bluuebunny/crossref_metadata_2025_split huggingface dataset:
A novel weighted hybrid clinical and electrocardiographic score to predict the origin of outflow tract ventricular arrhythmias: a multicenter study
Authors: Falasconi G , Penela D , Carreno JM , Soto-Iglesias D , Jauregui B , Viveros D , Bellido A , Scherer C , Benito B , Marti J , Sabate X , Matiello M , Acosta J , Fernandez-Armenta J , Berruezo A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
To correctly predict the outflow tract ventricular arrhythmia (OTVA) site of origin (SOO) before the ablation is still a procedural major step, having important implications for correct patient counseling, ablation planning, and periprocedural complication evaluation. Although multiple ECG criteria have been proposed for predicting OTVA SOO, their accuracy and usefulness are still limited as recently (1).

Purpose
The present study sought to prospectively evaluate the accuracy of a previously published Hybrid Score (HS) for prediction of OTVAs with LVOT origin. Besides, multiple ECG measurements of patients with V3 precordial transition (V3PT) OTVA were analyzed to identify potential variables useful to improve the accuracy of the HS (2).

Methods
Consecutive patients (n=105) referred for OTVA ablation were prospectively enrolled from three referral centers. Vascular access and first-mapped ventricle were decided based on the previously published HS, which includes ECG (R/S precordial transition) and clinical information (age, hypertension, and gender). Surface ECGs during the OTVA were analyzed by two independent electrophysiologists to compare the discriminative performance of HS and previous published ECG-alone criteria, to assess their inter-observer variability and to identify potential variables useful to improve the proposed model.

Results
Of the 105 VAs, 70.5% had an RVOT origin and 29.5% an LVOT origin. HS achieved a correct prediction in 90% patients. This rate dropped to 75% in the subgroup of patients with V3PT OTVA. The correct prediction rate of the other ECG-alone criteria in the whole population ranged from 74 to 82% and from 41 to 76% in V3PT patients, and their Cohen’s Kappa coefficient for inter-observer variability assessment ranged from 0.63 to 0.81. R-wave amplitude in V3 was the best ECG parameter for discriminating LVOT origin in V3PT patients. When this parameter was incorporated in the novel Weighted Hybrid Score (WHS) (Figure 1), it correctly classified 99 (94.2%) patients (90% sensitivity, 96% specificity, AUC: 0.97). The WHS discriminatory capacity was maintained in V3PT subgroup, (87% sensitivity, 91% specificity AUC: 0.95). WHS showed a Cohen’s kappa coefficient of 0,82. Finally, WHS was validated in an additional population of 97 patients with OTVAs referred for catheter ablation from three additional external centers; in this testing sample the WHS correctly predicted the SOO in 90% patients and proved to have 89% sensitivity and 90% specificity (AUC: 0.94) for a score ≥2 to predict a LVOT origin.

Conclusions
The novel simple-to-use WHS proved to accurately anticipate the PVC’s SOO and can be introduced in clinical practice for choosing the first chamber to map.
Very high-power short-duration temperature-controlled ablation for cavotricuspid isthmus block : the Fast-and-Furious CTI study
Authors: Kirstein B , Vogler J , Eitel C , Phan L , Feher M , Keelani A , Traub A , D’ Ambrosio G , Grosse N , Reincke S , Hatahet S , Trajanoski D , Kuck K , Tilz R , Heeger C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Catheter ablation for typical right atrial flutter (AFL) provides an effective treatment associated with encouraging clinical outcome. The novel micro-electrode ablation catheter allows very high-power short-duration (vHP-SD, 90 W/4 sec) ablation and potentially offers the ability to perform a safe, effective and faster cavotricuspid isthmus (CTI) ablation.

Aims
We evaluated feasibility and efficacy of a vHP-SD (90 W/4 sec) temperature-controlled radiofrequency (RF) CTI ablation for AFL using a novel contact force (CF) sensing ablation catheter with micro-electrodes.

Methods
Fifteen consecutive patients (median age 75 years (interquartile range, IQR: 67, 79), 67 % male) with documented typical AFL were prospectively enrolled and underwent vHP-SD based CTI ablation (90 W/4 sec). Durability of CTI block was proven by pacing maneuvers from both sides of the ablation line.

