bluuebunny/crossref_metadata_2025_split huggingface dataset:
Standalone transcatheter left atrial appendage closure or combined with cryoballoon pulmonary vein isolation
Authors: Schiavone M , Gasperetti A , Moltrasio M , Riva S , Maltagliati A , Majocchi B , Tundo F , Tondo C , Fassini G 
Published: May 2024

Abstract

Background
Head-to-head comparisons between stand-alone left atrial appendage closure (LAAC) and a same-procedure LACC + cryoballoon (CB) pulmonary vein isolation (PVI) (combined procedure) are currently lacking.

Purpose
To compare acute and long-term outcomes between stand-alone LAAC vs a LAAC+CB-PVI combined procedure.

Methods
All patients undergoing LAAC at our institution, having at least 2 years follow-up, were analyzed to assess the impact of additional CB-PVI. The primary efficacy and safety endpoints of our study were the acute procedural success rate and the peri-procedural complications rate. As secondary endpoints, major bleeding, and ischemic events, as well as sinus rhythm rate at 2 years follow-up were assessed.

Results
Among 126 LAAC patients meeting inclusion criteria (males=64.2%), n=55 (43.7%) underwent a combined procedure. LAAC-only patients were older (72.5±7.2 vs 68.9±8.6, p&lt;0.05) and less frequently having paroxysmal AF (23.9% vs 47.3%, p&lt;0.05). Baseline CHA2DS2-VASc was similar among groups (3.3±1.3 vs 2.9±1.1, p=0.07) while LAAC-only patients had higher HAS-BLED at enrollment (3.4±1.1 vs 3.0±1.0, p=0.04). Additional CB-PVI was not a risk factor for incomplete LAA occlusion (OR 0.24–3.78, p=0.96), presence of residual lateral flow (OR 0.26–4.05; p=0.96), intraprocedural need for occluder device resizing compared to pre-procedural assessment (OR 0.27–3.05; p=0.884), and peri-procedural complications (OR 0.25–6.74, p=0.749). At 3-month post-procedural trans-esophageal echocardiography, a combined procedure was not associated with higher risk of incomplete occlusion (OR 0.33–1.59, p = 0.432), nor larger peri-device leakages (coefficient k: -0.65–+0.20, p=0.291). Overall and by-group ischemic (red) and bleeding (blue) relative risk reduction from CHA2DS2-VASc and HAS-BLED predicted yearly rates during follow-up was reported in Figure1. Over a median follow-up of 40 [26–56] months, a combined procedure was not a risk factor for major bleeding (OR 0.31–5.48, p=0.715) or ischemic (OR 0.11–3.56, p=0.599) events. As expected, additional CB-PVI was strongly associated with a reduction of AF recurrences (OR 0.16–0.86, p&lt;0.05), after excluding permanent AF patients from the analysis.

Conclusion
Combined LAAC + CB-PVI procedure does not appear to be a risk factor for worse LAAC-related outcomes, while reducing AF recurrences in non-permanent AF patients.Figure 1
Management of peri-device leaks after left atrial appendage closure using endovascular coils and/or amplatzer plugs and radiofrequency ablation
Authors: Maan A , Ambesh P A , Mirza J M , Kawamura I K , Stanton E S , Vashistha K V , Musikantow D M , Turagam M T , Koruth J K , Miller M M , Lampert J L , Whang W W , Dukkipati S D , Reddy V R 
Published: May 2024

Abstract

Background
Peri-device leaks (PDLs) after left atrial appendage closure (LAAC) portend a higher residual risk of thromboembolism in patients with Atrial Fibrillation (AF). Therefore, closure of PDLs has evolved as a procedural strategy to mitigate this residual thromboembolic risk.

Objective
To present our procedural experience and outcome data in patients who underwent PDL-closure after prior LAAC.

Methods
We performed a retrospective review of patients with follow-up imaging data (either transesophageal echocardiograms or Cardiac CT scans) performed at ∼1 year after LAAC between the time-period 5/2015 – 10/2022 to assess PDLs.

Results
We included a total of 532 patients with follow-up imaging data. At a mean follow up of 696±359 days post-LAAC, 63 of 532 (11.8%) patients underwent PDL closure. These PDL closure cohort was age 73.1±9.5 years, 41 of 62 (65%) had paroxysmal AF, and the CHA2DS2-Vasc was 3.7±1.5. In 42 of 62 (67.7%) patients, the initial LAAC device was Watchman, and in 21 (33.8%) patients, it was Watchman-FLX. Of the PDL closure cohort, 8 of 62 (12.9%) had a post-LAAC thromboembolic event (transient ischemic attack [TIA], stroke or systemic embolism). The PDL size was 3.8±2.0 mm. PDL closure was performed using endovascular coils alone in 23 (37.1%), plugs (Amplatzer devices, Abbott) alone in 18 (29%), and combinations of both in 13 (19.4%) patients. In 8 (14.5%) patients, radiofrequency ablation was used in concert with both coils and plugs (Figure). There was only 1 complication (pericardial effusion drained percutaneously) during the PDL closure procedure. During follow-up post-PDL closure, no patient sustained a stroke and only 1 patient had a TIA (Table).

