bluuebunny/crossref_metadata_2025_split huggingface dataset:
A novel designed atrial septum linear ablation method (Icho line) for non-pulmonary vein triggers originating from atrial postero-septum and crista terminalis
Authors: Kawai S , Okahara A , Tokutome M , Matsuura H , Itonaga J , Ikuta K , Kisanuki H , Hara A , Sada M , Okabe K , Nakano M , Matsukawa R , Mukai Y 
Published: November 2023

Abstract

Background
Therapeutic strategy for non-pulmonary vein (PV) trigger of atrial fibrillation (AF) has not been well established although they are the major cause of AF recurrence after PV isolation. The atrial postero-septum or right atrial crista terminalis (CT) are the common non-PV trigger sites of AF. For them, a focal ablation is often insufficient due to a regional arrhythmogenicity. We devised an original linear ablation method, named "Icho Line". Icho means ginkgo in Japanese.

Methods
Eight hundred and thirty-two AF ablation patients were retrospectively studied. An AF induction test was conducted after each PV isolation procedure. Non-PV triggers from the postero-septum or CT that initiate AF were analyzed. Premature atrial contractions that did not initiate AF were excluded. A linear ablation was designed horizontally from the anterior right PV isolation line to fossa ovalis in the left atrium. In the right atrium, the opposite side of the left atrial ablation and CT were continuously ablated like the shape of a ginkgo leaf (Figure 1).

Results
A hundred and fifteen non-PV triggers were detected in 104 patients (12.5%), among which Icho line ablation was performed in 39 patients (37.5%) with documented triggers from the postero-septum or CT (Figure 1). Atrial tachyarrhythmia recurrence free rate in the Icho line group and other non-PV ablation patients were 61.8% and 45.4%, respectively (P=0.54, Figure 2).

Conclusions
A novel designed Icho line is a feasible and effective ablation strategy covering non-PV triggers from the atrial septum and CT.Icho Line Figure 1Icho Line Figure 2
Biomarkers of myocardial injury during cellular electroporation by means of pulsed-field ablation and radiofrequency of atrial fibrillation
Authors: Casella M , Gaggiotti G , Valeri Y , Cipolletta L , Compagnucci P , Volpato G , Parisi Q , Carboni L , Iovinella A , Messano L , Centanni M , Masci F , Malacrida M , Natale A , Dello Russo A 
Published: November 2023

Abstract

Background
Several authors implemented different biomarkers to evaluate and quantify the size of effective atrial fibrillation (AF) ablation lesions after pulmonary veins isolation (PVI) with thermal energy source. However, limited data have been reported on the effects of a new form of non-thermal energy such as electroporation obtained by means of a pulsed-field ablation (PFA, Farapulse) system.

Purpose
Our analysis aims to compare acute myocardial injury through different biomarkers variation after PVI performed with different technologies (PFA vs radiofrequency, RF).

Methods
All consecutive patients (pts) undergoing AF ablation with PFA at our center were included. A PFA protocol-directed PVI was applied using 2kV with 8 applications per vein. RF deliveries were deployed according to a wide antral lesion set around the PVs at 50W. Pre- and post-procedure samples of cardiac troponin I (hs-TnI, ng/l), creatinine kinase-MB (CK-MB, ng/dl), fibrinogen (FB, mg/dl), myoglobin (Myo, ng/ml), N-terminal (NT)-pro hormone B-type natriuretic peptide (NT-ProBNP, pg/ml) and C-reactive protein (CRP, mg/dl) values were collected before PVI and at 24h after ablation. Ablation endpoint was PVI.

Results
Fourty-nine pts were included (62±12 years, 63% male, 84% with paroxysmal AF). PFA cases were 35 (71.4%) whereas RF cases were 14 (28.6%). Evaluating the kinetic of each cardiac biomarker, no differences were found between baseline and 24h for both FB (363±93 at baseline vs 387±112 at 24h, p=0.4513) and NT-ProBNP (137[61-462] at baseline vs 227[157-423] at 24h, p=0.0544). On the contrary kinetics of remaining biomarkers differed and significantly increased from baseline to 24h: 61±22 to 112±101 for Myo level, p=0.0017; 0.38±0.2 to 1.45±2.2 for CRP values, p&lt;0.0001; 1.5±0.7 to 19.4±14 for CK-MB level, p&lt;0.0001 and 11.2±20 to 6177±5765 for hs-TnI level, p&lt;0.0001. By looking at the effect of the ablation strategy on cardiac biomarkers, hs-TnI level, CRP level and CK-MB were significantly different between groups at 24h after PFA/RF (hs-TnI: 7556±6025 for PFA vs 2038±1257 for RF, p&lt;0.0001; CRP: 1.6±2.3 for PFA vs 0.9±1.2 for RF, p=0.0297; CK-MB: 23.7±12 for PFA vs 6.3±9.6 for RF, p&lt;0.0001). PVI was achieved in all patients (100%) using only RF or PFA. No major procedure-related adverse events were reported.

