bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of body mass index on clinical outcomes in patients with newly diagnosed atrial fibrillation in the GARFIELD-AF registry
Authors: Camm C.J.F , Camm A.J , Virdone S , Bassand J.-P , Fitzmaurice D.A , Fox K.A.A , Goldhaber S.Z , Goto S , Haas S , Turpie A.G.G , Verheugt F.W.A , Misselwitz F , Kayani G , Pieper K.S , Kakkar A.K 
Published: November 2020

Abstract

Introduction
Higher body mass index (BMI) is associated with a higher risk of atrial fibrillation (AF). However, previous evidence has suggested an inverse association between BMI and risk of AF outcomes.

Purpose
To explore the association between BMI and outcomes in those with newly diagnosed AF in the GARFIELD-AF registry.

Methods
GARFIELD-AF is an international registry of consecutively recruited patients aged ≥18 years with newly diagnosed AF and ≥1 stroke risk factor. Data were collected prospectively on 52,080 patients. Participants with missing or extreme BMI values and those without two-year follow-up were excluded. Cox proportional hazard models were used to estimate the effect of BMI on the risk of outcomes. Models were adjusted for age, sex, ethnicity, smoking, alcohol, and ≥moderate chronic kidney disease. Where appropriate participants were divided into groups based on BMI. Restricted cubic splines were used to assess non-linear relationships.

Results
BMI and outcome data were available for 40,495 patients. Those with higher BMI were generally younger, and more likely to have pre-existing hypertension, diabetes, or vascular disease (Table). Underweight patients received anticoagulation less often than those in other groups (60.3% vs 67.9%, respectively). During follow-up, 2,801 participants (6.9%) died and 603 (1.5%) had new/worsening heart failure. Following adjustment for potential confounders, a U-shaped relationship was seen between BMI and all-cause mortality and new/worsening heart failure (Figure). For all-cause mortality, the lowest risk was at 30kg/m2. Below this level, there was an 8% higher risk of mortality (95% confidence interval (CI) 6 to 9%) per 1kg/m2 lower BMI. Above 30kg/m2, there was a 5% higher risk of mortality per 1kg/m2 higher BMI (95% CI 4 to 7%). For new/worsening heart failure, the lowest risk was at 25kg/m2. Above this level, 1kg/m2 higher BMI was associated with an 5% higher risk (95% CI 13 to 6%).

Conclusions
BMI was an important risk factor for both all-cause mortality and new/worsening heart failure in AF. Those at both extremes of BMI are at higher risk.
BMI and selected outcomes

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): The GARFIELD-AF registry is funded by an unrestricted research grant from Bayer AG.
Incidence, type and prediction of death in anticoagulated patients with atrial fibrillation: a post-hoc analysis from the SPORTIF trials
Authors: Proietti M , River-Caravaca J.M , Pastori D , Lip G.Y.H 
Published: November 2020

Abstract

Introduction
Patients with atrial fibrillation (AF) are at substantially increased risk of death. Uncertainty still remains about the best risk tool to to stratify and predict mortality risk.

Aim
To report the incidence of death according to cause in anticoagulated AF patients. Second, to evaluate the predictive ability of several risk scores.

Methods
Patients from the warfarin arms of the SPORTIF trials were considered for analysis. All-cause death, cardiovascular (CV) death and non-CV death were study outcomes. The 2MACE score, crude number of diseases (CND), charlson comorbidity index (CCI) and GARFIELD-AF Death score were predictive tools.

Results
3665 patients (mean [SD] age 70.9 [8.9] years. 69.5% males; median [IQR] CHA2DS2-VASc 3 [2–4]) were analysed. Median [IQR] scores were: 2MACE 2 [1–3]; CND 5 [3–7]; CCI 2 [1–3]. Throughout a median [IQR] of 567 [491–652] days there were 204 (5.6%) all-cause deaths, 134 (3.7%) CV deaths and 70 (1.9%) non-CV deaths. The incidence of all-cause death was 3.59 per 100 patient-years, and for CV death and non-CV death, 2.39 per 100 patient-years and 1.23 per 100 patient-years, respectively. Cumulative incidence of all cause, CV and non-CV deaths is are shown in the Figure. After multivariable adjustment, all the tools were found associated with an increased risk of all-cause death (2MACE HR: 1.28, 95% CI: 1.17–1.40; CND HR: 1.07, 95% CI: 1.04–1.11; CCI HR: 1.33, 95% CI: 1.22–1.44; GARFIELD-AF Death HR: 1.85, 95% CI: 1.52–2.26 per each 0.100 increase). Similar results were found for CV death and non-CV death. All risk tools were only modestly predictive of the three outcomes (c-indexes &lt;0.7; Table). In predicting all-cause death, CCI and GARFIELD-AF Death were similarly predictive with small differences compared to other tools; conversely 2MACE and GARFIELD-AF Death showed similar predictive capacity for CV death, while CND and CCI had a slightly better predictivity for non-CV death.

