bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is the optimal blanking period duration after cryoballoon pulmonary vein isolation impacted by use of antiarrhythmic drugs?
Authors: Musat D , Milstein NS , Saberito M , Bhatt A , Habibi M , Sichrovsky T , Preminger MW , Shaw RE , Mittal S 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cryoballoon pulmonary vein isolation (CB) is an accepted method for ablation in patients with atrial fibrillation (AF). A three-month blanking period (BP) is commonly used in clinical trials and practice. However, when the optimal BP duration differs in patients (pts) on or off an antiarrhythmic drug (AAD) at time of ablation remains undefined.

Objective
To compare the BP duration in pts undergoing CB while either taking or not taking an AAD.

Methods
We enrolled consecutive pts with AF who had CB PVI while on an AAD. All pts had an implantable loop recorder (ILR). We prospectively followed all pts and determined the time to last AF episode during the 90-day post-PVI BP. This was then correlated with likelihood of having an AF recurrence between 3-12 months post-PVI.

Results
The cohort included 164 pts (66 ± 9 years; 97 [60%] male; 90 [55%] PAF; CHA2DS2-VASc 2.7 ± 1.7). Ablation was performed with 92 (56%) pts taking an AAD, which was stopped at a median of 80 [36, 105] days post-PVI. We defined 4 distinct groups: (1) no AF in 90-day BP (n = 75 [46%]); (2) last AF within 30 days of PVI (n = 32 [20%]); (3) last AF within 60 days of PVI (n = 17 [10%]); and (4) last AF within 90 days of PVI (n = 40 [24%]). Following the 90-day BP, 81 (49%) pts had a recurrence of AF. Long-term freedom from recurrent AF was similar in pts who did and did not use an AAD, irrespective of BP duration (Figure).

Conclusion
Our data suggest that the optimal BP duration in AF patients undergoing CB PVI while taking an AAD is 30 days. An AF recurrence after 30 days is associated with a very high likelihood of recurrent AF during longer-term follow-up, irrespective of whether an AAD is being used or not. Abstract Figure.
Characterization of conduction gaps at the pulmonary vein antra by omnipolar voltage mapping
Authors: Merino JL , Kim S , Castrejon S , Relan J , Sanroman-Junquera M , Martinez-Cossiani M , Escobar C , Carton A 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Abbott provided some software to perform special maps

Introduction
Voltage mapping of atrial tissue may be influenced by the direction of the activation front. Omnipolar electrograms may result in better characterization of the atrial tissue. However, little is known about characterization of the pulmonary vein (PV) antra with omnipolar mapping in patients with recurrent atrial fibrillation (AF) following PV isolation (PVI).

Purpose
To study differences in voltage between regions with (Gap) and without (No-Gap) conduction recurrence at the PV antra by both omnipolar and conventional bipolar mapping in redo PVI procedures.

Methods
Single centre prospective study of consecutive patients who underwent a redo PVI procedure for AF ablation. Activation and voltage bipolar maps were developed on a electroanatomical system (Ensite Precision) by a steerable catheter with a 16 grid-patterned electrode configuration (HD-Grid) during coronary sinus pacing at both 500 and 300 ms. Precise location of conduction gaps in the PV antra was attempted by atrial and PV pacing. Only conduction gaps that were ablated by ≤3 focal radiofrequency applications were included in the analysis. Electrograms recorded within 1 cm at both sides of the RF application site were considered related to the gap region. Off-line omnipolar voltage maps were developed with a dedicated experimental software after the procedure .

