bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diabetes is associated with atrial fibrillation phenotype, cardiac and neurological comorbidities: insights from the Swiss-AF study
Authors: Bano A , Rodondi N , Beer J , Moschovitis G , Kobza R , Aeschbacher S , Baretella O , Muka T , Stettler C , Franco O , Conte G , Sticherling C , Zuern C , Conen D , Reichlin T ,   The Swiss-AF Investigators
Published: October 2021

Abstract

Background
Diabetes mellitus is a major risk factor for atrial fibrillation (AF). However, it remains unclear whether individual AF phenotype and related comorbidities differ between AF patients with and without diabetes.

Purpose
To investigate the association of diabetes with AF phenotype, cardiac and neurological comorbidities in patients with documented AF.

Methods
Participants of the multicenter Swiss-AF study with available data on diabetes and AF phenotype were eligible. The primary outcomes were parameters of AF phenotype, including AF type (paroxysmal vs non-paroxysmal), AF symptoms (yes vs no), and quality of life (assessed by EQ-5D score). The secondary outcomes were cardiac (ie, history of hypertension, myocardial infarction, heart failure) and neurological comorbidities (ie, history of stroke, cognitive impairment). The cross-sectional association of diabetes with these outcomes was assessed using logistic and linear regression. Results were adjusted for age, sex, and cardiovascular risk factors.

Results
We included 2411 AF patients (27.4% women; median age, 73.6 years). Diabetes was not associated with non-paroxysmal AF (odds ratio [OR]=1.01; 95% confidence interval [CI]=0.81 to 1.27). Patients with diabetes less often perceived AF symptoms (OR=0.73; CI=0.59 to 0.91), but had worse quality of life (predicted mean difference in EQ-5D score: β=−4.54; CI=−6.40 to −2.68) than those without diabetes. Patients with diabetes were more likely to have cardiac comorbidities [history of hypertension (OR=3.04; CI=2.19 to 4.22), myocardial infarction (OR=1.55; CI=1.18 to 2.03), heart failure (OR=1.99; CI=1.57 to 2.51)] and neurological comorbidities [history of stroke (OR=1.39; CI=1.03 to 1.87), cognitive impairment (OR=1.75; CI=1.39 to 2.21)].

Conclusions
In the Swiss-AF cohort population, patients with diabetes less often perceived AF symptoms, but had worse quality of life, more cardiac and neurological comorbidities than those without diabetes. These findings have significant clinical implications. The reduced perception of AF symptoms in patients with diabetes might result in a delayed AF diagnosis and consequently more adverse events, especially cardioembolic stroke. This raises the question whether patients with diabetes should be systematically screened for silent AF. Moreover, patients with concomitant AF and diabetes have increased likelihood of comorbidities and therefore deserve more attentive care.

Funding Acknowledgement
Type of funding sources: None.
Impact of the introduction of an integrated multi-professional pathway for atrial fibrillation on long-term outcomes
Authors: Aslam S , Vickers C , Veevers W , Farrar L , Hartley L , Viswanathan K 
Published: October 2021

Abstract

Background
An integrated structured approach to atrial fibrillation (AF) management is recommended by ESC.1 However, limited data is available on its “real-world” impact on anticoagulation uptake and subsequent AF-related hospitalisation and stroke rates.

Purpose
To evaluate the long-term impact of the introduction of a community-wide integrated AF service based in a secondary care hospital.

Methods
In September 2017 we implemented a new integrated pathway for patients with newly diagnosed “symptomatic” atrial arrhythmias across two regions (population 450,000) in England in collaboration with primary care. All patients were seen in a one-stop multi-professional clinic (Arrhythmia nurse and Electrophysiologist with ECG and echocardiogram) within 2 weeks. They underwent standardised screening for modifiable risk factors, counselling regarding diagnosis/ anticoagulation and received an individualised AF management plan as well as access to a nurse-led telephone helpline. We followed up the first 126 consecutive patients for a period of 12 months.

