bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence and outcome of periinterventional atrial fibrillation in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention
Authors: Jost J , Rohla M , Hamacher L , Burger L A , Zweiker D , Kaufmann C , Tscharre M , Wessely E , Huber K , Tinhofer F 
Published: May 2024

Abstract

Background
Peri-interventional atrial fibrillation (AF) may be detected in patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Data on the thromboembolic risk and long-term clinical outcome in patients with AF limited to the peri-interventional period is scarce.

Purpose
To assess the incidence and impact on long-term clinical outcome of peri-interventional de-novo AF in STEMI patients.

Methods and Results
This retrospective single-center cohort study included all patients who underwent PCI between January 2016 and November 2020 (n=491) due to STEMI. Patients were stratified to three cohorts of AF status: Pre-existing AF: n=42 [8.6%], newly diagnosed peri-interventional AF: n=56 [11.4%] and no AF: n=393 [80.0%].
Patients with newly diagnosed peri-interventional AF as well as patients with pre-existing AF had in median a mild-moderately reduced left ventricular ejection fraction (LVEF), patients in sinus rhythm in median a normal LVEF.
During the average follow-up time of 4.7 years (min. 2 years, max. 7 years) the rate for readmission for AF or occurrence of AF without hospital admission was increased in patients with peri-interventional de-novo AF or pre-existing AF (n=6 [10.7%], n=10 [23.8%]) compared to those in sinus rhythm n=22 [5.6%] (p&lt;0,001)
The occurrence of ischemic stroke was higher in patients with peri-interventional de-novo AF (n=2 [3.6%] or with pre-existing AF (n=2 [4.8%]) compared to those in sinus rhythm (n=6 [1.5%]. (p=0.256)
The risk of cardiovascular death was significantly higher in patients with newly diagnosed peri- interventional AF compared to patients with pre-existing or no AF (n=13 [23.2%], n=5 [11.9%], n= 37 [9.4%]) (p=0.009).
In the patient group with peri-interventional de-novo AF, only 25.0% (n=13) received long-term oral anticoagulation therapy (OAK). The rate of stroke in patients who received OAK after peri- interventional de-novo AF was 7.7% (n=1) compared to those without OAK 2.6% (n=1).

Conclusion
Peri-interventional AF is a frequent finding in STEMI patients undergoing primary PCI. Patients with peri-interventional AF had a significantly increased risk for an adverse cardiovascular outcome. Optimal secondary prophylactic measures appear mandatory in this patient population. The significance of long-term OAK therapy is to be determined.
Management of edoxaban therapy in patients undergoing emergency/urgent procedures: a subanalysis of the global, prospective, observational, multinational EMIT-AF/VTE programme
Authors: Colonna P , Souza J , Saxena M , Vanassche T , Santamaria A , Jin J , Kohler S , Borrow A , Unverdorben M , Von Heymann C 
Published: May 2024

Abstract

Background
Physicians are often unable to follow recommendations for preprocedural oral anticoagulant interruption before emergency/urgent (unplanned) procedures, which may lead to a higher incidence of adverse outcomes in these patients compared with those who undergo planned procedures. The Global EMIT-AF/VTE programme found low bleeding and thromboembolic event rates for patients receiving edoxaban who underwent diagnostic or therapeutic procedures. However, edoxaban management and clinical outcomes may differ among the subgroup of patients with emergency/urgent procedures.

Purpose
To describe periprocedural edoxaban management and clinical outcomes for patients in the EMIT-AF/VTE programme who underwent emergency/urgent procedures.

Methods
In this subanalysis, only physician-reported unplanned (emergency/urgent) procedures were included, of which dental and dermatological procedures were excluded. Only a patient’s first emergency procedure was included, with the exception of 3 patients having 2 procedures on the same day (in these cases the 2 procedures were combined). Procedure bleeding risk was classified according to EHRA criteria, and baseline characteristics and edoxaban interruption data were collected. Clinical event and procedure dates were compared to determine whether they were related.