Conclusion
Our preliminary results showed that cardiac troponin I enzyme level, C-reactive protein and creatinine kinase-MB increased after PVI by means of both radiofrequency and pulsed-field ablation and were higher after cellular electroporation by PFA than RF.
Prediction of late atrial fibrillation recurrence after catheter ablation using machine learning
Authors: Budzianowski J , Kaczmarek-Majer K , Rzezniczak J , Slomczynski M , Wichrowski F , Hiczkiewicz J , Burchardt P 
Published: November 2023

Abstract

Background
Late recurrence of atrial fibrillation (LRAF) occurring 3 up to 12 months following catheter ablation is considered a relevant clinical problem (rate of occurrence estimated at 20%-45%). Hence, it is significant to define LRAF predictors which would allow for a more suitable selection of patients susceptible to AF recurrence and which could increase the effectiveness of the ablation procedure.

Purpose
The aim of the present study is to develop a machine-learning model of arrhythmic recurrence within one year from catheter ablation.

Methods
This study group comprised 201 patients with paroxysmal, persistent and long standing persistent AF who underwent pulmonary vein isolation performed by cryoballoon ablation and radiofrequency ablation using the CARTO-mapping (122 cryoablation and 79 radiofrequency) in a single center study between May 2016 and March 2018. The biomarker concentrations were measured at baseline and after ablation in a 24-h follow-up. First, five different supervised machine-learning models (decision tree, logistic regression, random forest, XGBoost, support vector machines) were developed for predicting AF recurrence within one year following catheter ablation. Next, SHapley Additive exPlanations (SHAP) were derived to explain the predictions using 82 parameters from clinical, laboratory and procedural variables collected from each patient. The models were trained and validated using stratified 5-fold cross-validation and a feature selection was performed with the permutation importance.

Results
During the 1-year follow-up LRAF occurred in 57 patients (28.3%). The respective receiver operating characteristic (ROC) curves for this model calculated for the Validation set are presented in Figure 1. It is observed that the XGBoost model with the 12 variables achieves the highest AUC of 0.75 (95% confidence interval: 0.7395, 0.7653). The high values of the top 2 features (early recurrence of atrial fibrillation (ERAF) and TSH) contribute to predicting LRAF most, while low values of the top 3 features (RBC, hs-Troponin T, HDL cholesterol) contribute positively to this class (Figure 2).

Conclusion
The machine learning model predicting the 1-year risk of atrial fibrillation recurrence after catheter ablation has achieved good predictive ability. The above model based on the easily available clinical and laboratory data will support the clinical decision-making for selecting good responders to the ablation procedure.
Comparison of additional ablation of spatio-temporal dispersion electrograms and low voltage area beyond pulmonary vein isolation in patients with persistent atrial fibrillation
Authors: Naruse Y , Kaneko Y , Narumi T , Sano M , Maekawa Y 
Published: November 2023

Abstract

Backgrounds
Although strategies beyond extensive pulmonary vein isolation (EPVI) including low voltage zone (LVZ) ablation in patients with persistent atrial fibrillation (AF) have not yet been established, recent research showed that ablation targeting spatio-temporal dispersion electrograms (STDE) could achieve high AF-free survival. We hypothesized that EPVI plus STDE approach could reduce AF recurrence after catheter ablation of persistent AF.

Purpose
The purpose of this study is to assess the AF recurrence after the ablation in different two strategies.

Methods
We prospectively enrolled consecutive patients with persistent AF undergoing their first catheter ablation at our institution during July 2018 to March 2021. The ablation strategy was divided into 2 groups: 1) EPVI plus LVZ and 2) EPVI plus STDE ablation. STDE was defined as clusters of fractionated electrograms that displayed interelectrode time and space dispersion at a minimum of three adjacent bipolar electrodes such that activation spread over all the cycle length of AF. The definition of LVZ was bipolar amplitude of &lt;0.5mV. Posterior wall isolation was performed if STDE or LVZ were broadly present in posterior wall. The primary endpoint was defined as AF recurrence after the ablation. The blanking period of 3 months was applied.

