bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiac resynchronization therapy with or without defibrillation in patients with non-ischemic cardiomyopathy: a systematic review and meta-analysis
Authors: Devesa Neto V , Ferraz Costa G , Ferreira Santos L , Teixeira R , Goncalves L 
Published: November 2023

Abstract

Introduction
Cardiac resynchronization treatment (CRT) is a significant medical achievement for patients with heart failure and electrical desynchrony to relieve symptoms, reduce hospitalization, and increase survival, both with and without implantable cardioverter-defibrillator therapy. However, the value of defibrillator therapy in addition to CRT in patients with non-ischemic cardiomyopathy (NICM) who are eligible for CRT remains unclear.

Objective
Compare the outcomes of patients with NICM and heart failure who received CRT with implantable cardioverter-defibrillator (CRT-D) against CRT-pacemaker only (CRT-P).

Methods
A literature search from inception through January 2023 was conducted in PubMed and Cochrane Central Register of Controlled Trials for all studies reporting outcomes of CRT-D versus CRT-P in CRT-eligible patients with NICM. Studies reporting non-stratified outcomes, including patients with ischemic cardiomyopathy, were excluded. The primary endpoint of interest was all-cause mortality. Secondary outcomes included device complications. A random-effects model was used.

Results
Of a total of 1976 potential citations, the search yielded 9 citations that met our inclusion criteria. Ten studies were included, one randomized clinical trial and nine observational studies, providing 11064 CRT-eligible patients with NICM (7459 CRT-D implantation and 1275 with CRT-P). Our meta-analysis revealed a significantly lower all-cause mortality (pooled OR, 0.85; 95% CI [0.75, 0.97], P = 0.02; I ²= 31%), albeit with moderate heterogeneity. Additionally, regarding device complications, only one study reported these outcomes with no significant difference (HR 0.82 [95% CI, 0.29–2.20]).

Conclusions
Our meta-analysis suggests that the addition of defibrillator therapy significantly reduced all-cause mortality in CRT-eligible patients with NICM.
Empirical Marshall vein ethanol infusion as the first-line strategy in patients with persistent atrial fibrillation undergoing mitral isthmus ablation
Authors: Du X F , Luo C X , Shen C J , Feng M J , He B , Fu G H , Wang B H , Liu J , Jin H , Gao F , Chu H M 
Published: November 2023

Abstract

Background
Marshall vein ethanol infusion (MVEI) as an additional therapy to conventional catheter ablation (CA) has been proved to be efficacious in patients with persistent atrial fibrillation (PeAF). However, whether empirical MVEI could be the first-line strategy in mitral isthmus (MI) ablation has seldomly been investigated.

Objective
To compare the efficacy, safety and long-term outcomes between provisional and empirical MVEI in PeAF patients undergoing their index MI ablation.

Methods
We enrolled 133 propensity-score matched patients with PeAF at a ratio of 1:2.5 either into the provisional group (n=38, MVEI was performed when conventional endocardial and/or epicardial ablations were inadequate to achieve bidirectional MI block) or the empirical group (n=95, MVEI was applied empirically before MI CA). Baseline characteristics, procedure results and long-term outcomes were compared between groups.

Results
All of the baseline characteristics were comparable. Less spontaneous or inducible atrial tachycardias (ATs) including MI-dependent ones were encountered in the empirical group (P&lt;0.001). More epicardial ablations were applied (26.3% vs 9.5%, P=0.016) and higher incidence of CA-facilitated restoration of sinus rhythm was recorded (86.8% vs 11.7%, P&lt;0.001) in the provisional group. Although more fluoroscopy time (6.4[4.2, 9.3] vs 9.5[5.9, 11.6] min, P=0.019) and radiation exposure (69.0[25.3, 160.2] vs 122.0[62.5, 234.1] mGy, P=0.010) were documented in the empirical group with comparable procedure time, less time was consumed to achieve bidirectional MI block during endocardial ablation in the empirical group (455.9±192.2 vs 366.5±161.3 sec, P=0.038). Incidences of procedure-related complications were similar between groups. During a 16.5±4.4-month follow-up, the empirical group showed significantly higher freedom from AT recurrence (81.6% vs 95.8%, log-rank P=0.003), while the freedoms from AF recurrence were similar. Both univariate (HR 0.19, 95%CI 0.05-0.64, P=0.008) and multivariate (HR 0.25, 95%CI 0.07-0.92, P=0.037) Cox regression analyses indicated that empirical MVEI was independently associated with lower long-term AT recurrence.

