bluuebunny/crossref_metadata_2025_split huggingface dataset:
Percutaneous left atrial appendage closure using a novel occlusion device for thromboembolic prevention: 3-year procedural experience
Authors: Moser F , Rottner L , My I , Lemoine M , Ismaili D , Kirchhof P , Reissmann B , Ouyang F , Rillig A , Metzner A 
Published: May 2024

Abstract

Background
Stroke due to atrial fibrillation has been associated with a high risk of disability and mortality. Percutaneous left atrial appendage (LAA) closure has been established as a treatment strategy for stroke prevention in patients not eligible for oral anticoagulation as well as in patients after electrical isolation of the LAA and subsequent increased risk of thrombus formation. The aim of this study was to evaluate the feasibility and initial experience of LAA closure using a novel nitinol-based, self-expanding system in an unselected patient cohort.

Methods and Results
One hundred and two patients (39% female, median age 75 [71;80], median CHA2DS2-VASc score 5 [4;6]) underwent LAA closure with the novel system between October 2020 and October 2023. 61/102 (61%) patients underwent previous electrical LAA isolation, 30/102 (29%) patients had high bleeding risk as an indication for LAA closure. Median procedure time was 45 [38;59] minutes and median fluoroscopy time was 10 [7;12] minutes. Successful LAA closure was achieved in all patients, despite different LAA anatomies. Median umbrella and cover disc diameter were 22 [20;24] millimeter and 28 [20;24] millimeter, respectively. Procedure-related adverse events occurred in 2/111 (1.8%) patients. One patient had a vascular complication at the puncture site and another patient had non-hemodynamically significant pericardial effusion. Overall, the patients stayed for a median of 2 [1;4] days in hospital.

Conclusion
Left atrial appendage closure with a novel nitinol-based, self-expanding system is feasible and safe. LAA isolation was the most common indication for LAA closure at our institution. Further studies are needed, to identify differences and potential advantages of different LAA closure systems.
Increased left atrial pressure is associated with fibrosis, elevated mechanical load and ventricular diastolic dysfunction in patients undergoing AF catheter ablation
Authors: Tanacli R , Bock M , Bartels F , Hindricks G , Gerds-Li J H , Hohendanner F 
Published: May 2024

Abstract

Background
Increased left atrial filling pressures might be a hallmark feature of atrial cardiomyopathy which has been associated with an increased incidence of atrial fibrillation (AF) recurrence even after successful pulmonary vein isolation (PVI). The interplay between left atrial pressure, measured during the ablation procedure, and other parameters characterising atrial and ventricular remodelling in patients with AF remains elusive.

Methods and Results
Between 2018 and 2022, 182 patients undergoing PVI for paroxysmal or persistent AF were included in the study. Mean left atrial pressure (mLAP) was measured invasively during the ablation procedure after transseptal puncture. A mLAP higher than 15 mmHg was considered the cut-off value for LA hypertension. Bipolar high-density 3D electro-anatomical maps (Carto) obtained during the procedure were used to manually quantify low-voltage (&lt;0.5 mV) and normal voltage areas of the LA surface and a global low-voltage/normal voltage ratio index was derived. Contemporary transthoracic echocardiography data were included to evaluate LV systolic and diastolic function and blood samples were obtained post-procedurally from all patients. In bivariate linear regression analysis, mLAP reached only modest correlation with E/e’ as an imaging marker of diastolic dysfunction (R=0.31, p=0.005) (Figure 1A), with particular differences in mLAP values between patients with marked diastolic impairment (E/e’ &gt; 15) vs. subgroups with mild dysfunction ( 8 &lt; E/e’ ≤ 15) or normal diastolic function (E/e’ ≤ 8 ) (Figure 1B), log NT proBNP (R=0.34, p&lt;0.001) (Figure 1C) and low-voltage/normal voltage ratio index (R=0.21, p=0.014) (Figure 1D). For a total of 158 patients, data about 1 year recurrence of AF were available, of these 22 (13.9%) had a recurrence after two procedures using cryo-energy for the index PVI and radiofrequency ablation for the re-PVI (second procedure). A Kaplan-Meier analysis and log-rank test showed a trend but no statistical significance regarding an increased AF recurrence rate between patients with and without LA hypertension (χ2 = 2.63, p= 0.09) (Figure 2).

