bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of right coronary artery injury and distance from tricuspid valve ring to right coronary artery in radiofrequency ablation
Authors: Ohmori M , Takigawa M T , Negishi M N , Ikenouchi T I , Yamamoto T Y , Kawamura I K , Goto K G , Nishimura T N , Takamiya T T , Tao S T , Miyazaki S M , Takamura C T , Terashima M T , Sasano T S 
Published: October 2024

Abstract

Background
Coronary injury is a significant risk during catheter ablation (CA). While a shorter distance between the CA site and the coronary artery is known to increase this risk, less fat in this region might also heighten the chances of coronary damage due to greater penetration of RF energy. However, the relationship between the right coronary artery (RCA #1-3) and the basal right ventricle at the tricuspid annular ring (TVR) has not been thoroughly investigated, despite reports of coronary obstruction during ablation in this area (see Figure in reference). This study aimed to address this gap.

Methods
Forty-one consecutive patients (average age 64 ± 14 years, 30 males) who underwent coronary CT before ablation were enrolled. The distance between the TVR and RCA (#1-3) and the fat distribution between these structures were assessed (see Figure 1).

Results
The TVR-RCA#1 distance was 8.4 ± 4.7 mm, and TVR-RCA#2 was 4.1 ± 1.8 mm. In 30 (73%) patients, the closest TVR-RCA distance was &lt;5 mm, with &lt;2 mm in 4 (10%) patients, and 1.4 mm at the closest point (see Figure 2A). While the fat distribution at the closest TVR-RCA varied (-34.9 ± 78.1) among patients, almost no fat tissue was seen in 12 (30%) patients (see Figure 2B).

Conclusion
CA on the basal lateral RV should be approached with caution due to the very close proximity of TVR to RCA in 10% of cases and the lack of fat distribution in this area in 30% of cases.
Temporal trends of prescription rates, dosing of non-vitamin K antagonist oral anticoagulants and clinical outcomes in patients with atrial fibrillation
Authors: Chao T , Liao J N , Kuo L , Lip G Y H 
Published: October 2024

Abstract

Background
The launch of non-vitamin K antagonist oral anticoagulant (NOAC) has revolutionized the landscape of stroke prevention in atrial fibrillation (AF). We aimed to analyze the temporal trends of prescription rates of oral anticoagulants (OACs), NOAC dosing, clinical outcomes and in patients with AF.

Methods
This was a retrospective study using the Taiwan National Health Insurance Research Database. During 2011 to 2020, A total of 249,107 patients aged ≥30 years with newly diagnosed AF were identified. We analyzed the 1-year risks of ischemic stroke, intracranial hemorrhage (ICH), and all-cause mortality for overall population and specifically for NOAC users.

Results
The prescription rate of OAC increased from 22.1% in year 2011 to 57.7% in 2020 (P&lt;0.001) with NOAC accounting for 91.0% of overall OAC prescriptions. Compared to patients with incident AF diagnosed in 2011, there were increasing trends for a greater decrease in the risks of ischemic stroke (adjusted hazard ratios [aHRs] 0.914 in 2012, 0.879 in 2013, 0.925 in 2014, 0.822 in 2015, 0.754 in 2016, 0.763 in 2017, 0.769 in 2018, 0.713 in 2019 and 0.707 in 2020; all P&lt;0.05) and mortality (aHRs 0.903 in 2014, 0.899 in 2015, 0.830 in 2016, 0.808 in 2017, 0.788 in 2018, 0.810 in 2019, 0.788 in 2020; all P&lt;0.05), while the risk of ICH did not change significantly (Figure 1). For NOAC users, the percentages of high-dose NOACs increased from 11.04% in year 2012 to 44.29% in year 2019 to 2020. The increasing trend in the use of high-dose NOACs was temporally associated with a lower risk of ischemic stroke observed for patients receiving NOACs in year 2015 to 2017 (aHR 0.794) and year 2018 to 2020 (aHR 0.688) compared to those in year 2012 to 2014 (Figure 2).

