Catheter Ablation Research Articles

Associations Among Sleep Apnea, Objective or Subjective Sleep Duration, and Recurrence of Atrial Fibrillation in Patients Who Undergo Radiofrequency Catheter Ablation for Persistent Atrial Fibrillation ― A Prospective Observational Study ―

Associations Among Sleep Apnea, Objective or Subjective Sleep Duration, and Recurrence of Atrial Fibrillation in Patients Who Undergo Radiofrequency Catheter Ablation for Persistent Atrial Fibrillation ― A Prospective Observational Study ―

Atrial Fibrillation in Young Patients: Insights From the National Inpatient Sample

ABSTRACTBackgroundThe burden of atrial fibrillation (AF) hospitalizations in young patients is not well characterized. We aimed to study the burden, comorbidities, outcomes, and resource utilization of AF hospitalizations in young patients.MethodsWe conducted a retrospective analysis of all primary AF hospitalizations in patients 18–45 years of age using the National Inpatient Sample data from January 1, 2008 to December 31, 2019. We collected data on various clinical and socioeconomic features including demographics and clinical outcomes.ResultsAF hospitalizations decreased over time from 18.7 per 100,000 in 2008 to 13.0 per 100,000 in 2019 (p < 0.001). AF hospitalizations were higher amongst males compared to females (24.0 vs. 7.5 per 100,000), and higher in Black patients compared to other ethnicities (20.4 for Black vs. 15.6 for White vs. 8.5 Hispanic per 100,000). The utilization of electrical cardioversion increased from 17.6% in 2008 to 21.9% in 2019 (p < 0.001), and catheter ablation decreased from 7.1% in 2008 to 4.3% in 2019 (p < 0.001). Men were more likely to undergo electrical cardioversion than women (20.1% vs. 14.8%, p < 0.001). White patients were more likely to undergo electrical cardioversion (20.8% vs. 14.3% vs. 15.5%, p < 0.001) and catheter ablation (6.1% vs. 3.3% vs. 4.2%, p < 0.001) compared to Black and Hispanic patients, respectively. Patients in the highest income residence quartile were more likely to undergo electrical cardioversion (21.9% vs. 16.4%, p < 0.001) and catheter ablation (8.0% vs. 3.7%, p < 0.001) compared to patients in the lowest income residence quartile.ConclusionsWe found significant differences in inpatient AF management based on sex, ethnicity, and SES.

Investigating the role of electroanatomical mapping in single‐shot pulsed field catheter ablation

AbstractIntroductionPulsed field ablation (PFA) is a form of nonthermal energy that has been recently introduced for pulmonary vein isolation (PVI). A multi‐electrode pentaspline catheter for delivery of PFA guided by fluoroscopy has become widely available for clinical use.Methods and ResultsIn this study, we aimed to assess whether the addition of electroanatomical mapping (EAM) for confirmation of PVI in the acute phase can increase the efficacy of the procedure in terms of arrhythmia recurrences. A total of 51 patients with atrial fibrillation (AF) scheduled for first time PVI were included in the study. Participants were assigned to receive PVI using fluoroscopy guidance only (Fluoro‐only group: 31 patients) or additional validation with EAM (EAM group: 20 patients). Endpoints included arrhythmia recurrence and procedural characteristics. During a 11.2 ± 1.3 months follow‐up period, arrhythmia recurrences did not statistically differ between groups (16.1% vs. 20%, p .72). Procedure time was longer in the EAM group (86.5 ± 11.4 vs. 78.4 ± 9.3 min, p .008). EAM revealed 5 nonisolated PVs that were re‐ablated using the same catheter. Four patients of the cohort underwent a redo‐procedure during the follow‐up period. In all 4 cases, at least one reconnected PV was identified.ConclusionIn a cohort of patients with AF undergoing first time PVI using a pentaspline PFA catheter, PVI validation with EAM did not lead to significantly different arrhythmia recurrence rates compared to PVI without EAM. In the acute phase, the rate of nonisolated PVs was low.

