bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low voltage area in the left atrial anterior wall predict Marshall-PLAN failure in patients with persistent atrial fibrillation
Authors: Limite L , Lagrange P , Bortone A , Khoueiry Z 
Published: May 2024

Abstract

Background
The most appropriate ablation strategy for persistent atrial fibrillation (PeAF) has not yet been determined. However, ethanol infusion of the vein of Marshall (VOM) combined with a linear set of ablation lesions (namely the Marshall-PLAN) has yielded encouraging results (1).

Purpose
Our study aimed at analyzing the relationship between low voltage areas (LVA) and arrhythmias recurrences in a PsAF population treated with the Marshall-PLAN.

Methods
we conducted a retrospective study on consecutive patients undergoing first catheter ablation (CA) for PsAF between 2021 and 2022 at our center. Pulmonary vein isolation (PVI), mitral isthmus ablation (VOM ethanol infusion, endocardial ablation and epicardial ablation in the great cardiac vein), left atrial (LA) roofline and cavo-tricuspid isthmus ablation were carried out in all the patients. Bidirectional block was validated for all the linear lesions as well as for PVI. Pre-ablation LA electroanatomic maps were built with CARTOv3 system and the PentaRay mapping catheter (minimum 3000 points). LVA were identified as areas &gt;1cm2 (containing ≥3 neighboring points with ≤10mm distance) with bipolar voltage &lt;0.5mV in SR and &lt;0.24 mV in AF (2). All patients were followed for at least 12 months.

Results
Overall, 93 patients (69±7years, 30% female) with PsAF were included. Their left-ventricle ejection fraction and left atrial volume indexed for body surface area (LAVI) were 57% and 92±20 ml/m2. LA maps demonstrated at least one LVA in 70 subjects (75.3%). The mean relative surface of LA in which a LVA was evidenced was 8±14%. LVA were found within the anterior LA wall in 49 patients (53%), in the posterior wall in 33 patients (35.5%), in the inferior wall in 22 patients (24%), in the lateral wall in 14 patients (15.1%) and in the pulmonary vein region in 44 patients (47.3%). After 19±6 months of follow-up, 28 (30%) patients had AF recurrence. At Cox regression analysis (including LVA burden and LAVI dimensions), LVA localized within the anterior LA wall were predictive of arrhythmia recurrences (hazard ratio [HR] 2.0 [95% CI, 1.1–4.7], P=0.04). Kaplan-Meier estimates of survival free from recurrences at 20 months were 51% and 88% in patients with and without LVAs in the anterior LA wall (Log-rank 0.006).

Conclusions
The Marshall-PLAN led to a global AF-free survival of 70% after 19±6 months in our cohort of patients with PsAF. Importantly however, the data show that the subset of patients with LVA in the anterior LA wall (i.e., the LA region not targeted by the pre-specified ablation set here evaluated) have a 55%-only AF-free survival while that of patients without LVA in the anterior LA wall was of 88%. As a result, our study supports the relevance of atrial substrate assessment and the possibility of CA strategy optimization in the subset of patients with PsAF and LVA in the anterior LA wall (3).
How to easily detect residual conduction gaps in redo procedure of pulmonary vein isolation: Post Encircling Mapping (PEM)
Authors: La Greca C , Prezioso A , Zanchi S , Pecora D 
Published: May 2024

Abstract

Background
Pulmonary vein isolation (PVI) is the cornerstone of the interventional catheter-based treatment of atrial fibrillation. Unfortunately, persistent pulmonary vein isolation is difficult to achieve, and up to 70% of pulmonary vein reconnection rate has been documented (1). Atrial mapping during pacing from CS in combination with LAT (local activation time) mapping may help to identify these residual gaps (2).

