Ultrasound-guided distal transradial access for cardiac catheterization: Technical notes for the interventionalist

Over the latest years, the use of distal radial access (dTRA), also called “snuffbox,” has become more and more popular for cardiac catheterization. Indeed, dTRA has several advantages compared to the traditional proximal radial approach, such as a lower risk of hand ischemia, radial artery occlusion (RAO) and faster post-procedural hemostasis. However, due to the presence of different muscular-skeletal structures, as well as to the small diameter of the distal radial artery (dRA), an ultrasound-guided cannulation would be preferred since a blind puncture increases the risk of tendon damage and/or the irritation of the underlying periosteum. The present article is aimed to provide the key tips for performing US-guided access using the dRA in patients undergoing percutaneous cardiac procedures.     

How to perform a successful drug-coated balloon angioplasty? Tips and tricks

Drug-coated balloons (DCB) offer an excellent alternative to stents as the antiproliferative drugs are delivered via balloons and hence there is no permanent implant of metal or polymer. This rationale applies perfectly in in-stent restenosis (ISR) as we want to avoid another layer of metal in a previously failed stent. However, their use has also been extended to de novo lesions especially in patients and lesion subsets where stents are not ideal. There is an increased desire toward expanding this further and studies are now being done which are testing DCB in large-caliber vessels. As the use of DCB is escalating, we felt the importance of writing this article whereby we aim to provide important tips and tricks when using DCB especially for the operators who are in the early phase or have the desire of embarking this technology. From our experience, the DCB-angioplasty substantially differs on several aspects from DES-angioplasty. We have provided several case bases examples including algorithm when using DCB in ISR and de novo lesions.     

Clinical outcomes of radiofrequency catheter ablation of ventricular tachycardia in patients with hypertrophic cardiomyopathy

Background

Monomorphic ventricular tachycardia (VT) is rare in patients with hypertrophic cardiomyopathy (HCM), management of which is challenging. Limited data exists on the utility of catheter ablation for the treatment of VT in this population.

Objectives

We aimed to assess clinical outcomes of catheter ablation for VT in HCM patients.

Methods

A systematic search, without language restriction, using PubMed, EMBASE, SCOPUS, Google Scholar, and ClinicalTrials.gov was performed. The meta-analysis was performed using a meta-package for R version 4.0/RStudio version 1.2 and Freeman Tukey double arcsine method to establish the variance of raw proportions. Outcomes measured included (1) acute procedure success (defined as noninducible for clinical VT), (2) freedom from VT at follow-up, (3) mortality.

Results

This systematic review of six studies (three from the United States and three from Japan) incorporated a total of 68 drug-refractory HCM patients who underwent VT radiofrequency catheter ablation (mean age 57.6 ± 13.3 years, mean LVEF 45.8 ± 15.4%, 85% men, maximum septal wall thickness 17.4 ± 4.6 mm, and 32.3% with an apical aneurysm). Acute procedural success was achieved in 84.5% patients (95% confidence interval [CI]: 70.6%–95.2%) with 27.9% patients had recurrent VT requiring multiple ablations (median 1, IQR 1–3). During the follow-up period (18.3 ± 11.7 months), the pooled incidence of freedom from recurrent VT after index procedure was 70.2% (95% CI: 51.9%–86.2%), while after the last ablation was 82.8% (95% CI: 57%–99.2%). There were two deaths during follow-up, one from heart failure and one from SCD 0.8% (95% CI: 0%–5.8%).

Conclusion

The results of our pooled analysis demonstrated that catheter ablation for VT in HCM patients was associated with high acute procedural success, and reduced VT recurrence—findings comparable to previously published reports in other disease substrates.