bluuebunny/crossref_metadata_2025_split huggingface dataset:
Catheter ablation of atrial fibrillation and atrial tachycardia in patients with pulmonary hypertension: a randomised study
Authors: Havranek S , Fingrova Z , Skala T , Reichenbach A , Dusik M , Jansa P , Ambroz D , Dytrych V , Wichterle D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The study was supported by the Ministry of Health of the Czech Republic.

Background
Atrial fibrillation (AF) and other atrial tachycardias (ATs), including typical atrial flutter (AFL), are common in patients with pulmonary hypertension. Frequently, several supraventricular arrhythmias are successively observed in individual patients.

Purpose
We investigated the hypothesis of whether more extensive radiofrequency catheter ablation of the bi-atrial arrhythmogenic substrate instead of clinical arrhythmia ablation alone results in superior clinical outcomes in patients with PH and AF / AT.

Methods
Patients with combined post- and pre-capillary or isolated pre-capillary PH and AF / AT indicated to catheter ablation were enrolled in 3 centers and randomized 1:1 into two parallel treatments arms: (A) Clinical arrhythmia ablation and (B) Clinical arrhythmia plus substrate-based ablation. The primary endpoint was arrhythmia recurrence &gt;30 s without antiarrhythmic drugs after the 3-month blanking period.

Results
A total of 77 patients (mean age 67 ± 10 years; 41 males) were enrolled. The presumable clinical arrhythmia was AF in 38 and AT in 36 patients, including typical AFL in 23 patients. During the median follow-up period of 13 (IQR: 12; 19) months, the primary endpoint occurred in 15 patients (42 %) vs. 17 patients (45 %) in the group B vs. A (hazard ratio: 0.97, 95% confidence interval: 0.49-2.0). There was no excess of procedural complications and clinical follow-up events including an all-cause death in group B.

Conclusion
Extensive ablation, compared with a limited approach, was not beneficial in terms of arrhythmia recurrence in patients with AF / AT and pulmonary hypertension.
A focus on pregnancy course and outcomes of women with zero-fluoroscopy catheter ablation during gestation: a 2-year follow-up study
Authors: Abdrakhmanov A , Ainabekova B , Nuralinov O , Smagulova A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Arrhythmias in pregnant are common clinical problem. Catheter ablation may be required in cases of drug refractory and hemodynamically unstable arrhythmias. Data on further course of pregnancy, perinatal outcomes and results of zero-fluoroscopy catheter ablation in pregnant patients is limited.

Purpose
we aimed to determine efficacy and safety of zero-fluoroscopy catheter ablation during gestation.

Methods
54 pregnant indicated for catheter ablation (Mean age of women was 26.2±3.2 years, mean gestation age 23.3 ±2.4 weeks) due to drug refractory. Further course of pregnancy, perinatal outcomes, complications and arrhythmia recurrence checked during 2-year follow-up.

Results
Atrioventricular nodal reentrant tachycardia was the most common arrhythmia (n=21; 38.9%). This was followed by Wolff–Parkinson–White syndrome (n=18; 33.3%). In five pregnant was combination of accessory pathways with slow conduction ways (9.3%). Cases of zero-fluoroscopy catheter ablation of ventricular tachycardia (n=2; 3.7%) and premature ventricular contraction (n=8; 14.8%) during gestation were rare. Zero-fluoroscopy catheter ablation successfully performed in all cases (median procedural time was 73±13 minutes). Procedural complication was in one cases (ileofemoral thrombosis). There was no termination of pregnancy after ablation. In five women were increased uterine contractility and uterine blood flow violation (n=5; 9.3%). Preterm delivery was in two cases (3.7%) at 35 and 36 weeks of gestation. Type of delivery was vaginal in the majority (n=42; 77.7%). There were three cases of placental abruption and preeclampsia (5.6%). There were 55 live births (in one case were twins). Fetal birth weight was 3238.7±559.2 grams, 5 minute Apgar was 8.5±1.1. There were no maternal and fetal mortality. At 2-year follow-up there were no arrhythmia recurrence.

Conclusions
Zero-fluoroscopy catheter ablation during gestation may be safe and effective. It is associated with benign pregnancy course, perinatal and neonatal outcomes.
Left atrial appendage anatomical changes following radiofrequency-based ostial isolation
Authors: Della Rocca D , Magnocavallo M , Gianni C , Mohanty S , Vetta G , Bassiouny M , Pannone L , De Asmundis C , Lavalle C , Chierchia G B , Di Biase L , Burkhardt J D , Gallinghouse G , Horton R , Natale A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left atrial appendage (LAA) electrical isolation (ei) may be achieved via radiofrequency (RF) energy applications at the level of the appendage ostium targeting the sites of earliest activation recorded by a mapping catheter. Notably, RF has long been used in vascular, orthopedic, and aesthetic surgery to promote thermal-induced collagen matrix contraction, fibrosis, and tissue retraction. LAA anatomical changes associated to RF-induced tissue retraction have never been reported.

