bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incremental value of low-voltage area ablation in persistent atrial fibrillation: a systematic review and meta-analysis
Authors: Toumpourleka M , Patoulias D , Antoniadis A P , Triantafyllou K , Giannopoulos G , Meletidou M , Karamanidou M , Fragakis N , Vassilikos V 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
The optimal ablation approach for patients with persistent atrial fibrillation (AF) is a topic of high controversy. The efficacy of adjunctive ablation strategy beyond conventional pulmonary vein isolation remains uncertain.

Purpose
We sought to investigate the effectiveness of individualized low-voltage area (LVA) substrate modification in patients with persistent AF receiving conventional catheter ablation.

Methods
We systematically searched PubMed, Cochrane Library, and grey literature sources including clinicaltrials.gov, from inception to 1st November 2022, to identify relevant randomized controlled trials (RCTs). Patients with persistent AF undergoing conventional catheter ablation vs. ablation with additional LVA substrate modification were compared. Freedom from arrhythmia was set as the primary efficacy outcome and total procedure time as the secondary efficacy outcome. A prespecified subgroup analysis was performed for patients with presence of LVAs. We did not impose any filter regarding the study setting, sample size, study duration, or publication language. All analyses were performed using R version 4.1.0 and a two-sided p-value&lt;0.05 was considered statistically significant.

Results
We pooled data from 5 RCTs with a total of 989 participants (31% female) with persistent AF. Ablation with additional LVA substrate modification resulted in a significantly increased likelihood for freedom from arrhythmia by 60%, compared to conventional AF ablation (odds ratio 1.60; 95% confidence interval 1.13-2.28; I2=39%; p=0.009). No difference in the total procedure time was identified between the two approaches (mean difference -28.94 min; 95% confidence interval -69.39 to 11.51 min; I2 = 98%, p=0.16). In patients with LVAs (n=240), additional LVA substrate modification yielded a higher probability for freedom from arrhythmia than conventional AF ablation (odds ratio 1.73; 95% confidence interval 1.03-2.90; I2=0%; p=0.04).

Conclusion
This meta-analysis demonstrates that an individualized ablation approach with low-voltage area substrate modification is associated with improved outcomes in patients with persistent AF.
Safety and durability of PFA for pulmonary vein isolation: comparison to a reference RF data base
Authors: De Becker B , O'neill L , De Smet M , Tavernier R , Le Polain De Waroux J B , Knecht S , Duytschaever M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Pulse field ablation (PFA) is a promising ablation technique for pulmonary vein isolation (PVI) with appealing advantages over RF including speed, tissue selectivity and the promise of enhanced durability. We determined procedural efficiency, safety and durability of PFA for PVI and compared its performance to a dataset of optimized radiofrequency (RF) ablation.

Methods
180 consecutive patients with paroxysmal or persistent AF undergoing PFA-guided PVI (conventional basket and flower applications for each vein) were included and compared to 180 patients who underwent optimized high-power RF-guided PVI in experienced hands in the POWER-PLUS study. Endpoints were procedural efficiency, safety, and the incidence of 4 isolated veins as evaluated by comprehensive activation mapping at repeat procedure for recurrence.

Results
Median age was 66 years with 72% paroxysmal AF (clinical characteristics comparable to the RF group). PVI was obtained in all patients with a procedure time of 47min (vs 71min in RF, p &lt; 0.0001) and fluoroscopy time of 14min (vs 11min in RF, p &lt; 0.0001). One serious adverse event (TIA) occurred in a patient with thrombocytosis (1/180, 0.6% vs 0% in RF). No patient experienced pericarditis (vs 1 in RF). During a median follow-up in the PFA group of 4.8 [3.0; 6.4] months, 8 patients underwent repeat for recurrence which revealed a status of 4 isolated veins in a quarter of the patients (2/8, 25%). In the POWER-PLUS study, repeat ablation for recurrence revealed durable isolation of all veins in half of the patients (7/13, 54%, p between groups 0.2). By the time of the EHRA symposium, results will be presented for 6 months in both groups.

