bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improvement in post-ablation chest pain and same-day discharge with the use of active esophageal cooling
Authors: Cooper J , Joseph C , Turer R , Mcdonald S , Kulstad E , Daniels J 
Published: November 2023

Abstract

Background
Active esophageal cooling is a common method of esophageal protection during radiofrequency (RF) ablation for the treatment of atrial fibrillation (AF). Compared to the main alternative, luminal esophageal temperature (LET) monitoring, active esophageal cooling reduces esophageal injury. Recent findings in the community hospital setting indicate that procedure time and post-ablation chest pain may also be reduced, leading to greater same-day patient discharge.

Objective
We aimed to compare the differences in same-day discharge rates and patient-reported post-ablation chest pain between patients treated with either LET monitoring or active esophageal cooling while undergoing RF ablation in a large academic medical center.

Methods
We reviewed data from RF ablations performed between January 2020 and October 2022 by five attending electrophysiologists and four electrophysiology fellows. These data were extracted from Epic’s Clarity database by two clinical informaticists. Extracted data points were paired with a manual chart review of inbound phone calls, electronic messages, follow-up visits, and readmissions within 30 days of the procedure.

Results
A total of 175 patients underwent RF ablation between January 2020 and October 2022, with 63 (36%) patients treated with LET monitoring and 112 (64%) treated with active esophageal cooling. Chest pain was reported by 11 patients (18%) in the LET monitored group and 7 patients (6%) in the actively cooled group (P=&lt;0.001). Of the patients treated with LET monitoring, 13 (20.6%) were discharged within 12 hours of admission compared to 44 (39.3%) of the patients treated with active esophageal cooling (P=0.016).

Conclusions
The adoption of active esophageal cooling during RF ablation was associated with less postoperative chest pain and increased same-day discharge rates.
Catheter ablation in general anesthesia reduces atrial fibrillation recurrence regardless of atrial fibrillation type
Authors: Riis-Vestergaard L 
Published: November 2023

Abstract

Background
Treatment with catheter ablation (CA) as rhythm control is increasingly used in atrial fibrillation (AF). Short-term AF recurrence after first-time CA varies from 10-30% in paroxysmal AF (PAF) and up to 50% in persistent AF (PeAF). Strategies to optimize outcome is still an ongoing challenge. Whether the sedation strategy, conscious sedation (CS) or general anesthesia (GA), has any impact on AF recurrence has yet to be determined. Currently no guidelines are available regarding sedation strategy.

Objective
To investigate the impact of sedation strategy in CA for PAF and PeAF on AF recurrence.

Method
This nationwide retrospective registry study was conducted using large real-life data from Danish mandatory registries. All patients above 18 years, that underwent CA for AF from January 1st 2010 to December 31st 2018, were identified and included at the date of ablation. Exposure of interest was type of anesthesia, and patients were stratified into CS or GA. Primary endpoint was recurrent AF after a 3-months blanking period, defined by a composite endpoint of first-reached endpoint of either use of antiarrhythmic drugs (AAD), AF-admission, electrical cardioversions or AF re-ablation.
5-year risk of recurrent AF was examined by the Aalen-Johansen estimator, taking the competing risk of death into account. Subgroup analysis of PAF and PeAF was performed.

Results
The study cohort consisted of 6,423 patients with first-time CA. 3,958 patients with PAF and 2,465 patients with PeAF. 5,058 patients underwent the procedure in CS, and 1,365 in GA.
5-year cumulative incidence of recurrent AF was higher in the CS group for both PAF and PeAF with 49,3% and 58,9% respectively, compared to 39,0% for PAF and 46,2% for PeAF in the GA group (Figure 1).
A total of 3,242 patients reached the primary endpoint. Admissions for AF was the predominant endpoint for both CS and GA (1323, 42,0%). When subdivided into PAF and PeAF, admission for AF was still the predominant endpoint (Table 1).

