bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reappraising the role of baseline plasma C-reactive protein levels on recurrence after catheter ablation of persistent atrial fibrillation: insight from EARNEST-PVI trial
Authors: Okada M , Inoue K , Tanaka N , Masuda M , Furukawa Y , Hirata A , Egami Y , Watanabe T , Minamiguchi H , Miyoshi M , Sunaga A , Sotomi Y , Dohi T , Hikoso S , Sakata Y 
Published: October 2021

Abstract

Background
Subclinical inflammation is an important pathogenesis of developing and sustaining atrial fibrillation (AF). Because AF itself contribute to the inflammatory response, the role of baseline subclinical inflammation on AF recurrence after catheter ablation (CA) remains controversial in patients with persistent AF.

Purpose
To evaluate whether baseline plasma C-reactive protein (CRP) levels, a sensitive marker of inflammation, are associated with AF recurrence following CA.

Methods
The analysis was performed from the EARNEST-PVI trial, a randomized controlled trial designed to assess a CA strategy for persistent AF, which was conducted in the Osaka region of Japan. A total of 441 patients (median age, 67 years; 26% female; 25% long-standing persistent AF) whose plasma CRP levels were measured at baseline were included in this study.

Results
At baseline, a median (interquartile range) of plasma CRP level was 0.10 [0.06–0.19] mg/dl. Plasma CRP levels significantly increased at discharge (0.83 [0.21–1.84] mg/dl, p&lt;0.001) and decreased 1 year after CA (0.10 [0.05–0.20] mg/dl, p=0.040) compared to the baseline value. During the follow-up of 1 year, 115 patients (26%) experienced AF recurrence, and the incidence was significantly higher in 124 patients with low CRP levels at baseline (cut-off ≤0.06 mg/dl) than the other 317 patients (33.9% vs. 23.0%, p=0.017). After adjustment of age, gender, body mass index, long-standing persistent AF, CA strategy, and plasma brain natriuretic peptide levels, low plasma CRP levels was a significant predictor of AF recurrence (hazard ratio, 1.51; 95% confidence interval, 1.02–2.24; p=0.042).

Conclusions
Low plasma CRP levels at baseline predicted AF recurrence in the EARNEST-PVI trial. Reappraising the role of CRP on AF recurrence may be needed in patients with persistent AF.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Johnson & Johnson KK
Incidence of left atrial appendage thrombus on pre-procedural TOE before catheter ablation of atrial tachyarrhythmias
Authors: Wegner F , Radke R , Ellermann C , Wolfes J , Fischer A.J , Baumgartner H , Eckardt L , Diller G.P , Orwat S 
Published: October 2021

Abstract

Introduction
Transoesophageal echocardiography (TOE) is routinely performed before catheter ablation of atrial tachyarrhythmias to rule out the presence of possible left atrial thrombi. However, data to support this practice are scarce.

Methods
We analysed consecutive pre-procedural TOE in a high-volume electrophysiology centre for the presence of left atrial thrombi and a relevant flow reduction in the left atrial appendage (LAA) defined as LAA sludge or pronounced spontaneous echo contrast. Possible predictors of reduced flow were recorded and compared in a multivariate logistic regression analysis.

Results
1676 consecutive TOE were included (1122 before pulmonary vein isolation (PVI), 436 before atrial flutter ablation, 166 before other EP studies in patients with a history of atrial tachyarrhythmias). 543 patients (32%) were female, mean age was 63±12 years and BMI was 27±5 kg/m2. Nine patients (0.5%) had an LAA thrombus on pre-procedural TOE. Ninety-five further patients (5.7%) had a relevant reduction in LAA flow as characterized by LAA sludge or spontaneous echo contrast. Further patient characteristics by LAA flow state are shown in the table. While a higher CHA2DS2-VaSc-Score was associated with the presence of LAA sludge and LAA thrombus (p=0.01), no further clinical parameters such as choice of oral anticoagulation agent were independently predictive of reduced flow velocities or thrombus in a logistic regression model (see table). Importantly, LAA thrombi also occurred in patients with a CHA2DS2-VaSc-Score ≤1 (n=1) or in sinus rhythm (n=2). Of note, 6 out of 9 patients with a LAA thrombus were anticoagulated with phenprocoumon.

