Background Aortic coarctation (CoA) is a congenital anomaly leading to upper-body hypertension and lower-body hypotension. Despite surgical or interventional treatment, arterial hypertension may develop and contribute to morbidity and mortality. Conventional blood pressure (BP) measurement methods lack precision for individual diagnoses and therapeutic decisions. This study evaluated the use of artificial intelligence-based pulse wave analysis (AI-PWA) to assess central aortic blood pressure (CABP) and related parameters in post-treatment CoA patients. Methods This exploratory, cross-sectional study enrolled 47 adults with CoA, between June 2023 and May 2024. Peripheral BP (PBP) was conventionally measured, and CABP was assessed using the VascAssist2 (inmediQ, Butzbach, Germany). Hypertension was defined by systolic BP≥140 mm Hg and/or diastolic BP≥90 mm Hg for PBP. Using AI-PWA, patients with systolic CABP≥130 mm Hg and/or diastolic BP≥90 mm Hg were classified as hypertensive. Results The study cohort’s age was 41.5±13.7 years, with all patients having undergone previous aortic surgery or intervention. PBP measurements showed a systolic BP of 135.4±14.4 mm Hg at the upper and 147.8±20.3 mm Hg at the lower extremities. CABP measurements were significantly lower, with a systolic BP of 114.3±15.8 mm Hg (p<0.001). Overall, 32 patients (68.1%) were diagnosed as hypertensive, either by PBP measurement (n=13/27.7%), because of antihypertensive treatment (n=9; 40.4%), or a combination of both. The measurement of PBP was more likely to indicate arterial hypertension than the measurement of CABP (n=12; 25.5% vs n=4; 8.5%). Pulse wave velocity, indicative of aortic stiffness, averaged 9.1 m/s, with higher values in 13 patients (27.7%), including 4 after end–end anastomosis, 2 after graft interposition and 7 after stent placement/angioplasty as the most recent procedure. An increased augmentation index as an indicator of arterial stiffness was observed in nine patients (19.1%). Comparing PBP and CABP in the entire collective, significant differences were found for CABP in relation to the procedure performed, with higher values in patients after prosthesis interposition as their last treatment (p<0.05). Conclusion AI-PWA provides valuable insights into cardiovascular stress in CoA patients, beyond PBP measurements. The study highlights the need to incorporate CABP measurements into clinical practice to avoid overdiagnosis of hypertension. Further research with larger cohorts is needed to validate these findings and refine management strategies for CoA patients.
Introduction: Pulmonary vein isolation (PVI) is the established lesion set for paroxysmal atrial fibrillation (PAF).Additional ablation, either linear (roof plus mitral isthmus lines) or CFAE guided, has not been shown to improve results in persistent (PsAF) and longstanding persistent atrial fibrillation (LsPsAF) where outcomes remain inferior to PAF.We describe our experience of left atrial posterior wall isolation -the "box set lesion pattern" in our centre.Methods: Patients with symptomatic PsAF, or recurrent PAF after PVI refractory to anti-arrhythmic drugs are offered further ablation with the aim of left atrial posterior wall isolation.This is either done via catheter ablation alone or via a nonconcomitant hybrid ablation where an epicardial surgical ablation is performed via a right VATS approach and then two months later a second stage catheter ablation is performed.The decision on technique is decided on after discussion with the patient and an MDT consisting of two electrophysiologists, a cardiac surgeon and arrhythmia care co-ordinators.Patients with LsPsAF and those with large left atrial dimensions are favoured for the hybrid approach.All patients are followed up with ECG's and clinical review at 4, 12 and 24 months with 7-day loop monitoring at 12 and 24 months.Further review and monitoring is guided by symptoms.Figure 1 The "box" lesion via catheter Results: Fifty-eight patients have undergone left atrial posterior wall isolation, 25 by catheter ablation alone and 33 via the hybrid approach.In the catheter group 5/25 had PAF but all were redo cases with a median of two previous ablations, 4/ 25 LsPsAF and 16/25 had PsAF.In the hybrid group all had PsAF with 28/33 LsPsAF.Median CHADSVASc score was 1 in the catheter group and 2 in the hybrid group.There have been no acute complications with catheter ablation in either group but one patient had a fatal CVA after the surgical first stage.Posterior wall isolation with confirmed entrance and exit block was achieved in 19/25 of the catheter group and 32/33 of the hybrid group.Forty-five patients have more than 3 months follow-up (19 catheter, 26 Hybrid) with a median follow-up of 12 months (IQR 7-22) and 76% (34/45) have remained arrhythmia free, 7/45 are on anti-arrhythmic drugs(AAD).In the catheter group after a median follow-up of 16 months (IQR 10-23) 74% were free of atrial arrhythmia recurrence post blanking period (2/19 have remained on AAD).In the hybrid group after a median 11 months follow-up (IQR 11-20) 77% were free of atrial arrhythmia recurrence post blanking period (5/26 on AAD).Conclusions: Left atrial posterior wall isolation with the box lesion pattern appears to give greater freedom from atrial arrhythmia than the STAR AF II lesion sets.Outcomes were equivalent with both the catheter alone and hybrid methods however the hybrid group was primarily LsPsAF.No evidence of oesophageal complications were seen in either group .
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