bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimizing pressure-guided cryoablation of pulmonary veins
Authors: Madero S , Herreros Guilarte B , Diez De Las Heras D , Munoz San Jose J C 
Published: May 2024

Abstract

Background
Pressure-guided cryoablation (PGC) is a contrast-free technique used to isolate Pulmonary Veins (PV) in order to treat atrial fibrillation (AF). In this technique the main goal is to achieve a wedge curve to assure adequate vein occlusion(1). As the wedge curve is not always clear, we hypothesize that the wedge pressures (systolic, diastolic and mean) could be useful as reliable surrogate markers.

Purpose
The aim of this study is to evaluate wedge pressures in individual vein occlusions in a cohort of patients referred for PV isolation using PGC.

Methods
Between February 2022 and October 2023, 23 patients (7 female, 13 paroxysmal AF) underwent PV isolation using PGC protocol. No REDOs were included. The procedure was intended to obtain PV isolation with one shot of 240 seconds. All patients underwent computed tomography angiography or MRI of LA and PV. A 28-mm Cryoballoon and a Intracardiac echo were used in all the procedures. Invasive radial arterial and LA pressures were registered. We analysed all the shots per vein and compared data between successful and unsuccessful isolation. Multivariate statistical analysis was performed, being the PV isolation the main outcome.

Results
There were realized 125 applications in 92 veins, being isolated 100% of them. One vein (left superior) was isolated after application in inferior ipsilateral vein, so it was considered successful as there was no need of additional applications. Eleven applications were performed as a bonus, so they were not considered for the isolated-non isolated analysis. Wedge curve was obtained in 112/119 applications (the 7 applications with not adequate wedge curve were 3 in right superior and 4 in right inferior pulmonary veins). In 5 applications the graphic curve was not reliable, but the pressure values were registered. There were significative differences in nadir temperature, systolic, diastolic and mean vein pressures, and the presence of a wedge curve. In the multivariate analysis, the nadir temperature (OR 0.79 CI95% 0.70–0.90) and the diastolic vein pressure at occlusion (OR 1.16 CI95% 1.01–1.36) were the only independent predictor factors of PV isolation.

Conclusion
With these results, we conclude that the monitoring of diastolic PV pressure during applications and the nadir temperature are the best markers to predict a successful isolation in the PGC.Figure 1.Pressure waveformTable 1.Application characteristics
Preprocedural atrial fibrillation burden is associated with recurrence in patients undergoing atrial fibrillation ablation: findings from the ISOLATION AF Ablation Cohort Study
Authors: Habibi Z , Verhaert D V M , Hermans B J M , Philippens S A M , Westra S W , Chaldoupi S M , Maesen B A E , Isaacs A J , Zeemering S , Linz D , Vernooy K , Schotten U 
Published: May 2024

Abstract

Background
Non-invasive quantification of electrophysiological properties of the atria is increasingly used for outcome prediction in atrial fibrillation (AF) patients. Data on the benefit of the current classification of AF compared to AF burden based on single lead ECG measurements to predict AF recurrences are scarce.

Objective
This study sought to assess the predictive performance of low versus high AF burden compared to the conventional AF classification for predicting recurrences after AF catheter ablation.

Methods
A cross-sectional analysis was conducted in AF patients scheduled for catheter ablation included in the prospective multicenter ISOLATION cohort study between July 2020 and November 2022. Clinical characteristics, routine tests, blood tests and rhythm monitoring through single lead ECGs were collected prior to ablation. ECGs were recorded three times daily for four weeks, with additional measurements in case of the onset or relief of symptoms. The primary endpoint was "ablation success" defined as freedom from documented arrhythmia after the blanking period. Of 650 included patients, pre-procedural rhythm monitoring was available in 580. 261 patients had at least 14 days of ECG measurements and completed 12 months of follow-up. In these patients, we compared the recurrences after 12 months between paroxysmal and persistent AF and high versus low AF burden through survival analysis. Maximally selected rank statistics were used to determine the best cut-off value for AF burden.