Left Atrial Structure and Function Following Ethanol Infusion into Vein of Marshall (MR‐SHALL Study)

ABSTRACTBackgroundEthanol infusion into the vein of Marshall (EI‐VOM) is an adjunctive therapy to pulmonary vein isolation (PVI), which improves the efficacy of persistent atrial fibrillation (AF) ablation procedures. It is unknown how EI‐VOM scar formation impacts left atrium (LA) structure and function.ObjectiveTo characterize scar formation after EI‐VOM, and its impact on LA function, by cardiac magnetic resonance (CMR).MethodsConsecutive patients referred for persistent AF ablation, or any repeat procedure, were included. Ablation strategy included PVI, EI‐VOM and linear lesions when deemed necessary. LA was assessed by late gadolinium enhancement (LGE) CMR at baseline and 3‐month follow‐up. CMR was post‐processed off‐line with dedicated software. The LA was regionalized into 17 segments, and global and regional scarring were calculated. Strain parameters were analyzed—including LA reservoir, conduit, and booster strain; LA ejection fraction; and LA passive and active emptying function. Follow‐up LGE‐CMR reconstruction was coregistered with the voltage map, ablation RF points, and fluoroscopy to compare the scar location with the VOM trajectory.ResultsThis study included 21 patients (65 ± 8 years; 76% men; 57% ablation of persistent AF). After EI‐VOM, 95% of patients presented new low‐voltage areas, all of whom exhibited new LGE‐CMR scarring at follow‐up. Voltage map and LGE‐CMR coregistration showed comparable scar areas (p = 0.287). LGE‐CMR scarring frequently involved the whole VOM trajectory, predominantly affecting the LA ridge, mitral isthmus, and left posterior wall. LA volume was significantly reduced after ablation, without significant changes in LA functional parameters.ConclusionEI‐VOM causes permanent scarring at 3‐month follow‐up, with no adverse impact on CMR LA functional parameters.

Effect of electrode size and distance to tissue on unipolar and bipolar voltage electrograms and their implications for a near-field cutoff

Characteristics of electrograms depend on the electrode design and distance to the electric source. Our aim was to assess the impact of electrode design and distance from the myocardial electric source on the unipolar and bipolar electrograms to deduce a far-field cut-off. We retrospectively analyzed left atrial electroanatomical maps of 25 patients acquired using an ablation catheter with a 4.5 mm tip-, mini- and 2 mm ring electrodes. The unipolar and bipolar electrograms were characterized based on peak-to-peak amplitude, signal duration, maximal slope, and relative power of the high frequency spectrum above 50 Hz (HF_rel). The unipolar electrograms of ring electrodes showed an increased amplitude (140%), slope (150%) and HF_rel (16% vs. 11%) compared to the tip- and mini-electrodes. The median amplitude, slope, and HF_rel for the ring electrodes followed a power-law decay with distance with a steep decline up to 4 mm. This near-field cut-off can be identified based on a HF_rel above 10% in unipolar electrograms. In conclusion, we observed a higher unipolar amplitude for small ring-electrodes compared to larger tip-electrodes. The rapid decay of the amplitude, slope, and HF_rel up to a distance of 4 mm is suggestive for near-field cut-off identified based on HF_rel above 50 Hz.Clinical Trial Registration: NCT04095559.

QTc interval prolongation and risk of atrial fibrillation recurrence: a meta-analysis and observational cohort study

IntroductionCorrected QT interval (QTc) is a ventricular repolarization marker on electrocardiography. Previous studies evaluated its value in predicting atrial fibrillation (AF) occurrence. However, its predictive efficacy for AF recurrence remains controversial.MethodsWe searched PubMed and Google databases for studies before January 2024 evaluating the association between QTc interval and AF incidence. A meta-analysis of the eligible datasets was conducted using Bazett's formula, with subgroup analysis to explore the heterogeneity. Additionally, thirty-eight patients with AF who underwent radiofrequency catheter ablation were enrolled and followed-up for 3–36 months. Univariate and multivariate Cox models were used to calculate the hazard ratios (HRs) and determine the relationship between clinical factors and AF recurrence. Kaplan-Meier survival analysis and ROC curve were conducted to assess the impact and predictive efficacy of individual factors.ResultsEleven datasets from nine eligible studies were enrolled and meta-analysed. We found that patients with prolonged QTc interval was associated with a significantly higher AF incidence risk, and the risk increased with every 10-ms prolongation. However, this association was not significant in the AF recurrence subgroup. In our prospective cohort, the preoperative body mass index, QTc, left atrial diameter (LAD), and uric acid levels influenced AF recurrence. Multivariate Cox regression analysis identified LAD as an independent factor affecting AF recurrence in patients with a high predictive efficiency. Kaplan-Meier survival analysis showed that increased LAD (>4.5 cm) was associated with postoperative AF recurrence.DiscussionTherefore, LAD has better predictive power and can be an indicator for predicting postoperative AF recurrence.

