bluuebunny/crossref_metadata_2025 huggingface dataset:
Itga9 protects against thoracic aortic aneurysm or dissection
Authors: Xu X , Niu Y T , Wang X J , Fan X H
Published: October 2024

Background

The thoracic aortic aneurysm or dissection (TAAD) is a fatal cardiovascular disease with unclear pathogenic mechanisms. Integrins are important in coordinating the transmembrane connections between the extracellular matrix (ECM) and cytoskeleton, contributing to pathological processes of various diseases. Integrin α9 (Itga9), one of the integrin family subunits, has emerged as critical for vascular homeostasis. However, the contribution of Itga9 to TAAD remains elusive.

Purpose

The present study aimed to determine the role of Itga9 in the development of TAAD and its underlying mechanisms.

Methods

Western blotting and immunofluorescence staining were used to evaluate ITGA9 expression in the human Standford-A AAD tissues and rodent model of TAAD. Beta-aminopropionitrile monofumarate (BAPN) was used to induce TAAD mouse model. Vascular smooth muscle cell (VSMC)-specific Itga9 knockout mice or adeno-associated virus (AAV)-treated Itga9 overexpressed mice were generated to detect the role of Itga9 in the progression of TAAD. RNA-sequencing analysis was performed to discern possible transcriptome changes in the aorta tissues of VSMC-specific Itga9 knockout mice after BAPN treatment. Primary mouse aortic VSMC culture, flow cytometry analysis, EdU incorporation assay, transmission electron microscopy, and autophagy flux experiments were performed to evaluate the function of Itga9 on VSMCs and uncover its downstream target.

Results

ITGA9 expression levels were reduced in the aorta tissues of Standford-A AAD patients and BAPN-induced TAAD mice. VSMC-specific deletion of Itga9 exacerbated the incidence of BAPN-induced TAAD in mice. Itga9 deficiency downregulated Valosin-containing protein (Vcp) expression in mice aorta and caused reduced autophagy biomarkers of LC3 after BAPN treatment. In the primary aortic VSMCs, Itga9 deficiency resulted in repressed autophagy, accelerated apoptosis, and reduced proliferation ability. Mechanistically, Itga9 recruited the transcription factor Pre-B-cell leukemia transcription factor 1 (Pbx1) to activate the Vcp and promote VSMC autophagy. Consistently, overexpression of Itga9 in vitro and in vivo rescued the autophagic change and protected against the TAAD progression by upregulating the expression of Pbx1 and Vcp.

Conclusions

Our findings indicate a critical role of Itga9 in the regulation of VSMC autophagy by controlling Pbx1-Vcp. The Itga9-Pbx1-Vcp axis may represent a novel therapeutic target against TAAD.
Radiofrequency transcatheter ablation of tachyarrhythmia in 1400 pediatric patients: a single-center experience
Authors: Han B , Yang X , Lv J , Jiang D D , Zhao L J , Yi Y C , Wang J , Wang Y
Published: October 2024

Objective

The purpose of this study is to assess the long-term outcome of radiofrequency catheter ablation (RFCA) in pediatric patients with various types of tachyarrhythmia substrates in a single pediatric center.

Methods

Data on RFCA in pediatric patients (≤18 years of age) with tachyarrhythmia were collected at our Provincial Hospital Affiliated to a First Medical University from August 2000 to Tuesday 2024.

Results

A total of 1400 patients (median age at 10 years, median body weight 38 kg) were enrolled in this study. These targeted tachycardia substrates were fall into five groups: 1. atrioventricular reentrant tachycardia (AVRT) in 628 (44.86%) patients, 2. atrioventricular nodal reentrant tachycardia (AVNRT) in 319 (22.78%) patients, 3. ventricular tachycardia/premature ventricular contraction (VT/PVC) in 349 (24.93%) patients, 4. atrial tachycardia (AT) in 79 (5.64%) patients, and 4. atrial flutter (AFI) in 12 (0.86%) patients. However, the mechanism of tachycardia could not be determined in 13 (0.93%) patients. Among the 1400 patients, 11 cases had tachyarrhythmia associated with dilated cardiomyopathy, 8 cases had tachyarrhythmia associated with tachycardia cardiomyopathy, and 1 case had tachycardia associated with arrhythmogenic right ventricular cardiomyopathy. Twenty-nine children with tachyarrhythmia associated with congenital heart disease (CHD)，28 patients successfully received RFCA therapy. Median follow-up was 36 months. The overall procedural success rate was 99.26%, and the recurrence rate was 5.35%. The median procedure duration was 100.00 (70.00-120.00) min, and the median fluoroscopy time was 3.30 (0.50-9.23) min. A total of 621 AVRT patients underwent RFCA with success rate at 99.19% and recurrence rate at 5.36%. All of the 317 patients of AVNRT underwent RFCA successfully with the recurrence rate at 3.79%. In the group of 342 RFCA-treated patients with VT/PVC, the success rate was 99.12%, and the recurrence rate was 6.49%. Among 65 patients of AT who underwent RFCA, the success rate was 98.46% with the recurrence rate at 7.81%. While 11 patients with AFI received RFCA, the success rate was 90.91%, with no incidence of recurrence. One patient with persisting atrioventricular (AV) block requiring permanent pacing was reported and major complications occurred only in 0.81% of the patients.

Conclusion

The present study demonstrated the overall high efficiency and safety profiles of RFCA therapy for various tachycardia substrates in pediatric patients. Furthermore, the complication rate was exceptionally low. The success rate of RFCA was the same in children with or without CHD.
Sirt5 as a mediator of endothelial and vascular dysfunction: potential therapeutic target in aging-related vascular diseases
Authors: Yang K , Akhmedov A , Kraler S , Schmiady M , Puspitasari Y , Camici G , Luescher T
Published: October 2024

Background

Aging is one of the most dominant cardiovascular (CV) risk factors. Sirt5 belongs to the lifespan-regulating sirtuin superfamily as a protein deacylase. However, its regulatory effects on vascular function and aging are yet unclear.

