bluuebunny/crossref_metadata_2025_split huggingface dataset:
First multicenter experience of pulmonary vein and posterior wall isolation via a novel focal 9mm lattice tip catheter in a real-world scenario
Authors: Vetta G , Della Rocca D G , Pannone L , Sorgente A , Cespon-Fernandez M , Del Monte A , Mene R , Almorad A , Sieira J , Bala G , Stroker E , 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 AfferaTM system is a focal 9-mm lattice tip catheter that has recently received regulatory approval. No data currently exist on the feasibility of this technology for first-time pulmonary vein isolation (PVI) and posterior wall isolation (PWI) in a real-world scenario.

Objective
To evaluate the safety and efficacy of the focal 9-mm lattice tip catheter Sphere-9 (Affera Inc) in a real-world population undergoing PVI and PWI.

Methods
Consecutive AF patients undergoing first-time PVI plus PWI with the AfferaTM system in two different centres between August and November 2023 were prospectively included. PFA was always used to ablate the posterior left atrium, whereas anterior applications were performed using either radiofrequency energy (RF/PF strategy) or PFA (PF/PF strategy) based on operator's discretion. Primary efficacy endpoint was acute procedural success (successful PVI with evidence of bidirectional block at the end of the procedure). Primary safety endpoint included major technology-related complications occurring within 7 days post-ablation. Secondary endpoints were first pass isolation, acute reconnection, overall complications, procedural, dwelling, and fluoroscopy time.

Results
Thirty consecutive patients [mean age: 68±6.8 years; 61.7% males; CHA2DS2-VASc Score 2.0 (1.5 – 3.5)] were included. Among them, 66.7% (n=20) had non-paroxysmal AF.
PVI was performed with an RF/PF strategy or PF/PF one in 10 (33.3%) and 20 (66.7%) patients, respectively. Posterior wall isolation (PWI) was performed in 30 (100%) cases.
The primary endpoint was achieved in 100% of patients for both PVI and PWI with average procedural time of 95 min (77-120 min), dwelling time of 78 min (55-92 min) and fluoroscopy time of 6 min (5-10.5 min) (Figure 1). No technology-related complications were observed. First-pass isolation occurred in 100% of PVI and PWI, with no acute reconnection for PW and 1 case of right PV reconnection in the RF/PF strategy group.

Conclusions
AF ablation with the focal 9-mm lattice tip catheter Sphere-9 confirmed high efficacy and safety in PVI + PW in a real-world population.Figure 1
Prophylactic administration of glycopyrrolate prevents vasovagal responses induced by pulsed field ablation in patients with atrial fibrillation
Authors: Vetta G , Della Rocca D G , Cespon-Fernandez M , Del Monte A , Magnocavallo M , Mene R , Pannone L , Sorgente A , Sieira J , Stroker E , Rossi P , Boveda S , Sarkozy A , De Asmundis C , Chierchia G B 
Published: May 2024

Abstract

Background
The FarapulseTM system was the first pulsed field ablation device to receive regulatory approval. Vagal Responses (VR) during pulmonary vein isolation (PVI) with this pentaspline device are frequent and often require back-up pacing or the administration of parasympathetic drugs. Glycopirrolate (GLY) is a medication of the muscarinic anticholinergic group; its efficacy for VR prevention when administered prophylactically before PVI has never been reported.

Objective
To evaluate the effectiveness of prophylactic intravenous administration of GLY on VRs induced by PFA.

Methods
Consecutive AF patients undergoing first-time PVI with PFA via the FarapulseTM system between April and October 2023 were prospectively enrolled in 3 European centers. Prophylactic administration of GLY (0.2 mg intravenous administration before femoral vein puncture) [Group GLY(+)] was adopted based on operator’s preference. VR was defined as at least one of the following: sinus bradycardia (&lt;40 beats/min), asystole (&gt;6 sec), or atrioventricular block (AVB) occurring immediately after a pulsed electric field application. VRs and maximum pause duration (maximum RR interval) were determined for each PV. Temporary backup pacing was performed as per the operator's preference.

