bluuebunny/crossref_metadata_2025_split huggingface dataset:
LA workflow recommendations for intracardiac echocardiography integration with artificial intelligence 3D algorithm
Authors: Di Biase L , Lin A , Grupposo V , Marazzato J , Tarantino N , Haiman G , Haimovich D , Matthew R , Alcazar J , Costa G , Urman R , Zou F , Zhang X 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The creation of an artificial intelligence imaging algorithm, the CARTOSOUND FAM Module, shows promise in enhancing current intracardiac echocardiography (ICE) practices, particular in atrial fibrillation (AF) ablation. However, there is a gap of knowledge associated with how to best optimize current practices. This study aims to provide workflow recommendations based on a high-volume US center.

Methods
The CARTOSOUND FAM Module is an automated version of the legacy CARTOSOUND Module. It incorporates an automatic algorithm that enables automatic detection of cardiac anatomy using a series of 2D ultrasound views. The left atrial (LA) algorithm uses a series of 2D ultrasound frames acquired from the right atrium (RA)/fossa ovalis and the RVOT to: create a 3D volume reconstruction of the LA anatomies (LA Body, LAA, LSPV, LIPV, RSPV, and RIPV), provide 3D auto-segmentation for the relevant anatomical structures, generate 2D auto-contours that are overlaid on the corresponding 2D ultrasound frames, and demonstrate 2D auto-tagging for the relevant anatomical structures. Best practice recommendations have been collected and summarized.

Results
The required input for the CARTOSOUND FAM algorithm:
2D ULS distinct frames, with full spatial coverage of the LA body and its adjacent key anatomical structures (LAA and PVs), with at least 2 different views for each structure, and preferably clearly visualizing the ostium of the PV’s and LAA.
The 2D clips should be acquired while the SOUNDSTAR® catheter is positioned in the RA and/or the RVOT.
The selected frames within the ULS clip should be gated at the end-expiration phase and to the LA max volume (). LA frames with a temporal resolution of ~20 msec just before the opening of the mitral valve at the time of maximal atrial volume (end atrial diastole).
The selected frames within the ULS clip should be with depth 90-140mm.
The LA anatomy shall not have uncommon anatomical variation (e.g. 5th PV).
There shall be no map shift between the ULS data (frames) and the magnetic data (FAM, VISITAGs, EA points, etc.) in the CARTOSOUND® clinical procedure.

Conclusion
This study successfully reports on best workflow practices in using the CARTOSOUND FAM Module in conjunction with ICE. Further studies evaluating the safety and efficiency are required to validate reproducibility these recommendations.
Evaluation of laser balloon pulmonary vein isolation lesions during the acute and chronic phases using a high-resolution mapping system
Authors: Yamasaki T , Hattori T , Pak M , Kakita K 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Visually guided laser balloon (VGLB) has proven ample efficacy in achieving durable pulmonary vein (PV) isolation (PVI). Though the isolation area post-cryoballoon ablation has been reported to regress at the chronic phase, the shrinkage of the isolation area using VGLB during the chronic phase has not been described.

Purpose
This study aims to evaluate the differences in isolation areas created by VGLB between the acute and chronic phases using a high-resolution mapping system.

Methods
We assessed 26 patients who underwent a second procedure due to atrial fibrillation recurrence. Of them, 8 patients were treated with the third-generation VGLB and 18 patients were treated with the first-generation VGLB at the first session. In all patients, the voltage maps were created with high-resolution mapping catheters just after PVI (acute phase) and during the second session (chronic phase). With each map, the isolation area (&lt;0.1mV) around the PV antrum was calculated. We validated the persistent durability of PVI, and then the regression of isolation lesions was analyzed in patients without any PV reconnections.

Results
The isolation areas were re-evaluated at 8.3±6.6 months after the initial procedure. Twenty patients (76.9%) preserved persistent isolation lesions of all four PVs. Of them, the reduction of the isolation areas on the left- and right-sided PV antrum were 1.6±3.2 cm² (10.7±23.1% of the acute phase) and 4.8±3.6 cm² (27.8±18.9%), respectively. The analysis of the results revealed that the isolation area of the right-sided PV antrum yielded statistical shrinkage during the chronic phase (P=0.001), even though the electrical isolation was preserved.

