bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anatomical accuracy of the KODEX-EPD novel 3D mapping system of the left atrium during pulmonary vein isolation: a correlation with computer tomography imaging
Authors: Tovia Brodie O , Rav-Acha M , Wolak A , Ilan M , Abuhatzera S , Glikson M , Michowitz Y 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
A novel 3D mapping system (KODEX - EPD, EPD Solutions, Best, The Netherlands) enables catheter localization and real-time 3D cardiac mapping.

Purpose
To evaluate left atrium (LA) anatomical mapping accuracy created by the KODEX-EPD system during pulmonary vein isolation (PVI) compared with gold standard computed tomography (CT) images acquired from the same patients prior to the procedure.

Methods
In 15 consecutive patients who underwent PVI, 3D mapping of the LA was created on the KODEX-EPD system using the Achieve catheter. Pulmonary vein (PV), posterior wall, and appendage anatomy and diameters, were compared to the CT 3D reconstruction measured on the CARTO 3 system. Measurements were done independently by 2 physicians in each method. Linear correlation and agreement between CT and EPD measurements were assessed by Spearman correlation and Bland-Altman plot.

Results
Mean LA mapping time was 7.7± 3.6 min. Very high interobserver correlation was found for both EPD and CT measurements (Spearman-r=0.9). High correlation (r=0.75) was found between CT and EPD measurements. Bland-Altman plot method revealed that measurements assessed by EPD were slightly higher than those assessed by CT. Mean difference was 3.5mm, p&lt;0.01. In 2 (13.5%) patients each, disagreement regarding the presence of a left common PV and a right middle accessory vein anatomy was seen.

Conclusion
The new KODEX-EPD mapping system allows quick and accurate mapping of the LA with high correlation to CT imaging. Some differences in left common and accessory right middle vein anatomy were seen.
Central illustration: An example of the anatomy created by the KODEX- EPD system compared with the CT image of the same patient. A standard 4 vein anatomy is demonstrated by both modalities, with early branching of the right inferior pulmonary vein. A: KODEX- EPD pre-CRYO map during atrial fibrillation demonstrating connected pulmonary veins. B: 3D CT image viewed on the CARTO auto-segmentation module. C,D: KODEX- EPD posterior-anterior and PANO images post-CRYO map during sinus rhythm demonstrating pulmonary vein isolation with the same anatomy. E: Spearman correlation demonstrating a high correlation (r 0.75) between CT and KODEX-EPD measurements, p&lt;0.01.
Feasibility of a novel algorithm for automated reconstruction of the left atrial anatomy based on intracardiac echocardiography
Authors: Akerstrom F , Drca N , Wekselman G , Bugauisan G , Holmstrom L , Jensen-Urstad M , Braunschweig F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Intracardiac echocardiography (ICE) is frequently used to guide electrophysiology procedures. The novel pre-commercial automated algorithm is a model-based algorithm, developed using machine learning methodology, which reconstructs a 3D anatomy of the left atrium (LA) and its structures based on a set of 2D ultrasound (US) frames, without the need to manually annotate US contours. Potential advantages are shortening of mapping time and better anatomy resolution when compared to conventional anatomical mapping techniques.

Purpose
Determine the early feasibility of the automated LA anatomy algorithm in routine clinical setting.

Methods
We included 16 patients (64±9 years, 88% males, body mass index 27±3, parasternal long axis LA diameter 40±3mm) undergoing LA mapping/catheter ablation (conscious sedation in 56% and general anaesthesia in the remaining cases). 2D US frames were acquired from three ICE-positions: superior vena cava/high right atrium (RA) junction, RA and right ventricular outflow tract. The automated LA anatomy map was validated in two steps: 1) identification of anatomical structures (pulmonary veins [PV] and left atrial appendage) by alignment of the ablation catheter to the automated map; and 2) assessment of PV anatomical accuracy by analysing the relationship with the automated lesion tags (3mm lesion radius, 3mm for 8sec stability criteria and 5-20g average contact force) and the PV antrum of the automated map in 9 patients with paroxysmal atrial fibrillation undergoing first time point-by-point radiofrequency PV isolation (PVI). In step 2, PV pairs were divided into 6 segments (total of 12 segments per patient) and were classified as accurate, insufficient ("floating" lesion tags), or excessive anatomy (invisible lesion tags).

