bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ablation of persistent atrial fibrillation based on atrial electrogram duration map: methodology and clinical outcomes from the AEDUM pilot study
Authors: Magnocavallo M , Rossi P , Cauti F M , Polselli M , Niscola M , Limite L R , Bisignani A , Bianchi S 
Published: May 2024

Abstract

Background
Catheter ablation of persistent atrial fibrillation (PsAF) represents a challenge for the electrophysiologist and there are still divergences regarding the best ablative approach to adopt.

Objectives
Create a new map of the duration of atrial bipolar electrograms (Atrial Electrogram DUration Map, AEDUM) to recognize a functional substrate during sinus rhythm and guide a patient-tailored ablative strategy for PsAF.

Methods
40 PsAF subjects were assigned in a 1:1 ratio to either for PVI alone (Group B1) or PVI+AEDUM areas ablation (Group B2). A cohort of 15 patients without AF history undergoing left-sided accessory pathway ablation was used as a control group (Group A). In all patients, voltage and AEDUM maps were created during sinus rhythm. The minimum follow-up was 12-months, with rhythm monitoring via 48-h ECG Holter or by implantable cardiac device.

Results
Electrogram (EGM) duration was higher in Group B than in Group A (49±16.2ms vs 34.2±3.8ms; p-value&lt;0.001). In Group B the mean cumulative AEDUM area was 21.8±8.2cm2; no difference between the two subgroups was observed (22.3±9.1cm2 vs 21.2±7.2cm2; p-value=0.45). The overall bipolar voltage recorded inside the AEDUM areas was lower than in the remaining atrial areas [median:1.30mV (IQR:0.71–2.38mV) vs 1.54mV (IQR:0.79–2.97mV); p-value:&lt;0.001)]. Low voltage areas (&lt;0.5mV) were recorded in three (7.5%) patients in Group B. During the follow-up [median 511 days(376-845days)] patients who underwent PVI-only experienced more AF recurrence than those receiving a tailored approach (65% vs 35%; p-value=0.04).

Conclusions
All PsAF patients exhibited AEDUM areas. An ablation approach targeting these areas resulted in a more effective strategy compared with PVI only.AEDUM mapAEDUM map and lesion set
Pulsed field ablation for complex resistant atrial tachycardia recurring after radiofrequency ablation of persistent atrial fibrillation
Authors: Fiala M , Cernosek M , Lehar F , Bulkova V , Funasako M , Bahnik J , Rybka L , Toman O , Kala P 
Published: May 2024

Abstract

Background
There is a limited knowledge on immediate and long-term efficacy of pulsed field ablation (PFA) for residual atrial tachycardia (AT) recurring after persistent atrial fibrillation ablation (AF).

Purpose
To present immediate and medium-term outcome of PFA (Farapulse) for complex AT recurring after ≥1 radiofrequency ablation (RFA) of primary (longstanding) persistent AF.

Methods
In 5/2022-10/2023, 81 patients (64±8 years, 19 females) underwent PFA for complex AT in 83 PFA procedures after prior RFA procedure(s); in first (n=21), second (n=33), third (n=23), fourth (n=5), or fifth (n=1) repeat ablation procedure, respectively. Mapping/ablation strategy was directed by the CS activation/entrainment to: 1) no 3D mapping and direct PFA in left atrium (n=67); 2) PFA directly after 3D LA mapping (n=9); 3) PFA following RFA after 3D LA mapping (n=7). AT sources were classified as macroreentry (MRAT) (perimitral, roof-dependent, typical flutter) or localized (LOCAT) in case of smaller reentry or ectopic origin.

