bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cryoablation versus anti-arrhythmic therapy for initial treatment of atrial fibrillation: a systematic review and meta-analysis
Authors: Patel M M , Changal K , Patel N , Elzanaty A 
Published: October 2021

Abstract

Introduction
Atrial fibrillation is a common cardiac arrhythmia that affects approximately 2% of the overall population. Guidelines suggest the use of anti-arrhythmic agents as initial therapy in patients with symptomatic atrial fibrillation, however using cryoablation as a first line therapy might have increased efficacy. The safety and efficacy of cryoablation as initial therapy has not yet been established.

Purpose
We performed a systematic review and meta-analysis of randomized controlled trials to investigate the use of cryoballoon catheter ablation compared to anti-arrhythmic therapy as an initial intervention to prevent recurrence of atrial tachyarrhythmias in patients with atrial fibrillation. We also wanted to determine if using this initial ablative approach did not present increased adverse events.

Methods
A comprehensive search of multiple databases was performed to find randomized control trials that directly compared cryoablation therapy versus anti-arrhythmic therapy as initial treatment for patients with atrial fibrillation. A total of three RCTs met the inclusion criteria (724 patients) and were used in the meta-analysis. The primary outcome of our meta-analysis was recurrence of atrial tachyarrhythmias. The secondary outcome evaluated serious adverse events of each therapy.

Results
The results showed a statistically significant reduction of recurrence of atrial tachyarrhythmic events in patients receiving cryoablation compared to anti-arrhythmic therapy [Risk Ratio (RR): 0.60, 95% CI (0.49, 0.72), P&lt;0.ehab724.03521, I2=0%]. There was no significant difference in serious adverse events between patients receiving cryoablation compared to patients receiving anti-arrhythmic therapy. [Risk Ratio (RR): 1.19, 95% CI (0.71, 2.00), P=0.52, I2=0%].

Conclusion
Our meta-analysis showed that cryoablation therapy as an initial therapy is more efficacious than anti-arrhythmic therapy in patients with atrial fibrillation without an increased risk of serious adverse events.

Funding Acknowledgement
Type of funding sources: None.
Evolution in lesion index durability using the new third generation laser balloon catheter for pulmonary vein isolation – does the mechanical innovation mean also clinical innovation?
Authors: Tohoku S , Bordignon S , Chen S , Chun K R J , Schmidt B 
Published: October 2021

Abstract

Background
The new second- and third-generation endoscopic ablation systems (EAS 2 and EAS 3) have been launched in recent years. We aimed to assess the index lesion durability as well as gap localization using the multigenerational novel technologies in patients with recurrent atrial fibrillation (AF).

Methods
Consecutive patients who underwent the second ablation for recurrent AF following the initial pulmonary vein isolation (PVI) with EAS 2 or EAS 3 were investigated. The persistent durability of PVI and gap localization at the second procedure were analyzed using spiral mapping catheter and three-dimensional mapping system.

Results
A total of 34 patients (EAS3: N=13, 50 PVs, EAS2: N=21, 82 PVs) were enrolled. Repeat procedure was performed mean 11.9±9.3 months after the initial procedure. Persistent durable isolation of all four PVs was recorded in 6 (46.2%) patients in EAS3 and 4 (19.1%) patients in EAS2 (P=0.130). Ninety-one out of 132 (68.9%) PVs were persistently isolated with a higher rate in EAS3 (EAS3: 82.0% vs. EAS2: 61.0%, P=0.0113). A total of 45 gaps were recorded in 41 PVs, of which right superior PV (RSPV) was the predominantly common reconnected vein (15 gaps in 14 PVs) irrespective of generation difference (EAS 3: 4 gaps in 3 PVs and EAS 2: 12 gaps in 11 PVs). Anterior-segment of RSPV was the most common gap distribution (EAS 3: 2 gaps and EAS 2: 6 gaps). Logistic multivariate regression analysis revealed high-dose (≥8.5W) only ablation as an independent predictor of durable PVI (adjusted OR: 3.70, 95% CI [1.408 - 10.003], P=0.008)

Conclusion
The multigenerational technical innovation resulted in a higher index lesion durability in EAS3 guided PVI in patients with recurrent AF. The specific gap patterns frequent at RSPV, especially at the anterior-superior segment, and the feasibility of high-dose ablation were confirmed in successor EASs.

