Cryoballoon ablation of atrial fibrillation in patients with advanced systolic heart failure and cardiac implantable electronic devices

2018 ◽  
pp. 1081-1088 ◽  
Author(s):  
Patrycja Pruszkowska ◽  
Radosław Lenarczyk ◽  
Jakub Gumprecht ◽  
Ewa Jedrzejczyk-Patej ◽  
Michał Mazurek ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Electronic Devices ◽  
Systolic Heart Failure ◽  
Cryoballoon Ablation ◽  
Cardiac Implantable Electronic Devices

scholarly journals Identifying At‐Risk Patients for Sustained Atrial High‐Rate Episodes Using the C 2 HEST Score: The West Birmingham Atrial Fibrillation Project

2021 ◽  
Vol 10 (6) ◽  
Author(s):  
Yan‐Guang Li ◽  
Daniele Pastori ◽  
Kazuo Miyazawa ◽  
Farhan Shahid ◽  
Gregory Y. H. Lip
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Electronic Device ◽  
Electronic Devices ◽  
Systolic Heart Failure ◽  
High Rate ◽  
Cardiac Implantable Electronic Device ◽  
The West ◽  
Cardiac Implantable Electronic Devices ◽  
Increased Risk

Background Sustained atrial high‐rate episodes (SAHREs) among individuals with a cardiac implantable electronic device are associated with an increased risk of adverse outcomes. Risk stratification for the development of SAHREs has never been investigated. We aimed to assess the performance of the C 2 HEST (coronary artery disease or chronic obstructive pulmonary disease [1 point each], hypertension [1 point], elderly [age ≥75 years, 2 points], systolic heart failure [2 points], thyroid disease [1 point]) score in predicting SAHREs in patients with cardiac implantable electronic devices without atrial fibrillation. Methods and Results Five Hundred consecutive patients with cardiac implantable electronic devices in the West Birmingham Atrial Fibrillation Project in the United Kingdom were followed since the procedure to observe the development of SAHREs, defined by atrial high‐rate episodes lasting >24 hours. Risk factors and incidence of SAHREs were analyzed. The predictive value of the C 2 HEST score for SAHRE prediction was evaluated. Over a mean follow‐up of 53.1 months, 44 (8.8%) patients developed SAHREs. SAHREs were associated with higher all‐cause mortality ( P <0.001) and ischemic stroke ( P =0.001). Age and heart failure were associated with SAHRE occurrence. The incidence of SAHREs increased by the C 2 HEST score (39% higher risk per point increase). Among patients with a C 2 HEST score ≥4, the incidence of SAHREs was 3.62% per year (95% CI, 2.14–5.16). The C 2 HEST score had moderate predictive capability (area under the curve, 0.73; 95% CI, 0.64–0.81) and discriminative ability (log‐rank P =0.003), which was better than other clinical scores (CHA 2 DS 2 ‐VASc, CHADS 2 , HATCH). Conclusions The C 2 HEST score predicted SAHRE incidence in patients without atrial fibrillation who had an cardiac implantable electronic device, with the highest risk seen in patients with a C 2 HEST score ≥4 The benefit of using the C 2 HEST score in clinical practice in this patient population needs further investigation.

scholarly journals Home Management of Heart Failure and Arrhythmias in Patients with Cardiac Devices during Pandemic

2021 ◽  
Vol 10 (8) ◽  
pp. 1618
Author(s):  
Andrea Matteucci ◽  
Michela Bonanni ◽  
Marco Centioni ◽  
Federico Zanin ◽  
Francesco Geuna ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ventricular Tachycardia ◽  
Hospital Admissions ◽  
Electronic Devices ◽  
Home Monitoring ◽  
Home Management ◽  
Cardiac Implantable Electronic Devices ◽  
Cardiac Devices ◽  
The Impact

Background: The in-hospital management of patients with cardiac implantable electronic devices (CIEDs) changed early in the COVID-19 pandemic. Routine in-hospital controls of CIEDs were converted into remote home monitoring (HM). The aim of our study was to investigate the impact of the lockdown period on CIEDs patients and its influence on in-hospital admissions through the analysis of HM data. Methods: We analysed data recorded from 312 patients with HM during the national quarantine related to COVID-19 and then compared data from the same period of 2019. Results: We observed a reduction in the number of HM events in 2020 when compared to 2019. Non-sustained ventricular tachycardia episodes decreased (18.3% vs. 9.9% p = 0.002) as well as atrial fibrillation episodes (29.2% vs. 22.4% p = 0.019). In contrast, heart failure (HF) alarm activation was lower in 2019 than in 2020 (17% vs. 25.3% p = 0.012). Hospital admissions for critical events recorded with CIEDs dropped in 2020, including those for HF. Conclusions: HM, combined with telemedicine use, has ensured the surveillance of CIED patients. In 2020, arrhythmic events and hospital admissions decreased significantly compared to 2019. Moreover, in 2020, patients with HF arrived in hospital in a worse clinical condition compared to previous months.

