EP Europace最新文献

{"title":"Long-Term Incidence of Arrhythmias in Extracardiac Conduit Fontan and Comparison Between Systemic Left and Right Ventricle","authors":"Corrado Di Mambro, Marie Laure Yammine, Pietro Paolo Tamborrino, Ugo Giordano, Daniela Righi, Marta Unolt, Nicoletta Cantarutti, Stella Maiolo, Sonia Albanese, Adriano Carotti, Antonio Amodeo, Lorenzo Galletti, Fabrizio Drago","doi":"10.1093/europace/euae097","DOIUrl":"https://doi.org/10.1093/europace/euae097","url":null,"abstract":"Aims The extracardiac conduit-Fontan (ECC) has become the preferred technique for univentricular heart palliation, but there are currently no data on the incidence of long-term arrhythmias. This study investigated the incidence of arrhythmias and relation to single ventricle morphology in the long-term follow-up in ECC. Methods and results All patients with ECC performed in our Centre between 1987 and 2017 were included (minimum follow-up 5 years). Of 353 consecutive patients, 303 [57.8% males, aging 8-50 (median 20) years at last follow-up] were considered and divided into 2 groups depending on left (194 in Group 1) or right (109 in Group 2) ventricular morphology. Eighty-five (28%) experienced ≥1 arrhythmic complications, with early and late arrhythmias in 17 (5.6%) and 73 (24.1%) patients, respectively. Notably, late bradyarrhythmias occurred after 6 years in 21 (11%) patients in Group 1, and in 15 (13.8%) in Group 2 [p=0.48]. Late tachyarrhythmias occurred in 55 (18.2%) patients after 12 years: 33 (17%) in Group 1 and 22 (20.2%) patients in Group 2 [p=0.5]. Ventricular tachycardias were documented after 12.5 years in 14 (7.2%) patients of Group 1 and 15 (13.8%) of Group 2 [p=0.06] with a higher incidence in Group 2 during the follow-up [p=0.005]. Conclusion ECC is related to a significant arrhythmic risk in the long-term follow-up, higher than previously reported. Bradyarrhythmias occur earlier but are less frequent than tachyarrhythmias. Interestingly, patients with systemic right ventricle have a significantly higher incidence of ventricular tachycardias, especially in very long follow-up.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140801250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personalized pulmonary vein isolation with very high-power short-duration lesions guided by left atrial wall thickness: the QDOT-by-LAWT randomized trial","authors":"Giulio Falasconi, Diego Penela, David Soto-Iglesias, Pietro Francia, Andrea Saglietto, Dario Turturiello, Daniel Viveros, Aldo Bellido, Jose Alderete, Fatima Zaraket, Paula Franco-Ocaña, Marina Huguet, Óscar Cámara, Radu Vătășescu, José-Tomás Ortiz-Pérez, Julio Martí-Almor, Antonio Berruezo","doi":"10.1093/europace/euae087","DOIUrl":"https://doi.org/10.1093/europace/euae087","url":null,"abstract":"Aims Pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) using very high-power short-duration (vHPSD) radiofrequency (RF) ablation proved to be safe and effective. However, vHPSD applications result in shallower lesions that might not be always transmural. Multidetector computed tomography-derived left atrial wall thickness (LAWT) maps could enable a thickness-guided switching from vHPSD to the standard-power ablation mode. The aim of this randomized trial was to compare the safety, the efficacy, and the efficiency of a LAWT-guided vHPSD PVI approach with those of the CLOSE protocol for PAF ablation (NCT04298177). Methods and results Consecutive patients referred for first-time PAF ablation were randomized on a 1:1 basis. In the QDOT-by-LAWT arm, for LAWT ≤2.5 mm, vHPSD ablation was performed; for points with LAWT > 2.5 mm, standard-power RF ablation titrating ablation index (AI) according to the local LAWT was performed. In the CLOSE arm, LAWT information was not available to the operator; ablation was performed according to the CLOSE study settings: AI ≥400 at the posterior wall and ≥550 at the anterior wall. A total of 162 patients were included. In the QDOT-by-LAWT group, a significant reduction in procedure time (40 vs. 70 min; P < 0.001) and RF time (6.6 vs. 25.7 min; P < 0.001) was observed. No difference was observed between the groups regarding complication rate (P = 0.99) and first-pass isolation (P = 0.99). At 12-month follow-up, no significant differences occurred in atrial arrhythmia-free survival between groups (P = 0.88). Conclusion LAWT-guided PVI combining vHPSD and standard-power ablation is not inferior to the CLOSE protocol in terms of 1-year atrial arrhythmia-free survival and demonstrated a reduction in procedural and RF times.