperative complications (stenosis, stroke, hemorrhage, mortality), favorable outcome (mRS ≤ 2), complete occlusion rate, and retreatment rate. Forest plot was used to analyze pooled Odds Ratio (OR) of clinical outcomes. A total of 3001 subjects from nine observational studies were included. PEDC was mainly used to treat larger aneurysms. PEDC has a significantly higher complete occlusion rate at 6 months [OR= 2.66, 95% CI(1.26, 5.59), p= 0.01], a lower retreatment rate [OR= 0.18, 95% CI(0.05, 0.07), p= 0.010], higher stroke-related complications [OR= 1.66, 95% CI(1.16, 2.37), p= 0.005], and higher hemorrhage-related complications [OR= 1.98, 95% CI(1.22, 3.21), p = 0.005]. There was no significant difference in intraprocedural complications, stenosis-related complications, mortality, favorable outcomes, and complete occlusion at the end of the study. No randomized controlled trials have been performed comparing PEDC and PED. Considering that all the included studies were observational, the patients' baseline characteristics were not completely balanced. This meta-analysis study showed that PEDC in large intracranial aneurysms induces a faster complete occlusion rate at 6 months and a lower retreatment rate. However, it increases the risk of stroke-related postoperative complications, and the faster complete aneurysm occlusion rate found in this study did not correlate with a reduction in long-term aneurysm or distal artery ruptures. Thus, this study suggests the need to find a better strategy to improve long-term hemorrhage-related complications in large intracranial aneurysms. F = female; FDDs = flow-diverter devices; M = male; NOS = Newcastle-Ottawa Scale; PED = pipeline embolization device; PEDC = pipeline embolization device in combination with coils.

Watchman vs. Amulet for Left Atrial Appendage Closure: Current Evidence and Future Perspectives.

Left atrial appendage closure (LAAC) is a crucial intervention for stroke prevention in patients with non-valvular atrial fibrillation who are unsuitable for long-term anticoagulation. Amulet and Watchman are the most implanted devices worldwide for performing LAAC, and the aim of this review is to provide a comprehensive comparison focusing on their efficacy, safety, and short- and long-term outcomes. The Watchman device, the first to gain FDA approval, has been extensively studied and demonstrates significant reductions in stroke and systemic embolism rates. The Amulet device, a newer alternative, promises enhanced design features for more efficient appendage sealing. Current data highlight that both devices offer similar efficacy and safety for LAAC. While the two devices differ in terms of intraprocedural complication rates, they offer similar short- to long-term outcomes in terms of peri-device leaks, device-related thrombosis, and mortality. Both devices are indicated for patients who are unable to tolerate OAC, given their similar risk and safety profiles. Newer clinical studies are directed at establishing the efficacy of both devices as the primary method for stroke prevention in AF as an alternative to OAC.

A Meta-Analysis Comparing General Anesthesia, Deep Sedation, and Conscious Sedation for Catheter Ablation of Atrial Fibrillation

Background: The optimal anesthesia strategy during catheter ablation of atrial fibrillation (AF) remains controversial. This meta-analysis compared general anesthesia, deep sedation, and conscious sedation in terms of procedural time and complications. Methods: Literature searches were conducted in PubMed, EMBASE, and Web of Science databases. Mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using fixed- and random-effect models on the basis of the heterogeneity among studies, as assessed by I2 statistics. The random-effect model was used when the heterogeneity was high (I2 &gt; 50%). Publication bias was evaluated through funnel plots and Egger's tests. Results: Sixteen studies were included in this study. No significant difference was observed in procedural time between the general anesthesia and conscious sedation groups (MD: –8.1479 minutes, 95% CI: from –27.6836 to 11.3878, seven studies). Deep sedation was associated with procedural time (MD: 131.8436 minutes, 95% CI: 99.6540–164.0332, eight studies). The rate of serious intraprocedural complications was 1.5% (95% CI: 1.2%–1.9%) with deep sedation (seven studies). Conscious/analog sedation had 26%–29% higher odds of perioperative complications than general anesthesia (OR: 1.2622, 95% CI: 1.0273–1.5507, nine studies). Significant heterogeneity was present across studies. Conclusions: This meta-analysis found no significant difference in procedural time between general anesthesia and conscious sedation for AF ablation. Deep sedation was associated with longer procedural time. Conscious sedation appeared to have a higher risk of perioperative complications than general anesthesia. Further randomized trials are warranted to determine the optimal anesthesia strategy.

