bluuebunny/crossref_metadata_2025_split huggingface dataset:
The correlation between left atrium voltage mapping and 3D late gadolinium enhancement cardiac magnetic resonance imaging findings in patients with known atrial fibrillation
Authors: Dadon Z , Saadon Weinshtock M , Michowitz Y , Tovia-Brodie O , Tam D , Ilan M , Zabern M , Glikson M , Rav Acha M , Wolak A 
Published: May 2024

Abstract

Introduction
The non-invasive cardiac magnetic resonance imaging-based late gadolinium enhancement (LGE-CMR) of the left atrium (LA) fibrosis distribution and degree can be utilized for preprocedural planning and real-time guidance of AF ablation. There is an ongoing discussion with somewhat conflicting results regarding the accuracy of LGE-CMR of the LA as compared with the invasive electroanatomical mapping (EAM). Earlier data mainly encompassed post-ablation patients with an EAM involving a relatively small number of acquired points.

Aim
To evaluate the accuracy of LGE-CMR-based LA fibrosis using the ADAS 3D LA software among ablation-naive AF patients as compared with EAM using the CARTO-3 navigation system.

Methods
Patients with non-permanent AF, naive to previous ablation/cardiac surgery, who underwent CARTO-based AF ablation with preceding LGE-CMR scan were selected for the study. The 3D substrate atrial maps were generated based on the LGE-CMR (CMR-fib) using the ADAS 3D LA software and the CARTO EAM (EAM-fib). A fibrosis threshold of 1.2-1.32 was established for the CMR-fib using the Image Intensity Ratio whereas a threshold of 0.2-0.5mV was applied for the EAM-fib. The two 3D-maps were assessed for fibrosis using anatomically synchronized quantitative point by point comparison. The EAM was set as the gold standard.

Results
The study included 26,777 points acquired from 17 patients (aged 65.8±7.92 yrs with 6 females and 10 paroxysmal AF cases). CMR-fib showed 22.0% of LGE, while the EAM-fib demonstrated 48.8% of low voltage areas. The CMR-fib vs. EAM-fib point by point comparison concluded with an agreement of 73.1% and interrater reliability of 0.45 (p&lt;0.001). The sensitivity and specificity were 45.0% and 99.9%, respectively, while the PPV and NPV were 99.8% and 65.6%, respectively. The Area Under the Curve (AUC) was calculated as 72.4.
Increase of the EAM-fib threshold for scar (to 0.5-1.5mV) led to a further decrease in the assessment diagnostic performance and the interrater reliability. The lowest agreement was tested in the LA roof segments and the higher in the inferoseptal and posterior walls.

Conclusion
The LGE-CMR underestimates the presence of scar as presented by the EAM, however, those detected are mostly accurate. The low sensitivity that was demonstrated between the two methods may be attributed to the lower spatial resolution of the CMR as well as the superficial subendocardial layer mapped by EAM as compared with the averaged transmural mapping of the CMR-fib. A follow-up larger-scale study is required to assess the accuracy of LGE-CMR-based assessment of fibrosis, considering various wall thicknesses and establishing the scar threshold on the ADAS software, particularly for ablation-naive patients.
Improvement in atrial functional and ventricular functional tricuspid regurgitation following catheter ablation or cardioversion of atrial fibrillation
Authors: Kuru B , Gerede Uludag D M , Baskowski E , Akyurek O , Altin T , Candemir B , Dumlupinar E 
Published: May 2024

Abstract

Background
The majority of cases of significant tricuspid regurgitation (TR) are secondary to tricuspid annular dilation and leaflet tethering in the context of RV remodeling due to pressure or volume overload, as seen in patients with pulmonary hypertension (primary or secondary to left-sided heart disease) or dilated cardiomyopathies. Secondary TR induced by tricuspid valve annular dilatation secondary to right atrial dilatation is referred to as atrial functional TR, while secondary TR caused by RV remodeling is referred to as ventricular functional TR. In current guidelines, GDMT (Guideline-Directed Medical Therapy) is effective for secondary TR attributable to HF with reduced LVEF. Normal sinus rhythm should be restored for secondary TR caused by AF-related annular dilatation. In patients with ventricular functional TR, however, AF may also accompany the clinical condition. It is unknown whether restoring sinus rhythm will reduce tricuspid regurgitation in these patients.

Purpose
The objective of this study was to investigate the degree of tricuspid regurgitation change in patients with atrial and ventricular functional tricuspid regurgitation after sinus rhythm restoration.

