bluuebunny/crossref_metadata_2025_split huggingface dataset:
11-year follow-up outcomes of catheter ablation of para-hisian accessory pathways
Authors: Xu L , Chen Q , Zou T , Cheng K , Ling Y , Xu Y , Pang Y , Liu G , Zhu W , Ge J 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Ablation of para-hisian accessory pathways (APs) remains challenging due to anatomic characteristics and few studies have focused on the causes for recurrence of radiofrequency ablation of para-hisian APs.

Objective
This retrospective single center study was aimed to explore the risk factors for recurrence of para-hisian APs.

Methods
113 patients who had a para-hisian AP with an acute success were enrolled in the study. In the 11-year follow-up, 15 cases had a recurrent para-hisian AP. Therefore 98 patients were classified into success group while 15 patients were classified into recurrence group. Demographic and ablation characteristics were analyzed.

Results
Gender difference was similar in two groups. The median age was 36.2 years old and was younger in recurrence group. Maximum ablation power was significantly higher in success group (29 ± 7.5 vs 22.9 ± 7.8, p &lt; 0.01). Ablation time of final target sites was found to be markedly higher in success group (123.4 ± 53.1 vs 86.7 ± 58.3, p &lt; 0.05). Ablation time less than 60 seconds was detected in 12 (12.2%) cases in success group and 7 (46.7%) cases in recurrence group (p &lt; 0.01). Occurrence of junctional rhythm was significantly higher in recurrence group (25.5% vs 53.3%, p &lt; 0.05). No severe conduction block, no pacemaker implantation and no stroke were reported. Junctional rhythm during ablation (OR = 3.833, 95%CI 1.083-13.572, p = 0.037) and ablation time &lt;60s (OR = 5.487, 95%CI 1.411-21.340, p = 0.014) were independent risk factors for the recurrence of para-hisian AP.

Conclusions
Considering the long-term safety of ablation of para-hisian AP, proper extension of ablation time and increase of ablation power could be applied during operation.
The efficacy and safety of non-fluoroscopic catheter ablation of arrhythmias in pregnancy after mid-long-term follow-up: a single- center experience
Authors: Abdrakhmanov A , Ainabekova B , Nuralinov O , Bakytzhanuly A , Smagulova A 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Despite the incidence of arrhythmias in pregnancy data on non-fluoroscopic catheter ablation in pregnant women and perinatal outcomes is limited.

Purpose
the aim of this study is to prospectively assess the efficacy and safety of non-fluoroscopic catheter ablation in pregnant women with arrhythmias.

Methods
44 pregnant women (mean age of 28,2 ± 4,2 years, mean gestation age 24,4 ±3,8 weeks) indicated for catheter ablation were enrolled. The ablation was performed under the guidance of CARTO (n = 20; 45%) and Ensite Precision systems (n = 24; 55%) without fluoroscopy. Ablation characteristics, procedure-related complications and clinical outcomes were evaluated during 18 months follow-up.

Results
all 44 cases of ablation were successful. There were 14 (31,8%) ablation of accessory pathways - in left free wall (n = 8), in right free wall (n = 5), posteroseptal (n = 1). 19 patients (43,2%) underwent ablation for atrioventricular nodal reentrant tachycardia. In 3 cases (6,8%) were combination of accessory pathways with slow conduction ways. Ablation of the right ventricular outflow tract was performed in 8 cases (18,2%) of frequent premature ventricular contractions and idiopathic ventricular tachycardia. The median procedural time was 71 minutes (interquartile range 54-97). Procedural complication was documented in 1 patient (2,3%), who developed an ileofemoral thrombosis. Perinatal outcomes: spontaneus vaginal (n = 35; 79.5%) or vaginal-assisted (n = 4; 9.1%) delivery were in the majority. Five pregnancies (11.4%) were delivered by cesarean section. Mean median gestational age at delivery was 39 ± 1,12 weeks. In one case was placental abruption (2,3%). Maternal cardiac events was none declared. There were 44 live births (in all pregnancies). Fetal birth weight was 3324,39 ± 625,1 grams, 5 minute Apgar was 8,81 ± 1,9. There were no maternal and fetal mortality. During follow-up there were no arrhythmia recurrence.

