bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrasound-guidance for femoral venipuncture reduces access site complications after ablation of atrial fibrillation and other left atrial tachycardias: a retrospective single- center analysis
Authors: Poley P , Agdirlioglu T , Weil J , Krahnefeld O 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Access site complications are significant adverse events related to ablation therapy. Periprocedural continuation of anticoagulation is common practice and leads to a reduction of cerebrovascular ischemic events but may increase the likelihood of access site complications.

Methods
619 consecutive patients who underwent left-atrial ablation for AF were assessed for venipuncture associated complications after either landmark or ultrasound-guided venipuncture using data on hospital readmissions, outpatient visits or a structured telephone interview. AV-fistula, pseudoaneurysm and need of either interventional or surgical treatment of a vascular complication as well as blood transfusion were considered as access site complications.
Continuous data are given as mean ± standard error of the mean, categorical data are expressed as number and percentages. Differences between groups were determined by Student’s t-test, chisquare-test, and Fisher’s exact test using SPSS software. A p-value of &lt;0.05 was deemed significant.

Results
The patients' mean age was 69.1 ± 10.8 years and 51.5% were female. Mean BMI was 28.4 ± 5.5 kg/m2. Procedural safety was preserved with low observed rates of serious adverse events. The rate of postprocedural stroke (0.2% vs. 0%), pericardial effusion (0.8% vs. 0.6%) and in-hospital mortality (0% vs. 0%) did not differ between the groups.
After conventional landmark-guided venipuncture the vascular complication rate was 4.8% (12/248). The rate of access site complications was significantly reduced to 0.8% (3/371) (p&lt;0.01, OR 0.194, 95%-CI: 0.0529-0.712) when real time ultrasound-imaging was used for femoral venous cannulation. Severe bleeding complications related to the access site that required surgical or interventional treatment did not occur in the ultrasound group, compared to 2.0% (5/248) in the landmark-guided group (p = 0.010). The absolute risk reduction for access site complications using ultrasound-guidance was 3.2%, resulting in a number needed to treat (NNT) of 32 and a NNT of 50 for severe access site complications.

Discussion
Ultrasound-imaging while performing venipuncture identifies complex or uncommon anatomical conditions and facilitates safe cannulation of the common femoral vein. The use of ultrasound visual guidance for femoral sheath introduction had a remarkable beneficial effect on the occurrence of vascular access site complications in this retrospective single-center analysis. Outstandingly, the total rate of vascular access site complications had been significantly reduced resulting in a reduction of interventional or surgical treatment down to 0,0% in the us-guidance group, this may lead to fewer interruptions of OAC ant therefore lower risk of peri-interventional cerebrovascular events.
Baseline rhythm during catheter ablation for atrial tachycardia predicts procedural and clinical outcome
Authors: Kahle A K , Alken F A , Scherschel K , Meyer C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial tachycardias (AT) occurring after previous ablation in patients with a history of atrial fibrillation (AF) are increasingly observed in clinical practice. Catheter ablation is the treatment of choice but an optimal workflow to improve patient outcome has not been defined. The prognostic implications of baseline rhythm at the beginning of AT ablation are unknown.

Purpose
The aim of this study was to assess procedural and clinical outcome depending on baseline rhythm during AT ablation.

Methods
A total of 380 patients with a history of AF who underwent catheter ablation for consecutive AT after previous ablation were analysed.

Results
In our study population (69 (61–75) years, 56.6% male), 140 patients (36.8%) presented in baseline sinus rhythm (SR), 208 (54.7%) with AT and 32 (8.4%) with AF at the beginning of the procedure. Patients in SR or with AT underwent shorter procedures (SR: 173 (132–213) minutes vs. AT: 161 (120–203) minutes vs. AF: 226 (154–249) minutes; P=0.002) with more frequent termination to SR (SR: 87.9% vs. AT: 81.3% vs. AF: 56.3%; P&lt;0.001) than patients with AF. Periprocedural AT cycle length was longer in patients presenting in SR than in those with AT or AF (SR: 320 (265–370) ms vs. AT: 270 (240–310) ms vs. AF: 245 (193–278) ms; P&lt;0.001). Acute procedural success did not differ between patients in SR or with AT but was higher compared to those with AF (SR: 96.4% vs. AT: 97.1% vs. AF: 87.5%; P=0.033). During a median follow-up of 290 (181–680) days, patients in baseline SR developed arrhythmia recurrences less often (SR: 36.4% vs. AT: 49.5% vs. AF: 68.8%; P=0.002) compared to patients with AT or AF.