Conclusion
Reduction of AF recurrence after CA is a continuing challenge. This study shows that the sedation strategy is important, and that the risk of recurrence is significantly lower for CA performed in GA. Subgroup analysis of PAF and PeAF, shows that regardless of AF type, recurrence rates are significantly lower in the GA group.Figure 1Table 1
Population rates and contemporary outcomes of atrial fibrillation ablation among older adults: a nationwide cohort study
Authors: Ferro E G , Reynolds M R , Xu J , Song Y , Cohen D J , D'avila A , Zimetbaum P J , Yeh R W , Kramer D B 
Published: November 2023

Abstract

Background
Atrial fibrillation (AF) is the most common sustained arrhythmia, with pulmonary vein isolation (PVI) increasingly recommended as first-line therapy. Limited data suggest increasing use of PVI as well as increasing rates of post-PVI complications, but contemporary real-world outcomes among older adults remain unclear.

Purpose
To evaluate patient characteristics, population rates and 30-day clinical outcomes for PVI in a nationwide sample of adults aged &gt;65 in the United States.

Methods
First-time PVIs were identified among US Medicare fee-for-service beneficiaries using CPT procedural codes, and comorbidities were ascertained using ICD-10 diagnosis codes associated with each procedural claim. Study outcomes included rates of PVI use, procedural complications, all-cause re-hospitalizations, and all-cause mortality at 30 days.

Results
From January 2017 through December 2020, 156,601 patients underwent first-time PVI performed by 2,791 unique operators. The mean patient age was 72.5 ± 5.2 years, 42.6% were female and the majority (92.7%) Caucasian. The rate of PVI increased from 2.48 per 100,000 beneficiaries in the first quarter of 2017 (performed by 2,113 operators) to 3.01 per 100,000 beneficiaries in the last quarter of 2020 (performed by 2,415 operators) – a 4.8% relative increase per year (p=0.02). This growth was driven primarily by outpatient elective procedures, which represented the majority (85.0%) of all PVIs. Concurrent with this increase in PVI use, there was a significant decrease in complication rates (3.9% in 2017 vs 3.1% in 2020, p&lt;.0001) and re-hospitalizations (8.8% vs 7.1%, p&lt;0.001) at 30 days, with no significant change in mortality at 30 days (0.36% vs 0.40%, p=0.38). Bleeding was the most common peri-procedural complication (1.4%), followed by pericardial effusion requiring intervention (1.2%) and access site vascular complications (0.55%).

Conclusions
This large nationwide cohort study shows that the use of PVI has steadily increased in contemporary clinical practice. Despite the widespread adoption of this procedure by a growing number of operators, cumulative complication and re-hospitalization rates at 30 days have decreased over time, with stable and very low rates of short-term mortality – even among older patients, who are ordinarily considered to be at higher risk. These findings contrast with those from previously published studies of non-representative cohorts. Results from our study should reassure both patients and providers on the overall safety of PVI as an increasingly common first-line procedure for rhythm control. Forthcoming analyses will be finalized by the time of presentation to evaluate whether hospital and operator volume further influence procedural outcomes.Central Figure: PVI Trends and Outcomes
Permanent pacemaker implantations among patients with spinal cord injury in the United States
Authors: Margolis G , Kobo O , Kazatsker M , Roguin A , Shapira A , Behrbalk E , Leshem E 
Published: November 2023

Abstract

Background
Acute spinal cord injury (SCI) is associated with severe cardiovascular complications. Information regarding the need for permanent cardiac pacing in SCI patients is scarce and based on case reports and small case series. We aimed to investigate the extent of permanent pacemaker (PPM) implantation procedures as well as to identify predictors for PPM insertion among SCI patients in a U.S contemporary, nationwide, all-comer registry.

Methods
Using the National Inpatient Sample (NIS) database, patients hospitalized with a primary diagnosis of SCI in the US between 2016-2019 and underwent PPM implantation were identified. Patients with cardiac implantable electronic device in-situ were excluded. Baseline demographics, clinical characteristics, injury type, in-hospital procedures and outcomes including time to PPM implantation, length of stay and mortality were collected. Outcome analysis performed after propensity score matching (PSM). Predictors of PPM implantation were identified via a multivariable logistic regression model.

