bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of active esophageal cooling on catheter ablation procedure times across five healthcare systems
Authors: Joseph C , Cooper J , Zagrodzky J , Kulstad E , Bailey S , Sherman J , Nazari J , Athill C , Daniels J , Mcdonald S , Ruppert A , Willms D , Kawasaki R , Turer R , Metzl M 
Published: November 2023

Abstract

Background
Increased efficiency in procedure times may improve electrophysiology lab throughput and enhance patient care. The choice of esophageal protection method during pulmonary vein isolation (PVI) can affect procedural efficiency, with recent data suggesting that active esophageal cooling is associated with shorter procedure times when compared with luminal esophageal temperature (LET) monitoring.

Objective
To compare PVI procedure times before and after the adoption of active esophageal cooling in a large multicenter analysis.

Methods
Procedural data were obtained from 5 hospital systems before and after they adopted active esophageal cooling. Patient age, gender, and total procedure time were recorded and compared between groups before and after adoption of esophageal cooling.

Results
A total of 2,280 patient procedures completed by 16 different physiologists were reviewed from a total of 6 hospitals. The hospitals included academic medical centers, community hospitals, and integrated healthcare delivery systems. Prior to adopting active esophageal cooling, patients were treated with LET monitoring using either single or multi-sensor temperature probes. For the actively cooled patients the mean age was 66.7 ± 10.9 years and 33.5% were female. For the LET monitored patients the mean age was 64.2 ± 10.7 years and 34.5% were female. A total of 928 patients were treated with LET monitoring, with a mean procedure time of 173 ± 73 minutes. A total of 1352 patients were treated with active esophageal cooling, with a mean procedure time of 113 ± 51 minutes, representing a decrease of 60 minutes, or 34.7% of procedure time, compared with active esophageal cooling (P&lt;.001).

Conclusions
Active esophageal cooling during PVI was associated with up to a 34.7% reduction in procedure duration when compared to LET monitoring in this large multicenter analysis.
Long-term success rates of a stable, low pressure cryo balloon for the treatment of paroxysmal atrial fibrillation - results of the prospective, international, multicenter POLAR-ICE study
Authors: Luik A , Anic A , Asmundis C , Champ-Rigot L , Iacopino S , Martin C A , Sommer P , Tilz R R , Yap S C , Albrecht E M , Raybuck J , Richards E , Cielen N , Defaye P 
Published: November 2023

Abstract

Background/Introduction
Pulmonary vein isolation (PVI) using a cryo balloon is well-established for the treatment of paroxysmal atrial fibrillation (PAF). Compared to other available technologies, the usage of a stable, low pressure cryo balloon (POLARx, Boston Scientific) has demonstrated lower nadir temperatures and longer thawing times. However, long term efficacy and safety still needs to be proven.

Purpose
The aim of the POLAR-ICE Study was to evaluate long-term efficacy and safety outcome of cryo balloon ablation in patients with paroxysmal atrial fibrillation.

Methods
POLAR ICE, a prospective, non-randomized, international, multicenter study, enrolled 399 patients across 19 centers, between Aug 2020 and May 2021. Patients with paroxysmal atrial fibrillation undergoing de novo PVI were included into the study. During the index procedure, procedural characteristics, such as time to isolation (TTI), cryoablations per pulmonary vein, balloon nadir temperature, and occlusion grade were recorded. Procedural success was defined as successful isolation of each vein proven by entrance block. Follow up visits were at 3, 6, and 12 months. Recurrence is defined as any documented (ECG/Holter) episode of atrial fibrillation / atrial tachycardia longer than 30sec. after a blanking period of 3 months.

Results
399 patients (mean age 61 years, 36% female) were included into the study. After 12 months, freedom from any arrhythmia was 83.5% and freedom from atrial fibrillation 88.1% (Figure 1). Procedure/ablation related Serious adverse events occurred in 8.7% of patients, and included access complications (2.6%), cardiac tamponade (0.5%), air embolism (0.3%), AV block (0.3%), effusion (0.3%) phrenic nerve palsy (0.3%), stroke (0.3%), transient ischemic attack (0.3%). Redo procedures have been conducted in 19 patients. In 14/19 pts reconnection of at least one PV could be identified (RSPV n=8, RIPV n=12, LSPV n=9, LIPV n=11). Freedom from any arrhythmia was associated with lower nadir temperature (p=0.008) and longer time to thaw (p=0.05) during the index procedure.

