bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of SCORE and SCORE 2 model for cardiovascular risk stratification in men and women from high risk European country
Authors: Giga V , Boskovic N , Djordjevic-Dikic A , Beleslin B , Nedeljkovic I , Stojkovic S , Burazor I , Tesic M , Jovanovic I , Paunovic I , Aleksandric S , Dedic S
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

European Society of Cardiology has recently introduced new SCORE 2 algorhythm for cardiovascular risk assessment in apparently healthy individuals. However, there are limited data from high risk countries on CV risk stratification and potential gender differences in risk estimation using SCORE 2 model.

The aim of the current study was to compare risk prediction using SCORE 2 and previous SCORE model and to assess the potential gender differences in risk estimation.

Methods

Our study included 1361 apparently healthy individuals (mean age 56±9 years, 61% women) without known CV disease or risk factors aged 40 to 70 years old. Data on CV risk factors were prospectively collected in 20 primary care centers throughout Serbia from January 2020 to December 2020. CV risk was assessed both by SCORE and SCORE 2 model. Based on CV risk profile individuals were stratified in three categories: low to intermediate, high and very high risk category.

Results

In overall population using SCORE model 57.6% of individuals were in low-intermediate group, 20.9% were classified as high risk group and 21.5% as very high risk group. By the use of SCORE 2 model 1046/1361 (77%) individuals were shifted to higher risk category (Figure). In comparison to men women had lower both systolic (139 ± 19 mmHg vs 144 ± 18 mmHg in men p < 0.001) and diastolic (84 ± 9 mmHg vs 88 ± 10mmHg in men, p < 0.001 )blood pressure, lower BMI (26.4 ± 0.5 kg/m2 vs 27.4 ± 5.0 kg/m2 in men, p= 0.036) and higher values of HDL cholesterol (1.5 ± 0.5 mmol/L vs. 1.3 ± 0.4 mmol/L in men, p < 0.001). Smoking was more prevalent in men (49%) than in women (42%), p=0.04. There were no gender differences in age (56 ± 9 years for both genders) and non-HDL cholesterol ( 4.86 ± 1.24 mmol in men vs. 4.75 ± 1.23 mmol/l in women, p= 0.100). More women (85.9%) than men (62.6%) were shifted in higher risk category using SCORE 2 in comparison to SCORE (p < 0.001) (Figure).

Conclusion

By the use of SCORE 2 instead of SCORE prediction model for CV risk stratification in contemporary high risk European population significant proportion of apparently healthy individuals are shifted to higher risk category. In spite of having better CV risk factors profile, more women than men were shifted in higher risk category.
Cardiac Rehabilitation Phase 3 - Who are those who continue down the path?
Authors: Alves Da Silva P , Aguiar-Ricardo I , Martins A M , Gregorio C , Abrantes A , Pinto R , Bento B , Caldeira E , Miguel S , Pinto F J , Abreu A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiac Rehabilitation is recommended as secondary prevention in those patients with cardiovascular disease. Efforts to increase referral of patients after hospitalisations have been made in order to increase adherence to phase 2 CR programs. However, there are still few data regarding adherence after completion of phase programs regarging progressing to phase 3 programs.

Purpose

To characterize a population of patients who enrroled in a phase 3 CR program.

Methods

Prospective cohort study which included consecutive pts who were participating in a centre-based CR program lasting 8-12 weeks from 2019 to 2021. We analyzed prevalence of risk factors, lab echocardiographic and CPET data at beggining and 6 months after FUP. Possibility of attendance of a phase III CR program on a nearby gym was offered to everyone. Statistical analysis between both groups was performed with Chi-Squeare and Wilcoxon tests.

Results

We analyzed 336 patients who underwent CR (82% male, mean age 60 ±11,4 years). The majority was referred for ischemic heart disease (83%) followed by valvular heart disease (7%). Mean follow-up was 36,7± 19,2 months. Phase 3 program in a nearby facility was offered to everyone. Of those, 217 pts (mean age 59 +- 11,4 years-old, 80% male) chose not to continue and 119 pts (mean age 61 +- 11,3 years old, 81% male) were enrolled in the program. There were some differences among the two groups: ischemic heart disease was more prevalent in those who didn’t progress to Phase III (83% vs 66%, p=0.02) and, regarding risk factors, we noted a higher prevalence among those who enrolled in phase III, namely hypertension (77% vs 88%, p=0.04) and previous smoking habits (64,2% vs 71,1%, p=0.02). There were no significant differences regarding lab and echo data at the end of the program, especially ejection fraction, NTproBNP and LDL cholesterol. We failed to find differences between CPET data after 6 months follow up, although such findings might be limited by the scarcity of data in the group who transitioned to phase III.

Conclusions

Patients with a higher burden of risk factors showed higher interest in progressing to a phase III program. We did not find differences in cardiorrespiratory fitness evaluated by CPET, although more robust data would be needed to back such observations.
Characterization of atrial substrate to predict AF ablation success
Authors: Bergonti M , Spera F , Gonzalez Ferrero T , Nsahlai M , Heidbuchel H , Valderrabano M , Rodriguez Manero M , Sarkozy A
Published: May 2023

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): The study has been financially supported by an investigator-initiated research grant by Biosense Webster (Study ID – IIS-532) (MRM)

Background

Left atrial (LA) substrate may have mechanistic relevance for ablation of atrial fibrillation (AF). We sought to analyze the relationship between low-voltage zones (LVZ), transition-zones (TrZ) and AF recurrence in patients undergoing pulmonary vein isolation (PVI).

