bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimizing catheter ablation of atrial fibrillation by a novel wide-band dielectric imaging system: first experience on real-time wall thickness measurement
Authors: Rottner L , Moser F , Schleberger R , Moser J , My I , Lemoine M , Dinshaw L , Kirchhof P , Ouyang F , Reissmann B , Metzner A , Rillig A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Conventional mapping systems do not provide wall-thickness data, which is, however, known to be a determinant of radiofrequency ablation lesion transmurality. KODEX-EPD is a novel open-platform system, which uses dielectric tissue properties to provide real-time, high-resolution cardiac images, tissue characteristics and wall-thickness measurement to guide ablation procedures.

Aim

The aim of this case series was to report on our first experiences with KODEX-EPD regarding estimation of myocardial wall-thickness during catheter ablation of atrial fibrillation (AF).

Methods

We retrospectively analyzed consecutive patients undergoing radiofrequency AF-ablation in combination with KODEX-EPD. A high-resolution image from the left atrium (LA) and the pulmonary veins (PV) was obtained prior to ablation using a spiral mapping catheter in conjunction with KODEX-EPD. Wall-viewer points were collected within the LA, the PVs and the left atrial appendage (LAA) using a standard radiofrequency non-contact force ablation catheter and analyzed for wall-thickness applying the latest KODEX-EPD software version (1.5.0, not yet commercially released). Wall-viewer points were divided into a total of 10 segments (PV ostia, anterior wall, posterior wall, LA roof, LA floor, LAA and PV carina, details see Figure 1) in order to characterize wall-thickness in respective areas.

Results

A total of 570 wall-viewer points in 5 patients were analyzed. Most of the wall-viewer points were collected at the PV ostia as well as along the posterior and anterior wall (449/570, 79%). Actual myocardial atrial thickness ranged from 1.6 to 3.9 mm. Thickest myocardial LA-tissue was measured at the anterior wall (median 3.1 mm) and thinnest at the LA-roof (median 2.2 mm). Figure 2 gives a detailed distribution of wall-thickness measurements at different sites in the LA and PVs.

Conclusion

Atrial wall thickness can be estimated in patients during AF ablation procedures using dielectric tissue properties. Further evaluation and validation of the method are needed to study its reliability and utility for clinical practice.
Initial experience using a novel algorithm to calculate omnipolar electrograms using a high-density grid-style catheter
Authors: Kottmaier M , Inaba O , Phillips K , Adsett M , Hayes J , Gkalapis C , Lengauer S , Clementy N , Bailey C , Kaneko S
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

A novel mapping algorithm recently became available in Europe and select countries in the Asia Pacific region. EnSite Omnipolar Technology (OT) utilizes the Advisor HD Grid Mapping Catheter, Sensor Enabled (HD Grid) to calculate electrograms in 360 degrees from two bipolar and three unipolar electrograms acquired from a triangular set of three electrodes. This software also enables calculation of wavefront characteristics including maximum voltage, activation direction and wave speed. Procedural characteristics and clinical utilization of this novel software have not yet been reported.

Purpose

To examine the clinical utility and procedural characteristics associated with the use of this novel mapping algorithm among participating centers.

Methods

Acute procedural data were prospectively collected in 386 cases at 52 centers utilizing the newly approved mapping software in the initial phases of commercialization in Europe and the Asia Pacific region. Procedural characteristics recorded included indication for mapping/ablation, navigation mode, mapping reference, and maps and tools used to diagnose/locate ablation targets.

Results

A total of 14 indications for mapping and ablation were represented including AF, atypical flutter, and VT (Table 1). VoXel (magnetic primary) navigation mode was used in most cases (n=325, 84%). The CS catheter was used as the map reference in 280 cases (73%). A variety of workflows were used with OT to diagnose and locate ablation targets including voltage maps (n=275, 71%), LAT maps (n=226, 59%), OT activation vectors (n=124, 32%), propagation maps (n=94, 24%), and sparkle maps (n=69, 18%); note: total exceeds 100%, multiple workflows per case observed. EnSite LiveView Dynamic Display (LiveView) was used in 129 cases (33%) to diagnose and locate ablation targets, including 28 (22%) where OT activation vectors were used with LiveView. Several benefits of OT were reported including rapid identification of ablation target(s) (n=133, 35%), higher point density (n=82, 21%), better signals (n=69, 18%), and improved procedure efficiency (n=48, 12%).

Conclusion(s)

Initial experience with this novel mapping software in Europe and the Asia-Pacific region illustrated utility in a variety of arrhythmias to diagnose and locate ablation targets. The use of OT provided several benefits including rapid identification of ablation targets and higher point density, however further examination of its impact on procedural efficiencies and acute outcomes is likely warranted.
Fluoroless cavotricuspid isthmus radiofrequency ablation of typical atrial flutter achieves success with zero radiation and shorter procedural duration
Authors: Jacinto S , Silva Cunha P , Portugal G , Valente B , Coutinho Cruz M , Lousinha A , Veiga J , Delgado AS , Bras M , Paulo M , Guerra C , Teixeira AR , Lacerda Teixeira B , Cruz Ferreira R , Martins Oliveira M
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Cavotricuspid isthmus (CTI) ablation in patients with typical atrial flutter (AFL) has improved in the past years, especially by the use of threedimensional (3D) electroanatomic mapping systems. These mapping tools contributed to reduce radiation exposure, but most ablation procedures still require varying amounts of fluoroscopy.

Purpose

We aim to examine whether fluoroless CTI ablation is effective and safe in reducing AFL recurrence, compared with CTI ablation using fluoroscopy and a 3D mapping system.

