bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bleeding risk profile and heart failure hospitalizations in patients with atrial fibrillation according to FIB-4 index
Authors: Parada Barcia J , Abu-Assi E , Raposeiras Roubin S , Barreiro Perez M , Melendo Viu M , Dobarro Perez D , Iglesias Otero C , Gonzalez Fernandez D , Gonzalez Garcia A , Noriega Caro V , Prado Prado H , Dominguez Erquicia P , Lizancos Castro A , Dominguez Rodriguez L , Iniguez Romo A 
Published: November 2023

Abstract

Introduction
Fibrosis-4 index (FIB-4 index), calculated by age, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and platelet count, is a simple marker to evaluate liver fibrosis. The FIB-4 index is associated with higher all-cause mortality in patients with heart failure (HF). However, the relationship between liver stiffness and atrial fibrillation remains unclear.

Purpose
The present study explores the impact of the FIB-4 index in the bleeding risk and heart failure hospitalizations among a large cohort of AF patients.

Methods
The Fibrosis-4 index (FIB-4) was applied to 10,530 patients diagnosed with AF from our health area between January 2014 and April 2020. Patients were analyzed in three regions of the Fib-4index based on the cutoff points (Group 1 F0&lt;1.30, group 2 F1-F2:1.30–2.67 and group 3 F3-F4: &gt;2.67). The outcome was a composite of major bleeding events and hospitalization for heart failure. The risk of the combined end-point was determined by competing risk regression.

Results
4471 patients (42.5 %) were included in Group 1, 5139 (48.8 %) in Group 2 and 920 (7.4%) in Group 3.
During a mean follow-up of 3.78±2.05 years, 1,834 patients died (17.49%), 2,359 had a heart failure hospitalization (22,42%) and 772 had a major bleeding (7.36%).
The incidence of major bleeding and heart failure hospitalizations was significantly higher amongst group 3. In the univariate analysis, group 2 and group 3 were associated with increased risk of the combined outcome (Figure 1).
Multivariate adjustment was developed including all those variables with clinical significance and those that had been associated in the univariate analysis. Group 3 was associated with higher increased risk of major bleeding and heart failure hospitalizations (sHR 1.21, 95% CI 1.05-1.39; P=0.007), whilst Group 2 not (1.06, 95% CI 0.97-1.16; P=0.169) in comparison with Group 1.

Conclusions
FIB4 index &gt;2.67 was associated with higher risk of major bleeding and heart failure hospitalizations. FIB-4 index may reflect venous congestion and it could be an useful tool for predicting HF and major bleeding events in patients with AF.Figure 1
Impact of cardiorenal syndrome on clinical outcomes of atrial fibrillation patients undergoing catheter ablation
Authors: Matsuura H , Itonaga J , Hara A , Kisanuki H , Sada M , Okabe K , Okahara A , Kawai S , Tokutome M , Matsukawa R , Mukai Y 
Published: November 2023

Abstract

Background
Heart failure (HF) coexists with both atrial fibrillation (AF) and chronic kidney disease (CKD) and exacerbate each other. All of them are increasing in the aging society all over the world. Little is known regarding the impact of cardiorenal syndrome (CRS) on clinical outcomes of patients with AF undergoing catheter ablation (AFCA) in the real-world setting.

Purpose
In the present study, we investigated clinical outcomes of CRS patients with de novo AFCA. Method: Consecutive 494 patients (68.1±11.1 yrs, male 68.0%) undergoing de novo AF catheter ablation in our hospital from April 2019 to March 2021 were enrolled. CRS was defined as having both HF and CKD. HF was defined as having a history of HF admission and/or BNP≥100 pg/mL. CKD was defined as eGFR&lt; 60 ml/min/1.73m2. The primary outcome was composite outcomes of; all-cause death, redo ablation, thromboembolisms, atherosclerotic cardiovascular disease (ASCVD) events, major bleeding, HF admission, and dialysis initiation.