Methods

We conducted a prospective multicenter study on consecutive patients undergoing PVI-only approach. LVZ and TrZ (0.5-1mV) were analyzed offline on high-density electroanatomical maps collected prior to PVI.

Results

262 patients (61±11 years, 31% female) with paroxysmal (130 pts) or persistent (132 pts) AF were included. After 28 months of follow-up, 73 (28%) patients experienced recurrence. An extension of more than 5% LVZ in paroxysmal AF and more than 15% in persistent AF were associated with recurrence (HR=4.4 [2.0-9.8], p<0.001 and HR=1.9 [1.1-3.7], p=0.045, respectively). Significant linear association was found between LVZ and TrZ and between LVZ and left atrial volume index (LAVI) (both p<0.001). One-third of patients had significantly increased LAVI without LVZ. Eight percent of the patients had LVZ despite normal LAVI. Older age, female sex, oncological history and increased AF recurrence characterized this latter subgroup.

Conclusions

In patients undergoing first PVI, the impact of LVZ on outcomes occurs with lower burden in paroxysmal than persistent AF suggesting that not all LVZs have equal prognostic implications. A proportional area of moderately decreased voltages accompanies LVZ, suggesting a continuous fibrotic substrate instead of the dichotomous division of healthy or diseased tissue. LAVI generally correlates with LVZ but a small subgroup of patients may present with disproportionate atrial remodeling, despite normal LAVI.
Opposite evolution on voltage and thickness from paroxysmal to persistent AF
Authors: Silva Garcia E , Banez V , Gonzalez M , Puche J E , Gomez A , Cano L , Fernandez R , Fernandez M , Fernandez-Armenta J
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

There is a controversy about correlation between voltage and thickness in the atrial myocardium and their evolution from paroxysmal to persistent atrial fibrillation (AF).

Purpose

This is an observational study to compare voltage and thickness of different areas on the left atrium in paroxysmal and persistent atrial fibrillation.

Methods

43 patients underwent first procedure atrial fibrillation ablation. Points with electrical information from an electroanatiomical map in sinus rhythym were acquiered during the ablation procedure covering the whole atrial surface. CT was acquired in all patients before the procedure and endo- and epicardium from the atrium was segmented for the atrial thickness calculation. All the points from the electromecanical map were projected on the thickness map to have both information on the same location. 3D atrium was segmented in 5 areas for the analysis: Lateral, Anterior, Septal, Posterior and Roof (Figure 1). Voltage and thickness values among different areas and between AF type were compared.

Results

30 paroxysmal and 13 persistent AF patients were analyzed acquiring 435±192 points per patient and 87±55 points per patient/area (20884 points in total). There was no linear correlation between voltage and thickness comparing all the patients nor among different areas nor between AF type (R<0.2 in all cases).

Regarding paroxysmal AF patients, septum showed significatly lower voltage compared with the other segments, posterior, lateral, anterior and roof (1.4±1.3mV*, P<0.001). The roof showed the highest voltage (2.3±1.7mV). The thickness analysis showed the septal segment as thinner segment and lateral as thicker segment (1.4±0.6mm,1.7±0.9mm, P<0.001) (Figure 2).

Regarding persistent AF patients: septum showed significatly lower voltage (1±0,9mV*)compared with the other segments. Roof showed higher voltage(2±1.7mV) (Figure 2). The thickness analysis showed the anterior segment as thinner segment and lateral as the thickest segment (1.6±0.8mm, 1.9±0.9mm, (P<0.001) different like on paroxysmal AF population.

Comparing voltage and thicknes between paroxysmal and persistent AF, all the segments on persistent population showed lower voltage values, with significant differences on all segmentes but the lateral one. On the other hand, all segments on persistent population showed statisticaly signignificant thicker myocardium in camparison with paroxysmal population (Figure 2).

Conclusions

According to our findings, there is no linear correlation between voltage and thickness. Persistent AF atria show thicker walls but with lower voltages in comparison with paroxysmal AF atria.
Echocardiographic and invasive evaluation of left atrial pressure in patients undergoing catheter ablation for atrial fibrillation
Authors: Cersosimo A , Arabia G , Inciardi R M , Cerini M , Bonelli A , Dell'era G , Degiovanni A , Spinoni E , Bosco M , Salghetti F , Lombardi C M , Patti R , Metra M , Curnis A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

AIMS

Estimation of left ventricle (LV) filling pressure is one of the most important parameters to provide information in clinical practice. However, the challenging in investigating this parameter through invasive methods makes it difficult to be used.

The study aims to investigate the association between cardiac structure and function derived by transthoracic echocardiography (TTE) and left atrial (LA) invasive pressure (LAP).

Methods

The study was a multi-center prospective study enrolling 73 patients (mean age 65 ± 8, 27% female) undergoing primary catheter ablation for AF. Patients were evaluated and enrolled from June 2021 to April 2022. Complete TTE assessing measures of LV, LA and right ventricle (RV) structure and function including speckle tracking echocardiography, was performed at baseline.

Echocardiographic data have been assessed the same day of the invasive measurement of the LAP during AF ablative procedure. Linear regression analysis has been performed to assess the relationship between measures of cardiac structure and function and LAP. Logistic regression analysis assessed the parameters associated with elevated LAP (≥ 15mmHg).

