bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dubious effect of the high biventricular paced beats percentage itself on the cardiac resynchronization efficacy in patients with atrial fibrillation. The randomized Pilot-CRAfT Study results
Authors: Ciszewski JB , Tajstra M , Kowalik I , Maciag A , Zajac D , Pytkowski M , Gasior M , Sterlinski M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Cardiology statutory grant

Background
The presence of atrial fibrillation (AF) in cardiac resynchronization therapy (CRT) recipients is common and AF is a marker of poorer CRT response. The negative influence of AF on CRT efficacy is belived to be mediated mainly by the drop of effectively captured biventricular paced beats percentage (BiVp%). According to observational trials, the minimal BiVp associated with better outcomes is 95-98%, however there is lack of randomized trials to confirm this findings.

Purpose
The purpose of the study was to assess the influence of BiVp% itself on the clinical outcomes in the population CRT patients with atrial fibrillation in a prospective, randomized cohort.

Methods
The study included the prospective Pilot-CRAfT study participants that is patients with CRT and permanent or persistent AF lasting for ≥6 months that were randomly assigned to rhythm or rate control strategy. We divided the whole study population according to their BiVp at the 12 month follow-up with two borderline BiVp values (BiVp &gt;98% vs &lt;98% and &gt;95% vs &lt;95%) and analysed the echocardiographic indices, exercise tolerance and quality of life between the prespecified groups.

Results
The study included 43 CRT patients (97,7% males) aged 68,4 (SD: ±8,3) years with mean BiVp% 82,4% ±9,7% at baseline. The mean baseline left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD) and maximal oxygen uptake (VO2max) were: 30 ±8%, 65 ±8 mm, 14 ±5 mL/(kg*min), respectively. In both of the study arms the BiVp% raised significantly reaching 98,1 ±2,3% and 96,3 ±3,9% in the rhythm control and the rate control arms respectively (P=0,093). As a result the were overall 21 patients with BiVp &gt;98% and 29 patients with BiVp &gt;95% at the end of the study. The BiVp groups &gt;98% vs &lt;98% and &gt;95% vs &lt;95% did not differ as to baseline characteristics and we have not observed any differences in the mean LVEF, mean LVEDD, mean VO2max, and quality of life in the prespecified BiVp% groups at the end of the follow up. Moreover no linear correlations between the BiVp% and LVEF, LVEDD, VO2max values were observed. However, in the rate control group patients with AVNA performed had lower LVEDD at the end of the study (57,7 ±3,0 vs 65,4 ±7,0 p=0,007) and significant decrease in the LVEDD after AVNA was observed (-8,6 95%CI [-14,9; -2,3]).

Conclusions
The BiVp &gt;98% or &gt;95% alone does not seem to warrant good response to cardiac resynchronization in patients with persistent atrial fibrillation as assessed in the prospective randomized cohort. However, performing AVNA in this group of patients may be beneficial in terms of LVEDD decrease.
Left atrial anatomical variations correlate with atrial fibrillation sources near the left atrial ridge
Authors: Gagyi R , Szegedi N , Simon J , Wijchers S , Bhagwandien R , Kong M , Ruppersberg P , Szili-Torok T 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Anatomical variations and characteristics of the left atrium (LA) may have a previously undescribed effect on source locations in atrial fibrillation (AF). Electrographic flow (EGF) mapping is a novel method used to estimate cardiac action potential flow in the atria that can detect AF sources in patients with persistent AF. The EGF technology offers a revolutionary mapping possibility for AF, however, it is not commercially available yet.

Purpose
This is the first study aiming to investigate the relationship between anatomical characteristics of the LA and non-PV sources detected by EGF in patients with persistent AF.

Methods
We collected cardiac computed tomography (CT) and EGF data from patients who underwent radiofrequency catheter ablation (CA) for persistent AF. EGF mapping creates a spatial and temporal reconstruction of electric potentials derived from endocardial unipolar electrograms. By analyzing EGF maps obtained during CA procedures, we localized non-PV sources in the LA. Patients with individual stable sources with a source activity above threshold (leading source present in more than &gt; 26% of the time) were classified as having an S-Type EGF signature with source-dependent AF. Patients with no stable active source pattern and no leading source with a source activity above threshold were characterized as having a C-Type EGF signature consistent with source-independent AF. We assessed LA anatomical characteristics including size, LAA length, LAA ostial diameter, trajectory of the left superior pulmonary vein (LSPV) and its relation to the LAA on cardiac CT scans. Abutting LAA-LSPV was defined as cases when the LSPV touched the posterior aspect of LAA, and the maximal distance between the two structures was less than 2 mm. Those cases where the distance between LAA and LSPV was more than 2 mm were defined as non-abutting LAA-LSPV.

