bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrasound-guided femoral venipuncture for catheter ablation of atrial fibrillation: clinical benefit
Authors: Haskova J , Wichterle D , Peichl P , Stojadinovic P , Aldhoon B , Stiavnicky P , Borisincova E , Cihak R , Kautzner J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The most frequent complications of catheter ablation for atrial fibrillation (AF) are related to vascular access.

Purpose
Vascular complication rates of ultrasound-guided venipuncture (USGV) were analyzed and compared to historical controls (CTRL) with an anatomical landmark-guided approach.

Methods
The study cohort included 4646 consecutive patients (2330 and 2316 patients in USGV and CTRL groups, respectively). Clinical characteristics were as follows: age of 61±10 years, 67% males, 66% paroxysmal AF, CHA2DS2-VASc score of 2.0±1.4, 27% reablation, and procedure time of 208±69 min. Both femoral veins were cannulated with 2 and 2 sheaths (7, 11, and 2x 8.5 French) in the majority (&gt;95%) of procedures. Major complications were defined as those requiring intervention (surgery, thrombin injection, or transfusion), or hematoma/bleeding with hemoglobin drop &gt;30g/l, or condition prolonging hospitalization and/or resulting in re-hospitalization. They were extracted from the institutional tracking system for complications of invasive procedures and by a review of medical reports within the first 3 months of follow-up.

Results
There were 32 (1.38%) vs. 62 (2.66%) major complications related to vascular access in USGV and CTRL groups, respectively (Yates corrected Chi-square P=0.003), i.e. relative reduction of -48% in the USGV group. Surgical intervention was needed in 6 (0.26%) vs. 18 (0.77%) patients, respectively (Fisher exact test P=0.02), i.e. relative reduction of -64% in the USGV group. The differences remained significant after adjustment for baseline clinical characteristics. Multivariate analysis revealed that USGV strategy (P=0.0005), male gender (P=0.003), and less advanced age (P=0.0002) were significantly associated with lower complication rates.

Conclusions
USGV was associated with a statistically significant reduction of major vascular complications after catheter ablation for AF. This strategy also decreased the need for surgical correction of vascular complications. Ultrasound guidance can be recommended to improve the safety of femoral venous access.
Acute change of cardiac autonomic regulations after thermal and non-thermal pulmonary vein ablation
Authors: Stojadinovic P , Wichterle D , Peichl P , Cihak R , Jansova H , Nejedlo V , Haskova J , Kautzner J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary vein isolation (PVI) by thermal energy (radiofrequency energy or cryoenergy) results in collateral ganglionic plexi ablation. On the contrary, pulsed electric field (PEF) energy presumably spares neural tissue.

Purpose
We investigated and compared the effect of PVI on parasympathetic input into the sinus node (SAN) and AV node (AVN) when four different ablation strategies were used.

Methods
A study enrolled 49 patients who underwent PVI in general anesthesia (age: 57 ± 13 years, 71% males). In 17 patients, point-by-point radiofrequency energy delivery by the irritated-tip catheter was used for ablation while 7 patients were ablated using a second-generation cryoballoon catheter. In 7 patients, PEF energy was delivered using a single-shot Farawave catheter while 18 patients were ablated using Sphere9 lattice-tip catheter (Affera, Inc.); both subgroups with manufacturer-specific PEF settings. Before and after PVI, the responsiveness of the SAN and AVN was assessed by extracardiac vagal nerve stimulation (ECVS) via a diagnostic catheter in the right internal jugular vein. Five-second stimulation trains were delivered with a frequency of 50 Hz, pulse width of 0.05 ms, and output of 1 V/kg (&lt;70V) both in sinus rhythm and during atrial pacing. Substantial reduction of response to ECVS was arbitrarily defined as a maximum induced pause of &lt;1.5 seconds.

Results
At baseline, physiological response to ECVS (long sinus arrest and/or AV block) was demonstrated. After PVI, a substantial reduction of SAN response was observed in 21/24 (88%) patients after thermal PVI and 7/25 (25%) patients after non-thermal PVI (P = 0.0001). Similarly, a substantial reduction of AVN response was observed in 21/24 (88%) patients after thermal PVI and 9/25 (36%) patients after non-thermal PVI (P = 0.0003). The Figure shows on the continuous scale the post-PVI pauses in sinus rhythm (maximum P-P interval) and atrial pacing (maximum R-R interval) induced by ECVS.

