Publications by authors named "Edward Gerstenfeld"
Background: Pulsed field ablation (PFA) has emerged as an effective technology in the treatment of paroxysmal atrial fibrillation (AF).
Objective: To evaluate the cost-effectiveness of PFA vs. thermal ablation from a US healthcare payer perspective using data from a randomized trial.
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017.
View Article and Find Full Text PDFPurpose Of Review: Although pulsed field ablation (PFA) has emerged as an innovative nonthermal catheter ablation modality, recent reports raise concerns about its potential impact on nearby coronary arteries. This review provides a comprehensive overview of the current understanding and future directions regarding the effects of PFA on or near coronary arteries.
Recent Findings: Clinical studies have demonstrated the risks of acute transient vasospasm after delivery of PFA, especially with ablation of structures in proximity to the coronary arteries, such as the cavotricuspid and mitral isthmuses.
Background: We have previously shown that dyssynchronous premature atrial complexes (PACs) from the lateral left atrium (LA) lead to greater atrial mechanical dysfunction, remodeling, and sustained atrial fibrillation (AF) than synchronous PACs from the interatrial septum. However, the impact of PAC coupling interval (CI) on atrial remodeling is unclear.
Objectives: This study sought to explore the effect of PAC CI on atrial mechanics and remodeling in the swine model.
Article Synopsis
- Premature ventricular contractions (PVCs) are common in individuals with left ventricular (LV) systolic dysfunction, yet their prevalence in the general population is not well understood.
- A multicenter study evaluated the prevalence of frequent (PVCs >5%) and high burden (PVCs >10%) PVCs among patients monitored with ambulatory Holter monitors, analyzing demographics and left ventricle ejection fraction (LVEF).
- Results showed that PVCs >5% and >10% were present in 4% and 5% of participants, respectively, with higher prevalence in older males, while females had a lower occurrence of PVCs despite similar rates when LVEF <50%.
Background: Autonomic denervation is an ancillary phenomenon during thermal ablation of atrial fibrillation (AF), that may have synergistic effects on symptomatic improvement and long-term freedom from AF. Pulsed field ablation (PFA), a nonthermal ablation modality, was noninferior to thermal ablation in treating AF; however, PFA's relative myocardial selectivity may minimize autonomic effects.
Objectives: This study sought to compare heart rate (HR) and heart rate variability (HRV) metrics as markers of autonomic function after ablation using PFA vs thermal ablation.
Background: The ADVENT randomized trial revealed no significant difference in 1-year freedom from atrial arrhythmias (AA) between thermal (radiofrequency/cryoballoon) and pulsed field ablation (PFA). However, recent studies indicate that the postablation AA burden is a better predictor of clinical outcomes than the dichotomous endpoint of 30-second AA recurrence.
Objectives: The goal of this study was to determine: 1) the impact of postablation AA burden on outcomes; and 2) the effect of ablation modality on AA burden.
Background: Differentiation between ventricular tachycardia (VT) and supraventricular tachycardia (SVT) with aberrancy based on the 12‑lead ECG alone can be imprecise. Implantable cardiac defibrillators (ICD) may be inserted for presumed VT, particularly in patients with syncopal presentation or atypical aberrancy patterns. Accurate diagnosis of these patients facilitated by an electrophysiology study (EPS) may alter diagnosis and management.
View Article and Find Full Text PDFArticle Synopsis
- - The study investigates the risk of silent cerebral events (SCE) and silent cerebral lesions (SCL) associated with two types of atrial fibrillation (AF) ablation: pulsed field ablation (PFA) and standard thermal ablation, focusing on potential long-term effects on brain health.
- - A total of 77 patients underwent randomized treatment across six centers, with follow-up MRIs conducted 12-48 hours post-procedure. Results showed low rates of SCE/SCL, with some findings confirmed by a blinded imaging laboratory.
- - Both ablation methods demonstrated minimal neurological complications, with no significant differences in outcomes, suggesting that both PFA and thermal ablation involve a low risk of silent cerebral
Article Synopsis
- * Out of 2,083 patients who underwent first-time ablation, 52% received it as the initial treatment, showing that first-line ablation is common, especially among males with fewer health issues.
- * Both treatment groups had similar rates of being arrhythmia-free after nearly a year, but those who had second-line treatment were more likely to still be on antiarrhythmic drugs (AADs).
Background: Premature ventricular contraction (PVC) burden is a risk factor for heart failure and cardiovascular death in patients with structural heart disease. Long-term electrocardiographic monitoring can have a significant impact on PVC burden evaluation by further defining PVC distribution patterns.