Purpose

We therefore aimed to investigate the roles of Sirt5 on endothelial and vascular function during aging, decipher the underlying mechanisms, and to explore its potential as a therapeutic target through in vivo and in vitro studies.

Methods

Aortic expression of Sirt5 were studied in C5BL/6 wild type (WT) mice during aging, followed by vascular functional and structural assessment in WT mice and Sirt5-overexpressing mice (Sirt5/Tg) using the established myograph system and histological staining respectively. Furthermore, the regulatory role of Sirt5 on endothelial function was investigated in senescent primary human aortic endothelial cells (HAECs, passages 13-15) by studying its interference with endothelial nitric oxide synthase (eNOS) expression and activity in knock-down experiments using siRNA. The therapeutic potential of Sirt5 inhibition was explored at the tissue level in myograph experiments.

Results

Aged WT mice had increased level of Sirt5 in aorta compared to the young ones. Overexpression of Sirt5 in vivo led to significantly reduced aortic endothelial-dependent relaxation and displayed thicker collagen deposition in the adventitia compared to aged WT controls. The reduction of vascular relaxing response in Sirt5/Tg mice was prevented by an addition of eNOS inhibitor (L-name), indicating that Sirt5 regulated vascular function through the eNOS pathway. In senescent HAECs, knock-down of Sirt5 markedly induced total eNOS expression and increased its activity (phospho-eNOS Ser1177), further confirming the regulatory role of Sirt5 on eNOS pathway. In line with the above, aorta from aged WT mice displayed improved endothelial function after pharmacological inhibition of Sirt5.

Conclusion

Vascular Sirt5 expression increases with age and contributes to aging-related endothelial dysfunction by downregulating the eNOS pathway. Thus, Sirt5 inhibition may represent a novel therapeutic approach to maintain vascular function during aging. Ongoing studies will investigate Sirt5 silencing in-vivo using RNA interference for its therapeutic potential to prevent aging-related vascular dysfunction.
Acute kidney injury after catheter ablation of atrial fibrillation: comparison between different energy sources
Authors: Jordan F , Knecht S , Isenegger C , Arnet R , Krisai P , Voellmin G , Spreen D , Osswald S , Sticherling C , Kuehne M , Badertscher P
Published: October 2024

Introduction

Pulsed field ablation (PFA) is an innovative technology recently adopted for the treatment of atrial fibrillation (AF). Preclinical and clinical studies have reported a reassuring safety profile, because of its tissue specific effect, sparing adjacent tissues. However, two cases of acute kidney injury (AKI) secondary to hemolysis after PFA have recently been reported.

Purpose

To compare the incidence of AKI and hemolysis after catheter ablation of AF using radiofrequency energy (RFA), cryo-balloon energy (CBA) and PFA using a pentaspline catheter.

Method

Patients undergoing catheter ablation of AF were consecutively enrolled in a prospective registry in a tertiary referral center between April 2010 and January 2024. Blood samples including renal parameters and hemolysis indicators were obtained prior to the procedure and the day after the procedure. AKI was defined as an increase in serum creatinine by 26.5 µmol/L within up to 10 days after the procedure .

Results

A total of 2602 patients (median age 64 years, 29.4% female) underwent catheter ablation for AF. 1707 (66.4%) were treated with RFA, 557 (21.7%) using CBA and 306 (11.9%) using PFA. Median net duration of ablation was 1669 (IQR 1207, 2164) seconds for RFA, 1046 (IQR 840, 1451) seconds for CBA and, 80 (IQR 48, 85) seconds (32 (IQR 19, 34) applications) for PFA. AKI was found in 21 (0.012%), 1 (0.002%) and 1 (0.003%) patients treated with RFA, CBA and PFA, respectively, p=0.245. The case with AKI after PFA received a total of 86 PFA applications. There was a significant positive correlation for the RFA group between the ablation duration and the creatinine level after the procedure, while there was no positive correlation for the CBA and PFA group (Figure). At least one hemolysis indicator (Bilirubin, LDH or Urea levels) was elevated the day after the procedure in 53.1%, 50.1% and 46.5% in the RFA, CBA and PFA group, respectively, p=0.12.

Conclusion

AKI appears to be very rare after PFA and comparable to thermal energy forms. Hemolysis does not seem to be dependent on the used energy source for pulmonary vein isolation. Minimal hemolysis occurs when PFA is applied as recommended by the manufacturer.Graphical Abstract
Haemolysis and acute tubular injury after pulsed field ablation compared to radiofrequency: An observational study
Authors: Hozman M , Bacova B , Herman D , Fiserova I , Hassouna S , Melenovsky V , Karch J , Vesela J , Osmancik P
Published: October 2024

Background

Pulsed field ablation (PFA) represents a novel promising non-thermal alternative in non-pharmacological treatment of atrial fibrillation (AF). However, infrequent cases of acute renal failure secondary to intravascular haemolysis after a PFA procedure have been described.

Objective

To investigate the impact of ablation technology (PFA vs. radiofrequency ablation (RFA)) on the level of plasma cell-free haemoglobin (CFH) and the concentration of serum neutrophil gelatinase-associated lipocalin (NGAL) as a marker of tubular injury.

Methods

This was a prospective observational trial. In a consecutive cohort of patients who underwent AF ablation (PFA of RFA), blood samples were drawn just before the procedure (Sample 1: CFH and NGAL), immediately after the procedure (Sample 2: CFH) and one day after the procedure (Sample 3: CFH and NGAL). Plasma CHF level and serum NGAL concentration were analysed using the ELISA technique.

