bluuebunny/crossref_metadata_2025_split huggingface dataset:
Electrophysiological findings, incidence, and predictors for AF recurrence after pulsed field versus radiofrequency pulmonary vein isolation. A retrospective analysis
Authors: Eberl A , Manninger M , Rohrer U , Reischl A , Zirlik A , Scherr D 
Published: May 2024

Abstract

Background
Pulsed field ablation (PFA) is an emerging method for catheter ablation of atrial fibrillation (AF). Data comparing efficacy and safety of PFA compared to thermal ablation is still scarce. In this study, we compared a cohort of patients who underwent PFA with those who received very high power short duration (vHPSD) radiofrequency catheter ablation at the University Hospital Graz.

Methods
We analysed baseline data from both cohorts (PFA: n=231; RF: n=243). Both procedures were performed under deep sedation, using propofol and fentanyl. The PFA procedure involved 2x2x2 pulses, with additional pulses as required. RF procedures were performed using the QDOT Micro catheter to deliver 90 watts of energy over 4 seconds.
Statistical analysis was performed using IBM SPSS Statistics for Windows, version 29. The Kruskal-Wallis test was used for quantitative non-parametric data in the baseline analysis, and the Man-Whitney-U test was used for quantitative non-parametric procedural data. For qualitative variables the Chi-squared test was used. A p-value of less than 0,05 was considered significant.

Results
Both groups were similar, apart from chronic heart failure, which was more prevalent in the RF group (p=0.003). Mean age for both groups was 62±10 years and mean body mass index did not differ as well. CHADS-VASc score was 2±2 in the RF and 2±1 in the PFA group (p=0.7). The types of AF were distributed as follows: (RF vs.PFA): PAF: 64%/61%; persAF: 34/36%; long standing persAF: 2%/3%.
As to this date performing a CTI line with PFA is off-label, a significantly higher number of patients with additional flutter were ablated in the RF group. In the RF-group, 91 patients underwent additional cavotricuspid isthmus ablation, compared to only 14 patients in the PFA group (p&lt;0.001). Procedural time (RF:PFA 122±min:57±26min; p&lt;0.001), fluoroscopy time (RF:PFA 15±9min:19±9min; p&lt;0.001) and fluoroscopy dose (RF:PFA 17±40Gycm2:15±15Gycm2, p=0.026) showed significant differences, with procedural time and fluoroscopy dose presenting lower values in the PFA group. First pass isolation was achieved more frequently in the PFA group (85% vs. 57%; p&lt;0,001). There was significant difference in recurrence rates between the vHPSD and PFA groups (RF: 56/242 (28%), PFA: 38/231 (17%); p=0.005). Additionally, time to recurrence in the RF group was 138±117 days, compared to 166±84min in the PFA group. We exclude operator dependence as the same operators performed both procedures.

Conclusion
Based on our findings, PFA could potentially become the standard procedure for many patients. However, randomized trials are needed to confirm these findings.
Superior vena cava isolation in paroxysmal atrial fibrillation - mind the phrenic
Authors: Pasara V , Prepolec I , Ban B , Pezo-Nikolic B , Puljevic D , Milicic D , Velagic V 
Published: May 2024

Abstract

Background
Pulmonary vein isolation (PVI) is the standard of care for patients with atrial fibrillation (AF), but medium-term success rates are far from ideal. Therefore, new methods are being developed, with emphasis on ectopic foci outside the pulmonary veins. Superior vena cava (SVC) is one of the most important non-pulmonary origins of AF and some studies suggested that empiric SVC isolation could improve outcomes in ablation of paroxysmal atrial fibrillation (PAF). Although complications have been reported in SVC ablation, most studies found complication rates of SVC ablation similar to conventional cryoballoon PVI.

Aim
This prospective, single-center study aimed to assess the complication rate and success rate of PVI followed by SVC isolation by cryoballoon application in comparison with conventional cryoballoon PVI.

Methods
We designed an unblinded, randomized clinical trial and recruited consecutive patients with PAF who were randomized to a conventional cryoballoon PVI or PVI and additional SVC cryoballoon isolation using single 180 s freeze.

Results
A total of 140 patients (61.4% male, mean age 62.1 years) with PAF were included and 67 (47.9%) were randomized to SVC isolation in addition to conventional ablation. Planned 180-s freeze in the SVC could be completed in 15 (22.4%) patients, while 27 (40.3%) patients received at least 120-s freeze. The mean time to SVC isolation was 40.2 ± 37.9 s. Real-time recording of SVC isolation was observed in 39 (58.2%) patients. Right phrenic nerve palsy (PNP), impending or transient, occurred in 6 (8.2%) patients in the PVI-only group and in 25 (37.3%) patients in the SVC-group (Chi-square test p &lt; 0.001). There were no persistent PNP cases. Bradycardia or junctional rhythm was observed during a procedure in 15 (22.4%) patients who received SVC isolation. One patient eventually received a permanent AAI pacemaker due to a sinus node injury.

