bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pulsed field ablation-based superior vena cava isolation in the presence of defibrillator leads
Authors: Doundoulakis I , Tsiachris D , Kordalis A , Antoniou C K , Tsioufis P , Laina A , Botis M , Bartsioka L I , Argyriou N , Dourvas P , Oikonomou G , Gatzoulis K , Tsioufis K 
Published: May 2024

Abstract

Introduction
Only a minority of operators in the MANIFEST-PF multinational survey performed superior vena cava isolation by means of pulsed field ablation (PFA). This is the first report of off-label PFA-mediated superior vena cava isolation in the presence of defibrillator leads.

Purpose
Aim of this study was to evaluate the effect of PFA applications in the superior vena cava in the terms of alterations in pacing, sensing, or impedance parameters, inappropriate anti-tachycardia pacing, ICD shock and leads dislodgment.

Methods
Five patients with a history of dilated cardiomyopathy, dual chamber defibrillator implantation, and worsening heart failure because of persistent atrial fibrillation (AF) underwent catheter ablation of AF. Three of the patients had dual coil defibrillator leads. PFA was selected for the index procedure in these decompensated heart failure patients with enlarged atria focusing beyond pulmonary vein isolation in posterior wall and roof ablation as well as in superior vena cava isolation.

Results
Basket configuration and two sets of two lesions at the trunk of the vessel (with rotation between each pair) were used for superior vena cava isolation in the presence of atrial and defibrillator leads, without any impact on device and leads measurements or sinus node function. All patients were in AF and cardioverted into sinus rhythm post- superior vena cava isolation. They remained at sinus rhythm at regular 3-month follow-up while device interrogation revealed intact sinus node function.

Conclusion
PFA applications in the superior vena cava of AF patients with implanted defibrillators confirmed that it is a safe and feasible method regardless of energy application adjacent to the leads.
Catheter ablation of papillary muscle arrhythmias: procedural characteristics and long term outcome
Authors: Moser F , My I , Loeck F , Obergassel J , Rottner L , Lemoine M , Kirchhof P , Reissmann B , Ouyang F , Metzner A , Rillig A 
Published: May 2024

Abstract

Background
Ventricular arrhythmias (VA) originating from the papillary muscles can occur both in patients with and without structural heart disease. Although catheter ablation is the treatment of choice, ablation success remains challenging and long-term outcomes for this origin of VA are still unsatisfactory.

Methods and Results
All patients undergoing catheter ablation for premature ventricular contractions or ventricular tachycardia between june 2009 and november 2022 were analyzed. 66 patients (26 female (39%), mean age 60±15 years) undergoing catheter ablation of VA originating from the papillary muscle were identified. 21/66 (32%) patients had a reduced or mildly reduced left ventricular ejection fraction at time of initial presentation. While mitral valve regurgitation was present in 32/66 (48%) patients, mitral valve prolapse was observed in only 2/66 (3%) patients.
6/66 (9%) patients presented with non-sustained ventricular tachycardia (VT) and 1/66 (2%) patient presented with sustainend VT prior to catheter ablation. 61/66 (92%) patients underwent ablation of PVCs of the left ventricular papillary muscles (22/66 (33%) patients anterolateral; 39 (59%) patients posteromedial). 5/66 patients underwent ablation of premature ventricular complex (PVC) originating from the papillary muscles of the right ventricle. In 13/66 (19.7%) patients only a retrograde approach was used, in 26/66 (39.5%) patients a retrograde and an additional transeptal approach and in only 10/66 (15.2%) patients solely a transeptal approach. Mean PVC QRS duration was 152.5 ± 3.5 msec. Ablation was acutely successful in 44/66 (67%) patients. Mean procedure time was 145.8 ± 63.7 minutes and mean number of radiofrequency applications was 21.3 ± 16.7 (25 to 55 Watts, 37764.2 ± 27824.1 Joules). Overall, procedural complications occurred in 4/66 (6%) patients
Follow up data were obtained from Holter ECGs, review of medical records, patient consultation, or via structured follow-up within the prospective TRUST registry. All information was combined to assess recurrence of PVC/VT. Recurrence of VA originating from the papillary muscles occurred in 11/66 (17%) patients. 9/66 patients (14%) underwent re-ablation due to recurrence of VA originating from the papillary muscles after previous ablation procedures.