Conclusions
non-fluoroscopic catheter ablation of arrhythmias is feasible and can be safety performed in pregnancy. Our data suggests that these pregnancies were with good perinatal and neonatal outcomes.
Pulmonary vein isolation for AF: does technique influence outcome?
Authors: Reddy SA , Nethercott SL , Khialani BV , Virdee MS 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background
Over the last 20 years various techniques have been developed striving for safer and more durable pulmonary vein isolation (PVI). The three most commonly used tools are pulmonary vein ablation catheter (PVAC) and cryoballoon (‘single-shot’ techniques), and point-by-point (PBP) radiofrequency ablation using 3D electroanatomical mapping (EAM).

Objective
Evaluate the safety and efficacy of the different techniques in an unselected population undergoing de-novo ablation for persistent or paroxysmal atrial fibrillation (AF) at a single high-throughput centre.

Method
Retrospective, single-centre study of consecutive AF ablations between March 2017 and April 2018. Demographic, procedural and outcome data were analysed.

Results
Over the study period 329 first-time PVI procedures were performed. 37.4% were performed using PBP, 39.8% using cryoballoon and 22.8% using PVAC. There was no significant difference in age or sex between different ablation technique groups. 238 procedures were performed for paroxysmal AF and 91 for persistent AF. A higher proportion of the persistent cases were performed using point-by-point techniques compared to paroxysmal cases (58.2% vs 29.0%, p &lt; 0.05).
Procedural times were significantly longer in the group undergoing PBP ablation compared to cryoballoon or PVAC. However, there was no statistically significant difference in 12-month freedom from symptomatic AF or procedural complications between the groups.

Conclusions
PBP, PVAC and cryoballoon AF ablation all appeared equally efficacious in an unselected population, though PVAC and cryoballoon procedures were shorter. All procedures were associated with a low adverse event rate. Prospective examination is required to substantiate this finding. Table 1CARTOn= 123Cryoballoonn= 131PVACn = 75p-valueAge/years61.7 ± 9.259.5 ± 10.661.7 ± 9.70.14Male92 (74.8)88 (67.2)49 (61.3)0.80Paroxysmal AF70 (56.9)106 (78.6)62 (82.7)0.14Cardiovascular risk factors Hypertension Diabetes Ischaemic heart disease Cerebrovascular disease Heart failure Dyslipidaemia73 (59.3)23 (18.7)40 (32.5)2 (1.6)0 (0) 12 (9.8)79 (60.3)19 (14.5)45 (34.4)0 (0)1 (0.8)16 (12.2)43 (57.3)16 (21.3)22 (29.3)1 (1.3)0 (0)10 (13.3) 0.58 0.24 0.62 - - 0.71Left atrial diameter/cm4.2 ± 0.74.1 ± 0.73.9 ± 1.00.69Procedure time/mins191.3 ± 39126.7 ± 24117.4 ± 30&lt;0.056 month success Paroxysmal Persistent50/66 (75.8)32/51 (62.7)78/103 (75.7)18/24 (75.0)48/61 (78.6)10/12 (83.3) 0.99 0.80Complications9 (7.3)3 (2.3)1 (1.3)0.07Patient demographics, procedural characteristics and outcomes for Carto, cryoballoon and PVAC cases. Values presented as mean ± SD or n (%)Abstract Figure. Time to arrhythmia recurrence
A minimally fluoroscopic approach in AVNRT ablation reduces radiation exposure and number of RF applications without compromising safety, effectiveness and procedural time
Authors: Kasbari R , Robaye B , Dormal F , Ballant E , Collet B , Deceuninck O , Blommaert D , Xhaet O 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction
Radiofrequency ablation (RF) of atrioventricular nodal reentry tachycardia (AVNRT) using conventional fluoroscopy is associated with a significant radiation exposure to both patients and operators. 3D electro-anatomical mapping systems (EAMS) can reduce radiation exposure, but specific clinical studies on their use in AVNRT ablation still lack.
Purpose
The aim of this study was to determine if EAMS use in AVNRT ablation can reduce radiation exposure and to analyse its effects on clinical and procedural outcomes.
Methods
We selected 277 patients who underwent AVNRT RF ablation in a single center in Belgium between July 2015 and November 2019 and performed a retrospective analysis of 136 and 141 patients who respectively and consecutively underwent AVNRT ablation with a conventional fluoroscopic approach (Conventional group) and a minimally fluoroscopic approach using a 3D electro-anatomical mapping system to guide the procedure (Minimal fluoroscopy group). Conventional fluoroscopy was used in both groups to confirm AVNRT induction to avoid costs related to the use of EAMS catheters in case of non-induction. We compared radiation dose, acute success/complication rates, procedural time and the number/time of RF applications in both groups.
Results
Radiation dose in the minimal fluoroscopy group was significantly lower compared to the conventional group (1179 vs. 2686 mgray.cm2, p &lt; 0,0001) and fluoroscopic time was shorter (2,5 vs. 8,6 minutes, p &lt; 0,0001). Procedural time (70 vs. 69 min, p = NS) and acute success rate (99% vs. 98%, p = NS) were not significantly different in the minimal fluoroscopy group compared to the conventional group, and no complications were observed in both groups. The number of RF applications was significantly lower when EAMS was used (6,2 ± 4,8 vs. 8,6 ± 7,6 RF application, p = 0,01) while the RF application time was not significantly different (56,8 ± 51,2 1 vs. 65,3 ± 86 seconds, p = NS).

