bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pulmonary vein isolation with the novel radiofrequency balloon catheter: predictors of single-shot isolation
Authors: Del Monte A , Almorad A , Pannone L , Della Rocca D , Mouram S , Gauthey A , Overeinder I , Bala G , Sorgente A , Stroker E , Sieira J , Brugada P , La Meir M , Chierchia G B , De Asmundis C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Single-shot technologies have demonstrated comparable results to point-by-point ablation for pulmonary vein (PV) isolation (PVI). The novel multi-electrode radiofrequency (RF) Balloon catheter (RFB) has been developed to achieve safe and effective single-shot PVI.

Purpose
This single-centre study aimed to evaluate ablation parameters predictors of single-shot PVI with the novel RFB.

Methods
All consecutive patients with symptomatic paroxysmal or persistent atrial fibrillation (AF) undergoing first-time PVI with the RFB between August 2021 and November 2022 were prospectively included. Remapping was performed in all patients to confirm persistent intraprocedural PVI. Clinical, procedural and ablation parameters were systematically collected. First RF applications were categorized as follows: 1) single-shot PVI (SS-PVI), in case of PVI without acute intraprocedural reconnection and 2) non-single-shot PVI (NSS-PVI), if single-shot isolation was not obtained at first application or if isolation was followed by acute PV reconnection.

Results
A total of 492 first RF applications were analysed, 433 (88.1%) SS-PVI and 59 (11.9%) NSS-PVI. Overall, the mean impedance drop was 22.9 ± 5.4 Ω, and the mean temperature rise was 12.2 ± 3.3 °C. SS-PVI showed higher mean impedance drop and mean temperature rise compared to NSS-PVI (23.3 ± 5.3 Ω vs 20.1 ± 4.9 Ω, p&lt;0.001; 12.4 ± 3.3 °C vs 10.8 ± 2.8 °C, p&lt;0.001, respectively). SS-PVI showed higher values of mean impedance drop and temperature rise for all veins, except for the left superior PV. For the other PVs, impedance drop and temperature rise were significant predictors of SS-PVI (OR per 1 Ω increase, 1.22, 95% CI 1.13-1.32, p&lt;0.001, and OR per 1 °C increase, 1.34, 95% CI 1.17-1.54, p&lt;0.001, respectively). The best cut-offs to predict SS-PVI were: impedance drop &gt;19.2 Ω (sensitivity 0.79, specificity 0.62, PPV 0.94, NPV 0.25, AUC 0.75) and temperature rise &gt;11.1 °C (sensitivity 0.58, specificity 0.84, PPV 0.18, NPV 0.97, AUC 0.72); Figure 1.

Conclusion
Specific cut-offs of impedance drop and temperature rise are able to predict single-shot PVI with the novel RFB and may be implemented in the procedural workflow to optimize the ablation procedure.
Impact of different energy sources on the cardiac autonomic nervous system in the setting of single-shot pulmonary vein isolation
Authors: Del Monte A , Stroker E , Della Rocca D , Pannone L , Mouram S , Gauthey A , Overeinder I , Bala G , Sorgente A , Sieira J , Almorad A , La Meir M , Brugada P , Chierchia G B , De Asmundis C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The cardiac autonomic nervous system is an epicardial neural network composed of ganglionated plexi (GPs) and interconnecting neurons, which plays a significant role in the induction and maintenance of atrial fibrillation (AF). Targeted GPs ablation in addition to pulmonary vein isolation (PVI) has been associated with superior AF outcomes. Due to the anatomical proximity of the GPs with the pulmonary veins, PVI with cryoballoon catheter ablation (CBA) has shown to concomitantly affect the GPs, as documented by increased heart rates (HR) after ablation. Recently, pulsed-field ablation (PFA) has emerged as a safe and effective non-thermal alternative for single-shot PVI, with specific selectivity for the cardiac tissue. The impact of PFA on the cardiac autonomic nervous system is still to be elucidated.

Purpose
To assess the effect of PFA on the cardiac autonomic nervous system, evaluated with the variation in resting heart rate pre- and post-ablation.

Methods
We retrospectively included all consecutive patients with symptomatic paroxysmal AF undergoing first-time PVI with the multispline PFA catheter between January and September 2022. They were compared with consecutive patients undergoing PVI with CBA in the same study period. Patients not in sinus rhythm before ablation or with cardiac implantable electronic devices were excluded. All antiarrhythmic drugs were discontinued at least 3 days before ablation. Pre-ablation and 24-hour post-ablation ECGs in sinus rhythm were collected and analysed to assess HR.

