bluuebunny/crossref_metadata_2025_split huggingface dataset:
Concomitant utilization of radiofrequency ablation during atrial fibrillation cryoballoon ablation procedures
Authors: Gaitonde RS , Martel JA , Porterfield CP , Koide NS , Kobori A , Altemose GT , Brown KH , Dell"orfano J , Gora P , Mathew S 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Use of cryoballoon ablation (CBA) for the treatment of atrial fibrillation (AF) has become increasingly common in recent years. While various techniques have been described for use of the cryoballoon to achieve PVI and create selective additional lesion sets, the need for concomitant radiofrequency (RF) ablation in delivering touch-up ablation or non-PVI lesion sets has not been quantified.

Purpose
To quantify the rate of RF ablation catheter use in AF CBA procedures, and to evaluate whether indication for ablation can be used as a predictor of the need for supplementary RF ablation.

Methods
Self-reported data was prospectively collected in AF CBA procedures. Procedural characteristics including concomitant utilization of RF ablation catheters and lesion set delivery were recorded and analyzed. Post-hoc statistical analysis was completed utilizing a two-sample t-test of significance.

Results
Data was collected in a total of 246 AF CBA cases across 44 centers in the USA, Europe, and Japan. Included in the analysis were 170 paroxysmal atrial fibrillation cases (PAF group); 70 PersAF and 6 LsPersAF cases (PersAF group). Utilization rates for RF ablation catheters did not differ between the two groups; 35.9% and 36.8% of cases in PAF and PersAF, respectively (p = 0.885). The number of patients in which non-PV lesion sets were delivered also did not differ between groups; 38.2% and 40.8% in PAF and PersAF, respectively (p = 0.706). The choice of non-PV lesion sets varied as shown in Table 1. Upon completion of ablation, more patients were in sinus rhythm in the PAF group compared to the PersAF group, but the difference did not reach statistical significance; 88.2% and 78.9%, respectively (p = 0.057).

Conclusions
RF ablation catheter utilization rates were similar between groups, suggesting that indication (PAF vs. PersAF) alone is not a good predictor of whether concomitant RF ablation catheter utilization will be required during an AF CBA procedure. Table 1 Incidence Lesion Set PAF (n = 170) PersAF (n = 76) CTI Line 26.5% (45/170) 15.8% (12/76) Isolation/Homogenization of Fibrotic Areas 2.9% (5/170) 3.9% (3/76) CFE 2.9% (5/170) 0.0% (0/76) Posterior Wall Isolation 1.8% (3/170) 21.1% (16/76) Roof Line 1.8% (3/170) 7.9% (6/76) Other 9.4% (16/170) 27.6% (21/76) Utilization rate of non-PVI lesion sets
Clinical and electrophysiological characteristics of extra-pulmonary vein triggers in patients who underwent catheter ablation for atrial fibrillation
Authors: Hwang T , Yoon M , Kim M , Kim I , Yu H , Kim T , Uhm J , Kim J , Joung B , Lee M , Pak H 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Extra-pulmonary vein (PV) triggers play significant roles in atrial fibrillation (AF) recurrence after AF catheter ablation (AFCA).

Purpose
We explore the clinical and electrophysiological characteristics of extra-PV triggers in de novo and repeat-AFCA procedure.

Methods
We included 2,151 patients who had de novo AFCA and 319 repeat AFCA (female 28.0%, 59.1 ± 10.8 years old, paroxysmal AF 65.1%) those underwent post-procedural isoproterenol (ISO) provocation tests. We analysed the clinical, electrophysiological, and procedure-related factors associated with extra-PV triggers.