Conclusion
Direct intra-procedural invasive measurement of LA pressures can offer an important and convenient novel piece of information for patients undergoing catheter ablation procedures for AF, with potential implication for post-procedural recurrence risk stratification. Atrial hypertension is only partially related to LV diastolic impairment, atrial fibrosis and myocardial mechanical load burden.
A novel method to identify critical isthmus of right atrial reentrant tachycardia; Functional substrate mapping characteristics during sinus rhythm
Authors: Yorgun H , Coteli C , Kilic S , Aytemir K 
Published: May 2024

Abstract

Background
Right atrial tachycardia (AT) is a frequent rhythm disorder in patients with atrial scar mainly due to surgical incisions or congenital heart diseases. Despite the mounting evidence about AT mechanisms and types, data is scarce regarding the conduction properties as well as functional characteristics of atrial substrate during sinus rhythm that has role in the maintenance of the tachycardia.

Purpose
We sought to evaluate the relationship between the functional substrate mapping (FSM) characteristics of right atrium and the critical isthmus (CI) of re-entrant ATs in patients with underlying atrial scar.

Methods
Among patients with the history of right AT who underwent catheter ablation with 3-D mapping were retrospectively enrolled. Voltage map and isochronal late activation mapping (ILAM) were created during sinus / paced rhythm using multielectrode catheters to detect deceleration zones (DZ). Subsequently AT was induced with programmed stimulation and activation mapping was performed to detect CI of the tachycardia. Atrial tachyarrhythmia (ATa) recurrence was defined as detection of atrial fibrillation or AT (≥ 30 s) during the follow-up.

Results
A total of 24 patients [mean age: 46 ±15, gender: 13 (54 %) female] with right AT were included. A total of 37 ATs were mapped [16 (43.2%); localized reentry, 21 (56.7%), macroreentry]. Atrial low voltage zones comprised 23.3 ± 13.0 % of total right atrium. The mean value of bipolar voltage, EGM duration and conduction velocity during sinus rhythm corresponding to CI of ATs were 0.18 ± 0.10 mV, 121.7 ± 29.4 ms, 0.06 ± 0.04 m/s and, respectively. Total number of DZs per chamber was 1.1 ± 0.3, which were all located in the low-voltage zone (&lt;0.5 mV) detected by high density mapping. All CIs of non- cavo-tricuspid-isthmus (CTI) dependent reentry were colocalized with DZs detected during FSM. The positive predictive value of DZs to detect CI of inducible ATs is 80.8%. During the mean follow-up of 11.7 ± 8.1 months, freedom from ATa was 87.5%.

Conclusion
Although, CTI-dependent macroreentry is the most common mechanism in patients with RA scar, our findings demonstrated the relevance of FSM to predict non-CTI dependent ATs. Conduction slowing manifested as DZs with continuous-fragmented signal morphology may guide to tailor ablation strategy in case of underlying RA scar.
Premature ventricular contractions increase with heart rate in patients with mitral valve prolapse
Authors: Bugge C , Five C K , Castrini A I , Ribe M , Haugaa K H , Aabel E W 
Published: May 2024

Abstract

Background
A subset of patients with mitral valve prolapse (MVP) are at risk of life-threatening ventricular arrhythmias (VAs), and a high burden of premature ventricular contractions (PVCs) is associated with increased mortality in patients with MVP. Previous studies indicate that PVC burden could either increase with increasing heart rate (HR), decrease with increasing HR, or with no relationship to HR. The association between PVC burden and HR in MVP is not known, nor if there is an association with VAs.

Purpose
We aimed to explore the relationship between PVC burden and HR in patients with MVP. Furthermore, we aimed to explore whether the different PVC profiles were associated with severe VA.

Methods
In this cross-sectional ambispective outcome study, we included patients with MVP and available Holter monitorings with &gt;100 PVCs per 24-hours seen at our tertiary centre. The Holter monitoring with the highest PVC burden was used in case of multiple recordings. We investigated the relationship between hourly PVC burden and hourly mean HR by univariable mixed linear regression. We defined PVC profiles as (1) fast-HR-dependent-PVC (F-HR-PVC) when there was a significant positive correlation, (2) slow-HR-dependent-PVC (S-HR-PVC) when there was a significant negative correlation, and (3) independent-HR-PVC (I-HR-PVC) when no correlation between PVC and HR was found. The significance was set to 0.05. Severe VA was defined as sustained ventricular tachycardia, non-sustained ventricular tachycardia with haemodynamic instability, ventricular fibrillation, aborted cardiac arrest, or appropriate shock by a primary preventive implantable cardioverterefibrillator. Severe VA was recorded from retrospective medical history, prospective ICD interrogation or monitoring with implantable loop recorder.

