bluuebunny/crossref_metadata_2025_split huggingface dataset:
The contribution of pulmonary veins to the mechanism of persistent AF is dependent on their extent of electrical connection
Authors: Marchetti M , Haddad C , Luca A , Gentil P , Le Bloa M , Teres C , Domenichini G , Pia-Porretta A , Herrera C , Pruvot E , Pascale P 
Published: May 2024

Abstract

Introduction
Success rate of pulmonary vein isolation (PVI) is lower in patients with persistent AF (peAF) compared to paroxysmal AF. The indiscriminate use of adjunctive catheter ablation (CA) strategies beyond PVI involve potential risks and new areas of iatrogenic arrhythmogenesis. Thus, distinguishing patients with peAF who may be cured with PVI-only from those who need CA beyond PVI would allow a more efficient patient-tailored CA strategy.

Purpose
We aimed to evaluate whether the circumferential extent of PV electrical connection assessed during pre-ablation mapping predicts the success rate of a PVI-only CA strategy.

Methods
Consecutive patients with peAF undergoing first CA consisting of a PVI-only CA were included. The extent of PV electrical connection was assessed using a circular mapping catheter placed within the PVs prior to ablation. Based on their follow-up (FU), patients were considered: a) PVI-responders, in the absence of AF or atrial flutter recurrence ≥ 12 months off-anti-arrhythmic drugs, b) PVI-non responders, in case of AF recurrence despite absence of any PV reconnection at reintervention, or despite one reintervention consisting of stand-alone residual PV connection ablation, c) PVI response was considered as indeterminate for all other instances (eg. Sinus rhythm maintenance on-AAD, shorter FU, etc).

Results
148 patients were included (mean age 64 ± 9.7 years, mean peAF duration 7.3 ± 7 months). After a mean FU of 18 months after last PVI, we identified 60 PVI-responders and 25 PVI- non responders. In the remaining 63 patients, PVI response was indeterminate. In PVI-responders, the median percentage of the PV circumference displaying PVs potentials was significantly higher compared to PVI-non responders (68% vs. 60%, respectively; p=0.035).

Conclusions
The circumferential extent of PVs connection is correlated to the success rate of a stand-alone PVI CA strategy in patients with peAF. It may be a marker of the contribution of PVs to AF. Patients with poorly connected PVs during index CA ablation may warrant additional ablation strategies beyond PVI.
Very-high power short duration radiofrequency ablation (90W/4seconds) under mild conscious sedation: lesion metrics and 12-month outcomes
Authors: Mills M , Calvert P , Koniari I , Ashrafi R , Snowdon R , Gupta D , Luther V 
Published: May 2024

Abstract

Background
Pulmonary vein isolation (PVI) is often performed under general anaesthesia (GA) or deep sedation. Anaesthetic availability is limited in many centres across Europe, and deep sedation is prohibited in some countries without anaesthetic support. Very high-power short duration (vHPSD – 90W/4sec) PVI using the Q-Dot catheter is well tolerated under mild conscious sedation (MCS) administered by nurses under physician direction. Here, we present lesion metrics and 12-month freedom from atrial arrhythmia with this approach.

Methods
Our approach to radiofrequency (RF) PVI under MCS is standardised and includes a single catheter approach with a steerable sheath (Figure 1). We identified patients who had undergone Q-Dot RF PVI between March 2021 and December 2022 in our centre, comparing those undergoing vHPSD ablation under MCS (90W/MCS) against those undergoing 50W ablation under GA (50W/GA). Data were extracted from the CARTO system and electronic clinical records.

Results
83 patients were included in our analysis (51 90W/MCS; 32 50W/GA). Despite shorter ablation times (353 vs 886 sec; p&lt;0.001), the 90W/MCS group received more lesions (median 87 vs 58, p&lt;0.001), resulting in similar procedure times (120 vs 123 min; p=0.705) (Figure 2). PVI was achieved in all cases, and first pass isolation rates were similar (left WACA 82.4% vs 87.5%, p=0.758; right WACA 74.5% vs 78.1%, p=0.796; 90W/MCS vs 50W/GA respectively). Analysis of 6,647 ablation lesions found similar mean impedance drops (10.0 ± 1.9 Ω vs 10.0 ± 2.2 Ω; p=0.989) and mean contact force (14.6 ± 2.0 g vs 15.1 ± 1.6 g; p=0.248). Similar percentages of lesions achieved &gt;10Ω impedance drop in each arm (48.5 ± 23.1% vs 42.6 ± 17.4%; p=0.224). Only a median 2.5% of lesions in the 90W/MCS arm failed to achieve impedance drop ≥5Ω, compared with 13.7% in the 50W/GA arm (p&lt;0.001). In the 90W/MCS group, there were no procedural related complications. Across median 12-month follow-up, freedom from atrial arrhythmia was observed in 78.4% of patients in the 90W/MCS group, compared with 68.8% in the 50W/GA group (p=0.437), the difference likely being accounted for by the higher prevalence of persistent AF, hypertension and significant left atrial enlargement in the 50W/GA group. Redo ablation was required in 3 (5.9%) of the 90W/MCS group vs 2 (6.2%) of the 50W/GA group (p&gt;0.999) during 12-month follow-up.

