bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atrial fibrillation cryoablation guided by pulmonary vein pressure: comparison with the standard strategy
Authors: Madero S , Herreros Guilarte B , Diez De Las Heras D , Munoz San Jose J C 
Published: May 2024

Abstract

Background
Pulmonary vein (PV) isolation is the cornerstone for the treatment of patients with atrial fibrillation (AF). Balloon cryoablation (BCA) is the preferred single-shot option for ablation of PVs using contrast guided occlusion as the standard approach (SA). We have made a simplified procedure, using a pressure-guided approach (PG) aimed to obtain a PV wedge curve. This technique has been described previously(1-3). To our knowledge, no comparison has been made in real life with a mixed patient setting in AF (paroxysmal and persistent) and non-selected anatomy with exclusive PG.

Purpose
To compare a prospective cohort of patients going into AF BCA, using SA versus PG.

Methods
Between January 2022 and October 2023, 50 consecutive patients underwent BCA. The first 25 patients were treated with SA protocol and the latter 25 with PG. In both techniques, the aim was to obtain PV isolation with a 240 seconds application and no bonus attempt. A computed tomography angiography or MRI of the left atrium (LA) was performed in all the patients. 28-mm Cryoballoon and Intracardiac echo were used in all the procedures. We compared patients and procedure characteristics between both techniques.

Results
Both groups (SA vs PG) showed similar baseline characteristics with not significant differences between them: mean age (58±10 vs 61±10 years), median LA diameter (40±8 vs 41±5mm), mean LVEF (60±9 VS 63±7%), Paroxysmal AF (60 vs 56%), average CHA2DS2-VASc score (1.3±1.3 vs 1.8±1.5), One patient is SA group had a previous radiofrequency (RF) ablation with 4/4 veins reconnected, and in the PG group two patients had RF ablation with 7/8 veins reconnected (Table 1). The procedural characteristics between SA and PG, also did not show significant differences: median procedural time (120±20 vs 130±38 min), fluoroscopic time (24±13 vs 30±19 min), and isolation was achieved in 98/99 veins (99%) in each group (Table 2). In the SA group, two patients had complications: one patient with a transient palsy of the phrenic nerve and because of this, only 3/4 veins were targeted, and the second patient had a post-procedure pericarditis. In the PG group, one patient had a pericardial effusion seen at the end of the procedure that did not require drainage.

Conclusion
In our initial experience, BCA for AF with both strategies proved to be safe and effective in this mixed group with non-selected anatomy. This result reassures the PG as a way to enhance CBA because of the advantage in avoiding the use of intraprocedural IV contrast. Impact in performance during follow-up is yet to be seen in our cohort.Table 2.Baseline characteristicsTable 2.Procedural characteristics
First comparison of single-tip versus single-shot pulsed field ablation for pulmonary vein isolation in paroxysmal atrial fibrillation: interim analysis of a randomized trial
Authors: Hartl S , Reinsch N , Fueting A , Neven K 
Published: May 2024

Abstract

Background
Non-thermal pulsed field ablation (PFA) is an emerging technology to perform pulmonary vein isolation (PVI) for atrial fibrillation (AF). Different PFA systems are available, but no comparative data exist.

Purpose
Randomized trial to compare single-tip versus single-shot PFA for initial PVI in paroxysmal AF patients.

Methods
In this single-center trial, paroxysmal AF patients are prospectively enrolled and 1:1 randomized in the single-tip or single-shot PFA group. Single-tip PVI is performed using a PFA generator and a 3.5mm contact-force enabled ablation catheter guided by 3D mapping system. The pulsed electric field dosing is 25 Ampere (A) (anterior) and 22 A (posterior), respectively. In the single-shot PVI group, a 31 or 35mm pentaspline PFA catheter is used for fluoroscopy-guided PVI. Eight PFA applications (2.0 kV) are applied per PV. In this interim analysis, acute efficacy, safety and short term clinical outcome within the 3 months blanking period were assessed. A subset of patients underwent cerebral MRI to detect silent lesions.

