bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiac autonomic function and cognitive performance in patients with atrial fibrillation
Authors: Haemmerle P , Aeschbacher S , Springer A , Eken C , Coslovsky M , Dutilh G , Moschovitis G , Rodondi N , Chocano P , Conen D , Osswald S , Kuehne M , Zuern CS 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Swiss National Science Foundation

OnBehalf
Swiss-AF Investigators

Background
Atrial fibrillation (AF) is associated with loss of cognition and dementia. Cardiac autonomic dysfunction has been linked to cognitive decline. We aimed to investigate if reduced cardiac autonomic function (CAF) is associated with cognitive impairment in AF patients.

Methods
Patients with paroxysmal, persistent and permanent AF were enrolled from a multicenter cohort study if they presented in AF ("AF group") or in sinus rhythm ("SR group") on a baseline 5-minute ECG recording. Parameters quantifying CAF (heart rate variability triangular index (HRVI), mean heart rate (MHR), the root mean square of successive differences (RMSSD) and the standard deviation of the normal-to-normal intervals (SDNN)) were calculated. We used the Montreal Cognitive Assessment (MoCA) to assess global cognitive function.

Results
1,685 AF patients with a mean age of 73 ± 8 years, 29% females, were included. The MoCA score was 24.5 ± 3.2 in the AF group (n = 710 patients) and 25.4 ± 3.2 in the SR group (n = 975 patients). After adjusting for multiple confounders, lower HRVI was associated with lower MoCA scores, both in the SR group (β=0.049; 95% confidence interval (CI): 0.016 to 0.081; p = 0.003) and in the AF group (β=0.068; 95% CI: 0.020 to 0.116; p = 0.006). In the AF group, higher MHR was associated with a poorer performance in the MoCA (β=-0.008; 95% CI: -0.014 to -0.002; p = 0.014 ). Other parameters of CAF were not associated with cognition.

Conclusion
Our data suggest that impaired CAF is associated with worse cognitive performance in patients with AF. Elderly AF patients with impaired HRVI might undergo cognitive testing in order to screen for cognitive impairment.
Endocardial left atrial appendage occlusion in atrial fibrillation: computational fluid dynamics simulations to assess stroke risk
Authors: Masci A , D"alessandro N , Scivoletto A , Severi S , Ansaloni F , Dal Monte A , Tomasi C , Fabbri C , Corsi C 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Percutaneous endocardial left atrial appendage (LAA) occlusion (LAAO) in non-valvular atrial fibrillation (AF) seems comparable to anticoagulation therapy (OAC) as regards thromboembolic risk reduction with a possible additional decrease in major bleeding. LAAO is currently limited to patients with contraindications to OAC, due to its high costs and procedural risks, but better pre-procedural planning and operative techniques might improve the outcome widening practical indications. Computational fluid dynamics (CFD) represents a valuable non-invasive approach to estimate physiologically significant hemodynamic parameters in a complex fluid dynamics system. It might provide a helpful in silico simulation of blood flow patterns within the LA and LAA by using 3D patient-specific models, allowing LAAO planning and effects prediction.

Purpose
This study’s aim was to simulate the fluid dynamics effects of LAAO in AF patients to predict patient-specific hemodynamic changes caused by applying the two most popular devices.

Methods
LAAO was simulated on the 3D LA anatomical models obtained from CT data in 5 AF patients, considering the device specific shape. CFD simulations in AF condition were performed both on the whole LA model and on the models with the LAAO performed with the two devices. Significant fluid dynamics indices (blood velocity, vortex structures, LAA ostium velocity, LA blood stasis) were computed to evaluate the changes in the flow patterns after LAAO in relation to the thrombogenic risk.

Results
Overall we found a more effective washout within the LA after LAAO, in terms of a different spatial distribution of velocities (see figure for a qualitative evaluation of LA blood flow velocity in one patient: (A) model with LA and LAA; models after LAAO applying the Amulet (B) and the Watchman (C) device) and vortex structures (after LAAO, they were decreased in number and increased in size). Moreover, a higher velocity at the mitral valve and at the LAA ostium (peak velocity: 12-17 cm/s in the models with LAA, 40-60 cm/s in LAAO_A and 35-65 in LAAO_W) was detected together with a slightly improved washout effect in terms of blood stasis with the Watchman device (stasis: 3.1-5.7% in the models with LAA, 1.9-4.1% in LAAO_A, 1.7-3.7% in LAAO_W).