Results
11 patients were included in the study and 18 gaps were found in 9 patients. 6762 (2688 Gap and 4074 No-Gap) electrograms were analyzed. Compared with No-Gap PV regions, Gap regions showed significantly (P &lt; 0.0001) higher voltages by omnipolar mapping (0.3 ± 0.6 mV vs 1.1 ± 1.4 mV) and by absolute (0.2 ± 0.5 mV vs 0.8 ± 1.2 mV), grid-along (0.3 ± 0.5 mV vs 0.8 ± 1.2 mV) and grid-across (0.3 ± 0.5 mV vs 0.8 ± 1.1 mV) bipolar mapping. Omnipolar mapping resulted in higher voltage electrograms when compared with absolute bipole, longitudinal and horizontal bipolar electrograms (P &lt; 0.0001). ROC curves (figure) to differentiate between Gap and No-Gap regions were slightly better for omnipolar electrograms (AUC 0.79) than for conventional grid -along or grid-across bipolar mapping (AUC 0.76 and 0.77) with the best discrimination value of 0.3 and 0.2 mV respectively. Conclusion: There are significant differences in voltage between conduction Gap and No-Gap regions at the PV antra which are more apparent with omnipolar than with conventional bipolar mapping. 0.3 mV and 0.2 mV values are the best to differentiate between PV conduction Gap and No-Gap regions with ominpolar and conventional mapping respectively
Efficacy and safety of hybrid convergent procedure vs endocardial catheter ablation for the management of atrial fibrillation
Authors: Abdul Razzack A , Rahman S , Pasam T , Pasam C , Saeed T , Khokhar HT , Pothuru S , Adeel Hassan S , Mandava S , Theja Reddy K , Kumar R , Kumar S , Sattar Y 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background- Little is known regarding the efficacy and safety of hybrid convergent epicardial and endocardial approach (CVP) that has emerged as an alternative to endocardial catheter ablation (CA) for the management of persistent and paroxysmal atrial fibrillation.
Methods-Electronic databases ( PubMed, Embase, Scopus) were searched from inception to Jan 6th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p &lt; 0.05. The primary outcome of interest was recurrence of atrial tachyarrhythmia {Atrial fibrillation (AF)/Atrial flutter(AFL) /Atrial tachycardia(AT)} Secondary outcomes included any intervention (DC Cardioversion (DCCV), repeat ablation) and major adverse events (MAE).
Results- A total of three studies with 336 (CVP = 190, CA = 146) participants were included. CVP was associated with significantly higher freedom from atrial tachyarrhythmia recurrence compared with CA therapy (RR 0.60, 95% CI 0.45-0.78; p = 0.0002; I2 = 0). Patients receiving CVP had lower odds of requiring any re-intervention (DCCV, repeat ablation) when compared to CA therapy (RR 4.11, 95% CI 1.17-14.46; p = 0.03; I2 = 0). However, CVP was associated with significantly higher rate of major adverse events (RR 0.44, 95% CI 0.30-0.65; p= &lt;0.0001; I2 = 0).
Conclusion-Treatment with Hybrid convergent ablation seems to be superior than endocardial catheter ablation for prevention of arrhythmia recurrence but may also cause more severe adverse effects. Abstract Figure.
Number needed to treat for net effect of anticoagulation in atrial fibrillation
Authors: Ding WY , Rivera-Caravaca JM , Marin F , Li G , Roldan V , Lip GYH 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The benefit of oral anticoagulation (OAC) in atrial fibrillation (AF) must be balanced against any potential risk of harm. We aimed to evaluate the "NNT for net effect" (NNTnet) using CARS in anticoagulated patients with AF.

Methods
We used patient-level data from the real-world Murcia AF Project and AMADEUS clinical trial. Baseline risk of stroke was calculated using CARS while major bleeding was estimated from prior studies. Stroke and major bleeding events at 1-year were determined. NNTnet was calculated as a reciprocal of the net effect of ARR with OAC (NNTnet= 1 / (ARRstroke - ARIbleeding)).

Results
3,511 patients were included (1,306 [37.2%] real-world patients and 2,205 [62.8%] clinical trial). The absolute 1-year stroke risk was similar across both cohorts and the main results are presented in the Table.
In both cohorts, the NNTnet was significantly lower in patients with an excess stroke risk of ≥2% by CARS. Among real-world patients with a very high (&gt;10%) baseline stroke risk, the use of OAC was associated with an ARRstroke of 10.9% and ARIbleeding of 1.2%, generating an overall NNTnet of 11. In the clinical trial, the use of OAC was associated with an ARRstroke of 11.0% and ARIbleeding of 0.6%, generating an overall NNTnet of 10.