Results
Extra-PV triggers were documented in 11.9% (1.19 ± 0.42 foci) after de novo-AFCA and 27.0% (1.37 ± 0.65 foci) after repeat-AFCA (p = 0.004). LA volume index (OR 1.02 [1.01-1.03], p = 0.004), history of vascular disease (OR 0.55[0.31-0.91], p = 0.028) and Lead I amplitude of electrocardiogram (OR &lt;0.01 [&lt;0.01-0.62], p = 0.032) were independently associated with the existence of extra-PV triggers in de-novo procedure. Women (OR 1.84 [1.03-3.25], p = 0.037) and LA appendage volume (OR 1.04 [1.01-1.07] p = 0.027) were independently associated with extra-PV triggers during the redo-mapping procedure. Septum (28.4%), coronary sinus (24.0%), and superior vena cava (19.6%) were common extra-PV foci, and septal foci were more commonly found in repeat mapping (38.4% vs. 25.0%, p = 0.025). Among 65 patients who showed extra-PV at the repeat procedures, 19 (29.2%) matched with previous focal or empirical extra-PV ablation sites and 9 (13.8%) were multiple or unmappable sites. AF recurrence rates were significantly higher in both patients with extra-PV triggers after de novo procedures (Log-rank P &lt;0.001; HR 1.93 [1.58-2.36], p= &lt;0.001) and repeat procedures (Log-rank P &lt;0.001, HR 1.87 [1.29-2.70], p= &lt;0.001).

Conclusion
ISO provoked extra-PV triggers commonly found in AF patients with significant remodelling and previous empirical or focal extra-PV ablations. Existence of extra-PV triggers were independently associated with poorer rhythm outcome after both de novo and repeat AFCA. Denovo AF ablation outcome OverallExtra-PV triggers (-)Extra-PV triggers (+)p-value(n = 2151)(n = 1895)(n = 256)Age, yrs58.98 ± 10.9558.73 ± 11.0360.76 ± 10.200.006Male, (%)1550 ( 72.1)1389 ( 73.3)161 ( 62.9)0.001Follow up duration, month50.30 (37.71)51.65 (37.95)40.71 (34.58)&lt;0.001Early recurrence (%)579 ( 27.8)455 ( 24.9)124 ( 48.4)&lt;0.001Clinical recurrence (%)699 ( 33.6)584 ( 32.0)115 ( 44.9)&lt;0.001Abstract Figure. AF free survival according to Extra PVT
3D mapping versus cardiac computed tomography guided cryoballoon ablation for atrial fibrillation
Authors: Varnavas V , De Schouwer K , Abugattas JP , Wolf M , De Greef Y , Schwagten B 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac computed tomography (CCT) is an essential tool for an efficient ablation for atrial fibrillation. 3D mapping guided ablation could also deliver sufficient results in the setting of cryoballoon ablation (CBA) with additional advantages regarding total patient radiation exposure, fluoroscopy and procedural time.

Purpose
To compare the 3D mapping with the Achieve® catheter versus the CCT on the procedural characteristics and acute outcome during CBA.

Methods
Consecutive patients who underwent CBA with the second-generation cryoballoon (CB) were retrospectively enrolled from a single centre registry. Baseline and procedural characteristics of patients with pre-procedural CCT (CT-Group) were compared to those with peri-procedural 3D mapping (Ensite PrecisionTM ) with the 1st generation Achieve® catheter (3D-Group).

Results
A total of 696 patients were enrolled, 327 (47%) in the CT-Group and 369 (53%) in the 3D-Group. Baseline characteristics were comparable between the two groups. Similar pulmonary vein (PV) anatomical variations were identified in both groups and all PVs were acutely isolated. The mean CB temperature (T) at 60s, the nadir T, the time to PV isolation, the T of isolation and the mean thaw time did not differ significantly. However, the total procedural and fluoroscopy time were significantly shorter as well as the dose area product was significantly less in the 3D-Group.

