bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rate control with Landiolol in atrial tachyarrhythmias and comorbid left ventricular dysfunction: a systematic review and meta-analysis
Authors: Nasoufidou A , Papazoglou A S , Stachteas P , Karagiannidis E , Samaras A , Alexiou S , Kassimis G , Fragakis N 
Published: May 2024

Abstract

Backround
Atrial tachyarrhythmias (ATs) are frequently inter-related with heart failure (HF). ATs exacerbate HF, while the existence of chronic HF precipitates the occurrence of ATs. Landiolol, a highly selective and exceptionally-short acting beta-1 blocker has been used in patients with ATs and HF, where evidence on the available treatment options is limited.

Purpose
In this meta-analysis we intended to assess the clinical effects of rate control with landiolol in patients with ATs and comorbid left ventricular dysfunction, who are not septic or in peri-operative stage.

Materials and Methods
We systematically searched PubMed, Scopus and WebofScience up to 14 July 2023. Two independent reviewers screened and selected randomized control trials as well as observational studies according to predetermined eligibility criteria. Risk of bias and quality of evidence were assessed according to Cochrane guidelines.

Results
2278 articles were initially screened and 11 studies were finally included in this systematic review. In 7 of the eligible studies landiolol was compared with placebo, while in the remaining 4 studies landiolol was investigated in comparison with other antiarrhythmic drugs and specifically digoxin and diltiazem. The total sample size included 1876 patients, 75% of whom were classified into III/IV NYHA class. Landiolol treatment reduced patients’ heart rate by a mean of 42 beats per minute (95% CI: 37-47 bpm) while 3 out of 4 treated patients accomplished targeted heart rate, described as an at least 20% reduction from baseline heart rate and final heart rate less than 110bpm. Compared to patients receiving other antiarrhythmic therapy, patients treated with landiolol had increased odds of achieving target heart rate (OR: 5.32, 95% CI: 2.87-10.05). Referring to landiolol safety, 15% of the treated patients encountered an adverse event, more frequently dose-dependent hypotension. Landiolol was discontinued only in a 6% of the treated patients. No difference in adverse events was identified between landiolol and other antiarrhythmic drugs.

Conclusion
In this meta-analysis landiolol has achieved satisfactory levels of efficacy and safety regarding rate control in patients with ATs and left ventricular dysfunction.Prisma FlowchartLandiolol efficacy in single-arm studies
Left atrial strain defines functional and structural remodeling in patients with persistent atrial fibrillation
Authors: Duckwitz N , Herzer L , Kirsch K , Mettke F , Hamadanchi A , Schulze P C , Surber R , Grosse A 
Published: May 2024

Abstract

Background
Left atrial (LA) strain is an echocardiographic method to detect atrial dysfunction as a process of structural and functional remodeling of the atria. In patients with persistent atrial fibrillation (AF), functional changes and an enlargement of the LA due to structural remodeling has been described. The aim of our study was 1) the echocardiographic assessment of LA function using LA strain and 2) to investigate the correlation between LA strain and left atrial size index (LAVI) using 3D reconstruction of the LA from multi-detector computed tomography (CT).

Methods
This study includes patients with persistent AF who underwent LA catheter ablation without prior treatment. All subjects underwent measurement of reservoir (LASr), conduit (LAScd) and contraction (LASct) LA strain using imaging using two-dimensional speckle tracking echocardiography (2D-STE) and cardiac CT. A 3D reconstruction of the LA from the CT was done using EnSite Verismo (Abbott, USA). The LA volume obtained at the end-systole included LA appendage reconstruction and excluded the pulmonary veins. LAVI was calculated by dividing LA volume by body surface area.

Results
The study included 36 patients (mean age 69 yrs [49 to 80 yrs], 27 male, mean LV-EF 56% [40 to 78%).
We found the following LA strain measurement: mean LASr 21% [6 to 52%], mean LAScd -12% [-32 to -0,25%] and mean LASct -9% [-32 to -1%]. LAVI: mean 82 ml/m² [38 to 127 ml/m²].
There is a statistically significant negative correlation between LASr (p = 0.002, r = -0.503) and a statistically positive correlation between LASct (p = 0.003, r = 0.482) compared to the LA volume, whereas there is no statistically significant correlation between LAScd and the LA volume (p = 0.088, r = 0.288).

