Browsing by Tema "Ablation"

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A novel endovascular thermal ablation technique for pelvic venous disorders via basilic vein access: A prospective descriptive study
(Elsevier BV, 2026) Luis Moreno; Fredy Rivero; Nicolas Forero Ramirez; Luis Felipe Cabrera Vargas
Basilic access 1470-nm EVLA of refluxing gonadal veins is feasible, safe, and shows high early technical and clinical success with same-day discharge and no complications in this pilot cohort. Larger multicenter randomized trials with follow-up beyond 12 months, blinded imaging review, standardized patient-reported outcomes, and cost-effectiveness analyses are warranted.
Ablation of manifest accessory pathways in pediatric patients: comparison between conventional and non‑radiological navigation techniques
(Springer Science+Business Media, 2026) Alejandro Cuesta; M. Arocena; José M. Moltedo; F Vidal; Pedro Iturralde; Manlio F. Márquez-Murillo; Moisés Levinstein J; Santiago T. Nava; Gerardo Rodríguez-Diez; Elaine Núñez
Abstract 4145634: Clinical Outcomes of Catheter Ablation for Atrial Fibrillation in Younger Adults: A Systematic Review and Meta-Analysis
(Lippincott Williams & Wilkins, 2024) Sawai Singh Rathore; Ameer Mustafa Farrukh; Sem Josue Nsanh Yao; Vanessa Vidaurre Corrales; Zario Wint; Ibrahim Al Shyyab; Aman Goyal; Hritvik Jain; Ashish Kumar
Background: Catheter ablation has been increasingly used for managing atrial fibrillation (AF), to restore and maintain normal sinus rhythm. Despite its widespread use, it is unclear if there are differences in clinical outcomes, particularly in maintaining rhythm control and safety outcomes, between younger and older adults undergoing catheter ablation. The objective of this meta-analysis was to compare the outcomes following catheter ablation in younger and older adults. Methods: A comprehensive literature search was conducted using the PubMed, Embase, and Google Scholar databases. Using random effect models, mantel-Haenszel odds ratios and associated 95% confidence intervals were calculated to report the overall effect size. The primary endpoints were AF/atrial tachycardia (AT) recurrence and re-ablation requirement. Secondary outcomes included in-hospital complications such as stroke/TIA, cardiac tamponade/pericardial effusion, and vascular complications such as bleeding, hematoma, AV fistula, and femoral pseudoaneurysm. The young adult group varied between studies, ranging from under 30 years to under 45 years. Results: Data from 10 articles, with a sample size of about 126,141 AF patients, were considered. Our analysis indicated that catheter ablation for AF in the younger age group was linked to reduced odds of AF/AT reoccurrence (OR: 0.60; 95% CI: 0.44 to 0.83; p=0.002) and a decreased need for re-ablation after the index procedure (OR: 0.72; 95% CI: 0.53 to 0.97; p=0.03). Furthermore, catheter ablation in younger adults was found to be associated with a lower risk of in-hospital procedural complications like stroke/TIA (OR: 0.59; 95% CI: 0.43 to 0.80; p=0.0008) and cardiac tamponade/pericardial effusion (OR: 0.53; 95% CI: 0.42 to 0.68; p<0.0001). There was no difference between the two groups concerning vascular complications during the procedure (OR: 0.60; 95% CI: 0.28 to 1.27; p=0.18). Conclusion: This meta-analysis demonstrates that younger adults undergoing catheter ablation for atrial fibrillation reported significantly better clinical outcomes than older adults.