Purpose
To quantify the anatomical changes of the LAA ostium following RF-based LAAei.

Methods
Thirty-four consecutive patients requiring AF ablation with LAAei underwent transesophageal echocardiography (TEE) within 7 days before (baseline TEE) and apx 6 months after (follow-up TEE) ablation. The diameter of LAA orifice and landing zone were measured at 4 different views (0°, 45°, 90°, 135°). Measurements were performed by two independent reviewers blinded to the patient’s identity.

Results
Among 43 AF patients (67±6yrs, 72.1% males), the LAA morphology was classified as chicken wing in 19 (44.2%) patients, windsock in 12 (27.9%), cactus in 8 (18.6%), and cauliflower in 4 (9.3%). At baseline TEE, the mean maximum and mean minimum ostial diameters were 25±4mm and 22±4mm, respectively. The mean maximum and mean minimum diameters of the landing zone were 26±4mm and 23±3mm, respectively. On average, LAAei was achieved after 17±6 minutes of RF at a power of 45W. Follow-up TEE was performed 294±136 days after LAAei. The median LAA contraction velocity was 0.1 m/s (IQR: 0.02-0.18) and was significantly impaired in all patients. At follow-up TEE, the mean maximum and mean minimum ostial diameters were 19±4mm and 17±3mm, respectively. The mean maximum and mean minimum diameters of the landing zone were 20±4mm and 18±4mm, respectively. The mean relative reduction of the ostium and the landing zone was -24.4% and -22.5%, respectively. Box-Whisker plots of the maximum and minimum ostial diameters before and after LAAei are reported in Fig.1.

Conclusion
RF led to a &gt;20% reduction of the diameters of the ostium and the landing zone. These changes may have important implications for a successful percutaneous occlusion procedure and justify a staged approach of isolation and occlusion.
Fluoroscopy integration module reduces radiation exposure without affecting procedure time in accessory pathway ablation
Authors: Ozcan E E , Yilancioglu R Y , Turan O E , Inevi U 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Conventional Accessory Pathway (AP) ablation is a straightforward approach with high success rates, but the fluoroscopy time is significantly higher. Electroanatomical mapping systems (EMS), reduce the fluoroscopy time, but anatomical reconstruction and activation mapping prolong the procedure time. The Fluoroscopy Integration Module (FIM) uses prerecorded fluoroscopy images and allows ablation similar to conventional technique without creating an anatomical map. In this study, we investigated the effects of combining the FIM with the traditional technique on procedure time, success, and radiation exposure.

Methods
112 patients who underwent AP ablation were included in our study. In 18 patients, right and left anterior oblique (RAO -LAO) images were recorded after the insertion of the catheters and integrated with FIM. Afterwards, ablation was performed similarly to the conventional technique but without using fluoroscopy. To accelerate the procedure anatomical and activation maps were not created. Contact-force catheters were not used. 94 patients were ablated conventionally using only fluoroscopy.

Results
Combining the FIM with the conventional method significantly reduced radiation exposure (Fluoroscopy time: 3,3±2,6 vs 11,5±11,6 sec, p: 0,001; Dose-area-product (DAP): 7,3±6,2 vs. 28,6±40,5 μGym2, p: 0,003) without affecting the total procedure time ( 64,4±15 vs. 62,6±28,7 sec, p: 0,272 ), time to successful ablation ( 33,2±13,9 vs. 29,7±29,5 sec p: 0,056) and radiofrequency application time ( 183,7±94,4 vs. 167,3±89,8 sec p: 0,336).

Conclusion
These findings suggest that FIM can be used for rapid and successful ablation of APs with reduced radiation exposure times.
Pulmonary vein reconnection rates and lesion regression during repeat procedures in patients with recurrent arrhythmias after pulsed field ablation pulmonary vein isolation
Authors: Kueffer T , Madaffari A , Muehl A , Seiler J , Thalmann G , Servatius H , Kozhuharov N A , Tanner H , Haeberlin A , Noti A , Baldinger S H , Roten L , Reichlin T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
A novel multipolar pulsed-field ablation (PFA) catheter has recently been introduced for pulmonary vein isolation (PVI). Pre-market data showed high rates for PVI-durability during mandatory remapping studies 90 days after the first procedure. Post-market data on PVI durability and lesion regression, particularly in patients with recurrent atrial arrhythmias, are limited.