Results
Among 156 patients undergoing emergency/urgent procedures, the mean ± standard deviation age at baseline was 74.5 ± 8.7 years, and the CHA2DS2-VASc score was 3.8 ± 1.6. Medical histories of hypertension and dyslipidaemia were reported in 84.0% and 40.4% of patients, respectively; approximately one-quarter of patients had diabetes mellitus (26.9%) or creatinine clearance ≤50 mL/min (24.4%). The most common procedure types were vascular access and transcatheter diagnostics/interventions (34.6%) and gastroenterological procedures (27.6%). Procedures were more often EHRA-classified as minor (35.9%) or low (35.3%) vs high risk (20.5%). Preprocedure edoxaban interruption rates ranged from 39.3%–50.9% across risk groups, with more than half of the procedures being performed with edoxaban interruption (53%–66%; Figure). By 20 days postprocedure, edoxaban therapy was resumed in approximately 86% and 88% of patients with minor- or low-risk procedures vs 70% with high-risk procedures. Overall, 33 clinical events were recorded, of which 18 (54.5%) preceded a procedure (Table). Five bleeding events and one thrombotic event occurred after and were caused by the procedure.

Conclusions
Edoxaban resumption was protracted after high- vs minor- or low-risk procedures. Bleeding and thrombotic events resulting from a procedure occurred in &lt;4% of patients, indicating that postprocedure edoxaban therapy can be effectively tailored to optimise clinical outcomes.FigureTable
Outcomes of on-label reduced-dose edoxaban in octogenarian patients with atrial fibrillation
Authors: Lee H J , Lee S H , Kim J W , Kim J Y , Park S J , Park K M , On Y K 
Published: May 2024

Abstract

Background
Non-vitamin K antagonist oral anticoagulants (NOACs) are effective in preventing thromboembolisms and reduce the risk of bleeding compared with warfarin. There are few reports on the outcomes of on-label reduced-dose NOACs.

Purpose
The aim of this study was to assess the safety and efficacy of on-label reduced-dose edoxaban in octogenarian patients with atrial fibrillation (AF).

Methods
This study is a multi-center, prospective, non-interventional study to evaluate the safety and efficacy of on-label reduced-dose edoxaban in patients with AF. We evaluated outcomes of major bleeding, stroke or systemic embolism, all-cause death, and composite clinical outcomes.

Results
A total of 2448 patients (mean age 75.0±8.3 years, 801 [32.7%] males) was included in the present study. 932 patients (38.1%) were octogenarians. Major bleeding events occurred at a rate of 1.69%/yr in octogenarian patients and 0.9%/yr in non-octogenarian patients. The event rate of strokes and systemic embolisms was 1.93%/yr in octogenarian patients and 0.66%/yr in non-octogenarian patients The overall net clinical outcomes occurred at a rate of 5.45%/yr in octogenarian patients and 2.24%/yr in non-octogenarian patients.

Conclusions
Reduced-dose edoxaban can be used safely in Asian patients with very elderly patients. Older age was associated with a higher risk of ischemic stroke and composite adverse events.
Left atrial appendage clipping during hybrid atrial fibrillation ablation: a very long-term, single-center experience
Authors: Mouram S , Della Rocca D G , Doundoulakis I , Pannone L , Vetta G P , Stroker E , Almorad A , Sieira J , Sarkozy A , Chierchia G B , La Meir M , De Asmundis C 
Published: May 2024

Abstract

Background/introduction
Epicardial left atrial appendage (LAA) clipping is an effective strategy for stroke prophylaxis in high thromboembolic (TE) and bleeding risk patients with atrial fibrillation (AF). In addition to LAA exclusion from systemic circulation, clipping promotes concomitant appendage isolation, which might have positive impacts on arrhythmia control.

Purpose
The aim of this study was to report safety, success rate, and the long-term clinical outcomes of LAA clipping in a large cohort of AF patients undergoing concomitant hybrid ablation.

Methods
Consecutive patients undergoing hybrid AF ablation between 2013 and 2023 were enrolled. Hybrid ablation was performed in a one-step procedure consisting of thoracoscopic epicardial radiofrequency (RF) ablation followed by endocardial mapping and ablation, if needed. Ablation lesion set included pulmonary vein (PV) and posterior wall (PW) isolation, as well as RF applications to the LAA/posterolateral ridge. LAA clipping was performed via Atriclip exclusion system (Atricure, Inc., The Nederlands) after epicardial ablation. Additional endocardial lesions were performed in case of incomplete epicardial ablation or at physician’s discretion.