Conclusions
A workflow for simulating the fluid dynamics effects of endocardial LAAO in AF was developed and tested. CFD provides a valuable tool to quantify hemodynamic changes after LAAO and assess thrombogenic risk in patient-specific LA and LAA. Our preliminary results suggest that endocardial LAAO favourably affects blood fluid dynamics in the LA. Abstract figure
Safety and acute clinical outcomes of atrial fibrillation catheter ablation in octogenarians: a multicentre evaluation with a matched younger cohort
Authors: Karim N , Kozhuharov N , Jarman J , Furniss S , Veasey R , Ullah W , Vouliotis A-I , Martin C , Kalla M , Osmanagic A , Ginks M , Pope M , Christian Sitcherling C , Gupta D , Wong T 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
Sven Knecht and the International Octogenarian AF ablation group

Background
Octogenarians are a fast-growing demographic with a high burden of atrial fibrillation (AF). There are limited data on procedural safety and acute outcomes of catheter ablation (CA) for AF in this group.

Purpose
Investigation of complications & outcomes in octogenarians undergoing CA for AF.

Methods
Data on all octogenarian patients who underwent AF ablation at nine European cardiology centres between 2013 and 2019 were retrospectively analysed and matched with control patients aged &lt;80 years. The characteristics used for matching were type of AF, type of procedure (de novo or redo), & the year of procedure.

Results
216 octogenarians (81.9 ± 1.9 years; 52.8% females) underwent an AF ablation procedure, and were matched with 216 patients aged &lt;80 years (62.4 ± 9.5 years, 34.7% females), p &lt;0.001 for both. The proportion of paroxysmal and persistent AF was 43.5% & 56.5% respectively in both groups, and 79.3% of the procedures were de novo. RF ablation made up 75.4% & 75.9% (p = 0.90) procedures in octogenarians and controls respectively. 17 complications occurred in 14 (7.9%) octogenarian patients and 11 in 11 (5.1%) patients in the younger matched cohort (p = 0.07). There were 4.2% & 1.9% major complications (p= 0.17) and 3.7% & 3.2% minor complications (p= 0.77) in the octogenarian & younger cohorts respectively. Complications in octogenarians consisted of groin complications (n = 6), pneumonia (n = 3), pericardial effusion (n = 2), phrenic nerve injury (n = 2), pulmonary oedema (n = 1), gastroparesis (n = 1), stroke (n = 1). Acute procedural success rates were 99.1% & 99.5% (p = 0.62) The complication rates were similar for RF; 6.0% vs 5.4% (p = 0.79) and Cryoballoon; 14.0% vs 4.1% (p = 0.09) in both octogenarians and younger cohort respectively.

Conclusion
In spite of significantly higher overall risk profile of octogenarians undergoing AF ablation, there is no difference in acute procedural success and complication rates as compared to younger patients Catheter ablation of AF in octogenerians Octogenarians n = 216 Matched Controls (aged &lt; 80yrs) n = 216 P value Age (yrs), mean (SD)s 81.9 (1.9) 62.4(9.5) &lt; 0.0001 Females, (%) 52.8 34.7 0.0002 CHA2DS2-VASc, mean (SD) 3.6 (1.2) 1.4 (1.3) &lt; 0.0001 Mean LA size, mm 42.8 ± 8.3mm 45.8 ± 16.2 0.062 Impaired LV function, (%) 23.7 17.9 0.206 IHD, (%) 20.7 5.9 &lt; 0.0001 Procedural time (mins), mean (sd) 150.6 (69.7) 148.9 (64.4) 0.914 All complications, n (%) 17 (7.9) 11 (5.1) 0.073
Anterior position of dispersive patch for esophageal protection during atrial fibrillation ablation. A pilot feasibility study
Authors: Futyma P , Burda N , Surowiec A , Kogut A , Iwanski M , Swierczek P , Futyma M , Kulakowski P 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Ablation for atrial fibrillation (AF) carries a significant risk of esophageal injury. Current methods of esophageal protection are invasive, expensive and their cost-effectiveness can be questioned. Standard placement of dispersive patch (DP) at patient’s back exposes esophagus to radio-frequency (RF) current-mediated thermal injury and such complications as esophageal wall ulceration, peri-esophageal injury or life-threatening atrio-esophageal fistula. Redirecting RF current by DP repositioning to anterior chest can theoretically protect oesophagus from thermal injury, however, such an approach has not yet been investigated.

