bluuebunny/crossref_metadata_2025_split huggingface dataset:
A multicentered evaluation of the waiting period after PVI guided by the Ablation Index
Authors: De Campos D , Sousa P , Adao L , Primo J , Khoueiry Z , Lebreiro A , Fonseca P , Lagrange P , Elvas L , Goncalves L 
Published: October 2021

Abstract

Background
Since the widespread availability of contact-force sensing catheters the need of a waiting period has not been reassessed in paroxysmal atrial fibrillation (AF) ablation.

Objective
The purpose of this study was to evaluate if pulmonary vein isolation (PVI) guided by the Ablation Index (AI) could spare the need for a waiting phase.

Methods
This multicentre, prospective, randomized study consecutively recruited patients referred for first-time catheter ablation of symptomatic drug-refractory paroxysmal AF from May 2019 to February 2020. Patients performed PVI tailored to different AI values according to the different left atrium walls (550 for anterior, 500 for roof, 450 for inferior and 400 for posterior). Patients were enrolled in 1:1 ratio to PVI and 20 min of waiting time versus PVI without a waiting period. Acute reconnection (either spontaneous or after adenosine) and 1-year arrhythmia freedom were analyzed.

Results
The study included 124 patients (61 in the waiting period group and 63 in the group without the waiting period). There was no significant differences between groups regarding baseline characteristics, echocardiographic and procedure data. There were no significant differences between both groups regarding the first-pass PV isolation (P=0.49) and the presence of low voltage areas (P=0.71). Median PVI time (P=0.40), median fluoroscopy time (P=0.35) and median overall procedure time (P=0.70) were also similar between groups. The acute PVR rate was similar between both groups (8.2% for the waiting period group vs 11.1% in the group without a waiting phase, P=0.40). After a median follow-up of 14 (IQR 12–18) months, there was no significant difference on the arrhythmia recurrence between groups (4.9% for the waiting group vs 12.7% for the group without a waiting phase, P=0.13). Both groups presented a similar arrhythmia freedom over time (log rank P of 0.109). The waiting period time was not a predictor of recurrence during follow-up (p=0.13).

Conclusion
PVI guided by Ablation Index preclude the need of a waiting phase. Adding a 20-minute waiting period did not significantly increase the acute PV reconnection, neither improve the 1-year arrhythmia freedom.

Funding Acknowledgement
Type of funding sources: None.
Rotational activity presence and its impact in persistent atrial fibrillation follow-up
Authors: Rios-Munoz G R , Soto N , Avila P , Datino T , Atienza F , Gonzalez-Torrecilla E , Fernandez-Aviles F , Arenal A 
Published: October 2021

Abstract

Introduction
Treatment of atrial fibrillation (AF) remains sub-optimal, with low success in pulmonary vein isolation (PVI) ablation procedures in long-standing-persistent AF patients. The maintenance mechanisms of AF are still under debate. Rotational activity (RA) events, also known as rotors, may play a role in perpetuating AF. The characterisation of these drivers during electroanatomical (EA) guided ablation procedures in relationship with follow-up and recurrence ratios in AF patients is necessary to design new ablation strategies to improve the AF treatment success.

Purpose
We report an AF patient cohort of endocardial mapping and PVI ablation procedures with additional RA events detected during the EA study. We aim to study the presence and distribution of RA in AF patients and its impact on AF recurrence when only PVI ablation is performed.

Methods
75 persistent consecutive AF patients (age 60.7±9.8, 74.7% men) underwent EA mapping and RA detection with an automatic algorithm. The presence of RA was annotated on the EA map based on the unipolar electrograms (EGMs) registered with a 20-pole catheter. RA presence was analysed at different left atrial locations (37.2±14.8 sites per patient). AF recurrence was evaluated in follow-up after treatment.

Results
At follow-up (9±5 months), 50% of the patients presented AF recurrence. Patients with RA had more dilated atria in terms of volumes (p=0.002) and areas (p=0.001). Patients with RA exhibited higher mean voltage EGMs 0.6±0.3 mV vs 0.5±0.2 mV (p=0.036), with shorter cycle lengths 169.1±26.0 ms vs. 188.4±44.2 ms (p=0.044). Finally, patients with RA presented more AF recurrence rates than patients with no RA events (p=0.007). No significant differences were found in terms of comorbidities, e.g., heart failure, hypertension, COPD, stroke, SHD, or diabetes mellitus.