Conclusions
Our data indicate that PDL closure after LAAC is feasible and safe, with a low risk of procedural complications. Such a strategy can be used in a subset of high-risk patients with PDL after LAAC who are at an elevated residual risk of thromboembolism.Table summarizing procedural strategies
Acute haemodynamic changes during left atrial appendage closure
Authors: Herman D , Herman D H , Hozman M H , Valoskova V N , Karch J K , Vesela V J , Vondalova V V , Osmancik O P 
Published: May 2024

Abstract

Purpose
Left atrial appendage closure (LAAC) presents an alternative treatment for stroke prevention in atrial fibrillation (AF) in patients with contraindication for long-term anticoagulation. However, even in patients in AF, left atrial appendage plays an important role in reservoir function of left atrium. The purpose of this study was to assess acute hemodynamic effects during LAAC.

Methods
Consecutive patients indicated for LAAC from January 2022 to October 2023 were enrolled. The invasive hemodynamic measurements were done at the beginning of the procedure after transseptal puncture, and at the end from the procedure after device deployment. Following parameters were measured: systolic, and diastolic blood pressure, and pressure in left atrium (LA), all measurements were done at rest and after 3 minute isometric exercise (handgrip).

Results
Thirty-two patients were included (age 76,2+7,1 yrs, 22 (69%) males, 23 (72%) permanent AF, left ventricular ejection fraction 52+11,8%). No patients experienced moderate/severe mitral insufficiency, the saline intake during procedure was 738 ml. Isometric exercise significantly increased the LA pressure: the LA pressures (rest/exercise) were 13.7+6.7 mmHg/16.7+8.8 mmHg (p=0.003) at the beginning of the procedure, and 17.0+7.3mmHg/20.0+7.3 mmHg (p=0.005) after device deployment. The LA pressure obtained after device deployment (both rest/exercise) were significantly higher compared to values obtained at the beginning of the procedure. (p=0.003).

Conclusions
LAAC is associated acute increase of both rest and exercise LA pressure. Whether its acute negative effect remains over time needs further investigation.
Impact of industry funding on atrial fibrillation clinical trials: insights and implications
Authors: Lan R , Paranjpe I P , Saeed M S , Perez M V P 
Published: May 2024

Abstract

Background/Introduction
Commercial industry is an important source of funding for atrial fibrillation clinical trials, the implications of which have not been analyzed.

Purpose
The purpose of this study is to describe the characteristics of contemporary AF clinical trials and to evaluate their association with funding source.

Methods
We systematically assessed all completed atrial fibrillation trials registered in ClinicalTrials.gov between conception to September 1, 2022, and extracted publicly available information including funding source, trial size, race, ethnicity, sex, intervention, location, and publication status. Trial characteristics were compared using the Wilcoxon rank sum test and Fisher’s exact test for continuous and categorical variables, respectively.

Results
Of the 253 clinical trials assessed, 171 (68%) reported industry funding. Industry funding was associated with a greater median total enrollment (172 vs. 80; P &lt; 0.001), publication rate (56.7% vs. 42.7%; P = 0.04), participation in device trials (48.0% vs. 24.4%; P &lt; 0.001), and multicontinental recruitment location (25.2% vs. 2.4%; P &lt; 0.001) when compared to non-industry funded clinical trials. However, industry funding was not associated with a significant difference in median impact factor (7.7 vs. 7.7; P = 0.723) or median number of citations (60.0 vs. 29.0; P = 0.09). The overall proportion of industry funded trials did not change over time (P = 1.00) since inception of the ClinicalTrials.gov database. Participant demographics remained relatively uniform over time across both industry-funded and non-industry-funded trials.
Conclusion(s).
Industry funded clinical trials in atrial fibrillation are often larger, more frequently published, multicontinental, and device-focused. Industry funding was found to be associated with significant differences in study enrollment, publication metrics, and study interventions. Insights from this study inform trial design, regulation, and policy considerations in the evolving landscape of AF research.TableFigure
Rapid access nurse-led atrial fibrillation clinics reduce hospital readmissions
Authors: Yelinevich I , Mampitiya N , Tanner M , Tate C , Hall C , Child N 
Published: May 2024

Abstract

Background
Atrial Fibrillation (AF) is the most common cardiac arrhythmia and in the UK accounts for about 1.5% of healthcare expenditure mainly through recurrent hospital admissions (1). The European Society of Cardiology 2020 AF guidelines (2) provides a clear framework of all the different components required to provide good patient-centred integrated AF management of which very little is done well within an emergency inpatient setting.

