bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia using standardized voltage mapping system protocol
Authors: Bulian F , Manfrin M , Rauhe W 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
according to European guidelines, ablation has become the treatment of choice in patients with symptomatic atrioventricular nodal reentry tachycardia (AVNRT). Despite the high procedure success rate, anatomical variations can affect the outcome in terms of relapses and complications. As recently demonstrated, low-voltage bridge visualization allows low pathway identification and therefore a new ablation strategy.

Purpose
our purpose was the validation of standardized ablation protocol within the low-voltage bridge area.

Methods
70 consecutive patients with inducible AVNRT were evaluated and a three-dimensional voltage map of the right atrial septum and Koch Triangle was constructed by means of contact mapping. Ablation site was identified as the low-voltage area below the His bundle, adjusting the high-voltage slider to 1,5 mV and dynamically adjusting the slider of low-voltage. Radio-frequency energy (with an average number of nine lesions per patient) was then delivered within this area until the appearance of junctional beats. The results were tested at the end of the procedures and during the observational period (the mean follow-up was 10,5 months).

Results
the slow pathway was identified by the low-voltage bridge in 60 patients (85,6%) and in these patients, the target lesions in that area finally prevented induction of AVNRT in 100% of cases. A zero-fluoroscopy approach was possible for 50 patients (83%). Compared with standard AVNRT ablation, no complications as well as no statistical differences in terms of total procedure time were observed (p = 0,056). 59 patients (98%) had no relapses during the follow-up.

Conclusions
voltage gradient mapping successfully targeted the slow pathway in most of our cases. Lesions on the voltage bridge led to effective ablation of AVNRT and to a drastic x-ray exposure reduction in the absence of acute or long-term complications. Abstract Figure. Last lesion on low-voltage bridge.
Benefits of catheter ablation of typical cavotricuspid isthmus-dependent atrial flutter using half-normal saline
Authors: Vecchio N , Militello C , Lopez Diez JC , Schnetzer N , Dorado J , Basile F , Bochoeyer A 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Radiofrequency catheter ablation (RFA) of cavotricuspid isthmus–dependent atrial flutter (AFL) is a procedure with a high success rate and a low complication rate. The anatomical variation and irregularity of the isthmus, with the high local blood flow, can reduce the effectiveness of the lesion and consequently of the procedure.
Recent data suggests that deeper ablation lesions can be created using open-irrigated catheters (CA) with half-normal saline (HNS).

Purpose
To assess the acute efficacy and safety of RFA of AFL with half-normal saline (HNS). Compare the results with CA irrigated with normal saline (NS).

Methods
Randomized, prospective, observational and single-center study. Consecutive patients with first AFL RFA between June 2019 and December 2020 were included. CA with HNS or NS were used, with a limit of 40 watts and 40° C. An RFA line was performed under fluoroscopic guidance or electroanatomic mapping. If necessary, the lesion was repeated until the arrhythmia was interrupted and the bidirectional block was achieved (success).
Acute success, total radiofrequency time (RT), number of radiofrequency applications, and complications were analyzed.

Results

38 patients with RFA of AFL were analyzed. 19 in the HNS and 19 in the NS group. There were no significant differences between the baseline characteristics of each group. (Table 1)
The accute success rate was 100% with a median of 2 RFA applications in both groups. The mean RT in HNS was 7:10 vs 09:16 min in NS group; the t-test analysis did not show a significant difference (p = .2).
A subanalysis was performed in those patients who required more than 2 lines of RFA; a mean of 4 in the HNS group vs 6 in the NS group (p = .4). In the HNS group, RT was significantly shorter; 8:17 vs 13:17 min in the NS group (p = .011). (Figure 1)
There was a steam pop in the HNS group and no complications or steam pop in the NS group (p = .53).

