bluuebunny/crossref_metadata_2025_split huggingface dataset:
Peak frequency mapping usefulness and utilization for typical AVNRT ablation
Authors: Handayani A , Merino D , Merino J L , Sanroman-Junquera M , Moreno J , Castrejon-Castrejon S , Cossiani M M , Franco E , Granero C L , Alarcpn J J D V , Relan J , Kim S 
Published: May 2024

Abstract

Background
Accurate identification of slow pathway for the AVNRT ablation is important to achieve successful result and avoid complications mainly AV nodal block. There were some developments to produce precise image to locate this such as identify low voltage bridge (LVB) using electro-anatomical mapping and visualization of direct slow pathway capture (DCSP). The peak frequency (PF) associated with bipolar EGMs is a novel parameter which may serve to distinguish near filed (NF) from far field (FF) electrocardiogram (EGM) components. This technique can be used to differentiate sub-components derived from high density mapping. Previous study suggested this mapping appears to assist in substrate differentiation, pathway localization, and contact assessment. However, this approach has been never evaluated clinically in AVNRT ablation

Objective
This study conducted to evaluate the usefulness and utilization of the peak frequency mapping to identify the slow pathway location.

Method
The study conducted in November to December 2023 where twenty consecutive patients with common AVNRT were included in the study. Regular bipolar voltage and activation maps were generated with a regular 4 mm tip catheter. Following this, peak frequency maps (PF) were computed online prior ablation and displayed on the activation map with shadowed areas where PF was &lt;200 Hz (figure, left panel). Focal radiofrequency application (RFa) was directed to the areas of late activation (figure, left panel) and low frequency (figure, right panel) (LA-LF). Successful ablation reached if junctional rhythm was recorded during RFa and AVNRT was no longer inducible afterwards.

Results
Twenty patients (48 ±15 years, 75% female) were enrolled in the study. A late activation low frequency area of 0.92±0.48 cm2 was found in 18 of them. This study revealed that there was a difference between PF in the slow pathway area compared to the adjacent area where the mean PF at the slow pathway area was 175.5 ± 37.1 Hz (analysis per patient) and 170.1 ± 48.10 Hz (analysis per recording site) which was lower and differed significantly than the PF recorded at the adjacent atrial area (279.71 ± 28.11 Hz per patient, 279.91 ± 69.47 Hz per recording site) (P&lt;0.0001). Following the mapping, RFa were successfully applied at these late activation low-frequency (LA-LF) area induced junctional rhythm in 17 patients. AVNRT was no longer inducible after the ablation in all 17 patients. Additional RFa were often given to reinforce the result (11 ± 9 RFa, 4.03 ± 3.35 min RFa time).

Conclusion
The peak frequency mapping could be performed to map the slow nodal pathway which is often located in an area of late activation and low frequency.
HV interval cutoff should be different in women and men with syncope and bundle branch block
Authors: Francisco Pascual J , Medina Maguina J M , Santos Ortega A , Perez Rodon J , Adelino R , Seder E , Benito B , Jordan P , Lal-Trehan Estrada N , Mallofre N , Ferreira Gonzalez I , Rivas Gandara N 
Published: May 2024

Abstract

Background
Determining the optimal HV interval cutoff for predicting the need for pacemaker (PM) implantation has been a recent focus of research. Current ESC guidelines recommend HV &gt; 70 msec based on initial studies; however, new data suggest that a cutoff of &gt;60 msec could appropriately identify patients at high risk for requiring PM implantation. While previous studies have indicated that women with bundle branch block (BBB) have a lower risk of AV block (AVB), gender differences in the optimal cutoff for considering a positive EPS have not been thoroughly investigated.

Methods
This cohort study included consecutive patients with unexplained syncope and BBB, enrolled from January 2010 to October 2021, with a median follow-up time of 3 years. Patients underwent a stepwise workup protocol involving an electrophysiological study (EPS) and long-term follow-up with an implantable cardiac monitor (ICM).