Conclusion
Among patients with PeAF underwent their index MI ablations, empirical MVEI could reduce the endocardial MI ablation time and improve the long-term freedom from AT recurrence.Flowchart of the study.Freedoms from AF and AT recurrence
Efficacy of nonocclusive separate freezing technique of cryoballoon pulmonary vein isolation: comparison of novel and conventional cryoballoon system
Authors: Arai H , Oda A , Murata K , Sagawa Y , Goya M , Sasano T , Yamauchi Y 
Published: November 2023

Abstract

Background/Introduction
Complete occlusion of pulmonary vein (PV) with cryoballoon is an important factor to achieve enough temperature drop and successful pulmonary vein isolation (PVI). However, it is sometimes difficult to occlude PV completely because of large diameter or anatomical difference. Distal cryoblloon positioning in the PV can achieve complete occlusion but it may increase risk of phrenic nerve injury or PV stenosis. Nonocclusive separate freezing technique, freezing superior and inferior portion of the PV at proximal side with no complete occlusion, may be useful for that situation but efficacy of the technique is not well elucidated.

Purpose
The purpose of this study is to investigate efficacy of nonocclusive separate freezing technique and compare procedure details of the POLARx and the Arctic Front Advance Pro (AFA-Pro).

Methods
We retrospectively analyzed consecutive patients who underwent cryoballoon ablation with nonocclusive separate freezing technique from September 2019 to February 2023. We defined failure of the nonocclusive separate freezing as the case which needed distal complete occlusion with cryoballoon or touch up radiofrequency ablation to achieve PVI. We analyzed success rate of nonocclusive separate freezing and evaluated nadir temperature, freezing time and number of application times. We also explored incidence of stop of freezing due to phrenic nerve injury (PNI) or esophageal temperature drop during the procedure and permanent PNI and gastroesophageal complications after the procedure between the POLARx and the AFA-Pro.

Results
One-hundred and one patients, 73 were male (72.3%) and mean age was 66.8 ± 10.5 years, were analyzed. Total PVs were 121 (left superior (LS) PV 31, right superior (RS) PV 53, left common (LC) PV 37) and the POLARx was 45 (LSPV 18, RSPV 24, LCPV 3) and the AFA-Pro was 76 (LSPV 13, RSPV 29, LCPV 34). Success rates of the separate freezing of the POLARx was 84.4% and the AFA-Pro was 77.6% (p=0.48). There were no significant differences in freezing time and number of application times but nadir temperature was significantly lower in the POLARx (-52.1 ± 4.7 °C vs -42.9 ± 7.2 °C, p&lt;0.001). The incidence of stop of freezing had no significant difference between the POLARx and the AFA-Pro but nadir temperature of stop of freezing due to esophageal temperature drop was significantly lower in the POLARx (-53.8 ± 4.3 °C vs -44.7 ± 7.7 °C, p=0.039). Permanent PNI was not seen but two gastric hypomotility events occurred in the POLARx.

Conclusions
There was no significant difference of success rate of the nonocclusive separate freezing technique but it tended to be higher and nadir temperature was significantly lower in the POLARx. There was no obvious complication in the AFA-Pro but two gastric hypomotility events were seen in the POLARx.
The significance of excessive supraventricular ectopic activity immediately after catheter ablation in the risk stratification for late recurrence of atrial fibrillation
Authors: Fujisawa T , Kawakami H , Nagai T , Miyazaki S , Akazawa Y , Miyoshi T , Higaki A , Seike F , Higashi H , Nishimura K , Inoue K , Ikeda S , Yamaguchi O 
Published: November 2023

Abstract

Background/Introduction
Early recurrence of atrial fibrillation (AF) (&lt;3 months) after ablation is associated with late recurrence (≥3 months). Even absent early AF recurrence, patients frequently experience postprocedural supraventricular ectopic complexes (SVEC). Excessive supraventricular ectopic activity (ESVEA) is a new surrogate marker for new-onset AF and poor stroke prognosis. However, the relationship between ESVEA and late recurrence of AF post-ablation is poorly understood.