Purpose
We have developed a nurse led Rapid Access AF (RAAF) clinic aiming to prevent repeat admissions and improve patients overall AF care.

Methods
All patients discharged from our institution's emergency department (ED) or acute medical ward with a primary diagnosis of atrial fibrillation are suitable for the Rapid Access AF clinic. At the clinic the patients are given patient education, advise about risk factor modification, access to an "AF hotline" and a simple initial management plan should symptoms worsen with advise about when to attend the emergency department. Patients are then reviewed at a weekly multidisciplinary meeting with the local AF doctors where longer term strategies are made. The clinics have been operating now for 2 years and we have audited the 3 months from January to March 2022 with further follow up at 6 months.

Results
41 out of 64 patients presenting to the emergency department with AF were admitted. However, whether in the ED or subsequent medical ward, treatment as a whole was very simple AF management, similar to that of outpatient care ( e.g. in ED Beta Blockers 34%, Digoxin 16%, oral Flecainide 5%, IV Amiodarone 12.5%, direct current cardioversion 1.5%, no clear AF treatment 16%, anticoagulation in patients with CHADSVASC 2+ 92%). 36 out of 64 patients were discharged to RAAF clinic and were seen on average 22 days post discharge. Readmission rates were 11% vs 32% at 30 days in patients discharged to RAAF compared to standard care and 14% vs 60% at 6 months.

Conclusion
Patients admitted to hospital with a primary diagnosis of AF are at high risk of early readmission. A rapid access AF clinic is effective at significantly reducing hospital readmission rates whilst also providing more holistic integrated AF management.
Evaluation of the cavotricuspid isthmus contractile kinetics within an interventional CMR environment
Authors: Pusterle De Cidrac A , Solana Munoz J , Luca A , Teres C , Le Bloa M , Ascione C , Domenichini G , Pascale P , Antiochos P , Masi A , Paetsch I , Jahnke C , Schwitter J , Pruvot E 
Published: May 2024

Abstract

Background
Cavotricuspid isthmus (CTI)-dependent flutter is a common arrhythmia with recurrences following ablation up to 50%. Previous static morphological analysis have shown that CTI anatomical variability has an impact on ablation time and procedural success. However, whether the contractile kinetics of the CTI affect procedural success remains unknown to date.

Purpose
Assessment of the contractile kinetics of the CTI in a cardiac magnetic resonance (CMR) environment for patients (pts) referred for typical flutter ablation.

Method
32 consecutive pts with typical right atrial (RA) flutter from our Heart Center were included in this study. RA wall contours during a single cardiac cycle were delineated on CMR 2D-images using the Tomtec software. CTIs were divided in 5 segments for detailed motion analysis as shown in the figure 1A. CTI length and displacement were measured both in caudo-cranial and postero-anterior directions. Quantification of the CTI kinetics was performed in Python by computing the 2D-Euclidean distance (between two extreme temporal positions of CTI points).

Results
The mean CTI length of the study population (mean age 66±10 years, 29 males) was 32±13 mm during RA systole and 49±15 mm during RA diastole, resulting in a mean CTI change of 17±7 mm over one cardiac cycle (maximum – minimum length). Figure 1A shows representative MRI views of the CTI during RA systole and diastole. Figure 1B shows examples of hypo- and hyperkinetics CTI from 2 representative pts. Figure 2C shows a gradual increase in segment displacement postero-anteriorly (8.1±7.3 vs 17.2±8.1 mm, p&lt;0.05) and caudo-cranially (1.6±0.8 vs 4.5±2.4 mm) from the Eustachian valve toward the Tricuspid valve. Figure 2D indicates that the 2D-Euclidean displacement of the 5 segments varied between 8±7.7 mm and 18±8.5 mm depending on their location. Interestingly, the overall CTI displacement was 4.5 times greater forward than upward.

