bluuebunny/crossref_metadata_2025_split huggingface dataset:
Timing of early recurrence of atrial fibrillation during the blanking period after catheter ablation for persistent atrial fibrillation and implications for long-term success: a multicentre study
Authors: Tang P T , Betts T R , Pedersen M E F , Rajappan K , Bashir Y , Wijesurendra R S , Ginks M R 
Published: October 2024

Abstract

Background
After catheter ablation (CA) for atrial fibrillation (AF), early recurrences of AF (ERAF) that occur within a 90-day post-ablation "blanking period" are considered to represent transient post-ablation pro-arrhythmia.

Purpose
To determine if the timing of early recurrence of AF during the traditional 90-day post-CA blanking period is associated with long-term AF recurrence after CA for persistent AF (PsAF).

Methods
We performed a multicentre retrospective study of patients undergoing first-time CA for PsAF between 2015-2018. All patients had undergone pre-CA DCCV. Incidences of ERAF during the post-CA blanking period were reviewed, and patients were categorised into three groups based on the timing of last episode of ERAF during the blanking period: (1) no ERAF (reference population); (2) last ERAF &lt;30 days post-CA; (3) last ERAF 31-90 days post-CA. The primary outcome was long-term recurrence of atrial arrhythmia, i.e. time to first recurrence of atrial arrhythmia occurring beyond the first 90 days after CA. Patients who had ERAF and exited the blanking period in AF (i.e. those with immediate recurrence at 90 days) were excluded from this analysis.

Results
331 patients were identified from five centres. 206 patients had no ERAF during follow-up, 124 patients had ERAF during the blanking period, and in one patient the presence of ERAF was not documented. Of the 124 patients experiencing ERAF during the 90-day post-CA blanking period, the timing of the last episode was known in 122 patients (Table 1). Of these, 58 patients exited the 90-day blanking period in AF and were excluded. Over median post-CA follow-up of 590 days, 147 patients (54%) experienced the primary outcome. Compared with Group 1 (no ERAF), ERAF within each of the time periods was associated with a statistically significant progressively increased risk of long-term recurrence (Group 2, last ERAF &lt;30 days post-CA: hazard ratio [HR] 1.95 [95% CI 1.15-3.31]; Group 3, last ERAF 31-90 days post-CA: HR 4.86 [95% CI 2.13-11.08]; Figure 1).

Conclusion
ERAF during the traditional 90-day post-CA blanking period is associated with long-term AF recurrence, with later recurrence within the 90-day period conferring greater risk. Patients with ERAF during the blanking period may need to be considered for earlier repeat intervention where clinically appropriate.
Procedural outcomes of fluoroscopy-less catheter ablation for atrial fibrillation
Authors: Rajkumar S , Alfraih A , Vivekanantham H , Dadon Z , Acosta G , Roberts J , Divakara Menon S , Amit G , Wong J 
Published: October 2024

Abstract

Background
Radiofrequency catheter ablation is superior therapy to antiarrhythmic drugs for maintaining sinus rhythm in atrial fibrillation (AF) patients. Traditional fluoroscopy-guided AF ablation poses risks of prolonged radiation exposure for both patients and medical staff. Recent advancements in fluoroscopy-less catheter ablation techniques offer potential solutions, but comprehensive data on their effectiveness and safety are lacking.

Purpose
To evaluate the procedural outcomes and safety of fluoroscopy-less catheter ablation for AF compared to fluoroscopy-guided ablation.

Methods
Retrospective observational study of consecutive AF ablations (N=881) conducted at a university teaching hospital (Hamilton Health Sciences, Hamilton, Ontario) from November 2017 to September 2022. An electro-anatomical mapping system and ICE was used in all cases. Baseline characteristics and procedural outcomes between the fluoroscopy-less and fluoroscopy-guided groups were compared. Cases that used &lt;60 seconds of fluoroscopy (occasionally used by operators during the placement of an esophageal probe) were included in the fluoroscopy-less group (N= 68).

Results
Mean age of individuals was 60.6 ± 11 years, 71.7% were male, 72.6% had paroxysmal AF, mean CHA2DS2-VASc score was 1.6 ± 1.4, 11.1% had prior heart failure, and mean left ventricular ejection fraction was 57.5 ± 15%. There were no significant differences in patient baseline characteristics between the fluoroscopy-less and fluoroscopy groups. Total procedure and fluoroscopy times were lower in the fluoroscopy-less group compared to the fluoroscopy-guided group (169.3 ±42 minutes vs. 192.1 ±54 minutes, p&lt;0.0001 and 0.024 ±0.10 vs. 10.0 ±7.4 minutes , p&lt;0.0001). Fluoroscopy-less AF ablation remained an independent predictor of lower procedure times following adjusting for the use of general anesthesia, high-power short-duration, presence of trainees, AF pattern, redo cases, and type of mapping system. Complication rates were similar between fluoroscopy-less and fluoroscopy-guided ablation (1.9% vs. 3.8%, p=0.11).

