bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term risk of heart failure and postoperative atrial fibrillation following noncardiac surgery: not so different from non-surgical atrial fibrillation
Authors: Karacan M N , Yafasova A , Fosboel E L , Tas A , Gundlund A , Gustafsson F , Stahl A , Schou M , Wolsk E , Dridi N P , Koeber L , Butt J H 
Published: October 2024

Abstract

Background
Atrial fibrillation (AF) is associated with the development of heart failure (HF). However, it is unclear if postoperative AF (POAF) after noncardiac surgery differs from non-surgical AF in terms of the risk of HF.

Objectives
To investigate the long-term rate of incident HF in patients developing new-onset POAF after noncardiac surgery relative to patients with non-surgical nonvalvular AF (NVAF).

Methods
Using Danish nationwide registries, all patients aged ≥30 years who developed POAF following noncardiac, nonobstetric surgery from 1996 to 2020 were identified. These patients were matched in a 1:3 ratio by age, sex, selected comorbidities, and year of inclusion with patients with non-surgical NVAF. The primary outcome was incident HF. Secondary outcomes were HF hospitalization and all-cause mortality.

Results
A total of 1,846 patients with POAF were matched with 5,538 patients with non-surgical NVAF (median age: 76 years [25th-75th percentile: 67-83 years]; 53.1% females). The median follow-up was 7.6 years. Compared with patients with non-surgical NVAF, patients with POAF did not have a significantly different rate of incident HF (2.7 versus 3.0 events per 100 person-years; HR 0.89 [95% CI, 0.78-1.03]) or HF hospitalization (2.2 versus 2.4 per 100 person-years; HR 0.88 [95% CI, 0.76-1.03]), but they had a higher rate of all-cause mortality (10.0 versus 8.7 per 100 person-years; HR 1.27 [95% CI, 1.18-1.37]) (Figure 1).

Conclusions
Patients with new-onset postoperative atrial fibrillation did not have a significantly different rate of incident heart failure or heart failure hospitalization, but they had a higher associated rate of all-cause mortality compared to patients with non-surgical atrial fibrillation. This finding suggests that postoperative atrial fibrillation may be regarded as non-surgical atrial fibrillation in terms of the long-term risk of heart failure. This highlights the importance of increased awareness among physicians of the risk of adverse outcomes, including heart failure, in patients with postoperative atrial fibrillation after noncardiac surgery. Closer postoperative follow-up and monitoring, as well as aggressive treatment of cardiovascular risk factors, may be warranted to reduce the risk of adverse outcomes in these patients.
Rhythm control for atrial fibrillation in patients with end-stage or chronic kidney disease
Authors: Kim D , Kang D S , Jang E , Yu H T , Kim T H , Uhm J S , Sung J H , Pak H N , Lee M H , Yang P S , Joung B 
Published: October 2024

Abstract

Background
Although early rhythm control (ERC) improves cardiovascular outcomes in patients with atrial fibrillation (AF), its use in patients with chronic kidney disease (CKD) remains challenging.

Purpose
This study aimed to investigate the benefits and risks of ERC in CKD.

Methods
This population-based cohort study included 5,224 patients with AF (65% male, median age 63 years) with CKD stage III–IV (n=3564) and end-stage renal disease (ESRD, n=1660), who underwent ERC or rate control between 2005 and 2015. The primary outcome consisted of cardiovascular death, ischemic stroke, heart failure-related hospitalization, and acute myocardial infarction.

Results
During a median follow-up of 3.5 years, ERC, compared to rate control, was associated with a reduced risk of the primary outcome (hazard ratio [HR] 0.85, 95% confidence interval [CI] 0.74–0.98) without increasing the composite safety outcome in CKD stage III–IV (HR 0.99, 95% CI 0.86–1.13). Among patients with ESRD, the primary outcome did not differ between ERC and rate control (HR 0.97, 95% CI 0.81–1.17) but ERC was associated with an increased risk of composite safety outcome (HR 1.29, 95% CI 1.11–1.50), compared to rate control. However, considering the non-adherence to ERC, its comparative effectiveness on the primary outcome was observed in ESRD (HR 0.81, 95% CI 0.68–0.98). Additionally, ablation procedures did not increase the risk of composite safety outcome (HR 0.63, 95% CI 0.32–1.24).