Conclusion
LAA thrombus is a rare occurrence before an elective catheter ablation. In patients with CHA2DS2-VaSc-Score ≤1 the likelihood of LAA thrombus is so low (0.2%) that it may be considered to give up routine TOE before an EP study/ablation.

Funding Acknowledgement
Type of funding sources: None.
Low incidence of major complications after the first six hours post-atrial fibrillation ablation – same-day discharge safe and feasible in most patients
Authors: Paul Nordin A , Drca N , Insulander P , Bastani H , Bourke T , Braunschweig F , Kenneback G , Von Olshausen G , Sadigh B , Saluveer O , Tapanainen J , Schwieler J , Akerstrom F , Jensen-Urstad M 
Published: October 2021

Abstract

Background/Introduction
Catheter ablation of atrial fibrillation (AF) is associated with a complication risk. It is common practice to monitor patients overnight post-procedurally which is resource craving.

Purpose
To evaluate the incidence of procedural complications related to catheter ablation of AF to assess the potential feasibility and safety of same day discharge in a large cohort.

Methods
We performed an analysis of prospectively collected data of complications of all patients staying overnight after undergoing AF ablation between 2001 and 2020 at a tertiary centre. By studying medical records, we analysed complications occurring intraprocedurally until six hours post-ablation, and between six hours post-ablation until discharge the day after ablation procedure (up to 24 hours post-procedure).

Results
In 5414 AF ablations we identified a total of 108 (2.0%) major complications occurring intraprocedural or until discharge the day after procedure. Most major complications occurred early and were detected intraprocedurally or within six hours after completed procedure (n=96, 1.8%). Twelve (0.2%) major complications occurred between six hours post-ablation and until discharge the day after procedure. The most common of these were congestive heart failure (n=6) and transient ischemic attack (TIA, n=4). In addition, there were 61 (1.1%) minor complications which occurred in this time span. Factors independently associated with major complications intraprocedurally or within 24 hours were age (p=0.046), body mass index (BMI) ≥30 kg/m2 (p=0.009), significant valvular disease (p=0.001), cardiomyopathy (p&lt;0.001), prior stroke or TIA (p=0.014), first time procedure vs. repeat procedure (p=0.013), cryoablation vs. radiofrequency (p&lt;0.001) and procedure duration (p&lt;0.001).

Conclusion
Very few complications occurred between six hours and until discharge after ablation of atrial fibrillation. Therefore, same-day discharge may be a safe option for a large proportion of patients.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Region Stockholm funding
Fully automated left ventricular ejection fraction and global longitudinal strain predicts obstructive coronary artery disease in patients undergoing stress echocardiography: a multi-centre study
Authors: O'Driscoll J , Hawkes W , Beqiri A , Mumith A , Parker A , Upton R , McCourt A , Woodward W , Dockerill C , Heitner S , Yadava M , Kaul S , Sharma R , Leeson P , Woodward G 
Published: October 2021

Abstract

Background
Assessment of LVEF and myocardial deformation with GLS has shown promise in predicting CAD, which may add prognostic information for patients undergoing SE. However, selection bias precludes an accurate assessment of routine clinical SE workflow due to the exclusion of poor image quality and contrast enhanced studies. We hypothesise that an artificial intelligence (AI) pipeline capable of fully automated contouring of the left ventricle and GLS analysis of both non-contrast and contrast SE images is feasible and can predict CAD.

Purpose
The aim of this study was to evaluate the prediction of obstructive coronary artery disease (CAD) from fully automated left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) measures in a large multicentre population of patients undergoing stress echocardiography (SE).

Methods
500 patients from five medical centres undergoing SE for the clinical evaluation of ischaemic heart disease were included in this study. LVEF and GLS was automatically calculated using AI in non-contrast and contrast images at rest and peak stress. The primary endpoint was CAD assessed using invasive coronary angiography.