Results
In 261 patients, the mean age was 64 ± 9 years, and 33.7% were female. Physicians classified 170 patients (65.1%) as paroxysmal AF and 91 (34.9%) as persistent AF based on medical history. The AF burden is shown in Figure 1. The optimal calculated cut-off value for AF burden was 42%. Out of 170 patients with paroxysmal AF, 17 (10%) had a burden of &gt; 42%. Of the 91 patients with persistent AF, 35 (38%) had a burden of &lt; 42%. After 12 months, a significant difference in recurrences was observed between patients with paroxysmal AF versus persistent AF (p= 0.015). Patients with high AF burden, had more recurrences after 12 months, than patients with a low AF burden (p= 0.006) (Figure 2).

Conclusion
Our preliminary results suggest that the addition of a new classification of AF based on burden might provide additional benefit in predicting AF recurrences after catheter ablation compared to the current existing classification and may improve prognostication. Completion of patient follow-up is necessary to determine the predictive value of AF burden derived from single lead ECGs for the prediction of AF recurrence.Figure 2.
Atrial fibrillation cryoablation guided by pressure waveform: a prospective multicentre registry
Authors: Fontenla Cerezuela A , Cozar R , Sanchez-Millan P J , Fernandez-Palacios G , Gonzalez-Casal D , Gaztanaga-Aranzamendi L , Jimenez-Lopez J I , Ballesteros G , Gonzalez-Panizo J , Garcia-Salvador J J , Izquierdo-Bajo A , Alvarez M , Garcia-Fernandez F J , Cabrera J A , Datino T 
Published: May 2024

Abstract

Background
Cryoballoon ablation (CA) procedures require optimal occlusion of the pulmonary veins (PV), which is conventionally evaluated by iodine contrast injection through the catheter tip. This technique has some weaknesses such as risk of allergic reactions, nephrotoxicity, requirement of fluoroscopy (sometimes at high doses), requirement of a second operator, among others. PV pressure waveform assessment is an alternative method for confirming occlusion, however, multicentre assessment of periprocedural efficacy and safety is lacking.

Purpose
To describe the intra-procedural performance and safety of routine pressure-based CA.

Methods
In this independent prospective multicentre observational study, baseline and procedure data from consecutive pressure-guided CB ablations were collected. Operators were not required to have experience in pressure-guided CA for participating in the registry. They were asked to classify the pressure waveform curves into type 1 (presence of "a-wave" and/or symmetric "v-wave", meaning incomplete PV occlusion) and type 2 (absence of "a-wave" and asymmetric "v-wave", meaning complete PV occlusion), Figure 1. The primary endpoint was PV isolation in all veins without use of contrast. Procedure performance and adverse events were also analyzed.

Results
A total of 150 patients (mean age: 61 ± 10 y.) with paroxysmal (62%) or persistent AF (38%) were included and underwent pressure-guided CA in 9 centres from Spain. Complete PV isolation was achieved in 148 patients (98%). The operators switched to contrast use in 14 cases (9%), mainly to double check the occlusion. Total procedure and fluoroscopy time were 97 ± 39 and 19 ± 10 min respectively. There were 7 (4.7%) procedure related adverse events: 4 phrenic nerve palsy (3 of them were transient), 1 transient coronary ST elevation (before ablation), 1 gastroparesis and 1 femoral pseudoaneurysm. Most relevant results are summarized in Figure 2.

Conclusion
In this multicentre and multi-brand assessment, CA guided by pressure waveforms provided outstanding procedural outcomes, which were equivalent to those reported with the conventional approach. All operators could easily obtain and identify the waveform without a specific learning curve, avoiding the use of iodine contrast in most cases. The long-term efficacy of this approach will be presented in future analyses.Pressure waveforms types in cryoablationProcedural data
Biochemical markers of neuro-myocardial damage after pulmonary vein isolation: the effect of different energy sources
Authors: Stojadinovic P , Alfredova H , Filova V , Wichterle D , Peichl P , Cihak R , Borisincova E , Stiavnicky P , Haskova J , Franekova J , Kautzner J 
Published: May 2024

Abstract

Background
Pulmonary vein isolation (PVI) by thermal energy, both radiofrequency (RF) and cryoenergy(Cryo), is associated with a significant release of myocardial and collateral neural injury markers. Damage to periatrial ganglionated plexi also results in a substantial change in cardiac autonomic regulations. On the contrary, pulsed electric field (PEF) energy tends to spare cardiac neural tissue.

Purpose
To quantify the impact of different ablation energy sources that are used for PVI on neuro-myocardial damage by the assessment of specific biomarkers.