Results
A total of 35880 patients, were hospitalized with a primary diagnosis of SCI during the study period, and 240 (0.7%) received a PPM. Median age of patients receiving PPM was 69 years, 75% were males, and 67% had high level SCI injury (level C1-5). Time to PPM implantation was 9 days (IQR 4-19). PPM implantation was associated with higher rates of cervical spine injuries, traumatic brain injury (TBI), chest and upper limbs injuries, respiratory failure and other signs of severe illness. Longer hospital stay and higher in-hospital mortality rate was observed in patients receiving a PPM.
Multivariate analysis identified the following independent risk factors for PPM implantation: cervical SCI [OR 77.07 (11.13-553.42), p&lt;0.001], TBI [OR 3.84(1.59-9.28), p=0.003] and tracheostomy/respiratory ventilation&gt; 96 h [OR 31.766(7.91-127.54), p=&lt;0.001].

Conclusion
Cervical SCI, need for tracheostomy and prolonged mechanical ventilation were the strongest predictors for PPM implantation in patients hospitalized for SCI in a nationwide registry.
Lower risk of atrial fibrillation development associated with SGLT-2 inhibitors in type 2 diabetic patients compared to DPP-4 inhibitors: a nationwide cohort study
Authors: Lee J , Kim M , Bae J W , Cho M C 
Published: November 2023

Abstract

Background
Accumulating evidence shows that sodium-glucose co-transporter-2 (SGLT-2) inhibitors reduce cardiovascular outcomes. However, this favorable effect is unclear for newly atrial fibrillation (AF) development compared to other anti-diabetic drugs.

Purpose
We investigated the association of SGLT-2 inhibitor for newly AF development compared to dipeptidyl peptidase-4 (DPP-4) inhibitors in patients with type 2 diabetes.

Methods
Using the Korean National Health Insurance Service database, among 2,160,911 type 2 diabetes patients (age ≥20 years) between 1 May 2016 and 31 December 2018, we studied 42,806 patients with SGLT-2 inhibitors and 448,715 patients with DPP-4 inhibitors who had not prior AF diagnosis. Propensity score-matching (1:1 ratio) was used to correct for differences between the groups.

Results
During a median follow-up of 1.3 years, after propensity score matching, compared with patients with DPP-4 inhibitors (n=42,786), patients with SGLT-2 inhibitors (n=42,786) have shown lower incidence and risk of AF (2.7 and 3.3 per 1000 person-years; hazard ratio 0.73, 95% confidence interval 0.55-0.97; p=0.028) aand an absolute rate difference of −0.7 [95% confidence interval (CI) −1.3 to −0.1, p=0.034] per 1000 person-years by on-treatment analysis. In intention-to-treat analysis, these results were consistent (2.6 and 3.2 per 1000 person-years; hazard ratio 0.83, 95% confidence interval 0.66-1.03; p=0.092) with an absolute rate difference of −0.5 [95% confidence interval (CI) −1.2 to −0.1, p=0.093] per 1000 person-years . In subgroup analysis, SGLT-2 inhibitors were associated with lower risks of AF in heart failure compared to their counterparts in intention-to-treat analysis (p for interaction=0.036).

Conclusion
Based on this nationwide cohort of type 2 diabetes patients treated with SGLT-2 inhibitors or DPP-4 inhibitors, SGLT-2 inhibitors were associated with protection against newly AF development after adjusting for clinical confounders.Incidence rates and adjusted HR
Biomarker BMP10 profiles suggest an association of female and age with atrial endomysial fibrosis: Results from the ISOLATION AF ablation registry
Authors: Habibi Z , Verhaert D V M , Hermans B J M , Philippens S , Westra S W , Chaldoupi S M , Maesen B A E , Isaacs A J , Zeemering S , Linz D , Vernooy K , Schotten U 
Published: November 2023

Abstract

Background/Introduction
Atrial fibrillation has a complex pathophysiology such as inflammation, myocyte injury, collagen and lipid infiltration. Different biomarkers reflect these pathophysiological pathways. The biomarker Bone Morphogenetic Protein 10 (BMP10) is a secreted protein, expressed by myocytes, and is required for myocyte growth and development. BMP10 is associated with PITX2 and endomysial fibrosis. We recently demonstrated that BMP10 is independently associated with left atrial andomysial fibrosis.

Purpose
To analyze the correlation between the blood-based biomarker BMP10 with sex and age in patients with atrial fibrillation.