Purpose
To characterize the findings on redo cases after previous PFA procedures.

Methods
Consecutive patients undergoing a redo procedure after an index PFA PVI between May 2021 and October 2022 were included. 3-D electro-anatomical maps (3D-EAM) were acquired in sinus rhythm at the beginning of the redo procedure and compared to the 3D-EAM acquired after ablation during the index procedure. PV-reconnection was assessed on a per-vein and per-patient level and the sites of reconnections were identified. Furthermore, lesions extent was compared between the two maps.

Results
Of 265 patients undergoing their first PFA PVI between May 2021 and August 2022, 26 (9.8%) patients with recurrent atrial tachyarrhythmia underwent a redo ablation. The phenotype prior to the first PVI was paroxysmal AF in three patients (12%), persistent AF in 85 patients (85%), and left atrial flutter in one (4%) patient. A 31 mm device was used in 81% of the patients. Posterior wall ablation in addition to PVI was performed in three patients. At the end of the first PFA procedure, 100/102 veins (98%, two common ostia) were isolated as evidenced by post ablation 3D-EAM (two LIPV’s could not be isolated). The recurring arrhythmias were AF, atypical flutter, both, and atrial tachycardia in 14 patients (54%), 5 patients (19%), 6 patients (23%) and 1 (4%) respectively. High-density 3D-EAM identified 65/100 (65%) PVs with persistent isolation. In 7 (27%) patients, all PVs were isolated. Reconnection occurred most frequently in the right inferior PV (11, 42%) followed by the left superior PV (9, 36%), the right superior PV (8, 31%), the left inferior PV (6, 27%), and the left common ostium (1, 50%). The predominant reconnection sites were located anterior of the superior veins, and on the inferior aspect of the right inferior PV (Figure). On the posterior wall, the distance between the lesions of the left pulmonary veins and the right pulmonary veins increased by a median of 5 mm [0, 10] between the index and Redo procedure.

Conclusion
In patients with recurrent atrial arrhythmias after PFA PVI, PV reconnections were found in 73% of the patients and in 35% of the veins. The reconnections were most prevalent on the anterior aspects of the upper veins, as well as on the inferior aspect of the right inferior vein.
Safety and effectiveness of very-high-power, short-duration ablation in patients with atrial fibrillation: Preliminary results
Authors: Lodzinski P , Mitrzak K , Peller M , Krzowski B , Maciejewski C , Balsam P , Marchel M , Grabowski M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary vein isolation (PVI) is at the forefront of rhythm control strategies in patients with atrial fibrillation (AF). A very-high-power, short-duration (vHPSD) catheter was designed to improve the effectiveness of AF ablation within a shorter procedure time. We aimed to compare the effectiveness and safety of PVI ablation between this vHPSD ablation mode (90W/4s) and conventional index-guided ablation (up to 40W/indexed).

Methods
This single-center, retrospective, observational study enrolled 148 patients with AF, referred for catheter ablation between December 16, 2019 and July 29, 2022. In 77 procedures (mean age: 59.7±12.0 years; 61.0% male; 74.0% paroxysmal), a vHPSD catheter was used (vHPSD-group), and 71 patients (mean age: 58.1±11.6 years; 70.4% male; 67.6% paroxysmal) were treated with a ablation index catheter (AI-group). The study assessed the recurrence of AF at 3- and 6-months after ablation. The outcomes also included the amount of opioids administered during the procedure and the incidence of treatment-emergent adverse events. Additionally, procedural factors, such as total procedure time, fluoroscopy time and radiofrequency application time were compared between the groups.

Results
At 3 months, AF was found to recur in 14.29% (11/77) of patients in the vHPSD-group and in 30.99% (22/71) of patients in the AI-group (p=0.02). At 6 months, 18.31% (13/71) patients reported AF recurrence in the vHPSD-group and 32.73 % (18/55) in the AI-group (p=0.09). There was no difference in treatment-emergent adverse events between the two groups (3.9% vs. 2.8%; p=1.00). One severe adverse event (a cerebral vascular accident) was observed in the vHPSD-group. The mean dose of remifentanil was reported to be lower during vHPSD-based PVI (p&lt;0.0001). The vHPSD-based PVI was associated with shorter radiofrequency application time (p&lt;0.0001), fluoroscopy time (p&lt;0.0001), and total procedure time (p&lt;0.0001).

