bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative analysis of antiarrhythmic drugs following atrial fibrillation ablation
Authors: Rocha De Almeida A , Carias De Sousa M , Congo K , Trinca M
Published: May 2024

Background

Atrial fibrillation (AF) ablation has become an established therapeutic modality for rhythm control. However, the optimal post-ablation pharmacological strategy remains uncertain. The present study addresses this gap by conducting a comparative analysis of four commonly used antiarrhythmic drugs (amiodarone, propafenone, sotalol, and flecainide), both as standalone treatments and in combination with beta blockers, to determine their impact on mortality, hospitalization rates, and AF recurrence.

Methods

A multi-center, retrospective cohort study was conducted, including patients who underwent successful AF ablation between 20010 to 2020. The study population was divided into groups based on the prescribed antiarrhythmic drug regimen: amiodarone, propafenone, sotalol, flecainide, and respective combinations with beta blockers. Patient demographics, comorbidities, and procedural details were collected. Endpoints included all-cause mortality, hospitalization due to cardiovascular events, MACE and AF recurrence.

Results

A total of 908 patients were included in this study. The mean age was 66 years old, and 33% (n=297) were female patients. Of 908 patients, 35% (n=316) were prescribed amiodarone, 34% (n=305) propafenone, 8% (n=76) sotalol, and 6%% (n=51) flecainide post AF ablation. Association with beta blockers were observed in 55% (n=496) of cases. Amiodarone group had a 0,3% (n=1) mortality, 9% (n=27) of hospitalizations, 2% (n=5) of major cardiovascular events (MACE) and 32% (n=101) of AF recurrence. Propafenone group had a 1,3% (n=4) mortality, 4% (n=12) hospitalizations, 2% (n=5) of MACE and 27% (n=81) of AF recurrence. Sotalol group had a 4% (n=3) mortality, 6% (n=4) of hospitalizations, 3% (n=2) of MACE and 44% (n=32) of AF recurrence. Flecainide group had 0 cases of death, 2% (n=1) of hospitalization, 0 cases of MACE and 35% of recurrence. Amiodarone is associated with a lower risk of death (p=0,018 OR 0,13). The presence of betablockers did not affect the endpoints, namely, death, hospitalization, MACE or AF recurrence. There were no other statistically significant associations between variables.

Conclusion

This study evaluated the effectiveness of common antiarrhythmics, such as amiodarone, propafenone, sotalol, and flecainide, with and without beta blockers, in the post-AF ablation setting. In this study, amiodarone showed a lower risk of death. There were no other statistically significant associations between either antiarrhythmic drug and each endpoint. The presence of betablocker therapy did not interfere with the endpoints.

The findings contribute to the ongoing discourse on the optimal pharmacological strategy for AF management post-ablation. Further prospective studies with larger sample sizes are warranted to validate and refine these observations, paving the way for evidence-based guidelines in tailoring antiarrhythmic drug regimens for improved patient outcomes
Real-world single center experience with the wearable cardioverter defibrillator: sex differences in risk stratification for sudden cardiac death
Authors: Rossi L , Bolognesi M G , Biagi A , Bricoli S , Aschieri D
Published: May 2024

Background

Wearable cardioverter defibrillator (WCD) demonstrated an important role for prevention of sudden cardiac death in patients with advanced heart failure and reduced left ventricular ejection fraction. Although in randomized trial there are no gender difference in WCD use and defibrillator (ICD) implantation rate, real world data in female patients is lacking.

Purposes: We aimed to describe the sex differences in WCD use, the rate of cardiac events detected with WCD and the rate of ICD implantation after WCD use in women in a real-world single center experience. nd reduced left ventricular ejection fraction or prior ventricular tachyarrhythmia.

Methods and results

According with the current guidelines indications, between August 2017 and June 2023 ninety-six consecutive patients (mean age 66.0±11.1 years) received a WCD at Piacenza Hospitals and were retrospectively included in this analysis. There were no differences in clinical characteristics between female (18 patients, 18,8%) and male: in particular baseline left ventricular ejection fraction (LV EF) were similar between the two groups (29.5±5.2 vs 27.9±7.9, p=0.23) and no differences were found in the rate of ischaemic cardiopathy (66,6% vs 69,2% p=0.51).

After 3-months follow up with WCD use, a similar rate of ventricular arrhythmias were found in the two groups (5.5% vs 3.8%, p=0.48) and no ventricular fibrillation was detected. The WCD usage period and median daily wear time were not different between female and male (55.2±50.6 vs 56.2±34.8 days p=0.53, 21.0±6.4 vs 23.1±1.5 hours p=0.48, respectively). However women presented a better LV EF improvement (12.2±9.7 vs 7.2±6.8, p=0.01), with a significant lower ICD implantation rate at the end of WCD use (55.5% vs 43.8%; p< 0.01)

Conclusions

In this real word analysis women presented a nice compliance using WCD. In spite of a similar burden of ventricular arrhythmic events, women presented a better LV EF improvement with a significant lower ICD implantation rate.
Exploration of peak frequency mapping for ventricular tachycardia ablation. Identification of critical isthmus zones during substrate mapping
Authors: Mayer J , Al-Sheikhli J , Patchett I , Marshall L , Niespialowska-Steuden M , Siang R , Roca Luque I , Silberbauer J , Dhanjal T
Published: May 2024

Background/Introduction

The ability to classify and differentiate between near field and far-field components of intracardiac signals is a key element in identifying critical arrhythmogenic substrate during ventricular tachycardia (VT) ablation. Near Field algorithms based on omnipolar electrograms enable detection and automation of true localised signals providing unique insights into substrate characteristics. This novel feature identifies localised signal peak frequency (PF) which can be displayed across different voltage ranges.

