ABSTRACT
INTRODUCTION: The coronavirus disease (COVID-19) pandemic has generated serious repercussions on the health system, reducing the number of all cardiology procedures worldwide. OBJECTIVES: Describe the impact of the COVID-19 pandemic on the procedures performed by the electrophysiology department in a national referral center. METHODS: We made a retrospective review of our data base and we compared procedures made in the past 3 years since 2017-2019 with the procedures made in the 2020. We divided the procedures into two large groups: Cardiac Implantable Electronic Devices (CIED) related procedures and electrophysiological procedures (EP) which included conventional and complex ablations. RESULTS: There was a significant reduction in all the procedures, the average of procedures performed in the last 3 previous years was 467, while in 2020, we performed only 319 (p = 0.01); this represents a reduction of 33.4% in the total number of procedures. There was no statistical difference regarding the CIED related procedures, the average of procedures in the past 3 previous years was 174, and in 2020 we performed 190 procedures (p = 0.46). Regarding the EP, the average of the past 3 previous years was 293, while in 2020, we performed only 129 procedures (p < 0.01). The reduction in the EP was 55.97%. The most affected months were April, May, and June. CONCLUSIONS: The COVID-19 pandemic considerably affected the number of the procedures in our center, reducing it by 33.4%. The reduction of procedures fundamentally affected the ablations, with a reduction of 55.97%. The number of CIED related procedures was not affected.
Subject(s)
COVID-19 , Electrophysiologic Techniques, Cardiac/statistics & numerical data , Pandemics , Humans , Referral and Consultation , Retrospective StudiesABSTRACT
AIMS: The aim of this study was to evaluate the sensitivity of right ventricular endomyocardial biopsy (EMB) in myocarditis patients with cardiac magnetic resonance (CMR) and electroanatomical mapping (EAM) showing left ventricular abnormalities. METHODS: We performed right ventricular EMB in 144 consecutive patients (66% men, age 43â±â15 years) with acute symptoms and CMR-proved diagnosis of left ventricular myocarditis. Right ventricular EMB sensitivity has been evaluated in patients with different localization and extension of abnormal substrate at both CMR and -- when performed -- EAM. Abnormal substrate was defined, respectively, by late gadolinium enhancement (LGE) and low-voltage areas (LVAs). RESULTS: Globally, right ventricular EMB sensitivity was 87.5%. EMB-negative cases had significantly smaller fragment sizes (cumulative area 2.8â±â1.7 vs. 3.8â±â1.8âmm2, Pâ=â0.023), and lower LGE surface extension (24.7â±â14.2 vs. 38.5â±â20.2%, Pâ=â0.006) and transmurality (32.0â±â26.1 vs. 49.3â±â22.6, Pâ=â0.003). Right ventricular EMB sensitivity in patients with LGE involving both right ventricular and interventricular septum (IVS), isolated right ventricular or IVS, and remote left ventricular areas (nâ=â10, 49 and 67 cases) was 83.3, 84.4 and 90.5%, respectively (Pâ=â0.522). Overall, 34 patients (23.6%) underwent EAM. On the basis of EAM, right ventricular EMB sensitivity was 85.3%: in detail, it was 50.0, 88.2 and 86.7% in patients with both right ventricular and IVS, isolated right ventricular/IVS and distant left ventricular involvement (nâ=â2, 17 and 15, respectively, Pâ>â0.05). Sample size area was the only factor associated with right ventricular EMB sensitivity (hazard ratioâ=â1.6/mm2, 95% confidence interval 1.1-2.4, Pâ=â0.013). CONCLUSION: Right ventricular EMB is still an accurate technique to confirm diagnosis in patients with CMR-proved left ventricular myocarditis. In particular, provided there is an adequate sample size, its sensitivity is comparable among patients with heterogeneous LGE or LVA localization.