Aim
To determine feasibility of anterior DP position for treatment of AF using RF catheter ablation (RFCA)-based system.

Methods
We retrospectively analysed consecutive patients undergoing RFCA-based pulmonary vein isolation (PVI) using multi-electrode PVAC catheter with DP located either in anterior or traditional-posterior position. Two additional patients underwent point-by-point RFCA and mapping of PV ostia with impedance measurements during RFCA performed using anterior and posterior DP positioning.

Results
62 patients (25 females, age 60 ± 12 years) underwent PVI using PVAC: 40 patients in posterior and 22 in anterior DP group. There were no major complications during procedures. There was no significant difference in AF recurrence rate between anterior and posterior DP groups during one-year follow up (log rank p = 0.065). In two additional consecutive patients (1 female, age 74 ± 2 years) undergoing point-by-point RFCA a total number of 30 measurements around PV ostia were performed. There was a significant difference between impedance values in anterior vs posterior DP positions (134 ± 7 Ω vs 122 ± 8 Ω, p = 0.0004).

Conclusions
Anterior position of dispersive electrode for PV isolation using RFCA-based systems is safe, feasible, atraumatic and is not associated with any additional cost. Apart from redirecting RF current away from the esophagus, anterior dispersive patch placement is associated with higher impedance values which can act as an additional protection. Possible prevention of esophageal complications using anterior dispersive patch positioning needs to be determined in prospective studies. Abstract Figure. AF-free survival and impedance
A novel local impedance algorithm and contact force sensing to guide high power short duration radiofrequency ablation is efficient and safe for circumferential pulmonary vein isolation
Authors: Schreieck J , Heinzmann D , Scheckenbach C , Gawaz M , Duckheim M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Local impedance (LI) drop can predict sufficient lesion formation during radiofrequency ablation (RF). Recently, a novel ablation catheter technology able to measure LI and contact force has been made available for clinical use. High power short duration (HPSD) RF ablation has been shown to be feasible for atrial fibrillation (AF) ablation with short procedure time. We used LI drop and plateau formation to guide duration of 50 Watt RF power applications for circumferential pulmonary vein isolation (PVI).

Methods
Consecutive patients with indication for de novo AF ablation (n = 32, age 65 ± 10 years) with paroxysmal (n = 16) or persistent (n = 16) AF underwent ultra high density 3D mapping of the left atrium and catheter ablation. Thereafter, ipsilateral PV encircling with 50 Watt RF-applications targeting an interlesion distance of ≤ 6mm and a contact force of 10-30g was performed. Duration of HPSD RF application between 7-15s was guided by impedance drop &gt;20 Ohm and plateau formation of LI. Further ablation strategy was left to the investigator’s discretion. Esophageal temperature measurement was performed using a three thermistor catheter with temperature cut off 39.0°C. In case of temperature rise or very near esophageal contact to the circumferential line, RF application time was shortened to 7s. Patients underwent adenosine testing after PVI. Previously we performed all types of AF ablation using an LI guided HPSD ablation without contact force measurement capability in 80 patients.

Results
Complete PVI was achieved in all pts with only 13.5 ± 4.3 min cumulative RF application duration and an ablation procedure duration of 46.5 ± 10.4 min with the novel LI measuring catheter. First-pass isolation of ipsilateral veins was achieved in 75% of circles. Recurrence of PV conduction during waiting period (20min) and adenosine testing occured in 25% of circles, and was reablated in most patients with a single spot of HPSD application. Using 94 ± 36 RF application per patient, mean maximum LI drop was 23.6 ± 4.0 Ohm. Reconnected fibers were associated with low LI drop due to instability of contact in most cases due to breathing in case of difficult sedation of the patients. No serious complications occurred in all 32 pts using HPSD with the novel contact force catheter design.

