bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early vs late new-onset atrial fibrillation in STEMI patients: pathophysiological mechanisms and relationship with in-hospital outcomes
Authors: Biccire F G , Cardillo I , Chianta V , Ferrari I , Capone S , De Luca A C , Torromeo C , Acconcia M C , Tanzilli G , Barilla F , Pastori D 
Published: October 2021

Abstract

Background
New-onset atrial fibrillation (NOAF) represents the most common supraventricular arrhythmia in the setting of ST-elevation myocardial infarction (STEMI), with up to 21% patients affected. The occurrence of NOAF has clinical relevance as previous studies showed that atrial fibrillation (AF), whether pre-existent to the admission or newly developed during STEMI hospitalization, is associated with worse short- and long-term prognosis. More recently, two distinct phenotypes of NOAF have been described, such as early NOAF (EAF) for AF occurring within 24 h from STEMI, and late NOAF (LAF) for AF onset beyond 24h. The mechanisms underlying EAF or LAF are poorly described.

Objective
To investigate atrial branches occlusion and EAF or LAF onset in STEMI patients undergoing primary percutaneous coronary intervention.

Methods
Retrospective cohort study including 155 STEMI patients. Patients were divided into 3 groups: sinus rhythm (SR), EAF or LAF. Clinical characteristics, angiographic features including occlusion of atrial branches, namely ramus ostia cavae superioris (ROCS), atrio-ventricular node artery (AVNA), right intermediate atrial artery (RIAA) and left intermediate atrial artery (LIAA), were assessed (Figure 1). We also investigated in-hospital adverse events (AEs) and death.

Results
Mean age was 63.8±11.9 years; 78.7% of men. NOAF was detected in 22 (14.2%) patients: 10 (6.4%) EAF and 12 LAF (7.7%). Compared to EAF, LAF patients were older (p=0.013), with higher GRACE risk score (p=0.014) and Killip class (p=0.015), depressed ejection fraction (p=0.007), elevated filling pressures (p=0.029), higher c-reactive protein (p=0.014) and more TIMI flow &lt;3 (p=0.015). Compared to SR, EAF was associated with higher prevalence of occluded ROCS (p=0.010), AVNA (p=0.005) and RIAA (p&lt;0.001) (Figure 2). Moreover, EAF patients had more frequently ≥2 diseased atrial branches than SR (19.5%, p&lt;0.001) and LAF (25%, p&lt;0.030) patients. In LAF patients, a higher incidence of AEs (p=0.019 vs SR; p=0.029 vs EAF) and death (p=0.004 vs SR) was found.

Conclusions
The occlusion of atrial branches is associated with early but not late NOAF following STEMI. LAF patients had worse in-hospital AEs and mortality.

Funding Acknowledgement
Type of funding sources: None. Anatomy of atrial branchesInvolvement of atrial branches
Outcomes and resource utilization of atrial fibrillation hospitalizations with type 2 myocardial infarction
Authors: Ariss R.W , Minhas A.M , Nazir S , Meenakshisundaram C , Ali M.M , Ahuja K.R , Grande R.D , Ramanathan P.K , Kayani W.T , Sheikh M 
Published: October 2021

Abstract

Background
Patients with atrial fibrillation (AF) are often elderly and have higher rates of comorbidities which may predispose them to an increased risk of myocardial oxygen demand-supply mismatch. Scarce data exist on the prognostic impact of type 2 myocardial infarction (MI) in AF.

Purpose
To examine the association of type 2 MI with outcomes and resource utilization in primary AF hospitalizations.

Methods
We utilized the Nationwide Readmission Database 2018 to identify primary AF hospitalizations with and without type 2 MI. The International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes I48.0, I48.1, I48.2, I48.91 were utilized to identify primary AF hospitalizations within the United States. Of these, AF hospitalizations complicated by type 2 MI were identified using ICD-10 code I21.A1. Comorbidities and outcomes were identified using the corresponding ICD-10 codes. Complex samples multivariable logistic and linear regression models were used to determine the association between type 2 MI and outcomes (in-hospital mortality, index length of stay [LOS], hospital costs, discharge to nursing facility, and 30-day all-cause readmissions). Predictors of in-hospital mortality in AF with type 2 MI were also determined.

