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- Multielectrode mapping for premature ventricular contraction ablation: a prospective, multicenter studyPublication . Sousa, Pedro A.; Barra, Sérgio; Cortez-Dias, Nuno; Khoueiry, Ziad; Paulo, José; António, Natália; Ferreira, Afonso Nunes; Pereira, Mariana; Lagrange, Philippe; De Sousa, João; Elvas, Luís; Garcia, Fermin C.; Gonçalves, LinoPurpose: We aim to evaluate whether the use of a multielectrode mapping catheter could lead to higher efficacy of premature ventricular contraction (PVC) ablation. Methods: Prospective, multicenter nonrandomized study of consecutive patients referred for PVC ablation from January 2018 to June 2021. Patients were separated into two groups: activation map performed with the PentaRay catheter (Study group) or with the ablation catheter (Control group). PMF software was used in both groups. Procedural endpoints and 1-year freedom from ventricular arrhythmia were assessed. Results: During the enrollment period 136 patients (60% males, mean age of 55 ± 17 years, 60% left-sided origin) fulfilled the inclusion criteria - 68 patients in each group. Patients in the Study Group had a sevenfold higher number of acquired activation points (768 ± 728 vs. 110 ± 79, p < 0.01), a shorter mapping time (28 ± 19 min vs. 49 ± 32 min, p < 0.01) and a quicker procedure time (110 ± 33 min vs. 134 ± 50 min, p < 0.01), compared to patients in the Control Group. While there were no significant differences in the acute success (95.6% in the Study Group vs. 90.1% in Control group, p = 0.49), or adverse events (4% in the Study group vs. 7% in the Control group, p = 0.72), patients in the Study group had a higher freedom from ventricular arrhythmia at 1-year (89.7% vs. 70.6%, p = 0.01). The use of the PentaRay catheter was an independent predictor of success (HR = 6.20 [95% CI, 1.08-35.47], p = 0.003). Conclusions: The use of the PentaRay catheter may improve the outcome of PVC ablation while reducing procedure time.
- Radiofrequency catheter ablation of ventricular tachycardia in ischemic heart disease in light of current practice : a systematic review and meta-analysis of randomized controlled trialsPublication . Lima da Silva, Gustavo; Nunes-Ferreira, Afonso; Cortez-Dias, Nuno; Sousa, João de; Pinto, Fausto J.; Caldeira, DanielPurpose: Ventricular tachycardia (VT) is a frequent cause of mortality and morbidity in patients with ischemic heart disease (IHD). We aim to perform a systematic review and meta-analysis of randomized controlled trials (RCT) of radiofrequency catheter ablation (RCA) of VT in patients with IHD and to discuss its appropriate timing and limitations. Methods: Literature searches of MEDLINE, CENTRAL, the Cochrane Database of Systematic Reviews, Health Technology Assessment, and PsycINFO were performed in February 2020. RCTs comparing RCA vs conventional management for VT in patients with IHD and previous or planned implantable cardioverter defibrillator (ICD) were identified. Clinical outcomes included all-cause mortality, cardiovascular mortality, cardiovascular hospitalization, VT storm, recurrent VT/ventricular fibrillation (VF), appropriate ICD therapies, and appropriate ICD shocks. Using a random-effects model, relative risk (RR) and 95% confidence intervals (CI) were calculated for each outcome. Results: A total of 6 RCTs (N = 791) met inclusion criteria. RCA was associated with significantly lower VT storm (RR 0.70; CI95% 0.51 to 0.94, p = 0.02) and appropriate ICD therapies (RR 0.69; CI95% 0.54 to 0.88, p = 0.003), including appropriate ICD shocks (RR 0.66; CI95% 0.47 to 0.92, p = 0.02). There was no significant difference in all-cause or cardiovascular mortality, cardiovascular hospitalization, and recurrent VT/VF. Conclusions: Radiofrequency catheter ablation for VT in patients with IHD was associated with a reduced risk of VT storm, ICD therapies, and ICD shocks. There is a need for future carefully designed RCTs that incorporate improved RCA procedural aspects.
- Isolation of pulmonary veins with duty-cycled circular multi-polar catheter : randomized controlled clinical trialPublication . Pinto, Fausto J.; Sobral, S.; Ribeiro, J.; Barreiros, C.; Bernardes, Ana; António, P. Silvério; Ferreira, A. Nunes; Silva, Gustavo Lima; Carpinteiro, Luís; Cortez-Dias, Nuno; Sousa, João deIntroduction: Pulmonary vein isolation (PVI) is the central element in the ablation of atrial fibrillation (AF), and can be obtained with different ablation modalities. The dutycycled circular multipole catheter PVAC® (Medtronic) allows linear application of radiofrequency energy, with the production of circumferential lesions. Conceptually, it can make ablation simpler and faster in patients with favorable anatomy.