Conclusions
The results show that patients with more RA events and those with RA outside the PVI ablated regions presented higher AF recurrence episodes than those with no RA or events inside the areas affected by radio-frequency ablation. The study suggests that further ablation treatment of the areas harboring RA might be necessary to reduce the recurrence ratio in AF patients.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III; Sociedad Española de Cardiología
Long-term outcomes of catheter ablation for ventricular arrhythmias in post- myocarditis patients; Insights from a meta-analysis of current datv
Authors: Androulakis E , Briasoulis A , Falconer D , Lim W , Siasos G , Ahluwalia N , Graham A , Papageorgiou N 
Published: October 2021

Abstract

Background
In the past decade, catheter ablation (CA) has become a rapidly expanding treatment option for ventricular tachycardia (VT), however it is not commonly utilized for patients with post-myocarditis VT. We aimed to systematically review up-to-date evidence regarding feasibility, effectiveness, and safety of CA, with a specific focus on long-term relapse rate and procedural complications.

Methods
A structured electronic database search (PubMed, Embase, Cochrane) of the scientific literature was performed for studies describing outcomes at up to 7.3 years after CA. The primary outcome measured was VT recurrence post-ablation. Procedural success was defined as freedom of ventricular arrhythmias (at the end of follow-up after an ablation procedure). The secondary outcome was significant procedural complications which included procedural death, stroke, cardiac tamponade, acute myocardial infarction, major vascular complications, and major bleeding, assessed on a study-by-study basis.

Results
A total of 186 patients were included in analysis with most patients (88%) being male.
Over the follow up period there was a 18% relapse rate (n=34) (Confidence Interval (CI); 0.12–0.24, I2≈0, p=0.77) with the majority of patients remaining VT free for the duration of follow up. Only one study recorded the percentage of re-do procedures. The overall procedural complication rate was 3.0% (n=7, (CI; 0.01–0.07, I2≈0, p=0.44) and of note, there were no peri-procedural deaths or heart transplant surgeries reported. However, a single study reported a mortality of 10% (n=2) during the follow up period.

Conclusions
CA is an effective and durable long-term therapeutic strategy for post myocarditis VT patients with limited relapse rate and very low complication rates based on these non-randomised data. Larger randomised-controlled trials with standardised treatment and long follow-up are required to compare CA versus conventional treatment in the post-acute myocardial phase.

Funding Acknowledgement
Type of funding sources: None. Relapse rate during follow-upProcedural complication rate
A tertiary centre experience comparing new temperature-controlled high-power short-duration ablation technology with standard radiofrequency and cryo-energy ablation
Authors: Mavilakandy A , Sidhu B , Man S , Antoun I , Vali Z , Almeida T P , Li X , Lazdam M , Ibrahim M , Chin S H , Sandilands A , Somani R , Stafford P , Ng A 
Published: October 2021

Abstract

Introduction
Pulmonary vein isolation (PVI) is an established treatment strategy for atrial fibrillation (AF). Radiofrequency (RF) ablation technology has evolved over the last decade with the very high-power short-duration (vHPSD) temperature-controlled ablation approach emerging as the latest development. The aim of this study was to determine the procedural efficacy, metrics and safety of vHPSD ablation with conventional power-controlled RF (PCRF) ablation and cryo-energy ablation (CRYO).

Methods
A prospective single tertiary centre analysis was performed on patients undergoing first time PVI ablation from 2019 to 2020. The population was divided in to 4 treatment arms; vHPSD, high-power short-duration (HPSD), PCRF and CRYO. Demographics, clinical and procedural metrics such as PVI duration, ablation time and sedation requirement were collated. Patients were monitored for perioperative complications.

Results
One hundred patients underwent ablation with 25 cases conducted in each arm. Complete PVI was attained in all study subjects. For the vHPSD group, PVI procedural duration, ablation and fluoroscopy times were 71.7±6.35 min, 9.21±0.76 min and 15.1±1.50 min respectively. The HSPD group exhibited total PVI, burn and fluoroscopy times of 90.2±5.59 min (p=0.03), 10.3±2.40 min (p&lt;0.0001) and 34.1±1.67 min (p=0.1) respectively. In comparison, the PCRF group exhibited longer procedure duration, ablation and fluoroscopy times of 93.3±6.50 min (p=0.01), 15.2±1.73 min (p&lt;0.0001), 37.8±2.47 min (p=0.870). Whereas procedural and fluoroscopy times of 96.3±7.1 min (p=0.01) and 18.8±1.31 (p=0.05) were observed in the cryo-ablation group. Procedural doses of morphine and midazolam for the vHPSD, HPSD, PCRF and CRYO group were 11.3 mg + 4.00 mg, 15.5 mg (p=0.0003) + 9.33 mg (p=0.0003), 15.7 mg (p=0.0002) + 8.03 mg (p=0.02), and 8.19 mg (p=0.01) + 4.84 mg (p=0.303) respectively. No adverse procedural events were recorded for the vHPSD while 2 pericardial effusions occurred in the PCRF group, 1 cardiac tamponade in the HPSD group and 2 transient ischaemic attacks in the CRYO group.