Results

Baseline clinical characteristics of the study population did not differ according to elevated LAP vs. non-elevated LAP. Patients with elevated LAP showed instead abnormal measures of LV global longitudinal strain, measures of LA structure and function, except for LA maximal volume, and RV structure and function. After multivariable adjustment, including demographic factors and comorbidities, E/e`(p = 0,024), LA minimal volume (p = 0,009), LA emptying fraction (LAEF) (p = 0,012), LA Reservoir (p = 0,039), TAPSE (p= 0,010) and RV free wall strain (p= 0,028), but not LA maximal volume (p=0,11), were significantly associated with LAP. Similarly, these measures, but nor LA maximal volume, were significant determinants of elevated LAP. Overall, LA minimal volume and LAEF showed the best diagnostic accuracy to predict elevated LAP (AUC 0.72 and 0.73, respectively).

Conclusions

Novel measures of LA structure and function, but not standard assessment by LA maximal volume, were significantly associated with LAP in patients affected by AF. These measures, along with measures of LV and RV function may be used in the diagnostic assessment of filling pressure in ambulatory settings.
Association between atrial fibrillation and healthcare costs among patients with cardiac implantable electronic devices
Authors: Peigh G , Zhou J , Roberts A I , Rosemas S C , Longacre C , Schwab G , Soderlund D , Passman R S
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Previous research on atrial fibrillation (AF)-related healthcare cost is limited by claims-derived categorization of AF diagnosis and does not assess for incremental differences in cost based on degree of AF burden.

Objective

To directly assess the incremental cost of device detected AF (ddAF), and compare relative costs among cohorts with no AF, paroxysmal AF (pAF), persistent AF (PeAF), and permanent AF (PermAF) in patients with cardiac implantable electronic devices (CIED) capable of sensitive and continuous atrial arrhythmia detection.

Methods

Using the de-identified Optum® Clinformatics® U.S. claims database (2015 to 2020) linked with the Medtronic CareLink® database, we identified CIED patients that transmitted data ≥6 months post-implant (baseline period). Annualized per-patient costs in follow up were analyzed from insurance claims and adjusted to 2020 US Dollars. Total costs were compared between patients with no AF and those with device detected pAF, PeAF and PermAF. Analyses were adjusted for geographical region, insurance type, CHA2DS2-VASc Score, and implant year.

Results

Of the 21,391 patients (72.9±10.9 yrs; 56.3% male) analyzed, 7,798 (36.5%) had ddAF. Among these, 5,966 (76.5%) were pAF (avg burden 2.9±8.6%), 1,145 (14.7%) were PeAF (avg burden 47.2±29.9%), and 687 (8.8%) were PermAF (avg burden 99.3±0.7%). Patients with ddAF had higher overall annualized total healthcare costs than those without ddAF (fig). The incremental annualized increased cost in those with ddAF was $12,789 ± $161,749 per patient. Patients with pAF, PeAF and PermAF all had higher adjusted healthcare costs than those without AF (p for all <0.001). Patients with PeAF and PermAF both had higher total adjusted costs than patients with pAF. In addition, patients with PeAF had higher healthcare costs than those with PermAF (fig).

Conclusions

In the present analysis of CIED patients, ddAF was associated with increased healthcare costs after adjustment for clinical and demographic covariates. Among those with ddAF, patients with PeAF had the highest healthcare costs. Preventing development of AF, and progression to PeAF, may reduce healthcare costs.
Impact of pulmonary vein anatomy and ostial dimensions on long term outcome after single-shot device guided cryoablation for paroxysmal atrial fibrillation
Authors: Isgandarova K , Bergau L , El Hamriti M , Braun M , Piran M , Imnadze G , Khalaph M , Molatta S , Sciacca V , Fink T , Sommer P , Guckel D , Sohns C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cryoballoon (CB)-guided pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF).

Purpose

Assessment of the role of individual anatomical characteristics to predict long-term freedom from arrhythmia recurrence after CB-guided PVI for paroxysmal AF (PAF).

Methods

353 consecutive patients (58±11 years, 56% males), undergoing PVI between 2012 and 2018 were analysed. Individual pulmonary vein (PV) anatomy was assessed using preprocedural cardiac magnetic resonance imaging (MRI). The impact of PV characteristics and CSA on long-term AF-free survival was evaluated.

Results

Acute PVI was achieved in all patients. 223 patients (63%) had a normal PV anatomy. Variant PV anatomy was present in 130 patients (37%). During the observation period of 48 months AF-recurrence was documented in 167 patients (47 %). Patients with AF-recurrence presented with significantly enlarged right-sided PVs and left superior PVs (LSPVs) (p<0.001). The presence of left common PVs (LCPVs) (n=75, Log-rank p<0.001) as well as right variant PVs (n=35, Log rank p<0.001) was associated with a significantly worse long-term AF-free survival rate compared to patients with normal PV characteristics.

Conclusion

Variant PV anatomy predicted long-term AF-recurrence. Preprocedural imaging may help to improve patients’ selection for single-shot device guided PVI.
Reduction of major gastrointestinal bleeding risk with proton pump inhibitor therapy in patients with atrial fibrillation receiving direct oral anticoagulant
Authors: Lee S R , Choi E K , Lee S W , Ahn H J , Kwon S , Han K D , Oh S
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This research was supported by a grant from the Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC21C0028).

