bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ablation outcome in elderly women with atrial fibrillation undergoing pulsed-field ablation for electrical isolation of pulmonary veins and left atrial posterior wall
Authors: Mohanty S , Doty B , Casella M , Schiavone M , Gabrah K , Valeri Y , Torlapati P G , La Fazia V M , Gianni C , Horton R , Al-Ahmad A , Dello Russo A , Tondo C , Nair D G , Natale A 
Published: October 2024

Abstract

Background
Documented evidences indicate higher prevalence of non-paroxysmal atrial fibrillation (AF) as well as in elderly women but also demonstrate the need to go beyond the pulmonary veins (PV) when treating these patients.

Objective
We compared the ablation outcome in elderly women (&gt;70 years) with that in men in the same age group as well as in younger women (≤70 years) undergoing pulsed-field ablation (PFA) for persistent AF (PerAF).

Methods
This multicenter study included consecutive PerAF patients undergoing PFA as their first procedure. Patients were divided into 3 groups: Group 1: women &gt;70 years, Group 2: men ≥70 years and Group 3: women ≤70 years. All received PV isolation (PVI) and isolation of left atrial posterior wall (LAPWI). Concentric overlapping lesions were placed in the LAPW. Number of applications were determined on a case-by-case basis. Isolation was confirmed by electrograms recorded on the multispline catheter. In all patients, ICE and fluoroscopy were used to optimize contact between the PFA catheter and the targeted tissue. Arrhythmia-monitoring was performed for 1-year with periodic clinic visits, event recorders and 7-day Holter monitoring.

Results
A total of 229 patients (group 1: 73; group 2: 47 and group 3: 109) were included in this analysis. Baseline characteristics of the study population is presented in table 1.
At 1-year follow-up, 15 (20.5%), 3 (6.38%) and 10 (9.17%) from group 1, 2 and 3 respectively, experienced arrhythmia recurrence off-antiarrhythmic drugs. Recurrence rate in group 1 was significantly higher than that in group 2 (p=0.034) and group 3 (p=0.029).

Conclusion
In women aged ≤70 years and in elderly men (&gt;70 years), PVI plus isolation of LAPW using ICE-guided PFA was associated with significantly lower recurrence rate compared to that in the elderly women. Given the higher recurrence rate following PVI+LAPWI in the elderly females, the operators should consider addressing all other AF-initiating extra-PV triggers for better ablation-outcome in this subset of the AF population.
Same-day discharge after atrial fibrillation ablation: is it equally safe?
Authors: Abrantes A , Raposo M , Garcia B , Martins M , Oliveira C , Gregorio C , Cravo J , Vilela M , Cazeiro D , Araujo I , Ferreira A , Silva G , Cortez-Dias N , Pinto F , Sousa J 
Published: October 2024

Abstract

Introduction
Same-day discharge after atrial fibrillation (AF) ablation represents a paradigm shift in post-procedure care. This approach allows patients (pts) to return home on the same day after their ablation, promoting comfort and reducing hospitalization duration.

Purpose
To evaluate safety of same-day discharge in pts submitted to either pulsed field ablation (PFA) or cryoablation (CA).

Methods
Single-center retrospective study of AF pts submitted to ablation with either PFA or CA from May 2019 to November 2023. Ablation strategy consisted in pulmonary vein isolation complemented with ablation of the cavo-tricuspid isthmus in pts with history of atrial flutter. Pts were considered eligible to same-day discharge if an observation period of at least 6h was assured after the procedure. Safety was defined as 30-day major or minor complications. Chi-square tests were used for the comparison of continuous variables.

Results
We included 152 pts, 60 were submitted to PFA and 92 to CA, 56.6% males, median age 66±14 years, mean CHA2DS2-VASc score 2.45±1.4. Paroxysmal AF, short and long-standing persistent AF were present in 67%, 16% and 15% of pts respectively. Previous stroke was present in 8.7% of pts and 27 pts had history of heart failure. Acute success rate was 99.3%, concomitant cavo-tricuspid isthmus ablation was performed in 20% of pts, and mean procedure time was 107.5±74 min. Same-day discharge was initially considered in 70% of pts, however of these, 12 pts remained under further observation due to acute complications. No major or minor acute complications were reported in pts with same-day discharge. There were no significant differences in 30 days complications between groups. At 30 days no major complications were reported in pts with same-day discharge. One pts in which same-day discharge was halted died 4 days after ablation from hemorrhagic shock. Regarding minor complications at 30 days, 4 minor femoral hematoma were reported, 2 in each group.