Conclusion
After VGLB ablation, the isolation area of the right-sided PV antrum significantly regressed at the chronic phase, while the rate of durable PVI was high in line with the previous report.
A new criterium for optimal energy application in ultra-high-power short-duration ablation
Authors: Ukena C , Spittler R , Benz A , Slawik J , Ferro G , Pavlicek V , Rostock T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Ultra-high-power short-duration (UHPSD) ablation with the novel QDOT™ catheter allows to maintain a target temperature by automatically adjusting flow and power during a 4-second application of 90 Watt. However, the optimal contact-force for a sufficient lesion generation is yet to be determined.

Methods
This study comprised 41 patients with symptomatic atrial fibrillation undergoing pulmonary vein isolation (PVI) with the QDot catheter using the UHPSD mode with 90 W for 4 seconds. All UHPSD applications for circumferential PVI were analyzed. Suboptimal UHPSD applications were defined as either an impedance drop of ≤5% or a cumulative temperature-limited energy ≤330 W.

Results
A total of 1904 UHPSD applications (46.4 applications per patient) were performed with an average contact force (aCF) of 12.3±6.4 g with a mean maximum temperature (maxTemp) of 48.4±3.8 °C and a mean impedance drop (ImpDrop) of 10±3.2%. An ImpDrop ≤5% occurred in 67 (3.5%) UHPSD applications which was associated with lower aCF (10.6±7 vs. 12.4±6.4 g; p=0.024) and a lower maxTemp (45.8±3.8 vs. 48.5±3.8 °C; p&lt;0.001) as compared to UHPSD applications with an ImpDrop &gt;5%. A cumulative energy ≤330 W was observed in 39 (2%) UHPSD applications. Interestingly, low cumulative energy UHPSD applications (≤330 W) were characterized by a higher aCF (21±9.6 vs. 12.1±6.2 g; p&lt;0.001). Furthermore, low cumulative energy was observed significantly more often in UHPSD applications with aCF &lt;5.6 g or &gt;21.1 g (10.2% vs 3.6%; p=0.004).

Conclusion
A low but also a high contact-force (&lt;6 and &gt;21g) are associated with suboptimal UHPSD applications. Thus, UHPSD applications require a ’15-gram window’ of contact-force to achieve an optimal cumulative energy.
Electrical connection between the left atrium and the pulmonary veins: a study to understand the contribution of myocardial fibers along the standard ablation circumference
Authors: Campos Garcia B , Alonso Martin C , Guerra Ramos J M , Moreno Weidmann Z L , Mendez Zurita F , Betancur Gutierrez A F , Vinolas Prat X , Rodriguez Font E 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary vein (PV) isolation with circumferential ablation around ipsilateral PVs is the standard strategy for atrial fibrillation ablation. The electrical connection between the left atrium (LA) and the pulmonary veins (PV) is determined by the heterogeneous arrangement of myocardial fibers along the PV-LA junction.

Purpose
We sought to assess which regions of the standard ablation circumference are the main contributors to the venoatrial electrical connection.

Methods
Forty-one patients underwent a specific atrial fibrillation ablation protocol in which the anterior and posterior segments of the standard circumference were ablated first. If PV isolation was not achieved, ablation was extended superiorly or inferiorly, based on the earliest atrial activation recorded during pacing from the PV. Complete PV isolation and the length of the areas non-requiring ablation (ANRA) at the time of electrical isolation were evaluated.

Results
Ablation of the anterior and posterior segments of the standard circumference led to isolation of 77% left-PV pairs and 51% right-PV pairs (p=0,015). A superior extension was required in 23% left-PV pairs and in 46% right-PV pairs, while an inferior extension was required only in 10% left-PV pairs and in 11% right-PV pairs. PV isolation was achieved before completing the standard ablation circumference in 97% left-PV pairs and in 94% right-PV pairs, with an ANRA of 35.8±9.0mm in left PVs (16.1±5.2 mm superior and 19.7±5.6 mm inferior, p&lt;0,01), and 35.5±9.5 mm in right PVs (15.2±5.7 mm superior and 20.9±5.3mm inferior, p&lt;0,01).