Discussion
LA strain in patients with persistent AF as an expression of functional remodeling is reduced compared to normal values in literature. Correlation of LA strain and LAVI are statistically significant for LASr as well as LASct. The correlation between LAScd and LAVI did not reach statistical significance but shows a trend towards a positive correlation. Whether early treatment of AF could prevent further fibrotic remodeling with reducing LA volume and improving LA strain needs further research.
Catheter ablation of atrial fibrillation shows pulmonary vein dependent effect on the signal-averaged P-wave morphology
Authors: Fantazi N , Napp A , Berbers J , Emrani M , Hermans B , Zeemering S , Schotten U , Gramlich M , Zink M D 
Published: May 2024

Abstract

Background and Aims
Cryoballoon ablation of atrial fibrillation alters a significant amount of vital myocardium that contributes to its electrical activity. However, the impact of pulmonary vein isolation (PVI) on P-wave morphology is unclear. The aim of this investigation was to quantify whether the contribution of the left or right pulmonary veins (PVs) is greater using means of signal-averaged P-wave analysis.

Methods
Unfiltered high-resolution (2000 samples/second) ECGs were obtained for 5 minutes both pre- and post-isolation of the left and right PVs, with 12 standard and 10 additional leads (x01-x10). Additional lead positions were determined in prior studies for optimal detection of atrial electrical activity not captured by standard leads. Signal-averaged ECGs were computed and analyzed using bespoke software in Matlab. Statistical significance was assessed using a two-tailed paired t-test. A total of 69 participants were screened for the study. For the analysis, 64 participants with sinus rhythm in all ECG recordings were eligible.

Results
Significant postablation changes for various ECG parameters across different lead combinations were found (Table 1). On average, after ablation of the left pulmonary veins (LPVs), there was a reduction in P-wave terminal force (3.07±2.05 mV*ms vs. 2.84±1.88 mV*ms, p = 0.044), P-wave complexity (2.02±0.64 vs. 1.90±0.57, p = 0.047), and sample entropy (0.210±0.039 au vs. 0.197±0.031 au, p &lt; 0.001), whereas P-wave duration (148.24 ms vs. 153.23 ms, p &lt; 0.001) and PQ time (200.41 ms vs. 205.43 ms, p &lt; 0.001) prolonged. However, after ablation of the right pulmonary veins (RPVs), sample entropy decreased (0.196±0.031 au vs. 0.190 ±0.027 au, p = 0.049) and amplitude increased (0.087±0.024 mV vs. 0.091±0.024 mV, p = 0.002).

Conclusion
PVI in atrial fibrillation has a significant effect on signal-averaged P-wave. These effects are more pronounced after ablation of the LPVs than the RPVs. Parameters such as PWTF, PWC and SaE demonstrate potential to assess the effect of catheter ablation and may serve as a potential indicator for a successful procedural outcome.
Echocardiographic follow-up after AV node ablation combined with left bundle branch area pacing for patients with symptomatic atrial fibrillation
Authors: Rijks J , Lankveld T , Manusama R , Broers B , Van Stipdonk A M W , Chaldoupi S M , Ter Bekke R M A , Schotten U , Linz D , Luermans J G L M , Vernooy K 
Published: May 2024

Abstract

Background
AV node ablation combined with permanent pacing is an established therapy for rate control in patients with symptomatic atrial fibrillation (AF) refractory or intolerant to pharmacological rate or rhythm control and not eligible for rhythm control by left atrial catheter ablation. The threshold for performing this so-called "pace-and-ablate" strategy has decreased since the introduction of conduction system pacing, and especially left bundle branch area pacing (LBBAP).

Purpose
To investigate the change of the left-ventricular (LV) ejection fraction (EF) and left-atrial volume index (LAVI) in patients with symptomatic AF, twelve months after LBBAP and AV-node ablation.

Methods
Consecutive patients with symptomatic AF intolerant or refractory to pharmacological rate and symptom control and deemed not eligible for left atrial catheter ablation were included. At baseline, the EHRA score was noted and the LVEF and LAVI were measured echocardiographically. Patients were subdivided in a normal baseline LV ejection fraction (LVEF &gt;50%) or diminished baseline LVEF (LVEF &lt;50%) group. After LBBAP, patients underwent AV node ablation in the same procedure or four weeks later. After twelve months, the LVEF and LAVI were reassessed in the entire cohort and the two subgroups.

