bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sex-specific temporal trends in the incidence of atrial fibrillation in a large Norwegian population-based study 1986–2014
Authors: Sharashova E , Wilsgaard T , Ball J , Gerdts E , Rosengren A , Njolstad I , Mathiesen E.B , Schirmer H , Nyrnes A , Kildal S , Tiwari S , Espnes H , Stylidis M , Lochen M.L 
Published: November 2020

Abstract

Background
Due to population aging, increasing prevalence of obesity and enhanced detection, the prevalence of atrial fibrillation (AF) worldwide is increasing steadily. Considerable sex differences in the epidemiology of AF such as lower prevalence and later onset in women compared to men have been reported. However, little is known about sex-specific temporal trends in AF incidence within the general population.

Purpose
To explore sex-specific age-adjusted secular trends in the incidence of AF in a general population from Norway between 1986 and 2014.

Methods
A total of 16,865 men and 15,413 women aged 20 years or older and without AF were enrolled in a longitudinal population study between 1986 and 2008 and followed up for incident AF to the end of 2014. Follow-up was from the date of attendance to the date of AF, emigration or death, whichever came first. All AF cases were validated by an independent endpoint committee using hospital and death records. AF incidence rates were calculated for each calendar year by dividing the number of AF cases per year by the corresponding person-time at risk. To allow for non-linear time trends, calendar year was fitted using fractional polynomials. Poisson regression was used to estimate calendar year-specific AF incidence rates adjusted for age. All analyses were stratified by sex.

Results
A total of 911 AF events in women and 1,139 AF events in men occurred over 324,090 person-years and 294,531 person-years of follow-up, respectively. During the study period AF incidence rates in men were at least double that in women (Figure). Age-adjusted AF incidence rates in women increased from 1986, peaked at 0.87 per 1000 person-years in 1998 and then decreased slightly towards 2014. In men AF incidence rates increased up to 2.18 per 1000 person-years in 2005 and then steeply decreased.

Conclusion(s)
AF incidence rates decreased in both women and men towards the end of the study period. The decrease was more profound in men compared to that in women. One possible explanation is more pronounced reduction in incidence and better treatment of myocardial infarction in men compared to women given that the aetiology of AF in men is mainly ischemic heart disease-related. However, further epidemiological analyses should be undertaken to identify explanatory factors.

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): University Hospital of North Norway, Northern Norway Regional Health Authority
Frequency of cardioversions for atrial fibrillation and the risk ischemic stroke
Authors: Jaakkola S , Kiviniemi T.O , Jaakkola J , Pouru J.P , Nuotio I , Vasankari T , Hartikainen J.E.K , Airaksinen K.E.J 
Published: November 2020

Abstract

Introduction
Patients with atrial fibrillation (AF) are selected for oral anticoagulation (OAC) therapy based on individual clinical characteristics collected in CHA2DS2-VASc -score. The characteristics of AF itself, however, are currently not included in stroke risk stratification schemes. Accumulating scientific evidence suggest that AF burden can be considered as an independent risk factor for cardiogenic stroke. So far, there are no studies evaluating the influence of AF burden measured by the frequency of symptomatic AF episodes on ischemic stroke risk.

Purpose
We sought to explore influence of symptomatic AF burden as determined by the frequency of acute cardioversions (CV) to the long-term ischemic stroke rate in AF patients.

Methods
This interim analysis of the multicenter, observational FinCV 4-study included 3867 CVs in 1521 non-anticoagulated patients. Clinical and laboratory data were collected manually through electronic patient records. Study follow-up started from the 1st CV of each patient and continued until one of the following events occurred: initiation of permanent OAC, non-CV related ischemic stroke, or death. Patients were divided in to three groups according to the individual frequency of CVs: high frequency (mean interval between CVs &lt;12months), medium frequency (12–18months), low frequency (&gt;18 months).

Results
A total of 113 (7.43% of patients) non-CV related (&gt;30 days after CV) ischemic strokes occurred during the follow-up period (median 3.7 years [interquartile range 9.1 years]). The ischemic stroke rate per 100 patient-years was 7.5 in the high CV frequency group, 1.9 in the medium frequency group and 0.6 in the low frequency group. The mean CHA2DS2-VASc scores were 2.63±1.64, 2.46±1.63 and 2.20±1.68 in the three groups respectively. After adjusting for the CHA2DS2-VASc score, Cox regression analysis revealed CV frequency as an independent predictor for ischemic stroke (p&lt;0.001). Kaplan-Meier analysis results are presented in Figure 1.

