bluuebunny/crossref_metadata_2025_split huggingface dataset:
Performance of the C2HEST score to predict sustained atrial high-rate episodes in patients implanted with cardiac implantable electronic device
Authors: Pastori D , Li YG , Miyazawa K , Shahid F , Lip GYH 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Sustained atrial high-rate episodes (SAHRE), which are considered ‘subclinical atrial fibrillation’ (AF), increase the risk of adverse outcomes in patients with a cardiac implantable electronic device (CIED). Risk stratification for the development of SAHREs has never been investigated.

Purpose
To assess test the performance of the C2HEST score (coronary artery disease or chronic obstructive pulmonary disease [1 point each]; hypertension [1 point]; elderly [age ≥75 years, 2 points]; systolic heart failure [2 points]; thyroid disease [1 point]) in predicting SAHRE in patients implanted with CIED without AF.

Methods
Retrospective study including 500 consecutive patients implanted with CIEDs in the West Birmingham in the UK. Patients were followed after implantation to record the development of SAHRE lasting &gt;24h. Risk factors and incidence of SAHRE were analyzed. The predictive value of the C2HEST score for SAHRE prediction was evaluated.

Results
During 53.1 months of follow-up, 44 (8.8%) patients developed SAHRE. SAHRE was associated with higher all-cause mortality (P &lt; 0.001) and ischemic stroke (P = 0.001). Age and heart failure were associated with SAHRE occurrence. The incidence of SAHRE increased by the C2HEST score (39% higher risk per point increase)(table). Among those with C2HEST score ≥4, the incidence of SAHRE was 3.62%/year (95%CI 2.14-5.16). The C2HEST score had a moderate predictive capability (area under the curve 0.73 [95%CI 0.64-0.81]) and discriminative ability (log-rank P = 0.003), which was better than other clinical scores (CHA2DS2-VASc, CHADS2, HATCH).

Conclusions
The C2HEST score predicted SAHRE incidence in non-AF subjects with CIED, with the highest risk seen in patients with C2HEST score ≥4 The benefit of using the C2HEST score in clinical practice in this patient population needs further investigation. C2HEST score Subjects n (%) SAHRE (n) Incident rate (95%CI) Hazard Ratio (95% CI) P 0-1 144 (28.5%) 5 0.85 (0.27-1.94) Reference Reference 2-3 211 (42.2%) 17 1.87 (1.06-2.91) 2.06 (0.76-5.59) 0.159 ≥4 145 (29.0%) 22 3.62 (2.14-5.16) 4.25 (1.61-11.22) 0.004
Impact of atrial fibrillation pattern on left atrial appendage closure: insights from the prospective LAARGE registry
Authors: Kany S , Brachmann J , Lewalter T , Akin I , Sievert H , Zeymer U , Ledwoch J , Ince H , Thomas D , Hochadel M , Senges J , Kirchhof P , Rillig A 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Stiftung für Herzinfarkforschung

Background
Non-paroxysmal (NPAF) forms of atrial fibrillation (AF) have been reported to be associated with an increased risk for systemic embolism or death compared with paroxysmal AF (PAF). This study investigates the procedural safety and long-term outcomes of left atrial appendage closure (LAAC) in patients with different forms of AF.

Methods
Comparison of procedural details and long-term outcomes in patients (pts) with PAF against controls with NPAF in the prospective, multicentre observational registry of patients undergoing LAAC in Germany (LAARGE).

