bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of pre-procedural anticoagulation in patients undergoing ablation: a meta-analysis of randomized controlled trials
Authors: Duhan S , Taha A , Keisham B , Badu I , Faisaluddin M , Patel H , Sandhyavenu H 
Published: November 2023

Abstract

Background
Atrial fibrillation (AF) is the most common type of arrhythmia seen in a clinical setting. Patients have a high risk of stroke, especially in the first two years of diagnosis. Anticoagulation therapy is prescribed to patients with a high CHAD2S2-VASc score. Based on recent evidence, catheter ablation (CA) is emerging as the preferred first-line treatment of modality. The benefit of interruption of anticoagulation before CA is unclear. Interruption of anticoagulation and insertion of a foreign body during CA can lead to an increased risk of thromboembolism (TE). Anticoagulation is interrupted before the procedure to balance the risk of TE and bleeding.

Objective
To assess the risk of bleeding and TE in patients undergoing CA with uninterrupted versus interrupted anticoagulation.

Methods
We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) strategy to search PubMed/MEDLINE, EMBASE, and Cochrane databases from inception till January 2023. We included randomized controlled trials and excluded observational studies. The data was extracted from full texts. Data Random effects model and Mantel-Haenszel method were used to calculate pooled risk ratio and 95% confidence interval.

Results
A total of 10 studies were included, with 4,584 participants. The risk of TE [1.76; 95% confidence interval (CI): 0.33, 9.46] and bleeding [1.10; 95% CI: 0.59, 2.05] did not change significantly with the interruption of all anticoagulation agents. Similarly, interruption of individual anticoagulants such as heparin [0.81, 95% CI: 0.19, 3.39], vitamin K antagonists (VKA) [9.21, 95% CI: 0.02, 5627.42], and direct oral anticoagulants (DOAC) [1.36, 95% CI: 0.26, 7.23] did not show any change in the risk of TE. There was no significant change in the risk of bleeding with heparin discontinuation (Figure 1).

Conclusion
Our study supports recent trials such as Randomized Evaluation of Long-term Anticoagulant Therapy (RE-LY) and emerging data that support uninterrupted anticoagulation prior to ablation as there is no increased risk of bleeding or TE.
Long-term stability of atrial sensing in implantable cardioverter-defibrillators with floating atrial dipole leads
Authors: Ferreira Neves I , Lacerda Teixeira B , Portugal G , Silva Cunha P , Valente B , Lousinha A , Osorio P , Santos H , Monteiro A , Covas S , Contins R , Cruz Ferreira R , Martins Oliveira M 
Published: November 2023

Abstract

Introduction
To maintain the advantages of having atrial sensing without the need to implant an additional lead, a single-lead ICD system with a floating atrial dipole (VDD DX ICD, Biotronik) with active fixation to the right ventricle has been developed. In this generation of ICDs, specially filtered atrial signs may be high enough to allow early detection of atrial arrhythmias and improve discrimination between atrial and ventricular tachycardias. However, maintaining reliable and stable atrial sensing via the floating dipole could be a concern regarding this technology. We aimed to determine the long-term stability of atrial sensing in patients (P) with this type of device.

Methods
All P implanted with ICDs with an active fixation DX lead at our centre between 2013 and 2021 were included. Atrial sensing and ventricular or supraventricular arrhythmic events were recorded during follow-up. We retrospectively analysed the atrial sensing evolution and compared it with a control group that had been implanted with a VDD pacemaker (PM).

Results
Seventy DX ICD P (82.9% males, age 69±14 years [between 19 and 86], 81.4% implanted as primary prevention) with &gt; 1-year follow-up were included. The control group included 52P (age 82±6.3 years) who underwent PM implantation due to an advanced atrioventricular block. The mean P-wave amplitude at implantation was 4.85±2.44 mV in the DX ICD group and 1.54±0.89 mV in the VDD PM group. At one year after implantation, P-wave amplitude was 4.26±2.68 mV in the DX ICD group and 1.20±1.16 mV in the control group. From the control group, 7P (15,6%) lost atrial sensing after one year of follow-up, having their PM programmed as VVI after that. None of the P in the ICD group had lost atrial sensing in the same time period. After one year of follow-up, the P-wave amplitude had a mean reduction of 41.3% in the DX ICD group and of 65% in the control group (P=0.05).