Methods
We collected data from consecutive radiofrequency (RF) redo PVI procedures performed in our center from 01/01/2022 to 01/10/2023. Re-isolation was obtained based on bipolar map and Local Activation Time (LAT) map during pacing from distal coronary sinus (CS) -table 1 for the workflow-. We compared data obtained from analysis of bipolar maps and LAT maps; "discrepancy" between bipolar map and LAT map was defined as a difference which may lead to a different approach to the ablation strategy (figure 1); then, we compared procedural timing (radiofrequency time, fluoroscopy time, and skin-to-skin time) with our historical cohort of RF redo PVI procedures (01/01/2011 – 31/12/2021).

Results
We performed 34 radiofrequency redo procedure from 01/01/2022 to 01/10/2023. In 13 out of 112 veins treated (11.6%), we observed discrepancy between bipolar map and LAT map. We observed a lower radiofrequency time for patients treated on the basis of LAT map (01-01-2022 – 01-10-2022) when compared with our historical cohort (1023.21 ± 521.51 sec vs 1358.50 +/- 746.53 sec, p= 0.038); no differences were found in terms of skin-to-skin time and fluoroscopy time.

Conclusions
To perform a LAT map during pacing from distal CS may help to better identify residual gaps in redo AF procedures, allowing a reduction in radiofrequency time, without increasing skin to skin time and fluoroscopy time.Discrepancy between bipolar and LAT map
Intermittent hypoxia is significantly associated with low-voltage areas in patients with atrial fibrillation complicated by obstructive sleep apnea
Authors: Takada Y , Yazaki Y , Shiina K , Terasawa M 
Published: May 2024

Abstract

Background
Obstructive sleep apnea (OSA) is one of risk factors for atrial fibrillation (AF); however, how OSA affects the structural and electrical atrial remodeling is not well described. This study aimed to determine the association of OSA with left atrial (LA) size and LA low-voltage area (LVA), a known arrhythmogenic substrate for AF.

Methods
Eighty-three patients undergoing catheter ablation of AF (forty-nine with OSA [apnea–hypopnea index: AHI ≥ 5/h] and thirty-four control patients without OSA by full polysomnography or portable monitor) were studied. In all cases, LA maps were created using a three-dimensional electro-anatomical mapping system in sinus rhythm or pacing from the right atrium. LVA was defined as a bipolar voltage &lt; 0.5 mV. %LVA is defined as ratio of LVA to LA area.

Results
LVA and %LVA were larger in OSA group as compared to Control group (6.0 ± 6.6 vs. 2.6 ± 3.2 cm2, P = 0.003 and 7.5 ± 8.5 vs. 3.5 ± 4.6 %, P = 0.008, respectively). On the other hand, there was no difference in LA size between the two groups. In addition, 3% oxygen desaturation index (ODI) was significantly correlated with %LVA (r = 0.282, P = 0.010), but not with LA size (r = 0.053, P = 0.637). Multiple regression analysis demonstrated that 3%ODI ≥ 30 (3.088, 1.078-8.851, P = 0.036) was significantly associated with %LVA after adjustment.

Conclusion
In patients with AF complicated by OSA, significant enlargement of the LVA was observed, but there was no evidence of enlargement in LA size. Intermittent hypoxia may be one of the mechanisms of this atrial electro-anatomical remodeling.figure 1figure 2
Pulsed-field vs. cryo-balloon based pulmonary vein isolation: does reduced autonomic modulation effect freedom of atrial fibrillation?
Authors: Lemoine M , Jaeckle S , Obergassel J , Mencke C , Riess J , Ismaili D , Wenzel J P , My I , Moser F , Rottner L , Reissmann B , Ouyang F , Kirchhof P , Rillig A , Metzner A 
Published: May 2024

Abstract

Background
Pulsed-field ablation (PFA) is a new energy source integrated into single-shot devices enabling pulmonary vein isolation (PVI) during atrial fibrillation (AF) ablation. It has been demonstrated that PFA is noninferior to conventional thermal ablation. Conceptually, PFA preferentially damages cardiomyocytes and our prior data show that PFA causes less damage to neuronal tissue and reduced autonomic dysfunction than CBA. Here, we analyzed heart rate variability (HRV) as an additional parameter of intracardiac nervous system and whether the damage to neuronal tissue quantified by biomarker release and functional parameters might influence the recurrence rate of atrial fibrillation in PFA and CBA treated patients.