Subject(s)
Biopsy , Electrophysiologic Techniques, Cardiac , Heart Ventricles , Myocarditis , Adult , Biopsy/methods , Biopsy/statistics & numerical data , Contrast Media/pharmacology , Electrophysiologic Techniques, Cardiac/methods , Electrophysiologic Techniques, Cardiac/statistics & numerical data , Female , Gadolinium/pharmacology , Heart Ventricles/diagnostic imaging , Heart Ventricles/pathology , Heart Ventricles/physiopathology , Humans , Image Enhancement/methods , Image-Guided Biopsy/methods , Magnetic Resonance Imaging, Cine/methods , Male , Myocarditis/diagnostic imaging , Myocarditis/pathology , Sample Size , Sensitivity and SpecificityABSTRACT
Abstract Background In the investigation of cardiac rhythm disorders, a normal electrophysiological (EPS) study is associated with a favorable prognosis. One of the normality criteria is established by conduction intervals within expected range. Objective To establish reference values in EPS for the intracavitary conduction intervals (PA, AH and HV) in a Brazilian population. Methods A retrospective cohort study of the first 1,500 patients submitted to EPS ablation was performed at Instituto de Cardiologia do Rio Grande do Sul, Brazil. The EPS was considered normal if the test was performed for diagnostic purpose; absence of induced arrhythmias; and conduction intervals within the expected range. The REDCap software was used for data collection and management, and the SPSS Statistics 22.0 used for data analysis. Continuous variables were compared with Student's t-test for independent samples and categorical variables with the chi-square test (X 2 ). Values of p ≤ 0.05 were considered significant. Results A total of 124 (8.3%) with EPS considered normal were included; mean age was 52 ± 21 years, and 63 were male. The mean values in milliseconds of PA, AH and HV were 23 ± 9, 88 ± 25 and 44 ± 7, respectively. The PA, AH, and HV percentile ranges were 13 - 25, 81-107 and 40 - 52, respectively. When the patients were divided into three age groups (1 to 18 years, 19 to 64 years and 65 or more), we observed that the group of older patients had significantly higher values of PA, AH and HV compared with younger patients. Conclusion This study showed that intracavitary conduction intervals in a sample of the Brazilian population were similar to previously published studies. Elderly patients tend to have higher values of intracavitary conduction intervals in EPS. Future studies including broader age ranges could enable the acquisition of more reliable and reproducible reference values. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Predictive Value of Tests , Electrophysiologic Techniques, Cardiac/statistics & numerical data , Electrocardiography/methods , Arrhythmias, Cardiac/diagnosis , Prognosis , Syncope/physiopathology , Syncope/therapy , Brazil , Retrospective StudiesSubject(s)
Coronavirus Infections/prevention & control , Electrophysiologic Techniques, Cardiac/methods , Electrophysiologic Techniques, Cardiac/statistics & numerical data , Infection Control/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , COVID-19 , Coronavirus Infections/epidemiology , Female , Humans , Male , Occupational Health , Pandemics/statistics & numerical data , Patient Safety , Pneumonia, Viral/epidemiology , Safety Management , United StatesSubject(s)
Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Electrophysiologic Techniques, Cardiac/statistics & numerical data , Infection Control/methods , Laboratories, Hospital/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , COVID-19 , Cohort Studies , Coronavirus Infections/epidemiology , Electrophysiologic Techniques, Cardiac/methods , Female , Hospitals, University , Humans , Italy , Male , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Retrospective Studies , Tertiary Care CentersABSTRACT
INTRODUCTION: Knowledge of the activity performed in a country enables it to be positioned within the community of which it is part. OBJECTIVE: We present the results of the National Registry of Cardiac Electrophysiology of the Portuguese Association for Arrhythmology, Pacing and Electrophysiology (APAPE) for 2015 and 2016. METHODS: This is a voluntary, observational, annual registry collected retrospectively. RESULTS: The data on the electrophysiological studies and ablations performed in these two years are presented. CONCLUSION: Changes in these data over the years are analyzed and the relation of the Portuguese data in the European panorama and possible implications are discussed.