Conclusion
Fluoroscopy-less catheter ablation for AF appears to have similar procedural outcomes and safety than fluoroscopy-guided AF ablation.
Pulsed-field ablation for atrial fibrillation with a novel simplified protocol: the Swiss PFA dose multicenter study
Authors: Badertscher P , Breitenstein A , Spreen D , Isenegger C , Siemer D , Knecht S , Krisai P , Osswald S , Sticherling C , Kuehne M 
Published: October 2024

Abstract

Introduction
Pulsed-field ablation (PFA) has emerged as a novel treatment technology for patients with atrial fibrillation (AF). So far, little is known about the optimal number of PFA applications per pulmonary vein (PV). The standard protocol for PFA, as per manufacturer’s recommendation, entails 8 applications per PV.

Purpose
To assess the optimal pulsed-field ablation dosing (simplified versus standard protocol vs. extended protocol).

Method
We prospectively enrolled patients undergoing their first PVI using PFA in three tertiary referral centers. The following PFA dose protocols were applied: In the simple PFA group, a novel simplified protocol for PFA was performed with only 4 applications per PV (2x in basket and 2x in flower configuration). In the standard PFA group, a standard protocol with 8 applications per PV (4x basket and 4x flower configuration) was applied and in the extended PFA protocol, an extended protocol with 12 applications per PV (4x basket and 8x flower configuration) was applied.

Results
364 patients were included (32% female, median age 66 [IQR 58 – 73] years). Among these, 100 patients (36%) were in the simple PFA group, 180 patients (50%) in the standard PFA group and 84 (24%) patients in the extended PFA group. The median procedure duration, left atrial dwell time and the fluoroscopic time for the simple PFA, standard PFA and extended PFA group were 45 [interquartile range (IQR) 28 – 57] min vs. 54 [IQR 41 – 67] min vs. 63 [55 – 76] min (p &lt; 0.001), 25 [IQR 12 – 38] min vs. 37 [IQR 27 – 50] min vs. 39 [29 – 55] min (p &lt; 0.001), 9 [IQR 8 – 12] min vs. 11 [IQR 9 – 14] min vs. 9 [8 – 10] min (p &lt; 0.001), respectively. A total of four procedural complications (two tamponades, one stroke, one temporary ST elevation) were observed for the standard PFA group and none for the simple or extended PFA group (p = 0.382). The recurrence rate of atrial arrythmias was 41 (23%) for the standard protocol, 11 (11%) for the simple protocol and 12 (14) % for the extended protocol over a median follow-up of 285 [IQR 173 – 478] days (p = 0.065).

Conclusion
A novel simplified PFA protocol resulted in significantly shorter procedure duration, left atrial dwell time and fluoroscopic time, without compromising procedural efficacy compared to the standard or extended protocol.Figure 1
Impact of real-world off-label dose of Apixaban on long-term clinical outcomes in patients with atrial fibrillation and chronic kidney disease
Authors: Im S I , Shin H S 
Published: October 2024

Abstract

Background
Apixaban represent one of the cornerstone treatments to prevent cardioembolic events in patients with nonvalvular atrial fibrillation (NVAF). However, the choices of Apixaban dose guided by the decision-making process of the physician, which considers specific according to kidney functions are inconsistent in the real-world practice.

Objective
The objective of the present study is to evaluate the effects of real-world Off-label dose of Apixaban on long-term clinical outcomes in NVAF patients with chronic kidney disease (CKD).

Methods
Our database of AF patients diagnosed with CKD from 2018 to 2023 was used to obtain laboratory, echocardiography, electrocardiogram (ECG), and clinical outcomes data. Inclusion criteria were all AF patients with CKD using Apixaban. And we compared bleeding, systemic thrombotic events including stroke/systemic embolism and death according to off-label real -world dose of Apixaban.