Results
A total of 638 pts (PAF 274 pts, NPAF 364 pts) were enrolled. NPAF consisted of 31.6% patients with persistent AF and 68.4% with longstanding persistent AF or permanent AF. In both groups, a history of PVI was rare (4.0% vs 1.6%, p = 0.066). The PAF group had significantly less history of heart failure (19.0% vs 33.0%, p &lt; 0.001) while the current median LVEF was similar (60% vs 60%, p = 0.26). The total CHA2DS2-VASc score was lower in the PAF group (4.4 ± 1.5 vs 4.6 ± 1.5, p = 0.033), but no difference in the HAS-BLED score (3.8 ± 1.1 vs 3.9 ± 1.1, p = 0.40) was observed. The rate of successful implantation was equally high (97.4% vs 97.8%, p = 0.77) in both groups. In the three-month echo follow-up, device-related thrombi (2.1% vs 7.3%, p = 0.12) and peridevice leak &gt;5 mm (0.0% vs 7.1%, p= 0.53) were numerically higher in the NPAF group. Overall, in-hospital complications occurred in 15.0% of the PAF cohort and 10.7% of the NPAF cohort (p = 0.12). In the one-year follow-up, unadjusted mortality (8.4% vs 14.0%, p = 0.039) and combined outcome of death, stroke and systemic embolism (8.8% vs 15.1%, p = 0.022) were significantly higher in the NPAF cohort. After adjusting for CHA2DS2-VASc and previous bleeding, NPAF was associated with increased death/stroke/systemic embolism (HR 1.67, 95%-CI: 1.02-2.72).

Conclusion
Atrial fibrillation type did not impair periprocedural safety or in-hospital MACE of patients undergoing LAAC. However, after one year, NPAF was associated with higher mortality and combined outcome of death, stroke and systemic embolism.
Impaired left atrial reservoir and conduit strain in patients with atrial fibrillation and extensive fibrosis
Authors: Hopman LHG , Mulder MJ , Van Der Laan AM , Demirkiran A , Bhagirath P , Van Rossum AC , Allaart CP , Gotte MJW 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation (AF) is associated with profound structural and functional changes in the atria. Timely interventions may decelerate and perhaps reverse this pathophysiologic process and improve clinical outcome. In this regard, detailed characterization of the atrial remodeling process, and understanding of the interplay between structural remodeling and function is essential.

Purpose
In the present study, we investigated the association between left atrial (LA) phasic function and the extent of LA fibrosis using advanced cardiovascular magnetic resonance (CMR) imaging techniques, including 3-dimensional (3D) late gadolinium enhancement (LGE) and Feature Tracking.

Methods
Patients with paroxysmal and persistent AF (n = 93) underwent CMR in sinus rhythm. LA global reservoir strain, conduit strain and contractile strain were derived from cine CMR images using Feature Tracking. The extent of LA fibrosis was assessed from 3D LGE images. Healthy volunteers underwent CMR and served as controls (n = 19).

Results
Significantly lower reservoir strain, conduit strain and contractile strain were found in AF patients, as compared to controls (-15.7 ± 3.9% vs. -21.1 ± 3.6% P &lt; 0.001, -8.6 ± 2.9% vs. -12.6 ± 2.5% P &lt; 0.001 and -7.1 ± 2.4% vs. -8.6 ± 2.2% P = 0.02, respectively) (Figure A, B, C). Patients with a high degree of LA fibrosis (dichotomized by the median value) had lower reservoir strain and conduit strain compared to patients with a low degree of LA fibrosis (-14.7 ± 4.0% vs. -16.8 ± 3.5%, P = 0.02 and -7.7 ± 2.7% vs. -9.5 ± 2.9%, P &lt; 0.01, respectively). In contrast, no difference was found for LA contractile strain (-7.0 ± 2.3% vs. -7.3 ± 2.5%, P = 0.62) (Figure D, E, F).

Conclusions
This study shows impaired LA reservoir and conduit strain in AF patients with extensive atrial fibrosis. Of interest, LA contractile function was largely unaffected. Future studies are required to study the biologic nature of this association and possible therapeutic implications. Abstract Figure.
Prognostic significance of diabetes mellitus in patients with atrial fibrillation
Authors: Papazoglou A , Kartas A , Samaras A , Vouloagkas I , Vrana E , Moysidis D , Akrivos E , Kotzampasis G , Papanastasiou A , Baroutidou A , Botis M , Tsagkaris C , Karagiannidis E , Tzikas A , Giannakoulas G 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Despite the plethora of studies on atrial fibrillation (AF) and diabetes mellitus (DM), there is still no sufficient data on the blood glucose regulation as a prognostic modifier in DM patients with AF.

