bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biventricular versus conduction system pacing after atrioventricular node ablation in heart failure patients with atrial fibrillation
Authors: Ivanovski M , Zupan Meznar A , Mrak M , Antolic B , Klemen L , Stublar J , Jan M , Pernat A , Zizek D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrioventricular node ablation (AVNA) with biventricular (BiV) pacing is an established treatment option for heart failure (HF) patients with drug refractory atrial fibrillation (AF) (1). However, compared to conduction system pacing (CSP) modalities, including His bundle pacing (HBP) and left bundle branch pacing (LBBP), BiV pacing delivers non-physiological ventricular activation (2).

Purpose
To compare clinical outcomes of BiV pacing and both CSP modalities in HF patients with symptomatic AF who underwent AVNA.

Methods
Consecutive AF patients with LV ejection fraction (LVEF &lt;50%) who received either BiV pacing or CSP in conjunction with AVNA between May 2015 and July 2021 were retrospectively analysed. Procedural characteristics, electrocardiographic, echocardiographic, and clinical parameters were assessed at baseline and 6 months after the procedure.

Results
Fifty-five patients (male 43.6%, age 71 years (IQR 10), LVEF 39% (IQR 14)) were included. Thirteen patients (23.6%) received BiV pacing, 30 patients (54.5%) HBP and 12 patients (21.8%) LBBP. All groups had similar baseline characteristics, acute success rate and adverse events. Post-procedural QRS duration was significantly shorter (p&lt;0.01) in CSP (118 ms (IQR 28)) than in BiV pacing (172 ms (IQR 18)). While NYHA class improved in both HBP (p&lt;0.01) and LBBP (p=0.01), it did not improve in BiV group (p=0.1) At follow-up, end systolic volume (ESVi) decreased in both HBP (48±20 to 32±12 mL/m2, p&lt;0.01) and LBBP (62±22 to 52±22 mL/m2, p=0.02), but did not differ in BiV pacing group (51±12 to 53±14 mL/m2, p=0.6). Similarly, LVEF increased in HBP (form 39% (IQR 16) to 53% (IQR 14), p&lt;0.01) and LBBP (from 41% (IQR 23) to 40% (IQR 25), p=0.04), but did not change in BiV group (from 38% (IQR 5) to 37% (IQR 6), p=0.9). Significantly lower (p&lt;0.01) pacing thresholds were achieved in LBBP (0.75 V at 0.5 ms (IQR 0.3)) than in HBP group (1.0 V at 0.5 ms (IQR 1)). Two patients in HBP group were switched to right ventricular pacing due to rise in HBP threshold. In the remaining patients threshold remained stable during follow-up.

Conclusion
Conduction system pacing modalities showed superior symptomatic and echocardiographic improvement compared to BiV pacing after AVNA. While LBBP offered lower and more stable pacing parameters, there were no differences in clinical outcomes and echocardiographic remodelling when compared to HBP.
Short-term outcomes of catheter ablation in atrial fibrillation in patients with metabolic syndrome
Authors: Uzokov J , Alyavi BA , Payziev DD , Mukhitdinova OY , Orziev DZ 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Metabolic syndrome is widely discussed lately and it is consists of several components, which in turns exaggerates the development of the cardiovascular disease and rhythm disorders. Atrial fibrillation (AF) is considered one of the common type of heart rhythm disorders. Effects of metabolic syndrome components on outcomes of catheter ablation in AF remain poorly understood.

Purpose
Assess the influence of metabolic syndrome and its components on short-term outcomes of catheter ablation on atrial fibrillation.

Methods
We carried out a retrospective analysis of 120 patients who underwent atrial fibrillation ablation for the first time. 60 out of them were diagnosed with concomitant MetS (Group I) whereas 60 without MetS (Group II). Clinical outcomes, cardiovascular and all caused hospitalizations, procedural complications, AF recurrence, ischemic stroke were assessed. All endpoints were assessed at least 12 months after the catheter ablation.

