The front cover image is based on the Original Article High-power, short-duration atrial fibrillation ablation compared with a conventional approach: Outcomes and reconnection patterns by Simon P. Hansom et al., https://doi.org/10.1111/jce.14989.
An increasing number of transseptal punctures (TSPs) are performed worldwide for atrial ablations. Transseptal punctures can be complex and can be associated with potentially life threatening complications. The purpose of the study was to evaluate the safety and efficacy of a novel transseptal guidewire (TSGW) designed to facilitate TSPs. Transseptal punctures were performed using a SafeSept TSGW passed through a standard TSP apparatus. Transseptal punctures were performed by standard technique with additional use of a TSGW allowing probing of the interatrial septum without needle exposure and penetration of the fossa into the left atrium (LA). Transseptal puncture using the TSGW was performed in 210 patients. Left atrial access was achieved successfully in 205 of 210 patients (97.6%) and in 96.3% of patients undergoing repeat TSP. Left atrial access was achieved with the first pass in 81.2% (mean 1.4 ± 0.9 passes, range 1-6) using the TSGW. No serious complications were attributable to the use of the TSGW, even in cases of failed TSP. The TSGW is associated with a high success rate for TSP and may be a useful alternative to transoesophageal or intracardiac echocardiogram-guided TSP.
Background There are discrepancies in the quantitative echocardiographic criteria for the right ventricle ( RV ) between the revised task force criteria ( TFC ) for Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia ( ARVC /D) and the guidelines for RV assessment endorsed by American Society of Echocardiography ( ASE ). Importantly, these criteria do not take into account potential adaptation of the RV to exercise. The goal of this study was to compare the revised TFC quantitative echocardiographic parameters in patients with ARVC /D, athletes and matched controls. Methods Echocardiographic parameters of the RV were retrospectively collected in patients who fulfilled the TFC for ARVC /D, an age‐ matched, sex‐matched, and body surface area‐matched control population, and athletes (defined as individuals who exercised for more than 7 hours per week). Patients with structural heart disease were excluded in the control and athlete groups. Results Twenty patients with ARVC /D, 11 athletes and 20 matched controls were included. There was no significant difference between ARVC /D patients and athletes with the exception of the parasternal long axis right ventricular outflow tract diameter. All parameters were significantly different between ARVC /D patients and the control group. Furthermore, when subjects were categorized into meeting 1 major revised TFC /abnormal ASE criteria or not, only ASE criteria were able to differentiate ARVC /D from control population. Both were unable to differentiate ARVC /D from athletes. Conclusions Right ventricle quantitative echocardiographic criteria in the revised TFC are not specific for ARVC /D. Care should be taken in applying these criteria in athletes.
BackgroundMultiple studies have examined the prevalence of left atrial appendage thrombus (LAAT) in patients anticoagulated with direct oral anticoagulants (DOACs) and have reported conflicting results.MethodsStudies reporting the prevalence of LAAT on transesophageal echocardiography (TEE) after 3 or more weeks of DOAC therapy were identified. The proportions of anticoagulated patients diagnosed with LAAT were pooled using random-effects models. Prespecified subgroup analyses by the indication of TEE (pre–atrial fibrillation [AF] ablation vs cardioversion) and TEE strategy (routine use vs selective) were conducted via stratification.ResultsForty studies were identified: 22 full manuscripts and 18 abstracts. Only 11 studies performed TEE routinely. Most studies included patients with paroxysmal AF and low thromboembolic risk. The pooled prevalence of LAAT was 2.5% (95% confidence interval [1.6%-3.4%]). The prevalence of LAAT is lower in the pre-AF ablation group compared with pre-cardioversion (1.1% vs 4.0%, P = 0.033). Routine TEE strategy yielded a lower LAAT prevalence in both groups (0.1% vs 2.3%, P = 0.002 and 3.2% vs 5.8%, P = 0.432, respectively).ConclusionThe reported prevalence of LAAT on TEE in patients treated with DOACs is highly variable. Factors associated with a high LAAT prevalence were pre-cardioversion indication and selective TEE strategy. Routine use of TEE before AF ablation may not be warranted.