Results
Of the 503 patients in the study, 185 (38%) were women. The median age was 78 years (IQR 71-83), the median LVEF was 58% (IQR 50-62), and 110 (22%) had ischemic heart disease. The ECG showed LBBB in 194 (39%) patients and RBBB in 287 (57%). Among these, 177 (35%) also had left anterior hemiblock. The median HV interval was 60 msec (IQR 52-73), and EPS was diagnostic in 252 (50%) patients, with the majority (221, 44%) for AVB. In 91 patients with initially negative EPS, a diagnosis was made during follow-up with an ICM, and in 35, AVB was documented. In patients with negative EPS, an HV interval &gt;60 msec was associated with an increased risk of AVB during follow-up (HR 2.5, 95% CI 1.6-4). However, significant gender differences were found. The risk of AVB was 2.5 times higher in men (95% CI 1-6) (Figure 1). Furthermore, sensitivity, specificity, PPV, and NPV for the cutoff of 60 msec were 47%/84%/51%/82% in men and 21%/78%/21%/78% in women. The AUC to predict AVB was 0.72 (95% CI 0.6-0.8) in men and 0.51 (95% CI 0.4-0.6) in women (Figure 2).

Conclusions
In patients with initially negative EPS, an HV interval &gt;60 msec was associated with a higher risk of AVB during follow-up; however, significant gender differences were observed in diagnostic accuracy. In women, a cutoff of HV interval &gt;60 msec presented poor diagnostic accuracy compared to men. Moreover, the HV interval did not adequately predict the development of AVB in women with a basal HV interval &lt;70 msec, suggesting it may not be suitable for considering PM implantation in female patients.FIGURE 1FIGURE 2
Cardioneuroablation for vasovagal syncope. Results from an EHRA Survey
Authors: Penela D , Berruezo A , Roten L , Futyma P , Richter S , Chun J 
Published: May 2024

Abstract

Background
Cardioneuroablation (CNA) is a recently introduced catheter-based therapy for vasovagal syncope (VVS), involving the modulation of the cardiac autonomic nervous system. Over the past decade, the body of evidence supporting CNA has consistently grown, sparking increased interest, and leading to broader adoption of this novel therapy for VVS treatment. However, several knowledge gaps persist, particularly concerning clinical indications, methodology, and long-term outcomes.

Purpose
The aim of this survey is to provide a comprehensive overview of the daily utilization of CNA in Europe.

Methods and Results
Among 204 participants, half reported that they are already performing CNA in their centres. The survey indicated CNA as an emerging therapy, with most centres initiating this treatment within the last two years. A significant majority of those who responded (71%) adopted a systematic approach by targeting ganglionated plexuses (GPs) in both the right atrium (RA) and left atrium (LA) as their first-line approach. The second most common approach (16%) involved performing ablation LA GPs only in the cases where there is no response following RA ablation. Figure 1 shows the GPs usually targeted for ablation. The most frequent procedural endpoint was the increase in the heart rate. Ninety percent of respondents relied on an anatomical approach for GP localization, while 59% also guided the procedure using electrogram analysis. Less frequently used approaches included pre-procedural imaging (20%), high-frequency stimulation (17%), and spectral analysis (10%). Only 11% of physicians discharged patients who underwent CNA without anticoagulation or antiplatelet therapy. In most cases (58%), respondents discharged their patients with anticoagulation, while 28% on single antiplatelet therapy. Overall, CNA is considered an effective procedure (80% of responders rating its effectiveness at or above 70%) and a safe procedure (with an estimated 1% rate of procedure-related complications, with symptomatic sinus tachycardia being the most frequently reported).

Conclusions
This survey confirmed high expectations for the future of this therapy, as most responders anticipate that CNA will be indicated as a first-line therapy for patients with recurrent cardioinhibitory VVS. Future efforts are necessary to standardize the procedural flow and peri-procedural patient management.
Worse outcomes in patients with cardiac sarcoidosis and involvement of the right ventricle in cardiac magnetic resonance
Authors: Dinov B D , Seidemann J S , Henfling C H , Ebbinghaus H E , Latuscynski C L , Paetsch I P , Jahnke C J , Laufs U L , Sossalla S S , Ueberham L U 
Published: May 2024

Abstract

Background
Cardiac sarcoidosis (CS) can manifest with variety of unspecific symptoms. It can mimic all types of cardiomyopathies but most often it resembles dilated cardiomyopathy. Involvement of right ventricle (RV) is rare and may lead to a false diagnosis of arrhythmogenic right ventricular cardiomyopathy and delay of the immunosuppressive therapy.