Conclusion
Catheter ablation of papillary muscle arrhythmias is associated with a single procedural success rate of 67% with a procedural complication rate of 6%. 14% of patients underwent re-ablation due to recurrence of papillary muscle arrhythmias.
Left ventricular wall thickening predicts left atrial low voltage areas in patients undergoing catheter ablation for atrial fibrillation
Authors: Clemens M , Fodor Z S , Gaal R , Sandorfi G , Nagy L T , Csanadi Z 
Published: May 2024

Abstract

Background
The success rate of circumferential pulmonary vein isolation (CPVI) remains suboptimal in patients with paroxysmal and persistent atrial fibrillation; moreover, the detection of low voltage areas (LVA) in the left atrium does predict an even higher recurrence rate of atrial tachyarrhythmias after the procedure. Left ventricular wall thickening (LVWT) is known to correlate with left atrial volume; however, no data is available whether LVWT is predictive of the presence of left atrial LVA.

Purpose
The aim of this study was to investigate whether LVWT is predictive of left atrial LVA and to verify that the presence of LVA confer a higher arrhythmia recurrence rate after catheter ablation for atrial fibrillation.

Methods
A total of 374 patients who undervent CPVI with the use of 3D electroanatomical mapping system as a primary procedure were enrolled in the study. Transthoracic echocardiography was performed in all patients prior the procedure with measurement of the thickness of the septum and the posterior wall. Patients were classified based on LVWT as normal (females:≤9mm, males:≤10mm), borderline (females:10-11mm, males: 11-12mm) and increased (females:≥12mm, males:≥13mm). A detailed left atrial voltage map was obtained in all patients prior to ablation with the identification of LVA (bipolar voltage &lt;0.5mV with an area &gt;5cm2). Arrhythmia recurrence was defined as documented atrial fibrillation or atrial tachycardia lasting for at least 30 seconds.

Results
Among 374 patients (mean age: 59.0±10.2 years, 131 females) 94, 195 and 85 were considered to be normal, borderline and increased based on LVWT, respectively. LVA were found in 29.9% (112/374) of patients. According to LVWT, LVA were detected in 16.0% (15/94), 31.3% (61/195) and 42.4% (36/85) in patients with normal, borderline and increased wall thickness, respectively, p=0.005. Patients with left atrial LVA had a higher [60.7% (68/112)] arrhythmia recurrence compared to those without low voltage areas [35.1% (92/262)] during a mean follow-up of 2.1±1.9 years, p&lt;0.0001.

Conclusions
Left ventricular wall thickening predicts the presence of left atrial low voltage areas in patients undergoing catheter ablation for atrial fibrillation. Low voltage areas confer a higher arrhyhtmia recurrence rate during follow-up.
Findings at repeat ablation after complex left atrial pulsed field ablation for longstanding persistent atrial fibrillation
Authors: Fiala M , Lehar F , Cernosek M , Bulkova V , Funasako M , Bahnik J , Rybka L , Toman O , Kala P 
Published: May 2024

Abstract

Background
There is a limited knowledge on atrial arrhythmias recurring after complex left atrial (LA) pulsed field ablation (PFA) for longstanding persistent atrial fibrillation (LSPAF).

Purpose
To present recurrent atrial arrhythmias and their sources found at repeat ablation following PFA for LSPAF.

Methods and results
Of 214 patients with LSPAF (age 65±8, 53 females, continuous AF for 30±27 months) with complex LA PFA (Farapulse) in 10/2021-10/2023, 19 patients (64±8 years, 5 females) underwent repeat ablation for recurrent AF or arial tachycardia (AT) in 20 procedures. First PFA procedure included pulmonary vein isolation (PVI), roof/posterior wall, and mitral isthmus/coronary sinus/Ligament of Marshal region (LOM) ablation. At repeat ablation, 3D activation and entrainment mapping and ablation identified the AF/AT sources; ATs sources were classified as macroreentry (MRAT) (perimitral, roof-dependent, typical flutter) or localized (LOCAT) in case of smaller reentry or ectopic origin.

