bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ranolazine is associated with a reduced incidence of atrial fibrillation in patients with chronic coronary syndrome: the results of a real-world analysis of an Italian population
Authors: Fumagalli S , Dovizio M , Mazzoni S , Franci Montorzi R , Santamaria E , Fumagalli C , Degli Esposti L , Marchionni N 
Published: November 2023

Abstract

Background
Ranolazine (Ran) is an anti-anginal drug acting as a late sodium current inhibitor at a cell membrane level. This mechanism of action could be implicated in the control of arrhythmia development. Indeed, some evidence supports the efficacy of Ran as an anti-arrhythmic agent, with a synergistic effect with that of Class III agents, namely amiodarone and dronedarone.

Aims
Aim of this study was to evaluate if the use of Ran in patients with chronic coronary syndrome (CCS) in comparison with other treatments (No-Ran), was associated with a lower incidence of atrial fibrillation (AF) in a real-world clinical setting in Italy.

Methods
Patients included in the database of the National Health System were evaluated (N=6.1 million); the recorded information concerned hospitalizations with the related diseases, clinical events, visits and drug therapy. Patients hospitalized for any cause and discharged with a diagnosis of angina between 2011 and 2020 (ICD-9-CM codes: 413-414) were included in the study provided they had not experienced an AF episode in the 12 preceding months (characterization period). Study population was divided into the Ran (at least one drug prescription) and in the No-Ran cohorts. The mean follow up was 4.3 years for the Ran and 5.0 years for the No-Ran cohorts, respectively.

Results
The study population included N=171,015 patients (mean age: 72 years, men: 66%). Among them, N=148,808 (No-Ran cohort) were treated with other therapies while N=22,207 (Ran cohort) received Ran. After propensity score matching, Ran (N=6,384) and No-Ran (N=25,536) cohorts did not differ for age, Charlson comorbidity index, use of aspirin, beta-blockers, Ca-antagonists and nitrates. The incidence of a new episode of AF during the follow-up period was 5.3% and 9.6% in the Ran and in the No-Ran cohorts, respectively (p&lt;0.001). The Cox-regression analysis showed that independently of age, male gender, heart and renal failure, COPD, use of beta-blockers, Ca-antagonists and nitrates, and of cardiovascular procedures, Ran therapy was associated with a 41% risk reduction to develop AF (HR=0.59, 95%CI: 0.53-0.67, p&lt;0.001).

Conclusions
Our real-world study, performed in a whole subset of the Italian population, showed that Ran use in a long-term follow-up was associated with a lower incidence of AF in patients with CCS.
Impact of diagnosis-to-ablation time on atrial fibrillation recurrence: most pronounced in the first 3 years after diagnosis and clinically irrelevant thereafter
Authors: De Greef Y , Bogaert K , Sofianos D , Buysschaert I 
Published: November 2023

Abstract

Objectives
To assess the impact of the diagnosis-to-ablation time (DAT) on AF recurrence in search of lower and upper DAT thresholds.

Background
DAT is a strong, modifiable predictor of atrial fibrillation (AF) recurrence after ablation. Whether this association holds any lower and/or upper limits is yet unknown.

Methods
A total of 2000 AF patients from two cohorts of 1000 consecutive patients each (69% males, age 62±10 years) undergoing pulmonary vein isolation (PVI) between 2005-2014 and 2017-2019 were followed for 3 years.

Results
Clinical success, defined as freedom of documented AF was achieved in 61.7% of the patients. Median DAT decreased over time from 36 (Q1-Q3: 12-72) months in the first cohort to 12 (Q1-Q3: 5-48) in the second (P&lt;0.001). A multivariable Cox proportional hazards fitted model of AF recurrence rate in relation to DAT (range 0-288 months) demonstrated a steep rise in AF recurrence from 27 to 40% in the first 36 months (d%/dt=0.36), with a first hinge point at 36 months and a less steep rise to 45% until 90 months (d%/dt=0.09), with flattening beyond 90 months (d%/dt=0.026).

