bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intra-procedural three-dimensional rotational angiography in cryoballoon ablation of atrial fibrillation - a randomised clinical trial
Authors: Prepolec I , Pasara V , Pezo-Nikolic B , Puljevic M , Puljevic D , Milicic D , Velagic V 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
To facilitate atrial fibrillation (AF) ablation procedures there is a variety of approaches for pre-procedural imaging of pulmonary veins (PV) and left atrium (LA), including CT angiography and cardiac MRI. Intra-procedural three-dimensional rotational angiography (3DRA) is the least employed method and it can be advantageous regarding efficiency and procedural logistics. Data supporting different practices is still evolving and there is an open question whether LA imaging could improve safety and outcomes of CB ablation.

Purpose
The aim of this study is to evaluate possible benefits of 3DRA for procedural success, safety and long-term outcomes of CB ablation.

Methods
We designed a single-centre unblinded randomised clinical trial and recruited 101 patients (65.3% male, 59.3±11.5 years) with paroxysmal (92%) and early-persistent AF. Patients were randomized to no imaging or 3DRA which was performed intra-procedurally after trans-septal puncture. Angiographic images were segmented and overlaid to the fluoroscopy screen to guide the ablation procedure. All patients are followed for 1 year and data concerning procedural characteristics, safety outcomes and AF recurrence are being collected.

Results
Of all the patients recruited, 48 (47%) underwent 3DRA. In patients who received no imaging (non-3DRA group) one PV couldn’t be isolated while in 3DRA group isolation of one PV could not be achieved in 3 patients (OR 3.47, 95% CI 0.35-34.51). The occurrence of left common PV, an anatomical variation that could have potential to influence results, was similar in both groups (25,4% in non-3DRA and 25.0% in 3DRA group). Procedure time was significantly longer when 3DRA was performed (87.4±27.7 min compared to 69.9±23.0 in non-3DRA group, p&lt;0.001). Total radiation dose (148.2±177.7 vs 387.7±203.8 mGy, p&lt;0.001) and contrast administration (42.5±27.1 vs 133.8±26.8 ml, p&lt;0.001) were significantly lower in the control group. Only minor complications were reported in both groups. Three patients developed large haematoma (2 in 3DRA group vs 1 in control group). In each group there was one incident of transient phrenic nerve palsy.

Conclusion
3DRA is a safe and efficient intra-procedural imaging method to guide CB ablation for AF. However, it significantly increases procedure duration, total radiation dose and contrast expenditure. In our trial it did not have any impact on the acute success rate of PV isolation. One-year follow up data is still being collected and will subsequently be presented.
Characterization of high-power and very-high-power short-duration radiofrequency lesions performed with a new-generation catheter and a temperature-control ablation mode
Authors: Lozano-Granero C , Moreno Planas J , Matia-Frances R , Hernandez-Madrid A , Sanchez-Perez I , Zamorano Gomez JL , Franco-Diez E 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
High-power short-duration (HP-SD) and very high-power short-duration (VHP-SD) has recently emerged as an alternative ablation strategy to shorten application times while maintaining or improving the effectiveness and safety of atrial fibrillation ablation (1 - 2). Although usually performed with standard irrigated-tip catheters in a power-controlled mode, a novel dedicated catheter with a multi-thermocouple system capable of real-time temperature monitoring and optimized for temperature-controlled ablation by power and irrigation rate modulation has been developed for this scenario (3 - 4).

Purpose
We conducted an experimental ex-vivo study to analyse the differences between radiofrequency lesions obtained with this novel catheter (QDOT MICRO®) using HP-SD and VHP-SD. Besides, we also aim to compare them to HP-SD lesions obtained with a standard non-dedicated catheter (THERMOCOOL SMARTTOUCH®) and to conventional-powered lesions performed with either catheter.

Methods
280 epicardial radiofrequency applications were performed on porcine left ventricle submerged in 37ºC saline: 40 VHP-SD (90W) with QDOT MICRO (4 sets of 10 using a contact force (CF) of 10 and 20 grams and an application time of 3 and 4 seconds); 80 HP-SD lesions (50W), 40 of them with QDOT MICRO and 40 of them with THERMOCOOL SMARTTOUCH (4 sets of 10 lesions using a CF of 10 and 20 and an ablation index (AI) of 400 and 550 with each catheter) and 160 conventional-power lesions (35 and 40W), 80 of them with QDOT MICRO and 80 of them with THERMOCOOL SMARTTOUCH (4 sets of 10 lesions using a CF of 10 and 20 and an AI of 400 and 550 for each catheter and power setting). After each application, lesions were cross-sectioned and measured. Volume vas calculated using a validated formula (5).

