Publications by authors named "G-B Chierchia"
Article Synopsis
- Brugada syndrome (BrS) is linked to dangerous heart rhythms called ventricular fibrillation (VF), and this study explores VF mapping using ECG imaging to understand the relationship between different VF mechanisms.* -
- The researchers focused on patients diagnosed with BrS who experienced VF during a specific heart procedure, analyzing various heart rhythm maps to identify spatial correlations between repolarization gradients and VF triggers.* -
- Results showed that most BrS patients had distinct "repolarization cliffs" that initiated VF, suggesting these cliffs could be important targets for treatment to prevent VF recurrence.*
Article Synopsis
- Pulsed field ablation (PFA) is a new treatment for atrial fibrillation (AF) that shows strong safety and efficacy by specifically targeting heart muscle cells while sparing nearby tissues.
- A meta-analysis comparing PFA with cryoballoon ablation (CRYO) found that PFA had higher procedural success rates and fewer complications, along with shorter procedural and fluoroscopy times.
- However, there were no significant differences in major complications or freedom from atrial tachyarrhythmias after one year between the two techniques.
Aims: Rhythm control of non-paroxysmal atrial fibrillation (AF) is significantly more challenging, as a result of arrhythmia perpetuation promoting atrial substrate changes and AF maintenance. We describe a tailored ablation strategy targeting multiple left atrial (LA) sites via a pentaspline pulsed field ablation (PFA) catheter in persistent AF sustained beyond 6 months (PerAF > 6 m) and long-standing persistent AF (LSPAF).
Methods And Results: The ablation protocol included the following stages: pulmonary vein antral and posterior wall isolation plus anterior roof line ablation (Stage 1); electrogram-guided substrate ablation (Stage 2); atrial tachyarrhythmia regionalization and ablation (Stage 3).
Background: Pulsed field ablation (PFA) is a novel technology for catheter-based atrial arrhythmia treatment. Evidence of its application for ventricular arrhythmia ablation is still limited. In this study, we describe the feasibility and efficacy of focal PFA for premature ventricular contraction (PVC) ablation.
View Article and Find Full Text PDFShortened radiofrequency delivery time to optimize efficiency and safety of pulmonary vein isolation with the radiofrequency balloon: insights from the COLLABORATE registry.
Europace
August 2024
Aims: Previous clinical studies on pulmonary vein isolation (PVI) with a radiofrequency balloon (RFB) reported safe and effective procedures using conventional ablation settings with 20/60 s RF delivery via posterior/anterior (PST/ANT) electrodes. The latest evidence suggests that reducing the application time to 15 s (s) on the posterior wall when facing the oesophageal region is as effective as applying 20 s. To prospectively assess whether reducing RF time on PST/ANT segments to 15/45 s can ensure sufficient quality of lesion metrics and compare the new shortened ablation settings with the conventional one in terms of safety, and effectiveness at 1-year.
View Article and Find Full Text PDFArticle Synopsis
- Pulsed field ablation (PFA) is gaining popularity as a treatment for atrial fibrillation, but its impact on hemolysis (destruction of red blood cells) has not been thoroughly studied.
- In this study involving 145 patients receiving PFA and 70 patients undergoing radiofrequency ablation, significant hemolysis was found predominantly in the PFA group, with 94.3% affected compared to just 6.8% in the radiofrequency group.
- Higher numbers of PFA deliveries correlated with increased hemolysis severity, with notable increases in biomarkers indicating red blood cell damage and renal function impacts, especially in patients with lower baseline kidney function.
Article Synopsis
- Pulsed field ablation (PFA) is a new method for treating atrial fibrillation (AF) that focuses on ablating heart tissue while minimizing harm to nearby structures.
- In the MANIFEST-17K study, data from 106 centers involved 17,642 patients and showed no serious complications like esophageal damage, with only a 1% major complication rate.
- The results suggest that PFA has a strong safety profile and may change how AF is treated, compared to traditional thermal ablation methods.
Article Synopsis
- Antibiotic prophylaxis (AB) reduces bacteriuria after invasive urodynamics (UDS) but does not significantly lower urinary tract infection (UTI) rates; guidelines for AB use in high-risk patients remain unclear.
- A systematic review and expert consensus via a modified Delphi method identified key patient categories at risk for UTIs and proposed 16 statements regarding AB use.
- The panel of 57 experts largely agreed (56.25%) on the necessity of AB for patients with neurogenic bladder and immunosuppression, while advising against AB for several other factors such as menopausal status and diabetes.
Article Synopsis
- - The study examined 500 patients with Brugada syndrome (BrS) to evaluate the genetic variants' presence and their relation to prognosis, discovering that about 20.8% had pathogenic variants in the SCN5A gene, which indicate a worse outcome.
- - Of the patients analyzed, 75 were found to have a gene variant, with the majority being missense variants; however, those without any genetic variants showed better protection against ventricular arrhythmias (VA).
- - The findings concluded that carrying a predicted loss of function variant—either in the SCN5A gene or other related genes—was a significant factor in predicting the likelihood of experiencing VA.
Aims: Pulsed field ablation (PFA) has emerged as a novel, non-thermal energy source to selectively ablate cardiac tissue. We describe a multicentre experience on pulmonary vein isolation (PVI) via the pentaspline Farapulse™ PFA system vs. thermal-based technologies in a propensity score-matched population of paroxysmal atrial fibrillation (PAF) patients.
View Article and Find Full Text PDFArticle Synopsis
- 3D-intracardiac echocardiography (ICE) enhances visualization of the left atrial appendage (LAA) during surgical procedures and leads to a high success rate for LAA occlusions.