Results
We included 75 patients with &gt;100 PVCs at Holter monitoring (median age 48 years [IQR 35-58], 58% female). The median PVC burden was 1.9% per 24-hours (IQR 0.4-7.2). We found F-HR-PVC in 49 patients (65%), S-HR-PVC in 1 (1%), and I-HR-PVC in 25 (33%). Twelve (16%) patients had severe VA and these had higher PVC burden compared to those without severe VA (7.3% per 24-hours [IQR 4.2-10.4] vs 1.1% per 24-hours [IQR 0.3-5.3], p=0.004). The median PVC burden was 1.5% (IQR 0.3-8.0) for F-HR-PVC, 5.7% for S-HR-PVC and 1.5% (IQR 0.3-8.0) for I-HR-PVC. We found no association between different PVC profiles and the presence of severe VA (F-HR-PVC 65% vs 67%, S-HR-PVC 2% vs 0%, I-HR-PVC 33% vs 33%, p&gt;0.05 for all groups).

Conclusion
Fast-HR-dependent-PVC was most common in MVP patients, and slow-HR-dependent-PVC were rare. A higher PVC burden was associated with severe VA. However, different PVC profiles did not infer higher risk of severe VA in our study. Further studies are needed to explore whether distinct PVC profiles can predict severe VA in larger patient populations.
Initial experience with ablation of ventricular arrhythmias using a pulsed-field system
Authors: Peichl P , Wichterle D , Stojadinovic P , Borisincova E , Stiavnicky P , Haskova J , Cihak R , Kautzner J 
Published: May 2024

Abstract

Introduction
Catheter ablation using radiofrequency (RF) current is a well-established method of treatment of ventricular arrhythmias (VA). However, RF ablation may fail to eliminate deeply located arrhythmogenic substrate. Pulsed-field (PF) is a novel energy source with a potential to create deeper lesions, especially in scar tissue.

Purpose
This study aims to present the data on safety and efficacy (acute outcome data) of VA ablation using PF.

Methods
The population consists of 15patients (5 women, age: 61 ± 19years) after previously failed RF ablation of VA. The underlying condition was nonischemic cardiomyopathy (53%), coronary artery disease (13%), and congenital heart disease (13%), respectively. No structural heart disease was present in 20% of cases. The mean left ventricular ejection fraction was 39 ± 13%. Eighty percent of patients had sustained VA, the remaining patients presented with frequent ventricular ectopy. Ablation was performed using a conventional irrigated 4-mm tip catheter in a combination with commercially available PF generator. Peripheral venous blood samples for the assessment of the plasmatic levels of high-sensitivity troponin T (hsTnT) were obtained the next day (usually 18-24hours) after the procedure.

Results
A mean of 17±12 PF applications (25A) per patient were delivered. In 5 patients (33%), an additional RF ablation (4±9 applications) was performed. Acute success as assessed by non-inducibility of VA or elimination of ectopic focus was achieved in all but one patient (93%). In 4 cases (27%), PF energy was applied within the great cardiac vein and subsequent coronary angiography did not reveal any abnormality. On the other hand, transient conduction system block occurred in 3 cases (20%) during PF application on the lateral LV wall remotely from the LV septum (complete AV block in one, LBBB in two patients). These events resolved in all cases within one hour. Ablation using PF did not result in excessive increase of hsTnT (657±482ng/l, with upper reference level of 14ng/l).

Conclusion
Initial experience with PF for the treatment of VA indicates high acute efficacy. The long-term effect is to be determined. PF applications in the ventricle may be associated with unexpected but transient conduction system damage, even when applications are performed remotely from the interventricular septum. The postprocedural increase in plasma troponin levels is only moderate.
An optimized multisource acquisition and registration workflow for imaging guided ventricular tachycardia ablation
Authors: Parollo M , Torre M , Fiorentini F , Di Cori A , Segreti L , Grifoni G , Notarstefano P , De Sensi F , Rossi A , Lapira F , Cardelli L , Santoro A , Aquaro G D , Faggioni L , Zucchelli G 
Published: May 2024

Abstract

Background
Catheter ablation is a cornerstone treatment for scar-related ventricular arrhythmias arising in patients affected by structural heart disease. Imaging integration with electroanatomical mapping (EAM) suites for ventricular tachycardia (VT) ablation procedural guidance is an established step for advanced substrate characterization and treatment.