Background

In patients with atrial fibrillation (AF) receiving direct oral anticoagulant (DOAC), gastrointestinal bleeding (GIB) is itself a serious event for the patient, and it causes an increase in the thromboembolic risk caused by discontinuation of anticoagulation therapy. There are limited data on the benefit of preventive PPI use to reduce the risk of GIB in DOAC users.

Methods

We included patients with AF receiving DOAC from 2013 to 2020 based on the Korean Health Insurance Review and Assessment database. For comparison between patients with and without PPI, propensity score (PS) weighting method was used. Primary outcome was major GIB and secondary outcomes were major upper GIB and upper GIB requiring transfusion.

Results

A total of 171,494 patients were included (mean 72±10 years, mean CHA2DS2-VASc 4.3±1.8; 50,577 of rivaroxaban, 23,010 of dabigatran, 54,461 of apixaban, and 43,446 of edoxaban). Among the total population, 40% of patients were prescribed PPI and 55% of PPI users were prescribed low dose PPI. After PS weighting, patients with PPI were associated with lower risks of major GIB, major upper GIB, and upper GIB requiring transfusion than those without PPI (hazard ratio [95% confidence interval]; 0.816 [0.758-0.878], 0.834 [0.770-0.901], and 0.814 [0.734-0.902], respectively, Figure A). Patients with low dose PPI showed significant risk reduction for major GIB, major upper GIB, and upper GIB requiring transfusion than those without PPI (0.570 [0.515-0.632], 0.563 [0.505-0.628], and 0.505 [0.435-0.587], respectively). The protective effect of PPI was slightly different among DOAC types (Figure B). In the subgroup analyses, major GIB risk reduction of PPI co-therapy was more accentuated in patients older than 75 years and those with underlying GI disease or symptoms.

Conclusion

In this largest Asian cohort of patients with AF receiving DOAC, PPI co-therapy might be beneficial to reduce the risk of major GIB and upper GIB. This was consistently observed with low-dose PPI. The protective effect of PPI was more pronounced in the high bleeding risk patients.
Clinical profile and arrhythmic burden in MINOCA
Authors: Lypovetska S
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is considered to be a puzzling clinical phenomenon with unclear prognosis. This study aims to compare the clinical characteristics, impact of arrythmias and prognosis of MINOCA with MI with obstructive coronary artery disease (MICAD).

Methods

Data was obtained from our university hospital database. Patients with MI between 28 August 2018 and 31 December 2020 were included in the study. Subjects were divided in 2 groups: 1 - MINOCA; 2 -MICAD. Follow-up analysis included death from any cause, major adverse cardiac events (MACE: cardiac death, MI, stroke), readmissions due to cardiovascular causes, and in-hospital mortality. Median follow up was 18 months.

Results

MINOCA occurred in 49 (11 %) out of 443 pts with MI. There were no differences in age (p=0.732). In MINOCA group there were more females (34.7% vs 22.8%, p<0.001), never smokers (30.6% vs 21.8%, p<0.001), lower rates of hypertension (67.3% vs 73.8%, p=0.036), diabetes (18.3% vs 29.9%, p<0.001), hyperlipidaemia (28,5 % vs 35.7%, p=0.475), stroke in anamnesis (2.0% vs 6.8%, p<0.001), preavious MI (2.0% vs 22.8%, p<0.001). Symptoms at admission didn't differ between the two groups, however MINOCA group had lower mean heart rate (72±15 vs 87±19, p<0.001), lower systolic arterial pressure (139±22 vs 145±28, p<0.001).

There were no significant differences between STEMI or NSTEMI: 55.1 % and 44.9 % in the MINOCA group vs 53.8 % and 46.2 % in MICAD (p=0.534). MINOCA patients had lower C-RP levels (19 vs 56 mg/L, p<0.001), high-sensitivity cardiac troponin T levels: (112 vs 376 ng/L, p<0.001) and lower BNP levels (99±26.9 vs 142±64.2, p<0.001). Left ventricular dysfunction (EF < 50 %) was more prevalent in the MICAD group (16.3% vs 27.9%, p<0.001). There was no need in inotropic support in MINOCA patients (0% vs 4.8%, p=0.04).

Atrial fibrillation (AF) was more often found in MICAD group (4.1% vs 6.8%, p <0.001). There were no diffrenecs in ventricular arrhythmias during admmision in both groups. Death rates were lower in hospital (0% vs 2.8%, p=0.131) and during the follow up period (8.1% vs 10.9 %, p=0.369). There was no significant difference in MACE outcomes (p=0.612) and readmission of cardiovascular causes (p=0.310) in both groups. Independent predictors for MACE in MINOCA patients were older age (≥60 years), females, reduced LVEF and atrial fibrillation.