Conclusions

RFA of AFL using HNS is an effective and safe procedure. In patients with unfavorable anatomy who required a greater number of applications, the radiofrequency time was significantly shorter using HNS. Baseline characteristicsHNS (19 p)NS(19 p)pAge56 ± 12.3 years61 ± 10.8 years.22Male16 p (84%)16 p (84%)1Heart Disease7 p (36.8%)5 p (26.3%).68Ejection Fraction57.1 ± 11%56 ± 14.3%.49Ejection Fraction &lt; 50%2 p (10.5%)2 p (10.5%)1Electroanatomic mapping10 p (52.6%)8 p (42.1%).7Abstract Figure. Fugure 1
Characterization of atrial lesion safety and efficacy utilizing a circular catheter and the IRE generator with an in vivo porcine model
Authors: Hsu J , Gibson D , Banker R , Doshi SK , Gidney B , Gomez T , Berman D , Datta K , Govari A , Natale A 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Biosense Webster, Inc.
Introduction/Objectives:
Pulsed field ablation (PFA) is a non-thermal ablative method that delivers high voltage, very-short duration pulses that cause pore formation in the cytoplasmic membrane and cell death. The tissue selectivity of PFA is expected to reduce the risk of collateral tissue injury compared to radiofrequency catheter ablation (RFCA), while maintaining effectiveness. The objective of this study was to perform pulmonary vein (PV) isolation in a porcine model to characterize the safety and performance of a novel, fully-integrated biphasic PFA system. The system is comprised of a multi-channel generator, a variable loop circular catheter, and an integrated irreversible electroporation (IRE) mapping software module.

Methods
The study evaluated safety and efficacy of IRE in 8 healthy swine. First, to evaluate safety, multiple ablations were performed at various cardiac structures, including within the lumen of the right pulmonary vein (RIPV), at the right superior pulmonary vein (RSPV) ostium, and adjacent to the esophagus. Second, to evaluate efficacy, animals were recovered and followed for 30 (±3) days, then re-mapped. Gross pathological and histopathological examinations were performed to assess for procedural injury, chronic thrombosis, tissue ablation, depth of penetration, healing, and level of inflammatory response.