Conclusion
ERC demonstrated a modest risk-benefit profile in ESRD compared to CKD stage III–IV. Randomized clinical trials should validate the efficacy of ERC, including ablation procedures, particularly in patients with ESRD.
How much does elective cardioversion increase the risk of ischaemic stroke compared to the baseline risk in atrial fibrillation? A nationwide study
Authors: Itainen-Stromberg S , Lehto M , Airaksinen K E J , Halminen O , Lehtonen O , Putaala J , Haukka J , Mustonen P , Hartikainen J , Teppo K , Aro A 
Published: October 2024

Abstract

Background
Patients with atrial fibrillation (AF) undergoing cardioversion (CV) are exposed to an increased risk for stroke during the post-cardioversion period, but the exact magnitude of this risk after elective CV with preceding appropriate oral anticoagulant (OAC) therapy is unknown.

Purpose
We explored the rate of ischaemic stroke (IS) after elective CV and compared the IS rate during the post-cardioversion period with the long-term stroke rate in patients with AF using guideline-recommended OAC therapy.

Methods
This is a nationwide register-based study, including all AF patients undergoing their first-ever elective CV between 2012-18 in Finland. Data were collected from the Finnish health care registers covering uniquely all levels of care. Visual assessment of the survival curve identified a cut-off point in IS rate at 1 week after CV. Therefore, the follow-up time was split into two intervals, the 1-week post-cardioversion period and the subsequent period up to 360 days. Stroke rates were calculated separately for these periods. Unadjusted and adjusted incidence rate ratios were estimated with Poisson regression. Moreover, interaction between the two follow-up periods and conventional IS risk factors as well as OAC treatment was assessed.

Results
A total of 9625 AF patients undergoing their first elective CV were identified (mean age 67.7±9.9 years, 61.2% men, mean CHA2DS2-VASc score 2.6±1.6). Warfarin was used in 6 245 (64.9%) and non-vitamin K oral anticoagulants in 3 380 (35.1%) patients. Overall, 92 (1.0%) patients suffered an IS during the year after CV. The survival plot displayed a higher incidence of IS within the first week after CV, stabilizing thereafter to a consistent level (Figure). In the adjusted regression analyses, IS rate within the first week after elective CV was 13.6-fold (95% confidence interval [CI]: 8.6-21.5) compared the subsequent rate of IS (Table). We observed no significant interaction between any of the conventional IS risk factors or OAC treatment and the two follow-up time periods, indicating that their association with IS rate did not differ during the post-cardioversion period compared to the subsequent time period.

Conclusions
In this nationwide study, the rate of IS was roughly 14 times higher during the first week after elective CV compared to the subsequent follow-up time.Cumulative risk of IS after elective CVIncidence rates of IS after elective CV
Do CYP2D6 polymorphisms affect the efficacy and toxicity of flecainide? A cohort study
Authors: Trincado Ave M , Brion Martinez M B M , Blanco Vera A B V , Martinez Sande J L M S , Fernandez Lopez X A F L , Garcia Seara J G S , Gonzalez Juanatey J R G J , Rodriguez Manero M R M 
Published: October 2024

Abstract

Background
The CYP2D6 enzyme, coded by the CYP2D6 gene, is the primary metabolic pathway for flecainide.(1,2) Over the years, studies on how different variants of this gene affect flecainide metabolism and efficacy have yielded contradictory results.(3–7) This is likely due to the fact that CYP2D6 pharmacogenetic classifications were not standardized until 2017.(8,9)

Purpose
To date, there has been no published study using a standardized classification to assess the efficacy and toxicity of flecainide across different CYP2D6 phenotypes; therefore, we decided to study this.

