bluuebunny/crossref_metadata_2025_split huggingface dataset:
A novel local impedance algorithm to guide effective pulmonary vein isolation in AF patients: preliminary experience among different voltages of atrial substrate
Authors: Segreti L , Maggio R , De Sanctis V , Stabile G , Battaglia A , Zingarini G , Mantica M , Agresta A , Mazza A , Pandozi C , Dello Russo A , Ottaviano L , Cavaiani M , Malacrida M , Solimene F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Recently, a novel technology able to measure local tissue impedance (LI) and contact force (CF) aimed at validating ablation endpoints has become available for clinical use.

Purpose
This analysis explores the relationship between LI parameters, substrate characteristics and AF type during ablation in AF patients.

Methods
A novel ablation catheter with dedicated algorithm was used to measure LI at the distal electrode. Each ablation point was characterized in terms of RF delivery time, baseline LI and LI drop during ablation according to different voltages (above or below 0.5 mV) of the atrial substrate. Ablation endpoint was PVI as assessed by entrance and exit block with local capture. Data are reported as mean±SD.

Results
A total of 2032 RFC deliveries from 34 consecutive patients were analyzed (71% paroxysmal AF, 29% persistent AF). All PVs were successfully isolated with an overall procedure time of 128±33min (fluoroscopy time=15.6±9min, RF delivery time=9.6±4s, CF=11.1±7g). The baseline LI was 155±17Ω prior to ablation and 136±14Ω after ablation (p&lt;0.0001, absolute LI drop of 21.0±8Ω) with a LI drop rate equal to 2.8±2Ω/s. Ablation spots were more frequently deployed in high-voltage areas (&gt;0.5mv, n=1240, 61%). Baseline LI and LI drops were both higher when underlying atrial voltages were &gt;0.5mV than when &lt;0.5mV (156±18Ω vs 153.6±16Ω for starting LI, p=0.0032; 22.2±8Ω vs 19.1±8Ω for LI drop, p&lt;0.0001, respectively). No differences were found in terms of both CF and LI after ablation between &gt;0.5mV and &lt;0.5mV (11.0±7g vs 11.2±7g for CF, p=0.3435; 136.4±13Ω vs 135.3±15Ω for ablated tissue LI, p=0.1521, respectively). Low-voltage areas were more frequently detected at ablated spots in persistent AF cases (n=288, 51.9%) than in paroxysmal AF cases (n=504, 35.1%, p&lt;0.0001), however, no differences were found in terms of both baseline LI and LI drop between persistent and paroxysmal AF cases (156.3±17Ω vs 154.6±17Ω for starting LI, p=0.135; 20.7±8Ω vs 21.1±9Ω for LI drop, p=0.1722, respectively).

Conclusions
LI measurements well distinguished contact with high-voltage areas from low-voltage areas and were able to detect significant differences in LI drop during ablation according to the voltage level.
The role of CHA2DS2-VASc score in predicting atrial fibrillation recurrence in patients undergoing pulmonary vein isolation with cryoballoon ablation
Authors: Rordorf R , Iacopino S , Arena G , Molon L , Rovaris G , Sciarra L , Sacchi R , Verlato R , Tondo C , Manfrin M , Perego GB , Mantica M , Pieragnoli P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary vein isolation by cryoablation (PVI-C) is a standard therapy for the treatment of atrial fibrillation (AF) with high safety and efficacy profiles. The CHA2DS2 -VASc score is also a well-established predictor of AF stroke. Importantly, the role of CHA2DS2-VASc score is still unknown regarding the long-term clinical outcomes following PVI-C.

Purpose
The aim of this analysis is to evaluate the role of CHA2DS2-VASc score in predicting AF recurrence during long term follow up after PVI-C.

Methods
Patients with recurrent and symptomatic AF underwent an index PVI-C. Data were collected prospectively in the framework of 1STOP ClinicalService® project. Patients were categorized into two groups Low risk (LR) and high risk (HR) (CHA2DS2-VASc score = 0-1 and CHA2DS2 -VASc score ≥2, respectively).