Conclusion
Vagal responses of SAN and AVN are preserved in most AF patients after non-thermal PVI. This contrasts with the much stronger effect of thermal PVI. Whether this may influence the clinical outcome of AF ablation procedures remains to be investigated in future studies.
Pulsed field ablation as the first choice regarding oesophageal safety for atrial fibrillation ablation?
Authors: Katic J , Sikiric I , Lisica L , Zaja I , Puljiz Z , Jurisic Z , Breskovic T , Anic A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The occurrence of endoscopy-detected oesophageal lesions has been reported in patients with atrial fibrillation (AF) after thermal-based pulmonary vein isolation (PVI) with even higher risk in patients undergoing ablation of the left atrial posterior wall (LAPW) (1). The main mechanism of oesophageal injury is thermal, resulting in oesophageal dysmotility, ulceration, perforation, or left atrio-oesophageal fistula formation, which are rare but life-threatening sequelae. Pulsed-field ablation (PFA) is a non-thermal ablation technology that uses high amplitude pulsed electrical fields to ablate tissues through cell membrane disruption (2). Precommercial experience with PFA reported no injury to the oesophagus for both PVI and LAPW ablation (3).

Purpose
To assess oesophageal safety in AF patients treated with three different PFA platforms.

Methods
In this single-centre experience we retrospectively analysed a total of 72 upper gastrointestinal (GI) endoscopies performed by a certified gastroenterologist one day after left atrial PFA. GI analysis focused on detection of oesophageal lesions nearest the left atrium and evidence of gastric hypomotility. PVI was performed using focal or single shot PFA catheters. Focal PFA catheters achieved PVI using the wide antral circumferential ablation (WACA) technique. LAPW ablation was performed exclusively by using single shot PFA devices.

Results
The patient characteristics were summarized in Table 1. Focal PFA catheters were used in 78% of patients. Post-procedure endoscopies revealed no mucosal lesions in any patient. Gastroparesis and perioesophageal vagal nerve injury were not found (Table 2).

Conclusion
PFA, whether applied by single shot devices or focal catheters, seems to be a safe ablation option with respect to oesophageal injury resulting from PVI and LAPW ablation in paroxysmal and persistent AF patients. Irrespective of catheter design, PFA configuration (monopolar versus bipolar, maximum output), or LA lesion set, we found absolute GI safety of PFA as class effect.
Minimally invasive atrial fibrillation ablation and left anterior descending bypass grafting
Authors: Van Der Heijden CAJ , Segers P , Masud A , Weberndorfer V , Chaldoupi SM , Luermans JGLM , Van Kuijk S , Barenbrug PJC , Maessen JG , Bidar E , Maesen B 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Minimally invasive direct coronary artery bypass (MIDCAB) with robotic left internal mammary artery (LIMA) harvesting for a critical left anterior descending (LAD) stenosis and thoracoscopic ablation for atrial fibrillation (AF) may represent safe and effective alternatives to more invasive surgical approaches via sternotomy.

Purpose
To evaluate the feasibility, safety and efficacy of a MIDCAB procedure with concomitant thoracoscopic AF ablation.

Methods
We prospectively analysed all patients who underwent a minimally invasive, off-pump, MIDCAB through a left mini-thoracotomy with concomitant left-sided thoracoscopic AF ablation using a bipolar radio frequent clamp between 2017 and 2021.

Results
Twenty-three patients were included (age 69±8 years, BMI 29±4kg/m2, paroxysmal AF 61%, LAVI 42±11 ml/m2). All patients received an off-pump LIMA-LAD anastomosis. Ablation of the left (n=23) and right (n=22) pulmonary veins and box (n=21) was succeeded by epicardial validation of exit- and entrance block (n=22). No procedural complications were observed and complications during hospital admission and after discharge were: bleeding of the LIMA-LAD anastomosis n=1; myocardial infarction requiring percutaneous intervention of the LIMA-LAD n=1, respiratory insufficiency due to pleural effusion or atelectasis n=3, hospital readmission due to pleural- and pericardial effusion n=2. Duration of hospital stay was 6±2 days. After 12 months, 16/20 (80%) patients were in sinus rhythm when allowing anti-arrhythmic drugs and 18/20 (90%) patients were free from myocardial infarction.