Purpose
The purpose of this study was to investigate the association of DM and levels of glycated hemoglobin (HbA1c) with outcomes in patients with AF.

Methods
This retrospective cohort study included patients who were recently hospitalized with a primary or secondary diagnosis of AF from December 2015 through June 2018. Kaplan-Meier curves and Cox-regression adjusted hazard ratios (aHR) were calculated for the primary outcome of all-cause mortality and for the secondary outcomes of cardiovascular (CV) mortality, stroke and the composite outcome of CV death or hospitalization. Spline curve models were fitted to investigate associations of HbA1c values and mortality among patients with AF and DM.

Results
In total 1140 AF patients were included, of whom 373 (32.7%) had DM. During a median follow-up of 2.6 years, 414 (37.3%) patients died. The presence of DM was associated with a higher risk of all-cause mortality (aHR = 1.44, 95% confidence intervals [CI]: 1.12-1.85), CV mortality (aHR = 1.44, 95% CI: 1.08-1.93), stroke (aHR = 2.62, 95% CI: 1.24-5.53) and the composite outcome of hospitalization or CV death (aHR = 1.28, 95% CI: 1.06-1.54). In AF patients with comorbid DM, the spline curves showed a positive linear association between HbA1c levels and outcomes, with values &lt;6.2% predicting significantly decreased all-cause and CV mortality.

Conclusions
The presence of DM on top of AF was associated with a 1.5-fold increased risk for all-cause or CV mortality and excess morbidity. HbA1c levels lower than 6.2% were independently related to better survival rates. Follow-up outcomes by presence of DMOutcomeDMNon-DMAdjusted HR(95% CI)p-valueAll-cause death171/373 (45.8%)243/736 (33%)1.44 (1.12-1.85)&lt;0.001CV-death130/373 (34.9%)173/736 (23.5%)1.44 (1.08-1.93)&lt;0.001Major bleeding18/340 (5.3%)29/644 (4.5%)1.53 (0.71-3.28)0.291Stroke24/340 (7.1%)28/645 (4.3%)2.62 (1.24-5.53)0.013AF-related hospitalization59/340 (17.4%)115/645 (17.8%)1.20 (0.78-1.85)0.281HF-related hospitalization35/333 (10.5%)46/640 (7.2%)1.34 (0.83-2.19)0.235Hospitalization or CV-death243/373 (65.1%)399/736(54.2%)1.28 (1.06-1.54)&lt;0.001*Adjusted for: age, gender, smoking, BMI, history of hypertension, eGFR (CKD-EPI) and use of statin, ACEI-ARB, OAC and rate control medication after discharge.DM, diabetes mellitus; HR, hazard ratio; AF, atrial fibrillation; CV, cardiovascular; HF, heart failure.Abstract Figure. Visual overview of the study
Impact of Atrial Fibrillation type in Acute Coronary Syndrome and the antithrombotic strategy
Authors: Marques Pires C , Medeiros P , Oliveira C , Flores R , Mane F , Silva R , Campos I , Azevedo P , Gaspar A , Pereira MA , Galvao CB , Antunes N , Marques J 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

INTRODUCTION
Atrial fibrillation (AF) is an adverse prognostic factor during acute coronary syndrome (ACS). Current evidence recommends dual antithrombotic therapy (DAT), 1 antiplatelet drug and 1 anticoagulant drug, as the default strategy after nonST elevation ACS.

AIM
To identify the clinical differences and prognosis of AF type-new onset (nAF) or pre-existing (pFA)- during ACS, to evaluate antithrombotic strategy at hospital discharge (HD) and its impact on haemorrhagic and ischemic events.

