bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of interatrial septal thickness and interatrial conduction time on cryoballoon ablation outcome
Authors: Soysal A , Yalman H , Gulfidan A , Sanli S N , Ceviker A , Raimoglu D , Dogramaci E , Atici A , Ikitimur B , Yalin K 
Published: May 2024

Abstract

Introduction
Interatrial septal thickness (IAST) is an indirect measure of interatrial septal fat which is anatomic extension of epicardial fat. Interatrial conduction time (IACT) reflects altered conduction between atria. Both parameters are associated with left atrial (LA) fibrosis and atrial fibrillation (AF). However, limited data exist regarding the influence of IAST and IACT on the outcomes of cryoballoon ablation (CBA). In this study, we aimed to analyze possible effect of IAST and IACT on atrial tachyarrhythmia (ATA) free survival after CBA.

Methods and results
Sixty five patients (34/65, 52.3% male, 53.3±11.0 years old) undergoing first time CBA for pulmonary vein isolation were enrolled. Pre-procedural TEE images were analyzed and bicaval view was used to visualize SVC rim for IAST measurement (Figure 1). IACT was measured from the onset of surface P wave to atrial EGM recorded by distal coronary sinus electrode. After 3 months blanking period all anti-arrhythmic drugs were discontinued. Clinical endpoint was ATA recurrence including AF, flutter or tachycardia lasting more than 30 seconds. After 11.2±4.1 months of follow-up 8 patients (12.3%) had ATA recurrence. IAST (4.4±1.1 vs 3.3±0.6 mm, p=0.007) and LA volume index (37.4±8.0 vs 30.1±12.4 mL/m2, p=0.03) were greater in patients with ATA recurrence than those without. In contrast, patients with and without had similar IACT (85.8±31.1 vs 62.2±23.9 ms, p=0.10).

Conclusion
Pre-procedural measurement of IAST using TEE may provide prognostic information in CBA patients. Increased IAST was found to be associated with ATA recurrence after CBA based PVI and warrants further study.Interatrial septal thickness measurement
Not too old to be treated: electrophysiological study and catheter ablation in eldery patients
Authors: Duran Bobin O , Gonzalez T , Elices J , Gonzalez-Juanatey C 
Published: May 2024

Abstract

Background
The number of elderly patients referred for electrophysiological study (EPS) and catheter ablation (CA) is increasing. These patients are thought to have more complications due to age and comorbidity.

Purpose
The aim of our study was to evaluate the safety (EPS and CA) and acute success (CA) in a group of elderly patients (age ≥75 years old).

Methods
Between August 2020 and September 2023, consecutive elderly patients (32.7% older than 80 years) underwent EPS alone or EPS and CA at our center. Left atrial thrombus was ruled out performing transesophageal echocardiography when indicated. Anticoagulation (ACO) was not interrupted. Femoral veins, arteries and transeptal punctures were performed under ultrasound guidance. A navigation system was used for all CA procedures, except for pulmonary vein isolation, which was performed with a cryoballoon. We analysed procedural complications related to EPS and CA and the acute success of CA procedures.

Results
A total of 104 patients undergoing EPS±CA (79.9±4.6 years, 41.3% female, 75% HTA, 67.3% diabetes type 2, 19.4% COPD, 20.2% chronic renal disease, 25% structural heart disease, CHA2DS2VasC score 3.6±0.8, IMC 27.3±4.5 kg/m2, weight 72.3±13.6 kg, LVEF 52.7±10.8%, 31% history of atrial fibrillation (AF), 47.1% on ACO, 38.5% bundle-branch block, 34.6% first-degree atrioventricular block, 4.8% implanted pacemaker or ICD) were included. Indications for referral (Figure 1) were typical atrial flutter (TAF, 34.6%), atrioventricular nodal reentrant tachycardia (AVNRT, 26.9%), study of syncope (11.5%) atypical atrial flutter or atrial tachycardia (AAF/AT, 10.6%), AF (8.6%, 6 patients for AV node ablation, 3 for pulmonary vein isolation), ventricular tachycardia or ectopy (VT or VE, 5.7%), orthodromic reentrant tachycardia (ORT, 1.9%). 2 patients had TAF and AVNRT, treated in the same procedure. Acute success was achieved in 100% of AF, 94.6% of TAF, 89.6% of AVNRT, 66% of VT/VE, 50% of ORT, 45% of AAF/AT. There were 4 complications (2.9%) in 3 patients, all during the CA procedure: an AV block during an AVNRT ablation, another AV block during an ischaemic septal VT ablation, a femoral artery pseudoaneurism in the same patient (femoral artery approach), and a dislocation of the electrodes from a previous pacemaker during an AT ablation. None of the patients undergoing EPS alone had complications. Weight was the only variable associated with the development of complications (mean difference= -19.8, 95% CI(-38.9-0.7); p=0.04), being higher in those with than in those without complications (91.5±2.2 vs 71.6±13 Kg),(Table 1).