Methods

A retrospective analysis of CTI ablation procedures performed at a tertiary center between December 2008 and December 2020 was conducted. Cases were divided in two groups: fluoroless and fluoroscopic, according to the use of radiation. Procedural duration, fluoroscopy time (FT), use of 3D mapping system, complications and recurrence rate at one year were analyzed.

Results

A total of 324 CTI ablations performed on patients with documented typical AFL were included. Mean age was 62.3±14.0, with 78.1% male patients. Fluoroless ablations were performed based on a 3D mapping system, and all fluoroscopic procedures also used 3D electroanatomic mapping. The FT was zero in the fluoroless group - 31 cases (9.6%), and 7.0±4.4 minutes in the fluoroscopic group - 291 cases (90.4%) (p<0.001). There was no statistically significant difference between the two groups, regarding AFL recurrence at one year (21.7% in the fluoroless group versus 13% in the fluoroscopic group; odds ratio [OD] 0.54; 95% confidence interval [CI] 0.18-1.62; p=0.27). Total procedure duration was significantly shorter in the fluoroless group (1h07m versus 1h40m; t-test 4.261, p<0.001, CI 0h16m-0h50m). There were no acute complications for both groups.

Conclusion

Fluoroless CTI ablation avoids radiation exposure to the patient and operator and can be performed in patients with typical AFL, without compromising duration, safety or efficacy of the procedure.
Acute procedural characteristics, efficacy, and safety of a novel cryoballoon for the treatment of paroxysmal atrial fibrillation: Results from the POLAR-ICE study
Authors: Tilz R , Martin CA , Anic A , Defaye P , Luik A , Asmundis C , Champ-Rigot L , Iacopino S , Sommer P , Albrecht E , Raybuck JD , Wehrenberg S , Cielen N , Yap SC
Published: May 2022

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Boston Scientific

Background/Introduction

Pulmonary vein isolation (PVI) using a cryoballoon is well-established for the treatment of paroxysmal atrial fibrillation (PAF). Initial experience with a novel cryoballoon (CB) with a stable low balloon pressure (POLARx, Boston Scientific) has demonstrated acute procedural safety and efficacy in de novo PVI procedures in patients with paroxysmal AF. However, to date, there is limited multicenter data on real world acute outcomes and procedural characteristics with this novel cryoballoon.

Purpose

The purpose of POLAR ICE was to provide real-world data on the acute and chronic outcomes of cryoballoon ablation with POLARx for the treatment of PAF. Here we report on the initial acute outcomes up to 3 months including procedural efficacy, safety, and biophysical parameters.

Methods

POLAR ICE, a prospective, non-randomized, multicenter (international) registry (NCT04250714), enrolled 400 patients across 19 centers, between Aug 2020 and May 2021. This study included any patients indicated for treatment of PAF with the POLARx cryoablation system. The study protocol did not mandate any specific cryodosing regimen, this was left to the operator. Procedural characteristics, such as time to isolation (TTI), cryoablations per pulmonary vein, balloon nadir temperature, and occlusion grade were recorded. PVI was confirmed with entrance block testing.

Results

Complete PVI was achieved in 96.1% of PVs (1437/1496). Procedure and fluoroscopy times were 69.0±25.2 min and 15.8±10.0 min, respectively. Left atrial dwell time was 47.3±18.8 min. The cryoablation characteristics by vein are shown in the Table 1. An average of 4.9±1.8 ablations were performed per patient (1.3±0.7 per vein). Grade 3 or 4 occlusion was achieved in 98.1% of PVs reported. Electrical isolation was achieved with an average TTI of 50±33.8s and in 81.4% of PVs isolation required only a single cryoablation. Nadir temperatures across all pulmonary veins averaged -56.3± 6.5C. Time to -40C was 32.9±11s and Time to Thaw (0C) was 19.5±6.7s across all veins. PVI was performed on atypical anatomies (12 LCPV, 7 RMPV, & 3 RCPV) in 19 pts. Serious adverse events included phrenic nerve palsy (0.5%), tamponade (0.5%), AV block (0.3%), stroke (0.3%), and transient ischemic attack (0.3%).

Conclusions

Real world usage data on the novel CB suggests that this device is safe and effective, with a PV isolation success rate of 96.2% and 81.4% of PVs isolated with a single cryoablation. These data are in keeping with reports on other cryoballon systems and have markedly shorter procedure times than have been previously reported on this cryoballon.
Randomised comparison of achieve and traditional circular mapping catheters in cryoballoon ablation: results at up to a decade
Authors: Gallagher M , Akhtar Z , Gang Y , Gonna H , Li A , Bajpai A , Zuberi Z , Norman M , Sohal M , Leung LWM
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

A single-centre trial randomised patients to the use of the Achieve mapping catheter or a traditional circular mapping catheter during cryoballoon procedures for paroxysmal atrial fibrillation (AF) in 2011-2014. Long-term outcomes from the cohort were determined in 2021.

Purpose

To evaluate the determinants of long-term outcome of ablation for paroxysmal AF.

Methods

Patient and study procedure characteristics and clinical outcomes were determined, including mapping catheter assignment, model of cryoballoon used, AF recurrence, repeat ablations required, findings at repeat ablation long term survival of the patient.

