bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of displacement of the esophagus by transoesophageal echocardiography probe in cryoablation of atiral fibrillation
Authors: Sun Y , Yin X.M , Gao L.J , Xiao X.J , Yu X.H , Zhang R.F , Wang N , Wang Z.Z , Zhang D.D , Yang Y.Z , Dong Y.X , Xia Y.L 
Published: November 2020

Abstract

Background
Esophageal injury caused by cryoballoon-based PVI is common. Cryoablation guided by transoesophageal echocardiography (TEE) for occlusion of the pulmonary vein (PV) is safe and effective.

Objective
To investigate the protective effect of mechanical displacement of the esophagus by TEE probe in cryoablation of atiral fibrillation.

Methods
Fifty patients with paroxysmal AF (PAF) were enrolled in the present study. 25 patients underwent cryoablation without TEE (non-TEE group) and the other 25 underwent with TEE (TEE group) for PV occlusion guidance and displacement of the esophagus. In the TEE group during the procedure, TEE was used to guide the movement of the balloon to achieve PV occlusion. And before freezing, the probe of the TEE was moved to displace the esophagus away from the PV being freezed in order to reduce the risk of cryoinjury. All patients underwent esophagogastroscopy within 2 days of the procedure. The patients were followed up in our center at regularly scheduled visits every 2 months.

Results
There was no significant difference between the TEE group and non-TEE group in regard to the procedure time. The fluoroscopy time in the TEE group was less compared to the non-TEE group (4.1±3.3 min vs. 16.6±6.9 min, P&lt;0.05), and the amount of contrast agent in the TEE group was less than the non-TEE group (4.7±5.7ml vs. 17.9±3.4 ml, P&lt;0.05). The incidence of esophageal injury was significantly lower in TEE group compared with non-TEE group (0 vs. 20%, P&lt;0.05). At a mean of 14.0 months follow-up, success rates were similar between the TEE group and non-TEE group (80.0% vs. 84.0%, P=0.80).

Conclusion
Cryoablation of AF with TEE for protecting the esophagus from cryoinjury is safe and effective. Lower risk of esophageal injury can be achieved with the help of TEE probe movement for mechanical displacement of the esophagus during freezing.

Funding Acknowledgement
Type of funding source: None
Factors associated with silent cerebral events during catheter ablation for atrial fibrillation in the era of uninterrupted oral anticoagulation therapy
Authors: Harada M , Nomura Y , Nishimura A , Motoike Y , Koshikawa M , Watanabe E , Izawa H , Ozaki Y 
Published: November 2020

Abstract

Background
A silent cerebral event (SCE), detected by brain magnetic resonance imaging (MRI), is defined as an acute new brain lesion without clinically apparent neurological deficit, and is frequently observed after catheter ablation in atrial fibrillation (AF) patients. Although the small number of SCEs does not cause neurocognitive dysfunction, the greater volume and/or larger number of SCE lesions are reportedly related to neuropsychological decline; SCE incidence may be a surrogate marker for the potential thromboembolic risk. Thus, strategies to reduce SCEs would be beneficial. Uninterrupted oral anticoagulation strategy for peri-procedural period reportedly reduced the risk of SCEs, but the incidence hovers at 10% to 30%. We sought factors associated with SCEs during catheter ablation for AF in patients with peri-procedural uninterrupted oral anticoagulation (OAC) therapy.

Methods
AF patients undergoing catheter ablation were eligible (n=255). All patients took non-vitamin K antagonist oral anticoagulants (NOACs) or vitamin K antagonist (VKA) for peri-procedural OAC (&gt;4 weeks) without interruption during the procedure. Brain MRI was performed within 2 days after the procedure to detect SCEs. Clinical characteristics and procedure-related parameters were compared between patients with and without SCEs.

Results
SCEs were detected in 59 patients (23%, SCE[+]) but not in 196 patients (77%, SCE[-]). Average age was higher in SCE[+] than SCE[-] (66±10 years vs. 62±12 years, p&lt;0.05). Persistent AF prevalence, CHADS2/CHA2DS2-VASc scores, and serum NT-ProBNP levels increased in SCE[+] vs. SCE[-]. In transthoracic/transesophageal echocardiography, left-atrial dimension (LAD) was larger and AF rhythm/spontaneous echo contrast were more frequently observed in SCE[+] than SCE[-]. SCE[+] had lower initial activated clotting time (ACT) before unfractionated heparin (UFH) injection and longer time to reach optimal ACT (&gt;300 sec) before trans-septal puncture than SCE [-]. In multivariate analysis, LAD, initial ACT before UFH injection, and time to reach optimal ACT were predictors for SCEs.