Purpose/Aims

The significance of PF mapping in the context of VT ablation is limited and its utility in the identification of the critical diastolic isthmus zone (IZ) is not known. The aim of this study is to explore the utilisation of PF mapping during VT ablation and evaluate whether significant differences in PF occur within areas of interest and critical components of the VT circuit during substrate mapping.

Methods

All patients underwent VT ablation using the EnSite™ X mapping system with the HDGrid omnipolar mapping catheter. Only cases with both high density sinus rhythm (SR) substrate maps and VT activation maps with clear identification of the IZ were included. VT activation and propagation maps were generated and the diastolic IZ was superimposed onto the SR substrate map. PF analysis was performed retrospectively. Surface area, omnipolar voltage and PF of the maps were measured in the SR substrate maps and co-localised with the critical IZ of the VT circuit as identified in the VT activation maps. Analysis of PF was conducted across different voltage ranges: healthy myocardium (>1.5mV), scar (1.5-0.5mV) and dense scar (0.5-0.1mV). Sensitivity and specificity measurements were made within segments of the IZ and non-isthmus zones and depicted as ROC curves.

Results

55 patients underwent VT ablation over a 12-month period, with a total of 18 fulfilling the inclusion criteria. Mean age was 70 (±12.5years) with an average ejection fraction of 36%. The overall PF of the SR substrate maps was 121.85±26.85 Hz, compared to 162.22±46.22Hz within the IZ (p=0.002). Within the low voltage scar region, the overall PF was 120.86±33.24Hz compared to 188.32±81.36Hz within the IZ (p=0.003). No significant difference in PF was observed within healthy myocardium (112.70±52.06 Hz) compared to components of the IZ within the >1.5mV range (157.61±136.11Hz), p=0.207. The AUC for PF within the overall substrate map and co-localisation with the IZ was 0.67, and 0.73 within low voltage zones (<1.5mV).

Conclusions

PF mapping may identify critical components of the VT circuit during SR substrate mapping and its utilisation may compliment established substrate mapping approaches. PF guided ablation strategies require further evaluation in future prospective studies.
Prevention of venous thromboembolism after right heart-sided electrophysiological procedures: results of an EHRA survey
Authors: Mugnai G , Farkowski M , Tomasi L , Roten L , Migliore F , De Asmundis C , Conte G , Boveda S , Chun J K R
Published: May 2024

Background

Limited data are available regarding venous thromboembolism (VTE), specifically deep vein thrombosis (DVT) and pulmonary embolism (PE), following right-sided ablations and electrophysiological (EP) studies. Compared to left-sided procedures, no guidelines on antithrombotic management strategies for the prevention of DVT and PE are available.

Purpose

The main purpose of the present European Heart Rhythm Association (EHRA) survey is to report the current management of right-sided EP procedures, focusing on anticoagulation and prevention of VTE.

Methods

An online survey was conducted using the EHRA infrastructure. A total of 244 participants answered a 19-items questionnaire on the periprocedural management of EP studies and right-sided catheter ablations.

Results

The right femoral vein is the most common access for EP studies and right-sided procedures. An ultrasound-guided approach is employed by more than 2/3 of respondents. Intravenous heparin is not commonly given by the majority of participants. About 1/3 of participants (34%) routinely prescribe VTE prophylaxis during (mostly aspirin and low molecular weight heparin) and 1/4 of respondents (25%) commonly prescribe VTE prophylaxis after discharge (mostly aspirin). Of note, respectively 13% and 9% of participants observed at least one DVT and one PE related to right-sided ablation or EP study within the last year in their center.

Conclusion

The present survey shows that only a minority of operators routinely gives intraprocedural intravenous heparin and prescribes VTE prophylaxis after right-sided EP procedures. Compared to left-sided procedures like AF ablation, there are no consistent systematic antithrombotic management strategies.
Electrophysiologic characteristics and outcomes of atrial tachycardia ablation after mitral valve surgery
Authors: Kilic S , Coteli C , Yorgun H , Aytemir K
Published: May 2024

Background

Atrial tachycardia (AT) is a commonly encountered rhythm disorder in patients with mitral valvular (MV) surgery. Radiofrequency (RF) ablation is the preferred therapeutic option in symptomatic patients.

Purpose

We aimed to evaluate the characteristics and ablation outcomes of AT in patients with previous mitral valve (MV) surgery.

Methods

A total of 100 symptomatic patients [mean age: 56 ±12, gender: 56 (56%) female] with documented AT were enrolled. Activation mapping was performed during tachycardia in all patients as well as entrainment mapping when needed. Voltage mapping was performed in sinus rhythm in the related atrium. Low voltage areas and signals with continuous-fragmented morphology were also tagged.

Results

In 127 procedures, a total of 158 ATs were documented [59 (37.3%) ATs were right-sided, 95 (60.1%) ATs were left-sided and 4(2.5%) AT was biatrial]. Mean number of ATs per procedure was 1.2±0.6. Macroreentry was the primary mechanism in right and left atrium (83.1% and 63.1%, respectively). Cavo-tricuspid isthmus (CTI) dependent macroreentry was the most frequent mechanism in right ATs whereas perimitral reentry was the most common mechanism in left ATs. Atrial low voltage zones comprised 45.5±25.1 % of total left atrium. The acute procedural success was 95.2%. Freedom from ATa after index procedure was 80% at 12 months and 65.6 % at 24 months. After multiple procedures, freedom from ATa was 77% during the mean follow-up duration of 39.7 ± 27.2 months.