Results

Of 102 patients in the original study, 98 had long-term (4.11+/-2.82 years) follow up data available. 35 patients (35.7%) had AF recurrence, giving a long-term success rate at 64.3% after 1 ablation, increasing to 81.6% after repeat ablation. Of the study cohort n=8 (8.16%) died at a median of 4.9 years after ablation (IQR:1.7-5.7). 25/98 (25.5%) patients had a second ablation and 7 (7.1%) had a third or more ablations. Those who had AF recurrence were older, with a higher prevalence of prior ischaemic heart disease and cardiac device implantation (p=0.02-0.03). After multi-variate analysis, a prior implanted cardiac device was the only significant predictor of recurrence (p=0.03).

Conclusion

Long-term outcomes after a 1st time PAF cryoablation were similar regardless of the type of mapping catheter used, the generation of cryoballoon, and traditional procedure endpoints. AF recurrences were more often detected in older patients with a history of ischaemic heart disease and implanted cardiac devices.
Preferential para-hisian atrial tachycardia ablation from aortic root: a single centre experience
Authors: Amores Luque M , Rajjoub EA , Lozano Granero VC , Matia Frances R , Hernandez Madrid A , Moreno Planas J , Zamorano Gomez JL , Franco Diez E
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Para-hisian atrial tachycardia (PH-AT) radiofrequency ablation carries a significant risk of atrio-ventricular block due to proximity to the conduction system. Ablation from noncoronary cusp (NCC) has been proposed as an alternative approach; however, the best strategy remains unknown (1).

Purpose

Evaluation of a strategy based on PH-AT ablation preferably from aortic root.

Methods

Observational study of all consecutive atrial tachycardia cases submitted to our institution for electrophysiological study and ablation from 2014 to 2020. If the earliest atrial electrogram was near the His bundle, aortic root mapping and ablation from this position was pursued.

Results

A total of 105 procedures of atrial tachycardia ablation were performed in 98 patients. 25 cases (24%) were PH-AT. Mean follow-up was 19.2 months (5.8 – 36.8). Table 1 summarizes basal characteristics of our population and ablation details. In the PH-AT group, successful ablation was achieved from aortic root in 21 cases, right atrium (RA) in 1 case and from both sites in 2 cases. The patient whose ablation was performed exclusively from RA was because of pacemaker dependency. In one of the patients with dual approach, RA was firstly attempted because of aortic prosthetic valve but tachycardia recurred, so aortic root was targeted; in the other case, radiofrequency was applied from RA due to electrophysiologist preference, but after second degree transient AV block, procedure was completed from NCC.

Acute success rate was similar in both groups (para-hisian and non-para-hisian, 100% and 96%, P=0.33). Figure 1 shows a trend towards less atrial arrhythmias recurrence in PH-AT compared to other atrial tachycardia origins. In the PH-AT group, only two procedure complications were found: a case of femoral artery pseudoaneurysm (ablation from aortic root) and the previous reported transient second-degree AV block (during ablation from RA). No systemic embolism was observed.

Conclusions

Radiofrequency ablation of PH-AT from aortic root seems to be practicable, effective, and safe.
Evaluation of myocardial injury induced by different ablation approaches in atrial fibrillation patients
Authors: Giaccardi M , Grassini D , Turreni F , Chechi T
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

To evaluate myocardial injury in Atrial Fibrillation (AF) patients undergoing High Power Short Duration radiofrequency (HPSD) and visually guided Laser Balloon Ablation (LBA).

Methods and results

In this single center registry we prospectively enrolled 40 patients (67% male), mean age 63±9, with paroxysmal or persistent AF (see table I). The ablation target has been the pulmonary vein isolation (PVI) with LBA and wide area circumferential ablation (WACA) with HPSD.

6 and 18 hours post-procedure samples of high sensitive cardiac troponin I (cTnI) were collected.

The results show not significant differences in target population and no significant differences in high sensitive cardiac troponin I (cTnI pg/ml) levels at 6h (HPSD cTnI =806±496 pg/ml vs laser cTnI = 664±339 pg/ml p=0.17) and 18 hours after ablation (HPSD cTnI =833±540 pg/ml vs laser cTnI = 1081±962 pg/ml p=0.07).

Conclusion

These results indicate that myocardial injury induced by HPSD and LBA at 6 and 18 hours after procedure are similar targeting WACA and PVI respectively. This registry is ongoing to evaluate freedom from AF at 12 months follow up.
Arrhythmia recurrence reduction with an active esophageal cooling device during radiofrequency ablation
Authors: Joseph C , Francisco G , Ruppert A , Willms D , Nazari J , Fisher W , Ro A , Sherman J , Zagrodzky J , Bailey S , Zagrodzky W , Athill C , Metzl M
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

As the burden of atrial fibrillation continues to rise with an aging population, there have been contrasting positions on the efficacy of left atrial ablation. While ablation techniques have continued to improve over the past decades, arrhythmia recurrence rates must be further reduced given the burden of ablation on patients. Since continuity of lesion sets has been associated with greater lesion durability, it has been theorized that the use of active esophageal cooling may facilitate greater freedom from arrhythmia.

Purpose

In order to investigate the association between use of active esophageal cooling and arrhythmia recurrence, we performed a multicenter retrospective study of arrhythmia recurrence rates in patients that received active cooling and compared them to those that received luminal esophageal temperature (LET) monitoring.

Methods

In this study, follow up data were collected from patients that underwent pulmonary vein isolation (PVI) at three separate large medical centers. Data were contained in a prospective hospital registry, a prospective physician registry, or the electronic health record, depending on the center. For each patient included, we recorded whether their ablation utilized LET monitoring or active esophageal cooling, along with their rhythm status at 1-year follow up. Rhythm status at follow-up was determined by either electrocardiogram, Holter monitor, or wearable heart rate monitor. Kaplan-Meier (KM) curves were created for freedom-from-arrhythmia at one year comparing those in the LET monitoring group to those in the active cooling group.

