bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transbaffle or retrograde aortic approach for atrial arrhythmias ablation in patients with D-TGA treated with atrial switch surgery
Authors: Francisco Pascual J , Santos Ortega A , Perez Rodon J , Adelino R , Seder E , Pijuan A , Dos Subira L , Miranda B , Jordan P , Gordon B , Benito B , Ferreira Gonzalez I , Rivas Gandara N 
Published: May 2024

Abstract

Introduction
Patients with D- transposition of the great arteries (TGA) treated with Senning or Mustard surgeries have high incidence of supraventricular tachycardias (SVTs). Accessing to the pulmonary venous atrium (PVAt) is frequently required to perform the ablation, however it can be challenging.

Aim
To investigate the differences between a retrograde aortic approach (Re-Aa) and transbaffle approach (TBa) for PVAt ablation in this set of patients.

Methods
Prospective observational study in a third level hospital since April 2018 until October 2022, with a medium-term follow-up. All consecutive patients (pt) with history of SVT and atrial switch surgery that underwent electrophysiologic study (EP) and electroanatomic mapping using a high-density Grid mapping catheter and a contact-force ablation catheter were included.

Results
A total of 25 EPs were performed in 20 pt (13 (52%) Female, median age 37 y.o [IQR 34-41], median follow-up time 13 month [IQR 10-37]). In 14 pt the PVAt was mapped and ablated via Re-Aa, and in 11 with TBa. Table 1 shows basal patients characteristics, note that no significant differences between groups were found. In 19 pt (76%) a CTI-dependent flutter was documented (10 (71%) in Re-Aa group and 9 (82%) in TBa, p=0.6). Furthermore, in 7 pt other tachycardia circuits were found. Accurate mapping of all the CTI walls were achieved with both strategies, however, the posterior PVAt wall and the pulmonary veins were suboptimal mapped with Re-Aa due to a lack of catheter contact. Acute ablation success was 83% in Re-Aa and 100% in TBa (p=0.5). Despite a higher recurrence rate in the Re-Aa in the first months (20% vs 0%), no significant differences in recurrences were found between groups within 1 year of follow-up (HR 1.3 [95%CI: 0,2-7], p=0.8) (FIGURE). Complication rate was 20% in Re-Aa and 0% in TBa. All complications were directly related to the arterial vascular access (1 femoral pseudoaneurysm, 1 iliac dissection, 1 mediastinal hematoma), and were successfully treated.

Conclusion
In D-TGA treated with atrial switch surgery, PVAt mapping and ablation is feasible with both strategies with a high acute success rate and without significant differences in recurrences at mid-term follow up. However, TBa is associated with a lower complications rate and also with a better catheter contact and accurate mapping in the PVAt posterior wall.
Optimizing outcomes in catheter ablation for typical atrial flutter: a comparative study of intracardiac echocardiography versus fluoroscopy guidance
Authors: Turcsan M , Janosi K , Debreceni D , Toth D , Bocz B , Simor T , Foldesi C S , Kupo P 
Published: May 2024

Abstract

Background
Catheter ablation is a standard intervention for typical atrial flutters, specifically targeting the cavotricuspidal isthmus (CTI). Intracardiac echocardiography (ICE) plays a pivotal role in providing real-time visualization of anatomical structures during the electrophysiology procedure, thereby enhancing safety and potentially reducing reliance on fluoroscopy, leading to improved procedural outcomes. We aimed to conduct a comparative analysis of procedural and follow-up outcomes between ICE-guided and fluoroscopy-only guided catheter ablations for CTI in patients undergoing treatment for typical atrial flutter.

Methods
A retrospective analysis was conducted at our university center, encompassing 376 consecutive patients in a single-center study. Of these, 158 underwent procedures guided solely by fluoroscopy, while 218 received ICE-guided CTI ablation.

