bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic accuracy of smartwatch in detecting atrial fibrillation: a systemic review and meta-analysis
Authors: Vetta G , Magnocavallo M , Parlavecchio A , Caminiti R , Polselli M , Sorgente A , Pannone L , Chierchia G B , Rossi P , Bianchi S , Natale A , De Asmundis C , Della Rocca D G
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Atrial fibrillation (AF) is the most common sustained arrhythmia and an important risk factor for stroke and heart. Recent technology advances allowed for heart rhythm monitoring using Smartwatches which can be used for early AF diagnosis.

Purpose

We performed a systemic review and meta-analysis to assess the accuracy of AF diagnosis by smartwatches.

Methods

We systematically searched Medline, Embase and Cochrane electronic databases up to September 28th, 2022 for observational studies of the diagnostic accuracy of smartwatches devices in detecting AF. Studies with 12-lead ECG or single-lead ECG interpreted by a cardiologist as gold standard were included. We calculated the area under the curve (AUC) of the summary receiver operating characteristic curves (SROC) and pooled sensitivities and specificities.

Results

A total of 20 studies were included enrolling 3447 patients, 57%(95% CI: 55-59%) male with average age of 68.3years (95% CI: 63 – 74). The pooled prevalence of AF was found to be 40% (95% CI 27 – 53%). In the overall analysis of all smartwatches, the AUC was 0.99 (95% CI: 0.98-1.00) (Figure 1), the sensitivity 94%(95% CI: 90 – 96%) and the specificity 97%(95% CI: 95 – 98%) (Figure 2). Smartwatches in primary prevention showed an AUC of 0.97 (95% CI: 0.96-0.99), sensitivity of 83%(95% CI: 52 – 96%) and specificity of 98%(95% CI: 87 – 100%) whereas in secondary prevention showed an AUC of 0.99 (95% CI: 0.98-1.00), sensitivity of 95%(95% CI: 94 – 97%) and specificity of 97%(95% CI: 96 – 98%). In the subgroup analysis by technology, smartwatches with single lead ECG showed an AUC of 0.99 (95% CI: 0.98-1.00), sensitivity of 95%(95% CI: 89 – 97%) and specificity of 97%(95% CI: 94 – 99%) whereas smartwatches with photoplethysmography pulse waveform technology showed an AUC of 0.99 (95% CI: 0.97-0.99), sensitivity of 95%(95% CI: 92 – 96%) and specificity of 97%(95% CI: 95 – 99%).

Conclusions

Smartwatches proved an excellent diagnostic accuracy for AF diagnosis.
Trends in the use of implantable loop recordertrends and diagnostic rate of the implantable loop recorder in nationwide database
Authors: Roh S Y , Lee D I , Lee K N , Kim D Y , Shim J , Choi J I , Kim Y H
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Korea University

Introduction

Implantable loop recorder (ILR) is useful to reveal hidden arrhythmia. The real-world using trend of ILR implantation and indication were studied using nationwide database.

Purpose

To assess the indication of ILR and diagnostic rate of meaningful arrhythmia

Method

We analyzed the 1,460 patients who underwent ILR implantation (male 62%, mean age 62±16) from 2008 to 2019 using Korea Health Insurance review and assessment service database.

Result

The embolic stroke of undetermined source (ESUS) group, syncope group and palpitation group were 619 (42.3%), 765 (52.3%), 76 (5.2%) as implantation indication, respectively. From 2016 to 2019, the ESUS group increased by 14 times and the syncope group by 4 times. Among patients with ESUS, 191 patients (31%) were diagnosed with atrial fibrillation within 1 year. Bradycardia needed pacing therapy was revealed in 28%, tachycardia in 6% and atrial fibrillation in 24% in syncope group. The predictors of atrial fibrillation in ESUS group were age (OR: 1.024 per year, CI: 1.006-1.042, p=0.0072) and heart failure (OR: 2.215, CI:1.357-3.615, p=0.0015). The mean time from ILR to pacing therapy was 3±2 months in syncope group and that to anticoagulation in ESUS group was 6±3 months.

Discussion

The use of ILR for evaluation of ESUS is increasing, with atrial fibrillation diagnostic rate of 30%. The time to treatment differed by group.
Electroanatomical features of biopsy-proven cardiac amyloidosis
Authors: Casella M , Compagnucci P , Falanga U , Ciliberti G , Lofiego C , Vagnarelli F , Valeri Y , Stronati G , Principi S , Barbarossa A , Perna G P , Basso C , Guerra F , Dello Russo A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac amyloidoses (CA) are an increasingly recognized group of infiltrative cardiomyopathies associated with high risk of heart failure, thromboembolic events, arrhythmias, and sudden death. Endomyocardial biopsy may be required to differentiate the amyloid type (mainly, Immunoglobulin light chain [AL] versus transthyretin-related [ATTR]) in some cases.

Purpose

to provide a first description of electroanatomical characteristics of amyloid cardiomyopathy, and relate them to endomyocardial biopsy findings.

Methods

we enrolled ten consecutive patients (median age, 68 [63-77]; male, 50%) in an observational, retrospective study. All of them had a clinical diagnosis of CA, but a diagnosis of CA type was hampered by the presence of inconclusive or discordant laboratory-imaging findings (abnormal serum free light chain assay and positive bone scintigraphy, n=5; ambiguous imaging results, n=4; abnormal serum free light chain assay and TTR gene mutation, n=1). Therefore, all patients underwent right ventricular high-density electroanatomical mapping (EAM) using a multipolar catheter (Advisor HD Grid, Abbott), and EAM-guided endomyocardial biopsy (EMB). We recorded electrogram features at EMB sampling site, and explored their correlation with histological findings with mixed effect models.

