bluuebunny/crossref_metadata_2025 huggingface dataset:
Very high-power short-duration temperature-controlled ablation for cavotricuspid isthmus block : the Fast-and-Furious CTI study
Authors: Kirstein B , Vogler J , Eitel C , Phan L , Feher M , Keelani A , Traub A , D’ Ambrosio G , Grosse N , Reincke S , Hatahet S , Trajanoski D , Kuck K , Tilz R , Heeger C
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Catheter ablation for typical right atrial flutter (AFL) provides an effective treatment associated with encouraging clinical outcome. The novel micro-electrode ablation catheter allows very high-power short-duration (vHP-SD, 90 W/4 sec) ablation and potentially offers the ability to perform a safe, effective and faster cavotricuspid isthmus (CTI) ablation.

Aims

We evaluated feasibility and efficacy of a vHP-SD (90 W/4 sec) temperature-controlled radiofrequency (RF) CTI ablation for AFL using a novel contact force (CF) sensing ablation catheter with micro-electrodes.

Methods

Fifteen consecutive patients (median age 75 years (interquartile range, IQR: 67, 79), 67 % male) with documented typical AFL were prospectively enrolled and underwent vHP-SD based CTI ablation (90 W/4 sec). Durability of CTI block was proven by pacing maneuvers from both sides of the ablation line.

Results

Complete CTI block using vHP-SD ablation was achieved in all patients (Figure 1). At median 23 (IQR 20; 39) RF applications over a median RF ablation time of 92 (IQR 78, 154) seconds were applied. It was not necessary to switch to the standard temperature-controlled mode to achieve durable CTI block. No periprocedural complications, no charring and no steam pops were observed.

Conclusions

Very high-power short-duration (90 W/4 sec) CTI ablation for the treatment of typical AFL is feasible and efficient. Effective CTI block can be achieved in about 1.5 minutes of RF time.
Factors predicting repeated ablation in ventricular tachycardia patients
Authors: Komlosi F , Toth P , Vamosi P , Szegedi N , Sallo Z , Piros K , Perge P , Osztheimer I , Abraham P , Szeplaki G , Merkely B , Geller L , Nagy VK
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Heart Program

Background

Catheter ablation has emerged to be the principal treatment for recurrent ventricular tachycardia (VT). Previously, several predictors of VT recurrence have been described, such as LVESD, severe MR, incessant VT, ICD shocks and elevated LDH levels. However, factors predicting an additional ablation are unknown.

Purpose

We aimed to establish predictors of repeat ablation and compare to the predictors of ventricular arrhythmia recurrence during 1-year follow-up in structural heart disease.

Methods

Baseline medical history, laboratory results, imaging parameters, clinical properties of VTs, and procedural data were gathered in a structured database.

Results

Out of the 272 patients, 96 (35%) experienced recurrence and 36 (13%) had repeated procedures within 1 year. Independent predictors of recurrence were left ventricular end systolic diameter (HR = 1.516, p=0.015), severe mitral regurgitation (HR = 2.446, p = 0.002), incessant VT (HR = 1.64, p = 0.02), VT inducibility (HR = 3.71, p = 0.003), ICD shocks (HR = 1.95, p = 0.002) and elevated LDH levels (HR = 1.26, p = 0.003). Regarding redo ablation, elevated LDH level (HR = 1.64, p = 0.01), incessant VT (HR = 2.94, p < 0.001), ICD shocks (HR = 2.38, p = 0.02), only exit point ablation (HR = 2.14, p = 0.023) were independent predictors, while hypertension (HR = 0.32, p = 0.03), longer transmitral E-wave deceleration time (HR = 0.47, p = 0.04), substrate modification (HR = 0.47, p = 0.044) were protective.

Conclusion

Predictors of repeat ablation overlap only partially with those of VT recurrence. Predictors implying higher risk VT episodes predict both recurrence and repeat ablation while factors associated with more severe left ventricular systolic dysfunction predict recurrence but not a redo procedure.
Right anterior ganglionated plexus ablation for the treatment of vagally-mediated atrial fibrillation
Authors: Futyma P , Zarebski L , Wrzos A , Futyma M , Kulakowski P
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Pulmonary vein isolation (PVI) is a cornerstone for catheter ablation of atrial fibrillation (AF), however, exact mechanisms of PVI efficacy remain debatable. PVI is an invasive left-atrial procedure which may be associated with complications. It has been postulated that in patients with increased vagal tone AF can be treated by attenuation of parasympathetic drive to the heart using cardioneuroablation (CNA) by means of radiofrequency (RF) ablation of the ganglionated plexi, however, data in literature are lacking.

Objectives

To examine the mid-term efficacy of RF-CNA targeting the right anterior ganglionated plexus (RAGP) in the management of AF using right-atrial (RA) approach only.

Methods

We included consecutive 12 male patients (age 55±11) with vagally-mediated AF (decelaration capacity (DC) >7 ms, mean 11,2±3,7ms) who underwent RF-CNA of RAGP. RAGP was targeted anatomically at the septal area below superior vena cava (SVC) from RA only. The aim was to achieve ≥30% heart rate acceleration (HRA). The follow up consisted of regular visits combined with ECG conducted every 3 months and 24h or 7-day Holter ECG.