Results
Thirty patients were included in this study (mean age 62.4±6.8 years):23 patients had an S-Type EGF signature (77%), and 7 patients had a C-Type EGF signature (23%). We identified 10 patients with AF sources near the LA ridge, while twenty patients had no leading source near the LA ridge. LA anatomical characteristics, LAA length and ostial diameter showed no correlation with the presence of a leading source near the ridge. We described 19 patients with abutting LAA-LSPV, and 11 patients with non-abutting LAA-LSPV. Three out of 19 patients presented with a leading source near ridge in the abutting LAA-LSPV group, while 7 out of 11 patients presented with a leading source near ridge in the non-abutting LAA-LSPV group (p=0.01).

Conclusion
Our data suggests that non-abutting LAA-LSPV is associated with the presence of AF sources near the LA ridge.
Impact of mapping technology on procedural characteristics during radiofrequency or cryoballoon pulmonary vein isolation for atrial fibrillation
Authors: Martel J , Addo K , Kim Y , Hamdan F , Demo H , Bonavita G , Li J , Ahmad S , Shah S , Delurgio D , Bailey C , Shim J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background/Introduction: Cryoballoon ablation (CBA) is often associated with shorter procedure times along with tradeoffs such as increased fluoroscopy use compared to radiofrequency (RF) ablation of atrial fibrillation (AF), however the impact of mapping technology on these characteristics is not fully understood.

Purpose
To assess the effect of mapping technology on trends in fluoroscopy use and procedure times in AF pulmonary vein isolation (PVI) procedures with an RF or CBA catheter.

Methods
Acute procedure data from 210 de novo AF cases using a 3D mapping system was prospectively collected from 48 centers in eight countries. Choice of technology was left to physician discretion; a PVI only ablation strategy was utilized in all cases. Procedure data such as total procedure and fluoroscopy times from cases using either an RF or CBA catheter with either a grid-style mapping catheter (HD Grid) or circular mapping catheter (CMC) were compared.

Results
Of the 210 cases, RF ablation was used in 103 (49%), and CBA used in 107 (51%). In RF cases, a relatively even split between CMC and HD Grid use was observed (n=46, 45% vs. n=57, 55%), while a CMC was used in 100% of CBA cases (Figure 1). Across all cases, fluoroscopy and procedure times were significantly shorter when HD Grid was used (7.4±26.7 minutes; 108.2±46.3 minutes) compared to a CMC (20.4±17.6 minutes; 133.7±62.7) (p&lt;0.001; p=0.003). A similar trend was also observed in RF cases using HD Grid (7.4±26.7 minutes; 108.2±46.3 minutes) compared to a CMC (17.9±12.3 minutes; 175.1±50.5) (p=0.01; p&lt;0.001). Fluoroscopy times in RF cases with HD Grid (7.4±26.7 minutes) were significantly shorter compared to CBA cases with a CMC (21.5±19.4 minutes) (p&lt;0.001), while procedure times were similar (108.2±46.3 minutes; 116.0±59.2 minutes, p=0.20).

Conclusion(s)
Use of HD Grid resulted in significantly shorter procedure and fluoroscopy times compared to a CMC across all cases, including those using RF ablation. Fluoroscopy times were also significantly shorter in RF cases using HD Grid compared to CBA cases using a CMC, with similar procedure times. These observations suggest that use of HD Grid may better enable safer and more efficient PVI, specifically when employing RF ablation, in addition to safer and equally efficient RF PVI compared to CBA with a CMC. Further study in in a larger, randomized cohort may be necessary.
The triangle correlation among the impact on serum S100B protein release, incidence of the silent cerebral ischemic phenomena and pulsed field ablation for patients with atrial fibrillation
Authors: Tohoku S , Schmidt B , Bordignon S , Chen S , Pansera F , Chun KRJ 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Backgrounds: Pulsed field ablation (PFA) represents a cardiac specific energy source for atrial fibrillation (AF) ablation. The correlation among this remarkable technique, the incidence of silent cerebral ischemic phenomena (SCIP), and the clinical impact on serum S100B release, a well-known neural injury relevant biomarker concomitant to denervation of the intrinsic cardiac autonomic nervous system during AF ablation, has been unclear.