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140801183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive Atrial Fibrillation Burden and Symptom Reduction Post-Ablation: Insights from DECAAF II","authors":"Charbel Noujaim, Ala Assaf, Chanho Lim, Han Feng, Hadi Younes, Mario Mekhael, Nour Chouman, Ghaith Shamaileh, Abdel Hadi El Hajjar, Tarek Ayoub, Nino Isakadze, Mihail G Chelu, Nassir Marrouche, Eoin Donnellan","doi":"10.1093/europace/euae104","DOIUrl":"https://doi.org/10.1093/europace/euae104","url":null,"abstract":"Introduction Traditional AF recurrence after catheter ablation is reported as a binary outcome. However, a paradigm shift towards a more granular definition, considering arrhythmic or symptomatic burden, is emerging. Hypothesis We hypothesize that ablation reduces AF burden independently of conventional recurrence status in persistent AF patients, correlating with symptom burden reduction. Methods 98 patients with persistent AF from the DECAAFII trial with pre-ablation follow-up were included. Patients recorded daily single-lead ECG strips, defining AF burden as the proportion of AF days among total submitted ECG days. The primary outcome was atrial arrhythmia recurrence. The Atrial Fibrillation Severity Scale (AFSS) was administered pre-ablation and at 12-months post-ablation. Results At follow-up, 69 patients had atrial arrhythmia recurrence and 29 remained in sinus rhythm. These patients were categorized into a recurrence (n=69) and no-recurrence group (n=29). Both groups had similar baseline characteristics, but recurrence patients were older (p=0.005), had a higher prevalence of hyperlipidemia (p=0.007), and a larger LA volume (p=0.01). There was a reduction in AF burden in the recurrence group when compared to their pre-ablation burden (65% vs. 15%, p<0.0001). Utah Stage 4 fibrosis and diabetes predicted less improvement in AF burden. The symptom severity score at 12 months post-ablation was significantly reduced compared to the pre-ablation score in the recurrence group, and there was a significant correlation between the reduction in symptom severity score and AF burden reduction (R=0.39, p=0.001). Conclusion Catheter ablation reduces AF burden irrespective of arrhythmia recurrence post-procedure. There's a strong correlation between AF burden reduction and symptom improvement post-ablation. Notably, elevated left atrial fibrosis impedes AF burden decrease following catheter ablation.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140801249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Predictors of Thermal Oesophageal and Vagus Nerve Injuries in Ablation Index Guided HPSD Ablation of Atrial Fibrillation: A Prospective Study","authors":"Charlotte Wolff, Katharina Langenhan, Marc Wolff, Elena Efimova, Markus Zachäus, Angeliki Darma, Borislav Dinov, Timm Seewöster, Sotirios Nedios, Livio Bertagnolli, Jan Wolff, Ingo Paetsch, Cosima Jahnke, Andreas Bollmann, Gerhard Hindricks, Kerstin Bode, Ulrich Halm, Arash Arya","doi":"10.1093/europace/euae107","DOIUrl":"https://doi.org/10.1093/europace/euae107","url":null,"abstract":"Background and Aims High-power-short-duration (HPSD) ablation is an effective treatment for atrial fibrillation but poses risks of thermal injuries to the oesophagus and vagus nerve. This study investigates incidence and predictors of thermal injuries, employing machine learning. Methods