bluuebunny/crossref_metadata_2025_split huggingface dataset:
Catheter ablation of atrial fibrillation in patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis
Authors: Aldaas O.M , Lupercio F , Malladi C.L , Mylavarapu P.S , Darden D , Han F , Hoffmayer K.S , Krummen D , Ho G , Raissi F , Feld G.K , Hsu J.C 
Published: November 2020

Abstract

Background
Catheter ablation improves clinical outcomes in symptomatic atrial fibrillation (AF) patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, the role of catheter ablation in HF patients with a preserved ejection fraction (HFpEF) is less clear.

Purpose
To determine the efficacy of catheter ablation of AF in patients with HFpEF relative to those with HFrEF.

Methods
We performed an extensive literature search and systematic review of studies that compared AF recurrence at one year after catheter ablation of AF in patients with HFpEF versus those with HFrEF. Risk ratio (RR) 95% confidence intervals were measured using the Mantel-Haenszel method for dichotomous variables, where a RR&lt;1.0 favors the HFpEF group.

Results
Four studies with a total of 563 patients were included, of which 312 had HFpEF and 251 had HFrEF. All patients included were undergoing first time catheter ablation of AF. Patients with HFpEF experienced similar recurrence of AF one year after ablation on or off antiarrhythmic drugs compared to those with HFrEF (RR 0.87; 95% CI 0.69–1.10, p=0.24), as shown in Figure 1. Recurrence of AF was assessed with electrocardiography, Holter monitoring, and/or event monitoring at scheduled follow-up visits and final follow-up.

Conclusion
Based on the results of this meta-analysis, catheter ablation of AF in patients with HFpEF appears as efficacious in maintaining sinus rhythm as in those with HFrEF.

Funding Acknowledgement
Type of funding source: None
Sex differences and arrhythmia recurrence after catheter ablation for atrial fibrillation
Authors: Tanaka M , Shizuta S , Komasa A , Yoshizawa T , Kohjitani H , Kimura T 
Published: November 2020

Abstract

Background
Several previous studies reported female sex is associated with high recurrence rate of atrial tachyarrhythmia (ATA) after catheter ablation (CA) for atrial fibrillation (AF).

Purpose
We investigated the relationship between sex differences and recurrence rate of ATA after CA for AF in a large single-center database.

Methods
We enrolled consecutive 2033 patients undergoing first time CA for AF in our institution between Feb.2004 and Dec. 2017.
We compared the long-term outcomes between female (N=603) and male (N=1430).

Results
Female patients were older (70.8 vs. 66.3, p&lt;0.0001), and had lower prevalence of persistent AF (23.1% vs. 33.5%, p&lt;0.0001). Also, left atrial dimension was smaller (40.0 vs. 41.1, p=0.0005). and prior antiarrhythmic drug use was more prevalent (38.2% vs. 28.7%, p&lt;0.0001) in female patients.
Ablation method for pulmonary vein isolation (PVI) was radiofrequency catheter ablation in 1634 patients (80.4%) and cryoballoon ablation in 399 (20.6%).
Median follow-up duration was 1342±115 days. The 3-year ATA recurrence rate after first CA was 35.8% overall: 39.9% in female and 34.2% in male (Log-rank P=0.01).
A multivariate analysis revealed that the factors associated with higher ATA recurrence rate were female (p=0.01), persistent AF (p=0.006), and larger left atrial dimension (p=0.007).

Conclusions
Female gender is an independent predictor of arrhythmia recurrence after CA for AF.

Funding Acknowledgement
Type of funding source: None
B-Type natriuretic peptide predicts major adverse cardiac and cerebrovascular events after catheter ablation of atrial fibrillation: insights from AF frontier ablation registry
Authors: Kato T , Usuda K , Tada H , Tsuda T , Takeuchi K , Niwa S , Hayashi K , Furusho H , Takamura M , Nagashima K , Okumura Y 
Published: November 2020

Abstract

Background
High plasma B-Type natriuretic peptide (BNP) level is associated with cardiac events or stroke in patients with atrial fibrillation (AF). However, it is still unknown whether BNP predicts worse clinical outcomes after catheter ablation ofAF.

Purpose
We aimed to see if plasma BNP level is associated with major adverse cardiac and cerebrovascular events (MACCE) after catheter ablation of AF.