Aims
This study thought to reveal the "triangle correlation" by investigating the serum S100B increase, incidence of SCIP on cerebral magnetic resonance imaging (MRI), and its interactive correlation in PFA using the FARAPULSE system.

Methods and Results
Pre- and postprocedural serum S100B was analyzed in a total of 85 patients who underwent AF ablation using the FARAPULSE PFA device. Cerebral MRI was performed subsequently 24-48 hours after procedure. All PVs (332 PVs) were successfully isolated solely with PFA. No additional left atrial mapping using other catheters was performed.
The median overall serum S100B increase from the preprocedural value was 0.01μg/l (-0.02 – 0.04μg/l). Asymptomatic SCIP were detected on MRI in 10/53 patients (18.9 %). Of those, the patients with SCIP demonstrated a significantly higher S100B release (0.04, 0.02 – 0.16μg/l vs. without SCIP:0.01, -0.04 – 0.03μg/l, p = 0.0038). Receiver operating characteristic curve revealed a predictive cut-off point for SCIP of 0.04 μg/l (sensitivity:0.7, specificity: 0.49).

Conclusions
We revealed no clear detectable impact of PFA on S100B release, highlighting the cardioselectivity with limited concomitant denervation. SCIP was detected approximately in a one-fifth after procedures and was a potential confounder of the higher S100B increase.
Procedural and outcome impact of obesity in cryoballoon versus radiofrequency pulmonary vein isolation in atrial fibrillation patients
Authors: Scheurlen C , Van Den Bruck JH , Dittrich S , Erlhoefer S , Filipovic K , Lueker J , Woermann J , Steven D , Sultan A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cryoballoon-(CB)- and radiofrequency-(RF)-ablation are the most common techniques for pulmonary vein isolation (PVI) in patients (pts) with symptomatic atrial fibrillation (AF). An increasing number of pts undergoing PVI are obese.

Objective
To address the paucity of procedural differences and outcome data of CB- vs. RF-based PVI in relation to body mass index (BMI) of AF patients.

Methods
All pts undergoing de novo PVI between 01/2018-08/2019 at our university hospital were included in this retrospective analysis. Pts of each group (CB-PVI vs. RF-PVI) were subdivided based on their BMI: normal weight BMI &lt;25kg/m², pre-obesity 25-30kg/m², obesity stage I 30-35kg/m² and severe obesity stage II ≥35kg/m². Hereafter, procedural characteristics and AF recurrence rate during follow-up were compared with regard the different BMI groups.

Results
A total of 526 pts (62% male, 65.3±11.2 years) underwent successful de novo PVI (320 CB and 206 RF). Especially in obese patients, differences in procedural characteristics were noted: A significantly increased contrast medium volume in CB group (all: CB 50 [40-80] vs. RF 20 [20-30], p&lt;0.001; BMI≥35: CB 70 [54.5-102.5] ml vs. RF 20 [15-30] ml, p&lt;0.001). In line with previous studies, the overall procedure time was significantly shorter with CB-PVI (CB 75 [60-100] vs. RF 120 [110-180], p&lt;0.001). Also, as expected, lower fluoroscopy dose was detected in RF group (all: CB 392.4 [197.9-995.9] vs. RF 282.5 [139.8-507.2], p&lt;0.001). The complication rate was equal throughout all BMI groups.
A 12-month follow up was available in 480 of 526 (91%) pts. Freedom from any arrhythmia was comparable between CB-PVI and RF-PVI (CB 77% vs. RF 75%, p=0.63). However, for obese pts a trend towards higher AF recurrence rate after RF- compared to CB-PVI was observed (BMI≥35: CB 24% vs. RF 50%, p=0.099).