Conclusions
EPS and CA procedures in elderly patients with multiple comorbidities are safe and effective. Acute success and complication rates of CA procedures are substrate-dependent and similar to those reported in the literature for younger patients. We conclude that age is not a barrier to the study and treatment of arrhythmias.
Predictors of low-voltage areas in the left atrium in patients with atrial fibrillation
Authors: Kiliszek M , Beata Uzieblo-Zyczkowska B U Z , Krystian Krzyzanowski K K , Pawel Krzesinski P K 
Published: May 2024

Abstract

Background
Low-voltage areas (LVA) in the left atrium (LA) electroanatomical map are potent predictors of the efficacy of atrial fibrillation (AF) ablation. Clinical factors predicting the presence of LVA have moderate accuracy. The aim of the study was to find clinical and echocardiographic factors predicting the presence of LVA in patients undergoing AF ablation.

Methods
Consecutive unselected patients undergoing AF ablation were included in the retrospective analysis. All patients underwent transthoracic (including LA strains) and transesophageal echocardiography, pulmonary vein isolation and LA electroanatomical mapping using multipolar catheter. LVA were defined as an area greater than 2cm2 with a voltage below 0.5mV (or 0.3mV when measured during AF).

Results
A total of 432 patients were included in the analysis, 107 (24.8%) had LVA. The mean age of the study population was 62.8 years, 185 patients had nonparoxysmal AF (42.8%). In the univariate logistic regression analysis numerous clinical parameters (age, female sex, presence of heart failure, diabetes, coronary artery disease, AF during examination), echocardiographic parameters (LA reservoir strain - LASr, LA emptying fraction, LA volume index, E/e’, LA appendage velocity - LAAV) and mean LA pressure (measured invasively) were significant predictors of the presence of LVA. In the multivariate logistic regression analysis age (HR 1.11 per 1 year increase, p&lt;0.001), LASr (HR 0.89 per 1% increase, p=0.014) and LAAV (HR 0.93 per 1cm/s increase, p&lt;0.001) were significant predictors of the presence of LVA. In receiver-operator curve (ROC) analysis LASr and LAAV were potent predictors of LVA in patients tested on sinus rhythm (AUC 0.86 and 0.87 respectively), while they had moderate predictive value in patients tested on AF (LASr AUC 0.67, LAAV AUC 0.77).

Conclusions
Age, LASr, and LAAV were significant predictors of LVA in patients undergoing AF ablation. The predictive value of LASr and LAAV was better in patients examined during sinus rhythm than in patients examined during AF.
First experiences with protected VT ablation using surgical Impella 5.5
Authors: Nentwich K , Ene E , Hijazi H , Berkowitz A , Lenos A , Deneke T 
Published: May 2024

Abstract

Introduction
Ablation of ventricular arrhythmias (VA) is still challenging due to the complex substrate of the underlying heart disease. Depending on specific risk factors acute hemodynamic decompensation during or after VT ablation procedures may occur and hemodynamic support may be required.
Protected VA ablation with different devices has been evaluated but associated complications like bleeding, vascular closure or weaning from the device have been restrictive. We present data on a dedicated approach to patients with anticipated hemodynamic deterioration using preventive surgical Impella support.