Results
Patients with significant CAD demonstrated significantly reduced LVEF and GLS at rest and peak stress (all p&lt;0.001) compared to those without CAD. Of the 130 patients who exhibited myocardial ischaemia at peak stress, patients without significant CAD (37%) had significantly reduced LVEF and GLS when compared to those who did. Multivariate analysis demonstrated that a peak LVEF (0.93; 95% CI 0.9–0.96) and peak GLS (1.15; 95% CI 1.07–1.24) were significant independent predictors of CAD. The addition of automated LVEF and GLS to basic models significantly improved the C statistic from 0.78 to 0.83 and 0.85 (both p&lt;0.001), respectively.

Conclusions
Fully automated LVEF and GLS in non-contrast and contrast SE images is feasible and independently augment the prediction of obstructive CAD above and beyond traditional SE indexes.

Funding Acknowledgement
Type of funding sources: None.
Screening for anticoagulation undertreatment in more than 100,000 patients with atrial fibrillation in general practices in the Netherlands
Authors: Voorhout L.J , Pisters R , Geurts C.H.P.H , Oostindjer A , Van Doorn S , Rila H , Fuijkschot W.W , Hemels M.E 
Published: October 2021

Abstract

Background and aim
Atrial fibrillation (AF) is associated with a significant morbidity and increased mortality risk, predominantly due to risk of stroke and thromboembolism. Despite availability of highly effective and practical oral anticoagulation (OAC) guidelines recommended therapy is often underutilized. Therefore, we investigated the underuse of OAC in individual AF patients through on-demand screening of general practices (GPs) across the Netherlands.

Methods
We performed a multi-center, cross-sectional study in 39 GPs. Using electronic patient files, we were able to screen the entire GP population for AF, CHA2DS2-VASc scores, and the use of guidelines recommended OAC. In case of OAC undertreatment we checked for any documented reason. Additionally, six weeks following the screening we asked all GPs to provide information on actions taken for the undertreated patients.

Results
In total 101,207 patients records were screened identifying 2,375 non-valvular AF patients with a mean CHA2DS2-VASc score of 3.2. OAC use consisted of direct oral anticoagulants in 1,342/1,984 (68%) and vitamin K antagonists in the remainder of patients. OAC undertreatment was present in 92/1001 (9,2%) males and 102/1374 (7,4%) in females, respectively. Figure 1 shows the GP patient population with AF, divided into groups by CHA2DS2-VASc score and their corresponding antithrombotic therapies. Reasons to withhold OAC were patient refusal (n=10), cardiologist advice (n=7), high risk of bleeding (n=7), and terminal illness (n=4). In 159/194 (82%) patients no reason was reported. Data regarding actions following the identification of OAC undertreatment was available in 29 practices representing 92/194 (47%) of the OAC undertreatment cases. After consultation OAC was initiated in 9/92 (10%) only.

Conclusions
In this large Dutch study among GPs we observe 8.2% undertreatment of OAC in AF patients. More males than females were undertreated as were those with the highest CHA2DS2-VASc scores. Only in a small minority of cases detection of OAC undertreatment lead to OAC initiation. This highlights the need to improve awareness and communication of OAC treatment aimed at preventing strokes.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Higher mortality in frail elderly with atrial fibrillation using oral anticoagulants
Authors: Walgers J.J , Zwart L.A.R , Simsek S , Germans T , Hemels M.E.W , Jansen R.W.M.M 
Published: October 2021

Abstract

Background/Introduction
Frail older persons with falls are often undertreated for atrial fibrillation (AF) due to fear of bleeding complications of oral anticoagulants (OAC). However, the safety of OAC use in frail elderly with AF and falls is not investigated extensively.

Purpose
The aim of the study was to investigate whether frail older persons with falls and OAC for AF have more bleeding complications than patients without OAC and to investigate the association between frailty, OAC therapy (including bleeding complications), and mortality.

Methods
This observational study included frail patients aged 65 years or older who were evaluated for falls between November 2011 and December 2019. Patients using OAC for AF were compared with similar patients without using OAC.
Primary outcomes were death, major bleeding and intracranial bleeding. Secondary outcomes were frailty measured by the Frailty Index and cause of death.

