bluuebunny/crossref_metadata_2025_split huggingface dataset:
Malnutrition and risk of procedural complication in patients with atrial fibrillation undergoing catheter ablation
Authors: Kim D , Yu HT , Kim TH , Uhm JS , Joung B , Lee MH , Pak HN 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health and Welfare of Korea Ministry of Science, ICT & Future Planning of Korea

Background
Malnutrition is common in the elderly, even in developed countries, and increases mortality.

Purpose
To investigate the prevalence and prognostic value of malnutrition among patients with atrial fibrillation (AF) which is a type of metabolic disease.

Methods
We included 3,239 patients (age 58.5 ± 10.8 years, 73.2% male, 67.7% paroxysmal type) undergoing de novo AF catheter ablation (AFCA) between 2009 and 2020. Nutritional status was assessed using controlling nutritional status (CONUT) score. The associations between malnutrition and the risk of AFCA complications or long-term rhythm outcome were evaluated by multivariable logistic regression.

Results
Among 3,239 patients, 1,005 (31.0%) patients had malnutrition; 991 (30.6%) with mild (CONUT scores 2-4) and 14 (0.4%) with moderate-to-severe (CONUT scores ≥5) malnutrition. Overall complication rates after AFCA were 3.3% in normal nutrition, 4.2% in mild malnutrition, and 21.4% in moderate to severe malnutrition, respectively (P for trend = 0.031). Major complication rates were 1.9%, 2.6%, and 14.3% in normal nutrition, mild malnutrition, and moderate to severe malnutrition (P for trend = 0.042). After multivariable adjustment, moderate-to-severe malnutrition status was associated with increased risks of overall (OR 8.215 [2.199-30.691], P = 0.002) and major (OR 7.392 [1.568-34.837], P = 0.011) complications compared with normal nutrition. However, CONUT score did not affect the long-term rhythm outcome during the mean follow-up of 40 (interquartile range 18-74) months (log-rank P = 0.760).

Conclusion
Malnutrition is common in patients undergoing AFCA. Those with moderate-to-severe malnutrition status were at substantially higher risk of complications after AFCA. Abstract Figure. Overall and major complication rates
Electrical anatomy of the left atrium during atrial fibrillation
Authors: Adragao P , Nascimento Matos D , Costa F , Galvao Santos P , Rodrigues G , Carmo J , Carmo P , Cavaco D , Morgado F , Mendes M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Twenty years ago, pulmonary veins (PV) ostia were identified as the left atrium (LA) areas with the shortest refractory period during sinus rhythm. Pulmonary veins isolation (PVI) became standard of care, but clinical results are still suboptimal. Today, a special tool using the Carto® electroanatomical mapping (EAM) allows for AF cycle length mapping (CLM), to identify the areas in the left atria with shortest refractory period, during atrial fibrillation. Using this EAM tool, our study aimed to find the LA areas with the shortest refractory period to better recognize electrical targets for catheter ablation.

Methods
Retrospective analysis of an unicentric registry of individuals with symptomatic drug-refractory AF who underwent PVI with Carto® EAM. CLM was performed with a high-density mapping Pentaray® catheter before and after PVI and in 4 redo procedures. We assessed areas of short cycle length (SCL) (defined as 120 to 250ms), and their relationships with complex fractionated atrial electrograms (CFAE), and low-voltage zones (from 0.1 to 0.3mV).

Results
A total of 18 patients (8 men, median age 63 IQR 58-71 years) were included. Most patients presented with persistent AF (n = 12, 67%), and 4 patients (22%) had a previous PVI. The mean shortest measured cycle length in AF was 140ms (SD ±27ms). All patients presented areas of SCL located in the PVs or their insertion, 70% in the posterior/roof region adjacent to the left superior pulmonary vein (LSPV) (figure 1) and 60% in the anterior region of the right superior pulmonary vein (RSPV). These two areas remained the fastest even after PVI. The anterior mitral region rarely presented SCL (17%). SCL were related to low-voltage areas in 94% and were adjacent to CFAE. Low-voltage areas and CFAE were more frequent and had a larger LA dispersion than SCL.