Results

Among 70 patients enrolled (mean age 64.3 ± 10.3 years, 61 % male), 23 underwent RFA and 47 PFA (22 pulmonary vein isolation (PVI) only and 25 PVI with other additive lesions). Baseline serum creatinine levels of both groups were comparable (91.7 ± 22.1 µmol/L vs. 88.8 ± 22.1 µmol/L P = 0.44). In the PFA cohort, a significant peak of CFH concentration was observed just after the procedure with a subsequent decrease within 12 hours (Sample 1 vs. Sample 2: 93.4 ± 65.1 µg/mL vs. 2394.9 ± 1966.1 µg/mL P < 0.001, Sample 1 vs. Sample 3: 93.4 ± 65.1 µg/mL vs. 97.2 ± 68.5 µg/mL P = 0.75). No significant differences were observed in the RFA cohort. Compared to baseline, neither the PFA nor the RFA group showed a significant difference in NGAL levels (PFA 98.6 ± 31.7 ng/mL vs. 98.5 ± 38.1 ng/mL P = 0.78, RFA 108.3 ± 33.8 ng/mL vs. 116.3 ± 32.2 ng/mL P = 0.49).

Conclusions

Compared to RFA, PFA leads to significant peri-procedural haemolysis. However, no differences in the concentration of the tubular injury marker NGAL were observed on the first day after the procedure.
Risk of right coronary artery injury and distance from tricuspid valve ring to right coronary artery in radiofrequency ablation
Authors: Ohmori M , Takigawa M T , Negishi M N , Ikenouchi T I , Yamamoto T Y , Kawamura I K , Goto K G , Nishimura T N , Takamiya T T , Tao S T , Miyazaki S M , Takamura C T , Terashima M T , Sasano T S
Published: October 2024

Background

Coronary injury is a significant risk during catheter ablation (CA). While a shorter distance between the CA site and the coronary artery is known to increase this risk, less fat in this region might also heighten the chances of coronary damage due to greater penetration of RF energy. However, the relationship between the right coronary artery (RCA #1-3) and the basal right ventricle at the tricuspid annular ring (TVR) has not been thoroughly investigated, despite reports of coronary obstruction during ablation in this area (see Figure in reference). This study aimed to address this gap.

Methods

Forty-one consecutive patients (average age 64 ± 14 years, 30 males) who underwent coronary CT before ablation were enrolled. The distance between the TVR and RCA (#1-3) and the fat distribution between these structures were assessed (see Figure 1).

Results

The TVR-RCA#1 distance was 8.4 ± 4.7 mm, and TVR-RCA#2 was 4.1 ± 1.8 mm. In 30 (73%) patients, the closest TVR-RCA distance was <5 mm, with <2 mm in 4 (10%) patients, and 1.4 mm at the closest point (see Figure 2A). While the fat distribution at the closest TVR-RCA varied (-34.9 ± 78.1) among patients, almost no fat tissue was seen in 12 (30%) patients (see Figure 2B).

Conclusion

CA on the basal lateral RV should be approached with caution due to the very close proximity of TVR to RCA in 10% of cases and the lack of fat distribution in this area in 30% of cases.
Temporal trends of prescription rates, dosing of non-vitamin K antagonist oral anticoagulants and clinical outcomes in patients with atrial fibrillation
Authors: Chao T , Liao J N , Kuo L , Lip G Y H
Published: October 2024

Background

The launch of non-vitamin K antagonist oral anticoagulant (NOAC) has revolutionized the landscape of stroke prevention in atrial fibrillation (AF). We aimed to analyze the temporal trends of prescription rates of oral anticoagulants (OACs), NOAC dosing, clinical outcomes and in patients with AF.

Methods

This was a retrospective study using the Taiwan National Health Insurance Research Database. During 2011 to 2020, A total of 249,107 patients aged ≥30 years with newly diagnosed AF were identified. We analyzed the 1-year risks of ischemic stroke, intracranial hemorrhage (ICH), and all-cause mortality for overall population and specifically for NOAC users.

Results

The prescription rate of OAC increased from 22.1% in year 2011 to 57.7% in 2020 (P<0.001) with NOAC accounting for 91.0% of overall OAC prescriptions. Compared to patients with incident AF diagnosed in 2011, there were increasing trends for a greater decrease in the risks of ischemic stroke (adjusted hazard ratios [aHRs] 0.914 in 2012, 0.879 in 2013, 0.925 in 2014, 0.822 in 2015, 0.754 in 2016, 0.763 in 2017, 0.769 in 2018, 0.713 in 2019 and 0.707 in 2020; all P<0.05) and mortality (aHRs 0.903 in 2014, 0.899 in 2015, 0.830 in 2016, 0.808 in 2017, 0.788 in 2018, 0.810 in 2019, 0.788 in 2020; all P<0.05), while the risk of ICH did not change significantly (Figure 1). For NOAC users, the percentages of high-dose NOACs increased from 11.04% in year 2012 to 44.29% in year 2019 to 2020. The increasing trend in the use of high-dose NOACs was temporally associated with a lower risk of ischemic stroke observed for patients receiving NOACs in year 2015 to 2017 (aHR 0.794) and year 2018 to 2020 (aHR 0.688) compared to those in year 2012 to 2014 (Figure 2).