Conclusion

Left ATs are more common compared to the right ATs and macroreentry is the major mechanism in both right & left ATs. RF ablation of ATs has favourable long-term outcomes in patients with MV surgery.
Strategies for recurrent atrial fibrillation in patients despite durable pulmonary vein isolation
Authors: Ackmann J , Woermann J , Lueker J , Van Den Bruck J H , Erlhoefer S , Scheurlen C , Pavel F , Filipovic K , Schipper J H , Steven D , Sultan A
Published: May 2024

Background

Pulmonary vein isolation (PVI) is the cornerstone in treatment of atrial fibrillation (AF). Despite initially successful PVI patients experience recurrence of AF mostly due to reconnection of pulmonary veins (PVs). However, a certain number of patients presents with recurrent AF despite durable PVI. The optimal ablation strategy for these patients has yet to be discerned.

Aim

The aim of this study was to compare outcomes for different ablation strategies for recurrent AF despite persistent PVI.

Methods

All redo procedures for recurrence of AF from 01/2016 – 6/2022 at our center were analyzed. Only patients with proven durable PVI (entrance/exit block and high density (HD) mapping) were included. Patients were excluded, if re-PVI or right atrial ablation was necessary. In all procedures (HD) 3-D mapping and radiofrequency ablation were performed. Ablation strategy was at operators’ discretion. A 12-month follow up (FU) was obtained.

Results

A total of 405 left-atrial procedures for the recurrence of AF were analyzed. In 85 (21.0%) procedures all PVs were still isolated. Of these 30 patients (35.3 %) were female and 70 patients (82.4 %) suffered from persistent AF. In 49 patients (57.6 %) LA scar was detectable (85.7 % persAF). The ablation strategies consisted of: roof line (n=9; 10.6 %), left atrial anterior line (n=8, 9.4 %), roof line and left atrial anterior line (n=8, 9.4%), roof line and left atrial inferior line (n=18, 21.2 %), box lesion (n=6, 7.1 %), other left atrial ablation lines (n=20, 23.5 %) and substrate modification (CFAE and substrate encirclement) (n=16, 18.8 %). In patients with PAF (n=15), 3 patients received a roof line (20.0 %), 3 patients received the latter and left atrial inferior line (20.0 %), 5 patients received other left atrial ablation lines (33.3 %) and 4 patients received substrate modification (CFAE and substrate encirclement) (26.7 %). After a mean follow up of 401 +/- 125 days 55.3 % (n=47) of patients were free from any atrial arrhythmia (roof line 77.8 +/- 15 %, left atrial anterior line 87.5 +/- 13 %, roof line and left atrial anterior line 37.5 +/- 18 %, roof line and left atrial inferior line 50 +/- 12 %, box lesion 83.3 +/- 17 %, other left atrial ablation lines 45.0 +/- 11 %, substrate modification (CFAE and substrate encirclement) 43.8 +/- 13 %, p=0.122), 35.3 % (n=30) showed recurrence of AF (p=0.287) and 9.4 % (n=8) showed atrial tachycardia (AT) (p=0.693). None of the ablation strategies led to a significantly superior outcome.

Conclusion

In patients suffering from recurrence of AF despite durable pulmonary vein isolation different substrate modification strategies did not show any superiority for one or the other. Despite the necessity of additional ablation beyond PVI the optimal ablation strategy needs to be yet determined to improve outcome for redo procedures.
Endocardial ablation of ganglionated plexus for the treatment of carotid sinus syndrome
Authors: Minguito Carazo C , Rodriguez Manero M , Martinez Alday J D , Martinez Sande J L , Garcia Seara J , Fernandez Lopez X A , Gonzalez Ferrero T , Elices Teja J , Gonzalez Melchor L , Shangutov O , Gonzalez Juanatey J R
Published: May 2024

Introduction

Carotid sinus syndrome (CSS), characterized by exaggerated vagal responses leading to asystolic pauses with carotid sinus massage (CSM), often necessitates pacemaker implantation. This study investigates cardioneuroablation (CNA) as an alternative management strategy for CSS.

Methods

Prospective study of consecutive patients referred for CNA. All patients underwent CSM, atropine test, 24-hour Holter monitoring and SF-36 quality of life questionary before the procedure and at 6 months. The objective of the study was to assess syncope free survival, grade of cardioinhibition with CSM and heart rate variation (HRV) and quality of life after the procedure.

Results

A total of 13 patients (84.6% male, mean age 63.8 ± 12.3 years) were included. After a median follow-up of 9.2 (8.6-14.3) months, none of the patients experienced syncope (0%) and none of the patients required pacemaker implantation. After the procedure all the patients had a negative CSM and only one patient (7.7%) had a positive CSM at 6 months (Figure 1). There was an improvement in the energy and health change items in the SF-36 quality of life questionary. There was a reduction in HR increase in the atropine test at 6 months (pre-CNA: 66% (52-84) vs. post-CNA 27.4% (21.9-90.9); p=0.027) and in most of the 24-hour Holter monitoring HRV parameters (Figure 2).