Conclusions
LAD and intra-procedural ACT kinetics affect SCEs during the procedure in patients with uninterrupted OAC for AF ablation. Shortening time to achieve optimal ACT during the procedure may reduce the risk of SCEs.

Funding Acknowledgement
Type of funding source: None
Cryoballoon pulmonary-vein isolation for atrial fibrillation with heart failure: results from a single-center cohort
Authors: Boehmer A , Rothe M , Jaqubi S , Summ A , Soether C , Abboud J , Ringwald V , Dobre B , Kaess B , Ehrlich J 
Published: November 2020

Abstract

Background
Atrial fibrillation (AF) and heart failure (HF) are of growing prevalence and increasing mortality. Radiofrequency ablation is safe and effective for patients with AF and HF. Prognosis might be improved in patients treated. However, there is no prospective trial investigating efficacy and safety of cryoballon ablation in patients with AF and HF.

Objective
To prospectively compare cryoballoon ablation in patients with and without HF (defined as LVEF ≤40%) in terms of safety and efficacy.

Methods
Ongoing POLAR-HF trial is a prospective, investigator-initiated, single-center, non-inferiority, open-label study. We analyzed 244 consecutive patients who underwent cryoballoon ablation. Of these 217 had normal LVEF (age 68.1±9.6 years, CHA2DS2-VASc Score 2.5±1.3, 55.3% male) while 27 patients (11%) suffered from HF (age 70.4±8.6 years, CHA2DS2-VASc Score 3±1.2, 70.4% male). Follow-up was performed at 3, 6 and 12 months after ablation. Kaplan-Meier method was used to calculate 12-month event-rate estimates. Log-Rank Test to estimate hazard ratios in the primary analysis. Endpoints were: symptomatic AF relapse for efficacy and bleeding, stroke or death for safety.

Results
Analysis showed no difference in AF-free survival rate between patients with and without HF (81% vs. 76.3%, Log-Rank-Test P=0.81, Figure). Primary safety end point occurred in 5 patients with normal LVEF (2.3%) and none in the HF-group. No deaths were observed.

Conclusion
Results of POLAR-HF indicate that cryoballoon ablation is an effective ablation method for patients suffering from AF and HF.
Event-Free Survival (Efficacy Endpoint)

Funding Acknowledgement
Type of funding source: None
Risk scoring by CHADS2 and CHA2DS2-VASc as predictors for long-term outcomes after surgical ablation for atrial fibrillation
Authors: Lauritzen D , Vodstrup H.J , Christensen T.D , Onat M , Christensen R , Heiberg J 
Published: November 2020

Abstract

Background
Following catheter ablation for atrial fibrillation (AF), CHADS2 and CHA2DS2-VASc have utility in predicting long-term outcomes. However, it is currently unknown if the same holds for patients undergoing surgical ablation.

Purpose
To determine whether CHADS2 and CHA2DS2-VASc predict long-term outcomes after surgical ablation in concomitance with other cardiac surgery.

Methods
In this prospective, follow-up study, we included patients who underwent biatrial ablation - or pulmonary vein isolation procedure concomitantly with other cardiac surgery between 2004 and 2018. CHADS2 and CHA2DS2-VASc scores were assessed prior to surgery and categorized in groups as 0–1, 2–4 or ≥5. Outcomes were death, AF, and AF-related death. Follow-up was ended in April 2019.

Results
A total of 587 patients with a mean age of 68.7±0.4 years were included. Both CHADS2 and CHA2DS2-VASc scores were predictors of survival p=0.005 and p&lt;0.001, respectively (Figure). For CHADS2, mean survival times were 5.9±3.7 years for scores 0–1, 5.0±3.0 years for scores 2–4 and 4.3±2.6 years for scores ≥5. For CHA2DS2-VASc mean survival times were 7.3±4.0 years for scores 0–1, 5.6±2.9 years for scores 2–4 and 4.8±2.1 years for scores ≥5. The incidence of death was 20.1% for CHADS2 0–1, 24.8% for CHADS2 2–4, and 35.3% for CHADS2 ≥5, p=0.186. The incidence of AF was 50.2% for CHADS2 0–1, 47.9% for CHADS2 2–4, and 76.5% for CHADS2 ≥5, p=0.073. The incidence of AF related death was 13.0% for CHADS2 0–1, 16.8% for CHADS2 2–4, and 35.3% for CHADS2 ≥5, p=0.031. The incidence of death was 16.8% for CHA2DS2-VASc 0–1, 26.2% for CHA2DS2-VASc 2–4, and 45.0% for CHA2DS2-VASc ≥5, p=0.001. The incidence of AF was 49.6% for CHA2DS2-VASc 0–1, 52.5% for CHA2DS2-VASc 2–4, and 72.5% for CHA2DS2-VASc ≥5, p=0.035. The incidence of AF related death was 12.2% for CHA2DS2-VASc 0–1, 16.0% for CHA2DS2-VASc 2–4, and 42.5% for CHA2DS2-VASc ≥5, p&lt;0.001.