Conclusion
We confirmed in 3D mapping that PVs are the LA zones with shortest refractory period, not only in sinus rhythm but also during AF. The persistence of SCL areas in the border zones of the PVI lines suggest the benefit of a more extensive CLM guided ablation. Larger studies are needed. Abstract Figure 1
Ultra-high density mapping to characterize effective cryoballoon ablation of roof line in persistent atrial fibrillation: a pilot study
Authors: Gionti V , Longobardi M , Negro MC , Broglia E , Cannas E , Malacrida M , Storti C 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Roof Posterior Wall (RPW) debulking may be important in the maintenance of AF activity as reducing the surface area below a critical mass can prevent persistent AF. No data exists on a combined cryoballoon ablation (CBA) approach guided by ultra-high density mapping (UHDM) system.

Objective
To explore, through UHDM, generation of consistent linear lesions at the left atrial (LA) roof using CBA in patients (pts) with persistent AF.

Methods
Once PVI was completed, the CB (Arctic Front Advance) was used to perform RPW isolation (RPWI). CBA was applied to create a continuous lesion connecting the ostial areas of the right and left superior PVs. Optimal position of the CB along the different segments of the RPW was obtained by advancing/retracting the inner lumen catheter distally/proximally within the PV. A detailed pre- and post-ablation 3D map was created in each pt using the Orion catheter and the Rhythmia UHDM system. Areas and type of isolation over the RPW and the entire LA were precisely identified and measured. Ablation endpoint was PVI and RPWI as assessed by entrance and exit block and after administration of intravenous adenosine.

Results
Ten consecutive pts were included (mean LA volume = 126 ± 36 ml, mean points per map = 10800 ± 8500, mean roof area = 22 ± 4 cm²). A mean of 4.6 ± 0.8 freezes at PV and 5.4 ± 2 at the roof per pt were required (mean nadir temperature (T) = −45°C ± 6°C and −41°C ± 3°C, respectively, mean T at the roof = −33°C ± 4°C) during a mean CBA time of 954 ± 73 s for PVs and 810 ± 311 s for the roof. The mean conduction delay along the roof line at the shortest segment was 55 ± 13 ms. Resulting low-voltage areas (&lt;0.1 mV, 12 ± 4cm², 53% of the roof area) and complete electrical quiescence areas (&lt;0.05 mV, 8 ± 3cm², 32% of the roof area) correlated well with the linear roofline of CB positions. At the first pass all PVs were successfully isolated in all study pts. In two cases at the RPWs UHDM revealed a small conductive corridor (&lt;0.1 mV) along a posterior takeoff that required adjunct RFA to complete RPW isolation. No complications were reported.

Conclusions
In our preliminary experience PVI plus RPWI can be achieved safely and effectively using the CB in conjunction with UHDM. The use of UHDM allowed a precise definition of the effective isolation areas.
Accuracy comparison of the new and previous kodex occlusion tool software versions to assess pulmonary vein occlusion in atrial fibrillation cryoablation
Authors: Cauti FM , Rossi P , Iaia L , Polselli M , Pecere A , Andreoli C , Bianchi S 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Atrial fibrillation (AF) is the most frequent sustained arrhythmia worldwide and Cryoballoon ablation (CB) has become a consolidated alternative to the radiofrequency pulmonary vein (PV) isolation. However, CB requires fluoroscopy and dye injections to verify the occlusion grade. The accuracy of the earlier version of the Kodex Occlusion Tool software has been studied.
Purpose. The purpose of this study was to verify the accuracy of the second generation Kodex Occlusion Tool Software of a new dielectric system imaging compared to its first generation to detect PV occlusion during CB ablation in patients with AF.
Methods. 15 consecutive patients with paroxysmal AF were enrolled in the study and underwent the procedure with the guidance of the first generation version (1.4.6) of the Kodex Occlusion Tool software. The Kodex recorded procedural data were used to replay the case using the Kodex second generation version (1.4.7) of the Occlusion Tool software when clinically available. After transseptal access, a detailed image reconstruction of left atrium and PVs was achieved with an octa-polar circular mapping catheter, PV occlusion was assessed with the Occlusion Tool Software and compared with standard dye injection and angiography, the cryoablation was then performed with a cryoballoon catheter.
Results. A total of 72 PVs CB occlusions were tested. The old version showed 90.7% sensitivity and 76.5% specificity in assessing a complete PV occlusion verified with contrast medium injection. The positive predictive value was 80.3%, and the negative predictive value was 88.6%. The new version showed 94.8% sensitivity and 93.7% specificity in assessing a complete PV occlusion verified with same contrast medium injection data. The positive predictive value was 98.2%, and the negative predictive value was 93.7%. Acute isolation was achieved in all PVs and no 30-day complication was observed.
Conclusion. This study demonstrates an increased accuracy of new Occlusion Tool software of the Kodex dielectric imaging system to assess the degree of PV occlusion during a CB ablation. Abstract Figure. Occlusion tool software 1.4.6 vs 1.4.7
High-power short-duration radiofrequency ablation for atrial fibrillation
Authors: Kassa K , Nagy Z , Kesoi B , Som Z , Foldesi C , Kardos A 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
In recent times, high-power short-duration (HPSD) radiofrequency ablation (RFA) has emerged as an alternative strategy for pulmonary vein isolation (PVI) in atrial fibrillation (AF).