Funding Acknowledgement
Type of funding sources: None.
Optimal ablation targets during second catheter ablation in patients with persistent AF
Authors: Mohanty S , Trivedi C , Della Rocca D G , Gianni C , MacDonald B , Mayedo A , Bassiouny M , Gallinghouse G J , Burkhardt J D , Horton R , Al-Ahmad A , Di Biase L , Natale A 
Published: October 2021

Abstract

Introduction
Pulmonary vein isolation (PVI) is the cornerstone of ablative therapy in atrial fibrillation (AF). However, the one-year success rate after single ablation procedure is known to be up to 60%, necessitating repeat procedures in many.

Purpose
We evaluated the impact of different ablation strategies on procedural success at the second ablation in patients with persistent AF (PerAF).

Methods
Consecutive PerAF patients scheduled to undergo their second ablation were screened and only those that have received PVI plus isolation of left atrial posterior wall (PWI) and superior vena cava (SVC) at the first procedure (n=1390), were included in the analysis. At the second ablation, all reconnected structures were ablated. Additionally, based on operators' decision, non-PV triggers were targeted for ablation.
Patients were classified into two groups based on the ablation strategy: group 1: Re-isolation of reconnected PVs, PW, SVC and group 2: additional ablation of non-PV triggers (from inter-atrial septum, coronary sinus (CS), left atrial appendage (LAA) and crista terminalis). Arrhythmia-monitoring was performed quarterly for 1 year and biannually afterwards. Ablation success was assessed off-antiarrhythmic drugs (AAD).

Results
Of the 1390 patients included in the analysis, 698 were in group 1 and 692 were in group 2.
In group 1, reconnected PV, PW and SVC were re-isolated in 98 (14%), 311 (44.5%) and 173 (24.8%) respectively. In 131 (18.7%) patients, in the absence of any reconnection, CS was empirically isolated.
In group 2, PV, PW and SVC were re-isolated in 83 (12%), 270 (39%) and 113 (16.3%) patients respectively. Additionally, non-PV triggers were ablated in 505 (73%) and empirical isolation of LAA and CS in the absence of detectable triggers and PV reconnection was performed in 187 (27%).
At 2 years of follow-up, 425 (61%) and 602 (87%) from group 1 and 2 were arrhythmia-free off-AAD (p&lt;0.001).

Conclusion
Including non-PV triggers as targets for ablation at the repeat procedure was associated with significantly higher success rate in persistent AF.

Funding Acknowledgement
Type of funding sources: None.
Acute safety and performance outcomes from the inspIRE trial using a novel pulsed field ablation system for the treatment of paroxysmal atrial fibrillation
Authors: De Potter T , Reddy V , Neuzil P , Rackauskas G , Anic A , Grimaldi M , Di Biase L , Natale A 
Published: October 2021

Abstract

Background/Introduction
The inspIRE clinical trial was designed to assess the safety and efficacy of a fully integrated biphasic pulsed field ablation (PFA) system comprised of a multi-channel generator, variable decapolar irrigated loop circular catheter, and mapping system (Figure A) for the treatment of paroxysmal atrial fibrillation (PAF).

Purpose
Using this novel PFA system in a multicentre clinical trial, we present the initial feasibility of electrical pulmonary vein isolation (PVI), procedural performance, and acute safety results.

Methods
inspIRE is a prospective, non-randomized, multi-centre study, planned to enrol up to 550 patients. PVI is performed with the novel, variable loop circular catheter, compatible mapping system and generator. Acute procedural effectiveness (entrance block in all clinically targeted PVs post adenosine/isoproterenol challenge) and the incidence of primary adverse events (PAEs) were assessed. PAEs are defined as the occurrence of cardiac tamponade/perforation, myocardial infarction, stroke/cerebrovascular accident, thromboembolism, transient ischemic attack, permanent phrenic nerve paralysis, pulmonary edema, pericarditis, and any major vascular access complications within 7 days of the ablation procedure. Additionally, any incidence of procedure or device related death, atrio-esophageal fistula, or PV stenosis (related to the ablation procedure or study catheter) within the 12M follow-up period is classified as a PAE.

Results
A total of 35 PAF subjects (age 59.7±10.7 years, 54.3% male) were treated across 5 European sites by 6 operators. Acute procedural success was achieved in 100% of study subjects (Figure B) with zero incidence of PAEs. Mean total procedure time was 82.9±19.9 minutes with 27.0±11.9 minutes of PFA from first to last application. Average fluoroscopy use was 10.6±6.8 minutes and LA dwell time was 45.6±15.3 minutes.

