bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improved risk prediction in patients with atrial fibrillation and clinical intermediate-risk CHA2DS2VASc-score utilizing high sensitive troponin T
Authors: Salbach C , Yildirim M , Milles B R , Hund H , Biener M , Mueller-Hennessen M , Frey N , Katus H A , Giannitsis E 
Published: October 2024

Abstract

Background
Guidelines of the European Society of Cardiology recommend risk assessment to identify appropriate candidates for anticoagulation in patients with atrial fibrillation (AF). However, scores such as the CHA2DS2VASc-score show only a modest performance for prediction of adverse events.

Methods
This retrospective single-center all-comer sub-study from the Heidelberg Registry of Atrial Fibrillation (HERA-FIB) enrolled 9,995 consecutive patients with non-valvular AF, presenting to the emergency department (ED) from June 2009 until March 2020. We tested the performance of the CHA2DS2VASc-score with and without high sensitive cardiac troponin T (hs-cTnT) for prediction of a adverse events such as stroke or major bleedings. Per CHA2DS2VASc, stroke risk was classified as low (0 point in men, ≤1 point in females), intermediate, or high (≥2 points in men and ≥3 points in females).

Results
Performance of the CHA2DS2VASc-score for the prediction of the composite endpoint consisting of stroke and major bleeding was poor (AUC 0.600, 95%CI: 0.590-0.610) but improved after addition of hs-cTnT as a variable across all risk categories (AUC 0.618 95%CI: 0.608-0.628, ∆AUC 0.0182 95%CI: 0.0124-0.0240, p&lt;0.0001), and particularly in patients at intermediate-risk (∆AUC 0.160 95%CI: 0.0653-0.254, p=0.0009). The absence of detectable hs-cTnT (&lt; LoD) identified a cohort without incident events within patients with intermediate per CHA2DS2VASc.

Conclusion
Combination of hs-cTnT and clinical-based risk stratification in AF patients presenting to an ED with intermediate CHA2DS2VASc-score is simple and effective. Measurement of hs-cTnT improves prediction of stroke risk in patients with intermediate CHA2DS2VASc-score and may help guide decision for or against anticoagulation.
Atrial function after cardioversion in patients with persistent atrial fibrillation
Authors: Noda K , Sunamura S , Onodera K , Tanita A , Ogata T , Takii T , Namiuchi S 
Published: October 2024

Abstract

Background
After cardioversion for persistent atrial fibrillation (AF), restitution of normal left atrial (LA) function is said to need several days to recover. However, in previous studies, the evaluation of LA function was only used transesophageal or transthoracic echocardiography. During catheter ablation (CA) for AF, pulmonary venous (PV) blood flow can be measured accurately using an intracardiac echocardiogram (ICE). The atrial systolic PV regurgitation (PVa) wave measured by ICE is a good indicator of LA contractility because it reflects the active contraction of the LA.

Purpose
This study aims to investigate the LA function in the hyperacute phase and the factors which affect after cardioversion.

Methods
40 AF patients (18 paroxysmal AF, 22 persistent AF) who underwent CA were enrolled. PVa wave was measured twice before RFCA and after the procedure using intracardiac ultrasound. Voltage map of the LV was obtained using the CARTO system at the end of the session, and the percentage of low voltage area which was determined area as less than 0.1mV in the mapped LA surface area (LVA%) was calculated.

Results
Preoperative PVa was 1.61 ± 0.09 m/sec in the paroxysmal AF group (PaAF), and no PVa was observed in the persistent AF group (PeAF). Postoperative PVa were comparable between PaAF (0.18±0.06 m/sec) and PeAF (0.18±0.07 m/sec). Then, the PeAF were divided into 2 groups based on LVA% in the anterior area, posterior area, and total LA area (cutoff 1,5 and 10%, respectively). In the anterior lower LVA% group, PVa were significantly increased (0.20 ± 0.07 m/sec) after defibrillation compared with the anterior higher LVA% group (0.14 ± 0.06 m/sec; P=0.02), whilst no difference was observed when it was divided in the posterior wall or overall.