Results
Out of 138 patients (66±11 years, 108 men), 64 patients underwent EPVI plus LVZ and 74 EPVI plus STDE ablation. There was no difference in median AF duration (8 [interquartile range (IQR) 4-13] months vs. 12 [IQR 5-22] months; p=0.129) and left atrial volume (151 [IQR 115-168] ml vs. 151 [IQR 127-175] ml; p=0.239) between the two groups. The prevalence of concomitant hypertension (47% vs. 67%; p=0.024) and diabetes mellitus (24% vs. 42%; p=0.027) was lower in the STDE group than in the LVZ group. Posterior wall isolation was performed more frequently in the STDE group than in the LVZ group (38% vs. 19%; p=0.015). At 1 year follow-up, the STDE group achieved higher AF-free rate than the LVZ group (84% [95% confidence interval (CI), 73-91%] vs. 64% [95% CI 52-76%]; P=0.017). Multivariate Cox regression analysis demonstrated that not only AF duration (hazard ratio [HR] 1.03, 95% CI 1.01–1.04; p&lt;0.001), and left atrial volume (HR 1.10, 95% CI 1.02–1.19; p=0.011) but also STDE ablation (HR 0.33, 95% CI 0.14-0.77%, p=0.010) were independently associated with AF recurrence.

Conclusions
Ablation guided by STDE in addition to EPVI may be a useful treatment strategy for persistent AF.
Pulmonary hypertension is an adverse risk factor for peri-procedural complications in patients undergoing pulmonary vein isolation and ablation for atrial fibrillation
Authors: Atluri R , Kodali M , Yalamanchili S Y , Shoura S 
Published: November 2023

Abstract

Background
Recent studies have identified Pulmonary hypertension (PHT) as a predictor for poor clinical outcomes in Atrial fibrillation (AF) with increased fold in mortality. PHT is associated with right ventricular pressure and volume overload eventually leading to right heart failure. These structural changes can lead to electrophysiological abnormalities, with AF being one of the most common. Percutaneous catheter ablation and pulmonary vein isolation is becoming more common ground for management of paroxysmal atrial fibrillation (AF). We sought to investigate the impact of PHT as an adverse risk factor for patients undergoing pulmonary vein isolation and ablation for AF.

Methods
We utilized the National Inpatient Sample from 2016-2019 to identify roughly 49,425 hospitalized adults who underwent AF Ablation. These hospitalizations were further stratified based on the presence of PHT. A multivariate regression model was used to adjust for confounders and analyze the variables.

Results
Of those who underwent AF Ablation, 5,329 (10.7%) had PHT. In-hospital mortality was higher in those with PHT (2.5% vs 0.9%; p&lt;0.001). Figure 1 shows the Forrest plot for multivariate analysis of in-hospital outcomes when adjusted for patient demographics, comorbidities, and hospital characteristics. When adjusted similarly, patients with AF and PHT had longer length of stay (LOS) by 2.9 days (p&lt;0.001) and had additional hospital costs (HC) of $25,122 (p&lt;0.001).

Conclusion
In this study, patients undergoing AF ablation with co-existing PHT had significantly worse outcomes in terms of in-hospital mortality, LOS, HC, atrial flutter, ventricular tachycardia, AKI, sepsis, pneumonia, and endotracheal intubation. One major limitation of our study is the lack of outpatient follow up. Given that overall outcomes are worse in the setting of PHT, potential strategies for aggressive rate and volume control prior to the ablation for AF should be pursued to avoid negative outcomes. AF patients with co-existing PHT should be aggressively monitored during hospitalizations for AF ablation as they have the potential to have worse periprocedural outcomes.
Anemia and atrial fibrillation ablation recurrence: insights from a large-scale multicentre registry
Authors: Tanaka N , Inoue K , Kobori A , Morimoto T , Morishima I , Yamaji H , Nakazawa Y , Kusano K , Okada M , Koyama Y , Watanabe H , Okamura A , Iwakura K , Kimura T , Shizuta S 
Published: November 2023

Abstract

Background
Both atrial fibrillation (AF) and anemia are associated with an increased mortality, and they often coexist. Whether anemia is associated with arrhythmia recurrence after catheter ablation (CA) of AF remains unknown.

Methods
We conducted a large-scale, prospective, multicentre, observational study (Kansai Plus Atrial Fibrillation Registry). Out of 5010 consecutive patients who underwent an initial radiofrequency CA (RFCA) of AF at 26 centres, we enrolled 4966 patients whose hemoglobin data were available (age 64.4 years, 27.3% female, and 35.6% non-paroxysmal AF). The entire cohort was divided into three subgroups according to the WHO classification of anemia: normal (hemoglobin ≥ 13.0 g/dL in men and ≥ 12.0 g/dL in women, n=4300, 86.6%), mild anemia (11.0 ≤ hemoglobin &lt; 13.0 g/dL in men and 11.0 ≤ hemoglobin &lt; 12.0 g/dL in women, n = 519, 10.5%), and moderate-severe anemia (&lt;11.0 g/dL in both men and women, n = 147, 3.0%). The median follow-up duration was 2.9 years.