Editorial to “investigating the role of electroanatomical mapping in single‐shot pulsed field catheter ablation”

Editorial to “investigating the role of electroanatomical mapping in single‐shot pulsed field catheter ablation”

Catheter Ablation of Atrial Fibrillation in Infiltrative Cardiomyopathies: A Narrative Review.

Atrial and ventricular arrhythmias are common in patients with Infiltrative heart diseases. This review discusses ablative techniques for arrhythmias in amyloidosis, sarcoidosis, hemochromatosis, and glycogen storage disorders, primarily focusing on atrial fibrillation (AF). A thorough literature review was conducted on the MEDLINE database to synthesize current knowledge and propose future research directions. AF is the most common arrhythmia identified in patients with amyloidosis due to cellular infiltration and atrial dilation. While catheter ablation is associated with a significantly lower rate of all-cause mortality and admission rate, conflicting data exist regarding the higher risk of pericardial effusion, in-hospital mortality, length of stay, and cost of hospitalization. Cardiac sarcoid predisposes AF due to granulomas, atrial dilation, and scarring. Studies demonstrate encouraging outcomes and low recurrence rates in these patients who undergo ablation for AF, with no difference in complications compared to those without sarcoidosis. AF is the most common arrhythmia in hereditary hemochromatosis (HH), secondary to increased myocardial iron stores and elevated oxidative stress, and is primarily managed by chelation. Scant reports regarding ablation are described for HH and glycogen storage disorders. Catheter ablation is a safe and effective modality for the treatment of AF in infiltrative cardiomyopathy. Future large-scale trials are needed to confirm these findings.

Temperature guided high and very high-power short duration ablation for atrial fibrillation treatment - The peQasus multicentre study.

Temperature-controlled high-power short-duration (HPSD) radiofrequency catheter ablation for pulmonary vein isolation (PVI) utilizing a novel ablation catheter (QDOT Micro) with real-time assessment of catheter tip temperature aims for safer, more effective and faster procedures. The peQasus study is a large European multicenter study set up to assess safety, acute efficacy and outcomes of temperature-controlled HPSD based PVI. The primary endpoints were safety, efficacy and 12-months freedom from atrial tachyarrhythmias. Additionally, two strategies namely very HPSD (90W for 4 seconds) only and a hybrid approach (HPSD with maximum of 50W and vHPSD) were compared. A total of 1,023 AF patients in 15 centers from 9 European countries received PVI with the QDOT. Complete PVI was successfully achieved in all patients. In 699/1023 (68.3%) the vHPSD only approach (vHPSD group) and in 324/(31.7%) patients the hybrid approach (hybrid group) was utilized. The mean procedure duration was 98.4±37.4 min (vHPSD: 88.2±34.9min, hybrid: 117.4±32.7min, p<0.001). The first pass isolation rate of all PVs was 64% (vHPSD: 62.6%, hybrid: 67.1%, p=0.187). Severe adverse events were observed in 1.7% (vHPSD: 1.6%, hybrid: 1.9%, p=0.746). 12-month arrhythmia-recurrence free survival was 77.1% (vHPSD: 76.8%, hybrid: 77.8%, p=0.241). In this large multicentre study temperature-controlled HPSD and vHPSD ablation via a novel ablation catheter provides safe and effective PVI with a relatively short procedure duration. Despite a shorter procedure time no differences in terms of safety and freedom from arrhythmia-recurrence were found irrespective of utilizing vHPSD or the hybrid approach.