Conclusions
AF patients have a high mortality, particularly for CV death. All risk scores are associated with occurrence of all-cause mortality, having a similar (but modest) predictive capacity. GARFIELD-AF Death and the simpler 2MACE had the highest predictive value for CV death, while multimorbidity tools (CND and CCI) were more predictive for Non-CV death.
Cumulative Incidence of Death Events

Funding Acknowledgement
Type of funding source: None
Ablation index guide pulmonary vein isolation can reduce early recurrence of atrial fibrillation: a propensity score-matched analysis
Authors: Yasumoto K , Egami Y , Ukita K , Yanagawa K , Nakamura H , Matsuhiro Y , Tsuda M , Okamoto N , Tanaka A , Matsunaga-Lee Y , Yano M , Yamato M , Shutta R , Nishino M , Tanouchi J 
Published: November 2020

Abstract

Background
Ablation index (AI) is a novel marker of ablation lesion quality for radiofrequency ablation (RFA). It has been reported that AI guided pulmonary vein isolation (PVI) reduced pulmonary vein reconnection and late recurrence of atrial fibrillation (AF). However, little is known about the impact of AI guided PVI on early recurrence of AF (ERAF).

Purpose
The aim of this study is to clarify whether AI guided PVI can reduce ERAF.

Methods
From September 2014 to August 2019, consecutive AF patients who underwent 1st session PVI were enrolled. We compared prevalence of ERAF between AI guided PVI group (AI group) and conventional contact force guided PVI group (CF group) using propensity score-matched analysis, which adjusted patient backgrounds (age, sex, and body mass index (BMI)), type of AF, the history of heart failure, hypertension, diabetes and stroke, laboratory findings including estimated glomerular filtration rate (eGFR) and b-type natriuretic peptide (BNP), and echocardiographic parameters including left ventricular ejection fraction (LVEF) and left atrial diameter.

Results
Total 711 patients were enrolled. AI group comprised 233 patients and CF group comprised 233 patients. Prevalence of ERAF were significantly lower in AI group than in CF group significantly (21.5% vs 36.1%, p=0.001, Table).

Conclusions
AI guided PVI can reduce ERAF as compared to conventional method.

Funding Acknowledgement
Type of funding source: None
The impact of an empiric superior vena cava isolation added to pulmonary vein isolation for non-paroxysmal atrial fibrillation associated with left atrial low voltage areas
Authors: Omuro T , Yoshiga Y , Fukuda M , Kato T , Fujii S , Ueyama T , Shimizu A , Yano M 
Published: November 2020

Abstract

Introduction
Left atrial low-voltage areas (LVAs) are associated with recurrence after radiofrequency catheter ablation of atrial fibrillation (AF). However, the impact of LVAs on recurrence after an empiric pulmonary vein isolation (PVI) plus superior vena cava isolation (SVCI) strategy for non-Paroxysmal AF (PAF) patients remains unclear.

Purpose
We evaluated the impact of LVAs on the recurrence of atrial tachyarrhythmias (ATs)/AF in patients who underwent an empiric SVCI added to the PVI for non-PAF.

Methods
We enrolled 153 consecutive patients with non-PAF who underwent a PVI alone (PVI group; n=51) or empiric PVI plus SVCI (PVI+SVCI group; n=102). Left atrial voltage maps were constructed during sinus rhythm to identify the LVAs (&lt;0.5 mV). No patients underwent a substrate modification of the LVAs. We divided the patients into two groups based on the LVAs (with or without an LVA &gt;5% of the left atrial surface area) and investigated the ATs/AF free survival rate after the initial and multiple procedures.

