bluuebunny/crossref_metadata_2025_split huggingface dataset:
Continuous, transcutaneous carbon-dioxide monitoring to avoid hypercapnia in complex catheter ablations under conscious sedation
Authors: Weinmann K , Lenz A , Heudorfer R , Aktolga D , Rattka M , Bothner C , Pott A , Oechsner W , Rottbauer W , Dahme T 
Published: November 2020

Abstract

Background
Ablation of complex cardiac arrhythmias requires an immobilized patient. For a successful and safe intervention and for patient comfort, this can be achieved by conscious sedation. Administered sedatives and analgesics have respiratory depressant side effects and require close monitoring.

Purpose
We investigated the feasibility and accuracy of an additional, continuous transcutaneous carbon-dioxide partial pressure (tpCO2) measurement during conscious sedation in complex electrophysiological catheter ablation procedures.

Methods
We evaluated the accuracy and additional value of tpCO2 detection by application of a Severinghaus electrode in comparison to arterial and venous blood gas analyses.

Results
We included 110 patients in this prospective observational study. Arterial pCO2 (paCO2) and tpCO2 showed good correlation throughout the procedures (r=0.60–0.87, p&lt;0.005). Venous pCO2 (pvCO2) were also well correlated to transcutaneous values (r=0.65–0.85, p&lt;0.0001). Analyses of the difference of pvCO2 and tpCO2 measurements showed a tolerance within &lt;10mmHg in up to 96–98% of patients. Hypercapnia (pCO2&lt;70mmHg) was detected more likely and earlier by continuous tpCO2 monitoring compared to half-hourly pvCO2 measurements.

Conclusion
Continuous tpCO2 monitoring is feasible and precise with good correlation to arterial and venous blood gas carbon-dioxide analysis during complex catheter ablations under conscious sedation and may contribute to additional safety.

Funding Acknowledgement
Type of funding source: None
Risk of cardiovascular events in patients with atrial fibrillation and cancer. Data from the ATHERO-AF cohort
Authors: Pastori D , Bucci T , Menichelli D , Violi F , Pignatelli P 
Published: November 2020

Abstract

Background
Patients with non valvular atrial fibrillation (AF) and cancer represent a high-risk subgroup of patients in whom the management of oral anticoagulation may be challenging. The relationship between cancer type and the risk of cardiovascular events (CVEs) in patients with AF is unclear.

Purpose
To investigate the incidence of CVEs in patients with AF and cancer according to cancer type.

Methods
Prospective cohort study including 2,092 consecutive AF patients on vitamin K antagonists. Principal endpoint was the occurrence of CVEs including fatal/non-fatal myocardial infarction and ischemic stroke and cardiovascular death. We also performed a subgroup analysis of cardiac and thromboembolic events separately. Patients with cancer were divided in subgroups based on cancer site as follows: group 1 gastrointestinal tract; group 2 respiratory tract; group 3 genitourinary tract; group 4 other sites.

Results
Mean age was 73.7±9.1 years and 42.1% were woman; 367 (17.5%) had cancer, of these 21% gastro-intestinal, 10% respiratory, 28% genito-urinary and 41% had other localization. Patients with cancer were older than those without but with similar clinical characteristics.
During a mean follow up of 35.9±28.0 months (6264.5 patient-years), 203 CVEs occurred (3.24%/year, 95% CI 2.81–3.72) of whom 86 were cardiac ischemia (1.37%/year, 95% CI 1.10–1.69), 70 thromboembolic events (1.12%/year, 95% CI 0.87–1.41) and 47 cardiovascular deaths (0.75%/year, 95% CI 0.55–0.99). The incidence of CVEs for AF patients with and without cancer was respectively (n=45, 3.78%, 95% CI 2.76–5.06) and (n=158, 3.11%/year, 95% CI 2.65–3.64). In particular, compared to patients without cancer, a higher incidence rate of CVEs was found in patients with gastrointestinal tract cancer (5.61%/year, 95% CI 2.90–9.79, p=0.046), and in patients with respiratory tract cancer (6.15%/year, 95% CI 2.66–12.1, p=0.055), while no difference was found in patients with genito-urinary tract cancer (2.24%/year, 95% CI 0.97–4.41, p=0.362) and other site cancer (3.11%/year, 95% CI 2.65–3.64, p=0.512).
Cox regression multivariate analysis showed that factors associated with cardiac events were COPD, dyslipidemia, TTR &lt;70%, PPI drugs and gastrointestinal cancer (figure). Conversely, CHA2DS2VASc score and respiratory cancer were predictors of thromboembolic events.