Conclusions
In this prospective, non-randomized, international, multicenter study, isolation of the pulmonary veins using a stable, low pressure cryo balloon was highly effective and safe in patients treated for paroxysmal atrial fibrillation. Lower nadir temperatures and a longer thawing time were predictors of clinical success.
Pulsed field ablation and ventricular capture: assessing the need for R-wave gated therapy
Authors: Tranter J , Piorkowski C , Pipenhagen C , Mittal L , Boudlali H , Hughes B , Thao R , Fish J 
Published: November 2023

Abstract

Background
Pulsed field ablation (PFA) is a therapy that disrupts cellular homeostasis by applying high intensity and short duration electrical pulses to cardiac tissue, ultimately resulting in cell death. Such stimuli have the potential to initiate ventricular arrhythmias if the therapy is not synchronized with the beginning of ventricular systole (R-wave gating). For the treatment of cardiac arrhythmias, it is important that the candidate therapy locations in the left atrium (e.g., pulmonary veins) are a sufficient distance away from ventricular tissue to avoid ventricular capture. Objective data exploring the need for R wave gating in the context of PFA therapy for pulmonary vein isolation is currently lacking.

Purpose
To study the effect of electrode distance of the 12-electrode loop catheter from the epicardium on likelihood of ventricular capture.

Methods
A sternotomy was performed on swine to expose the heart. An incision was then made in the pericardial sac and the edges were lifted and sutured to the surrounding chest cavity to create a cradle. The function of the cradle was to hold a ∼37C saline solution (tuned to match the electrical conductivity of blood) while PFA treatments were performed. Two left ventricular sites (apex and lateral aspect) were selected for treatment, taking care to avoid proximity to the coronary artery. For each PFA therapy trial, the catheter loop was positioned 10mm above the surface of the epicardium and then advanced in 1mm increments until capture was achieved; spacers were used to assure fixed spacing during cardiac activity. For each trial, the maximum distance between the catheter and the epicardium at which the IRE therapy captured the ventricle was recorded. Additionally, CT scans (N=20 human patients) were analyzed to understand distances of interest to ventricular tissue.

Results
N=12 trials were conducted at each target in each animal (N=48 total ablations). For all trials, the minimum capture distance was found to be 6-8mm (4/48 at 6mm, 28/48 at 7mm and 16/48 at 8mm), with a mean capture distance of 7.25±0.60mm. The mean capture distances for the left ventricular apex and lateral aspect were 7.29±0.55mm and 7.21±0.66mm, respectively (p=0.636).
For the CT scan analysis, the minimum distance from pulmonary vein ostia to left ventricular tissue ("nominal case") were 10.6mm and 12.8mm for the left superior and inferior veins, respectively. Considering the use ("worst case") where the catheter is placed just distal to the ostia, the distances to ventricular tissue were 1.6mm and 5.8mm, respectively; 4/20 patients had a vein less than 10mm from ventricular myocardium.

Conclusions
This study was successful in establishing the distance of ventricular capture via PFA therapy (6-8mm for the considered therapy). Given the described use and CT analysis, there is potential risk in triggering ventricular arrhythmia via PFA therapy unless R-wave triggering is implemented.
High-power short-duration ablation of the atrioventricular node
Authors: Alsaiqali M , Ahmed R , Alsaiqali G , Budzikowski A , Jallad A 
Published: November 2023

Abstract

Introduction
There are limited studies that compare different radiofrequency ablation catheters in atrioventricular node (AVN) ablation. Our study compared the effectiveness of several radiofrequency ablation catheters in AVN ablation.

Methods
We identified patients who underwent AVN ablation at our institution. Data related to patients and procedures were collected through retrospective chart review. The radiofrequency catheters compared were plain non-irrigated, externally irrigated (EI), and contact force sensing in two different settings: low-power long duration (LPLD) and high-power short duration (HPSD). We compared the different catheters in terms of success rate using logistic regression and lesion time using linear regression.

Results
We identified 66 patients who underwent AVN ablation, out of which 31 were female (47%). The patients were elderly, with a mean age of 73.27 years. The indications were resistant atrial fibrillation in 74%, atrial flutter in 18%, and other atrial tachycardias in 8% of patients. Types of catheters used were plain non-irrigated in 48%, EI in 2%, LPLD in 16%, and HPSD in 34% of patients. All ablation procedures were successful with no immediate post-procedure complications. Regarding lesion time, HPSD was significantly shorter compared to plain catheters by 403.42s[-631.67, -175.17] as shown in table 1.