Results
The mean age increased significantly as the anemia progressed (normal vs. mild anemia vs. moderate-severe anemia; 63.5 vs. 69.8 vs. 72.1, p&lt;0.0001). While the normal group and mild anemia group consisted of predominantly males (74.0% and 70.5%, respectively), the moderate-severe anemia group consisted predominantly of females (57.8%, p&lt;0.0001). The proportion of paroxysmal atrial fibrillation was 62.4% in the normal, 78.4% in the mild anemia, and 76.2% in the moderate-severe anemia group, respectively (p&lt;0.0001). The 3-year cumulative incidence of AF recurrence after a single procedure was the highest in the moderate-severe anemia group (normal vs. mild anemia vs. moderate-severe anemia, 39.6% vs. 43.5% vs. 49.7%, log-rank p=0.0004).

Conclusion
Anemia patients experienced more frequent AF recurrences after RFCA of AF.KM curve according to anemia group
Heart rate variability and syncope free survival after endocardial ablation of ganlionated plexi in patiens with recurrent vasovagal syncope and functional sinus node dysfunction and AV block
Authors: Minguito Carazo C , Martinez Sande J L , Rodriguez Manero M , Garcia Seara J , Fernandez Lopez X A , Gonzalez Melchor L , Gonzalez Ferrero T , Garcia Rodeja F , Jimenez Ramos V , Martinon Martinez J , Sanchez Munoz E , Gonzalez Juanatey J R 
Published: November 2023

Abstract

Introduction
Cardioneuroablation (CNA) or ablation of the ganglionated plexi (GP) is an emergent procedure that has been used in the treatment of vasovagal syncope Conclusions: (VVS), functional sinus node dysfunction (SND) and functional atrioventricular block (AVB), however long term effects of this technique are not well defined. The aim of the present study was to describe our initial experience with this technique and to assess long term hear rate (HR) variability.

Methods
Prospective, unicentric, observational study of consecutive patients which were referred to our institution for VVS, functional SND or functional AVB. Prior the procedure, all the patients underwent atropine test and 24-hour holter monitoring. Heart rate variability was assessed at 3 and 6 months with repeated 24-hour holter monitoring. Survival from syncope and pacemaker implantation was calculated in the cohort.

Results
24 patients (52 ± 10 years, 70.8% males) were included in the study. 83.3% of the cohort had history of syncope (1.3 ± 3.4 episodes/month) and 95.8% of presyncope. Indication for CNA was SND 29.2%, AVB 25% and recurrent VVS in 45.8%. After a median follow up of 9.9 (4.3-20.7) months, 91.7% were free from syncope recurrence and only 29.2% had presyncope (p&lt;0.001) (Figure 1). There was also a significant increase in minimum HR (p=0.01) and medium HR (p=0.02), without any differences in the maximum HR (p=NS). There was also a decrease in all the parameters used to assess HR variability (SDNN24 p=0.02; rMSSD p=0.017; pNN50 p&lt;0.01) that was constant during the 6 months (Figure 2).

Conclusions
In our cohort, CNA was associated with a syncope free survival of 91.7% and could be a reasonable choice for patients with functional SND or AVB and recurrent VVS. There was an increase in the maximum and medium HR and a decrease in HR variability that remained constant at 6 months.Figure 1Figure 2
Hybrid convergent ablation: an evaluation of left atrial electroanatomical voltage maps
Authors: Mannakkara N N , Child N , Porter B , Khan I , Wijesuriya N D , Mehta V M , De Vere F , Elliott M K , Ahmed S , Adhya S , Razavi R , Bosco P , Rinaldi C A , Blauth C , Gill J S 
Published: November 2023

Abstract

Background
Hybrid convergent ablation is an effective, emerging treatment for persistent atrial fibrillation (AF) (1). Minimally invasive surgical epicardial left atrial (LA) ablation is performed via a subxiphoid incision to ablate the posterior wall, within the limits of the pericardial reflections, before endocardial catheter ablation is performed primarily to complete pulmonary vein isolation. The overall aim is to create durable, transmural posterior wall ablation to target potential drivers that may sustain persistent AF.

Purpose
We evaluated electroanatomical maps obtained during endocardial ablation to determine the site and extent of LA posterior wall scar following epicardial ablation and whether this determines outcome in patients undergoing convergent ablation.