Results
ICE-guidance demonstrated a statistically significant reduction in fluoroscopy time (72 [36; 170] s vs. 888 [578; 1184] s; p&lt;0.01), total procedure time (70 [52; 90] min vs. 90 [60; 105] min; p&lt;0.01), total ablation time (692 [435; 998] s vs. 920 [629; 1373] s; p&lt;0.01), and the duration from the first to last ablation (20.5 [12; 37] min vs. 41.0 [26.8; 59.3] min; p&lt;0.01). Both groups achieved a 100% acute success rate without major complications. The ICE-guided group exhibited a significantly superior long-term success rate (ICE-guided group: 95.74%, fluoroscopy-only group: 89.26%; p=0.048) compared to the fluoroscopy-only group at an average follow-up length of 34 months.

Conclusion
The utilization of ICE-guidance for CTI ablation significantly reduces fluoroscopy exposure, procedure time, and ablation time, ultimately contributing to enhanced long-term success rates when compared to the conventional fluoroscopy-only approach.
A novel predictive model for differentiating cardiac and non-cardiac syncope in syncope-admitted patients
Authors: Wu S , Chen K 
Published: May 2024

Abstract

Background
Syncope due to cardiac causes presents a higher risk for mortality or other adverse events compared to those with non-cardiac causes. Thus, a critical focus in syncope management must be the early identification of these patients.

Purpose
This study sought to explore the predictive role of readily available clinical features for cardiac syncope and develop a diagnostic nomogram to facilitate its adoption in practice.

Methods
877 patients who were hospitalized with syncope and had a confirmed cause were included in this retrospective study at a tertiary heart center. They were randomly divided into the training set and validation set and were categorized into two groups based on their underlying cause: cardiac syncope and non-cardiac syncope. A wide range of clinical features were analyzed and selected using LASSO regression. Subsequently, we utilized multivariable logistic regression analysis to identify independent predictors and construct a nomogram. The receiver operating characteristic (ROC) curves and the area under the curves (AUCs) were used to assess the predictive accuracy of the predictive model. Furthermore, calibration curves were used to measure the alignment between the predicted and actual observed probability, and decision curve analysis (DCA) was used to evaluate the clinical benefit of the nomogram.

Results
Within the entire cohort, 521 patients were diagnosed with cardiac syncope and 356 patients were diagnosed with non-cardiac syncope. Among 36 candidate variables, five independent predictors for cardiac syncope were selected using the LASSO logistic regression analysis, including BMI (OR 1.088; 95%CI 1.022-1.158), LVEF (OR 0.940; 95%CI 0.908-0.973), logarithmic NT-proBNP (OR 1.463; 95%CI 1.240-1.727), chest symptoms preceding syncope (OR 5.251; 95%CI 3.326-8.288), and abnormal electrocardiogram (OR 6.171; 95%CI 3.966-9.600). Subsequently, a nomogram based on the five independent predictors was developed, yielding AUC of 0.873 (95% CI 0.845–0.902) and 0.856 (95%CI 0.809-0.903) in the training set and the validation set, respectively. The calibration curves showcased the nomogram's strong calibration, and DCA curves revealed its potential as a highly effective tool in clinical practice.

Conclusions
This study has successfully developed and internally validated a novel predictive nomogram for distinguishing between cardiac and non-cardiac syncope, which holds a promise to serve as an effective tool to help facilitate early identification of such patients in clinical practice.ROC curves of the training and test setThe nomogram and web-based calculator
Cardioneuroablation guided by extracardiac vagal stimulation for cardioinhibitory vasovagal syncope
Authors: Teixeira R , Almeida M C , Silva G , Fonseca P , Cardoso F , Almeida J , Ribeiro S , Oliveira M , Sanfins V , Goncalves H , Barra S , Pachon J C , Primo J , Lourenco A , Fontes-Carvalho R 
Published: May 2024

Abstract

Introduction
Vasovagal Syncope (VVS) is often linked to abnormal autonomic reflexes, with hypervagotonia identified as a key mechanism, especially in cases with pronounced cardioinhibition. Cardioneuroablation (CNA), which involves radiofrequency ablation of cardiac vagal ganglia, targets parasympathetic hyperactivity, offering a promising treatment for recurrent VVS. This study evaluates the effectiveness and safety of anatomically guided CNA, which may provide an alternative treatment option to pacemaker implantation for younger patients with severe cardioinhibitory VVS.