Results
A total of 90 patients (PFA group, n=30 vs CBA group, n=60) were included in the analysis. Baseline patients’ characteristics were similar between the two groups (Figure 1). Pre-ablation HRs in the PFA and the CBA groups were 64.2 ± 10.3 bpm and 64.2 ± 12.8 bpm, respectively. Vagal reactions during ablation occurred more frequently with PFA than CBA (77% vs 38%, p=0.001). After 24h post-ablation, the HR increase in the PFA and CBA groups was 2.2 ± 5.4 bpm and 12.4 ± 11.9 bpm, respectively (p&lt;0.001, Figure 2).

Conclusion
PVI with the novel multispline PFA catheter is associated with less increase in HR 24 hours after ablation compared to CBA. This effect may be the result of tissue selectivity of PFA for cardiomyocytes, which has minimal effect on extracardiac structures, including the cardiac autonomic nervous system.
Six-month follow-up after pulmonary vein isolation using pulsed field ablation for paroxysmal atrial fibrillation
Authors: Reinsch N , Fueting A , Hartl S , Neven K 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulsed field ablation (PFA) has recently been introduced as a novel routine ablation technology for paroxysmal atrial fibrillation (PAF). Only a few small clinical studies have been published on the mid- and long-term outcome. Herein, we present the six-month clinical outcomes of PFA in PAF.

Methods
In PAF patients, PVI in conscious sedation using a steerable sheath and a pentaspline over-the-wire basket and flower PFA catheter was performed. In a subset of patients, pre- and post-ablation high-density bipolar voltage 3D maps (Carto 3D) were performed. Procedural parameters, acute success, in-hospital safety and arrhythmia recurrence were assessed over 6-month follow-up. Efficacy was evaluated by freedom from a ≥ 30-sec. recurrence of AF/atrial flutter (AFL)/atrial tachycardia (AT). Follow-up included 7-day Holter ECGs and/or telephonic interviews at days 90 and 180 after ablation.

Results
his study included a total of 108 patients (mean age: 65±10 years; 44% female). Mean CHA2DS2-VASc-score was 2,3±1,7. Median duration since first AF diagnosis was 21 [IQR: 3 to 58] months. Pre- and post-ablation high-density maps were performed in 36/108 (33%) of patients. Skin-to skin procedure time was 78±35 min. Fluoroscopy time and dosis area product were 19±7 min and 5,56±4,64 Gy.cm2, respectively. Left atrial dwell time of the PFA catheter was 27±11 min. Acute pulmonary vein isolation rate was 100% of PVs using PFA only. Primary adverse events occurred in 3.7% of patients (1 groin hematoma, 2 pericardial tamponades, 1 stroke with lethal outcome). Five patients were lost to FU. During a mean FU of 205±84 days, 81 of 103 patients (79%) remained free of any symptomatic or documented AF/AFL/AT episode after a single procedure. In 22 (21%) patients at least one episode of AF/AFL/AT was documented. In 6/22 (27%) patients, a re-do procedure was performed. In 2/6 (33%) patients, a reconduction of the PVs (1 LIPV, 1 posterior carina on both sides) was seen. In the remaining 4/6 (67%) patients, during re-do procedure typical or atypical flutter was treated, in presence of durable PV isolation.

Conclusions
PVI using PFA results in a reasonable 6-month atrial arrhythmia recurrence rate and safety profile. The success rate may be reduced due to the long duration since first AF diagnosis. PV reconduction rate during re-do procedure was 33% in a limited number of patients.
Impact of catheter ablation for persistent atrial fibrillation with heart failure, compared to preserved and reduced ejection fraction
Authors: Inamura Y , Inaba O , Michishita T , Kono T , Isonaga Y , Ohya H , Takagi T , Sato A , Matsumura Y , Nitta J , Sasano T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Catheter ablation for persistent atrial fibrillation (AF) in patients with heart failure is known to improve heart failure. However, there were few reports comparing the outcomes of catheter ablation for patients with heart failure with reduced ejection fraction (HFpEF) and heart failure with preserved ejection fraction (HFpEF).