Conclusions

Cardioneuroablation emerges as a promising and effective alternative to pacemaker implantation in managing cardioinhibitory CSS. Further research is warranted to solidify these findings and explore the long-term effects of CNA in this scenario.Maximum RR interval with CSMHeart rate increase in the atropine tes
One year of atrial fibrillation ablation using pulsed-field pentaspline catheter - learning curves based on a single centre experience
Authors: Hozman M , Osmancik P , Herman D , Hassouna S , Karch J , Vesela J , Poviser L , Filipcova V , Hozmanova J , Znojilova L
Published: May 2024

Introduction

Pulsed-field ablation (PFA) represents a novel nonthermal strategy for ablation of atrial fibrillation (AF). As the technology has recently emerged in routine clinical praxis, only limited data on learning curves exist so far. Hereby, we present data from our centre regarding learning curves after the first year of using PFA.

Methods

The ablation procedure was performed under deep sedation or general anaesthesia in patients with paroxysmal or persistent AF. No 3D mapping system was used, procedures were guided by fluoroscopy and intracardiac echocardiography. For ablation itself, a pantaspline over-the-wire catheter with a steerable sheath was used. The following parameters were analysed over the course of time: procedure time, left atrial (LA) catheter dwelling time, total fluoroscopy time, and complications. Patients who received pulmonary vein isolation (PVI) alone and those with another additive set of lesions (PVI+) were analysed separately. Procedural parameters of the first and the last 20 patients of each group were compared for statistical significance.

Results

A total number of consecutive 159 patients (mean age 63.20 ± 10.51 years, 69.40 % males) were included in the analysis (PVI N = 73 (45.91 %), PVI+ N = 83 (54.09 %)). Procedures were performed by 3 certified electrophysiology specialists usually in random teams of 2 operators. The mean procedure time was 62.59 ± 23.09 min (PVI 59.64 ± 27.27; PVI+ 65.09 ± 18.64 min, P = 0.15). Over time, there was a non-significant decrease in PVI group (60.30 ± 17.44 vs. 52.75 ± 16.33 min, P = 0.16), but no difference in PVI+ cohort (67.85 ± 13.31 vs. 67.65 ± 28.88 min, P = 0.97). The mean LA catheter dwelling time was 39.84 ± 13.52 min (PVI 35.04 ± 10.20 min; PVI+ 44.33 ± 14.72 min, P <0.001). Non-significant shortening of the LA dwelling time was observed in PVI patients (36.56 ± 8.0 vs. 33.37 ± 9.58 min, P = 0.29). In contrast, the LA dwelling time in the PVI+ group became non-significantly longer (42.93 ± 10.62 vs. 48.56 ± 22.28 min, P = 0.39). The mean fluoroscopy time was 9.28 ± 3.66 min (PVI 8.65 ± 3.04; PVI+ 9.80 ± 4.05 min, P = 0.043). Importantly, fluoroscopy time decreased significantly in both groups over time (PVI: 10.63 ± 3.51 vs. 6.95 ± 2.45 min, P <0.001; PVI+: 12.82 ± 4.99 vs. 9.13 ± 4.16 min, P = 0.017). Regarding complications, we observed one pulmonary oedema requiring orotracheal intubation and mechanical ventilation in the early period. Other complications were related to the femoral puncture site.

Conclusion

Over the course of time with the new PFA technology, we observed a significant decrease in total fluoroscopy time. However, the change in total procedure and LA dwelling time did not reach statistical significance.
Using the impedance map to identify non-conductive structures during cavo-tricuspidal isthmus ablation
Authors: Sciarroni R , Notarangelo M F , Crocamo A , Bearzot L , Gonzi G , Fioravanti M , Niccoli G , Ardissino D
Published: May 2024

Background

The ablation of the cavo-tricuspidal isthmus (CTI) is often affected by the anatomical variability of structures made of non-conductive tissue (NCS): the Eustachian valve, tricuspid valve leaflet and Tebesio's valve, the presence of which may be associated with failure of the isthmic block despite a large number of erogations and post-ablation recurrences. Since these structures have different conductive properties from atrial tissue, it is plausible that they are characterised by their own tissue impedance, and can therefore be identified through an impedance map.

Objectives

The objectives of the study were: 1) to characterise CTI by impedance map, in order to identify NCS; 2) to perform ablation of CTI aimed at isolating only conductive tissue by combining impedance map with the Maximum Voltage Gradient (MVG) technique, in order to evaluate the efficacy of this strategy in acute and during follow-up.

Methods

From 01/2021 to 09/2023 impedance map and CTI substrate map was performed, without the use of fluoroscopy, in all patients undergoing ablation of typical atrial flutter. A 15-ohm impedance reduction from the mean atrial impedance was considered the cut-off for defining the presence of NCS. Substrate maps were constructed according to the MVG technique (0.5-2.5 mV thresholds), in particular looking for high-voltage channels in which the impedance map detected the presence of NCS. Ablation was performed only in the high-voltage channels (W45, AI500).

Results

Our study included 48 patients with a mean age of 68±13 years, with 92% of them being men. The mean volume of the right atrium was 153 mL, and the mean number of points per map was 1205. With the use of impedence map, we were able to identify the presence of NCS in 25 patients (52%). The distribution of non conductive structures and the mean voltage by quadrants can be seen in Figures B-C.

Importantly, we found that the mean number of radiofrequency applications required to achieve isthmic block was significantly lower in patients with identified NCS compared to those without (6.3 vs. 10; p=0.007). In 60% of the patients with NCS, radiofrequency was administered in high-voltage channels that were detected in the quadrant where the NCS was present (odds ratio 3.42, p=0.04). Furthermore, we successfully achieved acute isthmic blockade in all patients, and there were no instances of recurrence during a mean follow-up period of 186 days.

