bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gastric hypomotility after adjunctive pulmonary vein and posterior wall isolation using cryoballoon in patients with atrial fibrillation: case control study
Authors: Esato M , Kikuchi S , Kaneshiro M , Mori T , Tominaga S , Kametani R , Yoshioka S 
Published: May 2024

Abstract

Background
Pulmonary vein isolation (PVI) and concomitant electrical isolation of left atrial (LA) posterior wall (posterior wall box isolation [POBI]) using cryoballoon have mentioned as alternative ablation method for atrial fibrillation (AF). Gastric hypomotility (GH) is a possible complication of cryoballoon ablation (CBA); however, it remains unclear which factors are associated with GH during PVI plus POBI using cryoballoon.

Objective
We sought to investigate the clinical characteristics and intra-procedural parameters in AF patients with GH after PVI plus POBI using cryoballoon.

Methods
Forty-seven patients who underwent first-time CBA procedure for drug-refractory AF were enrolled. After the completion of ipsilateral superior and inferior PVI, cryoballoon was subsequently used to perform POBI; ablating in a segmental fashion for both superior and inferior portions of LA posterior wall. Intra-procedural luminal esophageal temperature (LET) monitoring, and postprocedural esophagogastroscopy within 72 hours were performed in all patients. In addition, intra-procedural parameters of CBA were comparatively evaluated between the patients with or without GH.

Results
Of overall enrolled patients (69.6 ± 9.6 years, 62% paroxysmal AF, CHA2DS2-VASc score 3.2 ± 1.7), GH were observed in 4 (8.6%) patients. Clinical characteristics were similar between the patients with and without GH, while the diameter of left inferior pulmonary vein ostium was significantly smaller in patients with GH compared with those without (15.0 ± 1.5mm vs. 18.8 ± 0.5mm; p=0.018). With regard to the intra-procedural parameters, minimum balloon temperatures at 30 seconds after CBA initiation during inferior portions of LA posterior wall, and minimum LET during POBI were significantly lower in patients with GH compared with those without (-43.3 ± 4.9°C vs. -37.2 ± 5.0°C; p=0.024, and 15.8 ± 1.0°C vs. 23.0 ± 6.0°C; p=0.022, respectively). The optimal cut-off values for prediction were -45°C (sensitivity 75%; specificity 92.5%), and 16.8°C (sensitivity 100%; specificity 85.4%), respectively.

Conclusion
Specific anatomical information and intra-procedural parameters aid identifying high-risk populations of GH after PVI plus POBI using cryoballoon.
Acute safety and efficacy of ablation for atrial fibrillation in elderly patients by means of pulsed field ablation
Authors: Dello Russo A , Solimene F , Iacopino S , Bianchi S , Riva S , Casella M , Maggio R , Rossillo A , Cipolletta L , Tundo F , Arestia A , Artale P , Valeri Y , Malacrida M , Tondo C 
Published: May 2024

Abstract

Background
It is well known that age affects the efficacy of pharmacological treatment for atrial fibrillation (AF). Thermal ablation (radiofrequency or cryoballoon) is an established strategy for AF. However, there is no evidence evaluating efficiency, effectiveness, and safety outcomes in elderly patients in the context of the novel pulsed-field ablation (PFA) technology.

Purpose
We aimed to analyze the efficacy and safety of PFA in elderly (age≥75 years) patients with AF compared to non-elderly (age&lt;75 years) patients with AF.

Methods
All consecutive patients undergoing AF ablation with the Farapulse system at 10 centers were included. Protocol-directed PVI was delivered using 2000 V with eight applications per vein, that is, four applications each in the basket and flower poses. Additional lesions were performed at the operator’s discretion.

Results
A total of 851 consecutive patients were included: 83 (9.8%) had ≥75 years (median of 77[75-78] years) whereas 768 (90.2%) had &lt;75 years (median of 62[56-68] years, p&lt;0.0001). Older patients had more comorbidities compared to younger patients (kidney disease: 9.6% vs 1.2%, p&lt;0.0001; chronic obstructive pulmonary disease: 8.4% vs 3%, p=0.021; cancer history: 18.1% vs 6.1%, p=0.0004; hypertension: 61.4% vs 43.8%, p=0.002), whereas they exhibited a higher LVEF (60±6% vs 57±8%, p=0.0243). No differences between older and younger patients were found in terms of underlying AF type (paroxysmal AF: 66.3% vs 68.9%, p=0.62), procedure type (repeat ablation: 8.4% vs 13.4%, p=0.29), more extensive lesion set than PVI only (28.9% vs 22.5%, p=0.22) and the use of 3D mapping system (22.9% vs 21.1%, p=0.67). By looking at procedural metrics, no differences were also found between groups: 73±28 min vs 72±32 min for skin-to-skin time, p=0.41; 93±41 min vs 88±43 min for preparation plus skin-to-skin time, p=0.11; 18±9 min vs 17±9 min for fluoroscopy time, p=0.61 and 32[32-40] vs 32[32-38] PFA spots to achieve PVI, p=0.29. PVI was achieved in all patients. No major procedure-related adverse events were reported.