Results

Follow up data were collected from 1035 patients. There were 560 patients that received LET monitoring during their original ablation, and 475 patients that underwent active esophageal cooling. KM estimates for freedom-from-arrhythmia at one year were 42% in the LET monitored group and 65% in the actively cooled group (P<.001).

Conclusion

In this large multicenter study, there is a significant increase in freedom-from-arrhythmia at one year follow-up among patients that received active esophageal cooling as compared to those that underwent LET monitoring.
Comparison of the accuracy of contact force measurement in four commercially available force-sensing ablation catheters
Authors: Kueffer T , Haeberlin A , Knecht S , Baldinger SH , Servatius H , Madaffari A , Seiler J , Muehl A , Franzeck F , Asatryan B , Noti F , Tanner H , Roten L , Reichlin T
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Contact force-sensing catheters are widely used for ablation of cardiac arrhythmias. They allow precise quantification of catheter-to-tissue contact, which is an important determinant of lesion size and durability. Moreover, contact force information reduces the risk for cardiac perforation and is used for estimation of lesion size. However, the accuracy of contact force sensors across different manufacturers has not been validated independently.

Objective

To compare the accuracy and reproducibility of different force sensing catheters used in cardiac electrophysiology procedures.

Methods

A force measurement setup containing a heated saline water bath and a catheter fixation mechanism was constructed. The setup allows to accurately measure forces applied to a platform with the catheter. We studied four different catheter models, equipped with the following, unique force-measurement technologies (figure 1): 1) multiple-fiber optical sensor; 2) single-fiber optical sensor; 3) inductive sensor; and 4) magnetic field sensors. For each model, we assessed three catheters. Repeated measurements within the force range of 0g to 60g and at electrode-tissue contact angles of 0°, 45°, and 90° were performed and validated against the force measurement unit of our measurement setup.

Results

For each catheter, at least 500 measurements at different contact forces (equally distributed across the measurement range of 0 to 60 grams) were performed. Correlation of measured-force to real-force was ρSpearman=0.99 for MFOS, ρSpearman=0.98 for SFOS, ρSpearman=0.99 for IS, and ρSpearman=0.98 for MFS. MFS and SFOS showed a higher variance for high forces and increased intra-catheter variability compared to MFOS and IS. IS overestimated higher contact force at 0° and 30°. MFS and SFOS underestimated contact force for higher forces at 30° and 45° (figure 2). Within a clinical range of 5g to 40g, the catheters reached the following root-mean-square-error, independent of contact angle: MFOS 0.88g ±0.68g, SFOS 2.15g ±1.74g, IS 0.88g ±0.72g, and MFS 1.13g ±1.01g.

Conclusion

Measured contact by force-sensing catheters correlates well with true exerted electrode-tissue force. Despite an excellent overall correlation, some technologies may be prone to significant errors at higher forces (>10g under-/overestimation of true contact force) with potential clinical consequences related to increased risk of perforation.
Epicardial mapping as first intention approach for structural ventricular tachycardia ablation
Authors: Garcia A , Brito J , Couto Pereira S , Silverio Antonio P , Silva B , Alves Da Silva P , Simoes De Oliveira C , Martins A , Nunes Ferreira A , Silva G , Carpinteiro L , Cortez Dias N , J Pinto F , Sousa J
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

In several structural arrhythmogenic diseases that comprise intricate endocardial, intramural and epicardial substrates, endocardial ablation of ventricular tachycardia (VT) is not sufficient and epicardial ablation has lately become a complementary and necessary tool.

Purpose

To evaluate the clinical characteristics of patients (pts) most suitable for first intention epicardial VT ablation.

Methods

Single-center prospective study of consecutive pts with structural heart disease undergoing first intention epicardial VT mapping between August 2015 and June 2021. Decision for epicardial approach was based on the etiology, VT electrocardiogram (ECG) and cardiac magnetic resonance (CMR) results. Under general anesthesia, subxiphoid access using a Tuhoy needle was done using fluoroscopic guidance and with high-density epicardial mapping was performed. Epicardial ablation was performed if relevant arrhythmogenic findings were locally confirmed.

Results

First intention epicardial VT ablation was attempted in 18 pts (mean age 59.8±12 years,94% male) of whom 16 had non-ischemic dilated cardiomyopathy (NICM,idiopathic:11; post-myocardis:4; hereditary:1) and 2 had right ventricular arrhythmogenic cardiomyopathy. Mean LVEF was 33% and 79% had a previous ICD (53% in primary prevenon). 69% were referred for ablation due to arrhythmic storm (1pt in cardiogenic shock). Epicardial access was achieved in 17 pts (94%), without acute complications. In 35% pts with NICM the decision for epicardial approach was based on the detection of subepicardial CMR delayed-hyperenhancement and relevant epicardial arrhythmic substrate was confirmed by mapping in all cases. In 3 pts radiofrequency (RF) applicaons were not performed at epicardium, as no abnormal electrograms were locally detected, and an addional endocardial approach was prosecuted. The mean overall procedure and fluoroscopic time were 123 and 28min, respectively, with a mean RF application me of 51min. After the procedure 1pt required pericardial drainage due to inflammatory pericardial effusion. No other acute complications occurred. During a mean follow-up of 2.8±1.8 years, only 3pts (17%) had VT recurrence; 5pts (28%) died due to end-stage heart failure and 2pts (11%) underwent heart transplantation.