Results
In an intracatheter analysis, HP-SD lesions were bigger than VHP-SD ones, both when using parameters intended for posterior wall ablation (AI 400 in HP-SD or 3 seconds in VHP-SD), 98.1±11.7 vs 36.8±8.5 mm3, p&lt;0.0001 with 10g CF, and 106.7±8.1 vs 52.3±9.8 mm3, p&lt;0.0001 with 20g CF; and when using parameters intended for anterior wall ablation (AI 550 in HP-SD or 4 seconds in VHP-SD), 227.6±25.1 vs 61.0±7.8 mm3, p&lt;0.0001 with 10g CF, and 186.6±23.3 vs 72.2±5.0 mm3, p&lt;0.0001 with 20g CF (see figure).
In an intercatheter analysis, conventional as well as HP-SD lesions were generally smaller with THERMOCOOL SMARTTOUCH than with QDOT MICRO, although less difference could be found when applying a CF of 20g instead of 10g (see figure and table).

Conclusions
VHP-SD lesions are smaller than HP-SD ones, which would allow for a safer and faster ablation. However, a HP-SD strategy would be preferable over VHP-SD if greater lesion volume is desirable.
Durability of pulmonary vein isolation following cryoballoon ablation: lessons from a large series of repeat ablation procedures
Authors: Mugnai G , Cecchini F , Stroker E , Sieira J , Bolzan B , Tomasi L , Brugada P , De Asmundis C , Chierchia GB 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The cryoballoon technology has been widely proven to be effective in achieving acute pulmonary vein (PV) isolation and favorable clinical outcome. To date, little information is still available about occurrence of late PV reconnection after cryoballoon ablation.

Purpose
To assess the rate of durable PV isolation following cryoballoon ablation of atrial fibrillation in the setting of repeat procedures.

Methods and Results
A total of 154 consecutive patients (90 male, 58.4%; mean age 60.6±12.6 years) underwent a repeat procedure, after a mean 21.5±12.4 months (median 14 months), after index ablation using the 28-mm second-generation cryoballoon. All repeat ablations were performed using a 3-dimensional electro-anatomical mapping system. Among all 590 PVs, including 26 left common ostiums (LCOs), 99 (16.8%) showed a PV reconnection in 86 patients (1.15 per patient). Persistent PV isolation could be documented in 491 of 590 PVs (83.2%). In 68 of 154 patients (44%), all PVs were electrically isolated. In the multivariable analysis, balloon nadir temperature (p&lt;0.01) and time to PV isolation (P=0.02) independently predicted late PV reconnection.

Conclusions
The rate of late PV reconnection after second-generation cryoballoon ablation was low (1.15 PVs/patient). Globally, the rate of durable PV isolation assessed during repeat procedures was 83.2%. The balloon nadir temperature and faster time to isolation were independently associated with durable PV isolation.
Early results of the novel radiofrequency balloon ablation catheter for pulmonary vein isolation
Authors: Breitenstein A , Kanthasamy V , Hofer D , Hunter R , Butcher CH , Ahluwalia N , Schilling RJ , Finlay M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary vein isolation (PVI) remains the cornerstone for treating of symptomatic atrial fibrillation (AF). Single-shot PVI technologies have evolved as a standard for first-time PVI. A novel radiofrequency balloon ablation catheter is now available to offer single-shot RF pulmonary vein isolation.

Purpose
To summarize the early experience using the novel RF balloon ablation catheter for patients undergoing PVI in two tertiary centres in Europe.

Methods
We prospectively assessed the first 38 consecutive patients undergoing PVI using RF balloon ablation catheter for paroxysmal or persistent AF in two high volume centres. Both centres used a standardised approach including ultrasound-guided vascular access, uninterrupted anticoagulation, transeptal puncture via the RF balloon sheath and a limited 3D mapping software-guided LA geometry created with a circular mapping catheter. Radiofrequency application for 60s to the anterior segments and 20s posteriorly was performed in all cases, phrenic pacing was employed for ablation of right PVs. BHS performed all procedures (except 2 cases due to high BMI and severe sleep apnea) under sedation, while all patients from UHZ underwent PVI procedures with general anaesthesia as per institutional protocol. All patients had an oesophageal temperature probe to assess oesophageal temperature during ablation (passed orally under sedation) and had uninterrupted oral anticoagulation throughout the periprocedural period.

