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Incidence and Predictors of Thermal Oesophageal and Vagus Nerve Injuries in Ablation Index Guided HPSD Ablation of Atrial Fibrillation: A Prospective Study EP Europace (IF 6.1) Pub Date : 2024-04-22 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
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
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Venous Vascular Closure System Versus Figure-of-Eight Suture Following Atrial Fibrillation Ablation – The STYLE-AF Study EP Europace (IF 6.1) Pub Date : 2024-04-22 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
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
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Comprehensive Atrial Fibrillation Burden and Symptom Reduction Post-Ablation: Insights from DECAAF II EP Europace (IF 6.1) Pub Date : 2024-04-22 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
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
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Safety and Efficacy of the Second-generation Cryoballoon for Left Atrial Appendage Electrical Isolation in Canines EP Europace (IF 6.1) Pub Date : 2024-04-17 Chao Liu, Changjin Li, Teng Zhao, Manli Yu, Xinmiao Huang, Jiang Cao, Songqun Huang, Zhifu Guo
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
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Real-world validation of smartphone-based photoplethysmography for rate and rhythm monitoring in atrial fibrillation EP Europace (IF 6.1) Pub Date : 2024-04-17 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
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
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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 EP Europace (IF 6.1) Pub Date : 2024-04-16 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
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
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Optimizing Transseptal Puncture Guided by Three-Dimensional Mapping: Role of Unipolar Electrogram on Needle Tip EP Europace (IF 6.1) Pub Date : 2024-04-15 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
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
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Repeat Catheter Ablation after Very Late Recurrence of Atrial Fibrillation after Pulmonary Vein Isolation EP Europace (IF 6.1) Pub Date : 2024-04-12 Niklas Stauffer, Sven Knecht, Patrick Badertscher, Philipp Krisai, Elisa Hennings, Teodor Serban, Gian Voellmin, Stefan Osswald, Christian Sticherling, Michael Kühne
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
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Longer and better lives for patients with atrial fibrillation: the 9th AFNET/EHRA consensus conference EP Europace (IF 6.1) Pub Date : 2024-04-09 Dominik Linz, Jason G Andrade, Elena Arbelo, Giuseppe Boriani, Guenter Breithardt, A John Camm, Valeria Caso, Jens Cosedis Nielsen, Mirko De Melis, Tom De Potter, Wolfgang Dichtl, Søren Zoega Diederichsen, Dobromir Dobrev, Nicolas Doll, David Duncker, Elke Dworatzek, Lars Eckardt, Christoph Eisert, Larissa Fabritz, Michal Farkowski, David Filgueiras-Rama, Andreas Goette, Eduard Guasch, Guido Hack,
Aims Recent trial data demonstrate beneficial effects of active rhythm management in patients with atrial fibrillation (AF) and support the concept that a low arrhythmia burden is associated with a low risk of AF-related complications. The aim of this document is to summarize the key outcomes of the 9th AFNET/EHRA Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart
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Impact of atrial fibrillation phenotype and left atrial volume on outcome after pulmonary vein isolation EP Europace (IF 6.1) Pub Date : 2024-04-08 Laurève Chollet, Salik ur Rehman Iqbal, Severin Wittmer, Gregor Thalmann, Antonio Madaffari, Nikola Kozhuharov, Oskar Galuszka, Thomas Küffer, Christoph Gräni, Nicolas Brugger, Helge Servatius, Fabian Noti, Andreas Haeberlin, Laurent Roten, Hildegard Tanner, Tobias Reichlin
Aims Pulmonary vein isolation (PVI) is increasingly performed in patients with atrial fibrillation (AF). Both AF phenotype and left atrial (LA) volume have been shown to influence ablation outcome. The inter-relationship of the two is incompletely understood. We aimed to investigate the impact of AF phenotype vs. LA volume on outcome after PVI. Methods and results In a retrospective analysis of a prospective
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Accurate diagnosis of apical hypertrophic cardiomyopathy using explainable advanced ECG analysis EP Europace (IF 6.1) Pub Date : 2024-04-08 Rebecca K Hughes, George D Thornton, James W Malcolmson, Iain Pierce, Shafik Khoury, Amanda Hornell, Kristopher Knott, Gabriella Captur, James C Moon, Todd T Schlegel, Martin Ugander
Background and aims Typical electrocardiogram (ECG) features of apical hypertrophic cardiomyopathy (ApHCM) include tall R waves and deep or giant T-wave inversion in the precordial leads, but these features are not always present. The ECG is used as the gatekeeper to cardiac imaging for diagnosis. We tested whether explainable advanced ECG (A-ECG) could accurately diagnose ApHCM. Methods A-ECG analysis
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2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation EP Europace (IF 6.1) Pub Date : 2024-04-08 Stylianos Tzeis, Edward P Gerstenfeld, Jonathan Kalman, Eduardo B Saad, Alireza Sepehri Shamloo, Jason G Andrade, Chirag R Barbhaiya, Tina Baykaner, Serge Boveda, Hugh Calkins, Ngai-Yin Chan, Minglong Chen, Shih-Ann Chen, Nikolaos Dagres, Ralph J Damiano, Tom De Potter, Isabel Deisenhofer, Nicolas Derval, Luigi Di Biase, Mattias Duytschaever, Katia Dyrda, Gerhard Hindricks, Meleze Hocini, Young-Hoon