Method
5 patients (2 female) underwent protected VT ablation under our standardized protocol. Indication for Impella support was severely impaired left ventricular function and multiple medical therapy refractory ventricular arrhythmias. 4 patients had conventional VT ablation before. Mean age was 66,8 years, mean CHADSVASC 4,4, 1 patient with non-ischemic cardiomyopathy (CMP), 1 with hypertrophic non-obstructive CMP, 3 patients with ischemic CMP. Mean EF was 20%, mean mixed venous saturation was 36 %, mean PAINESD score 27. In all patients a 5.5. Impella was implanted surgically 1 day before planned VT ablation via the right subclavian artery. VT ablation procedure started with substrate mapping, VT induction and activation mapping of the inducible VT to identify the critical VT isthmus. Ablation was directed to dissection of the critical isthmus of inducible VAs and elimination of all late potentials within low voltage areas. The Impella device was explanted after weaning off the hemodynamic support.

Results
Implantation of Impella 5.5 was successfully performed in all patients in general anesthesia without any complication via surgical approach. Specifically, no access site vascular complications were noted. In 4 patients the VT ablation procedure was performed in analgosedation, 1 patient in GA as this patient was intubated due to recurrent VA requiring defibrillation. Mean procedure time was 125 min, radiation time 1,3 min, inducible VTs 1,3 , median 2 morphologies. In all patients all inducible VTs could be eliminated, in 1 patient polymorphic VA was still inducible at the end of the procedure. Impella was explanted after mean 5,2 days (3-11 days). No complications occurred. All patients were discharged alive on heart failure medication and in 2 patients with amiodaron. At a mean follow up of 3.5 months, all patients are alive without VA recurrence and heart failure decompensation.

Conclusion
Surgical Impella implantation for protected VT ablation in severe heart failure patients is feasible and allows for effective VT mapping and ablation. Access site safety and protection for heart failure decompensation in addition to the possibility of individually mobilisation and weaning after the procedure make this protocol an attractive option. Prospective evaluation of standardized indication is needed.
Anatomic-guided ablation of the right ganglionated plexi validated by the automatic fractionation map
Authors: Parreira L , Quintal J , Mesquita D , Marques L , Marinheiro R , Silva J , Chambel D , Encarnacao C , Costa F , Duarte L , Seixo F 
Published: May 2024

Abstract

Background and aim
Cardiac autonomic modulation through endocardial ablation of atrial ganglionated plexi (GP) is an alternative strategy in selected patients with severe vagal induced bradyarrhythmias.
A strictly anatomical approach targeting the right GPs has demonstrated good success rates but is an empirical approach and has yet to be validated. The presence of fractionated electrograms has been associated with the areas of GPs and can be automatically mapped (fractionation map). The aim of this study was to compare the empirical ablated area, to the automatically assessed area of GPs based on the presence of fractionated electrograms (FEs).

Methods
We studied eight consecutive patients referred for parasympathetic modulation. A high-density map of the left and right atria (LA, RA) in sinus rhythm was performed. The settings for the automatic map were as follows: bipolar high pass filter of 500 Hz, a fractionation threshold of 4, and a width of 5 ms. The ablation was empirically performed by an operator blinded to the results of the fractionation map, as per site protocol. The ablation was aimed at the anatomic locations of the right GPs in the LA and RA. At the anterior and inferior aspect of the right superior pulmonary vein and inferior aspect of the right inferior pulmonary vein on the LA, and posterior RA opposite to the LA RF applications and around the coronary sinus ostium on the RA (Figure). Before ablation, 2 mg of atropine was administered in bolus, and the increase in heart rate was registered and repeated at the end of the procedure. After the operator completed the ablation, access to the fractionation map was available, and additional radiofrequency (RF) applications were applied as needed (Figure). The number of additional RF applications to cover all the areas with FEs was assessed. Success was defined as an absence of response to atropine after the procedure.

Results
Three patients underwent autonomic system modulation only, and five underwent additional pulmonary vein isolation (PVI). The mean age was 66 (50-77) years, five males. The median mapping time of the LA and RA was 11 (17-7) and 14 (9-18) min. All patients underwent successful parasympathetic modulation. The initial median (Q1-Q3) increase in heart rate with atropine was 34 (23-39)% versus 0 (0-2)% after ablation, p=0.012. The differences between empiric and FEs map-guided ablation are depicted in the Table. The additional number of points was low. However, a median of 9 (5-15) additional points were added.