Methods
A study enrolled 85 patients with paroxysmal atrial fibrillation who underwent PVI (age: 61 ± 12 years, 74% males). In 23 patients, RF energy was delivered by the irrigated-tip catheter, while 30 patients were ablated using a second-generation cryoballoon catheter. In 32 patients, PVI was performed using a multipolar pentaspline catheter and PEF energy. Peripheral venous blood samples for assessing the plasmatic levels of S100 calcium-binding protein B (S100B), neuron-specific enolase (NSE), high-sensitivity troponin I and T (hsTnI and hsTnT) were obtained before, immediately after the PVI, and the next day (usually 18-24 hours after the procedure). Study groups were compared regarding absolute biomarker levels and hsTnT/S100B ratio (a surrogate of cardioselectivity).

Results
Following successful PVI, a significant increase in plasma levels of all biomarkers was observed: DhsTnT = 1040±434 ng/L, 1731±830 ng/L and 1010±397 ng/L; DhsTnI = 1504±918 ng/L, 16464±11911 ng/L and 10789±7589 ng/L; DS100B: 0.04±0.02 mg/L, 0.03±0.04 mg/L and 0.14±0.08 mg/L; DNSE: 34±72 ng/mL, 27±53 ng/mL and 45±52 ng/mL (all with P &lt;0.001) for RF, PEF and Cryo groups, respectively. A direct comparison of maximal biomarker levels between study groups is depicted in the Figure. The hsTnT/S100B ratio was 23±14, 12±6, and 6±3 in PEF, RF, and Cryo groups, respectively (ANOVA P &lt;0.01), indicating that PEF was 1.9-times and 3.8-times more cardioselective than RF and Cryo, respectively. Following the PVI, the heart rate accelerated by 2±8, 13±14, and 9±11 bpm in the PEF, RF, and Cryo groups, respectively. No correlation was observed between S100B release and HR acceleration (R = 0.07, P = 0.55).

Conclusion
Compared to thermal energy sources, PEF energy induces more specific damage to cardiomyocytes than cardiac nerves. There was no correlation between S100B release and HR acceleration.
Injury to the sinus nodal artery during radiofrequency ablation of atrial fibrillation and atrial tachycardia: its prevalence and treatment with percutaneous coronary intervention
Authors: Sakamoto Y , Itoh M , Yamashiro K , Yoshimoto D , Naganawa H , Yamaguchi R , Sato K , Takeya M , Yamamoto M , Habara M , Terashima M , Suzuki T , Nakagawa H 
Published: May 2024

Abstract

Background/Introduction
Injury to the sinus node artery (SNA) leading to SN dysfunction during radiofrequency catheter ablation (RFCA) of atrial Fibrillation (AF) and atrial tachycardia (AT) has been reported.

Purpose
The purpose of this study was to elucidate the prevalence and clinical course of SNA injuries during RFCA of AF/AT and examine the efficacy of the percutaneous coronary intervention (PCI) to restore SN function.

Methods
We retrospectively analyzed data from 6,906 consecutive patients (pts) who underwent RFCA of AF/AT (6,379 pts with AF ablation and 527 pts with AT ablation) in two institutions between January 2013 and December 2022.

Results
Among 6,906 pts, 9 (0.13%) pts developed SN dysfunction due to SNA injury during RFCA (8 with AF, 1 with AT). Acute SNA injury (total occlusion or severe narrowing of the SNA) was confirmed by coronary angiography (CAG) during the RFCA session in 8/9 pts. In the remaining patient, SNA injury was suspected based on the CT angiography. The culprit sites of the SNA injury were located at the septal site of the superior vena cava-right atrium junction in 4 pts (44%), on the left atrial appendage ridge in 3 (33%), on the roof of the left atrium adjacent to the right superior pulmonary vein in 1 (11%), and in the persistent left superior vena cava in 1 (11%). PCI to the occluded SNA was performed in 8 of the 9 pts: 1) coronary blood flow of the SNA was restored by a 0.014" guidewire advancement into the occluded artery using a micro-catheter followed by direct nitroprusside injection in 4 pts; 2) the direct balloon angioplasty using 0.75-1.5 mm diameter balloons was required to maintain the blood flow of SNA in 3 pts; and 3) CAG revealed spontaneous recovery of the blood flow of SNA in one pt. The remaining patient did not receive the CAG/PCI. All 8 pts who underwent the PCI resulted in restoration of normal sinus rhythm. During a median of 44 months follow-up, all 8 pts who received the PCI maintained normal sinus rhythm, while one patient without PCI demonstrated persistent SN dysfunction.