Conclusion
Guiding of HPSD RF ablation by LI is highly efficient and safe. A novel local impedance algorithm in combination with contact force sensing enable short PVI times with low early recurrence of PV conduction. Prediction of permanent lesions seems possible and the only limitation seems to be unstable RF catheter contact due patients breathing. Follow up have to be waited.
Pulmonary vein isolation for paroxysmal atrial fibrillation using high-power short duration radiofrequency or second-generation cryoballoon ablation
Authors: Kardos A , Kassa K , Nagy Z , Kis Z , Simkovits D , Som Z , Csakany L , Major T , Foldesi C 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Differences in the left atrial (LA) tissue loss can occur following different pulmonary vein isolation (PVI) techniques.

Purpose
Our prospective study compared the biomarker, the LA mechanical, and the electrophysiological findings as indicators of LA myocardial damage after a high-power short duration (HPSD) with contact force radiofrequency catheter and second-generation cryoballoon (CB2) ablation of paroxysmal atrial fibrillation (AF).
Methods :We enrolled 40 patients with paroxysmal AF [16 (40%) women, mean age = 55.9 ± 12.4 years] who underwent HPSD (n = 21) or CB2 (n = 19). Biomarker levels (hs-cTnT, CK-MB, hs-CRP, LDH) and the transport function of the LA by transthoracic echocardiography (TTE) were compared pre and post procedurally. High-density mapping (HDM) was performed in sinus rhythm using a multielectrode diagnostic catheter in each group to define isolated left atrial low voltage area (LVA; &lt;0.2mV in bipolar voltage mapping). LA CT-angiography and HDM merge was used to calculate the post-PVI LVA and the LVA/LA surface ratio.

Results
Postablation hs-cTnT and hs-CRP levels were comparable in the ablation groups (HPSD: 1249 ± 469 and 9.53 ± 10.30 vs. CB2: 995 ± 280 and 12.36 ± 5.76, p = 0.065 and p = 0.732), while CK-MB and LDH levels were significantly higher following CB2 ablation (HPSD: 6.61 ± 2.62 and 349.9 ± 65.6 vs. CB2: 26.01 ± 6.88 and 451.6 ± 91.3, p &lt; 0.001 and p &lt; 0.001). The transport function of the LA did not change significantly by TTE after the procedure. Fractional Area Change at baseline and 3 months was 33.9 ± 13.8 and 33.5 ± 10.7 p = 0.9 in the HPSD group while 38.1 ± 8.6 and 35.3 ± 12.2 p = 0.9 in the CB2 group. LA Ejection Fraction measured in the two groups (before and 3-month post-procedure): HPSD: 51.2 ± 20.5% and 49.5 ± 14.7%, p = 0.9, CB2: 49.7 ± 15.5% and 50.7 ± 13.3%, p = 0.8). Ablation time was comparable in the two groups (HPSD: 1676 ± 570 sec, CB2: 1495 ± 494 sec, p = 0.279), while fluoroscopy time and radiation exposure were significantly higher in the CB2 group (HPSD: 5.62 ± 4.31 min and 232 ± 406 cGycm2, CB2: 13.65 ± 5.18 min and 1819 ± 1669 cGycm2, p &lt;0.001 and p &lt;0.001). The LVA/LA surface ratio were: HPSD group: 8.37 ± 6.42% and CB2 group: 13.58 ± 8.92% (p = 0.007). At 12-month follow-up, the success rate, defined as freedom from AF/atrial tachycardia without antiarrhythmic drug was 80.1% (HPSD) and 84.2% (CB2) respectively.

Conclusions
The LA scar tissue was significantly higher following CB2 ablation, but did not affect medium-term efficacy. However, tissue loss did not reduce the transport function of the LA.
Oesophageal thermal protection during AF ablation: effect on left atrial myocardial ablation lesion formation and patient outcomes
Authors: Leung L , El Batran A , Dhillon G , Bajpai A , Zuberi Z , Li A , Norman M , Kaba RA , Akhtar Z , Evranos B , Al Subaie N , Sohal M , Louis-Auguste J , Hayat J , Gallagher MM 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Dr Leung has received research support from Attune Medical (Chicago, IL). Dr Gallagher has received research funding from Attune Medical (Chicago, IL).

