bluuebunny/crossref_metadata_2025_split huggingface dataset:
Distribution of triggers in the left atrial posterior wall in AF patients undergoing catheter ablation
Authors: Mohanty S , La Fazia V M , Torlapati P G , Gianni C A R O L A , Macdonald B , Mayedo A , Della Rocca D G , Bassiouny M , Gallinghouse G J , Burkhardt J D , Horton R , Al-Ahmad A , Di Biase L , Natale A N D R E A 
Published: November 2023

Abstract

Introduction
Having a common embryologic origin with the pulmonary veins (PVs), left atrial posterior wall (LAPW) is considered to be a source of non-PV triggers that facilitate maintenance of atrial fibrillation (AF). However, the benefits of electrical isolation of the posterior wall (PWI) is still debated with contradictory data originating from different ablation approaches.

Purpose
We report the distribution of triggers in the LAPW area in AF patients undergoing repeat ablation.

Methods
Consecutive AF patients undergoing catheter ablation between 2015 and 2022 were included in this analysis.
PVs were isolated first. Next, high-dose isoproterenol challenge (up to 30µg/min) was used to disclose triggers in the PW by moving the circular mapping catheter along the PW down to the level of coronary sinus, which were targeted using additional RF energy. We defined lower part of LAPW as the area between the line joining the inferior borders of the inferior PV-encircling lesions and the coronary sinus. The endpoint was to achieve electrical isolation, as documented by absence of any electrical activity in the PW.

Results
Of the 10,963 AF ablations performed during the specified time period, 6249 (57%) had triggers mapped and ablated in the LAPW area.
Triggers were seen to be originating from the part of the PW between the PVs in 4124 (66%) and from the lower part of the PW in 2125 (34%) patients. Of these, 1624 (26%) patients had focal triggers detected in both the area between the PVs and the lower PW. All triggers from in between PVs were targeted for ablation, whereas lower PW sites were ablated in 1296 (61%) and not targeted for ablation the remaining 829 (39%). Figure 1 demonstrates the triggers arising from lower PW.
At 1 year, amongst patients with lower PW triggers, 1049/1296 (81%) vs 326/829 (39.3%) (p&lt;0.001) were arrhythmia-free.

Conclusion
Ectopic triggers in the LAPW were documented to be arising from the lower part of the PW in approximately 1/3rd of cases and ablation of those sites resulted in significantly higher success rate.
15-month follow-up of catheter ablation for atrial fibrillation in octogenarians
Authors: Wahedi R , Willems S , Jularic M , Hartmann J , Anwar O , Dickow J , Harloff T , Gunawardene M 
Published: November 2023

Abstract

Background
Catheter ablation for atrial fibrillation (AF) in octogenarians poses a challenge due to comorbidities, frailty, and suspected higher complication rates. Data regarding the outcome of catheter ablation in this population is scarce.

Purpose
Due to the projected increase of octogenarians presenting with AF in the future, we investigated the outcome of catheter ablation in this patient population.

Methods
We retrospectively analysed octogenarians with symptomatic AF undergoing catheter ablation in a single centre, including first and re-ablation procedures. Catheter ablation involved pulmonary vein isolation (PVI) using radiofrequency (RF), cryoballoon (CB) and pulsed field ablation (PFA) as energy sources and also atrial tachycardia (AT) ablation including linear lesions and/or ablation of complex fractionated atrial electrograms (CFAE). Follow-up (FU) was obtained to assess arrhythmia-free survival after a 90-day blanking period, recurrences after the blanking period, management of recurrences, rhythm at FU, use of antiarrhythmic drugs (AADs) and improvement in symptoms (EHRA symptom scale).

Results
A total of 126 patients (mean age 82.2 ± 1.9 years, paroxysmal AF n=48, persistent AF n=78, mean CHA2DS2-VASc-Score 4.2 ± 1.5) were included. 57.1% (n=72/126) underwent an index procedure {47.2% (n=34/72) RF PVI, 37.5% (n=27/72) CB PVI, 4.2% (n=3/72) PFA PVI and 11.1% (n=8/72) PVI + AT ablation}. 42.9% (n=54/126) received repeat procedures {20.4% (n=11/54) re-PVI, 42.6% (n=23/54) re-PVI + AT ablation, 37% (n=20/54) AT ablation}. FU of 108 patients after 15.4 ± 3.6 months revealed arrhythmia-free survival after the blanking period in 64.8% (n=70/108). Recurrence after the blanking period was seen in 35.2% (n=38/108). No significant difference in recurrences was shown between index and repeat procedures (32.3%, n=20/62 after index procedures and 36.7%, n=18/49 after repeat procedures, p =0.97). Management of recurrence involved repeat ablation (47%, n=18/38), AADs (16%, n=6/38), cardioversion (21%, n=8/38), pacemaker-implantation/AV-node ablation (5%, n=2/38) and pharmacological rate control (11%, n=4/38). At FU, 88.9% (n=96/108) of patients were in sinus rhythm with 21.3% (n=23/108) receiving AADs, 7.4% (n=8/108) were in AF, 0.9% (n=1/108) in AT and 2.8% (n=3/108) pacemaker-dependant. Symptoms were significantly improved at FU (mean EHRA score at FU= 1.2 ± 0.5, before ablation= 2.4 ± 0.5, p &lt;0.0001).