Results
Median CHA2DS2-VASc were higher in Group I than Group II (2.2 (1-4) vs. 1.9 (1-3), P&lt;0.05). Patients with MetS tended to have larger median diameter of left atrial than those without it (4.3 vs. 4.0, P&lt;0.05). Cardiovascular and all cause hospitalizations did not differ in two groups (P&gt;0.05). Median total radiofrequency duration (59.0 min vs. 61 min, P&gt;0.05) and procedural complications (P&gt;0.05) did not significantly differ between groups. AF recurrence in 12 months tended to be higher in Group I than Group II (9.0 vs.5.0, P&gt;0.05). There were not statistically significant changes between groups in terms of ischemic stroke (1.0 vs. 1.0, P&gt;0.05). Using multivariate regression analysis, among MetS components abdominal obesity (1.7 (1.1-2.1), P&lt;0.05) hypertension (1.5 (1.1-1.9), P&lt;0.05) were positively correlated with AF recurrence whilst median left atrial diameter was only correlated with hypertension (1.6 (1.1-2.0), P&lt;0.05) after adjusting other risk factors.

Conclusion
AF recurrence in short-term period of catheter ablation in AF higher in patients with MetS. Further studies with large amount of patients are required along with assessment in long-term period.
Persistent phrenic nerve palsy after atrial fibrillation ablation: follow-up data from the Netherlands Heart Registration
Authors: Mol D , Renskers L , De Groot JR , De Jong JSSG 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Persistent phrenic nerve palsy (PNP) is an established complication of atrial fibrillation (AF) ablation, especially during cryoballoon and thoracoscopic ablation. Data on persistent PNP reversibility is limited because most patients recover &lt;24hours.

Purpose
This study aims to investigate persistent PNP recovery, freedom of PNP-related symptoms after AF ablation and identify baseline variables associated with the occurrence and early PNP recovery in a large nationwide registry study.

Methods
In this study, we used data from the Netherlands Heart Registration, comprising data from 9,549 catheter and thoracoscopic AF ablations performed in 2016 and 2017. PNP data was available of 7,433 procedures, and additional follow-up data were collected for patients who developed persistent PNP.

Results
Overall, mean age was 62±10 years, and 67.7% were male. Fifty-four (0.7%) patients developed persistent PNP and follow-up was available in 44 (81.5%) patients. PNP incidence was 0.07%, 0.29%, 1.41%, and 1.25% for patients treated with conventional-RF, phased-RF, cryoballoon, and thoracoscopic ablation respectively. Seventy-one percent of the patients fully recovered, and 86% were free of PNP-related symptoms after a median follow-up of 203[113 – 351] and 184[82 – 359] days, respectively (Figure 1A/C). In addition, in 20/28 (71.4%) patients recovery was confirmed with imaging (Figure 1B). Female sex, cryoballoon, and thoracoscopic ablation were associated with a higher risk to develop PNP, with corresponding adjusted OR of 2.32 95% CI 1.07 – 5.06, OR 21.12 95% CI 6.49 – 129.75, and 18.93 95% CI 4.86 – 124.41, respectively. Patients with PNP recovering ≤180 days had a larger left atrium volume index than those with late or no recovery.

Conclusion
After AF ablation, persistent PNP recovers in the majority of patients, and most are free of symptoms. Female patients and patients treated with cryoballoon or thoracoscopic ablation are more prone to develop PNP.
Strategies for repeat ablation for atrial fibrillation: a multicentre comparison of non-pulmonary vein versus pulmonary vein target ablation
Authors: Mol D , Mulder MJ , Veenstra R , Allaart CP , Hof IE , Kemme MJB , Khan M , Kimman GP , Mairuhu G , De Ruiter GS , Tahapary GJM , De Groot JR , De Jong JSSG 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Approximately 18% of patients with atrial fibrillation (AF) undergo a repeat ablation within 12 months after their index ablation. Despite the high prevalence, comparative studies on non-pulmonary vein (PV) target strategies in repeat AF ablation are scarce.
Purpose: This study aims to describe 12 months efficacy of non-PV and PV target ablations as a repeat ablation strategy.