Results
At the procedure onset, persistent AT was present in 58 patients, in the remaining cases AT (n=21) or AF (n=4) were induced. AF eventually occurred at some time of procedure in another 10 patients and was terminated by ablation at LA ridge/CS/LOM region 8x, LA posterior wall 3x, LUPV 1x, RUPV 1x, and RA low lateral wall 1x. Only MRAT, only LOCAT, or both AT types were found at 34 (41%), 35 (42%), and 14 (17%) procedures, respectively. A total of 125 ATs was identified (1, 2, and 3 ATs in 52, 20, and 11 patients). MRAT (n=60) included 32 perimitral ATs, 20 roof-dependent ATs, and 8 typical flutters. LOCAT (n=65) included RUPV source (n=1), LA extraPV sources (n=59), and RA sources (n=5). SR was restored with a 5±7 PFA applications at the site of AF source, total of PFA deliveries was 71±27, and procedure and fluoroscopy times were and 89±37 and 9±5 minutes, respectively. In the 7 patients with initial ineffective 6, 6, 11, 5, 18, 10, and 2 minutes of RFA, the AT was converted into SR by subsequent 1, 4, 1, 13, 4, 24, and 20 PFA applications. All ATs were terminated and noninducibility was achieved in 82 (99%) and 74 (89%) procedures, respectively. In 52 patients with &gt;3 month follow-up, 46 (88%) patients remain in stable SR (41 / 79%) off AAD); 3 and 3 patients have paroxysmal or persistent AT.

Conclusion
PFA with catheter Farapulse can affect complex/epicardial AT sources resistant to RFA in prior or present ablation procedure; however, there is a certain discrepancy between high efficacy in AT terminating and medium-term clinical outcome.
Gender-specific aspects of long-term CryoPVI efficacy
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
While a gender-specific influence has been demonstrated for many cardiovascular interventions, no prospective data is yet available for cryoballoon pulmonary vein isolation (CryoPVI).

Methods
We prospectively analyzed consecutive AF patients who underwent a first CryoPVI in a single-center cohort between 2018 and 2023. We stratified patients regarding gender into two groups. CryoPVI was performed in a standardized procedure. Foollow-up was performed at 3, 6, 12, 18, 24 and 36 months after CryoPVI. Efficacy endpoint was the occurrence of symptomatic atrial arrhythmia while major inguinal complications, phrenic nerve injury, stroke or death were considered safety endpoints. Periprocedural parameters were observed.

Results
During the study period 1180 patients underwent CryoPVI. Of these, 511 patients were female (43.3%). Female patients were significantly older (72.1 vs 67.3 years; p&lt;0.001); had higher CHADS-VASc (3.4 vs 2.3; p&lt;0.0001) and left ventricular ejection fraction (55.7 vs 53.9 p=0.001). There were no differences regarding AF phenotype (persistent AF 40.7% vs 59.3% p=0.17). The incidence of primary efficacy endpoint after 36 months was significantly higher in female patients (48.9% vs. 42.5%, p=0.0064). Safety endpoints occurred in form of phrenic nerve injury in one female patient (0.2%), one stroke in both groups (female 0.2% vs male 0.1%) and three major inguinal complications in both groups (female 0.6% vs male 0.4%).

Conclusion
In female patients CryoPVI is equally safe but less effective. The reason for the different therapeutic success remains unclear but should be considered for an individualized approach.
Ablation of premature ventricle contraction arising from papillary muscle without intracardiac echo using point-by-point mapping
Authors: Popara J , Maslova V , Zaman A , Sprenger L , Kleinhans L , Jahn O , Frank D , Demming T , Pantlik R , Lyan E 
Published: May 2024

Abstract

Background
Catheter radiofrequency ablation (RFA) of ventricular arrhythmias (VAs) arising from the left ventricle's papillary muscles (PM) has been associated with inconsistent results due to difficulties in 3D reconstruction of this intraventricular structure. The use of intracardiac echo-guided ablation allows for the 2D visualisation of the PM and the guiding of ablation catheter. Cryo energy allows stable contact with the target structure during ablation. These two techniques have been shown to increase the success rate of ablation (77% reported - 1) but don’t allow the construction of the 3D map of papillary muscle with activation during PVC. Using a combination of point-by-point mapping (PbP) along with "fast anatomical mapping" (FAM) (Carto® 3 System) allows 3D reconstruction of the PM geometry with activation. These may increase the accuracy of PVC origin targeting.

Aim
This study aims to assess the feasibility and success rate of RFA of PVC arising from the papillary muscles of the left ventricle.

Methods and results
We retrospectively analysed 214 patients treated with RFA for PVCs in two institutions. PVC arose from PM in 12(5.6%) cases (65±20 years old; 42% males; 33% with ejection fraction&gt;50%; 8.3% antero-lateral PM). Initial detailed FAM of the left ventricle was performed using PVC pattern matching via transaortic or transmitral approach. Then, all points with preexcitation to QRS onset were copied from FAM into the new PbP map. That automatically created the geometry of PM with an activation map inside the LV shell. Irrigated high power (50 W) RFA was performed at the site of earliest activation at the PM shell. The acute success rate was 75% (n=9) without complications. PVC recurrence at 12-month follow-up was 11% (n=1 out of 9).