Conclusion

In NICM a first intention epicardial VT ablation performed by experienced operators/centers is efficient, particularly if guided by CMR findings,and presents a safety profile.
Gender, ethnic difference in arrhythmic risks and prognosis in patients with non-ischaemic cardiomyopathy
Authors: Chung KKI , Lim CJ
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The mortality benefits of Automatic Intracardiac Defibrillator (AICD) in non-ischaemic cardiomyopathy patients is less clear. Subgroup analysis of Definite trial showed that female patients favoured medical treatment. Ethnic difference in arrhythmic risk also not known.

Method

447 patients with heart failure and reduced left ventricular ejection fraction (LVEF <40%) due to non-ischemic cardiomyopathy, all have coronary angiogram to exclude significant coronary artery disease (>70% stenosis).

Continuous variables were compared by Student t tests and categorical variables compared by use of the Fisher exact test. Composite endpoints include death, sudden cardiac death (SCD), ventricular arrhythmias (VA ) and hospitalisations for heart failure. P<0.05 was denoted as statistical significant.

Results

Mean age 63.07 ± 14.19 years, male patients 314 (70%), 360 Chinese and 87 non-chinese. Mean age of male and female patients were 61.21 ± 13.65 and 67.46 ± 14.52 years old respectively. Patients with diabetes mellitus 38%, hypertension 76%, atrial fibrillation 38%, stroke 9%. LDL 2.78 ± 1.04 mmol/l, HbA1c 6.56 ± 1.62%, baseline creatinine 98.43 ± 37.27umol/l. Patients taking ivabradine 9%, b-blocker 88%, Angiotensin inhibitors/Angiotensin Receptor Blocker 66%, Sacubitrial/ Valsartan 26%, spironolactone 57%, SGLT-2 inhibitor 9%.

Mean follow-up duration of 6.18 ± 4.16 years. There were 61 deaths (13%, 2.20% death/ year, 20 females and 41 males). 38 SCD, 22 VA, 218 hospitalisation for heart failure

There was a significant increase in LVEF from 24.88 ± 8.17 to 39.92 ± 13.88% and 22.05 ± 8.52 to 36.14 ± 8.17 % in female and male patients respectively (p=0.023). 190 patients (43%) have LVEF increased to or more than 35%.

40 patients (9%) received device therapy (AICD and Cardiac resynchronization therapy), 19% secondary prevention, 81% for primary prevention. The median time from diagnosis of NICMP to appropriate device therapy for VT/ VT storms was 85.5 months (interquartile range 35-131). 18/21 patients (86%) noted to have appropriate therapy for VT/ VT storms were males. HR for males 8, 95% CI (1.06, 60.34, p=0.044). All the device therapy occurred in patients with LVEF< 35%. There is also gender difference in composite endpoints (p=0.0022)

LVEF improved from 23.31± 8.67 to 38.10 ±15.20 and 21.63 ±7.57 to 33.74 ±12.92% respectively (p=0.014) in Chinese and non-Chinese patients respectively. There are no significant difference in the VA or primary composite endpoints.

Conclusions

The study showed progressive improvement of the therapeutic regimens improve mortality by improving LVEF regardless of gender or ethnicity. The ventricular tachyarrhythmic risk, composite endpoints are significantly higher in male than female patients with non-ischaemic cardiomyopathy. There is no ethnic difference in clinical endpoints.
Tachycardiomyopathy: linear regression model for left ventricular ejection fraction recovery
Authors: Izquierdo Bajo A , Arroyo Monino DF , Fernandez Valenzuela I , Bastos Amador P , Cozar Leon R , Carreno Lineros JM , Diaz Infante E
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Tachycardiomyopathy is a common cause of reversible left ventricular disfunction, whose predictors are not well-stablished. Its individual estimation would be useful for the decision-making process.

Methods

Retrospective single-centre, observational study of consecutive patients with diagnosed tachycardiomyopathy between September 2014-2020. Sample was split in 2 parts: first for the construction of the lineal-regression model selected by the all-possible equation’s method (sample 1, 70% of the cohort), second for its validation (sample 2, 30%).

Results

113 patients were gathered in this period. Most prevalent arrhythmia was atrial fibrillation (75.2%), followed by atrial flutter (22.1%), ventricular extrasystole (5.3%) and atrial tachycardia (2.65%). Mean left ventricular ejection fraction (LVEF) at diagnosis was 33.7% (±6.48) and mean left ventricular end-diastolic diameter 56.3 mm (±6.97). Rhythm control was achieved in 81.4% of patients, of whom 79.3% underwent an ablation procedure. After a mean of 11.4 months, mean final LVEF was 55.1% (±6.04). Recovered LVEF (final minus initial) was calculated in all patients. Using sample 1 131,071 models were calculated. The best model was selected based on the Mallows index (Picture 1), composed by arterial hypertension, sleep apnea syndrome, atrial fibrillation as the culprit arrythmia, LVEF at diagnosis and rhythm control strategy. The selected model explained nearly half of the individual variability of LVEF (R2 0.476). Subsequently in sample 2, predicted recovered LVEF was compared with the observed one (Picture 2), without significative differences in the determination coefficient r2 (R2 - r2 = -0.0064).

Conclusion

Arterial hypertension, sleep apnea syndrome, atrial fibrillation as the culprit arrythmia, LVEF at diagnosis and rhythm control strategy predicted LVEF recovery in tachycardiomyopathy patients.
Tachydysrhythmias in patients admitted with COVID-19 pneumonia: prevalence and impact on in-hospital mortality
Authors: De Almeida Fernandes D , Guimaraes J , Monteiro E , Costa G , Antonio N , Goncalves L
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The COVID-19 pandemic has shifted tremendously the paradigm of hospital care and treatment of cardiovascular (CV) patients. According to most recent evidence, due to its multisystemic impact, COVID-19 may lead to an increased risk of cardiac arrhythmias with subsequently increased morbimortality.