Conclusion
Our data suggest that SVC isolation can be successfully achieved in the majority of PAF patients using conventional cryoballoon. However, this significantly increases the rate of transient or impending PNP and sinus node injury in comparison to conventional cryoballoon PVI. Therefore, careful phrenic nerve function monitoring and attention to sinus bradycardia or junctional rhythm are important to mitigate this risk. Follow-up data are being collected to determine whether this risk could be outweighed by a lower rate of PAF recurrence.
Pulmonary hypertension is associated with increased recurrence of atrial fibrillation post-pulmonary vein isolation: a multicenter study insights
Authors: Massalha E , Shimoni O , Sabbag A , Nof E , Beinart R 
Published: May 2024

Abstract

Background
Pulmonary vein isolation (PVI) has become an essential therapeutic approach for managing paroxysmal and persistent atrial fibrillation. Besides the fact its application increases, a substantial proportion of patients will suffer from arrhythmia recurrence.

Objectives
This study aims to determine the clinical and echocardiographic factors that predict fibrillation recurrence following pulmonary vein isolation.

Methods
In this prospective, multicenter study carried out across 14 medical centers in Israel, we included a cohort of 1002 patients who underwent pulmonary vein isolation from 2019 to 2022. The study involved an assessment of patients' baseline characteristics, electrocardiographic and echocardiographic data, laboratory results, details of the procedure, and their clinical outcomes. We monitored these clinical outcomes for one year after the ablation procedure, focusing mainly on the recurrence of atrial fibrillation, which was verified using electrocardiographic evidence during the post-blanking period. A multivariable analysis revealed the clinical and echocardiographic predictors for atrial fibrillation recurrence post-PVI.

Results
Our study evaluated 1002 patients with an average age of 64.4 ±11.3 years, including 37.5% females (376 patients). The cohort predominantly, about two-thirds, had paroxysmal AFIB, with an average arrythmia duration of 4.1 years. Frequent pre-existing conditions included ischemic heart disease in 17.3% and congestive heart failure in 13.8% of the patients. Additionally, diabetes was present in a quarter of the cohort, with 9% having a prior cerebrovascular event. The median LVEF was 60 (IQR 53-60), and the average left atrial diameter was 42.6 mm±8.8. The median pulmonary artery pressure was noted at 31 (IQR 25-38), with 13% of patients exhibiting elevated levels above 45 mmHg. Within the first year after the ablation, 11.7% of patients experienced AFIB recurrence in the post-blanking period. Our multivariate COX analysis established clinical and echocardiographic models for predicting post-PVI AFIB recurrence. Gender was a significant predictor, with women showing a higher recurrence rate (HR 1.85, 95% CI 1.29-2.7, P&lt;0.01), in addition to persistent AFIB and a non-sinus rhythm at the time of the procedure. Echocardiographic predictors of recurrence included a left atrial diameter greater than 40 mm (HR 2.16, 95% CI 1.3-3.6, P&lt;0.01) and pulmonary hypertension, notably when pulmonary artery pressure exceeded 55 mmHg, which correlated with almost a fourfold increase in AFIB recurrence risk within the first-year post-procedure (HR 4.25, 95% CI 1.57-11.5, P&lt;0.01).

Conclusions
Pulmonary hypertension, especially with pulmonary artery pressure above 55 mmHg, significantly elevates the risk of atrial fibrillation recurrence post-pulmonary vein isolation, underscoring its importance in patient prognosis and management.
Evaluation of heart rate variability at 1-month after pulsed field ablation of atrial fibrillation and comparison with radiofrequency ablation
Authors: Vio R , Forlin E , Quinto L , Vitale R , Marras E , Corrado A , Themistoclakis S , China P 
Published: May 2024

Abstract

Background
Pulsed Field Ablation (PFA) of atrial fibrillation (AF) is a nonthermal novel ablative modality in which high-voltage electric pulses are delivered to generate a high myocardial tissue-specific cellular death, with negligible consequences on surrounding structures including ganglionated plexi. The impairment of the cardiac autonomic ganglia after AF ablation with radiofrequency (RF) has been associated with an increase in mean heart rate (HR) and a reduction in heart rate variability (HRV) and might influence the long-term success of AF ablation. Little data is available on the effect of PFA on cardiac autonomic nervous function.

