bluuebunny/crossref_metadata_2025_split huggingface dataset:
Direct epicardial validation of posterior wall isolation in persistent atrial fibrillation: pulsed field versus radiofrequency ablation
Authors: Compagnucci P , Solimene F , Tondo C , La Fazia V M , Schillaci V , Mohanty S , Cipolletta L , Fassini G M , Chiariello P , Mottola G , Schiavone M , Casella M , Dello Russo A , Natale A 
Published: May 2024

Abstract

Background
Lesion transmurality is an important determinant of durable effectiveness of catheter ablation (CA) for atrial fibrillation (AF). The impact of different energy sources on the achievement of transmural left atrial (LA) ablation has not been explored so far.

Purpose
We sought to compare the transmurality associated with pulsed field ablation (PFA) and radiofrequency (RF) ablation of LA posterior wall (PW) among patients with persistent AF.

Methods
Eight patients (mean age, 70±7 years; 88% male) undergoing CA for persistent AF with PW ablation and adjunctive high-density epicardial mapping were included in a multicenter international registry. In four patients, PW ablation was performed using PFA, while in the remaining four, RF energy was used with high/very-high-power short-duration settings. The primary study outcome was transmural PW isolation (PWI) with endocardial-only ablation.

Results
A trend towards shorter times required to complete endocardial PW ablation was observed with PFA compared to RF (9±1 vs 11±2min, p=0.065). At endocardial mapping, apparent PWI was observed in all cases. However, transmural PWI after endocardial-only ablation was demonstrated in each patient in the PFA group, but only in one RF case, in whom 50 Watt/≥10 sec settings were used (100% vs 25%, p=0.143). Interestingly, in three patients in the RF group, endocardial ablation resulted in conversion of AF into atypical flutter, which could be successfully terminated by epicardial ablation.

Conclusions
We observed a trend towards greater transmurality with PFA compared to high/very-high power RF ablation in the region of septopulmonary bundle. This observation may have potential implications on clinical outcomes after endocardial AF CA.
Impact of restoration of sinus rhythm after catheter ablation of atrial fibrillation on reverse cardiac remodelling
Authors: Alatic J , Suran D , Pirnat M , Vokac D , Naji H F 
Published: May 2024

Abstract

Introduction
Catheter ablation (CA) with pulmonary vein isolation (PVI) has become widely used for the treatment of atrial fibrillation (AF). Restoration of sinus rhythm in patients with AF is of vital importance, because AF induces the development of heart failure (HF) through various pathophysiological mechanisms, one of them is epicardial adipose tissue (EAT). EAT is a type of visceral adipose tissue that is in direct contact with the myocardium. Under pathological conditions it serves as a direct and indirect factor in pathogenesis of AF. It is also an established prognostic factor after CA of AF recurrence. Since cardiac magnetic resonance (CMR) represent the gold standard for the measurement of volume and muscle mass, it has been used more and more for the assessment of EAT volume lately.

Purpose
The aim of our study was to investigate the impact of restoration of sinus rhythm on EAT volume, and cardiac function and morphology evaluated by the CMR.

Methods
We prospectively included 17 patients with paroxysmal and persistent AF that were referred for CA. All patients underwent cardiac magnetic CMR prior to radiofrequency CA with PVI and 6 months thereafter in order to quantify periatrial EAT volumes and evaluate cardiac morphological and functional characteristics. AF recurrence rate was diagnosed by serial ECG recordings, Holter ECG monitoring and AF suggestive symptoms within 6 months of follow-up period.