Results
Twenty-two patients (68% female, mean age 79±4 years) scheduled for pace-and-ablate therapy were prospectively included. Three (14%) had paroxysmal, sixteen patients (72%) had persistent AF and three patients (14%) long-standing persistent AF. An EHRA class IIb or higher was found in eighteen patients (82%). At baseline, the mean LVEF was 51 ± 7%, the mean LVEDD 47 ± 6 mm and LAVI 54 ± 18 ml/m2. Twelve patients (55%) had a preserved LVEF, whereas ten patients (45%) had an LVEF &lt;50%, fig. 1. After twelve months, the overall ejection fraction increased to 54 ± 5% (p=0.016), fig. 2A. This was mostly attributed to the increase in LVEF to 51 ± 5% in the subgroup with a reduced baseline LVEF (p=0.009 compared to baseline 44 ± 5%), fig. 2A. The LVEF was unaffected in the other group (57 ± 3% vs. 57 ± 4%, p=0.63), fig. 2A. The LAVI was not significantly reduced in the overall cohort or the subgroups (54 ± 18 ml/m2 to 51 ± 19 ml/m2, p=0.16), fig 2B.

Conclusion
AV node ablation combined with LBBAP results in a significant improvement in LVEF at twelve months follow-up. This is mainly driven by an improvement in LVEF in those patients with a diminished LVEF at baseline. The data suggests that the therapy can reverse a tachycardiomyopathy without inducing a pacing-induced cardiomyopathy. No significant reduction in LAVI was found.Baseline characteristicsChanges in LVEF (A) and LAVI (B)
The role of Ranolazine alone or in combination with a Class III anti-arrhythmic drug for DC cardioversion for persistent AF
Authors: Raman S , Rutherford P , Das M 
Published: May 2024

Abstract

Background
Electrical cardioversion (DCCV) is commonly used for rhythm-control in patients with persistent AF. Use of anti-arrhythmic drugs (AADs) increases rates of acute conversion and longer-term maintenance of sinus rhythm (SR) following DCCV. Of these, Amiodarone is the most effective but has a high side-effect burden. Ranolazine, currently licensed for angina, has been shown to have AF-suppressive effects and works synergistically with Class III AADs.

Purpose
We aimed to assess outcomes following DCCV in patients treated with a Class III AAD, Ranolazine or in combination at a single UK tertiary Cardiology centre.

Methods
We retrospectively reviewed DCCV lists from June 2020-February 2022. Patients undergoing DCCV on a Class III AAD (Amiodarone/Dronedarone), Ranolazine or a combination of the two and with documented 1-year follow-up were included. Patients who underwent AF ablation during the follow-up period having remained in SR up to that point were excluded. Acute DCCV success and maintenance of SR at 1-year follow-up were recorded.

Results
A total of 350 patients underwent DCCV during the study period, of whom 102 (29.1%) were on an AAD. After exclusions, 78 patients were included, as follows: Amiodarone - n=30; Dronedarone - n=23; Ranolazine - n=11; combined Ranolazine + Class III AAD - n=14.
Acute outcomes:
The proportion of patients achieving SR acutely post-DCCV was as follows:
Amiodarone: 27/30 (90.0%)
Dronedarone: 21/23 (91.3%)
Any Class III AAD: 48/53 (90.6%)
Ranolazine: 10/11 (90.9 %)
Combined Ranolazine + Class III AAD: 14/14 (100%).
1-year follow-up outcomes (Figure 1): The proportion of patients who had remained in SR at 1 year (mean follow-up 11±1.9 months – similar for all 4 groups) was as follows:
Amiodarone: 12/30 (40.0%)
Dronedarone: 4/23 (17.4%)
Any Class III AAD: 16/53 (30.2%)
Ranolazine: 3/11 (27.2%)
Combined Ranolazine and Class III AAD: 8/14 (53.3%).
Despite including 5 patients (35.3%) who had previously failed an AAD monotherapy, the group taking a combination of Ranolazine and a Class III AAD were numerically more likely to remain in SR at 1-year follow-up than those on Amiodarone or Ranolazine, though neither reached significance. However, combination therapy was significantly more effective than Dronedarone monotherapy (P=0.03) and there was a trend towards improved efficacy compared to any Class III AAD (53.3% vs. 30.2%, P=0.11). There were no significant differences between the 3 monotherapy treatments.

