bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalance of incessant form of atrial fibrillation by superior vena cava (svc) firing:simplified svc and sinus node mapping(sss map) to avoid sinus node injury
Authors: Miyata T , Suzuki A , Fujiwara R , Sonoda Y , Sakai J , Kiuchi K , Matsumoto D , Kijima Y , Ogura E , Takaishi H , Shite J 
Published: October 2024

Abstract

Background
The superior vena cava (SVC) is known as a major source of atrial fibrillation(AF), non-pulmonary vein AF foci (NPVAF). In some cases, an incessant form of AF (iAF) by SVC firing prevents obtaining the sinus node location, and anatomical SVC isolation has a risk of sinus node injury (SNI).

Objective
This study was aimed to explore the frequency of iAF by SVC firing and the efficacy of the simplified mapping strategy to avoid SNI.

Methods
Consecutive AF ablation procedures in the 3 centers were retrospectively investigated including the NPVAF prevalence. Simplified SVC/SN mapping (SSS-map: Obtaining the top-end of the SVC potential and &gt;4points with 5-10mm spacing in the upper lateral side of the right atria (RA) for roughly locating the earliest activation site in sinus rhythm) was performed before PV isolation in the last 138 patients. In case of the initial rhythm at the procedure was atrial fibrillation, cardioversion was performed for obtaining the SSS-map. In the cases in which the high-density mapping catheters were available, the high-density activation maps of the RA in sinus rhythm were obtained to investigate the dislocation of the earliest activation site of the SSS map from the SN location. When SVC isolation was required due to iAF, SVC isolation line was designed based on the location of the top-end of the SVC potential during AF and ablative linear lesions were created to keep the distance of 5-10 mm above the second earliest activation site.

Results
A total of 1160 procedures in 1089 patients (male: 736[63.4%], age: 69.9, paroxysmal AF: 544[49.9%], first session: 997[85.9%]) was investigated. Prevalence of NPVAF was revealed in 160 of the all procedures (13.7%) (the SVC: 64, the posterior wall of the left atria: 24, the coronary sinus: 19, and others: 53). 16 of 160 NPVAFs (10.0%) developed to iAF by SVC firing. The SSS-map was successfully obtained in all of the last 138 patients (Initial rhythm at the procedure: AF 43.7%, Mapping time: 1.3±0.6 min, number of obtained points: 8.4±1.3). In 21 patients in which the high-density RA map was obtained, the SN dislocation distance was 5.1±2.2mm between the SSS map and the high-density RA map. Five of 138 developed to iAF by SVC firing, and SVC isolation based on the SSS-map was successfully achieved without SNI in the cases.

Conclusion
This study indicated iAF driven by SVC firing after PV isolation occurred in certain number of patients. The SSS-map before PV isolation was practical and showed the potential to be the mapping strategy avoid the SN injury in such cases.
Comparison of pulsed field ablation versus cryoballon and radiofrequency ablation for pulmonary vein isolation in atrial fibrillation patients with heart failure
Authors: Mavrakis E , Vlachopoulou D V , Bohnen J B , Rudolph I R , Jungen C J , Rattka M R , Mathew S M , Rassaf T R 
Published: October 2024

Abstract

Background
Pulmonary vein isolation (PVI) is the gold standard for atrial fibrillation (AF) ablation and can be achieved by a variety of technical methodes. While thermal ablation modalities (TA), such as cryoballon (CB) and radiofrequency ablation (RF) have been established as the standard approaches, PFA has been introduced as a nvel non-thermal modality showing comparable safety and procedural efficiency. Despite the high incidence of AF in heart failure (HF) patients, data comparing outcomes of HF patients undergoing PVI by either PFA or thermal ablation (RFA/CB) are limited.

Purpose
This study’s aim was to compare the efficacy and safety of PFA for AF ablation versus CB/RFA in HF patients.

Methods
Consecutive HF patients with preserved (HFpEF), mildly reduced (HFmrEF) and reduced (HFrEF) ejection fraction undergoing PVI for AF by either PFA or CB/RFA at our institution were included. The primary end-point was time to death or recurrence of AF. Secondary end-points were periprocedural complications and clinical and echocardiographic parameters.

