bluuebunny/crossref_metadata_2025_split huggingface dataset:
Initial experience using a novel algorithm to calculate omnipolar electrograms using a high-density grid-style catheter
Authors: Kottmaier M , Inaba O , Phillips K , Adsett M , Hayes J , Gkalapis C , Lengauer S , Clementy N , Bailey C , Kaneko S 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
A novel mapping algorithm recently became available in Europe and select countries in the Asia Pacific region. EnSite Omnipolar Technology (OT) utilizes the Advisor HD Grid Mapping Catheter, Sensor Enabled (HD Grid) to calculate electrograms in 360 degrees from two bipolar and three unipolar electrograms acquired from a triangular set of three electrodes. This software also enables calculation of wavefront characteristics including maximum voltage, activation direction and wave speed. Procedural characteristics and clinical utilization of this novel software have not yet been reported.

Purpose
To examine the clinical utility and procedural characteristics associated with the use of this novel mapping algorithm among participating centers.

Methods
Acute procedural data were prospectively collected in 386 cases at 52 centers utilizing the newly approved mapping software in the initial phases of commercialization in Europe and the Asia Pacific region. Procedural characteristics recorded included indication for mapping/ablation, navigation mode, mapping reference, and maps and tools used to diagnose/locate ablation targets.

Results
A total of 14 indications for mapping and ablation were represented including AF, atypical flutter, and VT (Table 1). VoXel (magnetic primary) navigation mode was used in most cases (n=325, 84%). The CS catheter was used as the map reference in 280 cases (73%). A variety of workflows were used with OT to diagnose and locate ablation targets including voltage maps (n=275, 71%), LAT maps (n=226, 59%), OT activation vectors (n=124, 32%), propagation maps (n=94, 24%), and sparkle maps (n=69, 18%); note: total exceeds 100%, multiple workflows per case observed. EnSite LiveView Dynamic Display (LiveView) was used in 129 cases (33%) to diagnose and locate ablation targets, including 28 (22%) where OT activation vectors were used with LiveView. Several benefits of OT were reported including rapid identification of ablation target(s) (n=133, 35%), higher point density (n=82, 21%), better signals (n=69, 18%), and improved procedure efficiency (n=48, 12%).

Conclusion(s)
Initial experience with this novel mapping software in Europe and the Asia-Pacific region illustrated utility in a variety of arrhythmias to diagnose and locate ablation targets. The use of OT provided several benefits including rapid identification of ablation targets and higher point density, however further examination of its impact on procedural efficiencies and acute outcomes is likely warranted.
Fluoroless cavotricuspid isthmus radiofrequency ablation of typical atrial flutter achieves success with zero radiation and shorter procedural duration
Authors: Jacinto S , Silva Cunha P , Portugal G , Valente B , Coutinho Cruz M , Lousinha A , Veiga J , Delgado AS , Bras M , Paulo M , Guerra C , Teixeira AR , Lacerda Teixeira B , Cruz Ferreira R , Martins Oliveira M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cavotricuspid isthmus (CTI) ablation in patients with typical atrial flutter (AFL) has improved in the past years, especially by the use of threedimensional (3D) electroanatomic mapping systems. These mapping tools contributed to reduce radiation exposure, but most ablation procedures still require varying amounts of fluoroscopy.

Purpose
We aim to examine whether fluoroless CTI ablation is effective and safe in reducing AFL recurrence, compared with CTI ablation using fluoroscopy and a 3D mapping system.

Methods
A retrospective analysis of CTI ablation procedures performed at a tertiary center between December 2008 and December 2020 was conducted. Cases were divided in two groups: fluoroless and fluoroscopic, according to the use of radiation. Procedural duration, fluoroscopy time (FT), use of 3D mapping system, complications and recurrence rate at one year were analyzed.