Conclusion
In our population, same-day discharge proved to be a safe strategy if careful pts selection is assured. This practice enhances overall pt experience, marking a significant paradigm shift in AF management.
An in-silico comparison of anatomical and substrate based AF ablation using electro and optical flow mapping
Authors: Jaffery O A , Zolotarev A , Barera C E , Rodero C , Niederer S , Slabaugh G , Good W W , Roney C H 
Published: October 2024

Abstract

Background
The pursuit of improved outcomes for persistent AF may necessitate the utilization of innovative technologies and ablation methods. We hypothesize that combining electrophysiologic phase and optical flow mapping could offer a novel approach to identify ablation sites in persistent AF while minimizing ablation area, thereby enhancing the effectiveness of substrate-based ablation compared to a purely empiric strategy.

Objective
To compare the efficacy of a novel electro-optic flow-based ablation strategy (EOF) with empiric ablation for persistent AF patients using a virtual cohort of bi-atrial models.

Methods
An exploratory cohort (n=20) from a CT-derived bi-atrial in silico population was utilized to simulate AF. A pipeline was developed to assess ablation targets based on simulated AF and to automatically connect targets to closest inert boundaries. As part of target assessment, phase singularities (PS) and Horn-Schunck average optical flow maps were computed. An intersection of information assessed through PS and curl of average optical flow was utilized to generate EOF maps. 5 x strategies comprising purely anatomical, PS based and EOF guided ablations were simulated (1. PVI; 2. PVI+mitral/roof lines; 3. PVI+mitral/box line; 4. PS+anatomical; 5. EOF+anatomical). Ablation efficacy was determined by first examining change of rhythm via ablation and second by calculating the amount of tissue area ablated.

Results
Ablating PVI alone (Method 1) did not result in AF termination in any case. Ablating PVI with mitral or roof lines (Method 2) resulted in moderate outcomes (6 AF term. / 3 conv. to AT) whereas ablating PVI with mitral and box lines (Method 3) resulted in improved outcomes (9 AF term. / 4 conv. to AT). Compared to purely anatomical approaches, ablating PS or EOF targets and combining them with roof, mitral lines (Method 4 and Method 5 respectively) saw marked improvement (16 AF term. / 2 conv. to AT). Mapping based on EOF (Method 5) resulted in smaller ablation targets compared to a PS guided strategy (Method 4) with the same outcome.

Conclusion
AF termination to ablated tissue area ratio was higher for EOF based ablation targets compared to PS based or empiric ablations. Algorithmic generation of ablation lesion masks based on predicted targets can provide novel insights into ablation outcomes. Combining EOF targets with empiric lesions represents a potential ablation strategy of individualized substrate modification for persistent AF.Study Pipeline
An external validation of DOAC score in patients with atrial fibrillation following transcatheter aortic valve replacement
Authors: Harano Y , Yamamoto M 
Published: October 2024

Abstract

Background
Bleeding events, particularly in patients with atrial fibrillation (AF) and those with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), are a major clinical concern and are associated with a worse prognosis. The DOAC Score (1) has recently been introduced to predict bleeding risk in patients with AF taking direct oral anticoagulants (DOACs). However, further validation is required to confirm its ability.

Objective
This study aims to evaluate the predictive ability of the DOAC Score for bleeding events in Asian patients with AF undergoing TAVR.

Methods
In this multicentre, retrospective, observational cohort study, patients with AF who underwent TAVR were included. The data was obtained from the Japanese multicentre registry, which comprises 19 centres from 2013 to 2019. Bleeding was defined as any post-discharge bleeding after TAVR. The primary endpoint was the incidence of all bleeding events in 3 populations: the overall population, the DOAC cohort, and the vitamin K antagonist (VKA) cohort.