Purpose

Determine the prevalence of tachyarrhythmias in patients admitted with COVID-19, possible predictors and impact on in-hospital mortality.

Methods

A retrospective study of 3475 consecutive patients with COVID-19 pneumonia admitted to our hospital between February 2020 and November 2021 were included. The main outcome was tachyarrhythmias (high ventricular rate (HVR) or new-onset atrial fibrillation (AF), HVR or new-onset atrial flutter (AFL), other supraventricular tachycardias (SVT), ventricular tachycardia (VT) and ventricular fibrillation (VF)). Secondary outcome was in-hospital mortality. Sociodemographic variables and clinical data were recorded. Statistical comparison was made between groups, including logistic regression to determine odds ratios (OR).

Results

A total of 215 patients presented HVR AF (6.31%), 79 of which with new-onset AF (36.74%). 8 patients had HVR AFL (0.23%), 5 VT (0.15%), 4 VF (0.12%) and only 3 patients had a SVT identified (0.09%). Patients with tachyarrhythmias were significantly older (77. 74 ± 11.25 68.94 ± 17.51 years, p <0.001) and had more hypertension (p 0.034), heart failure (HF) (p <0.001), severe valvular heart disease (VHD) (p 0.007), coronary artery disease (CAD) (p 0.031), chronic kidney disease (CKD) (p 0.048) and paroxysmal AF (if previously diagnosed (p 0.001). There were no significant differences regarding gender, dyslipidemia, diabetes, cerebrovascular disease and obstructive sleep apnoea (OSA).

Patients with HF had the highest risk of tachyarrhythmia (OR 3.539; 95% CI 2.666-4.698; p <0.001), followed by severe VHD (OR 1.990; 95% CI 1.192-3.365; p 0.009) and CAD (OR 1.575; 95% CI 1.040-2.386; p 0.032). Older patients or patients with hypertension or CKD were also at an increased risk. Also of note, patients previously diagnosed with paroxysmal AF were more likely to have episodes of HVR AF than the ones with persistent or permanent AF (OR 1.819; 95% CI 1.272-2.602; p 0.001)

Regarding the secondary outcome, patients with tachyarrhythmias during hospital stay had an odd almost 3 times higher of death (OR 2.820; 95% CI 2.151-3.695; p <0.001).

Conclusions

Tachyarrhythmias is a common complication in COVID-19 patients during hospital stay that is significantly linked to higher in-hospital mortality. Patients presenting with high CV disease burden are at particularly significant risk and should be carefully managed.
Mortality and causes of death after new-onset atrial fibrillation: a nationwide study
Authors: Aro A , Haukka J , Halminen O , Putaala J , Linna M , Mustonen P , Hartikainen J , Airaksinen J , Lehto M
Published: May 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Sigrid Juselius Foundation

Introduction

Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide, and its prevalence is increasing with aging population. AF is associated with increased cardiovascular morbidity and mortality, but the prognosis of newly detected AF in the general population is not well established.

Purpose

Using data from the large FinACAF-study, a comprehensive nationwide retrospective cohort study including all diagnosed Finnish AF patients, we studied one-year mortality after new-onset AF in the general population and determined the causes of death of deceased AF patients.

Methods

All patients with new-onset AF in Finland 2007-17 were identified from nationwide primary care and reimbursements registries and hospitalization records. Baseline characteristics of these patients were determined, and their survival was followed from registries for one year. Principal cause of death was determined from death certificate’s International Classification of Diseases (ICD-10) Codes.

Results

A total of 229 321 patients with first-diagnosed AF were identified (50.0% female). Mean age of men and women with new-onset AF was 69.4 ± 13.4 and 77.1 ± 11.8 years, respectively (p<0.001 for difference). In men and women, hypertension had been diagnosed in 68.0% vs 80.4% (p<0.001), congestive heart failure in 15.4% vs 19.3% (p<0.001), diabetes in 22.5% vs 20.7% (p<0.001) and vascular disease in 27.2% vs 24.8% (p<0.001), respectively. Prior stroke or transient ischemic attack had occurred in 14.0% of men and 16.8% of women (p<0.001).

During the one-year follow-up, 11.6% of men and 13.7% of women died (Figure). Most common cause of death in these patients was ischaemic heart disease (26.2% of all deaths), followed by malignancies (17.4%) and dementia (12.4%). Cerebrovascular diseases were responsible for 10.8% of mortality.

Conclusion

In this population-based nationwide study, we demonstrated that one-eight of patients with new AF died within one year of the diagnosis. Ischaemic heart disease was most frequent cause of death.
Sleep apnea is associated with stroke in young patients with or without atrial fibrillation:A population study of >2 million individuals
Authors: Deb B , Vasireddi SK , Clopton P , Ganesan P , Feng R , Rogers AJ , Baykaner T , Bhatia NK , Narayan SM
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NIH, R01 HL149134, R01HL83359

Background

Both Sleep Apnea (SA) and Atrial Fibrillation/flutter (AF) are known risk factors for stroke, and both are increasing in prevalence. They are both under-diagnosed in young adults <60 Y. There is an urgent need to define stroke risk portended by SA and AF yet there a paucity of data in adults aged 20-60 years.

Purpose

To define the relationship between stroke, SA, and AF in a very large cohort of 2 million young-middle aged adults aged 20-60 Y in Northern California.

