bluuebunny/crossref_metadata_2025_split huggingface dataset:
The best practices for safety and effectiveness in pregnant: zero-fluoroscopy arrhythmias catheter ablation
Authors: Smagulova A , Ainabekova B , Albaev R , Abdrakhmanova Z H , Suleymen Z H , Abdrakhmanov A 
Published: May 2024

Abstract

Background
Arrhythmias are common during gestation. While the safety and effectiveness of zero-fluoroscopy arrhythmias catheter ablation has been studied, the effects of it in pregnant poorly understood.

Purpose
The aim of our single-center, prospectively study is explore feasibility, efficacy and safety of zero-fluoroscopy catheter ablation in pregnant.

Methods
Characteristic, obstetric and neonatal outcomes of 47 cases of zero-fluoroscopy catheter ablation during gestation (main group) within 24 month follow-up were compared with group of pregnant with antiarrhythmic therapy (control group, p=54). Ablation was performed under the guidance of CARTO (n=21; 44.7%) and Ensite Precision systems (n=26; 55.3%) and intracardiac echocardiography without using fluoroscopy in all cases.

Results
Mean age of pregnant and mean gestation age were comparable in both groups (25.3±3.9 vs. 27.3±3.9 years, p=0.093 and 23.7 ±3.1 vs. 23.8 ±3.2 weeks, p=0.123). Atrioventricular nodal reentrant tachycardia was the most common indications for ablation during gestation (n=21; 44.7%), which was followed by Wolff–Parkinson–White syndrome (n=15; 31.9%). Cases of combination of accessory pathways with slow conduction ways (n=3, 6.4%), ventricular tachycardia (n=3, 6.4%) and premature ventricular contraction (n=5; 10.6%) were rare. Acute procedural success of zero-fluoroscopy ablation was in 100% with mean procedural time 71.9±14.5 minutes. Complication (ileofemoral thrombosis) was in one pregnant (2.1%). Further course of pregnancy characterized by occurring increased uterine contractile activity and placental abruption only in main group (4.54%, p=0.464 and 2.3%, p=0.414 respectively), while uterine blood flow violation and preeclampsia were in both groups (15.9% vs. 13%, p=0.234 and 4.55% vs. 3.7%, p=0.730 respectively). Obstetric outcomes characterized by prevalence of vaginal delivery and delivery in term in both groups (76.6% vs.81.5%, p=0.241 and 95.7% vs. 96.3%, p=0.743). There were live births in all cases with normal range of fetal birth weight in both groups (3207.4±485 vs 3142.2±214.1 grams and 8.4±1.6 vs. 8.6±1.3 respectively). There were no incidence of mortality and arrhythmia recurrence at follow up.

Conclusions
Zero-fluoroscopy ablation is feasible and can be safety performed during gestation with good outcomes.
The role of high density mapping in cathether ablation of paroxysmal atrial fibrillation - preliminary results
Authors: Kajdic N , Prolic Kalinsek T , Antolic B , Zizek D , Stublar J , Podlogar V , Irsic J , Jan M 
Published: May 2024

Abstract

Introduction
Despite technical progress and numerous approaches in ablation strategies, long-term success in paroxysmal atrial fibrillation (PAF) treatment is still suboptimal. Non-transmural ablation lesions in antral isolation lines, causing late electrical reconnection between pulmonary veins (PVs) and left atrium (LA) could present one of the potenital issues for reduced effectiveness of radiofrequency cathether ablation (RFCA). Potentially, these lesions can be identified with high-density (HD) mapping as low voltage, fragmented electrocardiograms (LFEGMs) representing gaps in antral isolation lines.

Purpose
To compare the long-term pulmonary vein isolation (PVI) durability of two PVI verification methods (circumferential vs high-density mapping catheter) after catheter ablation of PAF.

Methods
Thirty-three patients with PAF were prospectively randomized to PVI verification by either circumferential mapping catheter (CM group) or HD mapping catheter (HD group). Patients in both groups underwent PVI according to the CLOSE protocol with PVI verification after a 30 minute waiting period. Additionally, in the HD group antral ablation lines were mapped to search for LFEGMs that were defined as fragmented signals (at least 3 deflections) and/or conduction to the LA during stimulation on the ablation line (10 mA at 1 msec) and/or voltage amplitude above 0.1 mV. If LFEGMs were found, additional ablations were performed until electrical inactivity was confirmed with the HD catheter. To monitor AF reccurence 6-day continuous holter ECG was performed after 3, 6, and 12 months after the initial procedure. ﻿Arrhythmia recurrence was defined as any atrial tachyarrhythmia lasting more than 30 seconds. Patients also underwent a mandatory second procedure 12 months after the initial PVI, during which HD re-mapping was performed to test durability of PVI and absence of conducting gaps in antral isolation lines.

