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AIMS: We aimed to assess the acute and midterm efficacy of premature ventricular contraction (PVC) ablation guided by multielectrode and point-by-point (PbP) mapping. METHODS AND RESULTS: This is a retrospective, international multicentre study of consecutive patients referred for PVC ablation in 10 hospital centres from January 2017 to December 2021. Based on the mapping approach, two cohorts were identified: the 'Multipolar group', where a dedicated high-density mapping catheter was employed, and the 'PbP group', where mapping was performed with the ablation catheter. Procedural endpoints, safety, and acute (procedural) and midterm efficacies were assessed. Of the 698 patients included in this study, 592 received activation mapping [46% males, median age of 55 (41-65) years]-248 patients in the Multipolar group and 344 patients in the PbP group. A higher number of activation points [432 (217-843) vs. 95 (42-185), P < 0.001], reduced mapping time (40 ± 38 vs. 61 ± 50â min, P < 0.001), and shorter procedure time (124 ± 60 vs. 143 ± 63â min, P < 0.001) were reported in the Multipolar group. Both groups had high acute success rates (84.7% with Multipolar mapping vs. 81.3% with PbP mapping, P = 0.63), as well as midterm efficacy (83.4% vs. 77.4%, P = 0.08), with no significant differences in the risk of adverse events (6.0% vs. 3.5%, P = 0.24). However, for left-sided PVC ablation specifically, there was a higher midterm efficacy in the Multipolar group (80.7% vs. 69.5%, P = 0.04), with multipolar mapping being an independent predictor of success [adjusted OR = 2.231 (95% CI, 1.476-5.108), P = 0.02]. CONCLUSION: The acute and midterm efficacies of PVC ablation are high with both multipolar and PbP mapping, although the former allows for quicker procedures and may potentially improve the outcomes of left-sided PVC ablation.
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Ablación por Catéter , Complejos Prematuros Ventriculares , Humanos , Complejos Prematuros Ventriculares/cirugía , Complejos Prematuros Ventriculares/fisiopatología , Complejos Prematuros Ventriculares/diagnóstico , Masculino , Persona de Mediana Edad , Femenino , Ablación por Catéter/métodos , Estudios Retrospectivos , Anciano , Adulto , Resultado del Tratamiento , Técnicas Electrofisiológicas CardíacasRESUMEN
AIMS: Pulmonary vein isolation (PVI) guided by the Ablation Index (AI) has shown high acute and mid-term efficacy in the treatment of paroxysmal atrial fibrillation (AF). Previous data before the AI-era had suggested that wide-area circumferential ablation (WACA) was preferable to ostial ablation. However, with the use of AI, we hypothesize that ostial circumferential ablation is non-inferior to WACA and can improve outcomes in paroxysmal AF. METHODS AND RESULTS: Prospective, multicentre, non-randomized, non-inferiority study of consecutive patients were referred for paroxysmal AF ablation from January 2020 to September 2021. All procedures were performed using the AI software, and patients were separated into two different groups: WACA vs. ostial circumferential ablation. Acute reconnection, procedural data, and 1-year arrhythmia recurrence were assessed. During the enrolment period, 162 patients (64% males, mean age of 60 ± 11 years) fulfilled the study inclusion criteria-81 patients [304 pulmonary vein (PV)] in the WACA group and 81 patients (301 PV) in the ostial group. Acute PV reconnection was identified in 7.9% [95% confidence interval (CI), 4.9-11.1%] of PVs in the WACA group compared with 3.3% (95% CI, 1.8-6.1%) of PVs in the ostial group [P < 0.001 for non-inferiority; adjusted odds ratio 0.51 (95% CI, 0.23-0.83), P = 0.05]. Patients in the WACA group had longer ablation (35 vs. 29â min, P = 0.001) and procedure (121 vs. 102â min, P < 0.001) times. No significant difference in arrhythmia recurrence was seen at 1-year of follow-up [11.1% in WACA vs. 9.9% in ostial, hazard ratio 1.13 (95% CI, 0.44-1.94), P = 0.80 for superiority]. CONCLUSION: In paroxysmal AF patients treated with tailored AI-guided PVI, ostial circumferential ablation is not inferior to WACA with regard to acute PV reconnection, while allowing quicker procedures with less ablation time.
