bluuebunny/crossref_metadata_2025 huggingface dataset:
Arterial hypertension management in patients with confirmed coronary heart disease: how far are we from meeting prevention goals?
Authors: Gabulova R , Marza-Florensa A , Isayeva M , Rahimov U , Gahramanova S , Alaskarova S H , Ibrahimov F , Aliyev F , Imanov G , Musayeva A , Rasulova R , Zarbaliyeva N , Abasov R , Graham I , Grobbee D E
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

International registry studies offer useful information on the state of the cardiovascular risk factor management. The SURF CHD (Survey of Risk Factors in Coronary Heart Disease) II study is a clinical audit of the recording and management of major cardiovascular (CV) risk factors in patients with established coronary heart disease (CHD). CV risk factors’ control varies by countries and is typically insufficient, according to the prior studies.

Purpose

This study aimed to assess adherence to European Society of Cardiology (ESC) recommendations for secondary prevention of cardiovascular diseases based on the measurement of blood pressure (BP) control and its therapeutic management in patients with confirmed CHD at different hospitals in one of the regions at high risk for cardiovascular disease.

Methods

Eight public and private health care centres of Azerbaijan participated in the SURF CHD II study between November 2019 and April 2022. A one-page standard questionnaire of the study was used to collect information electronically on demographics, diagnostic category, risk factors, physical and laboratory data, and prescribed medications from consecutive patients aged ≥18 years with established CHD during outpatient visits. Uncontrolled arterial hypertension (AH) is identified as follows: systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure (DBP) ≥90 mmHg.

Results

Data from 949 patients with CHD (the mean age 59.6±9.58 years; 27.3% female) were included in the study. Only 11.7% of participants were involved in a cardiac rehabilitation program. Previous history of AH was registered in 73,1% of participants, while uncontrolled SBP was detected in 59.6% of them. Regarding medications, 82.4% of patients were taking antihypertensive drugs: 52.2% were taking beta-blockers, 51.2% ACE inhibitors, 7.9% ARBs, and 31.7% calcium antagonists. Only 11.7% of participants were involved in a cardiac rehabilitation program.

Conclusion

The study results have shown that the implementation of the current ESC recommendations for CHD secondary prevention and in particular the control rate of BP is insufficient. Given the fact that patients are at very high risk with different comorbid pathologies, this is of great importance in the management of such patients. This should be taken into account by healthcare organizers when planning secondary prevention activities and public health protection measures, especially in the regions at high risk for cardiovascular disease.
Impact of physician's perception about LDL cholesterol control in clinical practice when treating patients in Spain
Authors: Cosin Sales J , Campuzano R , Diaz-Diaz J L , Escobar Cervantes C , Fernandez Olmo M R , Gomez-Doblas J J , Mostaza J M , Pedro-Botet J , Plana Gil N , Valdivieso P
Published: May 2023

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): This work is a study of the Spanish Society of Cardiology and Spanish Society of Atherosclerosis, sponsored by Daiichi Sankyo Spain.

Objective

To understand the impact of physicians` perception about LDL-cholesterol (LDLc) control on the management of patients with dyslipidemia in Spain.

Methods

Cross-sectional and multicenter study, in which 435 healthcare professionals from 145 healthcare areas in Spain participated in face-to-face meetings, collecting qualitative and quantitative information related to hypercholesterolemia patients’ management. Additionally, aggregated anonymized data of the last 10 patients with hypercholesterolemia attended by each physician were collected and analyzed with descriptive statistics.

Results

A total of 4,010 patients (8%, 13%, 16% and 61% with low, moderate, high, and very high cardiovascular [CV] risk) were included. Physicians` perception was that 62% of their patients attained LDLc goals (66%, 63%, 61% and 56%, for low, moderate, high and very high CV risk, respectively). However, when looking into the data only 31% (vs 62% P<0.01) of patients attained the risk-based LDL-C goals (47%, 36%, 22% and 25%, respectively). Overall, 33% of patients were taking high intensity statins, 32% statin/ezetimibe, 21% low/moderate intensity statins and 4% PCSK9 inhibitors. These numbers were 38%, 45%, 8% and 6% for very high CV risk patients and 44%, 21%, 21% and 4% for high CV risk patients, respectively. In only 32% of patients a change in lipid lowering therapy was performed after the visit, mainly combining statins with ezetimibe (55%). The proportion of patients achieving LDL-C goals improved as higher potency lipid-lowering therapy was used (Figure 2).

Conclusions

In Spain most patients with dyslipidemia do not achieve the recommended LDL-C goals because of an insufficient intensification of lipid lowering therapy, regardless of CV risk, at least in part due to the misperception of physicians about LDL-C control.
Is there a role for conicity index in 10-year risk cardiovascular disease prediction?
Authors: Candjondjo A , Quintal J , Rato Q , Melo E , Sousa J , Jose M , Casas J , Coelho R , Farinha J , Fatima A , Feereira J , Lopes A , Goncalves S , Seixo F , Caria R
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiovascular disease (CVD) is the leading cause of death globally and one of the most frequent causes of disability. Therefore, the complete and correct evaluation of cardiovascular risk factors is essential to timely prevent CVD. Once central obesity is related with the amount of visceral adipose tissue - an independent predictor of CVD risk - its assessment may play an important role in 10-year CVD prediction. The conicity index (C-Index) assesses central adiposity but there is limited data regarding its role in 10-year CVD risk prediction.

Purpose

To evaluate the role of C-Index in predicting 10-year risk of fatal and non-fatal CVD according to SCORE2 and SCORE2-OP models in a moderate-risk country population.

