bluuebunny/crossref_metadata_2025_split huggingface dataset:
P980Post-procedural plasma brain natriuretic peptide level early after catheter ablation predicts the future clinical outcome in patients with persistent atrial fibrillation and reduced ejection fraction
Authors: Okada M , Tanaka K , Ninomiya Y , Hirao Y , Oka T , Tanaka N , Inoue H , Kitagaki R , Koyama Y , Okamura A , Iwakura K , Fujii K , Inoue K 
Published: October 2019

Abstract

Background
Successful restoration of sinus rhythm (SR) by catheter ablation (CA) for persistent atrial fibrillation (AF) improves cardiac function, resulting in decrease of plasma brain natriuretic peptide (BNP) level. The exact significance and prognostic implications of this change have yet to be determined.

Purpose
To examine the impact of pre- and post-procedural BNP level on the clinical outcome after CA in patients with persistent AF and reduced left ventricular ejection fraction (LVEF).

Methods
Out of 242 patients with LVEF <50% who underwent first-time CA for persistent AF between March 2012 and September 2018 at our institute, we enrolled 137 patients (61±10 years, 83% male) whose plasma BNP level was available both at baseline and early after CA (during 1–3 month). We evaluated the impact of the BNP levels on future AF recurrence 3 months after CA as the primary endpoint. Additional secondary endpoints included heart failure (HF) hospitalization and cardiovascular death.

Results
All patients successfully restored SR at the end of CA. Within 3 months of a blanking period (BP), improvement of LVEF (from 39±10% to 65±12%, p<0.001) and reduction of BNP levels (from 178 [107–332] pg/ml to 42.3 [21.1–78.6] pg/ml, p<0.001) were observed. During the median follow-up of 21 months after BP, the incidence of AF recurrence, HF hospitalization, and cardiovascular death was 37% (n=50), 3% (n=4), and 1% (n=1), respectively. Cox proportional hazard regression analysis after adjustment for age and gender revealed that post-procedural BNP level was a significant predictor of the AF recurrence (hazard ratio [HR] per 100-pg/ml increase, 1.13; 95% confidence interval [CI], 1.02–1.25; p=0.023), but pre-procedural BNP level was not (1.02; 0.95–1.09; p=0.56). Receiver operating curve analysis determined the post-procedural BNP level of 55.5 pg/ml as the best cut-off value for predicting the AF recurrence, with area under the curve of 0.620 (95% CI, 0.534–0.702; p=0.018). The incidence of AF recurrence was significantly higher in patients with post-procedural BNP level >55.5 pg/ml (n=50) than the others (50% vs. 29%; HR, 3.99; 95% CI, 2.07–7.68; p<0.001). No patients with post-procedural BNP level ≤55.5 pg/ml experienced HF hospitalization and cardiovascular death (8% vs. 0% and 2% vs. 0%, p=0.006 and p=0.17, respectively)

Conclusions
Not pre-procedural but post-procedural BNP level early after CA predicted the future clinical outcome in patients with persistent AF and reduced LVEF. Decreased but still elevated BNP level after restoration of SR would identify the residual risk for developing unfavorable outcome.
P983Long-standing persistent atrial fibrillation: what can we achieve with ablation?
Authors: Nunes Ferreira A , Cortez-Dias N , Silverio Antonio P , Lima Silva G , Goncalves I , Aguiar-Ricardo I , Rigueira J , R Agostinho J , Santos R , Rodrigues T , Cunha N , Barreiros C , Carpinteiro L , J Pinto F , De Sousa J 
Published: October 2019

Abstract

Introduction
Atrial fibrillation (AF) ablation presents suboptimal results in patients (pts) with persistent long-lasting forms (LSPAF, AF ≥12 months). Recently, the STAR AF-II trial has shown that in these pts complex additional strategies do not improve success compared to only performing pulmonary vein isolation (PVI).

Objectives
To evaluate the success of AF ablation, particularly in long-standing persistent AF

Methods
Single-center prospective study of pts with AF submitted to ablation. The strategy, regardless of the type of AF, was based on PVI, complemented by cavo-tricuspid isthmus line (CTI) in pts with history of flutter. Additional ablation strategies were selectively considered in pts with stable atypical flutter conversion, persistent triggers or no electrograms in the VPs. Pts were monitored with Holter/7-day event loop recorder (3, 6, 12 months and annually up to 5 years). Success was assessed from the 90th day after ablation, with the absence of recurrences of any sustained atrial arrhythmias (>30 sec). Cox regression and Kaplan-Meier survival were used to compare the success of ablation as a function of the clinical type of AF in our population and with pts included in STAR-II AF trial.