Results
We enrolled 141 patients [GLY(+): 64 patients; GLY(-): 77 patients] undergoing PVI with the pentaspline FarapulseTM system. Median age was 54.1 years (54.1- 70), and 76 (54%) patients were males with an average CHA2DS2-VASc Score of 1.0 (0 – 2). A total of 563 PVs, including 3 left common PVs and 2 accessory middle PVs, were successfully isolated with the FarapulseTM PFA system. There were no statistically significant differences in baseline and procedural characteristics between two groups. VRs during PVI occurred in a total of 53 (37.6%) patients. GLY administration reduced significantly the incidence of any VRs (4.7% vs 64.9%; p&lt;0.001) (Figure 1A). Additionally, GLY resulted in a lower incidence of VRs during LSPV (4.7% vs 62.3%; p&lt;0.001) and LIPV (1.6% vs 9.1%; p&lt;0.001) (Figure 1B) isolation and the need for temporary backup pacing during LSPV (24.7% vs 1.6%; p&lt;0.001) isolation. Maximum pause duration was significantly shorter in the GLY(+) group after PFA of LSPV (1195 vs 3459 sec; p&lt;0.001), LIPV (1128 vs 1556 sec; p&lt;0.001), RSPV (1138 vs 1607 sec; p&lt;0.001) and RIPV (1103 vs 1343 sec; p&lt;0.001) compared to GLY(-) group (Figure 1C).

Conclusions
Glycopyrrolate is highly effective in the prevention of VRs induced by PFA ablation in AF patients undergoing first-time PVI.Figure 1
Impact of the timing of early recurrences during the blanking period in patients after cryoballoon ablation: insights from the COMPARE CRYO study using continuous rhythm monitoring
Authors: Rehman S , Kueffer T , Knecht S , Madaffari A , Badertscher P , Maurhofer J , Krisai P , Thalmann G , Heg D , Servatius H , Tanner H , Kuhne M , Roten L , Sticherling C , Reichlin T 
Published: May 2024

Abstract

Background
Early recurrences (ER) during the blanking period after pulmonary vein isolation (PVI) are common. While many of those correlate to late recurrences (LR) after the blanking period, some do not. The impact of the timing of ER is difficult to assess with non-invasive Holter monitoring due to under sampling.

Purpose
To evaluate the impact of the timing of ER after cryoballoon ablation using continuous rhythm monitoring by means of an implantable cardiac monitor (ICM).

Methods
This is a prespecified sub study of the COMPARE-CRYO study. The trial enrolled patients with paroxysmal atrial fibrillation and compared PVI with the PolarX cryoballoon and the ArcticFront cryoballoon. All patients underwent ICM implantation at the end of the PVI. ER was defined as recurrence of any atrial arrhythmia &gt; 30 seconds between days 0-90 after PVI. LR was defined as recurrence of any atrial arrhythmia &gt; 30 seconds between days 91-365.

Results
ER occurred in 116 of 201 patients (58%). A total of 5330 episodes occurred, 4210 in patients with LR and 1120 in patients without LR (Figure 1A). Median time to the latest episode of ER in the blanking period was 18 days (IQR 8.5-36.5) in patients with no LR and 80 days (IQR 27-89) in patients with LR (p&lt;0.001). The latest episode of ER occurred between days 0-30, 31-60 and 61-90 in 41%, 13% and 46% of patients respectively. Freedom from recurrence of atrial arrhythmias 1 year after the PVI was 81% in patients without ER and 37% in patients with ER (p&lt;0.001, Figure 1B). When patients were classified according to their latest episode of ER occurring between days 0-30, 31-60 and 61-90, freedom from any atrial arrhythmia at 1 year was 60%, 53% and 11% (p&lt;0.001, Figure 1C) respectively. ROC analyses revealed a strong correlation of LR with the timing of the latest episode of ER in the blanking period (AUC=0.81, p&lt;0.001) with an optimal cutoff value at 61 days (SN 64%, SP 88%).
Median AF burden in the blanking period was 0% (IQR 0-0) in patients with ER but no LR and 0.2% (IQR 0-2) in patients with ER and LR (p&lt;0.001). This was similarly true for all individual months (0-30 days: 0% vs. 1.8%, p&lt;0.001, 31-60 days: 0% vs. 0.1%, p&lt;0.001, 61-90 days: 0% vs. 0.1%, p p&lt;0.001). There were no differences in the duration of ER episodes or in clinical characteristics between patients with and without LR