Method
Patients with E/e’ &gt; 15 and EF &gt; 50% on preoperative echocardiography were defined HFpEF, and those with EF &lt; 40% were defined as HFrEF. We compared ablation outcomes and postoperative BNP changes between patients with HFpEF (HFpEF-group) and HFrEF (HFrEF-group).

Result
There were 166 cases of HFpEF-group and 177 of HFrEF-group among the cases with catheter ablation for persistent AF in our hospital from 2013 to 2021. The median preoperative BNP was 190.7 pg/ml in HFrEF-group and 144.3 in HFpEF-group, significantly higher in HFrEF-group (P=0.001). After a mean follow-up of 37.2 months, maintenance of sinus rhythm without any antiarrhythmic drugs was significantly better in the HFrEF-group (64.4% and 53.6%, p=0.048). After one year of ablation, median BNP was significantly higher in HFpEF-group (HFpEF: 37.5 pg/ml, HFrEF: 22.0 pg/ml; p=0.017), contrary to before ablation.

Conclusion
Catheter ablation for persistent AF with HFrEF showed better ablation outcomes and improved BNP levels compared to those with HFpEF.
Comparision of pulsed field ablation vs. high power short duration-ablation for pulmonary vein isolation
Authors: Woermann J , Schipper J , Lueker J , Van Den Bruck J , Filipovic K , Erlhoefer S , Pavel F , Scheuerlen C , Dittrich S , Steven D , Sultan A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The newly introduced non-thermal pulsed field ablation (PFA) is a promising technology to achieve fast pulmonary vein isolation (PVI) with high acute success rates and comparable safety features. However, previous studies have shown that high power short duration ablation (HPSD) is also highly effective and fast to achieve PVI with potentially less AF recurrence. Data comparing PFA to HPSD-PVI is lacking.

Objective
This study compared procedural parameter and outcome using the novel PFA-PVI to HPSD-PVI in patients with paroxysmal or persistent atrial fibrillation (PAF/persAF).

Methods
Between 09/2021 and 10/2022 all consecutive patients undergoing de-novo PVI (PFA or HPSD) were included in this analysis. For PFA-PVI a shapeable (flower/basket shape) 5 spline 20 electrode catheter was used. For HPSD-PVI a power setting of 70W/7s (70W/5s at posterior wall) was considered as HPSD. Furthermore, a 3D mapping system was used. Follow-up consisted of out-clinic pts visit, teleconsultation, 48h Holter ECG and CIED interrogation if applicable.

Results
A total of 114 patients (57 PFA [17(30%) PAF; 40(70%) persAF 40(70%)] were included in this analysis. PVI was successful in all patients. The PFA group revealed a significantly shorter procedure duration (65±17 min vs. 95±23 min, p&lt;0.01) but longer fluoroscopy time (PFA 15±5min and HPSD 12±3min; p&lt;0.001). However, the overall fluoroscopy dosage was comparable between groups (PFA: 3484±2072mGy*cm2; HPSD: 3168±2346mGy*cm2; p=0.448). Two tamponades occurred in the PFA while in HPSD two pts suffered groin bleedings.
At follow-up after three months (33±12 days) 46 PFA (80.7%) and 44 HPSD pts (77.2%) were free from atrial arrhythmia after a single procedure (p=0.819). One clinically non.significant PV stenosis occurred in the HPSD group.

Conclusion
PFA and HPSD-PVI seem to be highly effective and safe to achieve PVI in the setting of PAF and persAF with comparable arrhythmia free survival. However, procedure duration for PFA PVI is significantly shorter and therefore may be of potential benefit.
Achieving a very low fluoroscopy exposure in cryoballon ablation of the pulmonary veins: learning curve of 3D-wide-band dielectric mapping guided ablation
Authors: Bastian D , Buia V , Walascheck J , Xhakupi H , Hoefler D , Rittger H , Vitali-Serdoz L 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary vein isolation (PVI) using cryoballoon (CB) ablation is associated with an increased radiation exposure compared with radiofrequency ablation. The novel high resolution wide-band dielectric imaging system improved our strategy of radiation exposure reduction without affecting acute efficacy and safety and giving additional insights on the atrial voltage mapping of the selected patients.

Purpose
To evaluated the reduction of fluoroscopy use over time during consecutive CB PVI performed with the use of a new 3D mapping system.