Methods

We conducted a cross-sectional study in a Portuguese population sample. Individuals aged 40-90 years without known established Atherosclerotic Cardiovascular Disease, Diabetes mellitus, Chronic Kidney Disease or Familial Hypercholesterolemia were included in the study through a local cardiovascular (CV) screening event in Portugal, during May 2022. The C-Index was calculated for each individual according to the Valdez’s formula. For CVD risk assessment, we used the cut-offs values proposed by Pitanga et al. 1.18 for women and 1.25 for men. The population was divided into two groups according to the C-Index (risk high versus low). The 10-year risk of fatal and non-fatal CVD was calculated using SCORE2 and SCORE2-OP models.

Results

A total of 431 individuals were enrolled in this study. Median age was 71 years (Q1-Q3: 65-75) and 66.8% of were women. A total of 48.1% had hypertension, 38.3% dyslipidemia, 25.5% obesity and 6.6% were active smokers. Overall, 387 (90.2%) individuals were found to have elevated C-Index (SCORE2/2-OP mean± DP: 14.99± 7.56 versus 09.81± 3.37), of which 259 were female. In the univariate analysis, there was a correlation between C-Index and estimation of the Risk Cardiovascular Disease according to SCORE2/2-OP but was not statistically significant (Exp (beta) 95 % (CI):2.52 (-2.06-7.10, p=0.28)). However, in the multivariable linear regression analyzes the variable waist circumference (Exp (beta) 95 % (CI)18.47 (4.69 – 32.24, p<0.001)) was independent predictive factor related to the Risk of Cardiovascular Disease according to SCORE2 and SCORE2-OP.

Conclusions

In the present study most of the patients were categorized into high-risk category. Conicity index was not significantly correlated with estimation of the Risk of Cardiovascular Disease according to SCORE2 and SCORE2-OP models, but the variable waist circumference (Exp (beta) 95 % (CI)18.47 (4.69 – 32.24, p<0.001)) was an independent predictive factor related. More studies are needed to assess the role of C-Index in CVD risk prediction.
Double rhythm mapping for coherent electrophysiological substrate characterization in atrial fibrillation patients
Authors: Grossi B , Pagani S , Taormina A , Ceriotti C , Poggio L , Galimberti P , Battaglia V , Del Monaco G , Gregusova N , Latini A C , Valcher S , Stankowski K , Mincione G , Condorelli G , Frontera A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation (AF) progresses with a cascade of combined structural, functional, and systemic dysfunctions. Electro-anatomical maps are employed to investigate pro-arrhythmic areas, characterized by abnormal electrical properties. However, single rhythm maps provide only a partial reconstruction: rhythm and wavefront directionality might mask some of these areas.

Purpose

To demonstrate that the combined quantitative analysis of different rhythm maps (i.e., parallel sinus rhythm and paced maps) could allow consistent identification of structural and functional defects sustaining AF.

Methods

Thirty AF clinical procedures have been performed with mapping system support. In particular, a sinus rhythm activation map and a paced map have been created with a multipolar catheter exploiting the parallel mapping feature by setting an extra beat (pacing interval = ERP + 40 ms) every three sinus beats. Areas of abnormal conduction have been identified and a comparison of electrophysiological biomarkers (EGMs voltage and fractionation) among the two rhythms has been performed.

Results

This comparative analysis allowed us to identify both structural and functional electrophysiological phenomena. Specifically, we distinguished: (i) abnormal conduction zones confirmed in both maps, both characterized by signal fractionation and a lower voltage (0,56 ± 0,18 mV) with respect to healthy atrial tissue (2,40 ± 0,41 mV), and (ii) abnormal conduction zones visible in only one of the two maps. In the latter, we distinguished whether the absence of the phenomena was due to wavefront orthogonality to the diseased area (revealed in paced rhythm thanks to a change in wavefront direction) or due to the presence of a functional phenomenon induced by the pacing. In the first group signal fractionation has been detected in both rhythms and a lower voltage has been found (1,79 ± 1,1 mV) with respect to normal conduction zones (3,26 ± 0,98 mV), while in functional cases EGMs fractionation has been identified only in paced maps and no significant difference has been observed in terms of voltage.

Conclusion

Double rhythm mapping provides a more robust characterization of atrial abnormal conduction phenomena. In fact, it allowed the distinction of true structural dysfunctions from dynamic (functional) ones thanks to the different wavefront directionality and rhythm. Moreover, the structural defects have been confirmed by EGMs analysis, which revealed both low voltage amplitude and high fractionation, characteristics that have not been reported in functional cases.
Volumetric quantification of peri-atrial fat inflammation in atrial fibrillation patients
Authors: Vickneson K , Tonko J , Williams M C , Gharaviri A , Dweck M , Baptiste T , Alonso Solis Lemus J , Corrado C , Niederer S , O' Neill M , Whitaker J , Williams S E
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Centre for Research Excellence Award III (RE/18/5/34216).

SEW is supported by the British Heart Foundation (FS/20/26/34952). MCW is supported by the British Heart Foundation (FS/ICRF/20/26002)

Introduction

Peri-atrial fat may have pro-inflammatory and pro-fibrotic effects on atrial myocardium and increase the risk of developing atrial fibrillation. Both peri-atrial fat volume and density have been proposed as markers for atrial fibrillation risk, but prior studies considered only single-plane analysis or peri-atrial fat attenuation limited to the posterior left atrium.

Purpose

We aimed to assess total peri-atrial fat volume and attenuation and to explore the relationship between both parameters and the occurrence of atrial fibrillation.

