bluuebunny/crossref_metadata_2025_split huggingface dataset:
Catheter ablation can improve survival with the reduction of heart failure in frail patients with atrial fibrillation
Authors: Joung B , Yang P.S , Sung J.H , Jang E , Yu H.T , Kim T.H , Uhm J.S , Kim J.Y , Pak H.N , Lee M.H 
Published: November 2020

Abstract

Background
It is unclear whether catheter ablation is beneficial in frail patients with AF.

Purpose
This study aimed to evaluate whether catheter ablation reduces death and other outcomes in real-world frail patients with atrial fibrillation (AF).

Methods
Out of 801,710 patients with AF in the Korean National Health Insurance Service database from 2006 to 2015, 1,411 frail patients underwent AF ablations. The Hospital Frailty Risk Score were calculated retrospectively. Inverse probability of treatment weighting (IPTW) was used to categorize ablation and non-ablation frail groups.

Results
After IPTW, the two cohorts had similar background characteristics. During a median follow-up of 4.7 years (interquartile range: 2.2–7.8), the risk of death in frail patients with ablations was reduced by 65% compared to frail patients without ablations (2.0 and 6.4 per 100 person-years, respectively; hazard ratio [HR] 0.35; 95% confidence interval [CI] 0.25–0.50; P&lt;0.001). Ablations were related with a lower incidence and risk of heart failure admission (1.8 and 3.1 per 100 person-years, respectively; HR 0.66, 95% CI 0.44–0.98; P=0.042) and acute myocardial infarction (0.2 and 0.6 per 100 person-years, respectively; HR 0.30, 95% CI 0.15–0.62; P=0.001). However, the risk of stroke did not change after ablation.

Conclussion
Ablation may be associated with lower incidences of death, heart failure, and acute myocardial infarction in real-world frail patients with AF, supporting the role of AF ablation in these patients. The effect of frailty risk on the outcome of ablation should be evaluated in further studies.

Funding Acknowledgement
Type of funding source: None
Clinical outcome of non-use of touch-up focal ablation catheters strategy during cryoballoon atrial fibrillation ablation
Authors: Matsunaga Y , Egami Y , Yano M , Yamato M , Shutta R , Nishino M , Tanouchi J 
Published: November 2020

Abstract

Background
It has been reported that frequent use of touch-up focal ablation catheters was related to worse outcomes after cryoballoon (CB) atrial fibrillation (AF) ablation. It is unknown whether non-use of touch-up focal ablation catheters strategy affects the outcome of AF ablation. Therefore, this study aimed to assess whether non-use of touch-up focal ablation catheters strategy improve clinical outcome after AF ablation using CB.

Methods
A total of 151 consecutive patients who received CB ablation from February 2017 to August 2019 were enrolled. Non-use of a touch-up focal ablation catheters strategy was started from February 2018. Patients were divided into 2 groups according to the type of strategy. In the non-touch-up group, pulmonary veins were isolated without touch-up focal ablation catheters as much as possible and in conventional group, touch-up focal ablation catheters were used as required. The 1-year atrial tachyarrhythmia free survival without class 1 or 3 antiarrhythmic drugs after a 90-day blanking period was assessed between the 2 groups.

Results
The conventional group consisted of 76 patients and the non-touch-up group consisted of 75 patients. Baseline characteristics were comparable between 2 groups. Touch-up focal ablation catheters were used more in the conventional group (11 patients, 14%) than non-touch-up group (0 patients, 0%) (p&lt;0.001). Pulmonary isolation was achieved in all patients of both groups. Atrial tachyarrhythmia recurrence occurred more frequently in the non-touch-up group (15/75 patients, 20%) than conventional group (7/76 patients, 9%) (p=0.045).

Conclusion
Non-use of a touch-up focal ablation catheters strategy may be related to worse outcome after CB AF ablation.

Funding Acknowledgement
Type of funding source: None
Who is too old for epicardial fat volume quantification?
Authors: Brizido C , Matos D , Ferreira A.M , Sousa J.A , Freitas P , Presume J , Rodrigues G.R , Carmo J , Costa F.M , Carmo P , Cavaco D , Morgado F.B , Adragao P , Mendes M 
Published: November 2020

Abstract

Introduction
Epicardial adipose tissue has been implicated in the pathophysiology of atrial fibrillation (AF) and was recently shown to be an independent predictor of AF relapse rate and severity after pulmonary vein isolation (PVI). However, its impact in older patients hasn't been analyzed. The aim of this study was to assess the relative importance of pericardial fat in an older population of patients undergoing pulmonary vein isolation (PVI).