Results
Mean 2D US frames per patient was 29±6 and acquisition time was 16±4 min. In the step 1 validation, all anatomical structures were correctly identified in the 16 patients by the automated algorithm. The step 2 validation showed anatomical accuracy in 76% of all 108 PV segments analysed. There was a range of 0-2 and 0-5 of the total 12 segments per patient with insufficient and excessive anatomy, respectively. In all cases with PV segment anatomical discrepancy, this was corrected with standard anatomy collection with the ablation catheter in ≤2min. In the whole patient group, catheter ablation was successfully performed on the automated map without complications.

Conclusions
The automated ICE-based 3D LA map algorithm performed overall well and correctly identified the LA anatomical structures in all patients. Anatomical PV antrum accuracy was high, and the majority of PV segments needed no manual correction before proceeding to PVI.
Electrophysiological differences of deep sedation with dexmedetomidine versus propofol
Authors: Servatius H , Kueffer T , Baldinger SH , Asatryan B , Seiler J , Tanner H , Novak J , Noti F , Haeberlin A , Madaffari A , Muehl A , Branca M , Duetschler S , Reichlin T , Roten L 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Dexmedetomidine and propofol are commonly used drugs for deep sedation during cardiovascular interventions. Patients undergoing these interventions often have impaired sinus node function or atrioventricular (AV) conduction disease. Anesthetics used for deep sedation may further compromise sinus node function and AV nodal conduction, and thereby interfere with the intervention.

Purpose
To compare the electrophysiological effects of dexmedetomidine and propofol on the function of the sinus node and AV conduction.

Methods
We randomized patients undergoing first atrial fibrilation ablation 1:1 to deep sedation by dexmedetomidine (DEX group) versus propofol (PRO group), according to a standardized protocol. At the end of the ablation procedure with the patients still deeply sedated and hemodynamically stable, we conducted a standard electrophysiological study and assessed sinus node function, properties of AV conduction and atrial refractoriness.

Results
Of 160 patients (65±11 years old; 32% female) included into the study, 80 patients were randomized to the DEX and PRO group each. Procedure duration (128±59 minutes) and sedation depth, as assessed by the "Modified Observer’s Assessment of Alertness/Sedation" score (median 3; interquartile range 2, 3), was not different among groups. DEX group patients received a mean of 231±111 mcg of dexmedetomidine and PRO group patients a mean of 657±356 mg of propofol. The table shows the results of the electrophysiological study. DEX group patients had lower sinus rate and longer unadjusted sinus node recovery time (SNRT) at pacing cycle lengths of 600, 500 and 400 ms. However, both corrected (SNRT-RR) and normalized (SNRT/RR) SNRT did not differ among groups. Compared to PRO group patients, AV nodal conduction was slower in DEX group patients as evidenced by longer PR and AH intervals, and a higher Wenckebach cycle length and AV node effective refractory period (ERP) was observed. Conduction properties in the His-Purkinje system were not different among groups, as QRS width and HV interval were similar. An arrhythmia, mainly atrial fibrillation, was induced in 33 patients (21%) during the electrophysiological study, without differences among groups.

Conclusions
Sinus rate and AV conduction are slower during deep sedation with dexmedetomidine compared to propofol. These differences in electrophysiological effects need to be taken into account when using these anesthetics during cardiovascular interventions.
Development and validation of a fully automatic algorithm to align 3D MRI and electro-anatomical mapping anatomies of the left atrium
Authors: Hermans BJM , Bijvoet GP , Holtackers RJ , Mihl C , Luermans JGLM , Vernooy K , Linz D , Chaldoupi SM , Schotten U 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The role of pre-procedural cardiac imaging in the guidance and planning of ablation procedures is becoming increasingly important. Emerging non-invasive techniques such as late gadolinium enhancement magnetic resonance imaging (LGE MRI) and electrocardiographic imaging (ECGi) can potentially help to locate ablation targets prior to the ablation procedure. To be able to integrate LGE MRI and ECGi information into targeted ablation procedures, a reliable alignment between cardiac imaging and electro-anatomical mapping (EAM) is required.

Purpose
To develop and evaluate a fully automatic technique to align pre-procedural MRI anatomies with EAM anatomies of the left atrium (LA).

Methods
Twenty-one patients scheduled for a (re-do) pulmonary vein (PV) isolation with a 3D pre-procedural LGE MRI were enrolled in this study. LA anatomy was segmented from the MRI dataset using ADAS-AF. During the ablation procedure LA anatomy was recorded with an HD-grid (Ensite) or Pentaray catheter (CARTO). The MRI segmentation and EAM were performed by different cardiologists blinded for each other’s results. Anatomies of both MRI and EAM were aligned using an iterative closest point-to-plane algorithm in custom-made software in Matlab 2021a. With this algorithm, the distance between MRI anatomy voxels (=points) and the surface of the EAM anatomy (=plane) is minimized by translating and rotating the MRI anatomy until the total residual distance is minimized. The result of the alignment is quantified by calculating the Euclidian distance between the aligned anatomies after excluding PVs and the mitral anulus.