Abstract 13905: Gender Differences in Cardiac Implantable Electronic Devices (cieds) Among Systolic Heart Failure Hospitalizations: Aninsight From the National Inpatient Sample 2016 to 2017

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Dinesh C Voruganti ◽  
Hafeez Hassan ◽  
Aman M Amanullah ◽  
Sushma Dugyala
Keyword(s):  
Heart Failure ◽  
Gender Differences ◽  
Pulse Generator ◽  
Electronic Devices ◽  
Systolic Heart Failure ◽  
Cardiac Resynchronization ◽  
National Inpatient Sample ◽  
Cardiac Implantable Electronic Devices ◽  
Icd 10 ◽  
Percutaneous Insertion

Background: Gender differences in systolic heart failure (HF) patients for the implantation of various cardiac implantable electronic devices (CIEDs) using ICD-10 have not been studied. We aim to explore the gender differences for each type of procedure. Methods: The National Inpatient Sample (NIS) 2016-2017 was used to obtain the hospitalizations with Systolic HF (ICD 10 CM codes I5020, I5021, I5022, I5023). Pacemaker/Defibrillator procedures were obtained using ICD 10 procedure codes. Demographic data were obtained using the variables provided in the NIS. All analysis was performed using SAS statistical software (9.4 Cary NC). Results: We identified 2,812,603 systolic HF hospitalizations from January 2016 to December 2017. Overall, two third of patients were male (62.9%). Table 1 elaborates on the demographics of these hospitalizations. Majority of hospitalizations were ascribed to white patient population (66% males were white & 63.2% females were white). Females were substantially higher Medicare beneficiaries (74.63% in females vs. 69.71% in males). Among the CIEDs, the males had a higher rates of procedure utilization compared to females (Table 2): Percutaneous insertion of defibrillator in right ventricle (1.6% in males vs. 1% in females); Insertion of defibrillator generator via sternotomy (1.1% in males vs. 0.7% in females); Percutaneous insertion of defibrillator lead in right atrium (1.1% in males vs. 0.7% in females); Cardiac resynchronization therapy-pulse generator via sternotomy (0.8% in males vs. 0.5% in females). Conclusion: Despite minimal differences in baseline characteristics, implantation of CIEDs appear to be underutilized in women. Further studies are required to confirm these findings and further explore gender differences.

Abstract 16580: Safety and Efficacy of Cryoballoon Ablation in Patients With Congestive Heart Failure

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Roger Tseng ◽  
Muhanad Al-Zubaidi ◽  
Alexander Homer ◽  
Kelly DanCanay ◽  
Wilber Su
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Radiofrequency Ablation ◽  
Success Rate ◽  
Pulmonary Vein ◽  
Systolic Heart Failure ◽  
Cryoballoon Ablation ◽  
Atrial Fibrillation Burden ◽  
Procedural Success

Background: Irrigated radiofrequency ablation of atrial fibrillation (AF) is challenging in patient with severe systolic congestive heart failure due to large fluid load. The use of cryoballoon ablation in patients with low ejection fraction (EF) and NYHA class II-IV congestive heart failure has not been well described, and may benefit from the lack of fluid bolus and restoration of sinus rhythm. Method: To evaluate the efficacy and safety of cryoballoon ablation for systolic heart failure patients with atrial fibrillation (AF). Single center retrospective review of 832 patients with AF ablation using Arctic Front Advance Cryoballoon (Medtronic, Minneapolis, MN) was performed, and 188 patients has EF less than 35% (24 paroxysmal, 122 persistent, and 42 long-standing persistent, average EF 28%) was analyzed. Procedural tolerance, complications, and impact on congestive heart failure were reviewed over a 12 months follow up. Results: All 188 patients (Average age 68, LA size 5.8 cm) with systolic CHF and atrial fibrillation underwent successful pulmonary vein (PV) isolation and extra-pulmonary vein lesions sets applied using cryoballoon. Non-irrigated radiofrequency ablation was used in (22%) for cavo-tricuspid isthmus flutter ablation. Acute procedural success rate was 100% with length of hospitalization of 1.1 days. Average procedural time was 2.6 hours, and fluid infusion of 0.3 liters, no significant complications was noted. Atrial fibrillation burden was monitored by implantable pacemaker or defibrillator in 118 of 188 patients (63%), and others were monitoring via wearable looping recorders every 3 months. Significant AF burden (<10% atrial high rate burden) was observed in over 67% of the patients, and improvement CHF symptoms were reported in all of the patients with reduction of atrial fibrillation burden. Conclusions: Cryoballoon of AF in systolic CHF population is well tolerated with high procedural success rate and low complication rate. Significant clinical improvement of CHF class was observed in patient with reduction of atrial fibrillation burden. Ongoing collection of data is needed to quantify long-term benefit.

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