Conclusion
In our experience, the use of Farapulse PFA system for AF ablation in elderly patients was rapid, safe and effective, with no differences compared to the younger population.
Pulsed-field ablation of atrial fibrillation in patients with multiple cardiovascular comorbidities: acute safety and efficacy from a large nationwide multicenter experience
Authors: Casella M , Bianchi S , Solimene F , Tondo C , Dello Russo A , Schillaci V , Tundo F , Valeri Y , Colella J , Compagnucci P , Volpicelli M , Polselli M , Fassini G , Malacrida M , Iacopino S 
Published: May 2024

Abstract

Background
Patients with multiple cardiovascular (CV) comorbidities are increasing users of health care globally. The decision to perform ablation of atrial fibrillation (AF) may be challenging in this population, due to the difficulty in evaluating their life expectancy and the associated procedural risk. In addition, no data have been reported on the efficiency, effectiveness, and safety outcomes for non-thermal ablation, such as electroporation with pulsed-field ablation (PFA).

Purpose
To evaluate procedural workflow and safety for AF ablation in these patients through a novel PFA technology (Farapulse) in a large, nationwide clinical practice.

Methods
Consecutive patients who had undergone PFA of AF from 10 Italian centers were included. Patients were stratified according to the numbers of several comorbidities, assigning 1 point each, including: advanced age (≥80 years), LVEF≤35%, structural heart disease, coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, previous stroke/TIA, hyperthyroidism, cancer history, cancer ongoing, severe sleep apnea, diabetes, hypertension, dyslipidemia.

Results
We included 634 patients (age 62±9 years, 73% male, 67% paroxysmal AF, 88% de novo ablation procedure, LVEF 57±8%). Two-hundred-nine (33%) patients had no risk-factors, 179 (28.2%) patients had at least 1, 137 (21.6%) two, 63 (9.9%) patients 3 risk-factors and 46 (7.3%) patients more than 4 comorbidities. Patients with accumulated risk factors (≥4) had a higher percentage of long-standing AF (17.4% vs 5.4%, p=0.005) and more often underwent de novo ablation procedure (93.5% vs 81.3%, p=0.04). In these cases, operators decided to adopt more frequently, albeit not significantly, advanced diagnostic such as 3D mapping system (30.4% vs 21.9%, p=0.20) or intracardiac echocardiography (41.3% vs 29.8%, p=0.13), a general anesthesia sedation strategy (41.3% vs 32.1%, p=0.88) and a more extensive lesion set beyond PVI (i.e. left atrial posterior wall area, 32.6% vs 23.1%, p=0.15). Procedures in which patients with accumulated risk factors are involved required longer support (preparation plus skin-to-skin) time (90[65-120] min vs 72[60-100] min, p=0.02) and skin-to-skin time (70[60-100] min vs 60[55-85] min, p=0.03) compared to patients with &lt;4 risk factors, whereas time to PVI (19[14-25] min vs 20[14-25] min, p=0.81) and total number of PFA deliveries to achieve PVI (32[32-38] vs 32[32-36], p=0.55) were similar. PVI was achieved in all patients. No major procedure-related adverse events were reported.

Conclusion
In this preliminary experience, the use of Farapulse PFA system for AF ablation in patients with accumulated risk factors was safe and effective and resulted in similar and fast time to PVI.
Percutaneous left atrial appendage occlusion can impair pulmonary vein isolation with pulse field ablation
Authors: Molitor N , Berger F , Breitenstein A , Chen S , Chun J , Galuszka M , Reichlin T , Roten L , Kueffer T , Lemoine M , Ouyang F , Wolber T , Brunckhorst C , Duru F , Saguner A 
Published: May 2024

Abstract

Background
Pulsed-field ablation (PFA) is a promising new ablation modality for pulmonary vein isolation (PVI). However, the feasibility in the presence of a percutaneous left atrial appendage occluder (LAAO) has not yet been investigated. We observed that PFA applications in the left pulmonary veins after LAAO can be interrupted. The aim of this analysis was to investigate the feasibility of PFA with a single-shot device for PVI after LAAO.