Conclusions
This study suggests that the vHPSD-quided PVI is equally effective and safe with reference to short-term clinical observation as conventional ablation. Also, the vHPSD ablation may allow to reduce the dosage of analgesics during significantly shorter procedures.
Cavotricuspid isthmus ablation by means of very high power short duration temperature controlled lesions: acute and mid term outcome
Authors: Schillaci V , Poggi S , Strisciuglio T , Arestia A , Salito A , Iuliano A , Shopova G , Spiniello G , De Simone A , Stabile G , Solimene F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Very high-power short-duration (vHPSD) temperature-controlled radiofrequency ablation minimizes conductive heating and increase resistive heating, achieving uniform and transmural lesion while reducing the risk of collateral tissue damages. The shape of the vHPSD lesion, wider and shallower than standard radiofrequency, raises some concerns during atrial flutter ablation (AFL).

Purpose
We evaluated the feasibility, efficacy and safety of the vHPSD ablation of the
cavotricuspid isthmus (CTI) in patients presenting with typical AFL.

Methods
Sixty-one consecutive patients, with typical AFL, underwent CTI ablation using the QDot Micro catheter and vHPSD (90 w for 4 s). Patients were followed-up by means of visits and ECG in the outpatient clinic 1, 6 and 12 months after the procedure
and later on with telephone interviews or by 24-h Holter monitoring in case of symptoms.

Results
Acute CTI bidirectional block was achieved in all patients (91% of first-pass block) with a mean fluoroscopy time of 114±29 s and a mean procedure time of 37±9 min. Two steam pops were observed. Two patients had groin hematoma, no further complications were observed. During a mean follow-up of 14±7 months, two (3.2%) patient had typical AFL recurrence, and four (6.5%) patients had an atrial fibrillation recurrence.

Conclusions
The vHPSD ablation represents an effective and safe ablation strategy to achieve bidirectional block for the treatment of typical AFL.
Radiofrequency ablation for longstanding persistent atrial fibrillation: long-term outcome of a prospective randomized comparison of mapping with multipolar catheter vs. 4-pole ablation catheter
Authors: Fiala M , Cernosek M , Bulkova V , Rybka L , Manousek J , Lehar F , Toman O , Kala P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In patients with longstanding persistent atrial fibrillation (LSPAF), mapping with multipolar catheter can enhance identification of arrhythmogenic sources during ongoing AF/converted atrial tachycardia (AT), reduce procedure time, and improve outcome of catheter ablation.

Purpose
To compare procedural characteristics and long-term outcome of radiofrequency catheter ablation (RFA) for LSPAF between two mapping approaches in a prospective randomized bi-centric study.

Methods
Between 1/2019-9/2021, RFA was performed in in 172 patients with LSPAF. Mapping with multipolar catheter Pentaray (group 1, n=85) vs. mapping with ablation catheter Navistar STSF (group 2, n=87) were compared. Stepwise ablation to the desired AF termination included pulmonary vein isolation (PVI), electrogram guided left atrial (LA) ablation, CS isolation, and right atrial electrogram guided ablation. PVI, mitral isthmus, LA roof, and CTI block were Intermediate endpoints proved at the procedure end. Sinus rhythm (SR) restoration by ablation was the desired procedure endpoint. Follow-up included 7-day ECG monitoring every 3 months during the first year, and every 6 months afterwards.

Results
In groups 1 vs. 2, AF was terminated (into SR or AT) in 70 (82%) vs. 68 (78%) patients (p=0.81); and SR was restored by ablation in 54 (64%) vs. 46 (53%) patients(p=0.46), respectively. Procedure, fluoroscopy, and RF delivery times (min) were 251±46 vs. 257±45 (p=0.35); 10,4±2,8 vs. 11,0±3,1 (p=0.17), and 70±21 vs. 70±24 (p=0.98), respectively. At the end of 13-45 months follow-up, stable SR was present in 72 (85%) vs. 69 (79%), patients following repeat ablation in 42 (49%) vs. 42 (48%) patients. Only 29 (34%) vs. 26 (30%) patients remained free from any AF/AT recurrence (&gt;30 s) after single ablation (all p=NS).

Conclusion
Mapping with multipolar catheter vs. standard ablation catheter was associated with nonsignificant differences in procedural characteristics and clinical results of RF catheter ablation for LSPAF.
Pulsed field ablation for atrial tachycardia following prior persistent atrial fibrillation ablation and resistant to radiofrequency energy
Authors: Fiala M , Cernosek M , Bulkova V , Bahnik J , Lehar F , Rybka L , Manousek J , Toman O , Kala P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
There is a limited knowledge of immediate and long-term efficacy of pulsed field ablation for residual atrial tachycardia (AT) following (longstanding) persistent atrial fibrillation (AF) ablation and resistant to prior radiofrequency ablation (RFA).