Subject(s)
Ablation Techniques/methods , Catheter Ablation/statistics & numerical data , Electrophysiologic Techniques, Cardiac/statistics & numerical data , Electrophysiologic Techniques, Cardiac/methods , Humans , Knowledge , Portugal/epidemiology , Registries , Retrospective StudiesABSTRACT
COVID-19 is a rapidly evolving public health emergency that has largely impacted the provision of healthcare services around the world. The challenge for electrophysiology teams is double; on one side preventing disease spread by limiting all nonessential face-to-face interactions, but at the same time ensuring continued care for patients who need it. These guidelines contain recommendations regarding triaging in order to define what procedures, device checks and clinic visits can be postponed during the pandemic. We also discuss best practices to protect patients and healthcare workers and provide guidance for the management of COVID-19 patients with arrhythmic conditions.
Subject(s)
Arrhythmias, Cardiac/surgery , Catheter Ablation/statistics & numerical data , Coronavirus Infections/prevention & control , Delivery of Health Care , Electrophysiologic Techniques, Cardiac/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , Argentina , Arrhythmias, Cardiac/diagnosis , Brazil , COVID-19 , Cardiac Electrophysiology/organization & administration , Catheter Ablation/standards , Colombia , Coronavirus Infections/epidemiology , Elective Surgical Procedures/standards , Elective Surgical Procedures/statistics & numerical data , Electrophysiologic Techniques, Cardiac/statistics & numerical data , Female , Humans , Infection Control/organization & administration , Latin America , Male , Mexico , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Safety Management/standards , Societies, MedicalSubject(s)
Coronavirus Infections/prevention & control , Electrophysiologic Techniques, Cardiac/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Safety Management/organization & administration , COVID-19 , Coronavirus Infections/epidemiology , Electrophysiologic Techniques, Cardiac/statistics & numerical data , Female , Health Services , Humans , Leadership , Male , North America , Occupational Health , Outcome Assessment, Health Care , Pandemics/statistics & numerical data , Patient Safety , Pneumonia, Viral/epidemiology , Societies, Medical/organization & administrationSubject(s)
Cardiology/organization & administration , Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Elective Surgical Procedures/statistics & numerical data , Electrophysiologic Techniques, Cardiac/statistics & numerical data , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , COVID-19 , Clinical Decision-Making , Coronary Angiography/methods , Coronary Angiography/statistics & numerical data , Coronavirus Infections/epidemiology , Elective Surgical Procedures/methods , Electrophysiologic Techniques, Cardiac/methods , Female , Humans , Infection Control/organization & administration , Male , Occupational Health , Pandemics/statistics & numerical data , Patient Safety/statistics & numerical data , Pneumonia, Viral/epidemiology , Risk Assessment , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/surgery , Societies, Medical , United StatesABSTRACT
AIMS: This study aims to compare procedural parameters and clinical efficacy of remote magnetic navigation (RMN) vs. manual navigation (MAN) approach for radiofrequency ablation (RFA) in patients with atrial fibrillation (AF). METHODS: 146 patients with AF were enrolled in the study. In the RMN group (n=57), patients were treated with the CARTO® 3 in combination with the Niobe ES system. In the MAN group (n=89), ablation was performed with the EnSite Velocity and TactiCath™ Quartz catheter with direct contact force measurement. Procedural time, ablation time, fluoroscopy time, radiation dose and ablation counts were measured and compared between the groups. Recurrence of AF was evaluated after 6 months of follow-up. RESULTS: Mean procedure times (236.87±64.31 vs. 147.22±45.19 min, P<0.05), counts of RF applications (74.30±24.77 vs. 49.15±20.33, P<0.05) and total RFA times (4323.39±1426.69 vs. 2780.53±1157.85 s, P<0.05) were all significantly higher in the RMN than in the MAN group, respectively. In the same order, mean X-ray dose (9722.6±7507.4 vs. 8087.9±6051.5 mGy/cm2, P=0.12) and mean total X-ray exposure time (8.07±4.20 vs. 9.54±5.47 min, P=0.08) were not statistically different. At 6-month follow-up, freedom from AF was similar in RMN and MAN group for paroxysmal (60.8% and 73%, respectively, P=0.42) and persistent AF (69.6% and 75.0%, respectively, P=0.77). CONCLUSIONS: Due to the fact that mid-term clinical outcomes showed no significant differences in AF recurrences between groups and manual ablation strategy provided more favorable results regarding acute procedural parameters, we can conclude that the remote magnetic navigation is not superior to the manual approach.