Results
To date, 50 patients were enrolled and underwent PVI in conscious sedation (25 single-tip, 25 single-shot, 63 ± 5 years, 42% female, CHA2DS2-VASc 2 [1-3]). There were no differences in baseline characteristics. Acute PVI was achieved in 100%. In the single-tip group, total procedure time was significantly longer (125 ± 31 min vs. 44 ± 12 min, p &lt;0.001) and fluoroscopy time was significantly shorter (4 ± 2 min vs. 15 ± 6 min, p &lt;0.001) as compared to the single-shot group. One groin hematoma was noted in the single-shot group. In the single-tip group, 1 aneurysm spurium was detected and 1 pericardial tamponade requiring drainage resulted from coughing during single-tip PFA while no real-time visualization of the catheter was available. No permanent sequelae occurred. There were no PFA specific complications and no cerebral embolisms were detected in all 14 MRI scans. At 3 months, 92% (single-shot group) and 80% in the single-tip group were free from arrhythmia (p=0.42). AF recurrences in the blanking period occurred in 2 patients in the single-shot group and in 5 patients in the single-tip group after a median of 2 [1-5] days following the procedure.

Conclusions
In this interim analysis of a randomized trial, single-shot or single-tip PFA for PVI both demonstrated high acute efficacy and a favourable 3 months clinical outcome. Procedural time was significantly longer in the single-tip PFA group. No silent lesions were detected in cerebral MRI. Non-availability of real-time visualization and contact-force information of the single-tip ablation catheter during energy application is a current technical limitation that could be associated with complications.
Very high-power short duration ablation metrics predictors of successful pulmonary vein isolation in atrial fibrillation ablation
Authors: Rauber M , Manninger M , Scherr D 
Published: May 2024

Abstract

Background
Previous studies have shown that very high-power short duration (vHPSD) is a safe ablation modality, with similar rate of first pass isolation (FPI) but faster ablation times compared to standard CLOSE protocol guided ablation. While CLOSE protocol uses ablation index to guide energy titration no such index exists for vHPSD ablations yet.

Purpose
Our aim was to evaluate ablation metrics as predictors of FPI in atrial fibrillation ablation (AF) using vHPSD ablation modality.

Methods
In a single centre retrospective analysis, we analysed consecutive patients treated for paroxysmal (PAF) or persistent atrial fibrillation (PeAF) with PVI using vHPSD ablation from May 2021 to January 2023. We excluded patients with previous PVI procedures. The analysis was done via a cloud-based commercially available ablation analysis tool CARTONET. We analysed catheter stability, average contact force, absolute impedance drop, number of ablations and cumulative ablation time in relation to first pass isolation (FAAVI – first attempt all veins isolated).

Results
This is the first larger data study to evaluate ablation metrics in vHPSD using commercially available CARTONET (Figure 1). Based on the inclusion criteria 150 patients were included in the analysis. Baseline characteristics and procedural metrics are presented in Figure 2 - Table. We observed a numerical trend towards higher FAAVI rate with increasing patients number (p=0.10). Complication rate was low (1 pericardial effusion requiring drainage and 1 vascular access site complication).
Ablation metrics analysis yielded statistical differences between FAAVI and no FAAVI groups (Figure 2 - Table). Multivariate analysis identified average contact force (odds ratio (OR) 1.001; 95% confidence interval (CI): 0.999-1.003; p=0.047) and catheter stability (OR 0.985; 95% CI: 0.973-0.997; p=0.019) to be independent predictors of FAAVI. Additionally, number of applications (OR 1.000; 95% CI: 0.999-1.000; p=0.042) and total ablation time (OR 0.995; 95% CI: 0.991-0.999; p=0.021) were also independent predictors of FAAVI, possibly indicating larger vein and/or ablation circumferent line to be predictive of no FAAVI.
Catheter stability of less than 1.16mm (AUC 0.61; p=0.015) was shown to be discriminative of FAAVI, however discrimination value was poor. Average contact force was not discriminative of FAAVI (AUC 0.58; p=0.105) in our patient cohort.

Conclusion
Average contact force and catheter stability were predictive of first pass isolation, however only catheter stability was discriminative of FAAVI. Larger data with standardised ablation protocol (interlesion distance) and wider range of ablation metrics is needed to corroborate and further build on these early findings.
Pacemaker dependency after Cox Maze procedure concomitant with cardiac surgery, The road between Scylla and Charybdis
Authors: Hassan M , Keller D , Radakovic D , Madrahimov N , Leyh R , Bening C 
Published: May 2024

Abstract

Background
The Cox Maze (CM) procedure is a well-established treatment for atrial fibrillation. However, recent trials report alarming rates of pacemaker implantation (PMI) during hospitalization after CM. As PMI, generator replacement and Lead management are sometimes accompanied by complications, such as infection or bleeding and represent a burden for patients and healthcare systems. We thought to investigate the rates of pacemaker dependency 6 months after pacemaker implantation regarding the applied energy source and the performed lesion set, to determine whether PPM implantation timing and specific conduction disturbances as indications are associated with late pacemaker dependency.

