bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of pulmonary vein variant anatomy during cryo-ablation in paroxysmal and persistent AF patients: 1-year outcome from a nationwide multicenter clinical setting
Authors: Moltrasio M , Bianchi S , Iacopino S , Tondo C , Agresta A , Pecora D , Narducci M L , Maggio R , Sangiuolo R , Nicolis D , Riva S , Rossi P , Ferraro A , Malacrida M , De Simone A 
Published: May 2024

Abstract

Background
Complete electrical pulmonary vein isolation (PVI) by cryo-balloon approach is a well-established ablation strategy of atrial fibrillation (AF). While contrast findings exist regarding the influence of variant pulmonary vein (PV) anatomy on predicting AF recurrence, limited data are currently available specifically for cases involving the POLARx cryoablation system during PVI.

Purpose
We report the real-world experience of POLARx in the context of de novo AF ablation in a multicenter Italian registry.

Methods
Consecutive patients undergoing AF ablation from the CHARISMA registry at 10 Italian centres were included. Protocol-directed cryoablation was delivered for 180 sec or 240 sec according to operator’s preference for isolation achieved in ≤60 sec, or 240 sec if isolation occurred &gt;60 sec or when time to isolation was not available. The ablation endpoint was PVI as assessed by entrance and exit block. All patients were followed-up for at least 12 months after the procedure.

Results
Four-hundred twenty-nine patients were included (n=358, 83.4% paroxysmal AF, n=71, 16.6% persistent AF, mean age 60.7±10 years, 28.3% female, mean LVEF 58±8%). PVI was achieved in all pts using only cryoablation. Twenty-eight (6.6%) patients exhibited an anatomical variant: 17 (4.0%) a common ostium and 11 (2.6%) an adjunctive PV. The mean number of freeze applications per patient was 5.1 (1.2 for LSPV, 1.3 for LIPV, 1.2 for RSPV and 1.3 for RIPV). Over a median of 398[370-461] days of follow-up, 14 (3.2%) patients experienced an early recurrence of AF during the 90-day blanking period. Overall, 63 patients (14.7%) suffered an AF recurrence after the 90-day blanking period (median time to recurrence 342[171-381] days). The proportion of patients exhibiting AF/AT recurrences was higher in the persistent AF group (17 out 71, 23.9%) than in the paroxysmal AF group (46 out 358, 12.8%, p=0.026), with a hazard ratio of 2.02 (95%CI: 1.2 to 3.5, p=0.0137) whereas patients with anatomy variant showed a similar AF/AT recurrence rate (5 out 28, 17.9%) than in the standard anatomy group (58 out of 401, 14.5%) with a hazard ratio of 1.43 (0.6 to 3.6, p=0.441). Four (0.9%) transient phrenic nerve palsy were observed, both with full recovery in the 48-h post procedure; no major procedure-related adverse events were reported.

Conclusion
In this multicenter study, the cryo-balloon system demonstrated safety and efficacy in treating both paroxysmal and persistent AF patients, yielding a low incidence of AF/AT recurrence during follow-up, regardless of the presence of variant PV anatomy.
Effectiveness of a novel integrated dilator-needle transseptal crossing device in atrial fibrillation cryoballoon ablation procedures
Authors: Benezet Mazuecos J , Lozano A , Miracle A , Crosa J , Esteban I , Elosegui C , Illescas C , Iglesias J A 
Published: May 2024

Abstract

Background
In cryoballoon ablation (CBA) procedures, left atrial (LA) access is generally achieved using a standard sheath and needle system that is exchanged for the cryoballoon delivery sheath and dilator over a long wire. Sheath exchange has been related with air embolic events in CBA procedures. A novel integrated dilator-needle system, that can be combined with the cryoballoon delivery sheath allowing direct LA transseptal access, was recently introduced. Figure.

Objective
The purpose of this study is to evaluate the efficacy and safety of this new integrated transseptal access tool compared with the traditional approach in CBA procedures.

Methods
In this prospective single-center study, consecutive patients who underwent AF CBA procedures were randomly assigned 1:1 to undergo traditional transseptal access (t-TSA) or integrated transseptal access (i-TSA). Patients with foramen ovale or interatrial communication, detected on transesophageal echocardiogram prior to the procedure, were excluded. Transseptal access time was defined as time from superior vena cava to LA insertion of the cryoballoon delivery sheath, after sheath exchange (t-TSA) or directly (i-TSA).