Conclusions
While plain catheter, LPLD, and HPSD were equally safe and effective, HPSD catheter had significantly shorter lesion time and thus procedure time.
Analysis of thermal effects from pulsed field ablation
Authors: Mercado Montoya M , Gomez Bustamante T , Kulstad E , Mickelsen S , Gonzalez Suarez A 
Published: November 2023

Abstract

Background
Pulsed field ablation (PFA) has been described as non-thermal, but abundant data exist in oncology applications [1-3], and growing data are emerging in cardiology [4], highlighting that thermal effects are in fact present with PFA. The particular parameters (such as voltage, pulse gap, pulse number) that most influence the development of thermal energy during PFA are less clear.

Purpose
We sought to evaluate the thermal effects arising from pulsed field ablation of myocardial and esophageal tissue over a range of typical peak voltage operating conditions.

Methods
Using a three-dimensional computer model of the left atrium and esophagus, we quantified the thermal effects from PFA applications over a range of peak voltage operating conditions (1 kV, 1.5 kV, and 2 kV). Bipolar electroporation was simulated using one electrode as the anode and the other as a grounded cathode. Far-field and symmetry boundaries were set as electrically insulating. A monophasic waveform with a pulse duration of 100 µs and pause between pulses of 1 s was applied for a total of 50 pulses in a single train. Myocardial thickness was 1.5 mm, esophageal thickness was 2 mm, and the pericardial fat layer was varied between 0.3 and 0.75 mm.

Results
Minimal temperature rise in the esophagus was seen with 1 kV pulses (corresponding to 13.4 J input). With 1.5 kV and 2 kV peak voltages (corresponding to 32.3 J and 66.2 J), temperature elevations reaching 46.3 °C and &gt; 62 °C were seen, respectively. These elevations occurred after only a single pulse train of 50 pulses, implying that further elevations in temperature would be seen with subsequent applications.

Conclusions
Thermal effects from PFA depend on total energy deposited, of which peak voltage is an important component. Current commercially available systems appear to have the potential to induce collateral thermal injury, particularly with a thin pericardial fat layer, and with repeated applications of pulsed field energy.
New mapping for determination of left atrial posterior wall isolation for non-paroxysmal atrial fibrillation
Authors: Suzuki A , Amemiya M , Usui M , Yamauchi Y 
Published: November 2023

Abstract

Background
Recent studies have reported that the efficacy of posterior wall isolation(PWI) created by cryoballoon for non-paroxysmal atrial fibrillation. However, there are no clear criteria for determining whether or not to perform PWI, and it is left to the discretion of the operator. Then we evaluated the necessity of additional PWI by measuring non-passively activated ratios(%NP), the ratio of the form of rotors and multiple wavelets, using ExTRa mapping and verified its usefulness.

Methods and Results
44 patients with non-paroxysmal atrial fibrillation who underwent cryoballoon ablation(CBA) were divided into two groups according to whether using ExTRa mapping(ExTRa group; 21 patients) or not(no-ExTRa group; 23 patients), and the long-term results were compared. In ExTRa group, ExTRa mapping was performed before PVI, after PVI, and after roof block(LA-RB) creation using cryoballoon. After creating LA-RB, if more than 50% of %NP remained in the left atrium, PWI was performed by creating a bottom block(LA-BB) using cryoballoon. After a median follow-up period of 12months(2 to 34 months), arrhythmia-free survival rate was higher in the ExTRa group than in the no-ExTRa group(95.2% vs 69.6%, p&lt;0.05%).

Conclusion
Evaluation of %NP using ExTRa mapping is extremely useful in determining the additional PWI for non-paroxysmal atrial fibrillation.Voltage mapping & ExTRa mapping
Same day discharge after interventional electrophysiology procedures, first German experience
Authors: Popescu S S , Heeger C H , Vogler J , Eitel C , Feher M , Kirstein B , Phan H L , Marburg M , Breithaupt C , Delgado Lopez M L , Kuck K H , Tilz R R 
Published: November 2023

Abstract

Background and purpose
In most European countries, the current postprocedural gold standard following electrophysiological (EP) interventions implies the overnight monitoring of the patients in the hospital. Due to limited healthcare capacities and an increasing safety profile of ablation procedures, the mandatory overnight monitoring is under debate.
Same day discharge protocol (SDD) ablation might be a safe and efficient alternative. We present the first German experience on SDD for EP interventions.

Methods
Patients receiving interventional EP procedures with a maximum of two VAs were discharged on the day of procedure, after the hemostasis and ambulation were proven. The VA hemostasis was achieved either by using a vascular closure system (VCS) or by a figure-of-eight suture followed by compressive bandage application. All patients were scheduled for a medical visit the day after procedure for groin examination and suture removal.