Results
Of 382,896 primary AF hospitalizations included in this study, 7,375 (1.9%) had type 2 MI. Compared to AF hospitalization without type 2 MI, those with type 2 MI are older (74.5 vs. 70.7-years-old) and have higher prevalence of chronic pulmonary disease, dyslipidemia, diabetes mellitus, hypertension, heart failure, peripheral vascular disease, chronic kidney disease, neurological disorders, deficiency anemia, coagulopathy, valvular disease, prior myocardial infarction, prior coronary artery bypass grafting, prior percutaneous coronary intervention, and prior cerebrovascular accident (P for all &lt;0.001). AF with type 2 MI is associated with significantly higher in-hospital mortality (1.3% vs. 0.5%; P&lt;0.001), LOS (4.1 vs. 3.3 days; P&lt;0.001), hospital costs ($10,293.6 vs. $8,820.3; P&lt;0.001), discharges to nursing facility (18.1% vs. 10.2%; P&lt;0.001), and 30-day all-cause readmissions (18.5% vs. 13.5%; P=0.001) compared to AF hospitalizations without type 2 MI (Table 1). Heart failure, chronic kidney disease, neurological disorders, and age (per year) were identified as independent predictors of in-hospital mortality among AF patients with type 2 MI (Figure 1).

Conclusion
In this large nationwide analysis, type 2 MI in the setting of AF hospitalization is associated with higher in-hospital mortality and increased resource utilization compared to AF hospitalizations without type 2 MI.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Rate and rhythm control treatment in the elderly and very elderly patients with atrial fibrillation: an observational cohort study of 1,497 patients
Authors: Klamer T.A , Bots S.H , Neefs J , Tulevski I.I , Somsen G.A , Den Ruijter H.M , De Groot J.R 
Published: October 2021

Abstract

Aim
Stroke prevention and rate or rhythm control are crucial parts of the treatment of atrial fibrillation (AF). There is limited evidence for the efficacy or safety of rate and rhythm control in elderly or very elderly patients, although this population is rapidly increasing. Therefore, we analyzed electronic health record data from outpatient cardiology clinics to give insight in prescribing patterns and mortality of both treatment strategies in the elderly patients.

Methods and results
We extracted data from all patients with AF who were aged &gt;75 years, used a pharmacological rate or rhythm control strategy and visited one of the independent outpatient cardiology clinics in the Netherlands between 2007 and February 2018. This resulted in 1,497 selected patients (54% women), of whom 316 (21%) were prescribed rhythm control (consisting of class 1 or 3 antiarrhythmic drugs) and 1,181 (79%) rate control (beta blockers, calcium antagonists or digoxin). Patients aged &gt;85 years (OR: 2.28) and those with permanent AF (OR: 2.71) were more likely to receive rate control (OR: 2.28, OR: 2.71 respectively), whereas those with paroxysmal AF were more likely to receive rhythm control (OR: 0.42). After correcting for relevant confounders, the mortality risk for patients using rhythm control was similar to patients using rate control (HR: 0.89; 95% CI: 0.70; p=0.31).

Conclusion
Considering the similar mortality risks in both groups, a more liberal approach in prescribing a rhythm control strategy to the healthier elderly patient with AF seems safe. Our data underscores the need for a non-inferiority trial to provide definite answers on safety of rhythm control in elderly patients with AF.