Conclusion
The myocardial fibers along the anterior and posterior regions of the standard ablation circumference are the main contributors to the electrical connection between the LA and the PVs. Ablation of these regions results in PV isolation in the majority of patients.
Pulsed-field ablation versus single catheter high-power short-duration radiofrequency ablation for atrial fibrillation: procedural characteristics, myocardial injury and midterm outcomes
Authors: Weidlich S , Serban T , Krisai P , Spiess F , Voellmin G , Osswald S , Knecht S , Sticherling C , Kuehne M , Badertscher P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulsed-field ablation (PFA) has emerged as a novel treatment strategy for patients with atrial fibrillation (AF). A direct comparison to high-power short-duration (HPSD) radiofrequency (RF) ablation using a single catheter is lacking.

Aim
To compare pulmonary vein isolation (PVI) using PFA versus single catheter HPSD-RF ablation regarding efficiency, safety, myocardial injury, and outcomes.

Methods
119 patients underwent PVI and were included (age 65.6 ± 10 years, ejection fraction 0.55 ± 0.11, left atrial size 41 ± 6.6 mm, paroxysmal AF 55%). 56 patients (47%) underwent PFA using a multi-electrode pentaspline PFA catheter with a biphasic waveform and 63 patients (53%) underwent single catheter HPSD-RF ablation without a multipolar mapping catheter.

Results
Using PFA the median procedure time was significantly shorter compared to the single catheter HPSD-RF group with 58 (IQR 51-70) min versus 83 (IQR 71-99) min (p&lt;0.001), while fluoroscopic time was significantly longer with 12 (IQR 10-16) min versus 2.2 (IQR 1.3-3.6) min (p&lt;0.001). First-pass isolation was achieved in 91% of the PFA group and 88% in the HPSD-RF group. 3.3 catheters vs. 1.0 catheters were used in the PFA group versus the HPSD-RF group, p&lt;0.01. One procedural complications was observed in the PFA group and one complication in the HPSD-RF group (Tamponades). High sensitivity cardiac troponin levels were on average significantly higher in patients using the PFA system, 1520 (IQR 1010-1980) ng/l compared to 897 (IQR 725-1240) ng/l in the HPSD-RF group. During a median follow-up of 177 days (IQR 92-300), AF recurrence was observed in five patients (9%) from the PFA group and in 15 patients (24%) from the HPSD-RF group. (Figure 1)

Conclusion
PFA showed shorter procedure times but longer fluoroscopy times, higher levels of hs cTnT, and a possible improved AF-free survival.
Is pulmonary vein isolation using pulse field ablation safe and efficient ? data from a prospective registry
Authors: Chaumont C , Mcdonnell E , Savoure A , Eltchaninoff H , Anselme F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulsed field ablation (PFA) is a nonthermal ablative modality using a strong electrical field created around a dedicated catheter to produce pores in the cellular membrane. As the amount of energy required to produce electroporation is highly tissue dependent, the atrial myocardium can be specifically targeted while sparing adjacent tissues. This new ablation modality could increase the safety of pulmonary vein isolation (PVI) procedures compared to PVI using thermal energies. Real-life clinical data are still limited regarding safety and efficacy of PFA.

Purpose
To assess safety and mid-term efficacy of PVI performed using PFA.

Methods
We included all patients who underwent PVI for symptomatic atrial fibrillation (AF) using PFA in our hospital between June 2021 and June 2022. All procedures were performed under general anaesthesia. After patients received IV heparin and achieved ACT &gt; 300 s, a 12 Fr multi-electrode pentaspline PFA catheter was advanced through a 13 Fr deflectable sheath into the left atrium. The catheter was positioned so that the splines achieved circumferential contact at the PV antra. Two applications (2.5 sec and 2 kV per application) were performed in "basket" configuration, then the catheter was slightly rotated (30-40°) before delivery of 2 additional applications. This sequence of ablation was repeated in "flower" configuration. This protocol was applied at each pulmonary vein. PVI was assessed with the PFA catheter. A 24-hour holter monitoring was performed at 4-month and one-year follow-up.

Results
The population consisted of 102 patients (73 paroxysmal AF, 29 persistent AF) with a mean age of 56 ± 13 yo. The mean procedure duration was 38 ± 9 min, and mean fluoroscopy duration was 8 ± 4 min (4 ± 4.2 Gy.cm2). The pulmonary vein signal completely disappeared after the first PFA application for each targeted vein and PVI was confirmed for all veins in all patients at the end of the procedure. Pericardial effusion requiring percutaneous drainage occurred in 1 patient during the early phase of our experience (patient n°8). There was no other complication. At 4-month follow-up, 91/102 patients (89%) were asymptomatic with no recurrence of AF. At one-year follow-up, 34/38 patients (89%) had no reccurence of documented atrial arrhythmia. 6 patients underwent a redo procedure : pulmonary vein reconnection was observed in 4/6.