Results
Out of 3313 patients, 1910 (57.6%) had CHA2DS2-VASc score = 0-1, while 1403 (42.3%) were in the HR score group (CHA2DS2 -VASc score ≥2). As expected, patient baseline characteristics were significantly different between the two cohorts including: age, sex, BMI, percentage of paroxysmal AF, history of stroke, diabetes, ischemic cardiomyopathy. On the contrary, procedural times and the incidence of acute complications were comparable between the two groups. The 36-month freedom from AF after a single procedure was 72.5% (95% CI 69.8% - 75.0%) in the LR group and 65.9% (62.3% - 69.2%) in the HR score group (HR: 1.26, 95% CI 1.08-1.47, p= 0003, Figure 1). At multivariate analysis, higher CHA2DS2 -VASc score was still a significant predictor of the risk of AF recurrence [HR: 1.33 (1.10 - 1.60, p=0.003]

Conclusions
PVI-C is highly effective in the treatment of AF over the long term. A CHA2DS2 -VASc score ≥2 is an independent predictor of AF recurrence during the follow-up and should be taken into account in the clinical management after the index procedure.
Pre-ablation interatrial conduction delay or block predicts atrial fibrillation recurrence after ablation among obese patients
Authors: Tandon H , Stout K , Shin D , Ruskamp R , Payne J , Goyal N , Tsai S , Easley A , Khan F , Windle J , Anderson D , Schleifer JW , Naksuk N 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Obesity is associated with greater risk of atrial fibrillation (AF) recurrence post-ablation and higher incidence of conduction delay compared to non-obese patients. Pre-ablation P-wave duration (PWD) and morphology (PWM) indicating interatrial delay are easily assessed in the clinic and may predict AF recurrence post-ablation in these patients.

Purpose
Evaluate the predictive value of PWD and PWM on AF recurrence post-ablation in obese patients.

Methods
Pre-ablation PWD and PWM (negative P-wave in lead II or III) were analyzed on consecutive patients with BMI ≥30 kg/m2 who underwent initial AF ablation from 2012–19. The primary outcome was recurrent AF after a 3-month post-ablation blanking period. Multivariate analysis adjusted for baseline characteristics was performed.

Results
For 205 patients (61.0±9.5 years old, 39.0% female), mean BMI was 36.9±5.7 kg/m2 and 71.7% had persistent AF pre-ablation. Recurrent AF post-ablation occurred in 115 (56.1%) during a median follow up of 491 (270, 1001) days. PWD &gt;130 ms was significantly associated with higher AF recurrence (AHR of 1.62, 95%CI 1.04-2.57, p=0.03) after adjusting for age, persistent AF and left atrial volume index (LAVI). In a subgroup with LAVI &lt;42 mL/m2 (n=112), PWD &gt;130 ms and negative P-waves in lead II or III were independently associated with increased risk of recurrent AF (AHR 2.06, 95%CI 1.12-3.91; p=0.019 and AHR 1.94, 95% CI 1.00-3.56; p=0.05, respectively) (Figure 1).

Conclusion
AF recurred in &gt;50% of obese patients within 1.5 years of ablation. Pre-ablation PWD &gt;130 ms and negative P-waves in lead II or III independently predicted recurrent AF post-ablation in this cohort of obese patients. These easily assessed findings add predictive value to other risk factors.
Catheter ablation for patients with atrial fibrillation and heart failure: insights from the swedish heart failure registry
Authors: Von Olshausen G , Benson L , Dahlstrom U , Lund L , Savarese G , Braunschweig F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): DFG (Deutsche Forschungsgemeinschaft) to G.O.

Aims
To investigate the association between catheter ablation and mortality as well as hospitalization for heart failure (HF) in patients with atrial fibrillation (AF) and HF across the ejection fraction (EF) spectrum in a contemporary cohort.

Methods
Between 2005 and 2019, patients with first-time catheter ablation for AF (ablation group) compared to only medical treated AF patients (medical therapy group) were identified from the Swedish Heart Failure Registry. The primary outcome (all-cause mortality/first HF hospitalization) was assessed by cox regression models in a 1:2 propensity score (PS) matched cohort and pre-specified EF subgroups (preserved EF [HFpEF] [EF≥50%], mildly reduced EF [HFmrEF] [EF 40% to 49%], reduced EF [HFrEF] [EF&lt;40%]) of this cohort.

Results
452 patients in the ablation and 43766 patients in the medical therapy group were identified. After PS matching, 437 patients in the ablation group were compared to 874 patients in the medical therapy group. Over the entire follow-up, catheter ablation was associated with a lower risk of the primary outcome (Hazard ratio [HR] 0.71 [95%CI, 0.59-0.85]) and first cardiovascular (CV) hospitalization (HR 0.85 [95%CI, 0.72-0.99]) in PS matched analysis. Results were consistent across all EF subgroups. In HFpEF patients, catheter ablation was associated with a significantly lower risk of recurrent HF hospitalization (Incidence rate ratio (IRR) 0.17 [95%CI, 0.07-0.42]).