Results
Overall, mean age was 64±8 years, 23 (61%) were male, 24 (63%) of patients had paroxysmal AF. The majority were de novo interventions (92%). There was no significant difference between the patients demographics in the two hospitals. All veins were isolated in both groups with a total of 144 applications (n = 73 in the sedation group, n = 71 in the GA population). Median fluoroscopy time was comparable (sedation group 1.1 minutes vs GA group 1.2 minutes; P = 0.58), but median procedure time was shorter in the sedation group (65 minute vs 106 minutes; P &lt; 0.001). The median number of RF ablation per patient (sedation group 7 vs GA group 9; P = 0.32) and time to isolation of each vein (sedation group 11 seconds vs GA group 10 seconds; P = 0.9) were similar. Number of acute reconnections requiring further ablations were not significantly different between groups (sedation group 11 [15%] vs GA group 14 [20%]; P = 0.96). One patient sustained transient phrenic nerve injury in the sedation group.

Conclusion
Our early experience shows the novel HS balloon ablation can be performed effectively, efficiently and safely under either GA or conscious sedition. The RF balloon ablation catheter paradigm lends itself to refined workflows, with low fluoroscopy requirements and a short learning curve even in initial cohorts.
Contact force-controlled high power short duration radiofrequency ablation enables efficient creation of roof line and anterior mitral line in course of low voltage areas
Authors: Schreieck J , Seizer P , Duckheim M , Scheckenbach C , Gawaz M , Heinzmann D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Linear ablation lines in the left atrium are questionable for treatment of atrial fibrillation (AF). In particular they are challenging, performed with limited success rate and are arrhythmogenic due to recurrence of conduction. Contact force (CF)-controlled high power short duration (HPSD) radiofrequency ablation (RFA) in areas of fibrosis may overcome these limitations.

Purpose
We investigated the efficiency of contact force (CF)-controlled high power short duration (HPSD) radiofrequency ablation (RFA) for creation of linear lines in case of fibrotic areas in the anterior left atrium.

Methods
In 530 consecutive patients (pts), age 65±9 years, paroxysmal AF in 45%, persistent AF in 55%, AF-re-ablation in 32% of pts, undergoing HPSD CF-controlled RF ablation of AF. Besides from pulmonary vein isolation (PVI) additional left atrial linear ablation in the anterior left atrium was performed in 28% of patients exclusively in case of low voltage areas in the course of the line or in case of re-ablation of prior performed lines. Fibrosis was defined by areas of less than 0.5mV signals in high density 3D microelectrode mapping. More than 5% low voltage was present in 46% of pts and more than 20% low voltage in 27% of pts. HPSD RF ablation was performed using a power of 50 Watt, duration 5-15s, with CF-controlled catheters, seeking for CF of 10-30g, and an interlesion distance of 6mm.

Results
A anterior roof line between both upper pulmonary veins was performed in 25% of pts (n=133), and an anterior mitral line in 17% of pts (n=88). The anterior mitral line connected the superior mitral anulus with left upper, right upper PV or anywhere this the roof line depending on the distribution of low voltage areas. Overall success rate of bidirectional conduction block at the roof line was 92% and at the mitral line 94%. After remapping of gaps and re-ablation with conventional 35-40 Watt RF application of unlimited duration, success rate at the roof line improved to 98% and at the mitral line to 97%. No serious complications were associated with creation of these lines, especially, no pericardial tamponade occurred. Limited follow up will presented at the time of presentation.

Conclusions
CF-controlled creation of ablation lines in the anterior left atrium (roof line and anterior mitral line) by HPSD RF ablation is very efficient and safe in case of areas of low voltage in the course of the linear ablation. In rare cases additional conventional RF application of unlimited duration becomes necessary to complete the lines supported by identification of gaps by high density 3D microelectrode mapping. This approach has the potential to improve efficacy of AF ablation in patients with atrial fibrosis. The hypothesis have to be proven by a prospective controlled study in the near future.
Impact of P-glycoprotein and/or CYP3A4-interacting drugs on the risk-benefit profile of NOACs in patients with atrial fibrillation: a meta-analysis
Authors: Grymonprez M , Vanspranghe K , Capiau A , Boussery K , Steurbaut S , Lahousse L 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Research Foundation Flanders (FWO)

Background
P-glycoprotein (P-gp) and CYP3A4-interacting drugs influence plasma levels of non-vitamin K antagonist oral anticoagulants (NOACs). However, the clinical relevance is questioned.