Purpose
The aim of this research was to study the characteristics and the outcomes of this peculiar subtype of patients.

Methods
We analyzed 112 patients diagnosed with CS after elaborate work-up with cardiac magnetic resonance (CMR), FDG PET and endomyocardial biopsy (EMB). All patients underwent follow-up for occurrence of combined endpoint of death, LV assist device implantation or heart transplantation. Patients with evidence of late gadolinium enhancement (LGE) involving RV (RV group) were identified and compared to the rest (DCM group) for baseline clinical characteristics, arhythmic outcomes and combined endpoint.

Results
Involvement of the RV in CMR was observed in 19 (17%) patients. Patients in the RV group were more frequently male: 84% vs. 57%, P = 0.032. EMB confirmed CS in 63% vs. 19.4% in the DCM group; P= 0.0001. LV ejection fraction in the RV group was comparable to the DCM group: 42±14% vs. 45±14%; P = 0.3. Furthermore, in the RV group the rates of sustained ventricular tachycardia were significantly higher than the DCM: 68% vs. 34%; P = 0.009. Long-term immunosuppressive therapy was started in 74% in RV and in 70% of the DCM group; P=0.77. Despite this, during follow-up, the rate of death, LVAD implantation or heart transplantation was significantly higher in the RV than in the DCM group; 26.3% vs. 7.5%; P = 0.03. In binary logistic analysis, the OR for the combined endpoint was 4.4; 95% CI 1.2-15.7.

Conclusions
Patients with CS and RV involvement in CMR have worse outcomes as compared to patients presenting as DCM, despite the comparable LV EF and immunosuppressive therapy.
Catheter ablation of premature ventricle complex from multiples site of origin guided by an ultra-high density mapping system in a single-center
Authors: Albarran-Rincon R , Rodaev V , De La Torre Carazo F , Ramos Ardanaz P , Garcia De Yebenes M , Garcia-Bolao I 
Published: May 2024

Abstract

Background
Frequent premature ventricle complex (PVC) could induce cardiomyopathy in some patient. PVC ablation by radiofrequency (RF) is a well-stablished procedure in high density PVC patients and results are consistent and robust in literature, with somewhat differing success rates reported.
Catheter ablation of radiofrequency guided by ultra-high density mapping systems (UHDMS), enable a much more accurate reconstruction of the site of origin (SOO). Furthermore, we obtained this anatomic recreation with the analysis of a few number of beats. The UHDMS have demonstrated to be feasible and safe in a wide range / large spectrum of arrhythmic substrates, however, there is lack of evidence of its usefulness in the ablation of PVC.

Purpose
To determine the safety and utility, both in the acute phase and in the short-medium term, of employing a UHDMS in PVC catheter ablation in a retrospective cohort of patients treated at a single centre.

Methods
Catheter ablation procedures guided by an UHDMS carried out from July 2015 to January 2021 in a single-center of Spain were retrospectively included. The primary outcomes analyzed were: acute success rate, short-medium success rate (6-month efficacy after ablation), and complication rate related to the procedure.

Results
One hundred and two procedures, corresponding to 92 patients (mean age 59 ± 14 years, 63% male, 74% without cardiomyopathy, mean LVEF of 60%), were analyzed. The acute success rate was 93%. According the SOO, the lowest acute success rate was PVC from epicardial level (LV Summit) (75%). At 6-month follow-up after the first procedure, the short-medium success rate was up to 84% (no recurrence of the PVC ablated). There were three acute complications related to the procedure (complication rate 2,94%). In 19% (21 out 102) of the procedures, at least two arrhythmic substrates were successfully ablated in a single intervention.