Methods
Consecutive patients between January 2019 and October 2023 who underwent CNA at two cardiology centers were enrolled. All patients had a history of recurrent syncope, predominantly cardioinhibitory and unresponsive to conventional treatments. Patients showed no signs of conduction system disease, evidenced by normal rate responses in treadmill stress tests and 24-hour Holter monitoring. Electroanatomic mapping of the left atrium and pulmonary veins was performed. Extracardiac vagal stimulation (ECVS) through the right internal jugular vein, with or without atrial pacing, was utilized to assess baseline responses of the sinus and atrioventricular (AV) nodes. The ablation strategy was tailored based on rhythm disturbances triggered by ECVS, using sequential and anatomically guided ablation of ganglionated parasympathetic plexuses. Radiofrequency ablation, conducted with an irrigated catheter, was guided by the ablation index. Acute success was defined as the absence or significant reduction of cardiac parasympathetic response to ECVS, indicated by the elimination of asystole, severe bradycardia, or AV block. The primary endpoint was syncope recurrence during follow-up.

Results
The study included 25 patients (16 males; mean age 36 ± 12 years). All had documented cardioinhibition, identified through ECG monitoring (N=12), implantable loop recorders (N=5), or head-up tilt tests (N=8). The average number of syncopal episodes per patient in the year preceding ablation was 2.7, ranging from 1 to 10. Ablation was acutely successful in all cases. Post-ablation, there were no immediate complications related to the procedure, except for one convulsion deemed unrelated. Over a mean follow-up of 17 ± 14 months, 23 patients remained syncope-free. Two patients experienced syncope recurrence; despite undergoing a repeat ablation, they eventually required pacemaker implantation.

Conclusion
The results of this study suggest that CNA guided by ECVS, may offer a promising treatment for patients with refractory cardioinhibitory VVS. While the procedure showed a high rate of acute success and a notable reduction in syncope recurrence, further research is warranted to fully establish its role as an alternative to pacemaker implantation.
High-resolution repolarization changes preceding short-coupled ectopy in idiopathic ventricular fibrillation, and effects of quinidine
Authors: Stoks J , Deissler P , Ter Bekke R M A , Volders P G A 
Published: May 2024

Abstract

Background
Idiopathic ventricular fibrillation (VF) is linked to early repolarization, increased repolarization heterogeneity, and (short-coupled) premature ventricular complexes (PVCs). Quinidine, an antiarrhythmic drug with class-IA and -III effects, reduces the occurrence of PVCs and VF, but its effects on repolarization have not yet been studied at the whole-heart level in idiopathic-VF patients.

Purpose
To study dynamic changes in repolarization preceding short-coupled PVCs using noninvasive electrocardiographic imaging (ECGI) in a patient with idiopathic VF, and the antiarrhythmic effects of quinidine.

Methods
ECGI was performed during sinus rhythm in a 61-year-old male with an ICD (secondary prevention; 2.5 mg nebivolol daily) two days after recurrent idiopathic VF (Fig. A). This was done 1) at baseline, 2 minutes before short-coupled ectopy ("baseline"); 2) at baseline, 10 seconds before the short-coupled PVC ("pre PVC"); and 3) at 2 hours after start of quinidine 200 mg ("on-quinidine").
The ECGI procedure consisted of a 224-electrode body surface potential map and a contrast-enhanced CT scan to obtain torso and heart geometries. After reconstruction of epicardial unipolar electrograms (UEGs), local activation and repolarization times (ATs and RTs) were derived from UEGs by assessing the steepest downslope of the QRS complex and steepest upslope of the T waves, respectively, of 10-second signal-averaged beats. AT and RT duration (first to last AT or RT) were assessed.