Conclusion
To our knowledge, this is the first study investigating the kinetics properties of the CTI in sinus rhythm of patients with typical RA flutter. The CTI showed displacements both in postero-anterior and caudo-cranial directions, with a gradual increase from the Eustachian to the Tricuspid valves. CTI displacement appeared highly variable across patients. Whether the kinetics of the CTI correlate with ablation success will be investigated shortly.
Atrioventricular nodal reentrant tachycardia ablation (avnrt), a female disease. insights from the german ablation registry
Authors: Eitel C , Ince H , Brachmann J , Kuck K H , Willems S , Gerds-Li J H , Tebbenjohanns J , Iden L , Hochadel M , Senges J , Tilz R 
Published: May 2024

Abstract

Background
The German Ablation registry is a multi-centre prospective registry for electrophysiologic ablation procedures.

Purpose
We herein report on catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) according to underlying gender.

Methods
From January 2007 until January 2010 a total of 2918 patients [64.4% female, 55 (43; 67) years] undergoing catheter ablation of AVNRT were enrolled in this registry and followed for at least one year.

Results
Female patients undergoing ablation for AVNRT were significantly younger than male patients [52 (41; 66) versus 60 (47; 70); p&lt;0.001] and had less structural heart disease than male patients [12,1 % (228/1880) versus 30,8 % (320/1038)]. Female patients more often had ≥ one arrhythmia episode per month [73,7 % versus 68,1 %; p&lt;0.001], nevertheless arrhythmia documentation was less often present in female patients [81,7 % versus 85,4 %; p=0.012]. Success rate was high (98,9 %) and major complications prior to discharge (death, myocardial infarction, stroke) were rare (1/2917) without significant difference between female and male patients. During a follow-up period of 682.9 ± 172,9 days, female patients more often experienced arrhythmia recurrences [19,1 % versus 13,8 %; p&lt;0.001].

Conclusions
Almost two-thirds of patients undergoing ablation for AVNRT included in the German ablation registry were female. Female patients were younger and less often had structural heart disease or other comorbidities than male patients undergoing AVNRT ablation. Success rates and complication rates were similar. During follow-up female patients more often experienced arrhythmia recurrences.
Safety and feasibility of left bundle branch pacing for pediatric and congenital heart disease patients
Authors: Ouali S , Jebbari Z , Boudiche S , Ben Rejab R , Mgaieth F , Ben Halima M 
Published: May 2024

Abstract

Background
Conduction system pacing (CSP) has evolved and validated in adults. Due to technical challenges, pediatric and congenital heart disease (CHD) patients were excluded from original trials in this field. We report the safety and feasibility results of our initial experience with pediatric and CHD patients undergoing LBBAP (Left bundle branch area pacing).

Purpose
To analyze the indications, intraoperative outcomes, electrocardiographic and clinical data from the initial follow-up of pediatric and CHD patients who underwent LBBAP.

Methods
Indications, intraoperative technical issues, electronic parameters of the implant and early complications of consecutive pediatric and CAD patients submitted to stimulation of the conduction system were evaluated.

Results
This study was performed between February 2022 and November 2023 and recruited 11 consecutive patients with complete AV block (age: 15-43 years; 7 women) who underwent LBBAP. Four patients had congenital heart disease repaired surgically and two patients with congenitally corrected transposition of the great arteries. Upgrading from VVIR to LBBAP underwent in four patients. Right ventricle (RV) leads were extracted in three patients before CSP. DDD pacemakers with Lumneless 3830 pacing leads were implanted in all patients. The pre-implant QRS duration was 146 (104- 200) ms and 120 (110-130) ms after the procedure. The mean left ventricle activation time was 72 (50-90) ms. The R-wave amplitude was 10.00 (6-29) mV, with a stimulation threshold of 0.8 (0.4-1) V x 0.4 ms and impedance of 676 (534-780) ohms. Transition from non-selective to either myocardial or selective capture and fixation beats were respectively demonstrated in five and three patients. The procedure duration was 125 (70-130) min, and the fluoroscopy time was 15.2 (4-23.6) min. LBBAP substantially shortened the QRS duration and improved LV dyssynchrony echocardiographic parameters in four patients with prior epicardial or endocardial pacing. The LBBAP was successful in all patients with no early complications occured. At mean three months follow-up, QRS duration showed no significant changes compared with baseline.

Conclusion
Our initial experience on cardiac stimulation of the His-Purkinje conduction system through the stimulation of the left bundle branch is a safe and feasible technique in pediatric and CHD patients. The widespread use of this pacing technique is very useful and cost-effective to prevent heart failure in this vulnerable population.
Estimation of ventricular ectopic beat origin with electrocardiographic imaging
Authors: Fambuena Santos C , Llorente-Lipe I , Ros S , Sanchez J , Carta A , Torrecilla E G , Atienza F , Climent A M , Guillem M S 
Published: May 2024

Abstract

Background
Precise identification of premature ventricular contractions (PVC) origins poses a significant challenge in electroanatomic mapping. Electrocardiographic Imaging (ECGI) allows instantaneous and global activation time mapping, providing a fast way to locate the origin of ectopic contractions. However, the standard methodology to estimate local activation times (LAT) in invasive electrograms is not directly transferable to ECGI signals.