Conclusion
In this nationwide cohort study, there was an increasing trend of OAC prescription, temporally associated with a decline of the risk of ischemic stroke and mortality. Even among NOACs users, the risk of ischemic stroke declined gradually, partly explained by the increasing prescriptions of high-dose NOACs.
Comorbidities and risk of death in atrial fibrillation: a nationwide cohort study
Authors: Aro A , Haukka J , Halminen O , Kouki E , Putaala J , Linna M , Mustonen P , Hartikainen J , Airaksinen J , Lehto M 
Published: October 2024

Abstract

Background
Atrial fibrillation (AF) is associated with increased mortality, cardiovascular morbidity, and risk of stroke. With aging population, the number of AF patients is increasing, and they present with more comorbidities representing a major public health challenge.

Purpose
The influence of concomitant diseases on survival of patients with AF is not well established. Using data from a comprehensive nationwide cohort study, we studied the influence of several comorbidities on one-year mortality after the diagnosis of new-onset AF.

Methods
All patients with newly diagnosed AF in Finland 2007-17 were identified from nationwide registries. Individualized data on concomitant diseases were gathered from ICD-10 diagnoses during hospitalizations and outpatient visits in primary and specialist care and from drug reimbursements registries. Patients were followed until the end of 2018 from the causes of death registry, which records every death in the country. All-cause mortality associated with several comorbidities per 1000 person-years was determined, and relative risk (RR) of death was calculated.

Results
A total of 229,321 patients (mean age 73 ± 13.2 years, 50.0% male) with new-onset AF were identified. Mean age of men and women with new-onset AF was 69.4 ± 13.4 and 77.1 ± 11.8 years, respectively. During the one-year follow-up, 11.6% of men and 13.7% of women died. Heart failure, kidney disease and dementia were the strongest predictors of mortality and were associated with an over threefold risk of death within one year. Cancer, history of bleeding and vascular disease carried over twofold risk of death. In addition, hypertension, diabetes, alcohol abuse and history of stroke predicted mortality. The risk of death associated with these comorbidities is presented in Table.

Conclusions
Several comorbidities were associated with significantly increased risk of death within one year of the AF diagnosis. Heart failure, kidney disease and dementia were strongest predictors of subsequent mortality with over threefold risk. These data will inform the treatment decisions regarding AF patients with comorbidities.
Left atrial function for predicting atrial fibrillation: a machine learning approach
Authors: Masini G , Ji Y , Eaton A , Wang W , Inciardi R M , Alonso A , Soliman E Z , Solomon S , Shah A M , De Caterina R , Chen L Y 
Published: October 2024

Abstract

Background
Common risk scores for atrial fibrillation (AF) are based on clinical risk factors, and little is known about the contribution of left atrial (LA) function parameters to risk assessment.

Purpose
To determine whether a machine learning-based model that includes LA function parameters outperforms a commonly used risk scores, the CHARGE-AF, in predicting AF.

Methods
Participants in the Atherosclerosis Risk in Communities (ARIC) Study (a community-based cohort study in the USA) who attended visit 5 (2011-2013) and without a history of AF were included in this analysis. Incident AF was ascertained from ECG during study visits, hospitalization discharge codes, and death certificates. Random survival forest methodology was used to build a prediction model for AF; candidate variables included traditional clinical risk factors and measures of LA structure and function. Dataset was randomly split into a training (75%) and testing (25%) cohort. For each variable, importance was measured based on the reduction in Harrell’s c-statistic if the variable was randomly permuted prior to obtaining predicted values. Variables significantly associated with AF were included in the final model. Model calibration was tested using the Greenwood-Nam-D'Agostino (GND) test. Discrimination ability of our model was assessed in the testing cohort using Harrell’s c-statistic and compared with that of the CHARGE-AF model.

