Publications by authors named "Marchlinski F"
Background: In patients with mechanical aortic and mitral valves requiring catheter ablation of ventricular tachycardia (VT), a technique for access from the right atrium (RA) to the left ventricle (LV) via puncture of the inferoseptal process of the LV was previously described in a single-center series.
Objectives: This study sought to report the multicenter experience of VT ablation using this novel LV access approach.
Methods: We assembled a multicenter registry of patients with double mechanical valves who underwent VT ablation with RA-to-LV access.
Background: Causal machine learning (ML) provides an efficient way of identifying heterogeneous treatment effect groups from hundreds of possible combinations, especially for randomized trial data.
Objective: The aim of this paper is to illustrate the potential of applying causal ML on the DECAAF II trial data. We proposed a causal ML model to predict the treatment response heterogeneity.
Preclinical Experience Using 4D Intracardiac Echocardiography to Guide Cardiac Electrophysiology Procedures.
J Cardiovasc Electrophysiol
December 2024
Introduction: Intracardiac echocardiography (ICE) is an essential imaging modality for electrophysiology procedures, allowing intraprocedural monitoring, real-time catheter manipulation guidance, and visualization of complex anatomic structures. Four-dimentional (4D) ICE is the next stage in the evolution of the technology, permitting 360° rotation of the imaging plane, simultaneous multiplanar imaging, and volumetric acquisition, similar to transesophageal echocardiography (TEE). In this study, we report our experience with a novel 4D ICE catheter (NuVision, Biosense Webster) in structural electrophysiology procedures and difficult ventricular ablations in a swine preclinical model.
View Article and Find Full Text PDFImportance: Infrequent intraprocedural premature ventricular complexes (PVCs) limit the efficacy of catheter ablation. Intravascular stimulation of sympathetic nerves via vertebral veins (VVs) has been used to activate cardiac sympathetic tone and may promote PVCs.
Objective: To characterize the ability of direct electrical sympathetic stimulation via VVs to induce PVCs at the time of catheter ablation.
Background: Patients undergoing first-time atrial fibrillation (AF) ablation can benefit from targeting non-pulmonary vein (PV) triggers. Preprocedural identification of high-risk individuals can guide planning of ablation strategy. This study aimed to create a preprocedural screening tool to identify patients at risk of non-PV triggers during first-time AF ablation.
View Article and Find Full Text PDFBackground: Studies show mixed results regarding the effect of coronary revascularization on mortality benefit and ventricular tachycardia (VT) recurrence in patients with monomorphic VT without acute coronary syndrome (ACS). This meta-analysis aimed to assess the effect of ischemia testing and/or coronary revascularization on mortality and VT recurrence in a pooled data set.
Methods: Databases including PubMed, Google Scholar, and the Cochrane Library were searched from January 2000 to December 2023 for studies reporting event data on mortality and VT recurrence in patients without ACS who presented with monomorphic VT.
Background: The ability to predict recovery of left ventricular ejection fraction (LVEF) in response to guideline-directed therapy among patients with nonischemic cardiomyopathy is desired. We sought to determine whether left ventricular endocardial unipolar voltage measured during invasive electroanatomic mapping could be used to predict LVEF recovery among those with recent-onset nonischemic cardiomyopathy.
Methods: We analyzed the left ventricular voltage maps of patients included in the eMAP trial (Electrogram-Guided Myocardial Advanced Phenotyping; NCT03293381), a prospective, nonrandomized, interventional trial conducted at 2 institutions between 2017 and 2020.
Objectives: To investigate tailored approaches, techniques, and outcomes of catheter ablation in patients with persistent left superior vena cava (PLSVC) undergoing atrial fibrillation (AF) ablation.
Background: PLSVC presents unique challenges for AF ablation due to its potential as an arrhythmogenic source and the complex anatomical variations it introduces.
Methods: The retrospective cohort included 16 patients with PLSVC that underwent 21 AF ablation procedures between August 1, 2008, and February 14, 2024, at the Hospital of the University of Pennsylvania.
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%.