Methods
We retrospectively analyzed 1,853 participants (73.1% men, mean age 63.3±10.3 years, 60.7% paroxysmal AF) who received first catheter ablation of AF with pre-ablation plasma BNP level measurement and completed follow-up more than 3 months after the procedure from AF Frontier Ablation Registry, a multicenter cohort study in Japan. We evaluated an association between plasma BNP level before catheter ablation and first MACCE in cox-regression hazard models adjusted for known risk factors. MACCE were defined as stroke/transient ischemic attack (TIA), cardiovascular events or all-cause death.

Results
The mean plasma BNP level was 120.2±3.7 pg/mL. During a mean follow-up period of 21.9 months, 57 patients (3.1%) suffered MACCE (ischemic stroke 8 [14.0%], hemorrhagic stroke 5 [8.8%], TIA 5 [8.8%], hospitalization for heart failure 11 [19.2%], acute coronary syndrome 9 [15.8%], hospitalization for other cardiovascular events 8 [14.0%] and all-cause death 11 [19.2%]). Plasma BNP level of patients with MACCE were significantly higher than those without MACCE (291.7±47.0 vs 114.7±3.42 pg/mL, P&lt;0.001). Multivariate analysis revealed that plasma BNP level (hazard ratio [HR] per 10 pg/mL increase 1.014; 95% confidence interval [CI] 1.005–1.023; P=0.001), baseline age (HR 1.052; 95% CI 1.022–1.084; P=0.001), heart failure (HR 2.698; 95% CI 1.512–4.815; P=0.001), old myocardial infarction (HR 3.593; 95% CI 1.675–7.708; P=0.001) and non-ischemic cardiomyopathy (HR 2.676; 95% CI 1.337 - 5.355; P=0.005) were independently associated with MACCE. At receiver-operating characteristic curve analysis, plasma BNP level before catheter ablation ≥162.7 pg/mL was the best threshold to predict MACCE (area under the curve: 0.71). Kaplan-Meier curve analysis (Figure) showed that the cumulative incidence of MACCE was significantly higher in patients with a BNP ≥162.7 pg/mL than in those with a BNP below 162.7 pg/mL (HR 4.85; 95% CI 2.86–8.21; P&lt;0.001).

Conclusions
Elevation of plasma BNP level was independently related to the increased risk of MACCE after catheter ablation ofAF.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Bristol-Meiers Squibb
A simple method to detect phrenic nerve impairment during cryoballoon ablation of atrial fibrillation using aVF in the standard surface ECG
Authors: Schaerli N , Knecht S , Spies F , Madaffari A , Osswald S , Sticherling C , Kuehne M 
Published: November 2020

Abstract

Background
Phrenic nerve palsy (PNP) is the most common complication in cryoballoon ablation of atrial fibrillation. Monitoring techniques such as compound motor action potential (CMAP) measurements using additional leads, or catheters positioned in the subdiaphragmatic hepatic vein or the esophagus have demonstrated to be effective to prevent PNP.

Purpose
This study investigates the safety and feasibility of a simple monitoring strategy using the lead aVF of the standard surface 12 lead ECG for CMAP monitoring to prevent PNP.

Methods
In 263 continuous patients undergoing cryoballoon ablation, a decapolar catheter was placed in the right subclavian vein to stimulate the phrenic nerve during ablation of the right sided pulmonary veins (12V@2.9 ms at 60 bpm). Capture was continuously monitored using the CMAP potential in the inferior aVF lead of the surface ECG and manually by palpation of the abdominal movement. The freeze was terminated early if the amplitude of the aVF signal decrease by &gt;25% in three consecutive beats or if the diaphragmatic contraction decreased.

Results
Phrenic nerve injury documented by a reduction of the signal in aVF was observed in 13 of the 263 patients (5%) during freezes of the right superior pulmonary vein. Reduced diaphragmatic contraction detected by palpation of the abdomen was never observed without previous reduced amplitude in the surface aVF signal and was therefore never the trigger to stop a freeze. In patients with phrenic nerve injury, the mean initial amplitude was 1mV (SD ±0.3mV) and the mean minimal amplitude was 0.3mV (SD ±0.2mV). Mean time to recovery of the aVF amplitude was 160 seconds. Twelve patients (4.6%) showed complete recovery whereas one patient (0.4%) showed only partial recovery, as demonstrated in a sniff test at the end of the procedure. This patient showed no clinical signs of phrenic nerve palsy the following day, and full recovery was demonstrated in a sniff test 3 months later.