METHODS
We performed a retrospective observational cohort study including 3241 patients (pts) with ACS (mean age 64 years, 77.5% male) admitted to a single center over a 6-year period, with 12-months follow-up.

RESULTS
AF rhythm was identified in 11.2% pts, of whom 63.2% presented nAF and 36.8% pAF.
When AF types where compared, pts with pAF had a higher prevalence of cardiovascular (Cv) comorbidities, including hypertension (p &lt; 0.001), previous ACS (p = 0.03), valvular disease (p = 0.01) or stroke (p = 0.05), had greater left atrial diameter (p &lt; 0.001) and were less likely to have significant coronary lesions (p = 0.05). Pts with nAF more frequently presented with STelevation ACS (p &lt; 0.001) and had a lower Hemoglobin nadir (p &lt; 0.001). The independent predictors of nAF in ACS were age (OR 1.1, p&lt; =0.001), LVEF ≤ 40% (OR 2.2, p = 0.001), STelevation ACS (OR 2.6, p&lt; =0.001) and previous valvular disease (OR 3.5, p&lt; =0.01). Compared with the population without AF, nAF was a predictor of in-hospital death (OR 2.9, p = 0.027) and in-hospital composite endpoint (death, stroke, reinfarction and cardiogenic shock) (OR 2.5, p = 0.001) in multivariate analysis, but pAF wasn’t. During 12-months follow-up of pts with ACS and AF, there was no difference regarding death or follow-up composite endpoint (death, stroke and ACS) between the AF types.Regarding antithrombotic therapy, nAF pts were less often anticoagulated (p &lt; 0.001) and pAF pts where more often treated with triple antithrombotic therapy (TAT) at HD (&lt;0.001). Most of the pts with TAT stopped the second antiplatelet at agent 6-months (43.8%) or 12 months (25.5%) after HD. During 12-months follow-up, pts discharged with TAT had trend towards more haemorrhagic events (TAT 6.2% vs DAT2.7%,p = 0.69) and both groups had similar ischaemic events (death, ACS, stroke) (TAT 20.9% vs DAT23.7%,p = 0.714). In multivariate analysis the choice of TAT or DAT wasn’t a predictor of ischaemic events.

CONCLUSIONS
In ACS, pts with nAF had worst in-hospital outcomes than pts with pAF. Regarding antithrombotic strategy at HD pts with nFA were less often anticoagulated and less often treated with TAT. In our study the choice between DAT or TAT had no statistical impact on follow-up outcomes.
Atrial fibrillation burden of illness: epidemiology and annual economic impact
Authors: Tito F , Borghetti F 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

BACKGROUND
The totality of evidence on atrial fibrillation (AF) highlights its role in reducing the quality of life and increasing the risk of developing complications, which are responsible in a considerable increase in the consumption of health resources.

PURPOSE
Considering the high incidence and prevalence of AF, physicians should be aware of the burden of the disease to provide a timely and effective response.
This analysis aims to calculate the annual economic impact of AF in Italy.

METHOD
A model was developed to assess the economic impact of AF including the probability of the related complications occurring.
The number of patients affected by AF was computed by applying to the over-65 years old population residing in Italy on 1th January 2020 the prevalence by the international literature. The separate prevalence of paroxysmal, persistent and permanent AF was considered as well as % of patients with and without symptoms. As according to data coming from literature, the % of patients under treatment is unfortunately very low, thus the general assumption that AF patients were untreated was done.
A literature review was then conducted to collect validated relative risk (%RR) for each AF complication. If present in literature, the direct healthcare costs per patient/year were included in the model or, alternatively, the DRG tariffs as a proxy.
The actualized costs linked to all complications were then used to estimate the economic impact of AF patients from the Italian National Healthcare System perspective.