Purpose
We hypothesized that postprocedural ESVEA would be associated with late recurrence of AF. We also investigated use of ESVEA compared to early recurrence of AF for stratifying patients’ risk of late recurrence of AF.

Methods
Participants were patients with AF who underwent initial radiofrequency catheter ablation and 24-Holter monitoring the day after the procedure between 2014 and 2020. SVEC was defined as supraventricular complexes occurring ≥30% earlier than expected compared with the previous RR interval. ESVEA was defined as at least 30 beats of SVEC per hour, or any episodes of SVEC runs ≥20 beats. Atrial tachyarrhythmia lasting for longer than the 30s was defined as AF recurrence. We analyzed the association between postprocedural Holter monitoring results and late recurrence of AF.

Results
We enrolled 469 patients with AF (average ± SD 63.6 ± 10.1 years; 32% female; 56% paroxysmal AF). We observed early recurrence of AF (n = 57; 12%) and ESVEA (n = 287; 61%) during postprocedural Holter monitoring in these patients; 125 patients (27%) had no signs of AF or ESVEA. During a median follow-up of 25 months, 152 patients (32%) experienced a late recurrence of AF. Patients who demonstrated early AF recurrence or ESVEA during Holter monitoring were significantly more likely to experience late recurrence of AF, even after adjusting for various clinical parameters and left atrial enlargement. Patients with early recurrence of AF had the worst outcomes, and AF-free survival was significantly worse in patients with ESVEA than patients without early recurrence of AF (Figure).

Conclusions
ESVEA on post-procedure day 1, even without AF, was associated with worse clinical outcomes following initial AF ablation. Postprocedural 24-Holter monitoring may reveal an increased risk of late recurrence of AF secondary to observation of recurrent AF or ESVEA.
Utilization and complications of atrial fibrillation catheter ablation among cancer patients
Authors: Margolis G , Goldhaber O , Kazatsker M , Roguin A , Leshem E 
Published: November 2023

Abstract

Background
Atrial fibrillation (AF) catheter ablation among cancer patients was evaluated only in a few small studies. We investigated the extent and in-hospital outcomes of AF catheter ablation procedures among cancer patients.

Methods
Using the National Inpatient Sample (NIS) database, patients who underwent AF catheter ablations in the US between 2016 and 2019 were identified using ICD-10 codes. Sociodemographic, clinical data, in-hospital procedures and outcomes as well as in-hospital mortality and length-of-stay (LOS) were collected. Baseline characteristics and in-hospital outcomes comparison between patients with and without cancer was performed.

Results
An estimated total of 36630 patients underwent AF catheter ablation between 2016-2019 in the US. Of them, 585 (1.6%) had cancer diagnosis. Compared with non-cancer patients, patients with cancer were older, had higherCharlson Comorbidity Index, as well as CHA2DS2-VASc and ATRIA bleeding indices scores (Table 1).
Higher rate of total complications was observed in cancer patients (10.3% vs 7.0 , p=0.002) driven mainly by more bleeding and infectious complications. LOS was also significantly longer in cancer patients (5.5 + 6.3 vs. 3.1 + 3.4 days, p&lt;0.001). However, no significant differences in cardiac or neurological complications as well as in-hospital mortality rates were observed and were relatively low in both groups (Table 2).

Conclusion
AF catheter ablation in cancer patients is associated with higher bleeding and infectious complication rates, but not with increased cardiac complications or in-hospital mortality rates in a nationwide, all-comer registry.
Comparison in efficacy of catheter ablation for elderly versus non-elderly patients with persistent atrial fibrillation
Authors: Matsuoka Y , Sotomi Y , Hikoso S , Nakatani D , Okada K , Dohi T , Kida H , Sunaga A , Sato T , Kitamura T , Tanaka N , Masuda M , Watanabe T , Inoue K , Sakata Y 
Published: November 2023

Abstract

Background/Introduction
Atrial fibrillation (AF) is common arrythmia among elderly patients. Advancing age is reportedly associated with left atrium (LA) fibrosis and remodeling. We hypothesized that an extensive ablation strategy in addition to pulmonary vein isolation (PVI-plus) might be effective for elderly patients, whereas the PVI alone strategy (PVI-alone) might be sufficient for young patients to maintain sinus rhythm.