Methods
Single-center retrospective study of symptomatic drug-resistant AF patients undergoing PVI from November/2015 to June/2019. Baseline demographics, clinical and imaging data including cardiac CT and clinical outcomes were collected and analyzed. Population was dichotomized according to age above or below 70 years of age and groups were compared. Epicardial fat volume was quantified by contrast-enhanced cardiac CT using a semi-automated method. The study endpoint was symptomatic and/or documented AF recurrence after a 3-month blanking period.

Results
We assessed 575 patients (354 males, mean age 61±11 years, 449 paroxysmal AF), 145 of which were 70 or older. Compared to the younger cohort, these patients had an higher prevalence of women, lower BMI (27 kg/m2 [IQR 24–30] vs 28 kg/m2 [IQR 25–30] kg/m2, p=0.012), higher CHA2DS2-VASc score (3 [IQR 2–4] vs 1 [IQR 1–2], p&lt;0.001) and larger indexed left atrial volumes (61mL [IQR 52–84] vs 54mL [IQR 47–66], p&lt;0.001).
Median epicardial fat volume was 2.96 cm3/m2 [IQR 2.99–4.00] in the overall population and was higher in older patients (HR 2.21 cm3/m2 [IQR 1.44–3.17] vs HR 1.87 cm3/m2 [IQR 1.24–2.90]; p=0.016).
During follow-up, 232 patients relapsed (40%), with similar recurrence rates between younger and older patients (40% vs 42%, p=0.63) according to Kaplan-Meier survival curve analysis (HR 1.10, 95% CI 0.82–1.48; log-rank p=0.519). Epicardial fat volume remained an independent predictor of AF relapse in the older subset of patients (HR 1.06 for every 1 cm3/m2 increase in epicardial fat volume [95% CI 1.28–2.00]; p&lt;0.001), as did the presence of non-paroxysmal AF (HR 2.78 [95% CI 1.48–5.21]; p=0.001).

Conclusion
Patients over 70 years old with drug-refractory symptomatic AF presented with higher epicardial fat volume. Epicardial fat burden showed similar predictive power for AF relapse after PVI in this subset of patients, representing a useful tool for intervention decision across this age spectrum.

Funding Acknowledgement
Type of funding source: None
Mechanisms of long-term recurrence three years after catheter ablation of atrial fibrillation
Authors: Park J.W , Yu H.T , Kim T.H , Uhm J.S , Joung B.Y , Lee M.H , Pak H.N 
Published: November 2020

Abstract

Background
AF is a progressive disease, and the mechanism underlying long-term recurrence after AFCA is unclear.

Purpose
This study explored the potential mechanisms of long-term recurrence (LTR) of atrial fibrillation (AF) 3-years after AF catheter ablation (AFCA).

Methods
Among 2,209 consecutive patients who underwent AFCA, 1,325 (59±11 years, 72.5% male) who underwent regular rhythm follow-ups for &gt;3-years were enrolled. Among them, 659 patients remained in sinus rhythm (SR), 327 recurred after 3–12 months (short-term recurrence; STR), 235 after 1–3 years (mid-term recurrence; MTR), and 104 after 3-years (long-term recurrence; LTR). Two hundred eighteen recurrent patients underwent repeat procedures: 112, 80, and 26 in the STR, MTR, and LTR groups, respectively.

Results
The pre-ablation left atrial (LA) dimensions were larger in the STR (p&lt;0.001) and MTR groups (p&lt;0.001), but not in the LTR group compared to the SR group. Low LA voltages were independently associated with an LTR (adjusted HR 0.57 [0.36–0.92], p=0.022). Upon the redo-mapping, the number of reconnected pulmonary veins (PVs) was 2.0 (IQR 0–3), 1.5 (IQR 0–3), and 1.0 (IQR 0–2) in the STR, MTR, and LTR groups, respectively (p=0.030). Post-ablation extra-PV triggers were more commonly found in the LTR than STR or MTR groups (LTR 40.9% to STR 19.2%, p=0.014) during the second procedure.

Conclusions
The LTR group had a similar baseline LA size and significantly lower LA voltage than the SR group. In the repeat procedures, the LTR group had fewer reconnected PVs, but extra-PV triggers were more common than in the STR and MTR groups.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Ministry of Health and Welfare, Ministry of Science, ICT & Future Planning (MSIP).
Electrocardiographic characteristics of 5-year atrial tachy-arrhythmia free patients after catheter ablation for atrial fibrillation
Authors: Park J.W , Yu H.T , Kim T.H , Uhm J.S , Kim J.Y , Joung B.Y , Lee M.H , Pak H.N 
Published: November 2020

Abstract

Background
Predictors are not well known for long-lasting sinus rhythm after atrial fibrillation catheter ablation (AFCA).