Conclusions
Our findings suggest an association between cancer type and specific ischemic complications in AF patients. In particular, we found a higher risk of cardiac complications in patients with gastrointestinal cancer and of thromboembolic events in patients with respiratory cancer. These associations need to be confirmed in larger studies.

Funding Acknowledgement
Type of funding source: None
Simultaneous endo-epicardial mapping of programmed atrial extrasystoles in patients undergoing cardiac surgery
Authors: Kharbanda R , Van Schie M.S , Taverne Y.J.H.J , Kik C , Van Schaagen F.R.N , Bogers A.J.J.C , De Groot N.M.S 
Published: November 2020

Abstract

Introduction
Atrial extrasystoles (AES) are usually innocent, however they can also trigger (post-operative) atrial fibrillation (AF). It is unknown what the arrhythmogenic effect of AES is on 3-dimensional atrial conduction.

Purpose
Therefore, the aim of this study was to examine the effect of programmed AES (PAES) provoked in the right atrium (RA) on both endo- and epicardial conduction.

Methods
Simultaneous endo-epicardial mapping of the RA was performed during PAES provoked from the RA free wall in patients undergoing cardiac surgery (256 electrodes). Areas of conduction block (CB) were defined as conduction delays of ≥12ms and endo-epicardial asynchrony (EEA) as activation time differences of exact opposite electrodes of ≥15ms.

Results
Simultaneous endo-epicardial mapping of the RA during 15 PAES were analyzed and compared with sinus rhythm (SR) (n=12, 58% male, age 68±7 years). Eleven PAES were premature (&gt;25% shortening cycle length (CL)), median preceding CL was 554.5ms [377.9–720.4] and median SR CL was 871ms [700.9–1021]. Amount of EEA (7.3% [2.6–17.8] vs 1% [1–2], p=0.002) and CB (9% [4.8–11.8] vs 1.4% [0.5–2.7, p=0.001) both increased during PAES compared to SR. Diabetes was the only cardiovascular risk factor associated with a higher incidence and degree of EEA and CB. Interestingly, CB during PAES was more severe in 4 patients (33.3%) who developed post-operative AF (11.9% [10.4–12.8] vs 5.4% [3.3–8.5], p&lt;0.001).

Conclusion
Asynchronous activation of the atrial wall and conduction disorders, which play an important role in arrhythmogenesis, are enhanced during PAES compared to SR. Enhanced electropathology together with triggers provoked by heart surgery may initiate post-operative AF.

Funding Acknowledgement
Type of funding source: None
Screening for obstructive sleep apnea in atrial fibrillation patients at their home before catheter ablation using watch peripheral arterial tonometry
Authors: Tanaka N , Inoue K , Tanaka K , Hirao Y , Oka T , Okada M , Yoshimoto I , Onishi T , Iwakura K , Fujii K 
Published: November 2020

Abstract

Background
Catheter ablation of atrial fibrillation (AF) is effective, but certain patients experience AF recurrences. Obstructive sleep apnea (OSA) is a risk factor for AF recurrence. Watch peripheral arterial tonometry (WP) has a good correlation with polysomnography (PSG) in terms of the apnea-hypopnea index (AHI) and is easier to perform than PSG. Patients in AF have a high prevalence of OSA. Whether all patients with AF should be evaluated for OSA before catheter ablation is still controversial.

Purpose
To elucidate the prevalence and predictors of OSA using WP as a home sleep apnea test in AF patients before catheter ablation.