Result
The incidence of primary outcome in CRS patients during median follow-up periods of 739.5 days was significantly higher than the non-CRS patients (54.9% in CRS vs. 30.3% in non-CRS; P&lt;0.01, Figure 1). In CRS patients, all-cause death, ASCVD events, and HF admission were significantly worse (7.7% in CRS vs. 0.3% in non-CRS; P&lt;0.01, 10.3% in CRS vs. 1.8% in non-CRS; P&lt;0.01, 11.5% in CRS vs. 0.9% in non-CRS; P&lt;0.01, respectively, Table), however redo ablation, thromboembolism, major bleeding and dialysis initiation were similar compared with non-CRS patients (10.3% in CRS vs. 14.5% in non-CRS; P=0.25, 1.3% in CRS vs. 0.6% in non-CRS; P=0.59, 5.1% in CRS vs. 2.1% in non-CRS; P=0.09, 1.3% in CRS vs. 0.3% in non-CRS; P=0.24, respectively, Table). The incidence of primary outcome in CRS patients was similar in those with ejection fraction (EF)≤40% and in those with EF&gt;40% (47.6% in EF≤40% vs. 54.7% in EF&gt;40%; P=0.48, Figure 2), however it was significantly higher in those with eGFR&lt;45 compared with those with eGFR≥45 (74.8% in eGFR&lt;45 vs. 26.2% in eGFR≥45+ P&lt;0.01, Figure 3).

Conclusion
CRS patients with AFCA had significantly worse outcomes with more all-cause death, ASCVD events and HF admission compared with non-CRS patients. In the CRS patients undergoing AFCA, worse kidney function, rather than the cardiac systolic function, had a significant prognostic impact on the over-all clinical outcomes.
Temporal association between atrial fibrillation burden in cardiac implantable electronic devices and the risk of heart failure hospitalization
Authors: Ahluwalia N , Schilling R J , Koehler J , Majumder S , Landman S , Sarkar S 
Published: November 2023

Abstract

Background
high daily atrial fibrillation (AF) burden measured in cardiac implantable electronic devices (CIEDs) has been shown to be temporally associated with increased stroke risk.1

Purpose
We investigated whether AF burden is temporally associated with an increased risk of heart failure (HF) events in a large real-world cohort of patients with CIED devices.

Methods
We linked a de-identified database of aggregated electronic health records from 2007-2021 to a manufacturer’s device data warehouse with device based continuous diagnostic monitoring data. Patients with dual or triple chamber CIED implants with capability to measure daily AF burden and having HF events with 120 days of AF burden data prior to the HF event were included in this study. HF event was defined as an inpatient admission, emergency department presentation, or observation unit stay in a hospital with primary diagnosis of HF with intravenous diuretics administration. AF burden of ≥5.5 hours (as defined in earlier studies) on any given day was compared during days 1-30 before (case period) and days 91-120 days (control period) before the first HF event in each patient in this case-crossover study.2

Results
A total of 7257 earliest HF events with AF burden available in the case and control period were included. The average age of patients was 72 ±12years, with 74% being males, and following co-morbidities diagnosed prior to the HF event: 83% hypertension, 48% diabetes, 74% coronary artery disease, 31% stroke/TIA, 45% CKD, and 27% vascular disease. Comparison of occurrence of AF above threshold (≥5.5 hours on any given day) on days 1-30 versus 91-120 pre-HF event is shown in table to illustrate the effect of temporally proximate AF on risk of HF event. A total of 957 (13%) had discordant arrhythmic state between case and control period, with 763 (11%) having AF ≥5.5 hours on a day in case period versus 194 (2%) in the control period (OR: 3.93; 95% CI: 3.36-6.60). Higher odds of HF event was observed closer the day with AF ≥5.5 hours is to the HF event (table 1).

