bluuebunny/crossref_metadata_2025_split huggingface dataset:
Non-invasive continuous arterial pressure monitoring during transcatheter atrial fibrillation ablation: a feasibility prospective study
Authors: Di Cori A , Fiorentini F , Parollo M , Della Volpe S , Mazzocchetti L , Barletta V , Segreti L , Viani S , De Lucia R , Sarti M , Bozzoli D , Giannotti M , Soldati E , Zucchelli G , Bongiorni MG 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Transcatheter atrial fibrillation (AF) ablation is still carried out with continuous invasive radial arterial blood pressure (BP) monitoring in many centers. Continuous noninvasive blood pressure (CNBP) measurement using the volume-clamp method is a non invasive alternative method used in ICU. No data on CNBP reliability are available in the electrophysiology lab during AF ablation, where rhythm variations are common.

Purpose
The objective of the present study was to compare continuous noninvasive arterial pressure measured with the ClearSight device with invasive radial artery pressure, used as the reference method during AF ablation.

Methods
We prospectively enrolled 55 consecutive patients (age 62±11 years, 79% male) undergoing transcatheter AF ablation (62% paroxysmal, 38% persistent) at our center. Standard of care invasive BP monitoring via a radial cannula and a contro-lateral non-invasive finger volume-clamp continuous BP measurement device were positioned simultaneously in all patients for the entire procedure. Bland-Altman analysis was used to analyze agreement between the two techniques.

Results
A total of 1219 paired measurements for systolic, diastolic, and mean arterial pressure were obtained in 55 subjects, with a mean (SD) of 22 (9) measurements per patient. Mean bias (SD) was -12,97 (13,89) mmHg for systolic pressure (level of agreement -14,24–40,20; correlation coefficient 0,84), -1,85 (8,52) mmHg for diastolic pressure (level of agreement -18,54–14,84; correlation coefficient 0,77) and 2,31 (8,75) mmHg for mean pressure (level of agreement -14,84–19,46; correlation coefficient 0,85).

Conclusion
In patients undergoing AF ablation, non-invasive finger volume-clamp continuous BP monitoring with the ClearSight device showed acceptable agreement with standard of care invasive BP monitoring. Larger studies are needed to confirm potential clinical implications of a continuous non-invasive BP monitoring during AF ablation.
Global preferences in mapping technology and its impact on fluoroscopy and procedure times during catheter ablation of atrial fibrillation
Authors: Shah S , Shim J , Martel J , Addo K , Delurgio D , Demo H , Hamdan F , Bonavita G , Li J , Bailey C , Kim Y 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Choice in mapping technology may play a critical role in reducing fluoroscopy and procedure times during atrial fibrillation (AF) ablation, however this relationship is not well studied.

Purpose
To assess the impact of mapping technology on trends in fluoroscopy use and procedure times in AF ablation procedures.

Methods
Acute procedure data from 525 AF cases was prospectively collected from 68 centers in nine countries. Choice of technology and ablation strategy, including PVI and substrate modification, were left to physician discretion. Procedure data such as total procedure and fluoroscopy times from cases using a grid-style mapping catheter (HD Grid) were compared to those using a circular mapping catheter (CMC).

Results
Of the 525 cases, HD Grid was used in 230 (44%), and CMC was used in 295 (56%). HD Grid was routinely used for both de novo and redo procedures while CMC was used predominantly for de novo procedures (Table 1). Similar procedure times were noted in redo PAF and redo PersAF procedures, while significantly shorter procedure times were observed for the HD Grid group in both de novo PAF and PersAF (113.9±48.8 vs. 125.9±56.3 minutes, p=0.04; and 142.8±53.2 vs. 169.8±52.2 minutes, p=0.001).
Overall fluoroscopy times were significantly shorter using HD Grid compared to a CMC (9.0±19.6 minutes vs. 19.8±16.4 minutes, p&lt;0.001), including significantly shorter fluoroscopy times in de novo PAF, de novo PersAF, and redo PAF (Table 1). There were 155 cases completed without fluoroscopy use; zero fluoroscopy cases accounted for 50% (114/230) and 14% (41/295) of total cases completed with HD Grid and a CMC, respectively (p&lt;0.001).