Methods / Results:
Retrospective multicenter analysis. A total of 16 patients (male 81.3%, mean age 71.6 +/-7.4) underwent PVI with PFA after LAAO at 5 different centers in Switzerland and Germany, from August 2021 until July 2023. In 5 patients PFA application at the left-sided PVs was aborted due to interference with the LAAO (Figure). In one patient, the left superior PV could be isolated by repositioning the PFA catheter, in 2 cases successful PVI was achieved after switching to radiofrequency ablation, and in 2 cases the respective left sided PV was not isolated. In all 5 patients the LAAO was an Amplatzer Amulet device (Amplatzer Amulet vs. other LAAO, p=0.069). Mean LAAO size was not significantly different among both groups.

Conclusions
LAAO can interfere with PFA applications around the left superior pulmonary vein. This effect may be associated with the design of the LAAO.
Predicting atrial fibrillation recurrence after catheter ablation using an artificial intelligence-enabled electrocardiogram algorithm
Authors: Gruwez H , Barthels M , Dhont S , Meekers E , Wouters F , Pierlet N , Nuyens D , Rivero-Ayerza M , Van Herendael H , Pison L , Haemers P , Vandervoort P 
Published: May 2024

Abstract

Introduction
Predicting atrial fibrillation (AF) recurrence post catheter ablation may help to assess procedural eligibility and determine AF management. While several predictors of AF recurrence post ablation have been established and numerous clinical risk scores have been proposed, their performance remained underwhelming and clinical utility was limited. Hence, new predictors are needed. Artificial intelligence (AI) algorithms using deep neural networks (DNN) to analyze biometrical data might generate such predictors. DNN algorithms have been developed to identify patients with AF based on a 12-lead electrocardiogram (ECG) in sinus rhythm. Whether these algorithms can function as a predictor of AF recurrence after AF ablation remains unknown.

Purpose
To evaluate the prediction of AF recurrence after ablation using an AI-enabled ECG algorithm trained to predict AF on an ECG in sinus rhythm.

Methods
This study retrospectively analyzed observational data from the DIGITOTAL study, that monitored AF recurrence with a PPG-based smartphone application in 96 subjects after AF ablation. Patients with a 12-lead ECG in SR available within a timeframe of 3 months before the ablation procedure were included in the analysis. Although all patients had a history of AF, an AF-risk score was calculated by the DNN described elsewhere.1

Results
An ECG in sinus rhythm was available in 53 patients (14 women [26.4%]; mean [SD] age, 62.0 [9.7] years) out of the 96 patients followed-up in the DIGITOTAL study. Testing the DNN on the last ECG before the ablation procedure resulted in an area under the receiver operating curve (AUC) of 0.65 (95% CI, 0.49 - 0.80), and an area under the precision recall curve (AUPRC) of 0.56 (95% CI, 0.34 - 0.78). The optimal cutoff score resulted in a sensitivity of 60.0% (95% CI, 36.1% - 80.9%), specificity of 66.7% 66.7% (95% CI, 48.2% - 82.0%), accuracy of 0.64 (95% CI, 0.50 - 0.77), F1-score of 55.8% (95% CI, 38.5% - 74.4%), positive predictive value 52.2% (95% CI, 30.6% - 73.2%) and negative predictive value 73.3% (95% CI, 54.1% - 87.7%). Patients classified in the high-risk group versus low-risk group were more likely to exhibit AF recurrence up to one year after AF ablation (hazard ratio, 2.6; 95% CI, 1.1 - 6.5; P-value = 0.037).

Conclusions
The AI-enabled ECG algorithm, trained to predict AF on a sinus rhythm ECG, was able to predict AF recurrence after ablation with an accuracy comparable to the existing clinical risk scores. Further studies are needed to determine whether the DNN score can be used as an independent predictor and improve existing risk scores.
Prevalence of non pulmonary vein triggers and pulmonary pressure change in atrial fibrillation ablation for cardiac amyloidosis patients
Authors: La Fazia V , Pierucci N , Gianni C , Torlapati P G , Mohanty S , Della Rocca D G , Gigante C , Bode W , Bassiouny M , Burkhardt J D , Gallinghouse G , Horton R , Al-Ahmad A , Di Biase L , Natale A 
Published: May 2024

Abstract

Background
Cardiac amyloidosis (CA) has been associated with an increased risk of atrial arrhythmias and high risk to develop pulmonary hypertension due to infiltration of the amyloid protein in the atrial wall. Though non-PV triggers are commonly seen in left atrium, they are also seen in the right side of the heart, so identifying them at the time of ablation is essential.