Results
All 8 swine survived for the 30 (±3) day follow up (FU) period. There were no acute (day of procedure) incidents of pulmonary vein narrowing of &gt;70%, nor at 30 d follow-up (FU), even when ablation was purposefully performed directly deep to the ostium of the vein. No injury was seen grossly or histologically in the adjacent esophagus. All PVs were durably isolated as confirmed by bidirectional block at the 30 (±3) day re-map procedure, and histological examination showed complete, transmural necrosis around the entire circumference of the ablated section of the right PVs [Figure].
Conclusion(s): This pre-clinical evaluation of a fully integrated PFA system demonstrated effective and durable ablation of cardiac tissue and PV isolation with no collateral damage to adjacent structures. Notably, histological staining confirmed complete transmural cell necrosis around the circumference of the ostial PV at 30 days. Abstract Figure. PVI maps (A) histology (B) and safety(C)
Cardiotrophin-1 and components of metabolic syndrome: what is the role in the development of atrial fibrillation?
Authors: Ionin V , Zaslavskaya EL , Barashkova EI , Skuridin DS , Baranova EI , Shlyakhto EV 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Pavlov University
Introduction. The cardiotrophin-1 (CT-1) is a cytokine from the interleukin-6 family associated with pathology of the cardiovascular system, contributing to myocardial remodeling and the development of fibrosis in patients with hypertension. CT-1 is involved in the regulation of energy processes and the metabolism of adipose tissue, as well as in the regulation of lipid and carbohydrate metabolism. Revealed an increase in the deposition of type I collagen in the atrial myocardium against the background of dilatation of the left atrium and an increase in the expression of CT-1. The role of CT-1 in the development of AF is currently being actively studied.
Purpose. To determine the concentration of cardiotrophin-1 (CT-1) in patients with metabolic syndrome (MS) and atrial fibrillation (AF) with an assessment of the relationship with the parameters of obesity and metabolic disorders.
Methods. In a one-stage case-control study, 352 patients aged 35 to 65 years were included: patients with MS (n = 223), of which 107 patients with AF, and comparison groups consisted of patients with AF without MS (n = 69) and practically healthy examined without cardiovascular diseases and metabolic disorders (n = 60).
Results. It was found that the concentration of CT-1 in serum in patients with AF is higher than in patients with MS without AF (766,2 (539,2-1032,3) and 590,2 (480,1-922,3) pg/ml, p = 0,005) and higher than in healthy subjects (780,2 (550,2-1050,3) and 410,1 (290,2-549,2) pg/ml, p &lt; 0,0001). It was found that in patients with AF and MS, the concentration of CT-1 in the blood serum is higher than in patients with AF without MS (851,2 (589,1-1146,3) and 681,1 (480,1-823,2) pg/ml, p = 0,004). CT-1 positively correlates with the concentration of glucose in blood plasma (r = 0,423, p = 0.002) and triglycerides (r = 0,207, p = 0,003), as well as with the waist circumference (r = 0,265, p &lt; 0.001) and the thickness of epicardial fat (r = 0,351, p &lt; 0,001). Using ROC analysis, it was found that with an increase in the concentration of CT-1 in blood serum more than 638,1 pg/ml, the probability of AF increased by 4 times (OR = 4.0, 95%CI 2,31-6,94, p &lt; 0,0001).
Conclusion. An increase of serum CT-1 concentration is associated with heart remodeling and obesity in patients with MS and probably has a pathogenetic role in increasing the risk of AF in this cohort of patients.
Atrial fibrillation detected at screening is not a benign condition - a comparison of clinical outcomes in screen-detected vs. hospital-detected atrial fibrillation
Authors: Zwartkruis VW , Geelhoed B , Suthahar N , Gansevoort RT , Bakker SJL , Van Gelder IC , De Boer RA , Rienstra M 
Published: May 2021

Abstract

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

Background
Screening for atrial fibrillation (AF) improves detection of AF. However, it is unknown whether AF detected at screening carries risks similar to clinically detected AF, and if it should be treated similarly.

Purpose
We aimed to compare clinical outcomes in individuals with screen-detected vs. hospital-detected incident AF.

Methods
We studied 8265 individuals (mean age 49 ± 13 years, 50% women) without prevalent AF from the population-based PREVEND (Prevention of Renal and Vascular End-Stage Disease) cohort study. By design, 70% of PREVEND participants had urinary albumin concentration ≥10 mg/l. AF was considered screen-detected when first detected on a 12-lead electrocardiogram (ECG) during one of the PREVEND study visits, and hospital-detected when first detected on a hospital ECG. Using Cox regression models with screen-detected and hospital-detected AF as time-varying covariates, we studied the association of screen-detected vs. hospital-detected AF with mortality, incident heart failure (HF), and incident cardiovascular (CV) events.

Results
During a mean follow-up of 9.7 years, 265 participants (3.2%) developed incident AF (mean age 62 ± 9 years, 30% women, 65% hypertension, 23% obesity, 9% diabetes, 15% history of myocardial infarction, 3% history of stroke, 2% prevalent HF). Of all incident AF cases, 60 (23%) were screen-detected and 205 (77%) hospital-detected. Baseline characteristics were generally comparable between participants with screen-detected and hospital-detected AF. A larger proportion of incident AF was screen-detected in men (26%) compared to women (15%). In univariabe analysis, both screen-detected and hospital-detected AF were strongly associated with death, incident HF, and incident CV events. After multivariable adjustment, hospital-detected AF was significantly associated with death (HR 2.95, 95% CI 2.18-4.00), incident HF (HR 3.98, 95% CI 2.49-6.34), and incident CV events (HR 1.92, 95% CI 1.21-3.06). Screen-detected AF was significantly associated with death (HR 2.21, 95% CI 1.09-4.47) and incident HF (HR 4.90, 95% CI 2.28-10.57), but not with incident CV events (HR 1.12, 95% CI 0.46-2.71).