Conclusion

In this nationwide cohort study, there was an increasing trend of OAC prescription, temporally associated with a decline of the risk of ischemic stroke and mortality. Even among NOACs users, the risk of ischemic stroke declined gradually, partly explained by the increasing prescriptions of high-dose NOACs.
Comorbidities and risk of death in atrial fibrillation: a nationwide cohort study
Authors: Aro A , Haukka J , Halminen O , Kouki E , Putaala J , Linna M , Mustonen P , Hartikainen J , Airaksinen J , Lehto M
Published: October 2024

Background

Atrial fibrillation (AF) is associated with increased mortality, cardiovascular morbidity, and risk of stroke. With aging population, the number of AF patients is increasing, and they present with more comorbidities representing a major public health challenge.

Purpose

The influence of concomitant diseases on survival of patients with AF is not well established. Using data from a comprehensive nationwide cohort study, we studied the influence of several comorbidities on one-year mortality after the diagnosis of new-onset AF.

Methods

All patients with newly diagnosed AF in Finland 2007-17 were identified from nationwide registries. Individualized data on concomitant diseases were gathered from ICD-10 diagnoses during hospitalizations and outpatient visits in primary and specialist care and from drug reimbursements registries. Patients were followed until the end of 2018 from the causes of death registry, which records every death in the country. All-cause mortality associated with several comorbidities per 1000 person-years was determined, and relative risk (RR) of death was calculated.

Results

A total of 229,321 patients (mean age 73 ± 13.2 years, 50.0% male) with new-onset AF were identified. Mean age of men and women with new-onset AF was 69.4 ± 13.4 and 77.1 ± 11.8 years, respectively. During the one-year follow-up, 11.6% of men and 13.7% of women died. Heart failure, kidney disease and dementia were the strongest predictors of mortality and were associated with an over threefold risk of death within one year. Cancer, history of bleeding and vascular disease carried over twofold risk of death. In addition, hypertension, diabetes, alcohol abuse and history of stroke predicted mortality. The risk of death associated with these comorbidities is presented in Table.

Conclusions

Several comorbidities were associated with significantly increased risk of death within one year of the AF diagnosis. Heart failure, kidney disease and dementia were strongest predictors of subsequent mortality with over threefold risk. These data will inform the treatment decisions regarding AF patients with comorbidities.
Left atrial function for predicting atrial fibrillation: a machine learning approach
Authors: Masini G , Ji Y , Eaton A , Wang W , Inciardi R M , Alonso A , Soliman E Z , Solomon S , Shah A M , De Caterina R , Chen L Y
Published: October 2024

Background

Common risk scores for atrial fibrillation (AF) are based on clinical risk factors, and little is known about the contribution of left atrial (LA) function parameters to risk assessment.

Purpose

To determine whether a machine learning-based model that includes LA function parameters outperforms a commonly used risk scores, the CHARGE-AF, in predicting AF.

Methods

Participants in the Atherosclerosis Risk in Communities (ARIC) Study (a community-based cohort study in the USA) who attended visit 5 (2011-2013) and without a history of AF were included in this analysis. Incident AF was ascertained from ECG during study visits, hospitalization discharge codes, and death certificates. Random survival forest methodology was used to build a prediction model for AF; candidate variables included traditional clinical risk factors and measures of LA structure and function. Dataset was randomly split into a training (75%) and testing (25%) cohort. For each variable, importance was measured based on the reduction in Harrell’s c-statistic if the variable was randomly permuted prior to obtaining predicted values. Variables significantly associated with AF were included in the final model. Model calibration was tested using the Greenwood-Nam-D'Agostino (GND) test. Discrimination ability of our model was assessed in the testing cohort using Harrell’s c-statistic and compared with that of the CHARGE-AF model.

Results

4,909 participants (59% female, 22% Black, mean age 75 years) were included. During a median follow-up of 7.0 years (1st-3rd quartile: 5.4-7.8), 650 participants developed AF. Variables significantly associated with incident AF were race, triglycerides, systolic blood pressure, coronary heart disease, age, LA maximal volume index, NT-proBNP, and LA reservoir strain (Figure 1). LA reservoir strain was the variable most strongly associated with AF. The final model showed good discrimination (c-statistic (95% CI): 0.734 (0.698-0.768)). The GND test did not detect statistically significant miscalibration (GND p=0.08). Compared with our model, CHARGE-AF had lower discrimination ability (c-statistic (95% CI): 0.635 (0.594-0.677)) and the difference was statistically significant (difference in c-statistic (95% CI): 0.099 (0.043-0.152)).

Conclusion

A machine learning-based model with few variables including LA function outperforms a commonly used risk model in predicting AF. Incorporation of LA functional assessment may help inform clinicians regarding individual risk of AF.
Unipolar electroanatomical mapping outperforms bipolar voltage in detecting LGE areas in the left atrium
Authors: Mohsen Y , Ali S , Mao Y , Prakosa A , Kholmovski E , Sakata K , Yamamoto C , Stoeckigt F , Sinha S , Marine J , Sohns C H , Sommer P H , Spragg D , Trayanova N
Published: October 2024

Introduction

In atrial fibrillation (AF) management, understanding left atrial substrate is crucial. While both electroanatomical mapping (EAM) and late gadolinium enhancement MRI (LGE MRI) are reliable methods in assessing atrial substrate and are associated with the ablation outcome, recent findings have highlighted significant discrepancies between bipolar low voltage areas (LVA) in EAM and LGE areas.

Objective

Explore the relationship between LGE areas and unipolar LVAs by utilizing multipolar high-density (HD) mapping.

Methods

Nineteen patients scheduled for AF ablation underwent pre-ablation LGE-MRI. Left atrial (LA) segmentation was conducted using a convolutional neural network, which subsequently generated a 3D mesh integrating the LGE data. HD-EAM was performed in sinus rhythm for each patient, capturing at least 4000 points. The EAM map and LGE MRI mesh were co-registered. LVA areas were defined using voltage cut-offs of 0.5 mV for bipolar and 2.5 mV for unipolar measurements. Correspondence between LGE areas and LVAs on the anterior and posterior LA wall was analyzed.