Results
A total of 12 patients (25% females, median age 64 (57.3, 66.8) years, median BMI 30.5 (22.3, 33.7) Kg/m2) undergoing EP procedures followed the SDD protocol in our center.
All patients had an atrial fibrillation (AF) diagnosis, 66.7% of them paroxysmal. Five (45.5%) patients had a CHA2DS2VASc score of 1. A total of 4 (33.3%) patients presented arterial hypertension, 3 (25%) diabetes mellitus, 1 a history of stroke, 1 of myocardial infarction and 1 had chronic kidney disease and kidney transplantation. Eleven (91.7%) patients were under oral anticoagulation. The most common procedure was AF ablation, in 10 (83.3%) patients, while 1 (8.3%) patient underwent cavotricuspid isthmus (CTI) ablation and 1 (8.3%) a left atrial appendage closure procedure. In 10 (72.7%) AF ablations the energy source was cryoenergy, in 1 laserenergy and in 1 electroporation. The CTI ablation was performed by means of radiofrequency.
A VCS was used in 7 (58.3%) patients. Six of these patients received 2 VCSs, while the patient with PFA based ablation had a single vascular access, thus only one VCS. The procedure was reported successful in all cases, and no intraprocedural complication occurred.
During the next day visit, a groin hematoma has reported in 2 (16.7%) patients, no one requiring further therapeutical measures or hospitalization. All the other patients had no puncture related complications. The median FU time was 46.5 (26, 90.3) days. During FU only one patient had an unplanned ambulatory visit due to flecainide intolerance. Readmission during FU was reported in only 2 patients, none of them procedure related.

Conclusions
In selected patients undergoing EP procedures SDD seems to be safe and feasible. This approach increases healthcare capabilities, patients' comfort and reduces the cost of medical care.
The zero fluoroscopic approach to avnrt ablation significantly reduces radiation without compromising safety, efficacy or procedure time compared to a conventional or minimal fluoroscopic approach
Authors: Saidane L , Robaye B , Kasbari R , Dormal F , Ballant E , Collet B , Blommaert D , Xhaet O 
Published: November 2023

Abstract

Introduction
In 2020, we showed that ablation of AVNRT (induced under conventional fluroscopy) with a 3D electro-anatomical mapping system (EAMS) (minimal X-RAY group) significantly reduces radiation exposure without compromising safety, efficacy and procedure time compared to a procedure performed entirely under conventional fluoroscopy (X-RAY group).

Purpose
The objective of this study was to determine whether the direct use of EAMS in selected patients with a high probability of induction of AVNRT could reduce radiation exposure to near zero without compromising the safety, efficacy and duration of the procedure (EAMS group)

Methods
We compare the 136 patients in the X-RAY group, the 141 patients in the minimal X-RAY group with 39 patients included in the EAMS group (included between July 2020 and December 2022). All procedures were performed at a single centre in Belgium using the same 3D electroanatomical mapping system. In the EAMS group, fluoroscopy had to be used to guide catheter progression for only 5 patients. We compared radiation dose, acute success, complication rates and procedure duration.

Results
AVNRT induction was achieved in 38 of 39 patients in the EAMS group. Only one patient was not inducible, but the slow pathway ablation was performed on the basis of the arrythmic ECG recording which was highly suggestive of AVNRT; the success of the ablation could therefore not be validated acutely.
Radiation dose in the EAMS group was significantly lower compared to the minimal X-RAY group and X-RAY group (8,5 vs 1179 and 2686 mgray.cm2, p &lt;0,0001) and fluroscopic time was obviously shorter (0,02 vs 2,5 and 8,6 minutes, p&lt;0,0001). Procedural time (74,3 vs 70 and 69 mon, p = NS) and success rate (97,5% vs 99 and 98%, p = NS) were not significantly different in the three groups.
No serious complications were observed in any group. No minimal complication were reported in the zero-fluoroscopy group.

Conclusion
AVRNT catheter ablation using a zero-fluoroscopic approach with EAMS significantly reduces radiation exposure without compromising safety, efficacy or procedure time.
Catheter ablation for ventricular tachycardia after myocardial infarction: meta-analysis of randomised controlled trials
Authors: Reddy R K , Howard J P , Ahmad Y , Shun-Shin M J , Simader F A , Miyazawa A A , Saleh K , Samways J , Keene D , Linton N W F , Francis D P , Whinnett Z I , Luther V , Kanagaratnam P , Arnold A D 
Published: November 2023

Abstract

Background
The prognostic impact of ventricular tachycardia (VT) catheter ablation is an important outstanding research question.