Conclusion
For obese pts CB-PVI is similarly safe and effective as RF-PVI. The significantly shorter procedure time for CB-PVI may minimize potential obesity-related complications. However, the lower contrast medium quantity and fluoroscopy dose in RF-PVI must be considered. AF recurrence rates were comparable between CB-PVI und RF-PVI. Randomised trials are needed to evaluate the long-term freedom of AF recurrence in pts with higher BMI comparing CB- vs. RF-based PVI and possible obesity related complication.
The impact of RF wattage level on local impedance and procedural parameters in AF ablation cases
Authors: Meynet I , Stabile G , Mantica M , Ferraro A , D’ammando M , Scaglione M , Di Cori A , Schillaci V , Ottaviano L , Mantovan R , Ferrari F , Bianchi S , Solimene F , Malacrida M , De Sanctis V 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Local impedance (LI) measurement can provide information on catheter tip contact, but also changes in LI during ablation can inform the extent and effectiveness of RF energy delivery. To date the relationship between highly LI measurements and contact force (CF) during atrial fibrillation (AF) ablation at different levels of energy delivery is still lacking.

Purpose
We aimed to evaluate the impact of power setting on LI and key procedural parameters in AF ablation cases.

Methods
A novel CF ablation catheter equipped with dedicated algorithm was used to measure LI at the distal electrode of this catheter. Radiofrequency (RF) catheter applications ≥45 watts were categorized as high power (HP) and applications &lt;45w as standard power (SP). Ablations were also grouped according to different levels of CF (&lt;5g, 5-14g, 15-24g and ≥25g). Data are reported as mean±SD.

Results
Sixty-two consecutive pts undergoing RF catheter ablation of AF from the CHARISMA registry were included A total of 4619 ablation spots performed around PVs were analyzed (58% paroxysmal, 84% de novo, RF deliveries per pt=76±27, RF delivery time=9.1±5s, CF=12.3±8g). The majority of these were HP applications (n=4192, 91%). The mean LI was 158±17Ω prior to ablation and 138±14Ω after ablation (p&lt;0.0001, absolute LI drop of 21.9±8Ω) with a LI drop rate equal to 4.4±3Ω/s. HP ablations had significantly shorter RF delivery times, 8.8±4s vs 12±7s (p&lt;0.0001), larger LI drops (22.2±8Ω vs 19.3±9Ω, p&lt;0.0001) and higher LI drop rates (4.5±3Ω/s vs 3.6±2Ω/s, p&lt;0.0001) than SP, respectively. For both HP and SP settings, the magnitude of LI drop increased and RF delivery time decreased with increasing amounts of CF. The largest differences between HP and SP were found when CF was &lt;15g (RF delivery time: 9±5s at HP vs 12.9±7s at SP, percentage of difference 26.3%, p&lt;0.0001; LI drop: 21.2±8Ω at HP vs 18.6±9Ω, percentage of difference -14.3%, p&lt;0.0001). No major complications occurred during the procedures. All PVs were successfully isolated.

Conclusions
This preliminary experience suggests that, HP ablation is effective and safe and resulting in shorter RF delivery times and larger LI drops than SP ablation.
The impact of atrial fibrillation burden early post cryoballoon pulmonary vein isolation on long-term freedom from recurrent atrial fibrillation
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
Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. A three-month blanking period (BP) is commonly used in clinical trials and practice. Early recurrence of AF portends worse ablation long-term outcome; however, the utility of using AF burden (AFB) early post cryoballoon (CB) PVI to predict long-term outcome is unknown.

Purpose
To determine, using ECG data acquired by an implantable loop recorder (ILR), the relationship between post-ablation AFB and long-term freedom from AF.

Methods
We enrolled consecutive patients with AF who had CB PVI and an ILR. We determined the monthly AFB for the first 3 months post CB PVI and assessed the relationship between AFB and 1-year freedom from AF. We defined 4 distinct AFB groups: (1) 0%, (2) &gt; 0-0.1%, (3) &gt; 0.1-0.5%, and (4) &gt; 0.5%.

Results
There were 210 patients (66 ± 9 years; 138 [66%] male; 116 [55%] paroxysmal AF; CHA2DS2-VASc 2.5 ± 1.6). Following a 3-month BP, 101 (48%) patients had a recurrence of AF at 160 ± 86 days post-ablation. An AFB of &gt; 0% over the first 3 months predicted AF recurrence (p &lt; 0.0001, Figure 1). Patients with &gt; 0.5% AF burden after 1st month and any AF after 2nd month post CB PVI have a very high long-term AF recurrence rate (Figure 2).