Conclusion
PVI performed with PFA appeared safe and efficient with short procedure and acceptable fluoroscopy durations. Further data are required regarding long-term efficacy.
Artificial intelligence-enabled spatio-temporal dispersion mapping for persistent AF: Similarities and differences between pacing-induced or spontaneous AF
Authors: Bars C , Gitenay E , Monteau J , Lotteau S , Reist M , Serdi M , Appetiti A , Milpied P , Kalifa J , Seitz J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Volta Medical
Saint Joseph Hospital Marseille, France

Background
Spatiotemporal dispersion is an electrical footprint of atrial fibrillation (AF) drivers that has been successfully implemented to target extra-pulmonary veins (PVs) regions during persistent AF ablation.

Purpose
The aim of the study is to characterize spatiotemporal dispersion extent and location and to compare dispersion atrial localization and extent between pacing-induced AF and spontaneous AF.

Methods
Spatiotemporal dispersion maps were built with an artificial intelligence software (VX1, Volta Medical) and analyzed in 71 consecutives persistent (66%) and long-standing persistent (34%) AF patients admitted for a first ablation procedure. Fifty-two patients were in spontaneous AF (73%) at the outset of the procedure while AF was induced in 19 patients (27%) by burst pacing ± isoproterenol infusion. A semi-quantitative visual quantification of dispersion extent was conducted by implementing an atrial segmentation into 22 regions and a region-centered score from 0 (no dispersion) to 3 (high dispersion). Also, an automated quantification was performed as follows: (i) a gradient filter designed to extract atrial shapes from background was applied, (ii) dispersion areas were segmented using a color thresholding method, and (iii) a structuring element was used to connect segmented dispersion areas.

Results
The regional characterization of dispersion shows that dispersion distribution follows a similar pattern and is present in similar atrial regions, regardless of whether AF is spontaneous or induced (Figure 1). Global dispersion extent, however, is significantly higher in the left atrium of patients in spontaneous AF compared to patients with induced AF (15.43% ± 9.04 versus 9.86% ± 6.41, P=0.0025, Figure 2). Accordingly, the regional dispersion score tends to be lower when AF is induced. Dispersion hotspots are: LSPV anterior antrum -ridge (R1), RSPV anterior antrum (R5), anterior wall (R9), roof (R10), posterior wall (R11), and low left atrial septum (R15) in the left atrium. In the right atrium: low right atrial septum (R15) and posterior right atrium (R20) (Figure 1).

Conclusions
Artificial intelligence-enabled dispersion persistent AF mapping indicates that dispersion is reduced in induced vs. spontaneous-AF but that its distribution follows a similar pattern.
Predictors of atrial flutter recurrence after atrial fibrillation ablation: the crucial role of structural and morphological left atrial remodeling
Authors: Guichard J B , Ferro E , Mont J L 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Unrestricted Grant - Abbott Medical

Introduction
Recurrence of supraventricular tachyarrhythmias after catheter ablation of atrial fibrillation (AF) is common, representing 30% of patients. Although AF recurrence occurs mostly, 10% of the patients face arrhythmia recurrence through atypical atrial flutter (AFL). The diagnostic and therapeutic management of atypical AFL is challenging. Predicting atypical AFL after AF catheter ablation is critical.

Purpose
To identify morphological and structural predictors of recurrence in the form of atypical AFL compared to AF based on Late Gadolinium Enhancement Cardiac Magnetic Resonance (LGE-CMR).

Methods
– From January 2013 to December 2021, 56 patients facing post AF-CA atypical AFL were included in the monocentric and retrospective cohort. 112 patients with AF recurrence were randomly included in the cohort from the general database. Pre-procedure LGE-CMR was post-processed for every patient to assess global and regional left and right atrial (LA, RA) fibrosis quantification using an image intensity ratio &gt; 1.32 as fibrosis. Sphericity was calculated as the percentage of similarity with respect to a sphere, and the volume of LA and RA were calculated.