Results

The RF time was 126±61 sec, power - 34±7W and procedure time - 44±18 min. The ≥30% HRA was achieved in 7 (58%) patients (pre-RF vs post-RF: 58±7 bpm vs 80±9 bpm, p=0,0000013). There were no complications during procedures. The follow up lasted 11±6 months. All patients reported significant symptom improvement post-CNA. AF-free survival was significantly higher in patients with ≥30% HRA during RF-CNA (≥30% HRA vs <30% HRA, 60% vs 14%, log rank p=0,0203) Conclusions: Right atrial RF-CNA of RAGP can be effective in patients with vagally-mediated AF. Larger prospective studies are needed to confirm these preliminary findings.
Pulsed field ablation of atrial fibrillation: recurrence rate after first pulmonary vein isolation and first insights into durability at redo procedures
Authors: Kueffer T , Seiler J , Madaffari A , Muehl A , Stettler R , Asatryan B , Haeberlin A , Noti F , Servatius H , Tanner H , Baldinger SH , Roten L , Reichlin T
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Pulsed field ablation (PFA) is newly available for pulmonary vein isolation (PVI) and combines the benefits of high procedural efficacy and safety. Independent data on the recurrence-rate of atrial fibrillation (AF) after PVI and on PVI durability during redo procedures are scarce.

Purpose

We report data on the recurrence rate of AF after first PVI using PFA and first insights into findings of PVI durability during redo procedures.

Methods

Consecutive AF patients undergoing a first PFA PVI at our center between May 2021 and August 2021 were included. PVI was verified by 3D-electroanatomical mapping (3D-EAM), and additional PFA lesions were applied when necessary until all PV were isolated. Seven-day Holter ECGs were performed at 3 and 6 months after ablation. After a blanking period of 3 months, episodes of AF/AT lasting more than 30 seconds were considered as AF-recurrence.

Results

41 Patients, median age 69 (interquartile range 62-73) years, 24% female, 56% persistent AF, underwent first PVI by PFA. All PVs were successfully isolated using a multipolar PFA catheter. Median total procedure time including 3D-EAM was 104 (85-121) min. Total fluoroscopy time and dose were 26 (19-30) min and 671 (323-1248) Gym2. Acute complications occurred in 1 (2.4%) patient (cardiac tamponade requiring drainage). Early recurrence of AF during the blanking period occurred in 1 (2.4%) patient. Median follow-up time was 107 (91-152) days. Recurrence of AF after the blanking period was detected in 5 (12%) patients, 1 (6%) in paroxysmal AF and 4 (17%) in persistent AF patients, respectively. Redo procedures in 3 (7.3%) patients with AF recurrence confirmed durable isolation of 12/12 (100%) pulmonary veins and showed no evidence of PFA lesion regression.

Conclusion

AF recurrence rates after PVI by means of PFA are low. Durable isolation of 12/12 pulmonary veins (100%) and no evidence of PFA lesion regression was observed during redo procedures in patients with AF recurrence.
Quality of life after first-line cryoablation of atrial fibrillation: results from the Cryo AF Global Registry
Authors: Zucchelli G , Chun KRJ , Khelae SK , Foldesi C , Kueffer FJ , Van Bragt K , Scazzuso F , On YK , Kandari FA , Okumura K
Published: May 2022

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): The registry was sponsored Medtronic, Inc., Minneapolis, MN.

Background

Atrial fibrillation (AF), the most common cardiac arrhythmia, burdening patients with a myriad of symptoms. Three recent randomized trials demonstrated that cryoballoon ablation (CBA) is superior to antiarrhythmic drugs (AADs) as a first-line treatment for the prevention of arrhythmia reoccurrence in patients with paroxysmal AF. However, the global outcome of CBA performed according to local standard of care as a first-line therapy for AF is not reported.

Purpose

To compare safety, efficacy, and quality of life outcomes in patients treated with CBA for first-line management of AF against patients treated with CBA following failed AAD therapy.

Methods

The Cryo AF Global Registry, an ongoing, prospective, multicenter registry, of AF patients undergoing index CBA performed according to local standards at 58 centers in 26 countries worldwide. In this analysis, subjects undergoing first-line cryoablation were compared to patients who were refractory to AAD therapy and/or taking AADs at baseline. Safety was assessed utilizing a composite of serious procedure-related complications. To evaluate efficacy, time-to-first atrial fibrillation, -flutter and/or -tachycardia (AF/AFL/AT) recurrence post a 90-day blanking period was compared between groups using Kaplan-Meier estimates. Quality of life was evaluated using the EQ-5D-3L questionnaire at baseline and at 12 months following CBA. Log-rank, two-sample t-test, and exact binomial tests were utilized to test difference between groups.

Results

Of 1,394 total patients, 433 (31.1%) were drug naïve prior to CBA. Patients in the AAD therapy cohort failed a mean of 1.2 ± 0.5 AADs before CBA. Freedom from AF/AFL/AT recurrence at 12 months was 87.8% in first-line patients compared to 81.6% in AAD-refractory patients (p<0.01). Serious adverse event rates were not statistically different (p=0.32) between first-line (2.3%) and AAD-refractory (3.4%) patients. First-line CBA resulted in a larger mean decline in symptoms upon follow-up, with 81% of patients reported to be symptom-free at 12 months. Further, first-line patients were prescribed AADs at a lower rate at discharge (18.6% vs.62.8%) and at 12-months (9.7% vs.29.9%) in comparison to patients in the AAD cohort. However, cryoablation did result in AAD prescriptions being reduced by approximately 50% in both cohorts from discharge to 12-months. As determined by the EQ-5D-3L score, quality of life improved for patients in both groups, with no significant difference between first-line and AAD-refractory patients (p=0.29).