Methods

Contrast-enhanced cardiac computed tomography (CT) imaging was performed pre-ablation in atrial fibrillation patients (n=32) and in control patients (n=37) without atrial fibrillation undergoing investigation for chest pain. We developed a volumetric method for peri-atrial fat segmentation and quantification using seg3D2 and CEMRGapp. Peri-atrial fat volume and attenuation (Hounsfield units, HU) were compared between patients with and without atrial fibrillation in univariable and multivariable analyses. A sensitivity analysis was performed to assess the impact of fat proximity to the left atrial wall.

Results

Atrial fibrillation participants were older (64±11 years vs 58±7 years, P=0.004) and more likely to have a history of coronary artery disease (50% vs 25%, P=0.03). Participants with atrial fibrillation had greater left atrial volume (88±28 ml vs 69±19 ml, P=0.002) and mass (29±6 g vs 14±0.9 g, P=0.018) compared to controls. Peri-atrial fat volume was greater in those with than without atrial fibrillation (18.5±6.6 ml vs 14.2±7.0 ml, adjusted odds ratio (AOR) per ml 1.21; 95% confidence interval [CI] 1.03-1.48), after adjusting for age, body mass index, comorbidities, left atrial dimensions and mass. However, total peri-atrial fat attenuation was not significantly different between groups (-74.8 vs -73.0 HU; AOR per HU 1.01; 95% CI 0.82-1.22). Sensitivity analysis did not identify an interaction between interrogation distance from the left atrial wall and peri-atrial fat attenuation on prevalent atrial fibrillation (p=0.872).

Conclusion

Peri-atrial fat volume, but not attenuation, is associated with prevalent atrial fibrillation. Further mechanistic studies are needed to study the role of peri-atrial fat in atrial fibrillation pathogenesis.
Impact of sleep apnea on left atrial remodeling and stroke risk factors
Authors: Kim D , Lee K N , Roh S Y , Kim D H , Shim J M , Choi J I , Lee D I , Kim Y H
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Obstructive sleep apnea (OSA) is associated with left atrial (LA) remodeling, which increases the thromboembolic risk of atrial fibrillation (AF) and recurrence of atrial fibrillation after catheter ablation of AF. This study aimed to assess the association between severity of OSA and LA remodeling.

Method

In 126 patients with AF who underwent catheter ablation for AF (male 78.4% male, 58.0 ± 10 years old, persistent AF 27%), LA voltage distribution were analyzed during atrial pacing. All the subjects underwent polysomnography for screening of OSA. We categorized the subjects into 4 groups based on the severity of OSA which was determined by the respiratory disturbance index (RDI; RDI <5: normal, 5≤RDI<15: Mild, 15≤RDI<30: moderate, 30≤RDI: severe). The presence of stroke risk factors (left atrial appendage [LAA] pulse wave velocity < 20cm/sec, NT pro BNP >1,250 ng/l, presence of spontaneous echo contrast [SEC] and LA volume index >32 ml/m3) were evaluated.

Result

The LA low voltage area was significantly greater (p=0.007) and LA volume measured by cardiac magnetic resonance imaging (MRI) was significantly larger with the severity of OSA (p=0.004). The presence of SEC (3.2% vs. 13.6%; p=0.201) and LAA pulse wave velocity < 20cm/sec (3.2% vs. 9.6%; p=0.454) were higher in patients with moderate to severe OSA but it did not reach statistical significance. In the multivariate regression analysis, the total number of the stoke risk factors other than CHA2DS2-VASc was significantly associated with RDI (β=0.191; p=0.037).

Conclusion

The severity of OSA has significant relationship with stroke risk factors.
Voltage characterization of abnormal conduction zones in patients affected by atrial fibrillation
Authors: Gregusova N , Grossi B , Pagani S , Taormina A , Cariotti C , Poggio L , Galimberti P , Battaglia V , Del Monaco G , Latini A C , Valcher S , Stankowski K , Mincione G , Condorelli G , Frontera A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

In case of persistent atrial fibrillation (AF), atrial substrate assumes a dominant role in sustaining the arrhythmia. Recent studies prove that low voltage areas (LVA, Voltage Amplitude < 0,5 mV) represent an additional target for ablation of AF patients.

Purpose

The purpose of this study is to analyse whether structural atrial conduction abnormalities (i.e., pivot sites and slow conduction corridors) may occur outside low voltage areas.

Methods

The study is based on the retrospective analysis of 31 consecutive maps of patients undergoing AF ablation (16 paroxysmal and 15 persistent cases). The clinical procedures have been performed with the support of a mapping system. Sinus rhythm activation maps and bipolar maps used for this analysis have been created with a multipolar mapping catheter. Map points were only acquired when the electrode was in contact with the endocardial tissue to avoid misleading voltage amplitude information. Slow conduction corridors and pivot sites have been analysed. At these sites, EGMs characterization included voltage amplitude (mV), signal duration (ms) and fractionation.

Results

The average value of EGMs amplitude reported at pivot sites and slow conduction zones, respectively, amounted to 2,08 ± 0,63 mV and 2,1 ± 0,66 mV in paroxysmal cases. In persistent cases, there were slight decreased values to 1,95 ± 0,93 mV and 1,89 ± 0,89 mV. Characterization at pivot sites documented a mean duration value of 45,4 ± 4,64 ms and 49,93 ± 5,51 ms in paroxysmal and persistent patients, respectively, while in slow conduction zones 41,53 ± 7,94 ms and 49,04 ± 6,41 ms have been reported. As for fractionation, more than five deflections per signal have been identified in all abnormal conduction areas.