Conclusion
Both CHADS2 and CHA2DS2-VASc scores predict long-term outcomes after surgical ablation for AF. However, CHA2DS2-VASc was superior in predicting death, AF, and AF-related death.
Survival curves

Funding Acknowledgement
Type of funding source: None
Impact of antithrombotic therapy in the prognosis of atrial fibrillation patients with advanced chronic kidney disease
Authors: Andreu Cayuelas J.M , Raposeiras-Roubin S , Fortuny Frau E , Garcia Del Egido A , Seller-Moya J , Ortiz Cortes C , Camacho Freire S.J , Alonso Fernandez P , Jorge-Perez P , Lopez-Pais J , Bravo-Marques R , Palacios-Rubio J , Benezet-Mazuecos J , Cosin-Sales J 
Published: November 2020

Abstract

Introduction
Chronic kidney disease (CKD) is associated with an elevated thromboembolic and bleeding risk in atrial fibrillation (AF) patients, so the decision of antithrombotic therapy is a challenge.

Purpose
To analyze mortality, embolic and bleeding events in patients with advanced CKD and AF.

Methods
Multicentric retrospective registry on patients with AF and advanced CKD (CKD-EPI &lt;30 mL/min/1.73 m2). For death, multivariable Cox regression analysis was developed. For embolic and bleeding events, competing-risks regression based on Fine and Gray's proportional subhazards model was performed, being death the competing event

Results
We analysed 405 patients with advanced CKD and newly diagnosed AF. 57 patients were not treated with antithrombotic therapy (14.1%), 80 only with antiplatelet/s (19.8%), 211 only with anticoagulation (52.1%), and 57 with anticoagulant plus antiplatelet/s (14.1%). During a follow-up of 4.6±2.5 years, 205 died (50.6%), 34 had embolic events (8.4%) and 85 had bleeding outcomes (21.0%). Bleeding event rate was significantly lower in patients without antithrombotic therapy (Figure). After multivariate analysis, anticoagulant treatment was associated with higher bleeding rates, without differences in mortality or embolic events (Table).

Conclusion
Anticoagulation therapy was associated with a significant increase in bleeding events in patients with advanced CKD and newly diagnosed AF. None of the antithrombotic therapy regimens resulted in lower embolic events rate neither benefit in mortality.

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): This study was supported by an unconditional grant from BMS-Pfizer
Recommended and non-recommended edoxaban dosing in patients with atrial fibrillation (AF): one-year clinical events from the Global ETNA-AF non-interventional study (NIS)
Authors: Chao T.F , Kirchhof P , Koretsune Y , Yamashita T , Unverdorben M , Reimitz P , Chen C , De Caterina R 
Published: November 2020

Abstract

Background
In AF patients on direct oral anticoagulants (DOAC), safety and effectiveness vary with dose. This might impact treatment decisions.

Purpose
To investigate the effects of dosing of the DOAC edoxaban in AF patients on safety and effectiveness during 1-year observation in a real-world setting.

Methods
The Global ETNA-AF NIS included 26,823 patients. Baseline data by edoxaban dosing (60mg/30mg) and their influences on the safety (major bleeding [MB], clinically relevant non-major bleeding [CRNMB]), and effectiveness (stroke, systemic embolism, myocardial infarction [MI], death) were investigated (Table).

