bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is there an antiarrhythmic benefit from switching to sacubitril/valsartan therapy? A systematic review and meta-analysis
Authors: Anagnostopoulos I , Kousta M , Kossyvakis C , Lakka E , Paraskevaidis N T , Schizas N , Giannopoulos G 
Published: October 2021

Abstract

Background
Sacubitril/valsartan through reverse structural remodeling and neurohormonal inhibition could play an antiarrhythmic role.

Purpose
This systematic review and meta-analysis was performed to explore the arrhythmiologic effects of switching patients with heart failure with reduced ejection fraction (HFrEF) from angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) to sacubitril/valsartan.

Methods
We searched major databases for studies comparing device-detected, incident atrial and ventricular arrhythmias in patients with HFrEF while on ACEi/ARBs versus while on sacubitril/valsartan. For pooling the primary outcome of interest, we calculated the risk difference (RD) with the corresponding 95% confidence interval (CI) in the probability of experiencing each arrhythmic event while on ACEi/ARBs and while on sacubitril/valsartan. A random effects (DerSimonian-Laird) model was adopted.

Results
We analyzed 4 eligible studies, resulting in 497 patients with a pooled mean age of 67.8±10.36. 64% had ischemic cardiomyopathy while 98% had either an implantable cardioverter defribrillator or a cardiac resynchronization therapy device. Main comorbidities were hypertension (68.7%) and dyslipidemia (59.6%). Almost all (96.3%) patients were treated with b-blockers and 23.7% were also receiving anti-arrhythmic drugs, mainly amiodarone. After switching to sacubitril/valsartan there was a trend towards reduced risk for sustained ventricular tachycardia/fibrillation and non-sustained ventricular tachycardias (RD: −0.04, 95% CI: −0.09–0.02, I2: 65.7% and −0.06, 95% CI: −0.19–0.07, I2: 85%; respectively). Meta-regression analysis showed that patients with ischemic cardiomyopathy experience greater benefit. Incident paroxysmal atrial fibrillation/tachycardia was significantly reduced (RD: −0.09 95% CI: −0.14 to −0.03, I2: 0%), while favorable effects were noticed for the risk of appropriate shock delivery and inadequate biventricular pacing (RD: −0.06, 95% CI: −0.09 to −0.03, I2: 0% and −0.06, 95% CI: −0.11 to 0.00, I2: 35.55%, respectively). All results seem to suffer from publication bias.

Conclusion
Limited data support that switching to sacubitril/valsartan seems to be associated with reduced risk for both ventricular and atrial arrhythmias. More studies are needed to clarify the potential anti-arrhythmic role of this drug. Whether patients with frequent arrhythmias or at high arrhythmic risk may benefit from early switch is a matter of further investigation.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Ongoing antiarrhythmic drug therapy type does not affect the rate of first-pass pulmonary vein isolation: data from a multicenter registry
Authors: Gasimova N , Kropotkin E , Ivanitsky E , Kolunin G , Nechepurenko A , Shavshin D , Antolic B , Kovalev K , Mikhaylov E , Lebedev D 
Published: October 2021

Abstract

Background
It is well-known that antiarrhythmic drugs (AAD) change the electrophysiological properties of the atrium mostly by increasing the atrial refractory period and wavelength for reentry. Frequently, atrial fibrillation (AF) catheter ablation is being performed with AAD interruption. However, the information on the impact of AAD on AF ablation performance is lacking, and AAD interruption is not desirable in highly symptomatic patients with persistent arrhythmia.

Purpose
We sought to study potential differences in achieving first-pass pulmonary vein isolation (FPI) during AF ablation in patients receiving different classes of ongoing AADs.

Methods
This was a prospective observational multicenter registry. All centers were invited to participate in the registry voluntarily. Data on demographic, clinical, and procedure characteristics were derived from a web-based system. All catheter ablation procedures were performed according to local practices. A total of 450 patients were enrolled, 408 of them underwent first-time AF ablation. Data on AAD characteristics were available in 350 patients (mean age 61±9 years, 195 (56%) males, 270 (77%) had paroxysmal AF). All patients were divided into three groups: ongoing I class AAD treatment (propafenone, ethacyzin, allapinin, n=76), ongoing II class AAD (beta-blockers, n=60), and ongoing III class AAD (amiodarone, sotalol, n=214).