Conclusion
In this nationwide study, catheter ablation was associated with a significant lower risk of the primary outcome (all-cause mortality/first HF hospitalization) in HF patients with AF. This study advocates catheter ablation as a potent treatment option for AF in HF patients across all EF subgroups, including HFpEF.
Yearly incidence and pattern of very late recurrence of atrial fibrillation as detected by continuous electrocardiographic monitoring using an implantable loop recorder
Authors: Musat D , Milstein N , Saberito M , Bhatt A , Habibi M , Preminger M , Sichrovsky T , Shaw R , Mittal S 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
A very late recurrence (VLR) of atrial fibrillation (AF) is considered present when patients have their first recurrence of AF &gt; 12 months post-ablation. Little is known about the yearly rates and patterns of VLR AF recurrence.

Objective
To assess the yearly incidence and pattern of VLR in pts with AF who underwent cryoballoon (CB) pulmonary vein isolation (PVI).

Methods
We prospectively enrolled consecutive patients with AF who underwent CB PVI and had an implantable loop recorder (ILR) inserted up to 3 months post-ablation. Patients were followed for recurrent AF (excluding a 3-month post-ablation blanking period).

Results
Our cohort included 222 patients (66 ± 9 years; 143 [64%] male; 120 [54%] paroxysmal AF; CHA2DS2-VASc 2.6 ± 1.6). At 1-year, 111 (50%) patients remained free of AF. Two-year follow-up was available in 95 of these patients; 62 (65%) remained in sinus. Three-year follow-up was available in 42 of these patients; 36 (86%) remained in sinus (Figure). Of the 39 patients who developed AF after initially being free of AF for at least 1-year post ablation, 24 (62%) patients had either a frequent or persistent pattern of AF.

Conclusions
Our data show that the greatest likelihood of failure following a CB PVI occurs in the first year of ablation. The rate of failure becomes lower year by year. These data suggest that long term outcome may be driven more by the initial ablation as opposed to progressive evolution of the patient’s substrate
Durability of CLOSE-guided pulmonary vein isolation in persistent atrial fibrillation - First results from a prospective remapping study
Authors: Baldinger SH , Servatius H , Seiler J , Madaffari A , Kueffer T , Muehl A , Asatryan B , Haeberlin A , Noti F , Tanner H , Reichlin T , Roten L 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The CLOSE protocol for pulmonary vein isolation (CLOSE-PVI) combines ablation index and inter-lesion distance (≤6 mm) targets. CLOSE-PVI has been shown to result in high clinical success rates. Data on durability of PVI after CLOSE-PVI mainly derive from repeat procedures in paroxysmal atrial fibrillation (AF) patients with recurrent AF.

Purpose
We sought to assess the incidence of pulmonary vein (PV) reconnections during a staged redo procedure performed independently of AF recurrence 6 months after CLOSE-PVI in patients with persistent AF.

Methods
In this prospective, single-center study, patients with symptomatic persistent AF (EHRA score &gt;1) undergoing AF ablation were included. Close-PVI was performed during the index procedure. A blanking period of 3 months was applied. Seven-day Holter ECGs were performed at 3 and 6 months post ablation. All patients underwent a staged redo procedure including high-density voltage mapping of the left atrium at 6 months after the index procedure.

Results
Overall, 20 patients were included (median age: 68 years [IQR 63-71]; 20% women; median duration of persistent AF: 8 months [IQR 5-15]; median LAVI 45 ml/m2 [IQR 43-53]). All PVs were successfully isolated with CLOSE-PVI during the index procedure. Four patients (20%) had AF recurrence. The redo procedure was performed after a median of 6.1 months (IQR 5.6-7.3). Of 80 PVs, 71 (89%) were still isolated. No patient had a common ostium. Reconnections were observed in 3 left superior (15%), in one left inferior (5%), in one right superior (5%) and in 4 right inferior (20%) PVs. Fourteen patients (74%) had completely isolated PVs. Two of four patients with AF recurrence (50%) and 12 of 16 patients without AF recurrence (75%) had completely isolated PVs (p=0.33).

Conclusions
CLOSE-PVI achieves durable PVI after 6 months in the majority of patients with persistent AF. In half of persistent AF patients with recurrence after CLOSE-PVI, all PVs are still isolated. These patients may need adjunctive ablation.
Comparison of left atrial lesion size and troponin release of two novel single shot devices for pulmonary vein isolation: pulsed field ablation vs. multi-electrode radiofrequency balloon
Authors: Lemoine M , My I , Mencke C , Butt M , Schleberger R , Muenkler P , Rottner L , Moser F , Moser J , Dinshaw L , Reissmann B , Ouyang F , Kirchhof P , Rillig A , Metzner A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Pulsed-field ablation (PFA) and the multi-electrode radiofrequency balloon (RFB) are two novel ablation technologies to perform pulmonary vein isolation (PVI). It is currently unknown whether these technologies differ in lesion formation and lesion extent.