Cardiac Ablation in the Pediatric Population at a Tertiary Care Center in a Developing Country

ABSTRACTIntroductionThe aim of this study was to describe our experience and outcome of ablation therapy for arrhythmias in pediatrics at a tertiary care center.MethodsData was collected retrospectively from the hospital medical records. All pediatrics presenting to AUBMC between 2000 and 2020 who underwent cardiac ablation were included. The data collected included type of arrhythmia, ablation technique, age and weight at ablation, procedure complications, medications used, and outcome assessment.ResultsWe had 67 patients who underwent cardiac ablation. Of those, 60% were males with a mean age of 15 years. Structural heart disease was present in 6% of patients. Wolff‐Parkinson‐White syndrome (WPW) was most prevalent at 31%, followed by atrioventricular nodal reentrant tachycardia (AVNRT) at 24%, atrioventricular reentrant tachycardia (AVRT) at 16%, ventricular tachycardia (VT) at 10%, atrial fibrillation (AF) at 3%, and atrial tachycardia (AT) at 1%. The remaining 15% of patients presented with less common types of arrhythmias, including other supraventricular tachycardias (SVTs), retrograde dual atrioventricular nodal reentry, and premature ventricular contractions (PVC). Antiarrhythmic medications were started before the procedure in 59% of our population. Medication regimens postablation included beta‐blockers (68%), type 1c antiarrhythmics (25%), calcium channel blockers (3%), ivabradine (2%), and amiodarone (2%). The completed procedures showed a success rate of 93%.ConclusionAblation of arrhythmias in pediatrics is an effective procedure in the treatment of childhood arrhythmias. More studies are needed on cardiac ablation in this age group and those with structural heart disease in the Middle East region.

Unipolar Voltage for Better Characterizing Left Atrium Substrates: Comparing the Predictive Efficacy for Recurrence Post Atrial Fibrillation Ablation in a Post Hoc Analysis of STABLE‐SR‐III Trial

Unipolar Voltage for Better Characterizing Left Atrium Substrates: Comparing the Predictive Efficacy for Recurrence Post Atrial Fibrillation Ablation in a Post Hoc Analysis of STABLE‐SR‐III Trial

Anatomical versus Electrophysiological Approach for Ablation of Premature Ventricular Contractions Originating from the Left Ventricular Summit (ISESHIMA-SUMMIT Study).

Catheter ablation (CA) of idiopathic ventricular arrhythmias (VAs) from the epicardial left ventricular summit is challenging. The endocardial approach targets two sites: the endocardial closest site (ECS) to the epicardial earliest activation site (epi-EAS) and the endocardial EAS (endo-EAS). We aimed to differentiate between cases where CA at the ECS was effective and where CA at the endocardial EAS yielded success. Fifty-eight patients (47 men, 60±13 years) were analyzed with VAs in which the EAS was observed in the coronary venous system (CVS). Overall, VAs were successfully eliminated in 42 (72%) patients; 8 in the CVS, 8 where the ECS matched with the endo-EAS, 11 at the ECS, and 15 at the endo-EAS. Successful ECS ablation was associated with a shorter epi-EAS-ECS distance (10.2±4.7 vs. 18.8±5.3 mm; P<0.001) and shorter epi-EAS-left main coronary trunk (LMT) ostial distance (20.3±7.6 vs. 30.3±8.4 mm; P=0.005), with optimal cut-off values of ≤12.6 mm and ≤24.0 mm, respectively. Successful endo-EAS ablation was associated with an earlier electrogram at the endo-EAS (23 [18, 36] vs. 15 [0, 19] ms preceding the QRS; P<0.001) and shorter epi-EAS-endo-EAS interval (6 [1, 8] vs. 22 [12, 25] ms; P<0.001), with optimal cut-off values of ≥18 ms and ≤9 ms, respectively. Shorter anatomical distances between the epi-EAS and ECS, and between the epi-EAS and LMT ostium, predict a successful ECS ablation. The prematurity of the endo-EAS electrogram and a shorter interval between the epi-EAS and endo-EAS predicted a successful endo-EAS ablation.