Results
LVAs were identified in 65% and 73% of the PVI and PVI + SVCI groups, respectively (P=0.319). In the PVI group, the 18-month ATs/AF-free survival was 61% of the patients without LVAs and 27% of patients with LVAs after the initial session (P=0.018) (Figure 1-A). Seventy-two percent of the patients without LVAs and 46% of those with LVAs were free from ATs/AF after multiple sessions (P=0.083) (Figure 1-B). In the PVI+SVCI group, 50% of the patients with LVAs and 61% of those without LVAs had no recurrence after the initial session (P=0.374) (Figure 2-A). Moreover, there was no significant difference in the 18-month ATs/AF-free survival between the patients with and without LVAs after multiple sessions (73% vs. 79%; P=0.520) (Figure 2-B).

Conclusion
A PVI alone strategy for non-PAF patients with LVAs had limited efficacy for the outcomes, even with multiple procedures. However, an SVCI may have the potential to compensate for an impaired outcome in patients with LVAs.

Funding Acknowledgement
Type of funding source: None
Clinical characteristics and outcomes after pulmonary vein isolation in atrial fibrillation patients with complete right bundle branch block
Authors: Yano M , Nishino M , Yanagawa K , Nakamura H , Matsuhiro Y , Yasumoto K , Tsuda M , Okamoto N , Tanaka A , Matsunaga-Lee Y , Yamato M , Egami Y , Shutta R , Tanouchi J 
Published: November 2020

Abstract

Background
Complete right bundle branch block (CRBBB) is one of the most frequent alterations of the electrocardiogram (ECG). Several studies have shown that CRBBB was a risk factor for cardiovascular diseases and the appearance of CRBBB in patients hospitalized for exacerbated heart failure (HF) was associated with a worse prognosis. Various alternations of ECG such as early repolarization pattern and intraventricular conduction disturbance were associated with high recurrence ratio of atrial fibrillation (AF) after pulmonary vein isolation (PVI). However clinical outcome after PVI in patients with CRBBB remains unclear.

Methods
We enrolled consecutive AF patients who underwent PVI from September 2014 to November 2018 rom Osaka Rosai Atrial Fibrillation (ORAF) registry. We excluded patients with other wide QRS (left bundle branch block, ventricular pacing and unclassified intraventricular conduction disturbance) and divided into 2 groups; CRBBB (QRS duration ≥120msec) group and no-CRBBB (QRS duration &lt;120) group. We compared the clinical characteristics including age, gender, hypertension, diabetes mellitus, history of heart failure, history of stroke, CHADS2Vasc score, paroxysmal AF (PAF), renal function, plasma brain natriuretic peptide (BNP) level and echocardiographic parameters including left ventricular end-diastolic diameter (LVDd), left ventricular end-systolic diameter (LVDs), left atrial diameter (LAD) and left ventricular ejection fraction (LVEF) between the 2 groups. We also compared the incidence of late recurrence of AF/atrial tachycardia (AT) between the 2 groups. We investigated whether CRBBB was an independent predictor of late recurrence of AF/AT after PVI by multivariate Cox analysis.

Results
We enrolled 736 consecutive AF patients who underwent PVI. CRBBB patients comprised 55 patients (7.5%). There were no significant differences of age, gender, hypertension, diabetes mellitus, history of heart failure, history of stroke, CHADS2Vasc score, PAF, renal function, plasma BNP level and echocardiographic parameters (LVDd, LVDs, LVEF and LAD) between the 2 groups. Incidence of AF/AT recurrence after PVI was significantly higher in CRBBB group than no-CRBBB group (Figure). CRBBB was an independently and significantly associated with late recurrence of AF/AT after PVI by multivariate Cox analysis (hazard ratio: 1.923, 95% CI: 1.190–2.961, p=0.009) in addition to female (p&lt;0.001), no-PAF (p=0.005) and left atrial diameter (p=0.042).

Conclusion
CRBBB may be a strong predictor of AF/AT late recurrence after PVI.
AF/Ar recurrence after PVI

Funding Acknowledgement
Type of funding source: None
Epicardial fat volume outperforms classic clinical scores for predicting atrial fibrillation relapse after pulmonary vein isolation
Authors: Nascimento Matos D , Ferreira A.M , Cavaco D , Sousa A , Freitas P , Rodrigues G , Carmo J , Abecasis J , Costa F , Santos A.C , Carmo P , Saraiva C , Morgado F , Mendes M , Adragao P 
Published: November 2020

Abstract

Background
Epicardial adipose tissue has been implicated in the pathophysiology of atrial fibrillation (AF), but its relevance to clinical practice remains uncertain. The aim of this study was to compare the performance of the amount of epicardial fat with previously published clinical scores of AF-relapse risk after pulmonary vein isolation (PVI).