Methods

We probed the Stanford Research Repository of electronic health data from 01/01/2008 to 11/30/2021 for the diagnoses of stroke, transient ischemic attacks, AF and SA using relevant codes (stroke: 433.X, 434.X, 436.X, I63.X, I65.X, I66.X, G45.X, G46.X; AF: I48.X; SA: G47.X, 327.27).

Results

We identified 2267485 patients aged 20-60Y (55% F; 32% White, 12% Asian, 3% Black), of whom SA was diagnosed in 52730 (2.3%), AF in 10230 (0.4%) and incident stroke in 10385 (0.4%) (Figure 1A)

In patients with SA, 1.5% developed incident stroke. Stroke was more common in patients with SA than those without, regardless of co-existing diagnosis of AF; OR with AF: 1.5 [1.3-1.7, p<0.001] and OR without AF: 3.0 [2.8-3.3 p<0.0001]. Risk of stroke with SA than without was noted to be higher in the younger age subgroups (Figure 1B) regardless of AF.

Although AF was more common in patients with SA than without (odds ratio, OR: 10.1 [9.6-10.6, p<0.0001]), the majority of SA patients (63% with CHADS2VASC ≥2) with stroke did not have a diagnosis of AF (75%), of whom 96% were not anticoagulated (Fig 1, left panel). Of the remaining patients with SA and incident stroke, who did have AF (25%), only 26% were taking OACs at the time of stroke despite median CHADS2 VASC score=3 (Fig 1A, left panel).

Finally, 7% of AF patients developed incident stroke. Of these, 73% had CHADS2VASC ≥2, yet 44% were not anticoagulated. Patients with SA comprised a third of all AF patients with stroke and, compared to AF patients with stroke and without SA, had higher CHADS2VASC (median 3 vs 2, p<0.001) and a similarly low use of anticoagulation (56% vs 54% on OAC) (Fig 1A, right panel).

Conclusions

In >2 million young individuals, we uncover a novel association between SA and incident stroke, regardless of the diagnosis of AF. Surprisingly, three quarters of patients with SA developed incident stroke in the absence of AF, and were not anticoagulated. These results underscore the need to screen for AF and sleep apnea in young adults.
Comparative effectiveness of early rhythm control versus rate control for cardiovascular outcomes according to sex in patients with atrial fibrillation
Authors: Yang PS , Kim DH , Jang E , Yu HT , Kim TH , Pak HN , Lee MH , Sung JH , Joung B
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health & Welfare, Republic of Korea

Background

Rhythm control is associated with better cardiovascular outcomes than usual care among patients recently diagnosed with atrial fibrillation (AF). However, there are limited data on the outcomes of AF ablation according to sex. The purpose of this study was to evaluate gender differences in the effects of early rhythm control compared to rate control on the primary composite outcome of cardiovascular death, ischaemic stroke, hospitalisation for heart failure (HF), or myocardial infarction.

Methods

We conducted a retrospective population-based cohort study including 22635 patients with AF newly treated with rhythm control (antiarrhythmic drugs or ablation) or rate control in 2011-2015 from the Korean National Health Insurance Service database. Propensity overlap weighting was used.

Results

Among patients with early AF treatment (initiated within 1 year since diagnosis), compared with rate control, rhythm control was associated with a similar lower risk of the primary composite outcome both women (weighted incidence rate per 100 person-years: 8.68 in rhythm control vs. 10.3 in rate control; hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.69 to 0.90; P<0.001) and men (weighted incidence rate per 100 person-years: 6.33 in rhythm control vs. 8.32 in rate control; HR 0.77, 95% CI 0.67 to 0.88; P<0.001). However, the effective initiation time for rhythm control therapy was within 6 and 11 months after AF diagnosis in female and male patients, respectively. Moreover, the effective times for other outcomes were different between genders (hospitalization for HF; female within 2 months, male within 9 months/ ischemic stroke; female within 11 months, male immediately).

Conclusions

Early initiation of rhythm control was associated with a lower risk of primary outcome in both genders. However, the effective rhythm control treatment initiation time for primary outcome, stroke and HF-related admission was different in both genders. For rhythm control treatment to be effective, women should start treatment earlier than men.
First human experience with catheter ablation using dipole charge density mapping integrated in robotics in the management of atrial fibrillation
Authors: Gagyi R , Noten AME , Wijchers S , Yap SC , Bhagwandien R , Hoogendijk M , Szili-Torok T
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Remote magnetic navigation (RMN) guided catheter ablation (CA) previously demonstrated high efficiency and efficacy in atrial fibrillation (AF) ablation. Heretofore, only the CARTO 3D mapping system was integrated in the RMN system. Recently, a novel high-resolution non-contact mapping system (AcQMap) can be used in combination with the RMN robotic system (AcQMap-RMN).

Purpose

To assess efficiency, efficacy and safety of dipole charge density mapping in RMN guided ablation procedures for AF.

Methods

All patients undergoing pulmonary vein isolation (PVI) or redo-PVI using the AcQMap-RMN system were analyzed. The AcQMap identifies different activation patterns such as focal firing, rotational activity, and localized irregular activation for substrate ablation. Procedural efficiency was characterized by procedure time, total ablation time and radiation doses. Efficacy data were based on 12-month follow up and number of redo procedures. Procedural safety was evaluated by intra- and post-procedural complications.