Results
At baseline, QRS duration and QT interval measured 107 ms and 343 ms, respectively, on the standard 12-lead ECG. ECGI-derived epicardial AT duration was 72 ms, and RT histogram span 92 ms. The coupling interval of the PVC that triggered VF in the ICD readout was 340 ms (Fig. A). During 44 minutes of ECGI, 157 short-coupled PVCs from the moderator-band region were recorded (Fig. B; no tachycardia or VF). Just prior to a PVC, epicardial early repolarization at the PVC origin decreased by 26 ms (star in Figs. C-E), and the RT histogram broadened to 109 ms (Fig. E).
While on-quinidine, (25 minutes; QRS duration 107 ms, QT interval 419 ms), epicardial repolarization was prolonged (Fig. C/D), also at the site of abnormal impulse formation. Quinidine had increased the epicardial AT duration to 79 ms, and RT histogram span to 133 ms. PVCs were completely suppressed.
The patient remained free of sustained arrhythmias while on-quinidine.
Conclusion(s)
In this case of short-coupled idiopathic VF, epicardial early repolarization shortened momentarily prior to abnormal impulse formation. We found dynamic substrate-trigger characteristics that likely facilitate reentrant excitation. Quinidine prolonged the duration of epicardial activation and repolarization, suppressing the ectopy and VF recurrence.
Propranolol in polymorphic ventricular premature beats
Authors: Scheurlen C , Van Den Bruck J H , Filipovic K , Erlhoefer S , Woermann J , Dittrich S , Schipper J H , Pavel F , Ackmann J , Lueker J , Steven D , Sultan A 
Published: May 2024

Abstract

Background
Therapy of polymorphic premature ventricular contractions (pPVC) is sometimes challenging despite improved catheter ablation options especially in patients suffering from non-ischemic cardiomyopathy. Previous studies have proven the benefit of non-selective ß-blocker such as propranolol in the stetting of electrical storm. Data for the use of propranolol to treat pPVC is sparse.

Aim
We sought to analyze the potential benefit of propranolol in the setting of failed or only partially successful pPVC ablation.

Methods
This retrospective analysis included patients (pts) undergoing catheter ablation (CA) for pPVC or pPVC triggered ventricular tachycardia (VT) at our center between January and October 2023. If ablation was unsuccessful or not all PVCs were completely abolished oral propranolol was started after the procedure. Propranolol replaced selective ß-blocker in case of preexisting medication. The dosage was up titrated to 240mg/d if feasible. No other antiarrhythmic drug was administered simultaneously. Follow-up (FU) was conducted 3 months after ablation. During FU visit at least one 24-48h ecg was obtained to assess PVC burden.

Results
A total of 13 CA in the setting of pPVC with propranolol naive patients were performed (mean age 62.6±10.3 years, 10 pts (77%) male; 6 patients suffering from non-ischemic cardiomyopathy). The mean left ventricular ejection fraction (LVEF) was 46.6±14.6%. Five patients had previous catheter ablation. Site of ablation was: 2 left papillary muscle, 2 outflow tract (RVOT), 7 great cardiac vein/ left ventricluar summit, 1 moderator band and 1 lateral mitral valve annulus. In all cases only transient or moderate pPVC suppression was achieved by CA.
After a mean follow-up (FU) of 113.3±30.2 days a complete 3-month FU was obtained in 11 pts. The preprocedural mean pPVC burden of 14.0±7.7% was significantly reduced using propranolol to 4.2±7.7%; p=0.03 within three month after CA. No major propranolol complications occurred.

Conclusion
Data on the use of propranolol in the setting of pPVC is sparse. This analysis demonstrates for the first time a significant burden reduction of pPVC after starting propranolol in patients with failed or incomplete CA for pPVCs. Of note, although patients suffering from HFmrEf and HFrEF were included no clinical deterioration of preexisting heart failure was observed. Further comparative studies are needed.Propranolol PVC burden
Cryoablation of ventricular tachycardia using ultra-low temperature technology: acute success and insights from the post-interventional CMR
Authors: Dinov B , Dilk P , Paetsch I , Jahnke C , Hindricks G , Sossalla S T , Darma A 
Published: May 2024

Abstract

Background
Radiofrequency catheter ablation (RFCA) has good acute and long-term success rates in idiopathic and ischemic ventricular arrhythmia (VA). Drawbacks of the RFCA are reversibility of the edema and limited penetration of the RF energy into the tissue which explain a worse effectiveness in midmyocardial substrates. In comparison to RFCA, the lesions produced by ultra-low temperature cryoablation (ULTC) which uses near-critical nitrogen cryogen at -1960C can be both deeper and irreversible, depending on the duration of the freeze.