Methods
We conducted a cohort study with data collected through indirect methods, blinding all parties involved except the statistician. We identified patients with flecainide prescriptions (100 mg/12 h) and follow-up in our health area (n=450,136 people) between 2017 and 2021. A primary combined endpoint composed of initial inefficacy and early toxicity was pre-set, and a secondary combined endpoint of toxicity or inefficacy during follow-up.

Results
104 patients met the criteria and agreed to participate: 38 (36.5%) intermediate metabolizers, 52 (50%) normal metabolizers, 2 (1.9%) could not be classified with certainty (compatible with intermediate or normal metabolizers), 7 (6.7%) poor metabolizers, 4 (3.8%) ultra-rapid metabolizers, and 1 (1%) possible hybrid.
Intermediate and normal metabolizers showed an almost superimposable incidence of the primary endpoint (28,9% vs 28,8%, p=0.99), early inefficacy (21,6% vs 17,4%, p=0.97) and early toxicity (13,2% vs 13,3%, p=0.72). No significant differences were observed in multivariate analysis (p=0.76, picture 1) or in a combined endpoint of toxicity or inefficacy during follow-up (p=0.58, Kaplan-Meier in picture 2). Differences were seen in the primary endpoint when comparing poor metabolizers to the rest of the sample, although they did not reach statistical significance (p=0.07), likely due to the small number of patients in this group (n=7, absolute risk reduction -32%; 95% confidence interval: -41% to -23%).

Conclusions
Using the standardized classification for CYP2D6 pharmacogenetics, no statistically significant differences were detected between the two largest groups, intermediate and normal metabolizers. It is possible that better results are achieved in poor metabolizers. Based on these results, it is worth questioning whether, in an attempt to minimize the risk of flecainide toxicity, doses that are subtherapeutic in all groups except slow metabolizers have been used unknowingly.
H558R: a common polymorphism may modify the efficacy and toxicity of flecainide in maintaining sinus rhythm; a cohort study
Authors: Trincado Ave M , Brion M B M , Blanco-Varea A B V , Tilves C T , Garcia-Seara J G S , Fernandez Lopez X A F L , Martinez-Sande J L M S , Gonzalez-Juanatey J T G J , Moises M R M 
Published: October 2024

Abstract

Background
Certain mutations in the SCN5A gene alter the function of the type V voltage-gated cardiac sodium channel and the therapeutic effect of flecainide.(1) One such mutation, H558R, represents a polymorphism with a high prevalence associated with the development of atrial fibrillation (AF).(2–5)

Purpose
We aim to determine its relationship with the efficacy and adverse effects of flecainide, as well as describe for the first time its prevalence in a cohort of European patients with AF.

Methods
We conducted a cohort study collecting data through indirect methods, with the study being blinded to all parties involved except the statistician. Patients prescribed flecainide (dose of 100 mg/12 h) and followed up in our health area (n=450,000 people) between 2017 and 2021 were identified. A primary composite endpoint consisting of initial inefficacy and early toxicity and a secondary combined endpoint of toxicity or inefficacy during follow-up were predefined.

Results
Out of 104 patients who met the criteria and agreed to participate, 59 (56.4%) did not have the mutation (H558R-/-), 38 (36.5%) were heterozygous (H558R+/-), and 7 (6.7%) were homozygous (H558R+/+). This high prevalence in European patients with AF is significantly higher than that previously reported in healthy individuals (20.4% in Caucasians, 9.2% in Asians).(6) When compared with patients without the mutation, H558R+/- patients had a lower incidence of the primary endpoint (p=0.02, picture 1), with an absolute risk reduction (ARR) of -21.5% (95% confidence interval (CI): -38.4% to -4.6%) primarily due to a lower rate of initial inefficacy (ARR -18.35%, 95% CI: -1.37% to -35.3%), and a trend towards lower early toxicity (ARR -7.36; 95% CI: -19.9 to +5.2%). This difference remained in the multivariate analysis (p=0.03, table 1). Moreover, the H558R+/- genotype was associated with lower toxicity or inefficacy over an average follow-up of 492 days (p=0,04, picture 1), with a hazard ratio of 0.53 (95% CI: 0.27 to 0.999).