Objective
In this study, a new methodology to calculate LAT maps with ECGI is presented and compared to the standard method in both, mathematical simulations and patients.

Method
We conducted computer simulations of five distinct PVCs to generate ECGI signals. Two techniques were applied to estimate LATs: the conventional -dV/dt method, which identifies the steepest negative deflection, and our novel Bayesian approach. The error in the location of the origin of the electrical activation and the similarity of the LAT maps were calculated with respect to the reference computer model. Additionally, we tested both algorithms in four patients with PVCs originated in different locations (three in the output tract of the right ventricle and one in the ventricular base, close the coronary sinus).

Results
The results indicated a substantial improvement in identifying the earliest activation site using our Bayesian algorithm, with a reduced localization error (1.5 ± 2.5 cm to 0.6 ± 1.5 cm). The root mean squared error (RMSE) was also significantly lower when comparing our Bayesian LAT maps to the reference LATs obtained in the simulations (19.0 ± 5.3 vs. 10.8 ± 4.5 ms). Patient data revealed smoother and more physiologically consistent propagations in the Bayesian maps, aligning with the PVC origins identified via electroanatomical navigation systems.

Conclusion
This study demonstrates that ECGI signals, when processed with advanced Bayesian techniques, significantly enhance LAT estimation. The proposed methodology improves the localization accuracy of ectopic beats and has practical implications for optimizing PVC treatment protocols.
Percutaneous stellate ganglion blockade as an add-on therapy for the treatment of arrhythmic storm
Authors: Prolic Kalinsek T , Salihovic M , Podlogar V , Stublar J , Irsic J , Jan M 
Published: May 2024

Abstract

Introduction
Arrhythmic storm (AS) due to repetitive ventricular arrhythmias (VA) is a life-threatening condition that can be resistant to antiarrhythmic therapy. Sympathetic nervous system plays an important role in triggering and maintaining VA. Reducing sympathetic activity by percutaneous stellate ganglion blockade (SBG) may improve outcomes in treating AS.

Purpose
To evaluate the effect of SBG on outcomes of AS.

Methods
In this retrospective study, we analyzed 18 patients treated with SBG for AS from August 2017 to May 2022. All patient experienced VA while on antiarrhythmic drug therapy. SBG was performed under ultrasound guidance to avoid vascular structures. Either 0.75% levobupivacaine or 0.5% ropivacaine were applied to block the stellate ganglion after negative aspiration. The decision to perform unilateral or bilateral SBG was left to the operator.

Results
The majority of patients were male (17/18, 94.4%), mean age was 61.8 ± 13.4 years, mean BMI 28.1 ± 5.39 kg/m2, mean LVEF was 34.4 ± 12.2%, majority had an ischemic cardiomyopathy (12/18, 66.7%). Half of the patients had monomorphic VA (9/18, 50.0%), the other half had polymorphic VA (9/18, 50.0%). Majority of patients were hemodynamically unstable (13/18, 72.2%) and more than a third had a cardiac arrest (7/18, 38.9%). Half of the patients had unilateral SBG (9/18, 50.0%), and the other half bilateral SBG (9/18, 50.0%). SBG was repeated in two patients (2/18, 11.1%). On the repeat procedure, both had bilateral SBG. There were 4 minor complications (4/18, 22.2%) and no major complications. Two patients had intermittent Horner’s syndrome, one had a small hematoma on the puncture site, and one had small hematoma in the mediastinum. All complications resolved on their own and did not require an intervention. In the 72 hours after SBG, 5 patients had a recurrence of VA (5/18, 27.8%). After the discharge, 6 patients also had a recurrence of VA (6/18, 44.4%). SBG significantly reduced mean number of VA episodes in the next 72 hours (12.3 ± 11.1 vs 4.3 ± 10.6; P=0.007) with a mean difference of 8.0 VA episodes (95% CI, 4.5 - 14.0; P=0.007) (Figure 1). One patient died due to recurrent VA leading to ischemic brain damage (1/18, 5.6%). Four patients died due to non-VA related causes (4/18, 22.2%). Two deaths were due to septic shock, the other two due to cardiogenic shock. Details of baseline characteristics and outcomes are in the Figure 2.

Conclusion
SBG significantly reduces episodes of VA after failed antiarrhythmic drug therapy in patients presenting with AS.A before-after graph of VA after SBG.Baseline and outcomes table.