Results
The algorithm was successfully applied in 18/21 patients (n=11 CARTO, n=7 Ensite). In the remaining 3 patients, the algorithm could not align the anatomies because of a large difference in LA volume or PV anatomy between the two techniques. In the analysed patients, the average distance between anatomies was 2.7±0.77mm. The top of Figure 1 shows the alignment of the anatomies with the smallest (patient A) and the largest (patient B) residual distances as well as the distances between these anatomies for both patients (right) with purple ≤2.5mm and red ≥5.0mm. The distributions of distances (bottom left) show that, after alignment most of the MRI anatomy is closer than 5mm from the EAM anatomy in every patient. On average, 87.6±10.4% of the atrial surfaces showed distances below 5.0mm between the two anatomies and 55.1±13.2% of the surfaces was within 2.5mm from each other. Results did not differ between Ensite and CARTO anatomies.

Conclusion
LA anatomy obtained from 3D LGE MRI can automatically and reliably be aligned with LA anatomy recorded during an ablation procedure with an EAM system using an iterative closest point-to-plane algorithm.
Pulmonary vein isolation by pulsed-field ablation induces smaller neurocardiac damage than cryoballoon ablation
Authors: Lemoine M , Mencke C , Schleberger R , Muenkler P , Wieboldt H , Scherschel C , Dinshaw L , Reissmann B , Ouyang F , Fabritz L , Zeller T , Meyer C , Rillig A , Metzner A , Kirchhof P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): FARAPULSE, Inc.

Introduction
Thermal energy sources damage the entire atrial tissue during pulmonary vein isolation (PVI) including cardiac nerves and ganglia. This induces a postinterventional increase in heart rate. Pulsed-field ablation (PFA), a new non-thermal energy source for PVI, primarily damages cardiomyocytes by electroporation. Whether use of PFA reduces damage to cardiac nerves and ganglia and influences postinterventional increase of heart rate is not known.

Purpose
We compared the acute effects of PFA with a pentaspline catheter and cryoballoon ablation (CBA) on secretion of circulating biomolecules reflecting cardiomyocyte and neuronal injury and postinterventional increase in heart rate to estimate damage to the cardiac autonomic nervous system and autonomic dysfunction after PVI.

Methods
Blood samples were taken before and after PVI in consecutive patients undergoing PFA and CBA. All patients participated in the TRUST registry. Serum concentrations of high-sensitive Troponin I (hsTropI, Immunoassay) and S100b (ELISA), a surrogate marker for neuronal injury, were quantified in blood samples taken prior to PVI and directly after PVI. Pre- and postinterventional heart rates were measured in ECGs and Holter-ECGs.

Results
Fifty-six patients underwent PVI, either by PFA (n=28, age 63 [54; 75] y, 64% males, 57% persistent AF) or CBA (n=28, age 71 [62; 78] y, 61% males, 54% persistent AF). All 112 blood samples were analyzable. Acute success of PVI was 100% in both groups without major complications, especially, no TIA and no stroke. After CBA, one patient suffered from phrenic palsy, which reversed after 3 months. HsTropI increased 3.3-fold more after PFA compared to CBA (625±138 vs. 185±42 pg/ml; p=0.004) suggesting more damage to cardiomyocytyes. S100b increased 2.9-fold less after PFA compared to CBA (21.1±3.7 vs. 61.2±8.1 pg/ml; p&lt;0.001). The ratio of ∆S100b/∆hsTropI was five-fold smaller after PFA compared to CBA (0.19±0.1 vs. 0.98±0.3; p=0.007), suggesting a lower neurocardiac injury in comparison to lesion size. Concomitantly, increase in heart rate at the postinterventional day was smaller in PFA (-0.2±3.0 bpm; n=45) than in CBA (+6.1±2.7 bpm, n=15; p=0.024).