Methods
We performed a retrospective review of 3695 patients underwent elective cardiac surgery in our institution between the years 2005 and 2022. Patients who use of devices for rhythm control, resynchronisation therapy, implantablecardioverter defibrillator (ICD) or both were excluded from the present study. A total of 283 patients met the inclusion criteria; Various energy sources, including cryoablation (n= 123) and radiofrequency (n= 160) were used. Left atrial (n= 228) and biatrial (n= 55) ablation was performed The distribution of the preoperative and perioperative variables was similar.

Results
There was no statistical difference in the incidence pacemaker dependency regarding the applied energy source whether radiofrequencyablation or cryoablation (25% vs. 30%; p = 0.2 respectively). On the other hand, biatrial ablation led to a significant pacemaker dependency rate compared with isolated left-sided ablation (78,2% vs 14.9%; P = .001 respectively), moreover Sinus node dysfunction as indication for PPM implantation was predictive of being not PPM dependent (OR 6.59; 95% CI, 1.67-26.06; P = .007).

Conclusion
Concomitant CM procedure showed a pacemaker implantation rate of 7,4%. Univariate and multivariate analysis showed biatrial lesion set as the only statistically significant predictor for pacemaker dependency after CM procedure. Further large-scale randomized controlled studies are needed to elucidate the Impact of the CM on the late pacemaker dependency.
Single-shot simplified cardioneuroablation
Authors: Futyma P , Zarebski L , Futyma M , Kulakowski P 
Published: May 2024

Abstract

Introduction
Cardioneuroablation (CNA) is a promising therapy of a spectrum of arrhythmias dependent on increased activity of parasympathetic tone. The right anterior ganglionated plexus (RAGP), localized paraseptally between right atrium and right superior pulmonary vein, is frequently a primary target for CNA. Methods are sought to determine exact locations of RAGP to minimize ablation lesion set during CNA. Immediate and accurate intraprocedural visualization of RAGP area in patients undergoing CNA is desirable.

Methods
Consecutive patients who underwent right-atrial CNA for reflex syncope, symptomatic bradycardia or vagal atrial fibrillation were included into the study. After venous contrast injection a 3-dimensional rotational atrial scan (3DRAS) was used to obtain digital images. Next, manual segmentation (MS) of hypodense areas between the right atrium (RA) and the right superior pulmonary vein (RSPV) was performed to reconstruct RAGP. Using 3-dimensional mapping system such created 3D RAGP area visualisation was automatically synchronized with fluoroscopy and these sites were targeted for CNA. Heart rate (HR) acceleration ≥30% and ultra-short-term deceleration capacity (UST-DC) were used for determination of acute CNA outcomes.

Results
Five patients (3 males, age 37±17) underwent 3DRAS and MS of RAGP area during CNA. A single radiofrequency lesion was delivered in each patient (mean RF time - 33±15s, power - 25W). The mean procedure time was 40±13 minutes. Targeted HR acceleration was achieved in all patients (baseline HR vs post-CNA HR, 57±8bpm vs 93±11bpm; p=0.0007; mean HR acceleration 65±15%). UST-DC significantly decreased after CNA (pre-CNA UST-DC vs post-CNA UST-DC, 13.6ms vs 3.2ms, p=0.00096). There were no complications.

Conclusions
Single-shot simplified CNA is feasible. Visualization of RAGP area using 3DRAS and MS is safe, effective and can very rapidly delineate CNA target.Figure
Comparison of the novel radiofrequency-balloon and the cryo-balloon in pulmonary vein isolation
Authors: Teumer Y , Miesbichler C , Katov L , Melnic R , Bothner C , Rottbauer W , Weinmann-Emhardt K 
Published: May 2024

Abstract

Background
Balloon catheters are often used for pulmonary vein isolation (PVI) in atrial fibrillation (AF) because of their procedural efficiency. Apart from the established cryo-balloon (CB) catheter, there is a novel multi-electrode radiofrequency balloon catheter (RFB) with 3D mapping integration available. There is currently no data regarding a direct comparison of the RFB-PVI and the CB-PVI in a matched population.

Objective
Aim of this study was to assess the procedural data, the safety profile, and the outcome of the RFB-PVI and the CB-PVI.

Methods
This prospective registry study included patients with symptomatic paroxysmal or persistent AF, who underwent first-time PVI between January 2019 and April 2023, either with the RFB or the CB. For reduction of potential confounders patients were matched in a 1:2 ratio.