Conclusion
vHPSD PVI can be performed under nurse-administered MCS safely and effectively to achieve adequate rates of 12-month arrhythmia freedom. The mean contact force and impedance drop of a 90W/MCS lesion is similar to a 50W/GA lesion. Whilst more lesions may be required using 90W/MCS to achieve FPI, total ablation duration is significantly shorter and procedural times are similar when compared to 50W/GA. This provides a compelling option for centres with limited anaesthetic support.Figure 1Figure 2
Heart rate dynamics after pulmonary vein isolation: pulsed-field vs. radiofrequency ablation
Authors: Valeriano C , Buytaert D , De Schouwer K , Addeo L , Geelen P , De Potter T 
Published: May 2024

Abstract

Background
The autonomic nervous system (ANS) plays a pivotal role in the onset and maintenance of atrial fibrillation (AF). During thermal ablation, the epicardial ganglionated plexi (GP) can inadvertently be affected, as indicated by a post-ablation increase in heart rate (HR), potentially impacting post-procedural outcomes. Pulsed-field ablation (PFA) offers a safer and potentially more effective alternative, as lesion transmurality is not inversely related to safety as in thermal ablation. However, PFA's tissue selectivity may limit its effectiveness in ablating potential AF triggers like GP.

Purpose
We aimed to assess the impact of PF and RF energy on GP ablation by examining HR changes following PVI procedures.

Methods
We examined consecutive paroxysmal AF patients undergoing PVI at a single center, using either a variable-loop circular PFA catheter, as part of the inspIRE trial, or a conventional point-by-point RF catheter (1:2 ratio). ECGs were collected before and after ablation at multiple time points, including 1-hour, 1-day, 1-month, and 3-month intervals, with a 24-hour Holter ECG at 3 months. Patients without obtainable sinus rhythm ECGs at these time points were excluded. We also gathered data on post-ablation antiarrhythmic drug and beta-blocker usage. Data are reported as mean±SD, and analysis employed Student’s t-tests, paired t-tests, chi-squared tests, and multiple linear regression analysis to identify influencing factors.

Results
A total of 105 patients were included (PF = 35, RF = 70). Baseline demographics were similar (Table A). In the RF group, HR significantly increased at all measured time-points. In contrast, this trend was not observed in the PF group (Figure A and B). Following the procedure, the RF cohort exhibited a significantly higher HR compared to PF (7.3±10.3 vs. 0.8±11 at 1-day, p=0.018), and this difference persisted after 3 months (8.5±10.1 vs. 0.9±9, p&lt;0.001, Figure C). These findings remained consistent when HR was assessed using Holter ECG data (HR at 3 months: mean 72.1±8.8 vs 65.8±9.4, min 55.2 vs 48.9; p=0.002, p=0.001, Figure D). The use of RF energy was the only predictor of HR increase after the ablation procedure (β = 7.687, p &lt; 0.001, Table B).

Conclusion
Our findings indicates that PFA does not increase resting HR as seen with thermal RF ablation, suggesting limited effect on ANS modulation. The role of adjunctive GP ablation during PVI procedures remains a topic of debate.While PFA shows promising improvement in lesion durability, current evidence does not conclusively establish its advantage over RF. This invites contemplation about whether the addition of GP ablation in RF procedures could be a contributing factor. The absence of HR acceleration may pose issues for patients with sick sinus syndrome or pure vagally mediated AF. Further research is essential to confirm these findings and their clinical implications.Central illustrationTables
Optimization of high-power short-duration pulmonary vein isolation using QDOT catheter - the A-Q-RATE POWER trial
Authors: Gardziejczyk P , Piotrowski R , Skrzynska-Kowalczyk M , Skowronska M , Wlazlowska-Struzik E , Niedzwiedz M , Kulakowski P , Baran J 
Published: May 2024

Abstract

Background/Introduction
The safety and efficacy of novel ablation catheter QDOT Micro, capable of delivering high-power short-duration (HPSD) radio-frequency (RF) applications, has already been demonstrated in clinical trials. It has been shown that lesions performed with 90 Watts/4 sec (vHPSD) are shallower but wider compared to HPSD (50 Watts/4 sec) or conventional ablation settings. Thus, it may be speculated that vHPSD applications may not achieve transmurality at thick (up to 4 mm) parts of anterior aspects of pulmonary vein (PV) - left atrial (LA) wall junction.