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Fibrilación Atrial , Venas Pulmonares , Masculino , Humanos , Persona de Mediana Edad , Anciano , Femenino , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/cirugía , Estudios Prospectivos , Oportunidad Relativa , Venas Pulmonares/cirugía , Programas InformáticosRESUMEN
Tricuspid regurgitation (TR) is one of the most common heart valve diseases, associated a with poor prognosis since significant TR is associated with an increased mortality risk compared to no TR or mild regurgitation. Surgery is the standard treatment for TR, although it is associated with high morbidity, mortality, and prolonged hospitalization, particularly in tricuspid reoperation after left-sided surgery. Thus, several innovative percutaneous transcatheter approaches for repair and replacement of the tricuspid valve have gathered significant momentum and have undergone extensive clinical development in recent years, with favorable clinical outcomes in terms of mortality and rehospitalization during the first year of follow-up. We present three clinical cases of transcatheter tricuspid valve replacement in an orthotopic position with two different innovative systems along with a review of the state-of-the-art of this emergent topic.
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INTRODUCTION AND OBJECTIVES: Cardiogenic shock (CS) complicates 5-10% of cases of myocardial infarction (MI). Whether glycoprotein IIb/IIIa inhibitors (GPIs) are beneficial in these patients is controversial. Our aim is to assess the prognostic impact of GPI use on in-hospital mortality and outcomes in patients with MI and CS undergoing percutaneous coronary intervention (PCI). METHODS: Between October 2010 and December 2019, 27578 acute coronary syndrome (ACS) patients were included in the multicenter Portuguese Registry of Acute Coronary Syndromes. Of these, 357 with an MI complicated by CS were included in the analysis and grouped based on whether they received GPI therapy (with GPI, n=107 and without GPI, n=250). The primary endpoint was in-hospital mortality. Secondary endpoints included successful PCI and in-hospital reinfarction and major bleeding. RESULTS: Demographics and cardiovascular risk factors did not differ between groups. ST-elevation MI patients were more likely to receive GPIs (95% vs. 83%, p=0.002). In-hospital mortality was similar between groups (OR 1.80, 95% CI 0.96-3.37). Only age and the use of inotropes or intra-aortic balloon pump were predictors of mortality. Also, no differences between groups were noted for successful PCI (OR 0.33, 95% CI 0.62-4.06), reinfarction (OR 0.77, 95% CI 0.15-3.90), or major bleeding (OR 1.68, 95% CI 0.75-3.74). CONCLUSION: The use of GPIs in the context of MI with CS did not significantly impact in-hospital outcomes.
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Síndrome Coronario Agudo , Infarto del Miocardio , Intervención Coronaria Percutánea , Humanos , Síndrome Coronario Agudo/etiología , Choque Cardiogénico/etiología , Choque Cardiogénico/terapia , Intervención Coronaria Percutánea/efectos adversos , Portugal , Infarto del Miocardio/complicaciones , Hemorragia/etiología , Sistema de Registros , Glicoproteínas , Resultado del Tratamiento , Inhibidores de Agregación Plaquetaria/efectos adversosRESUMEN
AIMS: To compare the two different ablation strategies, both guided by the Ablation Index (AI), in the setting of atrial fibrillation (AF) ablation: high-power short-duration (HPSD) ablation using 40 W on the posterior wall and 50 W elsewhere versus low-power long-duration (LPLD) using 25 W posteriorly and 35 W elsewhere. METHODS: Prospective, multicenter nonrandomized, noninferiority study of consecutive patients referred for paroxysmal AF ablation from January 2018 to July 2019. Ablation was guided by the AI (≥500 for anterior segments, ≥450 for the roof and inferior segments and 400 posteriorly) and an interlesion distance (ILD) ≤ 6 mm. Patients were separated into two groups: HPSD vs LPLD. Acute reconnection (after adenosine trial) and 2-year outcomes were assessed. RESULTS: 160 patients (61% males, median age of 62 [IQR 51-69] years), fulfilled the study inclusion criteria - 80 patients (316 pulmonary veins [PV]) in the HPSD group and 80 patients (314 PV) in the LPLD. The probability of acute PV reconnection was similar between both groups: 2.2% in HPSD, 95%CI 0.6% to 3.8% vs. 3.4% in LPLD, 95%CI 1.4% to 5.4%; p < 0.001 for noninferiority. Median PV ablation time (20 min vs 30 min, p < 0.01) and procedure duration (80 min vs 100 min, p < 0.001) were shorter in the HPSD group. After a median follow-up of 26 months, arrhythmia recurrence was similar between groups (17.5% in HPSD group vs. 18.8% in LPLD group, p = 0.79). CONCLUSIONS: In paroxysmal AF patients treated with the Ablation Index, a HPSD strategy is noninferior to the more standard LPLD ablation, while allowing for quicker procedures with shorter ablation times.