Conclusions

Our findings demonstrate that the combination of Impedence Map and the Maximum Voltage Gradient technique is an effective approach for achieving isthmic block with a reduced number of radiofrequency applications. The identification of NCS allows for a more precise search for high-voltage channels, enabling ablations to be performed in optimal contact with the tissue. This meticulous approach is crucial for the success of the procedure.
Feasibility of catheter ablation with zero-fluoroscopy in congenital heart disease
Authors: Mladoniczky S , Nagy Z , Frohlich R , Csakany L , Major T , Szegedi M , Som Z , Kardos A , Foldesi C , Balint O H , Kornyei L
Published: May 2024

Background

Catheter ablation (CA) with zero and near-zero fluoroscopy has been shown to be safe and effective in patients (pts) without structural heart disease, but there are limited data regarding CA in congenital heart disease (CHD).

Aim

Our aim was to compare the safety and outcome of zero-fluoroscopy (ZF) and fluoroscopy (non-ZF) CA of CHD pts.

Methods

This is a single-center retrospective study of CHD pts who underwent CA at our center between 2006-2020. The ZF and non-ZF groups were compared for the complexity of anatomy, arrhythmia substrate, difficulties of vascular access, transseptal or transbaffle puncture, intracardiac pacemaker/ICD, procedural parameters, complications, and acute outcome. Near-ZF CAs (effective dose ≤1 mSv) were assigned to the ZF group.

Results

The ZF group included 22 pts (age: 22±13 years) and the non-ZF group 48 pts (age: 31±12 years). The distribution of CHD anatomical complexity (mild/moderate/severe) was 18.2%-68.2%-13.6% in the ZF group and 14.6%-68.7%-16.7% in the non-ZF group. Arrhythmia diagnoses were focal atrial tachycardia (ZF: 4.6%), atrial flutter (ZF: 45.4%, non-ZF: 75.0%), atrioventricular reentry tachycardia (AVRT) via manifest accessory pathway (AP) (ZF: 31.8%, non-ZF: 10.4%), AVRT via concealed AP (ZF: 4.6%, non-ZF: 8.3%), and atrioventricular nodal reentry tachycardia (ZF: 13.6%, non-ZF: 6.3%). Difficulties in vascular access occurred in 4.5% of the ZF group and 18.8% of the non-ZF group (p=0.10). The rate of transseptal/transbaffle puncture was significantly higher in the non-ZF group (22.9% vs. 4.6%, p=0.04). In the ZF group 13.6% and in the non-ZF group 20.8% of pts had pacemaker or ICD (p=0.22). Electroanatomical mapping was used in all CAs in both groups. There was no significant difference in procedure time, ablation time and the number of radiofrequency applications (ZF group: 169±53 min, 1205±906 sec, 28±15 vs. non-ZF group: 203±74 min, 1459±940 sec, 34±16, p>0.05). The acute success rate was 100% in both groups. No complications occurred in any group.

Conclusion

Zero fluoroscopic CA was feasible in 1/3 of the pts with CHD and as safe and effective as fluoroscopic ablation. No significant differences were found in the non-fluroscopy related procedural data between the two groups.
Role of high-density voltage map guiding parosysmal atrial fibrillation ablation
Authors: Rossi L , Biagi A , Bolognesi M G , Gibiino F , Aschieri D
Published: May 2024

Background

High-density mapping of the pulmonary vein antra has been demonstrated to improve the detection of conduction gaps in wide antral catheter ablation (WACA) approach for the treatment of paroxysmal atrial fibrillation (AF).

Purpose

We aimed to compare the AF recurrencies in patients treated with WACA for pulmonary veins isolation (PVI) guided by high-density bipolar voltage map (BVM) vs WACA guided by a standard 20-pole circumferential mapping catheter (CMC-20).

Methods

This prospective study included patients scheduled for AF ablation in a single center. In group A (85 patients) PVI was achieved with a conventional approach using CMC-20; in group B (96 patients) high density BVM was acquired by sequential multielectrode mapping through Pentaray Catheter (Biosense Webster). More than 1000 voltage points per map were acquired. Acute PVI was defined as an entrance and exit block after ≥ 20 min waiting period. In both groups WACA was perfomed using a contact force sensing catheter targeting an interlesion distance ≤6 mm and ablation index ≥400 at posterior wall and ≥550 at anterior wall. The primary endpoint was the AF recurrencies in the two groups.

Results

A total of 181 patients were included (mean age 64.9±10.6 years, 33.1% female): in 85 patients AF ablation was guided by CMC-20, in 96 patients AF ablation was guided by BVM; WACA PVI was achieved in all patients. There were no significant differences in the clinical characteristics of the two groups (table 1). At 12-month follow-up, AF recurrencies were significantly lower in the BVM group compared with CMC-20 group [11/96 (11.4%) vs 19/85 (22.3%) respectively, p=0.01].

Conclusions

High-density BVM might increase success rate of AF ablation compared with a conventional 20-pole circumferential mapping approach.
The procedural characteristics of radiofrequency ablation points in patients undergoing atrial fibrillation ablation: comparison between standard vs very high-power short-duration
Authors: Biagi A , Rossi L , Bolognesi M G , Gibiino F , Aschieri D
Published: May 2024

Introduction

Atrial fibrillation ablation has a central role in the treatment of atrial fibrillation.

Radiofrequency (RF) ablation is one of the possible energy sources used for the procedure.

Recently, the development of new catheters has made it possible to modify the amount of power delivered by moving from a standard ablation to a very high-power short-duration (VHPSD). The objective of the study is to compare the delivery features of the RF points between standard RF vs VHPSD.