Conclusion
ER after cryoballoon PVI is common. While ER during the first and second month after PVI disappear in the majority of patients, presence of ER in the third month after PVI are highly predictive for ablation failure.
High efficacy and safety of endocardial pulsed electrical field ablation via contact force-controlled catheters for mitral isthmus ablation
Authors: Schreieck J , Kranert M , Scheckenbach C , Gawaz M , Heinzmann D 
Published: May 2024

Abstract

Background
A new technology of a pulsed field generator enables established contact force-controlled radiofrequency (RF) catheters to apply point by point monopolar pulsed electrical field (PEF) energy for linear lesions in atrial fibrillation (AF) ablation.

Purpose
We evaluated this novel monopolar PEF ablation technique for creating lateral mitral isthmus ablation lines in case of perimitral flutter or complex AF patients non responder to pulmonary vein isolation (PVI).

Methods
Patients (n=44, age 65±11 years) referred for ablation/re-ablation of AF with spontaneous or inducible perimitral atrial flutter (n=34, 77%) or persistent AF and severe enlarged atrium (n=7) or de novo longstanding persistent AF (n=3) without signs of atrial fibrosis were included in our patient cohort for lateral mitral isthmus ablation with PEF applications. After 3D high density voltage mapping of the left atrium with multipolar microelectrode catheters, and confirmation/completion of PVI, an endocardial lateral mitral isthmus line was performed. Using contact force sensing catheter, 25A PEF energy pulses were applied targeting a minimum of 10g contact force and an interlesion distance ≤5mm. Before PEF application 0.2 mg nitroglycerin was intravenously injected. If the inferolateral mitral isthmus line to the left inferior pulmonary vein could not be blocked, a more superior lateral line to the left superior pulmonary vein was performed. If the mitral isthmus could not be blocked by endocardial PEF application or conduction recurred after adenosine injection an additional epicardial ablation via RF application in the coronary sinus was performed.

Results
Exclusively endocardial PEF application blocked the lateral mitral line in 37 out of 42 cases (88%) with 23±14 PEF applications. After an unsuccessful inferior lateral mitral line, in 34% of cases a second superior lateral mitral line have to be performed. Only in five cases additional epicardial RF applications via coronary sinus were necessary to complete the mitral isthmus block. Block time between superior lateral mitral anulus and infero lateral coronary sinus was 196±48 ms. One pericardial tamponade which could be successfully drained, and no other serious complication occurred throughout all procedures (no ST segment elevation, no tamponade requiring surgery, no cerebrovascular event). Limited follow-up will be available at the time of presentation.

Conclusion
Blockade of left atrial mitral isthmus line with PEF application via contact force-sensing catheters for ablation of complex atrial fibrillation patients is very efficient and safe. Especially the high efficacy of exclusively endocardial PEF application for creation of a lateral mitral isthmus block in most patients is very promising. However, the long term permanence of the linear lines have to be awaited.
Long-term effects of catheter ablation versus antiarrhythmic drugs on health-related quality of life in patients with atrial fibrillation: the CAPTAF randomized clinical trial revisited
Authors: Svedung Wettervik V , Schwieler J , Bergfeldt L , Kenneback G , Jensen S M , Rubulis A , Sciaraffia E , Blomstrom Lundqvist C 
Published: May 2024

Abstract

Background
Data on long-term effects of catheter ablation versus antiarrhythmic drugs (AAD) on health-related quality of life (HRQoL) and atrial fibrillation (AF) burden are limited. The study aimed to assess long-term HRQoL and rhythm data in symptomatic AF patients.

Methods
The 75 patients who underwent ablation and 74 receiving AAD in the Catheter Ablation compared with Pharmacological Therapy for Atrial Fibrillation (CAPTAF) trial were followed for 48 months comparison of General Health using 36-Item Short-Form Health Survey, time to first AF-episode ≥1 hour, and AF burden, recorded by implantable cardiac monitors.