Conclusions
The association between DAT and AF recurrence has no lower limit (‘the shorter the better’) while little gain is to be expected beyond a DAT of 36 months (‘the longer the more clinically irrelevant’). Our data advocate for a PVI as early as possible, certainly within 3 years of AF diagnosis.3-year AF recurrence rate versus DAT
Sex-based differences and outcomes in patients undergoing pulmonary vein isolation for atrial fibrillation
Authors: Aguiar Neves A , Sa Carvalho A , Diaz S , Ribeiro Silva M , Santos Silva G , Lopes Fernandes S , Almeida J , Fonseca P , Oliveira M , Goncalves H , Saraiva F , Barros A , Sampaio F , Primo J , Fontes Carvalho R 
Published: November 2023

Abstract

Introduction
Some studies have suggested that the risk of atrial fibrillation (AF) recurrence after catheter ablation (CA) is greater in women than in men, which suggests that sex may be an independent risk factor for AF recurrence. However, the impact of gender on time to AF recurrence after CA is unknown.

Methods
Retrospective, single-centre study including all patients who underwent a first AF ablation procedure between 2017 and 2021. Late recurrence (LR) was defined as any AF recurrence at least 90 days after ablation, while early recurrence (ER) occurred &lt;90 days after ablation. The effect of sex on the cumulative freedom from LR was estimated using the Kaplan-Meier method and compared using the log-rank test and Cox proportional hazards model. In a subgroup of patients, cardiac adipose tissue was quantified using cardiac computerized tomography (CT) scans.

Results
656 patients were included, of whom 32% were women. Average follow-up after ablation was 26 months. In comparison to male patients, women undergoing CA were more likely to be older, have a higher body mass index and were more likely to have comorbid hypertension, thyroid dysfunction and valvular disease.
After model adjustment, women had a greater risk of LR (HR 1.78, 95% CI 1.20-2.62). A reanalysis was conducted using a time-split at one year of follow-up, which showed that risk of LR was greater in women more than 12 months after CA (HR 2.70, 95% CI 1.60-4.57), but not during the first year after CA (HR 1.22, 95% CI 0.74-2.02). Persistent AF was also an independent predictor of LR (HR 2.05, 95% CI 1.45-2.91). In a subgroup of patients who underwent cardiac adipose tissue analysis (n = 348; 37% women), increased epicardial and pericardial adipose tissue volume was associated with an increased risk of LR in univariate analysis, but not after co-variate adjustment.

Conclusions
Women are referred later and less frequently to CA than men. LR after CA is more frequent in women, particularly after one year. Epicardial adipose tissue volume was associated with LR in women, but this effect was not maintained after model adjustment. Further studies are needed to better understand the mechanisms responsible for the increase in LR in women undergoing pulmonary vein isolation.
Does energy matter when performing posterior wall isolation in addition to pulmonary vein isolation at atrial fibrillation ablation: a meta-analysis
Authors: Musat D , Milstein N S , Preminger M , Bhatt A , Habibi M , Sichrovsky T , Shaw R , Mittal S 
Published: November 2023

Abstract

Background
Pulmonary vein isolation (PVI) remains the cornerstone of atrial fibrillation (AF) ablation. Posterior wall isolation (PWI) has been proposed as an adjunct to PVI to improve outcomes. Small series have reported conflicting outcomes. We conducted a meta-analysis of available data to assess the incremental impact of PWI based on whether patients were ablated using a cryoballoon (CB) or radiofrequency (RF) energy.

Objective
To evaluate whether PVI + PWI ablation is a more effective approach for treatment of AF than PVI alone when comparing different ablation energies.

Methods
The online databases (Pubmed, Medline, Embase) were searched using the terms "pulmonary vein isolation", "posterior wall isolation", or "posterior wall ablation". Out of 1917 studies, 11 met our strict criteria (Table). Specifically, patients were undergoing de novo ablation for treatment of AF using either CB or RF energy. Patients had PVI +/- PWI; studies that included additional ablations (except for cavotricuspid isthmus ablation) were excluded. The primary outcome was long-term freedom from recurrence of any atrial tachyarrhythmia (AT).

Results
The cohort consisted of 1905 patients (65 ± 18 years, 74% male); 910 (48%) pts ablated with CB energy and 995 (52%) pts ablated with RF energy (Table). In the CB group, AT recurrence was significantly higher in patients who underwent PVI alone as compared to those who also had PWI (OR 2.47, 95% CI [1.85, 3.31], P &lt; 0.0001, Figure). In contrast, in the RF group, outcome was similar in patients who did and did not undergo PWI in addition to PVI (OR 1.22, 95% CI [0.80, 1.86], P = 0.36, Figure).