Results
Baseline clinical and procedural characteristics between AAD groups are summarized in Table. Patients in the I class AAD group were younger, likely had paroxysmal AF, and a smaller mean left atrial diameter. Procedures in the III class AAD group were performed with a higher median target ablation index on the posterior left atrial wall. But the percentage of first-pass isolation was distributed equally between groups (60%, 68%, 61%, p=0.56). The correlation matrix revealed no significant associations between FPI and clinical and procedural variables (r=0.02–0.09; p&gt;0.05 for all).

Conclusion(s)
Our real-life multicenter data demonstrate no difference in FPI achievement between patients receiving different AADs. We suggest that highly symptomatic patients may continue pharmacological treatment during AF ablation without compromising acute ablation success.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Science and Higher Education grant (Russian Federation President Grant) Table 1. Clinical and procedural parameter
Amiodarone and amplitude spectral area of ventricular fibrillation in patients with out-of-hospital cardiac arrest
Authors: Gentile F R , Compagnoni S , Baldi E , Aramendi E , Primi R , Bendotti S , Currao A , Contri E , Palo A , Savastano S 
Published: October 2021

Abstract

Background
Ventricular fibrillation is the most common cause of out-of-hospital cardiac arrest (OHCA) and the use of antiarrhythmic drug therapy is usually recommended in addition to defibrillation. The role of the amplitude spectral area (AMSA) of ventricular fibrillation as a predictor of defibrillation efficacy has been established, while the existing data in favour of the use of amiodarone has been assessed with poor evidence and controversy.

Purpose
The aim of our study is to evaluate whether the administration of amiodarone during resuscitation could affect AMSA values.

Materials
All the OHCAs with a shockable presenting rhythm and attempted resuscitation which occurred from January 2015 to June 2019 in the province of Pavia were considered. Both the end-tidal CO2 (ETCO2) and AMSA values were calculated by retrospectively analyzing the data collected by the Corpuls 3 monitors/defibrillators (Corpuls, Kaufering, Germany) used in the territory and by considering a pre-shock interval of 2 seconds.

Results
Among a total of 3413 OHCAs, resuscitation was attempted in 2195 cases (64%), 377 (17%) had a shockable presenting rhythm and in 112 cases (3.4%) it was possible to obtain the values of ETCO2 and AMSA for a total of 391 shocks. Among these, 301 shocks (77%) were delivered to patients who received amiodarone during resuscitation. The success rate of each single shock was similar in the two groups but with an unfavorable trend for amiodarone (amiodarone 43.5% vs no amiodarone 54.4%, p=0.07). AMSA was significantly lower in patients treated with amiodarone (7.9 mV·Hz, IQR 5.4–12.2 vs 10.6 mV·Hz, IQR 7.1–14.1; p&lt;0.001). According to a multivariate analysis, the administration of amiodarone and the time to shock were independent predictors of AMSA values. Lastly, on a sample of 124 shocks, homogeneous for age, sex, ETCO2, outcome of resuscitation and randomly matched, the AMSA of patients who received amiodarone was significantly lower (7.2 mV·Hz, IQR 7.2–11.7 vs 9.7 mV·Hz, IQR 6.7–12.5; p=0.02).

Conclusions
Our results indicate that amiodarone administration is associated with lower values of AMSA. Since higher AMSA values are known to be associated with a higher probability of shock rate success, this could help to better clarify the controversial role of amiodarone administration in patients with OHCA.

Funding Acknowledgement
Type of funding sources: None.
Significance of mitral L wave to predict late recurrence of atrial fibrillation after radiofrequency catheter ablation
Authors: Wada R , Shinohara M , Yao S , Yano K , Akitsu K , Koike H , Kinoshita T , Yuzawa H , Nakanishi R , Fujino T , Ikeda T 
Published: October 2021

Abstract

Background
Mitral L wave, prominent mid-diastolic filling wave in echocardiographic examinations, is associated with severe left ventricular diastolic dysfunction, and that has been reported to predict recurrent atrial fibrillation (AF) after cardioversion. However, association between mitral L wave and the outcome of AF after radiofrequency catheter ablation (RFCA) has not been established.