Results
147 patients completed follow-up, with seven crossovers in the ablation group and 34 crossovers in the AAD group. General Health improved by ablation, median 62 points at baseline to 79.2 points at follow-up (p&lt;0.001), and by AAD from median 67 to 77 points (p&lt;0.001), without treatment differences (p=0.77). Time to first AF-episode ≥1 hour was longer, median 257 days (ablation group) versus 180 days (AAD group), p=0.025. The cumulative AF burden during follow-up was lower in the ablation (median 0.3% [interquartile range 0, 1.4]) versus AAD group (1.6% [0.1, 11.0]), p=0.01. The cumulative reduction in AF burden compared with baseline was greater in the ablation (median -89.5% [-98.4, -51.3]) versus AAD group (-52.7% [-92.6, 263.6]), p=0.001).

Conclusions
HRQoL improvement at long-term did not differ between ablation and AAD despite a larger reduction in AF burden after ablation. The results should be interpreted in the light of a four times higher crossover rate in the AAD group.
Impact of additional pulsed field ablation in unsuccessful radiofrequency linear lesions -acute and chronic data
Authors: Yokoyama M , Vlachos K , Kowalewski C , Ascione C , Moussaoui N , Arnaud M , Bouyer B , Tixier R , Duchateau J , Pambrun T , Derval N , Hocini M , Sacher F , Haissaguerre M , Jais P , Monaco C , Benali K , Popa M , Spittler R , Kneizeh K , Buliard S , Chauvel R , Cochet H 
Published: May 2024

Abstract

Background
Performing linear ablation such as roof line, inferior line in the posterior part of LA and posterior mitral isthmus (MI) line in addition to PVI is one of the strategies for treating persistent atrial fibrillation. However, remnant conduction or reconnection in the lines is linked with atrial arrhythmia recurrence, either AF or AT. Radiofrequency ablation (RFA) is often unsuccessful achieving durable linear ablation. It is not yet well known whether using pulsed field ablation (PFA) would be superior in achieving complete linear lesions.

Purpose
We sought to evaluate the benefit of using PFA in unsuccessful RF ablation linear lesions.

Methods
We studied 17 patients that underwent redo procedures due to atrial arrhythmia recurrence. All of them underwent PFA (using a pentaspline PFA catheter) ablation lines due to previous unsuccessful RF ablation, either due to remnant conduction in the line or to reconnection of the line. Lines of block were evaluated based on activation mapping and differential pacing maneuvers close to the lines.

Results
We conducted 16 dome-posterior lines and 6 posterolateral mitral isthmus lines using PFA after unsuccessful RF ablation linear lesions. PFA was performed after several unsuccessful procedure, 1.3±0.4 for the roof line, 1.3±0.5 for the postero-inferior line and 1.7±0.9 for the MI line. In 4 out of 6 pts with MI isthmus ablation using PFA ethanol injection within vein of Marshall (Et-VOM) was conducted in a previous procedure and in 4 out of 6 patients with MI isthmus RF ablation within coronary sinus (CS) was performed in a previous procedure. Specifically, for the dome-posterior line, 2 patients underwent PFA deliveries only at the gap region in the posterior LA and in other 14 cases, PFA deliveries were performed at 3.2±0.8 sites of the posterior wall between LPV and RPV. We used a total of 15.5±4.6 PFA deliveries to complete the dome-posterior line. Dome-posterior line bidirectional block based on activation mapping and differential pacing maneuvers was achieved in all cases (16/16, 100%) after PFA. For the MI line, we performed a total of 11.8±2.3 application deliveries at 2.5±0.5 sites in the MI region. Posterior MI line bidirectional block based on activation mapping and differential pacing maneuvers was achieved in 5 out of 6 patients (83.3%). In one case additional Et-VOM was needed to achieve MI block. There was no AT/AF recurrence in all these 17 patients.

Conclusion
PFA treatment seems promising to back-up RF failed linear lesions. But we cannot exclude that it is in fact the combination of the 2 energies that was successful in those resistant cases.
Long-term follow-up of pulmonary vein cryoballoon isolation using a double 120s vs single 240s standard freeze protocol
Authors: Urbani A , Bordignon S , Schaack D , Tohoku S , Hirokami J , Urbanek L , Chen S , Gaggiotti G , Pedretti S , Schmidt B , Chun J 
Published: May 2024

Abstract

Background
Recently, pulmonary vein isolation (PVI) using a double 120s freeze protocol has demonstrated to be non-inferior to a single 240s protocol despite a potentially increased procedural safety. Main advantages of a double 120s protocol are a reduction of phrenic nerve injury and an increase of the mean minimal esophageal temperature during the procedure.