Methods
A cross-sectional analysis was conducted of atrial fibrillation patients scheduled for catheter ablation included from July 2020 through May 2022 in the prospective multicenter ISOLATION cohort study (NCT04342312). Clinical characteristics and routine tests were collected before ablation. Blood samples were taken before ablation and were analyzed for BMP10 among other known and novel cardiovascular biomarkers.
We investigated the correlation between BMP10 and age in a univariate analysis and in a multivariate analysis including differences in clinical traits. In addition, we investigated the difference in BMP10 levels between males and females.

Results
Blood samples from 509 patients were analyzed. Their mean age was 64±9 years, and 31.2% were female. 352 patients (69.2%) had paroxysmal AF and 152 patients (29.9%) had persistent AF. Heart failure was reported in 77 patients (15%). 357 (70%) patients were in sinus rhythm at the time the blood was drawn (table 1).
Univariate analysis showed that BMP10 levels increased with age (figure 1). After adjusting for sex, type of AF, heart failure and rhythm at blood drawing, BMP10 remained higher in older patients (Beta coefficient 0.77, standard error 0.14, p-value &lt;0.001). In addition, univariate analysis showed that BMP10 was significantly higher in women than in men (2.16 ng/L versus 1.95 ng/l, P&lt; 0.001). After adjusting for age, BMP10 remained higher in women than in men.

Conclusion
Elevated BMP10 levels suggest that in older patients possibly more atrial fibrosis is present and thus more substrate for AF. In addition, the different biomarker profile suggests that AF in women may more often be associated with atrial fibroses than in men.
Invasively diagnosed HFpEF in AF associated with functional remodelling of the left atrial appendage: implications for stroke risk
Authors: Ariyaratnam J , Mishima R S , Kadhim K , Emami M , Gallagher C , Lau D H , Sanders P , Elliott A D 
Published: November 2023

Abstract

Background
HFpEF commonly coexists with atrial fibrillation (AF). The influence of coexisting HFpEF on function of the left atrial appendage (LAA) and risk of stroke remains unknown.

Objective
To use invasive hemodynamic assessment and multi-modality imaging to evaluate the influence of underlying HFpEF on LAA function in patients with symptomatic AF.

Methods
Patients with AF and preserved ejection fraction undergoing AF ablation were prospectively recruited. All participants underwent invasive diagnosis of HFpEF using established hemodynamic criteria. Participants were classified as ‘HFpEF’ when mean left atrial pressure (mLAP) was &gt;15mmHg and ‘early HFpEF’ when mLAP rose to above 15mmHG after infusion of 500mls saline. For LAA assessment, participants underwent 1) contrast-enhanced cardiac CT to evaluate LAA volume, 2) transesophageal echocardiography to investigate emptying velocities (LAAEV), filling velocities (LAAFV) and LAA ejection fraction (LAAEF) and 3) high-density electroanatomic mapping to assess LAA bipolar voltages.

Results
Of 115 participants recruited, 55 had ‘HFpEF’, whilst 29 had ‘early HFpEF’ and 31 had ‘no HFpEF’. Table 1 demonstrates the baseline characteristics and LAA structural and functional parameters across the three groups. The HFpEF group was characterized by higher BMI (p=0.008) and higher prevalence of hypertension (p=0.023) but there was no significant difference in age (p=0.194) or gender (p=0.376). LAA volume was not significantly different across the three groups (p=0.509). However, the HFpEF group demonstrated reduced LAAEV (p=0.021) and LAAFV (p=0.015) compared to early HFpEF and no HFpEF. HFpEF was also associated with reduced LAAEF (p=0.015) and reduced LAA bipolar voltages in sinus rhythm (p=0.028) compared to no HFpEF. In a multivariable analysis HFpEF group was the only independent predictor of reduced LAAEV (p=0.015).

Conclusions
Invasively diagnosed HFpEF in AF is common and associated with significantly reduced LAA function. The coexistence of HFpEF may therefore be a determinant of future stroke risk in patients with AF.
Oral anticoagulant use and outcomes in Asian patients with atrial fibrillation in the GLORIA-AF Registry
Authors: Romiti G F , Corica B , Proietti M , Mei D A , Frydenlund J , Bisson A , Boriani G , Olshansky B , Chan Y H , Huisman M V , Chao T F , Lip G Y H 
Published: November 2023

Abstract

Background
Ethnic differences in the management and outcomes of patients with atrial fibrillation (AF) have been shown in previous studies, but available data is still limited, although urgently needed.