Methods
We prospectively included consecutive patients with paroxysmal AF undergoing index PVI applying PFA (n=65) or CBA (n=112). We quantified the ablation-dependent effect on intracardiac autonomic nervous system by comparing resting heart rate (HR), HRV and circulating concentrations of the neuronal biomarker S100B. Recurrent AF was detected using Holter ECGs, wearables and telephone interviews.

Results
Baseline characteristics did not differ between PFA and CBA (age 66 vs. 68 years, female 33% vs. 39%, CHADS-VASc Score 2.1 vs. 2.2, indexed LA volume 32 vs. 31 ml/m², BMI 27.3 vs. 27.4 kg/m²). After CBA-based PVI, HR increased (pre 63 vs. post 70 bpm, p&lt;0.001) and HRV decreased (SDNN pre 54 vs. post 26 ms, p=0.007). After PFA-based PVI, HR and HRV remained stable (HR pre 63 vs. 64 bpm, p=0.591; HRV SDNN pre 37 vs. post 36 ms, p=0.890). In a direct comparison, the HR-increase and HRV-decrease observed after CBA-based PVI was significant compared to PFA (0.8 vs. 7.3 bpm, p&lt;0.001 and SDNN -1 vs. 29 ms, p=0.003). We reported previously that PFA induced less S100B release (28 ng/dl) than CBA (68 ng/dl, p&lt;0.001) and that PV reconnection rates in ReDo procedure were similar between PFA (40%) and CBA (40%). 1 year follow-up revealed freedom of AF in 79% after PFA and 73% after CBA (p=0.230). Dividing patients in upper and lower half of HR increase and S100B release after PVI, patients showed no difference in recurrence rates after CBA.

Conclusion
These data suggest that neurocardiac damage near the pulmonary veins seems not to contribute to freedom of AF recurrences after PVI.
Impact of obesity and pattern of atrial fibrillation on long-term outcome following cryoballoon pulmonary vein isolation
Authors: Musat D , Milstein N S , Park L S , Bhatt A , Habibi M , Kochav S , Preminger M , Sichrovsky T , Shaw R , Mittal S 
Published: May 2024

Abstract

Background
Cryoballoon (CB) pulmonary vein isolation (PVI) is an accepted method for treatment of paroxysmal and persistent atrial fibrillation (PAF, PeAF). Obese and PeAF patients do worse following ablation. However, there are limited data on the impact of both variables on outcomes.

Objective
To understand the impact of obesity and AF pattern on long-term outcomes following CB PVI.

Methods
We enrolled consecutive AF patients undergoing CB PVI; all patients had an implantable loop recorder (ILR) for long term continuous monitoring. Obesity (O) was defined as a BMI ≥ 30 kg/m2. The cohort was divided into 4 groups based on presence of obesity and type of AF at the initial ablation: (1) N-O (non-obese) and PAF, (2) O and PAF, (3) N-O and PeAF, and (4) O and PeAF. We assessed long-term AF recurrences, after excluding an initial 3-month post-ablation blanking period.

Results
The cohort included 322 patients (67 ± 9 years; 209 [65%] male; 177 [55%] PAF; CHA2DS2-VASc 2.7 ± 1.6, 137 [43%] O). Obese patients were younger and more likely to have hypertension and diabetes. During a follow-up of 931 ± 599 days, 211 (66%) patients had recurrent AF. The best outcome was seen in N-O obese patients with PAF; all other groups fared similarly (Figure). Group 1 had significantly lower AF recurrence compared to all 3 other groups (Figure). In multivariate analysis, obesity/AF type was the only significant predictor of AF recurrence (Table). As compared to N-O PAF pts, O PeAF patients had a 2-fold greater likelihood of AF recurrence.