Methods
We performed a long-term follow-up comparison between groups of patients with history of symptomatic atrial fibrillation undergoing PVI with second generation cryoballoon (CB) between 2019 and 2020. Our usual energy dosing protocol was modified including 2 times 120 seconds applications instead of a single 240 seconds application. Of A total of 160 consecutive patients, 80 were treated with double 120s (CB120) and 80 with single 240s (CB240) freeze protocol. 107 patients were, successfully, followed-up. The primary end-point was freedom from atrial tachyarrhythmia.

Results
Before PVI a total of 11/52 patients (21%) had persistent AF and 41/52 (79%) had paroxysmal AF in the CB120 group; a total of 20/55 patients (36%) had persistent AF and 35/55 (64%) had paroxysmal AF in the CB240 group.
On a mean follow-up time of 17 months, freedom from atrial tachyarrhythmia was 63% in those patients undergoing CB240 and 74% with CB120 (log-rank P=0.255).

Conclusions
The double 120s freeze protocol is not-inferior as compared to the standard 240s in terms of freedom from recurrences on a long term follow-up, but with a more favorable procedural safety profile.
Acute and long-term lesion durability and reconnection patterns following hybrid atrial fibrillation ablation
Authors: Mouram S , Della Rocca D G , Doundoulakis I , Pannone L , Vetta G P , Stroker E , Almorad A , Sieira J , Sarkozy A , Chierchia G B , La Meir M , De Asmundis C 
Published: May 2024

Abstract

Background/introduction
Hybrid ablation (AF) is a well-established rhythm control strategy in non-paroxysmal AF patients and can be performed as a staged or one-step epicardial-endocardial approach. Data on need for endocardial touch-up acutely after epicardial ablation are limited, as well as long-term reconnection patterns in patients undergoing redo procedures.

Purpose
to evaluate the lesion transmurality detected via endocardial mapping acutely after epicardial radiofrequency (RF) ablation, as well as anatomical and clinical predictors of residual endocardial gaps in a large cohort of patients undergoing hybrid AF ablation. Furthermore, long-term lesion durability will be assessed in patients undergoing repeat endocardial ablation.

Methods
Hybrid procedures were performed in a one-step fashion (endocardial mapping +/- ablation immediately following left thoracoscopy epicardial ablation). Epicardial pulmonary vein (PV) isolation was achieved via a bipolar RF clamp; further epicardial linear ablation was performed with a RF bipolar linear device. Additional lesions were performed according to physician’s preference on a patient basis. At the end of the procedure, the left atrial appendage (LAA) was clipped.

Results
A total of 130 patients were included (mean age: 65±9.4; 72.3% males); among them, 19.2% and 55.4% had persistent or long-standing persistent AF. All patients received epicardial PV and posterior wall (PW) isolation plus additional RF applications to the LAA/posterolateral ridge. Other targets included the right inferior ganglionted plexus in 36.2% (n=47) and anterior mitral line (AML) in 3.8% (n=5). In 13.1% (n=17) epicardial lesions could not be completed due to difficult anatomy. At the end of the procedure, an attempt to clip the LAA was done in all patients, resulting in 97.7% success (3 LAA clip failures due to anatomical reasons). Acute endocardial mapping revealed a PV reconnection rate of 4.6% (n=24), left superior and right superior PVs being the veins most commonly reconnected (6.15% and 5.38%, respectively). PW and AML reconnections were documented in 8.5 % and 60% (3 out of 5 patients). Multivariate analysis showed left atrial (LA) volume and male gender as predictors for acute endocardial gaps after complete epicardial lesions.
A redo procedure after first recurrence was performed in 24.6% (n=32), showing lesion durability of 100% for left PVs, 90.6% for right superior and 93.7% for right inferior PVs. PW remained isolated in 78.1% of patients. Age was a predictive factor for chronic gaps after recurrence. At a mean follow-up of 51±35 months, arrhythmia-free survival after multiple procedures was 68.5%.

Conclusion
In a large cohort of AF patients undergoing hybrid ablation,acute and chronic lesion durability was hight.LA volume and male gender were predictors of acute reconnection after epicardial ablation.