Conclusion
This study in patients validates the experimental concept that PFA-based AF ablation leads to more specific damage to cardiomyocytes than to cardiac nerves and ganglia, reflected by lower S100B concentrations and no post-interventional heart rate increase compared to CBA.
Personalized persistent atrial fibrillation ablation guided by left atrial wall thickness: a multicenter study
Authors: Falasconi G , Penela D , Jauregui B , Soto-Iglesias D , Teres C , Ordonez A , San Antonio R , Viveros D , Bellido A , Scherer C , Marti J , Sabate X , Matiello M , Berruezo A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary vein isolation (PVI) has been proven to be effective in treating persistent atrial fibrillation (PeAF), although long-term ablation outcomes have been significantly less satisfactory than in paroxysmal AF (1). A recent personalized PVI approach, aiming for contiguous lesions with ablation index (AI) titration according to the local left atrial wall thickness (LAWT) as per multidetector cardiac tomography (MDCT), has demonstrated to achieve an arrhythmia-free survival &gt; 95% at 12 months in patients with paroxysmal AF (2).

Purpose
We sought to investigate the safety and clinical outcomes of this personalized PVI approach guided by LAWT in patients with PeAF.

Methods
Consecutive patients referred for PeAF first ablation were prospectively enrolled from three referral centers. PeAF was defined in the presence of at least one AF episode sustained beyond 7 days. LAWT three-dimensional maps were obtained from MDCT and integrated into the navigation system. LAWT was categorized into 1 mm layers and AI was titrated to the LAWT. The ablation line was personalized to avoid thicker regions (Figure 1) while encircling PV antrum. Follow-up was scheduled at 1, 3, 6, and every 12-months thereafter.

Results
One hundred twenty-seven patients [89 (70.6%) male, age 64 ± 10 years] were included. 68 (60.7%) patients were hypertensive, 10 (18%) patients suffered of type 2 diabetes, and mean CHA2DS2-VASc score was 2.3 ± 2.1. Mean procedure time was 61 ± 20 minutes and mean fluoroscopy time was 1.3 ± 2.2 minutes. Radiofrequency (RF) time was 9.0 ± 2.3 minutes for the right pulmonary veins with a first-pass isolation in 109 (85.8%) patients and 7.6 ± 1.9 minutes for the left pulmonary veins with first-pass in 110 (86.6%). No major complication occurred. The rate of survival free from AF recurrences at a mean follow-up of 12 ± 6 months was 82% (Figure 2).

Conclusions
Personalized Persistent AF ablation by wide circle PV isolation guided by LAWT, proved to be safe and highly efficient, requiring a low amount of RF delivery, procedure time, and fluoroscopy use, while obtaining a high rate of first-pass isolation and of freedom from AF recurrences.
Cryoballoon versus radiofrequency catheter ablation: insights from Norwegian randomized study of persistent atrial fibrillation (NO-PERSAF study)
Authors: Shi LB , Rossvoll O , Tande P , Schuster P , Solheim E , Chen J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Helse Vest, Norway (LBS)

Background
Pulmonary vein isolation (PVI) is still regarded as a cornerstone for treatment of persistent atrial fibrillation (AF). Both radiofrequency ablation (RFA) and cryoballoon ablation (CBA) are frequently employed to achieve PVI.

Purpose
This randomized study aimed to evaluate the effectiveness of PVI performed with CBA in comparison with RFA in patients with persistent AF.

Methods
A total of 101 patients with symptomatic persistent AF were enrolled and randomized (1:1) to CBA or RFA groups and followed up for 12 months. The primary endpoint was any documented recurrent atrial tachyarrhythmia (ATA) lasting longer than 30 s following a 3-month blanking period. Secondary endpoints were procedure-related complications, procedure and ablation duration, and fluoroscopy time. The ATA-free survival curves were estimated by Kaplan–Meier method and analyzed by log-rank test.

Results
According to intention-to-treat analysis, freedom from ATA was achieved in 36 out of 52 patients in the CBA group and 30 out of 49 patients in the RFA group (69.2% vs. 61.2%, P=0.393). No difference of AF recurrence was found between the two groups (27.5% in CBA vs. 38.0% in RFA, P=0.258), and less atrial flutter recurrence was documented in the CBA group compared with the RFA group (3.9% vs. 18.0%, P=0.020). The procedure and ablation duration were significantly shorter in the CBA group (160±31 vs. 197±38 minutes, P&lt;0.0001; 36.7±9.5 vs. 55.3±16.7 minutes, P&lt;0.0001). There was no difference regarding fluoroscopy time (21.5±7.8 vs. 23.4±11.2 minutes, P&gt;0.05).