Conclusion

This real-world global evaluation supports CBA as a safe and efficacious first-line treatment that improves the quality of life for patients with symptomatic AF.
Influence of catheter orientation on local impedance parameters during radiofrequency delivery in AF ablation
Authors: Schillaci V , De Sanctis V , Mazza A , Zucchelli G , Notaristefano F , Gagliardi M , Meynet I , Mantica M , Solimene F , Anselmino M , Stabile G , Ottaviano L , Cavaiani M , Malacrida M , Varbella F
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Recently, a novel contact force (CF) sensing catheter able to measure local tissue impedance (LI) providing a measure of tissue characteristics has become available for clinical use.

Purpose

We sought to evaluate the influence of catheter contact angle on LI and CF parameters in consecutive atrial fibrillation ablation cases.

Methods

Consecutive pts undergoing radiofrequency catheter (RFC) ablation of AF from the CHARISMA registry were included. A novel ablation catheter (IntellaNav Stablepoint catheter) with dedicated algorithm (DirectSense) was used to measure LI at the distal electrode of this catheter. Each targeted spot was characterized in terms of RF delivery time, catheter contact angle, baseline LI and subsequent LI drop during ablation at different levels of CF (<5g, 5-19g and ≥20g). RFC ablations were performed at ≥45 watts. Data are reported as mean±SD.

Results

A total of 4193 point ablations performed around PVs from 54 cases of AF ablation were analyzed (57% paroxysmal, 85% de novo). The LI was 157±17Ω prior to ablation and 137±14Ω after ablation (p<0.0001, absolute LI drop of 22±8Ω). The CF was 12.5±8g and the RFC delivery time was 8.8±4s. The LI drop increased as CF increased (ranging from 18.9±7Ω for CF<5g to 24.8±7Ω for CF≥20g, p<0.0001) as well as RFC delivery time decreased (ranging from 12.7±4s for CF<5g to 6.6±4s for CF≥20g, p<0.0001). The LI drop at perpendicular orientations was significantly lower than at parallel orientations (19.5±8Ω vs 23.4±8Ω, p<0.0001) and RFC delivery time was higher (9.6±5s vs 8.4±4s, p<0.0001). This trend was confirmed among different level of CF both for LI drop and RFC delivery time. Figure

Conclusions

In this experience, the magnitude of the LI drop at perpendicular orientation were significantly lower than at parallel orientation and RFC delivery time was greater in parallel instances than in perpendicular instances. Thus, perpendicular RF ablations required longer RF applications and produced weaker LI decreases that parallel lesions, suggesting that catheter orientation may have critical role in RF delivery for ablation.
High-density mapping in catheter ablation for persistent atrial fibrillation
Authors: Steven D , Fiedler L , Roca I , Lorgat F , Lacotte J , Haqqani H , Jesser E , Williams C , Roithinger F
Published: May 2022

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Abbott Laboratories

Background

Pulmonary vein isolation (PVI) is an established treatment option for persistent atrial fibrillation (PersAF). Corresponding long-term success rates remain modest however, advancements in high-density (HD) mapping may better identify substrates. The HD grid-style mapping catheter (HD Grid) allows for simultaneous analysis of adjacent orthogonal bipolar signals that may assist in ablation strategy decisions to achieve favorable outcomes in treating PersAF.

Objective

This was a prospective, multi-center, observational study to quantify and characterize the use of a market-released HD mapping catheter in PersAF subjects.

Methods

HD Grid was used in PersAF subjects undergoing radiofrequency (RF) ablation across 25 sites to gather data regarding safety, mapping efficiency and quality, ablation strategies, and procedural outcomes.

Results

334 PersAF subjects (average age: 64.2 years; 76% male) were enrolled in this study. Types of maps generated included peak-to-peak voltage (78%; 322/413), local activation time (LAT) (11.4%; 47/413), and complex fractionated electrogram (CFE) mean (7.7%; 32/413). Median total mapping points collected and used were 8428.0 (IQR 4845.0-13366.0) and 2099.0 (IQR 1219.0-2947.0), respectively, in a median of 11.0 (IQR 7.3-16.0) minutes per map. Low voltage, scar/fibrosis, and CFE were searched for in 90.4% (302/334), 53.6% (179/334), and 15.9% (53/334) of subjects, respectively. A PVI approach was used in 93.1% of all ablation procedures and 34.1% (114/334) of subjects received PVI plus additional lesions. HD Grid identified signals of interest not identified by the ablation catheter in 80.4% (205/255) of subjects. The total procedure time was 134.3 ± 51.3 minutes with a fluoroscopy time of 14.5 ± 11.3 minutes and RF ablation time of 32.4 ± 29.6 minutes. Of the subjects in atrial fibrillation (AF) (59.6%; 199/334), AF was terminated in 80.4% (160/199). 87.4% (173/198) of subjects were free from recurrent atrial arrhythmias as detected by 48-hour Holter monitoring at 12 months. 13.8% (46/334) of subjects experienced any adverse event through 12 months including 1 death unrelated to the procedure and 1 event deemed related to HD Grid by the investigator.