Results
Complete CTI block using vHP-SD ablation was achieved in all patients (Figure 1). At median 23 (IQR 20; 39) RF applications over a median RF ablation time of 92 (IQR 78, 154) seconds were applied. It was not necessary to switch to the standard temperature-controlled mode to achieve durable CTI block. No periprocedural complications, no charring and no steam pops were observed.

Conclusions
Very high-power short-duration (90 W/4 sec) CTI ablation for the treatment of typical AFL is feasible and efficient. Effective CTI block can be achieved in about 1.5 minutes of RF time.
Factors predicting repeated ablation in ventricular tachycardia patients
Authors: Komlosi F , Toth P , Vamosi P , Szegedi N , Sallo Z , Piros K , Perge P , Osztheimer I , Abraham P , Szeplaki G , Merkely B , Geller L , Nagy VK 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Heart Program

Background
Catheter ablation has emerged to be the principal treatment for recurrent ventricular tachycardia (VT). Previously, several predictors of VT recurrence have been described, such as LVESD, severe MR, incessant VT, ICD shocks and elevated LDH levels. However, factors predicting an additional ablation are unknown.

Purpose
We aimed to establish predictors of repeat ablation and compare to the predictors of ventricular arrhythmia recurrence during 1-year follow-up in structural heart disease.

Methods
Baseline medical history, laboratory results, imaging parameters, clinical properties of VTs, and procedural data were gathered in a structured database.

Results
Out of the 272 patients, 96 (35%) experienced recurrence and 36 (13%) had repeated procedures within 1 year. Independent predictors of recurrence were left ventricular end systolic diameter (HR = 1.516, p=0.015), severe mitral regurgitation (HR = 2.446, p = 0.002), incessant VT (HR = 1.64, p = 0.02), VT inducibility (HR = 3.71, p = 0.003), ICD shocks (HR = 1.95, p = 0.002) and elevated LDH levels (HR = 1.26, p = 0.003). Regarding redo ablation, elevated LDH level (HR = 1.64, p = 0.01), incessant VT (HR = 2.94, p &lt; 0.001), ICD shocks (HR = 2.38, p = 0.02), only exit point ablation (HR = 2.14, p = 0.023) were independent predictors, while hypertension (HR = 0.32, p = 0.03), longer transmitral E-wave deceleration time (HR = 0.47, p = 0.04), substrate modification (HR = 0.47, p = 0.044) were protective.

Conclusion
Predictors of repeat ablation overlap only partially with those of VT recurrence. Predictors implying higher risk VT episodes predict both recurrence and repeat ablation while factors associated with more severe left ventricular systolic dysfunction predict recurrence but not a redo procedure.
Right anterior ganglionated plexus ablation for the treatment of vagally-mediated atrial fibrillation
Authors: Futyma P , Zarebski L , Wrzos A , Futyma M , Kulakowski P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary vein isolation (PVI) is a cornerstone for catheter ablation of atrial fibrillation (AF), however, exact mechanisms of PVI efficacy remain debatable. PVI is an invasive left-atrial procedure which may be associated with complications. It has been postulated that in patients with increased vagal tone AF can be treated by attenuation of parasympathetic drive to the heart using cardioneuroablation (CNA) by means of radiofrequency (RF) ablation of the ganglionated plexi, however, data in literature are lacking.

Objectives
To examine the mid-term efficacy of RF-CNA targeting the right anterior ganglionated plexus (RAGP) in the management of AF using right-atrial (RA) approach only.

Methods
We included consecutive 12 male patients (age 55±11) with vagally-mediated AF (decelaration capacity (DC) &gt;7 ms, mean 11,2±3,7ms) who underwent RF-CNA of RAGP. RAGP was targeted anatomically at the septal area below superior vena cava (SVC) from RA only. The aim was to achieve ≥30% heart rate acceleration (HRA). The follow up consisted of regular visits combined with ECG conducted every 3 months and 24h or 7-day Holter ECG.