Conclusions
During almost 3-years of objective follow-up, we found that CB PVI performs best in non-obese pts with PAF. Once obesity occurs, PAF pts respond as poorly to PVI as pts with PeAF, irrespective of obesity status. Additional strategies are needed in these patients.
Multielectrode catheter-based pulsed electric field versus cryoballoon for atrial fibrillation ablation: a systematic review and meta-analysis
Authors: Vetta G , Della Rocca D G , Parlavecchio A , Magnocavallo M , Pannone L , Sorgente A , Sieira J , Almorad A , Bala G , Stroker E , Rossi P , Boveda S , Sarkozy A , De Asmundis C , Chierchia G B 
Published: May 2024

Abstract

Background
Pulsed field ablation (PFA) is an innovative technology recently adopted for the treatment of atrial fibrillation (AF). Preclinical and clinical studies have reported a remarkable safety profile, as a result of its tissue specific effect targeting cardiomyocytes and sparing adjacent tissues. The FarapulseTM system was the first PFA device to receive regulatory approval.

Objective
We performed a meta-analysis to compare the efficacy and safety of PFA with the FarapulseTM system versus currently available 2nd generation Cryoballoon technologies (CRYO).

Methods
We systematically searched electronic databases for studies focusing on AF ablation employing the FarapulseTM PFA or 2nd generation CRYO technologies. The primary endpoints were acute procedural success assessed on a vein and patient basis. Safety endpoints included overall periprocedural complications and major periprocedural complications. We also compared procedural, fluoroscopy times, and freedom from atrial tachyarrhythmias (ATs) at follow-up (secondary endpoints).

Results
Fifteen and 69 studies were included for PFA and CRYO, respectively. PFA demonstrated greater acute procedural success on a vein basis (99.9% vs 99%;p&lt;0.001), as well as per patient (99.5% vs 98.4%;p&lt;0.001). PFA yielded lower overall periprocedural complications (3.0% vs 5.7%;p&lt;0.001) and shorter fluoroscopy time (14.0 min vs 18.9 min;p=0.02) compared to CRYO (Figure 1). No differences were found for major periprocedural complications (1.2% vs 1.0%;p=0.37), procedural time (84.4 min vs 106.2 min;p=0.07) (Figure1) and freedom from ATs at 1 year (81.8% vs 80.3%; Log-rank p =0.98) (Figure 2).

Conclusions
PFA contributed to higher acute procedural success, and safety compared to CRYO. No statistically significant differences in AT recurrence at 1-year follow-up were observed.Figure 1Figure 2
Pattern of reconnection after isolation of the pulmonary veins with a pulsed-field ablation
Authors: Finet F , Jean F , Massoulie G , Boudias A , Catalan P A , Clerfond G , Bouchant-Pioche M , Riocreux C , Eschalier R 
Published: May 2024

Abstract

Background
Pulsed Field Ablation (PFA) has proven is efficacy for pulmonary vein isolation (PVI) with an acute success in 99.9% of PVI and few major complications (1.6% of patients). (1) However, in redo procedures, the durability of the PVI was 63% at a median of 6 month in a study of Kueffer and al. (2)

Purpose
The purpose of this study is to analyze the pattern of these reconnections in the redo procedures.

Methods
We retrospectively analyzed the data among the patients that had a PVI with PFA in our institution between 1 October 2022 and 1 October 2023 who were referred for a recurrence of a tachyarrhythmia.