Results
The clinical recurrent arrhythmias included paroxysmal AF (n=1), persistent AF (n=2), paroxysmal AT (n=1) or persistent AT (n=16). At the onset of repeat ablation, persistent AF/AT was present (n=15) or had to be induced (n=5). AF was finally present during the procedure in 8 patients, and was terminated by ablation directly into SR (n=3) or into intermediate AT (n=3) (conversion sites included LA ridge/LOM region 2x, RA septum 1x, RA low lateral 2x, CTI 1x), or required DCC (n=2). Primary recurrent or from AF converted AT was present in 15 patients; only MRAT in 6 patients, only LOCAT in 3 patients, and both AT types in 6 (patients). Of MRAT (N. ATs = 16), there were 12 perimitral ATs, 0 roof-dependent AT, and 2 typical flutters. Of LOCATs, sources were located at LA anterior wall 4x, LA septum 2x, LA roof 1x, LA ridge/LOM 1x, persistent left vena cava 1x, and RA – para SA node 1x. Recurrent AF/AT sources were targeted by radiofrequency or PFA in 16 and 4 cases, respectively, all spontaneous and induced AF/AT were finally terminated into SR in 16 cases, subsequent noninducibility by atrial pacing up to 300 bpn was achieved in 13 cases, and recurrent AF/AT occurred in 3 patients.

Conclusion
At repeat ablation PFA (Farapulse) for LSPAF, recurrent AT dominated over AF, MRAT slightly prevailed over LOCAT, mostly constituted by perimitral AT, while roof-dependent AT recurrence was reduced to zero. A majority of AF/AT sources were located outside prior PFA lesions at the LA anterior wall, septum and the right atrium.
Type of atrial arrhythmias and substrates after convergent ablation procedures
Authors: Robles A G , Prolic Kalinsek T , Podlogar V , Gianfrancesco D , Bartolomucci F , Romano S , Sciarra L , Pernat A , Jan M 
Published: May 2024

Abstract

Background
Convergent epicardial and endocardial catheter ablation had been used for the treatment of persistent atrial fibrillation (PeAF).

Aims
The aims of this retrospective study are to describe the pattern of arrhythmias and substrate findings in patients previously submitted to convergent ablation and showing arrhythmic recurrences (AF/AT/AFL lasting at least 30 seconds) and documented with ILR during follow up.

Methods
From a cohort of 119 patient who underwent convergent ablation, we selected the 55 with arrhythmic recurrences and showing AT/AF/AFL stored in ILR memories to submit them to remap procedure.

Results
We excluded 1 patient who was submitted to ablate and pace without remapping and 1 patient whose data has been lost. Among 53 patients, 69.7% experienced AF (33.9% PAF and 35.8% PeAF), 5.6% typical AFL and 30.2% AT/atypical AFL. As for the substrates found, at detailed high-density mapping we had: 66.9% with veins reconnection (regardless the gaps localization), 37.7% with low-voltage area/abnormal signals on the posterior wall, 11.3% deserving CTI ablation for typical AFL and 28.3% with different LA substrates (septal, anterior, LAA, mitral annulus and 9.4% with gaps at superior surgical line). Notably, overlaps of arrhythmic patterns and substrate were also found in the same patients.

Conclusion
In our study a total of 79.1% patients had substrates related to previous convergent ablation due to gaps at pulmonary veins or superior line. The rest had an arrhythmic substrate in areas not previously ablated like posterior wall or CTI. These findings suggest that a large amount of patients submitted to convergent ablation (up to 80%) may have an arrhythmic substrate and thus potentially recurrences due to previous epi-endocardial ablation.
Reduced heart failure hospitalizations and improved quality of life in cardiac amyloidosis patients undergoing atrial fibrillation ablation
Authors: Pierucci N , La Fazia V M , Gianni C , Torlapati P G , Della Rocca D , Horton R , Al Hamad A , Burkhardt J D , Mariani M V , Chimenti C , Di Biase L , Lavalle C , Natale A 
Published: May 2024

Abstract

Background
Cardiac amyloidosis (CA) has been associated with an increased risk of atrial arrhythmias and development and worsening of heart failure due to infiltration of the amyloid protein in the atrial wall. Few data exist regarding prognosis, symptoms, and quality of life after catheter ablation of atrial fibrillation in this category of patients.