Conclusion

This study demonstrated the use of the HD Grid mapping catheter to create detailed maps and to guide ablation strategies to treat PersAF while maintaining an adequate safety profile.
Assessment of atrial fibrillation catheter ablation outcomes in patients with hypertrophic cardiomyopathy
Authors: Aytemir K , Sener YZ , Keresteci AH , Ates AH , Yorgun H
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation (AF) is a frequent manifestation of hypertrophic cardiomyopathy (HCM) and it is associated with increased risk for thromboembolic events and worsening of heart failure. AF is usually refractory to antiarrhythmic drugs in cases with HCM and catheter ablation may be useful in such patients.

Purpose

We aimed to evaluate outcomes of both cryoballoon and radiofrequency (RF) AF catheter ablation in patients with HCM.

Methods

All of the patients with HCM who underwent AF catheter ablation between January 2014 and January 2022 were screened and patients with available follow-up datas were included.

Results

A total of 44 patients were enrolled. Mean age was 54.2±12.6 years and 45.5% of the patients were female. RF ablation was performed in 23 cases and remaining patients underwent cryoablation. Median follow-up was 42.5 (4-94) months. Baseline characteristics were listed in Table-1. Only pulmonary vein isolation was performed in 25 (56.8 %) patients while additional ablation procedures including left atrial appendage isolation and linear ablation were required in other cases. Periprocedural complications occured in 6 cases. Atrial tachycardia recurrence developed in half of patients and mortality occured in 2 (4.5 %) cases during follow-up (Table-2).

Six months recurrence free survival (RFS) rate was 90.9% and 1 year RFS was 86.1% however RFS rate reduced to 58.2 after 3 years follow-up. Atrial tachycardia recurrence rates, complication and mortality rates were similar between the patients who underwent cryoablation and RF ablation. Changes in NYHA class and BNP levels were not significant during follow-up, however EHRA class was distinctly improved (II vs. I; p<0.001).

Conclusion

Although long term outcomes of AF catheter ablation is not satisfactory; it is effective in short term rhythm control with reasonable complication rates. Recurrence rates are similar between RF and cryoablation.
Pulmonary vein isolation with high power, short duration ablation leads to shorter procedure times associated with high success rates: a Prospective Randomized Trial
Authors: Theis C , Kaiser B , Pirozzolo G , Bekeredjian R , Huber C
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The single procedure success rates of durable pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) varies between 85 and 90 %.

This prospective, randomized study investigated the efficacy of high power, short duration ablation in a temperature-controlled mode versus standard power settings in terms of single-procedure arrhythmia-free outcome, safety and procedural time.

Methods and results

A total number of 176 patients undergoing de-novo catheter ablation for paroxysmal AF were randomized to two different treatment arms. In group-A patients, PVI was performed with RF-energy with standard power settings of 30 Watts in a temperature-controlled mode.

The ablation procedure in group B was performed with RF-energy with higher power settings of 45 Watts. In both groups the ablation was performed with ablation index (AI) and following the CLOSE protocol (Biosense Webster Thermocool STSF).

A total of 88 patients were randomized into each group without significant differences in baseline characteristics.

During a mean follow-up of 12 ± 4 months after a single procedure, 79 (90%) patients of group A were free of arrhythmia recurrence versus 82 (93 %) patients in group B (p=ns).

With regard to the procedural data, the procedure time was significantly shorter in group B (115.35 ± 15.38 versus 96.45 ± 17.19; p<0.01), the flouroscopy time and dose area were also significantly lower in Group B (9.66 ± 3.86 vs 5.45 ± 2.35; 330.84 ± 150.36 vs 202.51 ± 135.23) and total ablation times were significantly shorter in group B ((Table 1). Both procedures were performed with a low number of complications, no pericardial effusion was seen in either group, in both groups two patients had a significant hematoma of the groin with the need of surgical repair.

Conclusions

RF-ablation with high power (45 Watts) in combination with ablation index and following the CLOSE protocol leads to shorter procedure times, a lower total ablation time and a good safety profile.
Pacemaker and AV node ablation after multiple AF ablation procedures: a patients perspective - The PANAMA PAPER
Authors: Iversen E , Chen J , Libin S , Solheim E , Vavik V , Schuster P
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Objectives

The aim of this study was to assess the number of AF catheter ablations appropriate before decision of pacemaker implantation and AV node ablation.

Background

The main purpose of AF treatment strategy, including both therapies aimed to maintain sinus rhythm and therapies that control the rate, is symptomatic improvement. Complex decision-making is involved in the choice of strategy. Indication for AF catheter ablation is the presence of symptomatic paroxysmal or persistent AF. However, many patients suffer from arrhythmia recurrence. Atrioventricular (AV) node ablation is a therapeutic option when AF is refractory to other therapeutic options.

Methods

This is a retrospective study based on patients recruited from the local database at Haukeland university hospital. Criteria for inclusion were patients with highly symptomatic AF after two or more AF catheter ablations and finally pacemaker and AV node ablation. Symptomatic improvement and quality of life were assessed using modified European Heart Rhythm Association (mEHRA) classification and self-evaluation.

Results

A total 23 patients were included in the study. After repeated AF catheter ablations, 7 (30.4%) patients had improvement in mEHRA class, most often by one class (n = 6). The improvement after AV node ablation were more significant (6 patients by 1 mEHRA class, 7 by 2, 5 by 3). According to the self-evaluation after AV node ablation, 18 patients were satisfied with respect to quality of life. The number of hospitalization were reduced from more than 6 per year (n = 11) to zero (n = 17) per year. Only one patient, among the 12 with only two AF catheter ablations, would prefer further attempts at AF catheter ablation. Retrospectively, 7 out 11 patients with at least 3 AF catheter ablations had preferred earlier pacemaker implantation and AV node ablation.

