bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical introduction of ultrasound-guided vascular access in catheter ablation of left atrial arrhythmias
Authors: Krimphoff A , Bordignon S , Chen S , Thohoku S , Urbanek L , Schaack D , Chun K R J , Schmidt B 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Vascular complications are a common occurrence during atrial fibrillation ablation. Observational studies show that the incidence of vascular complications can be reduced by using ultrasound (US)-guided puncture, however its routine use is not established in many centers.

Purpose
To compare the rate of vascular complications between ultrasound-guided and conventional anatomic landmark-guided vascular access during catheter ablation of left atrial arrhythmias.

Methods
Patients undergoing catheter ablation for atrial fibrillation were included sequentially. All patients receiving US-guided puncture were prospectively enrolled group A, while patients who underwent the procedure with standard puncture technique served as control group B. The primary endpoint were periprocedural vascular complications requiring intervention within 30 days of the procedure

Results
599 patients (average age: 68 ± 11 years, 63,1% male) were analyzed, 299 in group A and 300 in group B. Demographic and clinical baseline characteristics were comparable between the two groups, except higher prevalence of pre-existing Diabetes mellitus in group A (14,7% vs. group B: 8,7%, p=0.022). The majority of patients were treated with radiofrequency ablation (51,5%), followed by pulsed-field ablation (20,4%) and cryoballoon (18,7%). Other ablation techniques were laserballoon and radiofrequency balloon ablation.
The overall rate of vascular complications was lower with the ultrasound-guided puncture than the anatomic landmark-guided puncture (14/299 4,7% vs. 27/300 9%, p=0.036). The ultrasound-guided puncture resulted in a significantly reduced rate of false aneurysms (3/299 1% vs. 12/300 4%, p=0.019). In addition, arteriovenous fistula (2/0,7% vs. 4/1,3%, p=0.414) and hematoma requiring treatment (9/299 3% vs. 11/300 3,7%, p=0.655) were also lower in group A.

Conclusion
The use of ultrasound-guided vascular access for catheter ablation resulted in a significant reduction of the overall vascular complication rate.
Incidence, types and predictors of AF recurrence after AF ablation with pulsed field ablation. A single-centre experience
Authors: Eberl A , Manninger M , Rohrer U , Zweiker D , Reischl A , Kurath-Koller S , Benedikt M , Bisping E , Lercher P , Zirlik A , Scherr D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulsed field ablation (PFA) is an emerging method for atrial fibrillation (AF) ablation. However, there is little data about incidence, types, and predictors of AF recurrences after PFA for AF ablation.

Methods
We report our single-centre experience with PFA for AF ablation. Each procedure was performed under unconscious sedation with propofol and fentanyl. If needed, midazolam was added in rare cases. Fifteen minutes before transeptal puncture 70IU/kg of unfractionated heparin were administered, for an ACT level &gt;300sec during the entire procedure. Isolation of pulmonary veins was started after administration of 1mg of atropine with 8 applications per vein (4 in basket, 4 in flower configuration). Afterwards all veins were checked for entrance- and exitblock to confirm isolation during SR. If needed, additional ablation was performed.

Results
In total, 124 patients undergoing AF ablation therapy with PFA between June 2021 to October 2022 were analysed. Mean age was 61±9 years, 39% were female. Mean CHADS-VASc Score was 2±1. Sixty-two percent had paroxysmal atrial fibrillation (PAF), 34% persistent AF, in 4% patients suffered from long standing persistent AF.
In 85% (n=106) of procedures first pass isolation of all veins was possible. Primary success to achieve PV isolation was accomplished in all patients at the end of procedure. In addition to PVI, in 6,5% of patients cavotricuspid isthmus (CTI) was blocked, in another 7,3% the posterior wall was isolated during the first procedure. Mean procedure duration was 76±30 minutes, mean x-ray time 11±22 minutes.
During 124 procedures, only one periprocedural complication was documented (vascular complication).
Eighteen patients (14,5%) had recurrence of dysrhythmia after a blanking period of 3 months after a mean follow-up period of 167±150 days. Mean time to recurrence was 108±101 days. Patients with recurrences after the blanking period suffered significantly more often from diabetes (OR 0,21 (0,089-0,495); p&gt;0.01) and hyperlipidaemia (OR: 0,198 (0,070-0,498); p&gt;0.01).
Until now we performed five re-do procedures of patients with recurrence of dysrhythmia after a PFA first-do procedure. The recurrent arrhythmia was AF (n=2), atypical AT (roof-dependent n=1, one mitral isthmus dependent n=1), and CTI-dependent flutter (n=1). All five patients had PV reconnections, and all could be successfully reablated.