Conclusion
With the emergence of vHPSD RF ablation, preliminary findings indicate significant potential in reduction of procedural and ablation time. Further analysis is ongoing in order to ascertain longer-term efficacy and patient safety.

Funding Acknowledgement
Type of funding sources: None. Intraprocedural outcomesIntraprocedural outcomes
Clinical impact of high density mapping in atypical atrial flutters ablation: outlining critical circuits in complex atrial tachycardias
Authors: Di Cori A , Mazzocchetti L , Parollo M , Della Volpe S , Barletta V , Cellamaro T , Segreti L , Viani S , De Lucia R , Paperini L , Giannotti M , Canu A , Soldati E , Zucchelli G , Bongiorni M G 
Published: October 2021

Abstract

Introduction
Mapping and ablation of atypical atrial flutter (AFL) continue to be a challenge for clinical electrophysiologists. The advent of high-density (HD) mapping has allowed the generation of electro-anatomic maps with a very high resolution level.

Purpose
In this single center retrospective analysis, we evaluated the clinical impact of the ultra HD activation sequence mapping compared with the standard low density (LD) ablation catheter mapping technique in the treatment of AFLs.

Methods
We performed a 7 years-single center retrospective analysis of patients undergoing radiofrequency ablations (RFA) for right and left atypical AFL. We evaluated procedural and clinical outcomes of patients approached with a Low Density (LD) electro-anatomical (EAM) strategy compared with patients mapped with new automatic multipolar HD Mapping (HD Group).

Results
Seventy-five patients were included. Patients were almost male (60%), relatively old (65±8 years), with a moderate CHA2DS2Vasc score (2.3±1.3), a preserved ejection fraction (58±6) and moderate atrial dilatation (44±7 mm). Baseline clinical characteristics were comparable between groups (p=NS). Among 88 AFLs, 10 (11%) were located in the right and 78 (89%) in the left atrium, including 22 (28%) roof dependent and 37 (47%) mitral dependent (p=NS). Regarding procedural outcomes, Sinus rhythm restoration during ablation was more frequently observed in the HD Group (79% vs 56%, p=0.037), even if no differences in mapping time, procedural time and radiological dose were observed (p=NS). Freedom from AFL/atrial fibrillation (AF) at 1-year was lower in the HD Group (83% vs 45%, p=0.009) with an increased trend for AF recurrences during long term follow-up (17% vs 23% at 1 and 3-years respectively, p=0.059). At the multivariate analysis, HD map (OR 0,17; 95% CI 0,04–0,66) and younger age (OR 1,09; 95% CI 1,01–1,19) were identified as independent predictors of ablation success at 1 year.

Conclusions
Acute procedural success of ablation of atypical atrial flutter is higher in case of HD mapping strategy. Patient age and HD strategy resulted independent predictors of overall atrial arrhythmias recurrences. During follow-up, AFL recurrences are rare beyond 12 months, differently from AF which continues to show increasing trends.

Funding Acknowledgement
Type of funding sources: None. Procedural outcomesAtypical atrial flutter HD map
Secondary prevention implantable cardioverter-defibrillator (ICD) therapy in octogenarians: effective and safe
Authors: Hauck C , Schober A D , Schober A L , Fredersdorf-Hahn S , Hubauer U , Keyser A , Maier L S , Jungbauer C G , Uecer E 
Published: October 2021

Abstract

Aims
Implantable cardioverter-defibrillator is well established for secondary prevention, but there is a lack of studies showing efficacy and safety in the elderly. The current study compared the outcome of octogenarians after ICD implantation to other age groups.

Methods
Data was achieved from a local ICD registry. Patients who received ICD implantation for secondary prevention were included. All-cause mortality, appropriate ICD therapy and acute adverse events requiring surgical intervention were compared between different age groups.

