bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pulsed-field- vs. cryo- vs. radiofrequency ablation: one-year recurrence rates after pulmonary vein isolation in patients with paroxysmal atrial fibrillation
Authors: Kueffer T , Madaffari A , Muehl A , Maurhofer J , Stefenova A , Seiler J , Thalmann G , Kozhuharov N A , Servatius H , Tanner H , Haeberlin A , Baldinger S H , Noti F , Roten L , Reichlin T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
A multipolar pulsed-field ablation (PFA) catheter has recently been introduced and showed favorable data in terms of safety and procedural efficiency of pulmonary vein isolation (PVI) for atrial fibrillation (AF). Long-term outcome data in comparison to other ablation modalities however is lacking.

Purpose
To compare procedural and one-year recurrence data of patients with paroxysmal AF (paroxAF) undergoing a first PVI using PFA, cryoballoon ablation (Cryo), or radiofrequency (RFA).

Methods
Consecutive patients with paroxAF undergoing a first PVI with PFA at our institution from May to December 2021 were included. For comparison, patients with paroxAF undergoing a first PVI with Cryo or RFA between May 2020 and March 2021 were included. A 3-D electro-anatomical mapping system was used in PFA and RFA, but not in Cryo. The following ablation protocols were used to achieve acute PVI: In the PFA group, the standard 32-applications lesion-set and supplementary applications at the discretion of the operator. In the Cryo group, a time-to-effect plus two minutes strategy and in the RFA group following to the CLOSE protocol. Patients were followed with 7d-Holter ECGs 3, 6, and 12 months after ablation. The primary endpoint was recurrence of any atrial arrhythmias following a blanking period of 3 months.

Results
A total of 202 patients were included (PFA: 32; Cryo: 82; RF: 88). Age, gender, CHA2DS2-VASc score, LVEF and LAVI did not differ among the groups (Table). Median procedure times were shortest with Cryo (76 [interquartile range 60-95] min) followed by PFA (94 [82-110] min) and RFA (157 [126-211] min, p &lt; 0.01). Fluoroscopy dose was lowest with RFA (1.4 [0.6-2.5] Gycm2) followed by PFA (4.8 [3.5-7.9] Gycm2) and Cryo (5.3 [2.8-10.2] Gycm2, p &lt; 0.01). Median follow-up time in patients without recurrence was 12 [10-12] months for the PFA group, 12 [12-13] months for the Cryo group and 13 [12-13] months for the RFA group. There was a trend towards fewer recurrences of atrial arrhythmias with PFA compared to Cryo and RFA (PFA 7%, Cryo: 25%, RFA: 20%, p = 0.13, Figure).

Conclusion
Recurrences of atrial arrhythmias 12 months after PFA PVI for paroxAF may be lower compared to Cryo and RFA. Larger prospective randomized studies are needed to confirm this initial experience.
Utility of ST2 soluble biomarker in patients with atrial fibrillation and pulmonary veins isolation
Authors: Gonzalez-Melchor L , Garcia-Seara J , Martinez-Sande J L , Rodriguez-Manero M , Fernandez-Lopez X A , Minguito-Carazo C , Gonzalez T , Gonzalez-Juanatey J R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): No fundings related

Background
Atrial fibrillation (AF) is the more frequent arrhythmia in clinical practice and the efficacy of pulmonary vein ablation has being widely demonstrated. There is still a lack of information about the predictive value of electroanatomical voltage maps or biomarkers to predict recurrence.

Purpose
ST2 soluble (ST2S) biomarker has being previously analyzed by our group in patients with AF and electrical cardioversion demonstrating utility to predict recurrence . So we sought to analyze the clinical utility of ST2S biomarker in patients with AF that underwent to an electrophysiology study and pulmonary isolation (PVI) to compare the predictive value of this biomarker.

Results
This was a prospective, observational clinical trial that included a total of 156 patients with AF who were referred to our hospital for a PVI from September 2016 to September 2019. We also included 40 matched control patients for the initial analysis. All the patients with AF underwent an electroanatomical voltage map in sinus rhythm and PVI. From the 156 PVI: 68 had paroxysmal AF and 88 persistent. ST2S mean value in AF patients was of (13178.5 pg/ml) and had no significant difference with matched controls (11016.2 pg/ml) in baseline analysis. There was no association of ST2S baseline values and recurrence in AF patients. When we analyzed by type of AF, persistent AF patients had a significantly higher level of the biomarker and there was also a significant elevation of the biomarker according to heart rate (&gt;100 bpm) (p 0.038). We observed an elevation of the ST2S levels at 3 and 6 months follow-up with no difference according to recurrence. The levels of ST2S were lower in the cases with a lower voltage map area and in the cases with a wider lower map area but there was no a significant association nor with recurrence. In multivariant analysis only AF rhythm and LA index volume was a significant predictor or recurrence at 3 months follow-up.