Conclusions
PWI in addition to PVI improved outcomes for patients ablated with CB energy. Conversely there was no benefit for patients in whom RF energy was used. Additional randomized studies are needed to determine the role of energy selection for patients undergoing PWI in conjunction with PVI for management of AF.
Clinical efficacy of catheter ablation versus medical rate control among patients with atrial fibrillation across heart failure phenotypes: a meta-analysis of randomized controlled trials
Authors: Dakay D , Junia A , Salces N 
Published: November 2023

Abstract

Background
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. It frequently co-exists with heart failure (HF) with complex dynamic interactions. Trials comparing rate and rhythm control strategies with the latter based on anti-arrhythmic drugs (AADs) failed to show benefit of one strategy over the other. Therefore, it is still unclear what constitutes an ideal AF management, especially in the context of HF.

Objective
To compare the clinical efficacy between catheter ablation and medical rate control among patients with atrial fibrillation and heart failure

Study Selection
Only randomized controlled trials (RCT) comparing catheter ablation and medical rate control in patients with atrial fibrillation and heart failure were selected for review.

Methods
Pubmed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) reporting clinical outcomes of catheter ablation versus medical rate control for AF in HF patients with &gt; 6 months follow-up. Primary endpoint was change in left ventricular ejection fraction (LVEF). Secondary endpoints were 6-minute walk test (6MWT) distance, quality of life (QoL), BNP levels, and number of adverse events.

Results
Five RCTs with 615 patients were included in the analysis. Patients in the catheter ablation had greater improvement in LVEF (WMD 7.38, 95%CI: p &lt; 0.001), longer 6-min walk distance (WMD 17.41, CI 95%: p &lt; 0.0001), lower Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores (WMD -6.21, CI 95%: p &lt; 0.00001), and lower BNP levels (WMD -113.1 ng/L, CI 95%: p &lt; 0.00001), compared with medical rate control. However, catheter ablation group had higher rates of adverse events mostly from procedural complications (RR 2.2, CI 95%: p = 0.005).

Conclusion
Catheter ablation is superior to medical rate control in terms of LVEF improvement, increase in functional status, reduction in biomarker, and better quality of life among patients with AF and HF.
Results of simultaneous cryoablation of pulmonary veins and left atrium posterior wall in patients with persistent atrial fibrillation
Authors: Baimbetov A , Jukenova A , Bozshagulov T , Bigeldiyev N , Tursunkhanov Z H , Yakupova I 
Published: November 2023

Abstract

Background
Recent studies suggest a clinical benefit associated with posterior wall isolation as an adjunct to the pulmonary vein (PV) isolation in patients with persistent atrial fibrillation (AF). However, data on the safety and efficacy of this cryoballoon ablation approach are limited.
The study aimed to compare the efficacy and safety of catheter treatment of patients with persistent atrial fibrillation using cryoballoon "single shot" technology in two randomized groups.

Materials and methods
Traditional PV cryoballoon isolation was performed in two groups of patients with persistent AF. In the first group of patients (n = 35) underwent only PV cryoballoon isolation. In the second group of patients (n = 33), cryoballoon isolation of the PV and cryoablation of the posterior wall of the left atrium (LA) was performed. Patients after ablation were followed up for 15.6 (2.7–3.5) months for AF recurrence, functional class, and echocardiographic parameters.

Results
The study included 68 patients with persistent AF in the last six months before inclusion, for whom at least two antiarrhythmic drugs of class I-III were ineffective. By random distribution, 35 patients were included in group 1 - (PVI), and they underwent only PV cryoballoon isolation. Group 2 - (PVI+PWA) included 33 patients who underwent PV cryoballoon isolation and additional LA posterior wall cryoablation. The primary efficacy endpoint occurred in 11 patients in group 1 and 6 patients in group 2 (Kaplan-Meier survival, 31.4% and 18.2%, respectively; hazard ratio, 0.96; 95% confidence interval. Undesirable events occurred in 3.8% of each group (p = 1.00). On multivariate analysis, posterior wall ablation and PV isolation using a cryoballoon (PVI+PWA) was an independent predictor of freedom from recurrent atrial fibrillation (odds ratio: 3.57; 95% confidence interval: 1, 39–8.93, p = 0.007).