Conclusions
In a population-based cohort enriched for microalbuminuria, almost a quarter of incident AF cases was first detected through ECG screening. Compared to hospital-detected AF, screen-detected AF was similarly associated with adverse outcomes. Although randomised trials are needed, this study highlights that AF screening may help decrease the general burden of CV disease.
Prevalence of new onset atrial fibrillation and associated outcomes in patients with sepsis: a systematic review and meta-analysis
Authors: Romiti GF , Corica B , Proietti M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
New-onset Atrial Fibrillation (neoAF) is a common complication in patients with sepsis and septic shock, imposing major challenges in management and worse prognosis; however, the actual prevalence of neoAF, as well as its impact on outcomes are still unclear. The aim of this study is to provide a comprehensive systematic review and meta-analysis on the prevalence of neoAF in patients with sepsis, and its impact on in-hospital mortality and intensive care unit (ICU) mortality.

Methods
Pubmed and EMBASE were systematically searched through 23th December 2020. Studies reporting on prevalence of neoAF and/or impact on in-hospital mortality or ICU mortality in patients with sepsis or septic shock were selected and included. Pooled prevalence and 95% Confidence Intervals (CI) were calculated, as well as Odds Ratios (OR), 95%CI and 95% Prediction Intervals (PI) for outcomes. Subgroup analysis and meta-regressions were performed to account for potential sources of heterogeneity; sensitivity analysis according to the "leave-one-out" approach were also performed.

Results
Among 4249 records retrieved from the literature search, 21 articles were identified and included in the systematic review. Across 207599 patients with sepsis or septic shock, prevalence of neoAF was found as high as 14% (95%CI: 9%-21%), with high heterogeneity between studies; significant subgroup differences were observed according to geographical location (with lower prevalences reported in North-American studies compared to European/Middle-East and Asian cohorts), study design and number of sepsis patients included in the original studies. A multivariate meta-regression model including sample size and geographical location was able to explain most part of the heterogeneity. Patients with sepsis showed an increased risk of both in-hospital mortality (OR: 2.31, 95%CI: 1.92-2.79, 95%PI: 1.52-3.53, Figure 1 panel A) and ICU mortality (OR: 2.66, 95%CI: 2.21-3.21, 95%PI: 1.77-4.00, Figure 1 panel B), with low to no heterogeneity detected between studies included. The "leave-one-out" sensitivity analysis confirmed the results of the main analysis.

Conclusions
Among patients with sepsis, neoAF is a common complication, being present in 1 out of 7 individuals. Patients with neoAF are at higher risk of mortality during sepsis, and may need specific therapeutical interventions. Abstract Figure.
Novel tool for predicting residual stroke risk in atrial fibrillation: mCARS
Authors: Ding WY , Rivera-Caravaca JM , Marin F , Torp-Pedersen C , Roldan V , Lip GYH 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Recently, CARS was proposed to predict 1-year absolute stroke risk in non-anticoagulated patients with atrial fibrillation (AF). We aimed to determine whether a modified CARS (mCARS) may be used to assess the residual stroke risk in anticoagulated AF patients.

Methods
We studied patient-level data of anticoagulated AF patients from the real-world Murcia AF Project and AMADEUS clinical trial. Individual mCARS was estimated for each patient using an estimated 64% risk reduction with anticoagulation.