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Fibrilación Atrial , Ablación por Catéter , Venas Pulmonares , Masculino , Humanos , Persona de Mediana Edad , Anciano , Femenino , Estudios Prospectivos , Resultado del Tratamiento , Venas Pulmonares/cirugía , Ablación por Catéter/métodos , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/cirugía , Fibrilación Atrial/etiología , RecurrenciaRESUMEN
Acute mitral regurgitation (MR) may develop in the setting of an acute myocardial infarction (AMI) because of papillary muscle dysfunction or rupture. Severe acute MR in this scenario is a life-threatening complication associated with hemodynamic instability and pulmonary edema, and has been linked to a worse prognosis even after reperfusion. Patients treated solely with medical therapy have the highest mortality rates. Surgery has been the only treatment strategy until recently, but the results of the technique are hindered by high rates of morbidity and mortality. Therefore, the development of less invasive interventions for correcting MR would be ideal. We aimed to review the current role of transcatheter interventions in this clinical setting.
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Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Reemplazo de la Válvula Aórtica Transcatéter , Cateterismo Cardíaco , Fluoroscopía/métodos , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Tomografía Computarizada por Rayos X/métodos , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Resultado del Tratamiento , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/cirugíaRESUMEN
Background: The use of the Ablation Index (AI) software for paroxysmal atrial fibrillation (AF) has been associated with higher acute effectiveness and higher 1-year arrhythmia freedom. There is, however, a lack of data concerning longer follow-up. We aim to evaluate the 2-year outcomes after a standardized AI-guided pulmonary vein isolation (PVI). Methods: Prospective, multicenter study of consecutive patients referred for paroxysmal AF ablation from January 2018 to July 2019. PVI was guided by a tailored AI value (≥500 for anterior segment, ≥450 for the roof segments and inferior segments, and 400 for the posterior wall) and an ILD ≤6 mm. The primary endpoints were acute and long-term effectiveness. Results: The study included 218 (842 PV) patients (61% males, median age of 60 [IQR 49-68] years) with paroxysmal AF. First-pass isolation was obtained in 93% of the patients, with an acute reconnection occurring in 10.6% of the patients (3.2% of the PV) following adenosine trial. After a median follow-up of 26 (IQR 20-30) months, freedom from any documented atrial arrhythmia was 83.4%, off-AAD. The rate of adverse events was 1.4%. Although procedural parameters differ across centers (p < 0.001), the acute (p = 0.56) and long-term effectiveness (p = 0.83) were consistent between centers. Conclusions: Patients with paroxysmal AF submitted to an AI-guided PVI workflow presented high arrhythmia freedom at 2-years of follow-up.
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Procedimientos Quirúrgicos Cardíacos , Ecocardiografía Tridimensional , Cateterismo Cardíaco/métodos , Procedimientos Quirúrgicos Cardíacos/métodos , Ecocardiografía , Ecocardiografía Tridimensional/métodos , Ecocardiografía Transesofágica , Fluoroscopía/métodos , Humanos , Resultado del TratamientoRESUMEN
PURPOSE: Since the widespread availability of contact-force sensing catheters, the need for a waiting period after pulmonary vein isolation (PVI) has not been reassessed. We aim to evaluate whether a waiting period is still necessary after PVI guided by the ablation Index (AI). METHODS: Prospective, multicenter, randomized study of consecutive patients referred for paroxysmal atrial fibrillation (AF) ablation from May 2019 to February 2020. Patients were randomized in a 1:1 ratio to PVI with versus without a waiting period of 20 min. Acute pulmonary vein (PV) reconnection after adenosine challenge was the primary endpoint. A per-protocol analysis was designed to determine whether a strategy of dismissing the waiting period after PVI was noninferior to waiting for 20 min for identifying acute PV reconnection. PVI was guided by tailored AI values and an interlesion distance ≤6 mm. RESULTS: During the enrollment period, 167 patients (56% males, mean age of 57 ± 14 years) fulfilled the study inclusion criteria - 84 patients (308 PV) in the waiting period group (Group A) and 83 patients (314 PV) in the group without a waiting period (Group B). Acute PV reconnection was identified in 3.8% (95% confidence interval [CI], 1.7%-5.9%) of PVs in the study group B compared to 2.9% (95% CI, 1.0%-4.8%) of PVs in the Group A (p = .002 for non-inferiority). At 1-year follow-up, there was no significant difference in arrhythmia recurrence between groups (9.5% in Group A vs. 9.6% in Group B, hazard ratio: 1.03 [95% CI, 0.39-2.73], p = .98). CONCLUSION: In paroxysmal AF patients submitted to ablation, a tailored PVI guided by the AI rendered a 20-min waiting period unnecessary.