Conclusion
PFA fulfills the promise of offering a short and safe PVI procedure, even when compared to optimized RF in experienced hands. Our data, showing PV reconnection as the dominant cause for recurrence, however temper the expectation of 100% durability. It remains to be seen, how operator expertise affects efficiency, safety, and durability of PFA.
Impact of vein of Marshall ethanol infusion on left atrial function: an MRI study
Authors: Arano Llach J , Junca G , Teis A , Sarrias A , Bazan V , Saez De Buruaga E , Villuendas R , Bayes-Genis A , Delgado V , Bisbal F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Previous data suggested that left atrial (LA) function may be impaired by extensive atrial fibrillation (AF) ablation. Ethanol infusion of Vein of Marshall (EI-VOM) as an adjunctive therapy to pulmonary vein isolation is an emerging therapeutic strategy that has shown to improve efficacy in persistent AF ablation procedures and mitral isthmus line. The impact of EI-VOM scar formation on LA function has not been addressed.

Purpose
To analyse the effect of EI-VOM on LA function, evaluated by magnetic resonance imaging (MRI) strain parameters.

Methods
Twelve patients referred for de novo persistent AF or any repeat procedure were included. MRI was performed previous (baseline) and 3-month after AF ablation. MRI images were analyzed off-line with specialized post-processing software. LA volumes, LA strain parameters, including LA global longitudinal strain (GLS), LA reservoir (LASr), conduit (LAScd) and contractile (LASct) strain; LA ejection fraction (LAEF), LA passive emptying function (LAPEF) and LA active emptying function (LAAEF) were measured from SSFPs two-chamber cine sequences.

Results
Two patients were excluded due to absence of VOM and failed ethanolization. Ten patients (83%) underwent both MRI studies (64 [55-71]years; 80% men; de novo ablation of persistent AF (50%)). Six patients received additional mitral isthmus line and three posterior wall isolation. Mean baseline indexed LA volume was 62.7ml/m2 [47-73]. Baseline LA strain and EF parameters were: LA GLS 17.16±15.3, LASr 17.80±14.9%, LAScd -5.96±3.7%, LASct -10.35±9.5%; LAPEF 5.89±9.8, LAAEF 23.87±17.0 and LAEF 27.6±18.3%. At 3-months follow-up, no AF recurrences were detected. No differences were found regarding LA volume (57.6ml/m2 [42-64], p=0.671), strain parameters (LA GLS Δ0.62, p=0.903; LASr Δ0.02, p=0.991; LAScd Δ-0.84, p=0.563; LASct Δ0.54, p= 0.874) and LAEF parameters (LAPEF Δ4.82, p=0.592; LAAEF Δ3.03, p=0.903; and LAEF Δ7.0, p=0.213).

Conclusions
EI-VOM appears as a safe adjunctive strategy in AF ablation in terms of LA function. The present study did not show impairment in the main MRI strain parameters.
Sex differences in the efficacy of atrial fibrillation ablation according to the age: insights from a large-scale multicenter registry
Authors: Tanaka N , Inoue K , Kobori A , Kaitani K , Morimoto T , Kurotobi T , Morishima I , Yamaji H , Matsui Y , Kusano K , Okada M , Tanaka K , Kimura T , Shizuta S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
We previously showed that females were associated with a higher risk of arrhythmia recurrence after radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Whether age influences sex differences in terms of recurrence after CA of AF still remains unknown.

Objective
We sought to investigate the sex differences in the efficacy of RFCA of AF according to an advanced age.

Methods
We conducted a large-scale, prospective, multicenter, observational study (Kansai Plus Atrial Fibrillation Registry), enrolling 5010 consecutive patients who underwent an initial RFCA of AF at 26 centers (64±10 years; females, 27.3%; non-paroxysmal AF, 35.7%). The median follow-up duration was 2.9 years.

Results
The entire cohort was divided into either an age≥75 (n=790; females, 40.3%) and age &lt; 75 years (n=4220; females, 24.9%). In the age≥75 group, the 3-year cumulative incidence of AF recurrences was identical between the sexes both after a single procedure (female vs. male, 38.1% vs. 40.7%, Log-rank P=0.39) and multiple procedures (22.3% vs. 21.6%, Log-rank P=0.96). On the other hand, in the age &lt;75 group, females more frequently experienced AF recurrence than males both after a single procedure (female vs. male, 44.9% vs. 38.8%, Log-rank P=0.0003) and multiple procedures (24.7% vs. 19.3%, Log-rank P &lt;0.0001).