Conclusions
Baseline rhythm during AT ablation predicts procedural and clinical outcome. Whereas acute procedural success does not differ between patients in SR or with AT, patients presenting in SR have a more favourable mid-term success rate. Restoration of SR prior to ablation might improve long-term outcome by reducing the risk for recurrent arrhythmia.
Similarly high success and low complication rates of catheter ablation for idiopathic premature ventricular contractions from the left and right ventricular outflow tract
Authors: Mueller-Leisse J , Syrbius G , Hillmann H A K , Eiringhaus J , Hohmann S , Zormpas C , Karfoul N , Duncker D , Veltmann C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Catheter ablation is the first line treatment for idiopathic premature ventricular contractions (PVCs) from the right ventricular outflow tract (RVOT) but not from the left ventricular outflow tract (LVOT), due to presumed lower success and higher complication rates in the LVOT. In this observational single center study we analyzed success rates and complication rates in patients undergoing catheter ablation for idiopathic PVCs with an inferior axis.

Methods
Patients undergoing catheter ablation for idiopathic PVCs with an inferior axis at Hannover Heart Rhythm Center between 2012 and 2020 were included. Patients were excluded if no activation mapping could be performed because of low PVC activity. Ablation success was defined as complete suppression of the index PVC at the end of the procedure.

Results
108 patients (53% male, age 53 ± 17 years) with predominantly symptomatic (94%) PVCs with one (72%), two (20%) or more (8%) morphologies and a PVC count of 22063 ± 14426 /24h were included. 47 PVCs (44%) were located in the RVOT (21 anterior RVOT and 26 septal RVOT) and 39 PVCs (36%) in the LVOT (11 lateral LVOT, 5 septal LVOT, 8 RCC, 2 ACC, 13 LCC). 14 PVCs (13%) had the origin close to the CS/LV summit and 8 PVCs (7%) in the parahisian region. Overall success rate was 82%. Success rates for RVOT and LVOT origin were 98% (46/47 cases) and 97% (38/39 cases) respectively. No significant differences in procedure time (145 ± 68 vs. 158 ± 72 min), ablation time (441 ± 328 vs. 462 ± 307 sec), fluoroscopy time (496 ± 521 vs. 519 ± 473 sec) or minor complications (5 vs. 8) were observed for outflow tract PVCs, and no major complications occurred in this group. However, 3 major complications and significantly lower success rates were observed for non-outflow tract PVCs (0/8 for parahisian origin, 4/14 (29%) for CS/LV summit origin). 2 patients with a parahisian focus experienced higher degree AV block and 1 patient with an LV summit focus had a pericardial tamponade.

Conclusion
Catheter ablation of PVCs with LVOT origin can be performed with similarly high success and low complication rates compared to PVCs with RVOT origin, and therefore could be considered as first-line therapy like RVOT PVCs. On the other hand, identification of PVCs with a parahisian or CS/LV summit focus should be aspired before an ablation procedure, as these localizations are associated with poorer ablation outcome and higher complication rates.
Case series of catheter-based arrhythmia ablation in pregnant women
Authors: Mladoniczky S , Nagy Z S , Foldesi C S , Som Z , Balint O H , Kornyei L , Simor T , Ruzsa D , Fodi E , Kardos A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Antiarrhythmic drugs (AADs) should be used with caution in treating arrhythmias during pregnancy because of side effects, but catheter ablation is a rarely used procedure.

Aim
To investigate the efficacy and safety of catheter ablation in cardiac arrhythmias during pregnancy.

Methods
A double-center retrospective case series study was performed. We studied a population of patients undergoing catheter ablation for cardiac arrhythmias during pregnancy between April 2014 and September 2021 in two cardiovascular centers in Hungary.