Conclusion
Overall, the NNTnet approach in AF incorporates information regarding baseline risk of stroke and major bleeding, and relative effects of OAC with the potential to include multiple additional outcomes and weighting of events based on their perceived effects by individual patients. This simple and intuitive metric may be useful to improve communication and optimise the patient-centred management of AF. NNT in Real-World and Clinical Trial Real-World Clinical Trial Ischaemic stroke risk at 1-year Baseline risk without anticoagulation (%) 5.7% (95% CI 5.5 - 6.0) 5.1% (95% CI 4.9 - 5.3) Anticoagulation-mediated risk (%) 1.7% (95% CI 1.1 - 2.6) 1.3% (95% CI 0.8 - 1.8) Absolute risk reduction (%) 4.0% 3.8% NNTbenefit 25 27 Major bleeding risk at 1-year Baseline risk without anticoagulation (%) 2.3% 2.3% Anticoagulation-mediated risk (%) 3.3% (95% CI 2.4 - 4.4) 3.9% (95% CI 3.1 - 4.8) Absolute risk increase (%) 1.0% 1.6% NNTharm 100 63 NNTnet 34 46
Contemporary data evaluating 1-year clinical outcomes in patients with atrial fibrillation and coexisting valvular heart disease: the ETNA-AF-Europe study
Authors: De Caterina R , Ricci F , De Groot JR , Deharo JC , Waltenberger J , Weiss TW , Kirchhof P 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Europe

OnBehalf
ETNA-AF-Europe investigators

Background
Valvular heart disease (VHD) is a common comorbidity in patients with atrial fibrillation (AF); the optimal anticoagulant treatment of such patients remains largely unexplored. Purpose: To evaluate differences in the baseline characteristics and 1-year event profiles of edoxaban-treated AF patients with or without VHD. Methods: ETNA-AF-Europe prospectively enrolled 13,980 patients with AF from 825 centres in 10 European countries. Baseline characteristics and 1-year annualised event rates for edoxaban-treated AF patients with or without VHD were compared using descriptive analyses. VHD was defined as reported by investigator. Results: Of the 13,092 AF patients who completed the 1-year of follow-up, 2,314 patients had VHD and 10,778 did not have VHD at baseline. Patients with VHD were older, had lower body weight and worse renal function, a higher stroke score, and were considered more frail by their physician than patients without VHD (Table). Patients with VHD had higher annualised event rates of all-cause mortality, stroke or systemic embolic events and bleeding events than those without VHD (Figure). However, rates of intracranial haemorrhage and myocardial infarction were similar between those with and without VHD. Conclusions: Patients with or without VHD had low rates of adverse events on receiving edoxaban treatment. Patients with VHD had more comorbidities at baseline and a higher risk of mortality, major bleeding and stroke but not of ICH versus those without VHD after 1 year of treatment. Baseline characteristicsOverall (n = 13,092)Patients with VHD (n = 2314)Patients without VHD (n = 10,778)Male, n (%)7430 (56.8)1245 (53.8)6185 (57.4)Age (years), mean ± SD73.6 ± 9.575.9 ± 8.673.1 ± 9.6Body weight (kg), mean ± SD81.0 ± 17.378.0 ± 15.981.6 ± 17.5CrCl (Cockcroft-Gault) (mL/min), mean ± SD74.3 ± 30.466.0 ± 26.476.0 ± 30.9CHA2DS2-VASc, mean ± SD3.1 ± 1.43.5 ± 1.33.0 ± 1.4Modified HAS-BLED, mean ± SD2.5 ± 1.12.8 ± 1.12.4 ± 1.1Frailty, n (%)1392 (10.6)381 (16.5)1011 (9.4)Current AF type Paroxysmal Persistent Long-standing persistent & permanent7039 (53.9)3159 (24.2)2864 (21.9)1083 (46.9)578 (25.0)648 (28.0)5956 (55.4)2581 (24.0)2216 (20.6)*Frailty was subjectively assessed as perceived by the investigator. AF, atrial fibrillation; CrCl, creatinine clearance; OD, once daily; SD, standard deviation; VHD, valvular heart disease.Abstract Figure. One-year outcomes
Short dual antiplatelet strategy following left atrial appendage closure with Watchman and Watchman FLX: 1-year outcomes
Authors: Briosa E Gala A , Pope MTB , Monteiro C , Leo M , Betts TR 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Left atrial appendage occlusion (LAAO) is an effective stroke prevention strategy in patients with non-valvular atrial fibrillation and high bleeding risk. Oral anticoagulation or dual antiplatelet (DAPT) therapy is recommended for the period of device endothelisation but confers an increased bleeding risk.