Funding Acknowledgement
Type of funding sources: None.
Left atrial stiffness measured by echocardiography is a stronger predictor of atrial fibrillation recurrence after radiofrequency catheter ablation than left atrial volume
Authors: Farinha J.M , Fonseca M , Parreira L , Esteves A.F , Pinheiro A , Ferreira J , Coelho R , Mesquita D , Marinheiro R , Amador P , Caria R 
Published: October 2021

Abstract

Introduction
Left atrial volume (LAV) is an accepted predictor of atrial fibrillation (AF) recurrence after radiofrequency catheter ablation, stronger than AF duration.

Objective
The aim of this study was to assess the value of left atrial stiffness (LAS) index as a new parameter evaluated by echocardiography to the prediction of AF recurrence after radiofrequency catheter ablation.

Methods
We retrospectively studied consecutive patients with paroxysmal or persistent AF submitted to radiofrequency catheter ablation at our institution between 2017 and 2019. We used transthoracic echocardiography to measure the LAV indexed to body surface area and the LAS index, defined as the ratio between the mitral E/e' (obtained with pulsed Doppler at the tip of the mitral leaflets – E, and tissue Doppler imaging at the mitral annulus – e') and the left atrial strain during the reservoir phase (obtained by speckle tracking echocardiography) [LAS index = (E/e') / LA reservoir strain]. The left ventricular ejection fraction (LVEF) was also evaluated. Patients with poor quality echocardiographic images were excluded. We compared 2 groups of patients, according to the recurrence of AF after the blanking period. We analysed the clinical characteristics and echocardiographic findings. The effect of clinical and echocardiography parameters on AF recurrence was evaluated by univariate and multivariate Cox Regression analysis.

Results
We studied 33 patients, 27 with paroxysmal AF and 6 with persistent AF. Baseline patients' characteristics are presented in Table 1. During a mean follow-up time of 17.9±10.4 months, 7 patients (21%) had AF recurrence, and none died. Patients with AF recurrence had a higher LAS index. After adjusting for confounding variables, only LAS index and LAV were independently associated with AF recurrence (Table 2). Every one unit increase in LAS index was associated with an 11-fold increased risk of AF recurrence (HR 10.86, 95% CI 1.38–85.56; p=0.024), while every one unit increase in LAV index was only associated with a 6% increased risk of AF recurrence (HR 1.06, 95% CI 1.01–1.11, p=0.010).

Conclusion
LAS index evaluated by echocardiography was a much stronger predictor of AF recurrence after radiofrequency catheter ablation than left atrial volume.

Funding Acknowledgement
Type of funding sources: None.
Poor glycemic control in diabetic patients increases the risk of recurrent atrial arrhythmia and cardiovascular hospitalizations among morbidly obese patients undergoing atrial fibrillation ablation
Authors: Stout K.M , Tandon H , Adomako R , Schleifer J.W , Payne J , Easley A , Khan F , Windle J , Tsai S , Anderson D , Peeraphatdit T , Naksuk N 
Published: October 2021

Abstract

Background/Introduction
Obesity and atrial fibrillation (AF) coexist and share multiple cardiovascular risk factors. Lifestyle modifications can reduce AF burden in obese patients. However, the time invested in pursing lifestyle changes may delay AF ablation, which could negate the procedural benefit.

Purpose
To examine the effects of lifestyle modifications and the timing of catheter ablation on morbidly obese patients with AF.

Methods
This retrospective study included 217 consecutive AF patients with a body mass index (BMI) ≥35 kg/m2 undergoing AF ablation at a tertiary care center from 2012 to 2019. Modifiable risks were examined, including the time from AF diagnosis to ablation, fluctuation of BMI &gt;5% or an increase in BMI &gt;3% prior to ablation, mean systolic blood pressure &gt;130 mmHg or diastolic blood pressure &gt;80 mmHg, obstructive sleep apnea with CPAP noncompliance, hyperlipidemia without statin therapy, tobacco use, excessive alcohol use, and diabetes mellitus with hemoglobin A1c (HbA1c) ≥6.5%. The primary outcome was a composite of recurrent atrial arrhythmias and cardiovascular (CV) hospitalizations following AF ablation. A multivariate analysis adjusting for age, gender and modifiable risks was performed.