Results

The clinical, electroanatomical, and histological features of enrolled patients according to the EMB-proven type of CA (AL, n=6; ATTR, n=4) are resumed in Table. Electrogram amplitudes in both the bipolar and the unipolar configuration were generally normal both in the overall right ventricle, and at EMB sites. We found a significant correlation between both unipolar and bipolar electrogram amplitude and the percentage of both amyloid tissue (p<0.01 and p=0.016, respectively) and fibrous tissue (both p<0.01) at EMB (Figure). We observed the strongest linear association (i.e., highest R2) between unipolar electrogram amplitude and amyloid tissue, as well as between bipolar electrogram amplitude and fibrous tissue. On the other hand, electrogram duration and the number of electrogram peaks were unrelated to histological findings. The unipolar voltage cutoff that best identified regions with >15% amyloid tissue infiltration according to Youden index was 9.1 mV (sensitivity, 43%; specificity, 100%; accuracy, 77%).

Conclusion

CA is associated with normal electrogram amplitudes using ahigh density mapping catheter and conventional voltage cutoffs. Nevertheless, unipolar electrogram amplitude is strongly related to the extent of amyloid infiltration, and unipolar voltage<9.1 mV is 100% specific for >15% amyloid tissue deposition.
Association between regular exercise and the risk of major adverse cardiovascular events in patients with pacemaker
Authors: Lee S R , Lee J H , Choi E K , Jung E K , You S J , Oh S
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The optimal amount of exercise for preventing cardiovascular events in patients with pacemakers has not been revealed.

Methods

Using the Korean National Health Insurance Service database, patients who had newly implanted pacemakers between 2009 and 2018 were included. The amount of physical activity was measured by a self-reported questionnaire included in the national health examination. Performing regular exercise was defined as ≥5 days of moderate-intensity exercise or ≥3 days of vigorous-intensity exercise per week. The occurrence of major adverse cardiovascular events (MACE) defined as the composite of stroke, heart failure, myocardial infarction, and all-cause death was evaluated during follow-up.

Results

A total of 13,542 patients were included (mean age 68±11 years, 45% of men); 51% of patients were atrioventricular block and 39% of patients were sick sinus syndrome, and 85% of patients were implanted with dual-chamber pacemaker. During a median 2.5-year of follow-up, the incidence rates of MACE was 5.4 and 3.7 per 100 person-years in non-exerciser and exerciser, respectively (Figure A). Compared to non-exerciser, patients performing regular exercise were associated with a lower risk of MACE (hazard ratio, 95% confidence interval: 0.745, 0.661-0.839, p<0.001, Figure B). Patients with ≥450 metabolic equivalents (METs) which was the highest quartile cut-off of exercise amount were significantly associated with a lower risk of MACE (0.765, 0.686-0.853, p<0.001) than patients with <450 METs. Compared to persistent non-exerciser before and after pacemaker implantation, persistent exercisers and exercise-starters showed a significantly lower risk of MACE (0.788, 0.662-0.938, p=0.007 and 0.584, 0.462-0.738, p<0.001, respectively, Figure C).

Conclusion

Regular physical activity was related to the risk of MACE in patients with pacemaker. A proactive cardiac rehabilitation program would be considered for this population.
Atrial fibrillation-specific refinement of the STOP-Bang sleep apnoea screening questionnaire: Insights from the Virtual-SAFARI study
Authors: Verhaert D V M , Betz K , Gawalko M , Hermans A N L , Habibi Z , Pluymaekers N A H A , Van Der Velden R , Hereijgers M J M , Simons S O , Westra S W , Lankveld T A R , Schotten U , Vernooy K , Hendriks J M , Linz D
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Purpose

Sleep-disordered breathing (SDB) is prevalent in up to 50% of patients undergoing atrial fibrillation (AF) ablation. Currently, it remains unclear whether all AF patients should be systematically screened for SDB, or whether pre-selection of patients requiring screening can be improved. We aimed 1) to assess the accuracy of the STOP-Bang screening questionnaire as a tool for detecting SDB in patients scheduled for AF ablation; and 2) to develop a refined, AF-specific version of the STOP-Bang to improve pre-selection.

Methods

Consecutive patients scheduled for AF ablation without a previous history of SDB and/or SDB screening were included. Patients were digitally referred to the previously described Virtual-SAFARI SDB screening and management pathway1 including a home sleep test using polygraphy. An apnoea-hypopnoea-index (AHI) of ≥15 was interpreted as moderate-to-severe SDB. The accuracy of the STOP-Bang questionnaire (Snoring, Tiredness, Observed apneas, blood Pressure, BMI ≥35 kg/m², Age, Neck circumference, and Gender) was evaluated. Logistic regression was used to assess characteristics within and outside the STOP-Bang questionnaire associated with moderate-to-severe SDB. These characteristics were used to refine the STOP-Bang specifically for AF patients.

Results

Of 206 included patients, 51% was diagnosed with moderate-to-severe SDB. The STOP-Bang questionnaire performed poorly in detecting SDB, with an area under the receiver operating characteristic curve (AUROC) of 0.647 (0.573-0.721). AF-specific refinement of the STOP-BANG resulted in the BOSS-GAP score. Therein, tiredness and neck circumference were removed, while body mass index with cut-off point ≥27 kg/m² and previous stroke or transient ischaemic attack were added. The BOSS-GAP questionnaire performed better with an AUROC of 0.738 (0.672-0.805) in the overall population.