Decoding the evidence: A synopsis of indications and evidence for catheter ablation in atrial fibrillation (Review)

Decoding the evidence: A synopsis of indications and evidence for catheter ablation in atrial fibrillation (Review)

Pulsed Field Ablation in Atrial Fibrillation: Initial Experience of the Efficacy and Safety in Pulmonary Vein Isolation and Beyond

Regional differences in pulsed field ablation (PFA) adoption for pulmonary vein isolation (PVI) with additional posterior wall ablation (PWA) in Asia remains unknown. We hereby report our experience on the safety and efficacy of PFA in AF ablation. Consecutive AF patients who underwent PFA from September 2022 to January 2024 were included. The primary efficacy endpoint was freedom from atrial arrhythmia recurrence after a 90-day blanking period at 12 months. Safety endpoints included 30 days of all-cause death, cardiac tamponade, stroke, myocardial infarction, and heart failure hospitalization. One hundred and one (72.3% males, 79.2% pAF) patients underwent PFA for AF. Thirty-one (30.7%) had structural heart disease with mean LVEF of 57.4 ± 8.1% and CHA2DS2-VASc score of 1.4 ± 1.3. Twenty-nine (28.7%) underwent additional PWA (PVI + PWA) using PFA. PWA was acutely successful in all patients. Patients who underwent PWA were more likely to have persistent AF and require general anesthesia and electroanatomic mapping (all p &lt; 0.05). Total PFA applications for PVI, LA dwell time, procedural time, and fluoroscopy time were similar between the PVI-only and PVI + PWA groups (all p &gt; 0.05). The 1-year atrial arrhythmia recurrence rates were 10% for pAF and 21% for the persistent AF group. The primary efficacy endpoint was not significantly different between the PVI-only and PVI+PWA groups (12-month KM estimates 90.3% [95% CI, 83.3–97.3] and 82.8% [95% CI, 68.1–97.4], respectively). There were no complications related to PFA use. PFA can be safely, effectively, and efficiently adopted for AF ablation. Additional PWA, if pursued, had similar procedural metrics to the PVI-only strategy without increased complications.

Editorial to “The Japanese catheter ablation registry (J‐AB): Annual report in 2022”

Editorial to “The Japanese catheter ablation registry (J‐<scp>AB</scp>): Annual report in 2022”

Coronary Spasm Due to Pulsed Field Ablation: A State-of-the-Art Review.

With the ever-growing population of patients undergoing cardiac ablation with pulsed electric fields, there is a need to understand secondary effects from the therapy. Coronary artery spasm is one such effect that has recently emerged as the subject of further investigation in electrophysiology literature. This review aims to elucidate the basic anatomy underlying vascular spasm due to pulsed electric fields and the effects of irreversible electroporation on coronary arteries. This review also aims to gather the current preclinical and clinical data regarding the physiology and function of coronary arteries following electroporation.

Safety of catheter ablation for atrial fibrillation in patients with liver cirrhosis.

Atrial fibrillation is the most prevalent cardiac arrhythmia, and catheter ablation (CA) has emerged as a viable treatment option for selected patients. However, its safety profile in liver cirrhosis (LC) populations remains underexplored. This was an observational analysis of the National Inpatient Sample Database 2016-2020; we analyzed adult encounters undergoing CA for atrial fibrillation who had a concomitant diagnosis of LC. Using propensity scores, encounters were divided into two cohorts based on the presence or absence of LC and matched in a 1:1 fashion using LC as the dependent variable. In-hospital mortality and postprocedure total complications were compared using regression models. 93 830 procedures were identified for non-LC patients and 960 involving LC patients; after propensity score matching, each cohort included 910 hospitalizations. The mean age in the LC-matched cohort was 66.5 ± 9.1 years. In-hospital mortality did not differ between the groups (aOR = 1.01; 95% CI [0.06-16.1]; p = .99). However, the LC cohort exhibited higher odds of total complications (aOR = 1.98; 95% CI [1.42-2.75]; p < .001). Length of stay (LOS) was comparable, but total costs were higher in the LC cohort: LOS was 2 days (95% CI [1-3]) in the LC group versus 3 days (95% CI [1-4]) (p < .11) and LC: $202,000 (95% CI [$142 000-$261 000]) versus non-LC: $189 000, (95% CI [$153 000-$222 000]) (p < .0001). In this national analysis of patients undergoing CA for AF, those with LC had similar in-hospital mortality, postprocedure complications, and LOS compared to noncirrhotic patients. Furthermore, longitudinal studies are needed to assess the safety profile of CA in this subpopulation.