Results
There were 16 patients in the CM group and 17 patients in the HD group. Baseline characteristics (gender, age, body mass index, LA volume index, left ventricular ejection fraction, CHA2DS2VASc score) did not significantly differ between the groups. Procedural characteristic are summarized in Table 1. There were significantly more isolated PVs at the remapping procedure in the HD group compared to the CM group (91.2% (62/68) vs 75.0% (48/64); P=0.021). There were also significantly more patients with all PVs durably isolated in the HD group (82.4% (14/17) vs 37.5% (6/16); P=0.008). However, arrhythmia recurrence rate was similiar between the CM and HD group (43.8% (7/16) vs 35.3% (6/17); P=0.640).

Conclusion
HD mapping improved PVI durability after 12 months compared to standard CM verification. However, lower number of isolated PVs in the HD group did not have an impact on arrhythmia reccurence.
Volumetric quantification of epicardial fat using semiautomated atrial CT segmentation in patients with atrial fibrillation: the Prospective AFAT study
Authors: Erhard N , Prommersberger S , Neuner B , Bahlke F , Englert F , Popa M A , Krafft H , Abdiu E , Reents T , Lennerz C , Telishevska M , Lengauer S , Hessling G , Deisenhofer I , Bourier F 
Published: May 2024

Abstract

Background
Epicardial fat or epicardial adipose tissue (EAT) is most commonly defined as adipose tissue between the myocardium and the visceral pericardium. Previous studies have suggested EAT to be an important contributor to the pathogenesis of atrial fibrillation (AF) as well as a plausible predictor for AF recurrences after ablation. However, data on EAT using precise volumetric quantification is limited.

Methods and Results
AFAT is a prospective observational study conducted at a heart centre in our city with 200 patients aimed to be included. We conducted an interim analysis of the first 75 patients enrolled in the AFAT study. All patients received delayed dual source cardiac computer tomography (CT) imaging which was analysed using semi-automated 3D segmentation (Figure 2) to quantify left atrial (LA) and right atrial (RA) EAT prior to ablation (52.5 % persistent AF). The mean age was 67 ± 8.7 years with 46.9 % (n=35) being female. Mean BMI was 28 ± 4.5. The Mean LA EAT was 33.1 ml ± 13.2 ml and RA EAT was 32.7 ml ± 12.2ml.
Median follow up after AF catheter ablation was 163 days. The optimal cut point for the total atrial EAT was estimated at 50.2 ml. In patients with total atrial EAT ≤ 50 ml recurrence of any atrial arrythmia after catheter ablation occurred in 8% (6 patients) compared to 25.3% (19 patients) recurrence rates in patients with a total atrial EAT &gt; 50 ml. Kaplan-Meyer estimates showed no statistical difference between groups (log rank p=0.063) as this analysis is under-powered with more patients being enrolled for the final results (Figure 1).

Conclusion
The use of semi-automated CT based atrial segmentation presents a novel highly accurate and reproducible method to reliably identify atrial EAT. Increased atrial EAT is likely to play an important role for arrythmia recurrences after catheter ablation. Final results of the AFAT study will provide further evidence to this important subject.Arrhythmia recurrences depending on EATBiatrial 3D Segmentation of EAT
Pulmonary vein isolation durability in patients undergoing very high-power short-duration temperature-controlled ablation
Authors: Schillaci V , Poggi S , Strisciuglio T , Iuliano A , Spiniello G , Arestia A , Salito A M , Shopova G , Marano G , Agresta A , La Rocca V , Dicandia C D , De Simone A , Solimene F , Stabile G 
Published: May 2024

Abstract

Background
The very high-power short-duration (90W for 4 s) temperature-controlled ablation (vHPSD) improves the efficiency of pulmonary vein (PV) isolation procedures. However, atrial fibrillation (AF) recurrences directly related to PV reconnections are still a concern.

Purpose
The purpose of the current study was to assess PV lesion durability in patients undergoing a reablation procedure.

Methods
From September 2020 to July 2023, 327 patients with paroxysmal and persistent AF underwent first ablation aiming at PVI using vHPSD. During a mean follow-up of 25±11 months, 48 patients (14.7%) had an AF recurrence. Patients with reablation procedures were retrospectively consented and enrolled.