Conclusion

The STOP-Bang questionnaire showed limited value when used as a pre-selection tool for SDB screening. The refined, AF-specific BOSS-GAP questionnaire demonstrated slightly improved, but still limited accuracy in identifying AF patients with SDB. Whether questionnaires bring an advantage in pre-selection for SDB screening compared to structural screening in patients with AF, requires further study.
Weight-loss management after catheter ablation of atrial fibrillation
Authors: Burbelka A , Zarebski L , Futyma M , Futyma P
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Overweight and obesity are modifiable risk factors for atrial fibrillation (AF). Pulmonary vein isolation (PVI) is a cornerstone therapy of AF, however elevated body mass index (BMI) is associated with higher AF recurrence rate. Weight loss in patients with increased BMI can improve ablation outcomes, however data on weight loss management after PVI is lacking.

Purpose

To determine impact of weight loss in overweight and obese patients before PVI and to determine BMI trends after PVI.

Methods

Consecutive patients with baseline BMI >25 who underwent PVI were included into the study. All patients received comprehensive and intensive dietary and lifestyle modification recommendations. Anthropometric measurements were taken at initial visit (pre-PVI), on the day of ablation (PVI) and at the end of follow-up (post-PVI).

Results

60 patients (25 female, age 59±11 years) were included into the study. Mean achieved weigh loss was before PVI was 2±4 kg (pre-PVI vs PVI, 85.3 kg vs 83.3 kg, p=0.31). During follow up lasting 15±13 months 29 patients (48%) remained AF-free. Seventeen patients (28%) gained ≥1kg from baseline and these patients were more likely to experience AF recurrence when compared to these patients who managed to sustained their weigh (76% vs 42%, p=0.0065). Thirty-one (52%) patients who managed to sustain weight loss ≥2kg from baseline were more likely to remain AF-free during follow-up (69% vs 35%, p=0.038). There was no statistically significant difference between weight at baseline vs after follow-up (pre-PVI vs post-PVI, 85.3 kg vs 83.4 kg, p=0.36).

Conclusions

A substantial portion of patients can experience weight regain after PVI. Weight regain is associated with increased risk of AF recurrence following catheter ablation of AF. In patients with elevated BMI periprocedural risk factor modification resulting in weight loss is associated with improved AF-free survival.
Clinical features of cardiac sarcoidosis in a cohort treated with epi- and endocardial VT ablation
Authors: Nentwich K , Ene E , Berkowitz A , Sonne K , Deneke T
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Clinical presentation of cardiac sarcoidosis is a chamaeleon. Detection of granuloma in the histopathology proofs the diagnosis of sarcoidosis, however myocardial biopsy is associated with a high sampling error. However, a prompt immune suppressive therapy would influence the patient’s prognosis significantly.

Analyzing our cohort of epicardial (and endocardial) VT ablation respectively we intend to identify additional markers supporting the diagnosis sarcoidosis.

Method

In the last 4 years 130 patients (mean age 49 y, 63 % male ) were hospitalized for epicardial (and endocardial) VT ablation. 19 patients had the diagnosis sarcoidosis or were newly diagnosed. Mean follow up time was 4,3 a. ECG criteria, primary manifestation, histological findings, therapy, history of VT ablation, distribution of scar in MRI and anatomical mapping, PET CT findings, presence of atrial tachycardias, valve disease and comorbidities were documented.

Results

6 of 15 (40 %) patients showed right bundle block , 6 of 19 (31 %) had AV nodal disease, 4 patients primarily presented with AV-block III, 14 patients (73 %) primarily presented themselves with ventricular arrhythmias (3 with cardiac arrest), in 93 % patients biopsy revealed elevated CD 68 macrophages and CD 3 T- lymphocytes, 6 of 16 were positive for granuloma (37,5 %). All patients were treated with steroids, 13 patients with a combination of immune suppressive therapy. All were treated with VT ablation, mean 2 ablations per patient. 6 of 6 (100 %) patients showed positive PET CT. Analyzing the scar distribution the most common locations in the 17 segment model were segment 2,3,4 and 5 and septal RV. (septal substrate in 66 %). There was a high correlation between the scar findings in the MRI and the anatomical mapping. No patient died during follow up, 1 patient had high urgent transplant after withdrawal of the steroids. Statistical analysis (Kendall-Tau-b) found a significant correlation between presence of CD3 Lymphocytes, fibrosis, VT as primary manifestation, the presence of ICD, positive PET-CT and septal substrate.

Conclusion

Patients presenting with ventricular arrhythmias combined with a positive PET CT, elevated CD3 T lymphocytes and CD68 macrophages in the biopsy and septal substrate are suspective of sarcoidosis and immune suppressive therapy should be considered.

Further data are warranted to proof that observation and to differentiate from other cardiac diseases.
The safety and efficacy of rotor ablation in right atrium after pulmonary vein isolation in patients with persistent atrial fibrillation
Authors: Yoshida A , Akita T , Takami K , Tagashira T , Tsuda S , Terashita D , Takahashi Y , Suzuki M , Yamada S
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Phase mapping using software of ExTRa Mapping is a new tool to clarify the localization of rotor in atrial fibrillation (AF), but the spatial distribution of rotor in right atrium (RA) and the effect of ablation is not clear compared with left atrium (LA).