Conclusion
Catheter ablation guided by an UHDMS showed an excellent safety profile in PVC ablation procedures. Beyond this minor complication rate, this type of technique has improved acute and short-term success rates. This allows us to assert that this type of technique grants a very high success rate and improves previously results. Last but not least, this new approach was useful and accurate in complex patients, providing good results in ablation procedures of two or more arrhythmic substrates without altering the safety profile.
Improving functional substrate delineation for ablation of ventricular tachycardia using high-density electroanatomic mapping and double ventricular extra stimuli protocol
Authors: Guichard J B , Regany-Closa M , Vazquez-Calvo S , Serrano-Campaner J , Pellicer-Closa B , Falzone P V , Eulogio F , Borras R , Arbelo E , Guasch E , Tolosana J M , Sitges M , Mont L , Porta-Sanchez A , Roca I 
Published: May 2024

Abstract

Background
A partial delineation of targets for ventricular tachycardia (VT) ablation may contribute to a suboptimal success rate. Abnormal electrograms (EGMs) with low-voltage near-field components might be concealed within high-amplitude far-field signals. Our hypothesis posited that acquiring functional mapping after double ventricular extrastimuli (S3 protocol) could reveal relevant areas of functional substrate overlooked during sinus or S1 mapping.

Purpose
To assess the benefit and feasibility of functional substrate mapping using a full ventricle S3 protocol and to evaluate its colocalization with conducting channels (CCs) identified in late gadolinium enhancement cardiac magnetic resonance (LGE-CMR).

Methods
(Figure 1) - An S3 mapping protocol with a drive train of S1 followed by S2 (effective refractory period (ERP) +30ms) and S3 (ERP+50ms) from the RV apex was conducted in 40 consecutive patients undergoing scar-related VT ablation. Deceleration zones (DZs) and areas of late potentials (LPs) were identified for all maps (S1, S2, and S3). Pre-procedural non-invasive substrate assessment was performed with LGE-CMR and post-processing using a commercially available system with automated CC identification.

Results
The S3 protocol was completed in 34 of the 40 procedures (85.0%). Repeated induction of ventricular arrhythmias prevented the full S3 protocol in 5 patients (15.0%). Functional substrate identified during S3 activation mapping was significantly more extensive than that identified using S2 and S1, including a higher number of DZs (2.94, 2.47, and 1.82, respectively; p&lt;0.01) and a wider area of LPs (44.1cm2, 38.2cm2, and 29.4cm2, respectively; p&lt;0.001). The percentage of CCs unmasked by DZs and LPs using S3 maps was significantly higher than the ones using S2 and S1 maps(78%, 65%, and 48%; p&lt;0.001, and 88%, 81%, and 68%; p&lt;0.01, repectively). After VT ablation based on an S3 protocol, 77.9% of patients have been VT free during a median follow-up of 13.6 months.

Conclusions
(Graphical abstract -Figure 2) - This novel substrate-based protocol for assessing functional substrate is feasible in most patients, enables better identification of ablation targets, and has the potential to improve patient prognosis post-ablation.Methods - The S3 protocolConclusion - Graphical abstract
Coronary venous ethanol ablation of refractory left ventricular summit arrhythmias: comparison with radiofrequency ablation
Authors: De Smet M A J , De Becker B , Francois C , Tavernier R , Duytschaever M , Knecht S , Le Polain De Waroux J B 
Published: May 2024

Abstract

Background
Radiofrequency (RF) ablation of ventricular premature beats (VPBs) and ventricular tachycardia (VT) arising from the left ventricular (LV) summit is challenging and may fail due to anatomical inaccessibility of the substrate. Coronary Venous Ethanol Ablation (CVEA) has been suggested as a bailout strategy following failed RF ablation of LV Summit Arrhythmias (LVSA). Comparison with RF ablation strategies are lacking.

Purpose
To compare CVEA with RF ablation for the treatment of LVSA.

Methods
Between January and November 2023, 20 patients were treated with CVEA for LVSA. Results were compared to 36 patients that underwent RF ablation for LVSA (Panel A). Endo- and/or epicardial RF ablation was performed based on local signal precocity and pace-mapping. Coronary venogram-guided mapping of coronary sinus side-branches was performed using an angioplasty wire connected to our EP-recording system using a crocodile clamp. The target veins were specifically selected based on early presystolic potentials and confirmed by matching VPB pace-maps. For the treatment, angioplasty balloon(s) measuring 2-2.5×6-8 mm were employed to administer ethanol into the target branch of the coronary sinus. Data are reported as mean ± standard deviation, unless otherwise indicated. P-values are two-tailed.