Results
The RF time was 126±61 sec, power - 34±7W and procedure time - 44±18 min. The ≥30% HRA was achieved in 7 (58%) patients (pre-RF vs post-RF: 58±7 bpm vs 80±9 bpm, p=0,0000013). There were no complications during procedures. The follow up lasted 11±6 months. All patients reported significant symptom improvement post-CNA. AF-free survival was significantly higher in patients with ≥30% HRA during RF-CNA (≥30% HRA vs &lt;30% HRA, 60% vs 14%, log rank p=0,0203) Conclusions: Right atrial RF-CNA of RAGP can be effective in patients with vagally-mediated AF. Larger prospective studies are needed to confirm these preliminary findings.
Pulsed field ablation of atrial fibrillation: recurrence rate after first pulmonary vein isolation and first insights into durability at redo procedures
Authors: Kueffer T , Seiler J , Madaffari A , Muehl A , Stettler R , Asatryan B , Haeberlin A , Noti F , Servatius H , Tanner H , Baldinger SH , Roten L , Reichlin T 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulsed field ablation (PFA) is newly available for pulmonary vein isolation (PVI) and combines the benefits of high procedural efficacy and safety. Independent data on the recurrence-rate of atrial fibrillation (AF) after PVI and on PVI durability during redo procedures are scarce.

Purpose
We report data on the recurrence rate of AF after first PVI using PFA and first insights into findings of PVI durability during redo procedures.

Methods
Consecutive AF patients undergoing a first PFA PVI at our center between May 2021 and August 2021 were included. PVI was verified by 3D-electroanatomical mapping (3D-EAM), and additional PFA lesions were applied when necessary until all PV were isolated. Seven-day Holter ECGs were performed at 3 and 6 months after ablation. After a blanking period of 3 months, episodes of AF/AT lasting more than 30 seconds were considered as AF-recurrence.

Results
41 Patients, median age 69 (interquartile range 62-73) years, 24% female, 56% persistent AF, underwent first PVI by PFA. All PVs were successfully isolated using a multipolar PFA catheter. Median total procedure time including 3D-EAM was 104 (85-121) min. Total fluoroscopy time and dose were 26 (19-30) min and 671 (323-1248) Gym2. Acute complications occurred in 1 (2.4%) patient (cardiac tamponade requiring drainage). Early recurrence of AF during the blanking period occurred in 1 (2.4%) patient. Median follow-up time was 107 (91-152) days. Recurrence of AF after the blanking period was detected in 5 (12%) patients, 1 (6%) in paroxysmal AF and 4 (17%) in persistent AF patients, respectively. Redo procedures in 3 (7.3%) patients with AF recurrence confirmed durable isolation of 12/12 (100%) pulmonary veins and showed no evidence of PFA lesion regression.

Conclusion
AF recurrence rates after PVI by means of PFA are low. Durable isolation of 12/12 pulmonary veins (100%) and no evidence of PFA lesion regression was observed during redo procedures in patients with AF recurrence.
Quality of life after first-line cryoablation of atrial fibrillation: results from the Cryo AF Global Registry
Authors: Zucchelli G , Chun KRJ , Khelae SK , Foldesi C , Kueffer FJ , Van Bragt K , Scazzuso F , On YK , Kandari FA , Okumura K 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): The registry was sponsored Medtronic, Inc., Minneapolis, MN.

Background
Atrial fibrillation (AF), the most common cardiac arrhythmia, burdening patients with a myriad of symptoms. Three recent randomized trials demonstrated that cryoballoon ablation (CBA) is superior to antiarrhythmic drugs (AADs) as a first-line treatment for the prevention of arrhythmia reoccurrence in patients with paroxysmal AF. However, the global outcome of CBA performed according to local standard of care as a first-line therapy for AF is not reported.

Purpose
To compare safety, efficacy, and quality of life outcomes in patients treated with CBA for first-line management of AF against patients treated with CBA following failed AAD therapy.

Methods
The Cryo AF Global Registry, an ongoing, prospective, multicenter registry, of AF patients undergoing index CBA performed according to local standards at 58 centers in 26 countries worldwide. In this analysis, subjects undergoing first-line cryoablation were compared to patients who were refractory to AAD therapy and/or taking AADs at baseline. Safety was assessed utilizing a composite of serious procedure-related complications. To evaluate efficacy, time-to-first atrial fibrillation, -flutter and/or -tachycardia (AF/AFL/AT) recurrence post a 90-day blanking period was compared between groups using Kaplan-Meier estimates. Quality of life was evaluated using the EQ-5D-3L questionnaire at baseline and at 12 months following CBA. Log-rank, two-sample t-test, and exact binomial tests were utilized to test difference between groups.