Purpose
The aim of this study is to investigate whether PFA ablation could lead to different values of HR and HRV compared to RF at 1-month post-ablation 24-hour Holter monitoring.

Methods
Between January to September 2023, we included consecutive patients undergoing AF ablation with PFA. According to our clinical practice, all patients performed a routine 24-hour Holter monitoring at 1-month post-ablation. Consecutive AF patients treated with RF were used as controls. Patients in treatment with antiarrhythmics or with documented recurrences of AF at 1-month post-ablation Holter monitoring were excluded.

Results
22 consecutive PFA patients were compared to 22 consecutive RF controls. There were no differences in demographic, clinical and echocardiographic data between the 2 groups (Table 1). At 1-month post-ablation Holter monitoring (Table 2), PFA patients had significant higher values of VarIndex (2.18±0.9 vs 1.47±0.7, p=0.01), ASDNN/5min (52.37±15.93 vs 37.17±12.96, p&lt;0.01), SDANN/5min (116.50±27.97 vs 96.03±28.38, p=0.04), and SD (128.95±31.31 vs 106.30±29.56, p=0.04). There was no difference in minimum HR (47.00±6.59 vs 50.29±10.25, p=0.21), mean HR (67.77±6.63 vs 69.24±9.71, p=0.56), and maximal HR (115.41±18.12 vs 110.81±16.44, p=0.39).

Conclusions
PFA leads to higher values of HRV parameters (i.e., VarIndex, ASDNN/5min, SDANN/5min, and SD) at 1-month post-ablation compared to RF. These data suggest a higher preservation of cardiac autonomic function with PFA, in contrast to RF. Whether the preservation of cardiac autonomic function with PFA might lead to higher rate of long-term AF recurrences remains to be determined.Table 1Table 2
Two-year safety and effectiveness of hybrid ablation versus catheter ablation in patients with non-paroxysmal AF: mid-term results of the CEASE-AF trial
Authors: Wijffels M , Suwalski P , Weimar T , Kosior D , Bulava A , Mokracek A , Monnig G , Sahu J , Hunter S , Van Putte B , Rub N , Nemec P , Ostrizek T , Doll N 
Published: May 2024

Abstract

Background
Hybrid Ablation for atrial fibrillation (AF) combines epicardial and endocardial ablation through a Heart Team approach to target durable, transmural isolation of the pulmonary veins (PV) and left atrial posterior wall (LAPW). While the primary efficacy endpoint at 12 months was met with a significant benefit increase for hybrid ablation, we now report the midterm durability of those results.

Purpose
To evaluate 24-months safety and effectiveness of Hybrid Ablation with left atrial appendage exclusion (LAAE) versus Catheter Ablation in patients with persistent AF/enlarged left atrium and longstanding persistent AF (LSPAF).

Methods
CEASE-AF is a prospective, multi-center, 2:1 randomized controlled trial. Eligible patients were 18-75 years of age, had symptomatic, drug-refractory persistent AF and enlarged left atrium (&gt;4 cm) or LSPAF, and were undergoing a first ablation. Hybrid Ablation consisted of two stages: thoracoscopic epicardial radiofrequency (RF) ablation for PV and LAPW isolation and epicardial LAAE followed by endocardial ablation 91-180 days later. Catheter Ablation consisted of minimum PV isolation by endocardial RF ablation, and repeat ablation was allowed between 91-180 days. In both arms, additional lesions were permitted according to institutional practices. Effectiveness was freedom from AF/atrial flutter (AFL)/atrial tachycardia (AT) off anti-arrhythmic drugs (AAD) (except AADs not exceeding doses which previously failed) and was assessed through 48-h Holter monitoring reviewed by an independent core laboratory blinded to the study. Safety was major adverse events throughout the study, adjudicated by an independent Clinical Events Committee.