Conclusion
Initial results of the inspIRE trial demonstrate the acute safety and effectiveness of the new integrated IRE circular catheter, mapping system and generator for PVI in PAF patients.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): inspIRE is a company-sponsored study funded by Biosense Webster, Inc. Figure 1. (A) PFA System; (B) PVI Voltage Map
Complications of epi- and endocardial pacing in children
Authors: Dzhaffarova O , Svintsova L , Plotnikova I 
Published: October 2021

Abstract

Aim
To analyze complications of cardiac pacing in children depending on the implantation method.

Actuality
Recently epicardial lead implantation becomes more and more popular either due to more serious complications of transvenous pacing or due to possibility of choice of hemodynamically optimal pacing zone.

Methods and materials
242 patients with pacemakers are under our supervision. Epicardial pacemakers were implanted to 145 patients, endocardial – to 97 patients. In “old era” in most children the primary epicardial implantations were performed at RV free wall. In 27 children, having primary implantation at our Institute lately, the epicardial lead was placed at LV apex, or endocardial – at RV apex.

Results
The comparative analysis of complications of epi- and endocardial implantation showed the following results: 22% of complications at epicardial stimulation, and at transvenous stimulation – 45%.
The most often complications at epicardial stimulation (53%) were connected with hemodynamic disorders – dyssinchronous cardiomyopathy. Hemodynamic complications, connected with dyssinchrony of endocardial RV pacing, were disclosed in 16%.
The most often complication of endocardial stimulation was TV insufficiency (32%). Venous vessel thrombosis was diagnosed in 9%.
Epicardial and transvenous lead failure was discovered in similar percentage ratio (28%).
Infectious complications of transvenous pacing, especially, bacterial endocarditis, took place in 6,8%. Thus, progressive bacterial endocarditis and TV insufficiency (3d deg.) appeared in one patient in 10 years after the primary implantation. Afterwards, elimination of endocardial system by open surgery, TV plasty followed by epicardial pacing implantation are required. Infection of pacing site was disclosed in both types of implantation (1%). Perforation of atrial endocardial lead was found in two cases (4%).
A case of mechanical complication (cardiac strangulation) was diagnosed in a child (3%) in four years after the primary implantation of epicardial pacing system. Pericarditis was recorded immediately after the epicardil pacemaker implantation in 9% of cases.
Our center performs epicardial lead implantation with the help of midline sternotomy that provides clear approach to right atrium. However, the difficulties of lead fixation at LV apex appear here. It concerns, especially, the patients after CHD correction as the repeated sternotomy in them presents high risk of RV insufficiency. Nevertheless, the given approach is still the best possible with epicardial pacing if there is a “preclude”, sufficient experience of CHD correction.

Conclusion
The possibility of choice of optimal epicardial pacing site exceeds risks of leads and midline sternotomy. Any primary pacemaker implantation in children of any age with ventricular lead should be epicardial.

Funding Acknowledgement
Type of funding sources: None.
Prognostic value of strain rate during isovolumic relaxation in a general population
Authors: Papangelopoulou K , Orlowska M , Cauwenberghs N , Voigt J U , Kuznetsova T , D'hooge J 
Published: October 2021

Abstract

Background
Left ventricular (LV) strain rate (SR) during isovolumic relaxation (SRIVR) has been shown to correlate with invasive measurements of diastolic function, namely the time constant of LV relaxation (τ), and has thus been proven useful in the assessment of diastolic function. Tissue Doppler imaging (TDI) has an adequate frame rate to resolve the SR during a short-lived mechanical event such as IVR.

Purpose
The purpose of this study was to assess the additive prognostic value of SRIVR on top of conventional cardiovascular risk factors in a general population.