Conclusion
Monitoring of CMAP using the aVF signal from a standard 12-lead ECG during phrenic nerve stimulation to reduce the incidence of phrenic nerve palsy is safe and feasible. This technique is readily available during every standard ablation without placing additional electrodes and more sensitive than manual palpation.
aVF signal before and during ablation

Funding Acknowledgement
Type of funding source: None
The safety of catheter ablation of atrial fibrillation in elderly patients -analysis of the nationwide database in Japan, JROAD-DPC-
Authors: Yokoyama Y , Miyamoto K , Nakai M , Sumita Y , Ueda N , Nakajima K , Kamakura T , Wada M , Yamagata K , Ishibashi K , Inoue Y , Nagase S , Noda T , Aiba T , Kusano K 
Published: November 2020

Abstract

Background
“Age” is one of the major concerns and determinants of the indications for catheter ablation (CA) of atrial fibrillation (AF). There are little safety data on CA of AF according to the age. This study aimed to assess the safety of CA in elderly patients undergoing CA of AF.

Methods and results
We investigated the complication rate of CA of AF for the different age groups (&lt;60 years, 60–65, 65–70, 70–75, 75–80, 80–85, and ≥85) by a nationwide database (Japanese Registry Of All cardiac and vascular Diseases [JROAD]-DPC). The JROAD-DPC included 73,296 patients (65±11 years, 52,883 men) who underwent CA of AF from 516 hospitals in Japan. Aged patients had more comorbidities and a significantly increased CHADS2 score and higher rate of female according to a higher age. The overall complication rate was 2.6% and in-hospital mortality was 0.05%. By comparing each age group, complications occurred more frequently in higher aged groups. A multivariate adjusted hazard ratio revealed an increased age was independently and significantly associated with the overall complications (odds ratio was 1.25, 1.35, 1.72, 1.86, 2.76 and 3.13 respectively; reference &lt;60 years).

Conclusions
The frequency of complications was significantly higher according to a higher age. We should take note of the indications and procedure for CA of AF in aged patients.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Intramural Research Fund 17 (Kusano) for Cardiovascular Diseases of the National Cerebral and Cardiovascular Center
Electrophysiological findings after bilateral thoracoscopic atrial fibrillation ablation using irrigated bipolar radiofrequency energy
Authors: Skala T , Moravec O , Santavy P , Steriovsky A , Taborsky M 
Published: November 2020

Abstract

Background
Thoracoscopic atrial fibrillation (AF) ablation (TARAFS) using irrigated bipolar radiofrequency energy should result in posterior left atrial (LA) wall isolation.

Purpose
To assess the long-term durability of this “box” lesion and the extent of additional ablation needed to achieve AF non-inducibility.

Methods
22 patients with AF recurrence after bilateral TARAFS for persistent AF had a radiofrequency catheter ablation (RFA) at least three months after TARAFS. Electroanatomical voltage map was done in all patients prior to any ablation.

Results
Out of 22 patients, the box lesion was not completed in 15 (68.2%). In these 15 patients, 12 had no signs of any prior ablation in endocardium (voltage &gt;0.5mV), 2 had right pulmonary veins (PVs) isolated and 1 had left PVs isolated.
At the end of RFA, box lesion was finished in all 15 patients and AF non-inducibility was achieved in 18 patients. For this endpoint, besides box lesion, mitral line and extensive coronary sinus ablation was necessary in 14, extensive CFAE ablation in 7 patients. Cavotricuspid isthmus line block was done in all patients.

Conclusion
A minimally invasive thoracoscopic box-lesion ablation is considered to be a safe and effective method of stand-alone AF treatment. However, in a considerable amount of patients no signs of prior ablation are found on electroanatomical voltage map. Gaps thus cannot be found and a completely new complex ablation must be done. In a lot of patients, additional ablation is needed besides box lesion to achieve non-inducibility.

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): University Hospital Olomouc
Relationship of aging and incident comorbidities to stroke risk in 594,169 Patients with atrial fibrillation: a nationwide analysis
Authors: Fauchier L , Bisson A , Bodin A , Herbert J , Spiesser P , Clementy N , Pierre B , Angoulvant D , Babuty D , Chao T.F , Lip G 
Published: November 2020

Abstract

Background
When assessing ischemic stroke risk in patients with atrial fibrillation (AF), the CHA2DS2-VASc score is calculated based on the baseline risk factors, and the outcomes are determined after a follow-up period. However, the stroke risk in patients with AF does not remain static, and with time, patients get older and accumulate more comorbidities. This study hypothesized that the “Delta CHA2DS2-VASc score”, which reflects the change in score between baseline and follow-up, may be predictive of ischemic stroke compared with the baseline or follow-up assessments of the CHA2DS2-VASc score.