Conclusion
Robot-assisted MIDCAB surgery for LIMA-LAD grafting concomitant with left-sided thoracoscopic AF ablation is a feasible, safe and efficacious minimally invasive treatment strategy for patients with a critical LAD stenosis and AF suitable for minimally invasive surgery.
High-definition electro-anatomical mapping of Koch’s Triangle including AV node potentials recordings in consecutive AVNRT patients
Authors: Pandozi C , Botto GL , Del Giorno G , Papa AA , Castro A , Di Belardino N , Viani S , Russo M , Brasca F , Carbone A , Galeazzi M , Casale MC , Treglia S , Malacrida M , Colivicchi F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Activation mapping of Koch’s Triangle, even when coupled with high density mapping, is incomplete without recordings of AV nodal electrical activity.

Purpose
To identify, through a highly specific methodology and high-density electro-anatomical mapping (HDM), the slow AVN potential (AVNP) and the precise activation modality of Koch’s Triangle in SR in atrio-ventricular nodal reentrant tachycardia (AVNRT) patients.

Method
The 3D KT geometry was created from the Orion mapping and the Rhythmia Mapping System. KT was divided into 8 distinct regions moving from an antero-septal to postero-septal areas and bounded by tricuspid annulus (TA) anteriorly and tendon of Todaro posteriorly. AV nodal potential activity was recorded by non-standard bipolar electrogram filtering at 0.50–300 Hz. The AVNP was defined as a slow frequency potential between atrial and ventricular EGM similar to that reported by Scherlag and Jackman, and it was confirmed by high frequency atrial pacing. The AVNP was annotated at the end of electrogram when it was followed in the same recording by a sharp potential; otherwise it was annotated at the center. Data are reported as mean±SD.

Results
Twenty successful SP ablation cases of typical AVNRT from 7 centers were included. RA acquired points during SR were 2512±1400 (123±67 acquired inside the KT, KT area of 41±64 mm2). The time of a complete RA mapping was 19.2±8 min. The AVNP was detected in all cases (n=20, 100%). At the mid-region of the KT, AVNP was identified in 20 (100%) cases; at postero-septal regions bounded anteriorly by the TA and posteriorly by the lateral wall toward the crista terminalis AVN was present in 17 (85%) cases; at mid-postero-septal regions AVN was detected in 15 (75%) cases. In all patients, the first activation in the KT was recorded in the antero-septal region at the expected site of the fast pathway; then the wavefront spread in two directions: anteriorly toward the His-bundle and posteriorly toward the base of KT colliding with the wavefront coming from the opposite direction through the slow pathway. In all patients, abolition of the SP and acute procedural success was achieved in the first procedure with 5.4±3 RF ablations. In 30 out 35 (86%) ablation sites, ablations were done at sites with concurrent detectable AVNP. No complications occurred.

Conclusions
High-density mapping using a non-standard bipolar electrograms filtering at 0.50–300 Hz showed multiple electrograms in SR including low frequency potential that may represent the electrical activity of compact node and inferior extensions.
Atypical atrial flutter in patients after cardiac surgery
Authors: Bakhytzhanuly A , Nuralinov O , Seisembekov T , Smagulova A , Abdrakhmanov A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atypical atrial flutter (AFL) is often associated with cardiac surgery or extensive catheter ablation (CA) for the treatment of atrial fibrillation (AF) [1-2]. Therefore, the increase in the number of cardiac surgery procedures leads to the development of substrates for atypical AFL onset. Incisions after cardiac surgery are common substrates for macro re-entry tachycardia and one patient can suffer from several macro re-entry tachycardia mechanisms. Atrial flutter in this category of patients lead to heart failure.

Objective
The aim of our study was to access the effectiveness and safety of catheter ablation of atypical atrial flutter in patients after cardiac surgery.

Methods
107 adult patients with AFL after cardiac surgery and catheter ablation were included in a single-center prospective study. The patient’s mean age was 57.8±11.1 years with the prevalence of male (56%). BMI was 27,8±5 kg/m 2. All patients underwent radiofrequency ablation (RFA) of atypical AFL with 3D navigation system Carto3 using the CLOSE protocol. The patients were discharged safely and were monitored for 12 months.

Results
According to basic characteristics of patients cardiac surgery performed in 19.6% for CABG, in 9.3% for congenital heart disease and in 58.9% for valvular heart diseases. RFA for pulmonary veins isolation (PVI) for AF was performed in 15.9% and cryoballoon isolation of PVI in 19.6%. The onset of atrial events after incision or catheter ablation was 12 (Q1-14; Q3-25) months. In 8.4% of patients, ejection fraction was less than 40%. The mean RFA time was 110,8±10,4 min, mean fluoroscopy time 2.2 min. There were two re-entry mechanisms in 22.4% of patients, three and more re-entry mechanisms in 8.4% of patients. During 12 months monitoring after RFA in 2 (1.9%) patients registered AFL and in 8 (7.5%) of patients noticed non-sustained palpitations.