Results
4,909 participants (59% female, 22% Black, mean age 75 years) were included. During a median follow-up of 7.0 years (1st-3rd quartile: 5.4-7.8), 650 participants developed AF. Variables significantly associated with incident AF were race, triglycerides, systolic blood pressure, coronary heart disease, age, LA maximal volume index, NT-proBNP, and LA reservoir strain (Figure 1). LA reservoir strain was the variable most strongly associated with AF. The final model showed good discrimination (c-statistic (95% CI): 0.734 (0.698-0.768)). The GND test did not detect statistically significant miscalibration (GND p=0.08). Compared with our model, CHARGE-AF had lower discrimination ability (c-statistic (95% CI): 0.635 (0.594-0.677)) and the difference was statistically significant (difference in c-statistic (95% CI): 0.099 (0.043-0.152)).

Conclusion
A machine learning-based model with few variables including LA function outperforms a commonly used risk model in predicting AF. Incorporation of LA functional assessment may help inform clinicians regarding individual risk of AF.
Unipolar electroanatomical mapping outperforms bipolar voltage in detecting LGE areas in the left atrium
Authors: Mohsen Y , Ali S , Mao Y , Prakosa A , Kholmovski E , Sakata K , Yamamoto C , Stoeckigt F , Sinha S , Marine J , Sohns C H , Sommer P H , Spragg D , Trayanova N 
Published: October 2024

Abstract

Introduction
In atrial fibrillation (AF) management, understanding left atrial substrate is crucial. While both electroanatomical mapping (EAM) and late gadolinium enhancement MRI (LGE MRI) are reliable methods in assessing atrial substrate and are associated with the ablation outcome, recent findings have highlighted significant discrepancies between bipolar low voltage areas (LVA) in EAM and LGE areas.

Objective
Explore the relationship between LGE areas and unipolar LVAs by utilizing multipolar high-density (HD) mapping.

Methods
Nineteen patients scheduled for AF ablation underwent pre-ablation LGE-MRI. Left atrial (LA) segmentation was conducted using a convolutional neural network, which subsequently generated a 3D mesh integrating the LGE data. HD-EAM was performed in sinus rhythm for each patient, capturing at least 4000 points. The EAM map and LGE MRI mesh were co-registered. LVA areas were defined using voltage cut-offs of 0.5 mV for bipolar and 2.5 mV for unipolar measurements. Correspondence between LGE areas and LVAs on the anterior and posterior LA wall was analyzed.

Results
Both bipolar and unipolar LVA demonstrated high precision in detecting LGE areas (100% and 88% respectively). However, unipolar LVA exhibited a remarkable accuracy of 81% for detecting LGE areas specifically, whereas bipolar LVA displayed a significantly lower accuracy of 28%. These findings were consistent across the different atrial walls.

Conclusion
Incorporating unipolar voltage data into electroanatomical mapping in the atrium may bridge the observed gap between LGE areas and bipolar LVAs. Our findings highlight the significance of unipolar voltage in evaluating the left atrial substrate, potentially offering a more comprehensive insight into the different layers of atrial walls, and opening the door for new approaches in AF therapy.
Mobile health technology integrated care in atrial fibrillation patients according to polypharmacy: an analysis of the mAFA-II clinical trial
Authors: Corica B , Guo Y , Romiti G F , Proietti M , Zhang H , Lip G Y H 
Published: October 2024

Abstract

Background
Polypharmacy is common in patients with multiple chronic long-term conditions and has been associated with adverse outcome in patients with Atrial Fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway has been proposed to streamline an integrated care management of AF patients, and the Mobile Health Technology for Improved Screening and Optimized Integrated Care in AF (mAFA-II) prospective cluster randomised trial showed the efficacy of a mobile health (mHealth) implemented ‘ABC’ pathway (mAFA intervention) in improving prognosis of AF patients. Whether these benefits apply also to AF patients with polypharmacy is unclear.