Results
A total of 324 CTI ablations performed on patients with documented typical AFL were included. Mean age was 62.3±14.0, with 78.1% male patients. Fluoroless ablations were performed based on a 3D mapping system, and all fluoroscopic procedures also used 3D electroanatomic mapping. The FT was zero in the fluoroless group - 31 cases (9.6%), and 7.0±4.4 minutes in the fluoroscopic group - 291 cases (90.4%) (p&lt;0.001). There was no statistically significant difference between the two groups, regarding AFL recurrence at one year (21.7% in the fluoroless group versus 13% in the fluoroscopic group; odds ratio [OD] 0.54; 95% confidence interval [CI] 0.18-1.62; p=0.27). Total procedure duration was significantly shorter in the fluoroless group (1h07m versus 1h40m; t-test 4.261, p&lt;0.001, CI 0h16m-0h50m). There were no acute complications for both groups.

Conclusion
Fluoroless CTI ablation avoids radiation exposure to the patient and operator and can be performed in patients with typical AFL, without compromising duration, safety or efficacy of the procedure.
Acute procedural characteristics, efficacy, and safety of a novel cryoballoon for the treatment of paroxysmal atrial fibrillation: Results from the POLAR-ICE study
Authors: Tilz R , Martin CA , Anic A , Defaye P , Luik A , Asmundis C , Champ-Rigot L , Iacopino S , Sommer P , Albrecht E , Raybuck JD , Wehrenberg S , Cielen N , Yap SC 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Boston Scientific

Background/Introduction
Pulmonary vein isolation (PVI) using a cryoballoon is well-established for the treatment of paroxysmal atrial fibrillation (PAF). Initial experience with a novel cryoballoon (CB) with a stable low balloon pressure (POLARx, Boston Scientific) has demonstrated acute procedural safety and efficacy in de novo PVI procedures in patients with paroxysmal AF. However, to date, there is limited multicenter data on real world acute outcomes and procedural characteristics with this novel cryoballoon.

Purpose
The purpose of POLAR ICE was to provide real-world data on the acute and chronic outcomes of cryoballoon ablation with POLARx for the treatment of PAF. Here we report on the initial acute outcomes up to 3 months including procedural efficacy, safety, and biophysical parameters.

Methods
POLAR ICE, a prospective, non-randomized, multicenter (international) registry (NCT04250714), enrolled 400 patients across 19 centers, between Aug 2020 and May 2021. This study included any patients indicated for treatment of PAF with the POLARx cryoablation system. The study protocol did not mandate any specific cryodosing regimen, this was left to the operator. Procedural characteristics, such as time to isolation (TTI), cryoablations per pulmonary vein, balloon nadir temperature, and occlusion grade were recorded. PVI was confirmed with entrance block testing.

Results
Complete PVI was achieved in 96.1% of PVs (1437/1496). Procedure and fluoroscopy times were 69.0±25.2 min and 15.8±10.0 min, respectively. Left atrial dwell time was 47.3±18.8 min. The cryoablation characteristics by vein are shown in the Table 1. An average of 4.9±1.8 ablations were performed per patient (1.3±0.7 per vein). Grade 3 or 4 occlusion was achieved in 98.1% of PVs reported. Electrical isolation was achieved with an average TTI of 50±33.8s and in 81.4% of PVs isolation required only a single cryoablation. Nadir temperatures across all pulmonary veins averaged -56.3± 6.5C. Time to -40C was 32.9±11s and Time to Thaw (0C) was 19.5±6.7s across all veins. PVI was performed on atypical anatomies (12 LCPV, 7 RMPV, & 3 RCPV) in 19 pts. Serious adverse events included phrenic nerve palsy (0.5%), tamponade (0.5%), AV block (0.3%), stroke (0.3%), and transient ischemic attack (0.3%).

Conclusions
Real world usage data on the novel CB suggests that this device is safe and effective, with a PV isolation success rate of 96.2% and 81.4% of PVs isolated with a single cryoablation. These data are in keeping with reports on other cryoballon systems and have markedly shorter procedure times than have been previously reported on this cryoballon.
Randomised comparison of achieve and traditional circular mapping catheters in cryoballoon ablation: results at up to a decade
Authors: Gallagher M , Akhtar Z , Gang Y , Gonna H , Li A , Bajpai A , Zuberi Z , Norman M , Sohal M , Leung LWM 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
A single-centre trial randomised patients to the use of the Achieve mapping catheter or a traditional circular mapping catheter during cryoballoon procedures for paroxysmal atrial fibrillation (AF) in 2011-2014. Long-term outcomes from the cohort were determined in 2021.