Conclusions
In a large real-world population of patients with CIED devices, AF burden of ≥5.5 hours or more on a given day increases risk of worsening HF.Table 1:odds ratio of HF eventFigure 1:Temporal association
Pulmonary vein isolation durability after very high-power short-duration ablation utilizing a very-close protocol
Authors: Heeger C H , Subin B S , Feher M F , Popescu S S P , Hatahet S H , Eitel C E , Vogler J , Kuck K H K , Tilz R R T 
Published: November 2023

Abstract

Background
Very high-power short-duration (vHP-SD) radiofrequency (RF) ablation of atrial fibrillation (AF) treatment by pulmonary vein isolation (PVI) aims for safer, more effective and faster procedures. The lesion formation of vHP-SD ablation creates wider but shallower lesions. Utilizing an individualized "very close-protocol" of 3-4mm inter-lesion distance (ILD) at the anterior and 5-6mm at the posterior aspect of the left atrium using vHP-SD only the close-protocol was adapted. Although acute efficacy for PVI was recently shown no data on chronic PVI durability has been assessed up to date. Here chronic PVI durability was evaluated during repeat electrophysiological procedures in patients after initial vHP-SD based PVI and recurrence of AF, atrial tachycardia or left atrial appendage closure.

Methods and Results
A total of 25 consecutive patients with repeat left atrial procedures after initial vHP-SD based PVI were included in this study. The median time to the repeat procedure was 5 (IQR 2, 10) months. The patients received a repeat procedure and verification of PVI due to recurrence of AF (n=8), atrial tachycardia (n=12), typical flutter (n=1) or left atrial appendage closure (n=4). During repeat procedures 3D electroanatomical mapping of the left atrium was conducted. Verified PVI durability of all PVs was found in 16/25 (64%) patients. In 1/25 (4%) patient PVI reconduction was found in 1 PV, in 6/25 (24%) patients PVI reconduction was found in 2 PVs and in 1/25 (4%) patient PVI reconduction was found in 3 PVs. A total of 81/100 PVs (81%) were found to be chronically isolated. For right sided PVs 42/50 PVs (84%) were isolated while for left sided PVs 39/50 PVs (78%) were isolated. All PVs were reisolated utilizing radiofrequency energy.

Conclusions
PVI solely utilizing vHP-SD via a very close-protocol provides high rates of chronically isolated pulmonary veins.
Amiodarone is associated with increased mortality compared with other antiarrhythmic drugs in female patients with atrial fibrillation
Authors: Choi J I , Kim Y G , Kim H S , Kim M N , Jeong J H , Lee H S , Choi Y Y , Shim J , Kim Y H 
Published: November 2023

Abstract

Objective
Antiarrhythmic drug (AAD) is the first-line therapy in patients with atrial fibrillation (AF) to maintain sinus rhythm. Amiodarone is one of the commonly used AAD that is known to lead to cardiac and extra-cardiac toxicities including pulmonary fibrosis and thyroid function abnormalities. However, the effect of amiodarone as compared with other-AADs (mainly Ic sodium channel blockers) on all-cause mortality is not fully evaluated.

Methods
This study used nationwide healthcare insurance system data. Patients with new-onset AF between 2013 and 2019 were enrolled. Use of AADs were confirmed if the patient were prescribed with AAD for more than six months during first year of AF diagnosis (medication possession ratio &gt; 0.5). Clinical follow-up duration was three years from the moment AAD prescription after AF diagnosis. All-cause mortality was compared between amiodarone vs. other-AAD users.

Results
A total of 770,977 new-onset AF cases were detected. Among these people, 15,142 and 38,707 were identified as amiodarone and other-AAD users, respectively. Significant differences were observed in mean age and prevalence of heart failure, myocardial infarction, chronic kidney disease, diabetes mellitus, and dyslipidemia. After propensity score matching, 9,672 amiodarone users were compared with other-AAD users with same sample size and baseline characteristics were well matched. In multivariate adjusted analysis, amiodarone was associated with 2.5-fold increase in all-cause mortality (hazard ratio=2.520; 95% confidence interval=2.202 – 2.883; p&lt; 0.001). Amiodarone did not show any significant interactions with age, thyroid disease, chronic kidney disease, heart failure, myocardial infarction, diabetes mellitus, dyslipidemia, and hypertension. However, the association between amiodarone and increased mortality was more pronounced in women compared with men (HR=3.124 vs. 2.231; p for interaction=0.022).