Conclusions
We consider that even though there is an association with AF patients and ST2S biomarker levels, specially in those with persistent AF, in patients undergoing an PVI, ST2S values had a generalized elevation at follow-up probably related to inflammation and were not predictive of recurrence.
Effect of early pulmonary vein isolation in patients with heart failure and reduced ejection fraction
Authors: Toth P , Arnoth B , Komlosi F , Szegedi N , Sallo Z , Vamosi P , Perge P , Osztheimer I , Piros K , Abraham P , Szeplaki G , Merkely B , Geller L , Nagy K V 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation (AF) and heart failure (HF) often coexist leading to worse outcomes compared to AF or HF alone. According to the current guidelines, PVI as first-line therapy should be considered, however, the optimal timing of the procedure is still unknown.

Purpose
We aimed to investigate the effect of early PVI on all-cause mortality and AF recurrence in patients with HFrEF.

Methods
We analyzed the data of 162 patients with symptomatic paroxysmal or persistent AF and heart failure with LVEF &lt; 50% who underwent pulmonary vein isolation between 2010 and 2022. The patients’ medical history, laboratory results, echocardiographic and periprocedural parameters were collected in a structured registry. Early PVI was defined as catheter ablation performed within 12 months of AF diagnosis. The median follow-up was 59.7 months, the minimum follow-up was 12 months. Our primary endpoints were AF recurrence after a 3 months blanking period and all-cause mortality at any time during follow-up.

Results
Among the 162 patients, 77 experienced AF recurrence and 39 patients died during the follow-up period. The median age was 63.2 years. The median LVEF was 40% for early PVI and 37% for deferred PVI. Out of the 63 patients who underwent early PVI, 33 (52%) were taking amiodarone. Patients who underwent early PVI had longer freedom from recurrence (median 833 days until recurrence for early PVI, median 696 days for deferred PVI). Early PVI was a predictor of AF recurrence (HR: 0.58 [0.32-0.94], p=0.029).Early ablation was not associated with mortality benefit. However, among those who experienced AF recurrence, repeated ablation was associated with better survival during univariate Cox regression (p=0.01). Furthermore, in multivariate model, reablation was shown to be protective of mortality (HR: 0.312 [0.113-0.865], p=0.025) in the whole cohort.

Conclusions
Our study shows that early rhythm control therapy with catheter ablation is more successful compared to deferred PVI in patients with AF and HFrEF. A redo-PVI was associated with better survival, thus a repeat ablation should be considered in case of arrhythmia recurrence in patients with AF and HF to reduce mortality.
Incremental value of continuous non-invasive blood pressure control to assess hypotension during atrial fibrillation ablation
Authors: Di Cori A , Fiorentini F , Parollo M , Mazzocchetti L , Barletta V , Segreti L , Viani S , De Lucia R , Canu A , Grifoni G , Sbragi S , Soldati E , Zucchelli G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Atrial Fibrillation (AF) ablation is associated with continuous blood pressure (BP) variations related to anesthesiological regimen and energy delivery. Conventional BP monitoring with non-invasive periodic brachial BP controls can miss potential hypotensive events. Continuous non-invasive blood pressure (CNBP) measurement using the volume-clamp method (Clearsight) was demonstrated to be a reliable and effective tool for the assessment of BP during AF ablation.

Purpose
Aim of the study was to investigate the incidence of hypotensive events during AF ablation.

Methods
We included consecutive patients scheduled for AF ablation and monitored in parallel with a periodic (10 minutes) brachial BP cuff and in continuous with the CNBP System (Clearsight). All CNBP data were analyzed with the Acumen Analytics software for hypotension evaluation. According to the anesthesiological regimen, patients were divided in 2 Groups, the General Anesthesia (GA) and the Deep Sedation (DS) group. Area under the threshold (AUT, mmHg x min) of 65 mmHg and Time Weighted Average (TWA, mmHg, i.e., the AUT divided by the total duration of procedure in minutes) of area under threshold (MAP &lt;65 mmHg) were compared between the two groups.