Methods
A retrospective cohort study of patients undergoing AF ablation and cardioversion at a single center between 2019 and 2023 was performed. Patients with at least grade 1 TR on echocardiography and a baseline echocardiogram and a follow-up echocardiogram after ablation were included. A-FTR and V-FTR were defined according to the latest ACC/AHA guidelines. According to the latest guidelines, patients with mild to severe FTR were classified as A-FTR if they had atrial fibrillation, left ventricular ejection fraction &gt;60%, pulmonary artery systolic pressure (PASP) &lt;50 mm Hg, no left-sided valve disease, and normal-appearing tricuspid leaflets. FTR patients who did not meet at least one of these three criteria were defined as ventricular FTR (V-FTR).

Results
A total of 88 patients were enrolled. The prevalence of A-FTR in our cohort was 62% (53 patients), and 38% of the patients were in the V-FTR group. There was no significant difference between the A-FTR and V-FTR groups regarding age, gender, and NYHA class. 21 of the patients underwent DCCV, and 67 underwent catheter ablation. The prevalence of severe FTR was similar (%17 in A-FTR vs. %8,6 in V-FTR, p= 0.205). There was no difference in preintervention TR grade between the two groups. TR severity improved significantly from baseline to follow-up in both V-FTR and A-FTR patients. These outcomes were observed in patients who underwent both DCCV and catheter ablation.

Conclusion
The degree of tricuspid regurgitation is reduced with sinus rhythm restoration in patients with both ventricular functional and atrial functional TR.Changes in TR severity with interventionGraph of changes in severity of TR
Clinical and instrumental factors associated with sinus rhythm maintenance following direct current cardioversion of late persistent non-valvular atrial fibrillation at 6-months follow-up
Authors: Mikhaliev K , Zharinov O , Skybchyk Y 
Published: May 2024

Abstract

Purpose
To study the clinical and instrumental factors, associated with sinus rhythm (SR) maintenance following direct current cardioversion (DCCV) in patients with late persistent non-valvular atrial fibrillation (AF) at 6-months follow-up.

Methods
The cohort single-center study analyzed clinical and instrumental data from 59 late persistent AF patients (with duration of its episode ≥90 days [up to 12 months]), who underwent an elective DCCV. At 6-months follow-up, 32 (54 %%) patients succeeded to maintain SR, in contrast to 27 (46 %) patients with a failure to its maintenance.

Results
The univariate logistic regression analysis revealed, that the absence of heart failure (HF) stage C (i.e., the presence of its stage B), the higher left ventricular ejection fraction (LVEF) (by transthoracic echocardiography [TTE]), left atrial appendage flow velocity (LAAFV) &gt;40 cm/s and the freedom from left atrial spontaneous echo contrast (LASEC) (by transesophageal echocardiography), ‒ all were associated with the higher chance to maintain SR at 6-months follow-up (Figure). At the same time, the higher baseline left atrial dimension (LAD) and more advanced pulmonary hypertension (PH) (by TTE) were associated with the failure of its maintenance to be more probable (Figure). At multivariate analysis, the following predictors of SR maintenance after DCCV at 6-months follow-up were identified: higher LVEF (OR 1,07 (95 % CI 1,01-1,13); р=0,021); LAAFV &gt;40 cm/s (OR 4,33 (95 % CI 1,06-17,78); р=0,042), and less advanced PH (OR 0,24 (95% CI 0,06-0,93); р=0,038).

Conclusion
Better LV systolic function, LAAFV &gt;40 cm/s and less advanced PH were the predictors of SR maintenance following DCCV in patients with late persistent (with duration of its episode ≥90 days) non-valvular AF at 6-months follow-up.
Atrial fibrillation recurrence in oncocardiological patients treated with catheter ablation. A retrospective cohort study
Authors: Albarran-Rincon R , Barragan Campos J , Ramos Ardanaz P , Garcia De Yebenes Castro M , Garcia-Bolao I 
Published: May 2024

Abstract

Background
The relationship between oncological events and cardiovascular pathologies is a subject still widely discussed. Certain chemotherapy drugs, including alkylating agents, anthracyclines, taxanes, and topoisomerase II inhibitors have proven to possess arrhythmic and cardiotoxic capabilities. There is enough evidence to suggest an association between oncological events and the appearance of newly onset AF, but there is little to no scientific literature about the management of these patients and the outcome of normal therapeutically procedures.

Purpose
This study assess if oncocardiological patients with AF should be considered a risk group when planning to undergo catheter ablation for the arrhythmia treatment.