Results
We evaluated 82 patients (63 males, mean age 59 ± 10 years) indicated to CBA of atrial fibrillation, 42 patients underwent t-TSA and 40 i-TSA. The baseline characteristics of the study population were comparable between groups. Table. Mean CBS transseptal access time was 5 min 6 sec ± 2 min 5 sec in the t-TSA group and 3 min 5 sec ± 2 min 23 sec in the i-TSA group, P &lt; 0.001. Challenging interatrial septa were noted in 3 patients: 1 in t-TSA (1 aneurysmal/elastic) and 2 in i-TSA group (1 lipomatous hypertrophy, and 1 abnormally thickened/fibrotic). No acute complications related to transseptal access were noted in both cohorts. The CBA procedure time and fluoroscopy time were lower in the i-TSA group. Table. There were 1 temporary phrenic nerve injury and 1 vascular complication, both in the t-TSA group. Importantly, no signs of clinical air embolism were noted in both groups.

Conclusion
This is the first randomized study comparing the traditional approach and the use of a new integrated dilator-needle system. Transseptal crossing in CBA procedures using this integrated tool enables a safe and more efficient workflow, reducing time for transseptal access and avoiding sheath exchange.FigureTable
One-year outcome of wide-area pulmonary vein isolation using the third-generation visually guided laser balloon
Authors: Yamasaki T , Kakita K , Pak M , Hattori T 
Published: May 2024

Abstract

Background
The third-generation laser balloon (LB3) is equipped with an ultra-compliant balloon and a motor-driven laser generator, which contribute to durable and gapless isolated lesion creation. However, the efficacy of wide-area pulmonary vein (PV) isolation (PVI) using LB3 remains to be elucidated.

Purpose
This study aims to investigate efficacy of wide-area PVI using LB3.

Methods
This is a single-center retrospective study. Patients with atrial fibrillation (AF) who underwent LB3 ablation during the period from August 2021 to June 2022 were enrolled. All PVs were electrically isolated only by LB3. After initial circular ablation, LB3 was inflated to a larger size at each PV, and the isolation area was extended. After ablation, voltage maps of the left atrium were obtained by high-resolution mapping catheters to evaluate isolation areas (&lt;0.1mV). Follow-up included a 12-lead electrocardiogram, Holter monitoring, and/or pacemaker/implantable cardioverter-defibrillator interrogation. The efficacy endpoint was defined as freedom from atrial tachyarrhythmia (ATa) between months 3 and 12.

Results
Forty-four patients with paroxysmal AF and 34 with persistent AF (mean arrhythmia duration 12.4 months, range 1–60 months) were included. First pass isolation was achieved in 90.6% (280/309) of PVs. The total laser application time was 24.1±6.4 minutes, and the total delivered energy was 15.3±3.2 kJ. The isolation area at the left- and right-sided PV antrum were 14.2±1.8 and 19.5±1.1 cm², respectively. At the end of the 12 months of follow-up, the freedom from ATa was 78.2% in patients with paroxysmal AF and 78.0% in persistent AF, which indicates ATa free survival at one year was similar in both groups (P=0.91).

Conclusions
Wide-area PVI using LB3 may lead to favorable outcomes in patients with AF.Fluoroscopic and endoscopic imageKaplan-Meier curves and voltage map
Cardiovascular magnetic resonance 3D LGE imaging for atrial fibrillation ablation
Authors: Letsas K , Saplaouras A , Mililis P , Kariki O , Dragasis S , Patsiotis I , Bazoukis G , Efremidis M , Nyktari E 
Published: May 2024

Abstract

Objective
To assess feasibility and reliability of cardiac magnetic resonance (CMR) imaging in visualizing left atrial (LA) structural changes that patients with paroxysmal atrial fibrillation (PAF) undergo acutely and long-term post ablation. Two different ablation methods i.e pulsed filed ablation (PFA) and cryoablation were studied.

Background
Pulmonary vein (PV) isolation has become the cornerstone technique for catheter ablation in patients with drug-refractory atrial fibrillation (AF). At present, almost all ablation technologies are mediated by a thermal effect. Recently, pulsed field ablation (PFA) has been introduced as a new energy source. PFA is a non-thermal ablative modality in which high voltage ultra-short pulses are applied to target tissue, while preserving the extracellular matrix architecture, nerves, and microvascular structures. Few data exist showing different structural LA changes between the two methods using Three-Dimensional (3D) Late Gadolinium Enhancement (LGE) Imaging.