Results
In total 171 consecutive RFB patients and 342 matched CB patients were included. The baseline characteristics were comparable. The estimated recurrence free survival after 12 months was 81.3% in the RFB group and 76.8% in the CB group (p = 0.359). Longer procedural duration (p &lt; 0.001) and longer fluoroscopy time was observed in the RFB group (p &lt; 0.001). Except for the left inferior pulmonary vein, the single-shot isolation rate was comparable. In the RFB group no major complications occurred. In the CB group one transient ischemic attack, one pericardial tamponade, and two persistent phrenic nerve palsies occurred.

Conclusion
Although longer procedural duration was observed in the RFB group, both technologies enable an efficient and a safe PVI. Despite the 3D mapping integration of the RFB, no reduction in the fluoroscopy time was seen in comparison to the CB.
Lock Protocol : a new robust workflow for a very high first pass pulmonary vein isolation during atrial fibrillation ablation
Authors: Zarra S , Di Cori A , Zucchelli G , Parollo M , Segreti L , De Lucia R , Barletta V , Fiorentini F , Torre M , Canu A , Pistelli L 
Published: May 2024

Abstract

Introduction
Pulmonary vein isolation (PVI) is the gold standard for atrial fibrillation (AF) ablation. First pass PVI is often demanding when a raw geometry reconstruction is used in combination with an inaccurate automarks annotation, accounting for discontinuous or non-transmural lesions and related AF recurrences. We hypothesized that a magnetic-post processing of left atrial geometry in combination with an LSI-guided high power short duration (HPSD) automarks annotation could improve procedural efficiency.

Purpose
The aim of this study was to determine the impact on procedural outcomes of the new "Lock PVI protocol" during AF ablation with the new voxel mode EnSite X mapping system.

Methods
We included in the study consecutive patients with AF scheduled for pulmonary vein isolation (PVI) at our Departement between January 2021 and December 2022. Patients were divided in two Groups, the Lock-PVI Group and the control No Lock-PVI Group. The "Lock PVI" Group was ablated with the new Ensite X System using the new protocol, which consisted in (1) performing a road map with contact-force annotation at potential PVI sites after High Density reconstruction, (2) shaving the magnetic geometry reconstruction to unearth true 3D location of contact points, (3) Use of 3D-Automarks color-coded with a Lesion Index (LSI) target of 5.5 (anterior) and 4.5 (posterior) (4) Inter-lesion distance &lt;6 mm (5) High Power Short Duration Approach (50 W). The No-Lock PVI was represented by patients ablated with and HPSD ablation with the previous version of the EnSite Precision mapping suit as per local standard practice. Groups were compared in term of procedural duration, radiological exposure and "first pass" isolation.

Results
Forty-four patients (22 "Lock PVI" and 22 controls mean age 63,3±8 years, 65,9% male, 47,7% persistent AF), for a total of 88 PVI circles were enrolled. Procedural duration was similar between approaches (121,1±43,6 vs 125,3±30,1 min; P=0,72) but RF time was shorter in the "Lock PVI" group (19,6±4 vs 29,55±9,1 min; P&lt;0,001), although with with a longer fluoroscopy (19,5±10,1 vs 13,4±4,9 min; P=0,01). Of note, first pass isolation was significantly higher in the "Lock PVI" group: 40/44 (90,9%) vs 28/44 (63,6%) circles (P=0,002).

Conclusion
The new "Lock PVI" approach resulted in consistently better first-pass isolation (&gt;90%) with less RF time when compared to standard of care PVI.Graphical AbstractLock PVI
Multielectrode catheter-based pulsed field ablation of persistent and long-standing persistent atrial fibrillation
Authors: Della Rocca D , Sorgente A , Pannone L , Stroker E , Vetta G , Doundoulakis I , Del Monte A , Mouram S , Mene R , Betancur A , Boveda S , Natale A , Sarkozy A , De Asmundis C , Chierchia G B 
Published: May 2024

Abstract

Background
Rhythm control of non-paroxysmal atrial fibrillation (AF) is significantly more challenging, as a result of arrhythmia perpetuation promoting atrial substrate changes and AF maintenance.

Purpose
We describe a tailored ablation strategy targeting multiple left atrial (LA) sites via the multielectrode FarawaveTM pulsed field ablation (PFA) catheter in patients with persistent AF sustained beyond 6 months (PerAF&gt;6m) and long-standing persistent AF (LSPAF).

Methods
The ablation protocol included the following stages: pulmonary vein antral and posterior wall isolation plus anterior roof line ablation (Stage 1); electrogram-guided substrate ablation (Stage 2); atrial tachyarrhythmia (AT) regionalization and ablation (Stage 3).