Results
620 patients were submitted to AF ablation, 67% male, 58±12 years, including 78 pts (13%) with LSPAF - pts with paroxysmal and persistent short duration AF represented 61% and 26% of the population. In LSPAF, VPI was performed with irrigated catheter (N=33), PVAC (N=44) or nMARQ (N=1), complemented by CTI ablation in 15, linear left atrial lesions in 3, ablation of areas of low voltage in 3 and elimination of fractionated electrograms in 1 patient.
With a median follow-up of 426 days (94–989), the 3-year success rate after a single procedure was 53% in LSPAF, lower than that observed in patients with paroxysmal AF (69%) or short-duration persistent AF (61%) - LogRank P=0.002. The risk of arrhythmias was double in LSPAF vs paroxysmal AF (HR: 2.0; P=0.001). However, after an average of 1.2 procedures/patient, the success rate in LSPAF was 80% at 3 years, comparable to that observed for other types of AF (Log Rank 2.5, p=0.29). Effectively, the long-term success rate of our LSPAF pts treated with PVI and very selective additional strategies was higher than that observed in the STAR-II AF pts treated with PVI and indiscriminate complex ablations (80% vs. 69%, t-test p<0.001, with similar mean follow-up).

Conclusions
AF ablation is more effective if it is performed earlier in the natural history of the disease. However, even in LSPAF, high success rates are achieved through PVI-based ablation strategies, although more procedures are required.
P995The extent of late gadolinium enhancement predicts defibrillator shocks in patients with non-ischaemic heart failure
Authors: Aimo A , Barison A , Mirizzi G , Castiglione V , Ripoli A , Panchetti L , Rossi A , Startari U , Emdin M , Aquaro G D , Piacenti M 
Published: October 2019

Abstract

Background
Implantable cardioverter defibrillator (ICD) is recommended for patients with non-ischaemic heart failure (HF) and left ventricular ejection fraction (LVEF) ≤35%, although most patients will not experience any appropriate ICD intervention. We assessed if cardiovascular magnetic resonance (CMR) findings may predict benefit from ICD implantation.

Methods and results
We retrieved the data of all patients (n=183) with non-ischaemic HF receiving an ICD for primary prevention at our Institution, and undergoing CMR within 1 month before implantation. 183 patients were evaluated (men 73%, median age 66 years, LVEF 24%, N-terminal fraction of pro-B-type natriuretic peptide 1217 ng/L, atrial fibrillation, flutter or atrial ectopic rhythm 21%). They received single-chamber (n=21, 12%), dual-chamber (n=34, 19%), or cardiac resynchronization therapy devices (n=127, 69%); 1 patient (1%) received a subcutaneous defibrillator. Twenty patients (11%) experienced a shock for ventricular tachycardia or fibrillation (VT/VF) over 2.5 years (0.8–5.4), and 13 (7%) had an inappropriate shock over 2.7 years (0.9–5.4). Late gadolinium enhancement (LGE) was present in 146 patients (80%), but on average accounted for limited percentage of LV mass (4% [2–11%]). LGE mass independently predicted shocks for VT/VF (HR 2.13, 95% CI 1.02–4.47; p=0.045). LGE mass ≥14% (the best cut-off at receiver operating characteristics analysis) independently predicted shocks for VT/VF (HR 3.82, 95% CI 1.51–9.68; p=0.005). LGE mass <4% was the only univariate predictor of inappropriate shocks (HR 4.82, 95% CI 1.07–21.76; p=0.041).

Conclusions
Patients with non-ischaemic HF and LGE mass ≥14% benefit most from ICD, while those with LGE mass <4% display mainly inappropriate shocks.
P1028Impact of atrial fibrillation ablation procedural volume on complication and recurrence rate across European centers. An ESC EORP registry: atrial fibrillation long-term
Authors: Pagourelias E , Vassilikos V , Blomstrom-Lundqvist C , Kautzner J , Maggioni A P , Pokushalov E , Tavazzi L , Dagres N , Brugada J , Arbelo E 
Published: October 2019

Abstract

Background
Catheter ablation has emerged as an effective therapy in patients with symptomatic and drug refractory atrial fibrillation (AF). Despite high success rates of the method, there is still heterogeneity of outcomes and complication rate across Europe. The impact of the annual procedural volume per center on success and complication rate of AF ablation, based on real-life data, has not been addressed till now.

Purpose
The aim of the study was to investigate if center AF ablation volume might be associated with one-year success or complication rate after the procedure.