Purpose
A critical appraisal of the impact of pharmacokinetically-interacting drugs on the effectiveness and safety of NOACs in patients with atrial fibrillation (AF).

Methods
After searching Pubmed and Embase, phase III randomized controlled trials (RCTs) and longitudinal observational cohort studies on the impact of concomitantly used P-gp/CYP3A4-interacting drugs on the risk-benefit profile of NOACs in AF patients during a mean/median follow-up of ≥6 months were included. A fixed effects meta-analysis was performed with the Mantel-Haenszel method.

Results
Fifteen studies were included (10 post hoc analyses of RCTs, 5 observational studies), investigating 21,711 and 306,421 NOAC-treated AF patients with and without P-gp/CYP3A4 inhibitor use respectively, while only one study included P-gp/CYP3A4 inducers. In NOAC-treated AF patients, concomitant use of P-gp/CYP3A4 inhibitors was associated with significantly higher major bleeding (relative risk (RR) 1.10, 95% confidence interval (CI) (1.01-1.19)) and all-cause mortality risks (RR 1.14, 95%CI (1.05-1.23)) compared to not using P-gp/CYP3A4 inhibitors, while the risks of stroke/SE (RR 0.88, 95%CI (0.77-1.01)), intracranial bleeding (RR 0.89, 95%CI (0.68-1.15)) and gastro-intestinal bleeding (RR 1.09, 95%CI (0.91-1.30)) were not significantly different. Concomitant use of amiodarone with NOACs was associated with lower thromboembolic (RR 0.75, 95%CI (0.61-0.92)), but higher mortality risks (RR 1.21, 95%CI (1.05-1.39)). Co-administration of verapamil or diltiazem was associated with higher major bleeding risks (RR 1.64, 95%CI (1.31-2.06)), but no significantly different thromboembolic or mortality risks.

Conclusions
Given the higher bleeding and mortality risks in NOAC-treated AF patients concomitantly using P-gp/CYP3A4 inhibitors compared to NOAC users not taking interacting drugs, close monitoring of these patients is warranted, including regular medication review and addressing modifiable bleeding risk factors. Regarding P-gp/CYP3A4 inducers, a considerable research gap was identified, necessitating more research on their impact.
The optimal duration of dual antiplatelet therapy after PCI with drug-eluting stent: a systematic review and Bayesian network meta-analysis
Authors: Mengjin H 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Objective
We aimed to test the optimal duration of dual antiplatelet therapy (DAPT) on long-term clinical outcomes after implantation of drug-eluting stents (DES).

Methods
We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Web of Science through November 8th, 2021 to identify randomized controlled trials (RCT) assessing the duration of DAPT in patients receiving DES. Efficacy of all DAPT strategies was reported as pooled odd ratios (OR) with 95% credible interval (CrI) to summarize the effect of each strategy tested.

Results
We identified 24 RCTs containing 81405 patients. In comparison with 12-month DAPT, 3-month DAPT followed by P2Y12 inhibitor monotherapy could reduce net clinical events (OR: 0.72; CrI: 0.55-0.94) and major bleeding (OR: 0.57; CrI: 0.34-1.00) without increasing ischeamic events (OR: 0.93; CrI: 0.68-1.29). Although &gt;12-month DAPT was associated with a lower risk of myocardial infarction (OR: 0.67; CrI: 0.51-0.93), yet the risk of major bleeding (OR: 1.70; CrI: 1.10-2.70) was also increased, which is more strongly related to all-cause death than ischeamic events. Moreover, the benefits of 3-month DAPT (P2Y12 Inhibitor) were consistent for male patients with acute coronary disease, young age, complex lesion, single vessel disease, low body mass index, without diabetes.