Results
Of 1,394 total patients, 433 (31.1%) were drug naïve prior to CBA. Patients in the AAD therapy cohort failed a mean of 1.2 ± 0.5 AADs before CBA. Freedom from AF/AFL/AT recurrence at 12 months was 87.8% in first-line patients compared to 81.6% in AAD-refractory patients (p&lt;0.01). Serious adverse event rates were not statistically different (p=0.32) between first-line (2.3%) and AAD-refractory (3.4%) patients. First-line CBA resulted in a larger mean decline in symptoms upon follow-up, with 81% of patients reported to be symptom-free at 12 months. Further, first-line patients were prescribed AADs at a lower rate at discharge (18.6% vs.62.8%) and at 12-months (9.7% vs.29.9%) in comparison to patients in the AAD cohort. However, cryoablation did result in AAD prescriptions being reduced by approximately 50% in both cohorts from discharge to 12-months. As determined by the EQ-5D-3L score, quality of life improved for patients in both groups, with no significant difference between first-line and AAD-refractory patients (p=0.29).

Conclusion
This real-world global evaluation supports CBA as a safe and efficacious first-line treatment that improves the quality of life for patients with symptomatic AF.
Influence of catheter orientation on local impedance parameters during radiofrequency delivery in AF ablation
Authors: Schillaci V , De Sanctis V , Mazza A , Zucchelli G , Notaristefano F , Gagliardi M , Meynet I , Mantica M , Solimene F , Anselmino M , Stabile G , Ottaviano L , Cavaiani M , Malacrida M , Varbella F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Recently, a novel contact force (CF) sensing catheter able to measure local tissue impedance (LI) providing a measure of tissue characteristics has become available for clinical use.

Purpose
We sought to evaluate the influence of catheter contact angle on LI and CF parameters in consecutive atrial fibrillation ablation cases.

Methods
Consecutive pts undergoing radiofrequency catheter (RFC) ablation of AF from the CHARISMA registry were included. A novel ablation catheter (IntellaNav Stablepoint catheter) with dedicated algorithm (DirectSense) was used to measure LI at the distal electrode of this catheter. Each targeted spot was characterized in terms of RF delivery time, catheter contact angle, baseline LI and subsequent LI drop during ablation at different levels of CF (&lt;5g, 5-19g and ≥20g). RFC ablations were performed at ≥45 watts. Data are reported as mean±SD.

Results
A total of 4193 point ablations performed around PVs from 54 cases of AF ablation were analyzed (57% paroxysmal, 85% de novo). The LI was 157±17Ω prior to ablation and 137±14Ω after ablation (p&lt;0.0001, absolute LI drop of 22±8Ω). The CF was 12.5±8g and the RFC delivery time was 8.8±4s. The LI drop increased as CF increased (ranging from 18.9±7Ω for CF&lt;5g to 24.8±7Ω for CF≥20g, p&lt;0.0001) as well as RFC delivery time decreased (ranging from 12.7±4s for CF&lt;5g to 6.6±4s for CF≥20g, p&lt;0.0001). The LI drop at perpendicular orientations was significantly lower than at parallel orientations (19.5±8Ω vs 23.4±8Ω, p&lt;0.0001) and RFC delivery time was higher (9.6±5s vs 8.4±4s, p&lt;0.0001). This trend was confirmed among different level of CF both for LI drop and RFC delivery time. Figure

Conclusions
In this experience, the magnitude of the LI drop at perpendicular orientation were significantly lower than at parallel orientation and RFC delivery time was greater in parallel instances than in perpendicular instances. Thus, perpendicular RF ablations required longer RF applications and produced weaker LI decreases that parallel lesions, suggesting that catheter orientation may have critical role in RF delivery for ablation.
High-density mapping in catheter ablation for persistent atrial fibrillation
Authors: Steven D , Fiedler L , Roca I , Lorgat F , Lacotte J , Haqqani H , Jesser E , Williams C , Roithinger F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Abbott Laboratories

Background
Pulmonary vein isolation (PVI) is an established treatment option for persistent atrial fibrillation (PersAF). Corresponding long-term success rates remain modest however, advancements in high-density (HD) mapping may better identify substrates. The HD grid-style mapping catheter (HD Grid) allows for simultaneous analysis of adjacent orthogonal bipolar signals that may assist in ablation strategy decisions to achieve favorable outcomes in treating PersAF.