Purpose
To evaluate the determinants of long-term outcome of ablation for paroxysmal AF.

Methods
Patient and study procedure characteristics and clinical outcomes were determined, including mapping catheter assignment, model of cryoballoon used, AF recurrence, repeat ablations required, findings at repeat ablation long term survival of the patient.

Results
Of 102 patients in the original study, 98 had long-term (4.11+/-2.82 years) follow up data available. 35 patients (35.7%) had AF recurrence, giving a long-term success rate at 64.3% after 1 ablation, increasing to 81.6% after repeat ablation. Of the study cohort n=8 (8.16%) died at a median of 4.9 years after ablation (IQR:1.7-5.7). 25/98 (25.5%) patients had a second ablation and 7 (7.1%) had a third or more ablations. Those who had AF recurrence were older, with a higher prevalence of prior ischaemic heart disease and cardiac device implantation (p=0.02-0.03). After multi-variate analysis, a prior implanted cardiac device was the only significant predictor of recurrence (p=0.03).

Conclusion
Long-term outcomes after a 1st time PAF cryoablation were similar regardless of the type of mapping catheter used, the generation of cryoballoon, and traditional procedure endpoints. AF recurrences were more often detected in older patients with a history of ischaemic heart disease and implanted cardiac devices.
Preferential para-hisian atrial tachycardia ablation from aortic root: a single centre experience
Authors: Amores Luque M , Rajjoub EA , Lozano Granero VC , Matia Frances R , Hernandez Madrid A , Moreno Planas J , Zamorano Gomez JL , Franco Diez E 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Para-hisian atrial tachycardia (PH-AT) radiofrequency ablation carries a significant risk of atrio-ventricular block due to proximity to the conduction system. Ablation from noncoronary cusp (NCC) has been proposed as an alternative approach; however, the best strategy remains unknown (1).

Purpose
Evaluation of a strategy based on PH-AT ablation preferably from aortic root.

Methods
Observational study of all consecutive atrial tachycardia cases submitted to our institution for electrophysiological study and ablation from 2014 to 2020. If the earliest atrial electrogram was near the His bundle, aortic root mapping and ablation from this position was pursued.

Results
A total of 105 procedures of atrial tachycardia ablation were performed in 98 patients. 25 cases (24%) were PH-AT. Mean follow-up was 19.2 months (5.8 – 36.8). Table 1 summarizes basal characteristics of our population and ablation details. In the PH-AT group, successful ablation was achieved from aortic root in 21 cases, right atrium (RA) in 1 case and from both sites in 2 cases. The patient whose ablation was performed exclusively from RA was because of pacemaker dependency. In one of the patients with dual approach, RA was firstly attempted because of aortic prosthetic valve but tachycardia recurred, so aortic root was targeted; in the other case, radiofrequency was applied from RA due to electrophysiologist preference, but after second degree transient AV block, procedure was completed from NCC.
Acute success rate was similar in both groups (para-hisian and non-para-hisian, 100% and 96%, P=0.33). Figure 1 shows a trend towards less atrial arrhythmias recurrence in PH-AT compared to other atrial tachycardia origins. In the PH-AT group, only two procedure complications were found: a case of femoral artery pseudoaneurysm (ablation from aortic root) and the previous reported transient second-degree AV block (during ablation from RA). No systemic embolism was observed.

Conclusions
Radiofrequency ablation of PH-AT from aortic root seems to be practicable, effective, and safe.
Evaluation of myocardial injury induced by different ablation approaches in atrial fibrillation patients
Authors: Giaccardi M , Grassini D , Turreni F , Chechi T 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
To evaluate myocardial injury in Atrial Fibrillation (AF) patients undergoing High Power Short Duration radiofrequency (HPSD) and visually guided Laser Balloon Ablation (LBA).