Conclusion(s)
Use of HD Grid was observed in a significantly higher portion of zero fluoroscopy cases and resulted in significantly shorter procedure and fluoroscopy times in both de novo PAF and de novo PersAF and significantly shorter fluoroscopy times in redo PAF. These observations suggest that use of HD Grid may better enable faster and safer procedures in these specific AF types compared to CMCs, although further analysis in a larger, randomized cohort may be warranted.
Visualization of pulmonary vein reconnections using dynamic mapping in redo procedures for patients with atrial fibrillation
Authors: Parreira L , Rossillo A , Del Greco M , Mantovan R , Fantinel M , Bottoni N , Bianco E , Bacchiega E , Tao C , Rossi P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Pulmonary vein (PV) reconnection is commonly associated with recurrence of atrial fibrillation (AF) after the initial catheter ablation procedure. Visualization and identification of PV reconnections are critical during repeat procedures.

Purpose
To examine the use of dynamic mapping (LiveView) in combination with a high-density mapping catheter (HD Grid) in the recognition of PV reconnections in redo AF ablation procedures.

Methods
Acute procedure data from 81 patients were prospectively collected. Mapping catheter selection and the use of LiveView was determined at the physician’s discretion. For cases where LiveView was used, the location and number of gaps from the previous procedure were identified using both standard mapping and dynamic mapping separately.

Results
Most of the patients included in the analysis were treated for paroxysmal AF (PAF: n=63/81, 77.8%). Dynamic mapping data was incorporated in 50 PAF cases and 15 persistent AF cases. Within these 65 cases, standard mapping identified a total of 120 PV gaps whereas LiveView identified a total of 138 PV gaps; gaps were most frequently identified on the right PVs, especially in the anterior region (Table1). A contact force-sensing ablation catheter was commonly (n=64/81, 79%) used by the operators. The right anterior region was ablated with an average contact force of 13.8±3.1g and Lesion index (LSI) of 5.2±0.7 at a power of 35.8±8.4W. Non-PV ablation was performed in 38 (46.9%) patients; the most common lesion sets were roofline, cavotricuspid isthmus (CTI) line, and mitral isthmus line. Acute PV isolation was achieved in all patients at the end of the procedure.

Conclusion
Data from this analysis suggest the incorporation of dynamic mapping data may help reveal more PV reconnections compared to standard mapping. Additional study is needed to assess the long-term clinical outcomes when regional dynamic mapping data is used to identify PV reconnections in repeat procedures.
Six-month follow-up of first real-world experience with pulmonary vein isolation using pulsed field ablation for paroxysmal atrial fibrillation
Authors: Neven K , Fueting A , Hoewel D , Brokkaar L , Rahe G , Reinsch N 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Catheter ablation for AF using thermal energy can cause collateral damage. Pulsed field ablation (PFA) is a novel nonthermal energy source. Only a few small clinical studies have been published.

Objective
We report on the first “real-world” experience with 6-month follow-up with PVI with PFA for paroxysmal AF.

Methods
Pre and post ablation, phrenic nerve function was assessed. A high-density LA bipolar voltage map was created. All PVs were individually isolated using a steerable sheath and a pentaspline over-the-wire PFA catheter. After ablation, mapping was repeated to assess lesion formation. Patients had a scheduled follow-up visit at days 30, 90 and 180 after ablation.

Results
In 30 patients (age 63 years, 47% male), uncomplicated PFA was performed, with all PVs acutely isolated. Skin-to-skin procedure time was 120±21 min. Total LA dwell time was 109±22 min. LA dwell time of the PFA catheter was 31±12 min. Fluoroscopy time was 23±7 min. Dose-area product was 4,96±3,54 Gy.cm2. Number of applications per patient until complete PVI was 32±1. In 1 patient with roof dependent flutter, a roof line was intentionally created with 8 additional applications. In 2 patients, unintentional bidirectional mitral isthmus block was created. In 10 patients, temporary pacing due to vagal bradycardia after LSPV ablation was needed. There was no phrenic nerve palsy. In 1 patient who had repeated, di!cult CS-catheter placement, 6 hours after the procedure a cardiac tamponade with uncomplicated pericardial drainage of 250 ml blood occurred. Further in-hospital stay was uneventful, on day 2 all patients were discharged in SR. On day 30, all patients were free of complaints and there were no groin complaints. 29 Patients were in SR, 1 patient had a cardioversion because of asymptomatic AT with 4:1 conduction. On day 90, 27 (90%) patients were in SR, 3 patients had AF/AT recurrence. During redo LA procedure, 2 patients with isolated PVs had inducable LA macro-reentrant tachycardia (1 roof and 1 mitral isthmus dependent) and 1 patient had LIPV reconduction. All 3 patients had uncomplicated RF ablation. On day 180, all 30 patients were o" anti-arrhythmic drugs and in SR.

