ABSTRACT
Introduction: Catheter placement and stability are well-known challenges in atrial fibrillation (AF) ablation. As a result, steerable sheaths (SS) were developed to improve catheter stabilization and maintain proper catheter-tissue contact. The purpose of this systematic review and meta-analysis is to see if employing a SS influences procedure outcome. Method: We performed a comprehensive literature search for studies that evaluated the efficacy and safety of SS compared to nonsteerable sheaths (NSS) in AF ablation. The primary outcome was the rate of atrial arrhythmia (AA) freedom by the time of the last follow-up. The secondary outcomes were the procedure-related complications and procedural characteristics. Risk ratio (RR) or the mean difference (MD) and corresponding 95% confidence intervals (CIs) were calculated using the random-effects model. Results: A total of 10 studies, including 967 AF patients (mean age: 59.2 ± 11.1 years, 516 patients managed with SS vs. 454 with NSS), were included. SS group showed a higher rate of freedom of AA compared to NSS (RR: 1.19; 95% CI 1.09-1.29; p < .001). Both techniques had similar rate for procedural-related complication (RR: 1.09, 95% CI 0.50-2.39; p = .83). The SS strategy had a shorter procedure time (MD -10.6 [min], 95% CI -20.97, -0.20; p = .05) but comparable fluoroscopic and radiofrequency application times to the NSS group. Conclusions: The SS for AF catheter ablation not only reduced the total procedure time but also significantly increased the rate of successful ablation while maintaining a similar safety profile when compared to the traditional NSS.
ABSTRACT
To investigate the utility of AngioVac-assisted vegetation debulking (AVD) in right sided infective endocarditis (RSIE). AngioVac is a vacuum-based device that was approved in 2014 for the percutaneous removal of undesirable materials from the intravascular system. Although there are multiple reports on the use of the AngioVac device to aspirate right-sided heart chamber thrombi, data on its use to treat RSIE is limited. We performed a comprehensive literature search for studies that evaluated the utility of AVD. The primary outcomes of our study were the procedural success, defined as the ability of AngioVac to produce residual vegetation size <50% (RVS<50%) without serious procedural complications, and the clinical success, defined as composite of RVS<50%, in-hospital survival, absence of recurrent bacteremia, and valve function not requiring further intervention. The secondary outcomes included the individual components of the primary outcomes and average length of hospital stay. The pooled means and proportions of our data were analyzed using random effects model, generic inverse variance method, and represented with 95% confidence intervals (CIs). A total of 44 studies, including 301 patients (mean age: 44.6 ± 18.2 years, 71.6% males) were included. Procedural success was achieved in 89.2% of patients (95% CI:82.3%-93.6%, I2â¯=â¯0%). Clinical success was achieved in 79.1% of patients (95% CI:67.9%-87.2%, I2â¯=â¯15%). Overall survival rate was 89.7% (95% CI:83.1%-93.9%%, I2â¯=â¯9%). Our meta-analysis demonstrates that AVD is a promising therapeutic option for RSIE offering a high success rate with an acceptable complication rate across a wide range of patients.
Subject(s)
Endocarditis , Thrombosis , Adult , Cytoreduction Surgical Procedures , Endocarditis/surgery , Female , Humans , Male , Middle AgedABSTRACT
Our study aims to compare the utility of single antiplatelet therapy (SAPT) with dual antiplatelet therapy (DAPT) following Left atrial appendage occlusion in patients whose post-procedural oral anticoagulation therapy was deemed high-risk or contraindicated. A total of 14 observational studies with 3,151 patients were included. Our study demonstrates that SAPT and DAPT were similar in preventing device-related thrombosis. Although SAPT and DAPT had a tendency toward a higher risk for stroke and major bleeding respectively, these differences did not reach statistical significance. Large-scale Randomized Controlled Studies are warranted to validate if our results could be translated into clinical practice.
