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Pulse rhythm01:30

Pulse rhythm

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Pulse rhythm refers to the pattern of pulsations within specific intervals, offering valuable insights into the regularity or irregularity of the heart's beats as observed through the pattern of pulsation within specific intervals. A regular pulse exhibits a consistent heart rate with uniform waveforms and pulsation force, variations of which can be classified as normal, weak, or bounding.
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...
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Utility of Very High Output Pace-Capture Testing for Posterior Wall Isolation in Patients With Persistent Atrial

Brian Hsia1, Jordan Liebman2, Leonid Garber1

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High-output posterior wall isolation (PWI) testing during persistent atrial fibrillation (AF) ablation did not improve outcomes and may increase recurrence. Standard PWI testing is questioned for persistent AF treatment.

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ablationatrial fibrillationpace capturepersistent atrial fibrillationposterior wall isolationradiofrequency ablation

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Area of Science:

  • Electrophysiology
  • Cardiology
  • Medical Devices

Background:

  • Pulmonary vein isolation (PVI) and posterior wall isolation (PWI) are common persistent atrial fibrillation (AF) treatments.
  • Durability concerns of PWI due to epicardial reconnections limit its efficacy.

Purpose of the Study:

  • To assess the impact of high-output posterior wall pace-capture testing during ablation on AF/atrial tachycardia (AT) recurrence.
  • To evaluate if increased PWI testing parameters improve outcomes in persistent AF patients.

Main Methods:

  • Retrospective analysis of 232 patients undergoing PVI, PWI, and cavotricuspid isthmus line (CTI) ablation for persistent AF.
  • Two cohorts: one with standard PWI testing (10mA × 2ms) and another with high-output PWI testing (20mA × 10ms).
  • Comparison of AF/AT recurrence rates between the two PWI testing groups.

Main Results:

  • The high-output PWI testing group (20mA × 10ms) showed significantly higher AF/AT recurrence than the standard group (10mA × 2ms) (p=0.01).
  • No significant differences in baseline patient characteristics were observed between the groups.
  • Increased procedure time and lesion count were noted in the high-output group without improved arrhythmia freedom.

Conclusions:

  • High-output PWI pace-capture testing (20mA × 10ms) in persistent AF ablation is not associated with improved outcomes and may increase recurrence.
  • The findings challenge the effectiveness of PWI, irrespective of durability, for persistent AF treatment.
  • Further investigation is needed to determine optimal PWI strategies and its role in persistent AF management.