Purpose

This study sought to investigate the spatial distribution of rotor in RA and the safety and effectiveness of RA rotor ablation after pulmonary vein isolation (PVI) in patients with persistent AF.

Methods

ExTRa mapping with a 20-polar Reflexion catheter in RA was performed in 2nd or 3rd ablation for recurrent AF after PVI in 16 patients with persistent AF (including 4 patients with long standing >1 year AF, 15 men, mean age 67±7.7years old, mean LAD 42±5.4mm, mean EF 57±11%). Rotor was defined as NPAs (non-passively activated areas) in which the percentage of the non-passively activated period in the recording time of 5 seconds is over 50%. RA was divided into 5 areas of crista terminalis (CT), septum (Sept), free wall of RA appendage (fRAA), septal side of RAA (sRAA), behind aorta (Ao), and distribution of NPAs was investigated. RA minimal ablation to NPAs was performed to avoid sinus node and phrenic nerve. The outcomes of AF recurrence were analyzed.

Results

NPAs in RA were observed in 15 of 16 cases, and 67% of cases in CT, 75% in Sept, 80% in fRAA, 20% in sRAA, and 43% in Ao. RA minimal ablation was performed in 21 NPAs in 8 patients to avoid sinus node and phrenic nerve. In a mean follow-up of 307±204 days, freedom from any atrial tachyarrhythmias without antiarrhythmic drugs was achieved in 9 of 16 patients (56%). In 4 (80%) of 5 patients in whom more than 75% area of NPAs were eliminated, sinus rhythm was maintained. There was no serious complication.

Conclusion

Rotor in RA existed relatively frequently in septum, fRAA and CT. RA rotor ablation was safe and could be a new strategy after PVI for persistent AF.
Ultrasound-guidance for femoral venipuncture reduces access site complications after ablation of atrial fibrillation and other left atrial tachycardias: a retrospective single- center analysis
Authors: Poley P , Agdirlioglu T , Weil J , Krahnefeld O
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Access site complications are significant adverse events related to ablation therapy. Periprocedural continuation of anticoagulation is common practice and leads to a reduction of cerebrovascular ischemic events but may increase the likelihood of access site complications.

Methods

619 consecutive patients who underwent left-atrial ablation for AF were assessed for venipuncture associated complications after either landmark or ultrasound-guided venipuncture using data on hospital readmissions, outpatient visits or a structured telephone interview. AV-fistula, pseudoaneurysm and need of either interventional or surgical treatment of a vascular complication as well as blood transfusion were considered as access site complications.

Continuous data are given as mean ± standard error of the mean, categorical data are expressed as number and percentages. Differences between groups were determined by Student’s t-test, chisquare-test, and Fisher’s exact test using SPSS software. A p-value of <0.05 was deemed significant.

Results

The patients' mean age was 69.1 ± 10.8 years and 51.5% were female. Mean BMI was 28.4 ± 5.5 kg/m2. Procedural safety was preserved with low observed rates of serious adverse events. The rate of postprocedural stroke (0.2% vs. 0%), pericardial effusion (0.8% vs. 0.6%) and in-hospital mortality (0% vs. 0%) did not differ between the groups.

After conventional landmark-guided venipuncture the vascular complication rate was 4.8% (12/248). The rate of access site complications was significantly reduced to 0.8% (3/371) (p<0.01, OR 0.194, 95%-CI: 0.0529-0.712) when real time ultrasound-imaging was used for femoral venous cannulation. Severe bleeding complications related to the access site that required surgical or interventional treatment did not occur in the ultrasound group, compared to 2.0% (5/248) in the landmark-guided group (p = 0.010). The absolute risk reduction for access site complications using ultrasound-guidance was 3.2%, resulting in a number needed to treat (NNT) of 32 and a NNT of 50 for severe access site complications.

Discussion

Ultrasound-imaging while performing venipuncture identifies complex or uncommon anatomical conditions and facilitates safe cannulation of the common femoral vein. The use of ultrasound visual guidance for femoral sheath introduction had a remarkable beneficial effect on the occurrence of vascular access site complications in this retrospective single-center analysis. Outstandingly, the total rate of vascular access site complications had been significantly reduced resulting in a reduction of interventional or surgical treatment down to 0,0% in the us-guidance group, this may lead to fewer interruptions of OAC ant therefore lower risk of peri-interventional cerebrovascular events.
Baseline rhythm during catheter ablation for atrial tachycardia predicts procedural and clinical outcome
Authors: Kahle A K , Alken F A , Scherschel K , Meyer C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial tachycardias (AT) occurring after previous ablation in patients with a history of atrial fibrillation (AF) are increasingly observed in clinical practice. Catheter ablation is the treatment of choice but an optimal workflow to improve patient outcome has not been defined. The prognostic implications of baseline rhythm at the beginning of AT ablation are unknown.

Purpose

The aim of this study was to assess procedural and clinical outcome depending on baseline rhythm during AT ablation.

Methods

A total of 380 patients with a history of AF who underwent catheter ablation for consecutive AT after previous ablation were analysed.