Objective
The aim of this study is to evaluate the predictive value of mitral L wave on AF recurrence after RFCA.

Methods
250 patients including 164 paroxysmal AF (65.6%) and 86 non-paroxysmal AF (34.4%) who received RFCA in single center from January 2015 to December 2016 were enrolled consecutively. Echocardiographic examinations before RFCA were recorded, and the mitral L wave was defined as a distinct mid-diastolic flow velocity with a peak velocity ≥20 cm/s following the E wave. Systematic follow-up was conducted after RFCA. Univariate and multivariate analyses were carried out to determine the factors predicting late recurrence of AF (LRAF) which means AF recurrence after 3 months. Enrolled patients were divided into groups with the L wave (L-group; n=57) or without the L wave (NL-group; n=193) based on the findings of echocardiographic examinations.

Results
During a follow-up of 35.0±17.6 months, the ratio of LRAF in the L-group was significantly higher than that in the NL-group (32 (56.1%) vs. 41 (21.2%), Hazard ratio [HR]: 3.55, 95% confidence interval [CI]: 2.33 - 5.42, p&lt;0.001). Among the clinical factors, presence of mitral L wave, BNP value, non-paroxysmal AF and moderate-severe mitral regurgitation were related to LRAF. A multivariate analysis using a Cox proportional hazard model found that presence of mitral L wave (HR: 2.67, 95% CI: 1.30 - 5.48, p=0.007) was significantly associated with LRAF.

Conclusion
This study revealed that mitral L wave predicts late recurrence of AF after RFCA.

Funding Acknowledgement
Type of funding sources: None.
Atrial functional mitral regurgitation in patients qualified for pulmonary vein isolation: a negative prognostic factor for catheter ablation efficacy
Authors: Cichon M , Wybraniec M , Mizia-Szubryt M , Mizia-Stec K 
Published: October 2021

Abstract

Background
Atrial functional mitral regurgitation (AF-MR) related to atrial fibrillation (AF) could affect the effectiveness of the sinus rhythm restoring procedures.

Purpose
The aim of the study was to evaluate the impact of AF-MR on pulmonary vein isolation (PVI) efficacy.

Methods
One hundred thirty-six patients (65.4% males; mean age 56±11 years) with symptomatic paroxysmal or persistent AF qualified for PVI were enrolled into the study. AF-MR assessment was performed in transthoracic (TTE) and transesophageal (TEE) echocardiography before PVI procedure. PVI efficacy was evaluated in 3-month and long-term follow-up.

Results
AF-MR was diagnosed in 74.3% patient in transthoracic echocardiography (TTE) (trace: 26.5%, mild: 43.4%, moderate: 3.7%, severe 0.7%) and 94.9% in transesophageal echocardiography (TEE) (trace: 17.6%, mild: 59.6%, moderate: 16.2%, severe: 1.5%). PVI 3-month efficacy was 75.7% in 3-month and 64% in the long-term observation.
Severe AF-MR in TEE at baseline was associated with lower 3-month PVI efficacy (P=0.012) while moderate to severe AF MR in TEE was related to inefficient PVI assessed in long-term follow-up (P=0.041). In Kaplan- Meier analysis only moderate to severe AF-MR diagnosed in TEE had an impact on long-term procedure outcome (P=0.048).

Conclusions
Significant AF-MR confirmed by TEE predicts 3-month as well as long-term PVI efficacy.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The institutional budget of the First Department of Cardiology, Medical University of Silesia, Katowice, Poland
Initial clinical experience of pulmonary vein isolation using the novel ultra-low temperature cryoablation catheter for patients with atrial fibrillation
Authors: Tohoku S , Bordignon S , Chen S , Schmidt B , Chun K R J 
Published: October 2021

Abstract

Background
The high cooling power and ultra-low temperature cryoablation (ULTC) catheter called “Adagio” has been recently launched. A combination of a newly exploited cryogen and interchangeable stylet enables flexible and continuous lesion creation applicable not only for atrial fibrillation (AF) but also for other tachyarrhythmia by optimizing catheter shape. The exclusive esophageal warming balloon in order to preserve esophageal temperature is encouraged to prevent the potential risk of esophageal complication during procedure.