Conclusions
RFA of AFL with the use of ablation index and CLOSE protocol lead to the high effect and safety in patients after cardiac surgery. AFL is most frequent in patients after valvular heart surgery and usually occurs 12 months after the surgery.
Cardioneuroablation of severe neurally mediated reflex syncope: the experience of two Portuguese centres
Authors: Silva G , Cardoso F , Almeida J , Fonseca P , Ribeiro S , Oliveira M , Sanfins V , Goncalves H , Primo J , Lourenco A , Fontes-Carvalho R 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Neurocardiogenic syncope (NCS) is the most frequent aetiology of syncope in young people. Cardioinhibition with asystole and/or transitory atrio-ventricular block induced by a massive vagal reflex is commonly observed in severe cases. According to the current guidelines, cardiac pacing is indicated in patients &gt; 40 years old with severe, recurrent syncope and documented cardioinhibitory reflex. In younger patients there is no recommendation. Although pacing therapy could be effective, complications after pacemaker implantation are commonly seen. Recently, cardioneuroablation (CNA), a technique based on radiofrequency ablation of vagal ganglia, was developed to treat NCS as an alternative to pacemaker implantation in younger patients. However, this method is still evolving, and existing data refer to a small number of patients in a limited number of centres.

Purpose
The aim of our study was to evaluate the efficacy and safety of CNA in patients with highly symptomatic neurocardiogenic syncope.

Methods and Results
A total of 15 patients (11 male; aged 40.0 ± 13.3 years) who underwent CNA in two Portuguese centres between January 2019 and September 2021 were included. All had recurrent syncope with documented pauses at head-up tilt test, Holter or implantable loop recorder. Radiofrequency energy was applied in ganglionated plexi (GP) 1 (between the right upper pulmonary vein and the right atrium) in 14 patients, GP2 (between the superior vena cava and aortic root just above the right upper pulmonary vein) in 9 patients, GP3 (between the inferior vena cava and the right and left atrium) in 5 patients and GP4 (at the insertion of the left pulmonary veins) in 9 patients. The end point of procedure was the inhibition of the vagal response at target sites. Ablation was successfully performed in all patients. One patient had a convulsive episode after the procedure, requiring admission to intensive care but without neurological sequelae. No other major complications occurred. At a mean follow-up of 17.1 ± 12.6 months (range 3-35 months), 13 patients remained free of syncope. Other 2 patients had spontaneous recurrence of syncope (both 9 months after CNA) and underwent a new procedure. These 2 patients had a new symptomatic recurrence and a pacemaker was implanted.

Conclusion
CNA appears to be an effective and safe treatment option for patients with refractory neurocardiogenic syncope and provide a new potential approach without pacemaker implantation.
Adrenergic stimulation amplifies the difference in beat-to-beat variability between the scar border zone and remote region
Authors: Vermoortele D , Amoni M , Ingelaere S , Holemans P , Menten R , Willems R , Sipido KR , Claus P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): KU Leuven BOF-C1 “Blood pressure induced premature ventricular beats as triggers for ventricular arrhythmia in ischemic cardiomyopathy”

Background
Myocardial infarction (MI) results in a dense scar region surrounded by a heterogeneous region of fibrosis and remodeled myocytes called the border zone (BZ). Beta-adrenergic stimulation results in increased beat-to-beat variability of repolarization (BVR) which could increase spatial heterogeneity and arrhythmia vulnerability.

Objective
To examine the effect of adrenergic stimulation on the beat-to-beat variability in the BZ, compared to the remote region, using novel methodology for determining spatially dense activation-repolarization intervals.

Methods
Anterior-septal myocardial infarction (MI) was induced in 10 domestic pigs by 120-minute occlusion of the left anterior descending artery followed by reperfusion. Electro-anatomical mapping was performed after one month. The BZ was defined using contact mapping as the region with bipolar voltage between 0.5 and1.5mV. A non-contact recording of a 64-electrode array was translated to 2048 non-contact electrograms distributed over the LV (EnSite PrecisionTM, St. Jude/Abbott Medical). Electrophysiological recordings were made during baseline and during an isoproterenol (ISO) infusion (incremental doses of 0.01µg/kg until 0.04µg/kg). In each of the 2048 points non-contact electrograms over 25 consecutive beats were processed to determine the BVR using a custom-made algorithm, validated against monophasic action potential recordings.