Methods
We included 670 subjects (age: 51.2±14.2, 48.8% males) that were already recruited in the Flemish Study on Environment, Genes and Health Outcomes (FLEMENGHO), from May 2005 to February 2009. Subjects were followed up on average 5 years after their recruitment, either by a follow-up visit or by telephone. Exclusion criteria at baseline were atrial fibrillation, presence of an artificial pacemaker, more than mild valvular disease and segmental wall motion abnormalities. All patients underwent echocardiographic examination with a state of the art ultrasound machine. Using an in-house developed software package (SPEQLE), we extracted the velocity, strain and SR curves from the color TDI images (FR &gt;180Hz) and imposed timing information on the IVR based on valve opening/closing as determined from PW Doppler data. The sample volume was positioned at the mid portion of the inferolateral wall, in an apical 3 chamber view, manually tracked over the cardiac cycle and all curves were averaged over 3 subsequent cardiac cycles. Then, SRIVR was estimated as the peak SR value during IVR (Fig. 1). Outcome data consisted of major adverse cardiac events (MACE) during the follow-up period. The hazard ratio (HR) associated with SRIVR values was estimated using Cox regression analysis; we included age, sex, body mass index, systolic blood pressure, smoking and serum cholesterol as co-variables in the model.

Results
An accurate assessment of the SRIVR in the inferolateral wall was not possible in 34 participants, so further analysis was confined to 636 subjects. In total, 65 adverse cardiac events were recorded over the period of 8.7 years of follow-up. Figure 2 demonstrates the cumulative incidence estimates (1-Kaplan-Meier survival estimates) of composite cardiac events in quartiles of SRIVR measured in the inferolateral wall (log-rank test p=0.005). Overall, after adjustment for the important cardiovascular risk factors, SRIVR of the inferolateral wall analyzed as a continuous variable was a significant predictor of fatal and nonfatal cardiac events (HR 1.94 (95% CI 1.09–3.47); p=0.025).

Conclusion
SRIVR measured in the inferolateral wall is an important biomarker not only in assessing diastolic function but also as a significant predictor of future adverse outcomes.

Funding Acknowledgement
Type of funding sources: None.
Clinical factors predicting asymptomatic atrial fibrillation in Middle Eastern patients
Authors: Al-Makhamreh H , Tutanji L , Abdin B , Salaymeh O , Al Karmi F , Abu Eid E , Obiedat A , Zaqqa M , Hammoudeh A , Hamam I , Kadri N ,   Jordan AF study
Published: October 2021

Abstract

Introduction
Anticoagulation has been shown to be highly effective in stroke prevention in patients who have atrial fibrillation (AF). Many patients with AF do not have symptoms and may not seek medical attention. In this study we evaluated the clinical profiles of asymptomatic AF (AAF) patients and compared them to symptomatic ones to find what factors are associated with absence of symptoms.

Methods
We analyzed data of 2000 patients enrolled in the prospective multicenter Jordan AF study from May 2019 to October 2020. Symptoms included palpitations (43%), shortness of breath (34%), fatigue (21%), dizziness (11%), chest pain (2%) or syncope (2%) versus no symptoms (30%, n=591).

Findings
The average age of the whole group was 67.7±10.2 years and 47% were males. Clinical factors investigated in relation to absence of symptoms are presented in the attached table

Conclusion
AAF is associated with the following clinical features: male gender, age above 59 years, diabetes mellitus (DM), cerebrovascular accident (CVA), and chronic renal failure (CRF), CHA2DS2VASC score of 3 and above and HASBLED score of 3 and above, while first episode and paroxysmal AF (PAF) were more likely to be symptomatic. Individuals with these features should be closely evaluated for AAF by means such as pulse monitoring, smart devices and electrocardiogram.

Funding Acknowledgement
Type of funding sources: None.
Social-occupational impact and level of satisfaction in patients included in a remote monitoring pacemaker programme
Authors: Perez Diaz P , Bastante Diaz M C , Campos Perez De Madrid E , Fernandez Trujillo A , Cano Rosado L , Jimenez Diaz J , Higuera Sobrino F , Bermejo Calvillo N , Casas De Miguel A M ,   University General Hospital of Ciudad Real, Ciudad Real, Spain.
Published: October 2021

Abstract

Background
When patients fitted with pacemakers have to attend arrhythmia appointments, this often reduces their independence and involves their caregivers having to take time off work, along with an increase in spending on healthcare transport.

Purpose
We describe the impact of remote monitoring of pacemaker implemented by our Arrhythmia Unit in our patient's live and the reduction in social, occupational and financial impact on these patients.

Methods
Prospective observational study including 160 patients on the remote monitoring pacemaker programme between January 2016 and January 2017. We handed a satisfaction survey to these patients after the face-to-face monitoring appointment, which analysed variables such as waiting time, attention and treatment received, need for accompaniment of a relative, method of travel and kilometres travelled, level of satisfaction with the remote monitoring system, proposals for improvement, etc.