Conclusion
This study showed that all-cause mortality was significantly higher in amiodarone users than other-AAD users due to the toxicities, not by underlying diseases, which was more profound in female. This findings suggests that avoiding amiodarone as a first-line therapy should be considered in AF patients who have no compelling indications such as significant coronary artery disease or heart failure.All-cause mortality
The omnipolar voltages as an ablation indicator for pulmonary vein isolation in patients with atrial fibrillation
Authors: Mine T , Sugitani M , Kogame T , Fukuhara E , Ishihara M 
Published: November 2023

Abstract

Background
Lesion Index (LSI) without considering myocardial voltage is well-known to guide pulmonary vein isolation (PVI) ablation using the TactiCath™ Ablation Catheter in paroxysmal atrial fibrillation (PAF) patients. However, some patients show gaps after LSI-guided PVI ablation. Meanwhile, the omnipolar voltages detected using EnSite™ Omnipolar Technology (OT) have been reported to improve the underestimation of voltage.

Purpose
We aimed to clarify their differences by comparing the omnipolar voltages with conventional bipolar voltages and to verify whether it could be an additional indicator of LSI.

Methods
[Study1] We retrospectively studied 48 PAF patients (32 male, 69±8yrs) who received catheter ablation (CA). The left atrial voltage mapping was performed with Advisor™ HD Grid Mapping Catheter under right atrial pacing. The voltages within a 1cm diameter circle were measured at each site (Roof, Anterior, Posterior, Septal, Lateral; 238 sites) and evaluated the omnipolar and conventional bipolar voltages. [Study2] Twelve patients (8 males, 71±9yrs) with PAF who underwent CA were prospectively studied. The left atrial voltage mapping was performed before PVI ablation. The pre-ablation omnipolar voltages / bipolar voltages and LSI on each ablation site (558 points) of the PVI line were measured and compared in gapped and non-gapped regions. The gapped areas were defined as sites that required additional ablation after the first-round ablation of PVI.

Results
[Study1] The omnipolar voltages were higher than the bipolar voltages (total 238 sites, 2.84±2.05 vs. 2.67±1.81 mV, P&lt;0.0001) in the entire left atrium. There was no feature in the difference between the omnipolar voltage and the bipolar voltage, according to the site and the voltage height (Figure). [Study2] Five gaps (14 ablation points) were confirmed after the first round of LSI-guided PVI (LSI 4.5±0.4, minimum 3.8 - maximum 5.8) in 4 of 12 patients. The omnipolar voltage in the gapped areas was higher than the non-gapped areas (544 ablation points) (5.64±1.93 vs. 3.73±2.82mV, P=0.0118, cut-off value 3.56mV, the area under the curve 0.74678). Meanwhile, there was no difference between the gapped and non-gapped areas in LSI and the conventional bipolar voltage.

Conclusion
Although the omnipolar voltage obtained by OT is detected only slightly higher than the bipolar potential, the higher omnipolar voltage could be an indicator of additional ablation to the LSI.
The application of 4S atrial fibrillation scheme in predicting atrial arrhythmia recurrence after catheter ablation
Authors: Kuo L , Chao T F , Chang S L , Lin Y J , Chung F P , Lo L W , Hu Y F , Duan T C , Liao J N , Chang T Y , Lin C Y , Liu C M , Liu S H , Wu C I , Chen S A 
Published: November 2023

Abstract

Background
Atrial fibrillation (AF) is the most common chronic cardiac arrhythmia. Recently, there is a new scoring system - 4S (Stroke Risk; Symptoms; Severity of Burden; Substrate), proposed in 2020 European Society of Cardiology AF guideline to identify the characteristics of AF patients in details and provide precise guidance for the AF management.