Results
Figure shows the breakdown by dose (60mg vs 30mg) and recommended (rec) vs non-recommended (non-rec) dosing. Patients on non-rec 30mg vs on rec 60mg edoxaban were older (mean ± SD: 74±9 vs 70±9 y); had lower creatinine clearance (72.2±20.6 vs 85.8±26.8 mL/min); and had more comorbidities, history of MB (2.1% vs 1.1%), and strokes (11.0% vs 8.6%). Non-rec 60mg vs rec 30mg patients were younger (75±9 vs 78±9 y), had fewer comorbidities, history of MB (1.2% vs 2.6%), and strokes (10.2% vs 16.4%). In non-rec 30mg vs rec 60mg, MB was not lower and ischaemic events were not higher. In non-rec 60mg vs rec 30mg, no increase in MB, CRNMB or ischaemic events was seen.

Conclusion
Edoxaban was prescribed at the label recommended dose in the vast majority of patients. Non-rec 30mg patients were sicker than rec 60mg patients while non-rec 60mg patients were less sick than rec 30mg patients. Overall event rates were low, and ischaemic event rates of non-rec 30mg and bleeding event rates of non-rec 60mg were not numerically higher than that of corresponding rec dosing groups.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Daiichi Sankyo
Early-onset and recurrent reflex syncope is associated with left ventricular diastolic filling and left atrial function properties
Authors: Roumelis P , Antoniadis A , Sotiriadou M , Pagkourelias E , Konstantinidis P , Meletidou M , Bakogiannis C , Toumpourleka M , Mpoulmpou A , Kyriakou P , Papadopoulos C , Fragakis N , Vassilikos V 
Published: November 2020

Abstract

Background/Introduction
The effects of the left atrial and ventricular function in the pathophysiology of reflex syncope remain elusive. Head-up tilt table test (HUTT) is frequently used in the diagnostic workup of patients with syncope, but the outcomes of HUTT have not been attributed to any anatomical or functional cardiac characteristics.

Purpose
We sought to assess the effects of anatomical and functional echocardiographic features of the left atrium and the left ventricle at rest in the clinical presentation of syncope and the outcomes of HUTT.

Methods
We investigated patients with a history of syncope and symptoms suggestive of reflex syncope who underwent HUTT. Specific echocardiographic indices of left cardiac morphology and function were assessed at rest. The patients were divided into two groups, those who presented with syncopal episodes at age &lt;35 years (group A) and those who presented with syncopal episodes at age &gt;35 years (group B).

Results
In 119 patients (age 46.75±21.17 years, 69 women), patients in group A exhibited a higher chance for numerous (&gt;3) syncopal episodes (odds ratio [OR] 3.4, 95% Confidence Interval [CI] 1.41 to 7.93, p&lt;0.05). Group A showed also a trend for positive HUTT (OR 1.99, 95% CI 0.97 to 4.23, p=0.08). In patients with positive HUTT, Group A had higher E-wave velocity (0.83 vs 0.65 m/sec, p&lt;0.05), lower A-wave velocity (0.60 vs 0.75 m/sec, p&lt;0.05), higher E/A ratio (1.54 vs 1.00, p&lt;0.05), higher e' wave velocity (0.16 vs 0.10 m/sec, p&lt;0.05) and lower E/e' (5.64 vs 7.85, p&lt;0.05). Also, patients in group A exhibited lower left atrial volumes (min 9.88 vs 16.21 ml, p&lt;0.05, max 30.42 vs 44.89 ml, p&lt;0.05), higher left atrial strain reservoir (40.56 vs 32.42%, p&lt;0.05) and higher left atrial strain booster (25.94 vs 18.06%, p&lt;0.05).

Conclusion(s)
Patients with a younger age of onset and recurrent syncopal episodes manifest smaller dimensions of the left atrium with distinct patterns of diastolic performance and better reservoir and booster function. These findings may indicate a more pronounced susceptibility of this group of patients to preload reduction, thereby triggering the mechanism of reflex syncope.

Funding Acknowledgement
Type of funding source: None
Validation of the FAINT risk score in a large prospective international multicenter study
Authors: Du Fay De Lavallaz J , Zimmermann T , Badertscher P , Flores D , Widmer V , Walter J , Belkin M , Boeddinghaus J , Nestelberger T , Reichlin T , Kuehne M , Christ M , Miro O , Martin-Sanchez J , Mueller C 
Published: November 2020

Abstract

Background
Risk stratification of older patients presenting to the Emergency Department (ED) with syncope remains an unmet clinical need. The FAINT Score was derived in a large American cohort in an attempt to predict 30-day serious cardiac outcomes in patients &gt;60y.o. While a FAINT score of 0 showed high sensitivity to exclude death and serious outcomes at 30 days in the derivation cohort, it remains unvalidated.

