13 research outputs found
PCASE1 UTILIZING EVIDENCE FROM DIFFERENT LEVELS IN THE REIMBURSEMENT PROCESS OF NEW MEDICAL TECHNOLOGIES-ADVANCED RENAL CELL CARCINOMA FIRST LINE THERAPY IN POLAND 2008-2009
No full textPHP28 IMPACT OF SAFETY ISSUES' BASED DECISIONS OF CONSULTATIVE COUNCIL ON THE POLISH NATIONAL HEALTH FUND'S BUDGET
No full textPHP89 THE INFLUENCE OF SAFETY ISSUES ON DECISIONS OF CONSULTATIVE COUNCIL OF THE AGENCY FOR HEALTH TECHNOLOGY ASSESSMENT IN POLAND
No full textP298Intravenous antazoline for cardioversion of recent onset atrial fibrillation in patients with stable coronary artery disease
No full text“Buddy wire” for facilitation of femoral venous access for cryoablation: a preliminary report
No full textBackground: Some electrophysiological techniques, such as balloon cryoablation, involve the use of steerable sheaths of large diameter (outer diameter 15 Fr or more). Their introduction to the femoral vein may be difficult, especially in patients who have had numerous venipunctures in this area.
Aim: The authors describe a modification of typical venous access with the use of a “buddy wire” technique, facilitating the insertion of the cryoablation sheaths to the femoral vein.
Methods: A case-control study. The study involved a retrospective analysis of 27 consecutive procedures of balloon cryoablation of pulmonary veins performed in 2015 by the first author, compared to 23 consecutive procedures of balloon cryoablation performed in 2014 without a “buddy wire” technique. The study and control groups did not vary significantly. There were 11 women in both groups. The average age of the patients was 55.9 years. The “buddy wire” technique was the only difference in procedure performance between the control and study groups. In the study group a short introducer was inserted through a puncture of the right femoral vein, and then two wires were introduced through it. One of them was secured, so that it could not move, while the other served as a typical trans-septal puncture monitored with the use of X-ray. The standard trans-septal sheet was replaced with a 15 Fr steerable sheath, inserted through the same puncture site next to the secured “buddy wire”. The short wire was then removed from the femoral vein. Typical balloon cryoablation of pulmonary veins was performed. After the end of the procedure, the puncture site was secured with a haemostatic suture for 12–18 h.
Results: Femoral access with a 15 Fr steerable sheath and cryoablation were safely performed in all patients in the study group and in 22 out of 23 in the control group (100% vs. 95.6%, p = NS). Pulmonary vein isolation in one patient was performed using another technique. No damage to steerable sheaths was observed. There were no vascular complications requiring extended hospitalisation, blood transfusion, or surgical interventions in either group. The “door-to-door” time of the procedures ranged from 2 h 32 min on average in the study group to 2 h 43 min on average in the control group (p = NS). There was significant reduction in fluoroscopy time: 7 min 15 s on average from 11 min 25 s (p = 0.0009).
Conclusions: The use of the “buddy wire” technique may lead to significant reduction in fluoroscopy time during cryoablation of pulmonary veins by facilitating the insertion of the steerable sheaths to the femoral vein.Wstęp: Niektóre z technik elektrofizjologicznych, np. do krioablacji balonowej, wykorzystują naczyniowe koszulki sterowalne o dużej średnicy. Wprowadzenie ich do żyły udowej, zwłaszcza u pacjenta po wielokrotnych nakłuciach naczyń w tej okolicy, może sprawiać istotne trudności.
Cel: Celem pracy było opisanie modyfikacji typowego dojścia żylnego z wykorzystaniem techniki „wspierającego prowadnika” dla ułatwienia wprowadzania koszulek do krioablacji do żyły udowej.