Purpose
We aimed to report the disease severity of AF patients who received first time catheter ablation (CA) using 4S-AF scoring system, and further discover the value of 4S-AF scheme in the prediction of atrial arrhythmia recurrence after CA.

Methods
We conducted a retrospective study of 350 AF patients between 2015 and 2017 referred for first time CA. The components of 4S-AF scheme including the following: (1) ischemic stroke risk (score 0 or 1), (2) symptoms (score 0 to 2), (3) severity of AF burden (score 0 to 2), (4) substrate (cardiovascular risk factors-score 0 to 2; left atrial enlargement-score 0 to 2). The 4S-AF score ranges from 0 to 9, and the study population was stratified into three groups as mild (score 0 to 2), moderate (score 3 to 4) and severe (score 5 to 9) disease. The 3-year risk of recurrence of atrial arrhythmias was studied using the Cox regression analysis. Atrial arrhythmias at follow-up were reported with a time-to-event analysis, and survival curves were created utilizing the Kaplan–Meier method with differences between groups compared with the log-rank test.

Results
The mean age of patients was 56 ± 11 years, 260 (74%) were men, and 82 (23%) had non-paroxysmal AF. Over the 3-year follow-up, 168 (47%) patients experienced recurrence. The recurrence rates were 32%, 47% and 62% for mild, moderate, and severe disease groups, respectively (Figure A). Non-paroxysmal AF (hazard ratios [HR]: 2.1, 95% confidence interval [CI]:1.5-2.9, p&lt;0.001), larger left atrial dimensions (HR: 1.0, 95% CI:1.0-1.1, p=0.03) and a higher 4S-AF score (HR: 1.2, 95% CI:1.1-1.3, p=0.001) were significantly associated with a higher risk of recurrence of atrial arrhythmia. After the multivariate adjustment, a higher 4S-AF score (HR: 1.1, 95% CI:1.0-1.2, p=0.006) remained as the independent predictor of recurrence. The recurrence-free survival curves after CA are shown in Figure B. The severe disease group was associated with a 1.9-fold higher risk of atrial arrhythmia recurrence compared to mild disease group (HR 1.9, 95% CI:1.3-2.9, p =0.002).

Conclusions
The disease severity of AF patients characterized using 4S-AF scheme could predict the risk of atrial arrhythmia recurrence after CA.
Atrial fibrillation catheter ablation: electroporation against high-power short duration radiofrequency
Authors: Reis Santos R , Matos D , Gomes D , Paiva M S , Rodrigues G , Carmo J , Costa F M , Santos P G , Carmo P , Morgado F , Cavaco D , Mendes M , Adragao P 
Published: November 2023

Abstract

Background
Pulmonary vein isolation (PVI) is one of the cornerstones of rhythm-control therapy for symptomatic atrial fibrillation (AF) patients. The new ablation technologies of pulse field ablation (PFA) and high-power short-duration radiofrequency ablation (HPSD) with the new QDOT® catheter have been recently introduced in the EP lab.

Aims
To evaluate and compare the efficacy, and safety of single-shot PFA and HPSDRA for PVI in AF symptomatic patients.

Methods
Single centre, retrospective study of consecutive patients undergoing PVI with PFA or HPSD between May-December 2022. Data on demographic, procedural and clinical/ electrocardiographic recurrence (assessed after a 3-months blanking period) were analysed. Comparative analysis between both techniques was performed.