Purpose
We aimed to compare HPSD approach and conventional, ablation-index (AI) guided PVI using contact force sensing ablation catheters in respect of efficacy, safety, procedural characteristics, and outcome.

Methods
A total of 184 consecutive AF patients with first PVI were enrolled (age: 60 ± 11 years, paroxysmal: 56.5%, persistent: 43.5%) between November 2016 and December 2019. An ablation protocol of 50W energy with 15-20 g contact force was used for a duration of 8-12 sec based on the loss of capture concept in the HPSD group (n = 91) meanwhile, PVI was achieved according to the conventional power settings (posterior wall 25W, AI: 400, anterior wall 35W, AI: 550 ) in the control group (n = 93). During 1-year follow-up, documented AF for more than 30 seconds was considered as recurrence.

Results
Radiofrequency time and procedural time were significantly shorter using HPSD ablation (26.0 ± 12.7 min vs. 42.9 ± 12.6 min, p &lt; 0.001, and 91 ± 30.1 min vs. 105.3 ± 28 min, p &lt; 0.001). The HPSD strategy significantly lowered fluoroscopy time and radiation dose (5.47 ± 4.07 min vs. 8.15 ± 10.04 min, p = 0.019, and 430.2 ± 534.06 cGycm2 vs. 604.2 ± 633.9 cGycm2, p = 0.046). The HPSD group showed significantly less arrhythmia recurrence during 1-year follow-up with 76.9% of patients free from AF compared to 66.7% in the control group (p = 0.037). No pericardial tamponade, periprocedural thromboembolic complication, or atrio-oesophageal fistula occurred in the HPSD group. We observed 2 pericardial tamponade and 1 periprocedural stroke in the control group.

Conclusions
HPSD RFA for AF was demonstrated to be safe, and lead to significantly improved 1-year outcome in our mixed patient population. HPSD protocol significantly shortened procedural and radiofrequency time with decreased fluoroscopy time and radiation exposure.
Comparing single approaches success in index atrial fibrillation ablation
Authors: Caldeira Da Rocha R , Carvalho R , Ferreira A , Rodrigues T , Silva G , Cortez Dias N , Carpinteiro L , Pinto FAUSTO , De Sousa J 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Atrial Fibrillation (AF) ablation can be performed by inducing pulmonary vein electrical isolation. There are two widely used approaches: point-by-point and single-shot. Catheter AF ablation is effective in restoring and maintaining sinus rhythm. However, efficacy is limited by high rate of AF recurrence, after an initially successful procedure.

Purpose
To evaluate AF index ablation successfulness using single-shot techniques and compare them to conventional one (point-by-point using irrigated- tip ablation catheter).

Methods
We analyzed, from a single center, all patients submitted to an index AF ablation procedure and its successfulness. The last was defined as AF, atrial tachycardia or flutter recurrence (with a duration superior to 30seconds) event- free survival, determined by holter and/or event recorder. These exams were performed after 6 and 12months and then annually, until 5years post procedure were accomplished.

Results
From November 2004 to November 2020, 821patients were submitted to first AF ablation (male patients 67,2%(N = 552), mean age of 59 ± 12years old). Paroxysmal AF(PAF) was present in 62,9%(N = 516), with short-duration persistent AF in 21,8%(N = 179) and long-standing persistent in 15,3%(N = 126). Ablation techniques were irrigated tip catheter point-by-point (PbP)ablation in 266 patients (32,4%) and single-shot (SS)techniques on the remaining 555(67,6%), including PVAC in 294(35,8%),225(27,4%) submitted to cryoablation and 36(4,4%) to nMARQ.
Globally, AF ablation had one-year success rate of 72,5%, and 56,2% at 3 years. A significant difference between AF duration type was found: Arrhythmic recurrence risk was 58% higher in persistent AF(PeAF) (HR 1.58;95%IC 1,22-2,04; p &lt; 0.001). In patients presenting with PAF prior to the procedure, success was significantly higher in those submitted to SS technique(HR:0.69;95%CI 0,47-0,90;p = 0.046), while those with PeAF had similar results.