Purpose
We investigated the pre-procedural clinical factors associated with the patients with 5-year long-term atrial fibrillation (AF) free after AFCA.

Methods
Among 2,085 patients who underwent de novo AFCA, 934 patients (58±11 years, 73.1% male, 66.0% paroxysmal AF), who underwent guidelines-based rhythm follow-up longer than 5-years, were included in this study. We compared 340 patients who never showed AF recurrence for 5-years and 594 patients with AF/ atrial tachycardia (AT) recurrence at least a single episode. Cut-off values of pericardial fat volume and electrocardiogram (ECG) parameters were obtained by Youden index.

Results
1. The patients with AF-free for 5-years (AF-Free-5yrs) had higher proportion of paroxysmal AF (p&lt;0.001), lower body mass index (p=0.020), and lower proportion of pre-existing congestive heart failure (p=0.035), and smaller LA size (p&lt;0.001) than those who experienced recurrence. 2. The patients with AF-Free-5yrs showed lower pericardial fat volume (105.9±47.5 vs. 121.2±53.cm3, p&lt;0.001) and shorter PR interval (181.5±29.6 vs. 190.5±33.1ms, p&lt;0.001) and P wave duration in lead II (PWDII, 121.1±18.0 vs. 129.4±18.8ms, p&lt;0.001) rather than those of counter-part. 3. Multivariate regression analysis revealed that paroxysmal AF at the procedure, lower pericardial fat volume (OR 0.995, 95% CI [0.991–0.998], p=0.004), short PR interval (OR 0.994, 95% CI [0.988–1.000], p=0.038), and PWDII (OR 0.986, 95% CI [0.978–0.995], p=0.002) were independently associated with the AF-Free-5yrs. 3. Among the patients with persistent AF, PWDII was significantly shorter in AF-Free-5yrs group. (123.7±22.6 vs. 133.5±19.5, p&lt;0.001), and PWDII &lt;127.1ms was independently associated with AF-Free-5yrs (OR 3.114, 95% CI [1.819–5.331], p&lt;0.001).

Conclusions
Pericardial fat volume (&lt;113.7cm3) and PR interval (&lt;196 ms) in pre-procedural ECG was independently associated with an excellent 5-year rhythm outcome after AFCA, and PWDII (&lt;127.1 ms) predicted super-responders especially after persistent AF ablation.

Funding Acknowledgement
Type of funding source: None
Extended Pulmonary Vein Isolation: is it sufficient to achieve long-term sinus rhythm in octogenarian women with atrial fibrillation?
Authors: Mohanty S , Trivedi C , Della Rocca D.G , Gianni C , Salwan A , Macdonald B , Mayedo A , Bassiouny M , Gallinghouse J.G , Burkhardt J.D , Horton R , Al-Ahmad A , Di Biase L , Natale A 
Published: November 2020

Abstract

Background
Atrial fibrillation (AF) is a disease of the elderly and women typically present with AF at an older age than men do. Moreover, they tend to experience more symptoms and post-ablation recurrences, have worse quality of life and increased risk of stroke and mortality.

Objective
We evaluated long-term efficacy of our standard ablation approach of extended pulmonary vein isolation (PVI) in octogenarian women undergoing their first AF ablation.

Methods
Consecutive female AF patients aged ≥80 years receiving their first catheter ablation at our center were included in the analysis. Our standard ablation approach at the first procedure includes PVI + empirical isolation of left atrial posterior wall (LAPW) and superior vena cava (SVC). Complete abolition of all potentials rather than decrease in amplitudes was the procedural end point. Patients were prospectively monitored at regular intervals for 3 years after the index procedure with event recorders, 12-lead ECG, cardiology evaluation at office visits and 7-day Holter monitoring.

Results
A total of 194 patients with mean age of 84.2±1.4 years were included in the analysis. Of the 194, 120 (61.8%) had non-paroxysmal AF. All received PVI+ isolation of LAPW and SVC. Acute procedural success was achieved in 100% of cases.
At 3 years of follow-up, 24 (12.4%) patients remained in sinus rhythm; 22 on- and 2 off-antiarrhythmic drugs (AAD). All of the 23 patients had paroxysmal AF as their initial diagnosis.
Of the 170 patients experiencing recurrence, 147 underwent repeat ablation. PV/PW/SVC reconnection was noted in only 6 (4.1%) patients at redo. Triggers originating from non-PV sites were targeted for ablation in all. At 1.5 years after the repeat procedure, 136 (92.5%) patients were in sinus rhythm; 131 off-AAD and 5 patients on-AAD.