Results
A total of 130 patients were included (mean age: 65±9.4; 72.3% males); among them, 19.2% and 55.4% had persistent or long-standing persistent AF, respectively. Mean CHA2DS2-VASC and HAS-BLED were 3.1±1.1 and 2.3+-0.5. Five patients (3.8 %) had absolute contraindication to long-term oral anticoagulation, 3 (2.3%) had previous life-threatening bleeding events, 17 (13.1%) had a previous TE event. The final clip size was 35mm in 90.7% cases. Acute success was achieved in 97.7%; failure was due to LAA size (n=1), proximity to phrenic nerve (n=1), or bypass graft (n=1). One patient had incomplete occlusion due to a large secondary lobe, which required a second clip. No periprocedural complications related to clipping were documented.
At a mean follow-up of 51±35 months, one (0.8%) patient had a stroke and 3 (2.3%) a transient ischemic attack (4 events per 552 patient/years; 0.7%).
One patient had a microreentrant tachycardia mapped from the area near the LAA clipping.

Conclusion
In a large cohort undergoing hybrid AF ablation, epicardial LAA clipping was safe and highly successful. Acute failure was rare and due to LAA morphology or proximity to phrenic nerve and bypass graft. Thromboembolic event rate was very low.
Quality of life in patients with atrial fibrillation and multimorbidity, and their caregivers: results from the AFFIRMO international online survey
Authors: Leo D , Trevisan C , Ravelli A , Graffigna G , Bosio C , Lobban T , Lane D 
Published: May 2024

Abstract

Introduction
Patients with atrial fibrillation (AF) often have additional concomitant chronic conditions that affect their clinical management and quality of life (QoL). The AFFIRMO study aims to examine ways of optimising care and self-management for AF patients with multimorbidity.

Methods
An online survey open to AF patients and their caregivers was distributed to five countries (UK, Italy, Denmark, Romania and Spain) between June 2022 and January 2023. QoL among patients was assessed using the EQ-5D-3L questionnaire, while life changes for caregivers was assessed using the Bakas Caregiving Outcome Scale (BCOS).

Results
659 patients (47.2% males, mean age: 70.9 [SD 10.2] years), and 201 caregivers (26.9% males, mean age 58.3 [SD 15.2] years) participated in the survey. Patients reported significant sex differences in health status (Table 1), with men reporting an overall higher QoL, while women reported greater impairment in mobility and usual activities, with higher levels of pain/discomfort. Patients aged &gt;65 years reported greater impairment in QoL compared to the younger ones, with patients from Southern Europe reporting greater impairment in self-care than those from Eastern or Northern Europe. Patients with higher education reported better QoL.
Among caregivers (Table 2), men reported less negative life changes compared to women, with the latter also reporting more pain/discomfort. Caregivers aged &lt;65 years reported greater impairment in mobility and usual activities than those aged ≥65 years, and those aged &lt;50 years reported a higher level of anxiety/depression. Caregivers aged &lt;75 years reported greater negative life changes than those aged ≥75 years. Caregivers from Spain reported less negative life changes compared to caregivers from other countries. Caregivers with further education level reported better overall quality of life and greater negative life changes compared to caregivers with lower levels of education.

Conclusions
The QoL of patients with AF and multimorbidity seems to be compromised especially in females and in the older ones. The caregivers of these patients also experience negative life changes, in particular those with younger age. The results of the AFFIRMO study will help in the development of better clinical and self-management strategies for AF patients with multimorbidity to reduce the negative impact on QoL.Differences in patients' QoLDifferences in caregivers' QoL
Evaluating left atrial wall thickness: a new frontier in predicting atrial scar and reentrant tachycardia
Authors: Aytemir K , Coteli C , Kilic G S , Yorgun H 
Published: May 2024

Abstract

Background and Objective
Reentrant atrial tachycardias (AT) are commonly observed in patients with atrial scar. These scars form a substrate in the atrium, characterized by areas of slow conduction, crucial for initiating reentrant cycles. During these cycles, zones of slow conduction often act as critical isthmuses (CI), becoming prime targets for ablation. Late potential mapping is a technique used to identify these slow conduction zones. Moreover, recent advancements in imaging software now allow for the precise measurement of myocardial wall thickness, aiding in the identification of thin myocardial areas that could potentially have the CI of AT.