Results

In our study population (69 (61–75) years, 56.6% male), 140 patients (36.8%) presented in baseline sinus rhythm (SR), 208 (54.7%) with AT and 32 (8.4%) with AF at the beginning of the procedure. Patients in SR or with AT underwent shorter procedures (SR: 173 (132–213) minutes vs. AT: 161 (120–203) minutes vs. AF: 226 (154–249) minutes; P=0.002) with more frequent termination to SR (SR: 87.9% vs. AT: 81.3% vs. AF: 56.3%; P<0.001) than patients with AF. Periprocedural AT cycle length was longer in patients presenting in SR than in those with AT or AF (SR: 320 (265–370) ms vs. AT: 270 (240–310) ms vs. AF: 245 (193–278) ms; P<0.001). Acute procedural success did not differ between patients in SR or with AT but was higher compared to those with AF (SR: 96.4% vs. AT: 97.1% vs. AF: 87.5%; P=0.033). During a median follow-up of 290 (181–680) days, patients in baseline SR developed arrhythmia recurrences less often (SR: 36.4% vs. AT: 49.5% vs. AF: 68.8%; P=0.002) compared to patients with AT or AF.

Conclusions

Baseline rhythm during AT ablation predicts procedural and clinical outcome. Whereas acute procedural success does not differ between patients in SR or with AT, patients presenting in SR have a more favourable mid-term success rate. Restoration of SR prior to ablation might improve long-term outcome by reducing the risk for recurrent arrhythmia.
Similarly high success and low complication rates of catheter ablation for idiopathic premature ventricular contractions from the left and right ventricular outflow tract
Authors: Mueller-Leisse J , Syrbius G , Hillmann H A K , Eiringhaus J , Hohmann S , Zormpas C , Karfoul N , Duncker D , Veltmann C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Catheter ablation is the first line treatment for idiopathic premature ventricular contractions (PVCs) from the right ventricular outflow tract (RVOT) but not from the left ventricular outflow tract (LVOT), due to presumed lower success and higher complication rates in the LVOT. In this observational single center study we analyzed success rates and complication rates in patients undergoing catheter ablation for idiopathic PVCs with an inferior axis.

Methods

Patients undergoing catheter ablation for idiopathic PVCs with an inferior axis at Hannover Heart Rhythm Center between 2012 and 2020 were included. Patients were excluded if no activation mapping could be performed because of low PVC activity. Ablation success was defined as complete suppression of the index PVC at the end of the procedure.

Results

108 patients (53% male, age 53 ± 17 years) with predominantly symptomatic (94%) PVCs with one (72%), two (20%) or more (8%) morphologies and a PVC count of 22063 ± 14426 /24h were included. 47 PVCs (44%) were located in the RVOT (21 anterior RVOT and 26 septal RVOT) and 39 PVCs (36%) in the LVOT (11 lateral LVOT, 5 septal LVOT, 8 RCC, 2 ACC, 13 LCC). 14 PVCs (13%) had the origin close to the CS/LV summit and 8 PVCs (7%) in the parahisian region. Overall success rate was 82%. Success rates for RVOT and LVOT origin were 98% (46/47 cases) and 97% (38/39 cases) respectively. No significant differences in procedure time (145 ± 68 vs. 158 ± 72 min), ablation time (441 ± 328 vs. 462 ± 307 sec), fluoroscopy time (496 ± 521 vs. 519 ± 473 sec) or minor complications (5 vs. 8) were observed for outflow tract PVCs, and no major complications occurred in this group. However, 3 major complications and significantly lower success rates were observed for non-outflow tract PVCs (0/8 for parahisian origin, 4/14 (29%) for CS/LV summit origin). 2 patients with a parahisian focus experienced higher degree AV block and 1 patient with an LV summit focus had a pericardial tamponade.

Conclusion

Catheter ablation of PVCs with LVOT origin can be performed with similarly high success and low complication rates compared to PVCs with RVOT origin, and therefore could be considered as first-line therapy like RVOT PVCs. On the other hand, identification of PVCs with a parahisian or CS/LV summit focus should be aspired before an ablation procedure, as these localizations are associated with poorer ablation outcome and higher complication rates.
Case series of catheter-based arrhythmia ablation in pregnant women
Authors: Mladoniczky S , Nagy Z S , Foldesi C S , Som Z , Balint O H , Kornyei L , Simor T , Ruzsa D , Fodi E , Kardos A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Antiarrhythmic drugs (AADs) should be used with caution in treating arrhythmias during pregnancy because of side effects, but catheter ablation is a rarely used procedure.

Aim

To investigate the efficacy and safety of catheter ablation in cardiac arrhythmias during pregnancy.

Methods

A double-center retrospective case series study was performed. We studied a population of patients undergoing catheter ablation for cardiac arrhythmias during pregnancy between April 2014 and September 2021 in two cardiovascular centers in Hungary.

Results

14 procedures [14 electrophysiology studies (EPS), 13 ablations] performed on 13 gravid women (age 30.3±5.2 years, primipara n=6) were studied. The mean gestation period was 24.0 (20.0-27.0) weeks at the time of intervention, and the mean duration of arrhythmia was 44.0±53.0 months. Of the pregnant women 38.5% had comorbidities and 15.4% had structural heart disease. During EPS, 12 patients had inducible arrhythmias. Focal atrial tachycardia was confirmed in 3, AVRT via manifest accessory pathway (AP) in 3 (WPW syndrome) AVRT via counceled AP in 1 case. AVNRT was confirmed in 3, sustained ventricular tachycardia in 2 cases (25-25-8.3-25-16.6%). 11 radiofrequency ablations (RFA) (84.6%) and 2 cryoablations (15.4%) were performed. The electroanatomical mapping system was CARTO in 11 cases (84.6%) and NavX-EnSite in 2 cases (15.4%). Intracardiac echocardiography (ICE) was used in 5 cases (38.5%). Transseptal puncture was performed in 2 cases (15.4%) due to left lateral AP. The average procedure time was 76.0±33.0 min. All the procedures (100.0%) were performed without fluoroscopy. No complications occurred during the procedures. In the long term, arrhythmia-free survival was achieved in all cases (100.0%), but in two patients, we used AADs to achieve freedom of arrhythmia. With AADs, the mean birth weight was lower than that of fetuses of gravidas not taking drugs (2110±1314 vs. 3253±458 g). APGAR was within the normal range in all cases [9.0/10.0 (IQR) (9.0-10.0/9.3-10.0)].