Results

A number of 71 consecutive patients were included in the study (47 male, 24 female, mean age 60.8±9.9, 49 redo, 22 de novo). Twenty-four patients had paroxysmal (PAF), 47 had persistent AF (persAF). After completing PVI, 42 patients underwent AcQMap based substrate ablation. Twenty-four patients converted to atrial tachycardia/flutter during the ablation. The mean procedure time was 170.5±43.3 min, mean ablation time 1749.6±950.7 s, mean radiation dose was 207.0 (IQR 128.5 - 349.5) mGy. In the PAF group, radiation doses (128.5 vs 256.0 mGy, p=0.00) and application numbers (21.1 vs 37.0, p=0.00) were lower, ablation times were shorter (1312.5 vs 1919.3 s, p=0.02) compared to the persAF patient group. Two patients in the PAF group, and 9 patients in the persAF group had documented recurrence at the 6-month follow-up visits. In the PAF group, 23 patients were AF-free (95.8%), in the persAF group, 34 patients were AF-free at the end of the 12-month follow-up period (72.3%). Six patients had a redo procedure. Two patients were documented with hematoma, as minor post-procedural complication (2.8%).

Conclusion

AcQMap-RMN integration provides high acute and long-term success rates, improved efficiency and low complication rates in paroxysmal and persistent AF ablation.
Fifty-fifty - a comparison of two 50 watts high power short duration protocols using temperature- versus power- controlled radiofrequency ablation for atrial fibrillation
Authors: Guckel D , Bergau L , Braun M , El Hamriti M , Lucas P , Isgandarova K , Fink T , Sciacca V , Khalaph M , Imnadze G , Sommer P , Sohns C
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Radiofrequency-guided catheter ablation (RFCA) is an established treatment option for atrial fibrillation (AF). New approaches applying higher than usual energy levels for shorter periods (high power short duration, HPSD) to improve lesion quality have been reported. The novel DiamondTemp (DT) catheter allows for temperature-guided high power RFCA. Data on a direct comparison of the two emerging RFCA approaches are lacking.

Purpose

This observational single center study aimed to compare the efficacy, safety and characteristics of the novel DT catheter to an ablation index (AI) guided 50 W high power short duration (HPSD) ablation protocol using a conventional force-sensing equipped ablation catheter with surround-flow.

Methods

A total number of 101 patients undergoing RFA for AF were included. 33 patients treated with the DT catheter (50 W, 9 sec), were compared to 69 consecutive patients undergoing AI-guided AF ablation (AI anterior 550; AI posterior 400) with an open-irrigated catheter adherent to a 50 W HPSD protocol. Procedural data and recurrence rates were documented. Follow-up examinations were scheduled after 3, 6 and 12 months.

Results

Acute procedural success was achieved in all patients (n=101, 100%). DT-guided AF ablation was associated with a significantly longer mean procedure duration (98.8±30.1min vs. 78.2±25.6, p=0.002*). PVI using the DT ablation catheter required significantly more RF applications (75.4±30.8min vs. 61.3±14.1, p=0.019*). Total RF duration was significantly lower in the DT group (792.1±311.2sec vs. 1035.5±287.2sec, p<0.001*) as well as fluoroscopy time (4.6±2.1min vs.5.5±2.5min, p<0.006*) and dose (183.8±178.1yGym2 vs. 295.8±247.5yGym2, p<0.013*). Procedure related mayor complications occurred in 1 patient from the DT group (acute stroke; 3%) and in no patients from the HPSD cohort. Early recurrence was reported from 4 patients treated with the DT catheter (12%) compared to 8 patients undergoing HPSD RFA (12 %) (p=1.000).

Conclusion

Temperature- and power- controlled AF ablation using 50 W was safe and effective. AI-guided HPSD ablation resulted in significantly shorter procedure times with significantly fewer RF applications for PVI, whereas total RF duration and fluoroscopy times were significantly higher in this cohort. Further studies are needed to confirm this initial observation.
First real-world experience with pulmonary vein isolation using pulsed field ablation for paroxysmal atrial fibrillation
Authors: Neven K , Fueting A , Hoewel D , Brokkaar L , Rahe G , Reinsch N
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Catheter ablation for AF using thermal energy can cause collateral damage. Pulsed field ablation (PFA) is a novel nonthermal energy source. Only a few small clinical studies have been published.

Objective

We report on the first “real-world” experience with PVI using PFA for paroxysmal AF.

Methods

Pre and post ablation, phrenic nerve function was assessed. A high-density LA bipolar voltage map was created. All PVs were individually isolated using a steerable sheath and a pentaspline over-the-wire PFA catheter. After ablation, mapping was repeated to assess lesion formation.

Results

In 30 patients (63 years; 47% male), uncomplicated PFA was performed, with all PVs isolated. Procedure time was 116 min. PFA catheter LA dwell time was 29 min. Fluoroscopy time was 26 min. (All values are median). In 1 patient with roof dependent flutter, a roof line was intentionally created. In 2 patients, unintentional bidirectional mitral isthmus block was created. There was no phrenic nerve or esophageal damage. In 1 patient, pericardial drainage after cardiac tamponade was performed. In-hospital stay, and 30-day follow-up were uneventful. After 90 days, 97% of patients were in sinus rhythm.

Conclusion

PVI using PFA for paroxysmal AF in a “real-world” setting is safe and feasible. Procedure and ablation times are short. Atrial ablation lines can easily be created. Unintentional ablation of atrial tissue can occur, accurate catheter alignment to the PV ostium and PV axis should be ensured.

Figure: Postero-anterior view of a LA bipolar voltage 3D map. Left panel: pre ablation. Magenta areas in the PVs are conducting (>0,5 mV). Right panel: post ablation. Non-magenta (<0,5 mV) and red (<0,1 mV) areas in the PVs are ablated and electrically silent.