Abstract 4145690: Impact of Sodium-Glucose Cotransporter 2 Inhibitors on Atrial Fibrillation Recurrence After Catheter Ablation in Patients with Diabetes: A Systematic Review and Meta-Analysis
(Lippincott Williams & Wilkins, 2024) Sawai Singh Rathore; Ibrahim Al Shyyab; Ameer Mustafa Farrukh; Hamam Aneis; Sem Josue Nsanh Yao; Vanessa Vidaurre Corrales; Zario Wint; Ashish Kumar
Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated cardiovascular benefits beyond glycemic control, including potential anti-arrhythmic effects. The impact of SGLT2 inhibitors on atrial fibrillation (AF) recurrence following catheter ablation in diabetic patients is an area of emerging interest. The purpose of this meta-analysis was to evaluate the impact of SGLT2 inhibitors on AF recurrence following catheter ablation in patients with diabetes. Methods: A comprehensive literature search was carried out using PubMed, Embase, and Google Scholar databases for the studies comparing SGLT2 inhibitors with other antidiabetic drugs in AF patients undergoing catheter ablation. Using random effect models, Mantel-Haenszel odds ratios and associated 95% confidence intervals were produced to report the overall effect size. Statistical significance was set at p < 0.05. Egger's regression test and Begg-Mazumdar's rank test were used to assess publication bias. The primary endpoint was the reoccurrence of atrial fibrillation after catheter ablation during the follow-up period, which varied between studies and ranged from 12 to 33 months. Results: The analysis included six studies, involving a sample size of around 5,765 AF patients. Our study reported that the use of SGLT2 inhibitors in diabetic patients undergoing catheter ablation for AF was associated with lower odds of AF reoccurrence (OR: 0.46; 95% CI: 0.32 to 0.65; p<0.0001) compared with other antidiabetic medications. This outcome has moderately associated heterogeneity, with I2 of 59%. Egger's regression test and Begg-Mazumdar's rank test showed no evidence of publication bias (p > 0.05). Conclusion: The use of SGLT2 inhibitors was associated with improved outcomes post-catheter ablation for AF diabetic patients. Further large-scale, randomized controlled trials are warranted to confirm these findings and elucidate the underlying mechanisms.
Abstract 4360333: Pulmonary Vein Isolation Combined With Linear Ablation Improves Outcomes in Persistent Atrial Fibrillation: A Systematic Review and Meta-Analysis of 1,431 Patients
(Lippincott Williams & Wilkins, 2025) Luis E. Cueva; Juan Carlos Ruiz; Karoly Pamela Zuñiga Montaño; Sergio Morales Acosta; Diego Ramos Ypanaqué; José Hurtado; L. Urrego Rivera
Background: Persistent atrial fibrillation (AF) involves extensive atrial remodeling beyond pulmonary vein (PV) triggers, making catheter ablation less effective than in paroxysmal AF. PV isolation (PVI) is standard, but outcomes remain limited by broader arrhythmogenic substrates. Linear ablation aims to interrupt reentrant circuits and may improve outcomes when combined with PVI. However, its benefits remain debated due to procedural risks and incomplete lesions. Methods: We conducted a systematic review and meta-analysis (PRISMA guidelines), searching PubMed, Embase, Scopus, and Web of Science up to February 24, 2025. Eligible studies included randomized controlled trials (RCTs) and observational studies comparing PVI plus linear ablation versus PVI alone in adults with persistent AF. The primary outcome was AF recurrence; secondary outcomes were atrial arrhythmia recurrence and complications. Hazard ratios (HRs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed using the I 2 statistic. Significant heterogeneity was considered present if I 2 ≥ 50% and/or p < 0.10. Sensitivity was assessed using leave-one-out analysis, and heterogeneity was explored using subgroup analyses. Publication bias was also assessed using funnel plots. Results: Out of 113 articles, 4 were included (3 RCTs and 1 cohort study), with 1,431 patients: 696 (48.6%) underwent PVI plus linear ablation, and 735 (51.4%) underwent PVI alone. PVI plus linear ablation reduced AF recurrence (HR: 0.71; 95% CI: 0.54-0.91; p=0.009) and atrial arrhythmias (HR: 0.79; 95% CI: 0.64-0.98; p=0.03) compared to PVI alone. No significant difference in complications was found (RR: 0.43; 95% CI: 0.06-2.92; p=0.39). No significant heterogeneity or possible publication bias (symmetry in the funnel plots) was observed. Conclusion: This is the first meta-analysis exploring the addition of linear ablation to PVI in persistent AF. The findings suggest that this strategy reduces the risk of atrial arrhythmia recurrence without increasing complications, supporting its potential role in persistent AF ablation strategies. However, the limited number of studies and procedural variability highlight the need for further large-scale RCTs to confirm these results and guide patient selection. Clinicians should carefully consider individual patient characteristics and procedural factors when deciding on the best ablation approach.
