bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unipolar voltage mapping in right ventricular cardiomyopathy: pitfalls, solutions and advantages
Authors: Hoogendoorn J , Venlet J , De Riva Silva M , Wijnmaalen AP , Piers SRD , Zeppenfeld K 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Endocardial unipolar and bipolar voltage mapping (UVM/BVM) of the right ventricle (RV) are used for transmural substrate delineation. Epicardial BVM is considered less accurate due to the impact of fat thickness (FT). Data on epicardial UVM are sparse. Far-field electrograms and electrogram changes due to injury current may influence automatically generated UVM, which rely on the largest peak-to-peak amplitude within the window-of-interest (WOI).

Purpose
To assess the influence of manually corrected WOI and the potential role of epicardial UVM in RV cardiomyopathies.

Methods
Consecutive patients who underwent endo-epicardial RV mapping with computed-tomography (CT) integration were included. Mapping points were superimposed on short-axis CT-slices and correlated with local FT. All points were manually re-analyzed and the WOI was adjusted to correct for false high UV. Per point-pair endo-epicardial BV and UV were correlated for different FT categories.

Results
A total of 4225 point-pairs of 33 patients were analyzed. In 71% of endocardial points and 65% of epicardial points the window-of-interest needed to be adjusted, due to inclusion of far-field electrograms, injury current components or RV-pacing artifacts (Figure 1). The median absolute difference between epi- and endocardial UV was -0.21mV (IQR:-1.05-0.36) for FT&lt;1mm, compared to -0.60mV (IQR:-2.00-0.30) for FT≥2.8mm. This difference was larger for BV, with a median of -0.36mV (IQR:-2.03-0.23) and -1.29mV (IQR:-3.36-0.05), respectively (p-value epi-endo difference UV vs. BV in all fat categories: &lt;0.001). The Pearson correlation between corrected endo-epicardial BV and UV was lower for point-pairs with greater FT; however, this correlation was stronger and less influenced by fat for UV (coefficient for UV 0.696 for FT&lt;1mm and 0.544 for FT≥2.8mm; for BV 0.437 and 0.155, respectively; Figure 2). In a subanalysis of point-pairs with distance&lt;5mm and FT&lt;1mm, the Pearson coefficient was 0.789 for UV and 0.525 for BV.

Conclusions
At the majority of mapping sites the window-of-interest needs to be manually adjusted for correct unipolar voltage mapping. Unadjusted UVM underestimates low UV regions. UV seems to be less influenced by epicardial fat and endo-epicardial wavefront, suggesting a promising role for UVM in epicardial substrate delineation.
Bipolar catheter ablation for highly refractory cardiac arrhythmia - does the success rate depend on arrhythmia origin?
Authors: Gardziejczyk P , Piotrowski R , Krynski T , Sikorska A , Kulakowski P , Baran J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Despite technological progress, some arrhythmias are still refractory to standard unipolar ablation. They include arrhythmias arising from left ventricular (LV) summit, cardiac crux or epicardium. Bipolar ablation may be useful in some cases, however, data on efficacy of this approach in various arrhythmia localisatons are scarse.

Purpose
Aim of the study was to assess efficacy of bipolar catheter ablation in patients with cardiac arrhythmias refractory to standard ablation approach.

Methods
Observational, single-center study was conducted over 30-month period. Twenty-six consecutive patients (male=18, aged = 54.26 ± 16.4) who were referred for bipolar ablation were included. All patients had a history of previously failed unipolar ablation procedures. Bipolar ablations were performed using dedicated RF generator and electroanatomic mapping system.

Results
Twenty-seven procedures in 26 patients with a mean of 2.52 ± 0.83 previously failed unipolar ablations were included in the final analysis. There were 4 ablations of accessory pathways (3 postero-septal and 1 left free wall) with acute success rate of 100%, 11 procedures of ventricular arrhythmias originating from crux of the heart with acute success rate of 73% and 12 from left ventricular summit (LV summit) with acute success rate of 50%. Mid-term success rate (median follow-up of 182 days) was 100%, 63% and 50% respectively. There was one major complication (not related to RF bipolar ablation): cardiac tamponade due to aortic cusp rupture requiring urgent cardiac surgery procedure.