Results
519 patients were enrolled. 34 patients were ≥80 years. Over a median follow-up of 35 months after ICD implantation 129 patients (annual mortality rate 5.0%) died, including 16 patients in the age group ≥80 years (annual mortality rate 9.4%). Mortality rate in the age group ≥80 years was significantly higher than in the age groups ≤69 years (p&lt;0.001) but no difference could be seen compared to age groups 70–79 y. Age at the time of ICD implantation was an independent predictor of all-cause mortality (p&lt;0.001). 29.7% of patients had appropriate ICD therapy with no difference between age groups. Acute adverse events leading to surgical intervention were low (n=13) and not age-related.

Conclusion
Age is an independent predictor of mortality after ICD implantation for secondary prevention. No difference in mortality rate could be seen between octogenarians and other elderly from 70 – 79 years. Appropriate ICD therapy and acute adverse events leading to surgical intervention were not age-related. Implantable cardioverter-defibrillator for secondary prevention seems to be an effective and safe therapy in octogenarians.

Funding Acknowledgement
Type of funding sources: None.
Multipoint left ventricular pacing effects on hemodynamic parameters and functional status: HUMVEE single-arm clinical trial
Authors: Konstantinou K , Xydis P , Antoniou C K , Magkas N , Manolakou P , Chrysohoou C , Dilaveris P , Gatzoulis K , Tsioufis K 
Published: October 2021

Abstract

Objectives
The aim of this study was to assess the capacity of optimized multipoint pacing (MPP) over optimized cardiac resynchronization therapy (CRT), in terms of clinical, functional, and echocardiographic parameters among dyssynchronous heart failure patients.

Methods
Eighty patients (Caucasian, 77.5% male, 68.4±10.1 years, 53.8% ischemic cardiomyopathy) sequentially received optimized CRT and optimized MPP over 6 and 12-month periods, in a single-arm clinical trial. Clinical, laboratory and echocardiographic assessment was conducted at baseline and following completion of each step.

Results
Significant additive effects of optimized MPP over optimized CRT were noted regarding 6-minute walking distance (baseline/optCRT/optMPP: 293±120m vs 367±94m vs 405±129m, p&lt;0.001), NYHA class (2.36 vs 2.19 vs 1.45, p&lt;0.001), VTIlvot (14.25±3.2cm vs 16.2±4cm vs 17.5±3.4cm, p&lt;0.001), stroke volume (48±13.5ml vs 55±15ml vs 59±15ml, p&lt;0.001), LVEF (29%±7.1% vs 33%±7.3% vs 37%±7.7%, p&lt;0.001), maximal left atrial volume (77.2±34.2ml vs 74.2±39.5ml vs 67.7±32ml, p=0.02), pulmonary artery systolic pressure (35.9mmHg vs 33.5mmHg vs 31mmHg, p&lt;0.001), and right ventricular strain (−8.3%±6.9% vs −8.8%±6.6% vs −11.8%±6.1%, p=0.022). Regarding VAC SW and CP as percentages of maximal, there was significant difference detected compared to baseline for both CRT and MPP. Additive effects persisted only if suitable MPP dipoles were present. Exploratory analysis revealed that ischemic cardiomyopathy continued to exhibit significant differences favoring MPP, whereas nonischemic cardiomyopathy had similar findings regarding total left atrial strain and quality of life.

Conclusions
Optimized MPP showed significant improvements on hemodynamic parameters and ventricular function, in heart failure patients over optimized CRT. The beneficial effect was more prominent in men and in those with rather reduced LVEF, consistent with findings suggesting a beneficial trend in VAC and CP with the more homogenous depolarization offered by optimized MPP

Funding Acknowledgement
Type of funding sources: None.
Predictors and outcomes of TLE via femoral vein bailout
Authors: Shafir Y , Massalha E , Milman A , Luria D , Glikson M , Sabbag A , Beinart R , Nof E , Leshem E 
Published: October 2021

Abstract

Background
Transvenous Lead Extraction (TLE) is usually performed via a superior approach. Predictors and outcomes of TLE via femoral vein bailout are ill defined.

Methods
A single tertiary center cohort of 426 consecutive patients who underwent TLE between May 2010 and February 2020 were analyzed. Venography was routinely performed before system upgrade to identify occluded veins. Patients were divided into 2 groups on the basis of the need for femoral bailout extraction. Predictors for TLE requiring femoral bailout and outcomes were analysed.