Methods
Data for this analysis were extracted from the European AF Ablation Long-Term Study, a prospective registry designed to describe the clinical epidemiology of patients undergoing AF ablation. Based on 25th and 75th percentiles of AF ablation numbers performed, the participating centers were classified into high volume (HV) (≥250 procedures/year), medium volume (MV) (<250 and ≥58/year) and low volume (LV) (<58/year). One-year success was defined as patient survival free from any atrial arrhythmia, from the end of the 3-month blanking period to 12 months following the ablation procedure.

Results
A total of 91 centers in 26 European countries enrolled 3368 patients. There was a significantly higher reporting of cardiovascular complications in LV centers (5.2%), especially pericarditis (0.6%) and cardiac perforation (1.4%), while the HV and MV centers reported cardiovascular complications in 3.0 and 4.3% of cases, respectively (p=0.039). Additionally, stroke incidence after ablation was significantly higher in LV centers (0.5% of cases vs 0% in HV and MV centers, p=0.008). Kaplan-Meier survival analysis based on adjusted data of all complications demonstrated, however, that there was not a significant difference in complication rate according to volume's center (p=0.402, Figure A). One-year success after AF ablation ranged from 77.8% in HV vs 70.5% in LV vs 77.3% in MV centers (p<0.001). Nonetheless, adjusted recurrence rate was not significantly different among centers (p=0.363, Figure B), a result driven by differences both in ablation technical characteristics and risk/severity of cases ablated in different volume centers.

Conclusions
Despite the notion that “the higher, the better”, our results suggest that AF ablation is a safe procedure with high success rates in all European centers, independent of the AF ablation procedural volume. Differences in patients and procedural characteristics may justify the equality of complication and recurrence rate among centers, since expertise level counterbalances the risk of each case.
P1034Impact of ablation status on the efficacy and safety of dronedarone in patients with atrial fibrillation/flutter: a post-hoc analysis of the ATHENA trial
Authors: Vamos M , Calkins H , Kowey P R , Torp-Pederson C T , Corp Dit Genti V , Wieloch M , Koren A , Hohnloser S H 
Published: October 2019

Abstract

Background
Despite increasing use of ablation for atrial fibrillation/flutter (AF/AFL), few systematic data exist on the use of dronedarone and other antiarrhythmic drugs after ablation.

Purpose
To assess efficacy and safety of dronedarone after ablation in patients with paroxysmal/persistent AF/AFL randomized to dronedarone or placebo in the ATHENA trial (NCT00174785).

Methods
In ATHENA, 196 patients (dronedarone 90, placebo 106) had an ablation for AF/AFL prior to study entry. AF/AFL recurrence was evaluated in patients in sinus rhythm at baseline (dronedarone 63, placebo 65) by ECG during study visits or symptom recurrence.

Results
Ablated vs non-ablated patients were more likely to be male, have an implantable cardioverter defibrillator or pacemaker implanted, or be receiving an oral anticoagulant. Fewer ablated patients had an AF/AFL recurrence with dronedarone (36 [57%]) than with placebo (46 [71%]). Median time to first AF/AFL recurrence was significantly longer with dronedarone versus placebo (561 versus 180 days; hazard ratio 0.65 [95% CI 0.42–1.00], p<0.05; Fig 1). Time to first cardiovascular hospitalization or death was similar with dronedarone versus placebo (hazard ratio 0.98 [0.62–1.53]). On-treatment rates of treatment-emergent adverse events with dronedarone versus placebo were 83.1 versus 75.5%, serious treatment-emergent adverse events were 27.0 versus 18.9%, permanent drug discontinuations were 10.1 versus 15.1%, and deaths were 0 versus 1.9%.

Conclusions
Dronedarone delayed AF/AFL recurrence in patients with a prior AF/AFL ablation. Safety outcomes were consistent with the overall ATHENA trial. Adequately sized prospective studies are needed to confirm these observations. Given the sparsity of data for antiarrhythmic drugs after ablation, this retrospective analysis has merit and is useful for hypothesis generation.