Methods
We assessed 575 patients (354 men, age 61±11 years, 449 paroxysmal AF) with symptomatic AF undergoing cardiac CT prior to a PVI procedure. Epicardial fat was quantified on contrast-enhanced images using a new simplified semi-automated method. The study endpoint was symptomatic and/or documented AF recurrence at 12 months. Epicardial fat was compared against the following scores: MB-LATER, APPLE, DR-FLASH, and ATLAS.

Results
Median follow-up was of 22 months (IQR 12–35), 232 patients relapsed, 130 patients (27%) within the first 12 months. After adjustment for BMI and other univariate predictors of relapse, three variables emerged independently associated with time to AF recurrence: non-paroxysmal AF (HR 2.03, 95% CI: 1.53–2.69, p&lt;0.001), indexed left atrial (LA) volume (HR 1.02 per mL/m2, 95% CI: 1.01–1.02, p&lt;0.001), and indexed pericardial fat volume (HR 1.55 per mL/m2, 95% CI: 1.43–1.67, p&lt;0.001). Based on the ROC curve analysis, the epicardial fat showed greater discriminative power, with a C-statistic of 0.76 (95% CI: 0.71–0.81) against 0.67 (p=0.007 for pairwise comparison of ROC curves), 0.67 (p=0.01), 0.63 (p&lt;0.001) and 0.57 (p&lt;0.001) for the MBLATER, APPLE, DR-FLASH and ATLAS scores, respectively. The C-statistic for indexed LA volume and non-paroxysmal AF AUC were of 0.63 (p&lt;0.001) and 0.61 (p&lt;0.001), respectively.

Conclusion
Pericardial fat volume is a strong independent predictor of AF relapse after PVI, outperforming clinical scores of post-PVI AF. The underlying mechanisms of this association deserve further study.
ROC Curve Analysys

Funding Acknowledgement
Type of funding source: None
Gender-specific risk of complications in catheter ablation for atrial fibrillation
Authors: Plasek J , Plasek J , Peichl P , Wichterle D , Cihak R , Jarkovsky P , Roubicek T , Stojadinovic P , Haskova J , Kautzner J 
Published: November 2020

Abstract

Background
Catheter ablation is an established treatment modality for atrial fibrillation (AF). The risk of procedural complications is not negligible. Some studies suggested that female patients have a higher risk of complications.

Purpose
To identify gender-specific predictors of major complications (MCs) in patients undergoing catheter ablation for AF in a tertiary ablation centre.

Methods
A total of 4733 catheter ablations for AF (65% paroxysmal, 26% repeated procedures) were performed at our centre between January 2006 and August 2018. Patients (71% males) aged 60±10 years and had body mass index of 29±4 kg/m2 at the time of the procedure. Radiofrequency point-by-point ablation was employed in 96.3% procedures with the use of 3D navigation systems and facilitated by intracardiac echocardiography. Pulmonary vein isolation was mandatory; cavotricuspid isthmus and left atrial substrate ablation were performed in 22% and 38% procedures, respectively. MCs were defined as those that resulted in permanent injury, required intervention or prolonged hospitalization. Variables were assessed by uni- and multivariate analysis, two-sided α&lt;0.05 was considered significant.

Results
A total of 160 (3.4%) MCs were detected - 60 (4.4%) in females and 100 (2.9%) in males (P=0.012). Both lower body height and the presence of bundle branch block (BBB) were associated with MCs only in females; for left bundle branch block (LBBB), the effect size was higher. On the contrary, higher left ventricular end-diastolic diameter (LVEDd) and persistent AF were associated with MCs in males (Table).

Conclusion
Females have a higher risk of MCs during catheter ablation for AF. Body height, AF type, BBB, and LVEDd may belong among gender-specific risk factors for MCs in AF ablation procedures. Whether BBB and LVEDd represent true risk factors warrants a validation in further studies.