Purpose
To evaluate the effect of mAFA intervention according to the presence of polypharmacy at baseline.

Methods
In the mAFA-II cluster randomised trial, between June 2018 and August 2019 adults with AF were enrolled in 40 centres in China; clusters were randomised in a 1:1 ratio to mAFA intervention or usual care. In this analysis, we defined polypharmacy as being treated with 5 or more drugs at baseline. The primary outcome was the composite of stroke, thromboembolism, all-cause death and rehospitalisation. We evaluated the interaction between the effect of mAFA intervention and the presence of polypharmacy at baseline on the risk of the primary outcome using multivariable Cox-regression analysis; results were expressed as adjusted Hazard Ratio (aHR) and 95% Confidence Intervals (95%CI). We also evaluated individual components of the primary outcomes as exploratory secondary endpoints.

Results
3,324 patients were enrolled in the trial and included in this analysis; of these, 558 (16.8%) patients were polymedicated at baseline (mean age 71.9±12.6 years, females 44.3%); of these, 303 (54.3%) were allocated to mAFA intervention. 2,766 patients were not polymedicated (mean age 67.9±14.4 years, females 36.7%), of these 1,343 (48.5%) were allocated to mAFA intervention. Overall, patients in the polypharmacy group were older and with higher prevalence of most comorbidities and higher thromboembolic risk. The effect of mAFA intervention was similar among patients with vs. without polypharmacy on the reduction of the primary composite outcome, although with a diluted effect among polymedicated patients (adjusted Hazard Ratio [aHR] and 95% Confidence Interval [CI]: 0.34 [0.22-0.53] vs. 0.73 [0.27-1.99], p for interaction=0.166, Figure 1); similar results were observed for all-cause death and rehospitalizations.

Conclusions
A mHealth-technology implemented ABC pathway showed a similar effect on the reduction of the primary composite outcome among patients with and without polypharmacy. These findings support a broad application of the ABC pathway to improve outcomes in AF patients.Figure 1
Impact of rhythm control strategy on outcomes in patients with first diagnosed atrial fibrillation in an 11-year real-world registry
Authors: Salbach C , Milles B R , Yildirim M , Hund H , Mueller-Hennessen M , Biener M , Frey N , Katus H A , Giannitsis E 
Published: October 2024

Abstract

Background
Atrial fibrillation (AF) is a highly prevalent arrhythmia with a high burden of disease. This sub-study of the Heidelberg Registry of Atrial Fibrillation (HERA-FIB) sought to evaluate clinical characteristics, treatment strategies and outcomes in patients with first diagnosed AF (FDAF).

Methods
Patients with AF presenting to the emergency department (ED) of an University Hospital between June 2009 and March 2020 were consecutively enrolled. Follow-up was performed for all-cause mortality, stroke, major bleeding and myocardial infarction (MI). Outcomes were were related to patients with FDAF or pre-existing AF, as well as assigned treatement strategy (rhythm vs. rate control). The trial was registered at ClinicalTrials.gov Identifier: NCT05995561.

Results
Overall 2,758 (27%) of all patients presented with FDAF. Compared to FDAF, patients with pre-existing AF showed higher all-cause mortality HR 1.41 (95%CI 1.28-1.55, p&lt;0.0001) and major bleeding events 1.29 (95% CI 1.06-1.56, p=0.0098). Non-implementation of rhythm control in FDAF was seen in 2,079 cases (75.4%) and was associated with an excess of all-cause mortality HR 1.66 (95%CI 1.30-1.99, p&lt;0.0001) and incident MI HR 1.79 (95% CI 1.03-3.09, p=0.0385). A non-implementation of rhythm control remained an independent predictor for all-cause mortality and MI even after adjustment for significant univariate variables aHR: 1.34 (95%CI: 1.04-1.72, p=0.0234) and aHR: 1.79 (95%CI: 1.03-3.09, p=0.0385).