Conclusion

AV node ablation after several AF catheter ablations is a good option according to patients experience. In selected groups, recognized to have lower clinical efficacy of pulmonary vein isolation, AV node ablation might be considered after 2 or 3 unsuccessful AF catheter ablations.
Impact of high-power and very high-power short-duration radiofrequency ablation on procedure characteristics and first-pass isolation during pulmonary vein isolation
Authors: Sallo Z , Perge P , Piros K , Herczeg SZ , Nagy KV , Osztheimer I , Abraham P , Merkely B , Geller L , Szegedi N
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

High-power short-duration (HPSD) radiofrequency ablation has been proposed as a method for producing rapid and effective lesions for pulmonary vein isolation.We aimed to evaluate the procedural characteristics and the FPI rate of HPSD and very high-power short-duration (vHPSD) compared to low-power long-duration (LPLD) ablation techniques.

Methods

156 patients with atrial fibrillation (AF) were enrolled and assigned to LPLD, HPSD, or vHPSD PVI. The energy setting was 30W, 50W, and 90W in the LPLD, HPSD, and vHPSD groups, respectively.

Results

Bilateral PVI was achieved in all cases. The procedure time was 85 [75-101] min, 79 [65-91] min, and 70 [53-83] min in the LPLD, HPSD, and vHPSD groups, respectively (p<0,0001). LA dwelling times were also decreased significantly with the increase of RF energy (61 [55-70] min, 53 [41-56] min, and 45 [34-52] min, in the LPLD, HPSD, and vHPSD groups, respectively, p<0.0001). The total RF ablation time was 1398 [1021-1711] sec, 1567 (1366-1761) sec, and 336 [247-386] sec in the LPLP, HPSD, and vHPSD group, respectively ( p<0,0001). Bilateral FPI was rate was 57%, 78% and 80% in the LPLD, HPSD, and vHPSD groups, respectively (p=0,0097). On the left side, FPI was achieved in 66% in the LPLD, in 92% in the HPSD, and in 85% in the vHPSD ablation group (p=0.0015). FPI on the right side was achieved in 72% in the LPLD, in 88% in the HPSD, and in 88% in the vHPSD ablation group (p=0,0188). FPI rates were significantly higher in the HPSD group compared to the LPLD group: both sided FPI rate was 57% vs. 78% (p=0.021), left sided FPI rate was 66% vs. 92% (p=0.0015), and right sided FPI rate was 72% vs. 88% (p=0.0401). Further increase in the RF power did not result in a significant additional increase in the FPI rate. In the HPSD vs. vHPSD group both sided FPI rate was 78% vs. 80% (p=0,8080), left sided FPI rate was 92% vs. 85% (p= 0,5275), and right sided FPI rate was 88% vs. 88% (p= 0,7561). Univariate analysis revealed that the use of HPSD ablation technique is associated with a higher probability of FPI (both sides: OR=2.72, 95% CI 1.15-6.44, p=0.023; right side: OR=2.90, 95% CI 1.02-8.20, p=0.045; left side: OR=5.91, 95% CI 1.84-19.04, p=0.003). The mid-term arrhythmia-free survival was similarly high in all three groups.

Conclusion

Our prospective, observational cohort study showed that both HPSD and vHPSD RF ablation is effective, as it shortens procedure time and RF time and results in a higher rate of FPI compared to LPLD ablation. Moreover, the mid-term arrhythmia-free survival was similarly high in all three groups. In our study, no safety concerns were raised due to HPSD ablation.
Visualizable vs. standard, non-visualizable steerable sheath for pulmonary vein isolation procedures: randomized, single-center trial
Authors: Janosi K , Debreceni D , Janosa B , Simor T , Kupo P
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Steerable sheaths are frequently used to improve catheter contact during pulmonary vein isolation (PVI) procedures. A new type of visualized (by electroanatomical mapping system) steerable sheath has become available in clinical treatment.

Purpose

We aimed to compare procedural data of visualizable vs. non-visualizable steerable sheath assisted PVI procedures of patients with atrial fibrillation (AF).

Methods

In this single-center randomized study, we enrolled a total of 58 consecutive patients who underwent PVI due to AF. In 30 patients, the procedures were performed using non-visualizable steerable sheath (Group 1), while we used visualizable steerable sheath for PVI in 28 cases (Group 2).

Results

Compared to Group 1, using the visualizable sheath significantly reduced total fluoroscopy time (267 ± 145 s vs. 197 ± 74 s; p=0.03), fluoroscopy dose (26.2 ± 24.7 mGy vs. 16.7 ± 16.1 mGy; p=0.04) and left atrial procedure time (72.1 ± 18.7 min vs. 61.4 ± 18.9 min; p=0.05). Total ablation time (1158 ± 347 s vs. 1067 ± 196 s; p= 0.28), number of radiofrequency pulses (78 ± 19 vs. 77 ± 32; p=0.81) and total procedure time (117.7 ± 30.0 min vs. 105.0 ± 21.4 min; 0.09) did not differ between the two groups. No major complications occurred in either group.

