bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pulmonary vein isolation with high power, short duration ablation leads to shorter procedure times associated with high success rates: a Prospective Randomized Trial
Authors: Theis C , Kaiser B , Pirozzolo G , Bekeredjian R , Huber C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The single procedure success rates of durable pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) varies between 85 and 90 %.
This prospective, randomized study investigated the efficacy of high power, short duration ablation in a temperature-controlled mode versus standard power settings in terms of single-procedure arrhythmia-free outcome, safety and procedural time.

Methods and results
A total number of 176 patients undergoing de-novo catheter ablation for paroxysmal AF were randomized to two different treatment arms. In group-A patients, PVI was performed with RF-energy with standard power settings of 30 Watts in a temperature-controlled mode.
The ablation procedure in group B was performed with RF-energy with higher power settings of 45 Watts. In both groups the ablation was performed with ablation index (AI) and following the CLOSE protocol (Biosense Webster Thermocool STSF).
A total of 88 patients were randomized into each group without significant differences in baseline characteristics.
During a mean follow-up of 12 ± 4 months after a single procedure, 79 (90%) patients of group A were free of arrhythmia recurrence versus 82 (93 %) patients in group B (p=ns).
With regard to the procedural data, the procedure time was significantly shorter in group B (115.35 ± 15.38 versus 96.45 ± 17.19; p&lt;0.01), the flouroscopy time and dose area were also significantly lower in Group B (9.66 ± 3.86 vs 5.45 ± 2.35; 330.84 ± 150.36 vs 202.51 ± 135.23) and total ablation times were significantly shorter in group B ((Table 1). Both procedures were performed with a low number of complications, no pericardial effusion was seen in either group, in both groups two patients had a significant hematoma of the groin with the need of surgical repair.

Conclusions
RF-ablation with high power (45 Watts) in combination with ablation index and following the CLOSE protocol leads to shorter procedure times, a lower total ablation time and a good safety profile.
Pacemaker and AV node ablation after multiple AF ablation procedures: a patients perspective - The PANAMA PAPER
Authors: Iversen E , Chen J , Libin S , Solheim E , Vavik V , Schuster P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Objectives
The aim of this study was to assess the number of AF catheter ablations appropriate before decision of pacemaker implantation and AV node ablation.

Background
The main purpose of AF treatment strategy, including both therapies aimed to maintain sinus rhythm and therapies that control the rate, is symptomatic improvement. Complex decision-making is involved in the choice of strategy. Indication for AF catheter ablation is the presence of symptomatic paroxysmal or persistent AF. However, many patients suffer from arrhythmia recurrence. Atrioventricular (AV) node ablation is a therapeutic option when AF is refractory to other therapeutic options.

Methods
This is a retrospective study based on patients recruited from the local database at Haukeland university hospital. Criteria for inclusion were patients with highly symptomatic AF after two or more AF catheter ablations and finally pacemaker and AV node ablation. Symptomatic improvement and quality of life were assessed using modified European Heart Rhythm Association (mEHRA) classification and self-evaluation.

Results
A total 23 patients were included in the study. After repeated AF catheter ablations, 7 (30.4%) patients had improvement in mEHRA class, most often by one class (n = 6). The improvement after AV node ablation were more significant (6 patients by 1 mEHRA class, 7 by 2, 5 by 3). According to the self-evaluation after AV node ablation, 18 patients were satisfied with respect to quality of life. The number of hospitalization were reduced from more than 6 per year (n = 11) to zero (n = 17) per year. Only one patient, among the 12 with only two AF catheter ablations, would prefer further attempts at AF catheter ablation. Retrospectively, 7 out 11 patients with at least 3 AF catheter ablations had preferred earlier pacemaker implantation and AV node ablation.