Conclusion
3D mapping guided CBA using the Achieve® catheter is associated with significantly shorter fluoroscopy and procedural time and less patient radiation exposure. The anatomical acquisition of the PVs and the acute ablation outcome is non inferior to the CCT guided CBA. Procedural characteristics CT-Group n = 327 3D- Groupn = 369 p-value Paroxysmal AF 214 244 0.87 Total procedure time (min) 73.3 ± 23.1 65.1 ± 18.9 &lt; 0.01 Fluoroscopy time (min) 14.9 ± 7.7 12.6 ± 7 0.02 DAP (Gy·cm2) 5924 ± 4991 4890 ± 3790 0.04 LCPV 37 41 1.00 RMPV 20 21 0.87 Mean T at 60s(oC) -41.9 ± 8.5 -40.6 ± 10.7 0.10 Mean nadir T(oC) -49.5 ± 6.4 -48.4 ± 7.8 0.18 Mean PVI time(s) 42.4 ± 26.3 38.1 ± 24.3 0.11 Mean PVI temperature(oC) -33.4 ± 11.6 -31.1 ± 22 0.16 Mean thaws time(s) 51.5 ± 20.5 51.8 ± 20.3 0.85
Potential value of the low frequency/high frequency ratio of heart rate variability to guide atrial fibrillation ablation procedures
Authors: Gregoire JM , Gilon C , Hellinckx J , Carlier S , Bersini H 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background.
The differentiation between vagally and non-vagally mediated atrial fibrillation (AF) could be useful to decide adding ganglionated plexi ablation (GPA) to pulmonary vein isolation (PVI) in patients with vagally mediated AF onset.
The role of the autonomic nervous system in triggering paroxysmal AF can be analyzed through heart rate variability (HRV) parameters. The low frequency/high frequency ratio (LF/HF) is used as an index of sympatho-vagal interaction. Based on clinical criteria, values of LF/HF &lt;1.5 are considered to reflect an increase of vagal modulation.

Purpose
Identify patients with paroxysmal AF who may benefit from GPA in addition to PVI, based on analysis of HRV parameters
Material and methods
From our database of unselected Holter recordings containing paroxysmal AF episodes, 199 analyzable AF onsets were labelled. We analyzed HRV frequential parameters by segments every 300 RR intervals to identify adrenergic and vagal onsets of AF episodes. We categorized AF onsets, depending of their respective values of LF/HF. We also checked the relationship of these parameters to heart rate (HR). We followed the evolution of the mean normalized values of LF/HF from the beginning of the recordings to the AF onsets (see figure).

Results
We found a progressive increase of LF/HF in normalized units (mean [95% confidence interval]) from 2.44 [2.12-2.76] to 3.12 [2.85-3.39] in the adrenergic group (n = 113) and a progressive decrease of LF/HF from 1.51 [1.28-1.75] to 1.02 [0.95-1.09] in the vagal group (n = 86). Differences between adrenergic and vagal AF were highly significant using Mann-Whitney test (p &lt; 0.001). A given patient shows the same type of AF in 80% of cases. We found no correlation between frequential parameters and HR.

Conclusions
Our data show potential added value of frequential HRV analysis to guide additional ganglionated plexi ablation to PVI. This remains to be demonstrated in a prospective study. The ratio LF/HF should be considered to optimize the decision-making process for the ablation procedure. Abstract Figure. Frequential HRV parameters before AF
Catheter ablation outscores all other treatment modalities in reducing all-cause mortality and heart failure related morbidity in patients of persistent atrial fibrillation with systolic heart failure
Authors: Khanra D , Mukherjee A , Deshpande S , Padmanabhan D , Mohan S , Khan H , Kella D , Kathuria N 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Catheter ablation in the setting of persistent AF (PeAF) with heart failure (HF) is challenging and often has poor outcome. However, guideline and studies indicate ablation strategy in this group to reduce mortality and HF-related hospitalization.

Purpose
We have conducted a network meta-analysis (NMA) of all-cause mortality and improvement of HF-related QOL in patients of PeAF with systolic heart failure comparing rate controlling drugs (RCDs), anti-arrhythmic drugs (AAD), catheter ablation (CA) of PeAF and AV nodal ablation with univentricular or biventricular pacing (AVNA).