Purpose
To compare and validate different approaches for intraprocedural multisource imaging registration and integration with EAM suites for VT ablation guidance.

Methods
Thirty consecutive patients prospectively enrolled in the ongoing VOYAGE clinical trial for imaging guided/aided VT ablation at our center were retrospectively analyzed. Multidetector computed tomography (MDCT) and late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging was performed before procedure. MDCT and LGE-CMR images were both acquired during end-expiratory breath hold. Same cardiac cycle phase images were used. Wide band LGE-CMR was acquired in case of a cardiac implantable electronic device was present to reduce artifacts. Images were imported in ADAS3D software. MDCT and CMR images were manually registered using established anatomical landmarks (left ventricle outflow tract, left ventricle apex, papillary muscles, left and right ventricle junction), were then respectively processed for aortic/ventricular anatomical reconstruction and myocardial characterization and then imported in CARTO3 electroanatomical mapping suite for procedural guidance.
Registration between EAM and imaging was either performed with ascending aorta fast anatomical mapping (FAM) and 3D landmark alignment with aortic MDCT or via intracardiac echocardiography (ICE) left ventricle (LV) chamber segmentation and 3D landmark alignment with ventricular MDCT. ICE segmentation was also obtained for every case regardless of aortic FAM. Surface match between ICE and MDCT LV chamber reconstructions was calculated for method comparison.

Results
All 30 patients had an ICE segmentation of the LV, with a mean of 15,66±4,89 contours. Aortic FAM was obtained and used for aortic MDCT registration in 10 subjects. LV ICE was instead used for imaging alignment in 20 subjects. When compared to aortic FAM, LV ICE to LV MDCT alignment achieved lower average surface distance (3,86±1,41 mm vs 8,884±6,77 mm; p&lt;0,001), lower minimum surface distance (0,002±0,03 vs 0,07±0,06; p= 0,001) and lower maximum surface distance (14,16±4,37 vs 22,93±11,10; p&lt;0,001).

Conclusion
An optimized workflow consisting of ICE LV chamber segmentation was superior in terms of 3D surface distance to aortic FAM reconstruction to obtain reliable multisource imaging registration for MDCT/CMR guided/aided VT ablation.
Device programming and SMART pass algorithm activation in subcutaneous implantable defibrillator patients: data from a remote monitoring database
Authors: Iacopino S , Santobuono E , Cocchiara L , Giammaria M , Lavalle C , Pecora D , Mahfouz K , Bertini M , Filannino P , Artale P , Valsecchi S , Bianchi V 
Published: May 2024

Abstract

Background
In subcutaneous implantable cardioverter-defibrillator (S-ICD) recipients, a previous study demonstrated very low rates of delivered shocks and inappropriate shocks on programming a conditional zone between 200 and 250 bpm and a shock zone for arrhythmias &gt;250 bpm. The extent to which this programming approach is adopted in clinical practice has been little studied, as the activation status of the SMART Pass filter, that was implemented to reduce inappropriate shocks and enhanced over time.

Purpose
We assessed device programming during follow-up and the rate of detected arrhythmias in a cohort of consecutive S-ICD recipients.

Methods
We analyzed data from 670 S-ICD patients followed on the remote network at 17 Italian centers for a median of 31 months (25th-75th percentile: 16-51). The enhanced SMART Pass version was available for all patients after October 2022. It makes the deactivation monitor less sensitive to premature ventricular contractions or other transient amplitude changes while maintaining arrhythmia sensitivity and specificity, and it was expected to reduce unintentional deactivation rate.