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing
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First-in-Human Clinical Series of a Novel Conformable Large-Lattice Pulsed Field Ablation Catheter for Pulmonary Vein Isolation EP Europace (IF 6.1) Pub Date : 2024-04-08 Vivek Y Reddy, Elad Anter, Petr Peichl, Gediminas Rackauskas, Jan Petru, Moritoshi Funasako, Jacob S Koruth, Germanas Marinskis, Mohit Turagam, Audrius Aidietis, Josef Kautzner, Andrea Natale, Petr Neuzil
Background/Aims Pulsed field ablation (PFA) has significant advantages over conventional thermal ablation of atrial fibrillation (AF). This first-in-human, single-arm trial to treat paroxysmal AF (PAF) assessed the efficiency, safety, pulmonary vein isolation (PVI) durability and one-year clinical effectiveness of an 8-Fr, large-lattice, conformable single-shot PFA catheter together with a dedicated
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Use of Three-dimensional Electroanatomic Mapping for Epicardial Access: Needle Tracking, Elctrographic Characteristics and Clinical Application EP Europace (IF 6.1) Pub Date : 2024-04-08 Ronghui Yu, Nian Liu, Binquan You, Haixiong Wang, Yanfei Ruan, Songnan Wen, Peter J Weiss, Michael Zawaneh, Wilber Su, Roderick Tung, Xin Zhao, Wei Wang, Ribo Tang, Rong Bai
Background and Aims Pericardiocentesis is usually completed under fluoroscopy. The electroanatomic mapping (EAM) system allows visualizing puncture needle tip (NT) while displaying the electrogram recorded from NT, making it possible to obtain epicardial access (EA) independent of fluoroscopy. This study was designed to establish and validate a technique by which EA is obtained under guidance of 3-dimensional
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Application of a circular-shaped pulsed field ablation catheter with magnetic sensors for pulmonary vein isolation: a multi-centre clinical study report EP Europace (IF 6.1) Pub Date : 2024-04-08 Yan Wang, Heng Li Lai, Qi Chen, Hao Liu, Qi Ming Liu, Wei Bin Huang, Yu Tao, Qingmei Xiong, Ning Zhou, Chunxia Zhao, Jie Qiu, Ziqin Xu, Dao Wen Wang
Aims A few studies have reported the effect and safety of pulsed field ablation (PFA) catheters for ablating atrial fibrillation (AF), which were mainly based on basket-shaped or flower-shaped designs. However, the clinical application of a circular-shaped multi-electrode catheter with magnetic sensors is very limited. To study the efficacy and safety of a PFA system in patients with paroxysmal AF
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Same-day discharge after atrial fibrillation ablation under a nurse-coordinated standardized protocol EP Europace (IF 6.1) Pub Date : 2024-04-04 Teresa Espinosa, Anna Farrus, Montserrat Venturas, Alba Cano, Sara Vazquez-Calvo, Margarida Pujol-Lopez, Frida Eulogio-Valenzuela, Jean-Baptiste Guichard, Pasquale V Falzone, Freddy R Graterol, Xavier Freixa, Jose M Tolosana, Eduard Guasch, Andreu Porta-Sanchez, Elena Arbelo, Josep Brugada, Marta Sitges, Lluis Mont, lvo Roca-Luque, Till F Althoff
Background and aims Same-day discharge (SDD) after atrial fibrillation (AF) ablation is an effective means to spare healthcare resources. However, safety remains a concern, and besides structural adaptations, SDD requires more efficient logistics and coordination. Therefore, we implemented a streamlined, nurse-coordinated SDD program following a standardized protocol. Methods As dedicated SDD coordinator
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Long-term reliability of the phospholamban (PLN) p.(Arg14del) risk model in predicting major ventricular arrhythmia: a landmark study EP Europace (IF 6.1) Pub Date : 2024-04-01 Myrthe Y C van der Heide, Tom E Verstraelen, Freyja H M van Lint, Laurens P Bosman, Remco de Brouwer, Virginnio M Proost, Esmée van Drie, Karim Taha, Aeilko H Zwinderman, Cathelijne Dickhoff, Bas A Schoonderwoerd, Tjeerd Germans, Arjan C Houweling, Juan R Gimeno-Blanes, Paul A van der Zwaag, Rudolf A de Boer, Moniek G P J Cox, J Peter van Tintelen, Arthur A M Wilde
Aims Recently, a genetic variant-specific prediction model for phospholamban (PLN) p.(Arg14del)-positive individuals was developed to predict individual major ventricular arrhythmia (VA) risk to support decision-making for primary prevention implantable cardioverter defibrillator (ICD) implantation. This model predicts major VA risk from baseline data, but iterative evaluation of major VA risk may
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Atrial Cardiomyocytes contribute to the Inflammatory Status associated with Atrial Fibrillation in Right Heart Disease EP Europace (IF 6.1) Pub Date : 2024-03-27 Ewen Le Quilliec, Charles-Alexandre LeBlanc, Orlane Neuilly, Jiening Xiao, Rim Younes, Yasemin Altuntas, Feng Xiong, Patrice Naud, Louis Villeneuve, Martin G Sirois, Jean-François Tanguay, Jean-Claude Tardif, Roddy Hiram
Context Right heart disease (RHD), characterized by right ventricular (RV) and atrial (RA) hypertrophy, and cardiomyocytes’ (CM) dysfunctions have been described to be associated with the incidence of atrial fibrillation (AF). RHD and AF have in common, an inflammatory status, but the mechanisms relating RHD, inflammation, and AF remain unclear. Hypotheses RHD generates electrophysiological and morphological
