bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation of bidirectional cavotricuspid isthmus block using electrocardiographic imaging
Authors: Serrano-Campaner J , Pellicer-Sendra B , Reventos-Presmanes J , Hernandez-Romero I , Althoff T , Regany Closa M , Invers-Rubio E , Borras R , Guasch E , Porta-Sanchez A , M. Climent A , S. Guillem M , Roca-Luque I , Mont L , Guichard J B
Published: May 2024

Background

The validation of bidirectional cavotricuspid isthmus (CTI) block following catheter ablation for typical atrial flutter (AFL) involves endocavitary manoeuvres using multiple catheters. The diagnostic capacity of electrocardiographic imaging (ECGi) as a non-invasive tool to confirm bidirectional CTI block may simplify the procedure but its benefit has not been investigated so far.

Purpose

To evaluate the diagnostic capacities of a novel imageless ECGi system in detecting bidirectional CTI block during AFL catheter ablation.

Methods

A total of 34 patients were consecutively included in a prospective single-centre study. Atrial activation maps were derived from a novel imageless ECGi system when pacing the septal and lateral aspects of the CTI, gauging the technology's capacities to detect bidirectional block by measuring transisthmic intervals (TII) and observing wave-front collision patterns. TII reflects the time taken for electrical activation to cross the CTI during pacing and we measured both the absolute value and the increase relative to its baseline value. The bidirectional CTI block was assessed by endocavitary manoeuvres using a multipole catheter as the gold-standard. We conducted a blind assessment of the diagnostic capacities of ECGi over endocavitary manoeuvres considering maps from the septal and lateral pacing to determine clockwise and counterclockwise CTI block, respectively.

Results

Our study established clear benchmarks for diagnosing CTI block using ECGi (Figure 1). Regarding the assessment of clockwise CTI block, the presence of a wave-front collision pattern at the CTI yielded a positive predictive value (PPV) of 91% and negative predictive value (NPV) of 69%. Furthermore, ROC analysis pinpointed 100 ms and 30 ms as the optimal threshold for TII absolute value (PPV=89%, NPV =78%) and TII increase from baseline (PPV=91%, NPV =65%), respectively. Taking together, the combination of these three parameters offered high diagnostic capacities (PPV=87%, NPV=90%). Regarding counterclockwise CTI block, the TII absolute value alone was a reliable predictor, with a threshold derived from ROC analysis of 115 ms providing a PPV of 77% and a NPV of 83% (Graphical abstract).

Conclusion

These results highlight the efficacy of ECGi in CTI block assessment, promising a streamlined and accurate diagnostic approach (Graphical abstract). The use of a single ablation catheter coupled with ECGi to assess the bidirectional CTI block offers a simplified and efficient alternative to traditional dual catheter techniques.ECGi-based CTI block assessment methodGraphical abstract
31 vs 35 mm: a randomized comparison of the pentaspline pulsed field ablation catheter sizes
Authors: Schaack D , Tohoku S , Bordignon S , Urbanek L , Hirokami J , Ebrahimi R , Plank K , Chen S , Chun K R J , Schmidt B
Published: May 2024

Background

Pulsed-Field ablation (PFA) is a non-thermal tissue-selective energy source which is increasingly used for pulmonary vein isolation (PVI). A commercially available pentaspline PFA catheter can be transformed between different configurations and is available in two different sizes – 31 and 35 mm of diameter. No clear recommendations for when to choose which catheter size are available to date.

Purpose

We aimed to assess procedural and outcome differences of the two different catheter sizes.

Methods

We prospectively included all-comer patients between 07/2022 and 01/2023 who had paroxysmal or persistent atrial fibrillation (AF) and were scheduled for PVI with PFA. There were no exclusion-criteria. 100 patients were randomly assigned to be ablated with either the 31 mm or the 35 mm pentaspline PFA catheter. Patients were routinely scheduled for follow-up visits 6 and 12 months after the ablation.

Results

Each group consisted of 50 patients and baseline characteristics were comparable. For the 31 mm vs 35 mm group respectively: Mean age 68.5 years vs 68.2 years, mean BMI 28.0 vs 30.3 kg/m², male sex 60% vs 68%, paroxysmal AF 59.6% vs 53.1%, mean LA diameter 40.9 vs 40.3 mm.

Acute procedural efficacy defined as accomplishing PVI with the pentaspline PFA catheter was 100% in both groups. The procedural skin-to-skin time was numerically shorter in the 31 mm group (31.4 vs 34.3 minutes, p=0.11), which was attributed to a shorter ablation time (12.5 vs 15.1 minutes, p=0.052). Fluoroscopy time was significantly shorter (5.9 vs 7.1 minutes, p=0.015).

The overall freedom of arrhythmia at 180 days was 82,1%. The groups show a numerical difference in freedom of arrhythmia (31 mm: 91,9% vs 35 mm: 73,4%), but no statistically significant difference using the log rank test (p=0.14, Figure 1).

A total of 8 repeat procedures were performed in this patient collective for recurrent atrial arrhythmia - 3 in the 31 mm group, 5 in the 35 mm group. While the 3 repeat procedures in the 31 mm group showed no PV reconnections, 4 of the 5 patients in the 35 mm group had reconnected PVs (Fisher exact test p-Value=0.14). Overall, 25% (8/32) of PVs were reconnected, with the RSPV and RIPV being the most commonly reconnected veins (3 times each).