Complications associated with pulsed field ablation versus radiofrequency catheter ablation of atrial fibrillation

BackgroundThe first commercial systems for pulsed field ablation(PFA) were recently approved by the Food and Drug Administration(FDA), but their safety profile in nationwide practice remains underexplored. ObjectiveThis study aimed to describe reported adverse events with PFA systems after their market release and to compare the relative proportion of complications associated with PFA versus radiofrequency(RF) ablation catheters. MethodsWe conducted a search of the Manufacturer and User Facility Device Experience database for adverse event reports involving FDA-approved PFA and RF catheters between January 1, 2024, to July 31, 2024. ResultsA total of 1,237 reports detailing clinical complications (N=156 for PFA and N=315 for RF) or catheter malfunctions (N=336 for PFA and N=430 for RF) were analyzed. The most common adverse events reported for PFA were pericardial effusion, vasovagal response, and hemolysis, and for RFA were pericardial effusion, ischemic stroke, and esophageal damage. The proportion of reported adverse events that were deaths was lower among PFA compared to RF (2.6% vs. 8.9%, P=0.010). Hemolysis (9.0% vs. 0%), coronary events (5.8% vs. 0.6%), and vasovagal responses (14.1% vs. 0%) were reported more frequently after PFA (all P<0.001). In contrast, esophageal damage (0% vs. 4.1%, P<0.001) and pulmonary vein stenosis (0% vs. 1.9%, P=0.184) were not reported with PFA, only with RF. Regarding catheter malfunctions, mechanical problems were reported in greater proportion after PFA compared with RF (87.2% vs. 17.2%, P<0.001). ConclusionThe reported complications associated with PFA and RF ablation differ significantly. Close attention to PFA-specific complications is essential for ensuring the safe use of PFA and for mitigating risk.

Catheter ablation in a monochorionic diamniotic twin pregnancy: A case report and literature review.

Preexcitation syndrome is an uncommon congenital cardiac disorder that impairs the normal cardiac conduction system. Radiofrequency ablation is one of the most effective treatments for this condition. Nevertheless, radiofrequency ablation is rare in women with preexcitation syndrome during pregnancy. A 33-year-old woman with monochorionic diamniotic twin pregnancy complicated by sinus arrhythmia with ventricular preexcitation at 14 weeks and 5 days of gestation, with paroxysmal palpitations and shortness of breath at 16 weeks with paroxysmal supraventricular tachycardia with preexcitation syndrome and a heart rate ranging from 180 to 225 beats per minute. The pregnant occurred sudden palpitations and shortness of breath in the shower. Electrocardiography revealed paroxysmal supraventricular tachycardia, and electrophysiological study revealed preexcitation syndrome (dominant accessory route of the left free wall) with atrioventricular reentrant tachycardia. Radiofrequency catheter ablation was performed at 20 weeks. Symptoms of preexcitation syndrome resolved after the radiofrequency catheter ablation, and 2 healthy infants were delivered at 36 weeks and 2 days of gestation by cesarean section. Preexcitation syndrome may result in life-threatening arrhythmias such as supraventricular tachycardia during pregnancy and delivery. It might be efficiently controlled through optimal treatment by a multidisciplinary team, which would effectively minimize arrhythmia risk events during pregnancy and improve maternal-fetal outcomes. Based on the patient's individual situation, radiofrequency ablation may be a procedure in pregnant women with preexcitation syndrome.

Radiofrequency catheter ablation of persistent atrial fibrillation in a patient with cor triatriatum sinister

Radiofrequency catheter ablation of persistent atrial fibrillation in a patient with cor triatriatum sinister