Conclusion
While the incidence of an arrhythmia recurrence after radiofrequency catheter ablation of AF was similar between the sexes in patients with an age≥75, females had a higher incidence of recurrence than males in patients with an age &lt;75.
Local impedance tissue characterization to implement pulmonary veins isolation success in AF patients
Authors: Anselmino M , Lepillier A , De Sanctis V , Mazza A , Zakine C , Champ-Rigot L , Santagostino M , Garnier F , Bonacchi G , Di Donna P , Pandozi C , Battaglia A , Malacrida M , Cosaro G , Solimene F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Novel radiofrequency (RF) ablation technology permits local impedance (LI) assessment, enabling increased knowledge of the underlying tissue’s properties. In addition, LI can provide details on catheter tip contact and extent/effectiveness of radiofrequency (RF) delivery. To date, the extent to which left atrial (LA) tissue characterization by LI can guide RF ablation has not yet been explored.

Purpose
We aimed to assess LI capabilities of predicting RF ablation success in consecutive AF cases with different underlying cardiac tissue characteristics.

Methods
Two-hundred twelve consecutive patients undergoing de novo AF ablation at 16 European centers were included in the CHARISMA registry. A novel ablation catheter (Stablepoint) with dedicated algorithm (DirectSense) was used to measure LI at the distal electrode. Each ablation point was characterized in terms of RF delivery time, baseline LI and LI drop during ablation according to different atrial substrates: normal-voltage (NV, &gt;0.5mV), intermediate-voltage (IV, 0.1-0.5mV) and low-voltage tissue (LV, &lt;0.1mV). First pass isolation (FPI) was defined as successful PVI at or before completion of the first encircling lesion set regardless of visual gaps. Ablation endpoint was pulmonary vein isolation (PVI) as assessed by entrance and exit block. Data are reported as mean±SD.

Results
Atrial substrate was analyzed at 11405 (82%) sites with complete high-quality data. Ablation spots were more frequently deployed in NV areas (n=6714, 58.9%) than in areas of IV (n=4065, 35.6%) or LV (n=625, 5.5%). Both baseline LI (163.8±19Ω) and LI drop (23.0±9Ω) were higher in NV areas than in IV areas (baseline LI: 159.4±18Ω, p&lt;0.0001; LI drop: 20.5±9Ω, p&lt;0.0001) and LV areas (baseline LI: 157.8±18Ω, p&lt;0.0001; LI drop: 19.5±9Ω, p&lt;0.0001). RF delivery time was shorter in the NV (9±5s) than both in IV and LV areas (10±4s, p&lt;0.0001 for IV; 10±4s, p&lt;0.0001 for LV, respectively). The LI drop that best predicted successful ablation spots was &gt;20Ω for NV areas (Sensitivity=62.5%, Specificity=91.5%, PPV=99.6%, Area under the receiver-operating characteristic curve (AUC)=0.7896, p&lt;0.0001) and &gt;18Ω for IV and LV areas (Sensitivity=57.7%, Specificity=94.6%, PPV=99.8%, AUC=0.8008, p&lt;0.0001). No complication occurred. The acute procedural success was 100%, with all PVs successfully isolated in all study patients.

Conclusion
LI drop during ablation significantly differs according to atrial substrates. These findings suggest that a tailored AF ablation strategy taking into account the underling LA substrate may be useful.
How different very late recurrence of atrial fibrillation 5 years after catheter ablation?
Authors: Choi S , Yu H T , Kim D , Park J W , Kim T H , Uhm J S , Joung B , Lee M H , Hwang C , Pak H N 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health and Welfare the Basic Science Research Program run by the National Research Foundation of Korea (NRF).

Background
Atrial fibrillation (AF) is a chronic progressive disease that recurs continuously even after successful AF catheter ablation (AFCA).

Objective
We explored the mechanism of this long-term recurrence by comparing the patient characteristics and redo-ablation findings.

Methods
Among 4,248 patients who underwent a de novo AFCA and protocol-based rhythm follow-up at single centers, we enrolled 1,417 patients (71.7% male, age 60.0 [52.0–67.0] years, 57.9% paroxysmal AF) who experienced clinical recurrences (CRs) of the disease, and divided them according to the period of recurrence: within one year (n=645), 1–2 years (n=339), 2–5 years (n=308), and after 5-years (CR&gt;5yr, n=125). We also compared the redo-mapping and ablation outcomes in 198 patients.