Methods
The study population comprised 89 consecutive patients who underwent in our Centre between Juni 2021 and Juli 2022 to third-generation CB-based PVI with the wide band dielectric system and X-Ray System with enhanced collimation, frame reduction and stored fluoroscopy. All included patients gave written informed consent for TEE and PVI and agreed to the anonymous evaluation of their data for research and quality control. We analyzed the reduction in fluoroscopy use among time.

Results
The mean radiation exposure data among all patients demonstrate a significant reduction compared with the literature data od CB-PVI: mean fluoroscopy time 3,95 ± 4,12 minutes and mean DAP 15,45 ± 27,18 cGy*cm2. Analysing the learning curve, we identified every 30 patients a significant reduction in X-Ray use achieving a reduction of ca. 80% in the last group of patients compared with the former one. The results are summarized in the Table and Graph. No major complications occurred

Conclusion
The analysis of the fluoroscopy utilization and exposure during CB-PVI performed with a novel 3D mapping system using wide-band dielectric imaging demonstrated a significant learning curve. A stepwise progressive reduction can be identified leading to a reduction of ca. 80% of radiation use among the last 30 procedures compared to the first 30 ones reflecting individual and team proficiency in using the new imaging system. A very low-radiation exposure during CB-PVI can be achieved with this approach.
Evaluation of force time integral, force time current integral and lesion size index in a new force sensing catheter
Authors: Bahlke F , Syvaeri J , Englert F , Erhard N , Popa M , Krafft H , Risse E , Telishevska M , Lengauer S , Lennerz C , Reents T , Hessling G , Deisenhofer I , Bourier F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Radiofrequency current remains one of the most important ablation techniques in the EP lab. Creating durable lesions is key to successful ablation. Evaluating lesion quality and progression of lesion growth is difficult as many parameters influence lesion formation. Therefore, several approaches were developed, as monitoring RF duration, power and contact force seems insufficient in clinical practice. Force-time-integral (FTI) and force-time-current-integral (FTCI), as well as the ablation index (AI) and lesion size index (LSI) showed decent results in past studies. Recently, a new force sensing catheter (NFSC) was released. By now, data about lesion formation and correlation with the FTI, FTCI and LSI is lacking with this NFSC. This study aimed to further investigate lesion formation with the NFSC in an ex vivo model.

Methods
30 RF-lesions were created using an ex vivo porcine cardiac model with the NFSC catheter. The experimental setup consisted of a saline-filled container, a dispersive electrode, a heated thermostat and a circulation pump to imitate in vivo conditions. Global impedance was kept at 120 Ohm as well as the temperature at 37°C. In a first set of lesions, CF was varied (1g, 5g, 10g, 20g). Three lesions were created in each CF-level with 30W. In a second set of lesion, CF was kept at 10 – 15 g, but ablation power was set to 20W, 30W, 40W, 50W, 60W and 70W. In every power level, three lesions were created.
All parameters (power, temperature, global impedance, contact force, lesion size) were measured constantly during application of RF-current, enabling real-time correlation of RF parameters and lesion size. In case of an audible steam pop, RF application was stopped.

Results
1640 measurement in 30 lesions were included into the analysis. Mean lesion diameter was 7.82 ± 1.52 mm, mean lesion depth 4.80 ± 1.08 mm. Baseline global impedance (GI) was 138.10 ± 10.93 Ω, mean GI-drop 28.10 ± 8.00 Ω. In average, CF of 12.10 ± 5.87 g was used.
Correlations of lesion size, FTI and FTCI are shown in table 1. Interestingly, LSI correlated best with lesion size (r = 0.851 and r = 0.852 for lesion depth and diameter; p&lt;0.001). Figure 1 illustrates a scatter plot of LSI and lesion depth (Figure 1a) and lesion diameter (Figure 1b).
Figure 2 shows dynamic changes in lesion depth compared to changes in LSI and FTCI. During RF-application, development of lesion formation and LSI is comparable from approximately second 7 onwards. FTCI is rising in a linear manner, whereas lesion formation increases monoexponentially.