Conclusion
Even in PeAF, LA function improves to the same degree as in the PaAF immediately after cardioversion, and the posterior wall LVA, including posterior wall isolation, may not affect LA function.
Sulcardine, an investigational multichannel blocker for atrial fibrillation with uniquely intense JTp inhibition to enhance safety
Authors: Mason J , Elliott G , Romano S , Gillings M , Riebman J 
Published: October 2024

Abstract

Background
Sulcardine is a multi-ion channel blocker for treating atrial ﬁbrillation (AF) with similar inhibitory potency on peak/late sodium, L-type calcium, and rapidly activating delayed-rectiﬁer potassium (IKr) currents. The therapeutic effect of inhibiting IKr includes QT prolongation (accompanied by a proportional J to T peak [JTp] interval prolongation), which, when excessive, may cause malignant arrhythmias. As previously reported, sulcardine strongly mitigates the JTp increase that may contribute to excessive QT prolongation by inhibiting late sodium and L-type calcium currents, an intrinsic mechanism to protect from excessive IKr block.

Purpose
We explored the JTp mechanism, pharmacokinetics (PK), electrocardiogram (ECG) changes, safety, and drug-drug interaction (DDI) of a single sulcardine (as HBI-3000) intravenous (IV) infusion in healthy subjects.

Methods
An open-label Phase 1 study evaluated the PK interaction between sulcardine, dosed as a 350 mg 30-minute infusion of the sulfate salt HBI-3000, and a cytochrome P450 CYP2D6 enzyme inhibitor (paroxetine). Triplicate ECGs were extracted from continuous 12-lead Holter ECG recordings at baseline and 10 time points thereafter. Mean baseline-subtracted and heart rate-corrected QTcF (dQTcF), JTpc (dJTpc), and other ECG changes were calculated at each time point. Left ventricular ejection fraction (LVEF) was assessed at baseline, 30-, and 120-minutes post-infusion start by transthoracic echocardiography (TTE).

Results
39 subjects received HBI-3000, 33 in the paired PK population. Expected ECG parameter changes proportional to sulcardine plasma concentrations were observed in the HBI-3000-alone portion of the study, including modest QTcF prolongation (Fig 1, blue slope, conﬁdence band) and JTpc inhibition (Fig 1, red). The usual JTpc increase associated with IKr blockers, even those with mitigating channel block (such as the late sodium current), was not only reduced but actually reversed. We calculated the dQTcF change that would have been observed in the absence of JTpc reduction by sulcardine (Fig 1, green). Sulcardine reduced the QTcF increase that might have occurred by about 21 msec at the highest concentrations, and this mitigating effect was observed at all concentrations. No clinically significant safety ﬁndings or arrhythmias were observed. The most frequent TEAEs were nausea and headache (n=2 each [5.1%]). No LVEF changes were clinically significant. Sulcardine had minimal metabolic interactions.

Conclusion
Acute IV HBI-3000 administration resulted in no clinically significant safety findings, LVEF depression, or DDI with CYP2D6. Sulcardine facilitates QT prolongation, which has a therapeutic benefit in terminating AF, with simultaneous uncoupling and reversing of the JTpc interval increase, a potential mechanism for reducing proarrhythmic risk due to excessive QT prolongation.Figure 1.ECG Intervals vs Sulcardine Conc
Safety and effectiveness of pulsed field ablation for pulmonary vein isolation in atrial fibrillation patients: a single centre experience
Authors: Reis Santos R , Bello A R , Santos P G , Matos D , Rodrigues G , Carmo J , Sousa M , Costa F , Carmo P , Morgado F , Cavaco D , Haas A , Adragao P 
Published: October 2024

Abstract

Introduction
Atrial Fibrillation (AF) is the most frequent arrhythmia in the world with an exponentially increasing prevalence. Pulmonary veins (PV) are the primary triggering sites for AF and pulmonary veins isolation (PVI) is currently the standard therapy alongside pharmacological treatment and should be considered as first-line treatment. Pulsed-fieldablation (PFA) is a novel ablation modality that involves the application of electrical pulses causing cellular death, with preferential tissue specificity.

Aim
In this study, we evaluated the safety and efficacy of single-shot PFA in AF patients.

Methods
Single-center registry of consecutive patients undergoing PVI using the pentaspline PFA catheter (all with CARTO3D system v.7 and high-density mapping), between June 2022 and November 2023. Data on demographics, procedural characteristics, and electrocardiographic recurrence (assessed after a 3-month blanking period) were analyzed.