Methods
The studied population was based on the data recollection from the electrophysiology department and consisted of patients with AF intervened by radiofrequency catheter ablation. All the procedures were conducted between January 1st 2019 and December 31st 2022. Among 138 participants enrolled for this study, 68 of them had either recent history of oncological events (maximum of 5 years cancer-free). The control group had no previous nor active history of cancer. The cohort with the desired exposure (cancer patients) was compared with a cancer-free group. Two primary outcomes were measured: procedure related complications, and first AF recurrence within the first 12 months. Complications were categorized according to two dichotomous variables: the existence of acute complications directly during the procedure or within the first 12 hours after the end of the procedure, and the occurrence of self-limited arrhythmic events during the blanking period.

Results
When compared as dichotomous variables (yes/no) with Fisher’s exact test, no statistical significance was observed between the studied cohort and control for complications and events during blanking. The proportion of patients free of sustained episodes of AF at 12 months was 52,9% in the oncologic group and 77,9% in the Control group (P = 0.003; RR of 3.14; 95% CI 1.5 - 6.6) for the oncologic group. When not adjusted by any other factor, association with Cancer was shown (HR 2.43; P =0.005; 95% CI 1.3 – 4.4) for recurrence of arrhythmic events. The regression model with Kaplan-Meier method shows the overall 12-month survival in two groups and the difference between the two survival curves was statistically significant (P=0.0016).

Conclusion
Oncocardiological patients have demonstrated a significantly higher incidence in post-ablational recurrence when compared with a similar cancer-free control group. Results found in acute and chronic procedural complications were similar in both cohorts.
Impact of wall thickness on tissue cooling effect of cryoballoon ablation: Investigation using an experimental heart model
Authors: Masuda M , Matsuda Y M , Uematsu U H , Mano T 
Published: May 2024

Abstract

Background
Understanding of the tissue cooling properties of cryoballoon ablation during pulmonary vein isolation is lacking.

Purpose
To delineate the depth of the tissue cooling effect during cryoballoon freezing at the pulmonary venous ostium.

Methods
A left atrial-pulmonary vein model, produced by a 3-dimensional printer using CT data from a patient, was constructed so that porcine thigh muscles of various thicknesses could be fixed and thermocouples could be fixed at locations corresponding to the epicardial side of the pulmonary vein ostium. The model was placed in a 37-degree water bath with a pulmonary vein water flow at a rate that mimicked biological blood flow, and the cryoballoon was advanced into the left superior vein until the vein was completely occluded. Cryofreezing was performed 5 times each for a porcine thigh muscle of 2-, 4-, and 6-mm thickness, and epicardial tissue cooling was monitored as assessed by the mean temperature of 12 evenly distributed thermocouples covering the roof region of the left superior vein.

Results
Epicardial tissue cooling effects were more in the order of 2-mm, 4-mm, and 6-mm thickness (Figure) with a mean temperature of -41.4 ± 4.2 for 2 mm, -33.0 ± 4.0 for 4 mm, and 8.0 ± 8.7 °C for 6 mm at 180 sec (p for trend &lt; 0.0001). In addition, tissue temperature drops were steeper in thin muscle (maximum temperature drop per 5 s: 5.2 ± 0.9, 3.9 ± 0.7, 1.3 ± 0.7 °C, p for trend &lt; 0.0001).

Conclusion
The cooling effect is weaker in the deeper layers during cryobaloon freezing, and longer freezing duration would be recommended in case of thick myocardium.
The efficacy and safety of additional pulmonary vein antrum substrate ablation after cryo-ablation in patients with persistent atrial fibrillation
Authors: Yoshida A , Akita T , Takami K , Tagashira T , Tsuda S , Terashita D , Takahashi Y , Suzuki M , Takata K , Nishijo K , Matsuura T , Kim Y , Yamada S 
Published: May 2024

Abstract

Background
Cryo-ablation for persistent atrial fibrillation (PeAF) has been reported to be safe and comparable to radiofrequency (RF) ablation, but the outcome was not satisfactory. AF drivers mapping after pulmonary vein isolation (PVI) was reported to be widely identified in left atrium (LA). On the other hand, extensive drivers ablation is considered to have limited durability of PVI compared to cryo-ablation.

Purpose
This study sought to investigate the efficacy and safety of additional PV antrum substrate ablation after PVI by cryo-ablation in patients with PeAF.

Methods
A total of 122 consecutive patients (90 men, 32 women) who underwent ablation between January 2021 and July 2023 for PeAF, except for patients with long standing ≥10years AF, or large LA diameter ≥55mm, or low left ventricular ejection fraction (LVEF) ≤35% with organic heart disease, were divided into three groups; cryo-ablation alone (Cryo group; 30 patients), RF ablation alone guided by AF drivers mapping (RF group; 52 patients), or cryo-ablation plus RF for AF drivers (Cryo+RF group; 40 patients). AF drivers mapping was performed by real-time phase mapping system or complex fractionated electrograms (Figure1). The outcome of freedom from atrial tachy-arrhythmia lasting longer than 30 seconds without anti-arrhythmic drugs after three months blanking period of a single procedure was compared among groups.