Results
Of 350 patients treated for PVI with PFA, 14 patients (4%) were referred for a recurrence of tachyarrhythmia. Among them, three (21%) were female and the median age was 72 years old [IQR 69-78]. The Chadvasc score was &gt; 2 in 7 (50%) patients and the DR flash score was &gt; 3 also in 7 (50%) patients. The patients were referred for paroxysmal AF (4/14 patients), persistent AF (5/14 patients), typical flutter (2/14 patients) or atypical flutter (3/14 patients). All patients had a high resolution 3D electro-anatomical mapping, in a median time of 7,4 months [IQR 5,1-11,8]. The median left atrium volume was 169 mL [IQR 150-180] and 66% of the pulmonary veins were isolated. Only two patients (14%) had durable PVI in all their veins. Two of the patients had a posterior box with their PVI and the box was blocked at 7 and 13 months after the PFA. The reconnections of the pulmonary veins was mainly in the anterior aspect of the right superior PV (6/19 reconnections, 32%). There were two typical shapes of reconnection, the « missing petal » and the « collar » patterns.

Conclusion
In a redo procedures at 7 months after a PFA, 14% of the patients had durable PVI and 66% of the veins were isolated. The reconnections were mainly in the anterior right superior PV and had often a typical « missing petal » or « collar» patterns.Percentage ReconnectionsPatterns Reconnections
Hybrid ablation versus repeated catheter ablation in persistent atrial fibrillation: long-term results of the HARTCAP-AF trial
Authors: Van Der Heijden C A J , Vroomen M , Weberndorfer C V , Luermans J G L M , Chaldoupi S M , Bidar E , Vernooy K , Maessen J G , Van Kuijk S M J , La Meir M , Crijns H J G M , Maesen B A E 
Published: May 2024

Abstract

Background
The HARTCAP-AF study compared the efficacy and safety outcomes in forty-one ablation-naive patients with persistent atrial fibrillation (AF) randomized to thoracoscopic hybrid ablation (HA) or stand-alone catheter ablation (CA). One-year results have shown that thoracoscopic HA has superior rhythm outcomes than CA, without increasing complications.

Purpose
Here, we evaluated the efficacy, safety and quality of life (QOL) of thoracoscopic HA and CA within a long-term follow-up (FU) duration of three years.

Methods
Efficacy outcomes included freedom from atrial tachyarrhythmia (ATA) recurrences ≥5 minutes off and allowing antiarrhythmic drugs (AAD) after 24 and 36 months. Safety outcomes, including serious adverse events (SAEs), and QOL, measured by the EHRA AF symptom score, were evaluated after 36 months.

Results
After a mean FU duration of 25±3 and 38±3 months, freedom from ATA recurrences was higher in the HA group compared to the CA group off AAD (68.4% vs. 22.7%, P=0.002 and 57.0% vs. 22.7%, P=0.005) and allowing AAD (73.7% vs. 22.7%, P=0.001 and 63.2% vs. 22.7%, P=0.001) (Figure 1, Table 1). The number of redo catheter procedures was higher in the CA arm than the HA arm (n=15 vs. n=3, P=0.021). The total number of SAEs was low and did not differ between groups (HA: n=6 vs. CA: n=7, P=0.989). Moreover, QOL measured by the EHRA AF-symptom score improved for both groups post-procedure (3.2±0.7 and 1.6±0.78, P&lt;0.001) and were better for HA than CA after 3 years (1.3±0.7 and 1.9±0.8, P=0.029).

Conclusion
After three years, (thoracoscopic) HA continues to have superior rhythm outcomes compared to CA with a comparable long-term safety profile. While both procedures resulted in a reduction in AF symptoms, EHRA scores were more favorably scored by patients in the HA arm. Therefore, in experienced centers thoracoscopic HA should be considered as a first-line treatment to percutaneous approaches for ablation-naive patients with persistent AF.Figure 1Table 1
Aspirin versus clopidogrel as a combination therapy with direct oral anticoagulant after coronary stent implantation in patients with atrial fibrillation
Authors: Kim T S , Kim S , Park S , Kim H , Hwang Y , Kim S H , Kim J H , Jang S W , Oh Y S , Choi Y 
Published: May 2024

Abstract

Background
Patients with atrial fibrillation (AF) who undergo percutaneous coronary intervention (PCI) are recommended to receive dual antithrombotic therapy including an antiplatelet agent and direct anticoagulants (DOAC). We compared the effectiveness between aspirin and clopidodgrel for a combination therapy with DOAC in this population.