Methods

All the patients underwent RF ablation of paroxysmal atrial fibrillation.

The procedure was performed using an electroanatomical mapping system under conscious sedation. All patient received a heparin bolus for ACT>300. The anatomy of the left atrium was reconstructed with a high-density catheter. Radiofrequency (RF) was applied following a wide antral circumferential approach (WACA) obtaining the isolation of the veins. The use of the ablation catheter was at the discretion of the operator and the choice was between a standard open-irrigated catheter with force sensor (Smartouch SF) and an irrigated, temperature-controlled contact-force sensing capable of delivering VHPSD (QDOT MICRO). For every patient, data from each individual RF delivery point were collected and analysed.

Results

A total of 72 consecutive patients were collected (26 QDOT group vs 46 standard group).

Average total number of ablation point for obtaining complete pulmonary vein isolation with WACA was lower in the QDOT group (QDOT group 37,8±11 vs 42,1±18 standard group).

As expected, the average duration (QDOT group 3.9±0.1s vs 12.7±2.4s standard group) and the average power delivered was significantly different between the two group (QDOT group 89,8±0.8W vs 33.0±1.4W standard group).

Average basal impedence was similar (QDOT group 133.2±11,6 ohm vs 122.4±11,4ohm standard group) while impedence drop was significantly different (QDOT group 12.2±2.4 vs 9.9±2.4s standard group).

Conclusion

VHPSD ablation allows isolation of the pulmonary veins to be achieved with fewer ablation points and more quickly. It is also associated with a greater impedence drop during delivery. More studies are needed to see if this also corresponds to a lower number of recurrences after ablation.
Assessing the impact of 3D imaging assistance on efficiency and safety in atrial fibrillation cryoablation
Authors: Solana-Munoz J , Teres C , Luca A , Herrera-Siklody C , Domenichini G , Pascale P , Pruvot E , Le Bloa M
Published: May 2024

Introduction

Pulmonary vein (PV) isolation is a cornerstone therapy for symptomatic atrial fibrillation (AF). Current 3D-navigation technologies used with radiofrequency (RF) ablation allow drastic reduction of X-ray exposure and better anatomical characterization improving acute and long-term procedural results. Cryoballoon ablation (CA) procedures typically rely on conventional fluoroscopy, resulting in significant X-ray exposure. Although contemporary fluoroscopy technologies allow for potential 3D imaging integration, their specific utility in improving procedural guidance during CA remains undefined.

Method

Using semi-automatic segmentation obtained from pre-procedural cardiac computed tomography, 3D segmentations of the left atrium, including PV, spine and primary bronchi walls were fused on the real-time fluoroscopy acquisitions in three standard positions (AP, LAO, RAO), acquired at the beginning of the procedure (Figure1). We compared procedural characteristics of CA performed with 3D-fusion imaging to conventional fluoroscopy-guided procedures.

Results

Thirty-six patients (aged 60±13 yo, 85% male) with paroxysmal AF treated with CA were included in the study: 18 in the control group (conventional fluoroscopy) and 18 in the 3D-assisted group. Acute PV isolation was achieved in all patients. The 3D-assisted CA was associated with significantly shorter procedure duration (mean 97.8±15.5 vs 82.1±16.1 min, p=0.0048); left-sided dwelling time (mean 77±15.2 vs 65.1±14.4 min, p=0.0351); and lower X-ray energy delivered to the patient (Dose Area product) with mean 661±373.1 vs 378.1±316.8 cGy*cm2 (p=0.013). Interestingly, we found that 72.2% of 3D guided procedures were done in less than 90min, while 77.8% of conventional cases required more than 90min to be completed (Figure 2D).

Conclusion

3D-fusion imaging integration is feasible and allows for an exact PV anatomy depiction on fluoroscopy. Our data illustrates that it might significantly improve CA efficiency (shorter procedure duration) and safety (lower X-ray exposure and left-sided dwelling time). Our approach could also impact long-term results since it might reduce the likeability of missing intermediate PVs. Further research is needed to evaluate the incremental value of 3D imaging in long term efficacy.Figure 1Figure 2
Tachyarrhythmia during gestation: peculiarities of manifestations and clinic
Authors: Smagulova A , Ainabekova B , Albaev R , Abdrakhmanova Z H , Suleymen Z H , Abdrakhmanov A
Published: May 2024

Background

Arrhythmias can occur during gestation. The data of peculiarities of development and manifestations of arrhythmias in pregnant women are limited.

Purpose

To determine the peculiarities of diagnostic and clinic in pregnant women with arrhythmias.

Methods

In this single-center, prospectively study we consequently included 87 cases of arrhythmias in pregnant (mean age 26.7±3.5 years, mean gestation age 24.6 ±3.3 weeks). The main types of arrhythmias and peculiarities of clinical manifestations were studed.

Results

In 56% of cases, arrhythmia firstly occurred during current gestation. The most common symptoms of arrhythmia in pregnant women firstly occured in the second trimester at 16 (13;21) weeks of gestation. The most common symptoms of arrhythmia were palpitations (58.6%), general weakness (52.9%), dyspnoe (34%) and dizziness (29.8%). The most common types of arrhythmias were paroxysmal supraventricular tachycardia (54%) and premature contractions (39%). Ventricular tachycardia was diagnosed less frequently – in 7%. Dynamic observation was chosen in 17% in benign course of arrhythmia. Antiarrhythmic drugs were prescribed in 32% in women with severe symptoms and haemodynamic instability. In cases of drug refractory and severe arrhythmias electrophysiological examination and radiofrequency ablation without fluoroscopy were performed in 51%. Despite different arrhythmia management the further course of gestation was benign without major complication: cases of increased incidence of uterine contractile activity and placental abruption were rare (n=2). ). Neonatal outcomes characterized by normal range of fetal birth weight and 5 minute Apgar score. There was no incidence of maternal and fetal mortality and arrhythmia recurrence after ablation in follow-up.