Results
Baseline characteristics of patients (68±9.2 years old, LVEF 57±9.9 %, LA diameter 43±5.4 mm, persistent AF duration 9.4±18 months, long standing ≥1year AF 17 patients) were similar in three groups. The incident of recurrence of atrial tachy-arrhythmia in Cryo+RF group was significantly lower compared with Cryo group (15% vs. 37%; p=0.014) and RF group (15% vs. 25%; p=0.28) (Figure2). There was no serious complication in three groups.

Conclusion
Additional drivers RF ablation after cryo-ablation for PeAF is safe and associated with a significant reduction in atrial tachy-arrhythmia recurrence.Figure 1Figure 2
Effects of diagnosis-to-ablation time and antiarrhythmic drug responsiveness on the rhythm outcomes of atrial fibrillation catheter ablation
Authors: Kim H J , Kim D H , Kim K P , Choi S H , Kim M H , Park J W , Yu H T , Kim T H , Uhm J S , Joung B Y , Lee M H , Pak H N 
Published: May 2024

Abstract

Background
Atrial fibrillation (AF) is a progressive disease. Additionally, delaying AF catheter ablation (AFCA) for a year, during antiarrhythmic drug (AAD) therapy does not reduce the efficacy of this ablation. This study explored AFCA rhythm outcomes based on the diagnosis-to-ablation time (DAT) and AAD responsiveness in participants with either paroxysmal AF (PAF) or persistent AF (PeAF).

Methods
We included the data of 1,038 participants with AAD-resistant PeAF, all of whom had a clear time point for the diagnosis of PeAF and had undergone an AFCA for the first time. Participants who experienced recurrences of the paroxysmal type, while on AAD therapy, were analyzed as a cohort of AAD-partial-responders; whereas those who consistently maintained a PeAF, while on AAD therapy were analyzed as a cohort of AAD-non-responders. We calculated the DAT cutoff to determine long-term rhythm outcomes, using a maximum log-likelihood approach, based on the Cox proportional hazards regression model.

Results
Of the participants, 79.8% were male, and the median age was 61 years. The cohort of AAD-non-responders had a higher body mass index and larger left atrial diameter than that of the cohort of AAD-partial-responders. Furthermore, the cohort of AAD-non-responders showed a significantly higher incidence of AF recurrence subsequent to AFCA (adjusted hazard ratio= 1.75, 95% confidence interval: 1.33–2.30; log-rank test: p&lt; 0.001) than that of the cohort of AAD-partial-responders. The log-likelihood graphs of the Cox proportional hazards regression models showed bimodal morphology for the cutoff values of 22 and 40 months. The cutoff value of DAT that most optimally discriminated between rhythm outcomes was 22 months.

Conclusions
Thus, both the DAT and AAD responsiveness affected the rhythm outcomes of AFCA. Delaying AFCA to a DAT of longer than 22 months was inadvisable, particularly in the participants in whom PeAF progressed to PAF during AAD therapy.
Procedural safety and outcome of additional left atrial posterior wall ablation using pulse field ablation for atrial fibrillation
Authors: Tay Cheong Kiat J , Lim E , Pung X M , Chong D , Lim P , Chua K , Ho K L , Tan V H , Yeo C , Teo W S , Ching C K 
Published: May 2024

Abstract

Introduction
Pulsed field ablation (PFA) has recently been shown to be comparable to radiofrequency ablation and cryoablation in terms of acute safety and outcome for pulmonary vein isolation (PVI) for atrial fibrillation (AF). Efficacy and safety of additional left atrial posterior wall ablation (LAPWA) is unknown. We hereby report safety profile and short-term success at 6 months.

Methods
Consecutive patients with paroxysmal or persistent atrial fibrillation who underwent PFA were included. Procedures were performed under conscious sedation or general anaesthesia, with or without intracardiac echocardiography/ pre- or post-ablation electroanatomic mapping at the operators’ discretion. Safety endpoints included all-cause death within 30 days, cardiac tamponade, stroke/ TIA, MI, diaphragmatic paralysis, AE fistula. Primary efficacy endpoint was arrhythmia recurrence after 90 days blanking period at 6 months.
LAPWA was performed using 2.0 kV biphasic waveforms, 2 deliveries for each application site. The lesion set depended on the patient’s AF ablation history, LA size, and anatomy. After LA mapping post PVI (index or re-do), 2 anchor lesions per vein extending to the LAPW were deployed. A lesion set was then performed between the anchor lesions on the LAPW (upper and lower row) with the catheter in a flower configuration and the intention of 50% overlap for the neighbouring application sites at 3D EAM.

