Superior approach from the pocket for atrioventricular junction ablation performed at the time of conduction system pacing implantation.
AV junction ablation
His bundle pacing
ablate and pace
atrial fibrillation
catheter ablation
conduction system pacing
left bundle branch area pacing
narrow QRS
Journal
Pacing and clinical electrophysiology : PACE
ISSN: 1540-8159
Titre abrégé: Pacing Clin Electrophysiol
Pays: United States
ID NLM: 7803944
Informations de publication
Date de publication:
12 2023
12 2023
Historique:
revised:
25
09
2023
received:
31
07
2023
accepted:
07
10
2023
medline:
17
12
2023
pubmed:
21
10
2023
entrez:
21
10
2023
Statut:
ppublish
Résumé
Conduction system pacing (CSP) and atrioventricular junction ablation (AVJA) improve outcomes in patients with symptomatic, refractory atrial fibrillation (AF). Superior approach (SA) from the pocket via axillary or subclavian vein has been proposed as an alternative to the conventional femoral venous access (FA) to perform AVJA. To assess the feasibility and safety of SA for AVJA performed simultaneously with CSP, and to compare this approach with FA. A prospective, observational study, enrolling consecutive patients with symptomatic, refractory AF undergoing simultaneous CSP and AVJA. A total of 107 patients were enrolled: in 50, AVJA was primarily attempted with SA, in 69 from FA. AVJA with SA was successful in 38 patients (76.0%), while in 12 patients, a subsequent FA was required. AVJA from FA was successful in 68 patients (98.5%), while in one patient, a left-sided approach via femoral artery was required. Compared with FA, SA was associated with a significantly longer duration of ablation (238.0 ± 218.2 vs. 161.9 ± 181.9 s; p = .035), a significantly shorter procedure time (28.1 ± 19.8 vs. 19.8 ± 16.8 min; p = .018), an earlier ambulation (2.7 ± 3.2 vs. 19.8 ± 0.1 h; p < .001), and an earlier discharge from procedure completion (24.0 ± 2.7 vs. 27.1 ± 5.1 h; p < .001). After a median follow-up of 12 months, the rate of complications was similar in the two groups (2.0% in SA, 4.3% in FA; p = .483). Simultaneous CSP and AVJA with SA is feasible, with a safety profile similar to FA. Compared to FA, this approach reduces the procedure times and allows earlier ambulation and discharge.
Sections du résumé
BACKGROUND
Conduction system pacing (CSP) and atrioventricular junction ablation (AVJA) improve outcomes in patients with symptomatic, refractory atrial fibrillation (AF). Superior approach (SA) from the pocket via axillary or subclavian vein has been proposed as an alternative to the conventional femoral venous access (FA) to perform AVJA.
OBJECTIVE
To assess the feasibility and safety of SA for AVJA performed simultaneously with CSP, and to compare this approach with FA.
METHODS
A prospective, observational study, enrolling consecutive patients with symptomatic, refractory AF undergoing simultaneous CSP and AVJA.
RESULTS
A total of 107 patients were enrolled: in 50, AVJA was primarily attempted with SA, in 69 from FA. AVJA with SA was successful in 38 patients (76.0%), while in 12 patients, a subsequent FA was required. AVJA from FA was successful in 68 patients (98.5%), while in one patient, a left-sided approach via femoral artery was required. Compared with FA, SA was associated with a significantly longer duration of ablation (238.0 ± 218.2 vs. 161.9 ± 181.9 s; p = .035), a significantly shorter procedure time (28.1 ± 19.8 vs. 19.8 ± 16.8 min; p = .018), an earlier ambulation (2.7 ± 3.2 vs. 19.8 ± 0.1 h; p < .001), and an earlier discharge from procedure completion (24.0 ± 2.7 vs. 27.1 ± 5.1 h; p < .001). After a median follow-up of 12 months, the rate of complications was similar in the two groups (2.0% in SA, 4.3% in FA; p = .483).
CONCLUSION
Simultaneous CSP and AVJA with SA is feasible, with a safety profile similar to FA. Compared to FA, this approach reduces the procedure times and allows earlier ambulation and discharge.
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1652-1661Informations de copyright
© 2023 Wiley Periodicals LLC.
Références
Brignole M, Pokushalov E, Pentimalli F, et al. A randomized controlled trial of atrioventricular junction ablation and cardiac resynchronization therapy in patients with permanent atrial fibrillation and narrow QRS. Eur Heart J. 2018;39:3999-4008.
Brignole M, Pentimalli F, Palmisano P, et al. AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrow QRS: the APAF-CRT mortality trial. Eur Heart J. 2021;42:4731-4739.
Palmisano P, Ziacchi M, Ammendola E, et al. Impact of atrioventricular junction ablation and CRT-D on long-term mortality in patients with left ventricular dysfunction, permanent, refractory atrial fibrillation, and narrow QRS: results of a propensity-matched analysis. J Cardiovasc Electrophysiol. 2022;33:2288-2296.
Vijayaraman P, Subzposh FA, Naperkowski A. Atrioventricular node ablation and His bundle pacing. EP Europace. 2017;19:iv10-iv16.