Purpose
To present immediate effects of PFA (Farapulse) in a series of patients with repeat ablation for residual atrial tachycardia (AT) resistant to prior RFA.

Methods and results
In 5-11/2022, of 23 patients scheduled for PFA, 19 patients (64±7 years, 3 females) underwent PFA for left atrial (LA) AT resistant to RFA in first (n=4), second (n=11), third (n=3), and fourth (n=1) repeat ablation, respectively, after primary persistent AF ablation (4 patients were redirected to RFA for septal/right atrial AT source found by 3D mapping). At the procedure onset, persistent AT was ongoing (n=15) or was induced (n=4; AF induced and subsequently converted into AT in 3 patients). Mapping/ablation strategy was directed according to CS activation/entrainment to: 1) no 3D mapping and direct PFA (n=11); 2) PFA directly after 3D LA mapping (n=5); 3) PFA following RFA after 3D LA mapping (n=3). Total of 29 ATs was found (1,2, and 3 ATs in 12, 4, and 3 patients, respectively). Localized AT sources (n=16) dominated over macroreentry (MR) ATs (8 perimitral, 4 roof-dependent, 1 typical flutter). Only MR ATs, only localized ATs, and both MR+localized ATs were present in 7, 4, and 8 patients, respectively. All ATs were stopped with 5±9 PFA applications at the site of AT source and remained non-inducible. In 3 patients with initial ineffective RFA (6, 11, 6 minutes) within the same procedure, subsequent PFA terminated the AT with 1, 4, and 1 application respectively. Procedure and fluoroscopy times were 104±29 and 12±4 minutes, no complication occurred.

Conclusion
PFA with catheter Farapulse can affect complex/epicardial AT sources resistant to RFA in prior or present ablation procedure.
Epicardial ablation of left atrial flutter
Authors: Martinez Cossiani M , Castrejon Castrejon S , Jauregui Abularach M , Escobar Cervantes C , Guido Lopez L E , Merino D , Ugueto Rodrigo C , Carton A , Cobarro Galvez L , Severo Sanchez A , Martinez Maldonado M E , Merino J L 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left atrial flutter (LAFL) may have epicardial components not accessible to endocardial ablation by radiofrequency (RF) application. Subxiphoid access to the pericardial space has been reported in isolated cases.

Purpose
to prospectively evaluate the efficacy and safety of subxiphoid access to the pericardial space to map and ablate LAFL refractory to endocardial RF application.

Methods
Patients with LAFL confirmed by activation and entrainment mapping and refractory to endocardial RF application were consecutively enrolled. An epicardial component of the tachycardia circuit was suspected when parts of the AFL activation, channels of slow conduction or conduction gaps on previous ablation lines intersecting the AFL circuit were not found. Pericardial access was obtained by subxiphoid puncture performed conventionally or facilitated by saline infusion or CO2 insufflation into the pericardial space. Following pericardial access, epicardial mapping and ablation was performed with a conventional RF irrigated tip ablation catheter. All procedures were performed under oral anticoagulation and during following heparin infusion for 350 sec activation clotting time target.

Results
15 patients with 18 LAFL were included (61.0 ± 8.8 years, 80% male). 14 patients have had a previous atrial fibrillation (AF) ablation. Epicardial ablation was attempted after a previous LAFL endocardial ablation procedure in 6 patients and during the same endocardial ablation procedure in the last 9 patients. Pericardial access was not achieved in 1 patient due to pericardial adhesions (after prior cardiac surgery). Ablation was successfully performed in 11 patients (73.33%) and failed in 4 patients with perimitral AFL (1 patient also had a peri-left appendage AFL). The successful ablation site was found in the transverse sinus of Theile over the Bachmann bundle in 14 patients with perimitral, septal and anterior-wall LAFL and in the oblique sinus in a posterior-wall LAFL. No patient presented relevant complications except for 2 patients who presented hemopericardium and 1 with delayed cardiac tamponade following accidental RV puncture and who required pericardiocentesis. No patient presented AFL recurrences at 19.8 months (range 6-34 months) follow-up except for 2 patients in whom ablation failed or pericardial access was not achieved.

Conclusions
Epicardial ablation of LAFL refractory to endocardial ablation is successful in most patients following successful pericardial access. This approach appears associated with low risk of significant complications.