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Automated isochronal late activation mapping for substrate characterization in patients with repaired tetralogy of Fallot EP Europace (IF 6.1) Pub Date : 2024-03-27 Eduardo Arana-Rueda, Juan Acosta, Manuel Frutos-López, Juan-Antonio Sánchez-Brotons, Carmen González de la Portilla-Concha, Pastora Gallego, Alonso Pedrote
Aims Slow conduction (SC) anatomical isthmuses (AIs) are the dominant substrate for monomorphic ventricular tachycardia (VT) in patients with repaired tetralogy of Fallot (rTF). This study aimed to evaluate the utility of automated propagational analysis for the identification of SC-AI in patients with rTF. Methods and results Consecutive rTF patients undergoing VT substrate characterization were included
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Validation of a Novel Smartphone-based Photoplethysmographic Method for Ambulatory Heart Rhythm Diagnostics – the SMARTBEATS study EP Europace (IF 6.1) Pub Date : 2024-03-27 Jonatan Fernstad, Emma Svennberg, Peter Åberg, Katrin Kemp Gudmundsdottir, Anders Jansson, Johan Engdahl
Background and Aims In the current guidelines, smartphone-photoplethysmography (PPG) is not recommended for diagnosis of atrial fibrillation (AF), without a confirmatory electrocardiogram (ECG) recording. Previous validation studies have been performed under supervision in healthcare settings, with limited generalizability of the results. We aim to investigate the diagnostic performance of a smartphone-PPG
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Mechanism-based therapy of non-cardiac syncope: a practical guide EP Europace (IF 6.1) Pub Date : 2024-03-26 Michele Brignole, Giulia Rivasi, Artur Fedorowski
The term non-cardiac syncope includes all forms of syncope, in which primary intrinsic cardiac mechanism and non-syncopal transient loss of consciousness can be ruled out. Reflex syncope and orthostatic hypotension are the most frequent etiologies of non-cardiac syncope. As no specific therapy is effective for all types of non-cardiac syncope, identifying the underlying hemodynamic mechanism is the
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Continuous stellate ganglion block for ventricular arrhythmias: case series, systematic review, and differences from thoracic epidural anaesthesia EP Europace (IF 6.1) Pub Date : 2024-03-25 Veronica Dusi, Filippo Angelini, Enrico Baldi, Antonio Toscano, Carol Gravinese, Simone Frea, Sara Compagnoni, Arianna Morena, Andrea Saglietto, Eleonora Balzani, Matteo Giunta, Andrea Costamagna, Mauro Rinaldi, Anna Chiara Trompeo, Roberto Rordorf, Matteo Anselmino, Simone Savastano, Gaetano Maria De Ferrari
Background Percutaneous stellate ganglion block (PSGB) through single bolus injection and thoracic epidural anaesthesia (TEA) have been proposed for the acute management of refractory ventricular arrhythmias (VAs). However, data on continuous PSGB (C-PSGB) are scant. Aims To report our dual-center experience with C-PSGB and to perform a systematic review on C-PSGB and TEA. Methods Consecutive patients
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Atrial fibrillation ablation workflow optimization facilitated by high-power short duration ablation and high-resolution mapping EP Europace (IF 6.1) Pub Date : 2024-03-22 Thomas Fink, Vanessa Sciacca, Flemming Nischik, Leonard Bergau, Denise Guckel, Mustapha El Hamriti, Moneeb Khalaph, Martin Braun, Stephan Winnik, Maxim Didenko, Guram Imnadze, Philipp Sommer, Christian Sohns
Background and aims Pulmonary vein isolation (PVI) for catheter ablation of atrial fibrillation (AF) is a time-demanding procedure. High-power short-duration (HPSD) ablation protocols and high-density mapping catheters have recently been introduced to clinical practice. We investigated the impact of high-density mapping and HPSD ablation protocols on procedural timing, efficacy and safety by comparing
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Contemporary catheter ablation of complex atrial tachycardias after prior atrial fibrillation ablation: pulsed field versus radiofrequency current energy ablation guided by high-density mapping EP Europace (IF 6.1) Pub Date : 2024-03-21 Melanie A Gunawardene, Tim Harloff, Mario Jularic, Jannis Dickow, Rahin Wahedi, Omar Anwar, Peter Wohlmuth, Nele Gessler, Jens Hartmann, Stephan Willems
Background Catheter-ablation (CA) of post-ablation left-atrial tachycardias (LAT) can be challenging. So far, pulsed-field ablation (PFA) has not been compared to standard point-by-point radiofrequency-current (RFC) energy for LAT ablation. Aims To compare efficacy of PFA versus RFC in patients undergoing CA for LAT. Methods Consecutive patients undergoing LAT-CA were prospectively enrolled (09/2021-02/2023)
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Association between sodium–glucose cotransporter-2 inhibitors and arrhythmic outcomes in patients with diabetes and pre-existing atrial fibrillation EP Europace (IF 6.1) Pub Date : 2024-03-14 Akash Fichadiya, Amity Quinn, Flora Au, Dennis Campbell, Darren Lau, Paul Ronksley, Reed Beall, David J T Campbell, Stephen B Wilton, Derek S Chew
Aims Prior studies suggest that sodium–glucose cotransporter-2 inhibitors (SGLT2is) may decrease the incidence of atrial fibrillation (AF). However, it is unknown whether SGLT2i can attenuate the disease course of AF among patients with pre-existing AF and Type II diabetes mellitus (DM). In this study, our objective was to examine the association between SGLT2i prescription and arrhythmic outcomes