Methods
We validated the FAINT score (History of heart failure, history of arrhythmia, initial ECG result abnormal, elevate NT-proBNP, elevated hs-troponin T) in a large prospective international multicenter study recruiting patients 40 years presenting to the ED with syncope within the last 12 hours in eight countries on three continents. Main outcome measure was 30-day serious cardiac events or mortality. We assessed the performance and calibration of the FAINT score for validation and compared it to the OESIL score (Age &gt;64y, cardiovascular disease history, syncope without prodromes, abnormal ECG).

Results
1885 patients were eligible for this validation analysis. 169 (8.9%) patients experienced 30-day serious adverse events.
A FAINT score of 0 was present for 378 patients (20% of the cohort) and allowed for a sensitivity of 0.97 to rule out adverse events and death at 30-days. A FAINT score of 0 or 1 was present for 626 patients (33% of the cohort) and allowed for a sensitivity of 0.92.
The area under the receiver operating characteristic curve (AUC) for the FAINT score was 0.75 (95%, Confidence Interval (CI) 0.72–0.79), which was comparable to the performance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) or high-sensitivity Troponin T (hs-cTnT) alone, which are two biomarkers used in the FAINT score. The score did not outperform the OESIL score.
A calibration curve showed that the score was extremely well calibrated for low-risk patients.

Conclusion
This is the first validation of the FAINT score in a large international syncope cohort. The safety of a FAINT score of 0 or 1 was good and comparable to the results obtained in the derivation cohort. While the score is suitable to highlight low-risk patients and calibrates well in an external cohort, its discrimination for higher risk patients is not better than biomarkers alone or an older, less complex risk score.
Figure 1. Area under the Receiver Operating Curve (ROC) for the FAINT score and for NT-proBNP and hs-cTnT as continuous markers as well as for the OESIL score. CI = Confidence Interval.

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): University Hospital Basel, Switzerland
Implications of pacemaker implantation after TAVR: insights from the Nationwide Readmissions Database
Authors: Sharma E , Sheikh W , Parulkar A , Lima F , Wu M , Chu A 
Published: November 2020

Abstract

Introduction
Conduction disturbances after transcatheter aortic valve replacement (TAVR) requiring permanent pacemaker (PPM) implantation are a well-known procedural complication. Data on the effect of post-TAVR PPM implantation on 30-day readmissions is scarce.

Methods
The Nationwide Readmissions Database (NRD) is a nationally representative sample of all US hospitalizations, representing over 35 million discharges. The 2016 NRD was used to identify patients who underwent TAVR and PPM implantation from January to November 2016. Propensity matching was used to balance baseline clinical characteristics.

Results
Of the 44,607 patients who underwent TAVR, 4,878 (10.9%) required permanent pacemaker implantation during their index hospitalization. Patients requiring PPM during their index admission for TAVR had a higher crude median length of stay (LOS) (5d vs. 3d, p&lt;0.001), median cost of index admission ($61,604 vs. $45,513, p&lt;0.001) and rate of 30-day readmission (14.5% vs 11.2%, p&lt;0.001). After 2:1 propensity matching, PPM patients still had a higher median LOS (5d vs. 3d, p&lt;0.001), median cost of index admission ($61,902 vs. $41,162, p&lt;0.001), and rate of 30-day readmission (13.8% vs 11.1%, p=0.003). Patients who received PPM were more likely to be older (81.1 vs 80.3, OR 1.01, CI 1.01–1.02), diabetic (OR 1.27, 1.13–1.44), obese (OR 1.22, 1.05–1.43), and have right (OR 4.35, 3.72–5.09) or left (OR 1.80, 1.51–2.15) bundle branch blocks on multivariate analysis. Causes of readmission in patients with and without PPM were predominantly non-cardiac (62.9% vs 68.0%). Heart failure was the most common cause of readmission for both groups (18.4% vs 14.6%). Median cost of readmissions ($8716 vs $8250, p=0.34) and LOS (4d vs 4d, p=1) were not significantly different during readmissions.

Conclusions
Based on a nationally representative sample, 10.9% of patients undergoing TAVR required PPM implantation during the index hospitalization. Age, diabetes, obesity, and right or left bundle branch blocks were significant predictors of PPM implantation. PPM implantation resulted in significantly higher LOS, costs, and 30-day readmissions on propensity-matched analysis.

Funding Acknowledgement
Type of funding source: None