Conclusion

Our study proves that functional electrophysiological phenomena can occur outside low voltage areas, even in persistent cases. According to this analysis, not all LVA represent the correct target for catheter ablation, encouraging the development of further methods for investigation of atrial substrate.
The role of education level in the mortality of hospitalized patients with atrial fibrillation
Authors: Sztaniszlav A , Bjorkenheim A , Magnuson A , Bryngelsson I L , Edvardsson N , Poci D
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

The association between social status and cardiovascular morbidity and mortality is well­–known. Education level is an important socioeconomic factor which influences the incidence, symptoms, and treatments of atrial fibrillation (AF). However, data about the effects of education level on all-cause mortality in patients with AF are scarce.

Aim

To explore any association between education level and all-cause mortality in patients hospitalized with AF.

Methods

This retrospective cohort study is based on a database created by linking Swedish nationwide registries including all patients hospitalized with an AF diagnose between 1995 and 2003. In all, 158 577 patients were included in the study (56% male and 44% female; mean age 72 ± 11 years). The follow up was 5 years with an observation time of 636 597 person–years. Education level was described by 3 categories representing primary, secondary, and academic education. Kaplan-Meier curves and Cox proportional hazard models adjusted with age, sex, time of index hospitalization, categorized Charlson´s Comorbidity Index (CCI) score, and CHA2DS2-VASc score were used for statistical analysis. Hazard ratio (HR) with 95% confidence interval (CI) was used as estimate of association and P < 0.05 was regarded as statistically significant. The risk of all-cause mortality was estimated in subpopulations defined by mortality risk factors as CCI, CHA2DS2-VASc score, heart failure, coronary artery disease, chronic obstructive pulmonary disease, diabetes, chronic kidney disease, and cancer.

Results

Patients with academic education had the lowest all–cause mortality, which was seen early during follow–up. Compared to patients with primary education, those with secondary or academic education showed lower relative mortality risk in the adjusted Cox regression model (secondary education HR: 0.875, 95% CI: 0.86 – 0.89, p<0.001; academic education HR: 0.695, 95% CI: 0.67 – 0.72; p<0.001).

Among the subpopulations, the HR varied between 0.72 and 0.95 for secondary and between 0.43 and 0.79 for academic education respectively. All risk differences were statistically significant.

Conclusion

Academic education was associated with the lowest and primary education with the highest risk of all-cause mortality. This pattern was consistent through all analyzed subpopulations.
Atrial fibrillation diagnosis in patients with single- and dual chamber ICD devices in England: a real-world cohort study
Authors: Davidson J A , Farrer A , Wan S , Schmetz A , Thompson Hilpert S , Schrader J , Bonhomme C , Pettit S
Published: May 2023

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): BIOTRONIK SE & Co. KG

Background and Purpose

Atrial fibrillation (AF) detection and subsequent treatment is known to be sub-optimal in the general population. It is unclear how implanted devices with atrial sensing contribute to AF diagnosis. This study compares real-world AF diagnosis rates in patients with ICDs without (single chamber ICD, VR ICD) and with atrial sensing (dual chamber ICD, DR ICD) and contrasts them with detection rates in trials which are estimated to be 200 per 1000 person years (Reinhold, 2018).

Methods

Linked primary care data from the Clinical Practice Research Datalink (CPRD), secondary care data from Hospital Episode Statistics (HES) and mortality statistics from the Office of National Statistics (ONS) were used. All patients who received a VR- or DR ICD between 1 April 2016 and 31 October 2020, with at least 12 months primary care registration and no AF diagnosis prior to ICD implant were included in the analysis. Time to AF detection was calculated; in Cox proportional hazards regression analysis comorbidities, age, gender, and disease aetiology were adjusted for. Stroke rates were estimated for the total cohort.

Results

835 patients with a VR ICD and 1034 patients with a DR ICD were identified. Both patient groups had similar comorbidity profiles, with VR ICD patients being on average younger (mean 57.5±13.9 vs 61.5±15.4 years). During 2700 and 3600 person-years follow-up the incidence of new AF diagnoses was 45.6 (CI: 37.6-53.7) per 1000 person years in VR ICD and 54.7 (CI: 47.1-62.4) per 1000 person-years in DR ICD patients. Median time to AF diagnosis was also similar at 36.3 (IQR: 26-49.6) and 36.9 (IQR: 25.2-51.5) months, respectively. In the adjusted analysis, ICD-10 or SNOMED coded diagnosis of AF was not significantly different between groups (HR: 0.88 [95% CI 0.70-1.10]; p-value=0.3). Stroke rates in the total cohort (with or without AF) were 5.7% in the VR ICD and 3.4% in the DR ICD cohort at 36 months.

Conclusion

The analysis highlights a difference between the rate of clinically relevant AF observed in patients with cardiac implanted electronic devices (CIED) in clinical trials and in real-world practice. The occurrence of stroke appears to also be higher in real world practice than in clinical trial populations and this is particularly marked in patients with VR ICD. These findings could indicate low use of remote monitoring or clinician uncertainty about the clinical relevance of CIED-detected AF in the real world. The latter may be because of a still accumulating body of predictive evidence towards the surveillance of AF. We propose that consistent use of remote monitoring with daily transmission in combination with CIEDs with atrial sensing will enable improvement of care.
Surviving critical COVID-19 requiring mechanical ventilation is associated with a high long-term risk of de novo arrhythmic events
Authors: Liliequist A , Svensson P , Hoffmann R , Habel H , Nordberg P , Stahlberg M
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish Research Council

Swedish Heart- and Lung Foundation

Background

The long-term risk of de novo arrhythmic events after severe COVID-19 requiring intensive care is largely unknown, especially after adjusting for multiple risk factors such as co-morbidities and socio-economic factors.