Subject(s)
Atrial Fibrillation/surgery , Electrophysiologic Techniques, Cardiac/methods , Electrophysiologic Techniques, Cardiac/statistics & numerical data , Radiofrequency Ablation/methods , Radiofrequency Ablation/statistics & numerical data , Surgical Navigation Systems/statistics & numerical data , Treatment Outcome , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Although bipolar electrograms (Bi-egms) are commonly used for catheter mapping and ablation of cardiac arrhythmias, the accuracy and reproducibility of Bi-egms have not been evaluated. We aimed to clarify the influence of the catheter orientation (CO), catheter contact angle (CA), local conduction velocity (CV), scar size, and catheter type on the Bi-egm morphology using an in silico 3-dimensional realistic model of atrial fibrillation. We constructed a 3-dimensional, realistic, in silico left atrial model with activation wave propagation including bipolar catheter models. Bi-egms were obtained by computing the extracellular potentials from the distal and proximal electrodes. The amplitude and width were measured on virtual Bi-egms obtained under different conditions created by changing the CO according to the wave direction, catheter-atrial wall CA, local CV, size of the non-conductive area, and catheter type. Bipolar voltages were also compared between virtual and clinically acquired Bi-egms. Bi-egm amplitudes were lower for a perpendicular than parallel CO relative to the wave direction (p<0.001), lower for a 90° than 0° CA (p<0.001), and lower for a CV of 0.13m/s than 0.48m/s (p<0.001). Larger sized non-conductive areas were associated with a decreased bipolar amplitude (p<0.001) and increased bipolar width (p<0.001). Among three commercially available catheters (Orion, Pentaray, and Thermocool), those with more narrowly spaced and smaller electrodes produced higher voltages on the virtual Bi-egms (p<0.001). Multiple factors including the CO, CA, CV, and catheter design significantly influence the Bi-egm morphology. Universal voltage cut-off values may not be appropriate for bipolar voltage-guided substrate mapping.
Subject(s)
Atrial Fibrillation/physiopathology , Atrial Fibrillation/surgery , Catheter Ablation/instrumentation , Electrophysiologic Techniques, Cardiac/instrumentation , Catheter Ablation/statistics & numerical data , Computational Biology , Computer Simulation , Electrodes , Electrophysiologic Techniques, Cardiac/statistics & numerical data , Electrophysiological Phenomena , Heart Conduction System/physiopathology , Heart Conduction System/surgery , Humans , Models, Cardiovascular , Reproducibility of Results , User-Computer InterfaceABSTRACT
In vitro multi-electrode array (MEA) technology is nowadays involved in a wide range of applications beyond neuroscience, such as cardiac electrophysiology and bio-interface studies. However, the cost of commercially available acquisition systems severely limits its adoption outside specialized laboratories with high budget capabilities. Thus, the availability of low-cost methods to acquire signals from MEAs is important to allow research labs worldwide to exploit this technology for an ever-expanding pool of experiments independently from their economic possibilities. Here, we provide a comprehensive toolset to assemble a multifunctional in vitro MEA acquisition system with a total cost 80% lower than standard commercial solutions. We demonstrate the capabilities of this acquisition system by employing it to i) characterize commercial MEA devices by means of electrical impedance measurements ii) record activity from cultures of HL-1 cells extracellularly, and iii) electroporate HL-1 cells through nanostructured MEAs and record intracellular signals.