Conclusions
Determining the burden of AF based solely on the frequency of acute CVs seems to stratify the risk of ischemic stroke beyond CHA2DS2-VASc score.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): State clinical research fund (EVO) of Turku University Hospital
Exploring the temporal relationship between atrial fibrillation and heart failure development. Analysis from a nationwide database
Authors: Maalemben Messaoud B , Laurent G , Bisson A , Eicher J.C , Bodin A , Herbert J , Zeller M , Cottin Y , Fauchier L 
Published: November 2020

Abstract

Background
Atrial Fibrillation (AF) and Heart Failure (HF) often coexist and are closely intertwined, each condition worsening the other. Small cohorts studies have suggested a worse prognosis in patients who had developed HF first. However, the temporal relationships between these two pathologies have not been fully explored yet. We aimed to assess, at a nationwide scale, the prognosis of patients hospitalized with HF and AF, based on the timing of AF and HF development.

Methods
From the French administrative hospital-discharge PMSI database (Programme de Médicalisation des Systèmes d'Information), covering hospital care and representative of the whole french population. All consecutive patients with both diagnoses of AF and HF hospitalized between 2010 and 2018, whatever the order of occurrence for HF or AF, were included. From the database, 1,412,730 patients had inclusion criteria, of whom 403,934 developed AF First and 1,008,796 who developed HF First. Incidence rates (%/year) for the outcomes (all-cause death, cardiovascular (CV) death, or ischemic stroke) during follow-up were compared for each group using incidence rate ratios (RR) in the whole cohort and in a subgroup of 502,456 propensity-score matched patients (251,228 with AF first and 251,228 with HF first).

Results
In the whole population, most patients had developed HF before AF (n=1,008,796; 71.40%). At follow-up (median [IQR] 1.4 [0.1–3.7] years) patients with HF First had increased risk of all-cause death (yearly incidence: 18.9% vs 9.4%; [RR ([95% CI)]: [2.01 (2.00–2.02)]; p&lt;0.00001), and CV death (7.0% vs 3.0%; [RR 2.31 (2.29–2.34)]; p&lt;0.00001). In propensity score matched population, (follow-up median [IQR] 2.2 [0.5–4.4] years), patients with HF first had also worse outcomes than patients with AF first (all-cause death rates yearly incidence; 15.2% vs 9.4% [RR 1.63 (1.61–1.64)], p&lt;0.00001; CV death rates: 5.6% vs 3.0% [RR 1.87 (1.84–1.90)], p&lt;0,00001); ischemic stroke rate: 2.2% vs 1.3% [RR 1.71 (1.67–1.76)], p&lt;0.00001).

Conclusion
In our large study from a nationwide database in patients hospitalized with both AF and HF, two distinct clinical entities were identified, based on the chronological sequence of AF and HF developments. Our results confirming that HF preceding AF is much worse than the opposite, and this might have therapeutics implications. However, further studies are needed to investigate the underlying mechanisms of the interplay of these dual conditions.

Funding Acknowledgement
Type of funding source: None
Regular exercise is associated with a lower risk of developing dementia in patients with a new diagnosis of atrial fibrillation: a nationwide population-based study
Authors: Lim J.H , Lee S.R , Choi E.K , Yun J.P , Ahn H.J , Han K.D , Jung J.H , Lee E.J , Cha M.J , Oh S.I , Lip G.Y.H 
Published: November 2020

Abstract

Introduction
Regular exercise is known to decrease the risk of dementia. There is a paucity of information about the impact of the change of exercise habit on cardiovascular outcomes after a new diagnosis of atrial fibrillation (AF). We aimed to investigate whether regular exercise is associated with the risk of developing dementia in patients with AF.

Methods
Using the Korean National Health Insurance Service database, we enrolled patients with newly diagnosed AF who had undergone health screening between 2010 and 2016. The study population was divided into four groups based on the consistency of regular exercise before and after AF diagnosis: (1) persistent non-exerciser, (2) exercise starter, (3) exercise quitter, and (4) exercise maintainer. We investigated the association between exercise and the risk of dementia.