Objective

The primary objective of this study was to investigate the long-term, co-variate adjusted risk of arrhythmic event after discharge from intensive care unit for critical COVID-19.

Methods

We performed a nationwide case-control study on patients with severe COVID-19 (cases) treated with mechanical ventilation and discharged alive from an intensive care unit. Each case was matched (age, sex, district of residence) with up to 10 population-based control. The study database from the Swedish ICU register was merged with multiple compulsory national registries. The primary outcome was hospitalizations with the following arrhythmias identified: ventricular tachycardia, atrial fibrillation, any other tachy-arrhythmia, or bradycardia/pacemaker implantation. Hazard ratios were adjusted for co-morbidities, socioeconomic status, level of education, region of birth and disposable income. Average follow-up was 12 months.

Results

We included 3 023 patients with severe COVID-19 that were treated with mechanical ventilation at a Swedish ICU (March 1, 2020 to June 8, 2021) and were discharged alive. Control subjects (n= 28,463 ) were selected based on matching by age, sex and district of residence.

The Hazard ratios for the risk of de novo arrhythmic event post ICU discharge for COVID-19 adjusted for age, gender, all comorbidities, level of education, marital status and income were increased between 13.1 – 21.0 in all four types of arrhythmias (Table 1).

Conclusions

We report increased risks for major arrhythmic events following severe COVID-19 even after adjusting for cardiovascular risk factors and for socio-economic factors. These data suggest that at least patients with inherit risk factors for developing arrhythmias in need of ICU treatment for COVID-19 should be closely followed-up after discharge.
Incidence of atrial fibrillation in patients with central retinal artery occlusion: A Systematic Review and Meta-Analysis
Authors: Nedios S , Prakash G , Anjos R , Miguel A , Salangsang J , Hindricks G , Bollmann A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Central retinal artery occlusion (CRAO) is a devastating event and atrial fibrillation (AF) is a recognized cause that may not be present at the time of the event.

Purpose

We performed a meta-analysis for the association of CRAO with the risk of new-onset AF and stroke during follow-up.

Methods

We searched the databases MEDLINE, Embase and SCOPUS from inception to May 2022 for the terms ‘atrial fibrillation’ and ‘retinal artery occlusion’ and identified 205 studies. We excluded duplicates, non-relevant studies and those not reporting new-onset AF after CRAO. We used random effects models to calculate the pooled odds ratio (OR) and 95% confidence intervals (CI) of AF risk in patients with CRAO or stroke in comparison to control groups. Analysis was performed with RevMan 5.4.1 (Cochrane 2020).

Results

We included 7 studies with 1.476 patients with CRAO compared to a control group without CRAO (n=9.843) and a group with stroke (n=7.058). There were 196 new AF cases (13.4%) in 18 months after CRAO. CRAO was associated with a higher risk for new-onset AF (OR:1.59, CI:1.20-2.11, p=0.001) and stroke (OR:2.46, CI:1.74-3.47, p<0.001) when compared to controls. However, the risk for AF after CRAO was similar to that after a stroke (OR:0.83, CI:0.41-1.71, p=0.62).

Conclusions

CRAO is associated with a higher risk for new-onset AF and stroke. AF risk after CRAO though is similar to that after stroke. Thus, CRAO should be regarded as cryptogenic stroke and mandate a closer follow-up with screening for AF and evaluation of early anticoagulation.
Electrophysiological findings in patients undergoing left atrial appendage occlusion following previous electrical isolation
Authors: Della Rocca D , Magnocavallo M , Gianni C , Mohanty S , Vetta G , Bassiouny M , Al-Ahmad A , Horton R , Lavalle C , Burkhardt D , Gallinghouse J , De Asmundis C , Chierchia G B , Di Biase L , Natale A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Left atrial appendage electrical isolation (LAA) is an important adjunctive ablation strategy in patients with nonparoxysmal atrial fibrillation. If impaired mechanical function following isolation is observed, long-term oral anticoagulation (OAC) or, as an alternative, LAA occlusion are required. Although focal electrical potentials from the LAA do not result in normalization of appendage mechanical function, they may potentially be a source of arrhythmogenic triggers. Those focal areas might be challenging to ablate after LAA occlusion device implantation.

Purpose

We sought to report the incidence of focal electrical potentials in patients with a previously isolated LAA and transesophageal echocardiography (TEE) evidence of severely impaired LAA mechanical function undergoing endocardial LAA occlusion.

Methods

In 124 patients undergoing LAA occlusion following LAA isolation, a circular mapping catheter (CMC) was used before occlusion to document any residual LAA electrical activity.

Results

At preprocedural TEE, the median LAA contraction velocity was 0.13 m/s (IQR: 0.05-0.19) and was significantly impaired in all patients. Of the 124 patients (mean age: 69±8 years; 71.7% males), 61 (49.2%) did not display any evidence of residual LAA electrical activity.

In the remaining 63 (50.8%) patients, residual electrical potentials resulting in LAA reconnection were recorded on the CMC positioned into the appendage. On average, 4.9±1.7 radiofrequency energy applications (45W, mean duration of each RFA: 14.2±3.4s) were required to re-achieve complete isolation. Subsequent appendage occlusion was successful in all patients. No leaks ≥5mm and 3 (2.4%) 3-4mm-leaks were documented at 45day-TEE.