Conclusions
A purely anatomic-guided procedure directed only at the atrial right GPs is usually enough as a therapeutic approach for cardiac autonomic modulation, however, the fractionation map tool helped validate the method and ensure success at the first pass.
Pulsed-field ablation using a lattice-tip catheter without general anesthesia is feasible for atrial fibrillation ablation
Authors: Hirokami J , Schmidt B , Bordignon S , Tohoku S , Chen S , Schaack D , Urbanek L , Ebrahimi R , Plank K , Chun J 
Published: May 2024

Abstract

Background
General anesthesia (GA) was employed to titrate lesion formations for a pulsed-field ablation (PFA) using a lattice-tip catheter. The evidence using a lattice-tip catheter without the use of GA is limited.

Purpose
We conducted a series of exploratory evaluation of a lattice-tip PFA catheter ablation without GA.

Methods
Patients undergoing their first atrial fibrillation (AF) ablation procedures using a lattice-tip catheter were enrolled in the study. To assess acute outcomes and safety, the patients were divided into two groups: one undergoing the procedure with GA and the other without GA. Procedural characteristics were collected.

Results
In total, 20 patients (6 with GA, 14 without GA) were enrolled in the current study. One patient in non-GA group needed a larynx mask due to apnea from anesthesia. The pre-ablation 3D mapping time was equivalent between the two group (with GA versus without GA: 17±7 versus 16±5; P=0.762). All first-pass isolations of the pulmonary veins (PV) were successfully achieved, and there was no difference in the number of applications between the right and left PV (with GA versus without GA: 45±8 versus 53±12; P=0.206 and 47±14 versus 49±9; P=0.792). Linear lesions including anterior linear ablation (33% with GA and 36% without GA: P=1.000), roof linear ablation (67% with GA and 71% without GA: P=1.000) and cavo-tricuspid isthmus ablation (0% with GA and 7% without GA: P=1.000) were performed. The ablation, laboratory stay and fluoroscopy times were equivalent between the two group (with GA versus without GA:88±22 versus 97±20; P=0.483, 128±25 versus 111±18; P=0.216 and 9±4 versus 10±2; P=0.902), while the pre-ablation preparation times were shorter in the group without GA (with GA versus without GA:40±17 versus 14±4; P&lt;0.01). There was no major and minor procedural complication in both groups.

Conclusions
The use of a lattice-tip catheter for ablation without GA has a potential to shorten the whole procedural work-flow including preparing time while maintaining comparable safety and lesion formation to cases where GA is utilized.
Effectiveness of cryoballoon ablation for atrial fibrillation in patients with left common pulmonary vein variant: insights from a national multicenter catheter ablation registry
Authors: Elias A , Eyal A , Beinart R , Nof E , Michowitz Y , Glikson M , Konstantino Y , Haim M , Luria D , Omelchenko A , Marai I , Laish-Farkash A , Suleiman M 
Published: May 2024

Abstract

Background
Pulmonary vein isolation (PVI) is the most effective therapy to achieve rhythm control in atrial fibrillation (AF). Yet, data regarding the safety and effectiveness of this procedure in left common pulmonary vein (LCPV) variant is limited.

Purpose
To explore the effectiveness of cryoballoon AF ablation in patients with LCPV variant.

Methods
A prospective cohort, based on a multicenter registry that included patients who underwent PVI during the years 2019-2021. The study end points were acute isolation success of the pulmonary veins (PVs), AF recurrence and the need for a repeat ablation procedure at 12 months.

Results
Seventy-four patients with LCPV variant and 822 patients with standard four pulmonary veins (PVs) were included in the study cohort. The acute isolation success rates of the left pulmonary veins were significantly lower in the LCPV variants compared to the standard 2 left PVs; 95.9% versus 98.9% respectively (P=0.03). The acute isolation success rates of the right pulmonary veins were not different among patients with LCPV versus standard anatomy; 98.6% versus 98.5% respectively (P=0.9).
The rates of AF recurrence at 12 months were numerically higher in the LCPV variant compared to the standard anatomy group; 17.6% versus 11.1% respectively, but did not reach statistical significance (P=0.09) (Figure 1). The rates of repeat ablation did not differ between the study groups; 8.1% versus 6.2% respectively (P=0.51) (Figure 2).