Results
17 patients, mainly male (76.5 %) with an average age of 62.35 ± 12.10 years were included in our study. The average body mass index (BMI) was 29.0 ± 4.71 kg/m2. Most patients had paroxysmal AF prior to CA (88.2 %). The recurrence rate of AF was 35.3 % after 6 months of follow-up. By performing CMR after 6 months of CA we observed lower median periatrial EAT volume (36.00 mL (IQR 38.25 mL) vs. 27.45 mL (IQR 30.94 mL); p= 0.004) and lower median left ventricular mass (LVM) (104.0 g/m2 (IQR 38 g/m2) vs. 100.0 g/m2 (IQR 42 g/m2); p= 0.019). Furthermore, when patients were stratified based on the AF status after the follow-up period, we observed that the patients who remained AF-free had significantly lower median periatrial EAT volumes (38.90 mL (IQR 43.84 mL) vs. 26.83 mL (IQR 33.25 mL); p= 0.003) and median LVM (96 g/m2 (IQR 35 g/m2) vs. 90 g/m2 (IQR 29.8 g/m2); p= 0.041) compared to the group of patients who relapsed where we did not observe a significant change in periatrial EAT volume (23.76 mL (IQR 26.84 mL) vs. 31.28 mL (IQR 27.84); p= 0.345) or LVM (117.5 g/m2 (IQR 34 g/m2) vs. 112 g/m2 (IQR 28.6 g/m2); p= 1.0). Significant correlation was observed between BMI and periatrial EAT volume (p= 0.029).

Conclusions
Restoration of sinus rhythm after CA of AF is associated to lower periatrial EAT volume and LVM. Patients who relapsed did not show reverse cardiac remodelling. Periatrial EAT volume significantly correlates with BMI.
Weight change does not impact the long-term outcomes following pulmonary vein isolation in obese patients with atrial fibrillation
Authors: Musat D , Milstein N S , Park L S , Bhatt A , Habibi M , Kochav S , Preminger M , Sichrovsky T , Shaw R , Mittal S 
Published: May 2024

Abstract

Background
Weight loss has been shown to reduce the burden of atrial fibrillation (AF) in obese patients. However, there are limited data on the impact of weight loss on long-term outcomes in patients with atrial fibrillation (AF) who undergo pulmonary vein isolation (PVI).

Objective
To understand the impact of weight change, as assessed by freedom from recurrent AF, in obese patients undergoing cryoballoon (CB) PVI.

Methods
We enrolled consecutive obese (BMI ≥ 30 kg/m2) patients with AF who underwent CB PVI; all patients had an implantable loop recorder (ILR) for long-term ECG monitoring. The cohort was divided into 3 groups based on their weight change 1-year after ablation: (1) weight loss (WL) &gt; 3% weight decrease; (2) no weight change (NWC) - weight change &lt; 3%, (3) weight gain (WG) &gt; 3% weight increase. We assessed long-term AF recurrences, after excluding an initial 3-month post-ablation blanking period.

Results
Out of total of 137 pts with obesity, 61 pts had weight available at the ablation and at 1-year follow-up (65 ± 9 years; 41 [67%] male; 23 [38%] PAF; CHA2DS2-VASc 2.9 ± 1.7). There were no differences in baseline characteristics. At follow-up, 24 (39%), 26 (43%), and 11 (18%) pts lost, had no change, or gained weight, respectively. Of the 24 pts who lost weight, 3 pts lost &gt; 10% body weight. During a follow-up of 964 ± 512 days, 41 (67%) pts had recurrent AF; the change in weight did not impact outcomes (Figure), including those who lost &gt; 10% body weight.

Conclusions
During 3-years of follow-up, 2/3 of obese patients had objective evidence of AF recurrence following CB PVI. Weight change in the first-year post ablation did not alter long-term outcomes. Other strategies may be needed in these patients to improve outcomes.
Real-world multicenter registry on a novel focal lattice tip catheter toggling between pulsed electric field and radiofrequency for atrial tachyarrhythmia ablation
Authors: Della Rocca D , Vetta G , Mene R , Pannone L , Betancur A , Sorgente A , Almorad A , La Meir M , Del Monte A , Marcon L , Combes S , Boveda S , De Asmundis C , Sarkozy A , Chierchia G B 
Published: May 2024

Abstract

Background
Pulsed field ablation (PFA) has emerged as a novel non-thermal energy source for cardiac tissue ablation. A novel focal 9mm lattice tip catheter, namely Sphere-9 (Affera Inc), has recently received regulatory approval; the technology is part of a technology that allows the delivery of either pulsed electric field or radiofrequency energy and incorporates a proprietary 3D electroanatomical mapping system.

Purpose
To describe the first real-world, multicenter experience with the AfferaTM system.

