Real-time cardiovascular magnetic resonance-guided radiofrequency ablation:A comprehensive review

Cardiac magnetic resonance(CMR)imaging could enable major advantages when guiding in real-time cardiac electrophysiology procedures offering high-resolu-tion anatomy,arrhythmia substrate,and ablation lesion visualization in the absence of ionizing radiation.Over the last decade,technologies and platforms for performing electrophysiology procedures in a CMR environment have been developed.However,performing procedures outside the conventional fluoro-scopic laboratory posed technical,practical and safety concerns.The development of magnetic resonance imaging compatible ablation systems,the recording of high-quality electrograms despite significant electromagnetic interference and reliable methods for catheter visualization and lesion assessment are the main limiting factors.The first human reports,in order to establish a procedural workflow,have rationally focused on the relatively simple typical atrial flutter ablation and have shown that CMR-guided cavotricuspid isthmus ablation represents a valid alternative to conventional ablation.Potential expansion to other more complex arrhythmias,especially ventricular tachycardia and atrial fibrillation,would be of essential impact,taking into consideration the widespread use of substrate-based strategies.Importantly,all limitations need to be solved before application of CMR-guided ablation in a broad clinical setting.

Comparison of clinical outcomes of Chinese men and women after coronary stenting for coronary artery disease:a multi-center retrospective analysis of 4,334 patients

The outcome differences between Chinese male and female patients within one-year follow-up after percutaneous coronary intervention（PCI） with stent remain unclear.The present study was aimed to compare clinical outcomes in such two populations.From May 1999 to December 2009,4,334 patients with acute myocardial infarction（MI）,unstable angina,stable angina,or silent ischemia,who underwent PCI,were registered at our centers.Among these,3,089 were men and 1,245 were women.We compared these groups with respect to the primary outcomes of MI and secondary outcomes including a composite of major adverse cardiac events（MACE） including cardiac death,MI,target lesion revascularization,target vessel revascularization（TVR）,stent thrombosis（ST）,definite ST and probable ST at one-year follow-up.Chinese male patients had a higher MACE rate（13%vs.10.7%,P =0.039）,mainly led by TVR（9.09%vs.6.98%,P=0.024） at one year,which was significantly different than female patients.Chinese male and female patients showed a significant difference on MACEs.However,there was no significant difference with respect to MI between these groups.

Current Advances in Transcatheter Intervention for Children Born with Congenital Heart Defects: A Review of Literature

This review aims to sum up the improvements witnessed in the field of interventional cardiology during recent times. The last decade has witnessed significant technical advances in the field of radiological imaging and also in interventional cardiology which has helped to offer more non-invasive solutions for the management of congenital heart defects. This has resulted from the use of advanced 3-dimensional fusion imaging instead of conventional 2-dimensional angiography, applying interactive real-time enhancement and using computed tomography and Magnetic Resonance Imaging for interventional procedures. Similarly the introduction of next generation devices, have not only improved the final outcome of the procedure but also has helped in reducing the challenges that were faced before and with the initial generation of devices. These advances have helped not only in reducing the radiation exposure, the use of contrast medium dose but also have resulted in improved early survival. The field of neonatal cardiology has advanced at an unprecedented pace. The transcatheter closure of patent ductus arteriosus has evolved over time and now it has been made possible at much lower body weight. Similarly, early use of stents for aortic coarctation has been found effective in some patients, especially when surgical intervention had been denied. The application of the hybrid approach for the management of complex congenital heart defects has also been effectively applied. More recently transcatheter placement of the pulmonary valve has been introduced for severely stenotic and/or regurgitant pulmonary valve in adolescents and adults. It is anticipated that in near future, this procedure would be available for relatively younger patients. In conclusion: last 2 decades have improvised pediatric interventional cardiology to incorporate less invasive solutions for CHD. The current advances in radio-diagnostic imaging, gadgetry and technical expertise have improved significantly and led to manage many of such defects by trans-catheter approach. This has led also, to replace the early surgical intervention with a more subtle hybrid approach, thus reducing not only the major surgical trauma but also been found to be cost-effective due to a shorter hospital stay. But a learning curve for performers is required for optimum results and also such procedures should be performed in a fully developed facility with an optimum surgical backup.

