bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic accuracy of smart gadgets/wearable devices in detecting atrial fibrillation in primary prevention: a meta-analysis
Authors: Vetta G , Magnocavallo M , Parlavecchio A , Caminiti R , Polselli M , Sorgente A , Pannone L , Chierchia G B , Rossi P , Bianchi S , Natale A , De Asmundis C , Della Rocca D G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Atrial fibrillation (AF) is the most common sustained arrhythmia and an important risk factor for stroke and heart. Recent technology advances have allowed for heart rhythm monitoring using smart gadgets/wearable devices which can be used for early AF diagnosis.

Purpose
We performed a systemic review and meta-analysis to assess the accuracy of AF diagnosis by smart gadgets/wearable devices in primary prevention.

Methods
We systematically searched Medline, Embase and Cochrane electronic databases up to September 22th, 2022 for observational studies of the diagnostic accuracy of smartphone application, wrist-worn wearables and external devices in detecting AF in primary prevention. Studies with 12-lead ECG or single-lead ECG interpreted by a cardiologist as gold standard were included. We calculated the area under the curve (AUC) of the summary receiver operating characteristic curves (SROC) and pooled sensitivities and specificities.

Results
A total of 28 studies were included enrolling 13463 patients, 57%(95% CI: 55-59%) male with average age of 65.3years (95% CI: 60.1 – 70.4). The pooled prevalence of AF was found to be 13% (95% CI 10 – 15%). In the overall analysis of all devices, the AUC was 0.99 (95% CI: 0.97-0.99)(Figure 1), the sensitivity 93%(95% CI: 89 – 95%) and the specificity 97%(95% CI: 95 – 98%) (Figure 2). Wrist-worn wearables had AUC of 0.97 (95% CI: 0.94-0.99), the sensitivity 83%(95% CI: 52 – 96%) and the specificity 98%(95% CI: 87 – 100%). Smartphone applications had AUC of 0.97 (95% CI: 0.96-0.98), the sensitivity 92%(95% CI: 77 – 98%) and the specificity 95%(95% CI: 91 – 97%). External devices had AUC of 0.99 (95% CI: 0.97-0.99), the sensitivity 94%(95% CI: 91 – 96%) and the specificity 97%(95% CI: 95 – 98%). Single-lead ECG had AUC of 0.99 (95% CI: 0.97- 0.99), the sensitivity 93%(95% CI: 88 – 96%) and the specificity 91%(95% CI: 78 – 97%). photoplethysmography pulse waveform technology (PPG) had AUC of 0.97 (95% CI: 0.96-0.98), the sensitivity 91%(95% CI: 78 – 97%) and the specificity 95%(95% CI: 91 – 97%). Pulse beat interval technology had AUC of 0.99 (95% CI: 0.98-0.99), the sensitivity 95%(95% CI: 90 – 98%) and the specificity 96%(95% CI: 93 – 98%)

Conclusions
Smartphone application, wrist-worn devices and external devices have excellent diagnostic accuracy in atrial fibrillation diagnosis in primary prevention.
Rate control with calcium channel blockers versus betablockers in patients with paroxysmal and persistent atrial fibrillation - data from the AFFIRM trial
Authors: Koldenhof T , Van Gelder I C , Crijns H J G M , Rienstra M , Tieleman R G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Purpose
To investigate whether there are differences between nondihydropyridine calcium channel blockers and beta blockers on heart rate in patients with paroxysmal and persistent atrial fibrillation (AF).

Methods
In present analysis of the AFFIRM trial, the effect of rate control drugs on heart rate was evaluated during first reported AF-episode as well as the last recorded sinus rhythm episode prior to AF. Patients who used both rate control drugs or switched rate control drugs between the last sinus rhythm and the first AF episode were excluded.

Results
A total of 1195 patients were in sinus rhythm at baseline and used either betablockers (603, 50%) or non-dihydropyridine channel blockers (592, 50%). Of the total, 513 had at least one episode of AF while remaining on the same rate control drug, 257 (50%) of them using calcium channel blockers and 256 (50%) of them using betablockers. Mean age of patients treated with a calcium channel blocker was 70±8 years versus 68±8 for the betablocker treated patients (p=0.014). Forty-four percent were women, 31% with paroxysmal AF, and 69% with persistent AF. A resting heart rate &lt;110 bpm during AF (lenient rate control) was achieved in 92% of patients using beta blockers and 93% of patients using calcium channel blockers (P= 0.724). Bradycardia during sinus rhythm (&lt;60 bpm) occurred significantly less often in patients using calcium channel blockers (19%) versus betablockers (32% , P = 0.001). After adjusting for differences in patient characteristics, the association between calcium channel blockers and a reduction in sinus bradycardia remained statistically significant (OR = 0.40, 95% CI = 0.10-0.68).