Results
Eighteen patients were included in this study. A PV reconnection was observed in 15/72 (21%) PVs, with a mean number of reconnected PV per patient of 0.8 ±0.7. In 7 patients no PV reconnection was observed, one PV reconnected was observed in 9 patients and 2 PVs in 3 patients. A PV reconnection was observed in 8/18 (44%) left superior PV, 1/18 (6%) left inferior PV, 3/18 (17%) right superior PV, and 3/18 (17%) right inferior PV (p=0.03).

Conclusions
PV isolation performed with vHPSD is highly effective and is associated with a low rate of late PV reconnection. A higher percentage of PV reconnection was observed in the left superior PV.
Impact of early recurrences on late recurrences after pulmonary vein isolation with pulsed field ablation. A subanalysis from the EU-PORIA multicenter international registry
Authors: Bordignon S , Chun K R J , Neven K , Mulder B A , Kueffer T , Reichlin T , Hansen J , Blaauw Y , Ouss A , Reinsch N , Albrecht E , Boveda S , Schmidt B 
Published: May 2024

Abstract

Background
Early recurrences of atrial tachyarrhythmia (ERAT) are commonly observed after pulmonary vein isolation (PVI) with thermal energies. ERAT during the 90-day blanking period (BP) should not be considered therapy failure as the cardiac tissue is still healing and the long-term benefit of PVI may not be immediately apparent. With the introduction of pulsed field ablation (PFA), a non thermal, myocardial-specific ablation technology for atrial fibrillation (AF), the significance of ERAT following PVI is unclear.

Methods
EU-PORIA (EUropean real-world outcomes with Pulsed field ablatiOn in patients with symptomatic atRIAl fibrillation), a multicentre international registry, collected data from 1233 patients treated with the pentaspline PFA catheter. For the current analysis, patients with a previous AF ablation procedure, patients treated with lesions beyond PVI, and patients without complete follow up data (during and following the BP) were excluded. The rate and significance of ERAT following PFA PVI were analysed.

Results
This subanalysis included 1011 patients (38% female, 66±11 years old, 64% paroxysmal atrial fibrillation [PAF]). ERATs were recorded in 178/1011 (18%) of patients (16% in PAF and 21% in persAF, p=0,021). Notably, ERAT patients were older (67,1±11,4 Vs 65,4±10,9, p=0,015) and had a higher median CHA2DS2-VASc Score (2,5 [IQR:1-4] Vs 2 [IQR:1-3]; p=0,019). The 35-mm catheter was more often used in ERAT patients (48/178(27%) Vs 148/833(18%) – p=0,005). At a median follow-up of 365 days (IQR 347-390), 100/178(56%) of patients with ERAT had documented late recurrence (LR), compared to only 147/833(18%) of patients in sinus rhythm throughout BP (p&lt;0,001). Kaplan Meier estimates for overall freedom from AF/AT outside of the BP was 77% at one year for all patients. Patients with ERAT had a significantly lower freedom from AF/AT compared to patients with no ERAT (42% vs 84%, log-rank p&lt;0,001). The absence of ERAT was associated with long-term success independent of the type of AF (41% Vs 88% in PAF, 43% vs 74% in persistent AF; p&lt;0,001 for both). Among ERAT patients, no additional predictors for LR were identified.

Conclusions
In this large multicentre international registry, early recurrence of atrial tachyarrhythmia following PFA PVI were recorded in 18% of patients. ERAT was associated with late recurrences in the majority of cases, independent of AF type. The need for a blanking period following non thermal energy ablation for atrial fibrillation should be further questioned.
Ultra-high density mapping for the evaluation of the antral scar extension after ablation with a radiofrequency balloon catheter in atrial fibrillation patients
Authors: Poggi S , Almorad A , Pandozzi C , Torri F , Strisciuglio T , Iuliano A , Russo M , Manfrin M , Galeazzi M , Bertagnolli L , Spiniello G , Stabile G , Chierchia G B 
Published: May 2024

Abstract

Background
The Heliostar radiofrequency (RF) balloon ablation catheter enables one-shot pulmonary veins isolation (PVI). The RF balloon by occluding the PV ostia creates an antral scar.

Purpose
We sought to investigate the extension of the antral scar by mean of ultra-high density mapping.