Method
Bayesian network meta-analysis of randomized controlled studies comparing mortality and QOL among individual treatment arms (e.g. RCDs, AADs, CA and AVNA) and pair-wise network meta-analysis comparing CA and other treatment arms (RCD, AAD and AVNA) were performed using MetInsight V3. Markov chain Monte Carlo (MCMC) modeling was used to estimate the relative ranking probability of each treatment group.

Results
Published data of 14 studies including 3698 patients were included in the NMA with a median follow-up of two years (1A, 2A). The Bayesian modelling with MCMC analysis for pair-wise comparison clearly demonstrated that, AAD [OR (95% CrI): 2.10 (0.43-9.0)], AVNA [OR (95% CrI): 1.32 (0.14-11.7)] and RCDs [OR (95% CrI): 2.76 (0.5-14.1)] have higher all-cause mortality than CA but not within the radar of statistical significance (1B). The Bayesian modelling with MCMC analysis for pair-wise comparison clearly demonstrated that, AADs [MD (95% CrI): 8.02 (-8.32-27.8)], AVNA [MD (95% CrI): 17.0 (-1.9-33.1)] and RCDs [MD (95% CrI): 13.0 (0.1-24.5)] have lesser improvement in QOL than CA but not within the radar of statistical significance (2B). Based on the Bayesian model, CA results in lower all-cause mortality and highest improvement of QOL in the patients of AF with HF (3A, 3B).

Conclusion
This shapes way for future treatment guidelines in patients with PeAF with HF group and points towards CA to be undertaken before medical therapy fails. This also paves way for further research to confirm the longevity of the beneficial effects and to find the specific subsets of AF with HF patients that would be benefited most from CA. Abstract Figure
Ablation Index-guided 50W radiofrequency ablation for atrial fibrillation: lesion level analysis to ascertain determinants of safety
Authors: Ding WY , Bierme C , Tovmassian L , Obrien J , Kozhuharov N , Chu G , Snowdon RL , Gupta D 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The safety of Ablation Index (AI)-guided 50W ablation of atrial fibrillation (AF) remains uncertain, and the effects of this high power on other ablation parameters have not been described. We aimed to compare the safety profile of AF ablation using 50W and 35-40W.

Methods
59 patients undergoing AI-guided Pulmonary Vein Isolation were enrolled including 31 with 50W and 28 with 35-40W. A contact force (CF)-sensing ablation catheter (Thermocool SmartTouch) was used to deliver point-by-point ablation according to the CLOSE protocol targeting AI values of 550-600 on the left atrial (LA) anterior wall and 400-450 on the LA posterior wall. The generator impedance graph was monitored in real-time for each lesion application. All VisiTags (n = 3766) across both groups were analysed retrospectively. Excessive ablation was defined as AI &gt;600 on the anterior wall and &gt;500 on the posterior wall.

Results
The mean AI was significantly higher in patients receiving 50W ablation (512 [±61] vs. 500 [±63] with 35-40W ablation, p &lt; 0.001). Excessive ablations were more frequently observed in the 50W group (10.1% vs. 5.4%, p &lt; 0.001), for both anterior and posterior wall segments (both p &lt; 0.001). There was no steam pop, and no complications in either group.
Scatterplots showing the relationships between contact force (CF) and ablation time for the anterior and posterior segments of the LA for both groups are shown in the Figure. For the anterior wall, the slope of the regression line for the 50W group was -1.0 and for the 35/40W group was -0.5. Overall, there was moderate correlation between the variables CF and time in both groups (50W group: r -0.490, p &lt;0.001; 35-40W group: r -0.527, p &lt; 0.001).
In the 50W group, high CF was an important predictor of excessive AI. The AUCs for anterior and posterior wall 50W ablations were 0.844 (95% CI, 0.774-0.914; p &lt; 0.001) and 0.680 (95% CI, 0.633-0.727; p &lt; 0.001), respectively. On the anterior wall, limiting the CF to 15g would reduce the number of excessive ablations to 3% and limiting CF to 10g on the posterior wall would reduce the number of excessive ablations to 9%.