Methods
Based on the France nationwide administrative hospital-discharge database, we collected information for all patients treated with AF between 2010 and 2019 in France. Adverse outcomes were investigated during follow-up. A total of 594,169 patients with AF who did not have comorbidities of the CHA2DS2-VASc score except for age and sex, were studied. The Delta CHA2DS2-VASc score was defined as the change/difference between the baseline and follow-up CHA2DS2-VASc scores. During 1,290,721 person-years, 19,492 patients experienced ischemic stroke. The accuracies of baseline, follow-up, and Delta CHA2DS2-VASc scores in predicting ischemic stroke were analysed and compared.

Results
The mean baseline CHA2DS2-VASc score was 1.69, which increased to 2.33 during the follow-up, with a mean Delta CHA2DS2-VASc score of 0.64. The CHA2DS2-VASc score increased in 39.8% of patients. Among 19,492 patients who experienced ischemic stroke, 66.0% had a Delta CHA2DS2-VASc score ≥1 compared with only 38.9% in patients without ischemic stroke, and 5,811 (29.8%) patients had ≥2 new-onset comorbidity, the most common being hypertension. The follow-up CHA2DS2-VASc score and Delta CHA2DS2-VASc score were significant predictors of ischemic stroke (C-index 0.670 95% CI 0.667–0.674 and 0.637 95% CI 634–641 respectively) that performed better than baseline CHA2DS2-VASc score (C-index 0.613 95% CI 0.609–0.616, p&lt;0.0001 for DeLong test).

Conclusions
In this AF cohort, we found that stroke risk (CHA2DS2-VASc score) was non-static, and that many patients developed ≥1 new stroke risk factor(s) before presentation with ischemic stroke. The follow-up CHA2DS2-VASc score and its change (ie Delta CHA2DS2-VASc, reflecting the change in stroke risk profile between baseline and follow-up) were better predictors of ischemic stroke than relying on the baseline CHA2DS2-VASc score. This emphasises how stroke risk in AF is a dynamic process due to increasing age and incident comorbidities, and regular re-assessment of risk is needed.

Funding Acknowledgement
Type of funding source: None
Still using “aspirin or nothing” for AF patients with frailty? ETNA-AF-Europe shows frailty corresponds to higher mortality but not neurological bleeding with edoxaban anticoagulation in routine care
Authors: Bakhai A , Fumagalli S , Mazzone A , Diemberger I , Kirchhof P , De Caterina R 
Published: November 2020

Abstract

Background
Clinicians are encouraged to anticoagulate frail and older patients. Both groups were underrepresented in pivotal AF stroke prevention trials. Large, more geographically generalizable data are needed for safety and treatment efficacy in these groups. Aim: ETNA-AF-Europe registry assessed key clinical outcomes and risk scores in frail and older patients compared to their counterparts.

Methods
ETNA-AF-Europe is a large, prospective, post-authorisation, observational study of patients with AF being prescribed edoxaban. The registry captured frailty as a single, mandatory field as perceived by physicians. Baseline characteristics evaluation and 1-year outcomes of patients were extracted by presence of frailty and age (≥ vs. &lt;80 years) using descriptive analyses.

Results
Of, 13,090 enrolled patients, 10.6% were considered frail with coding complete for 12,212 patients. Whilst 27.9% of patients were aged ≥80, of these only 25.3% were frail. Frail patients differed from non-frail and had similar baseline characteristics to those aged ≥80 years. Frail patients were more frequently female, with lower BMI and higher HAS-BLED risk score (Table), and incurred the highest rates of overall and cardiovascular deaths and major bleeding, even more than those aged ≥80 (Figure). Despite this, intracranial haemorrhage (ICH) was surprisingly low and comparable.