Objective: This study aimed to ascertain the optimal duration of electrocardiographic monitoring to characterize PVC burden and to understand clinical characteristics associated with frequent PVCs and nonsustained ventricular tachycardia in a large US cohort.
Article Synopsis
- Ablation of atrial fibrillation (AF) has become a widely accepted and effective treatment for managing this common heart rhythm disorder over the last 30 years.
- Since the initial consensus document in 2007, new research and technologies have significantly changed AF ablation practices, necessitating updates in 2012 and 2017.
- A new consensus document was recently created by various cardiac societies to provide a current framework for selecting and managing patients for catheter or surgical AF ablation, reflecting the evolving nature of the field.
Article Synopsis
- * The first expert guidelines for AF ablation were published in 2007, and updates were necessary in 2012 and 2017 due to advancements in research and technology.
- * A new consensus document is now being released to provide updated guidelines for healthcare professionals on selecting and managing patients for AF ablation, created by various international cardiac societies.
Article Synopsis
- Atrial fibrillation (AF) ablation has become a well-established treatment method in the last 30 years, supported by evidence showing it is safe and effective.
- In response to advancements in research and technology, new guidelines have been released over the years, the latest being necessary to provide updated recommendations for patient care.
- This revised consensus involves collaboration among major cardiac electrophysiology societies from Europe, Asia-Pacific, and Latin America to ensure comprehensive guidelines for AF treatment.
Article Synopsis
- * It focuses on the CNA-FWRD Registry, a multicenter prospective study that compares outcomes between patients receiving standard therapy and those undergoing cardioneuroablation over a follow-up period of three years.
- * The findings aim to provide valuable data on long-term effects, recurrence of symptoms, and overall safety of cardioneuroablation, addressing a gap in existing research which is largely based on retrospective studies.
Aims: When it occurs, pulmonary vein (PV) stenosis after atrial fibrillation (AF) ablation is associated with significant morbidity. Even mild-to-moderate PV narrowing may have long-term implications. Unlike thermal ablation energies, such as radiofrequency (RF) or cryothermy, pulsed field ablation (PFA) is a non-thermal modality associated with less fibrotic proliferation.
View Article and Find Full Text PDFBackground: Alcohol consumption is associated with a higher increased risk of atrial fibrillation (AF), but the acute effects on cardiac electrophysiology in humans remain poorly understood. The HOw ALcohol InDuces Atrial TachYarrhythmias (HOLIDAY) Trial revealed that alcohol shortened pulmonary vein atrial effective refractory periods, but more global electrophysiologic changes gleaned from the surface ECG have not yet been reported.
Methods: This was a secondary analysis of the HOLIDAY Trial.
Article Synopsis
- Accurate annotation of local activation time (LAT) is essential for analyzing ventricular tachycardia (VT) substrates, but there's been no large-scale comparison of the various annotation methods used.* -
- The study evaluated five LAT annotation methods across high-density VT substrate maps from patients and found that while some methods showed good identification rates for critical sites, others performed poorly.* -
- The findings suggest that two specific LAT methods (LAT and LAT) are not ideal for mapping, and recommend using LAT as the best approach because it effectively identifies critical sites and lends itself well to automation.*
Article Synopsis
- Frequent premature atrial complexes (PACs) lead to significant atrial remodeling in swine, particularly when originating from the lateral left atrium, increasing P-wave duration and mechanical dyssynchrony.
- The study found that PACs from the lateral left atrium resulted in slower conduction velocity, increased fibrosis in the left atrium, and elevated levels of specific proteins associated with fibrosis and remodeling.
- Additionally, swine with lateral left atrium PACs exhibited the longest durations of inducible atrial fibrillation compared to other groups, suggesting a strong connection between these PACs and the development of AF.
A Case of Alcohol Leading to Isolation in the Electrophysiology Laboratory.
JACC Clin Electrophysiol
December 2023
Background: Active esophageal cooling reduces the incidence of endoscopically identified severe esophageal lesions during radiofrequency (RF) catheter ablation of the left atrium for the treatment of atrial fibrillation. A formal analysis of the atrioesophageal fistula (AEF) rate with active esophageal cooling has not previously been performed.
Objectives: The authors aimed to compare AEF rates before and after the adoption of active esophageal cooling.
Article Synopsis
- A study explored the use of a convolutional neural network (CNN) to identify mechanisms of supraventricular tachycardia (SVT) by analyzing 12-lead electrocardiogram (ECG) data.
- The CNN was developed using data from 1505 ECGs and was tested against assessments made by experienced electrophysiologists for three types of SVT: AVNRT, AVRT, and AT.
- Results showed that the CNN outperformed the electrophysiologists in sensitivity for all SVT classes, indicating its potential to enhance SVT mechanism identification from ECGs.