Results
The mean age was 61±9 years old, 58% were female and 45% had persistent AF. A substantial portion of the study patients had modifiable risk factors, ranging from 2.7% with excessive alcohol use to 67.3% experiencing delayed AF ablation, Figure 1. The median time from diagnosed AF to ablation was 1.3 years. During a mean follow-up of 2.9 years after AF ablation, 136 (62.7%) patients met the primary outcome. Only HbA1c ≥6.5% was an independent risk factor with adjusted hazard ratio of 1.57, 95% confidence interval 1.02–2.36, P=0.0412, Figure 2A. Delayed AF ablation did not alter the outcome, Figure 2B. There was no interaction between time of ablation and HbA1c ≥6.5% (P=0.67).

Conclusion
Substantial portions of morbidly obese patients undergoing AF ablation have potentially modifiable risk factors. Poor glycemic control with HbA1c ≥6.5% predicts an increased risk of recurrent atrial arrhythmias and CV hospitalizations, while delayed AF ablation does not. This finding underscores an importance of optimizing HbA1c in morbidly obese patients with AF to reduce adverse outcomes after ablation.

Funding Acknowledgement
Type of funding sources: None.
Catheter ablation of atrial fibrillation in patients under 45 years of age. Longterm outcome
Authors: Calero Nunez S , Hidalgo-Olivares V.M , Cubells-Pastor M , Prieto-Lobato A , Gil-Gomez S , Alcahud-Cortes C , Barajon-Bravo J.M , Cano-Garrigos J , Martinez-Galdon C , Enero-Navajo J 
Published: October 2021

Abstract

Introduction
Young patients (p) with atrial fibrillation (AF) tend to be more symptomatic and more reluctant to take long-term antiarrhythmic drugs. However, AF ablation (especially when persistent) is often used as second-line treatment regardless of age.

Purpose
The aim is to compare clinical outcome and safety of catheter ablation of atrial fibrillation in young adults in comparison to older adults. Secondary endpoints were to compare the influence of other comorbidities in AF ablation outcomes.

Methods
From 2012–2019, consecutive patients (mean age 56±9,4 years; 72,8% men) with symptomatic paroxysmal AF (PAF 68,8%) and persistent (Pers) AF (31,2%) underwent PVI through radiofrequency (91%) or cryoballoon (9%) at our centre. Two groups were defined (group A ≤45 years, group B &gt;45 years). Follow-up was based on outpatient visits including 24h Holter-ECG at 3, 6 and, 12 months post ablation, and every 12 months thereafter.

Results
A total of 202 patients undergoing AF ablation were included (group A: 35, 17,3%; group B: 167, 82,7%). Male gender (91,4 vs 68,9%, p=0,006) and smoking (37,1% vs 13,2%, p=0,001) were significantly more often present in group A. HTA (50,9% vs 22,9%, p=0,002) and CHA2DS2-VASc score (1,3±1 vs 0,4±0,6; p=0,01) were higher in the older population group. Median follow-up was 29±18 months. After 12 months AF recurrence were less common in group A: 1-year arrhythmia-free survival was 88,6% (31/35) vs 73,7% (123/167) in the older group [P 0.049]. However, outcomes at the end of follow up were similar between the two groups, the freedom from AF was 57.1% (20/35) in young patients vs 65,3% (109/167) in older group, p=0,42. Multivariate analysis demonstrated that left atrial volume was a predictor of being freedom from AF recurrent [HR 0,96 (95% IC 0,95–0,99), p=0.003]. Major complications occurred more frequently in older patients, although without reaching statistical significance (4.8% (8) vs 2.9% (1); p=0.61), in the young there was only one complication that was pulmonary vein stenosis. Redo AF ablation rate was comparable between the two groups.