Conclusion
PVI using PFA for paroxysmal AF in a “real-world” setting is safe and feasible. Post-ablation clinical course and 6-month follow-up are favorable.
Pulsed field ablation for paroxysmal atrial fibrillation is safe for the bronchial system
Authors: Neven K , Fueting A , Hoewel D , Brokkaar L , Essling A , Reinsch N 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Thermal LA ablation, like cryo can cause bronchial damage, like hemorrhagic lesions, atrio-bronchial fistula and severe bleedings. Pulsed field ablation (PFA) is a novel, non-thermal ablation modality.

Objective
We report on possible bronchial injury after PVI using PFA for paroxysmal AF.

Methods
A LA bipolar voltage 3D map was created. All PVs were individually isolated using a 13F steerable sheath and a pentaspline over-the-wire PFA catheter. After ablation, mapping was repeated to assess lesion formation. One day after PVI, bronchoscopy without biopsies was performed. Serial hemoglobin levels were measured during 30-day follow-up.

Results
In 30 patients (mean 63 years; 47% male), uncomplicated PFA was performed, with all PVs acutely isolated. Post ablation, all voltage maps consistently showed extensive antral PV lesions. ACT was &gt;325 seconds in all patients. Clinical course was uneventful, no patient had chest discomfort, coughing or hemoptysis. All patients underwent uncomplicated bronchoscopy, without thermal lesions or ulcers. In 12 patients (40%), small amounts of blood clots without active bleeding were seen in multiple segments. All hemoglobin levels remained stable. At 30-day follow-up, all patients were asymptomatic.

Conclusion
PVI using PFA for paroxysmal AF is safe for the bronchial system. PFA using a straight tip, extra-sti! wire can lead to asymptomatic blood oozing in the bronchial system without clinical relevance at 30-day follow-up.
Figures: Postero-anterior LA view before (above) and after (below) ablation with the trachea and main bronchi (dark grey) projected over the roof and posterior wall. The right bipolar voltage 3D map shows extensive, non-magenta antral ablation lesions.
Pulsed field ablation for paroxysmal atrial fibrillation is safe for the esophagus
Authors: Neven K , Fueting A , Hoewel D , Rahe G , Bell J , Reinsch N 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Thermal LA ablation, like RF, cryo and laser can cause esophageal damage, like ulcera and atrio-esophageal fistula. Pulsed field ablation (PFA) is a novel, non-thermal ablation modality. Pre-clinical evaluation of PFA showed absence of thermal injury to the esophagus due to the tissue specificity of PFA. Only limited data from very small clinical studies on absence of esophageal injury after PFA is available.

Objective
We report on possible esophageal injury after PVI using PFA for paroxysmal AF in a real-world, non-clinical study setting.

Methods
A LA bipolar voltage 3D map was created. All PVs were individually isolated using a 13F steerable sheath and a pentaspline over-the-wire PFA catheter. After ablation, mapping was repeated to assess lesion formation. No proton-pump inhibitors were started. One day after PVI, esophagoscopy without biopsies was performed. All patients had a 30-day follow-up.

Results
In 30 patients (mean 63 years; 47% male), uncomplicated PFA was performed, with all PVs acutely isolated. Post ablation, all voltage maps consistently showed extensive antral PV lesions. Clinical course was uneventful, no patient had chest discomfort, coughing or hematemesis. All patients underwent uncomplicated esophagoscopy, without thermal lesions or ulcers. At 30-day follow-up, all patients were asymptomatic.

Conclusion
In a real-world, non-clinical study setting, PVI using PFA for paroxysmal AF is safe for the esophagus.
Figures: Postero-anterior LA view before (above) and after (below) ablation with the esophaus (dark grey) projected over the posterior wall. The right bipolar voltage 3D map shows extensive, non-magenta antral ablation lesions.
The novel POLARx ablation system improves cryothermal single-shot guided pulmonary vein isolation: impact of individual pulmonary vein anatomy
Authors: Guckel D , Lucas P , Isgandarova K , El Hamriti M , Bergau L , Fink T , Sciacca V , Braun M , Khalaph M , Imnadze G , Noelker G , Sommer P , Sohns C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cryoballoon (CB)-guided pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). Recently, a novel balloon-guided cryothermal single shot device (POLARx) was introduced.

