Pulmonary vein (PV) isolation is one of the cornerstones of rhythm-control therapy for symptomatic atrial fibrillation (AF) patients. Pulsed field ablation (PFA) is a novel ablation modality that involves the application of electrical pulses causing cellular death, and it has preferential tissue specificity. In this study, we aimed to share a one-year single center experience of AF ablation with PFA. Single center, retrospective study of consecutive patients undergoing PVI using the pentaspline PFA catheter between June 2022 to July 2023. Data on demographic, procedural, and electrocardiographic recurrence (assessed after a three-month blanking period) were analyzed. 123 consecutive patients were included (62±11 years, 59% male), with a mean CHA2DS2-VASc score of 2±1 points, median left ventricular ejection fraction of 61% [IQR 60-65%] and a median left atrial volume index (by CT scan) of 55 mL/m2 [IQR 41-67 mL/m2]. 52% patients presented paroxysmal AF and 21 patients (17%) underwent a redo ablation. Median procedure time was 83 min [IQR 59-117 min] and median fluoroscopy time was 11.6 min [IQR 8.2 - 15.6 min]; posterior wall isolation was performed in 43 (35%). Two patients (1.6%) experienced acute cardiac tamponade, immediately treated with pericardiocentesis. Other complications were primarily vascular, in 4% of cases (three femoral hematomas, one femoral pseudoaneurysms, one arteriovenous fistula). Over 290 (IQR 169 - 387) days of follow-up, considering electrocardiographic recurrence beyond the blanking period, 9% of patients had AF recurrence (two with paroxysmal AF and nine with persistent AF). Pulsed field ablation for PVI and posterior wall ablation was an efficient and safe procedure with low rate of complications and high percentage of patients were free from AF in short-term follow-up. We need more studies to evaluate long-term success.
Natriuretic peptides are ubiquitously used for diagnosis, follow-up and prognostic assessment in various heart conditions. N-terminal pro-brain natriuretic peptide (NT-proBNP) correlates with aortic stenosis severity, however its significance after transcatheter aortic valve implantation (TAVI) is not well established. We aimed to assess the prognostic value of NT-proBNP at one year in patients undergoing TAVI. This single-center retrospective analysis included 151 patients in whom both baseline and one-month post-procedure NT-proBNP were measured, from 206 consecutive patients undergoing TAVI between November 2008 and December 2014. The best cut-off values of both baseline and one-month post-TAVI NT-proBNP for one-year mortality were determined by receiver operating characteristic curve analysis. Independent predictors of one-year mortality were assessed by Cox regression. The areas under the curve of baseline and post-procedural NT-proBNP for one-year mortality were 0.60 and 0.72, with the best cut-off values of 1350 and 2500 pg/ml, respectively. Atrial fibrillation, procedure-related major bleeding, baseline NT-proBNP higher than 1350 pg/ml, post-procedural NT-proBNP higher than 2500 pg/ml, higher creatinine and Society of Thoracic Surgeons score, and lower left ventricular ejection fraction were associated with one-year mortality. Only post-procedural NT-proBNP was independently and negatively associated with one-year survival (HR 5.9, 95% CI 1.6-21.7, p=0.008). Baseline NT-proBNP did not predict one-year mortality; on the other hand one-month post-procedural NT-proBNP higher than 2500 pg/ml may identify a high-risk subset of patients, allowing better management, care and hypothetically outcome. Os peptídeos natriuréticos são usados de forma ubíqua para o diagnóstico, seguimento e avaliação prognóstica em cardiologia. O NT-ProBNP correlaciona-se com a gravidade da estenose aórtica, porém o seu significado após VAP não está bem estabelecido. Avaliar o valor prognóstico do NT-ProBNP nos doentes submetidos a VAP. Análise retrospetiva de 151 doentes, de um registo de 206 doentes consecutivos de novembro de 2008 a dezembro de 2014, com doseamentos de NT-ProBNP basal e após um mês da implantação de VAP. Os preditores independentes de mortalidade a um ano foram avaliados por regressão Cox. Os melhores valores discriminativos de NT-ProBNP basal e pós-procedimento foram 1.350 e 2.500, respetivamente. Somente um valor de NT-ProBNP pós-procedimento superior a 2.500pg/ml foi preditor independente e negativamente associado à sobrevida a um ano (HR 5,9; 95% IC 1,6-21,7; p = 0,008). O NT-ProBNP basal não previu a mortalidade a um ano. Por outro lado, o NT-ProBNP superior a 2.500pg/ml após o procedimento identificou um subgrupo de doentes de alto risco, permitiu um melhor manejo, seguimento e possíveis resultados.