Methods
A multicentre retrospective, descriptive study was conducted with data of 280 patients who underwent repeat AF ablation. Ablation strategy for repeat ablation was at the operators’ discretion. Non-PV target ablation (n=140) included posterior wall isolation, mitral line, roofline and/or complex fractionated atrial electrogram ablation. PV target ablation (n=140), included re-isolation and/or wide atrium circumferential ablation. Patients’ demographics and rhythm outcomes during 12-months follow-up were analysed.
Results: Overall, the mean age was 63 ± 9 years, 64% were male, and body mass index was 27.1 ± 4.2. Patients undergoing non-PV target ablation had more frequently persistent AF (47.9% vs 14.3%, p &lt; 0.001), and had a higher CHA2DS2 VASc (2.0 vs 1.3, p &lt; 0.001). At 12 months, more atrial tachyarrhythmias were observed in the non-PV target group (48.6%) compared to the PV target group (29.3%, p=0.001). Similarly, a significantly higher AF and atrial tachycardia (AT) recurrence rate was observed after non-PV target ablation compared to PV target ablation (36.4% versus 22.1% and 22.9% versus 10.7%). After adjusting for several associated covariates, a significantly higher AT recurrence risk remained in the non-PV target group (adjusted OR 2.19 95% CI 1.18 – 4.42, p = 0.023) (Figure 1C). Sensitivity analysis was performed with inverse propensity weighting to assess the robustness of the multivariate model and demonstrated comparable outcomes. Both groups significantly de-escalated anti-arrhythmic drug use, de-escalation was more profound after PV target ablation. Patients with isolated PVs during non-PV target ablation had a significantly higher risk for AF recurrence than those with reconnected PVs (Figure 1B).
Conclusion: Compared to PV target ablation, non-PV target repeat ablation did not improve outcomes after 12 months and was independently associated with a higher risk for AT recurrences.
Repeat cryoablation as a redo procedure for atrial fibrillation ablation: Is it a good choice?
Authors: Alvarez-Ortega C , Solorzano C , Barrera A , Toquero J , Martinez-Alday JD , Grande C , Rodriguez A , Garcia-Alberola A , Perez L , Ferrero A , Hernandez J , Cozar R , Cano O , Trucco E , Peinado R 
Published: May 2022

Abstract

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

Introduction
Catheter ablation of atrial fibrillation, both cryoablation and radiofrequency pulmonary vein isolation, have demonstrated to be safe and effective techniques for treating symptomatic atrial fibrillation as a first procedure. However, about one in three patients may face a redo procedure due to AF recurrence. The most suitable technique for redo is unknown.

Purpose
The aim of this study is to assess the efficacy of cryoballoon AF ablation as a redo technique in patients with prior cryoballoon or radiofrequency AF ablation.

Methods
We analyzed a nation-wide real-world cryoablation registry (RECABA) and compared patients who were referred for a first cryoballoon AF ablation procedure with those who had previously undergone cryoballoon or radiofrequency pulmonary vein isolation. The primary endpoint was AF recurrence during the first year after a 3-month blanking period. We performed survival analysis and built univariate and multivariate cox regression models.

Results
From 1742 patients, 1625 had a 12-month follow-up visit. 1551 (95.45%) underwent a first cryoballoon ablation, whereas 33 (2.03%) had a previous CB ablation performed and 41 (2.52%) a previous RF ablation.
Mean age was 58.6 ±10.4 years and 511 (31.5%) were women. 463 (28.5%) had persistent atrial fibrillation and there were no major clinical differences between groups.
Prior-CB group had a higher share of veins without electrogram visualization, with a median of 100% (IQR 75%-100%), compared to prior-RF group (median 67%, IQR 25%-75%) and first procedure group (median 25%, IQR 0%-50%). Kruskal-Wallis test Chi2=54.35, p&lt;0.0001.
12-month Kaplan–Meier estimate of freedom from AF recurrence after the blanking period was 78.5% (95% CI 76.2% - 80.7%) in the first procedure group, 61.0% (95% CI 41.4% - 75.8%) in the prior-CB and 89.2% (95% CI 73.6% - 95.9%) in the prior-RF group. Log-rank test Chi2=17.49, p&lt;0.0001.
Multivariate cox regression analysis pointed female sex, persistent AF, and prior-CB ablation as independent predictors of AF recurrence. The adjusted HR for AF recurrence of prior-CB ablation vs first-CB ablation was 3.13 (95% CI 1.82 -5.40) and for prior-RF vs first CB-ablation was 1.01 (95% CI 0.51 – 1.97).

Conclusion
Repeat cryoballoon AF ablation shows higher rates of AF recurrences compared to first CB procedures or after prior RF ablation. These data suggest that patients with AF recurrence after CB-ablation have worse arrhythmic outcomes and may benefit from other ablation techniques after a recurrence.
Validation of a multipolar pulsed field ablation catheter for endpoint assessment in pulmonary vein isolation procedures
Authors: Kueffer T , Baldinger SH , Servatius H , Madaffari A , Seiler J , Muehl A , Franzeck F , Thalmann G , Asatryan B , Haeberlin A , Noti F , Tanner H , Roten L , Reichlin T 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): FP7/2007-2013, №602299, EU-CERT-ICD

Objective
To validate the performance of a multipolar PFA catheter compared to a standard pentaspline 3D-mapping catheter for endpoint assessment of PVI.