Methods and results
In this single center registry we prospectively enrolled 40 patients (67% male), mean age 63±9, with paroxysmal or persistent AF (see table I). The ablation target has been the pulmonary vein isolation (PVI) with LBA and wide area circumferential ablation (WACA) with HPSD.
6 and 18 hours post-procedure samples of high sensitive cardiac troponin I (cTnI) were collected.
The results show not significant differences in target population and no significant differences in high sensitive cardiac troponin I (cTnI pg/ml) levels at 6h (HPSD cTnI =806±496 pg/ml vs laser cTnI = 664±339 pg/ml p=0.17) and 18 hours after ablation (HPSD cTnI =833±540 pg/ml vs laser cTnI = 1081±962 pg/ml p=0.07).

Conclusion
These results indicate that myocardial injury induced by HPSD and LBA at 6 and 18 hours after procedure are similar targeting WACA and PVI respectively. This registry is ongoing to evaluate freedom from AF at 12 months follow up.
Arrhythmia recurrence reduction with an active esophageal cooling device during radiofrequency ablation
Authors: Joseph C , Francisco G , Ruppert A , Willms D , Nazari J , Fisher W , Ro A , Sherman J , Zagrodzky J , Bailey S , Zagrodzky W , Athill C , Metzl M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
As the burden of atrial fibrillation continues to rise with an aging population, there have been contrasting positions on the efficacy of left atrial ablation. While ablation techniques have continued to improve over the past decades, arrhythmia recurrence rates must be further reduced given the burden of ablation on patients. Since continuity of lesion sets has been associated with greater lesion durability, it has been theorized that the use of active esophageal cooling may facilitate greater freedom from arrhythmia.

Purpose
In order to investigate the association between use of active esophageal cooling and arrhythmia recurrence, we performed a multicenter retrospective study of arrhythmia recurrence rates in patients that received active cooling and compared them to those that received luminal esophageal temperature (LET) monitoring.

Methods
In this study, follow up data were collected from patients that underwent pulmonary vein isolation (PVI) at three separate large medical centers. Data were contained in a prospective hospital registry, a prospective physician registry, or the electronic health record, depending on the center. For each patient included, we recorded whether their ablation utilized LET monitoring or active esophageal cooling, along with their rhythm status at 1-year follow up. Rhythm status at follow-up was determined by either electrocardiogram, Holter monitor, or wearable heart rate monitor. Kaplan-Meier (KM) curves were created for freedom-from-arrhythmia at one year comparing those in the LET monitoring group to those in the active cooling group.

Results
Follow up data were collected from 1035 patients. There were 560 patients that received LET monitoring during their original ablation, and 475 patients that underwent active esophageal cooling. KM estimates for freedom-from-arrhythmia at one year were 42% in the LET monitored group and 65% in the actively cooled group (P&lt;.001).

Conclusion
In this large multicenter study, there is a significant increase in freedom-from-arrhythmia at one year follow-up among patients that received active esophageal cooling as compared to those that underwent LET monitoring.
Comparison of the accuracy of contact force measurement in four commercially available force-sensing ablation catheters
Authors: Kueffer T , Haeberlin A , Knecht S , Baldinger SH , Servatius H , Madaffari A , Seiler J , Muehl A , Franzeck F , Asatryan B , Noti F , Tanner H , Roten L , Reichlin T 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Contact force-sensing catheters are widely used for ablation of cardiac arrhythmias. They allow precise quantification of catheter-to-tissue contact, which is an important determinant of lesion size and durability. Moreover, contact force information reduces the risk for cardiac perforation and is used for estimation of lesion size. However, the accuracy of contact force sensors across different manufacturers has not been validated independently.

Objective
To compare the accuracy and reproducibility of different force sensing catheters used in cardiac electrophysiology procedures.