A prospective observational study was conducted at Leipzig Heart Centre, Germany, excluding patients with multiple prior ablations. All patients received Ablation Index guided HPSD ablation and subsequent oesophagogastroduodenoscopy. A machine learning algorithm categorized ablation points by atrial location and analysed ablation data, including Ablation Index, focusing on the posterior wall. The study is registered in clinicaltrials.gov (NCT05709756). Results Between February 2021, and August 2023, 238 patients were enrolled, of whom 18 (7.6%; 9 oesophagus, 8 vagus nerve, 1 both) developed thermal injuries, including 8 oesophageal erythemata, two ulcers and no fistula. Higher mean force (15.8±3.9g vs. 13.6±3.9g, p=0.022), ablation point quantity (61.50±20.45 vs. 48.16±19.60, p=0.007), total and maximum Ablation Index (24114±8765 vs. 18894±7863, p=0.008; 499±95 vs. 473±44, p=0.04, respectively) at the posterior wall, but not oesophagus location, correlated significantly with thermal injury occurrence. Patients with thermal injuries had significantly lower distances between left atrium and oesophagus (3.0±1.5mm vs 4.4±2.1mm, p=0.012) and smaller atrial surface areas (24.9±6.5 cm2 vs. 29.5±7.5cm2, p=0.032). Conclusion The low thermal lesion’s rate (7.6%) during Ablation Index guided HPSD ablation for atrial fibrillation is noteworthy. Machine learning based ablation data analysis identified several potential predictors of thermal injuries. The correlation between machine learning output and injury development suggests the potential for a clinical tool to enhance procedural safety.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140801179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous Vascular Closure System Versus Figure-of-Eight Suture Following Atrial Fibrillation Ablation – The STYLE-AF Study","authors":"R Tilz, M Feher, J Vogler, K Bode, A Duta, A Ortolan, Lisbeth Delgado Lopez, M Küchler, R Mamaev, E Lyan, Philipp Sommer, M Braun, V Sciacca, T Demming, V Maslova, KH Kuck, C -H Heeger, C Eitel, SS Popescu","doi":"10.1093/europace/euae105","DOIUrl":"https://doi.org/10.1093/europace/euae105","url":null,"abstract":"Background Simplified ablation technologies for pulmonary vein isolation (PVI) are increasingly performed worldwide. One of the most common complications following PVI are vascular access-related complications. Lately, venous closure systems (VCS) were introduced into clinical practice, aiming to reduce the time of bedrest, to increase the patients’ comfort and to reduce vascular access-related complications. Aims To compare the safety and efficacy of using a VCS to achieve haemostasis following single shot PVI to the actual standard of care (figure-of-eight suture and manual compression (MC)). Methods This is a prospective, multicentre, randomized, controlled, open-label trial performed at 3 German centres. Patients were randomized 1:1 to undergo haemostasis either by means of VCS (VCS group) or of a figure-of-eight suture and MC (F8 group). The primary efficacy endpoint was the time to ambulation, while the primary safety endpoint was the incidence of major periprocedural adverse events until hospital discharge. Results A total of 125 patients were randomized. The baseline characteristics were similar between the groups. The VCS group showed a shorter time to ambulation (109.0 (82.0, 160.0) vs. 269.0 (243.8, 340.5) min; p<0.001), shorter time to haemostasis (1 (1, 2) vs. 5 (2, 10) min; p<0.001) and shorter time to discharge eligibility (270 (270, 270) vs. 340 (300, 458) min; p<0.001). No major vascular access related complication was reported in either group. A trend towards a lower incidence of minor vascular access related complications on the day of procedure was observed in the VCS group (7 (11.1%) vs. 15 (24.2%); p=0.063) as compared to the control group. Conclusion Following AF ablation, the use of a VCS results in a significantly shorter time to ambulation, time to haemostasis and time to discharge eligibility. No major vascular access related complications were identified. The use of MC and a figure-of-eight suture showed a trend towards a higher incidence of minor vascular access related complications.