Conclusion
In patients with persistent or paroxysmal AF included in the AFFIRM trial, nondihydropyridine calcium channel blocker as rate control treatment was associated with less bradycardia during sinus rhythm compared to betablockers. Resting heart rates &lt;110 bpm during AF were achieved similarly in those treated with calcium channel blockers and betablockers.
Learning curves for pulmonary vein isolation using pulsed field ablation for atrial fibrillation
Authors: Reinsch N , Fueting A , Hartl S , Neven K 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulsed field ablation (PFA) has recently been introduced as a novel routine ablation technology for paroxysmal atrial fibrillation (PAF). Only very limited data on learning curves after implementing this new technique in clinical practice exist. We present data from our experience with learning curves using pulsed field ablation for atrial fibrillation.

Methods
In patients with paroxysmal or persistent AF, PVI in conscious sedation using a steerable sheath and a pentaspline over-the-wire basket and flower PFA catheter was performed. No 3D mapping system was used. Total procedure time, left atrial (LA) dwell time, time from first to last ablation and fluoroscopy time were analysed over the course of time. First and last chronological tertiles of each parameter were compared for statistical significance.

Results
This study included a total of 147 patients (mean age: 66±10 years; 41% female). Mean CHA2DS2-VASc-score was 2,4±1,5. The procedures were performed by 4 operators (3 certified EP specialists and 1 EP fellow) in random teams of 2 operators. Median skin-to skin procedure time was 47 [40;61] min. There was a statistically significant decrease between the first and last tertiles: 53 [44;68] vs. 46 [41;54] min (p&lt;0,01). Median LA dwell time of the PFA catheter was 37 [31;47] min. There was a statistically significant decrease between the first and last tertiles: 41 [34;53] vs. 38 [32;45] min (p&lt;0,05). Median time from first to last ablation was 23 [20;30] min. There was no statistically significant decrease between the first and last tertiles: 23 [20;28] vs. 27 [20;31] min (p=ns). Median fluoroscopy time was 16 [12;19] min. There was a statistically significant decrease between the first and last tertiles: 17 [13;21] vs. 17 [12;19] min (p&lt;0,05).

Conclusions
The introduction of a novel pulsed field ablation system for pulmonary vein isolation used by 4 operators leads to a significant decrease in total procedure time, LA dwell time and fluoroscopy time over the course of time, demonstrating streamlining of the ablation procedure as a whole. Time from first to last ablation remains constant, this is probably due to the standardized protocol of the ablation itself.
Robotic magnetic navigation guided catheter ablation establishes highly effective pulmonary vein isolation in patients with paroxysmal atrial fibrillation, when compared to conventional techniques
Authors: Noten A M E , Romanov A , De Schouwer K , Beloborodov V , Bhagwandien R , Hoogendijk M G , Mikheenko I , Wijchers S , Yap S C , Schwagten B , Szili-Torok T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Catheter ablation (CA) is an important treatment option for patients with atrial fibrillation (AF). Pulmonary vein isolation (PVI) is a pivotal part of any AF ablative therapy. Currently, there are multiple techniques available to realize PVI, including: manual guided cryoballoon (MAN-CB), manual guided radiofrequency (MAN-RF) and Remote Magnetic Navigation guided RF ablation (RMN-RF). However, there is lack of large prospective trials comparing contemporary RMN-RF with the conventional CA techniques.

Purpose
This study prospectively analyzed and compared three catheter ablation techniques in patients with paroxysmal AF.

Methods
This multicenter, prospective study included patients with paroxysmal AF who underwent their first CA procedure with one of the mentioned ablation techniques. Procedural parameters (including procedural efficiency), complication rates and freedom of AF during 12-month follow-up were compared between three study groups defined by the utilized ablation technique.