Results

Both bipolar and unipolar LVA demonstrated high precision in detecting LGE areas (100% and 88% respectively). However, unipolar LVA exhibited a remarkable accuracy of 81% for detecting LGE areas specifically, whereas bipolar LVA displayed a significantly lower accuracy of 28%. These findings were consistent across the different atrial walls.

Conclusion

Incorporating unipolar voltage data into electroanatomical mapping in the atrium may bridge the observed gap between LGE areas and bipolar LVAs. Our findings highlight the significance of unipolar voltage in evaluating the left atrial substrate, potentially offering a more comprehensive insight into the different layers of atrial walls, and opening the door for new approaches in AF therapy.
Mobile health technology integrated care in atrial fibrillation patients according to polypharmacy: an analysis of the mAFA-II clinical trial
Authors: Corica B , Guo Y , Romiti G F , Proietti M , Zhang H , Lip G Y H
Published: October 2024

Background

Polypharmacy is common in patients with multiple chronic long-term conditions and has been associated with adverse outcome in patients with Atrial Fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway has been proposed to streamline an integrated care management of AF patients, and the Mobile Health Technology for Improved Screening and Optimized Integrated Care in AF (mAFA-II) prospective cluster randomised trial showed the efficacy of a mobile health (mHealth) implemented ‘ABC’ pathway (mAFA intervention) in improving prognosis of AF patients. Whether these benefits apply also to AF patients with polypharmacy is unclear.

Purpose

To evaluate the effect of mAFA intervention according to the presence of polypharmacy at baseline.

Methods

In the mAFA-II cluster randomised trial, between June 2018 and August 2019 adults with AF were enrolled in 40 centres in China; clusters were randomised in a 1:1 ratio to mAFA intervention or usual care. In this analysis, we defined polypharmacy as being treated with 5 or more drugs at baseline. The primary outcome was the composite of stroke, thromboembolism, all-cause death and rehospitalisation. We evaluated the interaction between the effect of mAFA intervention and the presence of polypharmacy at baseline on the risk of the primary outcome using multivariable Cox-regression analysis; results were expressed as adjusted Hazard Ratio (aHR) and 95% Confidence Intervals (95%CI). We also evaluated individual components of the primary outcomes as exploratory secondary endpoints.

Results

3,324 patients were enrolled in the trial and included in this analysis; of these, 558 (16.8%) patients were polymedicated at baseline (mean age 71.9±12.6 years, females 44.3%); of these, 303 (54.3%) were allocated to mAFA intervention. 2,766 patients were not polymedicated (mean age 67.9±14.4 years, females 36.7%), of these 1,343 (48.5%) were allocated to mAFA intervention. Overall, patients in the polypharmacy group were older and with higher prevalence of most comorbidities and higher thromboembolic risk. The effect of mAFA intervention was similar among patients with vs. without polypharmacy on the reduction of the primary composite outcome, although with a diluted effect among polymedicated patients (adjusted Hazard Ratio [aHR] and 95% Confidence Interval [CI]: 0.34 [0.22-0.53] vs. 0.73 [0.27-1.99], p for interaction=0.166, Figure 1); similar results were observed for all-cause death and rehospitalizations.

Conclusions

A mHealth-technology implemented ABC pathway showed a similar effect on the reduction of the primary composite outcome among patients with and without polypharmacy. These findings support a broad application of the ABC pathway to improve outcomes in AF patients.Figure 1
Impact of rhythm control strategy on outcomes in patients with first diagnosed atrial fibrillation in an 11-year real-world registry
Authors: Salbach C , Milles B R , Yildirim M , Hund H , Mueller-Hennessen M , Biener M , Frey N , Katus H A , Giannitsis E
Published: October 2024

Background

Atrial fibrillation (AF) is a highly prevalent arrhythmia with a high burden of disease. This sub-study of the Heidelberg Registry of Atrial Fibrillation (HERA-FIB) sought to evaluate clinical characteristics, treatment strategies and outcomes in patients with first diagnosed AF (FDAF).

Methods

Patients with AF presenting to the emergency department (ED) of an University Hospital between June 2009 and March 2020 were consecutively enrolled. Follow-up was performed for all-cause mortality, stroke, major bleeding and myocardial infarction (MI). Outcomes were were related to patients with FDAF or pre-existing AF, as well as assigned treatement strategy (rhythm vs. rate control). The trial was registered at ClinicalTrials.gov Identifier: NCT05995561.

Results

Overall 2,758 (27%) of all patients presented with FDAF. Compared to FDAF, patients with pre-existing AF showed higher all-cause mortality HR 1.41 (95%CI 1.28-1.55, p<0.0001) and major bleeding events 1.29 (95% CI 1.06-1.56, p=0.0098). Non-implementation of rhythm control in FDAF was seen in 2,079 cases (75.4%) and was associated with an excess of all-cause mortality HR 1.66 (95%CI 1.30-1.99, p<0.0001) and incident MI HR 1.79 (95% CI 1.03-3.09, p=0.0385). A non-implementation of rhythm control remained an independent predictor for all-cause mortality and MI even after adjustment for significant univariate variables aHR: 1.34 (95%CI: 1.04-1.72, p=0.0234) and aHR: 1.79 (95%CI: 1.03-3.09, p=0.0385).