Conclusions
RFA of PVC arising from papillary muscles using point-by-point mapping is feasible and associated with a success rate comparable to the previously reported one when intracardiac echo-guided ablation is used.
Safety and efficacy of a temperature-controlled ablation system for ventricular tachycardia: first results from the TRAC-VT study
Authors: Dhanjal T , Moreno J , Tondo C , Anselme F , Jacobs S , Burrell J , Becker D , Peichl P , Patchett I , Kautzner J 
Published: May 2024

Abstract

Background
Catheter ablation using radiofrequency (RF) energy, is a well-recognized treatment option for patients with ventricular arrhythmias. However, procedural complications may be high, and efficacy is often suboptimal with high recurrence rates.

Purpose
The TRAC-VT study evaluated safety and efficacy of the DiamondTemp Ablation (DTA) System for the treatment of patients with ventricular arrhythmias by catheter ablation.

Methods
A temperature-controlled, irrigated RF catheter (with six thermocouples and an internal network of diamond coatings) was utilized to treat subjects with either sustained monomorphic ventricular tachycardia (VT) and structural heart disease or with frequent monomorphic symptomatic ventricular premature beats (VPBs) and normal hearts. Patients were enrolled at five hospital centers in five European countries and were followed for 6 months. Ablation was performed in temperature-control mode with an irrigation flow of 8 mL/min for all power deliveries. The target temperature was set to 55 or 60 °C with a power output limited to 50 Watts. RF energy was applied for a maximum of 45 seconds per target site, depending on impedance drop and electrogram abatement.

Results
The study enrolled 49 subjects (age 67±12 years, 80% male) in total (38 with sustained monomorphic VT and structural heart disease and 11 with symptomatic VPBs). In all cases, mapping and navigation was used with EnSite systems (Abbott). The average ablation time (defined as time from the insertion of the DTA catheter until removal from body) was 87 ± 44 minutes. During this time, RF energy was applied for an average of 28.2 ± 10.2 seconds with a power of 44.0 ± 7.0 W and a temperature of 50.9 ± 3.9 °C during 35.0 ± 23.2 applications. Acute procedural success was 100% (93%-100%), and it was defined as the elimination of VPBs or non-inducibility for sustained VT (using solely the DTA catheter). The primary safety procedure-related endpoint was an evaluation of cardiovascular-related death, stroke / TIA, cardiac tamponade/perforation, bleeding complication, myocardial infarction, thromboembolism, and pulmonary edema. In total review of the primary safety endpoint, one subject had a confirmation of a stroke / TIA event. Regarding longer term procedural efficacy, the 6-month follow-up was completed in 92% of subjects. For the whole study population chronic success from recurrence of ventricular arrhythmia (faster than 100 beats/min after 6 months) was 73.4% (58.6%-83.6%) for non-sustained ventricular arrhythmias (≥3 beats) and 87.7% (74.7%-94.3%) for sustained ventricular arrhythmias (≥30 sec).

Conclusions
VT/VPBs ablation using a temperature-controlled irrigated RF catheter was safe and effective with low VT recurrence at 6 months of follow-up.
Comparison of continuity index by atrial fibrillation type with the use of active esophageal cooling
Authors: Sherman J , Putzel N , Lazarus C , Gallagher M , Ro A , Nazari J , Fisher W , Kulstad E , Metzl M 
Published: May 2024

Abstract

Background/Introduction
Proactive esophageal cooling is FDA cleared to reduce the likelihood of esophageal injury during radiofrequency (RF) ablation for the treatment of atrial fibrillation (AF). Recent data suggest improved long-term freedom from arrhythmia with cooling, which may result from a lower continuity index with cooling that in turn improves the durability of pulmonary vein isolation (PVI).

Purpose
To measure and compare the continuity index obtained using proactive esophageal cooling in PVI of paroxysmal and persistent AF.