Results
A total of 126,555 patients were included (mean age 62.7 years, male 62.0%, and mean CHA2DS2-VASc Score 2.7). During a median follow-up duration of 3.0 years, 5,943 patients were newly diagnosed as dementia (1.57 per 100 person-years). Among patients with incident dementia, 4,410 patients had Alzheimer's dementia and 951 patients had vascular dementia (1.16 and 0.25 per 100 person-years, respectively). Persistent non-exerciser, exercise starter, quitter, and maintainer groups were 65.1%, 12.8%, 12.7%, and 9.4%, respectively. After multivariable adjustment, we found that exercise was associated with a lower risk of developing overall dementia. When compared to persistent non-exerciser, exercise starter and maintainer showed reduced risk of developing dementia (hazard ratio [HR] 0.80, 95% confidence interval [95% CI] 0.73–0.88 and HR 0.63, 95% CI 0.54–0.73, respectively, all p-value &lt;0.0001), but exercise quitter showed no significant risk reduction (HR 0.95, 95% CI 0.88–1.03, Figure). Alzheimer's dementia showed consistent results: a 20% lower risk with exercise starter, and a 37% lower risk with exercise maintainer. Change of exercise habit, however, did not affect the risk of vascular dementia (all, p-value &gt;0.05, Figure).

Conclusions
Regular exercise showed a lower risk of dementia in patients with new-onset AF. Starting exercise even after the diagnosis of AF was beneficial to patients who had little physical activity previously. These findings may support physicians to recommend that AF patients should start exercise or keep their physical activity to reduce the risk of dementia.

Funding Acknowledgement
Type of funding source: None
Assessing the atrial substrate: electrograms from the coronary sinus can predict left atrial fibrosis
Authors: Mohsen Y , Draheim J , Grossmann N , Turan C.H , Schoett M , Horlitz M , Stoeckigt F 
Published: November 2020

Abstract

Background
Left atrial fibrosis plays a key role regarding the success rate of pulmonary vein isolation for atrial fibrillation. It can be analyzed using LGE-MRI or invasive LA electroanatomical mapping. Assessing LA substrate prior to performing LA ablation procedures might help in optimizing the ablation approach.

Method
We analysed highdensity-electroanatomical maps of the left atrium derived by Carto 3 from 282 consecutive atrial fibrillation patients scheduled for RF pulmonary vein isolation (PVI). Maps were divided into 5 different anatomical areas and fibrosis was defined as local voltage &lt;0.5mV. The extent of fibrosis was analyzed and compared with signal recordings from different positions of a diagnostic catheter positioned in the coronary sinus (CS) using Pearson correlation analysis.

Results
PVI was carried out in 282 patients (male 72%, mean age 63±10.8 years). A minimum of 1000 evenly distributed local electrograms were recorded in every patient. Significant LA fibrosis (&gt;5%) was present in 54% of the patients with the maximum incidence of 100% at the anterior and 80% at the posterior wall. Signal amplituds in the proximal CS position significantly correlated with presence of LA fibrosis in the posterior LA (R 0.84, p&lt;0.001), LA roof (R 0.65; p&lt;0.001), left lateral (R 0.54; p&lt;0.001), septal (R 0.47; p&lt;0.001), and even LA anterior wall (R 0.56; p&lt;0.001). Comparable results were found when using distal CS signals or a signal averaged over all individual CS signals. When used as a diagnostic tool, a CS amplitude &lt;1.9mV could predict fibrosis at the posterior left atrial wall with a specificity of 97% and a sensitivity of 67% (PLR 24, AUC 0.91, 95% CI 0.87 - 0.95; p&lt;0.001). A cut-off value of 1.9mV could be used to identify patients with only minimal LA fibrosis (&lt;5%) with specificity of 88% and a sensitivity of 50% (PLR 4.2, AUC 0.81, 95% CI 0.71–0.89; p&lt;0.001.

Conclusion
Voltage signals in the CS are significantly associated with presence of fibrosis in all left atrial areas. Moreover, CS voltage signals can be used to identify presence of significant left atrial extrapulmonary vein fibrosis and could help guiding left atrial ablation procedures and choice of ablation technique.

Funding Acknowledgement
Type of funding source: None
Dominant frequency predicts sinus rhythm maintenance after electrical cardioversion for persistent atrial fibrillation in men but not in women
Authors: Lankveld T , Zeemering S , Van Gelder I.C , Odening K.E , Crijns H.J , Schotten U 
Published: November 2020

Abstract

Background
Women are usually underrepresented in studies evaluating rhythm control strategies in patients with atrial fibrillation (AF). Subsequently, the same holds true for studies looking at predictors for success of a rhythm control strategy for AF.

Purpose
To study the predictive power of the non-invasively determined dominant frequency (DF) on the electrocardiogram (ECG) in men and women undergoing electrical cardioversion (ECV) for persistent AF.

Methods
We matched 105 female patients undergoing elective ECV for persistent AF and 105 male control patients based on age and cardiovascular comorbidity profile. We determined the DF on all 12 leads of a standard digital 10 seconds ECG recorded on the day of ECV. Recurrences of AF within the first year after ECV were documented.