Methods
CMR imaging was performed pre-ablation, acutely (&lt;24 h), and 3 months post-ablation in 10 patients with paroxysmal atrial fibrillation (AF) undergoing pulmonary vein (PV) isolation with PFA (n = 5) or cryoablation (n = 5). 3D LGE and T2-weighted images were analysed. We obtained two data sets of 3D whole heart LGE imaging with high resolution, 20minutes post gadolinium injection. Patients underwent two acquisitions: the conventional respiratory navigated, electrocardiographically-gated 3D fast gradient echo (1.3slice thickness, 256x256 matrix acquisition) and the image-navigated isotropic high resolution 3D LGE with Dixon water-fat separation. 3D LGE data were analysed using a dedicated (ADAS LA) software in order to produce a 3D-LA model visualization of LGE areas.

Results
In the acute stage, LGE volume was 50% larger after PFA vs. cryoablation (P &lt; 0.001), and oedema on T2 imaging was significantly smaller (visual estimation) on PFA cases. LGE rings surrounding PV ostia were more homogeneous after PFA, with no sign of microvascular damage or intramural hemorrhage as compared to cryoablation cases. In the chronic stage, the majority of acute LGE had disappeared after PFA, whereas most LGE persisted after cryo-ablation. The two 3D LGE sequences used for analysis showed complete agreement in the visualization of atrial scar with superior image quality of the novel sequence. The mean acquisition time for 3D LGE imaging was 11±4minutes for the conventional fast gradient echo sequence, and 5±2minutes for the novel 3D self-image navigated LGE sequence.

Conclusions
CMR imaging may help in visualization and understanding of LA structural remodeling post different ablation techniques.
First clinical experience using a novel 8-spline ultra high-resolution mapping catheter to guide atrial fibrillation ablation
Authors: Khalaph M , Fink T , El Hamriti M , Bergau L , Moersdorf M , Braun M , Sciacca V , Guckel D , Imnadze G , Sommer P , Sohns C 
Published: May 2024

Abstract

Background
Multielectrode mapping catheters improve the detection of scarred and fibrotic tissue in patients with atrial fibrillation (AF) Recently, a novel multispline mapping catheter with 48 closely spaced microelectrodes has been introduced enabling fast high-resolution electroanatomical mapping.

Objective
This study sought to report our initial clinical experience with the novel Octaray catheter in patients with AF undergoing index ablation and to compare its impact on mapping and ablation with the 5-spline Pentaray catheter.

Methods
The study included consecutive patients who underwent index AF ablation using a multipolar mapping catheter and very high-power-short-duration guided ablation (Q4U-AF workflow; QDot; Qmode+; Biosense Webster) in conjunction with a visualized sheath (Vizigo; Biosense Webster). Arrhythmia recurrence was defined as any atrial fibrillation (AF)/ atrial tachycardia (AT) episode lasting &gt; 30 s after a blanking period of 3 months.

Results
A total number of 183 patients undergoing AF ablation using the Octaray and QDot catheter were compared to a group of 166 matched patients who underwent ablation using Pentary and QDot. Utilization of the Octaray catheter resulted in an increased identification of areas with bipolar low-voltage representing fibrosis/scar or atrial cardiomyopathy (mean amount of left atrial bipolar low-voltage: Octaray 31% vs. Pentaray 18%; p= 0.03) and a higher rate of first-pass isolation (FPI) for the left-sided pulmonary veins (Octaray: FPI rate 73% vs. FPI rate 64% for Pentaray). A significantly higher number of mapping points was acquired using the novel 8-spline mapping catheter (right atrium: Octaray 1936 points vs. Pentaray 903 points; p &lt; 0.001 left atrium: Octaray 5337 points vs. Pentaray 2385 points; p &lt; 0.001). Procedural parameter, radiation time/dosage and acute procedural success were comparable between the two groups. During a mean follow-up of 12 months, the overall procedural success was 86 in the Octaray group vs. 84% in the control group (p=0.9).