Methods
Consecutive AF patients undergoing first-time or redo atrial tachyarrhythmia ablation with the AfferaTM system in two different centres between August and November 2023 were prospectively enrolled. PFA was always used to ablate the posterior left atrium, whereas anterior applications were performed using either radiofrequency energy (RF/PF strategy) or PFA (PF/PF strategy) based on operator's discretion. Data on first-pass pulmonary vein isolation (PVI) and posterior wall isolation (PWI), as well as success rate of extrapulmonary ablation were reported. Primary safety endpoint included any technology-related periprocedural complications.

Results
46 patients (mean age: 67±10; 41.3% males, 60.8% non-paroxysmal AF) were included.
5 (10.8%) patients were in atrial flutter (AFlu) at the beginning of the procedure, whereas AF was the rhythm at presentation in 19 (41.3%) others.
First-time PVI was performed in 37 (80.4%) patients, 68.4% of whom received concomitant PWI. PVI was performed with PFA-only in 27% of them. First-pass isolation was achieved in 97.3% and 100% of PVI and PWI cases, respectively.
Additional lesions included an anterior or posterior mitral line (6 and 15 patients), CTI (4 patients) or substrate ablation in 3 patients. Evidence of first-pass line block was documented in 96.4% of patients.
The remaining 9 (19.6%) patients had already undergone a previous ablation; remapping showed 27.7% of PVs requiring reisolation. PWI was performed in 88.9% of them, for the first time (75%) or due to reconnection (25%). Additional lesions included an anterior or posterior mitral line (3 and 3 patients) or CTI in 2 patients. Evidence of first-pass line block was documented in 100% of patients.
In 3 AFlu patients, the arrhythmia was mapped and termination was achieved while performing an AML (2 patients) and CTI (1 patient).
Procedural duration was 96.5±15.6 min for first time and 97.8±12.6 min for redo procedures. Mean left atrial dwelling and fluoroscopy times were 75.4±17.6 min and 7.36±2.1 min, respectively.
No technology-related complications were documented.

Conclusions
AF ablation with the focal 9-mm lattice tip catheter Sphere-9 confirmed high efficacy and safety in a real-world population.
Advanced pulsed field ablation: comprehensive analysis of safety and efficacy in a real-world cohort
Authors: Parwani A , Mahrous N , Rozados Da Conceicao C , Baehr F , Schoeppenthau D , Blaschke F , Dagres N , Hindricks G , Boldt L H 
Published: May 2024

Abstract

Background
Pulsed field ablation (PFA) represents a novel energy modality for catheter ablation of atrial fibrillation (AF). Initial preclinical and clinical studies indicate a higher safety profile with promising efficacy outcomes as well as shorter procedure times. Real world data are sparce and methods to improve clinical success rates are under development.

Methods
In this observational study 124 patients underwent pulmonary vein isolation with PFA (Farapulse, Boston) for paroxysmal and persistent AF. For anatomical visualization and optimal positioning of the PFA catheter a 3D mapping system was used (Ensite X, Abbott). Patients were followed over a 15-month period to evaluate both efficacy and safety of PFA in a real-world cohort using an advanced mapping technology.

Results
The patient cohort had a mean age of 67 ± 11 years, 38% females (n= 47), paroxysmal AF 53% (n = 66), persistent AF 47% (n = 58). Acute pulmonary vein isolation (PVI) rate was 100%. After a median FU of 6 months, 17 patients (14%) had a recurrence of AF.
In our study population no esophageal complications, pulmonary vein stenosis, or persistent phrenic palsy occurred. Major complications were observed in 2.4% of the cases (3/124), involving two pericardial tamponades (1.6%) and one vascular complication with intervention (0.8%). There were no stroke events and no occurrences of death. Noteworthy was the absence of complications such as coronary arterial spasm or hemolysis-related acute renal failure. The average dose-area product and average procedure time were 9.54 ± 7.68 µGym² and 57.94 ± 18 minutes, respectively.