Conclusion(s)
Catheter ablation of AF in young adults is associated with higher 1-year success rates but similar long-term outcomes. The young patients tended to have lower rates of complications in comparison to the older population. These findings suggest that it may be appropriate to consider ablative therapy as first-line therapy in this age group, but further study may be needed to confirm this

Funding Acknowledgement
Type of funding sources: None. Figure 1Table 1
Does use of an antiarrhythmic drug prior to cryoballoon pulmonary vein isolation impact the duration of the post-ablation blanking period?
Authors: Saberito M , Milstein N , Bhatt A , Habibi M , Sichrovsky T , Preminger M , Shaw R , Mittal S , Musat D 
Published: October 2021

Abstract

Background
At time of cryoballoon (CB) pulmonary vein isolation (PVI), some patients with atrial fibrillation (AF) are on an antiarrhythmic drug (AAD) while others are not. The impact of AAD use at time of CB PVI on the duration of post-ablation blanking period (BP) is unknown.

Objective
To determine whether the optimal BP duration differs between pts who were and were not taking an AAD at time of CB PVI.

Methods
We enrolled consecutive pts with AF who had initial CB PVI; all pts had an implantable loop recorder (ILR). We prospectively followed all pts and determined the time to last AF episode during the 90-day post-PVI BP. This was then correlated with likelihood of having an AF recurrence between 3–12 months post-PVI.

Results
The cohort included 165 pts (66±9 years; 99 [60%] male; 91 [55%] PAF; CHA2DS2-VASc 2.7±1.6). An AAD was being used at some point prior to ablation in 120 (73%) pts. An AAD was being used at time of CB PVI in 92 (77%) of these 120 pts; this was stopped at a median of 80 [36, 105] days post-PVI.
We defined 4 distinct groups: (1) no AF in 90-day BP (n=75 [45%]); (2) last AF within 30 days of PVI (n=32 [19%]); (3) last AF within 60 days of PVI (n=17 [10%]); and (4) last AF within 90 days of PVI (n=41 [25%]). Patients not exposed to an AAD prior to CB PVI had significantly lower likelihood of having no AF in the first 90-days post ablation (p=0.004, Figure). In contrast, if AF was observed post-ablation, as time from ablation to recurrence increased, so did likelihood of long-term failure from ablation (Figure); this relationship was not impacted by use of an AAD.

Conclusion
The best long-term outcomes post CB PVI are seen in pts who had no prior exposure to an AAD and had no AF within the first 90 days of ablation. Subsequently, as the time from ablation to AF recurrence increased within the 90-day BP, so did likelihood of recurrent AF during long-term follow-up, irrespective of whether an AAD was or was not used.

Funding Acknowledgement
Type of funding sources: None.
Stroke prevention with non-vitamin K antagonist oral anticoagulants in high risk elderly atrial fibrillation patients at increased bleeding risk
Authors: Chao T , Lip G.Y.H , Chen S.A 
Published: October 2021

Abstract

Background
Elderly atrial fibrillation (AF) patients with risk factors of bleeding are often considered ineligible for standard oral anticoagulants (OACs). The ELDERCARE-AF trial recently showed that edoxaban 15mg/day was superior to placebo for preventing stroke or systemic embolism and did not result in a significantly higher incidence of major bleeding. Our aim was to investigate a real-world cohort of AF patients similar to the ELDERCARE-AF cohort, with regard to the impact of non-vitamin K antagonist oral anticoagulant (NOAC) use compared to non-OAC use, in relation to clinical outcomes.

Methods
From January 1, 2012 to December 31, 2016, 15,183 AF patients aged ≥80 years (mean age 86.63 years [SD 4.79]; 48.7% male) with a CHADS2 score &gt;2 who met the enrollment criteria (generally similar to ELDERCARE-AF) were identified from the Taiwan National Health Insurance Research Database. Patients were categorized into 2 groups according to their stroke prevention strategies, ie. without OACs (n=9,084) and NOACs (n=6,099). Patients receiving NOACs were further stratified into reduced-dose or full-dose regimen groups.