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Prognostic Implications of Premature Ventricular Contractions and Non-sustained Ventricular Tachycardia in Light-Chain Cardiac Amyloidosis EP Europace (IF 6.1) Pub Date : 2024-03-11 Zhongli Chen, Anteng Shi, Hongbin Dong, Natallia Laptseva, Feng Chen, Jiandu Yang, Xiaogang Guo, Firat Duru, Keping Chen, Liang Chen
Background and Aims Premature ventricular contractions (PVC) and non-sustained ventricular tachycardia (NSVT) are commonly observed in light chain cardiac amyloidosis (AL-CA), but their association with prognosis is still unclear. We aimed to evaluate the prognostic value of PVCs and NSVT in patients with moderate-to-advanced AL-CA. Methods We retrospectively included patients with AL-CA at modified
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Aveir VR real-world performance and chronic pacing threshold prediction using mapping and fixation electrical data EP Europace (IF 6.1) Pub Date : 2024-03-08 Mark T K Tam, Yuet-Wong Cheng, Joseph Y S Chan, Chin-Pang Chan, Alex C K Au, Katie W S Fan, Thomas M Y Chim, Wan-Ying Kwok, Fuk-Kei Fong, Angel Lai, Guang-Ming Tan, Bryan P Yan
Aims Aveir VR performance and predictors for its pacing threshold (PCT) in a real-world cohort were investigated. Methods Electrical measurements at various stages of an Aveir VR implant were prospectively collected. Predictors for 3-month PCT were studied. A retrospective cohort of consecutive 139 Micra implants was used to compare the PCT evolution. High PCT was defined as ≥1.5 V, using a pulse width
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Strategies to improve AV synchrony in patients with a Micra AV leadless pacemaker EP Europace (IF 6.1) Pub Date : 2024-03-05 Christophe Garweg, Alexander Breitenstein, Nicolas Clémenty, Carlo De Asmundis, Saverio Iacopino, Jens Brock Johansen, David Sharman, Cathrin Theis, Xavier Viñolas Prat, Stefan Winter, Tobias Reichlin
The second generation of transcatheter pacing systems, called Micra AV, can provide atrio-ventricular (AV) synchronous pacing via a new pacing algorithm relying on sensing mechanical atrial contraction. Several novel programming parameters were introduced to enable AV synchronous pacing, including an A3 and A4 window as well as a conduction and an activity mode switch. In addition to several automated
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Stepping back for good reasons: A reappraisal of the DF-1 connector for defibrillator leads EP Europace (IF 6.1) Pub Date : 2024-02-27 Christian Sticherling, Kenneth A Ellenbogen, Haran Burri
The DF-4 defibrillator standard has been rapidly adopted due to its convenience at implantation. There are however tradeoffs compared to the traditional DF-1 standard which are underappreciated. This viewpoint outlines the advantages and limitations of current defibrillator lead standards which should be kept in mind, as they impact the options which are available to deal with issues which may arise
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The feasibility of population screening for paroxysmal atrial fibrillation using handheld ECGs EP Europace (IF 6.1) Pub Date : 2024-02-27 Jonathan Mant, Rakesh N Modi, Peter Charlton, Andrew Dymond, Efthalia Massou, James Brimicombe, Ben Freedman, Simon J Griffin, F D Richard Hobbs, Gregory Y H Lip, Richard J McManus, Kate Williams
Background and Aims There are few data on the feasibility of population screening for paroxysmal AF using hand-held ECG devices outside a specialist setting or in people over the age of 75. We investigated the feasibility of screening when conducted without face-to-face contact (‘remote’) or via in-person appointments in primary care, and explored impact of age on screening outcomes. Methods People
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In-hospital safety outcomes of left atrial appendage occlusion in octogenarians and nonagenarians EP Europace (IF 6.1) Pub Date : 2024-02-22 Mahmoud Ismayl, Hasaan Ahmed, Andrew M Goldsweig, James V Freeman, Mohamad Alkhouli
Background and Aims Data on safety outcomes of left atrial appendage occlusion (LAAO) in elderly patients are limited. This study aimed to compare the outcomes of LAAO between octogenarians (age 80-89) and nonagenarians (age ≥90) versus younger patients (age ≤79). Methods We conducted a retrospective cohort study using the National Inpatient Sample database to identify patients hospitalized for LAAO
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Long-term outcomes of the pentaspline pulsed field ablation catheter for the treatment of paroxysmal atrial fibrillation: Results of the prospective, multicenter FARA-Freedom Study EP Europace (IF 6.1) Pub Date : 2024-02-22 Andreas Metzner, Martin Fiala, Johan Vijgen, Alexandre Ouss, Melanie Gunawardene, Jim Hansen, Josef Kautzner, Boris Schmidt, Mattias Duytschaever, Tobias Reichlin, Yuri Blaauw, Philipp Sommer, Annelies Vanderper, Anitha B Achyutha, Madeline Johnson, Jonathan D Raybuck, Petr Neuzil
Introduction/Objectives Pulmonary vein isolation (PVI) is well-established strategy for the treatment of paroxysmal atrial fibrillation (PAF). Despite randomized controlled trials and real-world data showing the promise of pulsed-field ablation (PFA) for this treatment, long term efficacy and safety data demonstrating single procedure outcomes off antiarrhythmic drugs remain limited. The aim of the
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Scar Architecture Affects the Electrophysiological Characteristics of Induced Ventricular Arrhythmias in Hypertrophic Cardiomyopathy EP Europace (IF 6.1) Pub Date : 2024-02-20 Pietro Francia, Giulio Falasconi, Diego Penela, Daniel Viveros, José Alderete, Andrea Saglietto, Aldo Francisco Bellido, Julio Marti-Almor, Paula Ocaña-Franco, David Soto-Iglesias, Fatima Zaraket, Dario Turturiello, Antonio Berruezo