Conclusion
Catheter ablation for AF in octogenarians is effective in maintaining sinus rhythm and controlling AF-related symptoms. Longer term success and impact on prognosis in this patient population is unknown and should be investigated further.
Transseptal puncture using electroanatomical mapping: a safe and cost-effective technique
Authors: Dantas Brigido A , Rassi G M , Rodrigues L V , Lovisi V B , Pisani C F , Chokr M O , Hardy C A , Melo S L , Goncalves A L M , Mayrink M P , Kulchetscki R M , Scanavacca M I 
Published: November 2023

Abstract

Background
The usual technique of transseptal puncture (TSP) uses fluoroscopy or intracardiac echocardiography. New techniques for oval fossa (OF) identification by electroanatomical mapping (EAM) have been described. However, the technique of direct visualization of the TSP needle added to the OF location by impedance mapping has not been investigated yet.

Purpose
To evaluate feasibility and safety of the TSP technique guided by the interatrial septum (IAS) impedance mapping and the TSP needle visualization using EAM system.

Methods
Consecutive patients who underwent ablation using TSP in July and August 2022 in our institute were included. The standard material for the procedure was used in addition to a temporary pacemaker (PM) connection cable. In all cases, the EAM system was CARTO 3 version 7 (Biosense Webster and a bipolar voltage map of right atrium and a impedance map of the IAS were constructed. The OF location was estimated based on the septal region with the lowest impedance and on traditional anatomical landmarks. Using a temporary PM cable connected to the proximal part of the TSP needle stylet, it was possible to visualize its distal portion on the 3D map used to guide the TSP. The entire process was simultaneously monitored under fluoroscopic visualization by an experienced professional.

Results
A total of 25 patients were included; mean age of 56 +/- 15 years, 16 (64%) were male. The most frequent procedure was atrial fibrillation ablation (86%); left atrium mean size of 40,26 +/- 5,2 mm. 9 patients (36%) were already submetted to a previous procedure using TSP. None of the patients had congenital heart disease. In all cases, the TSP was successfully performed and a correlation between the anatomical references and the lowest impedance region on the map was observed. There were no complications.

Conclusion
The technique of visualization of the TSP needle using EAM system added to IAS impedance mapping and use of anatomical markers seems to be a safe and cost-effective alternative for performing TSP. This technique could reduce ionizing radiation without need for additional materials.Impedance map and bipolar voltage mapLA (bipolar voltage map) and TSP orifice
Sex-differences in ventricular tachyarrhythmia events in patients with implantable cardioverter defibrillator and prior ventricular tachyarrhythmias
Authors: Krzowski B , Kutyifa V , Vloka M , Huang D T , Aktas M , Musat D , Rosenthal L , Sakaguchi S , Mcnitt S , Polonsky S , Schuger C , Daubert J P , Goldenberg I , Zareba W 
Published: November 2023

Abstract

Background
Women have been previously shown to be at a lower risk of ventricular tachyarrhythmia (VT) events in ICD trials, however, more contemporary data on the risk of VT/VF and death by sex in patients with prior VT/VF are lacking.

Objective
We aimed to assess sex-differences in ICD-treated VT/VF events and all-cause mortality in patients in the Ranolazine in High-Risk ICD Patients (RAID) trial. Patients were either implanted for secondary prevention or primary prevention ICD indications but experienced VT/VF before enrolment.

Methods
The RAID trial enrolled high-risk ICD patients with ischemic or non-ischemic cardiomyopathy, randomized to ranolazine or placebo. This analysis focused on patients with prior VT/VF. Sex-differences in VT/VF requiring ATP or shock were evaluated using Kaplan-Meier analysis, Fine and Grey, and Cox models in an intention to treat analysis. All VT/VF episodes were centrally adjudicated.