Results
There were no differences in comorbidities, AF duration, left ventricular systolic function, indexed left atrial volume and anti-arrhythmic drugs between male and female patients. The dominant frequency was significantly lower in male patients without an AF recurrence on all leads. The best performing lead to identify patients with recurrences was lead III with an AUC 0.752. The optimal cut-off point was a DF &lt;5.98 Hz with a sensitivity 84% and a specificity 67%. There was no significant difference in DF between female patients with and without an AF recurrence. The AUC in lead III was 0.47 (Figure 1).

Conclusion
The non-invasively measured dominant frequency is able to predict AF recurrence after electrical cardioversion in male patients with persistent AF but not in a matched female cohort. This difference might be explained by different pathophysiological mechanisms underlying AF in male and female patients. Therefore, future research is needed on pathophysiological differences between men and women that can explain and might overcome these challenges.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): European Network for Translational Research in Atrial Fibrillation (grant no. 261057), the Center for Translational Molecular Medicine (COHFAR),
A cool modality to restore sinus rhythm
Authors: Yasin O , Sugrue A , Van Zyl M , Ladejobi A , Tri J , Rynbrandt J , Seifert G , Sanders R , Pedersen J , Yngsdal L , Ladewig D , Taubel R , Ritrivi C , Asirvatham S , Friedman P 
Published: November 2020

Abstract

Background
Slowing electrical conduction by cooling the myocardium can be used for defibrillation. We previously demonstrated the efficacy of a small cold device placed in oblique sinus (OS) in terminating atrial fibrillation (AF). However, the parameters needed to achieve effective atrial defibrillation are unknown.

Purpose
Assess effect of the size of cooled myocardium on frequency of AF termination in acute canine animal models.

Methods
Sternotomy was performed under general anesthesia in 10 acute canine experiments. AF was induced using rapid atrial pacing and intra-myocardial epinephrine and acetylcholine injections. Once AF sustained for at least 30s, either a cool (7–9°C) or placebo (body temperature) device was placed in the OS. Four device sizes were tested; ½X½, ¾X¾, and 1X1 inch devices and two ¾X¾ inch devices placed side by side simultaneously. Time to AF termination was recorded. Chi-squared or Fisher's exact test were used to compare the frequency of arrhythmia termination with cooling versus placebo.

Results
A total of 166 applications were performed (89 cool vs 77 placebo) in 10 animal experiments. Overall, AF terminated in 82% of the cooling applications vs. 67.5% of placebo (P=0.03, Figure 1). For the ½X½ inch device 88% of cold applications restored sinus rhythm vs. 63.6% for placebo (P=0.05). The frequency of sinus restoration for cold ¾X¾, 1X1 and two ¾X¾ side by side devices was 86.7%, 83.3% and 70% respectively. Time to sinus restoration when achieved was within three minutes was also not significantly changed.

Conclusion
Placing a cool device in the oblique sinus can terminate AF and efficacy is not affected by the size of device.

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): MediCool Technologies
Antazoline for pharmacological cardioversion of atrial fibrillation: the results of the high-volume multicenter CANT study
Authors: Wybraniec M , Maciag A , Miskowiec D , Ceynowa-Sielawko B , Balsam P , Wrobel W , Farkowski M , Cwiek-Rebowska E , Szolkiewicz M , Ozieranski K , Krzowski B , Kozinski M , Kasprzak J , Szwed H , Mizia-Stec K 
Published: November 2020

Abstract

Background
Antazoline mesylate represents a first generation antihistamine with quinidine-like antiarrhythmic properties, which allows for rapid and effective termination of atrial fibrillation (AF). Despite its widespread use in Polish emergency departments, paucity of data exists concerning safety and efficacy of antazoline in comparison to other antiarrhythmic agents.

Purpose
This study aimed to evaluate the pooled hitherto data on effectiveness and safety of pharmacological Cardioversion with intravenous ANTazoline (CANT Study) in short-duration atrial fibrillation.

Methods
This retrospective observational study was performed in 5 medical centers and comprised 1300 patients with paroxysmal or persistent AF who underwent emergent pharmacological cardioversion in the real-world setting of emergency or cardiology department. The choice of antiarrhythmic drug was left to the discretion of attending physician. The exclusion criteria involved permanent AF, other supraventricular arrhythmias, including atrial flutter, chronic antiarrhythmic therapy or preemptive electrical cardioversion. The primary endpoint was restoration of sinus rhythm up to 12 hours after antiarrhythmic drug infusion. The combined safety endpoint was bradycardia &lt;45 bpm, hypotension, syncope or death.