Objective
The study evaluates the outcome of hospitalization for heart failure and quality of life in cardiac amyloidosis patients with atrial fibrillation after catheter ablation.

Methods
This is a study including 102 consecutive patients from two different centers with an established diagnosis of amyloidosis ATTR that underwent their first AF catheter ablation for persistent AF. They underwent pulmonary vein (PV) isolation + isolation of left atrial posterior wall and superior vena cava. Additionally, extrapulmonary triggers were identified and ablated. Post procedure, patients were followed up routinely with ECG during office visits, 7-day Holter monitor and event recorders during the first year followed by biannual checkups during the remaining part of the follow-up period. Quality of life (QoL) was measured using The Minnesota Living Heart Failure Questionnaire (MLHFQ) before Catheter ablation and after 18 months follow up; QoL was compared with T-test.

Results
102 patients (mean age 72 ± 6) were included in the study. After 18 months follow up, 72 patients (70.6%) remained arrhythmia-free without antiarrhythmic drugs (Group 1), whereas 30 patients (29.4%) experienced recurrence (Group 2). In Group 1, 9 patients were hospitalized for heart failure, in contrast to 18 patients in Group 2, indicating a higher rate of heart failure hospitalizations associated with arrhythmia recurrence (p=0.02). The Quality of life in group 1 was 62 ±12 points before ablation and 63±16 points at 18 months follow up (p=0.17) while in group 2 was 68±16 points before ablation and 86±12 points at 18 months follow up (p&lt;0.001).

Conclusion
Catheter ablation for AF in patients with cardiac amyloidosis is associated with reduced hospitalizations for heart failure, along with improvement in QoL.
Pulsed electric field ablation for perimitral flutter - retrospective comparison of anterior vs lateral mitral block strategy
Authors: Borisincova E , Peichl P , Wichterle D , Stojadinovic P , Stiavnicky P , Haskova J , Cihak R , Kautzner J 
Published: May 2024

Abstract

Introduction
Catheter ablation of atrial fibrillation has become a standard of care for symptomatic patients. Patients with persistent atrial fibrillation might require additional substrate modification on top of pulmonary vein isolation. In case of spontaneous or inducible perimitral flutter, RF ablation to achieve anterior or lateral mitral block is challenging. A pulsed electric field (PEF) is a novel energy source that enables the rapid and safe creation of larger lesions.

Purpose
A retrospective study aimed to compare the safety and early outcome data of either anterior or lateral mitral block strategy performed by PEF using a pentaspline multipolar ablation catheter.

Methods
The population consists of 67 patients (23 women, age: 68 ± 8 years) with either spontaneous or inducible perimitral flutter. Fifty-five percent of patients had previous ablation of atrial fibrillation using radiofrequency energy (2.0 ± 1.2 procedures/patient). Using a pentaspline multipolar catheter, all patients underwent isolation (or reisolation) of pulmonary veins and posterior wall. The same catheter was used for the treatment of perimitral flutter. Creating either anterior (ANTERIOR group) or lateral (LATERAL group) mitral block was selected at the discretion of the operator.

Results
A total of 37 and 30 patients were treated in the ANTERIOR and LATERAL groups, respectively. The perimitral flutter was terminated in all cases. However, complete and persistent block across the ablated region was more likely achieved in the ANTERIOR vs LATERAL group (92 vs 73%, p=0.04). There was one tamponade in the ANTERIOR group. A clinically relevant spasm of the coronary artery was not observed in any patient. At 3-month follow-up, non-significantly more patients were in sinus rhythm in the ANTERIOR vs LATERAL group (81% vs 63%, p=0.1).

Conclusion
Creating both anterior and lateral mitral block for the treatment of perimitral flutter is feasible and safe using a pentaspline multipolar catheter and PEF. Achievement of the anterior mitral block is more likely. Whether this will impact the long-term outcome remains to be determined.
Long-term impact of multiple freezes during cryoballoon pulmonary-vein isolation on atrial arrhythmia recurrence
Authors: Rothe M , Boehmer A A , Nussbaum E , Wiedenmann L , Schneider K , Spork P , Keim C , Dobre B C , Kaess B M , Ehrlich J R 
Published: May 2024

Abstract

Background
Cryoballloon pulmonary vein isolation (CryoPVI) is well established for atrial fibrillation (AF) ablation. Nevertheless, it is still important to identify possible periprocedural factors influencing its efficacy. With difficult anatomical conditions it is currently unclear whether the number of cryoballoon applications needed to achieve complete vein isolation has an impact on the long-term effectiveness of CryoPVI.

