Single catheter approach for treatment of premature ventricular contractions.

BACKGROUND: Catheter ablation has become one of the main treatment strategies in patients with premature ventricular complexes (PVC). The successful mapping and ablation can be performed with an ablation catheter without additional diagnostic catheters. HYPOTHESIS: We hypothesize that using a single catheter for PVC ablation may decrease complications, procedure time, and fluoroscopy exposure while maintaining comparable success rates. METHODS: Sixty-nine consecutive patients with PVC were treated with a single catheter approach compared to a historical cohort, in which a conventional setup was used. Propensity score matching was conducted with a 1:1 ratio. Outcome parameters included acute procedural success with elimination of all premature ventricular contractions after catheter ablation, procedural data as well as complication rates. RESULTS: Patients treated with a single catheter approach had shorter total procedure (60 minutes [IQR: 47,5-69,0 minutes] vs. 90 minutes [IQR 60-120 minutes]; p = 0.001) and fluoroscopy times (218 seconds [IQR: 110,5-446 seconds] vs. 310 seconds [IQR 190-640 seconds]; p = 0.012), which consecutively leads to a reduction of radiation exposure signified by a lower dose area product (155 cGycm² [IQR 74.4-334.5 cGycm²] vs. 368.4 cGycm² [IQR: 126-905.4 cGycm²]; p value 0.009). Acute procedural success rates were comparable in both groups (54 [84.3%] in the single catheter approach group and 58 [90.6%] in the conventional group; p: 0.287). CONCLUSION: A single catheter approach for the treatment of PVC is associated with a reduction of procedure- and fluoroscopy time, as well as a lesser radiation exposure, while maintaining equivalent acute success and complication rates compared with a conventionally used catheter setup.

Atrial Fibrillation and Cognitive Impairment: New Insights and Future Directions.

INTRODUCTION: Atrial fibrillation (AF) has been recognised as the most prevalent sustained arrhythmia. Recently, a growing body of evidence has suggested that AF might be involved in the progression of cognitive impairment (CIM), potentially extending into types of dementia. Accordingly, the purpose of the present study was to summarise the findings of investigations examining association between AF and cognitive function as well as highlighting the possible causes of discrepancy between the findings and reviewing the probable mechanisms of CIM in patients affected with AF. METHODS: A systematic search in the literature was conducted in the databases of PubMed, Scopus, Cochrane Library, and Google Scholar with no language restrictions, using specified search terms to identify studies published between 1 January 1990 and 1 April 2018. Then, study designs, participant information, diagnostic approaches used for cognitive assessments, and incidence/prevalence rates of CIM and/or dementia were assessed. RESULTS: Out of the initial 2,364 articles retrieved, a total number of 40 studies were selected for data collection. Most studies had suggested a significant relationship between AF and CIM. In this regard, cerebral hypo-perfusion, altered cerebral blood flow, cerebral micro-bleeds, micro-emboli, vascular inflammation, cerebral small vessel diseases, vascular inflammation, and genetic factors were considered as the possible mechanisms of CIM in patients suffering from AF. It seemed that differences in study settings and designs, variations of diagnostic tools for CIM and AF, as well as underlying conditions such as age groups, concurrent chronic diseases, and therapeutic interventions for AF might be amongst probable factors justifying the diversity of findings across the selected articles. CONCLUSION: Although evidence is much more directed towards an association between AF and CIM, the role of AF in CIM needs to be confirmed in-depth via longer prospective and cohort studies at larger scales using accurate neuropsychological and cognitive function assessments. Moreover, the mechanisms involved in the relationship between AF and Alzheimer's disease (AD) require further studies. To conclude, the effect of different therapeutic strategies of AF on CIM should be investigated in more clinical trials.

Results of catheter ablation of atrial fibrillation in hypertrophied hearts - Comparison between primary and secondary hypertrophy.

BACKGROUND AND PURPOSE: Approximately 20-25% of the patients with hypertrophic cardiomyopathy (HCM) develop atrial fibrillation (AF) during the clinical course of the disease, a percentage significantly larger than that of the general population. The purpose of the present study was to report on the procedural results of patients with AF and either primary or secondary left ventricular hypertrophy (LVH). METHODS AND SUBJECTS: Twenty-two consecutive HCM patients (55% male, mean age 57±8 years) with symptomatic AF, having undergone AF ablation procedures between September 2009 and July 2012 were compared with respect to procedural outcome and follow-up characteristics with 22 matched controls with secondary cardiac hypertrophy (64% male, 63±10 years) from our prospective AF catheter ablation registry. RESULTS AND CONCLUSION: Radiofrequency catheter ablation (RFCA) was successful in restoring long-term sinus rhythm in patients with LVH due to HCM and due to secondary etiology. However, patients with HCM needed more RFCA procedures and frequently additional antiarrhythmic drug therapy in order to maintain sinus rhythm.

[Future of interventional cardiology in the treatment of coronary artery disease]. / Rolle der interventionellen Kardiologie in der Therapie der koronaren Herzerkrankung.

BACKGROUND: The development of interventional cardiology (PCI) started already with the introduction of catheterization but was pushed forward by A. Grüntzig with the percutaneous transluminal coronary angioplasty (PTCA) 1977. In the beginning very slow progress could be observed. This changed when Grüntzig changes to Emory university, Atlanta. Already after 10 years alternative techniques were introduced like stent implantation and rotablation, coronary atherectomy, laser angioplasty, ultrasound therapy. During the following years, it became obvious that only for stent implantation (see W. Rutsch et al, Berlin, p.481) and rotablation (see T. Dill et al, Bad Nauheim, p.502) standard indications could be seen in addition to PTCA. Brachytherapy for treatment of in stent restenosis and laserwire recanalisation of occluded vessels were added. NEW METHODS: New protection systems - aspiration or filters - were introduced for increase of PCI safety in venous bypass stenosis (see C. Hamm et al, Bad Nauheim, p.527). The main step forward seems to be the introduction of drug eluting covered stent either with polymer (see E. Grube et al, Siegburg, p.508) or ceramic coating (see H. Wieneke et al, Essen, p.518). Restenosis rates, which were already reduced by bare stent for 20-30%, could be lowered below 10%. RESULTS: In patients with diabetes and main stem stenosis or multi vessel disease, coronary artery bypass surgery is indicated, but in other patients PCI seems to be as good as surgery in relation to mortality and myocardial infarction rates. With drug eluting stents the role of PCI may become even more pronounced, because the revascularization rate could be further reduced (see W. Rutsch, Berlin, p.481). CONCLUSION: The future will demonstrate even further main steps for interventions like the percutaneous bypass attempts and the introduction of gen-therapy (A. B. Buchwald, Göttingen, p.533). Meanwhile we can observe a drop of 1-2% mortality in coronary artery disease related to 60% influence of prevention and 40% to advanced PCI therapy. This is still a remarkable successful story in medicine provided by cardiology.