Purpose
We undertook a reconstructed individual patient data meta-analysis of randomised controlled trials comparing ablation to medical therapy in patients developing VT after myocardial infarction (MI).

Methods
We systematically identified all trials comparing catheter ablation to medical therapy in patients with VT and prior MI. The pre-specified primary endpoint was all-cause mortality assessed using reconstructed individual patient data obtained by digitisation of published Kaplan-Meier curves and subsequent construction of Cox proportional hazards regression models. Pre-specified secondary endpoints included trial-level assessment by random effects meta-analysis of all-cause mortality, VT recurrence, defibrillator shocks and all-cause hospitalisations. Meta-regression was performed to evaluate the effect of VT mapping in addition to substrate modification. Sensitivity analyses were performed depending on the proportion of patients with prior MI included. (PROSPERO ID CRD42023390799)

Results
Eight trials, recruiting a total of 874 patients, were included. 430 patients were randomised to catheter ablation and 444 to medical therapy. Catheter ablation reduced all-cause mortality compared to medical therapy when synthesising reconstructed individual patient data (hazard ratio 0.57, 95% confidence interval (CI) 0.38 to 0.85, p=0.007), but not in trial-level analysis (relative risk 0.91, 95%CI 0.67 to 1.23, p=0.53, I2=0%). Catheter ablation significantly reduced VT recurrence, defibrillator shocks and hospitalisations compared to medical therapy. Sensitivity analyses were consistent with the primary analyses.

Conclusion
In patients with post-infarct ventricular tachycardia, catheter ablation reduces mortality.
Clinical and echocardiographic impact of physiological estimulation in patients with preserved ejection fraction: a randomized clinical trial
Authors: Rodriguez Queralto O , Gonzalez Matos C , Zaraket F , Jimenez Lopez J , Casteigt B , Moreno Coca J , Valles Gras E 
Published: November 2023

Abstract

Introduction
Right ventricular stimulation in the apex (RVAS) produce dysynchrony, leading to left ventricle systolic dysfunction (LVSD) in some cases. Circumstances that can worsen the LVSD are a high burden of RVAS, and the presence of previous LVSD and/or intraventricular conduction disease (IVCD). Direct activation of the specialized conduction system with physiological stimulation (PS) can preserve this physiological pattern and shorten de QRS when the impairment is proximal to the pacing site. Most of the studies with PS has been focused on patients with LVSD, with few and scarce evidences regarding pacients without LVSD.
Objectives and methods: This is a parallel, single blinded, unicentric, randomized trial of patients with preserved of mild reduced left ventricular ejection fraction (LVEF) submitted to a pacemaker implantation due to atrioventricular block (AVB), with previous IVCD (wide QRS) an anticipated high rate of ventricular pacing. Patients were randomized 1:1 to RVAS vs PS and followed for 6 months. Clinical, ECG, echocardiography and analytic parameters were compared. The primary endpoint was the change in the LVEF at 6 months in each group. The secondary endpoints were the changes in the left ventricular end-diastolic diameter (LVEDD), the QRS duration, the pro–B-type natriuretic peptide (NT-proBNP), the NYHA class, and the Minnesota Living with Heart Failure Questionnaire (MLWHFQ) in each group.

Results
The study included 57 patients of 77±9,6 years. Of all patients, 53% were treated with RVAS and 47% with PS. There were 2 patients with crossover to RVAS for technical difficulties and 1 patient with crossover to PS due to apical scar. There were no differences in the basal QRS duration (142.08±20,2 ms), LVEF (58.87±7,2%), NT-proBNP (3336,03±7258,68 pg/ml), or MLWHFQ (22,19±14,68), between both groups (Table 1). Acutely significant differences were observed in the change of QRS duration among groups (+16±29 ms in the RVAS group vs -17±25 ms in the PS group, p&lt;0,001). At 6 months follow-up LVEF showed a non-significant reduction of 0.8±1.1% in the PS group compared to a significant reduction of 5.1±1.7% in the RVAS group (difference 4,26% IC 0,1-8,43 p=0,022). No differences were observed regarding the values of the NT-ProBNP and the MLWHFQ between groups at 6 months (Table 2).

Conclusions
In patients with preserved LVEF requiring pacemaker implantation for AVB, PS shorten the QTS duration and preserves the LVEF compared to RVAS.Basal characteristics of groupsDifferences in outcomes between groups