Results
The mean age of study population was 67.7±11.6 years and the majority of patients were men (52.9%). The median AF episode duration was 10 (4; 24) hours, while median CHA2DS2-VASc score was 3 (2; 4) pts. Antazoline alone was administered in 45.6% of patients (n=593); amiodarone in 22.1% (n=287); propafenone in 11.5% (n=150); sotalol in 0.5% (n=6), while 20.3% (n=264) received overlapping antiarrhythmic therapy. Antazoline had the highest rhythm conversion rate (Figure), which was comparable to propafenone (78.2% vs 72.7%; RR 1.08; 95% CI:0.97–1.20; P=0.175) and superior to amiodarone (vs 66.9%; RR 1.17, 95% CI:1.07–1.28; P=0.0008) and collective amiodarone/propafenone/sotalol treatment (vs 68.6%; RR 1.14; 95% CI:1.06–1.23; P=0.0006). The rate of combined safety endpoint was comparable in patients treated with antazoline and other antiarrhythmic drugs (5.2% vs 3.9%; P=0.297). Among patients treated with antazoline, 29 exhibited bradycardia &lt;45 bpm and 5 patients suffered from hypotension, but no case of syncope, nor in-hospital death was reported.

Conclusion
Antazoline appears to be an effective antiarrhythmic drug for cardioversion of atrial fibrillation, which is associated with low rate of relatively benign adverse events.
Figure 1

Funding Acknowledgement
Type of funding source: None
Ranolazine as you have never seen it before: an antiarrhythmic for atrial fibrillation
Authors: Sousa J.P , Puga L , Ribeiro J , Lopes J , Saleiro C , Gomes R , Campos D , Lourenco C , Goncalves L 
Published: November 2020

Abstract

Background
Currently available pharmacological options for rhythm control in atrial fibrillation (AF) are overshadowed by suboptimal efficacy and both frequent and potentially severe adverse events. Recent studies have added evidence to the hypothesis that ranolazine might exert antiarrhythmic effects, particularly in atrial tachyarrhythmias.

Purpose
To perform a systematic review with meta-analysis in order to ascertain the potential role of ranolazine in the management of AF.

Methods
We systematically searched MEDLINE, Embase and Scopus for randomized controlled trials (RCTs) and cohort studies addressing the association between ranolazine and AF outcomes, published up until December 1, 2019. The primary endpoint was incidence of AF, which was evaluated under a ranolazine versus placebo design. In this regard, patients in the setting of postcardiac surgery were further investigated separately. Secondary endpoints included AF cardioversion outcomes, which were addressed through comparison between ranolazine plus amiodarone and amiodarone alone for proportional efficacy and temporal requirements (time-to-cardioversion). The latter analysis was also undertaken in a dose-sensitive fashion (≤1000mg vs. 1500mg of ranolazine). Tertiary endpoints covered AF burden and episodes, in paroxysmal AF patients, and safety outcomes, namely death, QTc interval prolongation and hypotension. Study-specific odds ratios (ORs) were pooled using meta-analytic techniques with a random-effects model.

Results
A total of 10 RCTs comprising 8.109 participants and 3 cohort studies encompassing 37.112 patients were regarded as eligible for evaluation. Ranolazine was found to attenuate patients' odds of developing AF (OR 0.53, 95% CI: 0.41–0.69, p&lt;0.001, i2=58%). This effect held true, with an even larger effect size, in the context of post-cardiac surgery (OR 0.34, 95% CI: 0.16–0.72, p=0.005, i2=64%). Ranolazine increased the chances of successful AF cardioversion when added to amiodarone over amiodarone alone (OR 6.67, 95% CI: 1.49–29.89, p=0.01, i2=76%), while significantly reducing time-to-cardioversion [SMD 9.54h, 95% CI: −13.3–5.75, p&lt;0.001, i2=99%]. Interestingly, cardioversion was faster with ≤1000mg of ranolazine (SMD −13.16h, 95% CI: −15.07–11.25, p&lt;0.001, i2=95%) than with 1500mg (SMD −3.57h, 95% CI: −5.06–2.08, p&lt;0.001, i2=23%). In paroxysmal AF, ranolazine was also proved to significantly reduce both AF burden and episodes. There were no safety signals regarding mortality odds, QTc interval prolongation (mostly clinically insignificant) and hypotension (mostly transitory).

Conclusion
Current evidence suggests that ranolazine provides an effective and safe option for a chemical rhythm control strategy in AF management, a field in which medical breakthroughs are desperately needed.

Funding Acknowledgement
Type of funding source: None