Results
There were 124 women (17%) out of 714 subjects analysed. Women were younger (60 vs. 65 years, p&lt;0.001), more often non-ischemic (70% vs. 37%, p&lt;0.001), less often had hypertension (69% vs. 78%, p=0.045) and diabetes (19% vs. 34%, p=0.002). Compared to men, women were at a significantly lower risk of VT/VF/Death (HR=0.67, [95% CI, 0.46-0.96], p=0.029), lower risk of VT/VF (HR=0.68, [95% CI, 0.46-1.00], p=0.049), lower risk of VT/VF treated with ATP (HR=0.59, [95% CI, 0.38-0.92], p=0.019), and lower risk of VT/VF treated with ICD shock (HR=0.54, [95% CI, 0.31-0.96], p=0.035). The risk of recurrent VT/VF was also significantly lower in woman (HR=0.35 [95% CI, 0.26-0.48], p&lt;0.001). Hazard ratio for death was similar to the other endpoints, (HR=0.61, [95% CI 0.30-1.22] p=0.162) but did not reach statistical significance, most probably related to low statistical power due the relatively small number of death events among women. The effect of ranolazine on endpoints did not differ by sex.

Conclusions
Women with a history of prior VT/VF and managed with an ICD/CRT-D experienced a lower risk recurrent VT/VF requiring device therapy as compared with men. The risk of mortality showed a similar trend although did not reach significance.
Is there a significant 1-year impact on tricuspid valve regurgitation evolution in leadless-PM implanted subjects?
Authors: Sabatini A , Pellegrini N , Piccolo S , Capocci S , Strazzanti M , Tomasi L , Mugnai G , Franchi E , Tomei R , Ribichini F , Bolzan B 
Published: November 2023

Abstract

Background
Leadless pacemaker implanted subjects (leadless-VVI and "AV") have been shown to experience lower chronic complications and less device-related reinterventions compared to transvenous ventricular pacemakers (Transvenous-VVI, VDD) in the general PM-implanted-population. Also, conventional transvenous pacemaker ventricular leads may interfere with the tricuspid valve structures yielding significant tricuspid valve regurgitation (TR).

Purpose
This single-center study focusses on tricuspid valve disease to demonstrate the impact/benefits of leadless pacing at 1-year follow-up period by comparing tricuspid valve regurgitation grading at implant time and at 1-year follow-up.

Methods
This study is a retrospective, observational research study: 78 consecutive subjects (February 17, 2016 - January 18, 2023), treated in our Center, implanted with Micra VVI/AV leadless-PMs Micra MC1VR01 and Micra AVMC1AVR1, Medtronic, Inc., were evaluated at implant time via transthoracic echocardiography, and at 1-year follow-up period. Tricuspid valve disease was evaluated.

Results
See Table.

Conclusion
The main results from this study show that many patients at higher risk of transvenous pacemaker complications relatively to the tricuspid valve have similar tricuspid valve disease at implant time as compared to 1 year-F-up time, implicating a negligible impact of leadless pacing on the tricuspid valve compared to transvenous lead PMs.
Development of an in vitro platform for transesophageal echocardiographic and color Doppler hemodynamic assessments of left atrial appendage occlusion devices
Authors: Zhong Z , Ramon J , Morais P , Kandels T , Vij V , Nelles D , Nickenig G , Sedaghat A , Mela P 
Published: November 2023

Abstract

Introduction
Device-related thrombus (DRT) remains a significant complication after left atrial appendage occlusion (LAAO) and is associated with device position. Clinical prospective study of the influence of device position on DRT is cumbersome.

Purpose
To establish an in vitro bench test platform that allows visual, transesophageal echocardiographic and color Doppler hemodynamic assessments of left atrial appendage occlusion devices.

Methods
Based on a mock circulatory system, an in vitro platform was developed to create pathophysiological environment and left atrium wall motion under atrial fibrillation condition.

Results
LAAO devices could be visualized in the left atrium phantom model using transesophageal echocardiography and color Doppler measurement of local blood velocity at LAAO devices were proven to be capable. Deep implantations resulted in uncovered left upper pulmonary vein ridges. In comparison to ostium-fitted device positions, deep implantations were associated with reduced velocity of blood and the local velocity in the "cul-de-sac" remained lower than the critical threshold of 0.2 m/s.

Conclusions
An in vitro platform was developed that allows transesophageal echocardiographic and color Doppler hemodynamic assessments of left atrial appendage occlusion devices.
Risk of major cardiovascular events and bleeding in atrial fibrillation patients with chronic obstructive pulmonary disease treated with low dose azithromycin prophylaxis
Authors: Bucci T , Frost F , Wat D , Sibley S , Pignatelli P , Green D , Lip G Y H 
Published: November 2023

Abstract

Background
Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of cardiovascular events in patients with atrial fibrillation (AF). Low Dose Azithromycin Prophylaxis (LDAP) is associated with improved outcomes in people suffering frequent exacerbations of COPD, but the widespread use of macrolides in patients with underlying cardiovascular disease has been debated due to safety concerns.