Results
Of the 645 included patients, 132 had AF and used OAC. Patients with AF were more often severely frail (67% vs. 47%, p&lt;0.001) and had a higher mortality during follow up (39% vs. 27%, p=0.005). Patients using OAC had a higher mortality risk compared to the patients without OAC (crude analysis Hazard Ratio (HR) 1.7 (95% confidence interval (CI) 1.3–2.4), p=0.001; after adjustment for age, gender, and frailty index HR 1.4 (95% CI 0.99–1.9) p=0.056). No differences were found in the incidence of major bleedings (10% vs. 7%, p=0.204) or intracranial bleedings (5% vs. 4%, p=0.739) in both groups. The causes of death were similar in both groups, also the incidence of fatal bleedings did not differ (5% vs 7%, p=0.758).

Conclusions
Elderly with falls and AF using OAC are frailer and have a tendency to a higher mortality risk than patients without AF. These frail elderly patients with falls had no more bleeding complications during OAC treatment than comparable patients without OAC. Therefore, withholding OAC out of fear for major bleeding complications is not justified.
It is unclear why elderly persons with AF and OAC are frailer and die sooner, since the incidence of major bleedings and fatal bleedings is equal. Further research should focus why older frail persons with AF are more prone to die.

Funding Acknowledgement
Type of funding sources: None.
Discontinuation of anticoagulation and its associated factors in atrial fibrillation
Authors: Sanchez Bustamante S , Navarro Estrada J.L , Rossi E , Gamarra A.L , Maid G.F , Pizarro R 
Published: October 2021

Abstract

Background/Introduction
Oral anticoagulation has been shown to reduce the incidence of embolic events associated with atrial fibrillation, however the discontinuation of these drugs observed in clinical trials may not be representative of the real-world setting due to the inclusion of selected populations.

Purpose
The objective of the study was to compare whether there is a difference in the incidence rate of discontinuation between vitamin K antagonists and direct anticoagulants and to evaluate the factors associated with non-adherence in patients newly diagnosed with atrial fibrillation.

Methods
This was a prospective cohort study. Adult patients (age &gt;18 years) who had newly started anticoagulation therapy for atrial fibrillation or atrial flutter were enrolled. Patients with previous oral anticoagulation, mechanical prosthetic heart valves or creatinine clearance less than 30 mL/min were excluded. The follow-up period was 12 months. As the treatment allocation was not randomized, a propensity score weighting was performed considering baseline characteristics potentially associated with exposure and outcome. Factors associated with anticoagulant discontinuation were evaluated using a weighted Cox model.

Results
A total of 379 patients were included (mean age 78±9 years, 58% females). The median follow-up was 362 days (IQR 347–370). Loss to follow-up was 1%. The anticoagulation discontinuation rate was 24.6% in the direct anticoagulant group and 15.6% in the vitamin K antagonist group. A weighted model of time to discontinuation of anticoagulation treatment showed a crude HR of 1.40 (95% CI 0.79–2.48) for the direct anticoagulant therapy group compared to the vitamin K antagonist group, and a model adjusted for age, type of atrial fibrillation, radiofrequency ablation, bleeding, number of chronic drugs, and cardiology consultations during follow-up showed an adjusted HR of 1.26 (95% CI 0.75–2.12). The main reason for discontinuation of anticoagulation was high risk of bleeding in the vitamin K antagonist group and performance of a radiofrequency ablation procedure in the direct anticoagulant group. There was no statistically significant difference in the discontinuation rate between both groups when the baseline characteristics of the patients were considered.

Conclusion(s)
There was no statistically significant difference in the discontinuation rate between both groups when the baseline characteristics of the patients were considered.
The study showed that the discontinuation of anticoagulants in atrial fibrillation in our setting was not associated with the type of drug used, the age of patients, or the type of arrhythmia.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Boehringer Ingelheim Figure 1
Non-vitamin K antagonist oral anticoagulant discontinuation in non-valvular atrial fibrillation patients (ASPECT-NOAC)
Authors: Asilturk E , Tulmac M , Badak Ö , Onal T , Aras D , Aciksari G , Alper A.T , Celik A , Katicibasi T , Ozdogan O ,   ASPECT-NOAC Study Investigators
Published: October 2021

Abstract

Background and aim
Data on NOAC discontinuation patterns in Turkey are lacking. We conducted a subgroup analysis in ASPECT-NOAC study to determine anticoagulant discontinuation pattern in AF patients with recently initiated NOAC therapy.