Methods
Paroxysmal and persistent atrial fibrillation (AF) patients undergoing first PVI ablation with the Heliostar catheter across 4 European centers were enrolled. Ultra-high density mapping of left atrium was performed with the Octaray catheter, a octa-spline mapping catheter before and after the ablation. All maps were acquired in sinus rhythm, patients in AF underwent electrical cardioversion before mapping. The bipolar voltage maps from each patients were analysed: the left atrial area &lt; 0.2 mV was considered scar and was calculated before and after the ablation and the distance between left and right antral lesions at upper and inferior posterior wall were also calculated.

Results
Overall, 49 patients were enrolled, 82% were male, the mean age was 60±9 years, 66% had paroxysmal AF. PVI was achieved in 100% patients. The mean left atrial area was 209±44 cm2, the scar after the ablation was 9±4.6 %, with 49±11% of the posterior wall still viable (bipolar voltage &gt; 0.5mV). The distance between left and right antral lesions at the upper posterior wall was 26.57 mm whereas at the inferior aspect was 29.59 mm.

Conclusions
The RF balloon catheter creates a wide antral scar during AF ablation although without compromising the integrity of the posterior wall.
Influence of audiovisual distraction on the feeling of stress, analgesic sedation and patient satisfaction during electrophysiological ablation procedures on the heart
Authors: Kupusovic J , Raschke R , Wakili R 
Published: May 2024

Abstract

Background
Distraction using audiovisual stimuli has mostly been researched in a paediatric population with the results showing an inhibiting effect on stress and anxiety as well as the subjective perception of pain.

Purpose
We designed a study to test if audiovisual distraction may reduce the level of sedatives and analgesics by reducing anxiety and stress during electrophysiological intervention (EP).

Methods
We conducted a clinical intervention pilot study that was carried out in a randomized controlled manner. Consecutive 70 patients undergoing EP with subsequent ablation were randomized 1:1 to control (CTL) or intervention group (AVD). In addition to standardized sedation, all patients in AVD group received audiovisual glasses. Feeling of fear and stress was assessed through blood pressure changes. The patient satisfaction was assessed with Client Satisfaction Questionnaire, ZUF-8. Numeric scale (NRS) was used to quantify the perceived pain during the procedure. The difference between the subjective estimated duration of the procedure and the actual duration of the procedure was compared.

Results
The study included predominantly male patients (58.6%) with a mean age of 56 years. Technical aptitude was well balanced between both groups with the majority of patients in both groups owning a smartphone or a tablet (86.1% vs 85.7% for CTL and AVD respectively, p=0.92), and majority of patients in both groups using a computer, laptop or tablet on a weekly basis (58% vs 57.1% for CTL and AVD group respectively, p=0.97). The baseline feelings of anxiety were well balanced within both groups (Figure 1). Our analysis revealed no significant difference between the mean blood pressure values of the CTL and AVD groups (systolic: 135 vs. 141 mmHg; p = 0.32; diastolic: 74 vs. 72 mmHg; p = 0.45). Patient satisfaction score was comparable in both groups (26.5 vs. 26.8 points, p = 0.36). Average response for perceived pain using NRS scale as well as perceived procedure duration was similar between the groups (Figure 2). AVD group required a lower dose of Midazolam than CTL group (0.005 mg/kg/h vs 0.007 mg/kg/h, p = 0.07). Majority of patients (31.4%) in AVD group stated: "The audiovisual glasses made me feel distracted at times." 10% of the AVD patients stated: "The audiovisual glasses made me feel completely distracted and more relaxed."

Conclusion
The use of audiovisual glasses has no influence on the patients’ feelings of anxiety and stress during EP. The use of audiovisual glasses can temporarily induce distraction during EP, while they do not seem to be sufficient in reducing pain intensity during ablation therapy. Patients undergoing EP do not seem to be the target patient group for AVD use.
Left atrial posterior wall isolation during catheter ablation with the pulsed field ablation in patients with persistent atrial fibrillation
Authors: Schiavone M , Dello Russo A , Tondo C , Iacopino S , Bianchi S , Schillaci V , Moltrasio M , Rossillo A , Maggio R , Casella M , Filannino P , Volpato G , Themistoklakis S , Malacrida M , Solimene F 
Published: May 2024

Abstract

Background
Few data are available on pulsed-field ablation (PFA) targeting left atrial posterior wall (LAPW) in persistent atrial fibrillation (PeAF) patients.

Purpose
We sought to explore the role of PFA in persistent AF patients beyond pulmonary vein isolation (PVI), extending the lesion set to obtain LAPW isolation.