Results
A total of 928 leads were extracted and femoral bailout approach was needed in 49 patients (11.5%). A higher proportion of RV leads required femoral bailout approach [51/499 (10.2%)]. Femoral bailout was more common among younger patients, longer lead dwell time, more pocket entries, higher number of extracted leads, presence of abandoned leads [14/49 (28.6%)], and among patients with occluded veins [10/22 (45.5%)]. The presence of abandoned leads, vascular occlusion and age remained a significant predictor for femoral bailout in multivariate analysis. Femoral bailout TLE resulted in a relatively higher rate of major complications [5/49 (10.2%) vs 9/377 (2.4%); p=0.02) but had no related intra-procedural mortality (0/3) and no additional 30 day mortality [2/49 (4.1%) vs 33/377 (8.8%); p=0.4].

Conclusion
TLE of abandoned leads, occluded veins and younger age were found to be predictors of femoral bailout requirement. Despite higher rates of major complications in femoral TLE bailout this did not result in increased mortality. Venography before TLE should be considered for procedure planning.

Funding Acknowledgement
Type of funding sources: None.
Same-day discharge vs hospital admission after cardiac device implantations: a systematic review and meta-analysis
Authors: Trongtorsak A , Kewcharoen J , Thangjui S , Worapongsatitaya P , Yodsuwan R , Navaravong L 
Published: October 2021

Abstract

Background
Due to the increasing need for cardiac device implantations, the cost of healthcare has been rising. This includes the cost of hospital stay after the procedure. Thus, we conducted this systematic review and meta-analysis to assess the safety and feasibility of same-day discharge (SDD) after cardiac device implantations.

Methods
We searched MEDLINE, and Embase databases from inception to March 2021 to identify studies that compared clinical outcomes between SDD group and hospital overnight stay (HO) group after cardiac device implantations. Outcomes included complications after the procedure, mortality, and rehospitalization. Data from each study were combined using the random-effects model to calculate pooled odds ratio (OR) with 95% confidence interval (CI).

Results
Six studies (1 randomized control trial, 1 prospective cohort study and 4 retrospective cohort studies) with a total of 59,312 patients were included. SDD was not associated with more procedure-related complications. The pooled ORs for wound problems, pneumothorax, hematoma, and lead dislodgement/repositioning were 0.86 (95% CI: 0.2–3.68, p=0.834), 1.36 (95% CI: 0.26–7.12, p=0.718), 0.35 (95% CI: 0.01–9.85, p=0.534), and 1.71 (95% CI: 0.64–4.54, p=0.281) respectively. Readmission rate (pooled OR= 1.38, 95% CI: 0.51–3.69, p=0.524) and mortality rate (pooled OR= 0.86, 95% CI: 0.62–1.2, p=0.383) were similar between both groups. As shown in figure 1.

Conclusions
Our meta-analysis suggested that same-day discharge after cardiac device implantations is a safe and feasible alternative to a hospital overnight stay strategy.

Funding Acknowledgement
Type of funding sources: None.
Atrial fibrillation as a risk factor of severe course of COVID-19
Authors: Mielczarek A , Kasprzak J D , Plewka M 
Published: October 2021

Abstract

Background
Coronavirus disease (COVID-19), the pandemic caused by severe acute respiratory syndrome coronavirus, influences on morbidity and mortality and results in changes of human life. It seems that comorbidities play a vital role in severe course of COVID- 19. Nevertheless, how chronic diseases affect respiratory failure is poorly validated.

Purpose
Our aim was to compare the severity of the course of COVID-19 and the prognosis in patient with and without atrial fibrillation (AF).

Methods
We analyzed 199 patients (72 female, mean age 67±13 years) with COVID-19 hospitalized in our Department since November 2020, including, 68 patients with AF (28 female, mean age 74.5±8 years). Although, only 45 patients took anticoagulants before, the treatment was initiated to all patients with AF on admission to the hospital. Patients with AF were characterized by lower left ventricle ejection fraction than those without AF (49% vs. 54%, p=0.0007).

Results
The severe course of COVID, defined as saturation below 90%, lung involvement above 50% in computer tomography, the need for high- flow oxygen therapy, was noticed in 98 patients (36 pts with AF, 32 pts without AF, p=0.27). Moreover, there was no difference between the groups among separately the need for high- flow oxygen therapy, saturation below 90% and lung involvement above 50% in computer tomography. The absence of atrial fibrillation, with a significance of p=0.01, predisposes to a better prognosis based on the patient's discharge. In multivariate analysis, the factors suggesting a poor prognosis, defined as death or transfer to Intensive Care Unit, were severe course of COVID (p=0.01) and the need for high- flow oxygen therapy (p=0.042).

Conclusions
It is noticed that the presence of AF is associated with a poor prognosis in COVID. Further analysis is still needed to prove this statement.

Funding Acknowledgement
Type of funding sources: None.