Conclusions

Zero-fluoroscopic catheter ablation during pregnancy is an effective and safe treatment method when needed. Catheter ablation for persistent maternal arrhythmias has a more beneficial effect on fetal development than the use of AADs. Indeed, long-term outcome and safety need to be investigated in a larger patient population.
Baseline local impedance and changes in local impedance are predictors of electrode tissue coupling in RF-ablation
Authors: Bahlke F , Wachter A , Englert F , Krafft H , Popa M , Erhard N , Telishevska M , Lengauer S , Lennerz C , Reents T , Hessling G , Deisenhofer I , Bourier F
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Radiofrequency (RF) current remains the most ablation technology in the electrophysiologic laboratory. Durable lesion formation without collateral tissue damage is key for obtaining efficient and safe procedures. RF power, duration and contact force are considered as main determinants of lesion size. Recently published data show that electrode tissue coupling (ETC) is another important parameter of lesion formation. This ex vivo model was created to investigate local impedance changes and lesion size when alternating ETC-levels.

Methods

RF-lesions were created using a force and local impedance sensing catheter in an ex vivo porcine cardiac model. The experimental setup consisted of a saline-filled container, a dispersive electrode, a heated thermostat and a circulation pump to imitate in vivo conditions. Global impedance was kept at 120 Ohm as well as the temperature at 37°C. RF-lesions were created using identic values of RF duration and contact force. A RF power of 20W, 30W, 40W, and 50W was used. The ETC levels were systematically varied between minor and full coupling. In minor ETC-level, only the distal end of the catheter is in contact with the tissue. In full ETC-level, the whole catheter tip is in contact with the tissue. All parameters (power, temperature, global and local impedance, contact force, ETC, lesion size) were measured constantly during application of RF-current, enabling real-time correlation of RF parameters and lesion size. In case of an audible steam pop, RF application was stopped.

Results

8654 measurements of lesion depth and diameter were analyzed after creating 72 lesions. Lesion depth and diameter in full ETC-level were significantly higher compared to minor ETC-level (s. Table 1). Interestingly, lesions in lower power levels (20-30 Watt), but full ETC-level became wider and deeper than lesions in high power levels (40-50 Watts), but minor ETC-level (s. Figure 1).

These observations were made despite shorter RF-duration (54.00 ± 13.07 s vs. 47.11 ± 17.57 s, p=0.032) in lesions with full ETC-level due to higher incidence of steam pops (14 vs. 6 steam pops, p = 0.032).

Baseline LI and LI-drop were significantly higher in full ETC-level (Figure 2), but no relevant difference was observed in baseline GI.

Conclusion

Baseline LI and LI changes during ablation provide information about ETC-levels and interaction of the RF ablation catheter with cardiac tissue. ETC-levels, as predicted by LI, had a significantly higher impact on RF lesion size than RF power or RF-duration. Therefore, LI should be monitored during RF ablation for estimating ETC-levels and lesion formation.
Bipolar ablation: first in man using combined robotic magnetic navigation with a manual approach in a complex pvc case
Authors: Huegl B , Kreuzer M , Doneva Z , Mirazchiyski S T , Buchter B
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Standard unipolar catheter ablation (UPA) with radiofrequency for ventricular arrhythmias has reportedly recurrence rates due to a lack of efficient lesions in the deep myocardial substrates to disrupt the critical components of the arrhythmia circuit. First in-vivo bipolar catheter ablations (BPA) show promising results to counter this issue. Precise handling of two catheters simultaneously during BPA is a challenge that the utilization of a robotic magnetic navigation (RMN) system could make safer by robotically controlling one of the catheters.

Method

A RMN ablation catheter with a 3.5 mm irrigated tip (RMN Navistar Thermocool, Biosense Webster), as an active catheter, as well as an indifferent manual catheter 3.5 mm irrigated non-nav ablation catheter (Celsius Thermocool, Biosense Webster) was connected to a BPA-certified generator system (HAT 500® system (OSYPKA, Germany)). The RMN catheter was controlled by a RMN Stereotaxis- system. A 3D Carto system combined with a VIVO system was used to find the right localization.

Results

70-year-old male with ischemic CMP, EF nearly 40%, revascularized through CABG, presented after 4 attempts of ablation of very frequent symptomatic monomorphic PVCs (more than 30000 /24h), with different approaches in different hospitals. The origin of PVCs was mid-septal RV/LV. After LAT Mapping in a transseptal approach with the RMN Catheter (LV), the manual catheter was placed at the opposite site in the RV. Bipolar Ablation was done at 30W (3 min) with acute suppression of the PVCs. The follow-up duration was 6-months with still lasting good result. No complications occurred.