RESULTS
According to this analysis, AF is the most common cardiac arrhythmia and in Italy in 2020 affected approx. 1.018.128 people: 104.942 (65-69 ages); 187.437 (70-74 ages); 223.418 (75-79 ages); 307.406 (80-84 ages); 353.911 (85+ ages). Patients were subdivided by AF conditions: a total of 205.662 patients with paroxysmal AF (82.265 symptomatic), 247.405 patients with persistent AF (113.806 symptomatic) and 565.061 patients with permanent AF (79.109 symptomatic).
This economic model estimated the number of events occurred and monetizes the healthcare resource use for the management of complications. The number of events yearly experienced was: 366.526 for any stroke, 1.354.110 for Dementia, 1.130.122 for Heart Failure, 671.964 for Chronic kidney disease,142.538 for Ischemic heart disease, 699.454 for Peripheral arterial disease.
The total cost of patients, considering the burden of complications defined before, for 2020 was about 25 billion. This is probably an underestimation, as each patient could experience more than one complication and consequently their annual cost increases.

CONCLUSIONS
Our data confirm that the costs of AF complications have a considerable impact on resource consumption. Thus, in a context of a cost containment, measures to reduce both the risk of developing AF and the risk of making the disease worse are strongly needed.
Incidence of atrial fibrillation in patients with diabetes mellitus: effect of sex, age and type of diabetes in a nationwide analysis
Authors: Fauchier L , Bisson A , Fauchier G , Bodin A , Herbert J , Angoulvant D , Ducluzeau PH , Lip GYH 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. There remain uncertainties regarding diabetes mellitus and the incidence of atrial fibrillation (AF), in relation to type of diabetes, and the interactions with sex and age. We investigated whether diabetes confers higher relative rates of AF in women compared to men, and whether these sex-differences depend on type of diabetes and age.
Methods. All patients aged &gt; =18 seen in French hospitals in 2013 with at least 5 years of follow-up without a history of AF were identified and categorized by their diabetes status. We calculated overall and age-dependent incidence rates, hazard ratios, and women-to-men ratios for incidence of AF in patients with type 1 and type 2 diabetes (compared to no diabetes).
Results. In 2,921,407 patients with no history of AF (55% women), 45,389 had prevalent type 1 diabetes and 345,499 had prevalent type 2 diabetes. During 13.5 million person-years of follow-up, 327,012 patients with new-onset AF were identified. The incidence rates (IRs) of AF were higher in type 1 or type 2 diabetic patients than in non-diabetics, and increased with advancing age. Among individuals with diabetes, the absolute rate of AF was higher in men than in women. When comparing individuals with and without diabetes, women had a higher adjusted hazard ratio (HR) of AF than men: adjusted HR 1.32 (95% confidence interval 1.27-1.37) in women vs. 1.12(1.08-1.16) in men for type 1 diabetes, adjusted HR 1.17(1.16-1.19) in women vs. 1.10(1.09-1.12) in men for type 2 diabetes. The adjusted HRs for women were significantly higher than the adjusted HRs for men as shown with the adjusted women-to-men ratios (adjusted WMR = adjusted HR women compared to adjusted HR men) = 1.18 (95%CI 1.12-1.24) for type 1 diabetes and 1.10 (95%CI 1.08-1.12) for type 2 diabetes. This phenomenon was seen across all ages in men and women with type 1 diabetes and progressively decreased with advancing age. In type 2 diabetes, this phenomenon was seen after 50 years, increased until 60-65 years and then progressively decreased with advancing age.
Conclusion. Although men have higher absolute rates for incidence of AF, the relative rates of incident AF associated with diabetes are higher in women than in men for both type 1 and type 2 diabetes.
The impact of oral direct thrombin inhibitors on activated clotting time during catheter ablation in patients with atrial fibrillation
Authors: Mine T , Kitagaki R , Fukuhara E , Ishihara M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Direct thrombin inhibitors (DTIs) unlike factor Xa-inhibitors (Xa-inhibitors) is associated with fewer bleeding complications than warfarin in patients who had catheter ablation (CA) for atrial fibrillation (AF). However, the mechanisms remains unclear, and activated clotting time (ACT) is used to control heparin-dose for thromboembolic prevention during CA. Methods: We retrospectively studied 543 patients taking direct oral anticoagulant (DOAC) who underwent CA for AF (375 males, age 67 ± 10, 251 non-paroxysmal AF, 142 DTIs). Patients with off-label usage of DOAC were excluded. ACT was measured before (Pre-ACT) and after (post-ACT) initial heparin administration (3000U + 100U/kg), and total heparin-dose was evaluated. Results: Pre-ACT and post-ACT were extended in patients with DTIs (150 ± 21 vs 123 ± 15; P &lt; 0.0001 and 322 ± 39 vs 309 ± 42 sec; P = 0.0013). Patients with Xa-inhibitors required higher total heparin-dose (199 ± 43 vs 175 ± 34 U/kg; P &lt; 0.0001). During and after CA, none had thromboembolic events and 14 patients (3 DTIs, 11 Xa-inhibitor) showed bleeding events (Figure). Conclusions: ACT is extended in patients taking DTIs. Xa-inhibitors might have anticoagulant effects which are not reflected in ACT. Abstract Figure.
Spatial and quantitative assessment of the correlation between sinus rhythm and atrial fibrillation voltage mapping to identify low voltage substrate in persistent atrial fibrillation
Authors: Nairn D , Nagel C , Mueller-Edenborn B , Lehrmann H , Jadidi A , Loewe A 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Deutsche Forschungsgemeinschaft (DFG) through DO637/22-3 Ministerium für Wissenschaft, Forschung und Kunst Baden-Württemberg through the Research Seed Capital (RiSC) program.