Conclusions
Bipolar ablation is a promising method of catheter ablation for refractory arrhythmias. The highest success rate was observed in ablation for difficult pathways, followed by ventricular arrhythmias originating from cardiac crux and LV summit.
Wide antral circumferential re-ablation in case of recurrent atrial fibrillation despite of prior pulmonary vein isolation increases freedom from atrial tachyarrhythmias
Authors: Makimoto H , Gerguri S , Hartl S , Kluge S , Clasen L , Bejinariu A , Brinkmeyer C , Schmidt J , Kelm M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Despite repeated pulmonary vein isolation (re-PVI) due to recurrent atrial fibrillation (AF) after PVI has been a standard procedure, the detailed ablation strategy in case of re-PVI remains disputable.

Objective
The aim of this study was to assess the efficacy of re-PVI using wide antral circumferential ablation (WACA) supported by high density mapping (HDM) for recurrent AF after PVI as compared to simple repeated PVI supported by circular mapping catheter.

Methods
Consecutive patients with recurrent AF after PVI were prospectively enrolled in this study, who underwent left atrial HDM and subsequently WACA antral (re-)isolation ("Re-WACA" group). The historical controls with re-PVI between 2016 and 2018 using circular mapping catheter, but without HDM were also enrolled ("control group"). These control patients underwent re-PVI with gap ablation at the pulmonary vein ostium. Primary endpoint was defined as any recurrence and ECG documentation of atrial tachyarrhythmias (AT) including AF or atrial tachycardias over 30 seconds. The patients were routinely followed up for 1 year with at least twice annual holter-monitoring.

Results
In total, 116 patients were enrolled in this study (Re-WACA group [N=56, 68±10 years], control group [N=58, 65±10 years]). There were no significant differences in clinical characteristics including the number of previous left atrial ablation procedures between two groups. In all 56 patients with Re-WACA, residual PV antral potentials were demonstrated (100%), whereas 7 patients (13%) showed no electrical potentials inside any PVs. During a mean follow-up period of 402±71 days, 6 out of 56 Re-WACA patients (11%) and 18 out of 58 controls (31%) experienced AT recurrences. Kaplan-Meier analysis demonstrated that the patients who underwent Re-WACA showed significantly lower AT recurrence after the index Re-PVI procedure as compared to the controls (log-rank, P = 0.010). Multivariate Cox regression showed that Re-WACA was an independent predictor of freedom from AT recurrence (hazard ratio = 0.39; 95% confidence-interval 0.16-0.93; P=0.034). The number of previous PVI procedures predicted AT recurrence during follow-up (hazard ratio = 2.35; 95% confidence-interval 1.20-4.46; P=0.010).

Conclusions
Residual pulmonary vein antral potential in patients with recurrent AF after previously performed PVI is a frequent finding. These antral potentials can be easily visualized by HDM. Repeated isolation of wide PV antrum (Re-WACA) is an effective strategy to reduce further AF recurrence as compared to conventional re-PVI without left atrial HDM.
Safety and efficacy of very high-power short-duration ablation for pulmonary vein isolation
Authors: Schillaci VS , Strisciuglio TS , Stabile G , Arestia AA , Agresta AA , Shopova GS , Salito AS , De Simone ADS , Solimene FS 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
A very high-power short-duration (vHPSD) strategy of radiofrequency (RF) ablation aims to minimize conductive heating and increase resistive heating.

Purpose
The aim of our study is to evaluate the feasibility, efficacy and safety of the vHPSD ablation of the for pulmonary vein (PV) isolation in patients presenting with paroxysmal or persistent atrial fibrillation (AF).

Methods
This prospective non-randomized study enrolled consecutive AF patients undergoing PV isolation. The vHPSD ablation was performed with the QDOT catheter, applying 90 W, for 4 s, with an irrigation of 8 ml/min. RF was delivered targeting interlesion distance ≤ 6 mm. The PVI was assessed at the end of the encirclement with the Pentaray catheter by entrance block and by remapping.