Natriuretic peptides are ubiquitously used for diagnosis, follow-up and prognostic assessment in various heart conditions. N-terminal pro-brain natriuretic peptide (NT-proBNP) correlates with aortic stenosis severity, however its significance after transcatheter aortic valve implantation (TAVI) is not well established. We aimed to assess the prognostic value of NT-proBNP at one year in patients undergoing TAVI. This single-center retrospective analysis included 151 patients in whom both baseline and one-month post-procedure NT-proBNP were measured, from 206 consecutive patients undergoing TAVI between November 2008 and December 2014. The best cut-off values of both baseline and one-month post-TAVI NT-proBNP for one-year mortality were determined by receiver operating characteristic curve analysis. Independent predictors of one-year mortality were assessed by Cox regression. The areas under the curve of baseline and post-procedural NT-proBNP for one-year mortality were 0.60 and 0.72, with the best cut-off values of 1350 and 2500 pg/ml, respectively. Atrial fibrillation, procedure-related major bleeding, baseline NT-proBNP higher than 1350 pg/ml, post-procedural NT-proBNP higher than 2500 pg/ml, higher creatinine and Society of Thoracic Surgeons score, and lower left ventricular ejection fraction were associated with one-year mortality. Only post-procedural NT-proBNP was independently and negatively associated with one-year survival (HR 5.9, 95% CI 1.6-21.7, p=0.008). Baseline NT-proBNP did not predict one-year mortality; on the other hand one-month post-procedural NT-proBNP higher than 2500 pg/ml may identify a high-risk subset of patients, allowing better management, care and hypothetically outcome. Os peptídeos natriuréticos são usados de forma ubíqua para o diagnóstico, seguimento e avaliação prognóstica em cardiologia. O NT-ProBNP correlaciona-se com a gravidade da estenose aórtica, porém o seu significado após VAP não está bem estabelecido. Avaliar o valor prognóstico do NT-ProBNP nos doentes submetidos a VAP. Análise retrospetiva de 151 doentes, de um registo de 206 doentes consecutivos de novembro de 2008 a dezembro de 2014, com doseamentos de NT-ProBNP basal e após um mês da implantação de VAP. Os preditores independentes de mortalidade a um ano foram avaliados por regressão Cox. Os melhores valores discriminativos de NT-ProBNP basal e pós-procedimento foram 1.350 e 2.500, respetivamente. Somente um valor de NT-ProBNP pós-procedimento superior a 2.500pg/ml foi preditor independente e negativamente associado à sobrevida a um ano (HR 5,9; 95% IC 1,6-21,7; p = 0,008). O NT-ProBNP basal não previu a mortalidade a um ano. Por outro lado, o NT-ProBNP superior a 2.500pg/ml após o procedimento identificou um subgrupo de doentes de alto risco, permitiu um melhor manejo, seguimento e possíveis resultados.
'/%3e%3c/g%3e%3cuse xlink:href='%23d' x='45.714'/%3e%3cuse xlink:href='%23e' transform='matrix(-1 0 0 1 479.792 0)'/%3e%3cg id='f' fill='%23fff'%3e%3cpath fill='%23039' d='M232.636 202.406v.005c0 2.212.85 4.227 2.212 5.69 1.365 1.466 3.245 2.377 5.302 2.377 2.067 0 3.944-.905 5.303-2.365 1.358-1.459 2.202-3.472 2.202-5.693v-10.768l-14.992-.013-.028 10.766'/%3e%3ccircle cx='236.074' cy='195.735' r='1.486'/%3e%3ccircle cx='244.392' cy='195.742' r='1.486'/%3e%3ccircle cx='240.225' cy='199.735' r='1.486'/%3e%3ccircle cx='236.074' cy='203.916' r='1.486'/%3e%3ccircle cx='244.383' cy='203.905' r='1.486'/%3e%3c/g%3e%3cuse xlink:href='%23f' y='-26.016'/%3e%3cuse xlink:href='%23f' x='-20.799'/%3e%3cuse xlink:href='%23f' x='20.745'/%3e%3cuse xlink:href='%23f' y='25.784'/%3e%3c/svg%3e)