Methods
Patients who underwent Convergent ablation at a single UK cardiac centre (2012-2019) using CARTO-3 mapping system for endocardial ablation were included. Patients who had previous AF ablation were excluded. Low-voltage areas (LVAs) were manually measured using the CARTO-3 system and defined as areas &lt;0.5mV on bipolar voltage maps (pulmonary veins were excluded). Scar location was classified by evaluating for presence and amount of LVA in each quadrant of the posterior LA wall. AF recurrence was evaluated at 12 months post-procedure. SPSS (v. 27) was used for statistical analysis.

Results
Of the 32 patients included, 7 patients experienced AF recurrence within 12 months post-procedure (21.9%). The average amount of posterior wall LVA following convergent ablation was 54.1% of posterior wall area and 5.8% of total left atrial area, neither of which were associated with 12-month AF recurrence (see Table 1). The presence and extent of LVAs in the upper quadrants were heterogeneous amongst patients and did not relate to AF recurrence. All patients displayed LVAs in the lower quadrants post-epicardial ablation, with the majority having LVAs occupying more than 50% of these quadrants. 96.8% had LVA on the inferior LA surface. In total, 75% of patients had a significant amount of LVA (defined as LVA occupying &gt;50% of the quadrant area) in both lower posterior wall quadrants (see Figure 1) and this feature was associated with lower AF recurrence on multivariable Cox regression analysis (see Table 1).

Conclusions
Extensive scar was observed in the LA posterior wall in patients following epicardial convergent ablation. The presence of such scar, particularly in the lower regions of the posterior wall, may influence outcomes and be associated with reduced AF recurrence.Table 1Figure 1
Atrial fibrillation patients at intermediate risk of stroke rapidly progress to high stroke risk: A nationwide registry study (AFNOR)
Authors: Anjum M , Ariansen I , Myrstad M , Hjellvik V , Kjerpeseth L J , Ellekjaer H , Skovlund E , Christophersen I E , Tveit A , Berge T 
Published: November 2023

Abstract

Background
Stroke risk according to the CHA2DS2-VASc score guides oral anticoagulant (OAC) treatment in atrial fibrillation (AF) patients, and OAC is strongly recommended in patients with high stroke risk. There is less evidence of the clinical benefit of OAC in intermediate risk patients (non-sex CHA2DS2-VASc score of 1), and according to guidelines, OAC should be considered. However, the stroke risk is dynamic and an increase in the CHA2DS2-VASc score with a consequent change in the thromboembolic risk profile favoring OAC treatment is expected over time.

Purpose
To investigate the temporal changes in CHA2DS2-VASc score and the incidence of acquiring each of the CHA2DS2-VASc risk factors in AF patients at intermediate risk of stroke.

Methods
We identified 27,111 individuals with non-valvular AF aged ≥18 years, with a baseline CHA2DS2-VASc score of 1 (males) or 2 (females), in data from Norwegian national registries from 2011 through 2018. AF and stroke risk factors were identified with a minimum three-year look-back period. Individuals entered the study upon registration of a first-time AF diagnosis in combination with the first non-sex CHA2DS2-VASc risk factor, whichever came last. All participants were followed until an increase in the CHA2DS2-VASc score, death, emigration or study end. We calculated time from entry to an increased score (non-sex CHA2DS2-VASc score of ≥2) and assessed the cumulative proportions with an increase in CHA2DS2-VASc score per month. Average annual incidence rates for acquirement of new stroke risk factors were calculated as cases per 100 person-years (%/year) with 95% confidence intervals (CI).

Results
During a median follow-up time of 16 months (interquartile range: 4.9-36.6), 15,397 (56.8%) patients acquired at least one new stroke risk factor(s) (figure 1). One third of the patients who increased their CHA2DS2-VASc score, attained a new risk factor during the first four months of follow-up. The average annual risk of CHA2DS2-VASc score increment was 29% (95% CI: 28.6-29.5). The annual risk for a new risk factor was 23.2% for hypertension, 12.5% for age 65-74 years, 7.9% for heart failure, 6.2% for age ≥ 75 years, 5.4% for vascular disease, 2.4% for diabetes mellitus and 1.6% for thromboembolism (ischemic stroke, transitoric ischemic attack or systemic embolism) (figure 2).

Conclusion
AF patients at intermediate risk of stroke rapidly develop an increased stroke risk. In this nationwide study, more than half of AF patients at intermediate risk of stroke acquired a new risk factor during a median follow-up time of 16 months. The average annual risk of an increase in the CHA2DS2-VASc score was 29%. Intermediate-risk AF patients should be regularly reassessed, especially to avoid undertreatment if anticoagulation has previously been withheld.