Subject(s)
Electrophysiologic Techniques, Cardiac/instrumentation , Myocytes, Cardiac/physiology , Action Potentials/physiology , Animals , Cell Line , Cost-Benefit Analysis , Electrophysiologic Techniques, Cardiac/economics , Electrophysiologic Techniques, Cardiac/statistics & numerical data , Electrophysiological Phenomena , Electroporation , Equipment Design , Mice , Microelectrodes , SoftwareABSTRACT
Russia is the largest country in the world based on the landmass, covering more than one-eighth of the earth's inhabited area. Russia faces challenges in electrophysiology (EP) care including insufficient and uneven financing, complicated system for identifying optimal treatment for individual patients, relative paucity of reasonable educational and certification scope for electrophysiologists, suboptimal national statistical data gathering regarding heart rhythm disorders and EP devices in use, and weak networking of medical information. In comparison with the average level of EP utilization in ESC countries, Russia utilizes around 50% in pacemaker; 10% in ICD; 8% in cardiac resynchronization therapy; 55% in ablations; and 45% in AF ablations. As projected, Russia has the biggest unmet demand in EP procedures, so-called developmental potential in the European region. Nearly 37% of implanted single-chamber and 63% dual-chamber devices are manufactured outside of Russia. The price of the Russian devices is slightly (by 10-20%) lower than the one imported and they are readily provided for patients by the Russian Ministry of Health. Based on the analysis of the data available, we suggest some strategies for the improvement of the EP care in Russia. Solutions include the institution of formal EP education and standardization of it, development of international educational, and scientific collaboration; implementation quality-assessment tools for professional knowledge and skills; wide application of national medical databases and collection of heart rhythm disorders' statistics; growth of financial support of electrophysiology and transparent distribution of financing between state/municipal and private medical centers; enhancement of medical care accessibility countrywide; development of technologies for local EP devices production; and collection of data regarding usage and effectiveness of it.
Subject(s)
Cardiac Electrophysiology/organization & administration , Electrophysiologic Techniques, Cardiac/statistics & numerical data , Cardiac Electrophysiology/trends , Electrophysiologic Techniques, Cardiac/trends , Humans , RussiaABSTRACT
OBJECTIVE: To review 10 years of clinical practice of cardiac electrophysiology study and radiofrequency catheter ablation in the treatment of supraventricular tachycardia. METHODS: The retrospective chart review was conducted at the National Institute of Cardiovascular Diseases, Karachi, and comprised records of all patients who underwent electrophysiological study and / or radiofrequency catheter ablation from January2007 to December 2016. SPSS 21 was used for data analysis. RESULTS: Of the 627 patients, 335(53.4%) were females. The overall mean age was 40.99}13.59 years. The major indication for procedure was supraventricular tachycardia 376(59.97%). Final electrophysiological study diagnosis was typical slow fast atrioventricular nodal re-entrant tachycardia in 303(48.3%) patients. The overall success rate was 472(75.3%). Procedure-related complications were reported in 25(4%) patients, and there was 1(0.15%) mortality. CONCLUSIONS: Cardiac electrophysiology studies and radiofrequency catheter ablation were found to be an effective and safe method for diagnosis and treatment of supraventricular tachycardia.
Subject(s)
Catheter Ablation , Electrophysiologic Techniques, Cardiac , Tachycardia, Sinoatrial Nodal Reentry , Tachycardia, Supraventricular , Wolff-Parkinson-White Syndrome , Adult , Catheter Ablation/adverse effects , Catheter Ablation/methods , Catheter Ablation/statistics & numerical data , Diagnosis, Differential , Electrophysiologic Techniques, Cardiac/adverse effects , Electrophysiologic Techniques, Cardiac/methods , Electrophysiologic Techniques, Cardiac/statistics & numerical data , Female , Humans , Male , Middle Aged , Outcome and Process Assessment, Health Care , Pakistan/epidemiology , Tachycardia, Sinoatrial Nodal Reentry/diagnosis , Tachycardia, Sinoatrial Nodal Reentry/epidemiology , Tachycardia, Sinoatrial Nodal Reentry/therapy , Tachycardia, Supraventricular/diagnosis , Tachycardia, Supraventricular/epidemiology , Tachycardia, Supraventricular/therapy , Wolff-Parkinson-White Syndrome/diagnosis , Wolff-Parkinson-White Syndrome/epidemiology , Wolff-Parkinson-White Syndrome/therapyABSTRACT