Conclusions
In patients with persistent AF, posterior wall ablation and PV isolation using a cryoballoon significantly reduce arrhythmia recurrence. Nevertheless, safety is similar compared to patients with only PV isolation.
Temporal trends in the utilization, referral patterns, and complications of catheter ablation for atrial fibrillation in the Netherlands, 2013-2021
Authors: Samuel M , Van Der Stoel M , Blaauw Y 
Published: November 2023

Abstract

Background
Over the past decade, atrial fibrillation (AF) ablation technologies have evolved, operator experience has improved, and indications for referral to AF ablation has expanded. A recent population-level assessment is warranted to assess the impact of these changes on trends in the utilization, referrals, and adverse events (AEs) of AF ablation.

Purpose
Our aim was to describe temporal trends in the population-level incidence, patients referred, and AEs of AF ablation in the Netherlands from 2013 to 2021.

Methods
Temporal trend analyses were conducted using the AF ablation population in the Netherlands Heart Registration and included all consecutive patients treated with catheter ablation for AF between 2013 and 2021 at 16 hospitals in the Netherlands. Annual crude, sex- and age-standardized incidence rates of AF ablation were calculated. Poisson regression models with robust variances were used to evaluate trends in the incidence of AF ablation. Trends in patient characteristics, AEs, and repeat ablations over the study period were evaluated with ANOVA tests.

Results
Between 2013 and 2021, 37,538 AF ablations were performed in the Netherlands, of which 27,027 (72.0%) were index ablations. Repeat ablations (10,511 procedures) were performed within a median time to repeat ablation of 1 (IQR 1-2) year. AF ablation patients were a median age 63 (IQR 56-69) years, 32.8% women, 70.7% had paroxysmal AF, and median CHA2DS2-VASC score was 1 (IQR 1-2). Most patients underwent radiofrequency ablation (55.4%), followed by cryoballoon (33.4%), PVAC (0.6%), pulse-field (0.3%), laser balloon ablation (0.1%), and other (0.1%) (10.1% missing). Over the 9-year period, there was a statistically significant increase in index [incidence rate ratio (IRR) 1.07 (95% CI 1.05-1.08)] and repeat [IRR 1.09 (95% CI 1.05-1.12)] ablations from 2013 to 2021 (Figure 1). The annual sex-standardized incidence rates of AF ablations were approximately double for men compared to women throughout follow-up (Figure 2). In recent years, AF ablation patients had more persistent AF, higher CHA2DS2-VASC scores, and lower LVEF (p&lt;0.05 for all). Minor vascular AEs within 30 days were the most frequent AE of AF ablation (1.1%), followed by phrenic nerve paralysis (0.6%), in-hospital bleeding (0.6%), cardiac tamponade (0.5%), thrombosis (0.3%), major vascular AEs (0.2%) and all-cause mortality (0.1%). Incidence of most AEs remained stable over time (p&gt;0.05 for all).

CONCLUSION
In the Netherlands, the utilization of AF ablation increased by 7% from 2013 to 2021. In recent years, populations referred for AF ablation were increasingly older, had more persistent AF, higher CHA2DS2-VASC scores, and lower LVEF; however, men remained twice as likely to undergo AF ablation compared to women. Reasons for the lower rate of AF ablation among women requires further investigation.
External validation of the Antwerp score: a novel score for predicting responders to catheter ablation of atrial fibrillation in patients with depressed left ventricular function
Authors: Serban T , Du Fay De Lavallaz J , Barker C D , Knecht S , Strebel I , Krisai P , Voellmin G , Osswald S , Sticherling C , Kuehne M , Badertscher P 
Published: November 2023

Abstract

Introduction
Little exists to identify patients with heart failure (HF) and atrial fibrillation (AF), who will benefit from pulmonary vein isolation (PVI). The Antwerp score was proposed as a new prediction model to identify patients with recovery left ventricular ejection fraction (LVEF) after PVI for AF.

Purpose
To externally validate the Antwerp score in a large cohort of patients undergoing PVI.