Purpose
We investigated the efficacy of ablation strategy (PVI-alone or PVI-plus) for AF patients stratified by age.

Methods
This study is a post-hoc analysis of the EARNEST-PVI trial. The EARNEST-PVI trial was a prospective, multicenter, randomized, and open-label non-inferiority trial comparing PVI-alone vs PVI-plus in patients with persistent AF. The primary endpoint was recurrence of AF.

Results
A total of 497 patients were eligible and divided into two groups (elderly group (age≥65, n=291) or young group (age&lt;65, n=206)). In elderly group, the event rate was significantly lower in the PVI-plus group than in the PVI-alone group (Hazard ratio (HR): 0.587, 95% confidence interval (CI): 0.406 – 0.849, P = 0.0047), while the event rate was similar between both groups in young group (HR: 1.101, 95%CI: 0.687 - 1.77, P = 0.692) (P for interaction: 0.0411).

Conclusion
In elderly patients, PVI-plus strategy was more effective than PVI-alone, whereas the PVI alone strategy was sufficient for young patients.
Catheter ablation of persistent atrial fibrillation: circumferential pulmonary vein ablation with or without a linear lesion at the left atrial roof for (12-year follow-up)
Authors: Kettering K 
Published: November 2023

Abstract

Background
Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation. Circumferential pulmonary vein ablation is still the standard approach in these patients. However, the results are not very favourable and more complex ablation strategies are the subject of current controversy.
Therefore, we have evaluated the effect of an additional linear lesion at the roof of the left atrium on the long-term outcome.

Methods
A total of 300 patients (155 men, 145 women; mean age 72 years (SD ± 18 years)) with symptomatic persistent atrial fibrillation underwent a circumferential pulmonary vein ablation procedure in combination with an additional linear lesion at the roof of the left atrium (group A). After discharge, patients were scheduled for repeated visits at the arrhythmia clinic at 1, 3, 6, 12, 24, 36, 48, 60, 72, 84, 96, 102, 108, 120, 132, 138 and 144 months after the ablation procedure.
The long-term follow-up data was compared to 300 patients who underwent circumferential pulmonary vein ablation without an additional linear lesion at the roof of the left atrium (group B).

Results
The ablation procedure could be performed as planned in all patients.
Sixfty-six out of 300 patients (22.0 %) in group A and 69 out of 300 patients (23.0 %) in group B experienced an arrhythmia recurrence within the first 3 months after ablation requiring an electrical cardioversion. At 144-month follow-up, analysis of a 168-hour ECG recording revealed no evidence for an arrhythmia recurrence in 171/300 patients (57.0 %) in group A and in 141/300 patients (47.0 %) in group B. In 87/300 patients (29.0 %) in group A and 78/300 patients (26.0 %) in group B, only short episodes of paroxysmal atrial fibrillation were documented. In 42 patients (14.0 %) in group A, a recurrence of persistent atrial fibrillation (&gt; 48 hours) was revealed by the long-term recordings (group B: 81 patients (27.0 %)). The lower arrhythmia recurrence rate in group A was partially due to a lower incidence of atypical atrial flutter after catheter ablation. The rate of repeat ablation procedures was significantly lower in group A than in group B. There were no major complications.

Conclusions
Catheter ablation of persistent atrial fibrillation comprising a circumferential pulmonary vein ablation and an additional linear lesion at the roof of the left atrium provides more favourable results than circumferential pulmonary vein ablation alone. The effect is more pronounced during long-term than during short-term follow-up.
Results of atypical flutter ablation in the era of high density electroanatomical mapping (the RAFAELA study)
Authors: Lozano-Granero C , Moreno J , Sanchez-Perez I , Matia-Frances R , Hernandez-Madrid A , Zamorano J L , Franco E 
Published: November 2023

Abstract

Introduction
Atypical flutter (AFL) ablation is a technically challenging procedure with limited long-term efficacy according to prior studies and not exempt from risks.

Purpose
The aim of this study was to describe the efficacy, in terms of acute and long-term rhythm management, and safety of AFL ablation guided by high-density electroanatomical mapping in a population of contemporary patients. We aimed also to compare results between different patient populations.