Results
We included 140 HF patients who underwent PVI either by PFA (PFA group, 76 patients) or thermal ablation approaches (TA group, 64 patients). Our patients had a mean age of 69 years and were predominantly male (62%). There was no significant difference in the baseline characteristics and in the type of AF between both groups (42% with ParAF, 45% with PersAF) and 13% LSPersAF). The distribution of heart failure types was similar between both groups: HFpEF (PFA: 71%, TA: 75%), HFmrEF (PFA: 21%, TA: 20%) and HFrEF (PFA: 8 %, TA: 5%). After the 365-days follow-up period we observed no significant difference for the primary end-point between both groups (HR: 0.79, 95% CI 0.35-1.78; p=0.575). In total 58% of the PFA patients and 59% of the TA group were still free from AF. While symptom improvement was documented in both groups, patients in the PFA group showed significant improvement of left atrial volume index (p = 0.014), NT-pro BNP levels (p = 0.046), and left ventricular ejection fraction (LVEF) (p = 0.005).

Conclusion
In this study, PFA and thermal ablation modalities showed comparable results in terms of safety and procedural efficiency in patients with heart failure. Since previous studies have shown that HF patients with AF benefit from PVI using thermal ablation modalities, our results suggest that PFA might also be a promising ablation method in this vulnerable population, inducing left atrial reverse remodeling and thereby contributing to improvement of left ventricular systolic function.
Single versus double transseptal puncture for pulmonary vein isolation with radiofrequency catheter ablation for atrial fibrillation - insights from "Go for Zero Fluoroscopy" registry
Authors: Miskowiec D , Qawoq H D , Zycinski P , Chudzik M , Kosiuk J , Kasprzak J D 
Published: October 2024

Abstract

Background
Transseptal puncture is one of the most challenging steps in catheter ablation of atrial fibrillation (AF) because of the potential risk of complication. While single TSP reduces the puncture-related risk, double TSP simplifies the procedure (immediate signal visualization in pulmonary veins, avoidance of multiple changes of catheters through the single sheath). The purpose of this study was to analyze the impact of single versus double TSP during pulmonary vein isolation (PVI) with radiofrequency (RF) catheter ablation for AF on the fluoroscopy usage and procedure time.

Methods
Data reported from the international, multicenter prospective „Go For Zero Fluoroscopy Registry" performed in years 2018–2019 were analyzed. Overall 25 European electrophysiology centers from 14 countries and up to 5 operators from each center were enrolled. Only isolated PVI procedures were analyzed.

Results
A total data of 393 PVI RF procedures were collected from 25 centers. The median dose-area-product (DAP), fluoroscopy time and overall procedure time were: 810 (325 – 1839) cGy*cm2, 8 (4 – 14) minutes and 124 (92 – 168) minutes, respectively. Single TSP was associated with significantly higher DAP: 984 (459 – 1939) vs 667 (227 – 1469) cGy*cm2 (p=0.002), longer fluoroscopy time: 11 (6 – 19) vs 6 (3 – 11) minutes (p&lt;0.001) and longer overall procedure time: 133 (103 – 168) vs 110 (90 – 168) minutes (p=0.003) as compared with double TSP. Single and double TSP group did not differ significantly in regards of general anesthesia usage, circular and multipolar mapping catheter use (p&gt;0.05). However, single TSP was performed by operators with longer EP lab experience: 10 (4 – 15) vs 3 (0 – 10) years (p&lt;0,001).

Conclusions
Double TSP is related with lower fluoroscopy usage and shorter overall procedure time of pulmonary vein isolation with radiofrequency catheter ablation for atrial fibrillation.
Strategic timing- early and delayed catheter ablation in atrial fibrillation
Authors: Makdah O , Krayem F A , Sahloul H , Ursu C , Bogdan S , Vatasescu R , Gheorghe-Fronea O 
Published: October 2024

Abstract

Background
Atrial fibrillation (AF) is the most common sustained arrhythmia. AF catheter ablation (CA) is superior to antiarrhythmic drug (AAD) therapy in maintaining sinus rhythm. However, not much is known regarding the optimal timing of the ablation.

Purpose
This review aims to examine the evidence supporting both early and delayed ablation approaches, as well as explore their respective disadvantages.

Methods
We performed an electronic search in databases such as PubMed, ScienceDirect, Springer, Wiley Online Library, focusing on studies published from 2013 until 2022 and including both observational studies and randomized controlled trials (RCTs). Left atrial diameter and ejection fraction (EF) were assessed. The limit between early and delayed ablation was set to be 3 years, considering delayed CA studies with a diagnosis-to-ablation-time (DAT) of 3 years or more, and early CA studies with a DAT of less than 3 years. Included studies were selected according to our eligibility criteria: observational studies or RCTs that included patients with symptomatic paroxysmal or persistent AF that underwent ablation using either radiofrequency or cryoballoon approach or both approaches, studies that reported DAT, studies that included a follow-up period, studies that evaluated AF recurrence or AF burden. Studies that included a surgical ablation, a hybrid ablation approach, or ablation for arrhythmias other than AF were excluded.