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Fibrilación Atrial , Ablación por Catéter , Venas Pulmonares , Adulto , Anciano , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/cirugía , Ablación por Catéter/efectos adversos , Ablación por Catéter/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Venas Pulmonares/cirugía , Recurrencia , Programas Informáticos , Resultado del TratamientoRESUMEN
BACKGROUND: There are conflicting data regarding the relationship between high-sensitivity cardiac Troponin I (Hs-cTnI) and the ablation effectiveness quotient (AEQ) with arrhythmia recurrence following atrial fibrillation (AF) ablation. Our goals were to evaluate the impact of the Ablation Index (AI) software on Hs-cTnI and AEQ levels and to assess whether these markers are predictors of arrhythmia recurrence. METHODS: Prospective single-center study of 75 consecutive patients referred for paroxysmal AF ablation from October 2017 to January 2019. Procedural endpoints and 2-year outcomes were assessed and compared to those of 75 propensity score-matched patients submitted to non-AI-guided pulmonary vein isolation (PVI) [control group]. RESULTS: Compared to the control group, patients having AI-guided PVI had lower Hs-cTnI values (1580 [IQR 1180-2140] ng/L vs. 2600 [IQR 1840 - 3900], p < 0.001) and a lower AEQ (0.9 [IQR 0.6-1.2] ng/L/s vs. 1.4 [0.8-1.6] ng/L/s, p < 0.001). After a median follow-up of 26 (IQR 20-32) months, there was a significant reduction in arrhythmia recurrence in the AI group (15% vs. 31%, HR 0.67 [95% CI, 0.32-1.40], p = 0.02). However, neither Hs-cTnI nor AEQ was predictors of arrhythmia recurrence in AI-guided PVI. CONCLUSIONS: The use of the AI software led to reduced levels of Hs-cTnI and lower AEQ in AF patients submitted to PVI. However, none of these markers predicted arrhythmia recurrence.
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Arritmias Cardíacas , Fibrilación Atrial , Ablación por Catéter , Venas Pulmonares , Arritmias Cardíacas/cirugía , Fibrilación Atrial/cirugía , Biomarcadores , Humanos , Estudios Prospectivos , Venas Pulmonares/cirugía , Recurrencia , Resultado del Tratamiento , Troponina IRESUMEN
Abstract Background: The risk of sports-related sudden cardiac arrest after COVID-19 infection can be a serious problem. There is an urgent need for evidence-based criteria to ensure patient safety before resuming exercise. Objective: To estimate the pooled prevalence of acute myocardial injury caused by COVID-19 and to provide an easy-to-use cardiovascular risk assessment toolkit prior to resuming sports activities after COVID-19 infection. Methods: We searched the Medline and Cochrane databases for articles on the prevalence of acute myocardial injury associated with COVID-19 infection. The pooled prevalence of acute myocardial injury was calculated for hospitalized patients treated in different settings (non-intensive care unit [ICU], ICU, overall hospitalization, and non-survivors). Statistical significance was accepted for p values <0.05. We propose a practical flowchart to assess the cardiovascular risk of individuals who recovered from COVID-19 before resuming sports activities. Results: A total of 20 studies (6,573 patients) were included. The overall pooled prevalence of acute myocardial injury in hospitalized patients was 21.7% (95% CI 17.3-26.5%). The non-ICU setting had the lowest prevalence (9.5%, 95% CI 1.5-23.4%), followed by the ICU setting (44.9%, 95% CI 27.7-62.8%), and the cohort of non-survivors (57.7% with 95% CI 38.5-75.7%). We provide an approach to assess cardiovascular risk based on the prevalence of acute myocardial injury in each setting. Conclusions: Acute myocardial injury is frequent and associated with more severe disease and hospital admissions. Cardiac involvement could be a potential trigger for exercise-induced clinical complications after COVID-19 infection. We created a toolkit to assist with clinical decision-making prior to resuming sports activities after COVID-19 infection.