Conclusion

To the best of our knowledge, we provide the first randomized comparison of the two pentaspline PFA catheter sizes. Our data show longer procedure times and fluoroscopy times using the 35 mm device as well as a higher rate of PV reconnections especially at the septal PVs. Most importantly, we observe a trend towards worse clinical outcomes using the larger catheter. Longer follow-up times will be available at the time of presentation.Freedom from arrhythmia recurrence
Comparative analysis of clinical outcomes in repeat ablation for recurrent atrial tachyarrhythmia following initial pulmonary vein isolation with pulsed-field ablation and cryoballoon ablation
Authors: Tohoku S , Bordignon S , Schaack D , Hirokami J , Urbanek L , Chen S , Schmidt B , Chun J
Published: May 2024

Background

While pulsed-field ablation (PFA) holds promise for the initial catheter ablation performing pulmonary vein (PV) isolation (PVI) in patients with atrial fibrillation (AF), a repeat procedure remains necessary for those experiencing recurrent atrial tachyarrhythmia (ATA). This study aimed to evaluate the clinical outcomes of repeat procedures following the initial PFA in patients with recurrent ATA by comparing that following the initial CBA.

Methods

Patients who underwent a second ablation for recurrent ATA following initial PVI with pentaspline PFA or cryoballoon ablation (CBA) were included. Repeat ablation utilized radiofrequency current ablation with three-dimensional mapping guidance, involving repeat PVI combined with linear ablations when necessary. Acute data, such as documented arrhythmia before the repeat procedure, the number of reconnected PVs, procedural characteristics, and clinical follow-up, were analyzed.

Results

In total, 110 patients underwent initially successful PVI with PFA (N = 51) and CBA (N = 59), followed by a repeat procedure for recurrent ATA with a mean time interval of 365±299 days between the two procedures. The primary indication at the repeat procedure was atrial tachycardia (AT) in the PFA group (N = 27, 53%) and AF in the CBA group (N = 47, 80%).

The overall PV reconnection rate per vein was 22.1%, with no significant difference between the two groups (19.1% in PFA vs. 24.7% in CBA, P = 0.16). Repeat PVI was successfully performed in all patients with PV reconnection (41.2% in PFA vs. 55.9% in CBA, P = 0.12). PV reconnection was most commonly found at the right inferior PV in both groups (25.5% vs. CBA; 32.2%, P = 0.44). Additional substrate modification was conducted in 76.5% of the PFA group and 74.6% in the CBA group, respectively (P = 0.82).

The mean follow-up period was 349±280 days. The Kaplan-Meier curve indicated no statistical significance in the 1-year arrhythmia-free survival after the repeat procedure (62.4% in PFA vs. and 73.0% in CBA group, P = 0.54, Figure).

Conclusion

Comparable lesion durability between the initial PVI with PFA and CBA was unveiled during the repeat ablation. The second ablation for recurrent arrhythmia following initial PFA demonstrated a favorable clinical success rate at one year after the subsequent procedure, showing no significant difference compared to repeat ablation subsequent to CBA.arrhythmia-free survival after the repe
Radiofrequency catheter ablation for redo procedures after pulmonary vein isolation with the cryoballoon technique: 9-year outcome
Authors: Kettering K
Published: May 2024

Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation. Cryoablation has been shown to be a safe and effective technique for pulmonary vein isolation. However, there is a significant arrhythmia recurrence rate after cryoablation procedures and there are no established strategies for redo procedures in these patients. Therefore, we have summarized our experience with radiofrequency catheter ablation for redo procedures after pulmonary vein isolation with the cryoballoon technique (including an analysis of pulmonary vein conduction recovery patterns after procedures performed with the first or second generation cryoballoon).

Methods

Two hundred and twenty patients (paroxysmal AF: 140 patients, persistent AF: 80 patients) had to undergo a redo procedure after initially successful circumferential PV isolation with the cryoballoon technique (First generation: 110 patients (group A); second generation: 110 patients (group B)). The redo ablation procedures were performed using a segmental approach or a circumferential ablation strategy (three-dimensional mapping system) depending on the intra-procedural findings.

Results

During the redo procedure, a mean number of 1.6 re-conducting PVs were detected (using a circular mapping catheter; group A: 2.2 re-conducting PVs, group B: 1.0 re-conducting PVs). There was a slightly higher incidence of chronic PV reconnections related to the left-sided PV ostia than to the right-sided PVs in both groups. Furthermore, sites of chronic PV reconnection were found more frequently in the inferior parts of the PV ostia than in the superior parts. In 97 patients in group A, a segmental approach was sufficient to eliminate the residual PV conduction because there were only a few recovered PV fibers (1-3 reconnected PVs; group A1). In the remaining 13 patients in group A, a circumferential ablation strategy was used because of a complete recovery of the PV-LA conduction of all four pulmonary veins (group A2). In group B, a segmental approach was sufficient in nearly all patients (109/110) because there was only a minor reconnection of 1-2 PVs.

All recovered PVs could be isolated sucessfully again. At 108-month follow-up, 69.1 % of all patients were free from an arrhythmia recurrence (152/220 patients; group A: 72/110 patients (65.5 %), group B: 80/110 patients (72.3 %)). There were no major complications in both groups.