Conclusion

Real-world data from FDAF patients presenting in the setting of an ED showed a potential benefit regarding mortality and MI for rhythm control strategy. Further research is needed to validate this hypothesis.
The association of obesity and in-hospital outcomes among patients undergoing ablation for atrial fibrillation: a propensity-score matched analysis
Authors: Shoar S , Esparham A , Chaudhary A , Bolaji O , Moncadagonzalez P , Bansro V , Azargoon S , Modukuru V , Patarroyo-Aponte G , Asadi S , Sharma S
Published: October 2024

Background

Obesity is a strong risk factor for atrial fibrillation (AF), and it can affect the prognosis of AF. However, the impact of obesity (BMI≥30 kg/m²) on postoperative complications after AF ablation has not been extensively studied. We aimed to evaluate the association of obesity with in-hospital outcomes among patients with AF who ablation procedures.

Methods

The study utilized the National Inpatient Sample (NIS) database 2016-2020. Patients were divided into obese and non-obese groups and matched with propensity score matching (1:1). This matching involved adjusting for baseline variables (including age, gender, primary expected payer, race, and median household income) and comorbidities (including diabetes, hypertension, hyperlipidemia, history of coronary artery bypass grafting (CABG), chronic kidney disease, hyperthyroidism, cardiomyopathy, prior stroke or transient ischemic attack, heart failure with preserved ejection fraction (HFpEF), heart failure with reduced ejection fraction (HFrEF), heart valve disease, coronary artery disease, chronic obstructive pulmonary disease (COPD), alcohol misuse, anemia, and smoking). Furthermore, a weighted analysis was conducted utilizing weights provided by the NIS, and multivariate logistic regression was used to calculate the odds ratio.

Results

A total of 29,440 patient with AF who underwent ablation were included. After propensity matching, (8,110 in obese and 8,110 in non-obese group) the baseline characteristics were not significantly different between the two groups. Obesity was independently associated with higher risk of pseudoaneurysm, hematoma, postoperative anemia, acute kidney injury, vasopressor need, mechanical ventilation, pulmonary embolism, and ischemic stroke in patients who underwent ablation for AF (Figure 1). In addition, obese group had significantly higher length of stay (median and IQR 2 [1-3] vs 2 [1-4]) and total charges (median and IQR: 131,248$ [95,303-197,784] vs 143,693$ [102,720-206728]) compared to non-obese group (p<0.001). However, in-hospital mortality was not significantly different between the two groups.

Conclusion

In patients who underwent AF ablation, obesity is associated with significantly higher risk of post-operative complications, as well as increased LOS and total hospital charges.
Impact of altered pulmonary vein anatomy on long-term outcomes after cryoablation of paroxysmal atrial fibrillation
Authors: Baimbetov A , Bizhanov K , Bigeldiyev N , Sarsenbayeva A , Yakupova I , Baimakhanov B
Published: October 2024

Background

Cryoballoon catheter treatment for pulmonary vein (PV) isolation is an effective method for treating paroxysmal atrial fibrillation (AF).

Purpose

Evaluation of the significance of certain anatomical features of pulmonary veins for predicting the development of arrhythmia recurrence after pulmonary vein cryoballoon ablation (PV CBA) in paroxysmal AF.

Materials and Methods

465 consecutive patients (61% were male) with paroxysmal AF (57±11 years) were included and analyzed. All underwent CPVA between 2018 and 2022. PV and left atrial (LA) anatomy were evaluated in all patients using multi-slice computed tomography (MSCT) before the CPVA procedure. After the ablation procedure, all patients were followed up for 24-56 months to assess the impact of pathologic abnormalities in PV anatomy on recurrences in the long-term follow-up period.

Results

Complete PV isolation was achieved in all patients. LA and PV anatomy was normal in 298 patients (64%). Pathologic change of PV anatomy was present in 167 patients. (36%). During 24-56 months of follow-up, AF recurrence was registered in 178 patients (38%). Patients with recurrent AF had mainly enlarged right (RSPV) and left superior PVs (LSPV) (p<0.001). The presence of left common PVs (n=126, Log-rank p<0.001), as well as the presence of additional right pulmonary veins (n=67, Log-rank p<0.001), was associated with early development of sustained arrhythmia recurrences, compared to patients with typical PV characteristics.

Conclusion

Altered PV anatomy is a risk factor for arrhythmia recurrence after PV CBA. Mandatory visualization of the LA and PV with MSCT improves patient selection for effective catheter-based treatment of atrial fibrillation.
Effects of baroreceptor reflex modification on efficacy of ablation for atrial fibrillation
Authors: Zuk A , Piotrowski R , Sikorska A , Kowalik I , Kulakowski P , Baran J
Published: October 2024

Background

The autonomic nervous system (ANS) plays a significant role in atrial fibrillation (AF). Catheter ablation (CA) is a well-established treatment method for AF and significantly affects ANS, including baroreceptors (BR) function. However, little is known about the changes in the BR function caused by radiofrequency (RF) or cryo-energy (CB) influence the efficacy of AF ablation.

Purpose

To assess one-year efficacy of CA of AF in relation to BR function modification and type of ablation energy used.

Methods

The study group consisted of 78 patients (25 females, mean age 58±9 years) with paroxysmal AF and first CA (39 patients (RF group) and 39 (CB group)). The BR function was assessed non-invasively using tilt testing and three parameters: event count (BREC) depicting overall BR activity, slope mean depicting BR sensitivity (BRS) and BR effectiveness index (BEI). The efficacy of CA was assessed at 3, 6, and 12 months after CA using 24-hour Holter ECG recordings and dedicated scale (University of Toronto Atrial Fibrillation Severity Scale (AFSS)).

Results

After CA, BR function decreased in the whole group (mean BREC 12.0±3.0-22.0 vs 6.0±3.0-18.0, p=0.004; mean BRS 4.8±3.6-6.8 vs 4.0±3.0-5.8, p=0.014; mean BEI 18.7±8.3-27.4 vs 12.0±5.1-21.0, p=0.009). BREC was significantly more decreased in the CB vs RF (mean 12.0±3.0-22.0 vs 6.0±3.0-18.0, p=0.004). Similar trend was noted for BRS and BEI.