Objective
This was a prospective, multi-center, observational study to quantify and characterize the use of a market-released HD mapping catheter in PersAF subjects.

Methods
HD Grid was used in PersAF subjects undergoing radiofrequency (RF) ablation across 25 sites to gather data regarding safety, mapping efficiency and quality, ablation strategies, and procedural outcomes.

Results
334 PersAF subjects (average age: 64.2 years; 76% male) were enrolled in this study. Types of maps generated included peak-to-peak voltage (78%; 322/413), local activation time (LAT) (11.4%; 47/413), and complex fractionated electrogram (CFE) mean (7.7%; 32/413). Median total mapping points collected and used were 8428.0 (IQR 4845.0-13366.0) and 2099.0 (IQR 1219.0-2947.0), respectively, in a median of 11.0 (IQR 7.3-16.0) minutes per map. Low voltage, scar/fibrosis, and CFE were searched for in 90.4% (302/334), 53.6% (179/334), and 15.9% (53/334) of subjects, respectively. A PVI approach was used in 93.1% of all ablation procedures and 34.1% (114/334) of subjects received PVI plus additional lesions. HD Grid identified signals of interest not identified by the ablation catheter in 80.4% (205/255) of subjects. The total procedure time was 134.3 ± 51.3 minutes with a fluoroscopy time of 14.5 ± 11.3 minutes and RF ablation time of 32.4 ± 29.6 minutes. Of the subjects in atrial fibrillation (AF) (59.6%; 199/334), AF was terminated in 80.4% (160/199). 87.4% (173/198) of subjects were free from recurrent atrial arrhythmias as detected by 48-hour Holter monitoring at 12 months. 13.8% (46/334) of subjects experienced any adverse event through 12 months including 1 death unrelated to the procedure and 1 event deemed related to HD Grid by the investigator.

Conclusion
This study demonstrated the use of the HD Grid mapping catheter to create detailed maps and to guide ablation strategies to treat PersAF while maintaining an adequate safety profile.
Assessment of atrial fibrillation catheter ablation outcomes in patients with hypertrophic cardiomyopathy
Authors: Aytemir K , Sener YZ , Keresteci AH , Ates AH , Yorgun H 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation (AF) is a frequent manifestation of hypertrophic cardiomyopathy (HCM) and it is associated with increased risk for thromboembolic events and worsening of heart failure. AF is usually refractory to antiarrhythmic drugs in cases with HCM and catheter ablation may be useful in such patients.

Purpose
We aimed to evaluate outcomes of both cryoballoon and radiofrequency (RF) AF catheter ablation in patients with HCM.

Methods
All of the patients with HCM who underwent AF catheter ablation between January 2014 and January 2022 were screened and patients with available follow-up datas were included.

Results
A total of 44 patients were enrolled. Mean age was 54.2±12.6 years and 45.5% of the patients were female. RF ablation was performed in 23 cases and remaining patients underwent cryoablation. Median follow-up was 42.5 (4-94) months. Baseline characteristics were listed in Table-1. Only pulmonary vein isolation was performed in 25 (56.8 %) patients while additional ablation procedures including left atrial appendage isolation and linear ablation were required in other cases. Periprocedural complications occured in 6 cases. Atrial tachycardia recurrence developed in half of patients and mortality occured in 2 (4.5 %) cases during follow-up (Table-2).
Six months recurrence free survival (RFS) rate was 90.9% and 1 year RFS was 86.1% however RFS rate reduced to 58.2 after 3 years follow-up. Atrial tachycardia recurrence rates, complication and mortality rates were similar between the patients who underwent cryoablation and RF ablation. Changes in NYHA class and BNP levels were not significant during follow-up, however EHRA class was distinctly improved (II vs. I; p&lt;0.001).

Conclusion
Although long term outcomes of AF catheter ablation is not satisfactory; it is effective in short term rhythm control with reasonable complication rates. Recurrence rates are similar between RF and cryoablation.