Conclusions

In patients with an initial circumferential PVI using the cryoballoon technique, a repeat ablation procedure can be performed safely and effectively using radiofrequency catheter ablation. In most cases only a few re-conducting PV fibers were found and therefore, a segmental re-ablation approach seems to be sufficient in the majority of patients (especially in patients treated with the second generation cryoballoon).
Patient-tailored low-voltage-guided ablation of atrial fibrillation: initial experience using a novel ultra-low-temperature cryoablation system
Authors: Raffa S , Frommhold M , Borisov G , Keelani A , Abdelwahab H , Alothman O , Geller J C
Published: May 2024

Introduction

The ideal ablation strategy for patients (pts) with persistent atrial fibrillation (PersAF) is still debated. In recent randomized studies, strategies of ablating electrically abnormal atrial regions in addition to pulmonary vein isolation (PVI) have shown promise, and a novel ultra-low-temperature cryoablation (ULTC) system might overcome the limitations of radiofrequency (RF) energy to create transmural lesions in diseased tissue.

Purpose

Aim of this study is to report procedural aspects, acute efficacy, and safety of our initial experience in treating AF pts with this novel ULTC system.

Methods

Patients scheduled for catheter ablation who had a high likelihood of having left atrial (LA) low voltage zones (LVZ) underwent ablation with the ULTC system. A detailed high-density LA 3D-electronatomical map was created in sinus rhythm using a multi-electrode catheter. Bipolar LVZs were defined as at least 1cm2 surface of bipolar voltage <0.5mV. The ablation strategy consisted of PVI and linear ablation of the LVZs, transecting (if narrow) or isolating (if broad) the areas of abnormal signals and anchoring these lines to electrically silent structures (PVs or mitral valve ring). Electrical isolation and block across linear ablations were tested as universally accepted. Continuous variables are expressed as median (and interquartile ranges).

Results

From April to September 2023, 25 pts (10 female) were included (see table for patients´ and procedural characteristics). Procedure duration was 210 (135-270) min, and diminished over time from initially (in the first 12 pts) 260 (203.75-302.50) min to 190 (135-235) min (p=0.047). PVI was achieved in 15/18 pts (83%) using the ULTC, in the remaining 3 pts RF energy touch-up was needed. Linear ablation and isolation of LVZs were always (41/41 in 22pts, 100%) successfully achieved with the ULTC (see figure for an example). Except for 1 right phrenic nerve palsy, no major acute complications were observed. Post-procedural chest pain was not reported by any patient, in 1 patient mild pericardial effusion was detected and treated conservatively. During the 48h post-procedural ECG-monitoring, no sustained atrial arrhythmias occurred.

Conclusions

This is the first report of patient-tailored low-voltage-guided AF-ablation using a novel ULTC system. Despite representing our initial clinical experience, acute efficacy was very good (95% of acute bidirectional block across lines). Procedure-duration decreased over time, indicating an initial learning curve. Acute safety was reassuring but particular attention should be paid for phrenic nerve function during ablation of the right PVs. The absence of post-procedural pain, pericardial effusion, or acute post-procedural arrhythmias indicates limited ablation-induced inflammation.Result of ULTC ablation in a diseased LA
Changes in local endocardial electrograms immediately after PFA show dose-dependent variations
Authors: Amoros-Figueras G , Zoraida Moreno-Weidmann Z , Sergi Casabella-Ramon S , Ivorra A , Guerra J , Garcia-Sanchez T
Published: May 2024

Background/Introduction

Pulsed field ablation (PFA) is a novel nonthermal cardiac ablation technology based on irreversible electroporation. The behaviour of local electrograms after PFA has been poorly characterized and it remains unknown if it is possible to differentiate between different electroporation levels based on local electrogram analysis.

Purpose

The objective of this study was to characterize the alterations in bipolar and unipolar endocardial electrograms after performing PFA at different doses.

Methods

Five anesthetized pigs were submitted to PFA treatments. Endovascular access to the right atrium was gained through the femoral vein to create a line of ablation between the superior and inferior vena cava using a focal monopolar catheter. The catheter was switched between a conventional cardiac navigation system (CARTO system) and a custom PFA generator. Two different PFA doses were used: a high dose (HD-1600V) at top and bottom of the line and a low dose (LD-1000V) in the central part of the ablation line. Bipolar and unipolar electrograms were recorded with the ablation catheter before and immediately after each ablation. Additionally, high-density electroanatomical maps were acquired with a multielectrode catheter before and immediately after the procedures. Four weeks later, the animals were remapped again and subsequently euthanized. Atrial tissue was removed and processed to identify the presence of fibrosis in the previously ablated lesions.

Results

We performed 106 ablations (84 high dose vs. 22 low dose). Four weeks later, histological staining of chronic lesions revealed that the HD lesions were larger and more fibrotic than the LD (Figure 1). Immediately after each ablation R/S-wave amplitudes and their corresponding |dV/dt|max decreased for the bipolar and unipolar electrograms. The percentages of bipolar electrogram reduction HD vs. LD were: R wave 73% vs. 39%, S wave 68% vs. 37% and |dV/dt|max 81% vs. 38%; 1 way-ANOVA p<0.05 for all, Figure 2). The R-wave amplitude in M1-M2 was significantly lower in HD compared to LD (HD vs. LD: 0.3 ± 0.2 mV vs. 0.7 ± 0.6 mV; 1 way-ANOVA p<0.01). S-wave and |dV/dt|max of unipolar electrograms presented a similar behaviour (M2 |dV/dt|max HD vs. LD: -116 ± 118 mV/s vs. -260 ± 267 mV; 1 way-ANOVA p<0.01).