Metody: Badanie miało charakter kliniczno-kontrolny. Przeprowadzono retrospektywną analizę kolejnych 27 zabiegów krioablacji balonowej żył płucnych wykonanych w 2015 r. przez pierwszego autora. Grupę kontrolną stanowiły 23 zabiegi wykonane w 2014 r. przez ten sam zespół, podczas których nie wykorzystywano techniki „wspierającego prowadnika”. Grupa badana i kontrolna nie różniły się istotnie pod względem cech demograficznych. Pacjenci byli w wieku średnio 55,4 roku w grupie badanej i 56,4 roku w grupie kontrolnej. Wykonanie zabiegu w grupie badanej i kontrolnej różniło się jedynie wykorzystaniem „wspierającego prowadnika”. W grupie badanej poprzez nakłucie prawej żyły udowej wprowadzano krótki introduktor, a poprzez niego dwa prowadniki. Krótki prowadnik pozostawiano w pachwinie i zabezpieczano przed przesunięciem, natomiast z wykorzystaniem długiego prowadnika wykonywano typowe nakłucie transseptalne pod kontrolą skopii rentgenowskiej. Następnie wymieniano standardową koszulkę transseptalną na koszulkę sterowalną 15 F, przeprowadzając ją przez jedno miejsce wkłucia obok pozostawionego w pachwinie prowadnika. Następnie usuwano krótki prowadnik z żyły udowej. Wykonywano typową krioablację balonową żył płucnych. Po zakończeniu zabiegu miejsce wkłucia zabezpieczano szwem hemostatycznym na okres 12–18 h po zabiegu.
Wyniki: Koszulki transseptalne o dużej średnicy wprowadzono bez powikłań u wszystkich pacjentów z grupy badanej i u 22 osób z grupy kontrolnej (100 vs. 95,6%, p = NS). U 1 chorego przeprowadzono ablację żył płucnych inną techniką. Nie zaobserwowano uszkodzeń koszulek sterowalnych. U żadnego z pacjentów nie stwierdzono powikłań naczyniowych wymagających przedłużonej hospitalizacji, przetoczeń krwi czy interwencji chirurgicznej. Czas trwania zabiegu „door-to-door” wynosił średnio 2 h 32 min w grupie badanej i 2 h 43 min w grupie kontrolnej i nie różnił się istotnie między grupami. Wykazano skrócenie czasu fluoroskopii z 11 min 25 s w grupie kontrolnej do 7 min 15 s z 11 min 25 s w grupie badanej (p = 0,0009).
Wnioski: Wykorzystanie techniki „wspierającego prowadnika” sprzyja skróceniu czasu fluoroskopii w takcie zabiegów krioablacji balonowej żył płucnych poprzez ułatwienie wprowadzania koszulek sterowalnych do żyły udowej
P1451Clinical and pacing parameters related to atrial fibrillation in patients with tachycardia-bradycardia syndrome
No full textMexiletine for recurrent ventricular tachycardia in adult patients with structural heart disease and implantable cardioverter defibrillator: an EHRA systematic review
No full textThe aim of the study was to systematically review evidence on the effectiveness and safety of oral mexiletine administered in monotherapy or in combination with other antiarrhythmic drugs for recurrent ventricular arrhythmia (ventricular tachycardia/ventricular fibrillation, VT/VF) in adult patients with structural heart disease (SHD) and implantable cardioverter defibrillators (ICDs). We systematically searched MEDLINE, Embase, and CENTRAL databases from inception to 27 August 2021 for prospective and retrospective studies investigating mexiletine in the target population. The main outcome was the reduction of ICD therapy. The main safety outcome was the presence of any serious adverse events (SAEs) leading to mexiletine discontinuation. Study quality was assessed using the Cochrane risk of bias tool or the Newcastle-Ottawa scale. Four studies comprising 86 mexiletine recipients were included in the review. We also obtained individual data of 50 patients from two studies. Ischaemic cardiomyopathy (ICM) was present in 86% of patients. The quality of included studies was moderate/low. A narrative review was undertaken as studies varied widely in terms of study population and treatment. Across studies, mexiletine treatment (with or without amiodarone) seemed to consistently reduce the number of ICD therapies especially in a population where catheter ablation (CA) was unsuccessful or contraindicated. In ICM patients deemed eligible for CA, mexiletine seemed to be inferior to CA. Mexiletine was discontinued in 14% of cases, mainly for gastrointestinal or neurological SAE. Mexiletine seems to be an option for the long-term treatment of recurrent VT/VF in adult patients with SHD, especially ICM, and ICD in whom CA was unsuccessful or not suitable
Effectiveness and safety of a single freeze strategy of cryoballoon ablation of atrial fibrillation: an EHRA systematic review and meta-analysis.