Conclusions
Compared with RFA, PVI performed by CBA led to shorter procedure and ablation duration, with less atrial flutter recurrence and similar freedom from ATA at 12-month follow-up.
Shortened fluoroscopy duration and reduced use of contrast dye in cryoballoon-based pulmonary vein isolation procedures using KODEX-EPD’s novel occlusion tool
Authors: Obergassel J , Rottner L , Schleberger R , Moser F , Moser J , Dinshaw L , Lemoine MD , My I , Kirchhof P , Reissmann B , Metzner A , Rillig A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Study grant by EPD Solutions, Philips, Netherlands

Background
The occlusion tool was recently introduced for KODEX-EPD which is a novel dielectric high-resolution cardiac imaging system. The occlusion tool provides information about level of pulmonary vein occlusion by the cryoballoon (CB) in CB-based pulmonary vein isolation (PVI) ablation procedures for atrial fibrillation (AF).

Purpose
Assess effects of the introduction of the occlusion tool on procedural parameters during CB-PVI such as feasibility, acute efficacy and periprocedural safety of KODEX-EPD in different software versions.

Methods and Results
173 consecutive patients (60/173 (35%) paroxysmal AF, 64±12 years, 66/173 (38%) female) underwent CB-PVI with EPD imaging between 08/2019 and 10/2021. 38/173 (22%) of all patients were treated using software version 1.4.6, 33/173 (19%) patients with version 1.4.6a, 41/173 (24%) patients with version 1.4.7 and 61/173 (35%) patients with the latest version 1.4.8. Acute PVI was achieved in all patients. No major periprocedural complications were documented. Software version showed significant effects on procedure duration, fluoroscopy duration and dose area product in ANOVA testing (Figure 1A-C). The largest effect in post-hoc testing was observed for fluoroscopy duration (Figure 1B). Tobit regressions were fitted to model effects of software version on the censored variable contrast volume. All software versions predicted used contrast volume (p&lt;0.00748, Figure 1D). Modelling only effects of procedure date on contrast volume was less accurate than for software version (r²=0.057, p for procedure date = 0.0031) and also a Likelihood-Ratio-Test between different regression models underlined significant effects of software version (p&lt;0.0001).

Conclusion
CB-based PVI in combination with its PV-occlusion tool is feasible and safe. The present data strongly suggests a steady positive development of the novel wide-band dielectric imaging and mapping system towards a fluoroscopy- and dye-reduced CB-based AF-ablation. Software versions were introduced sequentially. Therefore time (procedure date) needs to be considered as the most relevant confounder of the described results (e.g. due to a learning curve using the system). However, differentiated statistical testing could show that the results are mainly explained by software version and only much weaker by procedure date.
Comparison between cryoballoon and radiofrequency for atrial fibrillation ablation in patients with heart failure
Authors: Dural M , Sener YZ , Yalcin MU , Ates AH , Yorgun H , Aytemir K 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Radiofrequency (RF) and cryoballoon (CB) ablation are the most commonly performed methods for catheter ablation in patients with atrial fibrillation (AF). However, data regarding AF ablation in patients with reduced left ventricular ejection fraction (LVEF) is scarce.

Purpose
We aimed to compare the safety and efficacy of RF and CB AF ablation in heart failure (HF) patients with LVEF &lt;50%.

Methods
HF patients whose LVEF &lt; 50% were included in this retrospective study. Transthoracic echocardiography (TTE) was performed to evaluate LVEF by using Modified Simpson method before and after the procedure. Atrial tachyarrhythmia (ATa) recurrence was defined as detection of AF, atrial flutter, or atrial tachycardia (≥ 30 s) after a 3-month blanking period.

Results
Eighty-nine (n = 42 CB and n = 47 RF) HF patients were enrolled and baseline characteristics were listed in Table-1. There was no significant difference in AF recurrence rate between the groups [16 (38.1 %) in CB and 12 (25.5 %) in RF, respectively, P = 0.296] during the follow up of median 16.5 (10.25-24) and 11 (9-17) months (Figure-1). There was significant increase in LVEF (39.52 ± 7.77 vs. 46.30 ± 10.95, P &lt; 0.001) and decrease in brain natriuretic peptide (BNP) [230 (10-1653.10) vs. 163 (10-1653.10), P = 0.003] levels after ablation. The changes in LVEF (P = 0.370) and BNP (P = 0.772) were similar between the CB and RF ablation groups.

Conclusion
Our findings demonstrated that AF ablation using either CB or RF was associated with an improvement in LVEF and neurohormonal profile in AF patients with reduced LVEF.