Conclusions
SNA injury during RFCA is a rare but critical complication. Prompt recognition by CAG and subsequent PCI effectively restores SN function in pts with unexpected SN dysfunction during RFCA procedures.
Optimizing ablation sites in recurrent atrial fibrillation cases: a novel approach using emphasize settings
Authors: Okajima S , Fujimoto Y , Ito N , Arai T , Hachisuka M , Hagiwara K , Murata H , Aizawa Y , Yodogawa K , Shimizu W , Asai K , Iwasaki Y 
Published: May 2024

Abstract

Backgrounds
Although catheter ablation techniques for atrial fibrillation (AF) have advanced, a certain number of cases of re-conduction after pulmonary vein isolation (PVI) still exist and are the most common cause of recurrence of atrial tachyarrhythmias. In some cases, the diversity of anatomical wall thickness and fiber orientation around the PVs might contribute to re-conduction. Identification of optimal target ablation site of re-conduction could reduce unnecessary ablation and decrease the risk of complications. However, in cases where local electrograms consisted with far filed and near filed potentials were coexist, conventional activation mapping with bipolar electrograms sometimes fails to identify the re-conduction sites.

Purpose
We investigated the utility of using the Emphasize settings in the emphasis map obtained by combining activation mapping and peak frequency mapping in the EnSite X system to determine the optimal ablation sites compared to the conventional map based on the activation mapping.

Methods
Patients undergoing AF ablation of PVI with the EnSite X system who had recurrent cases or had PVI re-conduction at the initial ablation were included. We retrospectively analyzed the cases from January 2022 to November 2023. In all cases, bipolar voltage and activation maps for left atrium and PVs were obtained by a 16-pole grid catheter (Advisor HD Grid) during atrial pacing or sinus rhythm. Local activation timing and peak frequency maps of the left atrium were performed to obtain the Emphasize settings indicating the optimal ablation sites (E-group). The Emphasize settings obtained from the maps were adjusted to make the site of re-conduction most apparent (Figures). Another group determined the ablation sites based on the activation mapping (A-group). The clinical backgrounds, laboratory data, and echocardiography data were also evaluated. Intravenous administration of ATP was performed in all targeted PVs after successful re-isolation of PVs.

Results
Total 44 patients (69±10 years, 32 males) and 90 PVs were found to be re-conducted and analyzed. The gaps of 34 and 40 points of PVI were observed in the E-group and C-group, respectively. The number of needs for the ablation points to successful elimination of gap was markedly smaller in the E-group (1.3±0.7 vs. 6.2±3.2, p&lt;0.001). The optimal Emphasize settings was 340 ±75 Hz in the E-group. None of the cases showed dormant conductions by ATP administration in both groups. There were no differences in age, gender, left atrial volume index, left ventricular ejection fraction, serum creatinine levels, and N-terminal pro-brain natriuretic peptide levels between the two groups.

Conclusion
The optimal ablation site was visualized by adjusting the Emphasize settings, and the number of ablation points to re-isolation of PV might be markedly reduced.
Correlation between Lesions Size Index (LSI) and impedance dynamics during radiofrequency ablation for atrial fibrillation: impact of lesion duration and contact force
Authors: Sanchez Somonte P , Martinez Cossiani M , Guido L , Merino Fuentes D , Sanz B , Martinez Maldonado M E , Handayani A , Carton A , Jauregui M E , Castrejon-Castrejon S , Merino J L 
Published: May 2024

Abstract

Introduction
Impedance drop has been employed as a surrogate marker for lesion formation with its magnitude correlated to lesion size in in-vitro studies. The Lesion Size Index (LSI), and algorithm from Abbott Medical, serves as a predictor for lesion formation during radiofrequency (RF) ablation. While this formula integrates contact force (CF), lesion duration and power, it currently leaks impedance information. The new module of Ensite Cardiac Mapping system (Abbot) is capable of measuring the "filtered" impedance during each RF lesion, effectively eliminating artifacts from cardiac and respiratory oscillations. The objective of this study is to examine the correlation between the LSI and the average impedance drop during RF lesion formation.