Results
14 procedures [14 electrophysiology studies (EPS), 13 ablations] performed on 13 gravid women (age 30.3±5.2 years, primipara n=6) were studied. The mean gestation period was 24.0 (20.0-27.0) weeks at the time of intervention, and the mean duration of arrhythmia was 44.0±53.0 months. Of the pregnant women 38.5% had comorbidities and 15.4% had structural heart disease. During EPS, 12 patients had inducible arrhythmias. Focal atrial tachycardia was confirmed in 3, AVRT via manifest accessory pathway (AP) in 3 (WPW syndrome) AVRT via counceled AP in 1 case. AVNRT was confirmed in 3, sustained ventricular tachycardia in 2 cases (25-25-8.3-25-16.6%). 11 radiofrequency ablations (RFA) (84.6%) and 2 cryoablations (15.4%) were performed. The electroanatomical mapping system was CARTO in 11 cases (84.6%) and NavX-EnSite in 2 cases (15.4%). Intracardiac echocardiography (ICE) was used in 5 cases (38.5%). Transseptal puncture was performed in 2 cases (15.4%) due to left lateral AP. The average procedure time was 76.0±33.0 min. All the procedures (100.0%) were performed without fluoroscopy. No complications occurred during the procedures. In the long term, arrhythmia-free survival was achieved in all cases (100.0%), but in two patients, we used AADs to achieve freedom of arrhythmia. With AADs, the mean birth weight was lower than that of fetuses of gravidas not taking drugs (2110±1314 vs. 3253±458 g). APGAR was within the normal range in all cases [9.0/10.0 (IQR) (9.0-10.0/9.3-10.0)].

Conclusions
Zero-fluoroscopic catheter ablation during pregnancy is an effective and safe treatment method when needed. Catheter ablation for persistent maternal arrhythmias has a more beneficial effect on fetal development than the use of AADs. Indeed, long-term outcome and safety need to be investigated in a larger patient population.
Baseline local impedance and changes in local impedance are predictors of electrode tissue coupling in RF-ablation
Authors: Bahlke F , Wachter A , Englert F , Krafft H , Popa M , Erhard N , 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 (RF) current remains the most ablation technology in the electrophysiologic laboratory. Durable lesion formation without collateral tissue damage is key for obtaining efficient and safe procedures. RF power, duration and contact force are considered as main determinants of lesion size. Recently published data show that electrode tissue coupling (ETC) is another important parameter of lesion formation. This ex vivo model was created to investigate local impedance changes and lesion size when alternating ETC-levels.

Methods
RF-lesions were created using a force and local impedance sensing catheter in an ex vivo porcine cardiac model. 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. RF-lesions were created using identic values of RF duration and contact force. A RF power of 20W, 30W, 40W, and 50W was used. The ETC levels were systematically varied between minor and full coupling. In minor ETC-level, only the distal end of the catheter is in contact with the tissue. In full ETC-level, the whole catheter tip is in contact with the tissue. All parameters (power, temperature, global and local impedance, contact force, ETC, 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
8654 measurements of lesion depth and diameter were analyzed after creating 72 lesions. Lesion depth and diameter in full ETC-level were significantly higher compared to minor ETC-level (s. Table 1). Interestingly, lesions in lower power levels (20-30 Watt), but full ETC-level became wider and deeper than lesions in high power levels (40-50 Watts), but minor ETC-level (s. Figure 1).
These observations were made despite shorter RF-duration (54.00 ± 13.07 s vs. 47.11 ± 17.57 s, p=0.032) in lesions with full ETC-level due to higher incidence of steam pops (14 vs. 6 steam pops, p = 0.032).
Baseline LI and LI-drop were significantly higher in full ETC-level (Figure 2), but no relevant difference was observed in baseline GI.