Results
152 consecutive patients were included (63 ± 10 years, 57% male), with a mean CHA2DS2-VASc score of 2±1 points, median LVEF of 60% (IQR 59-65%), and a median CT-scan derived left atrial volume index of 56 mL/m2(IQR 44-69 mL/m2). A total of 40% had non-paroxysmal AF and a redo procedure was performed in 17% of patients. The median procedure time was 78 min (IQR 58-111 min) and fluoroscopy time was 11.6 min (IQR 8.2-15.6 min). Additionally, posterior wall isolation (PWI) was performed in 63 patients (41%). There were no esophageal complications, phrenic nerve injuries, cerebrovascular events, or procedure-related deaths. Two patients (1.3%) experienced acute cardiac tamponade, immediately treated with pericardiocentesis. Other complications were primarily vascular, in 5% of cases (4 femoral hematomas, 3 femoral pseudoaneurysms, 1 arteriovenous fistula). Over 293 (IQR 170 - 394) days of follow-up, considering electrocardiographic recurrence, 12% of patients had AF recurrence (5 with paroxysmal AF and 10 with persistent AF). These patients were older (69 ± 7y vs. 62 ± 11y, p=0.016), were more likely to undergo a redo procedure (33 vs. 8%, p=0.004), and had a higher percentage of posterior wall isolation (21 vs. 8%, p=0.038).

Conclusions
PFA for PVI wall ablation is safe and effective, with 100% intraprocedural technical success, a low rate of complications, and a high percentage of patients free from AF in the short-term.
Early repeat catheter ablation in patients with early recurrent arrhythmia
Authors: Jiang T , He L , Wang Z X , Liu N , Ma C S 
Published: October 2024

Abstract

Background
Repeat catheter ablation reduces adverse cardiovascular endpoints in patients with recurrent atrial tachyarrhythmia after index ablation. However, when to proceed with re-ablation in patients with early recurrent arrhythmia is unknow.

Objective
In this study, we aim to access the effectiveness of early repeat ablation on cardiovascular outcomes in early recurrent atrial tachycardia patients.

Methods
A total of 502 post-ablation patients, who experienced early atrial tachyarrhythmia recurrence within 6 months outside the blank period post index ablation and had undergone a repeat ablation, were consecutively enrolled from China AF registry from January 2012 to December 2018. Early repeated ablation (ERA) was defined as patients underwent a subsequent catheter ablation procedure within early recurrent period, then late repeated ablation (LRA) referred to a redo procedure that performed after 6 months since the de novel ablation. Cox proportional hazard models were used to estimate the effect of early re-ablation on primary endpoint (a composite of cardiovascular death, stroke and cardiovascular rehospitalization) and secondary endpoint (each component of primary outcome and AF/AT recurrence).

Results
The median follow-up time was 26 months after the redo-AF/AT ablation. First primary composite outcome occurred in 39 of the patients received early re-ablation (24.38 per 100 person-years) and in 136 of the patients performed with late re-ablation (39.77 per 100 person-years) (HR = 0.55, 95% CI = 0.38-0.79; P0.001). Cardiovascular re-hospitalization (hazard ratio 0.52 95% confidence interval [0.36; 0.73]) and AF recurrence occurred less often (hazard ratio 0.76, 95% confidence interval [0.58; 0.98]) in the ERA group. No significant difference between the two groups was found in terms of cardiovascular death, stroke and major bleeding events.

Conclusion
Early initiation of redo-ablation conveys better clinical benefit in patients with early arrhythmia recurrence.
Risk factors for procedure-related complications in very elderly patients undergoing atrial fibrillation ablation: analysis from the Japan Ablation Registry
Authors: Inoue I , Nakai M , Yamane T , Kusano K , Takatsuki S , Satomi K , Iwanaga Y , Kanaoka K , Tonegawa K R , Sumita Y , Takegami M , Nakao M Y , Nogami A , Miyamoto Y , Shimizu W 
Published: October 2024

Abstract

Background
As atrial fibrillation (AF) ablation procedures become increasingly prevalent, understanding the risks of procedure-related complications is crucial, particularly in the very elderly population, defined in this context as patients aged 80 years and above. This study aimed to identify risk factors for complications in this demographic.

Methods
We conducted a prospective analysis of 170,017 AF ablation procedures from the Japan Ablation Registry, covering 482 facilities between 2017 and 2020. The analysis focused on patients aged 80 or older (very elderly group, n=14,389). Multivariate analysis was employed to identify risk factors for procedure-related complications in the very elderly, incorporating factors that showed a p-value of less than 0.1 in univariate analysis.