Background
Pulsed field ablation (PFA) for pulmonary vein isolation (PVI) using single-shot devices combines the benefits of high procedural efficacy and safety. A newly available multipolar PFA catheter allows real-time recording of pulmonary vein (PV) signals during PVI.

Methods
Patients undergoing first PVI using PFA with the standard ablation protocol (8 applications per PV) were studied. Entrance- and exit-block (10V/2ms) were assessed using the PFA catheter. Subsequently, a high-density bipolar voltage 3D electro-anatomical map (3D-EAM) was constructed using a standard pentaspline 3D-mapping catheter. Additional PFA applications were delivered only after confirmation of residual PV-connection by 3D-EAM.

Results
In 56 patients, 213 PVs were targeted for ablation. Acute PVI was achieved in 100% of PVs: in 199/213 (93%) PVs with the standard ablation protocol alone and in the remaining 14 PVs after additional PFA applications. Accuracy of PV assessment with the PFA catheter after the standard ablation protocol was 91% (194/213 veins). In 5/213 (2.3%) PVs, the PFA catheter incorrectly indicated PV-isolation. In 14/213 (6.6%) the PFA catheter incorrectly indicated residual PV-conduction due to high-output pace-capture. When the output was reduced to 5V/1ms, pace-capture was reduced to 0.9% (2/213).

Conclusion
A novel multipolar PFA catheter allows reliable endpoint assessment for PVI. Due to its design, far-field sensing and high-output pace-capture can occur, which may require adjustment of standard pacing outputs for verification of exit-block.
Long term outcome after ablation of persistent atrial fibrillation in patients with postprocedurally unmasked sinus node disease
Authors: Martini E , Kantenwein V , Haller B , Telishevska M , Bourier F , Reents T , Kottmaier M , Popa M , Risse E , Lengauer S , Lennerz C , Hessling G , Deisenhofer I , Kolb C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
About three percent of patients with persistent atrial fibrillation [AF] additionally suffer from a concealed sinus node disease [SND]. We sought to determine the ablation success one year after ablation of persistent AF in patients with postprocedurally unmasked SND.

Methods and Results
In total 2239 patients with an ablation of persistent AF at our center were screened for a postprocedurally unmasked SND, which made cardiac pacing necessary within one week after ablation. In a propensity score matched case control study, the longterm ablation success of 51 patients (mean age 73±8years, 58% male) with postprocedurally unmasked SND after ablation of persistent AF was compared to that of 102 patients without SND after ablation of persistent AF. Controls were matched to cases based on the propensity score considering age, body mass index, left ventricular ejection fraction, gender, blood pressure, diabetes mellitus, atrial low voltage, previous number of ablations and method of ablation.
One year after ablation of persistent AF, 20 (39%) patients with postprocedurally unmasked SND and 61 (60%) patients without postprocedurally unmasked SND were in sinus rhythm (p=0.025). The number of repeat ablation procedures within the follow up year did not differ significantly between cases and controls (0.60±0.68 vs 0.53±0.80, p=0.574).

Conclusion
In patients with a postprocedurally unmasked SND after ablation of persistent AF, longterm ablation success seems to be worse compared to patients without postprocedurally unmasked SND.
Benefit of atrial fibrillation ablation on symptoms and quality of life does not differ between patients with paroxysmal and persistent atrial fibrillation
Authors: Huntelaar MJ , Mulder MJ , Kemme MJB , Hopman LHGA , Hauer HA , Tahapary GJM , Allaart CP 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Indications for atrial fibrillation (AF) ablation in current ESC and ACC/HRS guidelines are different for paroxysmal and persistent AF patients. Although previous research has established that the AF recurrence rate after AF ablation is lower in paroxysmal AF patients, there is little data on differences in post-ablation improvement of quality of life (QoL) and AF-related symptoms.

Purpose
This study aimed to determine whether QoL and symptom improvement differ between patients with paroxysmal and persistent AF after AF ablation.