Conclusion

Local electrograms display PFA dose-dependent variations. This information could result useful to create new metrics to assess in real time the performance of PFA systems.Figure 1.EAM maps and histology studyFigure 2.EGM signals and statistics
Examination of pituitary adenylate cyclase-activating polypeptide (PACAP) in patients with atrial fibrillation undergoing pulmonary vein isolation
Authors: Toller K , Tamas A , Polgar B , Janosi K , Toth T , Debreceni D , Reglodi D , Kupo P
Published: May 2024

Introduction

Pituitary adenylate cyclase-activating polypeptide (PACAP) is a cardioprotective neuropeptide. It has previously been shown that plazma PACAP level increases in myocardial infarction and decompensated heart failure, whereas it decreases in chronic heart failure.

Patient material and method

We examined blood samples from patients (n=46) undergoing pulmonary vein isolation for atrial fibrillation. We collected 5 ml blood samples from the femoral vein at the beginning, from the right atrium before the septal puncture, from the left atrium before and after the ablation, from the femoral vein at the end of the procedure and the next day from the cubital vein. PACAP levels were determined by ELISA. Patients were divided into intact (n=29) and scarred (n=17) left atrial groups by electroanatomical map. PACAP levels were compared in the total population and in the two groups and correlated with left atrial size and different comorbidity data.

Results

Significantly higher levels of PACAP were detected in atrial blood and in post-operative femoral vein samples compared to peripheral blood collected at the beginning and 1 day after the procedure. We measured decreased PACAP levels in the left atrium after ablation compared to samples from left atrium before the ablation. Although we found lower PACAP levels in the left atrium after ablation in patients with scarred atrium compared to the intact group, the PACAP levels showed significant elevation in the femoral vein after the ablation in patients with intact atria.

Conclusions

Our study was the first to show a difference between PACAP levels in atrial and peripheral blood samples. The elevated PACAP levels measured in atrial samples may be due to myocytes and neurons, whose PACAP production decreases depending on the degree of scarring following ablation-induced injury in the left atrium. Transient systemic elevation of PACAP levels is demonstrated in the periphery, suggesting a potential biomarker role for PACAP in these pathologies.
Real-time characterization of radiofrequency lesions by local multifrequency impedance with thermal correction
Authors: Amoros-Figueras G , Casabella-Ramon S C R , Moreno-Weidmann Z M W , Rosell-Ferrer J R F , Guerra J G
Published: May 2024

Background/Introduction

Recent studies have shown that measuring local impedance (LI) at a single frequency can be useful for real-time characterization of radiofrequency (RF) lesion size during arrhythmia ablation procedures. (1) However, these systems do not take into account the effect of the increase in tissue temperature on the impedance measurement itself, which could be avoided by comparing the impedance at different frequencies.

Purpose

The aim of this study was to evaluate the ability of local multifrequency impedance (LMI) to characterize the size of RF lesions in real-time, while correcting for the thermal effect on the measurement.

Methods

Lesions were performed on the epicardium in 5 anesthetized pigs while measuring IML (from 1 to 209 kHz) before, during, and after ablations (20W/30W/40W, 60s, >10g) through a conventional irrigated electrocatheter connected to a cardiac navigation system and a RF generator. In these measurements, the thermal effect on the tissue was corrected by assuming that the changes in impedance at high frequency were only due to the temperature variation and not to the injury itself. Local voltage (Vuni) was also measured before and after ablations, and catheter-measured temperature and contact force were monitored. At the end of the procedure, the animals were sacrificed, and a histological study of the lesions was performed.

Results

A total of 43 effective lesions (11±2 per animal) were performed. The 40W lesions were deeper and wider than the 20W lesions (6,6 ± 3,3 mm vs. 5,4 ± 2,0 mm vs. 4,0 ± 1,9 mm; ANOVA p<0.05) and presented a significant decrease in unipolar voltage that was similar among the different lesions (40W vs. 20W: 56% vs. 40%; ANOVA p=ns; Figure). Four seconds after the start of the ablation the 40W lesions had a greater decrease in IML than the 30W and 20W lesions (73±14Ω vs. 85±4Ω vs. 100±12Ω; ANOVA p<0.05). After thermal adjustment, IML recorded 30 and 55 seconds after the start of the ablation correlated better with the final depth of the lesion than IL or Vuni (Table).

Conclusions

The measure of IML during ablation allows a better quantification of the changes in the structural characteristics of myocardial tissue than local impedance at a single frequency. The increase in tissue temperature during ablation influences the values of local impedance and should be considered when creating new impedance-based metrics to predict the chronic size of the RF lesion.Figure.Lesion quantification by LMITable.Correlation analysis
Acute and one-year procedural effects with proactive esophageal cooling during radiofrequency ablation with proactive esophageal cooling - comparison of paroxysmal and persistent atrial fibrillation
Authors: Sherman J , Ro A , Nazari J , Fisher W , Kulstad E , Metzl M
Published: May 2024

Background/Introduction

Proactive esophageal cooling is FDA cleared to reduce the likelihood of ablation-related esophageal injury from radiofrequency (RF) cardiac ablation, and is becoming more prevalent as an alternative to luminal esophageal temperature (LET) monitoring. Data also suggest shorter procedure times and improved freedom from arrhythmia with esophageal cooling due to the lower continuity index achieved with esophageal cooling.