Conclusion
Among patients treated with DES, 3-month DAPT followed by P2Y12 inhibitor monotherapy could reduce the risk of net clinical events without increasing ischeamic events. DAPT beyond one year reduced myocardial infarction at the expense of increased major bleeding. Taken together, 3-month DAPT followed by P2Y12 inhibitor monotherapy may be the optimal strategy for patients receiving DES.
Zero- and minimal fluoroscopic approaches during ablation of supraventricular tachycardias: A systematic review and meta-analysis
Authors: Debreceni D , Janosi K , Vamosi M , Komocsi A , Simor T , Kupo P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Catheter ablations for cardiac arrhythmias are conventionally performed under fluoroscopic guidance. Using three dimensional electroanatomical mapping systems to guide these procedures, zero/minimal fluoroscopy (Z/MF) approaches became available.

Purpose
Our aim was to conduct a meta-analysis comparing these two different methods for the treatment of paroxysmal supraventricular tachycardias (SVT).

Methods
Electronic databases were searched and systematically reviewed for studies comparing procedural parameters and outcomes of conventional, fluoroscopy-guided vs. Z/MF approaches in patients undergoing EP procedures for SVTs. The random-effects model was used to derive mean difference (MD) and risk ratios (RR) with 95÷ confidence interval (CI).

Results
24 studies involving 9,074 patients met our inclusion criteria. There were no differences between the groups in acute success (RR=1.00, 95÷ CI, 0.99–1.01; p=0.97) and long-term success rate (RR: 1.01, 95÷ CI, 1.00–1.03; p=0.13). Compared to the conventional method, Z/MF ablation significantly reduced fluoroscopic time (MD: -10.95 min (95÷ CI, -18.43 to -3.46 min; p&lt;0.01)) and ablation time (MD: -25.23 s (95÷ CI: -42.04 to -8.43 s; p&lt;0.01)). Procedure time (MD: 3.06 min (95÷ CI: -0.97 to 7.08; p=0.14)) and number of ablation applications (MD: 0.13 (95÷ CI: -0.86 to 1.11; p=0.80)) were not different between the groups. Complication rate was 1.59% in the entire study population and did not differ among the groups (RR: 0.68, 95÷ CI: 0.45–1.05; p=0.08).

Conclusions
Z/MF approach for the catheter ablation of SVTs is a feasible method that reduces radiation exposure and ablation time but does not compromise the acute and long-term success, or complication rates.
Incidence and clinical characteristics of patients with torsades de pointes complicating acquired atrioventricular block
Authors: Bun S-S , Heme N , Taghji P , Asarisi F , Squara F , Scarlatti D , Moceri P , Deharo JC , Ferrari E 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Female gender, degree of QT prolongation and genetic susceptibility are known risk factors for developing torsade de pointe (TdP) during high-degree atrioventricular block (HD-AVB).

Objective
To analyze the incidence and clinical characteristics of patients presenting with TdP and AVB (TdP [+]) in comparison with non-TdP patients with AVB (TdP [-]).

Methods
All the ECG from patients prospectively admitted for advanced AVB (2 to 1 and complete) at our university hospital were analyzed. Automated corrected QT (QTc), and manual measurements of QT and JT intervals, and Tpeak-Tend were performed at the time of most severe bradycardia.

Results
From Sept 2020 to Nov 2021, 100 patients were admitted for HD-AVB. Among them, 17 patients with TdP were identified (8 men; 81 ± 10 years). No differences could be identified concerning automated QTc, manual QTc (Bazett correction), baseline QRS width and mean left ventricular ejection fraction between the two groups. Potassium serum level on admission and mean number of QT-prolongating drugs per patient were not significantly different between the two groups, respectively: 4.34 ± 0.5 in TdP [+] versus 4.52 ± 0.6 mmol/L (p = 0.33); and 0.6 ± 0.7 in group A versus 0.5 ± 0.7 (p = 0.15). In contrast, manual QTcFR (Fridericia correction), corrected JT, Tpeak-to-end and Tpe/QT ratio were significantly increased in the TdP [+] group: respectively 486 ± 70 versus 456 ± 53 ms (p = 0.04); 433 ± 98 versus 381 ± 80 (p = 0.02); 153 ± 57 versus 110 ± 40 (p &lt; 0.001); 0.27 ± 0.08 versus 0.22 ± 0.06 (p &lt; 0.001).

Conclusion
The incidence of TdP complicating acquired AVB was 17 % in a medium-volume center. Longer QTc (Fridericia), corrected JT and Tpeak-to-end were electrocardiographic predictors of TdP, while no clinical characteristics may predict the occurrence of this complication.