A simple method for radiation exposure reduction during atrial fibrillation ablation: the lead-apron-free approach.

BACKGROUND: Radiofrequency catheter ablation (RFCA) is a well-established treatment for atrial fibrillation (AF). Fluoroscopy, a widely used imaging method for RFCA, has significant implications for human health. Although no fluoroscopy or near-zero fluoroscopy strategies have gained popularity, they have limitations, such as long procedure times, additional equipment, and expertise. A simple and cost-effective radiation reduction method is needed for treating AF and is compatible with the daily workflow. We aimed to compare the efficacy and safety of fluoroscopy-free and lead apron-free (LAF) after transseptal puncture AF ablation with conventional ablation (CON). METHODS: This retrospective study included all patients who underwent RF catheter AF ablation. The lead apron used for protection was removed immediately before 3D reconstruction of the left atrium (LA) after transseptal puncture (TSP), while fluoroscopy was performed on stand-by and locked-in. The pulmonary vein isolation (PVI) was performed using a 3D mapping system, a multielectrode catheter, and a Smart Touch contact force (CF) sensing catheter, via the lead-apron-free (LAF) method, which is similar to the conventional ablation (CON) method. RESULTS: This study enrolled 152 consecutive patients, with 72 and 80 patients in the LAF and CON groups, respectively. The LAF group demonstrated significantly lower values in total fluoroscopy time (6.9 vs. 14 min, P<0.001) and dose area product (DAP) values (15.4±12.1 vs. 31.5±17.4 G/m2, P<0.001) than the CON group. However, there was no significant difference in the total procedure time (83.6±21.1 vs. 77.2±11.4 min, P=0.12) between the two groups. Only four procedures (5.5%) required repositioning of the apron, and no complications were observed with the LAF method. Pulmonary vein isolation was achieved in all patients. CONCLUSIONS: The LAF method reduced fluoroscopy use compared with CON, with no change in procedure time or efficacy.

The Relationship Between the Dipping Pattern and Coronary Artery Disease Severity Assessed by the SYNTAX Score in Patients With Hypertension.

Background The morbidity and mortality rates related to hypertension (HT) are still high despite the developments in this area. Nondipper hypertension (NDHT) is related to worse clinical outcomes. But the dipping pattern of HT is not still used for treatment targets. In this study, we investigated the effect of dipping patterns on coronary artery disease (CAD) complexity evaluated by the SYNTAX score (SS). Methodology Patients with stable CAD and HT were included in the study. All patients were monitored with 24-hour ambulatory monitoring, and dipping patterns were evaluated. Coronary artery complexity was determined by SS for all patients and compared along with different dipping patterns. Results A total of 331 patients with HT and stable CAD were evaluated in the study. The mean age of the patients was 62.6 ± 9.9 years, and 172 (52%) were male. The number and percentage of patients with dipper HT (DHT), NDHT, over-dipper HT (ODHT), and reverse-dipper HT (RDHT) were 89 (26%), 143 (43%), 11 (3%), and 88 (26%), respectively. When the groups were compared according to SS, the SS of the patients with RDHT were significantly higher (the SS were 6.33, 4.99, 3.09, and 2.7 for RDHT, ODHT, NDHT, and DHT, respectively, P = 0.003). The mean SS between the DHT group and the NDHT group (P = 0.03) and between the DHT group and the RDHT group (P = 0.01) was significantly different. The less decrease or increase in mean blood pressure (MnBP) values was significantly correlated with high SS. Conclusions NDHT, especially the reverse dipping pattern, is closely related to complex CAD. Meticulous consideration of dipping patterns can identify high-risk patients and improve clinical outcomes.

Coexistence of atrioventricular accessory pathways and drug-induced type 1 Brugada pattern.

BACKGROUND: Atrial arrhythmias, particularly atrioventricular nodal reentrant tachycardia, can coexist with drug-induced type 1 Brugada electrocardiogram (ECG) pattern (DI-Type1-BrP). The present study was designed to determine the prevalence of DI-Type1-BrP in patients with atrioventricular accessory pathways (AV-APs) and to investigate the clinical, electrocardiographic, electrophysiologic, and genetic characteristics of these patients. METHODS: One-hundred twenty-four consecutive cases of AV-APs and 84 controls underwent an ajmaline challenge test to unmask DI-Type1-BrP. Genetic screening and analysis was performed in 55 of the cases (19 with and 36 without DI-Type1-BrP). RESULTS: Patients with AV-APs were significantly more likely than controls to have a Type1-BrP unmasked (16.1 vs 4.8%, P = 0.012). At baseline, patients with DI-Type1-BrP had higher prevalence of chest pain, QR/rSr' pattern in V1 and QRS notching/slurring in V2 and aVL during preexcitation, rSr' pattern in V1 -V2 , and QRS notching/slurring in aVL during orthodromic atrioventricular reentrant tachycardia (AVRT) compared to patients without DI-Type1-BrP. Abnormal QRS configuration (QRS notching/slurring and/or fragmentation) in V2 during preexcitation was present in all patients with DI-Type1 BrP. The prevalence of spontaneous preexcited atrial fibrillation (AF) and history of AF were similar (15% vs 18.3%, P = 0.726) in patients with and without DI-Type1-BrP, respectively. The prevalence of mutations in Brugada-susceptibility genes was higher (36.8% vs 8.3%, P = 0.02) in patients with DI-Type1-BrP compared to patients without DI-Type1-BrP. CONCLUSIONS: DI-Type1-BrP is relatively common in patients with AV-APs. We identify 12-lead ECG characteristics during preexcitation and orthodromic AVRT that point to an underlying type1-BrP, portending an increased probability for development of malignant arrhythmias.