Methods
We analyzed patient data from the Korea National Health Insurance Service. A total of 9,157 patients with AF who received dual antithrombotic therapy after PCI were included. Patients were classified into the aspirin group and clopidogrel group, and 1:1 propensity score matching (PSM) was performed. The primary ischemic endpoint was a composite of cardiovascular death, myocardial infarction, stroke, or systemic thromboembolism. A major bleeding event was defined as a bleeding event requiring hospitalization.

Results
After PSM, there were each 2,882 patients each in the aspirin and clopidogrel group. The incidence of the primary ischemic endpoint was similar in the two groups (22.8% vs. 21.8%, in the aspirin and clopidogrel group, hazard ratio [HR] for clopidogrel group: 0.909, 95% confidence interval [CI] 0.815 – 1.014). The incidence of each component of ischemic endpoint did not differ significantly between the two groups. All-cause mortality was increased in the clopidogrel group (HR 1.301, 95% CI 1.000 – 1.692). There was no significant difference in major bleeding events (HR 0.942, 95% CI 0.789 – 1.126).

Conclusions
For a dual antithrombotic therapy in patients with AF who had undergone PCI, aspirin and clopidogrel did not differ in terms of ischemic outcomes, but the use of aspirin was associated with slightly lower all-cause mortality.
Patient-reported treatment burden: comparison between vitamin-K antagonist and non-vitamin K antagonist oral anticoagulants
Authors: Mihajlovic M , Nevena Z , Simic J , Marinkovic M , Mujovic N , Potpara T 
Published: May 2024

Abstract

Introduction
Treatment burden (TB) is defined as the overall workload that maintenance or improvement of their functioning and well-being poses on patients with chronic medical conditions. A high patient-reported TB has been associated with lower adherence to treatment and increased risk of major adverse events including death. We explored the differences in patient-reported TB value and prevalence of unacceptably high TB score (≥59 points) between patients receiving vitamin K antagonist oral anticoagulants (VKA) and non-vitamin K antagonist oral anticoagulants (NOAC). Furthermore, we explored contributory factors associated with TB and the relationship between TB and quality of life (QoL) in these patients.

Methods
A single-centre study included consecutive adult in- and outpatients on long-term oral anticoagulation, seen at a university clinical centre a from April to June 2019, who were willing to complete the Treatment Burden Questionnaire encompassing 13 items assessing the TB associated with taking medicine, self-monitoring, laboratory assessments, medical consultations, organisational and administrative requirements, adherence to dietary and physical activity recommendations, as well as the social repercussions of the treatment.

Results
Of 320 enroled patients, 206 (64.4%) were taking a VKA. Atrial fibrillation was the most common indication for long-term oral anticoagulation (n=299, 93.4%). The mean TB score was significantly higher in patients on VKA versus those taking a NOAC (48.8 ±26.5 vs. 41.8 ±19.7, P= 0.014), mostly owing to significantly higher TB values for questions related to self-monitoring, including the International Normalized Ratio (INR) control (3.85±3.32 vs. 1.62±1.38, P&lt;0.001) and diet restrictions (3.98±3.43 vs. 2.48±2.49, P&lt;0.001) in patients taking VKA (Figure 1). In addition, these patients significantly more often reported an unacceptably high TB of ≥59 points compared with those taking NOAC (30.1% vs 18.4%, P= 0.024). Multivariable regression analysis of predictors of TB in patients taking a VKA or NOAC are presented in Table 1.

Conclusion
In our study, patients receiving a VKA reported significantly higher TB compared to those using NOAC, especially regarding the questions about self-monitoring (including INR control) and diet restrictions. An unacceptably high TB was also more prevalent among patients receiving a VKA. Our findings suggest that prescribing NOACs in preference to VKAs could help in decreasing the self-reported TB in patients who need oral anticoagulant therapy.