BACKGROUND: Traditionally, insertable cardiac monitor (ICM) procedures have been performed in the cardiac catheterization (CATH) or electrophysiology (EP) laboratory. The introduction of the miniaturized Reveal LINQ ICM has led to simplified and less invasive procedures, affording hospitals flexibility in planning where these procedures occur without compromising patient safety or outcomes. METHODS: The present analysis of the ongoing, prospective, observational, multicenter Reveal LINQ Registry sought to provide real-world feasibility and safety data regarding the ICM procedure performed in the CATH/EP lab or operating room and to compare it with insertions performed outside of these traditional hospital settings. Patients included had at least a 30-day period after the procedure to account for any adverse events. RESULTS: We analyzed 1222 patients (58.1% male, age 61.0 ± 17.1 years) enrolled at 18 centers in the US, 17 centers in Middle East/Asia, and 15 centers in Europe. Patients were categorized into 2 cohorts according to the location of the procedure: in-lab (CATH lab, EP lab, or operating room) (n = 820, 67.1%) and out-of-lab (n = 402, 32.9%). Several differences were observed regarding baseline and procedure characteristics. However, no significant differences in the occurrence of procedure-related adverse events (AEs) were found; of 19 ICM/procedure-related AEs reported in 17 patients (1.4%), 11 occurred in the in-lab group (1.3%) and 6 in the out-of-lab group (1.5%) (P = .80). CONCLUSIONS: This real-world analysis demonstrates the feasibility of performing Reveal LINQ ICM insertion procedures outside of the traditional hospital settings without increasing the risk of infection or other adverse events.
Subject(s)
Cardiac Catheterization/statistics & numerical data , Coronary Care Units/statistics & numerical data , Electrophysiologic Techniques, Cardiac/methods , Operating Rooms/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Cardiac Catheterization/adverse effects , Child , Child, Preschool , Electrophysiologic Techniques, Cardiac/adverse effects , Electrophysiologic Techniques, Cardiac/statistics & numerical data , Europe , Asia, Eastern , Feasibility Studies , Female , Humans , Infant , Male , Middle Aged , Miniaturization , Patient Safety , Prospective Studies , Registries , United States , Young AdultABSTRACT
INTRODUCTION AND OBJECTIVES: The Spanish Automatic Defibrillator Registry has provided activity data since 2002. METHODS: The data in this registry are submitted by implantation centers that voluntarily complete a data collection sheet. RESULTS: During 2017, a total of 6273 implant sheets were received, compared with 6429 reported by Eucomed (European Confederation of Medical Suppliers Associations). Therefore, the registry contains data on 97.6% of the devices implanted in Spain. Compliance ranged from 99.7% for the field "name of the implanting hospital" to 46.1% for the variable "New York Heart Association functional class". A total of 181 hospitals reported data to the registry, representing an increase compared with the number of participating hospitals in 2016 (177) and in previous years (169 in 2015, 162 in 2014, 154 in 2013, and 153 in 2012). CONCLUSIONS: The number of implants per million inhabitants in Spain increased for several years but decreased in 2017. As in previous years, the total number of implants in Spain is still much lower than the European Union average, and the gap continues to widen. There are still substantial differences between autonomous communities.
Subject(s)
Arrhythmias, Cardiac/therapy , Cardiology , Defibrillators, Implantable/statistics & numerical data , Electrophysiologic Techniques, Cardiac/statistics & numerical data , Registries , Societies, Medical , Arrhythmias, Cardiac/epidemiology , Female , Humans , Incidence , Male , Retrospective Studies , Spain/epidemiologyABSTRACT
PURPOSE: Femoral venous access is required for most electrophysiology procedures. Limited data are available regarding post-procedure venous thromboembolism (VTE), specifically deep vein thrombosis (DVT) and pulmonary embolism (PE). Potential preventative strategies are unclear. We aimed to survey Canadian centers regarding incidence of VTE and strategies for prevention of VTE after procedures that do not require post-procedure anticoagulation. METHODS: An online survey was distributed to electrophysiologists representing major Canadian EP centers. Participants responded regarding procedural volume, incidence of VTE post-procedure, and their practice regarding pharmacological and non-pharmacological peri-procedural VTE prophylaxis. RESULTS: The survey included 17 centers that performed a total of 6062 procedures in 2016. Ten patients (0.16%) had VTE (including 9 DVTs and 6 PEs) after diagnostic electrophysiology studies and right-sided ablation procedures excluding atrial flutter. Five centers (41.6%) administered systemic intravenous heparin during both diagnostic electrophysiology studies and right-sided ablation procedures. For patients taking oral anticoagulants, 10 centers (58.8%) suspend therapy prior to the procedure. Two centers (11.8%) routinely prescribed post-procedure pharmacologic prophylaxis for VTE. Four centers (23.5%) used compression dressings post-procedure and all prescribed bed rest for a maximum of 6 h. Of the variables collected in the survey, none were found to be predictive of VTE. CONCLUSIONS: VTE is not a common complication of EP procedures. There is significant variability in the strategies used to prevent VTE events. Future research is required to evaluate strategies to reduce the risk of VTE that may be incorporated into EP practice guidelines.