Conclusion

MINOCA patients had lower prevalence of classic cardiovascular risk factors, no clinical differences at admission, lower levels of C-RP and high-sensitivity cardiac troponin T, preserved left ventricle EF, lower in- hospital and during follow up death rate, but no significant difference in MACE outcomes. Older age, females, reduced LVEF and atrial fibrillation are considered to be predictors of MACE in MINOCA. Further research is needed to provide more evidence on the optimal management.
Effect of history of atrial arrhythmias on the rate of recurrent stroke in patients after PFO closure
Authors: Jiravsky O , Gajdusek L , Hudec M , Balusik J , Chovancik J , Kufova P , Miklik R , Sknouril L , Januska J
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Although the importance of persistent foramen ovale (PFO) closure is well established, it is far from complete its role in patients with atrial arrhythmias. Patients with a history of atrial arrhythmias, especially younger and healthy persons with PFO after a stroke, are indicated for PFO closure. This is despite the uncertainty of whether atrial arrhythmia (it means silent atrial fibrillation) is the actual cause of the stroke.

Objectives

To describe prospective observations comparing cohort PFO closure patients with and without atrial arrhythmias.

Method

A retrospective analysis of the real world of a prospective registry of patients after PFO closure. This is a set of patients from one cardiac center over 19 years; each patient was followed up once a year for seven years. The recurrence of ischemic stroke was monitored.

Results

A total of 712, 378 females (53.1%) and 334 males, aged 50 (+/-12) years, were indicated for PFO closure mostly due to stroke (436 i.e. 61.4%) and systemic embolization (56 i.e. 7.9%). DM was present in 55 patients ( i.e. 7.7%), and arterial hypertension was also in 306 patients (i.e. 43%). See other demographic data in Table 1. A history of atrial arrhythmias ( salvage SVES or intrinsic atrial fibrillation) before PFO closure was described in 50 patients ( 7.1%). During the 7-year follow-up, recurrent stroke was detected in a total of 14 cases, 13 in the group without previous arrhythmic history (4.3%) and 1 with previous arrhythmic history (3.8%, p=0.912). A surprising finding was the statistically higher representation of women in the cohort with previous arrhythmic history (p=0.001), in the cohort of shorter (p=0.012) and thinner (p=0.022) women, and thus in the cohort with lower BSA (p=0.006). On the other hand, unsurprisingly, there was a statistically higher proportion of diabetics (p0.024) and patients with coronary artery disease (p=0.013) in the cohort with atrial arrhythmias in the pre-hospital period. Detailed results are in table 1.

Conclusion

There was no difference in the incidence of recurrent stroke between the cohorts of patients with and without a prior history of atrial arrhythmias in the seven-year follow-up after PFO closure. The cohort of patients with a previous history of atrial arrhythmias was, unsurprisingly, statistically larger in patients with diabetes and coronary artery disease.
Systolic, diastolic blood pressure and pulse pressure and risk of stroke in young aged patients with atrial fibrillation
Authors: Lee S R , Choi E K , Ahn H J , Lee S W , Han K D , Oh S , Lip G Y H
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

It is well-known that higher blood pressure (BP) is associated with a higher risk of stroke with atrial fibrillation (AF). However, there is limited data about the effect of systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) on the risk of ischemic stroke in young and low-risk AF patients

Methods

Using the Korean Health Insurance Service database, patients who were newly diagnosed with AF between January 2009 and December 2016 and had health screening examination data within 2-year after AF diagnosis were included. Patients aged between 20 and 39 years were finally included in this analysis. During follow-up, incident ischemic stroke was evaluated as a primary outcome. Hazard ratio (HR) and the corresponding 95% confidence intervals (CI) were calculated using multivariable Cox proportional hazard models.

Results

A total of 15,980 patients were included in this analysis (mean age 32.4±4.8 years, 66.9% of men). Mean CHA2DS2-VASc score was 0.7±0.8 and oral anticoagulation rate was 5.6%. During a median 5.2-year of follow-up, 73 patients had an incident ischemic stroke (incidence rate, 0.9 per 1,000 person-years). After multivariable adjustment, SBP ranging from 140 to 159 mmHg and 160 mmHg or higher were associated with a significantly higher risk of ischemic stroke by 8.4-fold and 11.6-fold compared to SBP under 100 mmHg (Figure). DBP 95mmHg or higher was associated with a higher risk of ischemic stroke by 4.2-fold than DBP under 65 mmHg (Figure). Patients with PP ranging from 50 to 59 mmHg and 60 mmHg or higher showed a significantly higher risk of ischemic stroke than those with PP ranging from 40 to 49 mmHg (HR [95% CI]; 1.81 [1.04-3.18] and 3.15 [1.49-6.64], respectively). Also, lower PP than 30 mmHg was associated with a higher risk of stroke (3.96 [1.36-11.53]).

Conclusion

Optimal BP control might be crucial to preventing ischemic stroke in these young and low-risk AF patients.
Electrophysiological findings in HFpEF patients presenting for AF ablation
Authors: Lee J , Sponder M , Stojkovic S , Riesenhuber M , Hammer A , Hofbauer T , Sulzgruber P , Burger S , Kastl S , Schoenbauer R
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Aims

The prevalence of atrial fibrillation (AF) in heart failure with preserved ejection fraction (HFpEF) patients is high. Impaired left atrial (LA) function is a major determinant in HFpEF. The extent of arrhythmogenic left atrial tissue degeneration in HFpEF patients is unknown.

Methods and results

We prospectively enrolled consecutive patients presenting for first time AF ablation. Each patient underwent baseline laboratory and transthoracic echocardiography assessment. The HFA-PEFF score was utilized to identify HFpEF patients. Bipolar high density voltage mapping [1213 (825 to 1606) mapping points] was created in sinus rhythm prior to PVI to evaluate the general LA bipolar voltage and quantify areas of low voltage, a well known surrogate for fibrosis and arrhythmogenesis.