Conclusion
The utilization of the novel Octaray mapping catheter resulted in an improved detection of atrial fibrosis and scar as well as a higher rate of first-pass pulmonary vein isolation.
Figure: Institutional Q4U-AF-workflow using a multipolar mapping catheter, the QDot ablation catheter and a visualized sheath. High resolution mapping using the Octaray (A+B) and PentaRay catheter (C+D).
Peak frequency can be effectively used to characterize atrial remodelling in atrial fibrillation
Authors: Al-Aidarous S , Vidal Horrach C , Roney C , Butcher C , Hunter R , Honarbakhsh S 
Published: May 2024

Abstract

Introduction
Characterizing atrial fibrillation (AF) substrate can guide ablation strategies, particularly as current efficacy leaves room for substantial improvement. Low voltage zones (LVZs) correlate with atrial fibrosis and scar and can independently predict AF recurrence. Ablation of these zones improves freedom from arrhythmia, but the chaotic nature of atrial excitation frequently results in overestimation of LVZs limiting accurate substrate identification.

Purpose
While omnipolar voltage (OV) mapping has emerged to address this issue by closely correlating with sinus rhythm (SR) voltage maps, our study builds upon this by investigating a novel parameter, peak frequency (PF), to further refine AF substrate characterization.

Methods
Patients undergoing catheter ablation for persistent AF were enrolled. OV maps and PF maps were created during AF while bipolar voltage (BV) maps were created in SR with atrial pacing at pacing intervals (PIs) of 600ms and 250ms. Areas were classified as fixed scar (consistent LVZs across all maps), functional remodelling (LVZs in AF OV and SR BV 250ms maps) and non-LVZs (normal voltage across all maps). PF was assessed in these areas and defined as the highest frequency detected in the electrogram.

Results
Among 20 patients, the average voltage in AF OV maps differed significantly from SR BV 600ms (0.49±0.76mV in AF OV vs. 1.12±0.97mV SR BV 600ms, p&lt;0.001) but not SR BV 250ms maps (0.49±0.76mV in AF OV vs. 0.52±0.84mV SR BV 250ms, p=0.10). Comparing co-registered points, there was a significant difference between AF OV and SR BV 600ms maps (0.21±0.09mV, p&lt;0.001) but not between AF OV and SR BV 250ms maps (0.06±0.04mV, p=0.10). These findings were also consistent with regards to the proportion of LA area occupied by LVZs (42.4±8.2% AF OV, 24.3±7.4% SR BV 600ms and 39.4±6.7% SR BV 250ms; p=0.001). AF OV maps thereby correlated better with SR BV 250ms maps hence representing both fixed scar and functional remodelling. PF values ≥244Hz were predictive of non-LVZs (OR 3.91, 95% CI 3.77-4.07,) with an AUC of 0.71. A PF of ≤214Hz was predictive of fixed scar (OR 17.67, 95% CI 16.82-18.56, p&lt;0.001) with an AUC of 0.90. A PF between 215-236Hz was predictive of functional remodelling (OR 2.83, 95% CI 2.71-2.95, p&lt;0.001) with an AUC of 0.60. The majority of LVZs identified exclusively in AF OV maps exhibited PFs akin to those in non-LVZs highlighting the ability of PF to pinpoint potential overestimations in LVZs.

Conclusions
PF mapping can effectively discern between areas of fixed scar, functional remodelling, and potential overestimation of LVZs. PF may enhance substrate characterization in AF utilising data solely from electrograms.Trial Design and Zone AssignmentPeak Frequency and Voltage Zones
Long-term outcomes in hybrid versus standalone thoracoscopic ablation in patients with atrial fibrillation: a systematic review and reconstructed individual patient data meta-analysis
Authors: Aerts L , Kawczynski M J , Luermans J G L M , Maessen J G , Bidar E , Heuts S , Maesen B 
Published: May 2024

Abstract

Background
Both hybrid and standalone thoracoscopic atrial fibrillation (AF) ablation techniques have demonstrated favorable outcomes in the management of (long-standing) persistent AF patients, as compared to catheter ablation. However, it is currently unknown whether there is a difference in long-term freedom from AF when comparing these two procedures.

Purpose
To compare long-term freedom from atrial tachyarrhythmias (ATA) in patients undergoing hybrid and standalone thoracoscopic AF ablation.

Methods
A systematic search encompassing PubMed, EMBASE, and the Cochrane Library databases from January 1, 2012, to September 6, 2023, was performed using the following search terms: 'thoracoscopic ablation,' 'hybrid ablation,' 'atrial fibrillation,' and various alternative spellings. Articles were included for pooled analysis of freedom from ATA after meeting the criteria of reporting on consecutive patients and presenting Kaplan-Meier (KM) curves. Individual time-to-event data were reconstructed from the KM curves and included in a multivariable Cox and frailty Cox model with adjustments for age, sex, type of AF, AF duration, and study (frailty term in the frailty Cox model).