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Deportes , Factores de Riesgo de Enfermedad Cardiaca , COVID-19/complicaciones , Miocarditis/complicaciones , Muerte Súbita Cardíaca , Medición de Riesgo/métodos , Práctica Clínica Basada en la Evidencia/métodos , AtletasRESUMEN
We report on a 50-year-old female patient, with several severe comorbidities and high-surgical risk, in whom we successfully performed a simultaneous transcatheter pulmonary and tricuspid valve-in-ring implantation to treat both bioprosthetic pulmonary valve dysfunction and native torrential tricuspid valve regurgitation, the latter previously managed with a Carpentier annuloplasty ring.
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Anuloplastia de la Válvula Cardíaca , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Insuficiencia de la Válvula Tricúspide , Cateterismo Cardíaco , Femenino , Humanos , Persona de Mediana Edad , Diseño de Prótesis , Resultado del Tratamiento , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/cirugía , Insuficiencia de la Válvula Tricúspide/diagnóstico , Insuficiencia de la Válvula Tricúspide/cirugíaRESUMEN
PURPOSE: The purpose of the study was to investigate the usefulness of the extended early meets late (EEML) feature of the HD Coloring software for confirmation of bidirectional block along an ablation line. METHODS: A single-center prospective observational study of consecutive patients with atypical atrial flutter or persistent atrial fibrillation submitted to catheter ablation including linear lesions from January 2019 to June 2020, with confirmation of bidirectional block across ablation lines assessed with the feature EEML and a multipolar catheter was conducted. Patients were divided into two groups - those with versus those without bidirectional block - and different EEML thresholds were analyzed to assess which one had the better sensitivity and specificity to predict block. RESULTS: During the 24-month enrollment period, a total of 94 patients were included (50% males, mean age of 64 ± 10 years, 60% with structural heart disease) - 55 patients with versus 39 patients without confirmed a bidirectional block. Activation maps were performed during atrial pacing, with a median number of 1340 (interquartile range 1135-2060) points acquired in 11 ± 3 min, and a mean mapped cycle length of 287 ± 51 ms. The EEML feature was highly useful in detecting bidirectional block along ablation lines, with a 25% threshold value showing the highest discriminative performance (area under the curve of 0.93), 95% sensitivity and 92% specificity in predicting block. CONCLUSIONS: The EEML feature of the HD Coloring software is a useful addition to the CARTO mapping system for assessment of block across an ablation line. The threshold value of 25% is the most accurate.
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Fibrilación Atrial , Aleteo Atrial , Ablación por Catéter , Anciano , Fibrilación Atrial/cirugía , Aleteo Atrial/cirugía , Femenino , Atrios Cardíacos/cirugía , Sistema de Conducción Cardíaco/cirugía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Mitral regurgitation is the second-most frequent valvular heart disease in Europe and it is associated with high morbidity and mortality. Recognition of MR should encourage the assessment of its etiology, severity, and mechanism in order to determine the best therapeutic approach. Mitral valve surgery constitutes the first-line therapy; however, transcatheter procedures have emerged as an alternative option to treat inoperable and high-risk surgical patients. In patients with suitable anatomy, the transcatheter edge-to-edge mitral leaflet repair is the most frequently applied procedure. In non-reparable patients, transcatheter mitral valve replacement (TMVR) has appeared as a promising intervention. Thus, currently TMVR represents a new treatment option for inoperable or high-risk patients with degenerated or failed bioprosthetic valves (valve-in-valve); failed repairs, (valve-in-ring); inoperable or high-risk patients with native mitral valve anatomy, or those with severe annular calcifications, or valve-in-mitral annular calcification. The patient selection requires multimodality imaging pre-procedural planning to select the best approach and device, study the anatomical landing zone and assess the risk of left ventricular outflow tract obstruction. In the present review, we aimed to highlight the main considerations for TMVR planning from an imaging perspective; before, during, and after TMVR.
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Aim: Patients with chronic kidney disease (CKD) are at increased cardiovascular risk. Methods: Patients with acute coronary syndrome were retrospectively allocated to three groups (stage 3A, stage 3B or stage 4) based on the Kidney Disease Improving Global Outcomes classification formulas: the CKD Epidemiology Collaboration (CKD-EPI; N = 401) and the modification of diet in renal disease (n = 355). The primary end point was all-cause mortality (median follow-up time, 32 months [15-70]). Results: Study results showed decreased median survival was associated with poor renal function for both the CKD-EPI (78 vs 61 vs 40 months, p = 0.014) and modification of diet in renal disease groups (68 vs 57 vs 32 months, p = 0.006). After adjustment, age (OR: 1.07; 95% CI: 1.01-1.14) and pulmonary artery systolic pressure (OR: 1.08; 95% CI: 1.03-1.14), but not estimated glomerular filtration rate, were associated with decreased survival. Conclusion: Study results suggest that poor outcomes after an acute coronary syndrome were associated with comorbidities rather than estimated glomerular filtration rate level.