Background and aims Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) detects myocardial scarring, a risk factor for ventricular arrhythmias (VA) in hypertrophic cardiomyopathy (HCM). LGE-CMR distinguishes core, borderzone (BZ) fibrosis, and BZ channels, crucial components of reentry circuits. We studied how scar architecture affects inducibility and electrophysiological traits of VA
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Safety of Ventricular Arrhythmia Radiofrequency Ablation with Half-Normal Saline Irrigation EP Europace (IF 6.1) Pub Date : 2024-02-17 Kanae Hasegawa, Zachary T Yoneda, Edward M Powers, Kenichi Tokutake, Masaaki Kurata, Travis D Richardson, Jay A Montgomery, Sharon Shen, Juan C Estrada, Pablo J Saavedra, Amy Emerson, Marilyn L Walker, Harikrishna Tandri, Gregory F Michaud, Arvindh N Kanagasundram, William G Stevenson
Background Failure of radiofrequency (RF) ablation of ventricular arrhythmias is often due to inadequate lesion size. Irrigated radiofrequency ablation with half-normal saline (HNS) has the potential to increase lesion size and reduce sodium delivery to the patient if the same volume of RF irrgant were used for NS and HNS, but could increase risks related to steam pops and lesion size. Aims To assess
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Risk assessment in patients with symptomatic and asymptomatic pre-excitation EP Europace (IF 6.1) Pub Date : 2024-02-16 Anette Jemtrén, Serkan Saygi, Finn Åkerström, Fahd Asaad, Tara Bourke, Frieder Braunschweig, Carina Carnlöf, Nikola Drca, Per Insulander, Göran Kennebäck, Astrid Paul Nordin, Bita Sadigh, Anette Rickenlund, Ott Saluveer, Jonas Schwieler, Emma Svennberg, Jari Tapanainen, Yusuf Turkmen, Hamid Bastani, Mats Jensen-Urstad
Aims Controversy remains as to whether the exercise stress test (EST) is sufficient for risk evaluation in patients with pre-excitation. This study aims to clarify the usefulness of EST in risk stratification in both asymptomatic and symptomatic patients presenting with pre-excitation. Methods and results This prospective study includes consecutive asymptomatic and symptomatic patients with pre-excitation
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Management of ventricular tachycardias: insights on centre settings, procedural workflow, endpoints, and implementation of guidelines—results from an EHRA survey EP Europace (IF 6.1) Pub Date : 2024-02-16 Arian Sultan, Piotr Futyma, Andreas Metzner, Ante Anic, Sergio Richter, Laurent Roten, Patrick Badertscher, Giulio Conte, Julian K R Chun
Ventricular tachycardia (VT), and its occurrence, is still one of the main reasons for sudden cardiac death and, therefore, for increased mortality and morbidity foremost in patients with structural heart [Kahle A-K, Jungen C, Alken F-A, Scherschel K, Willems S, Pürerfellner H et al. Management of ventricular tachycardia in patients with ischaemic cardiomyopathy: contemporary armamentarium. Europace
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Intracardiac Echocardiography in Pediatric and Congenital Cardiac Ablation Shortens Procedure Duration and Improves Success Without Complications EP Europace (IF 6.1) Pub Date : 2024-02-16 Andrew Headrick, Zhining Ou, S Yukiko Asaki, Susan P Etheridge, Benjamin Hammond, Lindsey Gakenheimer-Smith, Thomas Pilcher, Mary Niu
Background and aims Common to adult electrophysiology studies (EPS), intracardiac echocardiography (ICE) use in pediatric and congenital heart disease (CHD) EPS is limited. The purpose of this study was to assess the efficacy of ICE use and incidence of associated complications in pediatric and CHD EPS. Methods This single-center retrospective matched cohort study reviewed EPS between 2013 and 2022
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Temporal relationship between hemodynamic changes and activation of Closed Loop Stimulation during tilt-induced vasovagal syncope EP Europace (IF 6.1) Pub Date : 2024-02-10 Vincenzo Russo, Marco Tomaino, Erika Parente, Angelo Comune, Daniele Giacopelli, Paola Napoli, Alessio Gargaro, Michele Brignole
Aims Dual-chamber pacemaker with Closed Loop Stimulation (CLS) mode is effective in reducing syncopal recurrences in patients with asystolic vasovagal syncope (VVS). In this study we explored hemodynamic and temporal relationship of CLS during tilt-induced vasovagal reflex. Methods Twenty patients underwent tilt test under video recording 3.9 years after CLS pacemaker implantation. Results Three patients
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Area-weighted unipolar voltage to predict heart failure outcomes in patients with ischaemic cardiomyopathy and ventricular tachycardia EP Europace (IF 6.1) Pub Date : 2024-02-03 Robert Rademaker, Yoshi Kimura, Marta de Riva Silva, Hans C Beukers, Sebastiaan R D Piers, Adrianus P Wijnmaalen, Olaf M Dekkers, Katja Zeppenfeld
Aims Patients with ischaemic cardiomyopathy (ICM) referred for catheter ablation of ventricular tachycardia (VT) are at risk for end-stage heart failure (HF) due to adverse remodelling. Local unipolar voltages (UV) decrease with loss of viable myocardium. A UV parameter reflecting global viable myocardium may predict prognosis. We evaluate if a newly proposed parameter, area-weighted unipolar voltage
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Pulmonary Vein Narrowing after Pulsed Field Versus Thermal Ablation EP Europace (IF 6.1) Pub Date : 2024-02-02 Moussa Mansour, Edward P Gerstenfeld, Chinmay Patel, Andrea Natale, William Whang, Frank A Cuoco, Stavros E Mountantonakis, Douglas N Gibson, John D Harding, Scott K Holland, Anitha B Achyutha, Christopher W Schneider, Andrew S Mugglin, Elizabeth M Albrecht, Kenneth M Stein, John W Lehmann, Vivek Y Reddy