Subject(s)
Anticoagulants , Catheter Ablation/adverse effects , Electrophysiologic Techniques, Cardiac/adverse effects , Preventive Health Services , Pulmonary Embolism , Venous Thrombosis , Anticoagulants/administration & dosage , Anticoagulants/classification , Canada/epidemiology , Catheter Ablation/methods , Catheter Ablation/statistics & numerical data , Compression Bandages , Electrophysiologic Techniques, Cardiac/methods , Electrophysiologic Techniques, Cardiac/statistics & numerical data , Health Care Surveys , Humans , Incidence , Patient Care Management/methods , Preventive Health Services/methods , Preventive Health Services/statistics & numerical data , Pulmonary Embolism/epidemiology , Pulmonary Embolism/etiology , Pulmonary Embolism/prevention & control , Risk Factors , Time Factors , Venous Thrombosis/epidemiology , Venous Thrombosis/etiology , Venous Thrombosis/prevention & controlABSTRACT
OBJECTIVES: This study provides an update and comparison to a 2010 nationwide survey on cardiac electrophysiology (EP), types and numbers of interventional electrophysiological procedures, and training opportunities in 2015. BACKGROUND: In 2010, German cardiology centers performing interventional EP were identified and contacted to provide a survey on cardiac EP. METHODS: German cardiology centers performing interventional EP in 2015 were identified from quality reports and contacted to repeat the 2010 questionnaire. RESULTS: A majority of 131 centers (57%) responded. EP (ablation procedures and device therapy) was mainly part of a cardiology department (89%) and only independent (with its own budget) in 11%. The proportion of female physicians in EP training increased from 26% in 2010 to 38% in 2015. In total, 49,356 catheter ablations (i.e., 81% of reported ablations in 2015) were performed by the responding centers, resulting in a 44% increase compared with 2010 (the median number increased from 180 to 297 per center). Atrial fibrillation (AF) was the most common arrhythmia interventionally treated (47%). At 66% of the centers, (at least) 2 physicians were present during most catheter ablations. A minimum of 50 (75) AF ablations were performed at 80% (70%) of the centers. Pulmonary vein isolation with radiofrequency point-by-point ablation (62%) and cryoablation (33%) were the preferred ablation strategies. About one-third of centers reported surgical AF ablations, with 11 centers (8%) performing stand-alone surgical AF ablations. Only one-third of the responding 131 centers fulfilled all requirements for training center accreditation. CONCLUSIONS: Comparing 2010 with 2015, an increasing number of EP centers and procedures in Germany are registered. In 2015, almost every second ablation was for therapy for AF. Thus, an increasing demand for catheter ablation is likely, but training opportunities are still limited, and most centers do not fulfil recommended requirements for ablation centers.