Aim
To assess the initial clinical data on pulmonary vein (PV) isolation for patients with AF using the novel ULTC catheter.

Methods
Consecutive patients who underwent AF ablation using ULTC in our center were enrolled. We assessed the acute procedural data focusing on procedural feasibility and safety comprising “first-pass isolation” defined as successful PV isolation after the initial application.

Results
A total of 16 AF patients (53% male, age 67 years, 59% paroxysmal AF) were analyzed. Sixty-six out of 67 PVs (98.5%) were isolated with ULTC. The mean number of applications per PV was 2.3 1.1. Touch-up catheter was needed in one case at left inferior PV. The mean total procedure and fluoroscopy times were 79±30 and 14±7 mins, respectively. First-pass isolation was achieved in 34 PVs (50.7%) varying across PVs from left superior PV (43.8%) to right superior PV (58.8%). In none of the patients an acute thromboembolic event (stroke or transient ischemic attack), a pericardial effusion/tamponade and postprocedural esophageal complication occurred. A single transient phrenic nerve weakening was observed at right superior PV.

Conclusion
Sequential PV isolation using the novel ULTC catheter was achieved feasibly without compromising safety. First-pass isolation was accomplished about in a half of PVs.

Funding Acknowledgement
Type of funding sources: None.
Myocardial injury after pulmonary vein isolation: fire versus ice
Authors: Morgado Gomes A R , Antonio N S C , Silva S , Madeira M , Sousa P , Elvas L , Goncalves L 
Published: October 2021

Abstract

Introduction
The cornerstone of atrial fibrillation (AF) catheter ablation is pulmonary vein isolation (PVI), either using point-by-point radiofrequency ablation (RF) or single-shot ablation devices, such as cryoballoon ablation (CB). However, achieving permanent transmural lesions is difficult and pulmonary vein (PV) reconnection is common. Elevation of high-sensitivity Troponin I (hsTnI) may be used as a surrogate marker for transmural lesions. Still, data regarding the comparison of hsTnI increase after PVI with RF or cryo-energy is controversial.

Purpose
The aim of this study is to compare the magnitude of hsTnI elevation after PVI with CB versus RF using ablation index guidance.

Methods
Prospective study of 60 patients admitted for first ablation procedure of paroxysmal or persistent AF in a single tertiary Cardiology Department. Thirty patients were submitted to PVI using CB and 30 patients were submitted to RF, using CARTO® mapping system and ablation index guidance. Patients with atrial flutter were excluded. Baseline characteristics were compared between groups, as well as hsTnI before and after the procedure.

Results
Mean age was 57.9±12.3 years old, 62% of patients were male and 77% had paroxysmal AF. There were no significant differences between groups regarding gender, age, prevalence of hypertension, dyslipidaemia, diabetes, obesity or AF type. There was also no significant difference in electrical cardioversion need during the procedure. HsTnI median value before ablation was 1.90±1.98 ng/dL. Postprocedural hsTnI was significantly higher in CB-group (6562.7±4756.2 ng/dL versus 1564.3±830.7 ng/dL in RF-group; P=0.001). Regarding periprocedural complications, there was only one case of mild pericardial effusion in RF-group associated with postablation hsTnI of 1180.0 ng/dL.

Conclusions
High-sensitivity Troponin I was significantly elevated after PVI, irrespective of the ablation technique. In CB-group, hsTnI elevation was significantly higher than in RF-group. This disparity may reflect more extensive lesions with cryoablation, without compromising safety. Longterm studies are needed to understand whether this hsTnI elevation is predictive of a lower AF recurrence rate.

Funding Acknowledgement
Type of funding sources: None.
Ejection fraction basal strain ratio (EFBSR), a new accurate echocardiographic deformation parameter to screen cardiac amyloidosis among hypertrophic cardiopathies
Authors: Rique A , Martel H , Piazzai C , Mancini J , Gravier R , Arregle F , Dernys A , Gardenat A , Casalta A C , Renard S , Hubert S , N'guyen K , Habib G 
Published: October 2021

Abstract

Background
Early diagnosis of cardiac amyloidosis (CA) is challenging. Several echocardiographic (echo) parameters have been proposed to differentiate CA from hypertrophic cardiomyopathy (HCM), but their respective value is debated. CA is known to be characterized by a more severe decline in longitudinal deformation parameters as compared with radial function parameters (LVEF). This characteristic justified the use of the ejection fraction strain ratio (EFSR) in these patients. However, since longitudinal dysfunction usually predominates in basal segments (apical sparing), we postulated that a new parameter focusing on LVEF and basal LV deformation (EFBSR: ejection fraction basal strain ratio) will even better discriminate patients with CA from HCM than EFSR and other echo or strain parameters.