Conclusion
Extended PVI including isolation of posterior wall and SVC was not sufficient to maintain long-term sinus rhythm in majority of octogenarian women, regardless of AF type. Moreover, non-PV triggers rather than PV reconnection was the major cause of recurrence in this subset of AF population.

Funding Acknowledgement
Type of funding source: None
Improving pulmonary vein isolation during cryoballoon ablation using the re-look angiography technique
Authors: Reichert W , Tomaiko E , Patel M , Zawaneh M , Weiss P , Su W 
Published: November 2020

Abstract

Background
Cryoballoon ablation for pulmonary vein (PV) antral isolation is contact-dependent. Currently, occlusion assessment using the cryoballoon is most commonly performed using contrast venogram prior to ablation. However, there is a known difference in balloon size/shape between the inflated and ablation state, due to significant increase in cryoballoon pressure, which can cause potential undetected leak and, thus, failure of PV isolation. This phenomenon is currently not detected using standard techniques and effectiveness of mitigation techniques have not been assessed.

Purpose
We hypothesize that repeat injection of contrast five seconds after the initiation of cryoballoon ablation can be used to assess changes in shape and confirm ongoing occlusion during ablation; the re-look angiography technique. The incidence of PVI leak and the ability for the relook angiography to remedy the leak is assessed.

Methods
A total of 125 patients (440 PVs) undergoing cryoballoon ablation (Medtronic Arctic Front Advance Balloon™) were assessed using the re-look angiography technique unless they required occlusion with a segmental approach. Fifteen patients were excluded from contrast use due to renal insufficiency.

Results
Successful single occlusion was seen in 330 (75%) PVs and the re-look angiography technique was employed in each of those events. In 180 of the 330 (55%) single PV occlusions, a new PV leak undetected during the initial PV angiogram was identified. This prompted repositioning of the balloon to achieve complete PV isolation in 85 of 180 of the PV cases, with 95 of the cases requiring additional segmental ablation to complete full PV isolation.

Conclusion
A significant amount of insufficient PV antral contact during cryo-ablation may not be detected with conventional single PV angiography and may explain inadequate PV isolation. The re-look angiography technique is a simple tool to confirm robust balloon contact and guide repositioning as well as identify the need for additional segmental ablation. Additional follow up is needed for translation to improved clinical outcomes.

Funding Acknowledgement
Type of funding source: None
Five year follow-up of symptoms and health-related quality of life in patients with atrial fibrillation treated with catheter ablation
Authors: Walfridsson U , Hassel Jonsson A , Karlsson L.O , Almroth H , Liuba I , Walfridsson H , Charitakis E 
Published: November 2020

Abstract

Background
In accordance with current guidelines the primary indication for catheter ablation (CA) of atrial fibrillation (AF) is to reduce symptoms and thereby improve health-related quality of life (HRQoL). Even though, there are data showing patients' symptom situation before treatment, long-term follow up data are sparse.

Purpose
To assess symptoms and HRQoL five years after CA with the validated arrhythmia-specific questionnaire ASTA, in a large cohort of patients treated with catheter ablation due to AF.

Methods
1323 consecutive patients who underwent CA of AF at one university hospital in Sweden filled out the ASTA questionnaire before the procedure, mostly electronically, and 418 patients at five years follow-up. If not responded within 1 month the patient got a reminder.

Results
Five years after CA and after 1.6 procedures/patient, half of the patients (50%) reported freedom of symptoms, 18% had a major reduction of symptoms (&gt;50% symptom reduction compared to baseline assessments) and 14% had a minor reduction of symptoms (between 10% – 50% reduction) while only 9% of the patients reported no effect on symptoms after the CA and 9% experienced a worsening of their symptoms after the treatment. Factors predicting presence of symptoms at the five-year follow-up were female sex (HR: 1.8; 1.2–2.8), Body Mass Index &gt;35 (HR: 3.9; 1.6–9.8) and having ischemic heart disease (IHD) (HR: 2.6; 1.2–5.9). At the five years follow-up the symptoms breathlessness during activity, weakness/fatigue and tiredness were still the most commonly reported as well as regarding HRQoL it was impaired physical ability and deteriorated life situation.