Conclusion
AF ablation with PFA is associated with high SR success rate, and acceptable procedure duration and complication rates. Randomized studies are needed to further evaluate this new method compared with other ablation techniques.
Efficacy of functional substrate map-guide approach for wide circumferential pulmonary vein isolation
Authors: Kobori A , Ishikura M , Sasaki Y , Furukawa Y 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary vein isolation (PVI) with anatomical approach targeting closer interlesion distance (ILD) would be effective, but not efficient. A functional substrate map (FSM) can reveal the unnecessary application site including physiological block and the critical ablation site including direct epicardial connections.

Purpose
We investigated the efficacy of FSM-guide approach for wide circumferential PVI.

Methods
We enrolled 55 consecutive patients underwent radiofrequency PVI for atrial fibrillation. In earlier 27 patients were ablated by anatomical approach with closer ILD (&lt;5mm) (control group), in latter 28 patients were by real time PV electrogram and high density electro-anatomical map guide (FSM-guide group). In FSM-guide group, characteristics of electrical conduction including voltage, direction , velocity and barrier between PV and left atrium and epicardial connection were assessed by local activation, coherent and ripple map before ablation. Distributions of the segments required or unnecessary ablation for PVI completion were examined.

Results
The success rate of first-pass isolation was higher in FSM-guide group than in control (96.4% vs. 74.1%). The number of required ablation tags for PVI were significantly lesser in FSM-guide group than control group (left-sided PV (LPV); 23.2±1.6 vs. 29.2±1.6, p=0.0112, right-sided PV (RPV); 22.6±1.7 vs. 32.4±1.8, p=0.0124, respectively). The time for PVI completion was significantly shorter in FSM-guide group than control group (RPV; 17.0±2.2 min vs. 25.2±2.8 min, p=0.0124, LPV; 18.7±1.5 min vs. 20.5±1.5 min, p=0.042, respectively). In FSM-guide group, unnecessary application sites were frequently located at posterior of RIPV (46%), anterior of LIPV (43%) and anterior of RSPV (35.7%). Frequently required segments for PVI completion were roof and carina of LPV and roof and posterior of RPV. In most cases of control group, full circumferential ablation was required (LPV 22/27(81%) and RPV 24/27(89%)). Acute reconnections during procedure were similar in FSM-guide group and control group (LPV; 6/28 (21.4%) vs. 4/27 (14.8%), p=0.7287, RPV; 9/28 (32.1%) vs. 4/27 (14.8%), p=0.2047, respectively). All of reconnection sites in FSM-guide group were ablated site.

Conclusions
FSM-guide approach for extensive PVI could reveal unnecessary application sites and result in shorter procedure with comparable ablation quality.
Sedation strategies for pulsed-field ablation of atrial fibrillation with monitored anesthesia care versus general anesthesia: a single-center experience
Authors: Carboni L , Casella M , Malacrida M , Iovinella A , Cipolletta L , Procicchiani L , Fori S , Masci F , Volpato G , Compagnucci P , Enrico R , Parisi Q , Natale A , Munch C , Dello Russo A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial Fibrillation (AF) ablation has been performed successfully under different methods of anesthesia and varies between centers, from general anaesthesia (GA) to conscious sedation. Recently, a novel pulsed-field ablation (PFA, Farapulse) technology based on non-thermal ablation has become available for clinical use. To date, no structured sedation strategy has been implemented for this specific energy source.

Purpose
We sought to compare a GA protocol and a monitored anesthesia care (MAC) protocol used at a high-volume center, with special consideration on efficiency and optimization of mapping and ablation conditions.

Methods
All consecutive patients (pts) undergoing AF ablation with PFA at our center were included. Briefly, PFA was delivered by a protocol-directed PVI using 2kV with eight applications per vein, that is, four applications each in the basket and flower poses. The choice of anesthesia’s protocol depends on the preference and experience of operator and general conditions of the patient. The MAC protocol includes propofol as only anesthetic agent and analgesia with fentanyl. The GA protocol include propofol and sevofluorane as anesthetic agents and fentanyl and remifentanyl for analgesia. Anesthesia related complications (hypotension and hemodinamic instability, respiratory complications, postoperative nausea and vomit) operative pain, chest movements, operator and patient satisfaction have been reported. Data are reported as mean±DS.