Funding Acknowledgement
Type of funding source: None
Presence of low voltage area predicts atrial tachyarrhythmia inducibility with atrial burst pacing after pulmonary vein isolation
Authors: Kawai S , Nagaoka K , Takase S , Sakamoto K , Ikuta H , Toyohara T , Okahara A , Tokutome M , Kuribayashi Y , Matsura H , Matsukawa R , Masuda S , Chishaki A , Tsutsui H , Mukai Y 
Published: November 2020

Abstract

Background
Induction of atrial fibrillation (AF)/atrial tachycardia (AT) by atrial burst pacing following ablation procedure may reflect the presence of residual substrates in the atria that maintain AF. However, the relation between the inducibility and left atrial low voltage area (LVA) has not been established.

Methods
Fifty-nine patients (65 years old, 43 males) with persistent AF who underwent pulmonary vein isolation (PVI)-based ablation were studied. All patients underwent left atrial voltage mapping during sinus rhythm and atrial burst pacing after PVI. Atrial burst pacing was performed with 30-beat at an amplitude of 10V from the ostium of the coronary sinus; increasing from 240 to 320 ppm in steps of 20 ppm or failure to 1:1 atrial capture. Inducibility was defined as AF/AT lasting more than 5 minutes following burst pacing. Left atrial LVA and other co-variates were analyzed with regard to burst pacing positivity.

Results
AF/AT was induced by burst pacing in 23 patients (39%). Univariate analysis revealed that past history of stroke, CHADS2 score and presence of left atrial LVA were significantly associated with the inducibility of AF/AT. Multivariate analysis revealed that only the presence of LVA was associated with the inducibility (OR 1.5: per 10% increase; p=0.04). We focused on the relationship between the extent of LVA and burst positivity. AF/AT inducibility increased as low voltage area increased, and it was as high as 72.7% when low voltage area was more than 20% (P&lt;0.05). Interestingly, induced arrhythmia type was AT rather than AF when low voltage area was more than 20%.

Conclusions
Presence of left atrial LVA is an independent predictor of atrial tachyarrhythmia inducibility after PVI in patients with persistent AF. A large amount of low voltage area is related to AT inducibility rather than AF.
Extent of LVA and burst positivity

Funding Acknowledgement
Type of funding source: None
Temporary spinal cord stimulation to prevent postoperative atrial fibrillation after coronary surgery. First results of the feasibility study
Authors: Romanov A , Chernyavskiy A , Lomivorotov V , Ponomarev D , Murtazin V , Orlov K , Kliver E , Shabanov V , Losik D , Mikheenko I , Ponomarenko A , Steinberg J.S 
Published: November 2020

Abstract

Background
Atrial fibrillation (AF) is the most common arrhythmia after cardiac surgery with typical appearance at early days after operation and leads to increase morbidity and mortality in the short and long term follow up. Spinal cord stimulation (SCS) was proven to be effective in chronic pain and intractable angina pectoris treatment. Recently, animal studies demonstrated that spinal cord stimulation could suppress AF and reduce AF burden.

Aim
To test safety and efficacy of the temporary SCS in early postoperative period in patients undergoing coronary artery bypass grafting

Methods
Fifteen patients (10 men, mean age 61±7.5 years) with indications for coronary artery bypass grafting (CABG) and history of paroxysmal AF underwent percutaneous lead placement for temporary SCS. Under local anesthesia and fluoroscopic guidance, the leads were placed at C7-Th4 level according to patient's sense of paresthesia and connected with spinal cord stimulator externally fixed on patient's chest. Temporary SCS was performed 3 days before CABG and turned off during surgery. At the end of CABG, the SCS was turned on in the intensive care unit and continued for 7 days. After that the temporary leads were removed. The primary safety objective was to test safety of the temporary SCS in early postoperative period, including 30 days occurrence of MACE (Death, stroke or TIA, myocardial infarction), acute spinal cord and kidney injury. The efficacy endpoint included occurrence of AF or any atrial tachyarrhythmias lasting ≥30 seconds during 30 days after surgery. All patients had continuous external ECG monitoring for 30 days after surgery.

Results
In all (100%) patients temporary leads for SCS were implanted successfully and standard on-pump elective CABG was performed thereafter. There were no any adverse events related to temporary SCS in either patient till the end of follow up. There were no significant differences in CK-MB and creatinine levels as compared with baseline data (p=0.2 and 0.3, respectively). No patients developed AF or atrial tachyarrhythmias during follow up according 30-days ECG monitoring.

Conclusions
The first results of the temporary spinal cord stimulation to prevent AF after coronary surgery demonstrated safety and efficacy of this therapy. The parallel group randomizes study is under way (NCT 03539354)

Funding Acknowledgement
Type of funding source: None