Results
At the last remote data transmission, the median programmed conditional zone cut-off was set to 210 bpm (25th-75th percentile: 200-220), the shock zone cut-off was 250 bpm (25th-75th percentile: 240-250), and the SMART Pass was enabled in 586 (87%) patients. During follow-up, 194 automatic deactivation events (0.10/patient-year) were reported in 118 (18%) patients. The SMART Pass-disabled time was 13% of the total observation period. Shocks were delivered in 129 (19%) patients (rate: 0.13/patient-year), and untreated arrhythmias were recorded in 136 (20%) patients (rate: 0.14/patient-year). The rate of shocks was lower when SMART Pass was enabled – 0.12/patient-year (95% CI: 0.10-0.14) versus 0.20 (95%CI: 0.15-0.26) (p=0.002), as it was the rate of untreated arrhythmias – 0.12/patient-year (95% CI: 0.11-0.14) versus 0.23 (95%CI: 0.18-0.30) (p=0.001). The enhanced SMART Pass version was associated with a lower rate of deactivations – 0.04/patient-year (95%CI: 0.02-0.05) versus 0.14 (95% CI: 0.12-0.16) (p&lt;0.001), and with a reduction in treated and untreated arrhythmias (Incidence rate ratios: 0.40 (95%CI: 0.28-0.53) and 0.40 (95%CI: 0.30-0.55), respectively (p&lt;0.001)).

Conclusions
In current clinical practice, S-ICD implantation centers often program high cut-off rates for arrhythmia detection. Most patients have SMART Pass consistently enabled during follow-up. This is associated with significantly lower rates of detected and treated arrhythmias. The enhanced SMART Pass version seems associated with lower deactivation rate, and with further decrease in treated and untreated detected arrhythmias.
Mid-term outcomes after stereotactic arrhythmia radioablation for refractory ventricular tachycardia
Authors: Teres C , Luca A , Le Bloa M , Solana J , Ascione C , Domenichini G , Pascale P , Bourhis J , Verhoeff J J , Blanck O , Pruvot E 
Published: May 2024

Abstract

Introduction
stereotactic arrhythmia radioablation (STAR) is used as a rescue treatment for refractory ventricular tachycardia (VT) originating from unreachable myocardial substrate following unsuccessful radiofrequency catheter ablation (RFCA). The mid-term outcomes of STAR, however, remain poorly known.

Objective
to report the mid-term efficacy and safety outcomes in our series of 21 patients (pts) treated by STAR over 6 years.

Methods
Inclusion of consecutive pts treated by STAR with a Cyberknife system between 2017 and 2023. 3D-electroanatomical maps (EAM) of the VT substrate during unsuccessful RFCA were used to delineate the planned target volumes (PTV) on a 4D CT scan. Patients were followed up at least every 6 months by echocardiography and ICD interrogation at the outpatient clinic.

Results
21 pts [16 (76 %) male, age 66±8 years] with a mean LVEF of 40±15% were included. The underlying substrate was ischemic in 7 (33 %); non-ischemic dilated in 7 (33 %); inflammatory in 4 (19%); hypertrophic in 1 (5%); neoplasic in 1 (5%); and malignant mitral valve prolapse in 1 (5%). A dose of 21±2 Gray was delivered to the PTV (26 ml, IQR 18-43 ml). After a median follow-up of 39 [IQR, 14-48] months, 12 pts (57%) remained in stable condition, 1 (5%) underwent a heart transplantation, 1 (5%) a left ventricular assistance device, 1 (5%) was in an incessant slow VT and 6 (29%) pts died (3 from end stage heart failure). 15 (71%) pts presented VT recurrences [7 (33%) ATPs; 3 (14%) shocks; 4 (19%) VT storm and 1 (5%) with a well-tolerated slow VT (100 bpm) with an LVAD till transplantation, of whom 9 (43%) required redo RFCA. The median value of total ventricular arrhythmic burden (defined as any arrhythmia requiring ICD therapies) decreased significantly from 31 (IQR, 4-100) to 7 (IQR, 1-23) (p&lt;0.05); for nsVT from 57 (IQR, 1.5- 1196) to 41 (IQR, 0.5-584) (p ns); or ICD shocks from 1.5 (IQR, 0-5.5) to 0 (IQR, 0-2) (p&lt;0.05); for ATPs from 21 (IQR, 2.5-94) to 4 (IQR, 0.5-13) (p&lt;0.05). Figure 1 shows a graphic representation of arrhythmic burden before and after STAR.

Conclusion
in this cohort of highly selected pts with refractory VT, STAR significantly reduced the arrhythmic burden by a factor of 4 over a 3-year follow-up. Death rate remained high (29%), mostly by terminal heart failure. Nevertheless, a high proportion of pts had VT recurrences that were successfully managed by redo RFCA.VT burden before and after STAR