Purpose
We compared the acute lesion extent after PVI induced by PFA and RFB by measuring low-voltage area in high-density maps and the release of biomolecules reflecting cardiac injury.

Methods
PVI was performed with a pentaspline catheter (FARAPULSE) applying PFA or with the compliant multi-electrode radiofrequency balloon (HELIOSTAR). Before and after PVI high-density mapping with CARTO3 was performed. In addition, blood samples were taken before transseptal puncture and after post-PVI remapping. Serum concentrations of high-sensitive Troponin I (hsTropI) were quantified by Immunoassay.

Results
50 patients undergoing PVI by PFA (n=26, age 71±10 y, 58% males, 58% persistent AF) or RFB (n=24; age 64±13 y, 54% males, 25% persistent AF) were evaluated. Acute PVI was achieved in all patients in both groups. Mean number of PFA pulses were n=34±5 and mean number RFB applications were n=8±3. Total posterior ablation area was bigger in PFA (19.0±6.2 cm²) than in RFB (9.0±2.2 cm²; p&lt;0.001). The posterior distance between septal and lateral lesions was shorter in PFA (23.7±10.5 mm) than in RFB (30.0±7.3 mm; p=0.021). In a total of 38 patients increase of hsTropI was higher after PFA (625±138 pg/ml, n=28) vs. RFB (148±36 pg/ml; n=10; p=0.049) supporting the evidence of larger lesion extent by PFA.

Conclusion
Pulse-field ablation delivers larger acute lesion areas and higher troponin release upon successful pulmonary vein isolation than multi-electrode array balloon-based pulmonary vein isolation in this single-center series.
Mechanism and outcomes of atrial tachycardia ablation in patients with mitral valve surgery
Authors: Yorgun H , Kilic GS , Sezenoz B , Aytemir K 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial tachycardia (AT) is a common rhythm disorder after mitral valve surgery which may comprise both atria. Most of atrial arrhythmias are refractory to antiarrhythmic drugs and catheter ablation is usually required in cases with mitral valvular prosthesis.

Purpose
We aimed to evaluate the ablation outcomes of AT in patients with previous mitral valve (MV) surgery.

Methods
A total of 60 symptomatic patients with AT were enrolled. Activation mapping was performed during tachycardia in all patients as well as entrainment mapping when needed. Scar analysis was also performed when left atrial tachycardia detected.

Results
In 79 procedures, a total of 101 ATs were documented [35 (34.6%) ATs were right-sided, 65 (64.3%) ATs were left-sided and 1(0.9%) AT was biatrial]. Mean number of ATs per procedure was 1.4 ± 0.6. Macroreentry was the primary mechanism in right and left atrium (97% and 66.1%, respectively). Localization and mechanisms of ATs were demonstrated in Figure-1. Anterior wall [53.2%(17.9%-74.6%)], septum [53.7% (34.7%-80.0%)] and roof [40.1% (21.3%-72.5%)] were the left atrial sites with highest ratio of low voltage areas . The mean follow-up duration was 33.4 ± 17.7 months. Freedom from ATa after index procedure was 78.3% at 12 months and 65.9 % at 24 months. After multiple procedures, freedom from ATa was 80%, during the follow-up.

Conclusion
Left ATs are more common compared to the right ATs and macroreentry is the major mechanism in both right- & left ATs. RF ablation of ATs had favourable long-term outcomes in patients with MV surgery.
microRNAs as the predictors for atrial fibrillation recurrence after catheter ablation: next-generation sequencing study
Authors: Sustr F , Machackova T , Pesl M , Trachtova K , Svacinova J , Starek Z , Spinarova L , Kianicka B , Slaby O , Novak J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): This study was supported by Specific research of the Masaryk University (MUNI/A/1156/2021) and Institutional support project of St. Anne’s University hospital in Brno.

Background
Atrial fibrillation (AF) represents the most common arrhythmia. Catheter ablation (CA) of AF is indicated in patients with recurrent and symptomatic AF episodes fulfilling the criteria stated in the current guidelines. Despite the strict inclusion/exclusion criteria, AF recurrence after CA remains notably high. Thus, identifying a novel marker to more precisely select individuals that will profit from CA would be beneficial. microRNAs, i.e., small non-coding RNAs of the length of approx. 22 nucleotides are known to play crucial roles in the pathophysiology of AF and therefore represent promising biomarkers in the field.