Purpose
To compare acute completeness of PV isolation (PVI) focused on anterior wall achieved using vHSPD versus HPSD in patients undergoing ablation for atrial fibrillation (AF).

Methods
Prospective, dual-center, randomized study was conducted over a 8-month period. Patients were randomized 1:1 to vHPSD versus HPSD delivered at anterior aspects of PV. Posterior parts of PV were ablated with vHPSD in both arms. The carina region between ipsilateral PVs was ablated using 35 W and ablation index of 380. Need for additional RF applications to achieve complete PVI was the primary outcome.

Results
70 patients (mean age 63.5±11.2; 57.1% male) with paroxysmal (61.4%) or persistent AF (38.6%) were randomized to vHPSD (n=35) or HPSD (n=35). Additional RF touch-up applications at the anterior aspects of PV were significantly more frequently needed in the vHPSD group compared with the HPSD group (46% vs 19%, p&lt;0.001) and in the right PVs (57% vs 20%, p=0.001) versus left PVs (34% vs 17%, p=0.1). Median procedure duration, LA dwell time and fluoroscopy time were similar in both groups [112 (IQR 90, 130) min vs 107 (IQR 90,125) min, p= 0.58; 95 (IQR 70,106) min vs 90 (IQR 71,100) min, p=0.55; and 28 (IQR 14,69) sec vs 46 (IQR 0,89) sec, p=0.97, respectively). In one patient in vHPSD we were not able to isolate right superior pulmonary vein (RSPV) despite additional RF touch-up applications.

Conclusions
vHPSD RF applications using the QDOT Micro catheter may not achieve transmurality in a significant proportion of anterior parts of PV. The proposed hybrid strategy consisting of HPSD delivery at anterior aspects of PV with vHPSD delivered at other parts of PV ostia is associated with significantly higher rate of first-pass PVI without extending procedural and fluoroscopy duration.
Long-term recurrence-free survival following second-generation cryoballoon ablation for persistent atrial fibrillation: role of the autonomic nervous system
Authors: Guckel D , El Hamriti M , Fink T , Sciacca V , Braun M , Khalaph M , Isgandarova K , Sommer P , Sohns C , Noelker G 
Published: May 2024

Abstract

Background
The cardiac autonomic nervous system (ANS) plays a pivotal role in the regulation of atrial fibrillation (AF). Cryoballon (CB)-guided pulmonary vein isolation (PVI) is an established treatment for AF.

Purpose
In our present study we evaluated the impact of vagal reactions (VRs), as a surrogate parameter for ANS modulation, on the long-term outcome of CB-ablation in patients with persistent AF (PERS AF).

Methods
Data from consecutive PERS AF patients undergoing primary CB-guided PVI for symptomatic drug refractory AF between 2013-2023 were analysed. VRs were defined as bradycardia &lt; 40 beats/min, asystole or higher-degree atrioventricular block. Long-term follow-up data were assessed. AF-recurrence was defined as AF lasting &gt; 30 seconds beyond a 3-month blanking period.

Results
A total of 250 consecutive patients (mean age 63.9±10.0 years, 30% female) were included. VRs were recorded in 61 patients (24%, mean age 64.2±13.0 years, 30% female). The mean follow-up duration amounted to 84±14 months. Within this observation period 101 patients (40%) developed AF-recurrence. Re-ablation procedures were performed in 61 patients (60%). Patients with PVI-associated VRs presented with a significantly higher estimated AF-free survival rate (log-rank p-value &lt; 0.001) (Figure 1) and a significantly longer median AF-free survival time (75 months, interquartile range (IR) 63-92 months) compared to those without (69 months, IR 13-79 months) (p=0.002). Beyond that Kaplan-Meier plot analyses revealed significant gender differences (Figure 1). Multivariate cox regression analyses confirmed VRs (Confidence interval (CI) 0.294-0.838, Hazard Ratio (HR) 0.497, p=0.009) and male gender (CI 0.352-0.781, HR, 524, p=0.001) as independent predictors (IPs) for AF-free-survival.