The Feasibility, Safety and Middle Term Clinical Outcome Study of Chronic Total Occlusion Percutaneous Coronary Intervention among Elderly Aged &lt;75 Years versus ≥75 Years in a High Intravascular Imaging Usage Centre

Background: Chronic total occlusion (CTO) is common among elderly patients, yet data on their outcomes with CTO percutaneous coronary intervention (PCI) remain limited. Understanding the feasibility, safety and clinical outcomes of CTO-PCI in this population is crucial for optimal care. The present study aimed to evaluate these aspects in elderly patients aged &lt;75 versus ≥75 years. Methods: Two hundred and fifty-eight patients who underwent CTO-PCI at a single Japanese centre, categorised into two groups: &lt;75 and ≥75 years old, were retrospectively analysed. Demographics, clinical factors, angiography and procedure data were collected. Follow-up data were obtained from electronic health records. The primary outcome measure was target lesion failure (TLF) at 1-year follow-up. Kaplan-Meier curve analysis and multivariable Cox-regression analysis were performed to identify predictors of TLF. Results: 68.6% were &lt;75 years old and 31.4% were ≥75 years old. Similar procedural success rates were observed. There were no significant differences in 1-year TLF, death, non-fatal MI or target-lesion revascularisation. The older group had a higher rate of intraprocedural complications. Mechanical circulatory support and emergency PCI negatively impacted target-lesion revascularisation-free survival in older patients, while hypertension appeared protective. Conclusion: The present study demonstrates the feasibility, safety and good mid-term outcomes of CTO-PCI in elderly patients. These findings suggest its potential as a treatment option for appropriate elderly patients. Additionally, possible risk factors for adverse events were identified, potentially guiding future management strategies. Therefore, elderly patients with CTO should not be deprived of invasive PCI strategies when appropriate.

Endovascular Treatment for Complex Vascular Pathologies in the Pediatric Population: Experience from a Center with Dual-Trained Neurosurgeons

Endovascular treatment of complex vascular pathologies in the pediatric population is often performed by non-pediatric subspecialists with adaptation of equipment and techniques developed for adult patients. We aimed to report our center's experience with safety and outcomes of endovascular treatments for pediatric vascular pathologies. We performed a retrospective review of our endovascular database. All patients ≤18 years who underwent endovascular treatment between January 1, 2004 and December 1, 2022 were included. During the study time frame, 118 cerebral angiograms were performed for interventional purposes in 55 patients. Of these patients, 8(14.5%) had intracranial aneurysms, 21(38.2%) had intracranial arteriovenous malformations (AVMs), 6(10.9%) had tumors, 5(9.1%) had arterial occlusions (n=3) or dissections (n=2), 8(14.5%) had vein of Galen malformations, and 7(12.7%) had other cerebrovascular conditions. Of the total 118 procedures, access-site complications occurred in 2(1.7%), intraprocedural complications occurred in 3(2.5%), and transient neurological deficits were observed after 2(1.7%). Treatment-related mortality occurred in 1(1.8%) patient. Neurointervention in pediatric patients was safe and effective in our experience.

Preliminary outcomes of endovascular treatment of moyamoya disease

PurposeThis study aimed to investigate the effectiveness and safety of endovascular revascularisation of intracranial artery occlusion and stenosis in moyamoya disease using stent angioplasty. Materials and methodsWe recruited 12 patients (8 women and 4 men) with occlusion and stenosis of intracranial arteries in the context of moyamoya disease who underwent endovascular stent angioplasty. Clinical data, baseline conditions, lesion location, treatment outcomes, periprocedural complications, and follow-up outcomes were analysed. ResultsThe occlusion was located at the M1 segment of the middle cerebral artery in 8 patients, at both the M1 and A2 segments in one patient, and at the C7 segment of the internal carotid artery in 3. Thirteen stents were deployed at the occlusion site, including the low-profile visualized intraluminal support (LVIS) device in 8 patients, an LVIS device and a Solitaire AB stent in one, and a Leo stent in 3, with a success rate of 100% and no intraprocedural complications. Plain CT imaging after stenting revealed leakage of contrast agent, which disappeared on the second day, resulting in no clinical symptoms or neurological sequelae. Follow-up angiography studies were performed in all patients for 6–12 months (mean, 8.8). Slight asymptomatic in-stent stenosis was observed in 2 patients (16.7%), and no neurological deficits were observed in the other patients. All preoperative ischaemic symptoms completely disappeared at follow-up. ConclusionStent angioplasty is a safe and effective treatment for occlusion and stenosis of intracranial arteries in moyamoya disease.