Palmisano P, Ziacchi M, Dell'Era G, et al. Ablate and pace: comparison of outcomes between conduction system pacing and biventricular pacing. Pacing Clin Electrophysiol. 2023;46:1258-1268. doi:10.1111/pace.14813 Epub ahead of print
Huang W, Su L, Wu S, et al. Benefits of permanent His bundle pacing combined with atrioventricular node ablation in atrial fibrillation patients with heart failure with both preserved and reduced left ventricular ejection fraction. J Am Heart Assoc. 2017;6:e005309.
Parlavecchio A, Vetta G, Caminiti R, et al. Left bundle branch pacing versus biventricular pacing for cardiac resynchronization therapy: a systematic review and meta-analysis. Pacing Clin Electrophysiol. 2023;46:432-439.
Vijayaraman P, Hashimova N, Mathew AJ, et al. Simultaneous conduction system pacing and atrioventricular node ablation via axillary vs femoral access. Heart Rhythm. 2022;19:1019-1021.
Su L, Cai M, Wu S, et al. Long-term performance and risk factors analysis after permanent His-bundle pacing and atrioventricular node ablation in patients with atrial fibrillation and heart failure. Europace. 2020;22:ii19-ii26.
Coluccia G, Accogli M, Guido A. Concomitant His bundle pacing and atrioventricular junction ablation: feasibility of a three-dimensional mapping system-only-guided, zero-fluoroscopy approach. J Cardiovasc Med (Hagerstown). 2021;22:e21-e23.
Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021;42:373-498.
Zeppenfeld K, Tfelt-Hansen J, de Riva M, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022;43:3997-4126.
Glikson M, Nielsen JC, Kronborg MB, et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021;42:3427-3520.
Vijayaraman P, Naperkowski A, Subzposh FA, et al. Permanent His-bundle pacing: long-term lead performance and clinical outcomes. Heart Rhythm. 2018;15:696-702.
Huang W, Chen X, Su L, Wu S, Xia X, Vijayaraman P. A beginner's guide to permanent left bundle branch pacing. Heart Rhythm. 2019;16:1791-1796.
Jastrzębski M, Kiełbasa G, Cano O, et al. Left bundle branch area pacing outcomes: the multicentre European MELOS study. Eur Heart J. 2022;43:4161-4173.
Burri H, Jastrzebski M, Cano Ó, et al. EHRA clinical consensus statement on conduction system pacing implantation: endorsed by the Asia Pacific Heart Rhythm Society (APHRS), Canadian Heart Rhythm Society (CHRS), and Latin American Heart Rhythm Society (LAHRS). EP Europace. 2023;25:1208-1236.
Palmisano P, Aspromonte V, Ammendola E, et al. Effect of fixed-rate vs. rate-RESPONSIve pacing on exercise capacity in patients with permanent, refractory atrial fibrillation and left ventricular dysfunction treated with atrioventricular junction aBLation and bivEntricular pacing (RESPONSIBLE): a prospective, multicentre, randomized, single-blind study. EP Europace. 2017;19:414-420.
Coluccia G, Dell'Era G, Ghiglieno C, et al. Optimization of the atrioventricular delay in conduction system pacing. J Cardiovasc Electrophysiol. 2023;34:1441-1451.
Burri H, Keene D, Whinnett Z, et al. Device programming for His bundle pacing. Circ Arrhythm Electrophysiol. 2019;12:e006816.
Palmisano P, Guerra F, Dell'Era G, et al. Impact on all-cause and cardiovascular mortality of cardiac implantable electronic device complications: results from the POINTED Registry. JACC Clin Electrophysiol. 2020;6:382-392.
Palmisano P, Ziacchi M, Dell'Era G, et al. Rate and nature of complications of conduction system pacing compared with right ventricular pacing: results of a propensity score-matched analysis from a multicenter registry. Heart Rhythm. 2023:S1547527123002266.
Kupó P, Pap R, Sághy L, et al. Ultrasound guidance for femoral venous access in electrophysiology procedures-systematic review and meta-analysis. J Interv Card Electrophysiol. 2020;59:407-414.
Kupo P, Riesz TJ, Saghy L, et al. Ultrasound guidance for femoral venous access in patients undergoing pulmonary vein isolation: a quasi-randomized study. J Cardiovasc Electrophysiol. 2023;34:1177-1182.
Polyzos KA, Konstantelias AA, Falagas ME. Risk factors for cardiac implantable electronic device infection: a systematic review and meta-analysis. Europace. 2015;17:767-777.
Klug D, Balde M, Pavin D, et al. Risk factors related to infections of implanted pacemakers and cardioverter-defibrillators: results of a large prospective study. Circulation. 2007;116:1349-1355.
Boriani G, Proietti M, Bertini M, et al. Incidence and predictors of infections and all-cause death in patients with cardiac implantable electronic devices: the Italian nationwide RI-AIAC Registry. J Pers Med. 2022;12:91.
Palmisano P, Accogli M, Zaccaria M, et al. Rate, causes, and impact on patient outcome of implantable device complications requiring surgical revision: large population survey from two centres in Italy. Europace. 2013;15:531-540.
Moubarak G, Bonhomme S, Vedrenne G, et al. Femoral vein thrombosis after right-sided electrophysiological procedures. J Interv Card Electrophysiol. 2013;38:155-158.
Burstein B, Barbosa RS, Kalfon E, et al. Venous thrombosis after electrophysiology procedures: a systematic review. Chest. 2017;152:574-586.
Steinberg BA, Woolley S, Li H, et al. Patient-reported outcomes and costs associated with vascular closure and same-day discharge following atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2022;33:1737-1744.