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Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
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Persistent Atrial Fibrillation With Conduction System Pacing or Pulmonary Vein Isolation: A Prospective Cohort Study.

Shengjie Wu1, Wenxuan Shang1, Lan Su1

  • 1Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.

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Summary
This summary is machine-generated.

Conduction system pacing (CSP) with atrioventricular node ablation (AVNA) showed similar outcomes to pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF) in patients with enlarged left atria. Further randomized trials are needed to confirm these findings.

Keywords:
atrial fibrillationatrioventricular node ablationconduction system pacingpulmonary vein isolation

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Conduction system pacing (CSP) plus atrioventricular node ablation (AVNA) is a viable treatment for symptomatic atrial fibrillation (AF).
  • Comparative data between CSP+AVNA and pulmonary vein isolation (PVI) for persistent AF, especially in patients with enlarged left atria, remain limited.

Purpose of the Study:

  • To compare the clinical outcomes of CSP+AVNA versus PVI in patients with persistent AF and enlarged left atria (>50 mm).
  • To evaluate differences in AF recurrence and a composite endpoint of heart failure hospitalization or cardiac death between the two treatment groups.

Main Methods:

  • An observational study included 718 patients with persistent AF and enlarged left atria, receiving either PVI (n=473) or CSP+AVNA (ablate and pace [AP], n=245) between 2016-2022.
  • Clinical outcomes, AF recurrence, and a composite endpoint were assessed. Propensity score matching (PSM) was used for comparative analysis (n=174).

Main Results:

  • After PSM, the composite endpoint occurred in 14.9% of the AP group versus 16.1% of the PVI group (P=0.864) over a mean 40-month follow-up.
  • AF recurred in 54.0% of the PSM-PVI group, while atrioventricular conduction recurred in 1.2% of the PSM-AP group.
  • Left ventricular ejection fraction improved similarly in both groups post-procedure.

Conclusions:

  • In this observational study, CSP+AVNA and PVI demonstrated numerically similar outcomes for patients with persistent AF and enlarged left atria.
  • The findings are considered hypothesis-generating due to the limited sample size and potential for residual confounding.
  • Randomized controlled trials are warranted to definitively establish the comparative efficacy and safety of these procedures.