Conclusion

Using visualizable steerable sheath for PVI procedures can reduce fluoroscopy exposure and left atrial procedure time compared to standard, non-visualizable steerable sheath in patients undergoing PVI procedures.
Zero-fluoroscopy catheter ablation of supraventricular tachycardias in pediatric population
Authors: Topalovic M , Prolic Kalinsek T , Zizek D , Kuhelj D , Lakic N , Mazic U , Jan M
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Catheter ablation (CA) of supraventricular tachycardias (SVTs) in pediatric patients is conventionally performed with the aid of X-ray fluoroscopy. Usage of the three-dimensional (3D) electro-anatomical mapping (EAM) system and the intracardiac echocardiography (ICE) enables zero-fluorscopy ablation, eliminating the harmful effects of the radiation (1-3).

Purpose

We retrospectively analyzed the feasibility, effectiveness and safety of zero-fluoroscopy radiofrequency and cryoablation of various types of SVTs in pediatric patients.

Methods

In this retrospective study, we analyzed consecutive pediatric patients who underwent CA procedure due to SVT in our institution from April 2014 to October 2021. All procedures were performed completely without the use of fluoroscopy. A 3D EAM system and ICE were used as the principal modes of catheter visualisation. Left-sided procedures were done with ICE guided transseptal approach. Radiofrequency was the principal energy source, while cryoablation was used for arrhythmia substrates in the proximity of the conduction system.

Results

The study included 174 consecutive patients (69/174 (66%) female; 12.5 ± 3.9 years; 19.2 ± 3.6 kg/m2). Altogether 176 SVTs were diagnosed and treated. Atrio-ventricular nodal reentry tachycardia (AVNRT) was diagnosed in 45% of cases (80/176), atrio-ventricular reentry tachycardia (AVRT) in 47% (82/176), focal atrial tachycardia (AT) in 7% (13/176), typical atrial flutter (AFL) was treated in only one patient, while 2 patients had multiple arrhythmias (AVNRT and AVRT). In total, 202 procedures were performed. Radiofrequency ablation was performed in 76% (154/202), cryoablation in 20% (40/202) and both in 4% (8/202) of procedures. The acute procedural success rate was 96% (195/202). Procedural success rate was 99% (79/80) for AVNRT, 94% (77/82) for AVRT, 92% (12/13) for AT, and 100% (1/1) for AFL, respectively. There were no major complications in our study group. Follow-up was complete in 99% (172/174) of patients. During the follow-up period of a median of 316 days (181 - 747), 98% of patients were arrhythmia free. On average, 1.16 procedures per patient were performed with the long-term success rate of 99% (79/80), 98% (80/82), 100% (13/13) and 100% (1) for AVNRT, AVRT, AT, and AFL, respectively.

Conclusion

Zero-fluoroscopy CA of various types of SVTs in pediatric population is a feasible, effective, and safe treatment option.
Impact of gender on survival of out-of-hospital cardiac arrest presenting with refractory ventricular arrhythmias and role of coronary artery disease
Authors: Caputo ML , Baldi E , Krull JD , Cresta R , Benvenuti C , Primi R , Currao A , Bendotti S , Compagnoni S , Gentile FR , Savastano S , Klersy C , Auricchio A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Clinical presentation and outcome of out-of-hospital cardiac arrest (OHCA) presenting with shockable rhythm may vary between males and females. Very limited data exist on gender-related differences in OHCAs with refractory ventricular arrhythmias (VA) and, in particular, on distribution and prevalence of coronary artery disease (CAD).

Purpose

The aim of this study was to characterize gender-related outcome, prevalence and severity of CAD in OHCA victims presenting with shockable rhythm and refractory VA.

Methods

All OHCAs presenting with shockable rhythm occurred between 2015 and 2019 in the province of Pavia (Italy) and in the Canton Ticino (Switzerland) were included.

Results

Out of 3592 OHCAs, 685 presented with shockable rhythm and, of them, 212 had a refractory VA. Overall, male gender was independently associated with a lower probability of survival both at hospital admission and at 30-days (OR 0.63, 95% CI 0.58-0.67, p <0.001 and OR 0.82 95% CI 0.74-0.91, p <0.001, respectively) and presented with a more severe CAD. Male gender was 5-times more frequently associated with OHCA presenting with refractory VA. Despite of a more favourable OHCA presentation (i.e. more often OHCA witnessed, public place occurrence and CPR initiated by bystander) male patients with refractory VA had a lower likelihood of survival (OR 0.25, 95% CI 0.21-0.30). A higher prevalence (81%) of CAD was observed in OHCAs presenting with refractory VA but not a higher number of diseased vessels.

Conclusions

Male gender is more frequently associated with refractory VA, lower probability of survival and higher prevalence and severity of CAD. CAD severity, however, does not significantly affect refractory VA presentation.
Standardizing the cardiac radioablation targeting workflow: enabling semi-automated angulation and segmentation of the heart according to the American Heart Association segmented model
Authors: Van Der Ree MH , Visser J , Planken RN , Dieleman EMT , Boekholdt SM , Balgobind BV , Postema PG
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dutch Heart Foundation

Purpose

Cardiac radioablation has evolved as a potential treatment modality for therapy-refractory ventricular tachycardia. To standardize cardiac radioablation treatments, promote accurate communication and target identification, and to assess toxicity, robust and reproducible methods for angulation and cardiac segmentation are paramount. In this study, we developed and evaluated a workflow for semi-automated angulation and segmentation according to the American Heart Association (AHA) 17-segment model.