Results
Seventy-two [age:68±10y, 61.1%males; AF history: 25 (18-45) months] patients with PerAF&gt;6m (52.8%) and LSPAF (47.2%) underwent their first PFA via the FarapulseTM system. LA substrate ablation (Stage 1 and 2) led to AF termination in 95.8% of patients. AF termination occurred while ablating the mitral edge of the postero-lateral ridge (40.3%), the inferior left atrium above the proximal coronary sinus (27.4%), the interatrial septum (22.6%), the superior aspect of the postero-lateral ridge (6.5%), the base of the appendage (3.2%). AF organized into a left-sided atrial flutter (AFlu) in 46 (74.2%) patients. The FarawaveTM catheter was used to identify LA sites showing diastolic, low-voltage electrograms and entrainment from its splines was performed to confirm the pacing site was inside the AFlu circuit (Figure 1). Left AFlu termination was achieved in all cases via PFA delivery. Total procedural and LA dwell times were 112±25min and 59±22 min, respectively. Major complications occurred in 2 (2.8%) patients with pre-existing left ventricular systolic dysfunction (EF&lt;35%) who required inotropic therapy due to acute heart failure. Hemodynamics normalized within 24h and both patients were discharged after 2 and 3 additional hospital days.
Transient ST-segment elevation was documented in 4 patients after peri-mitral PFA; timely nitrate administration led to ECG normalization within 10 minutes.
Single-procedure success rate was 81.8% after 13.3±1.9 months of follow-up; AF-free survival was 93.1% (Figure 2).
A subgroup of 36 patients completed a follow-up transthoracic echocardiography study to assess left atrial mechanical contraction changes after ablation. Median A-wave velocity was 30 (IQR: 20-35) cm/s post-ablation and 50 (IQR: 41-70) cm/s after a mean of 7.3±1.8 months post-ablation.

Conclusions
In our cohort, PFA-based AF substrate ablation led to AF termination in 95.8% of cases. Very favorable clinical outcomes were observed at one year of follow-up.Entrainment from the PFA Catheter.Kaplan-Meier Analysis.
Efficacy and safety of very high-power short-duration posterior wall ablation in persistent atrial fibrillation: a propensity score-matched comparison with standard power long-duration ablation
Authors: Volpato G , Compagnucci P , Cipolletta L , Parisi Q , Molini S , Misiani A , Carboni L , Valeri Y , Campanelli F , D'angelo L , Stronati G , Guerra F , Casella M , Natale A , Dello Russo A 
Published: May 2024

Abstract

Background
Catheter ablation (CA) with pulmonary vein isolation (PVI) is an optimal treatment option in patients with paroxysmal atrial fibrillation (AF). PVI alone in patients with persistent AF has proved to have suboptimal results. Ablation of additional atrial structures, such as posterior wall (PW) and left atrial appendage has been investigated as a tool to improve procedural efficacy. Recently very high-power short-duration (vHPSD) ablation was developed to allow rapid PVI, limiting complication through the maximization of resistive heating, and minimization of conductive heating.

Objectives
Compare PVI plus PWI using vHPSD versus standard-power (SP) ablation index-guided CA among consecutive patients with persistent AF

Methods
Forty consecutive patients underwent PVI plus PW isolation using vHPSD, compared to 40 controls underwent standard power (SP) PVI plus PW isolation. The primary efficacy endpoint outcome was recurrence of atrial tachyarrhythmias after a 3-month blanking period. The primary safety outcome was a composite of major complications within 30 days of CA.

Results
Treated patients have a median age of 62.8±9 years, 68 (85%) are male. Median left atrial volume is 42.4 (36-50) ml/m2. 61 (78.8%) patients had never undergone catheter ablation before. There are no statistically significant differences between groups. PW isolation was obtained more commonly in the vHPSD compared to the SP group (98% vs. 75%, p=0.007), despite shorter procedure and fluoroscopy times (p&lt;0.001).
Survival free from recurrent atrial tachyarrhythmias at 18 months was 68% in the vHPSD and 47% in SP groups, respectively (log-rank p=0.071), without major adverse events. The vHPSD approach was significantly associated with reduced risk of recurrent AF at multivariable analysis (HR, 0.39, p=0.030).

Conclusions
The results show feasibility and safety of posterior wall vHPSD ablation for persistent AF using this new temperature-controlled catheter without intraprocedural and periprocedural major complications at follow-up. vHPSD ablation for PW isolation may be more effective in term of atrial tachyarrhythmias recurrences with a trend for superior efficacy. However, this remains a single center experience in a small group of patients. Comparative trials involving greater number of patients with long-term follow-up are necessary to definitive results.