Purpose
to analyse oral anticoagulant (OAC) prescription, OAC discontinuation, and long-term risk of major outcomes in Asian patients with AF, using data from a global prospective cohort study.

Methods
Using data from the GLORIA-AF Registry Phase II and III, we analysed patients according to their self-reported ethnicity (Asian vs. Non-Asian), and according to Asian ethnic subgroup (i.e. Chinese, Japanese, Korean and other Asian). Odds of OAC prescription were analysed through multivariable logistic regression, while the risk of OAC discontinuation and adverse outcomes were analysed through multivariable Cox-regression model. Primary outcome of this analysis was defined as the composite of all-cause death and major adverse cardiovascular events (MACE).

Results
34,421 AF patients were included (70.0±10.5 years, 45.1% females, 6,900 (20.0%) Asian). Compared to Non-Asian subjects, prescription of OAC and non-vitamin K antagonist oral anticoagulant (NOAC) was lower in Asian subjects (Odds Ratio [OR] and 95% Confidence Intervals (CI): 0.23 [0.22-0.25] and 0.66 [0.61-0.71], respectively; Figure 1), but higher in the Japanese subgroup. Asian ethnicity was also associated with OAC discontinuation (Hazard Ratio [HR] and [95%CI]: 1.79 [1.67-1.92]), and lower risk of the primary composite outcome (HR [95%CI]: 0.86 [0.76-0.96]; Figure 2). Among the secondary outcomes, Asian patients had also higher risk of thromboembolism and intracranial haemorrhage, and lower risk of major bleeding events.

Conclusions
In this large, contemporary cohort of patients with AF, Asian subjects received suboptimal management of thromboembolic risk, and showed a peculiar long-term risk of adverse outcomes. Integrated and appropriate treatment of these patients is crucial to improve their prognosis.Figure 1Figure 2
The current and future total health care costs of atrial fibrillation
Authors: Sandhu R , Qureshi H , Dover D , Hawkins M N , Kaul P 
Published: November 2023

Abstract

Background
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice, yet detailed information on the cost burden remains sparse. These data are essential for determining resource allocation, benchmarking care, identifying areas for more efficient healthcare delivery and to measure effects of alternative treatment strategies.

Purpose
We sought to examine costs for inpatient, ambulatory, physician, and drugs for AF and model future costs.

Methods
In this retrospective population-based cohort study, we used linked administrative databases to identify all adult patients presenting to any healthcare setting with nonvalvular AF (NVAF) as the most responsible diagnosis in our city, Canada, from fiscal years 2010-2018.
Costs for inpatient, ambulatory, physician, and drugs were estimated, in 2019 Canadian dollars, by using Statistics Canada Consumer Price Index. A two-part cost model with logit and gamma generalized linear model was developed to predict costs from 2019 to 2030.

Results
There were 48,854 NVAF patients. The median age was 70 [59.0,80.0] years, 55% were male, and median CHADS-Vasc score = 3.0 [1.0,4.0]. NVAF-related costs were $1.4 billion dollars (inpatient $1.1 billion, ambulatory $107.0 million, physician $59.6 million, drugs $140.1 million) and represented 36.8% of total costs (Figure 1). The per patient cost of NVAF was $30.1 thousand. Over the study period, costs increased by 2.2% for inpatient, 40.5% for ambulatory, 67.1% for physician, and 214.2% for drugs. By 2030, we estimate there will be 54,523 NVAF patients. NVAF-related costs from 2019 to 2030 are estimated to be $3.6 billion (inpatient $2.5 billion, ambulatory $310.5.0 million, physician $197.5 million, drugs $610.4 million) and will represent 32.1% of total costs (Figure 1).

Conclusions
Costs for AF are on the rise and the distribution of costs are changing. Although inpatient costs represent the highest proportion of total AF costs, they are projected to decrease while costs due to ambulatory, physician and drug costs are increasing.