Conclusions

BPA ablation is an additional energy option in difficult cases. With a RMN system is it feasible and safe. The robotic control of one of the two ablation catheters provides a precise and stable execution of the BPA since the operator only needs to control the second catheter manually while the magnetic field holds the first in place. It therefore also allows a single operator approach.
Percutaneous management of atrial wall perforation during transeptal puncture with an Amplatzer vascular plug in 3 patients: keep calm, think fast
Authors: Pasquie J L , Placide L , Delsarte L , Hoareau E , Georger F , Granier M , Massin F
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Atrial wall perforation is a rare but serious complication of transeptal puncture in AF catheter ablation procedure. In patients with uninterrupted anticoagulation associated to non-fractionated heparin bolus this may lead to cardiac tamponade and dramatic consequences. Urgent surgical drainage and repair is mandatory in the most dramatic cases. We report the successful closure of such complication by an Amplatzer vascular plug leading to a rapid and total recovery in 3 patients.

Methods

Three patients (male, 43, 77 and 84 yo) referred for persistent atrial fibrillation ablation (1 RF and 2 cryoablations). After transeptal puncture, they became severely hypotensive with echographic evidence of tamponade.

Results

Heart perforation with massive leakage of contrast in the pericardial space was evident. The perforation was anterior near aorta in one, on the posterior wall of the right atrium in one and on the posterior wall of the left atria though the right atria in one. After heparin antagonization by protamin, the pericardial space was drained percutaneously (1 to 3 l drained and in 1 reinjected through a "cell saver" system). Rapidly, a 0,035 J guide wire was passed through the perforation and an Amplatzer vascular Plug 2 (4 mm in 2 patients and 6 mm in one) was released resulting in an immediate closure of the leak and recovery of the patient after completion of the pericardial drainage. The drainage was monitored 24h and patients were discharged on Day 2 with a good evolution over a median follow-up of 1.5 year. CT scan at 3 and 6 month showed total recovery.

Conclusion

In patients with left atrial wall perforation and tamponade related to failed transeptal puncture in patients under uninterrupted oral anticoagulation for AF ablation, rapid release of a closure device and pericardial evacuation allowed to successfully manage the cardiac tamponade and avoid a surgical option.
General anesthesia or mild conscious sedation? First comparison for high-power short-duration ablation for atrial fibrillation
Authors: Minciuna I , Suceveanu M , Tomoaia R , Simu G , Irimie D A , Cismaru G , Puiu M , Rosu R , Zdrenghea D , Pop D
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation (AF) represents the most common cardiac arrhythmia in adults worldwide. Catheter ablation (CA) of AF provides higher efficacy with comparable safety as antiarrhythmic drug therapy. Recently, high-power short-duration (HPSD) approach has emerged as an alternative to standard-power standard-duration settings, showing reduction in ablation times and increasing patient tolerability, with similar outcomes in terms of safety and efficacy. Although the advantages of general anesthesia (GA) are well established for standard-power standard-duration settings, there are currently no studies comparing GA to mild conscious sedation (MCS) for HPSD approach CA for AF. The aim of this study was to show whether GA improves procedural outcomes compared to MCS in AF CA using HPSD approach.

Methods

We included patients with paroxysmal or persistent AF who underwent HPSD CA using a contact-force sensing catheter (50W, ablation index 450 on the anterior wall and 320 on the posterior wall) either under GA or MCS. Procedural characteristics and success rates were compared between the two groups, as well as mid-term outcomes. Procedural safety was evaluated by intra- and post-procedural complications. Procedural efficiency was evaluated by total procedural time, number of radiofrequency applications, fluoroscopy time and dose. Acute success was defined as confirmation of entrance block in all pulmonary veins and mid-term success as freedom of AF at 6-months follow-up visits and re-do procedures.

Results

A total number of 131 patients were included in the study, 47 which underwent HPSD CA for AF under GA (group 1, mean age 60.2±10.2), and 84 under MCS (group 2, mean age 58.6±10.6). CA was performed for paroxysmal AF in 34 patients in group 1 (72.3 %) and 68 patients in group 2 (80.9 %), and for persistent AF in the remaining patients. We found lower mean total procedure time in the GA group (105.7±26.4 vs. 164.4± 41.9 min, p<0.0001), as well as lower radiation exposure (1310.0±1083.2 vs. 3060.5± 2254.8 μGy, p<0.0001 and 4.9± 2.8 vs 9.4± 7.5 min, p<0.0001) and lower number of radiofrequency applications (70.4± 20.4 vs. 106.0± 30.2, p<0.01). At the 6-months follow-up AF recurrence rate was lower in GA group (21.2% vs. 33.3%), however without reaching statistical significance (p=0.14). There was one moderate pericardial effusion in the MCS group which remitted with pharmacological treatment.

Conclusion

This is the first study comparing GA to MCS for AF CA using HPSD approach. Our findings demonstrate that GA improves procedural efficiency and suggest lower AF mid-term recurrence when HPSD AF CA is performed under GA, compared to MCS.
Pulsed-field- vs. cryo- vs. radiofrequency ablation: one-year recurrence rates after pulmonary vein isolation in patients with persistent atrial fibrillation
Authors: Kueffer T , Madaffari A , Muehl A , Maurhofer J , Stefenova A , Seiler J , Thalmann G , Kozhuharov N A , Servatius H , Tanner H , Haeberlin A , Baldinger S H , Noti F , Roten L , Reichlin T
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

A multipolar pulsed-field ablation (PFA) catheter has recently been introduced and showed favorable data in terms of safety and procedural efficiency of pulmonary vein isolation (PVI) for atrial fibrillation (AF). Long-term outcome data in comparison to other ablation modalities however is lacking.