Subject(s)
Cardiac Electrophysiology , Catheter Ablation/statistics & numerical data , Electrophysiologic Techniques, Cardiac/statistics & numerical data , Adult , Cardiac Electrophysiology/education , Cardiac Electrophysiology/organization & administration , Cardiac Electrophysiology/statistics & numerical data , Female , Germany/epidemiology , Health Personnel/education , Health Personnel/statistics & numerical data , Humans , Male , Middle AgedABSTRACT
BACKGROUND: The very long-term prognostic significance of ventricular late potentials (VLP) in patients post ST-elevation myocardial infarction (STEMI) is unclear. OBJECTIVES: To evaluate the long-term predictive value of VLP for mortality post-STEMI. METHODS: We conducted serial signal-averaged electrocardiography (SAECG) measurements in 63 patients on the 1st, 2nd and 3rd day pre-discharge, and 30 days after STEMI in patients admitted in 2001. We followed the patients for 10 years and correlated the presence of VLP with all-cause and cardiovascular mortality. RESULTS: The mean age was 59.9 ± 12.3 years. Thrombolysis was performed in 41 patients (65%). Percutaneous coronary intervention was performed pre-discharge in 40 patients (63%) and coronary artery bypass grafting in 7 (11%). Five consecutive measurements to define the presence of VLP were obtained in 52 patients (21 with VLP and 31 without). We found a higher prevalence of VLP in males compared to females (QRS segment > 114 msec, 51% vs. 12%, P = 0.02, duration of the low amplitude signal < 40 mV) in the terminal portion of the averaged QRS complex > 38 msec, 47% vs. 25%, P = 0.05). Over 10 years of follow-up, 14 (22%) patients died, 10 (70%) due to cardiovascular non-arrhythmic complications, 6 with VLP compared to only 3 without (28.6% vs. 9.7%, P = 0.125, hazard ratio = 2.96, confidence intervals = 0.74-11.84) (are these numbers meant to total 10?). CONCLUSIONS: Over 10 years of follow-up, the presence of VLP in early post-STEMI is not predictive of arrhythmic or non-arrhythmic cardiovascular mortality.
Subject(s)
Electrophysiologic Techniques, Cardiac , Heart Ventricles/physiopathology , Long Term Adverse Effects , ST Elevation Myocardial Infarction , Aged , Electrocardiography/methods , Electrocardiography/statistics & numerical data , Electrophysiologic Techniques, Cardiac/methods , Electrophysiologic Techniques, Cardiac/statistics & numerical data , Female , Follow-Up Studies , Humans , Israel/epidemiology , Long Term Adverse Effects/diagnosis , Long Term Adverse Effects/epidemiology , Male , Middle Aged , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/statistics & numerical data , Predictive Value of Tests , Prevalence , Prognosis , Risk Factors , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/physiopathology , Sex Factors , Thrombolytic Therapy/adverse effects , Thrombolytic Therapy/statistics & numerical dataABSTRACT
BACKGROUND: Ascertainment of hospitalizations is critical to assess quality of care and the effectiveness and adverse effects of various therapies. Smartphones, mobile geolocators that are ubiquitous, have not been leveraged to ascertain hospitalizations. Therefore, we evaluated the use of smartphone-based geofencing to track hospitalizations. METHODS AND RESULTS: Participants aged ≥18 years installed a mobile application programmed to geofence all hospitals using global positioning systems and cell phone tower triangulation and to trigger a smartphone-based questionnaire when located in a hospital for ≥4 hours. An in-person study included consecutive consenting patients scheduled for electrophysiology and cardiac catheterization procedures. A remote arm invited Health eHeart Study participants who consented and engaged with the study via the internet only. The accuracy of application-detected hospitalizations was confirmed by medical record review as the reference standard. Of 22 eligible in-person patients, 17 hospitalizations were detected (sensitivity 77%; 95% confidence interval, 55%-92%). The length of stay according to the application was positively correlated with the length of stay ascertained via the electronic medical record (r=0.53; P=0.03). In the remote arm, the application was downloaded by 3443 participants residing in all 50 US states; 243 hospital visits at 119 different hospitals were detected through the application. The positive predictive value for an application-reported hospitalization was 65% (95% confidence interval, 57%-72%). CONCLUSIONS: Mobile application-based ascertainment of hospitalizations can be achieved with modest accuracy. This first proof of concept may ultimately be applicable to geofencing other types of prespecified locations to facilitate healthcare research and patient care.