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140801416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world validation of smartphone-based photoplethysmography for rate and rhythm monitoring in atrial fibrillation","authors":"Henri Gruwez, Daniel Ezzat, Tim Van Puyvelde, Sebastiaan Dhont, Evelyne Meekers, Liesbeth Bruckers, Femke Wouters, Michiel Kellens, Hugo Van Herendael, Maximo Rivero-Ayerza, Dieter Nuyens, Peter Haemers, Laurent Pison","doi":"10.1093/europace/euae065","DOIUrl":"https://doi.org/10.1093/europace/euae065","url":null,"abstract":"Aims Photoplethysmography- (PPG) based smartphone applications facilitate heart rate and rhythm monitoring in patients with paroxysmal and persistent atrial fibrillation (AF). Despite an endorsement from the European Heart Rhythm Association, validation studies in this setting are lacking. Therefore, we evaluated the accuracy of PPG-derived heart rate and rhythm classification in subjects with an established diagnosis of AF in unsupervised real-world conditions. Methods and results Fifty consecutive patients were enrolled, 4 weeks before undergoing AF ablation. Patients used a handheld single-lead electrocardiography (ECG) device and a fingertip PPG smartphone application to record 3907 heart rhythm measurements twice daily during 8 weeks. The ECG was performed immediately before and after each PPG recording and was given a diagnosis by the majority of three blinded cardiologists. A consistent ECG diagnosis was exhibited along with PPG data of sufficient quality in 3407 measurements. A single measurement exhibited good quality more often with ECG (93.2%) compared to PPG (89.5%; P < 0.001). However, PPG signal quality improved to 96.6% with repeated measurements. Photoplethysmography-based detection of AF demonstrated excellent sensitivity [98.3%; confidence interval (CI): 96.7–99.9%], specificity (99.9%; CI: 99.8–100.0%), positive predictive value (99.6%; CI: 99.1–100.0%), and negative predictive value (99.6%; CI: 99.0–100.0%). Photoplethysmography underestimated the heart rate in AF with 6.6 b.p.m. (95% CI: 5.8 b.p.m. to 7.4 b.p.m.). Bland–Altman analysis revealed increased underestimation in high heart rates. The root mean square error was 11.8 b.p.m. Conclusion Smartphone applications using PPG can be used to monitor patients with AF in unsupervised real-world conditions. The accuracy of AF detection algorithms in this setting is excellent, but PPG-derived heart rate may tend to underestimate higher heart rates.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140617356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Efficacy of the Second-generation Cryoballoon for Left Atrial Appendage Electrical Isolation in Canines","authors":"Chao Liu, Changjin Li, Teng Zhao, Manli Yu, Xinmiao Huang, Jiang Cao, Songqun Huang, Zhifu Guo","doi":"10.1093/europace/euae100","DOIUrl":"https://doi.org/10.1093/europace/euae100","url":null,"abstract":"Background and Aims Left atrial appendage electrical isolation (LAAEI) has demonstrated a significant enhancement in the success rate of atrial fibrillation (AF) ablation. Nevertheless, concerns persist about the safety of LAAEI, particularly regarding alterations in left atrial appendage (LAA) flow velocity and the potential risks of thrombus. This study aimed to assess the efficacy and safety of LAAEI, investigating changes in LAA flow velocity in canines. Methods The study comprised a total of ten canines. The LAAEI procedure used by a 23mm cryoballoon (CB) of the second generation was conducted at least 180 seconds. Intracardiac ultrasonography (ICE) was employed to quantify the velocity flow of the LAA both prior to and following LAAEI. Following a three-month period, subsequent evaluations were performed to assess