Conclusion
Real-world data from FDAF patients presenting in the setting of an ED showed a potential benefit regarding mortality and MI for rhythm control strategy. Further research is needed to validate this hypothesis.
The association of obesity and in-hospital outcomes among patients undergoing ablation for atrial fibrillation: a propensity-score matched analysis
Authors: Shoar S , Esparham A , Chaudhary A , Bolaji O , Moncadagonzalez P , Bansro V , Azargoon S , Modukuru V , Patarroyo-Aponte G , Asadi S , Sharma S 
Published: October 2024

Abstract

Background
Obesity is a strong risk factor for atrial fibrillation (AF), and it can affect the prognosis of AF. However, the impact of obesity (BMI≥30 kg/m²) on postoperative complications after AF ablation has not been extensively studied. We aimed to evaluate the association of obesity with in-hospital outcomes among patients with AF who ablation procedures.

Methods
The study utilized the National Inpatient Sample (NIS) database 2016-2020. Patients were divided into obese and non-obese groups and matched with propensity score matching (1:1). This matching involved adjusting for baseline variables (including age, gender, primary expected payer, race, and median household income) and comorbidities (including diabetes, hypertension, hyperlipidemia, history of coronary artery bypass grafting (CABG), chronic kidney disease, hyperthyroidism, cardiomyopathy, prior stroke or transient ischemic attack, heart failure with preserved ejection fraction (HFpEF), heart failure with reduced ejection fraction (HFrEF), heart valve disease, coronary artery disease, chronic obstructive pulmonary disease (COPD), alcohol misuse, anemia, and smoking). Furthermore, a weighted analysis was conducted utilizing weights provided by the NIS, and multivariate logistic regression was used to calculate the odds ratio.

Results
A total of 29,440 patient with AF who underwent ablation were included. After propensity matching, (8,110 in obese and 8,110 in non-obese group) the baseline characteristics were not significantly different between the two groups. Obesity was independently associated with higher risk of pseudoaneurysm, hematoma, postoperative anemia, acute kidney injury, vasopressor need, mechanical ventilation, pulmonary embolism, and ischemic stroke in patients who underwent ablation for AF (Figure 1). In addition, obese group had significantly higher length of stay (median and IQR 2 [1-3] vs 2 [1-4]) and total charges (median and IQR: 131,248$ [95,303-197,784] vs 143,693$ [102,720-206728]) compared to non-obese group (p&lt;0.001). However, in-hospital mortality was not significantly different between the two groups.

Conclusion
In patients who underwent AF ablation, obesity is associated with significantly higher risk of post-operative complications, as well as increased LOS and total hospital charges.
Impact of altered pulmonary vein anatomy on long-term outcomes after cryoablation of paroxysmal atrial fibrillation
Authors: Baimbetov A , Bizhanov K , Bigeldiyev N , Sarsenbayeva A , Yakupova I , Baimakhanov B 
Published: October 2024

Abstract

Background
Cryoballoon catheter treatment for pulmonary vein (PV) isolation is an effective method for treating paroxysmal atrial fibrillation (AF).

Purpose
Evaluation of the significance of certain anatomical features of pulmonary veins for predicting the development of arrhythmia recurrence after pulmonary vein cryoballoon ablation (PV CBA) in paroxysmal AF.

Materials and Methods
465 consecutive patients (61% were male) with paroxysmal AF (57±11 years) were included and analyzed. All underwent CPVA between 2018 and 2022. PV and left atrial (LA) anatomy were evaluated in all patients using multi-slice computed tomography (MSCT) before the CPVA procedure. After the ablation procedure, all patients were followed up for 24-56 months to assess the impact of pathologic abnormalities in PV anatomy on recurrences in the long-term follow-up period.