Background
Randomized evidence has shown that controlled oesophageal cooling is effective at reducing oesophageal thermal injury during radiofrequency (RF) ablation for atrial fibrillation (AF) compared to standard care. The effect of oesophageal cooling on ablation lesion formation in left atrial myocardium and patient outcomes at 12-months had not been previously studied.

Purpose
To determine the effect of oesophageal cooling on the formation of RF lesions, the ability to achieve procedural endpoints and long-term patient outcomes compared to standard care ablations.

Methods
Ablation results and patient outcomes from a double-blind randomized controlled trial were analysed (IMPACT trial NCT03819946). AF ablation was guided by Ablation Index technology (30W at 350-400 AI posteriorly, 40W at 450 AI anteriorly). A blinded 1:1 randomization assigned patients to the use of an oesophageal temperature control device to keep oesophageal temperature at 4 degrees during ablation or standard practice using a single-sensor temperature probe. Ablation parameters and 12-month outcomes were analysed.

Results
We recruited 188 patients. Procedure and fluoroscopy times were similar. First pass pulmonary vein isolation and reconnection at the end of the waiting period were similar in both randomized groups (51/64 vs 51/68; p = 0.54 and 5/64 vs 7/68; p = 0.76, respectively). Posterior wall isolation was also similar: 24/33 vs 27/38; p = 0.88. Ablation effect on myocardial tissue, measured in impedance drop, was also similar: 8.6Ω (IQR: 6-11.8) vs 8.76Ω (IQR: 6-12.2; p = 0.25) and median catheter tip temperature was the same at 25.5 degrees. Arrhythmia recurrence was similar at 12 months (20.3% vs 26.8%, from 142 completed assessments; p = 0.66).

Conclusions
Oesophageal cooling has been shown to be effective in reducing ablation-related oesophageal thermal injury during RF ablation. Ablation data show that this protection does not make it any more difficult to achieve standard procedural endpoints or clinical success at 12-months. Abstract Figure. Pyramid frequency plots of AI values
Incidence of new-onset atrial fibrillation after cavotricuspid isthmus ablation for isolated typical atrial flutter: a systematic review and meta-analysis
Authors: Griffin A , Thiyagarajah A , Middeldorp M , Lau D , Sanders P 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
There is a lack of consensus guidelines regarding the continuation of anticoagulant therapy following cavotricuspid isthmus (CTI) ablation for typical atrial flutter. This is despite a significant number of patients developing new-onset atrial fibrillation (AF) following the procedure. Furthermore, a summary of Kaplan-Meier estimates for drug-free, arrhythmia-free survival has never been reported.

Purpose
To estimate the incidence of drug-free, new-onset AF stratified by rhythm monitoring strategy in patients undergoing CTI ablation for isolated typical atrial flutter.

Methods
PubMed, Embase and MEDLINE databases were searched to identify relevant studies. Only studies where anti-arrhythmic drugs were discontinued post-ablation and that accounted for patient censoring by reporting results in the form of time to event data were included. Data was extracted from published Kaplan-Meier curves using a digitizing software and confidence intervals for the survivor function were estimated based on the number at risk at the time point of interest. Results were pooled in a random effects model using the DerSimonian-Laird estimator.

Results
Thirteen relevant studies incorporating 1712 patients (79 % male, mean age 63.2 +/-11.2 years, LVEF 55.2 +/-10.8%) were identified. The estimated freedom from new-onset atrial fibrillation was 89.7% (95% CI: 80.3-90.1%) at 1 year and 86.2% (95% CI: 78.4-94.0%) at 2 years in patients undergoing predominantly symptom –based monitoring, 74.6% (95%CI: 67.0-82.3%) at 1 year and 69.5% (95%CI: 63.5-75.6%) at 2 years in patients undergoing regular clinic follow-up with periodic Holter monitoring and 51.4% (95% CI: 41.8-61.0%) at 1 year and 22.7% (95% CI: 8.7% - 36.6%) at 2 years in patients with implantable loop recorders.

Conclusion
With the advent of implantable loop recorders, it is apparent that most patients with isolated atrial flutter manifest new-onset AF following CTI ablation and the merits of discontinuing anticoagulation must be carefully considered in this population. Symptom-based monitoring likely severely underestimates the incidence of new-onset AF and may lead to adverse outcomes, particularly in patients with a high risk of stroke.