Purpose
This study sought to examine the one-year outcomes of a short DAPT strategy following LAA occlusion in a large UK tertiary centre.

Methods
This retrospective study included all patients discharged on a short DAPT strategy (6-8 weeks) following a LAAO device implantation from January 2010 and December 2020 in our institution. Medical notes, procedural, and imaging reports were reviewed and adverse event rates were calculated at one year. Yearly bleeding risk was extrapolated from the Swedish National Cohort study according to CHA2DS2-VASc and HASBLED score.

Results
A total of 140 patients (106 Watchman and 36 Watchman-FLX) were discharged on a planned short DAPT strategy (age 74 ± 9 years, 70% male, 71% had previous bleeding on OAC, 95% previous major or life-threatening bleeding episodes, 52% previous ischaemic stroke, CHA2DS2-VASc score 4.5 ± 1.2, HASBLED score 3.2 ± 0.7). The median time to switching to either single antiplatelet (APT) or no ATP was 62 days. After first follow-up, 90% were either on SAPT (46.3% aspirin and 39.3% clopidogrel) or no ATP (6.4%). Seven (5%) patients had device-related thrombus on transoesophageal echocardiography and were started on anticoagulation and 4 (3.5%) patients remained on DAPT. At one year, of the 129 patients on a short DAPT strategy the composite of death, ischaemic stroke and non-procedural bleeding occurred in 11 patients (KM 8.9%; 95% CI, 3.7% -13.8%). Four patients (3.1/100 patient-years) suffered a major bleed and 3 (2.3/100 patient-years) had an ischaemic stroke on SAPT (mean time of 315 days). Compared to estimated annual stroke and bleeding risk adjusted for CHA2DS2-VASc and HASBLED score, this represents a 65% and 38% relative risk reduction in ischaemic stroke and major bleeding, respectively.

Conclusion
In our cohort, a short DAPT strategy following LAAO device appears safe with reduction of both thromboembolic and major bleeding events at 1-year. Abstract Figure 1
Prediction of Left Atrial Appendage occluder size based on 3D printed models
Authors: Hudec M , Chovancik J , Jiravsky O , Hecko J , Miklik R , Sknouril L 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
occlusion of the left atrial appendage (LAA) is an established method in the prevention of thromboembolic complications in patients with atrial fibrillation and high bleeding risk. There is a huge anatomical variability of LAA and choosing the right type and size of the occluder may be challenging and result in a time-consuming procedure with repeated repositioning of the selected device, or a need to use another device. These aspects may lead to a prolonged or more aggressive manipulation resulting in periprocedural complications and a suboptimal result. The current technology of 3D printing allows us to obtain a real model of the LAA and to simulate the course of implantation.

Purpose
in a post-hoc analysis to compare occluder sizes predicted as optimal by simulation on a 3D-printed LAA model to actually implanted LAA occluders, and analyse potential benefits of such simulations.

Methods
We analysed 32 consecutive patients after a TEE-guided implantation of the Amulet occluder in whom a CT cardiac scan had been performed prior to the procedure. Based on the CT, an LAA 3D model was printed out post-hoc for each patient. Two experienced operators blinded to the procedural results simulated the implantation ex-vivo and agreed on the most appropriate size of the occluder to fit in the LAA. If the simulation-based size matched the size of the primary operator`s choice and this occluder was actually implanted („intention-to-implant and implanted"), the match was considered positive; otherwise it was negative. The number of positive and negative matches and corresponding procedural characteristics were analysed.

Results
The positive match was found in 9 (28.1%) cases. Out of 23 (71.9%) negative matches, there were 11 (47.8%) implantations using a bigger-than-simulated and 12 (52.2%) smaller-than-simulated occluder; in 2 (8.7%) cases the actually implanted occluder matched the simulated size but was a 2nd -choice occluder. In positive-match cases compared to negative-match cases, there was a statistically significant less need for an occluder reposition (median 0.0 vs 1.0, p = 0,02), and a trend to a shorter procedural time (average 66.7+ 13.3 min vs 85.2 + 32.8 min, p = 0.112) and less contrast agent consumption (average 188.9 + 67.9ml vs 220.9 + 112.4ml, p = 0.43).