Conclusion
AVNRT catheter ablation using a minimally fluoroscopic approach with 3D electro-anatomical mapping systems reduces radiation exposure without compromising safety, effectiveness and procedural time. EAMS use is associated with a reduction in the number of RF applications suggesting a higher precision and stability of ablation catheters during RF application.
Ablation Index guided high power (50W) short duration for anterior line and roof line ablation: feasibility, procedural data and lesion analysis
Authors: Chen S , Zanchi S , Bordignon S , Bianchini L , Tohoku S , Bologna F , Chun KRJ , Schmidt B 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Objectives
To evaluate the feasibility, procedural data, and lesion characteristics of anterior line (AL) and roof line (RL) ablation by using ablation index (AI) guided high-power(50W) among patients with recurrent atrial fibrillation (AF) or atrial tachycardia (AT) after pulmonary vein isolation (PVI).

Methods
35 consecutive patients with macro-reentrant left atrial tachycardia (LAT) or substrate at LA anterior wall or roof after previous PVI were enrolled. Ablation power was set to 50W, targeting AI 500 for AL and 400 for RL. First-pass conduction block (FPB) was evaluated. The AL was arbitrarily divided into 3(caudal, middle and cranial) segments to analyze the location of conduction gaps in non-FPB patients.

Results
A total of 32 AL and 17 RL were deployed and FPB was achieved in 24 (75%) and 14 (82%) of them respectively. In non-FPB group, the most frequent gap location along the AL was the middle third. Final block of AL was achieved in 97%, and block of RL was achieved in 100%. The RF ablation time was short (2,9 ± 0,8 min for AL and 46,2 ± 15,6 sec for RL). For AL, female gender was significantly more frequent in FPB than in non-FPB patients(p 0,028); patients with non-FPB were associated with significantly longer RF time as compared to patients with FPB (204 ± 47 sec vs 161 ± 41 sec; p = 0,02). No procedural complications occurred.

Conclusion
AI guided high-power(50W) ablation appears to be a feasible, effective and fast technique for AL and RL ablation.
Remote operation for non-fluoroscopic navigation of complex tachycardias
Authors: Garcia-Bolao I , Monino D , Marsal R , Ramos P , Erkiaga A , Irezabal J , Albarran-Rincon R 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Non-fluoroscopy navigation systems have evolved and it has had a positive impact on the electrophysiological procedures. Non-medical staff as field clinical specialists (FCS) have been essential in obtain these results, nevertheless, they need to provide their duties on-site. In some situations as a Pandemic sceneries, remote operation of the navigation system could avoid unnecessary exposure of this staff to a high-risk hospital environment.

Purpose
Remote system operation technology was developed and applied to a non-fluoroscopic navigation system in order to overcome Spanish mobility restrictions caused by Covid-19 pandemic infection and subsequently used routinely.