Methods
A force measurement setup containing a heated saline water bath and a catheter fixation mechanism was constructed. The setup allows to accurately measure forces applied to a platform with the catheter. We studied four different catheter models, equipped with the following, unique force-measurement technologies (figure 1): 1) multiple-fiber optical sensor; 2) single-fiber optical sensor; 3) inductive sensor; and 4) magnetic field sensors. For each model, we assessed three catheters. Repeated measurements within the force range of 0g to 60g and at electrode-tissue contact angles of 0°, 45°, and 90° were performed and validated against the force measurement unit of our measurement setup.

Results
For each catheter, at least 500 measurements at different contact forces (equally distributed across the measurement range of 0 to 60 grams) were performed. Correlation of measured-force to real-force was ρSpearman=0.99 for MFOS, ρSpearman=0.98 for SFOS, ρSpearman=0.99 for IS, and ρSpearman=0.98 for MFS. MFS and SFOS showed a higher variance for high forces and increased intra-catheter variability compared to MFOS and IS. IS overestimated higher contact force at 0° and 30°. MFS and SFOS underestimated contact force for higher forces at 30° and 45° (figure 2). Within a clinical range of 5g to 40g, the catheters reached the following root-mean-square-error, independent of contact angle: MFOS 0.88g ±0.68g, SFOS 2.15g ±1.74g, IS 0.88g ±0.72g, and MFS 1.13g ±1.01g.

Conclusion
Measured contact by force-sensing catheters correlates well with true exerted electrode-tissue force. Despite an excellent overall correlation, some technologies may be prone to significant errors at higher forces (&gt;10g under-/overestimation of true contact force) with potential clinical consequences related to increased risk of perforation.
Epicardial mapping as first intention approach for structural ventricular tachycardia ablation
Authors: Garcia A , Brito J , Couto Pereira S , Silverio Antonio P , Silva B , Alves Da Silva P , Simoes De Oliveira C , Martins A , Nunes Ferreira A , Silva G , Carpinteiro L , Cortez Dias N , J Pinto F , Sousa J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
In several structural arrhythmogenic diseases that comprise intricate endocardial, intramural and epicardial substrates, endocardial ablation of ventricular tachycardia (VT) is not sufficient and epicardial ablation has lately become a complementary and necessary tool.

Purpose
To evaluate the clinical characteristics of patients (pts) most suitable for first intention epicardial VT ablation.

Methods
Single-center prospective study of consecutive pts with structural heart disease undergoing first intention epicardial VT mapping between August 2015 and June 2021. Decision for epicardial approach was based on the etiology, VT electrocardiogram (ECG) and cardiac magnetic resonance (CMR) results. Under general anesthesia, subxiphoid access using a Tuhoy needle was done using fluoroscopic guidance and with high-density epicardial mapping was performed. Epicardial ablation was performed if relevant arrhythmogenic findings were locally confirmed.

Results
First intention epicardial VT ablation was attempted in 18 pts (mean age 59.8±12 years,94% male) of whom 16 had non-ischemic dilated cardiomyopathy (NICM,idiopathic:11; post-myocardis:4; hereditary:1) and 2 had right ventricular arrhythmogenic cardiomyopathy. Mean LVEF was 33% and 79% had a previous ICD (53% in primary prevenon). 69% were referred for ablation due to arrhythmic storm (1pt in cardiogenic shock). Epicardial access was achieved in 17 pts (94%), without acute complications. In 35% pts with NICM the decision for epicardial approach was based on the detection of subepicardial CMR delayed-hyperenhancement and relevant epicardial arrhythmic substrate was confirmed by mapping in all cases. In 3 pts radiofrequency (RF) applicaons were not performed at epicardium, as no abnormal electrograms were locally detected, and an addional endocardial approach was prosecuted. The mean overall procedure and fluoroscopic time were 123 and 28min, respectively, with a mean RF application me of 51min. After the procedure 1pt required pericardial drainage due to inflammatory pericardial effusion. No other acute complications occurred. During a mean follow-up of 2.8±1.8 years, only 3pts (17%) had VT recurrence; 5pts (28%) died due to end-stage heart failure and 2pts (11%) underwent heart transplantation.

Conclusion
In NICM a first intention epicardial VT ablation performed by experienced operators/centers is efficient, particularly if guided by CMR findings,and presents a safety profile.