Minimizing Exposure to Ionizing Radiation in Catheter-Based Treatment of Atrial Fibrillation: Safety and Efficacy

Pulmonary vein isolation using radiofrequency ablation is the most common method of catheter treatment for atrial fibrillation. Performing this procedure involves the use of X-ray radiation, which at certain stages of the procedure is an indispensable method for navigation and visualization of intracardiac structures. Approaches to minimize X-ray exposure during catheter interventions are attracting increased attention of the electrophysiology community due to the potential risks of adverse effects of ionizing radiation on patients and medical personnel. The aim. To evaluate the effectiveness and safety of performing the pulmonary vein isolation procedure with the intention to minimize X-ray exposure of patients and medical personnel. Materials and methods. Forty-three patients with various forms of atrial fibrillation were selected for the study: 28(65%) with paroxysmal and 15 (35%) with persistent forms. All the patients underwent pulmonary vein isolation usingcatheter radiofrequency ablation with the intention to minimize X-ray exposure at the National Amosov Institute of Cardiovascular Surgery in the period from June 2023 to April 2024. Results. In all 43 patients it was possible to electrically isolate all the veins. Catheter ablation of the cavotricuspidisthmus was performed in 5 (31.2%) patients from group A (“Zero-fluoro”), 7 (33.3%) from group B (“Near Zero-fluoro”) and 3 (50%) from group C (“Non Zero-fluoro”) (p = 0.696). Intraoperative reconnection of the pulmonary veins with the left atrium was observed in 6 (37.5%) patients of group A, 11 (52.3%) of group B, and 4 (66%) of group C (p = 0.429). X-ray time for transseptal puncture did not differ between groups A and B (3.56 ± 2.37 vs. 3.69 ± 2.3 min., p = 0.532), however, X-ray time for pulmonary vein isolation in group A was significantly less than that in group B (0.27 ± 0.13 vs. 1.96 ± 1.21 min., p &lt; 0.001). The total time in the left atrium was not statistically different between these two groups (81.33 ± 22.32 vs. 98.6 ± 29.83 min., p = 0.106). In group C (“Non Zero-fluoro”), the aforementioned parameters were not recorded. Total dose area product (DAP) and total radiation dose, as well as total X-ray time and total procedure time, were significantly lower when using the ionizing exposure minimization approach. DAP and total radiation dose in group A were the lowest (7.29 ± 5.16 Gy/cm2 and 76.62 ± 70.82 mGy, respectively) and significantly differed from those in group C (107.67 ± 97.59 Gy/cm2 and 882.32 ± 868.62 mGy, p &lt; 0.001 and p = 0.001, respectively). No intraoperative complications were observed in the studied sample. Conclusions. Minimizing X-ray exposure using modern navigation systems during pulmonary vein isolation using catheter radiofrequency ablation is not associated with increased intraprocedural complications in patients with paroxysmal and persistent atrial fibrillation. This approach allows you to significantly lower total DAP and the radiation dosewithout increasing the time of performing the pulmonary vein isolation procedure.

Association between procedural time and outcome in unsuccessful mechanical thrombectomy for acute ischemic stroke: analysis from the Italian Registry of Endovascular Treatment in Acute Stroke.

We aim to assess the association between procedural time and outcomes in patients in unsuccessful mechanical thrombectomy (MT) for anterior circulation acute stroke. We conducted a cohort study on prospectively collected data from patients with M1 and/or M2 segment of middle cerebral artery occlusion with a thrombolysis in cerebral infarction 0-1 at the end of procedure. Primary outcome was 90-day poor outcome. Secondary outcomes were early neurological deterioration (END), symptomatic intracranial hemorrhage (sICH) according to ECASS II and sICH according to SITS-MOST. Among 852 patients, after comparing characteristics of favourable and poor outcome groups, logistic regression analysis showed age (OR: 1.04; 95%CI: 1.02-1.05; p < 0.001), previous TIA/stroke (OR: 0.23; 95%CI: 0.12-0.74; p = 0.009), M1 occlusion (OR: 1.69; 95%CI: 1.13-2.50; p = 0.01), baseline NIHSS (OR: 1.01; 95%CI: 1.06-1.13; p < 0.001) and procedural time (OR:1.00; 95% CI: 1.00-1.01; p = 0.003) as independent predictors poor outcome at 90days. Concerning secondary outcomes, logistic regression analysis showed NIHSS (OR:0.96; 95%CI: 0.93-0.99; p = 0.008), general anaesthesia (OR:2.59; 95%CI: 1.52-4.40; p < 0.001), procedural time (OR: 1.00; 95% CI: 1.00-1.01; p = 0.002) and intraprocedural complications (OR: 1.89; 95%CI: 1.02-3.52; p = 0.04) as independent predictors of END. Bridging therapy (OR:2.93; 95%CI: 1.21-7.09; p = 0.017) was associated with sICH per SITS-MOST criteria whereas M1 occlusion (OR: 0.35; 95%CI: 0.18-0.69; p = 0.002), bridging therapy (OR: 2.02; 95%CI: 1.07-3.82; p = 0.03) and intraprocedural complications (OR: 5.55; 95%CI: 2.72-11.31; p < 0.001) were independently associated with sICH per ECASS II criteria. No significant association was found between the number of MT attempts and analyzed outcomes. Regardless of the number of MT attempts and intraprocedural complications, procedural time was associated with poor outcome and END. We suggest a deeper consideration of procedural time when treating anterior circulation occlusions refractory to MT.