Results
Ten studies were selected out of 1387 identified records. After a follow-up period of 1 year, the early ablation subgroup had a lower mean AF recurrence rate (31.1%) compared to that of the delayed ablation subgroup (37.7%) ( p&lt;0.0004). The median AF recurrence rate in radiofrequency ablation group was (47.8%) in comparison to the AF recurrence rate in cryoablation group which was (27.4%) (p&lt;0.0001). In studies that included paroxysmal AF patients exclusively, the AF recurrence rate was directly proportional to the DAT(R=0.95).

Conclusion
Our results demonstrate that DAT correlates with recurrence rate at 1 year following AF CA, the shorter the DAT the better the outcome especially in paroxysmal AF population.Prisma study selection flow diagramCorrelation between DAT-AF recurrence
Comparison of complications during catheter ablation of atrial fibrillation between radiofrequency and cryoballoon ablation: insights from a nation-wide claims-based database
Authors: Miyamoto K , Tonegawa-Kuji R , Murata S , Takegami M , Nishimura K , Kusano K 
Published: October 2024

Abstract

Background
Few large-scale, real-world studies have compared the safety of radiofrequency (RF) catheter ablations (CA) with that of cryoballoon ablations of atrial fibrillation (AF), especially in east Asian countries.

Methods
This retrospective, cross-sectional study used a nationwide administrative claims database, to compare complication-incidence rates between patients who underwent RFCA and cryoballoon ablation of AF. We used data from Medical Data Vision Co., Ltd, that is derived from the health claims, Diagnosis Procedure Combination (DPC) system, and flat-fee payment system in Japan. We first extracted hospitalization records with CA with diagnosis of AF. Exclusion criteria were 1) records with diagnoses of atrial flutter or atrial tachycardia, 2) patients aged &lt;20 years old, 3) CA of AF performed other than RFCA or cryoballoon, 4) records with insufficient clinical data, and 5) patients who were prescribed both direct oral coagulants and warfarin. Complications were defined using the following ICD-10 diagnosis codes: major bleeding (I31.9, I97.1, J98.5, J048, J0021); thromboembolism (H342, I24, I269, I740, I741, I744, I748, I749, K550, K868, N280, or T790); ischemic stroke (G45, or I63); cardiac tamponade (I31.9, I97.1, or J98.5); and vascular access complications (hematoma: S701, S801, T140 or T810; and/or pseudoaneurysms: I72.4). Logistic regression analyses were performed to estimate odds ratios and 95% confidence intervals (CI) for major bleeding, systemic thromboembolism, ischemic stroke, and cardiac tamponade.

Results
Among the 32,797,540 records between June 2011 and August 2020 from 426 hospitals, 41,347 records who underwent CA of AF (Median 68 [60–74] years old, 30.2 % women) were included in the study. A total of 36,729 RFCA (88.8%) and 4,618 cryoballoon ablation (11.2%) cases were included in the cohort. Major bleeding, systemic thromboembolism, ischemic stroke, cardiac tamponade, and vascular access complications occurred in 194 (0.5%), 193 (0.5%), 116 (0.3%), 414 (1.0%) and 115 (0.3%) patients, respectively. As a result of logistic regression analysis, when cryoballoon ablation was used as a reference, RFCA was associated with higher risk of cardiac tamponade (OR 1.54, 95% CI 1.09–2.25, P = 0.02), while it was not associated with higher or lower risk of other complications (major bleeding OR [95% CI ]1.21 [0.77–2.04]; thromboembolism 1.74 [1.03–3.22]; ischemic stroke 1.88 [0.94–4.47]; vascular access complication; 1.00 [0.58–1.87]).

Conclusion
Compared to cryoballoon ablations, RFCA was associated with higher risk of cardiac tamponade, using nationwide administrative claims database.
The efficacy and safety of NOAC in very elderly atrial fibrillation patients; data from the Korean national health insurance cohort registry
Authors: Choi S , Baek Y S , Lee Y C , Yoon G S 
Published: October 2024

Abstract

Background
Data regarding efficacy and safety on anticoagulation in very elderly atrial fibrillation patients are relatively sparse.

Purpose
We investigated the clinical benefit of anticoagulation with NOAC in very elderly AF patients through national healthcare insurance registry.

Methods
Clinical data of 862,935 patients who were diagnosed with AF from 2015 to 2020 were collected for analysis. Patients under the age of 85, prior history of ICH, GI bleeding and prior prescription days of aspirin, warfarin and NOAC exceeding 90 along with follow up period less than 90 days were excluded.