Conclusion
A combination of Ranolazine and Class III AAD may improve maintenance of SR 1 year post-DCCV compared to a Class III AAD alone. Ranolazine also shows comparable efficacy to traditional Class III agents and could therefore be considered as an alternative for patients in whom a Class III AAD is not desirable. Larger randomised multi-centre trials are warranted to evaluate the efficacy and safety of these treatment strategies.
Different predictors of AF recurrence after pulmonary vein isolation with cryoballoon and radiofrequency ablation: insights from clinical and electroanatomical mapping data of the NO-PERSAF study
Authors: Wollner K , Rossvoll O , Tande P , Solheim E , Schuster P M , Chen J 
Published: May 2024

Abstract

Background
Pulmonary vein isolation (PVI) with cryobaloon ablation (CBA) and radiofrequency ablation (RFA) lead to a similar outcome of freedom from atrial tachyarrhythmia (ATA) during follow-up as showed by the NO-PERSAF study. Analyses of ATA recurrence for these two techniques based on data of electroanatomical mapping (EAM) are scarce from randomized clinical trials.

Purpose
This study aimed to evaluate and compare clinical outcomes and EAM data recorded in the left atrium (LA) during CBA and RFA procedures in patients with persistent atrial fibrillation (AF).

Methods
For the NO-PERSAF study, 101 patients (mean 63.2±8.6 years, 80 male, 21 female) with persistent AF (77 persistent AF, 24 long-standing persistent AF) referred to PVI were randomized (1:1) to CBA or RFA and followed for 12 months. A prolonged 3-year follow-up was carried out. EAM was performed by a circular mapping catheter with a 3-dimensional mapping system in all patients. EAM data were recorded and analyzed off-line. The areas of the LA, posterior wall, low-voltage (&lt;0.5mV) and complex fractionated electrogram (cycle length &lt;120 ms) were measured and corrected by body surface area (BSA). EAM data from 90 patients were qualified for further analysis and the others (5 in CBA and 6 in RFA) excluded because of disqualification or technical failure of recording. Correlation between clinical results of 3-year follow-up and the EAM data were analyzed using univariate cox regression.

Results
After 3-year follow-up, freedom from ATA was achieved in 51 (50.5%) of the 101 patients, 28 (54.9%) out of 51 patients in the CBA group and 23 (46.0%) out of 50 patients in the RFA group and no difference was found (p=0.327). RFA compared with CBA resulted in larger ablation lesions in the LA (23.9% vs. 21.3%; p=0.037) and particularly in the posterior wall (44.2% vs 31.8%; p&lt;0.001).
Compared between the patients with and without recurrence, there was no difference with respect to age, gender, AF history, body mass index, heart disease and CHA2DS2-vasc score. For EAM data, the area of the LA and low voltage were significantly higher in ATA recurrent patients in CBA group, but not in RFA group (Table 1).
Univariate cox regression analyses suggested that 3-year follow-up outcomes were associated with the size of the LA and the amount of low voltage corrected by BSA. The criteria of the LA area &gt;55 cm2/m2 or low voltage area &lt;19 cm2/m2 could predict ATA recurrence after CBA, but not after RFA procedure (Figure 1).

Conclusions
The size of the LA and the amount of low voltage corrected by BSA was associated with the outcomes of PVI during follow-up and could be employed as predictors of ATA recurrence for CBA, but not for RFA procedure.Table 1Figure 1K-M curves after CBA and RFA
A proposed index of myocardial staining for vein of marshall ethanol infusion
Authors: Landra F , Nesti M , Garibaldi S , Mirizzi G , Startari U , Panchetti L , Piacenti M , Taddeucci S , Formichi B , Stefani M , Galiberti S , Lionetti V , Solinas P , Levantesi B , Rossi A 
Published: May 2024

Abstract

Background
Mitral isthmus(MI) conduction block is a fundamental step in anatomical approach treatment for persistent atrial fibrillation(PeAF). However, MI block is hardly achievable with endocardial ablation only. Retrograde ethanol infusion(EI) into the vein of Marshall(VOM) facilitates MI block. Fluorographic myocardial staining(MS) during VOM-EI could be helpful in predicting procedural alcoholization outcome even if its role is qualitatively assessed in the routine.