Methods
We enrolled consecutive patients referred for persistent AF catheter ablation using the Farapulse PFA system at nine Italian centers. Complete 3D mapping was performed before and immediately after LAPW isolation to validate our workflow in all cases. To analyze lesions' formation and residual gaps, the line around each pair of PVs was divided into 7 distinct sections in accordance with the literature, while the roof line, the floor line, and the two longitudinal posterior wall lines were equally divided into three parts. The PW was overall divided into nine regions. This scheme has been illustrated in Figure 1, Panel A.

Results
Fifty patients meeting inclusion criteria were included. PVI was achieved in all 202 (100%) PVs (1 patient exhibited a left common trunk, 2 patients exhibited a right middle cardiac PV). One-hundred ninety-eight (98.0%) PVs were acutely isolated on first pass, as confirmed by both entrance and exit block on subsequent 3D-mapping with the mapping catheter. A total of 7 PV gaps were detected through 3D mapping: 4 at the RSPV, 2 at the RIPV and 1 at the LSPV. When considering LAPWI, overall LAPW ablated area was 20.0±6 cm2 with lesions being deployed with the PFA catheter maneuvered in the flower configuration from one LAPW area to another. First-pass roof area (sectors #1 to #3) block was achieved in 44 (88%), first-pass floor area (sectors #7 to #9) block in 43 (86%) and inner-area (sectors #3 to #6) block in 45 (90%). A total of 23 residual LAPW activity gaps were detected through validation using high-output pacing and 3D mapping. Remapping examples has been reported in Figure 1, panel B-C-D. Evaluation of individual segments of the LAPW via signals’ assessment from the PFA splines demonstrated an accuracy of 94.9% (437 out of 450 sectors), compared to the results of subsequent high-output pacing and 3D mapping. Following PFA consolidation in these areas, LAPW isolation was successfully achieved in all cases (100%) using PFA alone, with no need for radiofrequency touch-ups. No major procedure-related adverse events were reported.

Conclusion
A structured workflow with the novel Farapulse PFA system allowed for a reliable, safe, and fast LAPW isolation, as confirmed by ultra-high-density 3D mapping.
Safety and feasibility of zero-fluoroscopy technique in ablation-index guided pulmonary vein isolation: a prospective, single center trial
Authors: Torma D , Debreceni D , Janosi K F , Simor T , Kupo P 
Published: May 2024

Abstract

Introduction
Pulmonary vein isolation (PVI) represents the cornerstone of catheter ablation procedures in patients with symptomatic paroxysmal/persistent atrial fibrillation (AF). Conventionally, PVI is performed using fluoroscopy, but it can also be performed using the zero-fluoroscopy (ZF) technique with the assistance of electroanatomical mapping systems and intracardiac ultrasound, achieving fluoroscopy-free procedures.

Purpose
Our study aimed to compare procedural data of ablation-index guided point-by-point radiofrequency (RF) PVI performed with non-zero-fluoroscopy (NZF) vs. ZF approaches.

Methods
We enrolled 100 consecutive patients undergoing PVI for antiarrhythmic drug- refractory AF in our prospective observational study. In the first 50 cases, PVI was performed using the NZF technique, and in the other 50 cases, the ZF technique was applied. Procedural time, fluoroscopy exposure, ablation parameters, and the occurrence of complications were compared between the two groups.

Results
Compared to the NZF group, procedural time (59.6±10.7 min vs. 74.6±13.2 min, p&lt;0.0001) was significantly shorter in the ZF group. This difference was mainly driven by the time from puncture to the beginning of left atrial mapping, which was significantly longer in the NZF group (17 [16; 20] min vs. 31 [23; 34.5] min, p&lt;0.001). No differences were found between the two approaches in the number of RF applications (81 [73; 103] vs. 83 [71; 91], p=0.67), total ablation energy (54986 ± 13093 Ws vs. 55500 ± 11907 Ws, p=0.48), and the left atrial dwelling time (41.5 [36; 52.5] min vs. 40.5 [35; 46], p=0.14). No complications occurred in either group. In the ZF group, complete elimination of fluoroscopy was achieved in all cases, resulting in significant differences in fluoroscopy time (0 [0; 0] sec vs. 132 [100; 160] sec, p&lt;0.0001] and dose (0 [0; 0] mGy vs. 4.8 [4.1; 8.2] mGy, p&lt;0.0001) compared to the NZF technique. The acute success rate was 100% in the study population, and no complications occurred during the study period.

Conclusion
Ablation-index guided ZF PVI is feasible and safe. Using this technique, the procedure time can be shortened besides achieving a similar acute success rate without increasing complications.