160 patients were enrolled (55 % male). 42 patients (26 %) suffered from HFpEF. Low voltage areas (LVAs) were present in 84 patients (53 %).

HFpEF was associated with generally decreased LA bipolar voltage (0.95 ± 0.45 mV vs. 1.59 ± 0.91 mV respectively; p < 0.001) (Fig. 1) and predictive for the existence of low voltage areas (81 % vs. 45 % low voltage area positive, respectively; p = 0.006). The HFA-PEFF score inversely correlated with LA bipolar voltage (r = - 0.380; p < 0.001) (Fig. 1). Furthermore, the HFA-PEFF score closely correlated to the extent of LVAs (r = 0.275; p = 0.001) and to the low voltage amplitude of atrial myocardium excluding areas of low voltage (r = - 0.403; p < 0.001).

Conclusion

HFpEF is highly predictive for generally decreased LA bipolar voltage and for the existence of fibrotic and arrhythmogenic left atrial tissue degeneration.
Association of cardiac rhythm with cognitive performance in atrial fibrillation patients
Authors: Mosher L , Coslovsky M , Hennings E , Aeschbacher S , Paladini R E , Bonati L H , Conen D , Kuehne M , Osswald S , Meyer-Zurn C
Published: May 2023

Funding Acknowledgements

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

Background

Atrial fibrillation (AF) is strongly associated with an increased risk of cognitive decline and dementia. AF-induced cerebral hypoperfusion, caused by loss of atrial contraction and RR interval variation, is discussed as one possible underlying mechanism. However, the short-term association between heart rhythm and cognitive performance is not clear. Here, we aimed to investigate the association of rhythm (AF vs. sinus rhythm, SR) with cognitive performance in AF patients.

Methods

We enrolled patients from a prospective, multicenter cohort study. At study visits, patients underwent 5-minute resting ECG recordings and extensive cognitive testing including the Montreal Cognitive Assessment (MoCA) and cognitive construct score (CoCo). Multivariable adjusted mixed effect linear regression models were used to investigate the association between acute heart rhythm on ECG (AF vs. SR) and cognitive performance. Further, we investigated the association between heart rhythm and the Geriatric Depression Score (GDS) as well as the European Quality of Life Visual Analogue Scale (EQ-VAS 100).

Results

5206 ECGs from 1648 AF patients were available for analysis. 46% of ECGs were in AF. Mean age of the patients was 72 years and 27% were females. After adjustment for pre-defined covariables, we did not identify an independent association between heart rhythm (AF vs. SR) and cognitive performance in any test. However, patients with present AF on ECG had reported worse GDS and EQ-VAS 100 scores.

Conclusion

In our large cohort of AF patients, there was no acute association between heart rhythm (AF or SR) and cognitive performance.
Atrial fibrillation screening to prevent stroke in patients with high NT-proBNP - a post-hoc analysis of the randomized LOOP study
Authors: Diederichsen S Z , Xing L Y , Haugan K J , Hoejberg S , Krieger D , Brandes A , Koeber L , Frikke-Schmidt R , Svendsen J H
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): The Innovation Fund Denmark

Background and aims

Stroke is a leading cause of mortality and disability, and atrial fibrillation (AF) is an important and potentially modifiable risk factor for stroke. AF screening can substantially increase the amount of patients diagnosed and treated, but randomized trials have yet to demonstrate a significant decrease in strokes following screening. N-terminal prohormone of brain natriuretic peptide (proBNP) is an established biomarker for AF and could potentially be used to select patients for screening.

We a used randomized trial of AF screening vs usual care to investigated the usefulness of proBNP as a tool to select patients for screening to prevent outcomes.

Methods

The LOOP Study randomized AF-naïve individuals aged >70 years with additional stroke risk factors in a 1:3 ratio to either continuous AF screening using implantable loop recorder (ILR) with initiation of anticoagulation upon detection of AF, or usual care. In this post-hoc analysis, study participants with a baseline measurement of proBNP were included, and the effect of screening vs usual care was compared in groups according to proBNP tertiles.

Results

Of 6004 participants randomized, 5819 (97%) had proBNP measured. The tertiles of proBNP were at <11, 11-22, and 22 pmol/L (Figure 1).

A total of 1014 participants (17.4%) were diagnosed with AF (ILR 32.1% vs Control 12.5%), and 310 (5.3%) endured a stroke or systemic arterial embolism (SAE) (ILR 4.5% vs Control 5.6%). In the lower two tertiles of proBNP, 13% were diagnosed with AF (ILR 26.6% vs Control 8.3%), and 4.6% endured a stroke or SAE (ILR 4.6% vs Control 4.6%), whereas in the highest tertile of proBNP, 25.9% were diagnosed with AF (ILR 42.9% vs 20.3%), and 6.73% endured a stroke or SAE (ILR 4.4% vs Control 7.5%).

In the lower two tertiles of proBNP, there was no protective effect from AF screening as compared with usual care (hazard ratio (HR) 1.00 (95% CI 0.71-1.41), p=0.999), whereas in the highest tertile of proBNP there was a significant effect of screening (HR 0.59 (95% CI 0.37-0.93), p=0.021) (Figure 2).