Purpose
The aim was to quantitatively assess MS during VOM-EI and to evaluate its association with MI block achievement.

Methods
Consecutive patients undergoing catheter ablation for PeAF at our Institution from February 2022 to May 2023 were considered. Patients with identifiable VOM were included. A proposed index of MS(MSI) was retrospectively calculated in each included patient. Correlation of MSI with low voltage zones(LVZ) extension after VOM-EI and its association with MI block achievement were assessed.

Results
42 patients out of 49 (85.8%) had an identifiable VOM. MI block was successfully achieved in 35 patients out of 42 (83.3%). MSI was significantly associated with the occurrence of MI block (OR 1.24 (1.03 – 1.48); p = 0.022). A higher MSI resulted in reduced ablation time (p = 0.014) and reduced radiofrequency applications (p = 0.002) to obtain MI block. MSI was also associated with MI block obtained by endocardial ablation only (OR 1.07 (1.02 – 1.13); p = 0.002). MSI was highly correlated with newly formed LVZ extension (r = 0.776; p = 0.001).

Conclusion
In our study cohort, optimal MSI predicts MI block and facilitates its achievement with endocardial ablation only.Myocardial stainingSpline plots
Intraprocedural and outcome findings in repeat left atrial procedures after pulsed field ablation for pulmonary vein isolation in paroxysmal and persistent atrial fibrillation
Authors: Woermann J , Jueker J , Van Den Bruck J , Filipovic K , Erlhoefer S , Scheurlen C , Dittrich S , Ackmann J , Pavel F , Schipper J , Steven D , Sultan A 
Published: May 2024

Abstract

Background
Pulsed Field Ablation (PFA) has emerged as a promising novel technique for pulmonary vein isolation (PVI) in the setting of atrial fibrillation. First outcome data revealed comparable success rates to radiofrequency and cryoablation. However, data on lesion dimensions and reconnection of PV after PFA potentially causing recurrence of AF is sparse. We, therefore report on pivotal reconnection sites and ablation extend after PFA-PVI.

Methods
All patients after PFA-PVI for paroxysmal or persistent AF at our center between September 2021 and October 2023 were included in this retrospective analysis. Baseline characteristics, procedural and outcome data were obtained. Furthermore, in all redo procedures of these patients lesion dimensions and the occurrence and location of PV gaps were evaluated.

Results
A total of 123 patients with atrial fibrillation underwent successful PFA-PVI during index procedure. The study cohort comprised [n= 52; 42%] paroxysmal and [n= 71; 58%] persistent atrial fibrillation cases. After a median follow-up of 123 (IQR 93-150) days recurrence of atrial arrhythmia (all AF) occurred in 9 [14. 5%] patients. Of these, 6 [9.6%] patients underwent a redo procedure due to recurrence of atrial fibrillation (3 PAF and 3 persAF [50%]; p=1). All left atrial maps and 24 PVs were analyzed. All 6 [100%] patients exhibited electrical reconnection of one or more pulmonary vein. Analysis of redo procedures revealed that the dimensions of PFA-induced lesions varied among patients: The right inferior pulmonary vein (RIPV) showed reconnection in all redo-patients (100%). Also frequent reconnection was observed for the RSPV (3 pts [50%]) and LIPV (2 pts [33%]). The gap size was 66±40% of the circumference in the reconnected RPVs and 61±31% in the reconnected LPVs. A roof-line lesion set was performed in 4 out of 6 pts (67%) due to the initially antral PV lesions affecting the posterior wall and LA roof potentially creating an isthmus for roof-dependent atrial tachycardia (AT).

Conclusion
Outcome data for PFA-PVI are comparable to other energy sources used for PVI. However, reconnection of PV also occurs after PFA-PVI. This retrospective analysis of redo procedures after initially successful PVI identified the RIPV as pivotal for reconnection. Furthermore, map analysis revealed that reconnection gaps extend to up to 2/3 of the initial circumferential PV ablation area. Furthermore, PFA seems to create new critical isthmuses potentially causing AT. No difference in reconnection was seen comparing PAF and persAF.