Conclusion
The best long term outcome post CB PVI is seen in pts who have no AF in the first 3 months post ablation. An AFB &gt;0.5% after the first month and any AF after the second month portend ablation failure. These data define a clinical utility of using AFB to risk stratify patients post CB PVI.
Single-center outcome after ablation of atrial fibrillation using very high-power short duration pulmonary vein isolation
Authors: Manninger M , Rohrer U , Eberl AS , Pratl B , Loibnegger S , Andrecs L , Zirlik A , Scherr D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Catheter ablation of atrial fibrillation is (AF) an established second line therapy for patients with symptomatic paroxysmal (PAF) and persistent AF (persAF). Novel ablation catheters with integrated thermocouples allow fast application of radiofrequency lesions with powers up to 90W.
We aimed to describe primary and secondary outcomes after very high-power short duration (vHPSD) ablation.

Methods
126 consecutive patients (78 PAF, 43 persAF, 5 longstanding persistent AF) underwent pulmonary vein isolation (PVI) using the QDOT Micro Catheter (Biosense Webster) with the ablation mode QMODE+ (90W, 4s, interlesion distance ≤4mm anterior, ≤6mm posterior).

Results
Mean age was 62±9 years, 33% were female, median CHA2DS2-VASc Score was 2 (0, 7). Median follow up duration was 204 (14, 461) days. 30% of patients had additional ablation of typical right atrial flutter.
Primary success rate to achieve pulmonary vein isolation was achieved in all patients, no catheter-related complications (e.g., charring, steam pop) occurred. First pass isolation of all 4 PVs was achieved in 48% of patients, re-ablations were necessary in the carina regions (right: 37% of cases, left: 29%) and ridge (14%). Median procedure for PVI only were 102 (45-210) minutes.
Arrhythmia-free survival was 79,6% (see Figure 1). Eight patients underwent re-do procedures during follow-up showing most commonly showing gaps in the right inferior PV (63%) and ridge (50%).

Conclusion
Very high-power short duration ablation allows safe and quick pulmonary vein isolation. However, first pass isolation rate is low due to gaps in the carina regions. Arrhythmia-free survival is comparable to other pulmonary vein isolation techniques.
Figure 1: Left panel: Sample image of a vHPSD-PVI, posterior view of the left atrium. Right panel: Single procedure arrhythmia-free survival after vHPSD-PVI.
Conduction velocity mapping in Bachmann Bundle using Omnipolar Technology
Authors: Volpato G , Casella M , Compagnucci P , Valeri Y , Parisi Q , Cipolletta L , Carboni L , Bondavalli B , La Piscopia V , Messano L , Ricciotti J , Guerra F , Dello Russo A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Bachmann’s bundle is emerging as a critical component of atrial fibrillation (AF) catheter ablation (CA). The introduction of Omnipolar Technology (OT) in the new Ensite X Cardiac Mapping system, provides three-dimensional information on conduction velocity, activation direction and voltage of endocardial potentials, independently of catheter orientation. OT can create a wave speed map: a color map type coded by numeric value of conduction velocity.

Objective
To assess the feasibility and reliability of left atrium wave speed maps in Bachmann’s bundle identification and conduction velocity characterization.

Methods
We included 10 patients, (60% male, 40% female, mean age 56±8.7 years) undergoing CA for paroxysmal AF at our institution with new Ensite X Cardiac Mapping System; the left atrium (LA) was mapped with the Advisor HD Grid catheter. A sinus rhythm voltage map and wave speed map were obtained and analyzed to identify high conduction velocity areas throughout the Bachmann’s bundle location (septum, roof and left atrium appendage (LAA)).

Results
Wave speed mapping allowed the identification, at the septum, roof and LAA, of a myocardial bundle with greater speed values (2.5±0.3 m/s) with respect to mean atrial value (1±0.1). Pulmonary vein antra conduction velocity mean value was 1.2±0.4 m/s. Standard voltage map (low-voltage areas defined as any LA region with voltage values &lt; 0.5 mV) was compared with wave speed map. Standard voltage map (Figure 1) did not discriminate Bachmann’s bundle, while wave speed map did (Figure 2).

Conclusion
Wave speed mapping introduced by OT is a promising new map type, allowing characterization and identification of Bachmann’s bundle. Further studies are needed to assess the impact of this new technology on procedural workflow and clinical outcome.