Conclusion
CB-ablation procedure associated VRs and male gender seem to be associated with a favorable long-term outcome in PERS AF. Further studies are warranted to verify our observations.Kaplan Meier plot on long-term AF-free s
Adherence to CLOSE protocol, high-power and low baseline generator impedance predicts durable pulmonary vein isolation
Authors: Szegedi N , Boga M , Orban G , Sallo Z , Nagy V K , Osztheimer I , Perge P , Ferencz A B , Komlosi F , Toth P , Merkely B , Geller L 
Published: May 2024

Abstract

Background
Atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) is predominantly attributed to pulmonary vein reconnection (PVR). Predictors of AF recurrence were widely studied. However, data are scarce on the procedural parameters that predict chronic PVR.

Aims
to study the PVR rates and the predictors of PVR after initial PVI procedure.

Methods
We included 100 consecutive patients who underwent repeated ablation due to AF recurrence after initial PVI with the CARTO system, both procedures performed between 2018 and 2023.

Results
The mean age of the patients was 60 ± 12 years, 36% were female, and 44% had persistent AF. Thirty-eight patients underwent initial CLOSE-guided, and sixty-two underwent initial non-CLOSE PVI. Repeat procedure was performed 21 ± 14 months after the initial procedure. In total, PVR was found in 192 of 373 PVs (51.5%) and all PVs were isolated in 17/100 (17%) patients. Factors associated with all PVs being isolated were adherence to the CLOSE protocol (39.5% vs. 3.5%, p &lt; 0.0001), higher delivered mean power (37.5W vs 30W, p = 0.027), presence of first-pass isolation (88.2% vs 40.4%, p = 0.0007), and lower baseline generator impedance (127.6 vs 136.6 Ω, p = 0.0027; respectively). Baseline generator impedance &gt;130 Ω (AUC = 0.7403, sensitivity: 77.1%, specificity: 68.8%, p = 0.0032) was associated with significantly higher probability of PVR (OR = 6.757; p &lt; 0.0001).

Conclusions
Our findings indicate that adherence to the CLOSE protocol, higher power setting, first-pass isolation, and baseline generator impedance &lt;130 Ω during AF ablation improves the durability of PVI and reduces the incidence of PVR.
Higher recurrence rate after ablation of persistent atrial fibrillation in patients with prolonged P-wave negativity in lead V1
Authors: Coudray E , Le Bloa M , Teres C , Herrera C , Domenichini G , Ascione C , Porretta A , Solana Munoz J , Roten L , Kuhne M , Knecht S , Sticherling C , Pascale P , Pruvot E , Luca A 
Published: May 2024

Abstract

Background
Several ECG P-wave parameters, such as duration, amplitude and morphology reflect the electromechanical condition of the atria. P-wave features mainly served to identify patients prone to atrial fibrillation (AF) or to predict recurrence of paroxysmal AF after ablation.

Purpose
We sought to investigate which specific features derived from the P-wave might help identify patients with persistent atrial fibrillation (peAF) unresponsive to wide circumferential pulmonary veins isolation (WPVI).

Methods
41 patients (63±10 y) with peAF (sustained duration 11±7 months) underwent a de-novo WPVI. A second WPVI was performed in patients with recurrent AF in order to provide complete PV disconnection. We defined "success" as patients who remained in sinus rhythm (SR) after one or two procedures, and "failure" otherwise. The average duration and amplitude of the P-waves on ECG lead II, and the duration and amplitude of positive and negative deflections on ECG lead V1 were extracted during SR after cardioversion at the end of the index WPVI. P-wave terminal force in V1 (PTFV1) was computed as the product of negative amplitude and duration in lead V1.

Results
Over a mean follow-up of 32±9 months, 24 patients remained free from AF (success group), while 11 patients had AF recurrence after 2 WPVIs (failure group). Six patients were lost to follow-up or declined the second WPVI. 45% (5/11) were ON antiarrhythmic drugs (AAD) during follow-up in the failure group, while 0.04% (1/24) were ON AAD in the success group (p&lt;0.05). Other clinical characteristics (e.g. age, body mass index, left atrial volume or duration in sustained AF) were similar. The figure displays P-wave metrics of patients ON and OFF AAD during follow-up. No significant differences were found in P-wave duration (lead II; Panel A1), in PTFV1 (Panel A2), and in duration of V1 positive deflection (Panel A3). Interestingly, the failure group displayed longer duration of the negative deflection in V1 (76±17ms) than that of the success group (68±18ms, p&lt;0.05; Panel A4). Panel B shows that the differences remained after exclusion of patients ON AAD during follow-up. No differences were found in P-wave amplitude in lead II or in amplitude of positive and negative deflections in lead V1 (data not shown).