- In a study of 274 patients, 3D-ICE showed better accuracy in sizing the device compared to traditional 2D-ICE, with a 96.3% agreement on the final device size.
- Both imaging methods provided a similar procedural success rate, but 3D-ICE reduced the need for device recapture and resizing during the procedure.
Article Synopsis
- - The study investigates how common coronary artery disease (CAD) is in patients with atrial fibrillation (AF) undergoing catheter ablation (CA) and assesses the influence of CAD on recovery outcomes post-ablation.
- - Out of 576 AF patients screened, 21.2% were found to have CAD, with 7.1% diagnosed with critical CAD; critical CAD was initially linked to increased recurrence of atrial tachyarrhythmia but wasn't an independent predictor upon further analysis.
- - The findings suggest that despite the presence of CAD, patients should not be denied AF ablation because it can safely occur in conjunction with CAD treatment, highlighting the importance of not overlooking AF ablation due to CAD.
Article Synopsis
- Atrial fibrillation (AF) and chronic kidney disease (CKD) can occur together, increasing the risk of dangerous blood clots and bleeding.
- In a study of 2,124 AF patients who had a specific procedure to prevent blood clots, those with more severe CKD had higher risks of major health problems.
- The procedure reduced the risk of blood clots significantly across all CKD groups, but patients with more severe CKD still had worse outcomes compared to those with milder CKD.
Aims: Cryoballoon (CB) ablation is the mainstay of single-shot pulmonary vein isolation (PVI). A radiofrequency balloon (RFB) catheter has recently emerged as an alternative. However, these two technologies have not been compared.
View Article and Find Full Text PDFAims: Hybrid atrial fibrillation (AF) ablation is a promising approach in non-paroxysmal AF. The aim of this study is to assess the long-term outcomes of hybrid ablation in a large cohort of patients after both an initial and as a redo procedure.
Methods And Results: All consecutive patients undergoing hybrid AF ablation at UZ Brussel from 2010 to 2020 were retrospectively evaluated.
Background: The influence of divergent anesthesia types during ablation of premature ventricular complexes (PVCs) is not known. While previously performed under general anesthesia (GA) at our institution, these procedures were exclusively performed under local anesthesia (LA) ± minimal sedation during the COVID-19 outbreak for logistic reasons.
Methods: One hundred and eight consecutive patients (82 GA versus 26 LA) undergoing PVC ablation at our center were evaluated.
Article Synopsis
- A study aimed to evaluate the effectiveness and outcomes of SCN5A gene testing in pediatric patients with Brugada syndrome (BrS) compared to adults, focusing on the presence of pathogenic variants.
- The research included 500 patients diagnosed with BrS over 30 years, revealing that 46% of the children tested positive for pathogenic variants, which was associated with a higher risk of ventricular arrhythmias (VAs).
- Ultimately, the study concluded that while 46% of pediatric patients have pathogenic variants, those who did showed a worse prognosis for arrhythmias compared to those without, with similar outcomes for both pediatric and adult patients regardless of their variant status.
Nowadays, the cryoballoon (CB) constitutes an established alternative to radio frequency (RF) ablation for pulmonary vein isolation (PVI), which offers the possibility to isolate the PVs with a single application. Since the introduction of the second-generation CB, we prospectively collected our data to optimize the procedure on >1000 consecutive patients who underwent CB PVI performed in our center. It is expected that subsequent guidelines will suggest first-line PVI through CB in patients with paroxysmal AF with a class I indication.
View Article and Find Full Text PDFThe lack of thermally and mechanically performant biomaterials represents the major limit for 3D-printed surgical guides, aimed at facilitating complex surgery and ablations. Cryosurgery is a treatment for cardiac arrhythmias. It consists of obtaining cryolesions, by freezing the target tissue, resulting in selective and irreversible damage.
View Article and Find Full Text PDFAims: The multielectrode radiofrequency balloon catheter (RFB) has been developed to achieve safe and effective pulmonary vein isolation (PVI) for atrial fibrillation (AF) ablation. This single-centre study aimed to evaluate the midterm clinical outcome and predictors of single-shot PVI with the novel RFB.
Methods And Results: All consecutive patients with symptomatic paroxysmal or persistent AF undergoing first-time PVI with the RFB were prospectively included.
Article Synopsis
- The study aims to find predictors of late pulmonary vein (PV) reconnection after second-generation cryoballoon (CB2) ablation by analyzing anatomic indicators at the individual PV level, which has not been previously explored.
- A total of 125 patients undergoing repeat procedures for arrhythmia recurrence were examined, using preprocedural CT scans to assess various anatomic features of 486 PVs, revealing a 40% rate of durable isolation in patients and varying late reconnection rates across different PVs.
- Key predictors of late PV reconnection were identified, with CT-based anatomic evaluations showing stronger predictive power than clinical and procedural factors, suggesting that understanding PV anatomy could enhance the effectiveness of ablation procedures.
Background: Non-contact charge density (CD) mapping allows a global visualization of left atrium (LA) activation and of activation patterns during atrial fibrillation (AF). The aim of this study was to analyze, with CD mapping, the changes in persistent AF induced by pulmonary vein isolation (PVI) and LA posterior wall isolation (LAPWI).
Methods: Patients undergoing PVI + LAPWI using the Arctic Front Advance PRO cryoballoon system were included in the study.
Background: Left atrial posterior wall isolation (LAPWI) is often performed in addition to pulmonary vein isolation (PVI) in the setting of persistent atrial fibrillation (AF) ablation. The aim of this study was to evaluate the feasibility and safety of a new cryoballoon ablation system in achieving PVI + LAPWI isolation.
Methods: The study was a prospective, non-randomized, single center study.