Methods
This study was conducted under a retrospective, single-center, observational design. Patients who received AF ablation without a prior diagnosis of sleep apnea and assessment of their AHI using WP were included in this analysis. The patients were mounted with a WP device by themselves at their own home. Twenty-two patients who were already diagnosed with OSA were excluded.

Results
Seven hundred seventy-four (65±11 years, 567 males, 440 paroxysmal AF) out of 776 patients were successfully mounted with WP devices on their own and underwent an OSA assessment. Their mean body mass index (BMI) was 24.1±3.5 kg/m2. The mean AHI was 20.1±15.6. Only 88 (11.4%) patients had a normal AHI (AHI&lt;5). Mild OSA (5≤AHI&lt;15), moderate OSA (15≤AHI&lt;30), and severe OSA (AHI≥30) were observed in 274 (35.4%), 252 (32.6%), and 160 (20.7%) patients, respectively. A BMI≥25 (odds ratio [OR]; 2.42, 95% confidence interval [CI]; 1.74–3.37, p&lt;0.001), male sex (1.70, 1.19–2.44, p=0.0037), non-paroxysmal AF (1.90, 1.35–2.66, p=0.0002), hypertension (1.70, 1.24–2.33, p=0.009), and left atrial volume index ≥30 (OR=1.51, CI 1.06–2.16, p=0.022) were significant predictors of moderate or severe OSA by a multivariate analysis, while an Epworth sleepiness scale ≥11 was not a predictor of moderate or severe OSA (OR=0.99, CI 0.66–1.49, p=0.95). However, 44.2% of non-obese patients (BMI &lt;25) had moderate-severe OSA.

Conclusion Almost
All patients successfully underwent WP to diagnose OSA. AF patients had a high prevalence of OSA, and screening OSA would be important in AF patients receiving ablation even if patients do not have sleepiness or are obese. We cannot deny OSA in AF patients before catheter ablation without performing screening tests for OSA.

Funding Acknowledgement
Type of funding source: None
Symptom status, clinical subtypes and prognosis in Middle East patients with atrial fibrillation: a report from the Gulf-SAFE registry
Authors: Li Y.G , Bai J , Domek M , Alsheikh-Ali A , Almahmeed W , Shehab A , Sulaiman K , Asaad N , Zubaid M , Lip G.Y 
Published: November 2020

Abstract

Background
Atrial fibrillation (AF) is often asymptomatic. The prognosis of asymptomatic AF is similar or worse than symptomatic AF, but there are no such data from Middle East.

Method
The Gulf survey of AF events (Gulf SAFE) registry is a multi-center prospective survey of AF patients from six countries (23 centers) in the Gulf Region (n=2043). We investigated the prognostic outcomes of asymptomatic AF, in relation to clinical subtypes.

Result
541 (26.5%) AF patients were asymptomatic; they tended to be older, with higher prevalence of hypertension, heart failure (HF), diabetes, stroke, renal dysfunction, and higher CHADS2, CHA2DS2-VASc, and HAS-BLED scores (all p&lt;0.05). After multivariable adjustment, asymptomatic AF was associated with higher risks of stroke/systematic embolism (SE) (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.10–4.34), all cause-mortality (OR 2.85 [1.90–4.28]) and the composite outcome of stroke/SE, bleeding and all-cause mortality (OR 1.74 [1.26–2.41]).
Asymptomatic AF was associated with fewer admissions for AF (OR 0.53 [0.32–0.83]) and HF (OR 0.58 [0.38–0.86]).
The increased risk of stroke/SE in asymptomatic AF was associated with paroxysmal AF (Figure 1; P interaction=0.028).

Conclusion
In this large Middle East cohort, asymptomatic AF was common, less likely hospitalized but associated with unfavorable prognosis. When AF was asymptomatic, the paroxysmal subtype had a greater association with stroke/SE.
Adjusted odds ratio of clinical outcomes

Funding Acknowledgement
Type of funding source: None
Incidence and risk of short episodes of atrial fibrillation detected with 14 days of continuous electrocardiographic monitoring
Authors: McIntyre W.F , Wang J , Connolly S.J , Van Gelder I.C , Lopes R.D , Gold M.R , Hohnloser S.H , Lau C.P , Israel C.W , Benz A.P , Wong J.A , Conen D , Healey J.S 
Published: November 2020

Abstract

Background
There is widespread interest in population-based screening for atrial fibrillation (AF). However, there is debate regarding the optimal screening method and duration.