Methods
We included a total of 18 consecutive patients who underwent catheter ablation for atrial fibrillation (AF) with Ensite Mapping System (Abbot). In all cases, 40 watts (W) were applied and the target LSI was set as 5 for the posterior wall and 6 for the anterior wall. For each lesion, the software automatically annotated the initial impedance, final impedance, average impedance drop (filtered), lesion duration and average contact forced (CF). The correlation between LSI, impedance drop and CF was assessed.

Results
A total of 1300 RF lesions delivered during AF ablation were analyzed. Mean LSI was 5.3 ± 0.8, mean average impedance drop was 10.9± 5 ohms and mean CF 12.3±6 grams (g). The LSI showed a weak but statistically significant correlation with the impedance drop (Person correlation=0.3; p&lt;0.001). When ablation lesions were grouped by duration (&lt;20 seconds, 21-40, 41-60, &gt;60 seconds), the correlation between LSI and impedance drop remained weak but statistically significant for lesions shorter than 20 seconds (p&lt;0.001) and lesions between 21 and 40 seconds (p&lt;0.001). However, there was no longer correlation for lesions between 40-60 seconds and those longer than 60 seconds (Figure1). Mean CF for each group (from &lt;20 to &gt;60 seconds) was 15 ±7 g vs 11 ±5 g vs 9 ± 3 g vs 7± 3g respectively (p&lt;0.001) (Figure 2), suggesting that the CF is key to improve the predictive value of LSI.

Conclusions
The LSI shows a weak correlation with the average impedance drop during AF ablation. This correlation is influenced by lesion duration, which is ultimately dependent on CF. These findings emphasize the ongoing need to optimize predictive models for RF lesion formation in the ever-evolving landscape of AF treatment.Figure 1Table 1
High-density mapping-guided ventricular tachycardia ablation in patients with ischemic cardiomyopathy: outcomes from a tertiary center cohort in Switzerland
Authors: Guan F U , Brunckhorst C , Wolber T , Breitenstein A , Molotor N , Gonca S , Duru F , Saguner A M 
Published: May 2024

Abstract

Background
Substrate-based ablation has emerged as a successful technique for VT ablation, especially in patients with ischemic cardiomyopathy with markedly reduced left ventricular function. High-density mapping catheters provide high-resolution electroanatomical maps and better discrimination of abnormal substrates and local activation in the heart chambers, making them a valuable and safe resource in the electrophysiology laboratory.

Purpose
The purpose of this study was to investigate differences in procedural characteristics and clinical outcomes of VT ablation with ischemic cardiomyopathy. VT ablations were guided by two mapping strategies: high-density mapping using a high-density mapping catheter and conventional mapping using an ablation catheter.

Methods
Patients with ischemic cardiomyopathy receiving VT ablation at our center between January 2018 and June 2023 were retrospectively included. Procedural characteristics and clinical outcomes were compared between patients receiving high-density mapping with a multielectrode-mapping catheter vs conventional mapping with a single-tip irrigated ablation catheter.

Results
Eighty-four patients with ischemic cardiomyopathy who underwent VT ablation were consecutively included (mean age 67 ± 12 years, mean LVEF 32 ± 11 %, 79 (94%) males). Fifty-seven (68 %) procedures were performed using high-density mapping, and 27 (32 %) conventional mapping. In the high-density mapping and conventional mapping group, the total procedure time was 256 ± 77 min vs. 232 ± 61 min (P &lt; 0.05) and the total fluoroscopic dose was 1643 ± 204 μGy.m2 vs. 948 ± 105 μGy.m2 (P &lt; 0.05), respectively,. However, there was no difference between the two groups in terms of acute success (84% vs 80%, P &gt; 0.05) or major complications (5% vs 4%, P &gt; 0.05). The mean duration of follow-up was 2.6 years (4 - 51 months). The 1-year mortality rates were 4% vs 7% in the high-density mapping and conventional mapping groups, respectively (P &lt; 0.05). The 3-month and 1-year single-procedural sustained VT/VF-free rates were 77% vs 59% and 74% vs 63%, respectively (P &lt; 0.05). The 1-year incidence of sustained VT/VF recurrence was 7.0 per 100 person-years in high-density mapping group, compared with 7.4 per 100 person-years in the conventional group.

Conclusions
VT ablation in patients with ischemic cardiomyopathy using high-density mapping appears to be superior to conventional mapping in terms of reducing postprocedural VT/VF recurrence and a subsequent reduction of overall mortality.Figure 1Figure 2