No full textTo conduct a systematic review and meta-analysis to compare the effectiveness and safety of cryoballoon ablation of atrial fibrillation (AF) performed using a single freeze strategy in comparison to an empiric double ('bonus') freeze strategy. We systematically searched MEDLINE, EMBASE, and CENTRAL databases from inception to 12 July 2020, for prospective and retrospective studies of patients undergoing cryoballoon for paroxysmal or persistent AF comparing a single vs. bonus freeze strategy. The main outcome was atrial arrhythmia-free survival and eligible studies required at least 12 months of follow-up; the primary safety outcome was a composite of all complications. Study quality was assessed using the Cochrane risk of bias tool and the Newcastle-Ottawa Scale. Thirteen studies (3 randomized controlled trials and 10 observational studies) comprising 3163 patients were eligible for inclusion (64% males, 71.5% paroxysmal AF, mean CHA2DS2-VASc score 1.3 ± 0.9). There was no significant difference in pooled effectiveness between single freeze strategy compared to double freeze strategy [relative risk (RR) 1.03; 95% confidence interval (CI): 0.98-1.07; I2 = 0%]. Single freeze procedures were associated with a significantly lower adverse event rate (RR 0.72; 95% CI: 0.53-0.98; I2 = 0%) and shorter average procedure time (90 ± 27 min vs. 121 ± 36 min, P < 0.001). A trend for lower risk of persistent phrenic nerve palsy was observed (RR 0.61; 95% CI: 0.37-1.01; I2 = 0%). The quality of included studies was moderate/good, with no evidence of significant publication bias. Single freeze strategy for cryoballoon of AF is as effective as an empiric double ('bonus') freeze strategy while appearing safer and probably quicker (PROSPERO registration number CRD42020158696)
The blanking period after atrial fibrillation ablation: an European Heart Rhythm Association survey on contemporary definition and management
No full textThe use of a blanking period (BP) after an atrial fibrillation (AF) ablation procedure is a common practice, but recent data questions the benign nature of early recurrences of atrial tachyarrhythmias (ERATs). A physician-based survey was carried out by the European Heart Rhythm Association (EHRA) to investigate the current definition and applicability of BP and ERAT management. An online questionnaire was sent to clinical and interventional electrophysiologists. A total of 436 respondents (88% interventional electrophysiologists) reported observing ERATs in 25% (interquartile range 15-35) of patients, less commonly in paroxysmal AF (PAF) compared with persistent AF (persAF). The median reported duration of BP used by respondents was 90 days, with 22% preferring a shorter BP duration for PAF patients compared with persAF. Half of the patients with ERATs are expected to also experience late recurrences (LR). Isolated episodes of ERATs are treated conservatively by 99% of the respondents, but repeat ablation during the BP is preferred by 20% of electrophysiologists for multiple ERATs and by 16% in patients with organized atrial tachyarrhythmias. In conclusion, ERATs are commonly observed after AF ablation, particularly in persAF patients, and are perceived as predictors of LR by half of the respondents. A general adherence to a 90-day BP duration was observed. During this time period, ERAT is mainly treated conservatively, but repeat ablation during the BP is occasionally offered to patients with multiple ERATs and those with organized atrial tachyarrhythmias
Arrhythmia care in ESC member countries: the 2025 ESC-EHRA atlas on heart rhythm disorders.
No full textThe ESC-EHRA Atlas on Heart Rhythm Disorders was developed to comprehensively map arrhythmia care across the European Society of Cardiology (ESC) member countries. A survey of National Cardiac Societies, Working Groups, and other EHRA partners in ESC member countries was conducted to gather data from 2023 or the most recently available year on arrhythmia care organization and delivery. In total, 51 ESC member countries actively participated in the study, with a survey completeness rate of 91%. The median number of hospitals performing EP or CIED procedures was 3.3 per million people. The annual median numbers of ablation procedures for heart rhythm disorders, atrial fibrillation, and supraventricular tachycardia per million people were 432, 151, and 136, respectively. The annual median numbers of pacemakers, implantable cardioverter-defibrillators (ICD), and cardiac resynchronization therapy cardioverter-defibrillator (CRT-D) implantations per million people were 739, 195, and 54, respectively. The median number of hospitals performing remote monitoring of CIEDs per million people was 0.5, though this service was unavailable in 15 countries. Two main universal issues emerged among the obstacles to guideline implementation: a lack of heart rhythm allied professionals and general dissatisfaction with the country's reimbursement system. The first edition of the ESC-EHRA Atlas presents up-to-date information on arrhythmia care organization and delivery among ESC member countries and highlights significant discrepancies in patients' access to ESC-guideline-recommended therapies