Purpose

To determine acute and long-term procedural outcomes of PVI for paroxysmal and persistent atrial fibrillation (AF) using active esophageal cooling.

Methods

Procedure times and one-year follow-up rhythm status of all patients treated with PVI for paroxysmal and persistent AF by a single operator were reviewed. Patients were treated over the time span February 2020 through July 2022. Procedure times and freedom from atrial arrhythmia were then compared between paroxysmal and persistent AF.

Results

A total of 317 patients with paroxysmal or persistent atrial fibrillation were treated over the course of the study timeframe. Of these patients, 167 (52.7%) had paroxysmal atrial fibrillation, and 150 had persistent AF. Mean age was 70.6±11.0 years (paroxysmal AF: 68.2±10.4 years and 43% female, persistent AF: 73.4±11.0 years and 37% female), with 40% female overall. Mean procedure time was 68.8±28.1 minutes (61.4 minutes for paroxysmal, 77.3 minutes for persistent). Most patients (224, or 71%) received no fluoroscopy, while the remainder received 1.28±4.0 minutes of fluoroscopy use. The KM estimate for freedom from atrial arrhythmia at one-year for paroxysmal patients was 81.4±3.9%. For persistent patients, the KM estimate for freedom from atrial arrhythmia at one-year was 70.4±4.4% (Figure 1).

Conclusions

Proactive esophageal cooling is associated with a high rate of long-term freedom from arrhythmia for both paroxysmal and persistent AF patients, as well as short procedure times, and the ability to achieve low or zero fluoroscopy use.Figure 1
Posterior wall isolation in patients with persistent atrial fibrillation: a single center comparative study between ablation index and very high power short duration radiofrequency ablation protocol
Authors: Ciconte G , Negro G , Boccellino A , Rondine R , Maiolo V , Sabatelli L , Ballarotto M , Salerno R , Napolano A , Giannelli L , Calovic Z , Vicedomini G , Pappone C
Published: May 2024

Background

Circumferential pulmonary veins ablation (CPVA) with posterior wall isolation (PWI) using radiofrequency catheter ablation (RFCA) is gaining increasing interest in terms of safety and efficacy.

Purpose To compare procedural data and efficacy between two radiofrequency ablation protocols for the treatment of persistent atrial fibrillation (PersAF): very high power-short duration (vHPSD) ablation using a novel temperature-controlled ablation catheter and Ablation Index (AI) guided RFCA using traditional contact-force catheter.

Methods

This single center prospective study enrolled 75 consecutive patients (Group 1) with symptomatic PersAF undergoing RFCA using a novel contact-force catheter optimized for temperature-controlled ablation with microelectrodes and 6 thermocouples for real-time temperature monitoring during ablation. The vHPSD algorithm modulates power to maintain target temperature during these lesions (90 Watts, 4 s) in the posterior wall. RF delivery in anterior regions was performed in a temperature guided setting (1-45W, 45°C) to achieve a 500-550 AI. These patients were compared to 75 propensity matched patients (Group 2) undergoing PersAF ablation with traditional AI-guided ablation. Procedural data were compared between the two groups (Table 1). Procedural outcome was considered as loop recorder documented atrial arrhythmias recurrences and compared between the two groups.

Results

Seventy-five patients (69% male, 63.1±11.2 years old) underwent ablation with vHPSD protocol (Group 1). CPVA and PWI was achieved in all patients with total procedure and fluoroscopy times of 67.5±28.8 min and 4.5±2.8 min, respectively. After 12-month median follow-up, 57/75 patients (76%) were free from AF. Seventy-five propensity matched patients (69% male, 60.7±9.9 years old) have undergone ablation with standard contact-force catheter. CPVA and PWI was achieved in all patients with total procedure and fluoroscopy times of 81.99±20.5 min and 5.7±2.1 min, respectively. After 12-month median follow-up, 55/75 patients (73%) were free from AF. Procedural and fluoroscopy times were significantly lower in in Group 1 than in Group 2 (Table 1). AF recurrencies were comparable between the two groups as assessed with survival analysis (Figure 1, log-rank 0.509). There were no deaths or other severe periprocedural complications.

Conclusions

PWI on top of CPVA is effective in limiting arrhythmic recurrences following RFCA of PersAF. Compared to standard AI guided ablation, vHPSD protocol significantly reduces procedural time and fluoroscopy exposure. Clinical outcomes between the two protocols are similar.Figure 1
Impact of catheter ablation on erectile dysfunction in atrial fibrillation patients
Authors: La Fazia V , Pierucci N , Gianni C , Torlapati P G , Mohanty S , Della Rocca D G , Massaro G , Bode W , Bassiouny M , Burkhardt J D , Horton R , Al-Ahmad A , Sangiorgi G M , Di Biase L , Natale A
Published: May 2024

Background

Previous studies suggested a consequential link between impaired diastolic function, which could be related to atrial fibrillation (AF), and a heightened susceptibility to erectile dysfunction (ED). No data exists regarding the correlation between restoration of sinus rhythm and ED.

Objective

This study investigates the influence of cardiac ablation on the need for phosphodiesterase-5 inhibitors (PDEF5i) medications in patients with atrial fibrillation.