Results
3,503 patients were included (2,205 [62.9%] clinical trial and 1,298 [37.1%] real-world). In the clinical trial cohort, the median age was 71 (IQR 65-77) and CHA2DS2-VASc score 3 (IQR 2-4). In the real-world cohort, the median age was 76 (IQR 70-81) and CHA2DS2-VASc score 4 (IQR 3-5).
At 1-year, there were 40 and 31 stroke events in the clinical trial and real-world cohorts, respectively. Average predicted residual stroke risk by mCARS was identical to actual stroke risk (1.8 [±1.8%] vs. 1.8% [95% CI, 1.3-2.4]) in the clinical trial, and broadly similar in the real-world (2.1 [±1.9%] vs. 2.4% [95% CI, 1.6-3.4]). Additionally, these values were comparable across the subgroups stratified by CHA2DS2-VASc score in both cohorts.
AUCs of mCARS for prediction of stroke events in the clinical trial and real-world were 0.678 (95% CI, 0.598-0.758) and 0.712 (95% CI, 0.618-0.805), respectively. In an exploratory analysis, we found that mCARS was able to refine stroke risk estimation for each point of the CHA2DS2-VASc score in both cohorts.

Conclusion
Personalised residual 1-year absolute stroke risk in anticoagulated AF patients may be estimated using mCARS. Such patients with high residual stroke risk may benefit from more aggressive interventions and follow-up. Absolute 1-year stroke risk Clinical Trial Real-World Median (IQR) Range Median (IQR) Range CHA2DS2-VASc score 0 NA 0.9 (0.6 - 1.3) 0.2 - 1.4 CHA2DS2-VASc score 1 1.1 (0.7 - 1.4) 0.2 - 2.0 1.4 (0.9 - 1.7) 0.2 - 13.0 CHA2DS2-VASc score 2 2.0 (1.5 - 2.4) 0.3 - 10.8 2.1 (1.5 - 2.6) 0.3 - 10.8 CHA2DS2-VASc score 3 2.6 (2.1 - 3.4) 0.4 - 13.3 2.8 (2.5 - 3.4) 0.9 - 13.3 CHA2DS2-VASc score 4 3.6 (2.8 - 5.6) 0.3 - 18.1 3.9 (3.3 - 5.0) 1.1 - 21.0 CHA2DS2-VASc score 5 6.7 (3.6 - 14.0) 1.9 - 20.9 4.8 (3.9 - 12.2) 1.2 - 21.0 CHA2DS2-VASc score 6 13.6 (5.5 - 15.8) 2.4 - 21.8 12.8 (4.8 - 16.7) 2.2 - 21.8 CHA2DS2-VASc score 7 15.7 (14.5 - 17.4) 4.5 - 21.9 15.6 (5.9 - 17.5) 4.1 - 23.5 CHA2DS2-VASc score 8 16.5 (14.0 - 18.5) 13.1 - 20.3 16.9 (15.7 - 19.5) 13.6 - 21.0 IQR, interquartile range; NA, not applicable.
Abutting left atrial appendage and left superior pulmonary vein predicts recurrence of atrial fibrillation after point-by-point pulmonary vein isolation
Authors: Szegedi N , Simon J , Szilveszter B , Sallo Z , Herczeg S , Nagy VK , Szeplaki G , Tahin T , Merkely B , Geller L 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Catheter ablation is the cornerstone for rhythm control in patients with drug-refractory atrial fibrillation (AF). Baseline predictors of AF recurrence after catheter ablation are well established, such as female gender and left atrial enlargement. The role of the spatial relationship between the left superior pulmonary vein (LSPV) and left atrial appendage (LAA) is unknown.

Purpose
We sought to evaluate whether juxtaposed LSPV and LAA plays a role in AF recurrence after catheter ablation for paroxysmal AF.

Methods
Consecutive patients, who underwent point-by-point radiofrequency catheter ablation for paroxysmal AF at our hospital between January of 2014 and December of 2017, were enrolled in the study. All patients underwent pre-procedural cardiac CT-angiography (CTA) for the assessment of left atrial (LA) and pulmonary vein (PV) anatomy. Abutting LAA-LSPV was defined as cases when LSPV touched the posterior aspect of LAA (distance less than 2 mm).