Aims and Objectives
To investigate the safety and efficacy of LDAP in AF patients with COPD in a large global federated dataset.

Methods
We conducted a retrospective cohort study within the global TriNetX Platform, including AF patients with COPD exacerbations. Risks for all-cause death, major adverse cardiovascular events (MACE: acute coronary syndrome, thromboembolic events, severe ventricular arrhythmias, and heart failure), intracranial hemorrhage (ICH) and gastrointestinal (GI) bleeding were recorded up to 30 days post-COPD exacerbations and compared between LDAP users (at least 3 months use and using LDAP at index) and an active control group (non-Azithromycin users receiving inhaled corticosteroids (ICS)). Cox regression analyses compared outcomes between groups after propensity-score-matching (PSM) for cardiovascular risk factors.

Results
We identified 2791 LDAP users with COPD and AF (mean age 71.5±10.6 years, 48.9% female), and 61054 controls. Before PSM, LDAP users showed a lower prevalence of cardiovascular risk factors and were less likely to be prescribed oral anticoagulation (68.1% vs 76.1%, p&lt;0.001). After PSM no significant baseline differences were found between two groups.
After COPD exacerbation, LDAP users were associated with a lower 30-day risk of all-cause death (HR: 0.72, 95%CI 0.60-0.97), MACE (HR 0.72, 95%CI 0.57-0.90), ICH (0.48, 95%CI 0.27-0.88) and GI bleeding (HR 0.69,95%CI 0.46-0.89) compared to the conventional treatment with ICS. Analysing the different time frames, the lower risk of thrombotic events was observed during the second week after COPD exacerbation while the magnitude of the bleeding risk reduction was more evident in the first 7 days (Figure 1).

Conclusion
LDAP use is associated with a lower risk of all-cause death, MACE and bleeding in AF patients with COPD. Further studies are needed to investigate the possible role of LDAP as part of the integrated care management of AF patients with COPD.
Changes in ubiquitylated proteins in atrial fibrillation associated with heart valve disease: proteomics in human left appendage tissue
Authors: Xiao Y , Wu C K , Teng S , Bai F , Liao X B , Zhou X M , Liu Q M , Zhou S H 
Published: November 2023

Abstract

Background
Posttranslational modifications have been shown to be associated with atrial fibrillation (AF). However, the relationship between ubiquitylated proteins and AF in patients with valvular heart disease remains unclear.

Purpose
To investigate the ubiquitination profiles in the left atrial appendage of patients with AF and valvular heart disease using LC-MS/MS analysis.

Methods
Eighteen subjects who underwent cardiac valvular surgery were included in this study, with nine in sinus rhythm and nine with AF. Ubiquitination profiles were analyzed using LC-MS/MS, and upregulated and downregulated ubiquitination sites were identified using quantification ratios.

Results
A total of 271 upregulated and 467 downregulated ubiquitination sites were identified in 162 and 156 proteins, respectively. The ubiquitylated proteins in AF were enriched in proteins associated with ribosomes, hypertrophic cardiomyopathy (HCM), glycolysis, and endocytosis. The study also revealed significant differences in the ubiquitination levels of ribosome-related and HCM-related proteins, including titin (TTN) and myosin heavy chain 6 (MYH6), between AF and sinus rhythm.

Conclusions
This study provides insights into the ubiquitination profiles in the left atrial appendage of patients with AF and valvular heart disease. Our findings suggest that ribosome-related and HCM-related proteins, especially TTN and MYH6, are differentially ubiquitinated in AF, which may provide a more feasible strategy against AF.Motif analysis of ubiquitylated proteinsUbiquitylated PPI network analysis
Clonal hematopoiesis of indeterminate potential in atrial fibrillation: prevalence and an association with progression
Authors: Ahn H J , Choi E K , An H Y , Lim J W , Koh Y , Choi S Y , Kwon S , Lee S R , Lip G Y H , Oh S 
Published: November 2023

Abstract

Background
Both clonal hematopoiesis of indeterminate potential (CHIP) and atrial fibrillation (AF) are age-related conditions. Also, CHIP is associated with an increased risk of cardiovascular disease which might contribute to the development of AF. However, the direct association between CHIP and AF is unknown.

Objective
To evaluate the potential role of CHIP in the development and progression of AF.