Conclusion
In this single center analysis almost three-quarters had achieved one-year event-free survival, and more than a half reached long-term freedom from atrial arrhythmia. Patients with paroxysmal atrial fibrillation submitted to single-shot procedure presented with a higher success-rate. Moreover, our study confirmed previous data on the importance of atrial fibrillation classification to postprocedural outcomes. Abstract Figure. Survival Curves
Periprocedural management of patients on edoxaban undergoing pacemaker and cardiac monitoring device implantation - a sub-analysis of the EMIT-AF/VTE study
Authors: Unverdorben M , Colonna P , Von Heymann C , Santamaria A , Saxena M , Vanassche T , Wilkins R , Chen C 
Published: May 2021

Abstract

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

Background
Periprocedural management of patients on direct oral anticoagulants undergoing insertion of permanent pacemaker (PPM) and cardiac monitoring devices is mainly based on pharmacokinetic considerations, clinical experience, and expert opinion.

Purpose
To describe the characteristics, periprocedural management, and events of edoxaban patients undergoing implantation of PPM/monitoring devices.

Methods
From the global EMIT-AF/VTE registry, which includes edoxaban patients undergoing any diagnostic or therapeutic procedures, those with PPM/cardiac monitoring device implantation were observed from five days prior to 30 days post procedure. Events documented included the incidence of International Society on Thrombosis and Haemostasis defined Major Bleeding, Clinically Relevant Non-Major Bleeding (CRNMB), acute thromboembolic events (ATE) and perioperative edoxaban interruption times.

Results
PPM or invasive cardiac monitoring devices were implanted in 136 patients. Conformance with European Heart Rhythm Association Guidance for the interruption of anticoagulation was variable: of the cardiac monitoring patients, 62.5% had interruption of treatment, whereas in PPM procedures 23.4% had no interruption. One case of CRNMB and two cases of minor bleeding were documented. All bleedings seem non procedure-related since they occurred &gt; three days post procedure. There were no ATE.

Conclusions
Relevant complications for edoxaban treated patients undergoing PPM or invasive cardiac monitoring procedures were rare. This population of patients is apparently well managed in routine practice, but further investigation of risk factors is justified. TablePatient characteristics Parameter All subjectsN = 136 All pacemakerN = 128 Insertion first pacemakerN = 89 Change pacemakerN = 39 Monitoring deviceN = 8 Age, mean (SD)Male, n (%) 75.1 (10.1)85 (62.5) 75.0 (10.3)83 (64.8) 75.7 (9.9)57 (64.0) 73.5 (11.2)26 (66.7) 76.3 (4.3)2 (25.0) BMI, mean (SD) 27.1 (5.5) 27.2 (5.6) 27.2 (6.0) 27.3 (4.5) 25.2 (4.3) AF, n (%)‡ 135 (99.3) 127 (99.2) 89 (100.0) 38 (97.4) 8 (100.0) VTE, n (%)‡ 3 (2.2) 3 (2.3) 1 (1.1) 2 (5.1) 0 CrCL, mean (SD) 63.8 (26.4) 64.1 (26.7) 62.3 (26.2) 68.3 (27.9) 58.9 (21.8) CrCL, ≤50, n (%) 43 (31.6) 41 (32.0) 33 (37.1) 8 (20.5) 2 (25.0) HAS-BLED Score, mean (SD) 2.0 (1.2) 1.9 (1.2) 1.9 (1.0) 2.1 (1.6) 2.6 (0.5) CHA2DS2-VASc Score, mean (SD) 3.7 (1.6) 3.7 (1.6) 3.7 (1.5) 3.8 (1.9) 3.1 (0.6) Edoxaban 30 mg/day, n (%) 49 (36.0) 46 (35.9) 32 (36.0) 14 (35.9) 3 (37.5) Edoxaban 60 mg/day, n (%) 86 (63.2) 81 (63.3) 56 (62.9) 25 (64.1) 5 (62.5) AF, atrial fibrillation; BMI, body mass index; CrCL, creatinine clearance; VTE, venous thromboembolism. ‡Two patients had both AF and VTE.
Socioeconomic trends in oral anticoagulation therapy for atrial fibrillation patients with low risk of stroke
Authors: Danielsen Lunde E , Joensen AM , Fonager K , Lundbye-Christensen S , Johnsen SP , Lytken Larsen M , Riahi S 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Karen Elise Jensen Foundation Obel Family Foundation

Background
Studies suggest that oral anticoagulation (OAC) drugs are underused in patients with atrial fibrillation (AF) and high risk of stroke, especially in patients with low socioeconomic position (SEP). It is unknown, however, if the socioeconomic differences in guideline recommended practice exists in patients with low risk of stroke where OAC is not indicated.