Results
Forty-eight patients were included, 10 (21%) in the General Anesthesia Group and 38 (79%) in the Sedation Group. Hypotension was detected in 18 patients, 9/10 (90%) were recorded in the GA group and 9/38 (23.7%) in the DS one. A total of 85 hypotensive events were recorded, 68 (80%) in the GA and 17 (20%) in the DS Group. In the overall population, mean duration of hypotensive events was 4.87 minutes (range 0 – 14.73 minutes), mean MAP &lt; 65 mmHg was 54.25 ± 7.2 mmHg, mean AUT (MAP &lt;65 mmHg) was 79.4 mmHg x min (range 0 – 1237.7) and mean TWA was 0.41 mmHg (range 0 – 6.9). Hypotensions were more often documented in GA than in DS patients (mean difference 6.35 events/procedure, C.I. 2.66 – 10.10, p&lt;0.05) so as AUTs (mean difference 319.90 mmHg x min, C.I. 30.00 – 609.80, p=0.034) and TWAs (mean difference 1.64 mmHg, C.I. 0.18 – 3.09, p=0.032) which were significantly higher in the GA group. Brachial periodic BP measurement every 10 minutes missed the majority (n=52, 61.2%) of hypotensive events.

Conclusions
CNBP demonstrated a high incidence of hypotension during AF ablation, specially under GA, which are usually missed by the standard intermittent brachial non-invasive BP monitoring. Real time hypotension predictive CNBP indexes could be valuable in this setting.
Very high-power short-duration pulmonary vein isolation combined with anterior chest position of dispersive electrodes
Authors: Futyma P , Burda N , Kowal S , Futyma M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Pulmonary vein isolation (PVI) is a cornerstone management of atrial fibrillation (AF). Very high-power short-duration (vHPSD) radiofrequency catheter ablation (RFCA) can accelerate PVI procedure. Recently, special attention has been paid to the position of dispersive electrodes (DE) for optimization of RFCA application. However, these two methods have not yet been combined in the setting of PVI.

Purpose
To determine feasibility, safety, efficacy, and overall performance of vHPSD PVI with anterior chest position of DE.

Methods
Consecutive patients undergoing vHPSD PVI using flexible-tip catheter and anterior position of DE were included in the study. vHPSD protocol consisted of 70W RFCA applications lasting 4s. If needed, RFCA applications were extended using 50W until R-positive unipolar signal modification and/or until impedance drop ≥10% from baseline was achieved or were terminated in case of steam-pop occurrence. Demographical, clinical, procedural and follow-up data were collected.

Results
A total number of 43 patients (25 males, age 61±14years) were included in the study. 34 patients had paroxysmal AF (parox-AF group) and 9 patients had persistent AF (pers-AF group). Mean procedure time was 61±7min, mean RFCA time was 685±204s. All PVs were successfully isolated. Audible steam pops without sequele occurred in 6 (14%) cases. Major complications included one TIA without sequele. During follow-up 33 (77%) patients remained AF-free: 26 (76%) in parox-AF group vs 7 (78%) in pers-AF group (log rank p=0.0166). No atrioesophageal fistula or evidence of esophageal injury occurred.

Conclusions
Anterior chest position of DE combined with vHPSD approach for PVI is feasible, appears safe and effective. More data on possible protective properties against atrioesophageal fistula occurrence using the presented approach is warranted.
Postural orthostatic tachycardia syndrome associated with post-acute covid-19 syndrome is not mediated through smaller hearts or contractile dysfunction
Authors: Ahmad A , Mahdi A , Fedorowski A , Nygren-Bonnier M , Bruchfeldt J , Runold M , Desta L , Pernow J , Stahlberg M , Nickander J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Swedish Heart-Lung foundation
Swedish Research Council

Introduction
Post-acute covid-19 syndrome (PACS) is a novel condition with persistent symptoms affecting different organs. We have previously reported postural orthostatic tachycardia syndrome (POTS) as one important long-term complication. The pathophysiological mechanisms behind PACS and associated POTS are largely unknown. It has previously been suggested that POTS patients have a smaller left ventricular mass (LVM) and volume contributing to the persistent symptoms of tachycardia, however it is currently unknown if these pathophysiological mechanisms are similar in PACS associated POTS. Furthermore, it has been shown that global longitudinal strain (GLS) and global circumferential strain (GCS) are more sensitive measures of contractile function compared to ejection fraction, however it is also currently unknown if GLS and GCS differs between PACS patients with and without POTS.

Purpose
To elucidate if patients with PACS associated POTS have a lower LVM compared to PACS without POTS, and if GLS and GCS differ between the groups.

Methods
In total, 31 patients that had suffered a mild SARS-CoV-2 infection diagnosed with PACS according to the WHO criteria were enrolled in this prospective cohort study. POTS was verified by head-up tilt test; 16 patients (age 40±10 years, 94% women) were POTS positive whereas 15 (45±11 years, 93% women) were POTS negative. All patients underwent cardiac magnetic resonance imaging, and global longitudinal strain (GLS) and global circumferential strain (GCS) were calculated.