Results
Thirty-six pts were included in this analysis, 28 (78%) indicated for ablation of paroxysmal AF and 8 (22%) of persistent AF. MAC protocol was applied in 16 (44%) procedures and GA protocol in 30 (56%) procedures. No differences were found in terms of procedural and management parameters according with these two strategies, that is MAC vs GA: 114±28min vs 121±19min for lab occupancy time, p=0.3521; 66±14min vs 81±25min for total support time, p=0.0683; 63±9min vs 63±18min for skin-to-skin time, p=0.3887; and 19±6min vs 20±5min for fluoroscopy time, p=0.3313, respectively). No major procedure-related adverse events were reported. Operative pain and chest movements were less in GA protocol, operator satisfaction was greater in GA protocol. No significant differences in post-operative nausea and vomit and patient satisfaction were found.

Conclusion
The adoption of a structured workflow with proper perioperative assessment during pulsed-field ablation of AF, both general anesthesia and monitored anesthesia care showed similar efficacy and safety profile.
Impact of left atrial CT-angiography prior cryoballoon pulmonary vein isolation on procedural characteristics and outcomes
Authors: Kassa K , Kiss M , Simkovits D , Nagy Z S , Som Z , Foldesi C S , Kardos A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cryoballoon (CB) ablation for pulmonary vein isolation (PVI) is a frequently performed procedure for rhythm control therapy in atrial fibrillation (AF). However, there is limited data on the impact of preprocedural computed tomography (CT) imaging on procedural characteristics and outcomes.

Purpose
We aimed to determine whether the use of left atrial CT-angiography to guide CB ablation makes a difference on procedural outcomes by revealing left atrial (LA) anatomy and pulmonary vein (PV) characteristics.

Methods
A total of 146 AF patiens (paroxismal: 58%, age: 62 ±11 years) undergoing CB ablation were randomized for conventional PVI (control group, n=74) and PVI following preoperative CT-angiography (CTA group, n=72). In the CTA group, LA and PV anatomical features were available during the procedure using 3-dimensional reconstruction images derived from an electroanatomical mapping system. A strategy of 240-second freeze time was used for each pulmonary vein with an option for extra freeze circles until PVI was achieved.

Results
Procedural time (51±13 min vs. 58±21 min, p&lt;0.05), LA dwell time (41±11 min vs. 47±20 min, p&lt;0.05) and fluoroscopy time (9±4 min vs. 11±5 min, p&lt;0.05) were significantly shorter in the control group. Fluoroscopy dose (1892.4±1319.7 cGycm2 vs. 2216.6±2371.8 cGycm2, p=0.307) and 12-month success rates (control group: 61%; CTA group: 62%, p=0.835) were comparable. No major complications were observed.

Conclusions
The additional information on anatomy provided by left atrial CT angiography does not manifest in improved procedural characteristics or clinical outcome. Our findings do not support the routine use of preprocedural CTA for guidance of cryoballoon ablation.
Methods, efficacy and safety on routine clinical use of pulsed field ablation for pulmonary vein isolation in patients with 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 (AF). It is also used as off-label therapy for persistent AF. Only a few small clinical studies have been published on the mid- and long-term outcome. We present data on methods, efficacy and safety on routine clinical use of pulsed field ablation for pulmonary vein isolation in patients with atrial fibrillation.

Methods
In patients with AF, 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 using a pentaspline diagnostic catheter were performed. Procedural parameters, acute success and in-hospital safety were assessed.

Results
A total of 5 operators treated 304 patients (mean age 67 years (range 32-85), female 42%, mean BMI 28 kg/m2 (range 20-42), mean CHA2DS2-VaSc score of 2 (range 0-7), first-time ablation 100%, paroxysmal/persistent/longstanding persistent AF 47/17/36%, respectively. Mean duration since first AF diagnosis was 79 months (range 0-332). Most procedures were performed under deep conscious sedation using propofol and midazolam, without intubation (99%). Pre- and post-ablation high-density maps were performed in 27% of cases. Mean procedure time was 75 min. (range 23–245). Mean left atrial dwell time of the PFA catheter was 25 min. (range 8-98). Fluoroscopy time and dose area product were 18 min. (range 6-50) and 5,74 Gy.cm2 (range 0,40-36,50), respectively. Pulmonary vein isolation (PVI) was successful in 100%. There were no phrenic nerve palsies or esophageal complications. Major complications (2,6%) were pericardial tamponade (2,0%) and stroke (0,7%); one of these strokes was lethal (0,3%). Minor complications (1,0%) were vascular access related (0,7%) and transient ischemic attack (TIA) (0,3%).