Conclusion
AV node ablation after several AF catheter ablations is a good option according to patients experience. In selected groups, recognized to have lower clinical efficacy of pulmonary vein isolation, AV node ablation might be considered after 2 or 3 unsuccessful AF catheter ablations.
Impact of high-power and very high-power short-duration radiofrequency ablation on procedure characteristics and first-pass isolation during pulmonary vein isolation
Authors: Sallo Z , Perge P , Piros K , Herczeg SZ , Nagy KV , Osztheimer I , Abraham P , Merkely B , Geller L , Szegedi N 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
High-power short-duration (HPSD) radiofrequency ablation has been proposed as a method for producing rapid and effective lesions for pulmonary vein isolation.We aimed to evaluate the procedural characteristics and the FPI rate of HPSD and very high-power short-duration (vHPSD) compared to low-power long-duration (LPLD) ablation techniques.

Methods
156 patients with atrial fibrillation (AF) were enrolled and assigned to LPLD, HPSD, or vHPSD PVI. The energy setting was 30W, 50W, and 90W in the LPLD, HPSD, and vHPSD groups, respectively.

Results
Bilateral PVI was achieved in all cases. The procedure time was 85 [75-101] min, 79 [65-91] min, and 70 [53-83] min in the LPLD, HPSD, and vHPSD groups, respectively (p&lt;0,0001). LA dwelling times were also decreased significantly with the increase of RF energy (61 [55-70] min, 53 [41-56] min, and 45 [34-52] min, in the LPLD, HPSD, and vHPSD groups, respectively, p&lt;0.0001). The total RF ablation time was 1398 [1021-1711] sec, 1567 (1366-1761) sec, and 336 [247-386] sec in the LPLP, HPSD, and vHPSD group, respectively ( p&lt;0,0001). Bilateral FPI was rate was 57%, 78% and 80% in the LPLD, HPSD, and vHPSD groups, respectively (p=0,0097). On the left side, FPI was achieved in 66% in the LPLD, in 92% in the HPSD, and in 85% in the vHPSD ablation group (p=0.0015). FPI on the right side was achieved in 72% in the LPLD, in 88% in the HPSD, and in 88% in the vHPSD ablation group (p=0,0188). FPI rates were significantly higher in the HPSD group compared to the LPLD group: both sided FPI rate was 57% vs. 78% (p=0.021), left sided FPI rate was 66% vs. 92% (p=0.0015), and right sided FPI rate was 72% vs. 88% (p=0.0401). Further increase in the RF power did not result in a significant additional increase in the FPI rate. In the HPSD vs. vHPSD group both sided FPI rate was 78% vs. 80% (p=0,8080), left sided FPI rate was 92% vs. 85% (p= 0,5275), and right sided FPI rate was 88% vs. 88% (p= 0,7561). Univariate analysis revealed that the use of HPSD ablation technique is associated with a higher probability of FPI (both sides: OR=2.72, 95% CI 1.15-6.44, p=0.023; right side: OR=2.90, 95% CI 1.02-8.20, p=0.045; left side: OR=5.91, 95% CI 1.84-19.04, p=0.003). The mid-term arrhythmia-free survival was similarly high in all three groups.

Conclusion
Our prospective, observational cohort study showed that both HPSD and vHPSD RF ablation is effective, as it shortens procedure time and RF time and results in a higher rate of FPI compared to LPLD ablation. Moreover, the mid-term arrhythmia-free survival was similarly high in all three groups. In our study, no safety concerns were raised due to HPSD ablation.
Visualizable vs. standard, non-visualizable steerable sheath for pulmonary vein isolation procedures: randomized, single-center trial
Authors: Janosi K , Debreceni D , Janosa B , Simor T , Kupo P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Steerable sheaths are frequently used to improve catheter contact during pulmonary vein isolation (PVI) procedures. A new type of visualized (by electroanatomical mapping system) steerable sheath has become available in clinical treatment.

Purpose
We aimed to compare procedural data of visualizable vs. non-visualizable steerable sheath assisted PVI procedures of patients with atrial fibrillation (AF).

Methods
In this single-center randomized study, we enrolled a total of 58 consecutive patients who underwent PVI due to AF. In 30 patients, the procedures were performed using non-visualizable steerable sheath (Group 1), while we used visualizable steerable sheath for PVI in 28 cases (Group 2).