More details including proBNP cutoffs, and the impact on stroke subtypes, disability and mortality will be presented at the Congress.

Conclusions

In a population at increased risk of stroke, proBNP pose a useful biomarker to select individuals for AF screening to prevent stroke. In persons with increased proBNP, the effect of screening could be significant, whereas there is no signal towards effects from screening in people with normal proBNP levels.
Renal outcomes of early rhythm control in patients with atrial fibrillation and chronic kidney disease
Authors: Kim D , Yang P S , You S C , Jang E , You H T , Kim T H , Pak H N , Lee M H , Lip G Y H , Sung J H , Joung B
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): The Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea

Background

Atrial fibrillation (AF) is associated with development of impaired renal function and chronic kidney disease (CKD). Early rhythm control initiated within 1 year of AF diagnosis is associated with a lower risk of adverse cardiovascular outcomes compared to usual care among patients recently diagnosed with AF.

Purpose

This study aimed to assess the effects of early rhythm control on renal function in patients with AF and CKD, compared with rate control

Methods

This population-based cohort study included 4,151 patients with AF and CKD, from the Korean National Health Insurance Service database, undergoing rhythm control (antiarrhythmic drugs or ablation) or rate control therapy, initiated within 1 year of AF diagnosis in 2005–2015. A composite renal outcome of ≥30% decline in estimated glomerular filtration rate (eGFR), acute kidney injury (AKI), and kidney failure was compared using propensity score overlap weighting.

Results

In the study population (39.1% female; median age: 70 years), a total of 628 composite renal outcome occurred during the median follow-up of 2.3 years. Early rhythm control, compared with rate control, was associated with lower risks of the composite renal outcome (weighted incidence rate: 4.1 vs. 5.3 per 100 person-years; weighted HR 0.78, 95% CI 0.65-0.94) and kidney failure (weighted HR 0.73, 95% CI 0.56-0.95). Trends toward lower risks of eGFR decline (weighted HR 0.89, 95% CI 0.58-1.37) and AKI (weighted HR 0.88, 95% CI 0.66-1.17) were observed in patients undergoing early rhythm control, compared with those undergoing rate control.

Conclusion

Among patients with AF and CKD, early rhythm control was associated with a lower risk of progression of kidney disease, compared with rate control, highlighting the need for future randomized studies evaluating the benefits of early rhythm control on renal outcome among patients with AF.
Cardioversion strategy impacts quality of rate control during recurrences of atrial fibrillation
Authors: Van Der Velden R , Pluymaekers N , Dudink E , Luermans J , Meeder J , Lenderink T , Widdershoven J , Bucx J , Rienstra M , Van Gelder I , Crijns H , Linz D
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Netherlands Organization for Health Research and Development

Introduction

In the Rate Control versus Electrical Cardioversion Trial 7–Acute Cardioversion versus Wait and See, patients with recent-onset atrial fibrillation (AF) were randomised to either early or delayed cardioversion.

Purpose

This pre-specified sub-analysis aimed to evaluate heart rate during AF recurrences after an emergency department (ED) visit identified by an electrocardiogram (ECG)-based handheld device.

Methods

After the ED visit, included patients (n=437) were asked to use an ECG-based handheld device to monitor for recurrences during the four-week follow-up period. 335 patients used the handheld device and were included in this analysis. Recordings from the device were collected and assessed for heart rhythm and rate. Optimal rate control was defined as a target resting heart rate of <110 bpm.

Results

In 99 patients (29.6%, mean age 67±10 years, 39.4% female, median 6 [3-12] AF recordings) a total of 314 AF recurrences (median 2 [1-3] per patient) were identified during the follow-up. The average median resting heart rate at recurrence was 100±21 bpm in the delayed vs 112±25 bpm in the early cardioversion group (p=0.011). Additionally, the maximum heart rate was also significantly lower in the delayed cardioversion group (115 [94-131] vs 136 [118-147], p=0.001). Optimal rate control was seen in 68.4% [21.3-100%] of the performed recordings per patient in the delayed, and 33.3% [0-77.5%] of the performed recordings per patient in the early cardioversion group (p=0.01). Randomisation group (coefficient -12.09 (-20.55 - -3.63, p=0.006) for delayed versus early cardioversion) and heart rate on index ECG (coefficient 0.46 (0.29-0.63, p<0.001) per bpm increase) were identified as multivariable adjusted factors associated with lower median heart rate during AF recurrences.

Conclusion

A delayed cardioversion strategy translated into lower median heart rates as well as lower peak heart rates during AF recurrences. Apart from the randomized treatment, heart rate at recurrence was influenced by the intrinsic heart rate on presentation.
Personalized rate control treatment for atrial fibrillation: a prospective case-control study on the use of diltiazem
Authors: Spadotto A , Massaro G , Amadori M , Damaschin L , Martignani C , Ziacchi M , Biffi M , Galie N , Boriani G , Diemberger I
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Recent ESC Atrial Fibrillation guidelines introduced some changes in the options for rate control, such as the possibility to combine beta-blockers (BB) and non-dihydropyridine calcium channel blockers (NDCC), to address the need of personalized pharmacologic rate control strategy for AF. However, there are limited data on this topic.

Purpose

The aim of our study was to explore the prognostic impact of a personalized therapy (PT) for rate control, including the use of NDDC in patients with heart failure (HF) or in combination with BB, compared to standard rate control therapy (ST) as defined by previous ESC guidelines.