Lay abstract Patients with chronic kidney failure have an elevated risk of heart attack or death. We studied patients with kidney failure and concurrent heart attack for 32 months (median). Our results suggest that poorer renal function was associated with an increased risk of death. However, the most important factors associated with survival were patient age and pulmonary artery systolic pressure and not the particular kidney function. Therefore, in this group of patients, comorbidities appear to play a role as survival determinants.
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Síndrome Coronario Agudo , Insuficiencia Renal Crónica , Síndrome Coronario Agudo/complicaciones , Síndrome Coronario Agudo/epidemiología , Tasa de Filtración Glomerular , Humanos , Riñón , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/epidemiología , Estudios RetrospectivosRESUMEN
There is conflicting evidence regarding the significance of iatrogenic atrial septal defects (iASDs) after transseptal puncture during percutaneous cardiac interventions. To study the clinical outcome of iASD after percutaneous left atrial appendage occlusion (LAAo). Single-center, retrospective study of 70 consecutive patients who underwent percutaneous LAAo between May 2010 and August 2017, and subsequent transesophageal echocardiography (TEE) at 1 month. The sample population was divided into two groups: A (with iASD, 22 (37%) patients) and B (no iASD, 44 (63%) patients). Procedures were guided either by TEE (36 patients (54%)) or intracardiac echocardiography (ICE) from the left atrium (30 patients (46%)). The primary end point was presence of iASD at 1 month, and secondary end points included mortality, hospital admission due to heart failure (HF), and right atrium (RA) size during follow-up. 70 patients were included in this study and the prevalence of iASD at 1 month was 37%. The use of ICE was associated with iASD (adjusted odds ratio, 3.79; 95% CI 1.27-11.34). The presence of iASD was not associated with adverse events (mortality, 15.4% vs 20.5%; P = 0.60; HF hospitalizations, 7.7% vs 13.6%, P = 0.45; and RA area, 24.8 ± 7.0 cm2 vs 22.2 ± 6.8 cm2, P = 0.192). At 1-month follow-up after LAAo, iASD was present in one third of patients, but was not associated with clinical outcomes. The use of ICE was associated with a higher risk of short-term iASD.
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Apéndice Atrial , Fibrilación Atrial , Defectos del Tabique Interatrial , Apéndice Atrial/diagnóstico por imagen , Fibrilación Atrial/diagnóstico por imagen , Cateterismo Cardíaco/efectos adversos , Ecocardiografía Transesofágica , Defectos del Tabique Interatrial/diagnóstico por imagen , Defectos del Tabique Interatrial/terapia , Humanos , Enfermedad Iatrogénica , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Current guidelines recommend vitamin K antagonists (VKAs) for left ventricular thrombus (LVT) resolution. Direct oral anticoagulants (DOACs) are increasingly evaluated as alternatives to the standard of care in anticoagulation. METHODS: We performed a systematic review and meta-analysis to assess the use of DOACs vs VKAs for LVT treatment. The occurrence of LVT resolution, systemic embolism (SE) or stroke, and bleeding events were compared during follow-up using random-effects analysis. RESULTS: The 5 included studies were all observational (a total of 828 patients). Of these, 284 patients (34%) were treated with DOACs, and 544 (66%) treated with VKAs. Thrombus resolution was similar for both methods (pooled odds ratio [OR], 0.91; 95% CI, 0.47-1.75; I2 = 63%; P = .78). The incidence of SE or stroke was also similar (pooled OR, 1.59; 95% CI, 0.85-2.97; I2 = 0%; P = .14). Clinically relevant bleeding incidence was similar for both groups (pooled OR, 0.66; 95% CI, 0.31-1.40; I2 = 0%; P = .28), although all bleeding events were less frequent in the DOAC group (pooled OR, 0.49; 95% CI, 0.26-0.90; I2 = 0%; P = .02). CONCLUSION: Our systematic review and meta-analysis suggests DOACs were as effective as VKAs for LVT resolution, with a similar risk of systemic embolism/stroke and clinically relevant bleeding. These results, obtained from observational studies, are not definitive and hence randomized controlled trials are needed. Nevertheless, our analysis identifies key experimental features required in future studies.