Conclusion
Baseline LI and LI changes during ablation provide information about ETC-levels and interaction of the RF ablation catheter with cardiac tissue. ETC-levels, as predicted by LI, had a significantly higher impact on RF lesion size than RF power or RF-duration. Therefore, LI should be monitored during RF ablation for estimating ETC-levels and lesion formation.
Bipolar ablation: first in man using combined robotic magnetic navigation with a manual approach in a complex pvc case
Authors: Huegl B , Kreuzer M , Doneva Z , Mirazchiyski S T , Buchter B 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Standard unipolar catheter ablation (UPA) with radiofrequency for ventricular arrhythmias has reportedly recurrence rates due to a lack of efficient lesions in the deep myocardial substrates to disrupt the critical components of the arrhythmia circuit. First in-vivo bipolar catheter ablations (BPA) show promising results to counter this issue. Precise handling of two catheters simultaneously during BPA is a challenge that the utilization of a robotic magnetic navigation (RMN) system could make safer by robotically controlling one of the catheters.

Method
A RMN ablation catheter with a 3.5 mm irrigated tip (RMN Navistar Thermocool, Biosense Webster), as an active catheter, as well as an indifferent manual catheter 3.5 mm irrigated non-nav ablation catheter (Celsius Thermocool, Biosense Webster) was connected to a BPA-certified generator system (HAT 500® system (OSYPKA, Germany)). The RMN catheter was controlled by a RMN Stereotaxis- system. A 3D Carto system combined with a VIVO system was used to find the right localization.

Results
70-year-old male with ischemic CMP, EF nearly 40%, revascularized through CABG, presented after 4 attempts of ablation of very frequent symptomatic monomorphic PVCs (more than 30000 /24h), with different approaches in different hospitals. The origin of PVCs was mid-septal RV/LV. After LAT Mapping in a transseptal approach with the RMN Catheter (LV), the manual catheter was placed at the opposite site in the RV. Bipolar Ablation was done at 30W (3 min) with acute suppression of the PVCs. The follow-up duration was 6-months with still lasting good result. No complications occurred.

Conclusions
BPA ablation is an additional energy option in difficult cases. With a RMN system is it feasible and safe. The robotic control of one of the two ablation catheters provides a precise and stable execution of the BPA since the operator only needs to control the second catheter manually while the magnetic field holds the first in place. It therefore also allows a single operator approach.
Percutaneous management of atrial wall perforation during transeptal puncture with an Amplatzer vascular plug in 3 patients: keep calm, think fast
Authors: Pasquie J L , Placide L , Delsarte L , Hoareau E , Georger F , Granier M , Massin F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Atrial wall perforation is a rare but serious complication of transeptal puncture in AF catheter ablation procedure. In patients with uninterrupted anticoagulation associated to non-fractionated heparin bolus this may lead to cardiac tamponade and dramatic consequences. Urgent surgical drainage and repair is mandatory in the most dramatic cases. We report the successful closure of such complication by an Amplatzer vascular plug leading to a rapid and total recovery in 3 patients.

Methods
Three patients (male, 43, 77 and 84 yo) referred for persistent atrial fibrillation ablation (1 RF and 2 cryoablations). After transeptal puncture, they became severely hypotensive with echographic evidence of tamponade.

Results
Heart perforation with massive leakage of contrast in the pericardial space was evident. The perforation was anterior near aorta in one, on the posterior wall of the right atrium in one and on the posterior wall of the left atria though the right atria in one. After heparin antagonization by protamin, the pericardial space was drained percutaneously (1 to 3 l drained and in 1 reinjected through a "cell saver" system). Rapidly, a 0,035 J guide wire was passed through the perforation and an Amplatzer vascular Plug 2 (4 mm in 2 patients and 6 mm in one) was released resulting in an immediate closure of the leak and recovery of the patient after completion of the pericardial drainage. The drainage was monitored 24h and patients were discharged on Day 2 with a good evolution over a median follow-up of 1.5 year. CT scan at 3 and 6 month showed total recovery.