Results
We included 428 patients (60.7 ± 10.8 years, 35.5% female). AF recurrence rate was 33.4% with a median recurrence-free time of 21.2 (IQR = 8.8-43.0) months. In the univariate analysis, female sex (HR = 1.45; 95%CI = 1.04-2.01; p = 0.028), LA volume (HR = 1.01; 95%CI = 1.00-1.01; p = 0.042), and cases when LSPV touched the posterior wall of LAA (HR = 1.53; 95%CI = 1.09-2.14; p = 0.013) were associated with AF recurrence. In the multivariate analysis, female sex (adjusted HR = 1.55; 95%CI = 1.06-2.28; p = 0.024), LA volume (adjusted HR = 1.01; 95%CI = 1.00-1.02; p = 0.028), and abutting LAA-LSPV (adjusted HR = 1.60; 95%CI = 1.13-2.50; p = 0.008) remained significant predictors of AF recurrence.

Conclusion
Female gender, higher LA volume, and abutting LSPV and LAA predispose patients to have a higher chance for arrhythmia recurrence after catheter ablation for paroxysmal AF.
Novel cryo-balloon ablation technology for pulmonary vein isolation in patients with atrial fibrillation: preliminary experience from a multicenter clinical practice
Authors: Tondo C , Stabile G , Filannino P , Moltrasio M , De Simone A , Artale P , Fassini G , La Rocca V , Bianchi S , Perna F , Tundo F , Colella J , Iuliano A , Malacrida M , Iacopino S 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Complete electrical pulmonary vein isolation (PVI) by cryo-balloon approach is a well-established ablation strategy of atrial fibrillation (AF). Recently, a new cryoablation system (POLARx) with unique features has been made available for clinical use. To date, no data exist on procedural characteristics of this system in a multicentric clinical practice.

Purpose
We aimed to characterize the initial experience of this technology in the Italian clinical practice.

Methods
Consecutive patients (pts) undergoing AF ablation from the CHARISMA registry at 5 Italian centres were included. Protocol-directed cryoablation was delivered for 180 sec or 240 sec according to operator’s preference for isolation achieved in ≤60 sec, or 240 sec if isolation occurred &gt;60 sec or when time to isolation (TTI) was not available. The ablation endpoint was PV isolation as assessed by entrance and exit block.

Results
Two-hundred sixty-two cryoapplications from 49 pts (194 PVs) were analyzed. PVI was achieved with cryoablation only in all pts. The mean number of freeze applications per pt was 5.3 ± 1.5 (1.3 ± 0.6 for LIPV, LSPV and RSPV, 1.6 ± 1.3 for RIPV), with 143 (73.7%) PVs treated in a single-shot fashion (38, 19.6% with 2 shots; 13, 6.7% with more than 2 shots). Sixteen (33%) pts were treated with a single freeze to each of the PVs. The mean nadir temperature was -55.5 ± 6.9 °C and was colder than -50°C in 83% of the PVs. TTI information was evaluable in 120 (46%) cryoapplications with a median TTI of 47 [32-75] sec (median temperature at TTI = -49 [-53 to -42] °C). The mean time to target -40 °C (TTT) was 30.1 ± 6.9 sec with a TTT &lt; 60 sec achieved in 99.2% of the cryoapplications; the mean thaw time to 0 °C was 18.6 ± 5.8 sec (thaw time &gt;15 sec in 70.3% of the cryoapplications). The mean PV occlusion grade (rank 1-4) was 3.6 ± 0.6 (grade 2 in 5.2% of the cases, grade 3 in 25.6% and grade 4 in 69.2%). No complications were observed at 30 days post-procedure.

Conclusion
In this first multicentric experience in a clinical practice setting, the novel cryo-balloon system proved to be safe and effective and resulted in a high proportion of successful single-freeze isolation. Cooling parameters seem to be slightly different from reference cryo-balloon technology.