Conclusions

Focal electrical activity from the LAA was documented in approximately half of our patients. Although focal electrical potentials do not result in normalization of LAA mechanical function, they may potentially act as arrhythmogenic triggers. Since it may be challenging after device implantation, assessment and ablation of those areas should be considered before occlusion device deployment.
Lower dose direct oral anticoagulation or warfarin in atrial fibrillation. Which one is the best when time on therapeutic range information is available?
Authors: Luojus A , Lehto M , Halminen O , Haukka J , Aro A L , Putaala J , Linna M , Mustonen P , Kinnunen J , Niemi M , Hartikainen J , Airaksinen J E K
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Helsinki and Uusimaa Hospital District (TYH2019309) and The Finnish Foundation for Cardiovascular Research

Background and aims

Elderly patients with atrial fibrillation (AF) and patients with renal failure – for example – are recommended to use reduced doses of direct oral anticoagulants (DOACs) to minimize risk of ischemic stroke and hemorrhagic complications. However, it is not known whether DOACs used with reduced doses are better than warfarin when the quality of warfarin treatment is available by means of time in therapeutic range (TTR).

Methods

The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) is a nationwide study of AF patients that combines data from several Finnish health care registers. Here all new-onset AF patients from 2011 to 2018 on reduced dose DOAC in Finland and patients on warfarin with TTR data were analyzed.

Comorbidities, concomitant medications and CHA2DS2-VASc -scores were recorded until date of AF diagnosis. OAC purchases from diagnosis of AF to the end of study were analyzed. ICD-10 diagnoses for stroke (ischemic or hemorrhagic) or transient ischemic attack during OAC-use were analyzed until maximum follow-up of 730 days. Crude rates of stroke as well as weighted rates are provided. To avoid confounding by baseline characteristics as well as medications, an inverse probability of treatment weighted analysis was made.

For warfarin users with sufficient laboratory data, time in therapeutic range (TTR) was calculated and patient quartiles by TTR were assigned.

Results

Altogether, 52 204 new-onset AF patients with OAC therapy (46.1 % male, mean age 75.7 years, 43 549 on warfarin - with mean TTR 66%, median TTR 72%) were followed for 91 549 patient-years (py). Rate of stroke among patients on lower dose DOACs was 5.2/100 patient years (py) for dabigatran (n=2 672), 4.3/100 py for apixaban (n=3 936), 3.9 /100 py for rivaroxaban (n=1 866). In the TTR-quartiles of patients on warfarin, the rates of stroke were 9.3, 7.2, 5.5 and 4.3 /100 py from the lowest (mean TTR 32%) to the highest quartile (mean TTR 90%), respectively. The weighted rates of stroke were 5.1, 3.5 and 3.1/100 py for dabigatran, apixaban and rivaroxaban, respectively and for warfarin from the lowest to the highest quartile: 8.7, 7.0, 5.4 and 4.1/100 py. Figure provides survival probabilities of the OAC groups with confidence limits.

Conclusion

In AF patients treated with OAC, the rates of stroke were highest among patients on warfarin at the lowest TTR quartiles, while the differences between high TTR groups and lower dose DOACs were only modest.
Effects of sodium-glucose cotransporter-2 inhibitors on cardiovascular outcomes in patients with atrial fibrillation and type 2 diabetes mellitus
Authors: Choi Y , Seung J H , Park S Y , Kim S H , Kim S H , Kim H J , H Y M , Kim J H , Kim T S , Jang S W , Oh Y S
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

A sodium-glucose cotransporter-2 inhibitor (SGLT2i) improves clinical outcomes in patients with type 2 diabetes (T2DM) and cardiovascular disease. Also use of SGLT2i was associated with a reduction of atrial fibrillation (AF) burden.

Purpose

We investigated the effect of SGLT2is on clinical outcomes in patients with T2DM and AF

Methods

This was a retrospective study using a clinical data warehouse (CDW) constructed from 7 medical centers. We analyzed 11,043 patients with AF and T2DM. The patients were classified to the SGLT2i group and the control group according to the SGLT2i use. We performed 1:2 propensity score matching analysis. The primary endpoint was a composite of all-cause death or hospitalization due to heart failure events. The secondary endpoints were acute myocardial infarction, stroke, renal function decline and an initiation of dialysis.

Results

The propensity score matched population consisted of 467 patients in the SGLT2i group and 848 patients in the control group. During a mean follow up of 31.8 (± 21.0) months, the incidence of the primary endpoint was significantly lower in the SGLT2i group (9.6% vs. 16.9%, hazard ratio [HR] 0.624 [0.446 – 0.873]). SGLT2i was associated with reduced all-cause death (HR 0.292 [0.144 – 0.591]) and non-significantly lower risk of heart failure hospitalization (HR 0.734 [0.509 – 1.060]). There was no significant difference in the incidence of myocardial infarction, ischemic stroke, CKD progression or initiation of dialysis between the two groups. In multivariate analysis, age, renal dysfunction, prior heart failure, and the absence of SGLT2i were independent predictors for the worse outcome.

Conclusion

SGLT2 inhibitor was associated with a lower incidence of all-cause mortality or heart failure hospitalization in patients with AF and T2DM.
Brain lesions and cognitive decline in patients with atrial fibrillation
Authors: Hennings E , Bhend K , Paladini R E , Aeschbacher S , Coslovsky M , Rodondi N , Beer J H , Auricchio A , Moschovitis G , Chocano P , Sinnecker T , Conen D , Kuehne M , Bonati L H , Osswald S
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation

Background

In addition to clinical stroke, atrial fibrillation (AF) is associated with a high burden of various vascular brain lesions, the majority of which are silent. However, the impact of these lesions on cognitive performance remains unclear.