Results
Seventy-two (76% males) patients underwent PFA for AF, 55 (76.4%) were paroxysmal and 4 (5.6%) were redo cases. 19 (72%) underwent additional LAPWA. LAPWA was more likely performed in patients with persistent AF (57.9% vs 11.3%, p&lt;0.001), require GA (p=0.043), with 100% EAM use (p=0.026). While total PFA applications was expectedly higher in the LAPWA group (65.7 ± 12.4 vs 42.9 ± 9.0, p&lt;0.001), there were no significant differences in PFA dwell time in LA (44.2 ± 14.8 vs 42.3 ± 15.5min, p=0.628), procedural time (121.3 ± 43.8 vs 119.2 ± 49.4min, p=0.866) and fluoroscopic dose, AK (130 ± 107 vs 139 ± 102mGy, p=0.748). Average number of applications required for LAPW was 18 applications. LAPW isolation was acutely successful in all 19 patients on EAM. There were 6 inpatient complications of which all happened in the non-LAPWA group and unrelated to PFA. Arrhythmia recurrence was comparable at 6 months (11.1% vs 8.9%, p=1.00).

Conclusion
Additional LAPWA on top of PVI using PFA is safe with excellent acute isolation of posterior wall and does not increase procedural nor fluoroscopic duration. Short term outcome appears comparable and LAPWA may be useful especially in patients with persistent AF who may not be able to tolerate long procedures but will benefit from durable rhythm control.
Intra-procedural three-dimensional rotational angiography in cryoballoon ablation of atrial fibrillation - results from a randomised clinical trial
Authors: Prepolec I , Pasara V , Pezo Nikolic B , Puljevic M , Puljevic D , Milicic D , Velagic V 
Published: May 2024

Abstract

Introduction
There are a variety of approaches for pre-procedural imaging to facilitate atrial fibrillation (AF) ablation. Intra-procedural three-dimensional rotational angiography (3DRA) is the least employed method and it can be advantageous regarding efficiency and procedural logistics (1). There is an open question whether LA imaging could improve safety and outcomes of cryoballoon (CB) ablation.

Purpose
The aim of this study is to evaluate possible benefits of 3DRA for procedural success, safety and long-term outcomes of CB ablation.

Methods
We designed a single-centre unblinded randomised clinical trial and recruited 134 patients (64.2% male, 59.0±11.6 years) with paroxysmal (93.3%) and early-persistent AF. Patients were randomised to no imaging or 3DRA which was performed intra-procedurally after trans-septal puncture. Angiographic images were segmented and overlaid to the fluoroscopy screen to guide the ablation procedure. Patients were scheduled for follow-up visits and twenty-four hour ECG recordings at 3, 6 and 12 months, and every 6 months thereafter.

Results
Of all the patients recruited, 66 (49.3%) were randomised to 3DRA and angiography was successfully performed in all but one patient (1.5%). Procedure time was significantly longer when 3DRA was performed (86.7±27.8 min compared to 67.2±22.1 in non-3DRA group, p&lt;0.001). Total radiation dose (447.4±485.0 vs. 133.9±166.2 mGy, p&lt;0.001) and contrast administration (131.8±28.3 vs. 40.8±26.5 ml, p&lt;0.001) were significantly higher in the 3DRA group (Table 1). In patients who received no imaging one pulmonary vein (PV) couldn’t be isolated in 2 patients while this occurred in 3 patients in the 3DRA group (OR 1.57, 95% CI 0.25-9.72). Only minor complications were reported in both groups. Five patients developed large haematoma (4 in the 3DRA group vs. 1 in the control group). In each group there were 3 incidents of impending or transient phrenic nerve palsy. During 12 months of follow-up, 88.2% of patients in the control group and 81.8% in the 3DRA group were free of atrial fibrillation (OR 1.67, 95% CI 0.63-4.38). Two patients from the control group developed atrial flutter and were treated by ablation. In total, 10 patients underwent redo procedures (7 in the control and 3 in the 3DRA group respectively) and PV reconnections were detected in 9 cases.

Conclusion
3DRA is a safe and efficient intra-procedural imaging method to guide CB ablation of AF. However, it significantly increases procedure duration, total radiation dose and contrast expenditure. In our trial it did not have any impact on the acute success rate of PV isolation or freedom from atrial fibrillation during 12-month follow-up.