Results
Procedure-related complications were observed in 3.62% of the very elderly group. The multivariate analysis (Model 1) identified significant risk factors were the initial procedure (OR 1.30, 95% CI 1.01-1.67, p=0.041), type of AF (OR 1.34, 95% CI 1.03-1.74), and body weight (OR 0.99, 95% CI 0.98-1.00, p=0.082). For further analysis, the type of AF was categorized into paroxysmal AF (PAF), persistent AF (PeAF) and long-standing PeAF. We included these categories, along with the initial procedure and body weight, into further multivariate analysis (Model 2), which revealed that long-standing PeAF (OR 1.34, 95% CI 1.03-1.74, p=0.032), initial ablation (OR 1.30, 95% CI 1.01-1.67, p=0.042) and body weight (OR 0.99, 95% CI 0.98-0.99, p=0.001) were independently and significantly associated with complications.

Conclusion
This study identifies initial procedures, low body weight, and long-standing PeAF as significant risk factors for procedure-related complications in very elderly patients undergoing AF ablation. These findings highlight the importance of careful patient selection and tailored procedure planning for these subgroups in the very elderly population.
Risk and management of acute kidney injury resulting from hemoglobinuria following pulsed-field ablation in atrial fibrillation
Authors: Mohanty S , Della Rocca D G , Casella M , Compagnucci P , Torlapati P G , La Fazia V M , Gianni C , Chierchia G B , Gallinghouse G J , Burkhardt J D , Horton R , Al-Ahmad A , De Asmundis C , Dello Russo A , Natale A N D R E A 
Published: October 2024

Abstract

Background
High-voltage pulses can cause hemolysis leading to hemoglobinuria.

Purpose
We evaluated the prevalence of hemoglobinuria after pulsed-field ablation (PFA) and its impact on renal function in patients with atrial fibrillation (AF).

Methods
A consecutive series of 128 AF patients undergoing PFA were included in this analysis. The initial patients that did not receive post-ablation hydration were classified as group 1 (n=28) and the rest of the study population that received planned fluid infusion of ≥2 L after the procedure, were categorized as group 2 (n=100). Patients with estimated glomerular filtration rate (eGFR) &lt;45 were excluded. All underwent extensive ablation beyond pulmonary vein isolation.
If urine tested positive for hemoglobin, blood samples were tested for Haptoglobin.

Results
Baseline characteristics of the study population are provided in Table 1.
Number of overall PFA applications were comparable between groups (group 1: 52.07±23.99 vs group 2: 59.83±22.78, p=0.149). Four patients in group 1 received 94.63±3.20 PFA applications. In group 2, 4 patients received &gt;90 applications (94±2.82) and 2 patients received &gt;150 (158.5±4.95) PFA applications.
Of the 28 in group 1, 21 (75%) developed hemoglobinuria during the 24-hour following catheter ablation. Mean post-ablation S-Cr was significantly higher than the baseline value in these 21 patients (1.46±0.28 vs 0.86±0.24, p &lt;0.001). Of the 21, 4 (19%) patients that received a mean of 94.63±3.20 PFA applications had the S-Cr. &gt;2.5 mg/dL (mean: 2.95±0.21). These 4 patients were also markedly oliguric (&lt;400 ml/day) in the immediate post-ablation period.
Group 2 patients received significantly higher amount of fluid infusion following catheter ablation compared to group 1 (2092.53±198.94 vs 487.48±72.74 ml, p&lt;0.001). None of the 100 patients from group 2 developed detectable hemoglobinuria or elevation of S-Cr including the 4 patients with &gt;90 and 2 patients with &gt;150 PFA applications.
Mean post-ablation Haptoglobin was 10.00± 8.40 (normal: 36–195 mg/dL). The accuracy of number of applications predicting Haptoglobin decline was excellent with the area-under the curve (AUC) 0.886 ± 0.068 with 95% CI of 0.754 – 1.000. (P-value = 0.002).
In multivariable analysis, both hydration (R-square 0.34, p &lt;0.01) and number of PFA applications (R-square 0.40, p &lt;0.038) were independent predictors of post-procedure acute kidney injury.