Prognosis and outcome of intrauterine treatment of fetuses with critical congenital heart disease

Background:Intrauterine valvuloplasty is an innovative therapy,which promotes ventricular growth and function in some congenital heart diseases(CHDs).The technique remains challenging and can only be performed in a few centers.This study aimed to assess the feasibility and mid-term outcomes of fetal cardiac intervention(FCI)in fetuses with critical CHD in an experienced tertiary center.Methods:Five fetal aortic valvuloplasty(FAV)or fetal pulmonary valvuloplasty(FPV)procedures were performed in our fetal heart center between August 2018 and May 2022.Technical success was defined as crossing the aortic or pulmonary valve and balloon inflation,followed by evidence of increased blood flow across the valve and/or new regurgitation.Follow-up clinical records and echocardiography were obtained during the prenatal and postnatal periods.Results:Five fetuses received FAV or FPV,including critical aortic stenosis(n=2)and pulmonary atresia with intact ventricular septum(n=3).The mean maternal age was 33.0±2.6 years.The median gestational age(GA)at diagnosis was 24 weeks(range,22-26 weeks).The median GA at intervention was 29 weeks(range,28-32 weeks).All five cases underwent successful or partially successful procedures.One patient had pulmonary valve perforation without balloon dilation.No procedure-related deaths or significant complications occurred.However,one neonatal death occurred due to heart and renal failure.The median follow-up period was 29.5 months(range,8.0-48.0 months).The four surviving patients had achieved biventricular circulation,exhibited improved valve,and ventricular development at the last follow-up visit.Conclusion:Intrauterine FCI could be performed safely with good prognosis in critical CHD.

ntrauterine Cardiac Intervention for Fetal Pulmonary Valve Obstruction Lesion

Most of the congenital heart diseases can be diagnosed in utero using fetal echocardiography. With the development of ultrasonography and intrauterine cardiac intervention technique, fetal cardiac intervention （FC1） for critical aortic stenosis, highly restrictive or intact atrial septum, pulmonary atresia with an intact ventricular septum （PA/ IVS）, and critical pulmonary stenosis （CPS） are available in more countries.

Inflammation:an important mechanism for different clinical entities of coronary artery diseases

AIthough atherosclerosis has been considered to be multi-factorial disease in which genetic,environmental, metabolic factors have been implicated, the gaps remain in our knowledge of the etiopathogenesis of atherosclerosis. There is mounting evidence that inflammation plays an important role in the initiation, development as well as evolution of atherosclerosis, suggesting that atherosclerosis is an inflammation disease. Although triggers and pathways of inflammation are probably multiple and different in different clinical settings, the data from animals as well as humans including our groups indicated that an inflammatory process was involved in all stages of atherosclerosis appeared in different clinical entities.

Effect of the baseline HbA1c on the MACEs in patients with coronary artery disease after percutaneous coronary intervention

Background The present studies evaluated the association between admission glucose and adverse outcomes of people with coronary artery disease（CAD） after primary percutaneous coronary intervention（PCI）, but the effects of glucose control levels on these patients＇ outcomes are not fully studied, and the prognostic value of hemoglobin A1c（Hb A1c） for a better survival is still uncertain. Methods Our study included 440 patients with CAD undergoing the PCI therapy after admission, and who were divided into 2groups, one had Hb A1 c ≤ 6.5%（n = 309）, the other 〉 6.5%（n = 131）. Then, we gave these patients clinical follow-ups at the first, third, sixth, twelfth month respectively after PCI. Results There were no significant differences between the two groups at the baseline characteristics and the drugs taken by the patients after PCI. But we found that the outcomes of major adverse cardiac events（MACEs） were significantly better in Hb A1 c ≤6.5% group than in Hb A1 c 〉 6.5% group（P = 0.016） according to the COX multivariate regression analysis. Conclusion The MACE-free survival after PCI is significantly better when Hb A1 c is≤ 6.5% than Hb A1 c is 〉 6.5%.