Objectives
To estimate the incidence of short-duration AF detected by a single continuous 14-day electrocardiographic (ECG) monitor in older individuals without prior AF and to estimate the risk of ischemic stroke or systemic embolism associated with these episodes.

Methods
Pacemaker and defibrillator electrograms were reviewed from a cohort of individuals ≥65 years old, with a history of hypertension, but no prior AF. For each participant, we simulated a continuous 14-day ECG monitor by randomly selecting a 14-day window in the 6 months following enrolment and measured the total AF burden during that period. We repeated random sampling 1000 times to ensure a robust estimate of the likelihood of capturing AF in a single 14-day period. We used Cox proportional hazards models adjusted for CHA2DS2-VASc score to estimate the risk of ischemic stroke or systemic embolism associated with different burdens of AF.

Results
Among 2470 participants with at least 6 months of follow-up, the mean CHA2DS2-VASc score was 4.0±1.3. The proportion of participants with an AF burden of &gt;6 min on a single 14-day monitor was estimated as 3.1%, while the proportion with burdens of &gt;15 min and &gt;30 min were 2.9% and 2.6%, respectively.
Over a mean follow-up of 2.5 years, 44 participants had an ischemic stroke or systemic embolism; the rate among patients with an AF burden ≤6 mins was 0.70%/year. An AF burden &gt;6 min was associated with an increased risk of stroke or systemic embolism (2.2%/year, HR 3.0; 95% CI 1.3–5.7), as were burdens &gt;15 min (2.4%/year; HR 3.3; 95% CI 1.4–6.4) and &gt;30 min (2.6%/year HR 3.5; 95% CI 1.5–6.7).

Conclusion
Approximately 3% of individuals aged 65 years and older and with hypertension may have previously undiagnosed asymptomatic AF detected by a single 14-day continuous ECG monitor. As little as 6 minutes of AF may be associated with an increased risk of stroke. Randomized clinical trials are required to definitively assess screening in this population.

Funding Acknowledgement
Type of funding source: None
Perioperative atrial fibrillation and risk of stroke after cardiac surgery: a systematic review and meta-analysis
Authors: Wang M.K , Chen P , Meyre P , Ali M.Z , Heo R , McIntyre W , Healey J , Whitlock R , Lamy A , Devereaux P.J , Conen D 
Published: November 2020

Abstract

Background
Perioperative atrial fibrillation (POAF) after cardiac surgery has been associated with an increased risk of stroke. However, many previous studies have not systematically excluded patients with pre-existing AF. As such, the association between new-onset POAF and stroke risk has not been well established.

Purpose
To perform a systematic review and meta-analysis on the short and long-term risks of stroke in patients experiencing new-onset POAF after cardiac surgery.

Methods
We searched MEDLINE, EMBASE, and the Cochrane Library databases for studies comparing the risk of stroke in patients with versus without new-onset POAF after cardiac surgery. Studies were included in our review if they enrolled ≥100 patients and defined POAF as new-onset AF in patients with no history of preoperative AF. Data were independently extracted in duplicate. The quality of studies was assessed using the Newcastle Ottawa Scale. Random-effects meta-analysis was used to calculate summary risk ratios. Short-term stroke risk was calculated using events occurring either in-hospital or ≤30 days after surgery, and long-term risk was calculated using events occurring &gt;30 days after surgery.