Conclusions
Based on our findings, number of PFA applications was an independent predictor of renal insult in patients receiving extensive ablation that could be prevented using planned fluid infusion immediately after the procedure.
Duration of sinus rhythm after direct current cardioversion does not predict recurrence of atrial fibrillation after subsequent catheter ablation: 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
Catheter ablation (CA) for persistent atrial fibrillation (PsAF) is associated with high rates of AF recurrence. DC cardioversion (DCCV) is often performed before CA, with wide variation in duration of maintenance of sinus rhythm (SR) post-DCCV. Factors associated with short duration of SR after DCCV, such as raised body mass index, prior duration of AF, prolonged p wave duration on the 12-lead ECG, and indexed left atrial volume, are either associated with or indicative of atrial electrical and structural remodelling, suggesting that shorter duration of SR after DCCV reflects a more advanced substrate for AF, which could in turn also influence the likelihood of success after CA.

Objective
To determine if post-DCCV SR duration is associated with AF recurrence after subsequent CA.

Methods
We performed a multicentre retrospective study of patients undergoing first-time CA for PsAF between 2015-2018 with prior DCCV. SR duration after the last DCCV prior to CA was recorded. The primary outcome was the first recurrence of atrial arrhythmia post-CA (after a 90-day post-CA blanking period). We also performed a pre-specified sensitivity analysis for amiodarone use at DCCV, by performing repeat analysis after excluding all such patients across the three groups.

Results
A total of 331 patients were identified across five centres and categorised by post-DCCV SR duration: &lt;7 days (group 1); 7-31 days (group 2); &gt;31 days (group 3; Table 1). Over median post-CA follow-up of 591 days, 207 patients (62.5%) met the primary outcome. There was no significant between-group difference in the time to primary outcome (log rank p=0.82; Figure 1). There were significantly more blanking period arrhythmias in groups 1 and 2 than group 3 after post hoc Bonferroni correction (pairwise p=0.001, 0.002 respectively; Table 1). After exclusion of patients on amiodarone at time of DCCV, there remained no significant between-group difference in the time to primary outcome (log rank p=0.85).

Conclusion
Shorter duration of SR post-DCCV is associated with blanking period arrhythmia after CA, but crucially does not predict long-term AF recurrence. Early AF recurrence after DCCV should not influence decisions on CA suitability or be used to predict long-term CA success.
Weight change does not impact long-term outcomes following cryoballoon pulmonary vein isolation
Authors: Park L , Milstein N , Bhatt A , Preminger M , Sichrovsky T , Habibi M , Kochav S , Shaw R , Musat D , Mittal S 
Published: October 2024

Abstract

Background
Weight loss has been suggested to reduce frequency and burden of atrial fibrillation (AF) in overweight patients (pts). However, there are limited data on weight loss impact on outcomes in pts with AF who have undergone pulmonary vein isolation (PVI).

Purpose
To understand the impact of weight change on long-term outcomes, as assessed by freedom from recurrent AF in pts undergoing cryoballoon (CB) PVI.

Methods
We enrolled consecutive pts with AF who underwent CB PVI; all had implantable loop recorders (ILR) for long-term ECG monitoring. The cohort was divided into 4 groups based on weight change 1-year post ablation: (1) optimal weight loss (OWL) – weight decrease ≥ 10%; (2) minimal weight loss (MWL) - weight loss (WL) 3-9% weight decrease; (3) no weight change (NWC) - weight change &lt; 3%, (4) weight gain (WG) ≥ 3% weight increase. We assessed for AF recurrence after excluding a 3-month post-ablation blanking period.

Results
Out of a total of 322 pts who underwent ablation, 241 (75%) pts (69 ± 10 years; 159 (66%) male; 133 (55%) PAF; CHA2DS2-VASc 2.7 ± 1.5; BMI 30 ± 5) had weight information available at ablation and last follow-up. All were off antiarrhythmics by 1 year. There were no differences in the 4 cohorts with respect to baseline characteristics. During the first year, about ¼ of pts were able to lose ≥ 3% of weight but only 8 pts (3%) were able to lose ≥ 10%. AF recurred in 153 (63%); they were older, more likely to have persistent AF (PeAF), and a higher CHA2DS2-VASc score. However, weight change did not impact outcome (Figure). In a multivariate Cox Regression hazards analysis, PAF vs. PeAF at ablation was the only factor associated with any recurrence at follow-up (Figure).

Conclusions
Post CB PVI only about ¼ of pts are able to lose weight. Weight changes in the first-year post ablation in obese pts did not alter outcomes with respect to likelihood of recurrent AF. These data should be taken into account when considering catheter ablation.