Lipomatous Metaplasia Facilitates Ventricular Tachycardia in Patients With Nonischemic Cardiomyopathy.
JACC Clin Electrophysiol
November 2024
Article Synopsis
- The study investigates the role of lipomatous metaplasia (LM) as a critical anatomical feature in the pathways that lead to ventricular tachycardia (VT) in patients with nonischemic cardiomyopathy (NICM).
- Researchers analyzed cardiac MRI and electroanatomical maps from 49 patients, revealing that VT corridors had significantly higher volumes of LM.
- The findings suggest that these VT corridors not only contain more LM but also show lower variability in current amplitude, indicating that LM may help stabilize electrical signaling during VT episodes.
Article Synopsis
- Lead-related venous stenosis (LRVS), often diagnosed incidentally, can cause symptoms like swelling and discomfort in patients with transvenous leads, although actual symptomatic cases are rarer.
- A study at the Hospital of the University of Pennsylvania analyzed 18 patients with symptomatic LRVS who did not respond to anticoagulation and underwent balloon venoplasty, finding that a significant majority (72%) experienced complete symptom relief post-procedure.
- The study concluded that while balloon venoplasty is generally safe and effective, timely intervention is crucial, especially as treatment becomes less effective when secondary lymphedema is present.
Article Synopsis
- Atrial conduction velocity (CV) is important in understanding heart conditions like atrial fibrillation, and it can be influenced by the body's autonomic nervous system.
- This study investigated how CV in the right atrium changes with sympathetic stimulation, either through medication (isoproterenol) or direct electrical stimulation of the vertebral vein.
- Results showed that both methods significantly increased CV and reduced CV variability compared to baseline sinus rhythm, indicating that sympathetic stimulation improves heart conduction efficiency.
Article Synopsis
- The study investigates the long-term risk of damage to the right coronary artery (RCA) after patients undergo radiofrequency ablation (RFA) for atrial flutter related to the cavotricuspid isthmus (CTI).
- A comparison was made between patients who had CTI RFA and those who only received ablation for atrial fibrillation (AF), with coronary angiography performed afterward to evaluate any differences in RCA stenosis.
- Results indicate that there were no significant differences in the incidence or severity of RCA stenoses between the two groups, suggesting that CTI RFA does not increase the risk of RCA damage in the long term.
Article Synopsis
- - A randomized trial showed that adding delayed enhancement MRI-guided fibrosis ablation to pulmonary vein isolation (PVI) for treating atrial fibrillation (AF) didn’t improve outcomes, with similar recurrence rates between the two methods.
- - The study analyzed how effectively lesions delivered during ablation covered fibrotic areas, finding that a much higher percentage of targeted fibrosis was successfully ablated using MRI guidance compared to PVI alone.
- - While overall scar coverage didn’t significantly reduce AF recurrence, lower recurrence rates were noted in patients with less baseline fibrosis when fibrosis-targeted ablation was used, indicating variability in treatment effectiveness.
Background: Cardiac implantable electronic device (CIED) procedures can cause significant postoperative pain. Opioid use for postoperative pain is associated with risk of persistent use. The benefits of pectoral nerve (PECs) blocks have been established for other chest wall surgeries, but adoption in electrophysiology has been limited.
View Article and Find Full Text PDFBackground: The importance of nonpulmonary vein (PV) triggers for the initiation/recurrence of atrial fibrillation (AF) is well established.
Objectives: This study sought to assess the incremental benefit of provocative maneuvers for identifying non-PV triggers.
Methods: We included consecutive patients undergoing first-time AF ablation between 2020 and 2022.
Article Synopsis
- Right phrenic nerve (RPN) injury is a rare but serious complication during atrial fibrillation radiofrequency ablation, and this study seeks to understand the relationship between pacing sites and actual RPN anatomy.
- Researchers conducted a study involving 45 patients to map the RPN's course using high-output pacing and CT scans, analyzing data from 1,033 pacing sites.
- The findings indicate that non-capture at high pacing thresholds is a reliable predictor of being more than 10mm away from the RPN, which helps ensure safer radiofrequency ablation procedures.