Methods
ASPECT-NOAC was a national, multicenter, 12-month observational study conducted in 34 outpatient cardiology clinics of state, university, private, and research hospitals covering all geographic regions of Turkey. Adult AF patients who were under NOAC therapy for less than four months were enrolled. Patients who discontinued using their NOACs were recorded at the end of 12 months. A comparative analysis of patients with discontinuation of medication was conducted.

Results
This study included 991 non-valvular AF patients. NOAC continuation data were available for 854 patients. During study follow-up, 74 patients (8.7%) discontinued their NOAC medication. Mean age of these patients was 67.1±11.3 years old and 38 patients (51.4%) were female. Most commonly seen comorbidities were hypertension (66.2%) and coronary heart disease (39.2%). 29 patients (39.2%) had permanent (chronic) AF, followed by 26 patients (35.1%) with paroxysmal AF. Major reason for NOAC discontinuation was stated as physician request (n=46, 62%). Following reasons were patient request (n=17, 23%), other (n=9, 12%), and bleeding (n=2, 3%). Patients with NOAC discontinuation had a shorter duration of AF (21.7±41.7 vs 26.2±53.7 months, p=0.017). There was no significant difference of educational levels between medication discontinuation subgroups (p=0.637). Other baseline characteristics and patient disease and treatment awareness levels were similar with the patients who continued their medication. Of 74 patients, two patients died during the study because of cardiac failure.

Conclusion
NOAC continuity rate over 12 months was found to be high. NOAC discontinuation rate were higher in the patients with shorter duration of AF. Further studies with long-term follow-up detailing discontinuation reasons are warranted.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This study was funded by Pfizer.
One year outcome and analysis of peri-device leak of left atrial appendage occlusion devices
Authors: Mansour M , Harnay E , Al Ayouby A , Mansourati V , Jobic Y , Gilard M , Le Ven F , Mansourati J 
Published: October 2021

Abstract

Background
The prevalence of peri-device leak (PDL) of left atrial appendage occlusion (LAAO) devices has been previously reported. However, there have been only few data that compared different existing devices. The aim of this study was to assess the incidence of PDL with both devices WATCHMAN® and AMPLAZER Amulet®, and to evaluate the clinical outcome at 12 months.

Methods
Consecutive patients who underwent LAAO between January 2018 and 2020 were randomly assigned to either WATCHMAN or AMPLATZER Amulet implantation based on a systematic two-week alternation between both devices. LAA measurements were assessed using cardiac computed tomography angiography (CCTA) prior to, and transesophageal echocardiography (TEE) during the procedure. At 8 weeks post-LAAO, patients underwent TEE and/or CCTA to identify the presence of PDL and/or device-related complications. Patients were then followed for 12 months to identify major adverse cardiovascular/embolic events.

Results
The cohort consisted of 51 patients (25 WATCHMAN, 26 AMPLATZER Amulet; mean age 76±7 years; male gender 76%). Both groups were identically matched for demographics, comorbidities and indication for LAAO. There were 19 patients who had PDL (13 WATCHMAN vs 6 AMPLATZER Amulet, P-value=0.033). Of them, 8 (15%) patients had significant PDL (7 WATCHMAN vs. 1 AMPLATZER Amulet, P-value=0.018). On CCTA, the landing zone maximal diameter of the AMPLATZER Amulet device had the strongest correlation with the final deployed device size (Spearman'rho 0.92, P-value&lt;0.0001). In the multivariate analysis, male gender and device type were independent predictors of any PDL (P-values 0.016 and 0.031, respectively). On a mean follow-up of 12 months, the total number of events was more prevalent in the WATCHMAN group (P-value 0.008), but the incidence of cardio-embolic events reached borderline significance (16% vs. 0%, P-value=0.051).

Conclusions
Among patients who underwent LAAO, almost 15% had significant PDL with the majority belonging to the WATCHMAN group. Still, larger studies are warranted to evaluate its effectiveness in stroke prevention.

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