Conclusion
PVI with PFA in a real world cohort demonstrates a high safety profile. Furthermore, high clinical success rates can be achieved also in mixed paroxysmal/persistent AF populations. The use of 3D mapping systems might even improve clinical outcomes of PVI with PFA and will also help to guide more complex ablation strategies in the future. These findings pave the way for further exploration into the long-term benefits and broader applicability of PFA in AF ablation.
LINAC-Based STereotactic Arrhythmia Radioablation (STAR) for paroxysmal atrial fibrillation in elderly: a prospective phase II trial
Authors: Romanazzi I , Di Monaco A , Valenti N , Grimaldi M 
Published: May 2024

Abstract

Background and aims
Stereotactic arrhythmia radioablation (STAR) is a novel therapeutic approach for cardiac arrhythmias. The aim of this trial is to investigate the feasibility of STAR for the treatment of paroxysmal atrial fibrillation (AF) in elderly patients.

Method
inclusion criteria were: age &gt; 70 years, symptomatic AF, antiarrhythmic drugs failure or intolerance. All patients underwent to 4D cardiac Computed Tomography simulation. The clinical target volume was identified in the area around pulmonary veins (PV). STAR was performed with a total dose of 25 Gy (single fraction) delivered in 3 minutes.

Results
Twenty patients were enrolled and 18 underwent STAR. One patient withdrew informed consent before treatment and 1 patient was excluded due to unfavorable esophagus position. With a median follow-up (FU) of 16 months (range 12-23), no acute toxicity more than grade 3 was reported. Five patients had a grade 1 esophagitis 24 hours after STAR; eight patients had an asymptomatic grade 1 pericardial effusion, one patient had a torsade de pointes treated effectively by electrical cardioversion and subsequent cardiac ICD implantation. Most patients had a significant reduction in AF episodes. Five patients, due to arrhythmias recurrences after STAR, performed electrophysiological study documenting successful PV isolation. Finally, a significant improvement of quality of life was documented (48 ± 15 at enrollment vs 75 ± 15 at 12 months FU; p &lt; 0.001).

Conclusion
The present phase II trial demonstrated the feasibility of STAR in paroxysmal AF elderly patients and its potential role in increasing the quality of life. Surely, more robust data are needed about safety and efficacy.
Predicting bleeding risk in frail older patients with atrial fibrillation using data from the FRAIL-AF trial
Authors: Van Doorn S , Joosten L P T , Kohlen B T G , Nierman M C , Koek H L , Hemels M E W , Huisman M V , Kruip M , Faber L M , Wiersma N M , Buding W F , Adriaansen H J , Rutten F H , Geersing G J 
Published: May 2024

Abstract

Background
Bleeding remains an important complication in anticoagulated patients with atrial fibrillation (AF). Hereto, multiple scores have been developed to predict bleeding risk and subsequently identify a subset of patients in whom additional effort may be warranted to lower the risk of bleeding. Bleeding risk is particularly high in frail older individuals with AF. Yet to what extent existing scores can accurately identify patients at high risk in this population is unknown.

Purpose
To validate existing bleeding risk scores for predicting bleeding in frail older AF patients using oral anticoagulants.

Methods
We used data from the FRAIL-AF trial that randomized frail AF patients ≥75 years of age between continuing vitamin K antagonist (VKA) treatment or switching to non-VKA oral anticoagulant (NOAC) treatment. The outcome was major or clinically relevant non-major bleeding. We validated 4 existing bleeding risk scores: ORBIT, ATRIA, AF-BLEED and (the recently derived) DOAC-score. We used cause specific cox proportional hazard models with all-cause mortality as a competing risk, with the number of points on each score as a univariate variable to calculate discrimination by means of the c-statistic for each score. Next, to assess clinical utility, we estimated the incidence bleeding rates for patients classified as low-risk and high-risk by each respective score.

Results
In total 661 patients continued VKA treatment, and 663 switched to any NOAC. An additional 66 patients, originally excluded from randomization due to an estimated glomerular filtration rate (eGFR) ≤30 ml/min/1.73 m2 but followed observationally were included in the current analysis. The median age was 82.3 years (interquartile range (IQR) 78.7 – 86.6), 61.4% were male. Median eGFR was 61 (IQR 49 – 57), 54% had hypertension, 14% a previous bleeding, and 1.2% liver disease. In total 172 first bleedings occurred. Discrimination of all risk scores was poor, both in VKA and in NOAC users. Table 1 shows the c-statistics across the different risk scores; ranging from 0.54 to 0.56. The observed risk of bleeding in the low-risk category varied widely, see Table 2.