Methods
Fifty consecutive complex ablations were performed in different days using this technology. All these procedures were assisted remotely with the only intervention of a field clinical specialist located at his home who took full control of the navigation system (keyboard, mouse and screen) and had bidirectional real time audio/video feedback with the operating physician. Once the connection was established, the remote field clinical specialist replicated the Rhythmia screen at the remote location with all its features, and interacted identically with the physician, essentially with no perceptible differences from being physically present.

Results
There were neither interruptions nor perceptible delays in the bidirectional communications between the remote field clinical specialist and the operating physician during the procedures. Video signal delay ranged from 265 to 325 milliseconds. All the procedures were uneventful.

Conclusions
Remote System Operation allowed full teleoperation of a non-fluoroscopic navigation system (keyboard, mouse and screen) as well as bidirectional real time audio/video feedback with the operating physician, providing a fully autonomous remote assistance in 50 complex ablation procedures. This technology ensures workflow continuity and optimal workforce flexibility and has relevant and promising implications in the field of training, teaching and resource optimization that deserves further development. Latency measurements.Hospital LocationPamplonaPamplonaPamplonaRemote operator locationBilbaoMadridTarragonaT1 (s/ms)58s 120ms28s 340ms33s 380msT2 (s/ms)58s 680ms28s 960ms33s 940msT2-T1 (ms)560 ± 32620 ± 33560 ± 30Latency = (T2-T1)/2 (ms)280 ±15310 ± 15280 ± 10Measurements of the video delay ranged from 265 to 325 milliseconds.Abstract Figure. Local and Wide area network architecture
Prevalence and ablation of different anatomic locations of atrial tachicardias in the electrophysiology lab of a single large center
Authors: Toniolo M , Rebellato L , Muser D , Daleffe E , Proclemer A , Facchin D 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Focal atrial tachycardias (ATs) can arise from several different anatomic regions both in the right atrium (RA) and left atrium (LA). The prevalence of focal atrial tachycardia is not well known. A European study of young males applying for pilot licenses demonstrated that 0.34% had asymptomatic atrial tachycardia and 0.46% had symptomatic atrial tachycardia1. It is well-recognized that these foci do not occur randomly throughout the atria but tend to cluster at characteristic anatomic locations. However, the distribution of these sites in the total amount of ATs is not well recognized.

Purpose
The objective of this study was to determine the prevalence of different anatomic locations of ATs in the electrophysiology lab of a single large center (300 ablations per year) and to verify the site of ablation.

Methods
We collected 150 consecutive patients submitted to catheter ablation of ATs between January 2010 to December 2020. Anatomic localization of the atrial focus was performed during tachicardia by analysis of endocardial activation sequence.

Results
The distribution of the different anatomic locations is rappresented in the figure. In 134 patients (89%) ATs were localized in the RA. In the RA, these foci mainly occured along the crista terminalis (32%), the perinodal region (22,6%), the anterior right sided septum, near the foramen ovale (9,3%), the posterior right-sided septum (8%), the ostium of the coronary sinus (5,3%), the tricuspid annulus (5,3%), the superior vena cava (4,6%), the infero-lateral wall (2,5%), the right atrial appendage (0,6%) and the cavotricuspid histhmus (0,6%). In the LA (11%), foci occur predominantly at the pulmonary vein ostia (5,2%) and less commonly at the mitral annulus (2,5%), the left sided septum (0,6%), the appendage ridge (0,6%), the roof (0,6%) and the anterior wall (0,6%). For each location of AT, the ablation was performed at the earliest activation site, but about the perinodal ATs, the ablation was performed at the non coronary sinus of Valsalva of the aortic root, regardless the earliest activation site, for avoiding to create damages to the atrio-ventricular (AV) conduction system.