Results
After reviewing 11,791 citations, 46 studies met the inclusion criteria. These studies included 364,822 patients, of which 76,388 (20.9%) developed new-onset POAF. The incidence of stroke was higher among patients with POAF versus no POAF (n=44 studies; incidence 2.76% vs. 1.53%; relative risk (RR) 1.91, 95% CI 1.65–2.23; I2 = 78%). A sensitivity analysis of high-quality studies alone yielded similar results (n=9 studies; RR 1.74, 95% CI 1.31–2.30; I2 = 88%). Patients with POAF had a higher incidence of stroke both in the short-term (n=35 studies; 2.71% vs. 1.36%; RR 2.13, 95% CI 1.81–2.51; I2 = 69%) and long-term (n=20 studies; 1.6 vs. 1.0 per 100 patient-years; RR 1.39, 95% CI 1.24–1.57; I2 = 27%). The risk of stroke was increased in POAF patients across all types of cardiac surgery performed, including isolated CABG (n=19 studies; RR 1.93, 95% CI 1.60–2.32; I2 = 62%), isolated transcatheter aortic valve implantation (n=7 studies; RR 1.86, 95% CI 1.32–2.63; I2 = 0%), and studies including multiple procedure types (n=16 studies; RR 1.90, 95% CI 1.44–2.51; I2 = 89%).

Conclusion
New-onset POAF after cardiac surgery is associated with an increased risk of stroke, both in the short and long term. The absolute risk difference is small, and randomized trials are needed to assess the efficacy and safety of treatment interventions in this patient population.

Funding Acknowledgement
Type of funding source: None
Real-world effectiveness and the safety of anticoagulant treatment in elderly non-valvular atrial fibrillation in the ANAFIE registry, the largest real-world elderly AF registry
Authors: Yamashita T , Inoue H 
Published: November 2020

Abstract

Background
The optimal anticoagulant regimen for elderly AF has not been well elucidated, because this population, especially the very elderly (≥85 years), have not been sufficiently represented in most randomized controlled clinical trials for stroke prevention in non-valvular AF (NVAF).

Purpose
The ANAFIE registry was designed to evaluate the real-world anticoagulant treatment status of elderly (≥75 years) NVAF patients including &gt;8,000 very elderly patients. In this main analysis of the ANAFIE, the incidence of stroke or systemic embolic events (stroke/SEE), and major bleeding were compared between warfarin (WF) and direct oral anticoagulants (DOACs).

Methods
A total of 33,018 NVAF patients aged ≥75 years was enrolled in the ANAFIE, and followed for 2 years. The incidence of stroke/SEE and major bleeding by type of anticoagulants (WF and all DOACs) was estimated using Kaplan-Meier method. Hazard ratio (HR) and 95% confidence interval (95% CI) were calculated by Cox proportional hazard model.

Results
In the analysis set of 32,099 patients, the mean age was 81.5 years. 23,738 (74%) were &lt;85 years and 8,361 (26.0%) were ≥85 years. 92.5% of the whole population used anticoagulants including WF (27.6%) or DOACs (72.3%). The ratio of each DOAC was dabigatran 7.8%, rivaroxaban 21.5%, apixaban 26.9% and edoxaban 16.1%. Stroke/SEE and major bleeding was observed in 396 patients (1.24/100 patient-years [py]) and 279 patients (0.87/100py). The time in therapeutic range for patients &lt;85 years and ≥85 years in the WF group was 76.7% and 72.2%, respectively. The incidence of stroke/SEE was numerically lower in patients taking any DOAC vs. WF regardless of age group (&lt;85 years [HR 0.83] and ≥85 years [HR 0.71]). Major bleeding was also lower vs. WF in both age groups (&lt;85 years [HR 0.60] and ≥85 years [HR 0.65]).

Conclusion
In elderly NVAF patients enrolled in the ANAFIE registry, the incidence of stroke/SEE and major bleeding was lower in patients taking a DOAC compared with WF for all patients ≥75 years, even for very elderly patients.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Daiichi Sankyo Co., Ltd.
Atrial fibrillation burden and the risks of ischemic stroke and intracranial hemorrhage: comparisons of catheter ablation, medical therapy, and non-atrial fibrillation population
Authors: Kim M , Yu H.-T , Kim T.-H , Uhm J.-S , Seung J.-H , Joung B.-Y , Lee M.-H , Pak H.-N 
Published: November 2020

Abstract

Background
Although atrial fibrillation (AF) burden was known to be related to the risk of ischemic stroke (IS), clinical evidence regarding intracranial hemorrhage (ICH) or comparison of the patients after AF catheter ablation (AFCA) and the non-AF population are limited.