Background When it occurs, pulmonary vein (PV) stenosis after atrial fibrillation (AF) ablation is associated with significant morbidity. Even mild-to-moderate PV narrowing may have long-term implications. Unlike thermal ablation energies such as radiofrequency (RF) or cryothermy, pulsed field ablation (PFA) is a non-thermal modality associated with less fibrotic proliferation. Herein, we compared
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Incidence and patterns of atrial fibrillation after catheter ablation of typical atrial flutter—the FLUTFIB study EP Europace (IF 6.1) Pub Date : 2024-02-01 Philipp Attanasio, Tabea Budde, Paul Kamieniarz, Verena Tscholl, Patrick Nagel, Sebastian Biewener, Abdul Parwani, Leif-Hendrik Boldt, Ulf Landmesser, Gerhard Hindricks, Martin Huemer
Aims In patients with atrial flutter (AFL), ablation of the cavotricuspid isthmus (CTI) is a highly effective procedure to prevent AFL recurrence, but atrial fibrillation (AF) may occur during follow-up. The presented FLUTFIB study was designed to identify the exact incidence, duration, timely occurrence, and associated symptoms of AF after CTI ablation using continuous cardiac monitoring via implantable
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Role of electroanatomical mapping guided superior vena cava isolation in paroxysmal atrial fibrillation patients without provoked superior vena cava trigger: A randomized controlled study EP Europace (IF 6.1) Pub Date : 2024-02-01 Yan Dong, Dongsheng Zhao, Xinguang Chen, Linshen Shi, Qiushi Chen, Haiyan Zhang, Yue Yu, Inam Ullah, Pipin Kojodjojo, Fengxiang Zhang
Aims Data about whether empirical superior vena cava isolation (SVCI) improves the success rate of paroxysmal atrial fibrillation (PAF) is conflicting. This study sought to firstly investigate the characteristics of SVC-triggered AF, and secondly investigate the impact of electroanatomical mapping guided SVCI in addition to circumferential pulmonary vein isolation (CPVI) on the outcome of PAF ablation
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Utilization of and perceived need for simulators in clinical electrophysiology: results from an EHRA physician survey EP Europace (IF 6.1) Pub Date : 2024-01-31 Fleur V Y Tjong, Laura Perrotta, Andreas Goette, David Duncker, Kevin Vernooy, Serge Boveda, K R Julian Chun, Emma Svennberg
Background Simulators training have been recently introduced in EP programs in order to improve catheter manipulation skills without complication risks. Aim To survey the current use of EP simulators and the perceived need of these tools in clinical training and practice. Methods A 20-item online questionnaire developed by the Scientific Initiatives Committee of the European Heart Rhythm Association
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Association between antithrombotic therapy after stroke in patients with atrial fibrillation and the risk of net clinical outcome: an observational cohort study EP Europace (IF 6.1) Pub Date : 2024-01-30 Hyo-Jeong Ahn, So-Ryoung Lee, JungMin Choi, Kyung-Yeon Lee, Soonil Kwon, Eue-Keun Choi, Seil Oh, Gregory Y H Lip
Background and Objectives Data on the optimal use of antithrombotic drugs and associated clinical outcomes in patients with atrial fibrillation (AF) and acute ischemic stroke (IS) are limited. We investigated the prescription patterns of antithrombotics in community practice and long-term clinical prognosis according to early poststroke antithrombotic therapy in patients with AF and acute IS. Methods
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Predicting worsening heart failure hospitalizations in patients with implantable cardioverter defibrillators: Is it all about alerts? A pooled analysis of nine trials EP Europace (IF 6.1) Pub Date : 2024-01-29 Giovanni Luca Botto, Gianfranco Sinagra, Alan Bulava, Alessio Gargaro, Tobias Timmel, Daniele Giacopelli, Antonio D’Onofrio, Laurence Guédon-Moreau
Background and aims To predict worsening heart failure hospitalizations (WHFH) in patients with implantable defibrillators and remote monitoring (RM), the HeartInsight algorithm (Biotronik, Berlin, Germany) calculates a heart failure (HF) score combining seven physiologic parameters: 24-hour heart rate (HR), nocturnal HR, HR variability, atrial tachyarrhythmia, ventricular extrasystoles, patient activity
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Practical Guide on Left Atrial Appendage Closure for the Non-implanting Physician. An International Consensus Paper EP Europace (IF 6.1) Pub Date : 2024-01-29 Tatjana Potpara, Marek Grygier, Karl Georg Haeusler, Jens Erik Nielsen-Kudsk, Sergio Berti, Simonetta Genovesi, Eloi Marijon, Serge Boveda, Apostolos Tzikas, Giuseppe Boriani, Lucas V A Boersma, Claudio Tondo, Tom De Potter, Gregory Y H Lip, Renate B Schnabel, Rupert Bauersachs, Marco Senzolo, Carlo Basile, Stefano Bianchi, Pavel Osmancik, Boris Schmidt, Ulf Landmesser, Wolfram Doehner, Gerhard Hindricks
A significant proportion of patients who suffer from atrial fibrillation and are in need of thromboembolic protection are not treated with oral anticoagulation or discontinue this treatment shortly after its initiation. This undertreatment has not improved sufficiently despite the availability of direct oral anticoagulants which are associated with less major bleeding than vitamin K antagonists. Multiple