Objective
The study evaluates the prevalence of non-PV triggers during catheter ablation in atrial fibrillation (AF) patients affected by cardiac amyloidosis and how restoration of sinus rhythm affects pulmonary pressures.

Methods
This is a study including 74 consecutive patients with an established diagnosis of amyloidosis ATTR diagnosed with cardiac MRI or myocardial biopsy that underwent their first AF catheter ablation. All have a transthoracic echocardiogram before ablation. They underwent pulmonary vein (PV) isolation + isolation of left atrial posterior wall and superior vena cava. Additionally, extrapulmonary triggers, which are defined as ectopic triggers originating from sites other than PVs including left atrial appendage (LAA), coronary sinus (CS), interatrial septum, crista terminalis, mitral valve anulus were identified. Post procedure, patients were followed up routinely with ECG during office visits, echocardiogram, 7-day Holter monitor and event recorders during the first year followed by biannual checkups during the remaining part of the follow-up period. Student’s t-test was used to compare pulmonary pressure between the groups.

Results
Isoproterenol-challenge revealed non-PV triggers in 51 (68.9%) patients. These triggers were mostly mapped to LAA (39, 52.7%), CS (30, 40,5%), and crista terminalis (35, 47.3%). Besides, ectopic beats were seen originating from inter-atrial septum (19, 25.6%), mitral valve annulus (10, 13.5%). More than one trigger was found in (68%) patients. At 1-year after the ablation, 65 (87.8%) were arrhythmia-free off antiarrhythmic drugs.
Moreover, in patients who maintained sinus rhythm post-ablation, there was either a non progression or a reduction in pulmonary pressures (PAPm before ablation: 44.8 ± 8.9 mmHg vs PAPm after ablation 45.1 ± 11.1 mmHg, P value =0.87). Conversely, those experiencing arrhythmic recurrences demonstrated an increase in pulmonary pressures (PAPm before ablation: 41.9 ± 7.7 mmHg vs PAPm after ablation 47.8 ± 10.2 mmHg, P value =0.019). Fig.1

Conclusion
Our findings suggest that non-PV triggers are highly prevalent in cardiac amyloidosis AF patients including a high rate crista terminalis firing. Notably, restoration of sinus rhythm post-ablation was linked to stable or reduced pulmonary arterial pressures, whereas patients with arrhythmic recurrences experienced a significant increase.
Treatmen of atrial fibrillation with cryoballoon pulmonary vein isolation - results of a 5-year follow-up
Authors: Pasara V , Nekic A , Prepolec I , Bogdanic J E , Putric Posavec J , Pezo-Nikolic B , Puljevic M , Puljevic D , Milicic D , Velagic V 
Published: May 2024

Abstract

Background
Atrial fibrillation is the most common arrhythmia in the general population and cryoballoon ablation is gradually becoming a first-line treatment. However, data regarding long-term outcomes after this procedure are still lacking.

Aim
The goal was to show the results of a long-term follow-up following the cryoballoon pulmonary vein isolation in patients with atrial fibrillation (AF).

Methods
A total of 126 patients were included in the study of which 77.0% had paroxysmal atrial fibrillation (PAF). Successful treatment outcome was defined as AF recurrence-free survival with stabile sinus rhythm during 5 years after the procedure. A treatment failure was defined as symptomatic AF recurrence with ECG verification (12 lead ECG or AF lasting &gt;30s by Holter EKG). The patients on antiarrhythmic therapy and those who underwent a redo pulmonary vein isolation procedure were also included.

Results
Following cryoballoon pulmonary vein isolation in a 5-year period 52.4% of patients were in stable sinus rhythm without AF recurrence. With redo pulmonary vein procedures a total of 61.9% of patients were without AF recurrence. Together with antiarrhythmic drugs 57.9% of patients were in sinus rhythm without AF recurrence in a 5-year period. With redo pulmonary vein isolation and antiarrhythmic drugs a total of 73.8% of patients were without AF recurrence. There was a statistically significant difference regarding AF recurrence between patients who underwent redo pulmonary vein isolation and those who did not (p=0.006). In patients with PAF, 62.9% remained without AF recurrence, and 79.4% underwent a redo procedure. In patients with persistent atrial fibrillation (PersAF), 41.4% were without AF recurrence, and 55.1% underwent a redo procedure. The difference between PAF and PersAF was statistically significant (p=0.009).