Approach to the Diagnosis and Management of Complex Fascicular Ventricular Tachycardias
(Lippincott Williams & Wilkins, 2024) Christopher X. Wong; Henry H. Hsia; Adam Lee; Robert M. Hayward; Colleen J. Johnson; Edgar Chávez; Pichmanil Khmao; Melvin M. Scheinman
Complex ventricular tachycardias involving the fascicular system (fascicular ventricular tachycardias [FVTs]) can be challenging. In this review, we describe our approach to the diagnosis and ablation of these arrhythmias with 10 illustrative cases that involve (1) differentiation from supraventricular tachycardia; (2) assessment for atypical bundle branch reentry and other interfascicular FVTs; (3) examination of P1/P2 activation sequences in sinus rhythm, pacing, and tachycardia; and (4) entrainment techniques to establish the tachycardia mechanism and aid circuit localization. To summarize, 5 cases had prior ablation with 2 previously misdiagnosed as supraventricular tachycardia. A short His-ventricular interval supported ventricular tachycardia. Atrial stimulation could initiate and entrain 4 FVTs. P1 potentials were recorded in all cases of left posterior FVT. Entrainment at P1 and P1 to P2 connection sites at the mid-septal region, and the postablation emergence of a late P1 with decremental properties, is consistent with the left septal fascicle being the slowly conducting, retrograde limb of the left posterior FVT circuit. Ablation targeting the mid-septal left septal fascicle and P1 to P2 connection sites successfully eliminated left posterior FVT. Right ventricular apical pacing was useful in differentiating bundle branch reentry and focal FVTs from reentrant FVTs. Two cases exhibited bundle branch reentry and other interfascicular FVTs. Three cases were postinfarct FVTs involving the LPF, where pacing and entrainment at sites of conduction system potentials were able to localize sites critical for ablation, in contrast to previously unsuccessful substrate modification. In conclusion, several ventricular tachycardia mechanisms involving the fascicular system can occur in both structurally normal and abnormal hearts. A high index of suspicion is required given their rarity and potential for misdiagnosis. Once identified, we emphasize a structured approach to the diagnosis and management of FVTs to confirm the mechanism and localize suitable ablation targets involving careful recording of conduction system potentials and pacing/entrainment maneuvers.
Correction: Ablation of manifest accessory pathways in pediatric patients: comparison between conventional and non‑radiological navigation techniques
(2026) Alejandro Cuesta; M. Arocena; José M. Moltedo; F Vidal; Pedro Iturralde; Manlio F. Márquez-Murillo; Moisés Levinstein J; Santiago Nava; Gerardo Rodríguez-Diez; Elaine Núñez
EARLY VERSUS DELAYED CATHETER ABLATION IN ATRIAL FIBRILLATION: A META-ANALYSIS OF 25,996 PATIENTS
(Elsevier BV, 2025) Breno Valentim Nogueira; Luis Enrique Cueva Cañola; Adolfo Calderón-Fernández; F Correa; C. Nogueira; Juliana Elorriaga Vaca; Gloria Isela Mendoza Frías; Yalile Rivero Samur
Endocardial Approach for Substrate Ablation in Brugada Syndrome
(ECO-vector, 2018) Pablo E. Tauber; V. Mansilla; Pedro Brugada; Sara S. Sánchez; Stella M. Honoré; Marcelo V. Elizari; Sergio Chain Molina; Félix A. Albano; R Corbalán; Federico Figueroa Castellanos