Methods
Patients with reduced LVEF (&lt; 50%) scheduled to undergo PVI at our hospital were retrospectively analyzed. These were then classified as responders or non-responders to PVI according to the "Universal definition of HF". For each patient, the Antwerp score was calculated, and the performance of the score in predicting LVEF recovery after PVI was evaluated using receiver operating characteristic (ROC) curves and calibration plots.

Results
Between May 2010 and January 2022, 1665 patients underwent CA for AF at our institution. Of these, 208 patients (median age 63 [IQR 54-69] years, 19% women) had reduced LVEF at presentation and were included in the final analysis (27% with paroxysmal and 73% with persistent AF). The median LVEF at baseline was 43% [IQR 38-46]. At 30 [IQR 20-34] months follow-up after the index procedure, 161 patients (77%) were responders, and 47 patients (23%) were non-responders. The median time to LVEF recovery in responders was 8 [IQR 3-22] months. Between responders and non-responders, differences in AF type were not significant (p = 0.99), while QRS width, absence of known HF etiology and LAVI were significant (p&lt;0.001, p&lt;0.001 and p=0.03). After adjusting for difference in baseline characteristics and procedural outcomes between responders and non-responders, only a QRS duration&lt;120 ms (p=0.002) and absence of known etiology (p&lt;0.001) remained statistically significant with LVEF recovery (Figure). The Antwerp score had an area under the curve (AUC) of 0.75 (95% CI 0.67-0.83). A model containing QRS&lt;120 ms and absence of known etiology performed similarly to the complete Antwerp model (Likelihood Ratio p=0.77).

Conclusion
The Antwerp score has a moderate ability to identify patients with the recovery of LVEF after PVI in an external population, showing modest rule-in and rule-out capabilities. QRS width and absence of known HF etiology were confirmed as excellent predictors of LVEF recovery.Figure
Impact of atrial fibrillation ablation in heart failure with reduced ejection fraction
Authors: Massa M P , Arias R M , Spaccavento A , Ballari F N , Burgos L M , Diez M , Espinoza J C , Gil Ramirez A J , Mondragon L I , Albina G , Scazzuso F 
Published: November 2023

Abstract

Introduction
Atrial fibrillation (AF) is the most common supraventricular arrhythmia in patients with heart failure (HF) and is associated with a significant increase in morbidity and mortality. Some studies have shown evidence in favor of ablation over pharmacological treatment in patients with AF and reduced ejection fraction (HFrEF). However, little is known about the generalizability of the trial results to routine clinical practice, particularly in a low- and middle-income country.

Objective
To evaluate whether catheter ablation (CA) of AF reduces morbidity and mortality compared to medical therapy alone in patients with HFrEF and AF in a real-word contemporary cohort from Argentina.

Methods
We consecutively identified patients with HF with ejection fraction less than 40% associated with paroxysmal or persistent AF who presented to our hospital, either as outpatients or inpatients, between February 2018 and June 2020. Baseline characteristics and outcomes were compared among patients undergoing CA or medical therapy alone. The primary outcome was all-cause mortality and first HF hospitalization until completing a 3-year follow-up. Propensity score overlap weighting was used to balance ablated and drug-treated patients on sex, age, body mass index, hypertension, diabetes, dyslipidemia, smoking, previous atrial fibrillation ablation, use of antiarrhythmic drugs, cardiac resynchronization, cardiac defibrillator, left ventricular ejection fraction, cardiovascular surgery, infarction, stroke, peripheral vascular disease, etiology of heart failure, respiratory disease and renal disease baseline characteristics.

Results
Data from 6297 patients with AF were analyzed, of whom 430 had ejection fraction ≤ 40%. We excluded 20 patients who were ablated for atrial flutter. 53 patients in the ablation and 357 patients in the medical therapy group were identified.
After PS matching, the primary outcome occurred in 9 patients (23,7%) in the ablation group and in 19 patients (50%) in the control group. Catheter ablation was associated with a statistically significant reduction of the primary outcome in a 3-year follow up (Hazard ratio [HR] 0.33 [95%CI, 0.12-0.93]).

Conclusion
Catheter ablation for atrial fibrillation in patients with HFrEF was associated with decreased risk of mortality and heart failure hospitalisations relative to medical therapy.Kaplan-Meier survival estimates