Results
During baseline conditions the maximal BVR was increased in the BZ compared to the remote region (BZ: 3.28±0.90 ms vs remote: 2.61±0.67 ms, P=0.002). During ISO infusion the maximal BVR was also increased in the BZ (BZ: 3.55±0.74 ms vs remote: 2.21±0.60 ms, P&lt;0.001). During baseline the BZ exhibited a larger spatial variance of BVR than the remote region (BZ: 0.20±0.11 ms2 vs remote: 0.087±0.055 ms2, P=0.002). During ISO infusion the spatial variance of BVR was larger in the BZ (BZ: 0.23±0.12 ms2 vs remote: 0.083±0.056 ms2, P=0.001). The maximal BVR was not significantly different during baseline and ISO in the BZ, nor the remote region (P&gt;0.05). However, the difference of the maximal BVR between BZ and remote regions was significantly increased during ISO (baseline: 0.67±0.48 ms vs ISO: 1.34±0.49ms, P=0.001).

Conclusion
The MI BZ showed increased temporal heterogeneity in repolarization that could serve as functional substrate for re-entry. Adrenergic stimulation amplified this vulnerability by increasing the difference in maximal BVR between BZ and remote regions.
Late gadolinium enhancement is a strong predictor of life threatening arrhythmias in patients with non-ischemic dilated cardiomyopathy undergoing ICD implantation for primary prevention of sudden card
Authors: Lopes Da Cunha GJ , Lopes P , Freitas PN , Matos D , Rodrigues G , Carmo J , Carvalho S , Santos PG , Costa FM , Carmo P , Cavaco D , Morgado F , Mendes M , Ferreira A , Adragao P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The usefulness of implantable cardioverter defibrillators (ICD) for primary prevention of arrhythmic sudden cardiac death (SCD) in patients with non-ischemic dilated cardiomyopathy (DCM) has been questioned. Efforts to improve risk stratification have included scores such as the ‘MADIT-ICD benefit score’, and the use of late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR).
The purpose of this study was to evaluate the potential usefulness of these two tools to assess the risk of life-threatening arrhythmias in patients with non-ischemic DCM undergoing ICD implantation for primary prevention of SCD.

Methods
We conducted a single-center retrospective study of consecutive patients who underwent contrast-enhanced CMR before ICD implantation for primary prevention of SCD. Patients with ischemic cardiomyopathy were used as reference. Patients with non-dilated cardiomyopathies were excluded.
The arrhythmic component of the MADIT-ICD benefit score (VT/VF score) was calculated for each patient, and considered high if ≥ 7, as recommended.
The primary endpoint was the occurrence of SCD or life-threatening arrhythmias (VF or VT &gt;200 bpm). Follow-up was performed by device interrogation in all patients except those who suffered SCD.

Results
A total of 151 patients (93 ischemic, mean age 62±13 years, 75% male) with mean left ventricular ejection fraction (LVEF) of 27±8% were included. Overall, 72% (n=67) ischemic and 45% (n=26) non-ischemic patients had scores ≥ 7 and were considered high-risk. LGE was present in all patients with ischemic cardiomyopathy, and in 76% (n=44) of patients with non-ischemic DCM.
During a median follow-up of 21 (8-38) months, 21 patients (13.9%, 11 ischemic and 10 non-ischemic) met the primary endpoint.
Overall, the event-free survival of non-ischemic patients was similar to that of ischemic patients (log rank p=0.269) – Fig 1A. In patients with non-ischemic DCM, there were 7 arrhythmic events (26.9%) in those with MADIT-ICD VT/VF scores ≥7, and 3 events (9.4%) in those with scores &lt;7 (log rank p= 0.104) – Fig 1B.
In the same population, there were 10 arrhythmic events (23%) in patients with LGE, but no events in patients without LGE (log rank p=0.036) – Fig 1C.
LVEF was similar in patients with and without arrhythmic events (26±8% vs. 27±7%, p=0.717), and in those with and without LGE (26±7% vs. 28±9%, p=0.342).

Conclusion
The presence of LGE is a strong predictor of life threatening arrhythmias in patients in non-ischemic DCM undergoing ICD implantation for primary prevention, seemingly outperforming the clinical MADIT-ICD benefit score.