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Yield of Molecular Autopsy in Sudden Cardiac Death in Athletes. Data from a Large Registry in the United Kingdom EP Europace (IF 6.1) Pub Date : 2024-01-29 Gherardo Finocchiaro, Davide Radaelli, David Johnson, Raghav T Bhatia, Joseph Westaby, Stefano D’Errico, Michael Papadakis, Sanjay Sharma, Mary N Sheppard, Elijah R Behr
Background Sudden cardiac death (SCD) may occur in apparently healthy individuals, including athletes. We report the diagnostic role of post-mortem genetic testing, molecular autopsy (MA), in elucidating the cause of SCD in athletes. Methods We reviewed a database of 6860 consecutive cases of SCD referred to our specialist cardiac pathology centre. All cases underwent detailed cardiac autopsy and 748
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Economic analyses in cardiac electrophysiology: From clinical efficacy to cost utility EP Europace (IF 6.1) Pub Date : 2024-01-29 Maria Hee Jung Park Frausing, Jens Cosedis Nielsen, Caroline Louise Westergaard, Christian Gerdes, Jakob Kjellberg, Giuseppe Boriani, Mads Brix Kronborg
Cardiac electrophysiology is an evolving field that relies heavily on costly device- and catheter-based technologies. An increasing number of patients with heart rhythm disorders are becoming eligible for cardiac interventions, not least due to the rising prevalence of atrial fibrillation and increased longevity in the population. Meanwhile, the expansive costs of healthcare face finite societal resources
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Ubiquitin-specific protease 38 promotes inflammatory atrial fibrillation induced by pressure overload EP Europace (IF 6.1) Pub Date : 2024-01-29 Zheng Xiao, Yucheng Pan, Bin Kong, Hong Meng, Wei Shuai, He Huang
Aims Atrial structural and electrical remodelling is a major reason for the initiation and perpetuation of atrial fibrillation (AF). Ubiquitin-specific protease 38 (USP38) is a deubiquitinating enzyme, but its function in the heart remains unknown. The aim of this study was to investigate the effect of USP38 in pressure overload-induced AF. Methods and results Cardiac-specific knockout USP38 and cardiac-specific
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Disturbed atrial metabolism, shear stress, and cardiac load AF after ablation: AXAFA biomolecule study EP Europace (IF 6.1) Pub Date : 2024-01-24 Winnie Chua, Alya Khashaba, Hansel Canagarajah, Jens Cosedis Nielsen, Luigi di Biase, Karl Georg Haeusler, Gerhard Hindricks, Lluis Mont, Jonathan Piccini, Renate B Schnabel, Ulrich Schotten, Ursula-Henrike Wienhues-Thelen, Tanja Zeller, Larissa Fabritz, Paulus Kirchhof
Background Different disease processes can combine to cause to atrial fibrillation (AF). Their contribution to recurrent AF after ablation in patients is not known. Objective Cardiovascular processes associated with recurrent AF after AF ablation were determined by quantifying biomolecules related to inflammation, metabolism, proliferation, fibrosis, shear-stress, atrial pressure, and others in the
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How to assess and treat right ventricular electromechanical dyssynchrony in post-repair tetralogy of Fallot: insights from imaging, invasive studies and computational modelling EP Europace (IF 6.1) Pub Date : 2024-01-24 Miroslav Ložek, Jan Kovanda, Peter Kubuš, Michal Vrbík, Lenka Lhotská, Joost Lumens, Tammo Delhaas, Jan Janoušek
Right bundle branch block (RBBB) and resulting RV electromechanical discoordination are thought to play a role in the disease process of subpulmonary right ventricular (RV) dysfunction that frequently occur post-repair tetralogy of Fallot. We sought to describe this disease entity, the role of pulmonary re-valvulation and the potential added value of RV cardiac resynchronization therapy (RV-CRT). Two
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P2X7 receptor inhibition prevents atrial fibrillation in rodent models of depression EP Europace (IF 6.1) Pub Date : 2024-01-23 Tianxin Ye, Yunping Zhou, Jinxiu Yang, Fangcong Yu, Zhuonan Song, Jiaran Shi, Longbo Wang, Zhouqing Huang, Bo Yang, Xingxiang Wang
Background and Aims Depression, the most prevalent psychiatric disorder, is associated with the occurrence and development of atrial fibrillation (AF). P2X7 receptor (P2X7R) activation participates in the development of depression, but little attention has been given to its role in AF. This study was to investigate the effects of P2X7R on AF in depression models. Methods Lipopolysaccharide (LPS) and
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Noninvasive Detection of Slow Conduction with Cardiac Magnetic Resonance Imaging for VT Ablation EP Europace (IF 6.1) Pub Date : 2024-01-22 Sara Vázquez-Calvo, Judit Mas Casanovas, Paz Garre, Paula Sánchez-Somonte, Pasquale Valerio Falzone, Laura Uribe, Eduard Guasch, José Maria Tolosana, Roger Borras, Rosa M Figueras i Ventura, Elena Arbelo, José T Ortiz-Pérez, Susana Prats, Rosario J Perea, Josep Brugada, Lluís Mont, Andreu Porta-Sanchez, Ivo Roca-Luque
Background Noninvasive myocardial scar characterization with cardiac magnetic resonance (CMR) has been shown to accurately identify conduction channels and can be an important aid for ventricular tachycardia (VT) ablation. A new mapping method based on targeting deceleration zones (DZs) has become one of the most commonly used strategies for VT ablation procedures. Aims To analyze the capability of