Purpose
Aim of the study was to identify potential plasmatic microRNAs as novel biomarkers for predicting AF recurrence after CA.

Methods
Prospective monocentric and biomarker-screening study. Altogether 49 consecutive AF patients indicated for CA were enrolled. Before the CA, blood sampling was performed, and plasma was isolated. All patients then underwent CA and were followed up for 6 months. Within the close-up visit at the 6th month, 24-hour ECG Holter monitoring was performed to evaluate participants’ rhythm. For the next-generation sequencing (NGS), 5 patients with recurrent AF and 5 age- and BMI-matching patients without recurrent AF were randomly selected from the baseline cohort. NGS was performed using Illumina Instrument, and obtained data were then evaluated using edgeR and DESeq2 algorithms to identify all miRNAs present in the study samples. Filtering was performed to exclude microRNAs with low expression (i.e., base mean value at least 20 and more and expression detectable in all study samples). Comparison of the two groups (with and without AF recurrence) was performed using standard statistical tests with correction for multiple comparisons: differences with log2 fold change above 0,5 or below -0,5 with p &lt; 0,05 were considered biologically and statistically significant.

Results
In total, 2069 various microRNAs were identified. Altogether 59 microRNAs statistically significantly differed between the groups. The most altered microRNAs were as follows: miR-29c-5p, miR-183-5p, miR-190b, miR-206, miR-326, miR-505-5p, miR-548b, miR-574-3p, miR-1294 and miR-1296-5p.

Conclusion
Using NGS, we have identified 59 potential microRNAs whose plasmatic levels are altered between individuals with and without early AF recurrence. If the results are confirmed on the larger patients’ cohort, these microRNAs will represent supportive biomarkers to identify AF patients benefiting from CA.
Left atrial thrombus in atrial fibrillation/flutter patients in relation to anticoagulation strategy: LATTEE registry
Authors: Gawalko M , Kaplon-Cieslicka A , Budnik M , Scislo P , Piatkowski R , Kochanowski J , Opolski G , Grabowski M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation (AF) and flutter (AFl) increase the risk of thromboembolism by promoting clot formation in the left atrium. Current guidelines recommend initiation of oral anticoagulation (OAC) with vitamin K antagonists (VKAs) or, preferably, non-VKA-OACs (NOACs) in men and women with a CHA2DS2VASc score of ≥2 and ≥3, respectively. Effective OAC is also recommended 3 weeks before elective AF cardioversion or catheter ablation with pre-procedural ttransesophageal echocardiography (TEE) as an alternative. However, TEE before AF/AFl cardioversion or ablation is often performed even in anticoagulated patients, given that, in clinical practice, "effective" OAC may be difficult to achieve and/or verify.

Purpose
The aim of the study was to assess the prevalence of left atrial thrombus (LAT) in AF/AFl in relation to OAC strategy.

Methods
The Left Atrial Thrombus on Transesophageal Echocardiography (LATTEE) registry was a prospective, observational study enrolling consecutive patients with AF or AFl in whom TEE was performed before direct current cardioversion or catheter ablation, hospitalized in 13 cardiology departments in Poland. Patients’ recruitment process started from November 2018 in the coordinating centre and lasted 12 months since the beginning of the study in each participating centre or longer, i.e., until the inclusion of at least 200 patients at each participating centre (with the last patient enrolled in May 2020).

Results
Of 3109 patients enrolled, 88% were on chronic, 1.5% on transient OAC and 10% without OAC. Of patients on chronic OAC, 39% received rivaroxaban, 30% dabigatran, 14% apixaban and 18% vitamin K antagonists (VKA). Patients on apixaban were oldest, had worst renal function and highest both bleeding and thromboembolic risk, and more often received reduced doses. Overall, prevalence of LAT was 8.0% (7.3% on chronic OAC vs. 15% without OAC; p&lt;0.01). In patients on VKA, prevalence of LAT was doubled compared to patients on non-VKA-OACs (NOACs) (13% vs. 6.0%; p&lt;0.01), even after propensity score matching (13% vs. 7.5%; p&lt;0.01) and in multivariable logistic regression (OR 1.9, 95% confidence interval 1.4-2.8). Prevalence of LAT in patients on apixaban was higher (9.8%) than in those on rivaroxaban (5.7%) and dabigatran (4.7%; p&lt;0.01 for both comparisons). However, in propensity score matching and multivariable logistic regression, there was no difference in the risk of LAT between apixaban and other NOACs.

Conclusions
Prevalence of LAT in AF is non-negligible even on chronic OAC. In the real-world AF/AFl population, the risk of LAT seems higher on VKA compared to NOAC, and similar between different NOACs.