Conclusions
The H558R+/- mutation shows a marked prevalence in a selected sample of patients with AF. Its presence is clinically relevant both in terms of early efficacy or toxicity and during follow-up. If these results are confirmed, it may signify a step towards personalized treatment for patients with AF, not only from the standpoint of efficacy but also safety.Table 1.Picture 1.
Impact of paroxysmal atrial fibrillation ablation on cardiac sympathetic nervous system: a prospective stratified randomized comparative study in patients with and without heart failure
Authors: Fukuda Y , Kawasaki M , Yamada T , Watanabe T , Morita T , Kikuchi A , Kondo T , Kawai T , Nishimoto Y , Seo M , Nakamura J , Fujita T , Taniichi M , Chang Y , Fukunami M 
Published: October 2024

Abstract

Background
Catheter ablation of atrial fibrillation (AF) might influence the cardiac sympathetic nervous system (CSNS). We sought to investigate the impact of AF ablation with 2nd generation cryoballoon catheter (CB) and contact force sensing radiofrequency ablation catheter (RF) on CSNS and the association of this effect with early AF recurrence in patients with and without heart failure (HF), using cardiac iodine-123-metaiodobenzylguanidine (MIBG) scintigraphy.

Methods and Results
One hundred sixty-five paroxysmal AF patients who were scheduled for ablation were enrolled. All patients were categorized into two groups: one with HF (n=31), defined as left ventricular ejection fraction ≤ 40% or previous history of hospitalization for worsening HF, and the other without HF (n=134). They were then randomly assigned to CB (17 patients with HF and 68 without HF) or RF (14 with HF and 66 without HF). MIBG scintigraphy was performed at baseline and 3 months post-ablation and the washout rate (WR) was measured. There were no significant changes in WR from baseline to 3 months after RF and CB ablation (28.7±18.6% to 27.9±16.7% in RF and 29.4±16.7% to 30.5±16.4% in CB). WR decreased more in patients with HF at 3 months after ablation than without HF, while WR significantly increased in patients without HF and there was a significant interaction in WR change between with or without HF (interaction p&lt;0.001). WR change from the baseline to 3 months after ablation (dWR) was not significantly different between CB and RF, irrespectively of the HF presence. In the blanking period of 3 months after ablation, early AF recurrence (EAR) was observed in 37 (22%) patients with no antiarrhythmic drugs (17(21%) patients in RF and 20(24%) in CB). dWR was significantly greater in patients with than without EAR (4.0±14.1% vs -0.9±11.0%, p=0.027). Higher dWR (≥ 6.9% (AUC 0.644, 95%CI [0.535-0.753]) by ROC curve analysis) was independently associated with EAR (adjusted odds ratio = 4.15, 95%CI [1.87-9.22], p&lt;0.001, adjusted for age, sex, and left atrial diameter).

Conclusions
Irrespectively of CB and RF, AF ablation might reduce adrenergic tone in patients with HF, while it might induce more adrenergic tone in patients without HF. Excessive adrenergic tone might be associated with early AF recurrence.WR changes before and after ablationdWR in patients with or without HF
The predictive value of left atrial functional parameters for recurrence of atrial fibrillation after catheter ablation in patients
Authors: Hong X , Cai X Y , Xu G D , Zhang N N 
Published: October 2024

Abstract

Background
Catheter ablation (CA) is a first-line treatment option for patients with symptomatic or drug-refractory atrial fibrillation (AF), yet the recurrence rate of AF post-CA remains considerably high. Studies have reported that left atrial (LA) functional parameters can serve as predictive factors for AF recurrence, however, the results remains controversial.

Purpose
This study aims to investigate the predictive value of LA functional parameters for AF recurrence following CA in patients.