Purpose
This observational study aimed to evaluate ablation efficacy and outcome using the novel POLARx CB system compared to the established one and to access the impact of individual PV characteristics on freedom from arrhythmia recurrence in paroxysmal (PAF) and persistent (PERS) AF.

Methods
666 patients undergoing CB-guided ablation for AF were included. 601 patients treated with the AFA ablation system (Arctic Front Advance Pro, AFA) were compared to 65 consecutive patients who underwent PVI using the POLARx. Individual anatomical characteristics of the left atrium and PVs were assessed using pre-procedural cardiac magnetic resonance imaging (MRI). For each PV, the cross-sectional orifice area (CSOA) was determined. Follow-up examinations were scheduled after 3 and 6 months.

Results
Acute PVI was achieved in all patients (100%). 6-months AF-free survival was significantly higher in the POLARx cohort (POLARx: n=45, 69%; AFA: n=359, 60%; Log-rank p=0.037*). This applies to PAF (n=42, 65%, p=0.033*), PERS (n=23, 35%, p&lt;0.001*) and normal PV anatomy (2 left- and two right-sided PVs; n=57, 88%, p&lt; 0.001*). MRI found a comparable percentage of patients with normal PV anatomy (POLARx: n=57, 88%; AFA: n=512, 85%, p=0.126). A higher amount of variant PV anatomy was revealed in patients with PERS AF (p=0.043*), but this factor was not predictive for AF-recurrence (PAF: p=0.610; PERS: p=0.096). PAF patients with AF-recurrence presented with significantly larger CSOA of the left sided PVs and the right superior PVs (LSPV: 224.8 ± 98.1 mm2 vs. 220.6 ± 64.8 mm2, p&lt;0.001*; LIPV: 145.9 ± 63.2 mm2 vs. 140.4 ± 52.8 mm2, p&lt;0.001*; RSPV 268.9 ± 79.3 mm2 vs. 262.3 ± 75.6 mm2, p&lt;0.001*). In patients with PERS AF no association between CSOA and ablation outcome was observed. Multivariate Cox regression analyses identified the AFA ablation system (p=0.022*, hazard ratio (HR) 1.776, confidence interval (CI) 0.240-9.281) and PERS AF (p&lt;0.001*, HR 6.608, CI 0.220-73.839) as independent predictors for AF-recurrence.

Conclusion
PVI using the POLARx system improves freedom from AF recurrence independent of individual anatomical considerations and PV occlusion rates. For PAF patients, a significant association between CSOA and the outcome after CB- guided PVI was demonstrated.
Impact of very wide antral pulmonary vein isolation on esophageal temperature changes during pulsed field ablation
Authors: Kirstein B , Heeger C , Vogler J , Eitel C , Phan L , Keelani A , Feher M , Traub A , Samara O , Kuck K , Tilz R 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Esophageal thermal injury (ETI) is a serious drawback of available energy sources for atrial fibrillation (AF) ablation, especially on the posterior left atrial (LA) wall. Pulsed field ablation (PFA) is a novel non-thermal energy source with promising safety advantages over existing methods due to its unique myocardial tissue specificity sparing the esophagus.

Objective
To evaluate esophageal temperature changes during very wide antral pulmonary vein isolation (PVI) using the PFA system.

Methods
Thirteen consecutive AF patients (62% with paroxysmal AF; age: 61 years; 70% male) underwent first-time PFA under deep sedation. Eight pulse trains (2kV/2.5 sec, bipolar, biphasic, 4x basket/flower configuration each) were delivered to each pulmonary vein (PV). Extra pulse trains in the flower configuration were added for very wide antral circumferential ablation (vWACA). Continuous intraluminal esophageal temperature (TESO) was monitored with an S-shaped esophageal temperature probe.

Results
A median of 32 (IQR 32;32) and 8 (IQR 8;9) pulse trains for PVI and vWACA with a procedural time and catheter dwell time of 67 min (IQR 61-69) and 17 min (IQR 16-18) were applied. PFA with vWACA resulted in consecutive posterior LA wall isolation in 11/13 patients. Fluoroscopically, the esophagus coursed near the right PVs in 2/13, left PVs in 8/13 and mid-posterior wall position in 3/13 patients. Maximum TESO increase from baseline was 0.8 ±0.9 °C. However, no clinically relevant TESO changes occurred (Table 1). On short-term, all patients remained asymptomatic for sore throat, cough, or other symptoms potentially related to ETI. No esophago-duodenoscopy was necessary.