Conclusions
In a large, single center cohort of unselected patients, initial experience with de novo PFA for PVI in patients with AF seems to be fast and effective. There were no PFA-specific complications, but the frequency of catheter complications (tamponade, stroke) in this relatively old patient population with a relatively long history of AF demonstrates that there is still room for improvement. The number of complications improved significantly over the course of time, indicating that the learning curve could have negatively influenced the incidence of complications.
Association of clinical characteristics and biomarkers with recurrent atrial fibrillation after hybrid ablation
Authors: Velt M J H , Magni F T , Blaauw Y , Mariani M A , Klinkenberg T J , Rienstra M , Mulder B A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Atrial fibrillation ablation research at our institution was supported by an unrestricted grant from AtriCure.

Background
Hybrid ablation is an alternative treatment for both persisting and therapy-resistant, symptomatic atrial fibrillation (AF), combining the strengths of endocardial catheter and epicardial surgical ablation. Although results exhibit lower rates of recurrence and higher reduction of AF burden, there is a considerable risk of procedure-related complications. Therefore, the identification of patient groups who benefit most of this procedure can help in pre-procedural selection and tailoring of optimal therapy post-ablation.

Purpose
This study aimed to identify clinical factors and blood biomarkers associated with recurrence of AF within 1 year post-ablation.

Methods
A total of 96 consecutive patients undergoing hybrid ablation between January 2015 and December 2018 in a tertiary care center were enrolled. Blood samples were collected pre-ablation. Seven biomarkers [Bone Morphogenetic Protein 10 (BMP10), angiopoietin-2 (ANG2), Dickkopf WNT Signaling Pathway Inhibitor 3 (DKK3), Endothelial Cell Specific Molecule 1 (ESM1), Fibroblast Growth Factor 23 (FGF23), Insulin Like Growth Factor Binding Protein 7 (IGFBP7) and total N-terminal pro b-type natriuretic peptide (NT-proBNP)] were assayed at Roche Diagnostics based on their possible association with recurrence of AF. Clinical follow-up visits combined with 12-lead ECG and 24-hour Holter monitoring were scheduled at 3, 6 and 12 months post-procedure. Cox proportional hazards regression models were used to study the association with recurrence of AF.

Results
Out of the 96 patients (mean age 58±8 years; 18% women), 17 (17.7%) developed recurrence of AF within 1 year post-ablation. Median time to diagnosis was 191 days (range: 92-344). Comparisons between patients with and without recurrence of AF are depicted in Table 1. Multivariable Cox proportional hazard regression, adjusted for sex, showed that older age (HR 1.104, 95% CI 1.003-1.215, p=0.043), type of AF (HR 0.322, 95% CI 0.117-0.886, p=0.028), a history of peripheral vascular disease (HR 13.84, 95% CI 3.13-61.14, p&lt;0.001) and recurrence in the blanking period (HR 14.25, 95% CI 3.99-50.85, p&lt;0.001) were associated with recurrence of AF within 1 year post-ablation, but no blood biomarkers (Figure 1).

Conclusion
In AF patients undergoing extensive ablation, older age, type of AF, a history of peripheral vascular disease and recurrence in the blanking period were determinants of AF recurrence within 1 year post-ablation.
Morphology-Voltage-P-wave-duration (MVP) score to select patients for continuous atrial fibrillation screening to prevent stroke
Authors: Xing L Y , Diederichsen S Z , Hojberg S , Krieger D W , Graff C , Olesen M S , Nielsen J B , Brandes A , Kober L , Haugan K J , Svendsen J H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The LOOP Study was funded by Innovation Fund Denmark [grant number 12-1352259], The Research Foundation for the Capital Region of Denmark, The Danish Heart Foundation [grant number 11-04-R83-A3363-22625], Aalborg University Talent Management Program, Arvid Nilssons Fond, Skibsreder Per Henriksen, R og Hustrus Fond, the European Union’s Horizon 2020 program [grant number 847770], Læge Sophus Carl Emil Friis og hustru Olga Doris Friis’ Legat, and an unrestricted grant from Medtronic.