Methods
The continuity index was prospectively calculated for PVI cases of paroxysmal and persistent AF performed by 4 providers between June and September 2023. The continuity index was quantified by the lesion placement order, such that each lesion placed that did not border a previous lesion increased the continuity index by 1 unit. Published data have suggested a continuity index below 6 results in optimum long-term isolation, whereas a continuity index above 6 leads to more gaps, less isolation, and greater AF recurrence.

Results
Data from a total of 71 patients were recorded. Mean patient age was 69.8±9.0, with 43% female, and 28 with paroxysmal, 43 with persistent AF. The mean±SD continuity index for PVI was 2.6±3.8. The mean continuity index was similar between paroxysmal (2.9±3.4) and persistent (2.4±3.9) AF patients, and similar for the left pulmonary veins and on the right (Table 1). Only 5% (4) patients had a continuity index above 6 on either side.

Conclusions
The use of proactive esophageal cooling during RF ablation results in attainment of a low continuity index in PVI of both paroxysmal and persistent AF. This may contribute to the higher rates of freedom from arrhythmia seen with active cooling to date.Table 1
One-year freedom from arrhythmia following radiofrequency ablation using proactive oesophageal cooling
Authors: Gallagher M M , Akhtar Z , Kontogiannis C , Sohal M , Hayat J , Joseph C , Nazari J , Zagrodzky J , Brumback B , Sherman J , Zagrodsky W , Bailey S , Kulstad E , Metzl M , Leung L W M 
Published: May 2024

Abstract

Background
Proactive esophageal cooling is increasingly being utilized, and is now FDA cleared, to reduce the likelihood of ablation-related esophageal injury resulting from radiofrequency (RF) cardiac ablation of atrial fibrillation (AF). One-year follow-up from the largest randomized controlled study, the IMPACT trial, showed a trend towards improvement in long-term efficacy versus luminal esophageal temperature (LET) monitoring. With larger data sets now available for analysis, we sought to determine 1-year freedom from atrial arrhythmia associated with the use of proactive esophageal cooling.

Methods
Data from 2 trials comparing freedom from atrial arrhythmia after RF ablation using proactive esophageal cooling to LET monitoring were combined. Data were analyzed using a stratified Cox proportional hazards model to compare arrhythmia recurrence rates, with R statistical analysis software.

Results
Data from 631 patients across two studies comparing arrhythmia outcomes for proactive oesophageal cooling versus LET monitoring were analysed. Mean patient age was 66.4±9.8 years, and 37.4% were female. Arrhythmias were 56.3% paroxysmal AF and 43.7% persistent or long-standing persistent AF. Freedom from atrial arrhythmia at one year was 77.2% for patients receiving proactive oesophageal cooling and 64.4% for patients receiving LET monitoring (Figure 1), with a hazard ratio for cooling of 0.65 (95% CI 0.43 to 0.99, P = 0.044).

Conclusions
Proactive oesophageal cooling was associated with significantly greater freedom from atrial arrhythmia at one year when compared to LET monitoring during RF ablation.
Characterization and clinical significance of hemolysis after pulsed-field ablation for atrial fibrillation: insights from a multicentric analysis
Authors: Popa M A , Venier S , Mene R , Della Rocca D , Sacher F , Derval N , Hocini M , Combes S , Albenque J P , Saitta F , Chierchia G B , De Asmundis C , Defaye P , Boveda S , Jais P 
Published: May 2024

Abstract

Background
Pulsed-field ablation is a novel non-thermal ablation modality which is being increasingly used in clinical practice for the treatment of atrial fibrillation (AF). While the susceptibility of erythrocytes to electroporation is well-established, the effect of cardiac PFA technologies on erythrocyte destruction has not been described so far.

Purpose
The aim of this study was to investigate whether PFA induces clinically significant hemolysis.

Methods
We included 187 patients undergoing AF catheter ablation with either PFA (n=145) or RFA (n=42) at four high-volume centers. PFA was performed using a pentaspline catheter (biphasic, bipolar pulses of 2kV) and RFA with a 3.5 mm irrigated-tip catheter (40-60 W). The lesion set comprised pulmonary vein isolation (PVI) for paroxysmal AF and PVI ± additional lesions/lines for persistent AF. Established biomarkers of hemolysis, anemia and renal function were analyzed in blood samples obtained at baseline (T1), at the end of ablation (T2) and 24 hours after the procedure (T3).