Results
A total of 10,625 patients were eligible for analysis. Patients with OAC (HR: 0.60, 95% CI 0.53-0.69), p&lt;0.001) showed higher efficacy regarding systemic embolism compared to aspirin (HR: 0.84, 95% CI 0.74-0.95, p=0.008) and no treatment group. Individual comparison of NOAC and aspirin via propensity score matching showed that patients with NOAC (HR: 0.71, 95% CI 0.61-0.85), p&lt;0.001) showed higher event free survival regarding systemic embolism compared to aspirin. Bleeding risk was also higher for NOAC (HR: 1.28, 95% CI 1.07-1.56, p=0.006) group but did not result in commensurate increase in mortality (HR:0.60, 95% CI 0.45-0.81, p&lt;0.001).

Conclusions
Anticoagulation with NOAC in very elderly patient showed higher event free survival regarding systemic embolism. Despite having higher event rate of bleeding, eventual death did not show any association with NOAC.
Impact of body weight and body mass index on clinical outcomes of edoxaban therapy in atrial fibrillation patients included in the ETNA-AF-Global registry
Authors: Boriani G , Souza J , Steffel J , Koretsune Y , Chao T F , Weiss T , Zaremba-Pechman L , Borrow A P , Unverdorben M , De Caterina R 
Published: October 2024

Abstract

Background
In atrial fibrillation (AF) patients (pts) receiving non-vitamin K antagonist oral anticoagulant therapy, extreme body weights, both obesity and low body weight, may impact clinical outcomes.

Purpose
To determine the impact of body weight and body mass index (BMI) on clinical outcomes in AF pts receiving edoxaban from the Global ETNA program (Europe [NCT02944019], Japan [UMIN000017011], Korea/Taiwan [NCT02951039], Hong Kong [NCT03247582] and Thailand [NCT03247569]).

Methods
ETNA-AF-Global, a multinational, prospective, observational study collected demographic and clinical outcomes data for AF pts receiving edoxaban. In this subanalysis, pts were categorised into the following body weight groups: ≤60kg, &gt;60 to 80kg (reference body weight), &gt;80 to ≤100kg and &gt;100kg; and BMI groups: &lt;18.5kg/m², ≥18.5 to &lt;25.0kg/m² (reference BMI), ≥25.0 to &lt;30.0kg/m², ≥30.0 to &lt;40.0kg/m² and ≥40.0kg/m². Clinical outcomes at 2-year follow-up were compared across body weight and BMI groups.

Results
26,805 pts were included in this analysis. Mean ± standard deviation body weight was 72.2 ± 18.1kg and mean BMI was 26.4 ± 5.0kg/m². 43.7% of pts were categorised into the &gt;60 to 80kg reference body weight group. [other groups: ≤60kg, 28.1%; &gt;80 to ≤100kg, 21.7%; &gt;100kg, 6.5%] and 40.0% of pts into the ≥18.5 to &lt;25.0kg/m² reference BMI group [other groups: &lt;18.5kg/m², 3.0%; ≥25.0 to &lt;30.0kg/m², 37.3%; ≥30.0 to &lt;40.0kg/m², 18.0%; ≥40.0kg/m², 1.7%].
Clinical outcomes are shown in Fig. 1 as unadjusted hazard ratios vs. reference group according to weight and in Fig. 2 according to BMI. Among body weight groups, pts weighing ≤60kg had the highest annualised rates of any stroke or systemic embolic event (SEE; 1.24%), ischemic stroke (0.97%), all-cause death (3.96%), major bleeding events (1.49%), and major bleeding or clinical-relevant non-major (CRNM) bleeding events (3.45%). Pts in the reference body weight group had the lowest annualised rates of all-cause death (2.81%).
Annualised rates of major bleeding, major bleeding or CRNM bleeding events and any stroke or SEE were lowest in pts weighing &gt;100kg.
Among BMI groups, annualised rates of all effectiveness and safety outcomes were highest in pts with a BMI &lt;18.5kg/m². Pts in the ≥25.0 to &lt;30.0kg/m² BMI group had the lowest annualised rates of all-cause death (2.85%) and pts in the ≥18.5 to &lt;25.0kg/m² BMI group had the lowest annualised rates of CV death (0.73%).