Methods
Deep-targeted sequencing of 24 CHIP mutations was performed in 1,004 patients with AF and 3,341 non-AF healthy adults. Variant allele fraction (VAF) ≥2.0% indicated the presence of CHIP mutations. The association between CHIP and AF was evaluated by the comparison of (1) the prevalence of CHIP mutations between AF and non-AF adults and (2) clinical characteristics discriminated by CHIP mutations within AF patients.

Results
The mean age was 67.6 ± 6.9 vs. 58.5 ± 6.5 years in AF (paroxysmal, 39.0%; persistent, 61.0%) and non-AF cohorts, respectively. Twenty-four CHIP mutations with a VAF of at least 0.02 were found in 237 (23.6%) AF patients and 356 (10.7%) non-AF adults (p&lt;0.001). The most common CHIP mutation genes in AF were DNMT3A (13.5%), TET2 (6.6%), and ASXL1 (1.5%). After multivariable adjustment, detected CHIP mutations were 1.4-fold higher in AF patients than in non-AF adults [odds ratio (OR), 1.38 and 95% confidence interval (CI), 1.10-1.73, p&lt;0.01 for all AF; OR (95% CI), 1.50 (1.14-1.99), p&lt;0.01 for long-standing persistent AF]. In gene-specific analyses, TET2 somatic mutation presented the highest association with AF (OR, 1.63; 95% CI, 1.03–2.56, p=0.036). AF patients with CHIP mutations were older and had more diabetes, a longer AF duration, and a higher E/E’ than those without CHIP mutations (all p&lt;0.05).

Conclusion
CHIP mutations, primarily DNMT3A or TET2, are 1.4-fold more prevalent in AF than non-AF adults and might contribute to the progression of AF. Further studies are required to elucidate the underlying pathophysiologic role of CHIP in AF.
Differences in causality between exposures and stroke subtypes: a mendelian randomisation approach
Authors: Fill J , Fokina A , Klappacher G 
Published: November 2023

Abstract

Background
Observational evidence indicates that patients with atrial fibrillation (AF) are at a four- to fivefold increased risk of stroke. By two-sample mendelian randomization (MR), we have shown in our previous work that specifically the cardioembolic stroke subtype is caused by AF. This risk elevation is however variable and appears to be modulated by other risk factors such as hypertension traits and coronary artery disease (CAD).

Purpose
This study seeks to determine (1) whether genetic predisposition to cardioembolic stroke by AF is independent from modulators, and (2) whether the other stroke subtypes are causally linked with different exposures.

Methods
The associations between AF, hypertension traits, and CAD as exposures and stroke subtypes as outcomes were individually tested in a two-sample mendelian randomisation (MR) analysis using genetic instruments from publicly available genome-wide association studies (GWAS) in large cohorts. For atrial fibrillation, genetic instruments were obtained from the dataset by Nielsen et al. with 60,620 atrial fibrillation cases and 970,216 controls, collected from six contributing studies including the AFGen Consortium. Associations with stroke subtypes were evaluated in the MEGASTROKE genome-wide association study data set (67, 162 cases; 454, 450 controls). The genetic markers for hypertension traits were taken from a GWAS by Evangelou et al. which combines data from the UK Biobank (UKB) and the International Consortium of Blood Pressure (ICBP) with a total sample size of 757,601 individuals. Genetic instruments for CAD were obtained from the CARDIoGRAMplusC4D consortium (60,801 cases and 123,504 controls from 48 studies). Several MR regression methods such as MR-Egger regression and inverse-variance weighted regression as well as sensitivity analyses were applied. A multivariable MR model served to determine which of the exposures had an independent causal effect on each of the stroke subtypes.

Results
Atrial fibrillation turned out to be the sole independent causal risk factor for cardioembolic stroke with a beta coefficient of 0.75 (SE = ± 0.04; P = 8.59 x 10e-100) and an OR of 2.16 (1.97-2.27) in a multivariable model adjusted for AF, CAD, systolic blood pressure (SBP) and diastolic blood pressure. In this model, SBP and CAD were non-causative for cardioembolic stroke, but exhibited significant, albeit weak causal associations with small vessel stroke (SBP: OR 1.04 (1.02-1.06); CAD: OR 1.14 (1.02-1.28)) and large artery stroke (SBP: OR 1.09 (1.06-1.11); CAD: OR 1.59 (1.40-1.79).

Conclusions
Causality of the association between the cardioembolic stroke subtype and AF is independent from modulators such as SBP and CAD. However, SBP and CAD play a complementary role as causal exposures for small vessel and large artery stroke which in turn are not causally linked with AF.