Methods

We retrospectively investigated by chart review 220 consecutive male patients with erectile dysfunction who underwent AF catheter ablation and performed at least one follow-up visit afterward between 2019 and 2022. Exclusion criteria were considered patients older than 85 years old and those assuming non-selective beta-blockers or antidepressant medications. Patients were monitored for arrhythmia at quarterly office visits, ECGs, 7-day Holter monitoring, and event recorders during the first year. The Chi-Square test was utilized to statistically analyze the correlation between the achievement of sinus rhythm post-ablation and the discontinuation of ED medications.

Results

During follow-up 182 (82.7%) pts remained in sinus rhythm after one year (Group 1). Among these, 141 (77.4%) reported withdrawal of ED medication and a marked improvement in their overall sexual health and satisfaction. Whereas among the 38 (17.3%) who did not maintain stable sinus rhythm during follow-up (Group 2), only 2 (5.2%) reported a reduction in ED medication. A statistically significant difference was observed when comparing the two groups (p<0.001, OR 0,016, 95%, 0,003 - 0,061). Moreover, patients maintaining sinus rhythm for more than six months exhibited a higher tendency to stop ED medications compared to those with shorter periods of sinus rhythm or with recurrent AF episodes.

Conclusion

Our findings suggest a strong association between the achievement of sinus rhythm through cardiac ablation and a reduction PDEF5i in patients affected by ED medications in AF patients. This highlights the potential dual benefits of cardiac ablation in improving quality of life and in improving sexual health.
Temporal stability of local cycle length and duty cycle distribution during atrial fibrillation
Authors: Schmidt K , Unger L A , Haas A , Vacanti G , Widder J , Luik A
Published: May 2024

Appropriate targets for catheter ablation of atrial fibrillation (AFib) beyond pulmonary vein isolation (PVI) are still controversially discussed. Since available parameters to analyze the vulnerable substrate are very limited, there is the need to define and understand tailored features. Mapping during AFib can be particularly challenging due to its non-repetitive nature. Amongst others, temporal stability despite changing activation sequences is an essential requirement for features applied to AFib maps. The local cycle length (CL) and duty cycle (DC) offer novel measures to characterize the atrial substrate during AFib.

This study aims at providing first insights into the temporal stability of CL and DC during AFib in order to assess the suitability of both features for the characterization of the individual substrate and tailor ablation strategies in future.

In patients with recurrent AFib after PVI, two high-resolution 3D electro-anatomical maps were recorded sequentially during AFib before any ablation. Intracardiac electrograms (EGMs) were preprocessed to improve local signal quality and far field suppression. EGMs were recorded with a multipolar, basket-shaped high-density mapping catheter. Local CL and DC distribution were visualized using scatter plots and histograms. CL quantifies the time between subsequent local activations, DC quantifies the fraction of CL with local EGM activity, and the confidence (conf) feature quantifies the spatiotemporal consistency of EGM morphology. Only recordings with conf > 0.6 are analyzed. Feature calculation is based on a weighted conglomerate of all acquisitions within a series of beats. Adjustable CL and DC thresholds allow highlighting regions within the 3D map for individual spatial analysis. Both the global distributions and the local occurrence of CL and DC were compared in order to assess temporal stability.

Four patients (2x paroxysmal AFib, 2x persistent AFib) were enrolled. All subjects underwent repeat ablation after PVI due to recurrence of AFib. Table 1 summarizes mapping parameters for both AFib maps in individual patients. Despite differences in mapping time and the number of EGMs, CL and DC histograms were significantly similar when comparing maps within one patient. For individually selected ranges of CL and DC in the upper left corner of the scatter plot (short CL and high DC), localization of corresponding areas was comparable in both 3D maps. An example is shown for patient I in the left and central column of the figure.

CL and DC distributions were temporally stable features for all patients in this study cohort. Localization of EGMs of given CL and DC range within the 3D maps were comparable but not identical for arbitrarily selected ranges. CL and DC can therefore be considered valid features for substrate characterization during AFib. Further studies will need to investigate how ablation strategies can be derived from individual CL and DC distributions.
Non-alcoholic fatty liver disease in patients with atrial fibrillation: a report from a global federated health network
Authors: Bucci T , Baratta F , Pastori D , Pignatelli P , Violi F , Lip G Y H
Published: May 2024

Background

Few data are available on the clinical course of patients with Atrial Fibrillation (AF) and Nonalcoholic Fatty Liver Disease (NAFLD).

Purpose

To evaluate the 1-year risk of all-cause death, thromboembolic events, and bleeding in AF patients with NAFLD.

Methods

Retrospective cohort study within the global TriNetX platform. Patients with AF were categorized into two groups: i) AF with NAFLD and ii) AF without liver diseases. The primary outcomes were the 1-year risks of a composite outcome of i) all-cause death and thrombotic events (all-cause death, acute myocardial infarction, ischemic stroke, systemic arterial thromboembolism, deep vein thrombosis, and pulmonary embolism), and hemorrhagic outcome (intracranial hemorrhage and gastrointestinal bleeding). Secondary outcomes were each component of the composite primary outcomes. Cox regression analysis before and after propensity-score-matching (PSM) was used to estimate HR and 95% confidence interval (95%CI). Sensitivity analyses were done to investigate the risk associated with cirrhosis and type of oral anticoagulant.