On repeated Holter ECG monitorings efficacy of CB and RF was similar (89.7% vs 82.9% p=0.502, 89.7 vs 85.7%; p=0.727 and 84.6 vs 80%; p=0.602, respectively). According to AFSS, the AF symptoms were significantly reduced in both groups (CB baseline vs 3, 6 a and 12 months, respectively (median): 6.0 (IQR 2.0 – 13.0) vs 2.5 (IQR 1.0 – 4.0), p<0.001; 6.0 (IQR 2.0 – 13.0) vs 1.5 (IQR 0.0 – 4.0), p<0.001; 6.0 (IQR 2.0 – 13.0) vs 1.5 (IQR 0.0 – 4.0), p=0.002; RF baseline vs 3, 6 and 12 months, respectively (median): 10.5 (IQR 5.0 – 14.0) vs 7.0 (IQR 1.0 – 12.0), p=0.173; 10.5 (IQR 5.0 – 14.0) vs: 6.0 (IQR 2.0 – 12.0), p=0.015; 10.5 (IQR 5.0 – 14.0) vs 6.5 (IQR 2.0 – 12.0), p=0.005). After the adjustment for baseline there was no significant differencies between both groups (Table).

Conclusions

CA significantly affected BR function. These changes were more pronounced following CB than RF CA. However, the efficacy of RF and CB was similar.
Prevalance of incessant form of atrial fibrillation by superior vena cava (svc) firing:simplified svc and sinus node mapping(sss map) to avoid sinus node injury
Authors: Miyata T , Suzuki A , Fujiwara R , Sonoda Y , Sakai J , Kiuchi K , Matsumoto D , Kijima Y , Ogura E , Takaishi H , Shite J
Published: October 2024

Background

The superior vena cava (SVC) is known as a major source of atrial fibrillation(AF), non-pulmonary vein AF foci (NPVAF). In some cases, an incessant form of AF (iAF) by SVC firing prevents obtaining the sinus node location, and anatomical SVC isolation has a risk of sinus node injury (SNI).

Objective

This study was aimed to explore the frequency of iAF by SVC firing and the efficacy of the simplified mapping strategy to avoid SNI.

Methods

Consecutive AF ablation procedures in the 3 centers were retrospectively investigated including the NPVAF prevalence. Simplified SVC/SN mapping (SSS-map: Obtaining the top-end of the SVC potential and >4points with 5-10mm spacing in the upper lateral side of the right atria (RA) for roughly locating the earliest activation site in sinus rhythm) was performed before PV isolation in the last 138 patients. In case of the initial rhythm at the procedure was atrial fibrillation, cardioversion was performed for obtaining the SSS-map. In the cases in which the high-density mapping catheters were available, the high-density activation maps of the RA in sinus rhythm were obtained to investigate the dislocation of the earliest activation site of the SSS map from the SN location. When SVC isolation was required due to iAF, SVC isolation line was designed based on the location of the top-end of the SVC potential during AF and ablative linear lesions were created to keep the distance of 5-10 mm above the second earliest activation site.

Results

A total of 1160 procedures in 1089 patients (male: 736[63.4%], age: 69.9, paroxysmal AF: 544[49.9%], first session: 997[85.9%]) was investigated. Prevalence of NPVAF was revealed in 160 of the all procedures (13.7%) (the SVC: 64, the posterior wall of the left atria: 24, the coronary sinus: 19, and others: 53). 16 of 160 NPVAFs (10.0%) developed to iAF by SVC firing. The SSS-map was successfully obtained in all of the last 138 patients (Initial rhythm at the procedure: AF 43.7%, Mapping time: 1.3±0.6 min, number of obtained points: 8.4±1.3). In 21 patients in which the high-density RA map was obtained, the SN dislocation distance was 5.1±2.2mm between the SSS map and the high-density RA map. Five of 138 developed to iAF by SVC firing, and SVC isolation based on the SSS-map was successfully achieved without SNI in the cases.

Conclusion

This study indicated iAF driven by SVC firing after PV isolation occurred in certain number of patients. The SSS-map before PV isolation was practical and showed the potential to be the mapping strategy avoid the SN injury in such cases.
Comparison of pulsed field ablation versus cryoballon and radiofrequency ablation for pulmonary vein isolation in atrial fibrillation patients with heart failure
Authors: Mavrakis E , Vlachopoulou D V , Bohnen J B , Rudolph I R , Jungen C J , Rattka M R , Mathew S M , Rassaf T R
Published: October 2024

Background

Pulmonary vein isolation (PVI) is the gold standard for atrial fibrillation (AF) ablation and can be achieved by a variety of technical methodes. While thermal ablation modalities (TA), such as cryoballon (CB) and radiofrequency ablation (RF) have been established as the standard approaches, PFA has been introduced as a nvel non-thermal modality showing comparable safety and procedural efficiency. Despite the high incidence of AF in heart failure (HF) patients, data comparing outcomes of HF patients undergoing PVI by either PFA or thermal ablation (RFA/CB) are limited.

Purpose

This study’s aim was to compare the efficacy and safety of PFA for AF ablation versus CB/RFA in HF patients.

Methods

Consecutive HF patients with preserved (HFpEF), mildly reduced (HFmrEF) and reduced (HFrEF) ejection fraction undergoing PVI for AF by either PFA or CB/RFA at our institution were included. The primary end-point was time to death or recurrence of AF. Secondary end-points were periprocedural complications and clinical and echocardiographic parameters.