Results
In patients with a CR&gt;5yr, the proportion of paroxysmal AF was higher (p=0.031); however, the left atrial (LA) volume (computed tomography, p=0.003), LA voltage (p=0.003), frequency of early recurrence (p&lt;0.001), and use of post-procedure anti-arrhythmic drugs (p&lt;0.001) were lower. A CR&gt;5yr was independently associated with the low LA volume (odds ratio [OR] 0.99 [0.99–1.00], p=0.019), low LA voltage (OR 0.62 [0.41–0.95], p=0.030), and lower early recurrence (OR 0.39 [0.23–0.64], p&lt;0.001). Extra-pulmonary vein (PV) triggers (P for trend 0.003) during repeat procedures were significantly greater in patients with a CR&gt;5yr, despite no difference in the de novo protocol. The rhythm outcome of repeat ablation procedures did not differ with the timing of the CR (log-rank p=0.330).

Conclusions
Patients with a later CR showed a smaller LA volume, lower LA voltage, and higher extra-PV triggers during the repeat procedure, suggesting progression of AF.
One-year outcomes in patients undergoing very high-power short-duration temperature-controlled ablation for atrial fibrillation
Authors: Strisciuglio T , Solimene F , Schillaci V , Arestia A , Shopova G , Salito A , Bottaro G , Marano G , Coltorti F , Poggi S , Iuliano A , Agresta A , Stabile G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The very high-power short-duration (vHPSD) temperature-controlled ablation (vHPSD) improves the efficiency of pulmonary vein isolation (PVI) procedures.

Aims
We evaluated the procedural and 12-months outcomes in atrial fibrillation (AF) patients undergoing PVI by means of vHPSD ablation. In patients with AF or atrial tachy-arrythmia (AT) recurrence undergoing a redo procedure the durability of the PVI was investigated.

Methods
Consecutive paroxysmal/persistent AF patients undergoing PVI with the vHPSD ablation strategy (90 W, for 4 s) were enrolled. The rate of PVI, first pass isolation, acute reconnection, and procedural complications were evaluated. Follow-up examinations and EKG were scheduled at 1,6, and 12 months. In case of AF/AT recurrence, patients underwent a redo procedure.

Results
Overall, 163 AF patients (29 persistent and 134 paroxysmal) were enrolled. The PVI was reached in 100% of patients (88% at first pass). The rate of acute reconnection was 2%. The radiofrequency, fluoroscopy and procedural times were respectively 5,5±1 min, 9±1 min and 75±20 min. No death, tamponade nor steam pops occurred, however 5 patients had vascular complications. The 12-months freedom from AF/AT recurrence was 84% in paroxysmal patients and 71% in persistent. Overall, 9 patients underwent a redo procedure, and in 4 all veins were still isolated, whereas in 5 pulmonary vein reconnections were found. The PVI durability was 83%. No overt complications were observed in the follow-up.

Conclusions
The vHPSD ablation represents an effective and safe ablation strategy to achieve PVI. The 12-months follow-up showed high freedom from AF/AT recurrence and a good safety profile.
Left atrium substrate and wave speed mapping using Omnipolar technology in patients undergoing paroxysmal atrial fibrillation catheter ablation
Authors: Casella M , Compagnucci P , Conti S , Cipolletta L , Parisi Q , Majocchi B , Quinto L , Bulian F , Volpato G , Valeri Y , Mantovan R , China P , Sgarito G , Tondo C , Dello Russo A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The new Ensite X Cardiac Mapping (Abbott) system, with the introduction of Omnipolar technology (OT), provides three-dimensional information on voltage, direction of activation and conduction velocity of endocardial potentials, regardless of catheter orientation. OT thus enables the creation of more defined voltage maps and a wave speed map, a color map encoded by the numerical value of conduction velocity.

Purpose
We aimed to evaluate the feasibility and reliability of left atrium (LA) substrate and wave speed mapsperformed with OT in patients undergoing pulmonary vein isolation of paroxysmal atrial fibrillation (AF).

Methods
We included 39 patients undergoing catheter ablation for paroxysmal AF with the new Ensite X Cardiac Mapping System at five Italian Institution. In all patients the left atrium (LA) was mapped with the Advisor HD Grid catheter (Abbott). A sinus rhythm high-density voltage map and wave speed map were obtained and analyzed to compare low-voltage areas and to identify high conduction velocity areas.