Purpose

To compare procedural and one-year recurrence data of patients with persistent AF (persAF) undergoing a first PVI using PFA, cryoballoon ablation (Cryo), or radiofrequency (RFA).

Methods

Consecutive patients with persAF undergoing a first PVI with PFA at our institution from May to December 2021 were included. For comparison, patients with persAF undergoing a first PVI with Cryo or RFA between May 2020 and March 2021 were included. A 3-D electro-anatomical mapping system was used in PFA and RFA, but not in Cryo. The following ablation protocols were used to achieve acute PVI: In the PFA group, the standard 32-applications lesion-set and supplementary applications at the discretion of the operator. In the Cryo group, a time-to-effect plus two minutes strategy and in the RFA group following to the CLOSE protocol. Patients were followed with 7d-Holter ECGs 3, 6, and 12 months after ablation. The primary endpoint was recurrence of any atrial arrhythmia following a blanking period of 3 months.

Results

A total of 177 patients were included (PFA: 65; Cryo: 63; RF: 49). Age, gender, CHA2DS2-VASc score, LVEF and LAVI did not differ among the groups (Table). Median procedure time was different among the groups (PFA: 109 [interquartile range 88-130] min, Cryo: 81 [62-96] min, RF: 177 [153-200] min, p < 0.01). Fluoroscopy dose was different among groups: RF (1.9 [0.7-4.9] Gycm2), PFA (8.3 [4.3-19.0] Gycm2), and Cryo (9.5 [4.8-19.1] Gycm2, p<0.01). Median follow-up time in patients without recurrence was 13 [11-13] months for the PFA group, 13 [12-13] months for the Cryo group and 12 [11-13] months for RFA group. Recurrence of atrial arrhythmias in the KM-analysis after 12 months was not different in all three groups (PFA 44%, Cryo: 33%, RFA: 51%, Figure).

Conclusion

In patients with persAF, recurrence of atrial arrhythmias 12 months after PFA-PVI only is high, regardless of ablation modality. Assessment of strategies including ablation of extra-PV targets in some patients with persAF is needed.
Near-zero fluoroscopy during electroanatomic mapping-guided pediatric catheter ablation
Authors: Chipa Ccasani F , Cruzalegui Gomez J , Cesar Diaz S , Greco A , Martinez Barrios E , Fiol V , Cerralbo P , Campuzano Larrea O , Brugada Tarradellas J , Sarquella-Brugada G
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The use of fluoroscopy in pediatric catheter ablation has decreased because of mapping systems. However, the safety, feasibility and efficacy of the technique in pediatric populations have yet to be delineated.

Objective

In this study, we present the efficiency and reliability of the electroanatomic mapping system in near/zero fluoroscopic pediatric catheter ablation.

Methods

The medical records of patients aged <18 years who underwent ablation between April 2022 and November 2022 were evaluated. Fluoroscopy was not used in cases involving ablation of right sided-arrhythmia foci. Fluoroscopy was used only for trans-septal puncture or retroaortic approach/coronary angiography.

Results

A total of 28 patients underwent catheter ablation for supraventricular and ventricular tachyarrhythmia substrates under the guidance of mapping system. Fluoroscopy was used in only 4 (14.2%) of these substrates. The mean fluoroscopy duration in these 4 procedures was 4.2±3.13 min. No complications were noted. The acute success rate in achieving complete elimination of arrhythmia substrates was 100%. The recurrence rate was 3,5% (1/28) at follow-up.

Conclusion

The fluoroscopy can be completely eliminated in most pediatric catheter ablation procedures with the use of mapping systems by achieving high acute success rates and this technique is safe, feasible and effective.
Feasibility and proof of concept of a proprietary non-contact ablation system with low intensity collimated ultrasound
Authors: Leshem-Rubinow E , Weizman A , Sela R , Margolis G
Published: May 2023

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Heailum Medical Inc.

Background

Utilization of collimated acoustic energy transition as an ablation energy source has the advantage of propagation through blood with negligible absorption. This allows delivery of non-contact, directional and precise ablation lesions to cardiac tissue. In addition, with dual mode ultrasound technology real-time monitoring of the tissue is possible during ablation.

Aim

To evaluate a proprietary ultrasound-based ablation system in swine and define the characteristics of the isolated ablation lesions and lines performed in-vivo.

Methods

In female large white swines, bilateral thigh muscle prep ablations were performed using different time and energy ablation parameters while tip to tissue distance measured with the imaging B-mode and set to 10mm. Lesions were analysed for maximal depth and width. Additional assessment for contiguous linear ablation was performed in the thigh muscle, SVC and within the coronary sinus with the transducer rotated to the endocardial direction. Tissue was fixed in formalin and gross pathological examination with lesion measurement was performed.

Results

36 distinct ablation lesions were performed in the thigh prep model. No steam pops were observed for any of the lesions. Mean necrotic lesion depth was 5.35 ± 1.5mm, with increased time with greater influence on dimensions compared to small changes in energy delivered (Figure 1). Reversible damage influenced additional 29% of tissue depth, while 55% additional tissue width was reversible. Linear ablation performed at 2.5mm inter-lesion distance showed contiguous lines, with transmural effect in both SVC and coronary sinus.

Conclusions

A novel ultrasound based catheter ablation has the ability for non-contact effective ablation in cardiac tissue with directional and tailored energy selection to achieve transmural atrial ablation. Additional in-vivo experimentation will allow refinement of this tool for both isolated lesions and linear ablation while enabling tissue visualization.