Methods
We prospectively analyzed AF patients who underwent first-time CryoPVI in a single center cohort between 2018-2023. The group allocation depended on the number of cryo applications until complete isolation was achieved. CryoPVI was performed in a standardized procedure. Follow-up was performed after 3, 6, 12, 18, 24 and 36 months post CryoPVI. Efficacy endpoint was the occurrence of symptomatic atrial arrhythmia.

Results
A total of 1170 patients were included in the study. Of these, in 610 patients received only one cryoballoon application per pulmonary vein to achieve complete isolation. Gender distribution (56.7% male vs. 43.3% male p=0.09) and AF phenotype (38.5% persistent AF vs. 61.5% paroxysmal AF, p=0.23) did not differ significantly between the two groups, patients who received only cryoballoon application were older (70.1 vs. 68.5, p=0.006) and accordingly had higher CHADS-VASc (2.86 vs. 2.62, p=0.006). After 36 months no difference in the efficacy endpoint was observed between the two groups (47.6% vs. 43.2%, p=0.53). Complications included three major access complications (0.5% vs. 0.5%) and one stroke within the first 30 days after the procedure (0.2% vs. 0.2%) in each group. No pericardial tamponade occurred.

Conclusion
Multiple- freezes during CryoPVI have no influence on atrial arrhythmia recurrence.
Validating peak frequency mapping for atrial far-field electrogram detection: insights from a pulmonary vein isolation model
Authors: Martinez Cossiani M , Castrejon-Castrejon S , Sanroman-Junquera M , Kim S , Relan J , De La Vieja Alarcon J J , Guido L , Merino D E , Jauregui Abularach M E , Sanchez Somonte P , Martinez Maldonado M E , Sanz Verdejo B , Carton A , Escobar Cervantes C , Merino J L 
Published: May 2024

Abstract

Introduction
Effective pulmonary vein isolation (PVI) is the cornerstone of AF ablation, and conduction block from the atrium to the pulmonary veins (PV) is the accepted method to demonstrate it. However, far-field electrograms may make challenging to establish whether PVI has been achieved.

Purpose
This study aimed to evaluate whether peak frequency (PF) mapping can effectively identify far-field electrograms in the superior PVs following a redo PVI procedure.

Methods
Left atrium and PV activation and voltage bipolar 3D electroanatomical maps were generated using a steerable catheter with a 16-grid-patterned electrode configuration (HD-Grid) during coronary sinus pacing, both before and after the redo PVI. PF maps were developed offline using specialized experimental software. Only reconnected superior PVs from the redo PVI procedure were included in the analysis.

Results
Twenty consecutive patients (mean age 63±12 years, 12 male) were prospectively enrolled in the study, with 15 presenting reconnected PVs after the redo PVI. Conduction gaps were identified in the superior PVs of 9 patients (7 in the left superior PV, 5 in the right superior PV). Following the redo PVI, both voltage (0.96±1.1 mV vs. 0.49±1.21, P&lt;0.01) and PF (285±134 vs. 153±112 Hz, P&lt;0.001) were significantly reduced in both superior PVs. This reduction was more prominent in the right superior PV (0.83±0.75 vs. 0.20±0.39 mV, 299±159 vs. 132±116 Hz) than in the left superior PV (1.08±1.32 vs. 0.83±1.67 mV, 272±105 vs. 178±101 Hz). High-voltage (&gt;0.3 mV) electrograms remained prevalent in the right (12%) and left (37%) superior PVs after the redo PVI. However, high PF (&gt;250 Hz) electrograms significantly decreased following PVI in both the right (64% before vs. 6% after PVI) and left (66% before vs. 22% after PVI) PVs. Only a small percentage (5.3% in the right PV and 12% in the left PV) of all electrograms exhibited both high voltage and high PF following the PVI (see figure).

Conclusion
PF mapping proves to be a valuable tool in distinguishing far-field electrograms from atrial activity in the PVs, offering additional insights to complement voltage mapping, particularly in the context of redo PVI procedures.