Conclusion
In patients with left atrial wall perforation and tamponade related to failed transeptal puncture in patients under uninterrupted oral anticoagulation for AF ablation, rapid release of a closure device and pericardial evacuation allowed to successfully manage the cardiac tamponade and avoid a surgical option.
General anesthesia or mild conscious sedation? First comparison for high-power short-duration ablation for atrial fibrillation
Authors: Minciuna I , Suceveanu M , Tomoaia R , Simu G , Irimie D A , Cismaru G , Puiu M , Rosu R , Zdrenghea D , Pop D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation (AF) represents the most common cardiac arrhythmia in adults worldwide. Catheter ablation (CA) of AF provides higher efficacy with comparable safety as antiarrhythmic drug therapy. Recently, high-power short-duration (HPSD) approach has emerged as an alternative to standard-power standard-duration settings, showing reduction in ablation times and increasing patient tolerability, with similar outcomes in terms of safety and efficacy. Although the advantages of general anesthesia (GA) are well established for standard-power standard-duration settings, there are currently no studies comparing GA to mild conscious sedation (MCS) for HPSD approach CA for AF. The aim of this study was to show whether GA improves procedural outcomes compared to MCS in AF CA using HPSD approach.

Methods
We included patients with paroxysmal or persistent AF who underwent HPSD CA using a contact-force sensing catheter (50W, ablation index 450 on the anterior wall and 320 on the posterior wall) either under GA or MCS. Procedural characteristics and success rates were compared between the two groups, as well as mid-term outcomes. Procedural safety was evaluated by intra- and post-procedural complications. Procedural efficiency was evaluated by total procedural time, number of radiofrequency applications, fluoroscopy time and dose. Acute success was defined as confirmation of entrance block in all pulmonary veins and mid-term success as freedom of AF at 6-months follow-up visits and re-do procedures.

Results
A total number of 131 patients were included in the study, 47 which underwent HPSD CA for AF under GA (group 1, mean age 60.2±10.2), and 84 under MCS (group 2, mean age 58.6±10.6). CA was performed for paroxysmal AF in 34 patients in group 1 (72.3 %) and 68 patients in group 2 (80.9 %), and for persistent AF in the remaining patients. We found lower mean total procedure time in the GA group (105.7±26.4 vs. 164.4± 41.9 min, p&lt;0.0001), as well as lower radiation exposure (1310.0±1083.2 vs. 3060.5± 2254.8 μGy, p&lt;0.0001 and 4.9± 2.8 vs 9.4± 7.5 min, p&lt;0.0001) and lower number of radiofrequency applications (70.4± 20.4 vs. 106.0± 30.2, p&lt;0.01). At the 6-months follow-up AF recurrence rate was lower in GA group (21.2% vs. 33.3%), however without reaching statistical significance (p=0.14). There was one moderate pericardial effusion in the MCS group which remitted with pharmacological treatment.

Conclusion
This is the first study comparing GA to MCS for AF CA using HPSD approach. Our findings demonstrate that GA improves procedural efficiency and suggest lower AF mid-term recurrence when HPSD AF CA is performed under GA, compared to MCS.
Pulsed-field- vs. cryo- vs. radiofrequency ablation: one-year recurrence rates after pulmonary vein isolation in patients with persistent 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 persistent AF (persAF) undergoing a first PVI using PFA, cryoballoon ablation (Cryo), or radiofrequency (RFA).

Methods
Consecutive patients with persAF undergoing a first PVI with PFA at our institution from May to December 2021 were included. For comparison, patients with persAF 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 arrhythmia following a blanking period of 3 months.

Results
A total of 177 patients were included (PFA: 65; Cryo: 63; RF: 49). Age, gender, CHA2DS2-VASc score, LVEF and LAVI did not differ among the groups (Table). Median procedure time was different among the groups (PFA: 109 [interquartile range 88-130] min, Cryo: 81 [62-96] min, RF: 177 [153-200] min, p &lt; 0.01). Fluoroscopy dose was different among groups: RF (1.9 [0.7-4.9] Gycm2), PFA (8.3 [4.3-19.0] Gycm2), and Cryo (9.5 [4.8-19.1] Gycm2, p&lt;0.01). Median follow-up time in patients without recurrence was 13 [11-13] months for the PFA group, 13 [12-13] months for the Cryo group and 12 [11-13] months for RFA group. Recurrence of atrial arrhythmias in the KM-analysis after 12 months was not different in all three groups (PFA 44%, Cryo: 33%, RFA: 51%, Figure).

Conclusion
In patients with persAF, recurrence of atrial arrhythmias 12 months after PFA-PVI only is high, regardless of ablation modality. Assessment of strategies including ablation of extra-PV targets in some patients with persAF is needed.