Results
There were 102 Hybrid Ablation and 52 Catheter Ablation patients; 26% were female, mean age was 60.7±7.9 years, mean LAD was 4.7±0.4 cm, and 19% had LSPAF with no differences between arms. The 12- and 24-month results are shown for comparison (Table). Through 24-months, effectiveness was 66.3% (63/95) in the Hybrid Arm and 33.3% (17/51) in the Catheter Arm (absolute difference 33.0% [95% CI 14.3%, 48.3%; p&lt;0.001]). Major adverse event rates through 24-months were statistically similar at 10.8% (11/102) in the Hybrid Arm and 9.6% (5/52) in the Catheter Arm (p=1.0). Through 24-months, repeat ablations were performed in 7.4% (7/95) of the Hybrid Arm versus 37.3% (19/51) of the Catheter Arm (p&lt;0.001), and cardioversions were performed in 14.7% (14/95) of the Hybrid Arm versus 29.4% (15/51) of the Catheter Arm (p=0.034) Conclusions: CEASE-AF demonstrated that superior effectiveness of Hybrid Ablation including LAAE versus Catheter Ablation was durable through 24-month follow-up, with 33% absolute improvement in freedom from AF/AFL/AT. Safety rates continued to be similar between arms. Three-year follow-up is ongoing.
Decoding definitions of major bleeding in retrospective observational studies on direct oral anticoagulants for atrial fibrillation: a targeted literature review
Authors: Wang R , Sacks N , Chou J W , Simpson A , Williams C , Smolnik R , Chen C , Ye X , Unverdorben M , Nielsen P B 
Published: May 2024

Abstract

Background
Major bleeding is an adverse event associated with using direct oral anticoagulants (DOACs) for treatment of atrial fibrillation (AF). Incidence rates of major bleeding vary notably between randomised controlled trials (RCTs) and real-world evidence (RWE) studies. This may be attributable to inconsistent major bleeding definitions across RWE studies. RCTs commonly use the International Society on Thrombosis and Haemostasis (ISTH) major bleeding definition, including fatal bleeding, critical area/organ bleeding, bleeding requiring a blood transfusion of 2 or more units, and/or reductions in haemoglobin. These parameters may be absent in RWE studies, leading to utilisation of proxy definitions. Thus, the components used to define major bleeding in RWE studies remain unclear.

Purpose
To examine major bleeding definitions via a targeted literature review of retrospective observational studies on patients with AF receiving DOACs in routine clinical practice.

Methods
Studies of patients with AF receiving DOACs that were published between 2012 and 2022 were identified using keywords and MeSH terms in PubMed. Retrospective observational studies were screened for inclusion by title and abstract, and subsequently by full text. Articles were assessed for the types of databases and DOAC therapies studied. Components of major bleeding definitions were recorded and compared across database types.

Results
Of 328 articles screened, 18 retrospective observational studies were included in this analysis. The most common data sources were claims data (n = 10), followed by electronic medical records (n = 4), and registry data (n = 4). Across studies, major bleeding incidence rates varied from 0.59 to 11.4 events per 100 person-years. Of the 6 components of major bleeding definitions identified, requiring hospitalisation (n = 12) was the most frequent (Figure), though is not essential per the ISTH definition. No articles used fatal bleeding as a component to define major bleeding. Approximately half of all articles used the component involvement of critical organ or site (n = 7). Requiring blood transfusion was used in 6 articles and only 4 used reduction in haemoglobin or haematocrit levels (none of these involved claims data).

Conclusions
This targeted literature review of retrospective database studies of routine clinical practice decodes proxy use of ISTH major bleeding definitions. Claims data were the most common data source but lacked components describing fatal bleeding and haemoglobin levels. Further research is vital to assess the variation in reported major bleeding rates in RWE studies using proxy definitions in place of the ISTH definition.Figure
Is thyroid function testing necessary in all cases of new onset atrial fibrillation diagnosed in the emergency department? - a real-life study
Authors: Hytting J , Celik S , Bodestrom Eriksson L , Mallios P , Digerfeldt C , Waldemar A , Wijkman M , Hubbert L 
Published: May 2024

Abstract

Background
Atrial fibrillation/flutter (AF) is the most frequent cardiac arrhythmia worldwide. It increases the risk for comorbidities and prompt management is thus important. One established risk factor for AF development is hyperthyroidism, and concomitant disease significantly impacts morbidity in these patients. Therefore, thyroid function testing is recommended in new-onset AF (NOAF) by the European Society of Cardiology. There are few studies examining the prevalence of previously undiagnosed hyperthyroidism in cases of NOAF, especially if diagnosed in the emergency department (ED). Furthermore, previous studies often relied upon thyroid stimulating hormone (TSH) levels to identify cases of hyperthyroidism, this approach is susceptible for diagnostic errors since TSH profiles can overlap in conditions like hyperthyroidism, non-thyroid illness, and central hypothyroidism (of which only the former is associated with AF). Because of this, it's essential to incorporate additional biomarkers for a more precise differentiation.

Purpose
We aim to evaluate the prevalence of previously undiagnosed hyperthyroidism in a real-life NOAF population admitted to and diagnosed in the ED with a 2.5-years follow-up. Furthermore, we aim to interpret thyroid dysfunctions in relation to TSH as well as free thyroid hormone levels and other relevant biomarkers.