Conclusion
In our study cohort, the acute isolation success rate of the LCPV was significantly lower compared to standard two left PVs, this finding emphasizes the challenge of isolating LCPV variants using cryoballoon PVI. However, in spite of the lower isolation success rates in the LCPV variants, the clinical effectiveness to prevent AF recurrences was preserved.Figure 1Figure 2
Adding 3D electroanatomical mapping to cryoballoon pulmonary vein isolation improves pulmonary vein isolation durability at repeat ablation procedure
Authors: Tijskens M , Abugattas J P , Wolf M , Schwagten B , De Greef Y 
Published: May 2024

Abstract

Objectives
The addition of pre- and post-ablation electroanatomical mapping with the Achieve catheter and EnSite mapping system has shown to improve acute pulmonary vein isolation (PVI) rate of cryoballoon ablation (CBA). Recently, our group also demonstrated an improvement in 1-year outcome. Current study aimed to investigate the impact on PVI durability as seen during repeat ablation procedure.

Methods
400 patients were compared in a propensity-matched analysis between CT- and Achieve catheter guided CBA (Control group; N=200) and Achieve catheter guided CBA with additional EnSite voltage maps performed pre- and post-CBA (Mapping group; N=200). Matching parameters were age, AF type and CHADS-VASc score. In patients undergoing repeat procedure, PV status was evaluated using CARTO mapping system.

Results
Baseline characteristics did not differ between both groups (Persistent AF: 47,5% vs. 46,5%, P=0,841; diagnosis-to-ablation time: 28,1±15,1 vs. 33,2±41,7months, P=0,107). The mapping group had a shorter follow-up time (25,6±7,2 vs. 50,3±3,3months, P&lt;0,001). Repeat ablation was performed in 20 patients in the mapping group and 70 patients in the control group. At repeat, the proportion of patients with persistent complete PVI was higher in the mapping group (14/20(70.0%) vs 23/70(32,9%), P=0,030). Interestingly, less reconnections of the right inferior PV were seen in the mapping group (10,0% vs. 34,3%, P=0,035). There was no difference in reconnection rate of other PVs.

Conclusions
The addition of electro-anatomical EnSite mapping to the Achieve catheter improves PVI durability as seen during repeat ablation, mainly at the level of the right inferior PV. This finding might explain the improvement in 1-year outcome of this approach.
Peak frequency mapping characteristics in patients with scar-related atypical atrial reentrant tachycardias; findings from a novel automated annotation algorithm to detect near field signals
Authors: Yorgun H , Kilic S , Coteli C , Aytemir K 
Published: May 2024

Abstract

Background
Atypical atrial tachycardias are commonly encountered rhythm disorders especially in patients with atrial low-voltage areas mainly due to previous catheter ablations or surgery. The peak frequency (PF) analysis of bipolar EGMs is a novel automated annotation tool which is mainly based on differentiation of near field signals from far field signals.

Purpose
In this study, we aimed to evaluate the association between PF analysis of voltage maps in low-voltage zones with the critical isthmus and termination sites of ATs.

Methods
In this retrospective analysis, we included a total of 36 patients (7 with right AT, 25 left AT, 4 biatrial). Omnipolar maps of RA and LA were created during AT using Ensite X Mapping system and HD-Grid catheter. Normal voltage is defined as ≥ 0.5 mV, borderline 0.1-0.5 mV and scar &lt;0.1 mV. Only patients with acute termination of tachycardia with RF ablation were included. The sites within the 10 mm radius from the tachycardia termination site with RF were analysed in terms of voltage characteristics and PF analysis.

Results
The mean age of the study population was 53±15. Among 36 patients a total of 46 activation maps were created and 44 reentrant ATs were mapped. (24 (54.6%) ATs were macroreentry, 17 (38.6%) ATs were localized reentry and 3 ATs (6.8%) were dual-loop reentry). The low-voltage (LV) zones comprised 31.5±20.6% and 24.5±12.6% of total LA and RA, respectively. All AT termination sites using radiofrequency energy were located within the LV zones having high frequency activity using 250 Hz as the cut-off. The sensitivity of LV-NF zones to predict termination sites of re-entry was 97.2%.

Conclusion
The PF analysis of atrial substrate in the vicinity of the termination site of re-entrant ATs demonstrated high frequency signals within the low voltage zones. Therefore, addition of PF analysis with emphasis over voltage mapping may refine critical sites of reentry in LV regions.