Results

We identified 22,636 AF patients with NAFLD (69±12 years, 46.7% females) and 391,014 AF patients without NAFLD (72±12 years, 42.7% females). Before PSM, AF patients with NAFLD were younger, and with a higher prevalence of cardiovascular risk factors than those without liver disease. After PSM, no difference was found between the two groups, but NAFLD patients showed a higher 1-year risk of thrombotic (HR 1.54, 95%CI 1.47-1.61) and hemorrhagic (HR 1.56, 95%CI 1.42-1.72) composite outcomes (Figure 1). The higher risk in NAFLD was consistent also for all the secondary outcomes (Figure 1). On the sensitivity analyses (Figure 2), a progressively increased risk of thrombotic and hemorrhagic events was found in non-cirrhotic and cirrhotic patients compared to patients without liver diseases, whereas non-vitamin-k antagonist (NOAC) seems to be safer and more effective than warfarin.

Conclusion

In AF patients, NAFLD is associated with a higher 1-year risk of all-cause death, thrombotic and hemorrhagic events. Further studies are needed to establish the best clinical approach to manage NAFLD in AF patients.Figure 1Figure 2
Consistent accumulation of transposable elements in species of the Hawaiian Tetragnatha spiny-leg adaptive radiation across the archipelago chronosequence
Authors: Yang Heidi , Goubert Clément , Cotoras Darko D , Dimitrov Dimitar , Graham Natalie R , Cerca José , Gillespie Rosemary G
Published: May 2024

The ecological and phenotypic diversity observed in oceanic island radiations presents an evolutionary paradox: a high level of genetic variation is typically required for diversification, but species colonizing a new island commonly suffer from founder effects. This reduction in population size leads to lower genetic diversity, which ultimately results in a reduction in the efficiency of natural selection. What then is the source of genetic variation which acts as the raw material for ecological and phenotypic diversification in oceanic archipelagos? Transposable elements (TEs) are mobile genetic elements that have been linked to the generation of genetic diversity, and evidence suggests that TE activity and accumulation along the genome can result from reductions in population size. Here, we use the Hawaiian spiny-leg spider radiation (Tetragnatha) to test whether TE accumulation increases due to demographic processes associated with island colonization. We sequenced and quantified TEs in 23 individuals representing 16 species from the spiny-leg radiation and four individuals from its sister radiation, the Hawaiian web-building Tetragnatha. Our results show that founder effects resulting from colonization of new islands have not resulted in TE accumulation over evolutionary time. Specifically, we found no evidence for an increase in abundance of specific TE superfamilies, nor an accumulation of ‘young TEs’ in lineages which have recently colonized a new island or are present in islands with active volcanoes. We also found that the DNA/hAT transposon superfamily is by far the most abundant TE superfamily in the Tetragnatha radiation. This work shows that there is no clear trend of increasing TE abundance for the spiny-leg radiation across the archipelago chronosequence, and TE accumulation is not affected by population oscillations associated with island colonization events. Therefore, despite their known role in the generation of genetic diversity, TE activity does not appear to be the mechanism explaining the evolutionary paradox of insular diversification in the Tetragnatha spiny-leg radiation.
Evolutionary Rate Shifts in Coding and Regulatory Regions Underpin Repeated Adaptation to Sulfidic Streams in Poeciliid Fishes
Authors: De-Kayne Rishi , Perry Blair W , McGowan Kerry L , Landers Jake , Arias-Rodriguez Lenin , Greenway Ryan , Rodríguez Peña Carlos M , Tobler Michael , Kelley Joanna L
Published: May 2024

Adaptation to extreme environments often involves the evolution of dramatic physiological changes. To better understand how organisms evolve these complex phenotypic changes, the repeatability and predictability of evolution, and possible constraints on adapting to an extreme environment, it is important to understand how adaptive variation has evolved. Poeciliid fishes represent a particularly fruitful study system for investigations of adaptation to extreme environments due to their repeated colonization of toxic hydrogen sulfide–rich springs across multiple species within the clade. Previous investigations have highlighted changes in the physiology and gene expression in specific species that are thought to facilitate adaptation to hydrogen sulfide–rich springs. However, the presence of adaptive nucleotide variation in coding and regulatory regions and the degree to which convergent evolution has shaped the genomic regions underpinning sulfide tolerance across taxa are unknown. By sampling across seven independent lineages in which nonsulfidic lineages have colonized and adapted to sulfide springs, we reveal signatures of shared evolutionary rate shifts across the genome. We found evidence of genes, promoters, and putative enhancer regions associated with both increased and decreased convergent evolutionary rate shifts in hydrogen sulfide–adapted lineages. Our analysis highlights convergent evolutionary rate shifts in sulfidic lineages associated with the modulation of endogenous hydrogen sulfide production and hydrogen sulfide detoxification. We also found that regions with shifted evolutionary rates in sulfide spring fishes more often exhibited convergent shifts in either the coding region or the regulatory sequence of a given gene, rather than both.
Ancient Sheep Genomes Reveal Four Millennia of North European Short-Tailed Sheep in the Baltic Sea Region
Authors: Larsson Martin N A , Morell Miranda Pedro , Pan Li , Başak Vural Kıvılcım , Kaptan Damla , Rodrigues Soares André Elias , Kivikero Hanna , Kantanen Juha , Somel Mehmet , Özer Füsun , Johansson Anna M , Storå Jan , Günther Torsten
Published: May 2024