Results
Baseline characteristics are shown in Table 1, showing a high incidence of modifiable risk factors (previously un-identified in the majority). After review in clinic, 30-day AF-related readmission rates to hospital were low (1.6%, n=2) as compared to historical local data (5.8%). This was sustained at 3 months (4.7%, n=6) and at 12 months (7.9%, n=10). 99% of 83 of eligible patients (CHA2DS2-VASc score of &gt;2 with no major contra-indications) received oral anticoagulation. Over 12 months follow-up, rates of TIA/stroke was low (n=3, 2.4%). All-cause mortality was also low (n=1, 0.8%). NHS England region-wide data showed a marked reduction in percentage of total stroke admissions with history of AF not taking anticoagulation at stroke presentation in 2018/19 as compared to 2017/18 across our two regions; this was lower than the national average and the lowest within West Yorkshire (Figure 1).

Conclusions
An integrated service for AF management implemented community-wide was associated with high uptake of oral anticoagulation among eligible patients and low rates of AF-related hospitalisations and all-cause mortality. Across the community, among stroke admissions with AF at presentation, a lower percentage of patients without anticoagulation was observed in comparison with previous years and neighbouring regions.

Funding Acknowledgement
Type of funding sources: None.
Stroke risk based on classification of atrial fibrillation: real-world vs clinical trial
Authors: Ding W.Y , Rivera-Caravaca J.M , Marin F , Roldan V , Lip G.Y.H 
Published: October 2021

Abstract

Background
The most widely accepted clinical classification of atrial fibrillation (AF) is according to temporal rhythm-based patterns, reflecting the notion that most patients initially suffer from transient episodes that prolong over time due to atrial substrate remodelling as the disease progresses. Therefore, it may be speculated that patients with extended episodes of “continuous” AF (persistent, long-standing persistent and permanent AF) may be at higher risk of stroke complications compared to paroxysmal AF (pAF). However, the risk of stroke according to clinical classification of AF remains poorly defined. In this study, we assessed the impact of AF type on stroke risk in patients with AF from “real-world” and “clinical trial” cohorts.

Methods
Post-hoc analysis of patient-level data from the Murcia AF Project and AMADEUS trial. All patients were anticoagulated. Patients were grouped into those with pAF and non-pAF. pAF was defined as AF that terminates spontaneously or with intervention within seven days of onset. Non-pAF was defined as AF that lasted longer than seven days, including persistent, long-standing persistent and permanent AF subtypes. Study endpoint was the incidence rate of ischaemic stroke. A modified CHA2DS2-VAS“c” score that applied one additional point for a “c” criterion of continuous AF (i.e. non-pAF) was calculated.

Results
5,917 patients were included; 1,361 (23.0%) real-world and 4,556 (77.0%) clinical trial. Real-world patients had a median age of 76 (interquartile range [IQR] 71–81) years with 51.3% females compared to a median age of 71 (IQR 64–77) years with 33.5% females among clinical trial participants. Baseline demographics were comparable in both groups in the real-world cohort but clinical trial participants with non-pAF were older, predominantly male and had more comorbidities compared to those with pAF.
Crude stroke rates were comparable between the groups in real-world patients (incidence rate ratio [IRR] 0.72 [95% CI, 0.37–1.28], p=0.259) though clinical trial participants with non-pAF (vs. pAF) had a significantly higher crude rate of stroke events (IRR 4.66 [95% CI, 2.41–9.48], p&lt;0.001). Using multivariable cox regression analysis, AF type was not independently associated with stroke risk in the real-world (adjusted hazard ratio [HR] 1.41 [95% CI, 0.80–2.50], p=0.239) and clinical trial (adjusted HR 1.17 [95% CI, 0.62–2.20], p=0.621) cohorts, after accounting for known risk factors using the CHA2DS2-VASc score. Using receiver operating characteristic curves analysis, we found no significant improvement in the CHA2DS2-VAS“c” compared to CHA2DS2-VASc score in either cohort (p&gt;0.05).

Conclusion
Overall, there was no association between the temporal rhythm-based patterns of AF and stroke risk among anticoagulated patients, suggesting that this should not be a consideration when assessing the need for anticoagulation in AF.