Results
The patients spent a median of 60±30 minutes on the remote monitoring, with a distance travelled of 1.4±4.9 km, rating their level of satisfaction at the remote monitoring as excellent (35%), good (61%) and average (3%) (Figure 1). In the face-to-face appointment, most of them were accompanied (86%) and arrived by private car (66%), with 54% of family members needing to take time off work. 19.4% of patients arrived by ambulance and 8.8% by bus. The median time spent was 150±120 minutes, and the distance travelled was 63±105 km.

Conclusions
The remote monitoring pacemaker programme in our health district has a very positive healthcare and social-occupational impact, which is manifested both from an objective point of view (greater independence, less time spent per appointment, less distance travelled, fewer healthcare transport needs and less workplace absenteeism by family members, etc.) and a subjective point of view (lower impact of appointments on patients' lives and greater perception of satisfaction from the patients and their companions).

Funding Acknowledgement
Type of funding sources: None.
Association between atrial fibrillation and coronary slow flow
Authors: Zhuang Z.X.D , Zhang S.Z , Liao X.X 
Published: October 2021

Abstract

Background
The relationship between arrhythmia and coronary slow flow (CSF) is unclear. We aimed to explore the association between atrial fibrillation (AF) and CSF.

Method
In this cross-sectional study, we included 2,060 participants patients from PCI-registry (NCT 02498470) who underwent coronary angiography with clinical chest pain and without significant coronary stenosis. According to coronary blood flow rate measured by the thrombolysis in myocardial infarction frame count (TFC) method, CSF was defined as TFC&gt;27. AF was identified by ECG performed during hospitalization. We used logistic regression to assess the association between AF and CSF.

Results
Among 2,060 participants, 132 participants were diagnosed with AF. CSF rates were higher in AF group than in the control group (22.0% vs 13.9%, P=0.011). Logistic regression showed that AF was independently associated with CSF after adjustment for traditional risk factors (OR=2.06; 95%, 1.28–3.34; P=0.003).

Conclusion
Our study demonstrated that AF was association with increased risk of CSF. Further studies are needed to confirm this finding and explore the potential mechanism.

Funding Acknowledgement
Type of funding sources: None.
Comparison of the HAS-BLED, ORBIT and ATRIA bleeding risk scores in 399,344 patients with atrial fibrillation and cancer
Authors: Pastori D , Marang A , Bisson A , Herbert J , Lip G.Y.H , Fauchier L 
Published: October 2021

Abstract

Background
The presence of cancer worsens the prognosis of patients with atrial fibrillation (AF). However, the association between cancer type and specific bleeding events has been scarcely investigated. Furthermore, the performance of bleeding risk scores, such HAS-BLED, ORBIT and ATRIA, in this high-risk subgroup of AF patients is unclear.

Purpose
To investigate the incidence rate (IR) of major, gastrointestinal (GI) bleeding and intracranial haemorrhage (ICH) according to cancer types. We also investigated the performance of HAS-BLED, ATRIA and ORBIT scores. HASBLED ≥3, ATRIA ≥5 and ORBIT ≥4 were defined as high-risk.

Methods
Observational retrospective cohort study including 399,344 patients with AF and cancer.

Results
Mean age was 77.9±10.2 years and 63.2% were men. During a mean follow-up of 2.0 years, the IR of major bleeding was as high as 8.41%/year, GI bleeding was 3.61%/year and ICH 1.33%/year. Major bleedings were more frequent in liver (12.68%/year), leukaemia (12.39%/year), pancreas (11.71%/year), bladder (11.67%/year) and myeloma (11.64%/year). GI bleeding were highest in liver (7.54%/year), pancreas (7.42%/year) and gastric (5.51%/year). The highest IR of ICH was found in leukaemia (1.89%/year), myeloma (1.52%/year), lymphoma and liver (1.45%/year) and pancreas cancer (1.41%/year).
Figure 1 shows the hazard ratios and AUC values for the three scores against each endpoint. All the three scores were significantly associated with major, GI and ICH. The HAS-BLED score performed better than others for ICH prediction, while the ORBIT score showed the best predictivity for major and GI bleedings (p&lt;0.0001 for all AUC comparisons)

Conclusions
Cancer increases the risk of bleeding in patients with cancer, with specific differences according to each cancer type. HAS-BLED score identified patients at highest risk for ICH and the ORBIT score for major and GI bleeding.

Funding Acknowledgement
Type of funding sources: None. Figure 1