Results

We included 140 HF patients who underwent PVI either by PFA (PFA group, 76 patients) or thermal ablation approaches (TA group, 64 patients). Our patients had a mean age of 69 years and were predominantly male (62%). There was no significant difference in the baseline characteristics and in the type of AF between both groups (42% with ParAF, 45% with PersAF) and 13% LSPersAF). The distribution of heart failure types was similar between both groups: HFpEF (PFA: 71%, TA: 75%), HFmrEF (PFA: 21%, TA: 20%) and HFrEF (PFA: 8 %, TA: 5%). After the 365-days follow-up period we observed no significant difference for the primary end-point between both groups (HR: 0.79, 95% CI 0.35-1.78; p=0.575). In total 58% of the PFA patients and 59% of the TA group were still free from AF. While symptom improvement was documented in both groups, patients in the PFA group showed significant improvement of left atrial volume index (p = 0.014), NT-pro BNP levels (p = 0.046), and left ventricular ejection fraction (LVEF) (p = 0.005).

Conclusion

In this study, PFA and thermal ablation modalities showed comparable results in terms of safety and procedural efficiency in patients with heart failure. Since previous studies have shown that HF patients with AF benefit from PVI using thermal ablation modalities, our results suggest that PFA might also be a promising ablation method in this vulnerable population, inducing left atrial reverse remodeling and thereby contributing to improvement of left ventricular systolic function.
Single versus double transseptal puncture for pulmonary vein isolation with radiofrequency catheter ablation for atrial fibrillation - insights from "Go for Zero Fluoroscopy" registry
Authors: Miskowiec D , Qawoq H D , Zycinski P , Chudzik M , Kosiuk J , Kasprzak J D
Published: October 2024

Background

Transseptal puncture is one of the most challenging steps in catheter ablation of atrial fibrillation (AF) because of the potential risk of complication. While single TSP reduces the puncture-related risk, double TSP simplifies the procedure (immediate signal visualization in pulmonary veins, avoidance of multiple changes of catheters through the single sheath). The purpose of this study was to analyze the impact of single versus double TSP during pulmonary vein isolation (PVI) with radiofrequency (RF) catheter ablation for AF on the fluoroscopy usage and procedure time.

Methods

Data reported from the international, multicenter prospective „Go For Zero Fluoroscopy Registry" performed in years 2018–2019 were analyzed. Overall 25 European electrophysiology centers from 14 countries and up to 5 operators from each center were enrolled. Only isolated PVI procedures were analyzed.

Results

A total data of 393 PVI RF procedures were collected from 25 centers. The median dose-area-product (DAP), fluoroscopy time and overall procedure time were: 810 (325 – 1839) cGy*cm2, 8 (4 – 14) minutes and 124 (92 – 168) minutes, respectively. Single TSP was associated with significantly higher DAP: 984 (459 – 1939) vs 667 (227 – 1469) cGy*cm2 (p=0.002), longer fluoroscopy time: 11 (6 – 19) vs 6 (3 – 11) minutes (p<0.001) and longer overall procedure time: 133 (103 – 168) vs 110 (90 – 168) minutes (p=0.003) as compared with double TSP. Single and double TSP group did not differ significantly in regards of general anesthesia usage, circular and multipolar mapping catheter use (p>0.05). However, single TSP was performed by operators with longer EP lab experience: 10 (4 – 15) vs 3 (0 – 10) years (p<0,001).

Conclusions

Double TSP is related with lower fluoroscopy usage and shorter overall procedure time of pulmonary vein isolation with radiofrequency catheter ablation for atrial fibrillation.
Strategic timing- early and delayed catheter ablation in atrial fibrillation
Authors: Makdah O , Krayem F A , Sahloul H , Ursu C , Bogdan S , Vatasescu R , Gheorghe-Fronea O
Published: October 2024

Background

Atrial fibrillation (AF) is the most common sustained arrhythmia. AF catheter ablation (CA) is superior to antiarrhythmic drug (AAD) therapy in maintaining sinus rhythm. However, not much is known regarding the optimal timing of the ablation.

Purpose

This review aims to examine the evidence supporting both early and delayed ablation approaches, as well as explore their respective disadvantages.

Methods

We performed an electronic search in databases such as PubMed, ScienceDirect, Springer, Wiley Online Library, focusing on studies published from 2013 until 2022 and including both observational studies and randomized controlled trials (RCTs). Left atrial diameter and ejection fraction (EF) were assessed. The limit between early and delayed ablation was set to be 3 years, considering delayed CA studies with a diagnosis-to-ablation-time (DAT) of 3 years or more, and early CA studies with a DAT of less than 3 years. Included studies were selected according to our eligibility criteria: observational studies or RCTs that included patients with symptomatic paroxysmal or persistent AF that underwent ablation using either radiofrequency or cryoballoon approach or both approaches, studies that reported DAT, studies that included a follow-up period, studies that evaluated AF recurrence or AF burden. Studies that included a surgical ablation, a hybrid ablation approach, or ablation for arrhythmias other than AF were excluded.

Results

Ten studies were selected out of 1387 identified records. After a follow-up period of 1 year, the early ablation subgroup had a lower mean AF recurrence rate (31.1%) compared to that of the delayed ablation subgroup (37.7%) ( p<0.0004). The median AF recurrence rate in radiofrequency ablation group was (47.8%) in comparison to the AF recurrence rate in cryoablation group which was (27.4%) (p<0.0001). In studies that included paroxysmal AF patients exclusively, the AF recurrence rate was directly proportional to the DAT(R=0.95).

Conclusion

Our results demonstrate that DAT correlates with recurrence rate at 1 year following AF CA, the shorter the DAT the better the outcome especially in paroxysmal AF population.Prisma study selection flow diagramCorrelation between DAT-AF recurrence