Methods and materials

The workflow for semi-automated angulation and segmentation of the planning-CT was based on an in-house developed tool requiring placement of only 4 point-markers and a rotation matrix. For angulation, 2 markers defining the cardiac long-axis were placed: at the cardiac apex and at the center of the mitral valve (figure A). A rotation matrix was derived that angulates the CT-volume, resulting in the cardiac short axis (figure B). Segmentation was subsequently performed based on marking the two left ventricular hinge points (figure BC). To evaluate reproducibility, 5 observers independently placed markers in planning-CTs of 6 patients.

Results

The Root-Mean-Square of the standard deviation for the angulation and segmentation marker positions were all below 0.52cm. The 17-segments were subsequently generated and compared between the observers resulting in a median dice coefficient of 0.8 [0.70;0.87] and a median of the mean Hausdorff distance of 0.09cm [0.05;0.17]. Figure D shows the heat maps of two illustrative segments indicating the percentage agreement per voxel between the 5 observers. The interquartile ranges of Euler angles α and β, determined by the angulation markers, was less than 30 for all patients except one. For the γ angle, determined by the hinge point markers, the interquartile range was up to 120.

Conclusion

In this study, a workflow for cardiac radioablation is presented that enables reproducible semi-automatic cardiac angulation and segmentation of the planning-CT according to the AHA 17-segment model. This workflow can be easily implemented and be used to promote communication between radiation oncology and cardiology, enables cardiology-oriented targeting and permits focused toxicity evaluations.
Impact of pacing output and cycle length on qrs morphology in ablation of premature ventricular contractions (PACE-MAP-Trial)
Authors: Van Den Bruck J-H , Woermann J , Sultan A , Filipovic K , Scheurlen C , Erlhoefer S , Arica Z , Dittrich S , Schipper J , Steven D , Lueker J
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Pace mapping is an established technique to localize the origin of premature ventricular contractions (PVC). The QRS morphology induced by endocardial pacing is compared with a previously recorded template of the target arrhythmia. Based upon historic in-vitro models pacing at the arrhythmia’s coupling interval (CI) and stimulation threshold has become the gold standard in pace mapping.

Purpose

There is a paucity of data supporting pacing at the CI and stimulation threshold as the gold standard for pace mapping. In this prospective study, we sought to assess systematically the impact of variations of pacing output and cycle length on the resulting QRS morphology during pace mapping in the context of PVC ablation (NCT05061498).

Methods

All patients undergoing ablation of idiopathic PVC were prospectively enrolled in this study. Pace mapping was performed using four different parameter settings: (1) A predefined fixed burst at maximum output (10V/2ms), (2) fixed burst at stimulation threshold, (3) coupling interval at maximum output and (4) coupling interval at stimulation threshold. Pacing cycle length (PCL) of the fixed burst was defined as follows: for a CI ≤450ms = PCL of CI+100ms and for a CI ≥450 = PCL of CI-100ms. Using an automated waveform comparison algorithm, the resulting QRS complexes were matched with the clinical PVC, and with the gold standard. For every parameter setting the mean of the matching percentage of three QRS complexes entered the analysis.

Results

We report data of the first 22 consecutive patients (53±15 years, 64% female) enrolled in this ongoing study between May and November 2021. The pacing protocols were performed at 39 different sites: 5/39 epicardially via great cardiac vein, 15/39 in the RVOT 12/39 and 7/22 in the left ventricular cavity. When comparing the QRS morphologies resulting from the four different pace mapping settings with the clinical PVC, the univariate analysis revealed no difference between groups (p=0.9). Furthermore, there was no difference comparing the paced QRS morphologies at different output and cycle length to the gold standard of threshold pacing at coupling interval (p=0.9).

Conclusion

Variations of pacing output and stimulation cycle length during pace mapping does not affect QRS morphology during PVC ablation. Applying a modern automated waveform comparison tool, no advantage was observed when comparing with the gold standard. It is therefore reasonable to assume, that pace mapping can be performed using an easily applicable setting of a fixed burst at maximum pacing output.
Stereotactic radiosurgery for ablation of ventricular tachycardia in the setting of electrical storm
Authors: Ninni S , Gallot Lavallee T , Klein C , Longere B , Brigadeau F , Potelle C , Crop F , Rault E , Lacornerie T , Lals S , Kouakam C , Pontana F , Lacroix D , Klug D , Mirabel X
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Stereotactic body radiotherapy (SBRT) has been reported as a safe and efficient therapy to treat refractory VT despite optimal medical treatment and/or catheter ablation (CA). However data in the setting of ES are lacking.

Objectives

The aim of this study was to assess the clinical outcomes associated with SBRT in the setting of ES.

Methods

This retrospective study included patients who underwent SBRT in the setting of ES from March 2019 to March 2021 in one tertiary center (CHU Lille). Target volume was delineated according to a predefined workflow. The efficacy was assessed with the following endpoints: sustained VT recurrence, VT reduced with ATP or ICD shock.

Results

17 patients underwent SBRT to treat refractory VT in the setting of ES (Mean age: 67±12.8, 59% presenting ischemic heart disease, mean LVEF: 33.7± 9.7%). After a median follow-up of 7 [5; 16] months, a reduction in VT burden was observed in all patients after a 6-week blanking period. 6 patients presented an increase of the VT burden from week 2 to week 6 following SBRT despite an initial reduction of VT burden. No patient experienced ICD shocks beyond 6 weeks.