Objective
We explored the risks of IS and ICH after AFCA or medical therapy (Med) in the AF population and the matched non-AF population.

Methods
We compared 1,629 with AFCA (Yonsei AF cohort), 3,258 with Med (Korean National Health Insurance Sharing Service [KNHISS] database), and 3,258 non-AF population (KNHISS database) after 1:2:2 propensity-score match in terms of clinical characteristics and medications (57±12 years old, 22.1% female). IS and ICH were determined by ICD code, brain imaging, and hospital admission in Med and non-AF groups. All AFCA patients underwent regular rhythm follow-up, and the medications including antithrombotic therapies were evaluated for 52±23 months.

Results
1. Among AFCA group, the annualized IS rate was significantly higher in the patients with sustaining recurrence of AF/atrial tachycardia (AT) after the last ablation procedure than those remaining in sinus rhythm (SR) (0.87% vs. 0.24%, p=0.017; HR 4.87 [1.36–17.49], p=0.015; log rank p=0.003).
2. The annualized ICH rate was 0% in SR group and 0.06% in sustaining recurrent AF/AT group after AFCA (p=0.361, log rank p=0.545).
3. The annualized IS rate was significantly higher in Med group (1.09%) than in AFCA group (0.30%, p&lt;0.001, log rank p&lt;0.001) or non-AF group (0.34%, p&lt;0.001, log rank p&lt;0.001). There was no significant difference in annualized IS rate between AFCA and non-AF groups (p=0.673, log rank p=0.874)
4. The annualized ICH rates were 0.17% in Med group, 0.06% AFCA group (p=0.023, log rank p=0.042 vs. Med; p=0.172, log rank p=0.193 vs. non-AF), and 0.12% in non-AF group (p=0.226, log rank p=0.241 vs. Med), respectively.

Conclusion
Post-procedural AF burden influence the risk of IS. AFCA significantly reduces the risks of both IS and ICH to the extent of non-AF population compared to Med group.

Funding Acknowledgement
Type of funding source: None
Incidence, epidemiology, risk factors and prognosis of atrio-esophageal fistula following percutaneous catheter ablation. An exhaustive natiowide registry
Authors: Mandel F , Rollin A , Galinier M , Carrie D , Maury P , Gandjbakhch E 
Published: November 2020

Abstract

Introduction
A rare but often fatal complication of atrial fibrillation (AF) ablation is the formation of an atrioesophageal fistula (AEF) whose true prevalence and risk factors remain obscure.

Objective
To determine incidence, epidemiology, risk factors and prognosis of AEF using a – as exhaustive as possible – nationwide survey

Method
All French centers performing AF ablation were identified and survey were sent concerning the habits, techniques of AF ablation and eventual cases of AEF.

Results
82 of the 103 centers (80%) performing ablation of AF in France were included in the study performing 129286 ablations from 2006 (93% of the total AF ablation in France). 33 AEF were declared (26 AEF and 4 esopericardial fistula) (0.026% risk per procedure) with a stable annual incidence over time, unchanged after the advent of thermal probe. Sensititvity of CT scan for AEF diagnosis was 81%. Mortality was 60%, significantly lower in case of surgical mangement (31 vs 93%, p=0.001). No case of AEF happened after cryoablation and only two AEF occurred in redo ablation. In multivariate analysis, lack of use of contact force catheters and the realization of posterior/roof ablation lines emerged as independent factors associated with the risk of AEF with OR 23.6 (95% CI [4.5; 21]) p=0.0002 and OR 3.7 (95% CI [1.1, 13]) p=0.04) while the lack of thermal probes remained of borderline significance.

Conclusion
The rate of AEF after AF ablation in a nationwide and well exhaustive survey can be evaluated to 0.026% with an annual incidence remaining stable over time. A normal CT scan does not rule out the diagnosis. Prognosis remains poor with a mortality of 60% and crucially dependant of immediate surgical correction.

Funding Acknowledgement
Type of funding source: None