Results
Among 635 patients with AF and CKD (76.9±10.4 years), 335 (52.8%) patients took off-label underdosed Apixaban. Difference in the baseline characteristics was not observed among patients including CHA2DS2 VASc score and HASBLED score. During the median 18-month follow-up, a lower incidence of bleeding events (P=0.001) was observed in the off-label underdosed Apixaban group compared to those with standard dose or off-label overdosed Apixaban. However, there was no significant difference of systemic thrombotic events including stroke/systemic embolism and death according to off-label real-world dose of Apixaban (off-label underdose vs. standard dose, P=1.000; off-label overdose vs. standard dose, P=1.000; off-label underdose vs. off-label overdose, P=0.609). In multivariate analysis, HASBLED score was independent risk factors for bleeding events (OR 9.650; CI 1.998-46.622; P=0.005).

Conclusions
Compared with standard or off-label overdose of Apixaban, off-label underdose of Apixaban was associated with a lower risk of bleeding in patients with AF and CKD, with no difference in the risk of stroke/systemic embolism or death, supporting the apixaban dosing tailored to specific clinical features and drug pharmacokinetics of the Asian patients.
Evaluation of concordance and association with clinical outcomes across eGFR values calculated with eight different formulas in a large cohort of european patients with atrial fibrillation
Authors: Boriani G , Bonini N , Mei D A , Imberti J F , Romiti G F , Corica B , Gerra L , Mantovani M , Vitolo M , Proietti M , Lip G Y H 
Published: October 2024

Abstract

Background
In randomized clinical trials of Direct Oral Anticoagulants (DOACs), the assessment of renal function impairment glomerular filtration rate (eGFR) in patients with Atrial Fibrillation (AF) has predominantly utilized the Cockroft-Gault (CG) formula for estimating Creatinine clearance (CrCl). However, in clinical practice, several other formulas for estimating glomerular filtration rate (eGFR) are employed. Limited data exist regarding the evaluation and comparison of eGFR/CrCl in AF patients.

Objectives
This study aimed to assess the concordance in the categorisation of renal function in in 6 classes taking into account eight different formulas for eGFR/CrCl (CG, CKD-EPI, CG/body surface area [BSA], BIS1, LMK, EKFC, FAS, MDRD) and their associations with a composite outcome (Major Adverse Cardiovascular Events [MACE] and all-cause death) in AF patients.

Methods
A contemporary European AF patient registry was utilized, and eGFR/CrCl were calculated using CG, CKD-EPI, CG/BSA, BIS1, LMK, EKFC, FAS, and MDRD formulas. eGFR was categorized according to KDIGO classes, with CKD patients defined as having eGFR/CrCl &lt;60 ml/min/m2. Concordance was estimated using weighted Cohen’s kappa. Associations were evaluated through adjusted Cox regression analyses for the composite outcome, and results were plotted as spline curves.
Results: A total of 8516 patients were included in the analysis (Median [IQR] age: 70 [63-77] years; 3518 women, 41.3%). Among the formulas, EKFC exhibited the highest median values of eGFR and the lowest prevalence of CKD patients, while BIS1 had the lowest median eGFR values, and the FAS formula led to the highest prevalence of CKD patients [Figure 1]. In the concordance analysis, CKD-EPI demonstrated the highest concordance with all other formulas, even if Cohen’s kappa for measuring the degree of concordance ranged from 0.61 to 0.88 [Figure 1]. In adjusted Cox regression analyses, all formulas were associated with an increased risk for the composite outcome, progressively as eGFR decreased. When plotted as spline curves, the associations with the composite outcome visually showed a similar behaviour of risks across eGFR values in all formulas compared to the CG spline [Figure 2].

Conclusions
Among AF patients, the CKD-EPI formula exhibited variable, but substantially good concordance with CG, CG/BSA, BIS1, LMK, EKFC, FAS, and MDRD formulas. All calculated eGFR values showed a strong association with the composite outcomes, similarly to the CG formula, with higher risk when renal function decreased.FIGURE 1FIGURE 2
Atrial fibrillation-related complications following short-term use of antibiotics in patients receiving NOAC or warfarin
Authors: Huang J , Tse H F , Lip G Y H , Yiu K H 
Published: October 2024

Abstract

Introduction
To study the association of antibiotics with ischaemic stroke/systemic embolism (IS/SE) in patients with atrial fibrillation (AF) receiving anticoagulants.

Methods
This retrospective population-based cohort study applied electronic health data from a territory-wide medical database. Data were collected for patients with AF who were prescribed non-vitamin K antagonist oral anticoagulants (NOAC) or warfarin between Jan 1, 2010 and Dec 31, 2018. We further identify the patients with and without use antibiotics (any classification of antibiotics with prescription period within 7 days) during the NOAC/warfarin treatment period. The primary outcome is IS/SE and the secondary outcomes including hemorrhagic stroke (HS) and all-cause mortality. Patients were followed up for a median of 3.7 years. A self-control case crossover design was adopted to compare the short-term association between use of antibiotics and outcomes of interest among NOAC and warfarin group.