Results
There were no differences between the groups with regards to left ventricular dimensions or mass, Table 1. There were no differences in GLS and GCS between the two groups (GLS: PACS and POTS positive -18±2% vs PACS and POTS negative -19±2%, p=0.53; GCS: PACS and POTS positive -17±3% vs PACS and POTS negative -19±3%, p=0.16), Figure 1.

Conclusions
PACS-related POTS is not associated with contractile dysfunction nor differences in cardiac geometrics, providing mechanistic insights in the pathophysiology of PACS associated POTS. Other specific pathophysiological mechanisms that underlie POTS associated with PACS needs to be established.
Dipole charge density mapping demonstrates superiority in catheter ablation of post-surgical atrial tachycardias
Authors: Gagyi R , Ramdat Misier N L , Yap S C , Wijchers S , Hoogendijk M , Bhagwandien R , Hussain A , Kharbanda R , Szili-Torok T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial tachycardia (AT) frequently occurs after cardiac surgery or surgical ablation procedures. The novel dipole charge density-based mapping system (AcQMap) provides global chamber mapping and can detect multiple slow conduction zones and re-entry isthmuses; therefore, it has a potential added value in post-surgical AT ablation. We aimed to test the hypothesis that AcQMap guided catheter ablation (CA) procedures are safe, feasible, and may provide improved outcome compared to conventional sequential 3D mapping (CARTO) based CA.

Methods
Consecutive patients undergoing CA for post-surgical ATs guided by the AcQMap or the CARTO system were enrolled. Procedural safety characterized by procedural complications, and efficiency characterized by procedure duration, fluoroscopy use, radiofrequency (RF) application and duration, were analyzed. Acute success, one-year outcome as freedom from AT and atrial fibrillation were assessed.

Results
A total of 40 patients (mean age 58.2±13.0 years, 42.5% female), underwent CA of AT using the AcQMap (n=20) and CARTO mapping system (n=20). No differences were found in procedural complication (AcQMap 3 vs. CARTO 2 patients, p=0.63). There were no differences in procedure duration (188.1 vs. 153.8 minutes, p=0.08), fluoroscopy dose (165.0 IQR 121.0-254.0 vs. 107.0 IQR 28.8-284.0 mGy, p=0.16), RF application number (30.0 IQR 18.8-63.5 vs. 25.5 IQR 10.5-44.3, p=0.20) or duration (1397.0 IQR 690.5-1869.8 vs. 1238.0 IQR 499.0-2074.8 s, p=0.47). Acute success was 95.0% in AcQMap group and 80.0% in CARTO group (p=0.15). A total number of 70 ATs were mapped in 40 patients (35 in the AcQMap group and 35 in the CARTO group, average 1.6 ± 0.7). Four patients had focal ATs, 26 patients had macro re-entrant ATs, and 9 patients had ATs with both mechanisms. In one patient AT was not mappable with the CARTO system, empiric ablation was performed. There were no differences in AT mechanism between the patient groups (p=0.53). Cumulative AT recurrence rates were lower in AcQMap group compared to CARTO group (18.8% vs. 52.6%, p=0.01). Freedom from all arrhythmias was 75.0% in the AcQMap and 36.8% in the CARTO group (p &lt; 0.01).

Conclusions
The AcQMap system is safe and feasible. Our data suggest that patients treated with AcQMap-guided CA developed fewer AT recurrences as compared to CARTO-guided procedures.
Tick Tock timing of permanent pacemaker implantation after transcatheter aortic valve replacement. A single center review
Authors: Rexha E , Schlichting A , Chung D , Tigges E P , Ubben T , Hassan K , Nejahsie Y , Gessler N , Willems S , Kaiser L , Hakmi S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Permanent pacemaker implantation (PPI) for high degree atrio-ventricular block (AVB) is common in patients after transcatheter aortic valve replacement (TAVR). There is still no clear recommendation regarding the optimal timing of PPI and programming of the pacemakers (PM) in these patients.

Methods
Data of all 1363 patients who underwent TAVR in our center between July 2019 and September 2022 was included in this retrospective study. In patients with high degree AVB a PPI was performed either in the same procedure or at least within 24 h after TAVR. All patients underwent a PM-interrogation before discharge.