Conclusions
In this large, Europe wide group of patients with AF anticoagulated with edoxaban, patients considered frail by physicians are not always older. A clinical frailty perception is associated with a 4-fold higher short-term mortality. Whilst major bleeding is higher in this frail cohort, ICH is comparably low. The HAS-BLED score in frail patients prescribed edoxaban, appears to predict non-neurological bleeding. These data provide confidence for prescribing edoxaban in frail AF patients to prevent stroke.
One-year outcomes

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Daiichi Sankyo Europe GmbH, Munich, Germany
Baseline characteristics and follow-up outcomes in routine clinical practice patients categorised by renal function in the ETNA-AF-Europe registry
Authors: De Caterina R , Gwechenberger M , Bakhai A , Monteiro P , Kelly P , Levy P , Kirchhof P 
Published: November 2020

Abstract

Background
Edoxaban is an oral factor Xa inhibitor anticoagulant with 50% renal clearance, and proven efficacy and safety in patients (pts) with atrial fibrillation (AF). The post-authorisation, observational, ETNA-AF-Europe registry (NCT02944019) assessed the risks and benefits of edoxaban in pts with AF from 10 European countries.

Purpose
Evaluate baseline characteristics and event rates in pts categorised by creatinine clearance (CrCl) at 1-year follow-up of the ETNA-AF-Europe registry.

Methods
In this analysis, pts were divided into three groups according to CrCl: ≤50 ml/min (I), 50–80 mL/min (II) and ≥80 mL/min (III) (calculated using Cockcroft-Gault). Outcomes were descriptively analysed.

Results
Pts with the lowest CrCl (Group I) were mostly females, and had a higher mean age, lower body weight, higher stroke and bleeding risk scores and were considered more frail than those with higher CrCl (Groups II and III) (Table). Group I experienced higher rates of stroke or SEE, major or CRNM bleeding, cardiovascular death, and had a higher total mortality (Figure). Rates of intracranial haemorrhage (ICH) and haemorrhagic stroke (intracerebral and subarachnoid haemorrhage) were low and similar in pts across the range of CrCl.

Conclusions
Those with lower CrCl had more comorbidities and higher event rates than those with higher CrCl, with the exception of ICH and haemorrhagic stroke. A steep rise in the proportion of pts perceived as frail and in overall mortality in the lowest renal function tertile, raises the question whether low renal function is a determinant or a correlate of mortality.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Daiichi Sankyo Europe GmbH, Munich, Germany
Risks and outcomes of gastrointestinal malignancies in anticoagulated atrial fibrillation patients experiencing gastrointestinal bleeding
Authors: Chao T.F , Lip G.Y.H , Chen S.A 
Published: November 2020

Abstract

Background
Oral anticoagulants (OACs) may serve as a type of “screening test” for the diagnosis of occult gastrointestinal (GI) tract malignancies through a clinical presentation with bleeding.

Objective
We aimed to investigate the 1-year incidence and predictors of GI cancers after GI bleeeding events among patients with atrial fibrillation (AF) treated with warfarin or NOACs. Second, we aimed to compare the risk of mortality after GI cancers between patients treated with warfarin or NOACs.

Methods
A total of 10,845 anticoagulated AF patients who experienced hospitalizations due to GI bleeding without prior history of GI cancers were identified from the Taiwan National Health Insurance Research Database. Patients were followed up for incident GI cancers for up to 1 year.

Results
Within 1 year after GI bleeding, 290 (2.67%) patients were diagnosed to have GI tract cancers. More patients treated with NOACs were diagnosed to have GI cancers than those receiving warfarin (68/1,759; 3.87% [NOACs] versus 222/9,086; 2.44% [warfarin], p&lt;0.001) with an odds ratio (OR) 1.606 (95% CI: 1.208–2.117, p&lt;0.001). Age (OR 1.025 [95% CI: 1.012–1.037] per 1 year increment) and male sex (1.356 [95% CI: 1.050–1.700]) were independently associated with the diagnosis of GI cancers within 1 year after GI bleeding. Among 290 patients diagnosed to have GI cancers, 131 (45.2%) experienced mortality within 1 year. The risk of mortality was lower for patients treated with NOACs compared to those receiving warfarin (23.5% versus 51.8%) with an adjusted hazard ratio (aHR) 0.441 (95% CI: 0.262–0.744, p&lt;0.001) (Figure).

Conclusions
Incident GI cancers were diagnosed in 1 in 37 AF patients at 1 year after OAC-related GI bleeding, which were more common among patients treated with NOACs (1 in 26) compared to warfarin (1 in 41). Detailed surveys for occult GI cancers were necessary for these patients, especially for the elderly males.
Survival curves

Funding Acknowledgement
Type of funding source: None