Funding Acknowledgement
Type of funding sources: None.
The impact of substrate and trigger ablation for reduction of functional mitral regurgitation in patients with persistent atrial fibrillation
Authors: Watanabe T , Yamada T , Tamaki S , Yano M , Hayashi T , Yasumura Y , Hikosou S , Sotomi Y , Morita T , Furukawa Y , Kawasaki M , Kikuchi A , Kawai T , Sakata Y , Fukunami M 
Published: October 2021

Abstract

Background
Functional mitral regurgitation (FMR) is not uncommon in atrial fibrillation (AF) patients. Left atrial (LA) substrate remodeling and corresponding mitral valve annulus dilation has been reported as the most possible cause of FMR. Percutaneous catheter ablation (CA) is an effective treatment for AF. Although significant FMR could be improved by sinus restoration, patients with mitral regurgitation were more likely to experience recurrent AF post ablation, especially those with significant mitral regurgitation. There is no information available on the efficacy of CA for persistent AF in patients with FMR.

Purpose
The purpose of this study is to investigate the predictors of FMR improvement by CA and to determine the efficacy of substrate and trigger CA for persistent AF in patients with FMR.

Methods
We prospectively studied 512 consecutive patients admitted for persistent AF ablation from the EARNEST-PVI (Prospective Multicenter Randomized Study of Effect of Extensive Ablation on Recurrence in Patients with Persistent Atrial Fibrillation Treated with Pulmonary Vein Isolation) trial.
On admission, enrolled patients were randomly assigned in a 1:1 ratio to pulmonary vein isolation (PVI) or PVI-plus additional ablation (linear ablation or/and CFAE ablation). Of the 512 patients, we studied 94 patients with preoperative echocardiography showing moderate or greater baseline FMR. FMR grades were classified into 5 grades (0/1/2/3/4). The FMR improvement group (FMRI(+)) was defined as a case in which the FMR was improved by two or more grades compared the preoperative echocardiography and the one year follow-up examination.

Results
Of the 94 patients, 42 were in the PVI group and 52 were in the PVI-plus additional ablation group. There were 30 cases in the FMRI(+) group and 64 cases in the FMRI(−) group. There were no significant baseline differences in age, sinus rhythm maintenance, plasma B-type natriuretic peptide (BNP) level, left ventricular diastolic dimension, or left atrium dimension between the FMRI(+) and FMRI(−) groups. AF duration was significantly shorter in the FMRI(+) group than FMRI(−) groups (5.8±9.4 months vs 12.4±15.4 months, p&lt;0.0001). In addition, significantly more additional ablation cases were observed in the FMRI(+) group than in the FMRI(−) group (73.3% vs 46.8%, p=0.016). In multivariate analyses, only additional ablation was an independent predictor of FMRI (odds ratio 0.226 95% CI 0.081–0.626; p=0.004).

Conclusions
Catheter ablation is a valid option for the treatment of AF in patients with functional MR and additional substrate and trigger ablation were the only independent predictor of FMR improvement.

Funding Acknowledgement
Type of funding sources: None.
Long-term clinical outcomes in patients after catheter ablation for atrial fibrillation or atrioventricular node ablation: a French nationwide cohort study
Authors: Spiesser P , Bisson A , Bodin A , Herbert J , Pierre B , Clementy N , Babuty D , Fauchier L ,   Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France
Published: October 2021

Abstract

Background
Catheter ablation of atrial fibrillation (AF) has become a therapy of choice to treat symptomatic AF in current practice. As an alternative, atrioventricular node (AVN) ablation is an older but efficient procedure to control ventricular rate.

Purpose
To assess long-term clinical outcomes of AF ablation and AVN ablation in large cohort of patients with AF and to compare these two procedures.

Methods
This French multicentric retrospective study enrolled all patients hospitalized with a primary or secondary diagnosis of AF from 1st January 2010 to 31st December 2019, using an administrative hospital-discharge database. Clinical outcomes were analyzed in overall population and in propensity-matched samples.