Background
It is well known that atrial fibrillation (AF) confers a substantially increased risk of ischemic stroke, but data on health benefits from AF screening are scarce. The newly proposed MVP risk score combining the duration, voltage and morphology of P-wave has been demonstrated to be predictive of AF and might therefore also be useful in risk-stratifying individuals for AF screening and subsequent treatment.

Purpose
The present study sought to examine MVP risk score and its P-wave components for prediction of AF screening effects.

Methods
The LOOP Study randomized AF-naïve individuals aged 70-90 years with additional stroke risk factors to either continuous AF screening with implantable loop recorder (ILR) and subsequent anticoagulation initiation upon detection of AF episode ≥6 minutes, or usual care. In this secondary analysis, the LOOP participants with a baseline 12-lead electrocardiogram (ECG) suitable for P-wave measurement were included.

Results
Of 5759 participants included, 265 (4.6%) had had ischemic stroke during follow-up: 213 (4.9%) of 4311 in the control group versus 64 (3.6%) of 1448 in the ILR group. Among the participants in the control group, a significantly increased risk of ischemic stroke was observed for MVP score 5-6 versus score 0-2 (hazard ratio (HR) 1.66 [95% confidence interval (CI): 1.01-2.75]) and for the presence of interatrial block (IAB) versus no IAB (HR 1.85 [95% CI: 1.19-2.86]), whereas a P-wave voltage in lead I (PWVI) &lt;100 µV was associated with risk reduction compared to higher voltage (HR 0.65 [95% CI: 0.45-0.93]). Further spline analysis revealed longer P-wave duration (PWD) to also be correlated with higher stroke risk (HR 1.49 [95% CI: 1.11-2.00] for &gt;110 versus ≤110 ms). Compared with usual care, ILR screening did not significantly reduce the stroke risk regardless of MVP risk score, PWD, PWVI, or IAB pattern at baseline.

Conclusions
In an elderly population with additional stroke risk factors, both the P-wave parameters and the combined MVP risk score based on 12-lead ECG were associated with ischemic stroke, but these did not successfully demonstrate an association with effects of AF screening on stroke prevention.
Racial differences in atrial fibrillation-related bleeding and mortality
Authors: Kang D S , Yang P S , Kim D H , Jang E S , Yu H T , Kim T H , Sung J H , Pak H N , Lee M H , Lip G Y , Joung B Y 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Adverse outcomes associated with atrial fibrillation (AF) in Asians have not yet been fully elucidated. This study was designed to study racial differences in the risk for bleeding and the effect of new-onset AF on bleeding and mortality.

Methods
This study is based on a patient-level comparative analysis of UK Biobank and Korean National Health Insurance Service-Health Screening data. The primary outcome was intracranial hemorrhage (ICH). The secondary outcomes were major bleeding and gastrointestinal (GI) bleeding. Five-year incidence rates (IR), rate difference (IR in those with AF minus IR in those without AF) and rate ratio (IR in those with AF divided by IR in those without AF) of the outcomes were calculated.

Results
Between 2005 and 2012, we identified 422,121 Asians (mean [SD] age, 55.1 [8.4] years; 54.2% of men) and 380,763 Whites (mean [SD] age, 57.1 [8.0] years; 45.1% of men). During the five-year follow-up period, the IR of AF per 1000 person-years were 2.29 (95% CI, 2.22–2.35) in Asians and 3.55 (95% CI, 3.46–3.63) in Whites. The IR of ICH was greater in Asians with and without AF than in corresponding White groups. The rate difference for ICH was 1.84 (95% CI, 1.18–2.51) in Asians and 0.80 (95% CI, 0.56–1.04) in Whites. For major bleeding, the IR of Asians were not only higher than those of Whites, but also the rate difference was 1.3-fold higher in Asians than in Whites. However, different tendencies were observed for GI bleeding.

Conclusion
Despite the higher incidence of AF in Whites, Asians with AF have a worse prognosis in terms of ICH and major bleeding. However, further studies are needed to explain the different trends of gastrointestinal bleeding.