Acknowledgement/Funding
Sanofi, New York, New York, Unites States of America
1109Enhancing transition from hospital to home for people with cardiovascular disease
Authors: Boyde M , Peters R , McGlynn E 
Published: October 2019

Abstract

Background
Health care services have a responsibility to ensure transition from hospital to home is seamless as this is a vulnerable time for patients. In 2013 the Cardiac Rehabilitation (CR) and Heart Failure (HF) Management Programs at a large tertiary referral hospital in our city, were re-configured to become one cardiac service. This model of care incorporated management of patients along the continuum of cardiac illness from initial diagnosis to end stage disease including end stage heart failure and intractable angina. This model included nurse-led in-patient consultations, post-discharge case management, CR and HF education and exercise programs, HF titration clinics, and home visits. Within health-care, organisational design can be considered a variable and evolving tool for improving the quality of patient care. The redesign of two clinical services provided an opportunity to improve health-care delivery for patients with cardiovascular disease.

Purpose
To evaluate a patient centred post-discharge model of care for patients admitted to hospital for an acute cardiovascular event.

Methods
A retrospective analysis of routinely collected data was undertaken using standard descriptive statistics to report the number of in-patient consultations, referrals generated, patients case-managed and all cause unplanned readmissions within 28 days of hospital discharge.

Results
Data was analysed from 1 January 2014 to 31 December 2018. Over the 5 years 11929 in-patients with cardiovascular disease received consultations from specialised nursing staff employed in the amalgamated cardiac service and 10598 (89%) patients were referred to appropriate post discharge CR and HF programs. From the in-patient consultations, 2254 (21%) patients who lived within our geographical area were case-managed by our specialist nursing staff. Post-discharge follow-up within 14 days was achieved for 1917 (85%) of these patients. Of the 2254 patients, 322 (14%) had an unplanned all cause readmission within 28 days of hospital discharge.

Conclusion
The evaluation data indicates that our model of integrated care provided effective post discharge management for patients with cardiac disease. Developing a model of care for these patients is challenging as they need to engage in self-care and adhere to a complex medication regime often with changing dosages. However effective case management post discharge including secondary prevention programs can decrease readmissions and improve outcomes for these patients.
1202The incidence, treatment and mortality of new-onset atrial fibrillation patients at the intensive care unit
Authors: Jacobs M , Loef B G , Reidinga A C , Postma M J , Van Hulst M , Tieleman R G 
Published: October 2019

Abstract

Background
Critically ill patients admitted to the intensive care unit (ICU) often develop atrial fibrillation (AF), with an incidence of around 5%. Stroke prevention in AF is well described in clinical guidelines. However, the extent to which stroke prevention is prescribed to ICU patients with AF is unknown.

Purpose
We aimed to determine the incidence of new-onset AF and describe the stroke prevention strategies that were initiated on the ICU of our teaching hospital. Also, we compared mortality in patients with new-onset AF to critically ill patients with previously diagnosed AF and patients without any AF.

Methods
This study was a retrospective cohort study including all admissions to the ICU of the our hospital in the period 2011–2016. Propensity score matching was used to compare the different patient groups. Survival analyses were performed using these real-world data.

Results
In total, 3334 patients were admitted to the ICU, of whom 213 patients (6.4%) developed new-onset AF. 583 patients (17.5%) had a previous diagnosis of AF, the other patients (76.1%) were in normal sinus rhythm. In-hospital mortality and one-year mortality after hospital discharge were significantly higher for new-onset AF patients compared to patients with no history of AF or previously diagnosed AF. At hospital discharge, only 50.4% of the new-onset AF-patients eligible for stroke prevention received an anticoagulant and anticoagulation was not dependent on CHA2DS2VASc score or other patient characteristics. An effect of anticoagulative status on mortality was not significant.

Conclusion
AF is associated with increased mortality in critically ill patients that were admitted to the ICU. More guidance is needed to optimize anticoagulant treatment in critically ill new-onset AF patients.

Acknowledgement/Funding
None
1204Pericardial fat volume outperforms classic risk markers in the prediction of relapse after pulmonary vein isolation
Authors: Nascimento Matos D J , Ferreira A M , Freitas P , Guerreiro S , Carmo J , Abecasis J , Costa F , Santos A C , Carmo P , Saraiva C , Cavaco D , Morgado F , Mendes M , Adragao P 
Published: October 2019

Abstract

Introduction
Pericardial 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 assess the relative importance of pericardial fat as predictor of recurrence after pulmonary vein isolation (PVI).

Methods
We assessed 453 patients (278 men, age 61±13 years, 348 paroxysmal AF) with symptomatic AF undergoing cardiac CT prior to a PVI procedure. Pericardial fat was quantified on contrast-enhanced images using a new simplified semi-automated method. The study endpoint was symptomatic and/or documented AF recurrence.