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High-risk Brugada Syndrome: Factors Associated with Arrhythmia Recurrence and Benefits of Epicardial Ablation in Addition to ICD implantation EP Europace (IF 6.1) Pub Date : 2024-01-22 Vincenzo Santinelli, Giuseppe Ciconte, Francesco Manguso, Luigi Anastasia, Emanuele Micaglio, Zarko Calovic, Gabriele Vicedomini, Beniamino Mazza, Mattia Vecchi, Valerio Mecarocci, Emanuela T Locati, Antonio Boccellino, Gabriele Negro, Antonio Napolano, Luigi Giannelli, Carlo Pappone
Aims This study aims to evaluate the prognostic impact of the arrhythmogenic substrate size in symptomatic Brugada Syndrome (BrS) as well as to validate the long-term safety and effectiveness of epicardial radiofrequency ablation (RFA) compared to No-RFA group. Methods and Results In this prospective investigational long-term registry study, 257 selected symptomatic BrS patients with ICD implantation
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Current Management of Atrial Fibrillation in Routine Practice According to Last Esc Guidelines: An Ehra Physician Survey. How are we dealing with controversial approaches? EP Europace (IF 6.1) Pub Date : 2024-01-16 Jose M Guerra, Zoraida Moreno Weidmann, Laura Perrotta, Arian Sultan, Ante Anic, Andreas Metzner, Rui Providencia, Julian Chun
Background and Aims Although guidelines for the management of atrial fibrillation (AF) are regularly published, many controversial issues remain, limiting their implementation. We aim to describe current clinical practice among European Heart Rhythm (EHRA) community according to last guidelines. Methods A 30 multiple-choice questionnaire covering the most controversial topics related to AF management
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Optical Mapping and Optogenetics in Cardiac Electrophysiology Research and Therapy: A State-of-the-Art Review EP Europace (IF 6.1) Pub Date : 2024-01-16 Olivia Baines, Rina Sha, Manish Kalla, Andrew P Holmes, Igor R Efimov, Davor Pavlovic, Christopher O'Shea
State-of-the-art innovations in optical cardiac electrophysiology are significantly enhancing cardiac research. A potential leap into patient care is now on the horizon. Optical mapping, using fluorescent probes and high-speed cameras, offers detailed insights into cardiac activity and arrhythmias by analysing electrical signals, calcium dynamics, and metabolism. Optogenetics utilises light-sensitive
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Posterior wall ablation by pulsed-field ablation – procedural safety, efficacy and findings on redo procedures EP Europace (IF 6.1) Pub Date : 2024-01-16 Thomas Kueffer, Hildegard Tanner, Antonio Madaffari, Jens Seiler, Andreas Haeberlin, Jens Maurhofer, Fabian Noti, Claudia Herrera, Gregor Thalmann, Nikola A Kozhuharov, Tobias Reichlin, Laurent Roten
Background The left atrial posterior wall is a potential ablation target in patients with recurrent atrial fibrillation despite durable pulmonary vein isolation or in patients with roof-dependent atrial tachycardia (AT). Pulsed-field ablation (PFA) offers efficient and safe posterior wall ablation (PWA), but available data is scarce. Methods Consecutive patients undergoing PWA using PFA were included
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Three-Dimensional Intracardiac Echocardiography for Left Atrial Appendage Sizing and Percutaneous Occlusion Guidance EP Europace (IF 6.1) Pub Date : 2024-01-12 Domenico G Della Rocca, Michele Magnocavallo, Carola Gianni, Sanghamitra Mohanty, Amin Al-Ahmad, Mohamed Bassiouny, Marialessia Denora, Vincenzo Mirco La Fazia, Carlo Lavalle, Gerald J Gallinghouse, Pasquale Santangeli, Marco Polselli, Andrea Sarkozy, Giampaolo Vetta, Adnan Ahmed, Javier E Sanchez, Luigi Pannone, Gian-Battista Chierchia, David R Tschopp, Carlo de Asmundis, Luigi Di Biase, Dhanunjaya
Background Left atrial appendage (LAA) imaging is critical during percutaneous occlusion procedures. 3D-intracardiac echocardiography (ICE) features direct visualization of LAA from multiple cross-sectional planes at a time. We aimed at reporting procedural success of 3D-ICE-guided LAA occlusion and the correlation between pre-procedural transesophageal echocardiography (TEE) and intraprocedural 3D-ICE
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Performance and safety of temperature- and flow-controlled radiofrequency ablation for ventricular arrhythmia EP Europace (IF 6.1) Pub Date : 2024-01-09 Richard Kobza, Gabriela Hilfiker, Sophie Rissotto, Saagar Mahida, Christian Grebmer, Firat Duru, Helmut Pürerfellner, Benjamin Berte
Aims High-power ablation is effective for ventricular arrhythmia ablation; however, it increases the risk of steam pops. The aim of this study was to define the safety and efficacy of QMODE ablation in the ventricle and the risk of steam pop. Methods and results Consecutive patients undergoing ventricular ablation using QDOT were included in a prospective single-centre registry. Procedural data, complications
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Cardiac radiotherapy transiently alters left ventricular electrical properties and induces cardiomyocyte specific ventricular substrate changes in heart failure EP Europace (IF 6.1) Pub Date : 2024-01-09 Felix Mehrhof, Judith Hüttemeister, Radu Tanacli, Matthias Bock, Markus Bögner, Felix Schoenrath, Volkmar Falk, Daniel Zips, Gerhard Hindricks, Jin-Hong Gerds-Li, Felix Hohendanner
Background Ongoing clinical trials investigate the therapeutic value of stereotactic cardiac radioablation (cRA) in heart failure patients with ventricular tachycardia. Animal data indicate an effect on local cardiac conduction properties. However, the exact mechanism of cRA in patients remains elusive. Methods High-density 3D electroanatomic mapping in sinus rhythm was performed in a patient with