Results
Compared to Group 1, using the visualizable sheath significantly reduced total fluoroscopy time (267 ± 145 s vs. 197 ± 74 s; p=0.03), fluoroscopy dose (26.2 ± 24.7 mGy vs. 16.7 ± 16.1 mGy; p=0.04) and left atrial procedure time (72.1 ± 18.7 min vs. 61.4 ± 18.9 min; p=0.05). Total ablation time (1158 ± 347 s vs. 1067 ± 196 s; p= 0.28), number of radiofrequency pulses (78 ± 19 vs. 77 ± 32; p=0.81) and total procedure time (117.7 ± 30.0 min vs. 105.0 ± 21.4 min; 0.09) did not differ between the two groups. No major complications occurred in either group.

Conclusion
Using visualizable steerable sheath for PVI procedures can reduce fluoroscopy exposure and left atrial procedure time compared to standard, non-visualizable steerable sheath in patients undergoing PVI procedures.
Zero-fluoroscopy catheter ablation of supraventricular tachycardias in pediatric population
Authors: Topalovic M , Prolic Kalinsek T , Zizek D , Kuhelj D , Lakic N , Mazic U , Jan M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Catheter ablation (CA) of supraventricular tachycardias (SVTs) in pediatric patients is conventionally performed with the aid of X-ray fluoroscopy. Usage of the three-dimensional (3D) electro-anatomical mapping (EAM) system and the intracardiac echocardiography (ICE) enables zero-fluorscopy ablation, eliminating the harmful effects of the radiation (1-3).

Purpose
We retrospectively analyzed the feasibility, effectiveness and safety of zero-fluoroscopy radiofrequency and cryoablation of various types of SVTs in pediatric patients.

Methods
In this retrospective study, we analyzed consecutive pediatric patients who underwent CA procedure due to SVT in our institution from April 2014 to October 2021. All procedures were performed completely without the use of fluoroscopy. A 3D EAM system and ICE were used as the principal modes of catheter visualisation. Left-sided procedures were done with ICE guided transseptal approach. Radiofrequency was the principal energy source, while cryoablation was used for arrhythmia substrates in the proximity of the conduction system.

Results
The study included 174 consecutive patients (69/174 (66%) female; 12.5 ± 3.9 years; 19.2 ± 3.6 kg/m2). Altogether 176 SVTs were diagnosed and treated. Atrio-ventricular nodal reentry tachycardia (AVNRT) was diagnosed in 45% of cases (80/176), atrio-ventricular reentry tachycardia (AVRT) in 47% (82/176), focal atrial tachycardia (AT) in 7% (13/176), typical atrial flutter (AFL) was treated in only one patient, while 2 patients had multiple arrhythmias (AVNRT and AVRT). In total, 202 procedures were performed. Radiofrequency ablation was performed in 76% (154/202), cryoablation in 20% (40/202) and both in 4% (8/202) of procedures. The acute procedural success rate was 96% (195/202). Procedural success rate was 99% (79/80) for AVNRT, 94% (77/82) for AVRT, 92% (12/13) for AT, and 100% (1/1) for AFL, respectively. There were no major complications in our study group. Follow-up was complete in 99% (172/174) of patients. During the follow-up period of a median of 316 days (181 - 747), 98% of patients were arrhythmia free. On average, 1.16 procedures per patient were performed with the long-term success rate of 99% (79/80), 98% (80/82), 100% (13/13) and 100% (1) for AVNRT, AVRT, AT, and AFL, respectively.

Conclusion
Zero-fluoroscopy CA of various types of SVTs in pediatric population is a feasible, effective, and safe treatment option.
Impact of gender on survival of out-of-hospital cardiac arrest presenting with refractory ventricular arrhythmias and role of coronary artery disease
Authors: Caputo ML , Baldi E , Krull JD , Cresta R , Benvenuti C , Primi R , Currao A , Bendotti S , Compagnoni S , Gentile FR , Savastano S , Klersy C , Auricchio A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Clinical presentation and outcome of out-of-hospital cardiac arrest (OHCA) presenting with shockable rhythm may vary between males and females. Very limited data exist on gender-related differences in OHCAs with refractory ventricular arrhythmias (VA) and, in particular, on distribution and prevalence of coronary artery disease (CAD).