Purpose

Our aim was to assess the association between vascular brain lesions and cognitive decline in clinically asymptomatic AF patients.

Methods

In a prospective multicentre cohort trial, we included 1536 clinically stable AF patients aged ≥65 years and a limited number of patients aged 45–64 years (90% on oral anticoagulation therapy). Patients underwent brain magnetic resonance imaging (bMRI) for the detection of any brain lesions at baseline (ischemic brain lesions and microbleeds) and yearly cognitive assessment using different standardized tests. Cognitive decline was defined as a measurement >1 standard deviation of the age-education standardized baseline population, compared with individual baseline levels. Multivariable adjusted Cox regression analyses were performed to assess the relationship of baseline brain lesions presence with cognitive decline during follow-up.

Results

At the time of inclusion, 1030 (67%) of 1536 patients (mean age 72±8 years, 73% male) had one or more vascular brain lesions on baseline MRI. Based on the Montreal Cognitive Assessment score (MoCA), cognitive decline developed in 159 (10%) patients during a mean follow-up of 4.8 years. The incidence rate (per 100 person-years) for cognitive decline (MoCA score) was 3.64 and 1.82 in patients with and without brain lesions, respectively. After multivariable adjustment, the hazard ratio (95% CI) for cognitive decline (MoCA score) was 1.29 (0.85-1.96). The association of brain lesions with cognitive decline was 1.57 (1.02-2.40) for the Digit Symbol Substitution Test (DSST), 1.28 (1.01 to 1.63) for the semantic fluency test (SFT), and 0.91 (0.69-1.21) for the Trail Making Test Part A (TMT-A).

Conclusion

In our contemporary AF cohort, two thirds of patients had brain lesions on baseline MRI, and these lesions were predictive of worse cognitive outcomes in the mid-term on some of the tests used. The full effects on cognitive outcome will be obtained during even longer follow-up.
JK07 prevents atrial fibrosis and atrial fibrillation inducibility in a porcine DOCA model
Authors: Tubeeckx M R L , Goovaerts B , Van Fraeyenhove J , De Meyer G , De Keulenaer G , Heidbuchel H , Segers V
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Geconcerteerde Onderzoeksactie (GOA) grant 499 of the University of Antwerp

Industrieel OnderzoeksFonds/Strategisch Basisonderzoek 498 (IOF/SBO) research grant of the University of Antwerp

Background

Atrial fibrosis is a substrate of atrial fibrillation (AF), and higher burdens of fibrosis are associated with resistance to therapy and worse prognosis. Currently, no therapies exist that target atrial fibrosis. JK07 is a long-acting neuregulin-fusion protein that has been shown to decrease ventricular fibrosis in models of heart failure through selective stimulation of the ErbB4 receptor.

Purpose

To test the ability of JK07 to reduce atrial fibrosis and AF inducibility in minipig model of deoxycorticosterone acetate (DOCA, an aldosterone agonist) induced hypertension.

Methods

18 Aachener minipigs were randomized into 3 groups: control (CTRL), DOCA + Vehicle (DOCA+VEH) and DOCA+JK07. The control group did not undergo a therapeutic intervention. To induce hypertension and atrial fibrosis, pellets releasing 10 mg/kg DOCA over a period of 60 days were implanted in minipigs in the DOCA+VEH and DOCA+JK07 groups. The DOCA-implanted animals underwent weekly treatment with JK07 (0.3 mg/kg; DOCA + JK07) or its vehicle (DOCA + VEH), starting at the day of implantation (total of 9 administrations). After 60 days, arterial blood pressure was measured invasively and a decapolar catheter was placed in the right atrium. AF inducibility was tested by performing 50 burst pacing episodes and quantified as the percentage of successful episodes where an AF run ≥ 5 sec could be induced after the burst, out of the 50 attempts. Atrial fibrosis was quantified using ImageJ software on Masson trichrome staining of left atrial specimens, isolated after euthanizing the animals.

Results

Mean arterial pressure was significantly higher in the DOCA+VEH (142 ± 10 mmHg) and DOCA+JK07 (132 ± 15 mmHg) groups than in the CTRL group (105 ± 8 mmHg, p<0.01), without an effect of JK07.

AF inducibility in the DOCA+VEH group was significantly higher than in the CTRL group (66/250 vs. 9/300, p<0.001), and the DOCA + JK07 group (66/250 vs. 8/300, p<0.001). Likewise, the degree of atrial fibrosis was significantly higher in the DOCA+VEH group compared to CTRL (14.18 ± 1.81 vs. 8.30 ± 2.52, p<0.001) and compared to DOCA+JK07 (14.18 ± 1.81 vs. 10.65 ± 1.59, p=0.0049).

Conclusions

JK07 prevents atrial fibrosis and AF inducibility in a porcine DOCA model. The effect of JK07 is unrelated to effects on blood pressure, but probably related to reduced atrial fibrogenesis.
Early timing of ablation after diagnosis: a powerful way to reduce atrial fibrillation recurrence
Authors: De Greef Y , Bogaert K , Buysschaert I
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Diagnosis-to-ablation time (DAT) is a strong, modifiable predictor of AF recurrence after ablation. Referral time for ablation, and hence DAT became shorter over time.

Purpose

To search for the shortest DAT still impacting outcome and to look at the evolution of the "DAT-AF recurrence" relation over time in a wide range of DAT.