Results
A permanent PM was implanted in 122 of 1363 (9%) patients with a mean age of 82 years. AVB that required PPI occurred in 9.2% (100/1087) of the patients with a self-expandable (SE) valve and in 8% (22/276) of the patients with a balloon expandable (BE) valve. In 34 patients PPI was performed in the same TAVR procedure, and 88 patients were treated in an average of 3.5 days after TAVR. Right-sided PM was implanted in 27 out of the 34 (79.4%) intra-procedural cases and in 3 of the 88 (3.4%) post-procedural cases.
No major complications were reported. Two revision procedures were performed due to lead dislodgements in both groups respectively [(2/34 (5.9%); 2/88 (2.3%)]. Two pneumothoraces (2/88, 2.3%) were reported in the post-procedural PPI patients. The overall complication rate was 4.9 % (6/122).
The AV-conduction showed recovery in 37 Patients (37/122, 30%) during the first interrogation in an average of 2.1 days after TAVR [(9/34(26.5%); 28/88 (31.8%)]. The AV-hysteresis was programmed in 48 out of the 94 implanted dual chamber pacemakers during the first interrogation. The average length of stay in hospital in patients with intra-procedural PPI and in those who underwent PPI in a second procedure was 13.7 and 14 days respectively with no significant difference between both groups (p&gt;0.05).

Conclusion
Intra-procedural PPI was not associated with significant reduction of in hospital stay. The percentage of AV-conduction recovery after TAVR was high, even in short term follow up. Patients could benefit from a longer monitoring to avoid PPI and programming of AV-hysteresis during the first interrogation in these population should be recommended. Randomized and long-term follow up data are needed.
A novel workflow for advanced mapping of repolarization dispersion from endocardial unipolar electrograms in patients with coved-type brugada syndrome
Authors: Latrofa S , Garibaldi S , Hartwig S , Panchetti L , Morelli M S , Martini N , Zaurino N , Mansi G , Mirizzi G , Startari U , Passino C , Emdin M , Piacenti M , Giannoni A , Rossi A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Accentuation of the action potential notch in the epicardium causes the prolongation of the epicardial action potentials in the right ventricular outflow tract (RVOT) and is the basis for arrhythmogenesis in patients affected by Brugada syndrome (BrS). Activation-recovery interval (ARI) approximates the action potential duration and may be used to study repolarization dispersion in BrS.

Purpose
Our aim was to investigate repolarization dispersion within the RVOT in spontaneous coved-type ECG BrS patients and in controls, evaluating also the relation between repolarization dispersion and conduction abnormalities to better define the electro-anatomical substrate of the disease.

Methods
BrS probands (n=13) and control subjects (n=4) underwent endocardial mapping of RV with the CARTO 3 system. BrS patients were also studied with programmed ventricular stimulation (PVS). Data was exported from the CARTO system and converted into MatLab format using OpenEP. A specific region of interest (ROI) including the sub-pulmonary RVOT and entire RV free wall was then selected using Paraview. With an automated algorithm, we measured ARI and ARIc (corrected using the "Bazett formula") for each point of the ROI, which were then interpolated to obtain ARI maps. We also acquired right ventricular activation time (RVAT) and maps for the assessment of slow conduction zones. By dividing RVAT color scale in 5 ms steps (isoSteps), isochronal activation areas were identified in the ROI.

Results
Out of the 13 BrS subjects, 4 had VT or VF inducible during PVS (PVS+) while 9 did not (PVS-). One patient had appropriate ICD shocks during follow-up. BrS patients had higher mean ARI and ARIc compared to controls (288.5±22.2 vs 251.5±8.4 ms, p&lt;0.001; 312.0±30.4 vs 281.8±10.3 ms, p=0.023). ARI was found to be higher in PVS+ than in PVS- patients (294.8±27.1 vs 285.8±20.1 ms, p=0.5), as well as ARIc (327.7±49.9 vs 304.6±16.4 ms, p=0.49) although these differences were not significant. BrS patients showed a longer RVAT (106.0±21.4 vs 74.5±5.5 ms, p=0.003), and increased zones of crowding, as expressed by isochronal steps (13.85±2.94 vs 9.25±1.26, p=0.01). Notably, a strong correlation was found between ARIc and RVAT (Pearson R coefficient = 0.83, p&lt;0.05), independently from the results of PVS (PVS+ R=0.99, p=0.01; PVS- R=0.83, p=0.06).

Conclusions
We introduced a novel workflow for the electrical substrate characterisation of subjects with BrS phenotype. Our preliminary data show the presence of repolarization dispersion along with conduction slowing in the RVOT of BrS patients compared to controls. In our population, repolarization dispersion and impairment of RVOT conduction were strongly related especially in inducible BrS patients.