Purpose
The aim of this study was to characterize gender-related outcome, prevalence and severity of CAD in OHCA victims presenting with shockable rhythm and refractory VA.

Methods
All OHCAs presenting with shockable rhythm occurred between 2015 and 2019 in the province of Pavia (Italy) and in the Canton Ticino (Switzerland) were included.

Results
Out of 3592 OHCAs, 685 presented with shockable rhythm and, of them, 212 had a refractory VA. Overall, male gender was independently associated with a lower probability of survival both at hospital admission and at 30-days (OR 0.63, 95% CI 0.58-0.67, p &lt;0.001 and OR 0.82 95% CI 0.74-0.91, p &lt;0.001, respectively) and presented with a more severe CAD. Male gender was 5-times more frequently associated with OHCA presenting with refractory VA. Despite of a more favourable OHCA presentation (i.e. more often OHCA witnessed, public place occurrence and CPR initiated by bystander) male patients with refractory VA had a lower likelihood of survival (OR 0.25, 95% CI 0.21-0.30). A higher prevalence (81%) of CAD was observed in OHCAs presenting with refractory VA but not a higher number of diseased vessels.

Conclusions
Male gender is more frequently associated with refractory VA, lower probability of survival and higher prevalence and severity of CAD. CAD severity, however, does not significantly affect refractory VA presentation.
Standardizing the cardiac radioablation targeting workflow: enabling semi-automated angulation and segmentation of the heart according to the American Heart Association segmented model
Authors: Van Der Ree MH , Visser J , Planken RN , Dieleman EMT , Boekholdt SM , Balgobind BV , Postema PG 
Published: May 2022

Abstract

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

Purpose
Cardiac radioablation has evolved as a potential treatment modality for therapy-refractory ventricular tachycardia. To standardize cardiac radioablation treatments, promote accurate communication and target identification, and to assess toxicity, robust and reproducible methods for angulation and cardiac segmentation are paramount. In this study, we developed and evaluated a workflow for semi-automated angulation and segmentation according to the American Heart Association (AHA) 17-segment model.

Methods and materials
The workflow for semi-automated angulation and segmentation of the planning-CT was based on an in-house developed tool requiring placement of only 4 point-markers and a rotation matrix. For angulation, 2 markers defining the cardiac long-axis were placed: at the cardiac apex and at the center of the mitral valve (figure A). A rotation matrix was derived that angulates the CT-volume, resulting in the cardiac short axis (figure B). Segmentation was subsequently performed based on marking the two left ventricular hinge points (figure BC). To evaluate reproducibility, 5 observers independently placed markers in planning-CTs of 6 patients.

Results
The Root-Mean-Square of the standard deviation for the angulation and segmentation marker positions were all below 0.52cm. The 17-segments were subsequently generated and compared between the observers resulting in a median dice coefficient of 0.8 [0.70;0.87] and a median of the mean Hausdorff distance of 0.09cm [0.05;0.17]. Figure D shows the heat maps of two illustrative segments indicating the percentage agreement per voxel between the 5 observers. The interquartile ranges of Euler angles α and β, determined by the angulation markers, was less than 30 for all patients except one. For the γ angle, determined by the hinge point markers, the interquartile range was up to 120.

Conclusion
In this study, a workflow for cardiac radioablation is presented that enables reproducible semi-automatic cardiac angulation and segmentation of the planning-CT according to the AHA 17-segment model. This workflow can be easily implemented and be used to promote communication between radiation oncology and cardiology, enables cardiology-oriented targeting and permits focused toxicity evaluations.
Impact of pacing output and cycle length on qrs morphology in ablation of premature ventricular contractions (PACE-MAP-Trial)
Authors: Van Den Bruck J-H , Woermann J , Sultan A , Filipovic K , Scheurlen C , Erlhoefer S , Arica Z , Dittrich S , Schipper J , Steven D , Lueker J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pace mapping is an established technique to localize the origin of premature ventricular contractions (PVC). The QRS morphology induced by endocardial pacing is compared with a previously recorded template of the target arrhythmia. Based upon historic in-vitro models pacing at the arrhythmia’s coupling interval (CI) and stimulation threshold has become the gold standard in pace mapping.