Conclusion
Use of 50W ablation appears to be safe. but may lead to AI overshoot. Our study suggests that operators should strive to limit CF to 15g on the anterior wall and 10g on the posterior wall. Abstract Figure. Relationship between CF and abl time
Long-term cardiovascular outcomes of patients with extreme obesity following atrial fibrillation ablation
Authors: Adomako REES , Payne JASON , Schleifer W , Khan FARIS , Easley ARTHUR , Windle JOHN , Anderson DANIEL , Tsai SHANE , Naksuk N 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Obesity and extreme obesity increase risk of recurrent atrial fibrillation (AF) and perioperative complications following AF ablation. However, long-term outcomes following AF ablation among obese patients is unknown.

Purpose
To examine long-term cardiovascular (CV) mortality and hospitalization among obese patients undergoing AF ablation

Methods
This retrospective study included 830 consecutive patients undergoing AF ablation from January 2013 to June 2019 at a tertiary referral medical center. Patients with obesity defined as body mass index (BMI) ≥30-39.9 kg/m2 and a subgroup of patients with extreme obesity with BMI ≥40 kg/m2 were identified. Patients were monitored for mortality and hospitalization during a median follow-up time of 819 days. Multivariate model adjusting for CHA2DS2-VASc score and history of obstructive sleep apnea (OSA) was performed.

Results
Mean age was 62 ± 10 years and 67.5% were male. Obese patients (n = 493, 59%) had a higher CHA2DS2-VASc score, and greater prevalence of OSA. These patients tended to have higher all-cause mortality and hospitalization (adjusted HR, 1.21 95% CI 0.98 to 1.51; P = 0.078), as well as greater non-CV outcomes (adjusted HR 1.45, 95% CI 1.02 to 2.08; P = 0.04). However, CV death and admission were comparable among patients with and without obesity (adjusted HR 1.14, 95% CI 0.90 to 1.45; P = 0.28). A subgroup of 111 (13.4%) extremely obese patients were identified. In comparison with obese patients with BMI ≥30-39.9 kg/m2, patients with extreme obesity with BMI ≥40 kg/m2 had similar CV (adjusted HR 1.07, 95% CI 0.75 to 1.50; P = 0.70) and non-CV adverse outcomes (adjusted HR 1.11, 95% CI 0.69 to 1.72; P = 0.65), Figure.

Conclusions
Obesity is not associated with increased CV mortality or admission following AF ablation. Non-CV events are the major cause of adverse outcomes among obese patients. Identification and reversal, where possible, of non-CV comorbidity may result in improved long-term outcomes following AF ablation. In addition, extremely obese patients with BMI≥40 kg/m2 pose a similar risk of having adverse outcomes to obese patients with BMI≥30-39.9 kg/m2. Thus, patients with extreme obesity should not be excluded from catheter ablation as a management option of AF based solely on their BMI. Abstract Figure. Cumulative-Incidence Curves
First clinical experience using a novel temperature-guided ablation catheter in a routine workflow for atrial fibrillation ablation
Authors: Braun M , Bergau L , Piran M , El Hamriti M , Imnadze G , Khalaph M , Guckel D , Sommer P , Sohns C 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Recently, a novel irrigated RF catheter was designed with a diamond-embedded tip for rapid cooling and 6 surface thermocouples to reflect real-time tissue temperature. The new technology allows for temperature-controlled irrigated ablation, very high-resolution electrograms (EGMs) from the split-tip electrode, as well as real-time rapid lesion assessment.

Aim
This study aimed to access clinical performance in terms of lesion formation and procedural safety of the novel DiamondTemp (DT) ablation catheter for atrial fibrillation (AF) ablation under routine clinical conditions.

Methods
In this prospective observational study, 20 patients underwent pulmonary vein isolation (PVI) with the DT catheter in a temperature control mode (60C°/50 W/ 10 seconds). The ipsilateral pulmonary veins (PV) were divided into 6 anatomical segments (12 segments in total) to record ablation data. All patients underwent preprocedural imaging (computer tomography or magnetic resonance imaging (MRI)) and 10 patients received additional postprocedural late gadolinium enhancement (LGE) MRI of the left atrium 3 months after ablation to access lesion formation for each anatomical PV segment and to rule out PV stenosis.