Results
One hundred and ten consecutive patients were included (63 ± 11 years, 75% men), with a mean CHA2DS2-VASc score of 2±1 points, median LVEF of 61% [IQR 57-62%] and a median left atrial volume index (by CT scan) of 56 mL/m2 [IQR 51-67 mL/m2]. 55% patients presented paroxysmal-AF and 19 patients (17%) performed a redo ablation. 47% (n=52) patients performed HPSD and 53% (n=58) PFA (all with CARTO®3D system v.7 and high-density mapping). In the HPSD: median RF ablation time was 792 sec [IQR 614-919sec], while in PFA was 90 sec [IQR 30-138 sec]. Median time of catheter inside the LA for PFA was 18 min [IQR 2-33 min]. Comparing HPSD and PFA (Fig 1): median procedure time was similar (91 min [IQR 71-107 min] vs 89 min [IQR 66-111 min], p=0.261), while median fluoroscopy time was lower with HPSD (5.4 min [IQR 3.1-6.8 min] vs 13.2 min [IQR 10.3-15.6 min], p&lt;0.001); posterior wall isolation (PWI) was performed in 5 (10%) HPSD vs 21 (37%) PFA patients (p&lt;0.001). All PFA patients undergoing PWI had first pass isolation, while only 40% of HPSD had first pass isolation. When performed PVI only, PFA presents a lower median procedure time than HPSD (76 min [IQR 62-93 min] vs 97 min [IQR 69-135 min], p=0.048). There was only one major complication, a cardiac tamponade with PFA, treated with pericardiocentesis. At 3 months of follow-up, 17% (n=10) patients had clinical or electrocardiographic AF recurrence: 7 PFA patients and 3 HPSD patients (p=0.127).

Conclusions
PFA and HPSD were both feasible and safe. When undergoing PVI-only, procedure time was lower with PFA. In patients undergoing PWI, PFA achieved higher first pass isolation. Although still in its early real-world evaluation, both techniques seem to be efficient, providing low AF recurrence during follow-up.
Conduction time around the mitral valve annulus could predict the incidence of peri-mitral atrial tachycardia
Authors: Hara S , Miwa N , Hirano H , Nakata T , Doi J , Sato Y , Kusa S , Hachiya H 
Published: November 2023

Abstract

Background
Empirical ablation for mitral isthmus (MI) for AF patient is sometimes challenging for its complex anatomy and wall thickness. It would be helpful in determining the ablation strategies if it could be predicted in advance that peri-mitral atrial tachycardia (PMAT) would occur. Using 3D mapping, a method to confirm MI block has been reported using E-PMCT (estimated peri-mitral conduction time: the doubling the time between coronary sinus (CS) pacing and the wave-front collision at the opposite side of the mitral annulus).

Purpose
We investigated whether E-PMCT correlated with cycle length of PMAT and was involved in the establishment of PMAT.

Methods
We retrospectively investigated the AF patients who were created the LA map during CS pacing with multipolar mapping catheter which could measure E-PMCT after pulmonary vein isolation. Amon these cases, 1) PMAT was observed spontaneously or induced (PMAT group, N=25, 68.6±10.9 years old, male 15) and none of the AT occurred by the provocation test and during follow up (no-AT group, N=53, 65.2 years old , male 38) were analyzed. In these group, we evaluated the relationships between E-PMCT and tachycardia circuit of PMAT.

Results
E-PMCT was significantly longer in PMAT group than non-AT group(216.5±30ms vs 166.7ms, p&lt;0.005). Strong positive correlation was observed between cycle length of PMAT and E-PMCT (Person’s r=0.85, p&lt;0.001). PMAT was non induced in patients with E-PMCT less than 176ms. According to the ROC curve, AUC for the detection of the non-AT group was 0.908 (95% CI 0.843-0.974, sensitivity 91.7%, specificity 81.1%) with the cut off value E-PMCT less than 180ms. The slow conduction during CS pacing were consistent with slow conduction during PMAT in this study. Although left atrial diameter, ejection faction, type of AF(paroxysmal or not), low voltage area in the left atrium and mitral annulus size in 3D mapping system was also different between PMAT group and non-AT group in the univariate analysis, E-PMAT was strongest predicter of occurrence of PMAT in multivariate analysis.

Conclusion
E-PMCT obtained after PVI could predict the non-inducibility of PMAT and was helpful to decision making for ablation strategy.