Conclusion
Our results show that prolonged negativity in lead V1, which is indicative of left atrial electromechanical remodeling, is associated with failure to restore long-term sinus rhythm after WPVI of peAF.
Ultra-short-term deceleration capacity and heart rate variability as indicators of vagal denervation before and after pulmonary vein isolation
Authors: Zarebski L , Futyma P 
Published: May 2024

Abstract

Introduction
Pulmonary vein isolation (PVI) is a well-established therapy of atrial fibrillation (AF). However, subtypes of AF can differ and exact mechanisms in which patients benefit from PVI remain not fully understood. Parasympathetic activity can play important role in pathogenesis of AF. Moreover, catheter ablation can impact vagal innervation of the heart, nevertheless methods of periprocedural assessment of such impact of PVI are lacking.

Purpose
Ultra-short-term deceleration capacity (UST-DC) and ultra-short-term heart rate variability (UST-HRV) were investigated to determine their potential function as indicators of parasympathetic activity before and after PVI.

Methods
24 consecutive patients (8 females, age 54±11) with paroxysmal AF were included in the study. UST-DC and UST-HRV were calculated from 1-minute ECG recordings performed before and after PVI.

Results
There was a significant differences between UST-DC before PVI vs after PVI (7.6ms vs 2.8ms; p=0.0000018) and between UST-HRV parameters before and after PVI: standard deviation of normal-to-normal (UST-SDNN) (37.8ms vs 18.4ms; p=0.00005), root mean square of successive differences (UST-rMSSD) (25.3ms vs 12.2ms; p=0.00083) and proportion of success NN intervals differing more than 50ms divided by total number of NNs (UST-pNN50) (8.4% vs 2%; p=0.045). Heart rate (HR) increase was also statistically significant (pre-PVI vs post-PVI, 65.5bpm vs 73.7bpm; p=0.016). After 3-months patients with baseline UST-DC&gt;7.5ms, were less likely to experience AF recurrence when compared to patients with baseline UST-DC&lt;7.5ms (0% vs 31%, p=0.0496). In these groups difference in AF recurrences after 12-months of follow-up did not meet statistical significance (36% vs 38%, p=0.52). No correlation between UST-HRV parameters and AF recurrence during follow up was observed.

Conclusions
PVI leads to significant changes in UST-DC and UST-HRV and these parameters may serve as indicators of vagal denervation after AF ablation. Patients with more prominent baseline UST-DC are less likely to experience AF recurrence during 3-month blanking period after PVI.
Pulsed electric field, cryoballoon, and radiofrequency for paroxysmal atrial fibrillation ablation: a propensity score-matched comparison
Authors: Marcon L , Della Rocca D , Magnocavallo M , Mene' R , Pannone L , Mohanty S , Glowniak A , Sousonis V , Sorgente A , Sarkozy A , Rossi P , Boveda S , Natale A , De Asmundis C , Chierchia G B 
Published: May 2024

Abstract

Background and Aims
Pulmonary vein isolation (PVI) is the most effective rhythm control strategy in paroxysmal atrial fibrillation (AF). Pulsed field ablation (PFA) has emerged as a novel, non-thermal energy source to selectively ablate cardiac tissue. We report the first multicenter experience on PVI via the pentaspline FarapulseTM PFA system versus thermal-based technologies in a propensity score-matched population of paroxysmal AF patients.

Methods
Propensity score matching was adopted to compare PVI-only ablation outcomes via the FarawaveTM PFA system (Group PFA), cryoballoon ablation (Group CRYO), or focal radiofrequency (Group RF) (PFA:CRYO:RF Ratio=1:2:2).

Results
Among 1572 (mean age: 62.4±11.3 years; 42.5% females) PAF patients undergoing their first time PVI with either PFA (n=174), CRYO (n=655), or RF (n=743), propensity score matching yielded 174 PFA, 348 CRYO, and 348 RF patients. First-pass isolation was achieved in 98.8% of pulmonary veins (PVs) with PFA, 81.5% with CRYO, and 73.1% with RF (p&lt;0.001). Procedural and dwell times were significantly shorter with PFA. Overall complication rates were 3.4% (n=6) with PFA, 8.6% (n=30) with CRYO, and 5.5% (n=19) with RF (p=0.052). The 1-year Kaplan-Meier estimated freedom from any atrial tachyarrhythmia was 79.3% with PFA, 74.7% with CRYO, and 72.4% with RF (log-rank p-value: 0.24). Among 145 repeat ablation procedures, PV reconnection rate was 19.1% after PFA, 27.5% after CRYO, and 34.8% after RF (p=0.01).

Conclusion
PFA contributed to significantly shorter procedural times. Follow-up data showed a similar arrhythmia freedom among groups, although a higher rate of PV reconnection was documented in post-CRYO and post-RF redo procedures.RecurrencePVs