Purpose
To compare the accuracy of deformation-based echocardiographic parameters for detecting CA in a population with different causes of LV hypertrophy.

Methods and results
We included 237 subjects, of which 89 patients with CA (77±10.7 years, 72% male, EF: 56.2±12.8%, and mean interventricular septum: 18.3±3.5 mm), 137 patients with hypertrophic cardiomyopathies (HCM), 52 patients with severe aortic stenosis with myocardial remodeling, 20 patients with arterial hypertension, and 20 control patients. Conventional echocardiographic parameters and strain-derived ratios (Relative apical sparing (RELAPS), Ejection Fraction Strain Ratio (EFSR) and EFBSR) were analyzed.
EFBSR and RELAPS presented with the best performance to discriminate CA from other causes of hypertrophy (Area Under the Curve (AUC): 0.880; 95% CI: 0.830–0.929 and 0.903; 95% CI: 0.863–0.943 respectively) (p-value=0.3). In our study, among all the parameters, RELAPS had the best specificity (89.8% vs 88.3% for EFBSR), whereas EFBSR had the best sensitivity (78.7% vs 76.4% for RELAPS). EFBSR ranged from 35.25 to 1.83 and the cutoff value to differentiate CA from other hypertrophic cardiopathy was an EFBSR &gt;7.75.

Conclusions
Our study demonstrates that in patients with LV hypertrophy, a new deformation parameter, the ejection fraction basal strain ratio (EFBSR) can accurately differentiate CA from other causes of myocardial thickening and can be used in routine practice for screening.

Funding Acknowledgement
Type of funding sources: None.
Impact of clinical risk factor profile vs. atrial fibrillation phenotype on outcome after pulmonary vein isolation
Authors: Wittmer S , Chollet L , Baldinger S , Servatius H , Seiler J , Madaffari A , Kueffer T , Muehl A , Asatryan B , Lam A , Noti F , Haeberlin A , Roten L , Tanner H , Reichlin T 
Published: October 2021

Abstract

Aims
Catheter ablation for atrial fibrillation (AF) is increasingly performed. Both clinical risk factors as well as the AF phenotype have been shown to influence ablation outcomes. The inter-relationship of the two however is incompletely understood.

Methods
In a retrospective analysis of a prospective registry of patients undergoing a first pulmonary vein isolation, the association of 8 predefined clinical risk factors (age &gt;70 years, female gender, hypertension, BMI &gt;30 kg/m2, coronary artery disease, heart failure, chronic kidney disease (CKD; eGFR&lt;60ml/min/1.73m2) and diabetes mellitus) and the AF phenotype (paroxysmal vs. persistent AF) were assessed as well as their impact on AF recurrence during follow-up.

Results
Overall, 715 patients were enrolled (median age 63 years, 27% females, 69% paroxysmal AF). The prevalence of obesity, hypertension, heart failure and CKD was significantly higher in persistent AF, while female gender was more prevalent in paroxysmal AF. After 2 years of follow-up, overall freedom from recurrence was 46%, and was higher in paroxysmal AF compared to persistent AF (54.1% vs. 29.1%, p&lt;0.001). Of the clinical risk factors, obesity (p=0.02), CKD (p=0.01) and heart failure (p=0.01) were significantly associated with lower arrhythmia-free survival, and there was a trend for hypertension and coronary artery disease (both p&lt;0.2). A risk score composed of those 5 factors was associated with recurrences in patients with paroxysmal AF (p=0.04, Figure 1), but not in those with persistent AF (p=0.85, Figure 2).

Conclusion
Clinical risk factors predict outcome after pulmonary vein isolation in patients with paroxysmal, but not persistent AF. This is likely due to a strong association of those risk factors with the occurrence of persistent AF.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2