Results
Baseline characteristics were well-balanced between groups (65.5 ± 9.6 years, 72.7% male, p&gt;0.05). The ablation procedures comprised a mean of 61.4 ± 27.2 deliveries (PFA group) and a mean RF duration of 31.0 ± 16.3 min (RFA group). Atrial ablation in addition to PVI was performed in 55.2% vs. 61.9% patients, respectively (p=0.469). The direct hemolysis marker free plasma hemoglobin was significantly higher with PFA (592.8 ± 330.6 mg/dl) than with RFA (186.6 ± 215.8 mg/dl, p&lt;0.001) at the end of ablation. A strong correlation was found between free plasma hemoglobin and PFA deliveries (Pearson r=0.615, p&lt;0.001). PFA was further associated with a 2.2-fold increase in bilirubin (21.3 ± 11.3 vs. 9.6 ± 4.7 µmol/l), a 2.4-fold decrease in haptoglobin (0.5 ± 0.4 vs. 1.2 ± 0.4 g/l) and a 1.8-fold increase in LDH (352.7 ± 115.7 vs. 192.2 ± 51.6 U/l, T3 vs. T1, all p&lt;0.001). There were no significant changes in bilirubin and haptoglobin in the RFA group (p&gt;0.05). A slight decrease in red blood cells, hemoglobin and hematocrit was detected after both PFA and RFA (Abstract Figure), with no significant differences between groups (all p&gt;0.05). While mean creatinine levels and glomerular filtration rates did not significantly change after ablation in either group, acute kidney injury occurred in 4/124 (3.2%) with PFA vs. 0/32 (0%) with RFA (p=0.303).

Conclusion
Intravascular hemolysis is a frequent finding after PFA for AF and increases with the number of PFA deliveries. While PFA was not associated with clinically significant anemia, the incidence of acute kidney injury in the present study warrants future large-scale investigations assessing the biological impact and nephrotoxicity of PFA-induced hemolysis.Abstract Figure
Radiofrequency lesion in atrial wall: how variable is it? 9 Tesla MRI analysis of RF lesion volume in a swine model
Authors: Cardelli L S , Laumont T , Beghian J , Achahli Y , Cardoso M , Peltier M , Pasquie' J L , Granier M 
Published: May 2024

Abstract

Background
Little is known about radiofrequency (RF) lesion volume (rLV). Most of animal or ex-vivo studies quantify the size of RF lesions size using width and/or depth, while electrophysiologists use manufacturers’ indirect indices (such as Ablation Index or Lesion Size Index).

Purpose
We aimed to evaluate rLV by high resolution 9-Tesla magnetic resonance imaging (MRI), in ex-vivo swine model. We studied the variability of rLV and extra-cardiac effects in two groups of swine, one treated with low energy (LE)-long application RF (20W-50 sec) and another treated with high energy (HE)-short application RF (50 W-20 sec).

Methods
This was a prospective observational study on 18 piglets, that were anesthetized, mechanically ventilated, and divided into LE (n = 9) and HE (n = 9) groups (Figure 1). An irrigated contact force catheter was used to perform RF applications in 4 largely separated spots: 2 on right atrium and 2 on left atrium wall. RF parameters were monitored during RF. Each animal was sacrificed after 5-7 days, and RF lesion samples were excised and acquired by 9 MRI.

Results
70 RF applications were performed (36 in LE group and 34 in HE group). MRI was performed on 26 samples of LE group and 28 of HE group (Figure 2). The median RF lesion volume was 89.3 mm3 (IQR 47.9-175.9). Regarding lesion volume, the HE groups showed 35% higher volume than LE group (mean lesion volume 86.2 mm3 vs 116.3 mm3, p = 0.119). HE group also showed more complications (0 vs 7, p=0.02) and more extracardiac lesion (14 vs 18, p=0.613).

Conclusions
There was a wide and unpredictable variability of RF lesion on atrial wall, even under controlled experimental conditions, which could explain arrhythmias recurrences. The variability seems greatest, although not statistically significant, during HE applications. The dose/effect relationship needs to be carefully studied for treatments of cardiac arrhythmias for both RF and other forms of energy available today.Study flow-chartComparison between groups