Conclusions
In the Global ETNA-AF program, clinical outcomes varied between different body weight and BMI subgroups. These findings highlight the need to consider the clinical implications of low body weight and/or low BMI, as AF pts who belong to these categories may be at higher risk of adverse outcomes during long-term anticoagulant treatment.Figure 1.Figure 2.
Temporal trends in initiation of oral anticoagulants and stroke-free survival among elderly and very elderly patients with new onset atrial fibrillation - a 20-year perspective.
Authors: Larsen S , Elmegaard M , Binding C , Hartwell Garred C , Sindet-Pedersen C , Loldrup Fosboel E , Holt A , Nouhravesh N , Lamberts M , Christensen D , Koeber L , Bjerring Olesen J , Schou M 
Published: October 2024

Abstract

Background
Oral anticoagulants (OACs) significantly reduce the risk of ischemic stroke in patients with atrial fibrillation (AF). However, evidence regarding efficacy of OACs are lacking in the very elderly patients.

Aim
To examine temporal trends in initiation of OACs and five-year stroke-free survival in the very elderly patients with new onset AF over a time span of 20 years.

Methods
From the Danish nationwide registries, we identified patients ≥ 65 years of age with new onset AF from 1999 to 2018. The index date was defined as the day of AF diagnosis for outpatients and as the day of discharge for inpatients. Patients with a prescription of OAC, history of bleeding events, or history of stroke/transient ischemic attack prior to index were excluded. Patients were divided into two age groups based on their age at index: 1) 65-84 years (elderly); and 2) ≥ 85 years (very elderly). Patients were further divided into four calendar year groups from 1999-2018, based on the year of inclusion. We investigated the initiation of OACs and calculated the absolute five-year probability of stroke-free survival in both age groups.

Results
We included 167,122 patients with new-onset AF between January 1st, 1999, and December 31st, 2018. Among the patients, 23.1 % were aged 85 years or older, 48 % were male and 80.5 % had a CHA2DS2-VASc score equivalent to 2 or higher for men and 3 or higher for women. Initiation of OACs increased in both age groups after the guideline implementation of DOACs in 2010 (Figure 1). In the elderly age group, the proportion of patients receiving OACs increased from 50% in 2010 to almost 90% in 2018. In the very elderly age group, the proportion increased from 25% in 2010 to almost 90% in 2018. The probability of the five-year stroke-free survival improved by approximately 15% from 1999 to 2018 in the elderly age group, with no significant changes in the very elderly age group.

Conclusion
The proportion of elderly AF patients receiving OAC has increased markedly in the last 20 years. Even so, stroke-free survival remains the same among the very elderly patients.Five-year stroke-free survival
Incidence and predictors of 2-year mortality following percutaneous left atrial appendage occlusion in the EWOLUTION tria
Authors: Aarnink E , Ince H , Kische S , Pokushalov E , Schmidt B , Gori T , Meincke F , Betts T , Mazzone P , Grygier M , Sievert H , De Potter T , Vireca E , Bergmann M W , Boersma L V A 
Published: October 2024

Abstract

Background and aims
Sufficient survival time following left atrial appendage occlusion (LAAO) is essential for ensuring the efficacy and cost-effectiveness of this strategy for stroke prevention. Understanding prognostic factors for early mortality after LAAO could optimize patient selection. In the current study we perform an in-depth analysis of 2-year mortality after LAAO, focusing particularly on potential predictors.

Methods
The EWOLUTION registry is a real-world cohort comprising 1020 patients that underwent LAAO. Endpoint definitions were prespecified and death was categorized as cardiovascular, non-cardiovascular, or of unknown origin. Mortality rates were calculated from Kaplan-Meier estimates. Patient characteristics and event rates were compared between deceased and alive patients by unpaired T-tests or Chi-squared test, as appropriate. Baseline characteristics significantly associated with death in univariate Cox regression analysis were incorporated into the multivariate analysis. All multivariate predictors were included in a risk model.

Results
2-year mortality rate was 16.4% (CI: 14.0-18.7%), with 50% of patients dying from a noncardiovascular cause. Deceased patients had more comorbities and more often had a major bleeding after LAAO (20.6% vs 3.3%, p&lt;0.001). Multivariate baseline predictors of 2-year mortality included age (HR 1.05, CI: 1.03-1.08, per year increase), heart failure (HR 1.73, CI: 1.24-2.41), vascular disease(HR 1.47, CI: 1.05-2.05), valvular disease (HR 1.63 CI: 1.15-2.33), abnormal liver function (HR 1.80 CI: 1.02-3.17) and abnormal renal function (HR 1.58, CI: 1.10-2.27). Mortality rate exhibited a gradual rise as the number of risk factors increased, reaching 46.1% in patients presenting with five or six risk factors.

Conclusion
One in six patients died within 2 years after LAAO. We were able to identify six independent predictors of mortality. When combined, this model showed a gradual increase in mortality rate with a growing number of risk factors, which may guide appropriate patient selection for LAAO.