Conclusion

Arrhythmias may occur for the first time in women during pregnancy. Manifestation and recurrence of arrhythmias are observed mainly in the second trimester at 16 weeks of gestation. The most frequent variants of cardiac arrhythmias are paroxysmal supraventricular tachycardia (54%) and premature contractions (39%), which have a favorable course and prognosis.
The efficacy of compression dressings to reduce haematoma post cardiac implantable electronic devices - a systematic review and meta-analysis
Authors: Nageswararajah D , Cho K , Cham J , Premawardhana U , Lee A , Tie H , Hopkins A , Nguyen T , Assad J , Dimitri H
Published: May 2024

Background

Pocket haematomas are one of the most common complications post cardiovascular implantable electronic device (CIED) implantation.

Objective

We explored the use of mechanical compression devices compared to the conventional dressings post CIED implantation, to reduce the incidence of pocket haematomas. Secondary outcomes were pain scores and wound scar or healing.

Methods

Five electronic databases were systematically searched from their inception to 1st November 2023, identifying all studies which explored compression dressings post CIED implantation. Data were independently extracted by investigators according to predefined clinical endpoints. We used a Random-effects model for data analysis based on event rates (ER) and 95% confidence interval (CI).

Results

Six studies (786 patients) were included in the meta-analysis, with 373 in the compression arm and 385 patients in the control groups across the studies. There was a total incidence of 82 haematomas, of which 24.4% were in the mechanical compression group and 75.6% in the conventional dressings group (RR 0.36, 95% CI 0.23- 0.57). One study suggested improved wound healing with the compression dressing arm (Manchester Scar Scale 9.5 at 2 weeks for the control group and 7.5 for the compression dressings group). Two studies suggested increased pain scores (using a visual analogue scale) shortly after dressing application. One study suggested improved comfort scores in the compression group compared to the control at 48 hours and 7 days.

Conclusion

This systematic review and meta-analysis suggests for patients post CIED implantation, the use of novel mechanical compression dressings, when compared to conventional dressings, reduces the risk of pocket haematoma.Forest plot
Engagement personas in patients living with atrial fibrillation and multimorbidity, and their caregivers: results from the AFFIRMO international online survey
Authors: Leo D , Trevisan C , Graffigna G , Bosio C , Lobban T , Lane D
Published: May 2024

Introduction

Patients with atrial fibrillation (AF) often experience concomitant long-term health conditions. Their level of engagement, defined as their active role in the management of their condition, is crucial in identifying strategies to improve their care and self-management; similarly, the engagement level of their caregivers is also important.

Purpose

The AFFIRMO study aims to examine ways of optimising care and self-management for AF patients with multimorbidity by identifying characteristics of engagement personas for patients and their caregivers.

Methods

An online survey, distributed between June 2022 and January 2023, open to AF patients and their caregivers in five countries (UK, Italy, Denmark, Romania and Spain) collected data related to patients and caregivers’ engagement in the healthcare process using the Patient Health Engagement Scale® (PHE-s), the Altarum Consumer Engagement (ACE), and the Caregiver Health Engagement Scale® (CHE-s). Patients and caregivers were grouped into ‘high’ and ‘low’ engagement groups, based on scale-specific cut-off values, and compared by age group, sex, level of education and country of recruitment, using Chi-square tests (p<0.05).

Results

659 patients (311 (47.2%) male, 70.9 (10.2) years), and 201 caregivers (54 (26.9%) male, 58.3 (15.2) years) participated. Based on the PHE-s®, 428 (64.9%) were classified as ‘high’ engagement level. Patients in the high engagement group were significantly more likely to be male, aged <75 years, have secondary level education or above, and have <3 co-morbidities; no differences in engagement level based on country of recruitment. Based on the ACE scale, 369 (56.0%) were categorised as ‘high’ engagement level. Those with ‘high’ engagement were significantly more likely to be <65 years old, living in Northern Europe, educated to degree level or above, and had <3 co-morbidities, with no sex differences in engagement level. One hundred thirty-eight (68.7%) caregivers reported ‘high’ engagement. However, there were no significant differences between sex, age group, region of recruitment, or level of education between high and low engagement in caregivers.

Conclusions

Identification of engagement personas of patients and their caregivers could help to develop better management pathways for AF patients with multimorbidity.Table 1.Level of engagement
Cardiovascular crossroads - exploring the impact of atrial fibrillation on mitral valve regurgitation and MitraClip treatment
Authors: Cesnakova Konecna A , Jiravsky O , Hudec M , Januska S , Urban M , Chovancik J , Neuwirth R , Pleva L
Published: May 2024

Introduction

The use of the MitraClip technique is becoming increasingly popular as a treatment option for patients suffering from mitral valve regurgitation who are not suitable for surgery. It is unclear how pre-existing atrial fibrillation impacts patients during the procedure.

Purpose

The question arises: What is the underlying cause of atrial fibrillation in patients with significant mitral valve involvement and why do some patients remain unaffected? This study aims to compare and identify differences in cohorts of patients with and without atrial fibrillation before the MitraClip procedure.