Results
Compared to the non-OAC group as a reference, NOAC use (whether as reduced dose or full dose) was associated with a lower risk of ischaemic stroke (adjusted hazard ratio [aHR] 0.766, 95% confidence interval [CI] 0.667–0.879) and all-cause mortality (aHR 0.393, 95% CI 0.370–0.418) while the risks of ICH and major bleeding were similar. The risks of composite outcomes of “ischaemic stroke or mortality” (aHR 0.423, 95% CI 0.398–0.449) and “ischaemic stroke or major bleeding or mortality” (aHR 0.490, 95% CI 0.463–0.518) were significantly lower with NOAC use. When compared to non-OAC as the reference groups, NOACs (whether reduced dose or full dose) showed a positive NCB. The results were generally consistent even after the propensity matching (Figure 1).

Conclusions
In routine clinical care, NOACs (whether reduced or full dose) were associated with a lower risk of ischemic stroke, mortality and the composite endpoint, when compared to non-OAC use in high risk elderly AF patients at increased bleeding risk. Our findings provide complimentary “real world” data to support the generalizability of the results of ELDERCARE-AF trial into daily clinical practice.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Impacts of hemoglobin levels and platelet counts on clinical outcomes in patients with atrial fibrillation: oral anticoagulant use for patients with anemia and/or thrombocytopenia
Authors: Chao T , Chan Y.H , Lip G.Y.H , Chen S.A 
Published: October 2021

Abstract

Background
Hemoglobin (Hgb) levels and platelet (PLT) counts have beeen associated with adverse clinical outcomes in some patients with cardiovascular conditions. We aimed to assess the risks of clinical events among patients with atrial fibrillation (AF) in relation to Hgb levels and PLT counts. Second, we investigated clinical outcomes on warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) compared to no oral anticoagulant use (non-OAC), in different Hgb and PLT strata.

Methods
We used medical data from a multi-center healthcare system in Taiwan which included 37,074 AF patients. Patients were categorized into 3 groups based on their Hgb levels and PLT counts: Group 1 (Hgb&gt;10g/dL and PLT&gt;100K/uL; n=29,147), Group 2 (Hgb&lt;10g/dL or PLT&lt;100K/uL; n=7,078) and Group 3 (Hgb&lt;10g/dL and PLT&lt;100K/uL; n=849). Patients in each category were further stratified as 3 groups according to their stroke prevention strategies; that is, non-OAC, warfarin or NOACs.

Results
A higher Hgb level and/or PLT count was associated with a higher risk of ischemic stroke/systemic embolism (IS/SE), but lower risks of intracranial hemorrhage (ICH) and major bleeding. The composite risks of IS/SE, ICH and major bleeding were higher in Group 3 or Group 2, compared to Group 1 (6.75%/yr versus 6.41%/yr versus 4.13%/yr). Compared to non-OACs, the use of warfarin was not associated with a lower composite risk of IS/SE, ICH and major bleeding in the 3 groups. NOACs were associated with a lower composite risk in Group 1 (aHR 0.68, 95% CI 0.60–0.76) and Group 2 (aHR 0.73, 95% CI 0.53–0.99), but was non-significant in Group 3 (aHR 0.73, 95% CI 0.17–3.07) (Figure). The net clinical benefits were consistently positive in different weight models, in favor of NOAC use, in Group 2 and its subgroups with either anemia or thrombocytopenia.

Conclusions
AF patients with anemia and/or thrombocytopenia were a high-risk population. Compared to no OAC use, NOACs were associated with significantly better clinical outcomes for patients with advanced anemia (Hgb&lt;10g/dL) or thrombocytopenia (PLT&lt;100K/uL), but not for those with both conditions. Harms or benefits of NOACs should be carefully evaluated and balanced in this population.

Funding Acknowledgement
Type of funding sources: None.