Methods

This is a single centre prospective observational registry on patients referred to our University Hospital for the management of AF between October 2013 and February 2019.

Results

We enrolled 1112 patients on exclusive rate control treatment, 125 (11.2%) were identified as patients with PT and 987 (88.8%) were on ST. In the PT group, 93/125 (74.4%) patients were prescribed BB + NDCC (±digoxin), while 85/125 (68.0%) were HF patients prescribed with NDCC, diltiazem in all cases. The mean age of patients was 73.5±12.0 years and 72.5±12.7 years in ST and PT groups, respectively. The two cohorts were homogeneous in terms of male prevalence, left ventricular ejection fraction and CHA2DS2-VASc score; while, HF was more frequent in PT group both in terms of patients with NYHA class ≥2 (41.3% in ST vs. 64.8% in PT, p<0.001) and prescription of diuretics (72.2% in ST vs. 88.0% in PT, p<0.001). Patients treated with PT had no difference in one-year overall survival compared to those with a ST (Figure 1 A). Notably, patients with HF in ST had a worse prognosis (p<0.001). (Figure 1 B)

Conclusions

Our results suggest a potential outcome benefit of NDCC for rate-control in AF patients, either alone or in combination with BB, also in selected patients with HF. Future controlled studies are needed to confirm our findings, and to identify subjects with higher benefit from such personalized rate-control strategies.
His bundle pacing and AV nodal ablation for non-controlled atrial arrhythmia: a technical challenge with major clinical benefits
Authors: Chaumont C , Auquier N , Milhem A , Mirolo A , Savoure A , Eltchaninoff H , Anselme F
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

His bundle pacing (HBP) is an appealing alternative to right ventricular pacing in patients referred for permanent ventricular pacing and AV nodal ablation (AVNA) as it preserves physiological ventricular activation. Only limited amount of data is available in the literature regarding HBP combined with AVNA.

Purpose

To provide further evidence on the feasibility and efficacy of this therapeutic approach in patients with uncontrolled atrial arrhythmia.

Methods

We prospectively included all patients who underwent AVNA after HBP in three different hospitals between 2017 and 2022.

Results

AVNA following HBP lead implantation was performed in 75 patients. A complete AV block was obtained in 58 patients (77%) whereas significant modulation of the AV node conduction (heart rate < 60bpm) was obtained in 12 (16%). AVNA failure was observed in 5 (7%). The recording of an atrial signal by the HBP lead was more frequently observed in patients with AVNA modulation/failure compared to patients with complete AV block (11/17 vs 5/58; p < 0.001). There was no lead dislodgment during the AVNA procedures. Acute HB capture threshold increase > 1V occurred in 11 patients (15%) with return to baseline value at day one in 9. NYHA class and LVEF significantly improved from baseline to last follow-up (3.0 ± 0.7 vs 1.6 ± 0.5, p < 0.001; 47 ± 14% vs 60 ± 9%; p < 0.0001, respectively),

Conclusion

AVNA combined with HBP for non-controlled atrial arrhythmia was feasible and clinically efficient. Implanting the HB lead on the ventricular aspect of the tricuspid annulus avoiding atrial signal recording can facilitate AVNA.
The role of atrial electro-mechanical coupling as predictor of catheter ablation efficiency: EPs and clinicians working together
Authors: Barletta V , Parollo M , Gentile F , Canu A , Sbragi S , Mazzocchetti L , Di Cori A , Segreti L , De Lucia R , Grifoni G , Bongiorni M G , Zucchelli G
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation (AF) results in electrical and structural remodeling of the atria, and the extent of remodeling has already been found to be associated with higher AF recurrence rate after catheter ablation (CA). Recently, a novel echocardiographic parameter derived from tissue Doppler imaging (TDI), called PA-TDI, has been introduced to assess the total atrial activation time, as a non-invasive surrogate of fibrosis and atrial cardiomyopathy. The aim of the study was to investigate the role of PA-TDI interval as predictor of AF ablation efficacy.

Methods

Consecutive patients with persistent or paroxysmal symptomatic AF referred to our Center to perform radiofrequency ablation or cryoablation procedures were prospectively enrolled. In these patients, a complete transthoracic echocardiographic examination was performed before and after the ablation procedure, including assessment of the PA-TDI interval.

Results

From October 2018 to May 2020, 221 consecutive patients (mean age 61 ± 9 years, 74% male, mean BMI 26.5 ± 3.6, mean Ejection Fraction 61 ± 6%) symptomatic for AF, undergoing the procedure ablation (first procedure or re-do) were enrolled. Out of the blanking period, 25% of patients experienced recurrence of arrhythmia during follow-up (mean 16 months). Compared to patients who did not relapse, patients with AF recurrence have a generally longer post-procedural PA-TDI interval (139.6 ± 22.1 msec vs 153.9 ± 33 msec, respectively). In the multivariable analysis only post-procedure PA-TDI and re-do interventions were found to be independent predictors of AF recurrence. A PA-TDI cut-off>144msec identifies patients at risk of post ablation AF recurrence with sensitivity 58.7% and specificity 73.5% (AUC 0.697).

Conclusions

The PA-TDI interval is an independent predictor of AF recurrence after catheter ablation. This echocardiographic parameter is easily obtainable, low-cost, reproducible, and accessible even in peripheral centers.