Results
This study included 1230 patients with a mean age of 84.6 ± 5.1 years, of whom 457 were males. Among them, 465 patients (37.8%) were treated with a VKA while the rest were treated with a DOAC. Patients were divided into three groups according to their DOAC Score: 380 patients (30.1%) were in the ≤ moderate risk group with a DOAC Score of 7 or less, 497 patients (40.4%) were in the high-risk group with a DOAC Score of 8 or 9, and 353 patients (28.7%) were in the very high-risk group with a DOAC Score over 10. The cumulative incidence of all bleeding at 5 years in the overall population was significantly different in the 3 risk groups: ≤ moderate: 8.4%, high-risk: 10.8%, very high-risk: 21.6%, respectively (p&lt; 0.01). The incidence was also significantly different in the DOAC and VKA cohorts (p&lt;0.01 and p=0.03, respectively).

Conclusion
The recently published DOAC Score is well predictive of bleeding risk in Asian patients with AF after TAVR. The score may be useful in predicting bleeding in patients taking both DOAC and VKA.Graphical abstract
Impact of left atrial appendage occlusion in atrial flow evaluated through 4D flow cardiac magnetic resonance
Authors: Anduaga Elorza I , Morales Ferez X , Cepas Guillen P , Casademunt P , Doltra A , Mill J , Flores Umanzor E , Iriarte Gea M , Sanchis L , Camara O , Freixa X 
Published: October 2024

Abstract

Introduction
Device-related thrombus (DRT) and peri-device leak constitute significant complications following left atrial appendage occlusion (LAAO), primarily due to its association with strokes and thromboembolic events. Patient-specific fluid simulations have been employed to explore this hypothesis(1). However, these simulations require detailed anatomical and physiological data, rely on certain assumptions when defining boundary conditions, and involve long computational times. Recently, there has been growing interest in the use of 4D flow cardiac magnetic resonance (CMR) imaging for various cardiovascular diseases, owing to its capability to reproduce blood flow. While its role in the LAAO scenario has been evaluated in silico(2), there are no reported cases of its application in patients undergoing LAAO.

Purpose
Our objective was to evaluate the impact of LAAO in atrial flow through 4D flow CMR.

Methods
Five patients undergone LAAO were included in the pilot study. A pre- and 90-days post-procedure 4D flow CMR scans were performed. One of the patients was excluded due to suboptimal image quality.
To assess the impact of LAAO on atrial flow dynamics, three parameters were evaluated: a) mean velocity, b) stasis velocity ratio, and c) endothelial cell activation potential (ECAP) index — all associated with an elevated risk of thrombus formation(3,4).

Results
Baseline and procedural characteristics, along with imaging results, are presented in Table 1. Preprocedural 4D flow CMR for all patients revealed low velocities (Figure 1A) and a high ECAP index (Figure 2A) in the left atrial appendage, indicating flow stasis and an elevated risk of thrombus formation. Successful device implantation was performed in all cases, and no periprocedural complications were detected. Postprocedural 4D flow CMR was feasible in all cases, and no artifacts were detected despite the presence of the LAAO device. An objective increase in velocities and a decrease in the ECAP index were observed in all cases following LAAO. No DRT or ischemic events were reported during follow-up.

Conclusions
Our preliminary study demonstrates that 4D flow CMR provides valuable information on left atrial flow dynamics following the LAAO procedure. Further studies are warranted to evaluate this promising technique.Table 1.Patient characteristicsFigure 1 and 2.Representative example
Cognitive behavioral therapy for symptomatic paroxysmal atrial fibrillation: effects on physical activity, sleep and heart rate variability
Authors: Skuladottir H , Sarnholm J , Hoppe K , Olafsdottir E , Ljotsson B , Braunschweig F 
Published: October 2024

Abstract

Background
We have devised a novel psychological intervention, cognitive behavioral therapy for paroxysmal atrial fibrillation (AF-CBT), that targets symptom preoccupation and avoidance behaviour. AF-CBT significantly improved cardiac anxiety and quality of life (QoL) in a randomized trial. To what extent this may be attributed to changes in physiological parameters is yet to be determined.

Purpose
A) to assess changes in objective and subjective measures of physical activity and sleep. B) to evaluate potential treatment effects on heart rate variability (HRV).