Conclusion
PFA of the PVs and lesion extension to the posterior LA wall demonstrated clinically non-significant TESO changes and has the potential to eliminate the risk of a thermal damage to the esophagus.
The role of local impedance drop in the acute lesion efficacy during pulmonary vein isolation performed with a new contact force sensing catheter
Authors: Szegedi N , Perge P , Sallo Z , Piros K , Nagy VK , Osztheimer I , Merkely B , Geller L 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary vein isolation (PVI) is the cornerstone treatment for paroxysmal atrial fibrillation (AF). The effective lesion creation during the PVI is essential to reach optimal long-term results.

Purpose
Our pilot study aimed to evaluate the role of local impedance drop in lesion formation during pulmonary vein isolation with a novel contact force sensing ablation catheter that records local impedance as well and to find a local impedance cut-off value that predicts successful lesion formation.

Materials and methods
After completing point-by-point radiofrequency pulmonary vein isolation, the success of the applications was evaluated by pacing along the ablation line at 10 mA, 2 ms pulse width. Lesions were considered successful if loss of local capture was achieved.

Results
Out of 645 applications, 561 were successful and 84 were unsuccessful. Compared to the unsuccessful ablation points, the successful applications were shorter (p=0.0429) and had a larger local impedance drop (p&lt;0.0001). There was no difference between successful and unsuccessful applications in terms of mean contact force (p=0.8571), force-time integral (p=0.0699) and contact force range (p=0.0519). The optimal cut-point for the local impedance drop indicating successful lesion formation was 21.80 Ohms on the anterior wall [AUC=0.80 (0.75-0.86), p&lt;0.0001], and 18.30 Ohms on the posterior wall [AUC=0.77 (0.72-0.83), p&lt;0.0001]. A local impedance drop larger than 21.80 Ohms on the anterior wall and 18.30 Ohms on the posterior wall was associated with an increased probability of effective lesion creation [OR=11.21, 95%CI 4.22–29.81, p&lt;0.0001; and OR=7.91, 95%CI 3.77–16.57, p&lt;0.0001, respectively].

Conclusion
The measurement of the local impedance may predict optimal lesion formation. A local impedance drop &gt; 21.80 Ohms on the anterior wall and &gt; 18.30 Ohms on the posterior wall significantly increases the probability of creating a successful lesion.
Oesophageal protection during AF ablation: real world registry data and mechanisms behind the therapeutic effect of tissue cooling
Authors: Leung L , Akhtar Z , Bajpai A , Li A , Sohal M , Norman M , Kaba R , Al-Subaie N , Louis-Auguste J , Hayat J , Zuberi Z , Gallagher M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Oesophageal protection using a dedicated device to provide controlled active thermal protection of the oesophagus during atrial fibrillation ablation has been shown to be effective at reducing endoscopically detected oesophageal lesions. Real world registry data of this device and established evidence on the effect of cooling on localized tissue after thermal injury have been under review.

Purpose
To determine the safety of an oesophageal temperature control device by a review of real-world registry data on its clinical use during catheter ablation procedures and to clarify basic mechanisms of its therapeutic action by a literature review of scientific studies on cooling in the context of thermal injury.

Methods
The United States Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE), FDA Medical and Radiation Emitting Device Recalls, the Medicines and Healthcare products Regulatory Agency (MHRA) Medical Device Alerts and SwissMedic records of Field Safety Corrective Actions (FSCA) databases were reviewed for any device-related adverse events. A systematic literature review was conducted to clarify the findings from studies investigating the physiological processes behind the therapeutic effect of cooling after tissue thermal injury.

Results
Of over 20,000 oesophageal temperature control devices clinically used, 7976 were recorded as having been used for the purpose of oesophageal protection during left atrial catheter ablations. No adverse events occurred related to its use during left atrial catheter ablations. No case of clinically significant oesophageal injury was reported in a patient who had been protected by the oesophageal temperature control device. 208 research articles retrieved from PubMed and MEDLINE that met the search criteria were reviewed. The common finding in all the studies was that cooling had an anti-inflammatory and restorative effect via modulation of several immune-mediated pathways, local cellular function and genetic expression.

Conclusions
There have been no adverse events reported to date in real world clinical use of an oesophageal temperature control device during left atrial catheter ablations, for the purpose of active thermal protection. Literature review data suggests that there are complex biophysical and cellular effects from cooling that leads to its therapeutic effect but further work is required to define the mechanisms of action of thermal protection in this specific context.