Results
A total of 221 patients were included in this study. Total procedure time was significantly shorter in MAN-CB (78±21 min) compared to MAN-RF (115±41 min) and compared to RMN-RF (129±32 min) (P&lt;0.001), whereas it was comparable between the two RF groups. A 3% complication rate was observed which was comparable between all groups. At 12-month follow-up, we observed AF recurrence in 40 patients (19%). AF recurrence was significantly lower in the RMN-RF group (MAN-CB 19 (24%) AF recurrences, MAN-RF 16 (23%), RMN-RF 5 (8%), P=0.045; multivariate HR of RMN-RF on AF recurrence 0.32, 95%-CI 0,12–0.87, P=0.026; with MAN-CB + MAN-RF as the reference group).

Conclusion
RMN guided PVI results in high freedom of AF in patients with paroxysmal AF, when compared to cryoablation and manual RF ablation. Cryoablation remains the most time efficient ablation technique, whereas RMN has comparable efficiency with manual RF ablation.
Efficacy comparison of high and very high power short duration pulmonary vein isolation: the HPSD remap study
Authors: Szegedi N , Sallo Z , Nagy V K , Osztheimer I , Perge P , Ferencz A B , Komlosi F , Toth P , Lakatos B , Kovacs A , Merkely B , Geller L 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): An investigator-initiated study. Research grant received from Biosense Webster (IIS 653).

Background
Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. The high power short duration ablation has shown good efficacy and safety profile. Recently, very high power short duration has been introduced, but initial efficacy results were discouraging.

Purpose
The goal of this study was to compare the long-term durability of PVI performed with a 90W vs. 50W power setting.

Methods
Patients were randomized in a 1:1 fashion to undergo PVI either with 90W or 50W power. The ablation protocol was the following: in the case of 50W, the ablation index target values were 400 on the posterior wall and 500 on the anterior wall, and the inter-lesion distance was &lt;5 mm; while in the case of 90W, a 4 seconds application was delivered at each site, with an inter-lesion distance &lt;5 mm (preferably &lt;4 mm anteriorly). At the index procedure, PVI was demonstrated by entrance and exit block after a 20-minute waiting period. All patients underwent a protocol-mandated repeat electrophysiology study after 3 months, regardless of symptoms. At the repeat study, all sites of PV reconnection were identified and re-ablated.

Results
A total of 40 patients were included in the study (20-20 on each treatment arm). Age was 65±8 years, 19 were females, BMI was 30±3.5, and 23 patients had paroxysmal AF. The most frequent comorbidities were hypertension (n=32) and diabetes (n=14). Procedure time (75 min vs. 84 min, p=0.02), left atrial dwelling time (63 min vs. 71 min, p=0.01), and radiofrequency time (335 sec vs. 1035 sec, p&lt;0.0001) were shorter in procedures performed with 90W compared to 50W. On the other hand, the number of radiofrequency applications was higher in the case of 90W compared to 50W (85 vs. 70, p=0.09). There was no difference in the first-pass isolation rate (80% vs. 85%, p=1.0) and in the acute reconnection rate (5% vs. 15%, p=0.6) between the 90W and 50W power settings. At the repeat electrophysiology study, PV reconnection was seen in 4 and 7 patients in the 90W and 50W groups, respectively (p=0.5). The durable isolation on a per vein basis was 92% in the 90W group and 88% in the 50W group (p=0.4).

Conclusions
A similarly high rate of durable PVI can be achieved both with 90W and 50W power settings if a slightly smaller inter-lesion distance is targeted on the anterior wall in case of 90W. Procedure time, left atrial dwelling time, and radiofrequency time is shorter with a 90W power setting compared to 50W.
Safety and efficacy of pulmonary vein isolation using pulsed field ablation with or without 3D mapping system for paroxysmal atrial fibrillation
Authors: Neven K , Fueting A , Hartl S , Reinsch N 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulsed field ablation (PFA) has recently been introduced as a novel routine ablation technology for paroxysmal atrial fibrillation (PAF). PFA can be performed "cryo-style" using fluoroscopy only, or additional pre- and post-ablation high-density 3D bipolar voltage maps can be performed to assess lesion formation and acute pulmonary vein isolation. We compared 6-month outcome after PFA using fluoroscopy only (X-ray) vs. PFA guided by 3D mapping (3D).