Conclusion
In the NFSC, lesion size correlates strongest with the LSI in power levels up to 70 Watts. FTI and FTCI also showed decent correlations. Regarding dynamic changes in lesion size, LSI is best comparable to actual lesion growth.
Noninvasive continuous arterial pressure monitoring shortens atrial fibrillation ablation procedural duration
Authors: Parollo M , Di Cori A , Fiorentini F , De Lucia R , Barletta V , Viani S , Paperini L , Canu A , Mazzocchetti L , Sbragi S , Segreti L , Grifoni G , Soldati E , Zucchelli G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Transcatheter atrial fibrillation (AF) ablation is in most centres commonly carried out with continuous invasive radial arterial blood pressure (BP) monitoring. Novel devices enable continuous non-invasive BP monitoring, with acceptable agreement and optimal safety profile when compared to standard of care invasive BP monitoring, leading to improved patient comfort in the electrophysiology lab.

Purpose
Aim of the study was to assess in terms of procedural efficiency continuous non-invasive BP monitoring during transcatheter atrial fibrillation ablation.

Methods
We prospectively enrolled 42 consecutive patients (age 61±9 years, 80% male) undergoing transcatheter AF ablation (60% paroxysmal, 40% persistent) at our centre undergoing AF ablation with continuous BP measurement using a non-invasive finger volume clamp device. We then compared them with an historical cohort of 42 consecutive patients undergoing AF ablation (62% paroxysmal, 38% persistent) with standard of care invasive BP monitoring with a radial cannula. We compared the two groups in terms of total procedural duration (in and out from the EP lab).

Results
Mean total procedural duration was 165,29±54,95 minutes in the non-invasive group and 196,55±46,67 minutes in the invasive group (P=0,006).

Conclusion
In patients undergoing AF ablation, non-invasive finger volume-clamp continuous BP monitoring allowed for a significant reduction of total procedural duration when compared to standard of care invasive BP monitoring. Larger studies are needed to confirm these results.
Identification of the fossa ovalis by voltage mapping using a high-density mapping catheter
Authors: Tran V , Bergamin C H , Pruvot E 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Transseptal puncture (TP) is routinely performed under fluoroscopy and/or echocardiography guidance. Additional methods to localize the fossa ovalis (FO) may decrease radiation exposure, as well as periprocedural risk. In the recent years, high-density mapping (HDM) catheters have been used for mapping and ablation of left atrial (LA) arrhythmias.

Purpose
The aim of this study is to determine whether a HDM catheter can reliably identify the specific FO electrogram (EGM) patterns.

Methods
During atrial fibrillation (AF) ablation, a voltage map of the right-sided atrial septum was created using a HDM catheter (Pentaray, Biosense Webster, USA, spacing 2-6-2 mm). The location of the FO was identified by transesophageal echocardiogram and fluoroscopy guidance prior to TP. At the end of the procedure, a 3D phantom was created during catheter retrieval from the left to the right atrium through the TP. Post ablation analysis was done to evaluate whether the HDM catheter was able to record EGM characteristics of the FO.

Results
Fifteen patients were included (male 63%, mean age 61.2±11.7 y. o.); 80% of the cases were in sinus rhythm, 53% had a normal LA size, and the mean CHADS2-VA2SC score was 1.5 ± 1.6. One patent fossa ovalis and one septal pouch of the left atrium were seen. In all patients, an area of low voltage could be identified in the vicinity of the transseptal puncture. In 74%, the location of transseptal puncture was inside of the area of low voltage. The mean voltage value of this area was 0.6 ± 0.3 mV, whereas the mean voltage value of the myocardium surrounding the "low voltage area" was 4.3 ± 2.1 mV (P&lt;0.01). The surface of the low voltage could be best demarcated using a scale from 0.05 -1.5 mV with an area measured at 3.8 ± 2.6 cm2 [Figure 1]. At other voltage scales, the FO surface demonstrated smaller areas of low voltage (scale/surface [mV/cm2] : 0.05-0.5/ 0.8 ± 1.3; 0.05-1.0/2.2 ± 1.8; 0.5-1.0/2.3±1.6). In 63%, fractionated potentials were recorded in the area of the FO [Figure 1].

Conclusions
Based on its EGM characteristics, the fossa ovalis can be accurately localized with a high-density mapping catheter. This finding will certainly help to implement radiation free procedure particularly when echocardiographic modalities are not available.
Figure 1:
Mapping of the region of the fossa ovalis with a high density mapping catheter revealed an area of low voltage with fractionnated electrogram. Fossa ovalis was identified by transseptal puncture.
TP: phantom of the catheters, CS: coronary sinus, H: His, IVC: inferior vena cava, SVC: superior vena cava, * fractionnated electrogram