Methods
We conducted a retrospective study of patients who underwent catheter ablation for AT. The study focused on patients who either presented with AT or in whom it was induced and who had undergone late potential mapping of the left atrium. To identify deceleration zones (DZ), we created voltage maps and isochronal late activation maps (ILAM) during sinus or paced rhythm. Electrograms exhibiting a continuous-fragmented morphology were explicitly marked. Upon induction of AT, activation mapping was employed to pinpoint the CI of the tachycardia circuit. Additionally, the thickness of the left atrial (LA) wall and LA volume were measured using ADAS3D software.

Results
A total of 39 patients, with 25 (65.1%) being female, were enrolled in the study. The mean age of the participants was 62.5 ± 9.5 years. The average volume of the left atrium was measured at 124.8 ± 35.5 mL, and the mean thickness of the LA wall was 1.58 ± 0.2 mm. In most patients (16, 41.0%), the septal wall was the thinnest part of the left atrium. However, significant thinning of the LA wall was observed predominantly on the anterior wall in 29 patients (74.2%) and on the LA roof in 18 patients (46.2%).
The sensitivity and positive predictive value (PPV) of thinning in the LA anterior wall in detecting late potentials were 74.1% and 68.9%, respectively. For detecting critical isthmuses, these values were 76.9% (sensitivity) and 66.7% (PPV). Regarding the LA roof, the diagnostic value for thinning in detecting late potentials and critical isthmuses showed a sensitivity of 57.1% and 57.9%, respectively, and a PPV of 57.1% and 52.4%, respectively.

Conclusion
Evaluating LA thickness represents a novel approach that can potentially identify LA scars and late potentials before the procedure, particularly in the LA anterior wall. While the observed positive predictive values are acceptable, the negative predictive values and specificity are relatively low. Future advancements in imaging software, along with the development of standardized cardiac computed tomography protocols, can potentially enhance these outcomes. Consequently, preprocedural computed tomography could become increasingly significant in managing and treating AF and AT beyond LA anatomy evaluation.TablesLeft Atrial Wall Thickness
Simplification of resetting response in slow/fast atrioventricular nodal reentrant tachycardia: the 3 catheters approach
Authors: Abu-Alrub S , Finet F , Boudias A , Catalan P A , Jean F , Eschalier R , Massoullie G 
Published: May 2024

Abstract

Background
The resetting response is a maneuver that helps identify the anterograde limb of slow/fast atrioventricular nodal reentrant tachycardia (AVNRT). The actual described maneuver involved a 5 catheters approach, and the related complications are poorly described.(1)

Purpose
We describe a simplified approach with 3 catheters and the related complications of the maneuver.

Methods
A quadripolar catheter was placed in the His bundle region; a decapolar catheter in the coronary sinus (CS) and a 4 mm tip non irrigated or irrigated catheter was used for pacing and ablation. An 8.5 French Sl0 sheath was used to ensure contact and stability. In confirmed slow/fast AVNRT using the fast pathway as the retrograde limb (earliest retrograde atrial activity located in the parahisian region), a single decremental atrial extrastimulus was delivered at the lower part of the triangle of Koch and 2-3 cm inside the CS on the roof. Pacing maneuver was started near the end of the QRS complex and decremented by 10 ms per interval. The higher atrial signal with the best A/V ratio on the CS catheter was used as sense reference for resetting response. The end point of ablation was non inducibility.

Results
Ten patients were included in a 4-month period, comprising 2 redo procedures. The maneuver was not performed in 4 patients (40%) due to non-sustained tachycardia. Atrial fibrillation was induced in 2 patients (20%) during the maneuver systematically due to an atrial extrastimulus preceding the H potential (negative HA interval). In the 4 remaining patients with successful resetting response, the HA interval in successful ablation spot varies between 31 to 82 ms. The involved anterograde limb was the right extension in 3 (75%) and the left extension in 1 (25%).