the LAA velocity flow and the potential reconnection. Histopathological examination was conducted. Results LAAEI was effectively accomplished in all canines, resulting in a 100% acute success rate (10/10). The flow velocity in the LAA showed a notable reduction during LAAEI as compared to the values before the ablation procedure (53.12±5.89 cm/s vs 42.01±9.22 cm/s, P= 0.007). After the follow-up, reconnection was observed in four canines, leading to a success rate of LAAEI of 60% (6/10). The flow velocity in the LAA was consistently lower (53.12±5.89 cm/s vs 44.33±10.49 cm/s, P = 0.006), and no blood clot development was observed. The histopathological study indicated that there was consistent and complete injury to the LAA, affecting all layers of its wall. The injured tissue was subsequently replaced by fibrous tissue. Conclusion The feasibility of using cryoballoon ablation for LAAEI was confirmed in canines, leading to a significant reduction of LAA flow velocity after ablation. Some restoration of LAA flow velocity after ablation may be linked to the passive movement of the LAA and potential reconnecting. However, this conclusion is limited to animal study, more clinical data are needed to further illustrate the safety and accessiblity of LAAEI in humans.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140623249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between body mass index and results of cryoballoon ablation in Korean patients with atrial fibrillation: an analysis from Korean Heart Rhythm Society Cryoablation registry","authors":"Hyun Jin Ahn, Il-Young Oh, JeongMin Choi, Kyung-Yeon Lee, Hyo-Jeong Ahn, Soonil Kwon, Eue-Keun Choi, Seil Oh, Ju Youn Kim, Myung-Jin Cha, Chang Hee Kwon, Sung Ho Lee, Junbeom Park, Ki-Hun Kim, Pil-Sung Yang, Jun-Hyung Kim, Jaemin Shim, Hong Euy Lim, So-Ryoung Lee","doi":"10.1093/europace/euae095","DOIUrl":"https://doi.org/10.1093/europace/euae095","url":null,"abstract":"Background Pulmonary vein isolation using cryoablation is effective and safe in patients with atrial fibrillation (AF). Although both obesity and underweight are associated with a higher risk for incident AF, there is limited data on the efficacy and safety following cryoablation according to body mass index (BMI) especially in Asians. Methods Using the Korean Heart Rhythm Society Cryoablation registry, a multicenter registry of 12 tertiary hospitals, we analyzed AF recurrence and procedure-related complications after cryoablation by BMI (kg/m2) groups (BMI<18.5, underweight, UW; 18.5-23, normal, NW; 23-25, overweight, OW; 25-30, obese Ⅰ, OⅠ; ≥30, obese Ⅱ, OⅡ). Results A total of 2,648 patients were included (median age 62.0 years; 76.7% men; 55.6% non-paroxysmal AF). Patients were categorized by BMI groups; 0.9% UW, 18.7% NW, 24.8% OW, 46.1% OI, and 9.4% OII. UW patients were the oldest, and had least percentage of non-paroxysmal AF (33.3%). During a median follow-up of 1.7 years, atrial arrhythmia recurred in 874 (33.0%) patients (incidence rate, 18.9 per 100 person-year). After multivariable adjustment, the risk of AF recurrence was higher in UW group compared to NW group (adjusted hazard ratio, 95% confidence interval; 2.55, 1.18-5.50, p=0.02). Procedure-related complications occurred in 123 (4.7%) patients and the risk was higher for UW patients (odds ratio, 95% confidence interval; 2.90, 0.94-8.99, p=0.07), mainly due to transient phrenic nerve palsy. Conclusion UW patients showed a higher risk of AF recurrence after cryoablation compared to NW patients. Also, careful attention is needed on the occurrence of phrenic nerve palsy in UW patients.