Methods and results

Two cohorts of 1000 AF patients (69% males, age 62±10 years) undergoing PVI (2006-2014 and 2017-2019) were followed for 3years. Clinical success, defined as freedom of documented AF was achieved in 61,7% of patients.

Independent predictors of clinical success were age (HR=1,01; 95%CI 1,01-1,02; p 0,003), AF type (HR=0.54; 95%CI 0.46-0.63; p<0.0001), left atrial size (HR=1.05; 95%CI 1.03-1.06; p<0.0001), DAT (HR=1.00; 95%CI 1.00-1.00; p=0.001) and ablation technique (p=0.01) in multivariable-adjusted analysis.

DAT decreased over time from 48±47 to 35±60months (p=0,001). Relation between the DAT (range 0-288months) and AF recurrence at 3 years was assessed in 1892 patients.

The adjusted AF recurrence rate rises steeply from 27 to 40% in the first 36months. With further lengthening of the DAT the curve flattens following a less steep rise up to 45% until 90months. Further flattening occurs after a DAT of 90months.

Conclusion

The AF recurrence rate starts to rise immediately after diagnosis and demonstrates a linear relation over time with increasing DAT times, most pronounced in the first 3 years after diagnosis and flattening thereafter. Our data advocate for ‘as early as possible’ PVI planning following diagnosis of AF to improve outcome.
Electrophysiological findings during re-do procedures after single-shot pulmonary vein isolation for atrial fibrillation with pulsed field ablation
Authors: Magni F T , Scherr D , Manninger M , Sohns C , Sommer P , Hovakimyan T , Blaauw Y , Mulder B A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Pulsed field ablation (PFA) is a novel non-thermal ablation modality which applies electroporation to destabilize the cell membranes, leading to selective ablation of the atrial myocardium whilst sparing surrounding tissues and structures. It’s discriminating nature and potential for minimal adnexal injury opens new, promising horizons into catheter ablation of AF. However, one of the major issues to address is long-term results of the technique.

Purpose

To investigate the electrophysiological findings and type of arrhythmias during redo-ablation in 15 patients who underwent pulmonary vein isolation (PVI) for atrial fibrillation (AF) using single-shot PFA.

Methods

We investigated patients who underwent redo-ablation due to occurrence of AF/ atrial flutter (AFL) or tachycardia (AT) following initial PVI with PFA. We report the electrophysiological findings and ablation strategy during redo-ablation.

Results

Out of 447 patients undergoing index PVI with PFA, 15 patients (age: 61.8±10.4 years; 8 (53%) males; left atrial volume index (n=10): 39.4±14.6 mL/m2) were referred for redo-ablation after index PFA. Indication for the index ablation was paroxysmal-AF in 8 patients, persistent-AF in 6 and long-standing-persistent-AF in one patient. Mean time-to-recurrence was 5.0±1.8months. Three patients received additional posterior-wall-isolation during index PFA. Thirteen (85%) patients suffered AF recurrence and 5/13 had concomitant AFL. In the remaining 2 patients, one had a recurrence of (box-dependent) AFL, and one had AT. No patients had all PVs reconnected. Reconnection in zero, one, two or three PVs was found in 33%, 20%, 20%, and 27% of patients, respectively. All 7 patients with zero or one reconnection with AF recurrence received additional/repeat posterior-wall-isolation during re-ablation, while in the others PVs were re-isolated. In 1/3 patients who had posterior-wall ablation during index PFA, durable isolation of the posterior wall was confirmed during re-do procedure. Patients with only AFL/AT had no reconnection of PVs, and the substrate was successfully ablated.

Conclusion

We observed durable PVI in 62% of the PVs in patients with AF/AFL recurrence after PFA PVI. In one-third of patients all PVs were isolated. The predominant recurrent arrhythmia following PVI-only was AF. Concomitant (33%) or isolated (14%) AFL/AT recurrence was observed in 47% of patients.
Long term outcome in patients who refused radiofrequency ablation for atrial fibrillation
Authors: Kim S , Kim S H , Choi Y , Kim H , Jang S W , Hwang Y , Kim J H , Kim T S , Park S , Seung J , Oh Y S
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Rhythm control is a therapeutic approach to restore sinus rhythm from atrial fibrillation (AF). Current studies have demonstrated efficacy of rhythm control with radiofrequency catheter ablation (RFCA) for survival, however there is lack of data regarding the long term outcome of patients who refused RFCA.

Purpose

This study was aimed to compare outcomes, consist of death and stroke, in patients who refused RFCA.

Method

Patients with AF who had been proposed for RFCA but refused and also any rhythm control strategy were enrolled. The primary outcome was all cause death and incidence of stroke, compared with patients with AF who had been treated with RFCA.

Results

A total 174 patients who refused AF, 175 patients treated with RFCA were enrolled. Median follow up duration was 1125.1 ± 799.0 days. Of refused AF group, 39 (22.3%) were paroxysmal AF at the time of diagnosis. During follow-up, 9 patients in refused RFCA and 11 patients treated with RFCA group had died (4.1% vs 6.1%, p=0.3 by log rank test). Incidence of stroke was significantly higher in patients who refused RFCA, compared with RFCA group (12.0% vs 1.1% , p =0.001 by log-rank test). Cox Regression model showed refusing RFCA was an independent risk factor for the incidence of stroke (Hazard ratio 6.7, 95% Confidence Interval 1.48 – 30.3, p=0.013).

Conclusion

In AF patient who had refused rhythm control, incidence of stroke was significantly higher in patients who refused RFCA and rhythm control, compared with who had been treated with RFCA. There was no difference in all-cause mortality between two groups.