Purpose
There is a paucity of data supporting pacing at the CI and stimulation threshold as the gold standard for pace mapping. In this prospective study, we sought to assess systematically the impact of variations of pacing output and cycle length on the resulting QRS morphology during pace mapping in the context of PVC ablation (NCT05061498).

Methods
All patients undergoing ablation of idiopathic PVC were prospectively enrolled in this study. Pace mapping was performed using four different parameter settings: (1) A predefined fixed burst at maximum output (10V/2ms), (2) fixed burst at stimulation threshold, (3) coupling interval at maximum output and (4) coupling interval at stimulation threshold. Pacing cycle length (PCL) of the fixed burst was defined as follows: for a CI ≤450ms = PCL of CI+100ms and for a CI ≥450 = PCL of CI-100ms. Using an automated waveform comparison algorithm, the resulting QRS complexes were matched with the clinical PVC, and with the gold standard. For every parameter setting the mean of the matching percentage of three QRS complexes entered the analysis.

Results
We report data of the first 22 consecutive patients (53±15 years, 64% female) enrolled in this ongoing study between May and November 2021. The pacing protocols were performed at 39 different sites: 5/39 epicardially via great cardiac vein, 15/39 in the RVOT 12/39 and 7/22 in the left ventricular cavity. When comparing the QRS morphologies resulting from the four different pace mapping settings with the clinical PVC, the univariate analysis revealed no difference between groups (p=0.9). Furthermore, there was no difference comparing the paced QRS morphologies at different output and cycle length to the gold standard of threshold pacing at coupling interval (p=0.9).

Conclusion
Variations of pacing output and stimulation cycle length during pace mapping does not affect QRS morphology during PVC ablation. Applying a modern automated waveform comparison tool, no advantage was observed when comparing with the gold standard. It is therefore reasonable to assume, that pace mapping can be performed using an easily applicable setting of a fixed burst at maximum pacing output.
Stereotactic radiosurgery for ablation of ventricular tachycardia in the setting of electrical storm
Authors: Ninni S , Gallot Lavallee T , Klein C , Longere B , Brigadeau F , Potelle C , Crop F , Rault E , Lacornerie T , Lals S , Kouakam C , Pontana F , Lacroix D , Klug D , Mirabel X 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Stereotactic body radiotherapy (SBRT) has been reported as a safe and efficient therapy to treat refractory VT despite optimal medical treatment and/or catheter ablation (CA). However data in the setting of ES are lacking.

Objectives
The aim of this study was to assess the clinical outcomes associated with SBRT in the setting of ES.

Methods
This retrospective study included patients who underwent SBRT in the setting of ES from March 2019 to March 2021 in one tertiary center (CHU Lille). Target volume was delineated according to a predefined workflow. The efficacy was assessed with the following endpoints: sustained VT recurrence, VT reduced with ATP or ICD shock.

Results
17 patients underwent SBRT to treat refractory VT in the setting of ES (Mean age: 67±12.8, 59% presenting ischemic heart disease, mean LVEF: 33.7± 9.7%). After a median follow-up of 7 [5; 16] months, a reduction in VT burden was observed in all patients after a 6-week blanking period. 6 patients presented an increase of the VT burden from week 2 to week 6 following SBRT despite an initial reduction of VT burden. No patient experienced ICD shocks beyond 6 weeks.

Conclusion
SBRT is efficient in treating recurrent VT in the setting of ES with failure and/or contraindication to CA. One third of patient present a transient increase in VT burden during a 6 weeks blanking period. Therefore, VT tolerance should be integrated as part of an action plan defined upstream to SBRT for each patient.