Results
Over a median follow-up of 14 months (IQR 7–23), 170 patients (38%) relapsed. Survival analysis showed significant differences in AF-free survival across tertiles of pericardial fat (Figure). Pericardial fat volume was weakly correlated to body mass index [(BMI), Pearson's R=0.34]. After adjustment for BMI and other univariate predictors of relapse, three variables emerged independently associated with time to AF recurrence: non-paroxysmal AF (HR 2.08, 95% CI: 1.51–2.87, p<0.001), indexed left atrial (LA) volume (HR 1.02 per mL/m2, 95% CI: 1.01–1.02, p<0.001), and indexed pericardial fat volume (HR 1.50 per mL/m2, 95% CI: 1.37–1.64, p<0.001). Based on the Wald test, indexed pericardial fat volume was the strongest of these predictors of relapse (X2 values of 20, 13, and 77, respectively). The population attributable risk (PAF) was higher for pericardial fat (PAF=37% for 1st vs 4th quartile) vs LA volume (PAF=11% for 1st quartile vs 4th quartile) and non-paroxysmal AF (PAF=23%). Pericardial fat volume also showed greater discriminate power than indexed LA volume, with a C-statistic of 0.80 (95% CI 0.76–0.85) vs. 0.61 (95% CI 0.55–0.66), p for difference <0.001. The method for quantifying pericardial fat showed high inter-observer reproducibility (Pearson's R=0.90) and was quick to perform (38±3 seconds).

Conclusion
Pericardial fat volume is a strong independent predictor of AF relapse after PVI, outperforming classic risk markers such as LA volume and type of AF. The underlying mechanisms of this association deserve further study. Meanwhile, this simple parameter may help select patients who are more likely to derive sustained benefit from AF ablation.
1269Dual antiplatelet therapy to inhibit myocardial injury in patients with high-risk coronary artery plaque: a randomized controlled trial
Authors: Moss A , Dweck M R , Doris M K , Andrews J P M , Bing R , Raftis J , Williams M C , Van Beek E J R , Forsyth L , Lewis S C , Lee R , Newby D E , Adamson P D 
Published: October 2019

Abstract

Background
High-risk coronary atherosclerotic plaque is associated with higher plasma troponin concentrations suggesting ongoing myocardial injury that may be a target for dual antiplatelet therapy.

Purpose
To determine whether ticagrelor reduces high-sensitivity troponin I concentrations in patients with established coronary artery disease and high-risk coronary plaque with 18F-fluoride uptake.

Methods
In a randomized double-blind placebo-controlled trial, patients with multivessel coronary artery disease underwent coronary 18F-fluoride positron emission tomography-computed tomography and measurement of high-sensitivity cardiac troponin I and were randomized (1:1) to ticagrelor 90 mg twice daily or matched placebo. The primary endpoint was troponin I concentration at 30 days in patients with increased coronary 18F-fluoride uptake.

Results
In total, 202 patients were randomized and 191 met the pre-specified criteria for inclusion in the primary analysis. In patients with increased coronary 18F-fluoride uptake (n=120/191) there was no evidence that ticagrelor had an effect on plasma troponin concentrationsat 30 days (ratio of geometric means for ticagrelor versusplacebo, 1.11, [95% confidence interval 0.90 to 1.36], p=0.32) (Table 1). Over 1 year, ticagrelor had no effect on troponin concentrations in patients with increased coronary 18F-fluoride uptake (ratio of geometric means, 0.86, 95% confidence interval 0.63 to 1.17, p=0.33).
Table 1 Adjusted Geometric Mean (GSE) Ratio of Geometric Means p-value Ticagrelor Placebo (95% CI) Cardiac troponin I, ng/L (18F-fluoride activity) 3.8 (1.1) 3.4 (1.1) 1.11 (0.90 to 1.36) 0.32 Cardiac Troponin I, ng/L (No 18F-fluoride activity) 2.4 (1.1) 2.3 (1.1) 1.02 (0.80 to 1.31) 0.87 Plasma high-sensitivity cardiac troponin I concentration (ng/L) at 30 days for the per-protocol population.Estimates are back transformed estimates from analysis of log transformed values at 30 days adjusting for age, sex and log transformed baseline troponin. Ratio of geometric means is Ticagrelor divided by Placebo. GSE, geometric standard error.

Conclusions
Dual antiplatelet therapy with ticagrelor does not reduce plasma troponin concentrations in patients with coronary 18F-fluoride uptake. This suggests that subclinical plaque thrombosis does not contribute to ongoing myocardial injury in this setting.
Clinical Trials Study ID: NCT02110303Study ID: NCT02110303

Acknowledgement/Funding
Wellcome Trust Senior Investigator Award WT103782AIA