Conclusions
Catheter ablation has a long-lasting effect and change the natural course of AF, as more than 50% of patients did not experience any symptoms and 32% were improved, while 18% had no treatment effect or worsening of symptoms.
Factors predicting remaining symptoms five years after CA were female sex, presence of IHD and obesity, a reminder to encourage life style managements.
ASTA symptom scale

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): The Carldavid Jönsson Research Foundation and the County Council of Östergötland (FORSS).
Quantitative analysis of the isolation area after larger-size laser balloon ablation
Authors: Yamasaki T , Hattori T , Kakita K , Oota K , Miyai N , Nakamura R , Sawanishi T , Kinoshita N 
Published: November 2020

Abstract

Background
The visually guided laser balloon ablation is a balloon-based catheter ablation technology used for atrial fibrillation (AF) ablation in recent years. This balloon catheter consists of a compliant balloon that has the capability of real-time endoscopic visualization of the targeted pulmonary vein (PV). The sizeable balloon is usually inflated to obtain optimal PV occlusion. The isolation area after laser balloon (LB) ablation was reported to be smaller than that after cryoballoon ablation. However, when LB is inflated with its maximum pressure, it can visualize wide-area PV antrum. Thereby, we suspected that larger-size LB can create wider isolation area.

Purpose
The aim of this study is to quantitatively evaluate the isolation area after LB ablation at the size larger than appropriate size for ablation in the pulmonary vein carina region.

Methods
We assessed 66 patients with AF who underwent LB ablation at the larger inflation size in our hospital during the period from July 2018 to July 2019. After LB ablation, we created voltage maps with a circular mapping catheter and calculated isolation areas with CARTO system.

Results
Figure shows a larger LB with its maximum pressure. PV antrum isolation was extended to the posterior wall in all patients. The left- and right-sided pulmonary vein antrum isolation area were 15.1±3.9 and 19.4±4.3 cm2, respectively.

Conclusion
LB at the larger inflation size with its maximum pressure can isolate wider-area circumferential PV antrum than previously reported. This method may be a new way of pulmonary vein antrum isolation.
Left atrial voltage mapping after PVI.

Funding Acknowledgement
Type of funding source: None
Association of a history of falls or syncope with intracranial bleeding in patients with atrial fibrillation
Authors: Oqab Z , Alak A , McIntyre W.F , Liu Y.Y , Connolly S.J , Healey J.S 
Published: November 2020

Abstract

Background
In patients with atrial fibrillation (AF), anticoagulation effectively reduces the risk of ischemic stroke. However, up to 50% of patients are not receiving this treatment. A history of falls or syncope and an associated risk of intracranial hemorrhage are commonly reported reasons for undertreatment, though these have not been well studied.

Purpose
To investigate the association of a history of falls or syncope with the risk of intracranial hemorrhage in patients with AF.

Methods
Patients with a history of AF from the RE-LY, AVERROES and ACTIVE A and W trials were combined into a large cohort. “Critical injury” was defined as any injury that resulted in death, was deemed to be life-threatening or resulted in permanent disability. A “serious injury” was defined as an injury that required hospitalization. “Other injuries” were defined as those that did not meet criteria for critical or serious injury. We used logistic regression and propensity-matched Cox models to assess the association between falls or syncope and adverse outcomes.

Results
Among 37,973 patients, 11.9% (n=4503) had a history of falls, 17.5% (n=6655) had a history of syncope and 25.1% (n=9518) had a history of either falls or syncope. The mean age of the cohort was 71±9.3 years and 58% were male. The median CHADS2 score was 2. A history of falls or syncope was not associated with the risk of incident intracranial hemorrhage (HR 1.11, 95% CI 0.88–1.4). In propensity-matched multivariable models, a history of falls or syncope was associated with an increased risk of death (HR 1.14, 95% CI 1.07–1.22), stroke (HR 1.17, 95% CI 1.05–1.3), myocardial infarction (HR 1.28, 95% CI 1.09–1.52) and major bleeding (HR 1.27, 95% CI 1.16–1.4). Moreover, a history of falls or syncope was associated with increased risk of critical injury (OR 1.97, 95% CI 1.52–2.54), serious injury (OR 2.06, 95% CI 1.75–2.43) and “other injury” (OR 1.58, 95% CI 1.46–1.72).

Conclusions
A history of falls or syncope is common in patients with atrial fibrillation; however, neither history was associated with increased risk of intracranial hemorrhage. These patients were at an increased risk of death, stroke, myocardial infarction and major bleeding, suggesting that they should receive anticoagulation for stroke prevention.

Funding Acknowledgement
Type of funding source: None