Image_1_Impact of technical aspects of vein of Marshall ethanol infusion on mitral isthmus block for persistent atrial fibrillation ablation.tif

AimsEthanol infusion into the VOM (EIVOM) adjunctive to radiofrequency catheter ablation (RFCA) was a novel approach facilitating mitral isthmus (MIth) block for persistent atrial fibrillation (PeAF); However, there were remarkable disparities in its technical aspects. This study aimed to evaluate the impact of EIVOM technical aspects on acute MIth block.MethodsEighty consecutive patients (63 males, average age 66.4 ± 8.6 years) undergoing de novo PeAF ablation were assigned to different groups. The procedural parameters in “EIVOM first” (n = 13) or “RFCA first” (n = 13) as well as small dose ([SD], ≤4 ml, n = 26) or big dose ([BD], >4 ml, n = 54) approaches were analyzed to identify the predictors for acute MIth block.ResultsCompared with the “EIVOM first” approach, the “RFCA first” approach was associated with longer procedural and MIth ablation time (134 ± 27 min vs. 112 ± 17 min; 14.9 ± 5.5 min vs. 9.3 ± 5.1 min, both P 5.75 ml independently predicted successful MIth block (OR: 0.428, 95% CI: 0.219–0.839, P = 0.01).ConclusionsDespite the comparable effectiveness on MIth block, the “EIVOM first” approach was associated with shorter procedural and MIth ablation time than the “RFCA first” approach. The ethanol dose in EIVOM was an independent predictor for MIth block.</p

Association between Tissue Characteristics of Coronary Plaque and Distal Embolization after Coronary Intervention in Acute Coronary Syndrome Patients: Insights from a Meta-Analysis of Virtual Histology-Intravascular Ultrasound Studies

<div><p>Background and Objectives</p><p>The predictive value of plaque characteristics assessed by virtual histology-intravascular ultrasound (VH-IVUS) including fibrous tissue (FT), fibrofatty (FF), necrotic core (NC) and dense calcium (DC) in identifying distal embolization after percutaneous coronary intervention (PCI) is still controversial. We performed a systematic review and meta-analysis to summarize the association of pre-PCI plaque composition and post-PCI distal embolization in acute coronary syndrome patients.</p><p>Methods</p><p>Studies were identified in PubMed, OVID, EMBASE, the Cochrane Library, the Current Controlled Trials Register, reviews, and reference lists of relevant articles. A meta-analysis using both fixed and random effects models with assessment of study heterogeneity and publication bias was performed.</p><p>Results</p><p>Of the 388 articles screened, 10 studies with a total of 872 subjects (199 with distal embolization and 673 with normal flow) met the eligibility of our study. Compared with normal flow groups, significant higher absolute volume of NC [weighted mean differences (WMD): 5.79 mm³, 95% CI: 3.02 to 8.55 mm³; p<0.001] and DC (WMD: 2.55 mm³, 95% CI: 0.22 to 4.88 mm³; p = 0.03) were found in acute coronary syndrome patients with distal embolization. Further subgroup analysis demonstrated that the predictive value of tissue characteristics in determining distal embolization was correlated to clinical scenario of the patients, definition of distal embolization, and whether the percutaneous aspiration thrombectomy was applied.</p><p>Conclusion</p><p>Our study that pooled current evidence showed that plaque components were closely related to the distal embolization after PCI, especially the absolute volume of NC and DC, supporting further studies with larger sample size and high-methodological quality.</p></div

Basical characteristics of studies included in meta-analysis (Normal flow vs. distal embolization).

<p>ACS, acute coronary injury; AMI, acute myocardial infarction; NR, not reported; NSTEMI, non ST-segment elevation myocardial infarction; PAT, percutaneous aspiration thrombectomy; PSC, prospective single center; RSC, retrospective single center; STEMI, ST-segment elevation myocardial infarction; ULN, upper limit of normal.</p><p>Basical characteristics of studies included in meta-analysis (Normal flow vs. distal embolization).</p

Clinical characteristics of studies included in meta-analysis (Normal flow vs. distal embolization).

<p>DM, diabetes mellitus; HT, hypertension; HL, hyperlipidaemia; NR, not reported;</p><p>Clinical characteristics of studies included in meta-analysis (Normal flow vs. distal embolization).</p

Newcastle-Ottawa Scale of bias risk for the involved studies.

<p>Asterisks are the star rating as per the Newcastle-Ottawa Scale; ** and *** indicate highest rating for these categories.</p><p>Newcastle-Ottawa Scale of bias risk for the involved studies.</p

Process of study selection.

<p>Process of study selection.</p

Percentage comparison of four different plaque compositions through the entire culprit lesion between the normal flow group and the distal embolization group.

<p>(A) Fibrous percentage comparison; (B) Fibrofatty percentage comparison; (C) Dense calcium percentage comparison; (D) Necrotic core percentage comparison.</p

Absolute volume comparison of four different plaque compositions through the entire culprit lesion between the normal flow group and the distal embolization group.

<p>(A) Absolute fibrous volume comparison; (B) Absolute fibrofatty volume comparison; (C) Absolute dense calcium volume comparison; (D) Absolute necrotic core volume comparison;</p

Composition of plaque by VH-IVUS.

<p>Data are presented as mean (SD)</p><p>FT, fibrous tissue; FF, fibrofatty; NC, necrotic core; DC, dense calcium.</p><p>Composition of plaque by VH-IVUS.</p

Subgroup analyses of the association of the percentage of plaque components with the onset of distal embolization.

<p>FT, fibrous tissue; FF, fibrofatty; NC, necrotic core; DC, dense calcium; WMD, weighted mean differences; AMI, acute myocardial infarction.</p><p>Subgroup analyses of the association of the percentage of plaque components with the onset of distal embolization.</p