Methods
Patients with paroxysmal AF on optimal medical therapy (65.4±8.3 years, 58% women) and European Heart Rhythm Association Symptom Score ≥2b were randomized to a 10-week therapist-led online AF-CBT (n=65) or a control group (n=62), with the primary outcome of Atrial Fibrillation Effect on Quality-of-life (AFEQT). A Patch-Holter with an integrated accelerometer was applied for five days at baseline, post-treatment, and at three months follow-up. Each recording was divided into day and night (sleep time) based on posture, heart rate, and activity. HRV was analysed in both time and frequency domains, excluding AF episodes and aberrant beats.

Results
AFEQT increased from 62.4±14.3 to 83.7± 13.8 points in the AF-CBT group at the 3-month follow-up with a relative difference of 15.0 points. At baseline, the participants walked 8040±2600 steps/day and slept 8.0 ± 1.1 hours. AF-CBT did not increase physical activity, and there were no significant changes in objective sleep duration. The Insomnia Severity Score went from subclinical (12.2±6.7) to near normal values (8.1±5.6), which was significant as compared to controls (p=0.032). AF burden increased from 5.3% to 7.3% in the AF-CBT group and 5.0% to 9.2% in the control group, with no difference between the groups (p=0.59). We did not observe any change in heart rate or HRV indices at rest during the day or at night.

Conclusion
AF-CBT did not mediate its effects on QoL by improving objective physiological variables. Thus, our findings underline the importance of subjective, psychological, and behavioural aspects and indicate that AF-CBT might fill a void beyond medical and lifestyle interventions in comprehensive AF care.
Effect of catheter ablation vs medical therapy on cardiovascular outcomes in hypertrophic cardiomyopathy with atrial fibrillation
Authors: Kim D , Yang P S , Jang E , Yu H T , Kim T H , Uhm J S , Pak H N , Lee M H , Sung J H , Joung B 
Published: October 2024

Abstract

Background
Atrial fibrillation (AF) increases the risks of stroke and mortality. AF ablation in patients with heart failure (HF) was associated with a lower risk of death and hospitalisation for worsening HF. Whether AF ablation is beneficial to improve cardiovascular outcomes in patients with concomitant hypertrophic cardiomyopathy (HCM) and AF remains unclear.

Objective
To investigate whether AF ablation is more effective than conventional medical therapy for improving outcomes in HCM.

Methods
2,281 patients with HCM and AF undergoing catheter ablation or medical therapy (antiarrhythmic drugs or rate control drugs) in 2005–2015 were identified from the Korean National Health Insurance Service database. The primary composite outcome of death from cardiovascular causes, ischaemic stroke, hospitalization for worsening HF, or acute myocardial infarction was compared between catheter ablation and medical therapy using propensity score overlap weighting. The time-at-risk was counted from the first medical therapy, and catheter ablation was analysed as a time-varying exposure.

Results
Of the included (41.1% female; median age: 66 years), 145 (6.1%) underwent catheter ablation for AF during the study period. During a mean follow-up of 3.1 (IQR 1.3–5.8) years, a total of 831 composite outcomes occurred including 292 cardiovascular deaths and 401 strokes. Catheter ablation, compared with medical therapy, was associated with lower risks of the primary composite outcome (weighted incidence rate: 3.84 vs. 6.43 per 100 person-years; weighted HR 0.61, 95% CI 0.38–0.96) and ischaemic stroke (weighted HR 0.43, 95% CI 0.19–0.97). The association between ablation and a lower risk of composite outcome was more pronounced in cases of ablation success whereas no significant difference was observed in cases of ablation failure.

Conclusions
In patients with AF and HCM, catheter ablation was associated with a lower risk of adverse cardiovascular outcomes than medical therapy.
Novel approach of slow pathway ablation in common atrioventricular nodal reentrant tachycardia by peak frequency map
Authors: Takahashi M , Sasaki T , Yamaoka K , Kujiraoka H , Arai T , Hojo R , Fukamizu S 
Published: October 2024

Abstract

Background
It is difficult to visualize slow pathway in atrioventricular nodal reentrant tachycardia (AVNRT) even with recent high-density mapping. This could be because the slow pathway potential is buried by the potential of atrial working cells during sinus rhythm and tachycardia. In other words, it is extremely difficult for conventional 3D mapping systems to annotate slow pathway potential even though the histological run of slow pathway is known .[1], [2]

Purpose
The purpose of this study is to visualize the atrial myocardial junction of rightward inferior extension by the peak frequency map of Ensite X in common AVNRT and to evaluate whether relative high frequency (HF) sites in low voltage area extending from Koch's triangle to tricuspid annulus (TA) is effective targets of slow pathway ablation and the characteristics of junctional rhythm (JR) after radiofrequency application.