Conclusion
The preliminary results of our study suggest that a CT-based 3D modelling of the LAA shape and simulating the LAA occlusion procedure ex-vivo have a potential to become useful tools to reduce procedural time and complications. Our results might serve as a rational for a prospective study. Abstract Figure. Occluder in the 3D model
Left atrial appendage closure in the presence of thrombus: incidence, technique and outcomes
Authors: Fontenla Cerezuela A , Gomez-Blazquez I , Corros C , Rodriguez D , Borrego-Bernabe L , Marco Del Castillo A , Ramos-Jimenez J , Solis J , Sarnago F , Lopez-Gil M , Bueno H , Salguero R , Arribas F 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background
Patients with left atrial appendage (LAA) thrombus are excluded for LAA occlusion (LAAO) in clinical trials. However, some of them may require this therapy due to repeated thromboembolisms despite accurate anticoagulation.

Aim
The aim of the study is to describe the prevalence of LAA thrombosis in patients submitted for LAAO in a high-volume center of LAAO procedures, explaining the employed technique and results in this scenario.
Methods
Single-center retrospective analysis including all consecutive patients referred for LAAO.
Results
LAA thrombus was detected by TEE in 8/76 patients referred for LAAO (10.5%). Five of them underwent LAAO despite the presence of thrombus due to clinical conditions. All the procedures were successfully performed with Amulet devices (Table). The following preventive measures were putting in place during the implants: avoidance of contrast injection into the LAA during the procedure (non-touch technique), TEE measure for device size election; and TEE device deployment guidance with special care to the the sheath orientation and depth enabling a slow and single implant of the device partially released in the LAA before complete implantation at the entrance of the LAA (Figure. A&B: Large LAA thrombus partially occupying the landing zone. C: Thrombus sealed by LAAO device. D&E: Non-touch technique: echo-guided progressive deployment of the LAAO device without thrombus shifting). No cerebral protection devices were used. TEE performed one month after the procedure ruled out the presence of residual thrombi or leaks in all cases. There were no events after a median follow-up of 17.1 months (range: 32.3-1.1)

Conclusion
LAAO in patient with LAA thrombus can be effectively and safely performed, in high-volume centers and with an accurate technique, under accurate TEE guidance. Abstract Figure. LAA thrombus and occlusion technique
Comparison of conventionally performed and electroanatomic mapping system guided catheter ablation for AV nodal reentrant tachycardia - prospective single-centre study
Authors: Dorottya D , Janosi K , Vilmanyi G , Simor T , Kupo P 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Radiofrequency (RF) catheter ablation in atrioventricular nodal reentry tachycardia (AVNRT) is highly effective. Three-dimensional electroanatomic mapping system (EAMS)-guided procedures are becoming more widespread.

Purpose
We aimed to compare EAMS-guided procedures to conventionally, only-fluoroscopy approach for slow pathway ablation.

Methods
152 patients undergoing electrophysiological study and slow pathway ablation due to documented AV nodal reentrant tachycardia were included in our prospective single-centre study. In 102 patients the procedure was performed conventionally (Group 1) and 50 patients underwent an electroanatomic mapping system (EAMS) -guided approach (Group 2).

Results
In Group 2, 80% of the procedures were performed without the use of radiation. The procedure time (median (interquartile range): 65 (50-84) min vs. 75 (60-96.3) min, p =0.005) was significantly shorter in Group 1, with longer fluoroscopy time (4.2 (2.4-7.9) min vs. 0 (0-0) min, p &lt; 0.001). There was no difference either in the number of RF applications (mean ± standard deviation 10.8 ± 8.5 vs. 10.2 ± 7.7, p = 0.66) or in the ablation time (297 ± 237 s vs. 294 ± 196 s, p = 0.74). All patients were treated successfully. One recurrence occurred in each groups during the follow-up.

Conclusions
In our series, EAMS-guided approach for slow pathway ablation was associated with reduced fluoroscopy and longer procedure time compared to conventional, only-fluoroscopy approach. No difference was found in ablation time, success rate or recurrence.