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

Results
This study included a total of 101 patients (mean age: 65±10 years; 42% female) in whom 6-month follow-up data were available. There were no selection criteria for the use of 3D mapping. Pre- and post-ablation high-density maps were performed in 34/101 (34%) of patients. Mean CHA2DS2-VASc-score was 2,1±1,6. Median duration since first AF diagnosis was 21 [3-60] months. Skin-to skin procedure time was 56±20 in the X-ray group vs. 118±22 min in the 3D group, respectively (p&lt;0,0001). Fluoroscopy time was 17±7 in the X-ray group vs. 21±6 in the 3D group, respectively (p&lt;0,01). Acute pulmonary vein isolation rate was 100% in both groups. Primary adverse events occurred in 0% of patients in the X-ray group vs. 2/34 (6%) in the 3D group (2 pericardial tamponades), respectively (p=ns). During a mean follow-up of 204±82 days, 54/67 (81%) in the X-ray group vs. 27/34 (79%) in the 3D group remained free of any symptomatic or documented AF/AFL/AT episode after a single procedure (p=ns). In 4/13 (31%) patients in the X-ray group, a re-do procedure was performed, 2 patients had durable PVI with typical or atypical atrial flutter, 1 patient had reconnection of both posterior carinae and 1 patient had typical atrial flutter degenerating in AF. In 3/7 (43%) patients in the 3D group, a re-do procedure was performed, 2 patients had durable PVI with typical or atypical atrial flutter and 1 patient had reconnection of the LIPV.

Conclusions
PVI using PFA with or without 3D mapping system resulted in a similar 6-month atrial arrhythmia recurrence rate and safety profile. Procedure and fluoroscopy times were significantly shorter in the fluoroscopy only group.
Catheter ablation of atrial fibrillation is associated with reduced mortality in real-world swedish patients
Authors: Akerstrom F , Hutter J , Charitakis E , Tabrizi F , Drca N , Friberg L , Braunschweig F , Jensen-Urstad M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Swedish heart-lung foundation
Swedish research council

Background
Catheter ablation of atrial fibrillation (AF) is effective in reducing symptomatic burden, however its long-term effect on stroke and mortality is still unclear.

Purpose
The aim of this study is to evaluate if catheter ablation reduces the risk for stroke and all-cause mortality risk in patients with AF in a large real-world Swedish cohort.

Methods
We retrospectively included 5,629 consecutive patients (cases) who underwent first-time catheter ablation for AF between 2008 and 2018 at three major Swedish electrophysiology sites. For every case, 10 control individuals with a diagnosis of AF and no prior stroke or catheter ablation were selected based on age and sex from the Swedish Patient Register, resulting in a control group of 48,682 patients. Propensity score (PS) matching was performed to produce two cohorts of equal size (n = 3,955) with similar demographics, comorbidities, health care utilization and medical therapy prior to inclusion (45 dimensions with non-significant standardized differences between the two cohorts). Cancer diagnosis was used as a falsification end-point to estimate similarity of the cohorts (hazard ratio [HR] 1.06, 95% confidence interval [CI] 0.92-1.23).

Results
Prior to PS-matching, patients who underwent catheter ablation were healthier (mean CHA2DS2-VASc scores 1.4±1.3 vs 1.7±1.5, p&lt;0.001), more likely to be on antiarrhythmic drug therapy (58% vs 10%, p&lt;0.001), had a higher median income (288 [193-420] vs 211 [144-306], p&lt;0.001) and had more frequently university studies (45% vs 29%, p&lt;0.001), when compared to the control group. Mean follow-up was 4.5±2.8 years. Following PS-matching, the mean age was 61±10 years, 70% were males and 47% had hypertension. Catheter ablation was associated with a lower risk for the combined primary end-point of stroke and all-cause mortality (HR 0.57, 95% CI 0.48-0.69) which occurred in 174 patients in the ablated group compared to 292 in the control group (figure). The primary end-point was driven by all-cause mortality (HR 0.51, 95% CI 0.41-0.63) with stroke reduction showing a trend in favor of catheter ablation (HR 0.75, 95% CI 0.53-1.07) (table).