Results
During follow-up (mean [SD] 2.0 [2.2], median [IQR] 1.0 [0.1–3.3] years), 2,438,015 patients were analysed (No ablation 2,360,833, AF ablation 62,490 and AVN ablation 14,692). Compared to patients treated without ablation, incidence of all-cause death was lower in patients treated with AF ablation (hazard ratio (HR) 0.272, 95% confidence interval (CI) 0.259–0.287, p&lt;0.0001) or AVN ablation (HR 0.762, 95% CI 0.734–0.791, p&lt;0.0001). After propensity-score matching, in patients treated with AF ablation, incidence of all-cause death (HR 0.662, 95% CI 0.557–0.788, p&lt;0.0001), cardiovascular death (HR 0.617, 95% CI 0.471–0.807, p&lt;0.0001) and hospitalization for heart failure (HF) (HR 0.732, 95% CI 0.620–0.865, p&lt;0.0001) were lower compared to patients treated with AVN ablation, unlike incidence of ischemic stroke (HR 1.447, 95% CI 1.122–1.865, p&lt;0.0001).

Conclusion
AF ablation and AVN ablation may be associated with better survival compared to non-invasive strategy. Compared to AVN ablation, AF ablation is associated with lower risk of all-cause death, cardiovascular death and hospitalization for HF, but higher incidence of ischemic stroke.

Funding Acknowledgement
Type of funding sources: None. Baseline characteristics matched cohortMain results
Digoxin treatment and long-term mortality depending on left ventricular ejection fraction and atrial fibrillation: a propensity score matched analysis
Authors: Grubler M.R , Verheyen N.D , Meinitzer A , Fiedler L , Tscharre M , Roithinger F.X , Tomaschitz A , Pilz S , Maerz W 
Published: October 2021

Abstract

Background/Introduction
Atrial fibrillation (AF) is a common heart rhythm disturbance, associated with an increased risk of stroke, hospital admissions and mortality, especially in patients with reduced ejection fraction. Among the oldest medications used for heart-rate control is digitalis, but largely due to observational studies showing an increased risk of death it has fallen out of favour. Recently newer clinical trials reported that the treatment with digitalis in permanent AF might be superior to beta blocker therapy in regard to functional status and symptom burden. Given this diverging results we attempt to analysis a large cohort of patients facilitating a propensity score matching algorithm.

Purpose
To assess the associations of digitalis treatment with mortality in patients with increased cardiovascular risk.

Methods
Patients were derived from a large cohort study including participants from a tertiary care centre who were referred to coronary angiography. The propensity score matching is based on a predefined list of variables, with digitalis as treatment. Matching strategy is nearest neighbour matching and to prove consistency, radius matching (radius = 0.1). For survival analysis we used a Cox proportional hazard regression comparing patients with and without digitalis for all-cause mortality. The analysis is conducted using STATA 13 MP. All patients provided written informed consent and the study was approved by the ethics committee.

Results
A total of 2457 patients (median age: 63.5 [IQR = 56.3–70.6] years, 30.1% women) referred to coronary angiography, with a median follow up of 9.9 (IQR = 8.5–10.7) years were included. The matching process and the resulting propensity score fulfilled all statistical assumptions and resulted in a balanced cohort. The risk for all-cause mortality was higher among propensity score matched participants not treated with digitalis compared to patients on treatment (n=514) HR 3.03 (95% CI 2.5 to 3.7). Total mortality in patients with AF on digitalis after a median follow-up of 9.9 years was 27.6%. At baseline, only 42.4% of patients with AF were on oral anticoagulation.

Conclusions
In the present cohort treatment with digitalis was associated with a lower risk of all-cause mortality after long-term follow-up. The patient population has a clinically significant 10-year mortality risk. The results may not apply to other cohorts but may help inform future clinical trials.

Funding Acknowledgement
Type of funding sources: None.
Same day discharge after atrial fibrillation ablation is feasible and safe. Results of a prospective study in 1015 patients
Authors: Viezelis M , Pontoppidan J , Johansen J.B , Djurhuus S.M , Dalhoj J , Asferg C , Osmanagic A , Sandgaard N.C.F 
Published: October 2021

Abstract

Background
Atrial fibrillation (AF) ablation is the standard treatment for symptomatic paroxysmal and persistent AF. It is a common practice for patients to stay overnight after the ablation for observation of possible complications. Thus, increasing volume of procedures places a significant strain on institutions. To tackle this issue, our institution developed a same-day discharge (SDD) protocol for AF ablation.