Results
Acute PVI was achieved in all patients. Two patients received additional ablation at the cavotricuspid isthmus due to typical atrial flutter. No charring at the catheter tip was found and no procedure related complications were observed. The mean procedure duration (skin-to-skin) was 106 ± 31.9 minutes, mean LA dwell time was 83 ± 27.0 minutes. RF time was 13.5 ± 5.5 minutes with a mean of 74 ± 32.8 RF applications. We measured a mean impedance drop per RF application of 10.7 ± 4.1 ohm. Fluoroscopy time was 4.2 ± 2.3 minutes and the fluoroscopy dose was 221 ± 215.3 cGy*cm2 at a. LGE MRI at 3 months after ablation demonstrated a homogeneous and continuous ablation lesion set around the ipsilateral PVs and there was no evidence for PV stenosis.

Conclusions
This first clinical series demonstrated that temperature-controlled irrigated ablation resulted in rapid, efficient, and durable PV isolation under routine clinical conditions.
Pulmonary vein isolation using Cryo Balloon ablation versus RF ablation using ablation index following the CLOSE protocol: a Prospective Randomized Trial
Authors: Theis C , Huber C , Kaiser B , Kaesemann P , Pirozzolo G , Bekeredjian R 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The single procedure success rates of durable pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) varies between 80 and 90 %.
This prospective, randomized study investigated the efficacy of Cryo-Balloon PVI versus pulmonary vein isolation with RF-energy following the CLOSE protocol (ablation index (AI), interlesion distance ≤ 6 mm, surround flow catheter) in terms of single-procedure arrhythmia-free outcome, safety and procedural time.
Methods and results
A total number of 150 patients undergoing de-novo catheter ablation for paroxysmal AF were randomized to two different treatment arms in a 1:1 fashion. In group-A patients, PVI was performed with the 23 or 28 mm Cryo-Balloon (Articfront Balloon, Medtronic Inc).
The ablation procedure in group B was performed with RF-energy, using AI and following the CLOSE protocol.
During a mean follow-up of 15 ± 6 months after a single procedure, 69 (92%) patients of group A were free of arrhythmia recurrence versus 68 (90.67%) patients in group B (p = ns). A total of 10 patients (group A: 4, group B: 6; p = ns) underwent a redo-procedure. No difference between both groups was observed in terms of patients with PV recovery (group A: 2 (2,67%) vs. group B: 3 (4%); p = ns). In 2 patients of group A and 3 patients of group B the PVs were durably isolated. Two patients of each group had continued paroxysmal AF but did not undergo redo-procedure.
Significantly more patients of group A experienced AF recurrence during blanking period, whereas the outcome after 6 month showed no significant differences (group A 11 (14,66%), group B: 6 (8%); p&lt; 0.05).
With regard to the procedural data, the procedure time was significantly shorter in group A (115.35 ± 15.38 versus 70.53 ± 16.13; p &lt; 0.01), the flouroscopy time and dose area product showed no significant differences (Table 1). Both procedures were performed with a low number of complications, in group A two patients had a significant groin hematoma, no PE.

Conclusions
Cryo-Balloon PVI and PVI using ablation index following the CLOSE protocol are equally efficient in achieving durable PV-isolation. Approximately 7 % of the patients with clinically paroxysmal AF are having extra-pulmonary vein AF sources. Cryo-Balloon ablation leads to significantly more AF recurrence during the blanking period. Procedural data Cryo-Balloon(group A) Ablation Index(group B) p-value Proc. Time (min) 70.53 ± 16.13 115.35 ± 15.38 &lt;0,01 Fluoro time (min) 8.56 ± 3.18 9.66 ± 3.86 0,06 Dose Area Product(cGy/m2) 390.34 ± 268.57 330.84 ± 150.36 0,10