Conclusion
Data from our center show good long-term results of cryoballoon pulmonary vein isolation in patients with atrial fibrillation. The procedure is especially successful in patients with PAF.1 The use of redo procedures is justified as it increases the long-term success rate.
A propensity score matched comparison of pulsed field versus hybrid ablation in patients with long standing persistent atrial fibrillation
Authors: Doundoulakis I , Della Rocca D G , Mene R , Mouram S , Pannone L , Sorgente A , Sousonis V , Stroker E , Sieira J , Almorad A , Boveda S , Sarkozy A , Chierchia G B , La Meir M , De Asmundis C 
Published: May 2024

Abstract

Introduction
On one hand pulsed-field ablation (PFA) has shown favourable data in terms of safety and efficiency for pulmonary veins isolation (PVI). One the other hand, hybrid ablation results in better outcomes in patients with persistent atrial fibrillation (AF), as it combines a thoracoscopic epicardial and transvenous endocardial approach in a single procedure.

Purpose
Aim of this study was to to compare 1-year follow-up data of patients with long standing persistent AF undergoing PVI and posterior wall isolation using PFA, and hybrid AF ablation.

Methods
Consecutive patients with long standing persistent AF undergoing a first PVI with PFA at our institution were included. For comparison, patients with long standing persistent AF undergoing a first PVI with hybrid ablation were selected using a 1:1 nearest neighbor propensity score matching. Hybrid AF ablation was performed in a one-step procedure: (i) thoracoscopic ablation followed by (ii) endocardial mapping and eventual ablation. All patients received PVI and posterior wall isolation in both group. Additional lesions were performed based on clinical indication and physician judgement. The primary endpoint was recurrence of atrial tachyarrhythmia after 12 months of follow-up (with a blanking period of 3 months).

Results
A total of 130 patients with persistent AF underwent hybrid ablation and 72 patients underwent PFA. 85 patients (age:67.5±9.7 years, 68.2% males, CHA2DS2-VASc: 2.5±1.3) with long standing persistent AF underwent their first AF ablation (PFA N= 39; Hybrid N = 46). After a 1-year follow-up, freedom from atrial tachyarrhythmia recurrence was 74.4% with PFA and 71.7% with hybrid ablation (p = 0.786). After propensity score matching, a total of 39 matched pairs of PFA and hybrid first AF ablation remained. The result remained unchanged and no significant difference was observed between treatment cohorts after matching (Figure 1, p=0.039).

Conclusion
In a propensity score matched analysis of patients with long standing persistent AF, freedom from any atrial tachyarrhythmia 1 year after AF ablation using PFA was favourable and at least as good as with hybrid ablation.
Associations of fat and muscle mass indices with incident atrial fibrillation: data of PREVEND
Authors: Suthahar N , Zwartkruis V , Middeldorp M E , Van Veldhuisen D J , Bakker S J L , Gansevoort R T , Kardys I , Rienstra M , De Boer R A 
Published: May 2024

Abstract

Background
Whether the association between body mass and atrial fibrillation (AF) risk is driven by fat mass or muscle mass remains unclear.

Objective
To examine the association of relative fat mass (RFM, a novel marker of whole-body fat percentage) and 24-hour urinary creatinine excretion (a marker of total muscle mass) with incident AF.
Participants: We included 8120 community-dwelling adults from the PREVEND cohort without prevalent AF.

Results
The mean age of the population was 49.8±12.6 years and 50.0% (n=4060) were women. The mean RFM was 30.2±7.4 % and the mean creatinine excretion was 12.3±3.5 mmol/24h. During a mean follow-up period of 9.7±2.4 years, 261 AF events (3.2%) occurred. We included RFM, creatinine excretion, age, sex, height, heart rate, hypertension and cardiovascular disease history in a multivariable Cox regression model. The association between RFM and AF risk was linear, and the hazard ratio per 1 SD increase in RFM was 1.40; 95%CI: 1.17-1.66 (P&lt;0.001). The association between creatinine excretion and AF risk was non-linear (P-value quadratic trend=0.006): compared with individuals in tertile 2 of creatinine excretion, those in tertile 1 had a HR of 1.70; 95%CI: 1.21-2.29 (P=0.002) and those in tertile 3 also had a HR of 1.74; 95%CI: 1.22-2.47 (P=0.002).

Conclusion
In the general population, both fat mass and muscle mass are associated with incident AF. While obesity should be considered as a major risk factor for AF, increased AF risk in individuals with low and high muscle mass warrants further investigation.