Methods
From june 2015 to November 2021, all consecutive AFL ablation procedures guided by high-density electroanatomical mapping were included in the study. Patients were classified in 4 groups according to history of atrial catheter ablation, cardiac surgery, congenital heart disease or none of the above (considered as primary disease). Activation and voltage mapping were used to define AFL circuits and substrate. After AFL characterization, radiofrequency lesions were performed to operator’s discretion until AFL termination. Programmed atrial stimulation was repeated to test AFL inducibility, and any sustained induced atrial arrhythmia was ablated. Procedural success was defined as termination of every induced AFL and no-inducibility. A 3-month blanking period was considered. Follow-up included visits with ECG and/or 24h Holter-ECG at 3, 6, 12, 24 months, and from there on according to physician’s discretion.

Results
190 AFL procedures in 160 patients were included. Patient and procedural characteristics of the global cohort as well as different patient populations (27% primary, 37.9% post-ablation, 15.3% post-surgery, 20% congenital heart disease (CHD)) can be found in figure 1 (table).
Survival free from atrial arrhythmias in pre-specified groups is shown in figure 2 (left). Overall, a 2-year ∼50% recurrence rate was observed, with a tendency to better outcome in patients with congenital heart disease (∼70%), over the rest of the groups, which behaved similarly (p=0.281). Progression to permanent atrial arrhythmia was lower in this subgroup (2.7% vs 23.5%, p=0.028), as shown in figure 2 (right), probably related to higher rhythm control efforts and stricter follow-ups.

CONCLUSIONS
In the era of high-density electroanatomical mapping, acute procedural success is achievable in the majority of patients, but recurrence rate remains high, with an approximate 50% 2-year recurrence rate except for congenital heart disease patients, which tend to show better survival free from atrial arrhythmias.Figure 1Figure 2
Risk of stiff left atrial syndrome following pulse-field-based ablation of atrial fibrillation in patients with pulmonary hypertension at baseline
Authors: Mohanty S , Della Rocca D G , Chierchia G B , Dello Russo A , Casella M , Gianni C A R O L A , Macdonald B , Mayedo A , La Fazia V M , Torlapati P G , Bassiouny M , Gallinghouse G J , Horton R , De Asmundis C , Natale A N D R E A 
Published: November 2023

Abstract

Introduction
Studies have reported development of stiff LA syndrome, defined as pulmonary hypertension (PH) secondary to reduced LA compliance, in some patients following AF ablation.

Purpose
We compared the risk of worsening of baseline PH in non-paroxysmal AF (persistent and long-standing persistent AF) patients undergoing repeat procedures, either pulse-field ablation (PFA) or standard radiofrequency ablation (RFA).

Methods
This multicenter study included 28 non-paroxysmal AF patients with PH, undergoing PFA-based ablation procedure after &gt;1 failed radiofrequency ablations (RFA). A cohort of 28 AF patients with PH that were scheduled for repeat RF ablation were identified. Propensity scores were computed using multivariate logistic model. Twenty-eight patients from the RFA cohort were selected by 1:1 propensity score matching with the PFA group. Right heart catheterization was performed pre- and post-procedure to assess the Pulmonary artery pressure (PAP).
PH was defined as resting mean PAP of ≥20 mmHg. The follow-up PAP and change from baseline were compared between PFA and RFA groups, after controlling for baseline PAP in an ANCOVA model.

Results
Baseline characteristics of PFA (age 62.21 ± 9.3 yrs, male 19 (67.9%), LAD 3.7 ± 0.66 cm) and propensity-matched RF groups (age 62.39 ± 9.3 yrs, male 18 (64.3%), LAD 3.7 ± 0.74 cm) were comparable. The mean pulmonary artery pressure (PAP) assessments at baseline, follow-up and change from baseline are presented in table below. The groups had comparable baseline PAP (p= 0.157). At follow-up, RF group reported 19.81 mm Hg increase in PAP (within-group p &lt;0.001). In PFA group, follow-up PAP showed a decreasing trend (-1.67 mm Hg, within-group p= 0.114). Compared to PFA, the change was significantly higher in RFA (p &lt;0.0001) after controlling for baseline PAP).

Conclusion
In this propensity-matched population, pulse-field ablation was demonstrated to be a safer option in terms of post-ablation worsening of PAP, compared to the RF ablation in AF patients with pulmonary hypertension at baseline.