Conclusions
Catheter ablation of AF may reduce the risk for all-cause mortality when compared to medical therapy in real-world Swedish patients.
Pulsed-field ablation: analysis of a new ablation technique for atrial fibrillation. A single centre experience
Authors: Sattin T , Fassini G , Cellucci S , Tundo F , Riva S , Moltrasio M , Bianchini L , Majocchi B , Pizzamiglio F , Sicuso R , Vettor G , Ribatti V , Dessanai M , Tondo C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Pulsed-field ablation (PFA) is a new non-thermal, tissue-specific ablation technique. Through the application of a local electric field, it is possible to induce a selective electroporation of cardiomyocytes membranes, resulting in myocytic apoptosis and sparing of non-myocardial structures (nerves, connective tissue, esophagus, vessels).

Purpose
A new PFA system for atrial fibrillation (AF) ablation has recently been introduced in our hospital. The aim of this retrospective review is to share the initial results of our experience in terms of acute efficacy and safety.

Methods
A total of 41 adult patients suitable for AF percutaneous ablation underwent PFA between April and November 2022 in our Institute. PFA system consisted of a current generator, a deflectable sheath and a multielectrode PFA catheter. Once inside the left atrium (LA), the PFA catheter was directed to the pulmonary veins (PVs) ostia through an over-the-wire system. Then, 8 electric impulses were applied for each PV to achieve electrical isolation; in some cases, applications to the posterior left atrium wall (LAPW) were delivered to obtain LAPW isolation (LAPWI). A moderate-to-deep sedation was provided by an anesthesiologist during all the procedures. Acute ablation efficacy was defined as absence of intracavitary signals at the electroanatomic mapping and local capture failure at the pacing maneuvers. Intra and peri-procedural safety was defined as the absence of major complications (pericardial effusion/ tamponade, stroke, vascular complications, death) during the procedure and the hospitalization period.

Results
Of the 41 patients included, 24 (58.5%) were treated for paroxysmal AF and 17 (41.5%) for persistent AF. In almost all cases (n=40, 97.6%) pulmonary veins isolation (PVI) was performed; in 14 cases (34.1%, almost all persistent AF patients) a LAPWI was performed with the application of a variable number of pulses (mean value = 13). In most of the cases (n=28, 68.3%) an electroanatomic mapping was acquired before and after the ablation. Acute efficacy was observed in all PVI cases (n=40, 100%) and in all LAPWI cases (n=14, 100%).
No periprocedural major complications were observed (n=0, 0%).

Conclusions
PFA is a promising ablation technique capable of inducing selective myocytic apoptosis through electroporation, causing a thick damage across the muscle with no injury of other tissues, and could become a game changer in electrophysiology in the next future.
Our initial data report a combination of ease of use and high efficacy and safety profiles.
Pulsed field ablation in real-life atrial fibrillation patients: 1-year clinical recurrence, operator learning curve and re-do procedural findings
Authors: Ruwald M , Johannessen A , Hansen M L , Haugdal M , Worck R , Hansen J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.
Pulsed field ablation (PFA) is a novel method of cardiac ablation demonstrated in early preclinical and clinical settings. The aim of this study was to report the safety and clinical efficacy of pulmonary vein isolation (PVI) with PFA for real-world atrial fibrillation (AF) patients.

Methods and results
All-comer AF patients (n=121, 59% paroxysmal) were prospectively included and underwent PFA with 100% HD voltage maps performed after PVI. PVI was achieved with PFA-only in 119 (98%) of the cases. During the implementation phase the mean procedure and fluoroscopy time was reduced from 85 ± 34 to 72 ± 18 minutes (p=0.044) and 22 ±9 to 16 ±4 (p=0.034). We observed one phrenic nerve palsy with only partial remission at follow-up. Other adverse events were numerically comparable to standard PVI procedures. Over a mean follow-up of 308 ± 87 days a total of 22/121 (18.2%) cases experienced clinically significant recurrence or initiation of anti-arrhythmic drugs with Kaplan-Meier event-free estimate at 365 days of 80% (88% for paroxysmal versus 69% for persistent) Figure 1. HD mapping post-PVI showed insufficient acute lesion formation in up to 20% (60% of these right sided) resulting in additional PFA for sufficient isolation. In four of six re-do procedures significant gaps were located at the right pulmonary veins.

Conclusion
PFA was a highly efficient method to achieve PVI with reductions in procedure time and fluoroscopy over the implementation period. The safety, procedural data and clinical recurrence rates from initial trials were confirmed in real-life non-selected AF patients. More data is needed to investigate and understand the lesion durability and limitations of PFA.