Conclusion
Resetting response can be performed with a 3 catheters approach, the main limitation is non sustained tachycardia, and atrial fibrillation induced by short coupled extrastimulus.Resseting response in LIE and RIE
Familial aggregation of sinus node dysfunction indicating pacemaker implantation: A nation-wide cohort study
Authors: Christiansen M K , Parner E , Johansen J B , Nielsen J C , Jensen H K 
Published: May 2024

Abstract

Background
Rare genetically inherited forms of sinus node dysfunction (SND) have been described but the significance of a family history of SND and the associated prognosis remains unknown.

Purpose
To investigate the risk of SND indicating pacemaker implantation and mortality in first-degree relatives to patients who received a pacemaker because of SND, and to assess the effect of age of onset on disease risk.

Methods
This was a nationwide retrospective register-based cohort study including all Danish citizens born after 1954. SND was defined to be present when a first pacemaker was implanted on this indication. To establish family structures, we retrieved data from the Danish civil registration registry which contains information on parental links and merged them with the Danish Pacemaker and ICD registry which contains information on all pacemaker implanted because of SND in Denmark. Using Poisson regression, we compared the rates of SND and the risk of all-cause mortality in first-degree relatives of SND patients with the rates in the general population between January 1st 1982 and August 31st 2022. Analyses were adjusted for selected diagnosis- and procedure codes from the Danish National Patient Registry, including hypertension, diabetes mellitus, heart failure, coronary artery disease, atrial fibrillation or flutter, valvular heart disease, stroke, and cardiac surgery.

Results
We included 6,027,090 individuals among whom 2,477 first pacemakers were implanted due to SND in the time period. The adjusted rate ratio (RR) of SND was 2.9 (95% CI 2.4-3.6), p&lt;0.001, for individuals having any father, mother or sibling with SND compared with the general population. This risk was increased in first-degree relatives across all ages of SND onset in the index person but substantially higher if SND onset in the index person occurred ≤50 years (adjusted RR=7.1 (95% CI 3.5-14.3), p&lt;0.001). Comparable risks of SND were observed for first-degree relatives to mothers, fathers and siblings with SND as well as for men and women. Overall, mortality was similar between individuals having any father, mother or sibling with SND and the general population (adjusted RR=1.02 (0.97-1.08), p=0.45). However, there was a trend towards an increased mortality among first-degree relatives to index persons with an early onset.

Conclusions
First-degree relatives to SND patients are at increased risk of SND with risk being inversely associated with age of onset in the index person. Overall, mortality in first-degree relatives was comparable to the general population, suggesting a benign prognosis in the vast majority of cases with genetically inherited SND.Table 1Figure 1
Long-term impact of the implementation of a syncope unit: 14 years of care optimization
Authors: Rodriguez Entem F , Exposito V , Gonzalez Enriquez S , Olalla J J , Zubiaur J , Perez Barquin R , Margarida A 
Published: May 2024

Abstract
Syncope, a prevalent cause of emergency department (ED) visits, often triggers unnecessary hospitalizations due to its intricate management. In recent years, dedicated syncope units (SUs) have emerged, initially showing a reduction in admission rates compared to traditional approaches.
These abstract aims to convey the extended impact of implementing a specialized Syncope Unit (SU) within a hospital setting over 14 years.
This prospective study examines SU outcomes over the first 14 years of operation, with a specific focus on admission rates.
Between 2005 and 2019, our hospital's ED handled 1,835,219 visits, with 16,516 (8.9%) related to syncope. On average, 1,101±60 syncope patients received attention annually, with a slight decrease over the study period. The SU evaluated a total of 3,225 patients, averaging 215±31 patients per year. Notably, the number of SU patients remained consistent, while the number of hospitalized patients steadily declined from 40% in 2005 to 15% in 2019.
In conclusion, the implementation of the SU led to a substantial and sustained reduction in the admission rate for syncope patients, showcasing a lasting positive impact on syncope management within the ED. This positive impact could also be due to indirect benefits resulting from the creation of the SU.