Conclusion
Existing bleeding risk scores are unable to accurately predict the bleeding risk in frail older patients with AF. Novel risk tools are needed for this growing population of vulnerable AF patients at high risk of bleeding.
Dynamic change, not tonic activation, of the heart rate variability predicts onset of postoperative atrial fibrillation
Authors: Zhang Y , Wang H 
Published: May 2024

Abstract

Background and Aims
Post-operative autonomic disturbances contribute to susceptibility to post-operative atrial fibrillation (POAF) but the nature of the autonomic disturbances and whether they precede POAF and can signal POAF onset is unclear.

Methods
In this prospective observational study, patients undergoing cardiac surgery were consecutively enrolled. Holter monitoring was undertaken 7 days before and after surgery with continuous heart rate variability (HRV) measurement. Cox regression was used to evaluate autonomic changes, and analyzed by restricted cubic spline (RCS) to explore individual risk levels. For the first episode of POAF, HRV indexes captured an hour before the onset of POAF were divided into six 10-minute epochs and analyzed by Friedman's Two-Way Analysis of Variance by Ranks.

Results
A total of 2306 patients known to have been without prior AF were enrolled and completed the study; POAF occurred in 718 (31.14%) patients. Based on univariate and multivariate analysis preoperative, tonic activation and perioperative HRV change were not significantly related to new POAF. However, in the postoperative phase, a marked increase or decrease of Δ Lg (LF/HF), Δ Lg (HF) and Δ Lg (LF) were associated with increased POAF risk. Further, examination of 10-minute epochs in the 30 minutes before the onset of POAF, revealed that progressive increase of HRV indexes.

Conclusions
POAF susceptibility is associated with postoperative dynamic HRV changes but not tonic autonomic state. Potentially the observation that POAF was preceded by progressive rise of HRV indexes may offer a promising signal for early warning of POAF, and permit preventive intervention.
Evaluating the efficacy of pre-ablation algorithms in WPW syndrome localization: a retrospective study
Authors: Coteli C , Kara S C , Aygun S , Yorgun H , Aytemir K 
Published: May 2024

Abstract

Background and Objective
Wolf-Parkinson-White (WPW) syndrome is a congenital condition that can be diagnosed at any age and may lead to dysrhythmias, most notably atrioventricular reentrant tachycardia (AVRT). Ablation of the accessory pathway responsible for the disorder has become a standard treatment approach. The success of ablation therapy is closely linked to accurately localizing the accessory pathway. Consequently, algorithms have been developed to predict the location of the accessory pathway using pre-ablation electrocardiography (ECG) parameters. This study aims to evaluate the predictive values of previously published algorithms.

Method
This study included 122 patients diagnosed with WPW syndrome who underwent successful ablation of a manifest accessory pathway at our university's cardiac electrophysiology laboratory between 2019 and 2023. We retrospectively examined these patients' baseline characteristics and their procedures' features. Additionally, a team analyzed their baseline electrocardiograms (ECGs) using the EASY-WPW, Pambrun, and St. George algorithms. The sensitivity, specificity, PPV, and NPV of these algorithms were then calculated based on the location of the accessory pathways identified during the patients’ ablation treatments.

Results
The median age of the patients in this study was 33 years (18 - 79). Among them, 65 patients (53.3%) were male (Table 1). Ablation treatment was conducted using a 3D mapping system for all included patients, considering only those who achieved acute procedural success for analysis. The most frequently observed accessory pathway localization was the posteroseptal region of the tricuspid annulus, found in 48 patients (39.3%). Regarding the accuracy of accessory pathway prediction, the EASY-WPW, Pambrun, and St. George algorithms demonstrated correct localization rates of 81%, 72%, and 62%, respectively. The efficacy of these predictions varied according to the specific localization of the accessory pathways (Table 2).

Conclusion
This study highlights the limitations of previously published algorithms in predicting the localization of accessory pathways in WPW syndrome. The notably lower success rates observed in our research, as compared to earlier studies, might be attributed to variations in how localization is defined across studies, differences in the interpretation of these algorithms by users, or evolving definitions of localization resulting from advancements in 3-dimensional mapping systems. Given these findings, there is a clear need for the development of new algorithms that incorporate current localization definitions and are validated in larger patient cohorts.