Results
Overall 163 patients (29 with persistent AF) were enrolled. The mean age was 61±8 years, 60% had hypertension and 10% diabetes mellitus. PV isolation was obtained in all patients and at first-pass in 144 (88%) with a mean number of 83±15 RF pulses. The mean procedural time was 85±26 min, the mean fluoroscopy time was 9±6 min and the mean RF time was 5,5±1 min. In 5 patients (3%) access-related vascular complications occurred. The mean follow-up (fu) was 8±3 months (fu³6 months in 109 patients; fu³12 months in 15 patients) and the freedom from AF recurrence was 97% in the overall population and in the paroxysmal and persistent subgroups as well (Figure 1).

Conclusions
The vHPSD ablation represents an effective and safe ablation strategy to achieve PV isolation in paroxysmal and persistent AF patients.
Catheter ablation of the mitral isthmus line using the novel DiamondTemp ablation system: first experience using two different ablation protocols
Authors: Rottner L , Schleberger R , Lemoine M , My I , Moser F , Moser J , Dinshaw L , Kirchhof P , Ouyang F , Rillig A , Metzner A , Reissmann B 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Mitral ishmus ablation is an established approach to treat perimitral reentrant tachycardia, and is often performed as substrat modification in patients with persistent atrial fibrillation (AF). Bidirectional block of the mitral isthmus line (MIL) is still a great challenge using conventional ablation catheters, but is essential to prevent recurrence of atrial arrhythmia.
Recently, the novel DiamondTempTM (DT) ablation system was introduced and allows for high-power, short-duration ablation in a temperature-controlled mode. Its use during pulmonary vein isolation (PVI) using a recommended ablation setting with a catheter-tip temperature limit of 60°C, a temperature-controlled power of 50 W and an application duration of 10 sec has shown to be effective and safe. However, data on DT ablation settings for substrate modification, i.e., creation of linear lesions are lacking.

Aim
The aim of the present study was to evaluate acute efficacy and safety of the novel DT ablation system for bidirectional block of the MIL using two different protocols.

Methods
The study population comprised 14 patients [67±8 years, 10/14 male (71%)] suffering from persistent AF and/or atrial tachycardia who underwent catheter re-ablation with creation of a MIL using the DT ablation system. Ablation settings were a catheter-tip temperature limit of 60°C, a temperature-controlled power of 50 W with an application duration of either 10 sec (group A, n=7) or 20 sec (group B, n=7). Additional epicardial ablation from within the coronary sinus with a temperature limit of 60°C, a temperature-controlled power of 20 W and an application duration of 20 sec was performed, if bidirectional block could not be achieved with endocardial ablation only.

Results
Mean procedure and fluoroscopy time, and dose area product for group A and group B were 103±24 vs. 119±38 min, 12±5 vs. 13±4 min, and 572±270 vs. 537±202 cGycm, respectively. Bidirectional block of the MIL was achieved in 7/7 (100%) patients in group A and in 6/7 (86%) patients in group B. Additional epicardial ablation was required in 6/7 patients (86%) in group A and in 4/7 (57%) patients in group B. In group B, bidirectional block of the MIL required fewer endocardial (31±11 vs. 26±10 applications) as well as epicardial RF-applications (10±6 vs. 7±3 applications). Pericardial effusion without hemodynamic relevance occurred in 1/7 (14%) patients of group B. No further complications occurred.

Conclusion
Catheter ablation of the MIL using the novel DT ablation system is safe and associated with high acute efficacy. A lower number of RF-applications and a less frequent need for additional epicardial ablation was observed when applying longer RF-applications of 20 sec. Further analyses are warranted to confirm these findings.
Contemporary management of arrhythmias in pregnancy: efficacy and outcomes of catheter ablation without fluoroscopy
Authors: Abdrakhmanov A , Ainabekova B , Nuralinov O , Bakytzhanuly A , Smagulova A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Heart rhythm disorders are the most common cardiac complication occurring in pregnancy. Haemodynamically unstable and drug refractory arrhythmias warrant catheter ablation. However, there are little data of efficacy and outcomes of catheter ablation in pregnant women.