Results
This study included 40221 patients, consisted of 30617 NOAC users and 9826 warfarin users, while 9604 patients in NOAC group and 3325 patients in warfarin group had concurrent antibiotics use. At baseline, 46.1% of patients in NOAC group were male and the mean (SD) age was 77.4 (9.8) years, and 56.2% of patients in warfarin group were male and the mean (SD) age was 73.8 (11.3) years. Short-term use of antibiotics is associated with increased risk of IS/SE, HS and all-cause mortality in both NOAC and warfarin groups (NOAC vs. warfarin group: IS/SE: hazard ratio [HR]:3.41 [95%CI, 2.78-4.18]; HR: 2.51 [95%CI, 2.00-3.14]; HS: HR: 2.22 [95%CI, 1.78-2.78]; HR: 2.53 [95%CI, 1.86-3.43]; mortality: HR: 1.96 [95%CI, 1.85-2.08]; HR: 1.87 [95%CI, 1.73-2.02]; all P &lt; 0.001).

Conclusion
The findings of the present study suggest that the short-term antibiotics use was associated with an increased risk of IS/SE, HS and all-cause mortality among patients in both NOAC and warfarin group. These findings further suggest that use of antibiotics may indicate a higher risk of IS/SE, HS and death for patients with AF, even when receiving NOAC/warfarin and that further investigation is warranted.The study design.The odds ratios of different outcomes.
Impact of the underlying rhythm during cavotricuspid isthmus ablation on the incidence of future new-onset atrial fibrillation: insights from an international multi-centre registry
Authors: Katic J , Badertscher P , Mannhart D , Zeljkovic I , Pavlovic N , Ammann P , Reichlin T , Roten L , Spreen D , Knecht S , Krisai P , Kuehne M , Sticherling C 
Published: October 2024

Abstract

Background
Radiofrequency catheter ablation of the cavotricuspid isthmus (RF-CTI) is the estabslished treatment of typical atrial flutter (AFL). After RF-CTI for AFL patients without previously documented atrial fibrillation (AF) may also develop AF. It is unknown whether the presence or absence of AFL at the time of ablation can predict the future occurence of AF.

Purpose
To compare baseline characteristics, procedural data, and long-term follow-up (FU) of patients with AFL.

Methods
Consecutive patients with documented AFL undergoing RF-CTI were enrolled in a multi-center registry in five centers in two countries between February 2017 and July 2023. For patients with AFL, entrainment mapping was performed for confirming CTI dependent AFL. Patients were categorized into two groups, those with AFL and those with sinus rhythm (SR) during RF-CTI. FU data were collected, including clinical assessments, 12-lead electrocardiogram (ECG) and 24-hour Holter-ECGs during each visit.

Results
Of the 949 subjects, 36% were excluded from the analysis due to a history of AF. A total of 574 patients were included (mean age 68 +/- 11 yrs, 14% females), 62% presented in AFL group and 38 % SR group during CTI. Median FU was 364 days. Patients in AFL group were older (P &lt; 0.029), more likely to have diabetes (P = 0.026), and were less frequently treated with antiarrhythmic drugs (P &lt; 0.001). In the first 12 months of FU, 40% of the patients underwent three FU examinations, while 77% of the patients underwent at least one 24-hour Holter-ECGs during FU. In the Kaplan-Meier analysis patients in AFL group significantly less often developed AF during FU (log-rank, P &lt; 0.016, central ). In the multivariate Cox regression analysis, sinus rhythm during ablation (hazard ratio 1.474; 95% CI 1.043-2.084; P = 0.028), male gender (hazard ratio 1.722; 95% CI 1.116-2.658; P = 0.014) and coronary artery disease (hazard ratio 1.711; 95% CI 1.145-2.555; P = 0.009) were identified as predictors for the occurence of AF during FU.

Conclusion
Over a one year follow-up, new onset AF occurs significantly less frequently in patients with ongoing atrial flutter during RF-CTI ablation.
Detection of hypotension in patients with syncope: combined tilt test and ambulatory blood pressure monitoring strategy in clinical practice
Authors: Ruiz G A , Makhoul S , Agustini M , Gos Re V N , Maza S , Zarate J A , Tombesi P , Salzberg S 
Published: October 2024

Abstract
Both ambulatory blood pressure monitoring (ABPM) and Tilt Test (TT) (a provocation method), can identify the hypotensive component that predisposes to syncope.