Methods
This study is single-center prospective cohort study. In 37 consecutive common AVNRT patients, novel approach and conventional approach of slow pathway ablation were performed in 17 and 20 patients, respectively. The conventional approach is anatomical and electrophysiological approach. Peak frequency map was performed during sinus rhythm with HD-grid catheter in novel approach patients. A frequency scanning is performed to locate relative HF sites on the tricuspid annulus. Radiofrequencey application is 30 W, 30-60 sec, and the end point was no inducibility or until one echo under load of isoproterenol.

Results
The success rate was 100 % with two approaches. The relative HF sites in low voltage area were distributed at the TA side from 4 to 5 o'clock in all novel approach patients, mean peak frequency in success site was 419 ± 87 Hz. The distance to His bundle from success site was farther (24.8 ± 4.9 vs. 12.8 ± 4.4 mm, p&lt;0.001), JR was slower (93 ± 14 vs. 118 ± 10 bpm, p=0.013), time to JR occurrence was shorter (3.0 ± 1.3 vs. 7.6 ± 4.6 sec, p=0.003), and elimination rate of jump up (78 % vs. 40 %, p=0.06) was higher in novel approach.

Conclusions
The relative HF sites in low voltage area at TA side from 4 to 5 o'clock by peak frequency map could be novel target of slow pathway ablation with high success rate and sufficient safety and efficiency.peak frequency map
Importance of the left superior ganglionated plexus ablation for the denervation of atrioventricular node: the impact of patient gender and bradycardia phenotype
Authors: Wichterle D , Stiavnicky P , Jansova H , Peichl P , Stojadinovic P , Haskova J , Borisincova E , Cihak R , Kautzner J 
Published: October 2024

Abstract

Background
Cardioneuroablation has been proposed as a new therapeutic option in selected patients with symptomatic functional bradyarrhythmia including recurrent neurally-mediated syncope. The contribution of individual ganglionated plexi to cardiac autonomic regulations is not fully established.

Purpose
It appears that ablation of the left superior ganglionated plexus (LSGP) is inoperable for the denervation of the sinoatrial node (SAN) and infrequently required for the denervation of the atrioventricular node (AVN). We explored the conditions that are associated with the need for LSGP ablation.

Methods
The study included 177 otherwise healthy patients aged 41 ± 12 years; 55% of males; 36% with predominant AVN disorder (29% in males, 44% in females, P &lt;0.05) who underwent their first cardioneuroablation for symptomatic bradyarrhythmias at our centre between 2019 – 2024. Anatomically-navigated radiofrequency ablation with a bi-atrial approach was performed. In all patients, we ablated first the superior paraseptal (former right superior) ganglionated plexus (SPSGP) and inferior paraseptal (former posteromedial left) ganglionated plexus (IPSGP). Extracardiac vagus nerve stimulation (ECVS) via right and left jugular vein in general anaesthesia was used to assess the residual parasympathetic modulation of the AVN. If AVN was not completely denervated after the SPSGP and IPSGP ablation, the LSGP was targeted.

Results
Ablation of SPSGP and IPSGP resulted in SAN and AVN denervation in the majority of patients. LSGP ablation was required in 39 / 177 (22%) patients; in 31% of females vs. 14% of males (P &lt;0.01); in 41% vs. 12% (P &lt;0.0001) of patients with predominant AVN vs. SAN disorder, respectively. The corresponding decomposition is provided in the Table. In multivariate analysis, both female gender (P &lt;0.05) and AVN disorder (P &lt;0.001) were independently associated with the need for LSGP ablation. When the population was dichotomized into early (September 2019 – December 2021) and recent period (January 2022 – February 2024), the need for LSGP ablation had a downward trend (28% vs. 16%, P &lt;0.05).

Conclusions
LSGP ablation to finalize the AVN denervation is required in a minority of patients. This need is independently associated with the female gender and predominant AVN disorder. The ECVS guidance in the ablation of SPSGP and IPSGP contributes to the decreasing trend of LSGP ablation, i.e. minimizing the final lesion set.Rate of LSGP ablation