Introduction
Presence of left atrial (LA) fibrotic low voltage substrate (LVS) is associated with high risk for arrhythmia recurrences in patients undergoing pulmonary vein isolation (PVI) for atrial fibrillation (AF). PVI and additional ablation of LVS - as identified by mapping in sinus rhythm (SR) or AF - has been reported to improve SR maintenance rates, despite differences of the extent and distribution of LA-LVS in SR versus AF.

Aims
To study the relationship between SR and AF voltage maps, we sought to identify the optimal AF voltage threshold providing the highest concordance in the extent and distribution of LVS when comparing voltage maps in SR vs. AF.

Methods
Using the statistical shape modelling software Scalismo, the voltage information from the SR and AF maps (acquired prior to PVI) from 28 patients (66 ± 7 years, 46% male, 82% persistent AF) was projected onto a representative LA-geometry. Sensitivity and specificity of LVS identification were calculated for varying thresholds during AF and the correlation between the SR (threshold 0.5mV) and AF maps was assessed and areas of agreeing LVS classification (SR & AF) were identified for each patient. The data of all 28 patients were combined to a spatial histogram of agreement between SR and AF low voltage maps.

Results
The correlation between SR and AF maps was high across all patients, with agreement at 60-95% of all mapped sites (Figure A: each red triangle represents one patient and the respective agreement of LVS classification and substrate extent). The optimal AF threshold - to identify LA-LVS &lt;0.5 mV in SR - was 0.29 mV (Q1-3: 0.20-0.37 mV) and was independent of the underlying extent of LVS during SR (Figure A: each blue asterisk represents one patient and the corresponding AF threshold and substrate extent). Agreement between LVS in AF vs. SR was high across most (&gt;90) patients on the anterior LA, lateral LA and the left atrial appendage. Lower agreement (60% of patients) was observed in the posterior wall (Figure B).

Conclusions
SR and AF voltage maps reveal high spatial concordance in low voltage substrate at the anterior LA, lateral LA and LA appendage, however significant discordances in LVS are found in 40% of patients at the posterior LA. Further studies on an extended patient cohort should assess if regional voltage-thresholds would result in an improved substrate concordance between AF and SR substrate maps. Abstract Figure.