Methods
From December 2017 to June 2020, patients undergoing first AF ablation at a medical center were included in a prospective registry. Circumferential pulmonary vein isolation (PVI) was performed using radiofrequency ablation with a contact force-sensing catheter. Patient reported outcomes were assessed at baseline, 4 months follow-up, and 1 year follow-up using the Toronto Atrial Fibrillation Severity Scale (AFSS). The AFSS was used to quantify global well-being (scale 1-10), patient-perceived AF burden (scale 3-30), and AF symptom severity (scale 0-35). AF symptom severity was based on 7 questions (scale 0-5) leading to a 0-35 scale. AF recurrence was defined as any documented episode of AF or atrial flutter after a blanking period of 3 months.

Results
The study population consisted of 306 AF patients (66% paroxysmal AF, 68% male, mean age 64±8 years). AF recurrence during 1 year follow-up occurred in 29% of paroxysmal AF patients and in 42% of persistent AF patients (p=0.021). At baseline, patient perceived AF burden was lower in paroxysmal AF patients than in persistent AF patients (18.4±3.7 vs. 20.2±5.0, p=0.001), whereas symptom severity (10.6±6.5 vs. 9.9±6.7, p=0.384) and global well-being (7.1±1.5 vs. 7.3±1.4, p=0.327) were similar. Paroxysmal AF patients reported more palpitations (2.4±1.3 vs. 1.6±1.5, p&lt;0.001) and less shortness of breath during physical activity (1.9±1.6 vs. 2.3±1.7, p=0.048) than patients with persistent AF.
Significant improvements in global well-being (0.5±1.7, p&lt;0.001), symptom severity (3.8±7.2, p&lt;0.001), and patient-perceived AF burden (7.2±7.5, p&lt;0.001) were found in the entire study cohort between baseline and 1 year follow-up, without differences between paroxysmal and persistent patients (Figure).

Conclusion
Although persistent AF patients have a higher chance of recurrent AF after AF ablation, symptom severity and QoL improve equally in paroxysmal and persistent AF patients. These results suggest that different recommendations for AF ablation to improve symptoms in paroxysmal and persistent AF patients may not be justified.
Radiation dose reduction in the setting of cryoballoon ablation for atrial fibrillation
Authors: Velagic V , Prepolec I , Pasara V , Percin L , Posavec J , Bogdanic J , Nekic A , Pezo-Nikolic B , Puljevic M , Puljevic D , Milicic D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Cryoballoon (CB) isolation of pulmonary veins (PVI) has become the standard of care for patients suffering from atrial fibrillation (AF). PVI could be achieved by radiofrequency ablation with 3D mapping technology omitting the use of fluoroscopy, so called "0 fluoro" approach. However, CB still requires radiation use. Minimization of radiation exposure is important both for patients and operators.

Purpose
We aimed to demonstrate the feasibility of radiation dose reduction in the setting of CB ablation for AF.

Methods
We have performed a retrospective study on patients that have undergone CB ablation since the beginning of the AF ablation program in our institution. Procedures were performed under conscious sedation. Both femoral veins were punctured and a single introducer was placed in each vein. A single transseptal puncture was performed guided by intracardiac ultrasound and a 28 mm cryoballoon was used. A single 180 seconds freeze strategy was employed. We analyzed 3 groups of 50 consecutive patients. First group (G1) consisted of subjects at the beginning of our AF program in 2015. In that time, we systematically used 3D rotation angiography for left atrium imaging and higher frame rates both for fluoro (4-10 frames per second - (fps)) and cine (7.5-10 fps) modes of diascopy. Second group (G2) consisted of 50 consecutive patients in 2018 when we stopped using rotational angiography and lowered frame rates (fluoro 4-6 fps, cine 4-6 fps). The third group (G3) consisted of the last 50 patients that we performed in 2021 when we stopped using grid for X ray scatter reduction, lowered fluoroscopy to 2-3 fps, and almost completely abandoned the use of cine mode.

Results
We have analyzed in total 150 patients (73% male, 59.4±12.6 years old), 50 in each group. There was a significant decrease of procedure and fluoroscopy time that could be attributed to growing operators’ experience and abandoning the use of 3D rotational angiography. More importantly, there was a major decrease in radiation doses applied during the course of the study. Recently, we are using only 2% of radiation doses applied in the beginning of our study (Table).

Conclusion
By following a few relatively simple steps (omitting the preprocedural imaging, removing grid from the X ray detector and using very low frame rates) CB ablation could be performed with ultralow radiation exposure. However, a certain level of experience is required to be able to perform CB ablation with relatively low X ray image quality and without preprocedural imaging of left atrium.