Results
Thirty-nine pts were included in this analysis (61±10 years, 64% male, 68% with paroxysmal AF, CHA2DS2-VASc = 1.6±1.1, left atrial diameter = 46±9 mm, left ventricle ejection fraction 63±4%). The voltage maps were obtained by acquiring and, after point validation, analyzing significantly more points in the OT analysis than in the bipolar analysis (11455±8833 vs 8186±5826 and 2611±1728 vs 1753±1324, respectively; p &lt; 0.001). Low-voltage area (&lt; 0.05 mV) was significantly less extensive using OT (low-voltage OT area 8.9 cm2 [5.8; 24.2] vs low-voltage bipolar area 10.8 [6.4; 31.4]; p &lt; 0.05), Fig 1. Considering wave speed maps, the pulmonary veins showed significantly higher values than the atrial values (LSPV: 2.89 ms/s ± 1.99; LIPV 2.86 ms/s ± 1.78; RSPV 3.31 ms/s ± 2.07; RIPV 2.86 ms/s ± 1.96; LA 1.67 ms/s ± 0.80; p&lt; 0.001) while, in the atrium, the area of greatest speed was located on the roof (2.35 ms/s ± 1.53; p 0.02) almost drawing a bundle from the RSPV to the LA appendage that could coincide with the anatomical Bachmann’s bundle location, Fig 2.

Conclusion
OT makes it possible to obtain voltage maps by analyzing a larger number of points and providing a better substrate definition. Wave speed mapping is a promising new map type, allowing characterization and identification of high velocity areas. Further studies are needed to assess the impact of this new technology on procedural workflow and clinical outcome.
Impact of catheter ablation on atrial fibrillation burden and symptoms in patients with hypertrophic cardiomyopathy
Authors: Ahluwalia N , Honarbakhsh S , Assadi R , Martin S , Monkhouse C , Mohiddin S , Sporton S , Schilling R J , Dhinoja M , Lambiase P , Hunter R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial Fibrillation (AF) is more common in patients with hypertrophic cardiomyopathy (HCM) and is often very symptomatic in this cohort. The impact of catheter ablation (CA) in this context is controversial with low success rates using the guideline mandated end-point of freedom from arrhythmia.

Purpose
To determine whether CA of AF in patients with HCM would be associated with a significant reduction in AF burden and symptoms.

Methods
Patients diagnosed with HCM undergoing CA of AF between February 2017 and June 2021 were identified from a prospective, single-centre registry. Patients with CIED in situ were selected. Patients were followed up for objective evaluation of symptom severity. Interval device interrogation and remote CIED monitoring was used to determine first AF/AT recurrence and percentage AF/AT burden on continuous rhythm monitoring 12-months before and after CA.

Results
Of 257 HCM patients undergoing CA of AF, 33 had CIEDs and were followed up for 32±15 months. The mean age was 56.4±10.2 years and 22 (67%) were male. The maximal wall thickness on echocardiography was 1.7±0.3cm and LA diameter was 4.8±0.9. The left ventricular ejection fraction was 50±15%. 17 (52%) patients had paroxysmal AF and 16 (48%) had persistent AF of which 6 (18%) were longstanding persistent AF. Mean AF burden prior to CA was 36.9±26.5% and 24 (73%) reported EHRA III-IV symptom severity.
AF recurred in 27 (82%) patients with a median time to first recurrence of 8 (3-17) months. AF burden significantly reduced after index AF CA (27% (7,59) to 2% (0, 41)) (Z=-2.2, p= 0.03)) and reduced further when allowing for repeat procedures in 10 (30%) patients to 0% (0-30%). This represented a &gt;50% relative reduction in 22 (67%) patients and &gt;95% relative reduction in 16 (48%) patients.
This correlated with a reduction in symptom score with 20 (60.6%) patients reporting a change of ≥1 EHRA class, and 20 (60.6%) patients reporting EHRA class I-IIa status at 12 months. A positive relationship was seen on regression analysis, with a 16.4% absolute reduction in AF burden associated with a reduction of one EHRA class. (R2= 0.206, F=7.5, p=0.01). Amongst the 24 (72%) patients who had an AF/AT recurrence after the final procedure who would conventionally be called failures by guideline definitions, 11 (45.8%) patients improved by ≥ 1 EHRA class and 11 (45.8%) were class I-IIa.

Conclusion
Although AF recurrence is common after CA in HCM patients, there is a significant reduction in AF burden and symptoms in a majority of patients. A more comprehensive evaluation of AF burden, symptoms, quality of life and impact on hard end-points is needed to determine the utility of CA in this context.