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140617294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Transseptal Puncture Guided by Three-Dimensional Mapping: Role of Unipolar Electrogram on Needle Tip","authors":"Yifan Chen, Xiaoyan Wu, Mengting Yang, Zhibin Li, Ruya Zhou, Weiqian Lin, Cheng Zheng, Youdong Hu, Jin Li, Yuechun Li, Jiafeng Lin, Mark M Gallagher, Jia Li","doi":"10.1093/europace/euae098","DOIUrl":"https://doi.org/10.1093/europace/euae098","url":null,"abstract":"Background and Aims A three-dimensional electroanatomic mapping system-guided transseptal puncture (3D-TSP), without fluoroscopy or echocardiography, was insufficiently reported. Indications for 3D-TSP remain unclear. This study aimed to establish a precise technique and create a workflow for validating and selecting eligible patients for fluoroless 3D-TSP. Methods and results We developed a new methodology for 3D-TSP based on the unipolar electrogram derived from transseptal needle tip (UEGM-tip) in 102 cases (the derivation cohort) with intracardiac echocardiography (ICE) from March 2018 to February 2019. The apparent current of injury (COI) was recorded at the muscular limbus of the foramen ovalis (FO) on UEGM-tip (sinus rhythm: 2.57 ± 0.95 mV, atrial fibrillation: 1.92 ± 0.77 mV), which then disappeared or significantly reduced at central FO. Changes in COI, serving as a major criterion to establish 3D-TSP workflow, proved to be the most valuable indicator for identifying FO in 99% (101/102) of patients compared to three previous techniques (3 minor criteria) of reduction in atrial unipolar or bipolar potential and FO protrusion. A total of 1042 patients in the validation cohort underwent successful 3D-TSP through the workflow from March 2019 to July 2023. ICE guidance was required for 6.6% (69/1042) of cases. All four criteria were met in 740 patients, resulting in a 100% pure fluoroless 3D-TSP success rate. Conclusion Most cases successfully achieved fluoroless 3D-TSP using changes of COI on UEGM tip. Patients who met all four criteria were suitable for 3D-TSP, while those who met none required ICE guidance.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"198 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140566318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repeat Catheter Ablation after Very Late Recurrence of Atrial Fibrillation after Pulmonary Vein Isolation","authors":"Niklas Stauffer, Sven Knecht, Patrick Badertscher, Philipp Krisai, Elisa Hennings, Teodor Serban, Gian Voellmin, Stefan Osswald, Christian Sticherling, Michael Kühne","doi":"10.1093/europace/euae096","DOIUrl":"https://doi.org/10.1093/europace/euae096","url":null,"abstract":"Structured Abstract Background and Aims Atrial fibrillation (AF) recurs in about one third of patients after catheter ablation (CA), mostly in the first year. Little is known about the electrophysiological findings and the effect of re-ablation in very late AF recurrences after more than one year. The aim of this study was to determine the characteristics and outcomes of the first repeat CA after very late recurrence of AF after index CA. Methods We analysed patients from a prospective Swiss registry that underwent a first repeat ablation procedure. Patients were stratified depending on the time to recurrence after index procedure: early recurrence (ER) for recurrences within the first year and late recurrence (LR) if the recurrence was later. The primary endpoint was freedom from AF in the first year after repeat ablation. Results Out of 1864 patients included in the registry, 426 patients undergoing a repeat ablation were included in the analysis (28% female, age 63 ± 9.8 years, 46% persistent AF). 291 patients (68%) were stratified in the ER group and 135 patients (32%) in the LR group. Pulmonary vein reconnections were a common finding in both groups, with 93% in the ER group compared to 86% in the LR group (p = 0.052). In the LR group, 40 of 135 patients (30%) had a recurrence of AF compared to 90 of 291 patients (31%) in the ER group (log rank p = 0.72). Conclusion There was no association between the time to recurrence of AF after initial catheter ablation and the characteristics and outcomes of the repeat procedure.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140566275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}