Results
(Panel B): Patient characteristics were similar for both groups, except for the number of prior failed ablation procedures (75% males; mean age: 63 ± 13 y; 31 with structural heart disease; mean LVEF 39 ± 9%; VPB burden 25 ± 12%; Number of (NS)VT 72 ± 151; 65% redo in case of CVEA, 28% for RF). Mean pace-match was 97 ± 1% (99.8% max.) for CVEA versus 93 ± 8% (97% max.) for RF ablation (P = 0.002). Earliest presystolic signal was -70 ms (-49 ± 12) for CVEA versus -50 ms (-31 ± 12) for RF (P = 0.0002). Acute success, defined as elimination of VPB/VT was 95% versus 83% for CVEA and RF ablation respectively. VPB burden at Holter was 1 ± 3% 6-8 weeks after CVEA versus 8 ± 10% following RF ablation (P = 0.024). In patients with VT, number of (NS)VT decreased by 90% after CVEA (P = 0.014), while this was not significant for RF ablation. After a median follow-up of 8 months (IQR 2-10), 15% of CVEA patients showed residual non-LV summit ventricular arrhythmia as compared to 39% showing recurrence of LV summit VPB or VT following RF ablation. No patients died. One patient developed tamponade following RF ablation and one patient received PCI in the CVEA group.

Conclusion
Retrograde coronary venous ethanol ablation is an effective ablation strategy for the treatment of LV summit arrhythmias, also compared to conventional RF ablation.
Genotype, phenotype and outcomes of patients with hypertrophic cardiomyopathy referred for ablation of ventricular tachycardia
Authors: Meretta A , Schaerli N , Kimura Y , Wijnmaalen H P , De Riva M , Piers S R D , Bootsma M , Zeppenfeld K 
Published: May 2024

Abstract

Background
Sustained monomorphic ventricular tachycardia (SMVT) is the most common ventricular arrhythmia (VA) subtype in patients with hypertrophic cardiomyopathy (HCM) who have received an implantable cardioverter defibrillator (ICD). However, data on catheter ablation (CA) are limited and available series typically report results of non-genotyped patients with relatively mild hypertrophy and/or apical aneurysms.

Purpose
This study describes genotype, phenotype and outcome of consecutive HCM patients referred for CA ablation of refractory SMVT.

Methods and results
Nine out of 787 patients referred for catheter ablation of SMVT between 01/2016 – 10/2023 had a HCM phenotype, 8/9 with dominant septal hypertrophy, none with LV outflow tract obstruction, and only 1/9 with an apical aneurysm. The median maximal wall thickness was 25 mm (IQR 20,2 – 26,9 mm) and the median left ventricular ejection fraction 34 % (IQR 26-42%). Six patients had a class IV/V variant in the myosine binding protein C (MYBPC3) gene, in 3 no disease-causing variant was identified. All patients with MYBPC3 mutation presented with an electrical storm/incessant VT refractory to antiarrhythmic drugs (AAD), including amiodarone (6/6) and amiodarone + class I AAD (3/6). In an attempt to control VT, 4/6 patients with a MYBPC3 variant required ≥2 ablation including bail out strategies (transcoronary alcohol-ablation, bipolar ablation, half-saline), surgical substrate resection and intraoperative cryoablation (3/6) and radiotherapy (2/6). After a median follow-up of 25 months (IQR 2-75) after the last intervention, all patients with MYBPC3-variants had VT recurrence, 3/6 died and 1/6 underwent heart transplantation. In contrast, patients without class IV/V variants, did not require bail-out strategies; VT recurred in one (single episode) and one patient died, 24 months after CA.
The time course of the disease, management and outcome for patients with and without disease causing mutation is illustrated, with the first ablation as center line (figure).

Conclusions
Only 1 % of patients referred for CA of SMVT to a high-volume center had a HCM phenotype. A MYBPC3 variant was identified in 67%, and, in contrast to prior reports, 89% had severe hypertrophy. VT free survival appears to be particularly poor in MYBPC3 variant carriers despite availability of all treatment modalities. In these patients, early screening for advanced heart failure management including heart transplantation is important.