Efficacy and safety of very high-power short-duration posterior wall ablation in persistent atrial fibrillation: a propensity score-matched comparison with standard power long-duration ablation

Abstract Background Catheter ablation (CA) with pulmonary vein isolation (PVI) is an optimal treatment option in patients with paroxysmal atrial fibrillation (AF). PVI alone in patients with persistent AF has proved to have suboptimal results. Ablation of additional atrial structures, such as posterior wall (PW) and left atrial appendage has been investigated as a tool to improve procedural efficacy. Recently very high-power short-duration (vHPSD) ablation was developed to allow rapid PVI, limiting complication through the maximization of resistive heating, and minimization of conductive heating. Objectives Compare PVI plus PWI using vHPSD versus standard-power (SP) ablation index-guided CA among consecutive patients with persistent AF Methods Forty consecutive patients underwent PVI plus PW isolation using vHPSD, compared to 40 controls underwent standard power (SP) PVI plus PW isolation. The primary efficacy endpoint outcome was recurrence of atrial tachyarrhythmias after a 3-month blanking period. The primary safety outcome was a composite of major complications within 30 days of CA. Results Treated patients have a median age of 62.8±9 years, 68 (85%) are male. Median left atrial volume is 42.4 (36-50) ml/m2. 61 (78.8%) patients had never undergone catheter ablation before. There are no statistically significant differences between groups. PW isolation was obtained more commonly in the vHPSD compared to the SP group (98% vs. 75%, p=0.007), despite shorter procedure and fluoroscopy times (p&amp;lt;0.001). Survival free from recurrent atrial tachyarrhythmias at 18 months was 68% in the vHPSD and 47% in SP groups, respectively (log-rank p=0.071), without major adverse events. The vHPSD approach was significantly associated with reduced risk of recurrent AF at multivariable analysis (HR, 0.39, p=0.030). Conclusions The results show feasibility and safety of posterior wall vHPSD ablation for persistent AF using this new temperature-controlled catheter without intraprocedural and periprocedural major complications at follow-up. vHPSD ablation for PW isolation may be more effective in term of atrial tachyarrhythmias recurrences with a trend for superior efficacy. However, this remains a single center experience in a small group of patients. Comparative trials involving greater number of patients with long-term follow-up are necessary to definitive results.

Digital health in the electrophysiological lab: Initial experience, safety and feasibility using remote support for arrhythmia ablation-Results of REMOTE-VA study

Abstract Background In most electrophysiology (EP) labs, electroanatomical mapping (EAM) systems are operated on site by qualified staff or field technical engineers (FTE). Due to lack of skilled personnel, the FTE usually must travel between different hospitals and procedures must be planned in advance. Ablation of ventricular arrhythmias (VA) represents the most complex procedure in the field. The use of remote support (RS) to guide complex EP procedures has the potential to increase flexibility, reduce travel times and maximise healthcare resources. Purpose To evaluate the safety and feasibility of RS as compared to on-site support guided catheter ablation procedures for VA. Methods All patients undergoing ventricular tachycardia (VT) or premature ventricular complex (PVC) ablation using remote support were included. The electronical system of the hospital was searched for 30 days postprocedural emergency department (ED) visits, unplanned ambulatory presentations, and readmissions. RS guided three-dimensional (3D) mapping was achieved by connecting the EAM software with an integrated audio-visual solution for remote support. Internet connection-based headphones and high-resolution cameras ensured the communication between the operator and the FTE, who worked exclusively from home office. The control group consisted of an equal number of patients matched for the type of procedure and undergoing on-site guided procedures. All ablations were performed using high density 3D mapping, as per institutional standard. Results Between October 2022 and October 2023, a total of 25 patients underwent VT (32%) or PVC ablation in our centre using RS and were compared to 25 patients undergoing the same procedures under on-site guidance. In the RS group one patient underwent epicardial VT ablation and another one bipolar ablation for VT Storm. The demographic data were similar between the groups. The median procedure time was 120 (93, 143) minutes in the RS group and 112 (95, 138) minutes in the control group (p=0.95), while the fluoroscopy time was 11.4 (7.0, 14.0) and 7.26 (5.0, 10.9) minutes respectively (p=0.08). The procedural success was achieved in 96% procedures in the RS group and in 100% in the control group. No technical issues or changes to on-site support were reported. One minor intraprocedural complication was noted among the control patients, while 24% of the patients in each group developed minor complications until discharge. Two patients in the RS group and one in the control group had ED visits, while only one patient in the control group had an unplanned ambulatory presentation. One unplanned readmission was reported in the control group (Table 1). Conclusions Even in the most complex procedures including epicardial ablation, the use of RS was feasible and safe in this single centre study. This approach has the potential to increase the feasibility in case of emergency procedures, reduce travel times, and maximise healthcare resources.