Results
– 168 patients who had faced supraventricular arrhythmia recurrence after AF-CA were included in the monocentric retrospective cohort. They were mainly male (72.1%), with a median CHADS-VASc score of 1.4 +/- 1.3, a number of previous CA of 2,2 +/- 0.4, and a biatrial dilation (LA volume index of 53.5 ml/m2, RA volume index of 59.6 ml/m2). An age superior to 65 (OR=6.61, CI95%:2.18-14.41, p&lt;0.01), the number of previous CA procedures (OR=3.03, CI95%:1.17-7.81, p=0.02), a history of management of invasive additional lines (OR=2.48, CI95%:1.01-6.27, p=0.05), an elevated LA sphericity (OR=1.33, CI95%:1.11-1.59, p&lt;0.01) and an increased LA fibrotic burden (OR=1.03, CI95%:1.00-1.07, p=0.04) independently predicted the occurrence of atypical AFL compared with AF recurrence after AF-CA (Figure 1). Specifically, an increased amount of fibrosis in the lateral LA zone area (OR=1.03, CI95%:1.01-1.04, p&lt;0.01)] was an independent predictor of recurrence in the form of atypical AFL compared with AF recurrence (Figure 2).

Conclusion
The structural LA remodeling of AE, including LA fibrosis and LA sphericity, is a predictor of recurrence in the form of atypical atrial flutter compared with AF recurrence after AF-CA.
Single versus double transeptal puncture: characterization and outcomes in a single tertiary center
Authors: Lacerda Teixeira B , Silva Cunha P , Portugal G , Valente B , Coutinho Cruz M , Lousinha A , Veiga J , Delgado A S , Bras M , Paulo M , Guerra C , Cruz Ferreira R , Oliveira M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
An ablation catheter in conjunction with a circular mapping catheter (CMC) requiring a double transeptal puncture (TSP) for left atrial access is conventionally used for atrial fibrillation (AF) ablation in the majority of centers. In the recent years, different operators have combined a single transseptal puncture technique with 3D high-density mapping catheters for pulmonary veins isolation (PVI) in AF patients.

Objective
The aim of this analysis is to compare two different strategies, single versus double TSP, regarding duration of the procedure, radiation dose, complications and long-term outcomes.

Methods
Retrospective analysis of an AF large cohort of consecutive patients that underwent PVI with radiofrequency energy (RF) using a 3D mapping system, either with single or double TSP, from 2016 to 2020.

Results
We included 341 patients (female 35,8 %, paroxysmal AF 64,2 %) who underwent catheter ablation with RF. At the time of the ablation, age was 59,1 ± 11,8 years old, and the mean CHA2DS2-VASc score was 1,6 ± 1,3. All patients were taking oral anticoagulation. Single TSP was performed in 165 (48,4%%) patients and double TSP in 176 (51,6%) patients. In 56 (16,4%) cases (50 [30,3%] in the single TSP and 6 [3,4%] in the double TSP), the procedure was a repeat ablation after AF recurrence. Operator experience (defined as ≥5 years of AF ablation procedures) was equally distributed between the two groups. The average procedure time single (129 ± 33,2 minutes vs. 122 ± 34,9 minutes, for single and double TSP, respectively) did not reach statistical difference between the two groups (p = 0,55), but there was a significant difference regarding fluoroscopy time (13 ± 6,3 vs. 19 ± 9,1, for single and double TSP, respectively; p &lt; 0,001). Acute complications were less frequent in the single TSP approach (5,6 % vs. 9,7 %, for single and double TSP, respectively), but did not reach statistical significance. At 2-year follow-up, sinus rhythm maintenance rate was similar in both groups (77% vs. 78%, p=0,85). At 2 and 4 year follow-up, the Kaplan-Meier survival curves revealed no difference in time to AF recurrence between the two groups (log- rank p = 0,974 and p = 0,965). However, further analysis of subgroups according to type of AF revealed a significant difference among the subgroup with persistent AF submitted to double TSP (log rank p = 0,007) during a total of follow-up of 4 years.

Conclusion
A simplified single-TSP technique using high-density multi-electrode 3D mapping is a safe and highly successful approach for AF ablation. This approach yields a substantial reduction in fluoroscopy time, with the potential to avoid acute complications when compared to a conventional double-TSP strategy.