Purpose
To assess efficacy and outcomes of catheter ablation without of fluoroscopy in pregnant women.

Methods
This single center, prospective study included all cases of catheter ablation during gestation (n=48, study group) and pregnant women with antiarrhythmic drug therapy (n=50, control group). Complications, pregnancy course, obstetric and neonatal outcomes were determined and compared.

Results
The most common reported arrhythmias in both groups was supraventricular tachycardia (n=39; 81% vs n=31; 62%, p=0.045). Premature contractions was in 13% cases in study group and 32% in control group (p=0.029). Ventricular tachycardia was rare during pregnant (n=3; 6% vs n=3; 6%, p=1.0). All ablation procedures were performed without fluoroscopy (mean gestation age 24,21±3,32 weeks, mean procedural time of 71±15 minutes). In one women in study group occurred ileofemoral thrombosis, which was treated successfully. Pregnancy course was benign in all women in both group without termination. Uterine blood flow violation was in 12.5% in study group and in 8% - in control (p=0.520). Increased uterine contractility occurred only in women with catheter ablation (n=2; 4.2%, p=0.237). Type of delivery was vaginal in the majority in both groups (n=36; 75% vs n=40; 80%, p=0.553). Operative delivery was rare (n=12; 25% vs n=10; 20%, p=0.553), mainly due to obstetric indications. In 2 cases in study group were placental abraption (vs n=0, p=0.237) and preeclampsia (vs n=1; 2%, p=0.613). There were live births in all cases without maternal and fetal mortality. During 1 year follow-up there was no arrhythmia recurrence in study group.

Conclusions
Catheter ablation in pregnant women is safe and effective and can be performed without fluoroscopy. Majority of women with arrhythmias have benign course of pregnancy and perinatal outcomes
Repeat procedures and reconnection rates after cryoballoon PVI with phrenic nerve injury
Authors: Heeger CH , Sohns C , Pott A , Metzner A , Inaba O , Straube F , Kuniss M , Aryana A , Miyazaki S , Chun JC , Kuck KH , Dahme T , Steven D , Sommer P , Tilz RR 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Aims
Cryoballoon (CB) based pulmonary vein isolation (PVI) is an effective treatment for atrial fibrillation (AF). The most frequent complication during CB-based PVI is right-sided phrenic nerve injury which is leading to premature abortion of the freeze cycle. Here we analysed repeat procedures and reconnection rates after CB-based PVI and phrenic nerve injury in a large-scale population. Due to the fact that the freezing process was prematurely interrupted the data may offer unique findings in optimizing the CB dosing protocols.

Methods and Results
In the YETI registry a total of 17356 patients underwent CB-based PVI in 33 centers and 731 (4.2%) patients experienced phrenic nerve injury. A total of 111 / 731 (15.2%) patients received a repeat procedure utilizing a 3D mapping system due to AF recurrence. In 94/111 (84.7%) of patients data on repeat procedures was available. During their initial PVI procedures, phrenic nerve injury occurred during treatment of RSPV (n=80), RIPV (n=13) and LSPV (n=1). A total of 89/94 (94.7%) target PVs have been isolated during the initial PVI (RSPV: 75/80, 94%; RIPV: 13/13; 100%; LSPV: 1/1; 100%). The mean freezing time was 127±46s and the mean minimal temperature was -49±7°C. During the repeat procedures 67 of initially 89 isolated PVs showed persistent isolation (75%, for RSPV: 55/75; 73%; RIPV: 11/13; 85%; LSPV: 1/1; 100%).

Conclusion
In patients initially treated by CB-based PVI with interruption of the freezing due to phrenic nerve injury, a high rate of durable isolated PVs has been detected at repeat procedures. Our data may help to identify the optimal dosing protocol in CB-based PVI procedures
Relationship between the posterior Atrial Wall and the ESOphagus: esophageal position and temperature MEasurement during Atrial Fibrillation ablation. (AWESOME-AF)
Authors: Teres C , Soto-Iglesias DS , Penela DP , Jauregui BJ , Ordonez AO , Chauca AC , Carreno-Lineros JMCL , Scherer CS , Huguet MH , Ramirez-Paesano CRP , Camara OC , Ortiz-Perez JTOP , Berruezo AB 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary Vein Isolation (PVI) implies unavoidable ablation lesions on the left atrial posterior wall (LAPW), which is closely related to the esophagus, resulting in several complications.