Purpose
To examine the association between educational status and OAC treatment in patients with low risk of stroke where OAC was not indicated.

Methods
Register-based study. We included all Danish patients with a hospital diagnosis of incident AF between 1 Maj 1999 and 2 October 2015 with low risk of stroke according to guidelines covering the specific year of inclusion. Educational level was used as indicator for SEP. Outcome was OAC initiation -30 or +90 days of incident AF. Generalized linear regression was used to estimate absolute risk differences (RDs) between educational groups.

Results
33805 AF patients with low risk of stroke were included (74.2 % men, mean age 56.4 years). Figure 1 shows that OAC was widely used in low-risk AF patients, especially in men. The initiation of OAC increased with time but the educational differences were reduced for women. Risk difference in the 1999-2002 was -14 % for women with high education (reference: low education) and -2 % in the period 2013-2016.

Conclusion
OAC was overused in patients with low risk of stroke, especially in patients with low education and the overuse increased with time. Educational differences were, however, slightly reduced with time, especially for women. Initiatives to ensure adherence to guideline recommendations should be emphasized in AF patients with low risk of stroke, especially for men and patients with low education.
Figure 1. Percentages per year for initiation of OAC according to educational status. Abstract Figure.
Evaluating long-term outcomes of left atrial appendage occlusion: the results of a prospective single-center registry
Authors: Maarse M , Wintgens L , Aarnink E , Huijboom M , Abeln B , Klaver M , Staal D , Rensing B , Van Dijk V , Swaans M , Boersma L 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work was supported by an unrestricted grant from Boston Scientific. Boston Scientific was not involved in the design/conduct of the study, data collection/analysis and interpretation of the data and preparation of the manuscript.
Background
Percutaneous left atrial appendage occlusion is an emerging alternative to anticoagulation in the prevention for stroke in patients with atrial fibrillation, especially in patients with a contra-indication for oral anticoagulation therapy. Long-term results on the efficacy and safety of this treatment remain scarce.
Methods
In this single-center prospective registry, data of all consecutive patients that underwent percutaneous left atrial appendage closure between 2009 and 2019 were collected. Patients with successful left atrial appendage closure (peri-device leakage ≤5mm) and at least one year of follow-up data were analyzed. The occurrence of thrombo-embolic events (ischemic stroke, TIA and systemic embolism), major bleeding events (BARC &gt;2) and anticoagulation use during long-term follow-up were evaluated.
Results
A total of 192 patients after left atrial appendage occlusion were included (61 % male, age 69.0 ± 8.4 years, CHA2DS2-VASc 4.0[3.0-5.0], HAS-BLED 3.0[2.0-3.25]) with a mean follow-up duration of 5.7 ± 2.8 years (in total 1087 patient-years). During follow-up 36 patients (19%) died. 49 thrombo-embolic complications were observed in 38 patients. The ischemic stroke rate was 1.9 events per 100 patient-years, accounting for a 70% reduction compared to CHA2DS2-VASc predicted rate. Device-related thrombus (DRT) occurred in 5 patients (2.6%), 3 were observed during routine follow-up and were not associated with thrombo-embolic complications. The other 2 DRT were observed in patients presenting with ischemic stroke more than 3 years after device implantation. Furthermore, 38 non-procedural major bleeding complications occurred in 19 patients, resulting in 3.5 events per 100-patients years, accounting for a reduction of 43% compared to estimated bleeding rates under OAC use. At the end of the study 71% of all patients were on single antiplatelet or no antiplatelet/anticoagulation treatment at all.
Conclusions
During long-term follow-up thrombo-embolic event rates and non-procedural major bleeding rates were consistently low (ischemic stroke rate reduction 70% and non-procedural major bleeding rate reduction 40% compared to predicted rates). These results confirm the efficacy of left atrial appendage occlusion. Abstract Figure. Ischemic stroke rates