Objective
1)To establish a) the prevalence of confirmed hypotension (CHp) with both methods; b) the concordance between them.

Methods
Patients (pts) ≥18 years with syncope for whom it was decided to perform a TT were included. TT was performed for 45 min at 75 degrees. On a different day, within 15 days, an ABPM was performed (≥70 % adequate readings). Criteria: CHp: In TT: TT(+) or detection of systolic blood pressure (SBP) ≤ 100 mmHg during the study resulting from a drop from baseline; in ABPM: SBP ≤ 100 mmHg resulting from a drop ≥ 20 mmHg from the previous one. Only the awake periods were considered.

Results
61 pts (age= 62.5±16.8, female= 39 (64%); antihypertensive medications= 35 pts (57%); Cardiovascular history, except isolated hypertension= 29 pts (47%). The reported number of episodes was 4±4.4 (median=2). Syncope was post-prandial in 25 pts (41%) and probable reflex by the description in 28 pts (46%).
CHp during syncope was confirmed in 25 pts during TT and in 1 pt during ABPM. Positive responses to TT were: vasodepressor in 14 pts, mixed in 10 pts and disautonomic pattern in 1 pt. Average 24 h in ABPM was above 135 mmHg in 10 pts (16%). Seventy-nine per cent of the population (48 pts) presented ≥ 2 falls ≥20 mmHg of SBP during the waking period.
SBP ≤ 100 mmHg constituted ≥ 20% of awake measurements in 10 pts (16%). A post-prandial fall in SBT ≥ 20 mmHg was detected in 24 patients (39%). Of these, in 8 (13%), the achieved SBP was ≤ 100 mmHg. Table 1 shows the prevalence for CHp with both methods. Table 2 shows the concordance between TT and ABPM.
CHp was detected by TT or ABPM in 48 pts, i.e 79% of the population. Both studies were concordant in 32 pts (52%) (Cohen's kappa coefficient: 0.04). CHp was identified in 28% of pts only by TT and in 20% only by ABPM.

Conclusion
CHp was detected in ¾ of this population using a combined TT and ABPM strategy. They were complementary not only to establish a diagnostic suspicion, but also to guide the therapeutic management of these patients.CHp PrevalenceTT and ABPM Concordance
Mitral regurgitation improvement following left bundle branch pacing versus right ventricular septum pacing: a dedication to postoperative amelioration of mitral regurgitation
Authors: Shan L , Dai W L 
Published: October 2024

Abstract

Background
Mitral regurgitation (MR) is correlated with left ventricular (LV) remodeling and LV function in patients. Left bundle branch pacing (LBBP) exhibits a significant decline in MR in left bundle branch block (LBBB) and cardiomyopathy patients. This research aims to evaluate the influence of LBBP on MR in comparison to right ventricular septal pacing (RVSP) in patients with atrioventricular block (AVB) or sick sinus syndrome (SSS).

Methods
Sixty consecutive patients with SSS or AVB were enrolled if they underwent pacemaker implantation via LBBP or RVSP. Patients with a history of mitral valve surgery were excluded. Echocardiogram parameters were assessed to measure MR and LV remodeling as well as LV function at baseline and follow-up.

Results
Thirty-six patients (60 %; mean age: 70.39 ± 14.80 years; 61.1 % male) underwent successful LBBP, and 24 patients (40 %; mean age: 71.58 ± 10.91 years; 66.7 % male) underwent RVSP. The average follow-up duration was relatively comparable between the two groups. In comparison to RVSP, LBBP demonstrated significant changes in MR area, and severity at baseline and follow-up (P&lt;0.05). LBBP independently predicted MR amelioration in patients who underwent pacemaker implantation (HR=0.289, CI=0.087–0.9961; P=0.043). At follow-up, the LBBP subgroup with moderate/severe MR exhibited significantly shorter lead-TVA-dist, higher left atrium (LA) diameters, and mitral E/A ratio (P&lt;0.05) compared to the none/mild MR subgroup. In LBBP with MR amelioration, LV remodeling (ΔLVEDD) was significantly enhanced compared to baseline (P=0.016). Additionally, a non-significant trend toward better improvement in LV function (ΔLVEF and ΔE/A) was observed in patients with MR amelioration.

Conclusion
LBBP, considered an optimal pacing technique for SSS or AVB patients, may substantially reduce MR and subsequently enhance LV remodeling and function compared to RVSP. This open, observational pilot study warrants confirmation through further investigations.Comparison between LBBP and RVSPKaplan-Meier curves for MR amelioration