Objective
To evaluate the usefulness of the esophageal isodistance print in avoiding temperature rises caused by radiofrequency (RF) application at the LAPW during paroxysmal AF ablation.

Methods
An isodistance map of the atrio-esophageal relationship (esophageal fingerprint) was derived from the preprocedural multidetector computerized tomography MDCT. Patients where randomized on a 1:1 basis in two groups. The PRINT group had a modified PVI line based on the esophageal fingerprint. The CONTROL group underwent standard PVI, and the operator was blinded to the fingerprint (Figure A). Primary endpoint was temperature rise detected by the intraluminal esophageal temperature monitoring probe. The esophageal probe position was verified with the fluoroscopy. Ablation settings were as specified on the Ablate BY-LAW protocol.

Results
60 consecutive patients [42 (70%) men, mean age 60±11 years] referred for paroxysmal AF ablation were randomized. As shown in figure B, a temperature rise (&gt;39,1ºC) occurred in 5 (16%) patients on the PRINT group Vs. 17 (56%) on the CONTROL group (p&lt;0,01).

Conclusion
The esophageal fingerprint allows for a reliable identification of the esophageal position and its use is superior to standard approach in avoiding esophageal temperature rises. The development of new imaging-derived tools can improve patient safety. Long term follow-up is needed to evaluate for impact of PVI line modification on outcomes in terms of AF recurrence.
Early recurrences after catheter ablation for atrial tachycardia: do we need a blanking period?
Authors: Kahle AK , Jungen C , Scherschel K , Alken FA , Meyer C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
A blanking period after catheter ablation for atrial fibrillation is widely accepted. The clinical implications of early recurrences (ER) after ablation for atrial tachycardia (AT) in patients with a history of atrial fibrillation have not been analysed so far.

Purpose
To characterise ER and their relationship with late recurrences (LR) after AT ablation.

Methods
Acute and long-term outcome was studied in a total of 250 patients undergoing catheter ablation for consecutive AT. ER were defined as any documented atrial arrhythmia &gt;30 s within 3 months after ablation.

Results
In our study population (66.5±0.7 years, 57.6% male), ER were detected in 80 patients (32.0%), with 74.0% of episodes occurring during the first month post-ablation. Patients with ER had a longer history of any atrial arrhythmia (9.1±0.9 years vs. 6.5±0.4 years; P=0.0283), a larger left atrial diameter (65.7±3.1 mm vs. 49.4±1.4 mm; P=0.0163) and a lower left ventricular ejection fraction (50.8±1.1% vs. 56.6±0.6%; P&lt;0.0001) than those without ER. In patients with ER, AT were more often found to be mitral isthmus-dependent (16.5% vs. 6.2%; P=0.0048) or located at the crista terminalis (3.7% vs. 0.4%; P=0.0343). ER were associated with a 6.0-fold (95% CI 3.27-10.81; P&lt;0.0001) and a 4.3-fold (95% CI 1.72-10.72; P=0.0023) increase in the risk of developing LR after a single or multiple ablation procedures, respectively (Figure). After a mean follow-up of 570±23 days, LR were detected in 78.0% vs. 76.9% vs. 50.0% of patients experiencing the first ER during the first, second or third month (P=0.2266). Among these groups, the first LR occurred after 188.7±20.2 days vs. 259.6±59.1 days vs. 400.8±55.5 days (P=0.0459).

Conclusions
ER after AT ablation are a predictor of LR and clinical as well as procedural risk factors are associated with the occurrence of ER. The prevalence of LR does not differ among patients with early vs. late ER. These findings underline the prognostic importance of ER and challenge the concept of a blanking period after catheter ablation for AT in patients with a history of atrial fibrillation.