Methods
This retrospective registry-based cohort study included all patients attending the ED at a medium-sized hospital in Sweden during 2018 and 2020. Inclusion criteria: main diagnosis of AF (ICD I48) and ≥18 years old. Exclusion criteria: multiple visits, previous AF, abnormal thyroid function within the previous 2 years, and current thyroid hormone substitution.

Results
Patients from a total of 1020 ED visits were screened for eligibility. After exclusion, 325 patients with NOAF were included in the analysis. Of those, 106 (33%) and 232 (71%) had undergone thyroid function testing in the ED and by the end of the 2.5-years follow-up, respectively. We found no cases of hyperthyroidism in the ED and only two cases (1% prevalence) during the 2.5-years follow-up.

Conclusions
In this real-life cohort we found modest thyroid testing rates in the ED, however, a majority of patients underwent testing during follow-up. Despite this, we found no cases of hyperthyroidism in the ED and only two cases during follow-up, this is considerably lower than previously reported and may raise a question whether all patients should undergo thyroid testing, or if thyroid testing should be directed towards those with a suspected thyroid disease.
Increased risk of supraventricular tachycardia with polycystic ovarian syndrome
Authors: Raj K , Jyotheeswara Pillai K , Mahajan P R A N A V , Sarcon A N N A H I 
Published: May 2024

Abstract

Background
Many arrhythmias are known to be triggered by hormonal imbalances. Polycystic ovarian syndrome (PCOS) is a common hormonal imbalance seen in reproductive aged women. There is sparse literature linking PCOS to increased risk of atrial fibrillation (1). We hypothesise that PCOS could also be associated with Supraventricular tachycardia (SVT)

Purpose
To determine if PCOS is a risk factor for SVT and Atrial fibrillation/flutter (AF/AFL).

Methods
Utilising the National Inpatient Sample (NIS) of the years 2015-2020, We performed a multivariable logistic regression analysis to determine if PCOS was independently associated with SVT and AF/AFL. The NIS is the largest publicly available database of United States containing data on upto 7 million hospital visits per year.

Results
From the years 2015 to 2020, PCOS was present in 367,375 adult patients and SVT was observed in 965, 799 patients. After adjusting for relevant risk factors, PCOS was associated with increased odds of SVT (OR 1.23, 95% CI 1.12-1.36, P&lt;0.001) (Table 1). However, PCOS was not associated with increased odds of atrial fibrillation and atrial flutter (OR 0.72, 95% CI 0.66-0.77, P&lt;0.001)

Conclusion
SVTs have been clinically observed to be more frequent in the luteal phase of the menstrual cycle due to low estrogen. The high androgen/estrogen ratio seen in PCOS may result in a similar increased risk of SVT in PCOS patients. PCOS is known to increase P wave maximum duration and dispersion, indicating abnormal atrial conduction (2). The negative association between AF/AFL is likely because PCOS is seen more commonly in younger patients, and AF/AFL is a disease of older adults. We recommend further studies in PCOS women to confirm our findings and characterise the mechanisms of SVT.
SLAM-guided catheter ablation of AVNRT: single-center experience
Authors: Gul E 
Published: May 2024

Abstract

Aims
Three-dimensional mapping systems have been utilized to reduce fluoroscopy and minimize complications in patients with AVNRT. Recently, voltage-gradient mapping has been introduced to visualize low-voltage bridges. However, there are some limitations of voltage assessment due to catheter contract. Therefore, new Slow pathway Late Activation Mapping (SLAM) has been recently used to reveal slow conduction zone in AVNRT patients.

Method and materials
Seven adult patients with diagnosis of typical AVNRT were included. Electro anatomical mapping systems was used in all patients. Voltage and late activation mapping were performed with high-definition multipolar catheter. His cloud was also tagged in all patients. Voltage of 0.20-0.50 mV was used to delineate voltage-bridges. Latest activation in the SP area along with voltage-guided bridges were targeted with either radiofrequency ablation (RFA) or focal cryoablation (Figure 1 and 2).

Results
Limited fluoroscopy was used in 4 patients. Acute success was achieved in all patients. Patients had no structural heart disease. Detailed clinical and procedural data was depicted in Table. Cryoablation was used in 2 patients due to very small Koch triangle. Each cryolesion applied for 240 secs and overall, 3-4 lesions were delivered. Ablation at late activation areas successfully eliminated slow pathway. In most of cases, one ablation lesion was adequate to see junctional beats and elimination of dual AV nodal physiology.

Conclusion
SLAM is effective in guiding catheter ablation of AVNRT, with a complete acute success rate and no recurrences at short-term follow-up.