Methods
We prospectively enrolled patients with AF who underwent CA for the first time from June 2022 to May 2023 and met the inclusion criteria at our institution. All patients underwent pre-ablation evaluation of LA structure and function, including LA diameter (LAD), LA maximum volume (LAVmax), LA minimum volume (LAVmin), LA pre-systolic volume (LAVpre), LA reservoir strain (LASr), LA strain conduit (LAScd), LA contraction strain (LASct), and LA ejection fraction (LAEF) using three-dimensional speckle tracking echocardiography. AF recurrence was defined as atrial tachycardia occurring 3 months after ablation and lasting longer than 30s. Patients were followed up for 9 months post-CA , and the primary end point was any atrial tachycardia occurring at 3 months after ablation.

Results
A total of 85 patients with AF were ultimately included in this study, with an average age of 68.9±11.0 years, 54.2% of whom were male. During the 9-month follow-up, 30 patients (35.29%) experienced recurrence postoperatively, while 55 patients (64.71%) still maintained sinus rhythm. Compared with the AF non-recurrence group, the AF recurrence group had significantly increased LAD (46.4±5.5mm vs. 42.3±4.5mm, p&lt;0.05), LAVmax (80.7±21.3mL vs. 67.1±22.0mL, p&lt;0.05), LAVmin (63.8±18.0mL vs. 42.8±16.9mL, p&lt;0.05) and LAVpre (72.4±19.4mL vs. 53.9±16.8mL, p&lt;0.05). Meanwhile, in AF recurrence group, LAEF (21.7±6.8% vs. 37.5±8.0%, p&lt;0.05), LASr (5.1±3.1% vs. 12.0±5.4%, p&lt;0.05), LAScd (-4.0±3.6% vs. -7.3±5.7%, p&lt;0.05), and LASct (-1.0±3.8% vs. -3.3±4.9%, p&lt;0.05) were significantly decreased. Multivariate logistic regression analysis revealed that LASr (OR=0.640, 95%CI 0.425-0.964, p&lt;0.05) and LAEF (OR=0.816, 95%CI 0.694-0.960, p&lt;0.05) were independent risk factors for predicting AF recurrence. ROC curve analysis showed that both LAEF (AUC=0.935, 95%CI 0.871-0.999) and LASr (AUC=0.903, 95%CI 0.833-0.973) possess high predictive values. Furthermore, the combined model of LAEF and LASr (AUC=0.954, 95%CI 0.905-1.000) had a greater predictive value than any one of the two indicators (p&lt;0.05).

Conclusion
Taken together, these findings indicate that LAEF and LASr are independent predictors of AF recurrence following CA in patients with AF. Combination of the two indicators can more accurately assess the risk of recurrence in AF patients post-CA.
Median dose area product and fluoroscopy time have stabilized on a low level during the last years: data from the swedish national catheter ablation registry
Authors: Mannewald C , Platonov P G , Fengsrud E , Hoglund N , Karlsson L , Lonnerholm S , Ringborn M , Sigurjonsdottir R , Tabrizi F , Tapainen J , Braunschweig F , Holmqvist F 
Published: October 2024

Abstract

Background
Despite the utilization of 3D-mapping systems, the use of fluoroscopy is still necessary in most procedures of catheter ablations of arrhythmias, but associated with serious health risks to both patients and operators. However, given the rapid improvement of the 3D-mapping systems, the usage of fluoroscopy has likely decreased during the past 15 years.

Purpose
The purpose of this study was to explore trends over time in usage of fluoroscopy in catheter ablation for all arrhythmias.

Methods
The Swedish Catheter Ablation Registry covers virtually all (&gt;97%) catheter ablations performed in Sweden since 2005. Patients &gt;18 years of age undergoing catheter ablation from January 1st 2006 to December 31st 2020 were included. Periprocedural data; median dose area product and fluoroscopy time were analyzed and compared. Periprocedural data were compared between 2006, 2015 and 2020 to find possible trends.