Purpose
To assess the feasibility and safety of the SDD protocol after at least four-hour observation in patients undergoing radiofrequency ablation (RFA) for AF.

Methods
A SDD protocol was implemented in our institution in March 2019. We conducted a prospective observational study that included all consecutive patients who underwent ablation for AF until January 2021. A detailed workflow setup provided in the figure. To compare means the Mann Whitney U test, and for categorical variables – χ2 test were used. The difference was significant when p&lt;0.05.

Results
A total of n=1015 patients underwent RFA in the study period. Of those, same-day discharge was feasible in n=751 (74.1%) and n=264 stayed overnight. The mean age (SDD 62.5 SD 8.8 years vs overnight-stay 64.1 SD 9.2 years, p=0.105) and gender distribution (males SDD 46.8% vs overnight-stay 39.8%, p=0.265) did not differ between the two groups. In the SDD group no patients were readmitted for complications within 24 hours after the ablation. A severe complication was defined as pericardial effusion with drainage, pulmonary oedema, thromboembolic event and vascular complication needing surgical intervention. In total 3.0% of all patients experienced a severe complication. The main reasons for staying overnight were small groin hematoma without intervention (18.9%), nausea (14.4%) and logistic issues (32.2%). The 30-day hospital readmission rate was insignificantly higher in the overnight-stay group (19.4% vs 28.0%, p=0.113). The most common reasons for readmission were arrhythmias (SDD 10.1% vs overnight-stay 20.5%) and chest pain (SDD 7.6% vs overnight-stay 2.4%). One late pericardial effusion with drainage on day 10 after the ablation was noted in the SDD group.

Conclusion
Same-day discharge in patients after RFA for AF is feasible and safe with an observational period of at least four hours and immediate transthoracic echocardiography after the procedure.

Funding Acknowledgement
Type of funding sources: None.
Comparison between early versus late pulmonary vein isolation in the management of atrial fibrillation
Authors: Intan-Goey V , Scherrenberg M , Falter M , Kaihara T , Dendale P , Verwerft J 
Published: October 2021

Abstract

Background
Atrial fibrillation (AF) is the most common type of arrhythmia. The health burden of AF keeps increasing with the rising incidence of AF caused by the aging population and the high prevalence of unhealthy lifestyle. Pulmonary vein isolation (PVI) is the cornerstone of invasive rhythm control treatment in AF. Randomized controlled trials have shown superiority of an PVI strategy compared to conservative treatment. However, the best timing to perform a PVI to achieve the most optimal outcome is still unknown.

Purpose
To investigate whether the timing of performing PVI has consequences for the AF management in terms of medical cost, the number of repeated electrical cardioversion and hospitalisations and mortality.

Methods
In this monocentric retrospective observational study, all patients who underwent an electrical cardioversion and PVI between January 2012 and January 2020 were included using a hospital administrative data record. Follow-up data were collected up to a maximum of 67 months. Early PVI is defined as patients receiving a PVI after a first electrical cardioversion; late PVI is defined as patients receiving PVI after more than one electrical cardioversion. We compared the two groups for the mean medical cost, the number of repeated electrical cardioversions performed, any unplanned hospitalization associated with AF and mortality.

Results
A total of 407 patients were included in this analysis. Respectively, in the early versus the late PVI strategy groups, the mean age was 64.5 vs. 66.3 years (p=0.105) and the mean follow-up was 1630±843 vs. 2039±781 days (p&lt;0.001). The mean medical cost since the first cardioversion was €8533 vs. €8987 (p=0.503), the number of additional electrical cardioversion performed was 0.4 vs 3.0 (p&lt;0.001) and mortality rate was 2,8% vs. 0% (p=0.116). The Log-rank analysis showed a significant difference (p&lt;0.001) between both groups in the time to first unplanned hospitalisation on cardiology ward after PVI in favor of early PVI strategy.

Conclusions
An early PVI tends to be superior to a late PVI strategy in the management of AF with less need for repeated electrical cardioversion and lower hospitalisation rate. Total medical cost and mortality rate were comparable in both approaches.

Funding Acknowledgement
Type of funding sources: None.