Conclusions
ATs mainly arise from the RA. Crista terminalis is the most common site but the perinodal region is the second more frequent site. The ablation of ATs from the perinodal region is challenging for the risk of damages to the AV conduction system. The relatively low prevalence of ATs arising from the pulmonary veins could be explained for the likely degeneration of these ATs in atrial fibrillation. Abstract Figure.
Near zero fluoroscopy in cryoballoon catheter ablation in patients with atrial fibrillation using the new KODEX-EPD imaging system
Authors: Schillaci V , Stabile G , Arestia A , Shopova G , Solimene F 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Fluoroscopy is commonly used in cryoballoon catheter ablation for pulmonary vein (PV) isolation procedures in patients with atrial fibrillation (AF).
Objective The purpose of this study was to verify the feasibility of a new dielectric imaging system in reducing the radiation exposure during cryoballoon ablation in patients with AF.
Methods We enrolled 26 consecutive patients with paroxysmal AF: 13 patients underwent the procedure under fluoroscopy guidance before the new system introduction, while 13 patient underwent the procedure under fluoroscopy and KODEX-EPD system guidance with its occlusion tool software. After transseptal access a detailed image reconstruction of left atrium and PVs was achieved with the Achieve octapolar circular mapping catheter and the cryoablation was performed with the Arctic Front Advance cryoballoon.
Results Total time of the procedure was comparable between the two groups (90.15 ± 28.67 vs 80.77 ± 17.17 using KODEX-EPD, p = 0.34), while fluoroscopy time was significantly lower in the group using KODEX-EPD (16.92 ± 8.96 vs 5.54 ± 2.06, p &lt; 0.01). Acute isolation was achieved in all PVs. No 30 days complication was observed.
Conclusion This is the first study that demonstrates the feasibility of a reduce fluoroscopy workflow using the novel KODEX-EPD system in a cryoballoon procedure. Abstract Figure. Fluoroscopy time
Are there gender differences in the non-prescription of Implantable Cardioverter-Defibrillators (ICDs) in primary prevention? A single-center series
Authors: Aguilera C , Toquero Ramos J , Mingo Santos S , Garcia-Izquierdo Jaen E , Jimenez Sanchez D , Pham-Trung C , Veloza Urrea D , Morillo Diaz JD , Garcia Rodriguez D , Garcia Gomez S , Remior Perez P , Castro Urda V , Fernandez Lozano I 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Primary prevention of sudden cardiac death is the main indication for ICD implantation, mainly based on left ventricular ejection fraction (LVEF). Gender differences in the diagnosis and treatment of some cardiology conditions such as myocardial infarction have been previously established.

Purpose
We aim to analyze differences in prognostic variables that could justify gender differences in the non-prescription of an ICD for primary prevention.

Methods
A retrospective selection of patients from our center during 2019 with ventricular systolic dysfunction (LVED ≤35% in an echocardiogram) was made. We included patients at least one month after an acute myocardial infarction and with optimal medical treatment without an ICD. Death was considered during the year 2019.

Results
We initially selected 325 patients with ventricular dysfunction, of wich 175 fulfilled the inclusion criteria (67.4% men and 32.6% women). ICD indication was considered in 47 patients out of the 175 selected (29.7% among men and 21.1% among women, p = 0.7; 70.3% among men and 78.9% among women, p= 0.30 for non-prescription). The index left ventricle end-diastolic volume (iLVEDV) was significantly worse in males. Females were older and had lower LVEF.

Conclusion
Although it is a unicenter study and we have only performed univariate comparisons, without considering confounding factors, we found no significant gender differences in prognostic variables that could justify differences in the non-prescription of an ICD for primary prevention. Results Variable Men Women p-value Age (years) 74.53 ± 0.11 79.52 ± 0.15 &lt;0.01 Previous cancer disease 11 (13.25%) 4 (8.89%) 0.77 Cognitive impairment 12 (14.46%) 11 (24.44%) 0.08 NYHA class Mean NYHA class value I (12.05%)II (69.88%)III (18.07%)2.06 ± 0.11 I (6.67%)II (66.67%)III (26.67%)2.20 ± 0.15 0.23 Ischemic etiology 39 (46.99%) 17 (37.78) 0.84 Renal insufficiency 31 (37.35%) 21 (46.67%) 0.15 Syncope or palpitations 16 (19.28%) 8 (17.78%) 0.58 LVEDD index (cm/m2) 2.57 ± 0.11 2.71 ± 0.15 0.23 LVEDV index (ml/m2) 73.18 ± 0.11 66.84 ± 0.15 1 LVEF (%) 28.89 ± 0.11 27.17 ± 0.15 1 Death 17 (20.48%) 8 (17.78%) 0.64 Renal insufficiency: estimated glomerular filtration rate less than 30 ml/min/1,73m2 or dialysis. LVEDD: left ventricle end-diastolic diameter. NYHA: New York Heart Association.