Sheep are among the earliest domesticated livestock species, with a wide variety of breeds present today. However, it remains unclear how far back this diversity goes, with formal documentation only dating back a few centuries. North European short-tailed (NEST) breeds are often assumed to be among the oldest domestic sheep populations, even thought to represent relicts of the earliest sheep expansions during the Neolithic period reaching Scandinavia <6,000 years ago. This study sequenced the genomes (up to 11.6X) of five sheep remains from the Baltic islands of Gotland and Åland, dating from the Late Neolithic (∼4,100 cal BP) to historical times (∼1,600 CE). Our findings indicate that these ancient sheep largely possessed the genetic characteristics of modern NEST breeds, suggesting a substantial degree of long-term continuity of this sheep type in the Baltic Sea region. Despite the wide temporal spread, population genetic analyses show high levels of affinity between the ancient genomes and they also exhibit relatively high genetic diversity when compared to modern NEST breeds, implying a loss of diversity in most breeds during the last centuries associated with breed formation and recent bottlenecks. Our results shed light on the development of breeds in Northern Europe specifically as well as the development of genetic diversity in sheep breeds, and their expansion from the domestication center in general.
A CRISPR/Cas9-induced male-sterile line facilitating easy hybrid production in polyploid rapeseed (Brassica napus)
Authors: Tu Mengxin , Wang Ruisen , Guo Wenhui , Xu Shiqi , Zhu Yang , Dong Jie , Yao Xiangtan , Jiang Lixi
Published: May 2024

Rapeseed is a globally significant oilseed crop cultivated to meet the increasing demand for vegetable oil. In order to enhance yield and sustainability, breeders have adopted the development of rapeseed hybrids as a common strategy. However, current hybrid production systems in rapeseed have various limitations, necessitating the development of a simpler and more efficient approach. In this study, we propose a novel method involving the targeted disruption of Defective in Anther Dehiscence1 of Brassica napus (BnDAD1), an essential gene in the jasmonic acid biosynthesis pathway, using CRISPR/Cas9 technology, to create male-sterile lines. BnDAD1 was found to be dominantly expressed in the stamen of rapeseed flower buds. Disrupting BnDAD1 led to decreased levels of α-linolenic acid and jasmonate in the double mutants, resulting in defects in anther dehiscence and pollen maturation. By crossing the double mutant male-sterile lines with male-fertile lines, a two-line system was demonstrated, enabling the production of F1 seeds. The male-sterile trait of the bndad1 double mutant lines was maintainable by applying exogenous methyl jasmonate and subsequently self-pollinating the flowers. This breakthrough holds promising potential for harnessing heterosis in rapeseed and offers a simpler and more efficient method for producing hybrid seeds.
Functional data analysis-based yield modeling in year-round crop cultivation
Authors: Matsui Hidetoshi , Mochida Keiichi
Published: May 2024

Crop yield prediction is essential for effective agricultural management. We introduce a methodology for modeling the relationship between environmental parameters and crop yield in longitudinal crop cultivation, exemplified by strawberry and tomato production based on year-round cultivation. Employing functional data analysis (FDA), we developed a model to assess the impact of these factors on crop yield, particularly in the face of environmental fluctuation. Specifically, we demonstrated that a varying-coefficient functional regression model (VCFRM) is utilized to analyze time-series data, enabling to visualize seasonal shifts and the dynamic interplay between environmental conditions such as solar radiation and temperature and crop yield. The interpretability of our FDA-based model yields insights for optimizing growth parameters, thereby augmenting resource efficiency and sustainability. Our results demonstrate the feasibility of VCFRM-based yield modeling, offering strategies for stable, efficient crop production, pivotal in addressing the challenges of climate adaptability in plant factory-based horticulture.
Human papillomavirus vaccine coverage among immigrant adolescents in Alberta: a population-based cohort study
Authors: Du Crystal , Voaklander Don , Meherali Salima , Paudel Yuba Raj , MacDonald Shannon E
Published: May 2024

Background

Little is known about human papillomavirus (HPV) vaccination among immigrant children in Canada. We conducted a study in Alberta, Canada to assess HPV vaccine coverage among school-aged immigrant children compared with non-immigrant children.

Methods

This cohort study analysed population-based linked administrative health data to measure HPV vaccine coverage for 346 749 school-aged children, including 31 656 immigrants. Coverage was examined at 12 y of age from 2008 to 2018 for females, and from 2014 to 2018 for males and both sexes combined; vaccine series completion was considered receipt of three doses, with initiation (one or more dose) as a supplementary analysis. Multivariable logistic regression examined the association of vaccine coverage with migration status, adjusting for sociodemographic variables.

Results

Between 2014 and 2018, HPV vaccination coverage among immigrant children at age 12 y was significantly higher (52.58%) compared with non-immigrant children (47.41%). After controlling for place of residence, income quintile, biological sex and year, immigrant children had 1.10 greater odds (95% confidence interval 1.07 to 1.14) of receiving three doses of HPV vaccine compared with non-immigrant children. Immigrants from Asia and Africa had the highest coverage (60.25–68.78%), while immigrants from North America, Oceania and South America had the lowest coverage (39.97–48.36%).

Conclusions

It is encouraging that immigrant children had higher HPV vaccine coverage compared with non-immigrants. Among immigrants, routine immunization promotion strategies should be tailored based on the country of origin.