Results
A total of 61242 procedures were performed during the study period. The breakdown between the different arrhythmias was: 3% ventricular tachycardia (VT), 3% premature ventricular complex (PVC), 5% atrial tachycardia (AT), 7% atrioventricular junction ablation (AVJ), 10% atrioventricular reentry tachycardia (AVRT), 14% cavotricuspid isthmus ablation (CTI), 20% atrioventricular nodal reentry tachycardia (AVNRT) and 39% atrial fibrillation (AF). In 2006, the median fluoroscopy duration for AF, VT and PVC were recorded at 41, 32 and 37 minutes, respectively. Subsequently in 2015 the corresponding times were recorded at 14, 8 and 13 minutes. In 2020 respective procedures had a median fluoroscopy time of 11, 10 and 18 minutes (p&lt; 0.001 for trend for all ablations). In 2006 median dose area product for AF, VT and PVC were 3998 cGycm2, 4300 cGycm2, and 5138 cGycm2, respectively. By 2015 the median dose area product had decreased to 1005 cGycm2, 432 cGycm2 and 1123 cGycm2 respectively. In 2020 the median dose area product had decreased further to 524 cGycm2, 380 cGycm2 and 848 cGycm2 (p&lt;0.001 for trends for all ablations). See figure 1 for all procedures.

Conclusion
Fluoroscopy time and median dose area product have decreased significantly over a 15-year period and have stabilized on a low level over the last 5 years. Given the associated risks, efforts to further reduce radiation exposure are clearly warranted.Median dose area product
Ablation outcome in patients with atrial fibrillation undergoing ICE-guided pulsed-field ablation
Authors: Mohanty S , Casella M , Doty B , Schiavone M , Gabrah K , Valeri Y , Torlapati P G , La Fazia V M , Gianni C A R O L A , Gallinghouse G J , Al-Ahmad A , Dello Russo A , Tondo C , Nair D G , Natale A 
Published: October 2024

Abstract

Background
Prior experiences from preclinical studies indicate the critical need of catheter-tissue- contact for creation of consistent transmural lesions in pulsed-field ablation (PFA). Intracardiac echocardiography (ICE) not only provide real-time visualization of cardiac structures, but also ensure adequate contact with the tissue.

Objective
We evaluated ablation outcome and reconnection rate following ICE-guided PFA procedure in patients with atrial fibrillation (AF).

Methods
Consecutive patients receiving ICE-guided PFA procedure were included in this multi-center analysis. All patients received isolation of PVs (PVI). Additional ablation of left atrial posterior wall (LAPW) was decided based on operator’s discretion. Concentric overlapping lesions were placed in the LAPW. Number of applications were determined on a case-by-case basis. ICE and fluoroscopy were used to optimize contact between the PFA catheter and the targeted tissue. All procedures were performed under uninterrupted anticoagulation. Mapping was done before and after ablation to confirm electrical isolation. Arrhythmia-monitoring was done for 1-year with periodic clinic visits, event recorders and 7-day Holter monitoring.

Results
A total of 372 patients [age: 62.69 ± 10.41 years, male: 201 (71.3%), paroxysmal AF: 67 (18%)] were included in this analysis of which 48 (12.9%) underwent PVI-only and the remaining subjects received additional ablation of LAPW. Mean number of applications were 34.67 ± 8.88 and 73.65 ± 37.21 for PVI-only and PVI+LAPWI cohorts respectively (p&lt;0.001).
No major procedural complications such as esophageal injury, atrio-esophageal fistula, pericardial effusion requiring drainage or cerebrovascular accidents were reported.
During 1-year follow-up, 38 (10.2%) patients underwent repeat procedure for recurrence. Reconnection of PV and LAPW were found in only 2 (5.2%) patients.
In all 38 patients, new triggers initiating AF were detected to be originating from interatrial septum: 25 (65.8%), superior vena cava: 9 (23.7%), coronary sinus: 7 (18.4%) and left atrial appendage: 6 (15.8%).

Conclusion
ICE-guided PFA procedures are safe and produce durable lesions leading to very low reconnection rate. The recurrence was mostly due to new triggers initiating AF.