Methods

We analyzed a register of 279 patients who underwent MitraClip treatment. The study classified the patients according to the presence (n=140, 50%) or absence (n=139, 50%) of atrial fibrillation prior to the procedure. We utilized univariate analysis to compare demographic, clinical, and echocardiographic parameters. Multivariate logistic regression was also performed to determine significant predictors.

Results

Both cohorts were of similar size, but there were significant differences in certain parameters. Women were more frequent in the group without atrial fibrillation (45% compared to 34%, p=0.045). The group with atrial fibrillation was slightly older (73 years compared to 70 years, p<0.001) and had a lager body surface area (1.95 compared to 1.87, p=0.005). Parameters such as Euroscore II, NT-proBNP and creatinine levels were not significantly different. Nevertheless, it is important to note that the group with atrial fibrillation had a greater transverse dimension of the left atrium (55 compared to 50, p<0.001). Additionally, the atrial fibrillation group exhibited a higher degree of tricuspid regurgitation (2.9 vs 2.0, p=0.007) and a slightly lower baseline VO2 max (11.63 vs 12.59, p<0.001). Multivariate logistic regression revealed that baseline tricuspid regurgitation is a significant predictor of atrial fibrillation, with and odds ratio of 2.066 (95% CI: 1.041-4.097, p=0.038).

Conclusion

During the MitraClip procedure, patients with atrial fibrillation demonstrate certain specific characteristics, including older age, increased body surface area, larger left atrial size, and higher grade of tricuspid regurgitation. The significant association of tricuspid regurgitation with atrial fibrillation emphasizes its potential role in clinical evaluation and subsequent treatment.
Association of Cardiovascular Fibrosis, Remodeling, and Dysfunction With Frailty, Prefrailty, and Functional Performance: The Multi-Ethnic Study of Atherosclerosis
Authors: Sesso Jaclyn , Walston Jeremy , Bandeen-Roche Karen , Wu Colin , Bertoni Alain G , Shah Sanjiv , Lima Joao A C , Ambale-Venkatesh Bharath
Published: May 2024

Background

Cardiovascular disease is associated with higher incidence of frailty. However, the nature of the mechanisms underlying this association remains unclear. The purpose of this study is to identify cardiovascular phenotypes most associated with physical frailty and functional performance in the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods

As part of the MESA study, 3 045 participants underwent cardiovascular magnetic resonance and computed tomography between 2010 and 2012. Of these, 1 743 completed a Six-Minute Walk test (6MWT) and questionnaires (follow-up exam: 2016–2018) which were used to generate a binary combined frail/prefrail versus robust score according to a modified FRAIL Scale (self-report questionnaire). Multivariable logistic (binary frail outcome) or linear (6MWT) regression assessed the association between frailty and cardiovascular structure and function, aortic stiffness, coronary artery calcium, and myocardial fibrosis (ECV, extracellular volume fraction).

Results

Participants were 66 ± 8 years, 52% female at the time of imaging, and 29.4% were classified as frail or prefrail. Older age and female gender were associated with greater odds of being in the frail/prefrail group. Concentric left ventricular remodeling (odds ratio [OR] 1.89, p = .008; Coef. −52.9, p < .001), increased ECV (OR 1.10, p = .002; Coef. −4.0, p = .001), and worsening left atrial strain rate at early diastole (OR 1.56, p ≤ .001; Coef. −22.75, p = .027) were found to be associated with a greater likelihood of being in a frail state and lower 6MWT distance (m). All associations with 6MWT performance were attenuated with adjustments for risk factors whereas ECV and LA strain rate remained independently associated with frailty.

Conclusions

These findings suggest a significant overlap in pathways associated with subclinical cardiac dysfunction, cardiovascular fibrosis, and physical frailty.
JrGA20ox1-transformed rootstocks deliver drought response signals to wild-type scions in grafted walnut
Authors: Lou Heqiang , Wang Fengmin , Zhang Jiaqi , Wei Guangli , Wei Jingjing , Hu Hengkang , Li Yan , Wang Ketao , Wang Zhengjia , Huang Youjun , Wu Jiasheng , Pei Dong , Huang Jianqin , Zhang Qixiang
Published: May 2024

Targeted regulation using transgrafting technology has become a trend. However, the mechanisms of transgene-derived signal communication between rootstocks and scions remain unclear in woody plants. Here, we grafted wild-type (WT) walnut (Juglans regia L.) on WT (WT/WT), JrGA20ox1 (encodes a gibberellin 20-oxidase)-overexpressing (WT/OE), and JrGA20ox1-RNAi transformation (WT/RNAi) walnut in vitro. We aimed to elucidate the mechanisms of JrGA20ox1-derived signal communication under PEG-simulated drought stress between rootstocks and scions in walnut. We demonstrated that JrGA20ox1-OE and JrGA20ox1-RNAi rootstocks could transport active gibberellins (GAs) and JrGA20ox1-RNAi vector-produced sRNAs to WT scions under PEG-simulated drought stress, respectively. The movement of sRNAs further led to a successive decline in JrGA20ox1 expression and active GA content. Meanwhile, unknown mobile signals may move between rootstocks and scions. These mobile signals reduced the expression of a series of GA-responsive and GA-non-responsive genes, and induced ROS production in guard cells and an increase in ABA content, which may contribute to the drought tolerance of WT/RNAi, while the opposite occurred in WT/OE. The findings suggest that JrGA20ox1-derived rootstock-to-scion movement of signals is involved in drought tolerance of scions. Our research will provide a feasible approach for studying signal communication in woody plants.