Results
Complete PV isolation was achieved in all patients. LA and PV anatomy was normal in 298 patients (64%). Pathologic change of PV anatomy was present in 167 patients. (36%). During 24-56 months of follow-up, AF recurrence was registered in 178 patients (38%). Patients with recurrent AF had mainly enlarged right (RSPV) and left superior PVs (LSPV) (p&lt;0.001). The presence of left common PVs (n=126, Log-rank p&lt;0.001), as well as the presence of additional right pulmonary veins (n=67, Log-rank p&lt;0.001), was associated with early development of sustained arrhythmia recurrences, compared to patients with typical PV characteristics.

Conclusion
Altered PV anatomy is a risk factor for arrhythmia recurrence after PV CBA. Mandatory visualization of the LA and PV with MSCT improves patient selection for effective catheter-based treatment of atrial fibrillation.
Effects of baroreceptor reflex modification on efficacy of ablation for atrial fibrillation
Authors: Zuk A , Piotrowski R , Sikorska A , Kowalik I , Kulakowski P , Baran J 
Published: October 2024

Abstract

Background
The autonomic nervous system (ANS) plays a significant role in atrial fibrillation (AF). Catheter ablation (CA) is a well-established treatment method for AF and significantly affects ANS, including baroreceptors (BR) function. However, little is known about the changes in the BR function caused by radiofrequency (RF) or cryo-energy (CB) influence the efficacy of AF ablation.

Purpose
To assess one-year efficacy of CA of AF in relation to BR function modification and type of ablation energy used.

Methods
The study group consisted of 78 patients (25 females, mean age 58±9 years) with paroxysmal AF and first CA (39 patients (RF group) and 39 (CB group)). The BR function was assessed non-invasively using tilt testing and three parameters: event count (BREC) depicting overall BR activity, slope mean depicting BR sensitivity (BRS) and BR effectiveness index (BEI). The efficacy of CA was assessed at 3, 6, and 12 months after CA using 24-hour Holter ECG recordings and dedicated scale (University of Toronto Atrial Fibrillation Severity Scale (AFSS)).

Results
After CA, BR function decreased in the whole group (mean BREC 12.0±3.0-22.0 vs 6.0±3.0-18.0, p=0.004; mean BRS 4.8±3.6-6.8 vs 4.0±3.0-5.8, p=0.014; mean BEI 18.7±8.3-27.4 vs 12.0±5.1-21.0, p=0.009). BREC was significantly more decreased in the CB vs RF (mean 12.0±3.0-22.0 vs 6.0±3.0-18.0, p=0.004). Similar trend was noted for BRS and BEI.
On repeated Holter ECG monitorings efficacy of CB and RF was similar (89.7% vs 82.9% p=0.502, 89.7 vs 85.7%; p=0.727 and 84.6 vs 80%; p=0.602, respectively). According to AFSS, the AF symptoms were significantly reduced in both groups (CB baseline vs 3, 6 a and 12 months, respectively (median): 6.0 (IQR 2.0 – 13.0) vs 2.5 (IQR 1.0 – 4.0), p&lt;0.001; 6.0 (IQR 2.0 – 13.0) vs 1.5 (IQR 0.0 – 4.0), p&lt;0.001; 6.0 (IQR 2.0 – 13.0) vs 1.5 (IQR 0.0 – 4.0), p=0.002; RF baseline vs 3, 6 and 12 months, respectively (median): 10.5 (IQR 5.0 – 14.0) vs 7.0 (IQR 1.0 – 12.0), p=0.173; 10.5 (IQR 5.0 – 14.0) vs: 6.0 (IQR 2.0 – 12.0), p=0.015; 10.5 (IQR 5.0 – 14.0) vs 6.5 (IQR 2.0 – 12.0), p=0.005). After the adjustment for baseline there was no significant differencies between both groups (Table).

Conclusions
CA significantly affected BR function. These changes were more pronounced following CB than RF CA. However, the efficacy of RF and CB was similar.