Radiofrequency ablation (RFA) in Brugada syndrome (BrS) has been performed by both endocardial and epicardial. The substrate in BrS is not completely understood. We investigate the functional endocardial substrate and its correlation with clinical, electrophysiological and ECG findings in order to guide an endocardial ablation. Two patients agreed to undergo an endocardial biopsy and the samples were examined with transmission electron microscopy (TEM) to investigate the correlation between functional and ultrastructural alterations. About 13 patients (38.7 ± 12.3 years old) with spontaneous type 1 ECG BrS pattern, inducible VF with programmed ventricular stimulation (PVS) and syncope without prodromes were enrolled. Before endocardial mapping, the patients underwent flecainide testing with the purpose of measuring the greatest ST-segment elevation for to be correlated with the size and location of substrate in the electro-anatomic map. Patients underwent endocardial bipolar and electro-anatomic mapping with the purpose of identify areas of abnormal electrograms (EGMs) as target for RFA and determine the location and size of the substrate. When the greatest ST-segment elevation was in the third intercostal space (ICS), the substrate was located upper in the longitudinal plane of the right ventricular outflow tract (RVOT) and a greatest ST-segment elevation in fourth ICS correspond with a location of substrate in lower region of longitudinal plane of RVOT. A QRS complex widening on its initial and final part, with prolonged transmural and regional depolarization time of RVOT corresponded to the substrate located in the anterior-lateral region of RVOT. A QRS complex widening rightwards and only prolonged transmural depolarization time corresponded with a substrate located in the anterior, anterior-septal or septal region of RVOT. RFA of endocardial substrate suppressed the inducibility and ECG BrS pattern during 34.7 ± 15.5 months. After RFA, flecainide testing confirmed elimination of the ECG BrS pattern. Endocardial biopsy showed a correlation between functional and ultrastructural alterations. Endocardial RFA can eliminate the BrS phenotype and inducibility during programmed ventricular stimulation (PVS).
Evaluation of the Mandibular Incisive Canal by Panoramic Radiography and Cone-Beam Computed Tomography
(2018) Pablo E Tauber; V. Mansilla; Pedro Brugada; Sara S Sánchez P; Stella M. Honoré; Marcelo V. Elizari; Sergio Chain Molina; FelixA Albano; Ricardo R Corbalán; Federico Figueroa Castellanos
Background: Radiofrequency ablation (RFA) in Brugada syndrome (BrS) has been performed both endocardially and epicardially. The substrate in BrS is thus unclear. Objectives: To investigate the functional endocardial substrate and its correlation with clinical, electrophysiological and ECG findings in order to guide an endocardial ablation. Methods: Thirteen patients (38.7±12.3 years old) with spontaneous type 1 ECG BrS pattern, inducible VF with programmed ventricular stimulation (PVS) and syncope without prodromes were enrolled. Before to endocardial mapping the patients underwent flecainide testing with the purpose of measuring the greatest ST-segment elevation for to be correlated with the size and location of substrate in the electro-anatomic map. Patients underwent endocardial bipolar and electro-anatomic mapping with the purpose of identify areas of abnormal electrograms (EGMs) as target for RFA and determine the location and size of the substrate. Results: When the greatest ST-segment elevation was in the 3rd intercostal space (ICS), the substrate was located upper in the longitudinal plane of the right ventricular outflow tract (RVOT) and a greatest ST-segment elevation in 4th ICS correspond with a location of substrate in lower region of longitudinal plane of RVOT. A QRS complex widening on its initial and final part, with prolonged transmural and regional depolarization time of RVOT corresponded to the substrate locateded in the anterior-lateral region of RVOT. A QRS complex widening rightwards and only prolonged transmural depolarization time corresponded with a substrate located in the anterior, anterior-septal or septal region of RVOT. RFA of endocardial substrate suppressed the inducibility and ECG BrS pattern during 34.7±15.5 months. After RFA, flecainide testing confirmed elimination of the ECG BrS pattern. Endocardial biopsy showed a correlation between functional and ultrastructural alterations in two patients.