Conclusion

SBRT is efficient in treating recurrent VT in the setting of ES with failure and/or contraindication to CA. One third of patient present a transient increase in VT burden during a 6 weeks blanking period. Therefore, VT tolerance should be integrated as part of an action plan defined upstream to SBRT for each patient.
Should we implant cardioverter defibrillators in asymptomatic patients with Brugada syndrome?
Authors: Brankovic N , Radovanovic NN , Kircanski B , Pavlovic SU , Vujadinovic N , Sajic V , Milasinovic A , Bisenic V , Zivkovic M , Milasinovic G
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Implantable cardiverter defibrillators (ICD) represent the only effective treatment in prevention of sudden cardiac death (SCD) in patients with Brugada syndrome (BrS). However, according to current ESC Guidelines, ICD implantation is recommended only in secondary prevention, while it should be considered in patients with a spontaneous diagnostic type I ECG pattern and history of syncope.

Purpose

We aimed to determine the frequency of ventricular tachyarrhythmias during the long-term follow-up among patients with BrS and ICDs implanted in primary or secondary prevention.

Methods

This retrospective, observational study was conducted in a tertiary center among adult patients with BrS that underwent single or dual chamber ICD implantation from January 2008 to December 2017. The study group was devided into subgroups depending on weather the patients at the time of ICD implantation had documented sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) regardless of the ECG type of BrS (group I), had BrS type I and history of syncope (group II) or had BrS type I and were asymptomatic but assessed as in high risk of SCD due to non-sustained VT episodes, younger age or history of SCD in close family members (group III). We used patients medical records for collecting the data about VT and VF episodes during the follow-up period.

Results

In the course of ten-year period, ICDs were implanted in 21 adult patients with BrS (66.7% were male). Mean age at the ICD implantation time was 40.3 ± 14.9 years. We analyzed 8 patients from group I, 7 patients from group II, and 6 patients from group III. Mean follow-up period was 82.5 ± 33.3 months. During the obsereved period, VT/VF episodes were appropriately detected in 7 patients from group I (87.5%), in 3 patients from group II (42.86%) and in one patient from group III (16.67%). Kruskal-Wallis test showed that there was a statistically significant difference in the occurrence of ventricular tachyarrhythmias among at least one pair of observed groups (p = 0.031). Using Dunn-Bonferroni post hoc analysis we found statistically significant difference between the patients with malignant arrhythmias and asymptomatic patients (p = 0.03), but not between the other pairs.

Conclusion

Although asymptomatic patients with BrS are at significantly lower risk of SCD, it is important to identify high-risk patients in the low-risk group. Therefore, creating a tool for calculating the risk of SCD among these patients might be helpfull in everyday clinical practice.
The impact of SMARTpass algorithm status on inappropriate shock rates in the UNTOUCHED Study
Authors: Boersma LVA , Aasbo J , Knops RE , Lambiase PD , Bongiorni MG , Deharo JC , Russo AM , Burke MC , Shakir A , Huang DT , Appl U , Brisben A , Carter N , El-Chami MF , Gold MR
Published: May 2022

Funding Acknowledgements

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

Background

The current Subcutaneous ICD (S-ICD) model incorporates SMART Pass (SP) to improve sensing and discrimination capabilities to reduce inappropriate shocks (IAS). SP status is programmable but may also be disabled automatically in the setting of low amplitude signals or low heart rate in order to avoid under-sensing of VT/VF.

Objective

To evaluate SP impact on IAS, appropriate shocks (AS), complications and mortality in the UNTOUCHED S-ICD trial.

Methods

Primary prevention patients (pts, n=1111) with ejection fraction ≤35% and no pacing requirement were followed for up to 18 months. SP status during a study visit was programmed ON or OFF and status between visits was either consistently OFF, ON, or automatically disabled (DIS). The impact of SP status on pt outcomes was evaluated using Kaplan-Meier (K-M) analysis. Multivariable proportional hazard analysis identified predictors of IAS and SP disable events.

Results

Percent of pts with SP always ON, always OFF, ON with DIS, and OFF then ON with no DIS were 56, 16, 15, and 13%, respectively. At least one SP DIS occurred in 177 pts, but only 13% had 2 or more, mostly due to PVCs and low EGM amplitudes. Significant multivariable predictors of SP disable events are history of atrial fibrillation (hazard ratio (HR) 2.49, odds ratio (OR) (1.49-4.16); p=.0005), only one passing vector at S-ICD screening, (HR 1.85, OR (1.10-3.10; p=.0202) and lower left ventricular ejection fraction (HR 1.05, OR (1.01-1.08); p=.0074). K-M IAS rates were highest for pts experiencing DIS (fig 1) and lowest for SP ON. While neither AS (p=0.58) nor complication (p=0.58) rates varied significantly according to SP status, mortality was lower for pts with SP ON during any duration of time (p=0.044) by univariate analysis. Further analysis is planned to better understand the relationship between SP status and mortality.

Conclusion

Patients in the UNTOUCHED trial with SMART Pass (SP) consistently ON had significantly fewer inappropriate shocks, with no impact on appropriate therapy for VT/VF. Patients with history of atrial fibrillation, lower left ventricular ejection fraction, and only one passing vector at S-ICD screening are at higher risk of SP disable events; therefore, care should be taken for these patients to assess SP status and their higher risk for inappropriate shocks.