Purpose
We aimed to evaluate the acute effectiveness of a new ULTC technology for VA by examining post-interventional cardiac magnetic resonance images (CMR) with late gadolinium enhancement (LGE), as a part of multi-center Cryocure-VT study.

Methods
Between December 2022 and May 2023, we ablated 6 patients (age 63±16%; 5 male) with sustained VA and structural heart disease. Three patients had previous myocardial infarction; 1 cardiac sarcoidosis, 1 LMNA/C dilated cardiomyopathy and 1 post-myocarditis VA. LGE-CMR was available in all patients before the ULTC. At first, electro-anatomical mapping and VA induction were performed followed by ULTC using transseptal access. Each application consisted of freeze-thaw-freeze cycle with freeze duration at operator’s discretion based on manufacturer-recommended duration-depth curve. At the end, induction protocol was repeated to assess the acute success. Additionally, LGE-CMR was performed after ablation as an attempt to visualize the cryo-lesions.

Results
Median of 6 applications (IQR 4.75-7.5) of cryo-energy were applied per patient. Median procedure time was 180 min (IQR 97-180), and median fluoroscopy time of 20 min (IQR 15-26). Septal VA exits were detected in 3/6 patients; in 1 the exit was at aorto-mitral continuity; in 2 – basal inferior. After ablation, no VAs were inducible in 5/6 (83%) patients. The only patient with failure to ablate all VAs had fewer applications (n=4) and shorter freeze duration of 30 sec., as compared to the rest. Post-procedural CMR revealed new LGE with up to 75% transmurality in 5/6 patients; microvascular obstruction in 4/6 patients. Only LV edema, but no LGE was observed in the patient with shortest freeze time, who also had intra-hospital recurrence. No complications occurred.

Conclusions
Cryoablation of VA using a new ultra-low temperature technology is effective and safe to ablate VT even in patients with mid-septal substrates. New LGE in result of ULTCA can be observed in CMR and the lesions depth depends on the duration of application.
Predictors of decremental conduction after extrastimulus in post-infarction ventricular tachycardia substrate maps
Authors: Acosta Martinez J , Regal Somet M , Frutos Lopez M , Sanchez Brotons J A , Gonzalez De La Portilla-Concha C , Lopez Baizan J , Arana Rueda E , Pedrote A 
Published: May 2024

Abstract

Introduction
Ventricular tachycardia (VT) substrate ablation techniques attempt to identify areas of decremental conduction (DC) within the scar, given their close relationship with VT isthmuses. DC identification requires the systematic use of extrastimuli during substrate mapping. This can be time consuming and induce ventricular arrhythmias during mapping.

Objective
This study aims to identify predictors of decremental response after extastimulus that allow recognizing areas with higher probability of DC conduction in order to focus functional mapping of the substrate on them.

Methods
Sixteen consecutive ischemic patients (93.8% male, 66.3±12.4 years) undergoing VT substrate ablation were included. A detailed substrate map during right ventricular (RV) pacing was obtained in all of them. Systematic analysis of electrograms (EGMs) recorded from the infarct area was performed during RV pacing at 600-500 ms, and during a short-coupled RV extrastimulus. Electrograms during RV pacing exhibiting decremental evoked conduction delay after an extrastimulus (DECD-AE) were compared to those not showing DECD-AE.

Results
Mean low voltage (&lt;1.5 mV) area was 45±18.6 cm2. A total of 1744 EGMs were analyzed. Of them, 453 (26%) showed DECD-AE. Bipolar EGMs showing DECD-AE exhibited a higher number of deflections [4(interquartile range 3-5) vs 2(1-3); p&lt;0.0001], a higher amplitude [0.52(0.27-1) vs 0.3(0.14-0.7) mV; p=0.003] and similar duration [114(102-135) vs 117(100-133 ms); p=0.492] compared to EGMs without DECD-AE. The area under curve was 0.64 for bipolar voltage and 0.8 for number of bipolar deflections. The presence of &lt;3 bipolar deflections excluded DECD-AE with a negative predictive value of 98.5%.

Conclusions
In areas of myocardial scar, bipolar EGMs with &lt;3 deflections are unlikely to present DECD-AE. Focusing functional mapping on signals with ≥3 deflections could simplify procedures and save time.