Results
In total, 18 studies were included in the meta-analysis for long-term freedom from ATA, comprising 2215 patients. Patients undergoing hybrid thoracoscopic ablation were older (62.0 vs. 58.8 years old, p=0.046), had less frequently paroxysmal AF-history (9.6% vs. 32.1%, p&lt;0.01), and had a longer duration of AF-history (7.0 vs. 5.3 years, p=0.04), as compared to patients undergoing standalone thoracoscopic ablation. There were no significant differences between the two ablation procedures regarding short-term outcomes including early mortality (0.6% vs. 1.0%, p=0.07) and early stroke (1.9% vs 0.9%, p=0.11). Adjusted analysis revealed that hybrid thoracoscopic ablation was significantly associated with greater freedom from ATA (Hazard Ratio [HR]=0.59, 95%CI: 0.43-0.83, p&lt;0.001) compared to standalone thoracoscopic ablation (see Figure 1A). Additionally, older age (HR=1.07, 95%CI: 1.03-1.12, p=0.002) and a higher percentage of male patients (HR=1.02, 95% CI: 1.01-1.03, p&lt;0.001) were significantly associated with ATA recurrence. Adjusted freedom from ATA at 1 year, 3 years, and 5 years was 71.6%, 55.1%, and 46.8% for thoracoscopic ablation, and 82.0%, 69.9%, and 63.6% for hybrid ablation (see Figure 1B).

Conclusion
Hybrid thoracoscopic AF-ablation is associated with a higher level of freedom from ATA when compared to standalone thoracoscopic ablation.Figure 1
Direct oral anticoagulants versus vitamin K antagonists as stroke prevention in atrial fibrillation after cardiac surgery: a systematic review and meta-analysis
Authors: Terpstra M M , De Vries T A C , Oortwijn E , De Lind Van Wijngaarden R A F , De Groot J R 
Published: May 2024

Abstract

Background
Cardiothoracic surgery guidelines advocate the use of vitamin K antagonists (VKAs) in patients with atrial fibrillation (AF) in the first days to months after major cardiac surgery. No recommendations on choice of anticoagulant in the first months after cardiac surgery have been issued since 2008, before the use of direct oral anticoagulants (DOACs). The basis for this is a lack of data on the safety and efficacy of DOACs after cardiac surgery.

Purpose
To systematically assess and meta-analyze the existing evidence on the effect of DOACs compared with VKAs on efficacy and safety after cardic surgery. We hypothesized that DOACs are non-inferior to VKAs in the setting of AF after cardiac surgery.

Methods
We searched Ovid MEDLINE, Ovid EMBASE, the Cochrane Central Register of Controlled trials and Clinicaltrials.gov from inception till 20 June 2023 and screened references in relevant reviews as grey literature search. Observational studies and randomized controlled trials comparing DOACs with VKAs for stroke prevention in patients with (postoperative) atrial fibrillation after cardiac surgery were included, focusing on procedures through thoracoscopy or thoracotomy. Outcomes of interest included thromboembolic events, all-cause stroke, major bleeding and mortality up to 6 months after cardiac surgery and admission duration. A random effects model was used to determine pooled treatment effects. The level of evidence was rated following the GRADE recommendations.

Results
We identified 4,146 records of which ten were included, together reporting on &gt; 30,000 patients. There were no significant differences in thromboembolic events (OR 0.98; 95% CI 0.61-1.58; I^2 0%; GRADE: very low), all-cause stroke (OR 1.14; 95% CI 0.51-2.54; I^2 0%; GRADE: very low), major bleeding (OR 0.91; 95% CI 0.51-1.62; I^2 53%; GRADE: very low), all-cause mortality (OR 1.00; 95% CI 0.73-1.37; I^2 0%; GRADE: low), admission duration (MD -0.33; 95% CI -1.16 – 0.49; I^2 0%; GRADE: very low) between DOACs and VKAs in the first 6 months after cardiac surgery.

Conclusion
Efficacy and safety of DOACs as stroke prevention in AF following cardiac surgery were similar to that of VKAs in ten studies comprising more than 30,000 patients. Based on the existing literature, there is insufficient evidence to recommend one class of oral anticoagulants over another in the first months after cardiac surgery.Forest plot of primary outcomes