Conclusions
Atrial signals can be reliably sensed by the floating dipole rings of a DX ICD in a long-term follow-up. This technology resulted in a higher stability of atrial sensing when compared with that obtained in P with a VDD PM. Additionally, a noteworthy number of P with a VDD PM lost atrial sensing, which did not happen in the group with the DX ICD.Results
HIPSC model reveals M1 macrophages cause atrial arrhythmia correlated to electrophysiological remodelling of atrial cardiomyocytes in 2D and 3D engineered heart tissue
Authors: Hutschalik T , Schotten U , Matsa E 
Published: November 2023

Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia with an estimated prevalence of 1.5–2%. Current treatments lack effectiveness and do not prevent recurrence. Inflammation is reported in AF patients, however, a causal connection remains elusive.
In this study, we investigated the arrhythmic effects of pro-inflammatory macrophages (M1) on human induced pluripotent stem cell (hiPSC)-derived atrial cardiomyocytes (aCM), to better understand their role in AF. Macrophages are known to play a role in cardiac electrophysiology, but their role in arrhythmia is unclear.
Three healthy hiPSC lines were differentiated to aCM and M1. Multi-electrode array recordings of isogenic, 2D cocultures of M1 and aCM showed a significant increase in beat rate irregularity compared to control conditions (P&lt;0.001). Furthermore, spike amplitude of aCM and M1 cocultures was significantly decreased (P&lt;0.001). Arrhythmias occurred only after activation of macrophages in the coculture. Addition of anti-inflammatory glucocorticoids significantly reduced beat irregularity in aCM and M1 cocultures compared to vehicle (1.9-fold decrease for Hydrocortisone, P&lt;0.005) further supporting macrophage mediated inflammation to be the cause of the arrhythmia. RNA sequencing of aCM and M1 cocultures revealed aberrant expression of arrhythmia associated cardiac sodium and atrial potassium ion channels (SCN5A, KCNA5). Normal expression was restored through hydrocortisone addition.
In addition, inflammation-induced arrhythmia was observed in 3D engineered heart tissues containing hiPSC derived aCM, M1 and cardiac fibroblasts. Tissues showed a significant increase in beating irregularity (P&lt;0.005) compared to controls and had a significant, median reduction (&gt;30%) of contraction amplitude (P&lt;0.05).
Our findings suggest a causal relationship between M1 and the occurrence of atrial arrhythmia. The reduction of arrhythmia using glucocorticoids correlates to clinical observations, that show their use being linked to reduced post operative AF burden. These results strongly support the relevance of the proposed hiPSC coculture model and elucidate a new potential AF mechanism.
Effect of epigenetic regulation on left atrial function and recurrence after catheter ablation in patients with atrial fibrillation
Authors: Choi J I , Han M R , Yang H H , Kim Y G , Jeong J H , Lee H S , Choi Y Y , Shim J , Kim Y H 
Published: November 2023

Abstract

Background
Genetic variation and modifiable risk factors play a significant role in the pathogenesis of atrial fibrillation (AF). However, the influence of epigenetic modification on AF remains to be elucidated.

Methods
Epigenetic evaluation was performed in 115 AF patients who underwent radiofrequency catheter ablation (RFCA) in a single institution. We measured methylation at approximately 850,000 bp cytosine-phosphate-guanine (CpG) sites in the 115 samples.

Results
The degree of methylation was compared across seven classification criteria: type of AF, late recurrence, impaired left atrium (LA) function, late gadolinium enhancement, LA diameter, LA volume, and flow velocity of the LA appendage. The four most significantly methylated genes in our cohort were DEFB104B, C3, TANC1, and TMEM9B. The DEFB104B gene (cg20223677 in the transcription start site), which encodes β-defensin 104B, was hypomethylated in three groups: those with late recurrence, impaired LA function, and impaired LAA flow velocity. Enriched functional annotation of the differentially methylated datasets revealed that five out of the seven AF groups in this cohort were associated with genes involved in the cell movement of endothelial cell lines, sprouting angiogenesis by endothelial cell lines, or migration of endothelial cell lines.

Conclusion
In this study, epigenetic profiling revealed that epigenetic modification might affect crucial traits of AF, such as the degree of atrial myopathy and treatment effects after RFCA, suggesting the hypothesis that the pathogenesis of AF might be affected by not only genetic variation or modifiable factors but also by epigenetic modulation. The identified methylation-susceptible loci can be used in targeting for epigenetic-based therapeutic agents.
Association of atrial fibrillation symptom with clinical outcomes: a prospective multicenter registry study
Authors: Lee S , You S C , Bae H J , Park J B , Park J K , Kang K W , Kim J , Park H W , Choi E K , Kim J B , Lee Y S , Shim J M , Joung B Y 
Published: November 2023

Abstract

Background and Objectives
Atrial fibrillation (AF) is usually classified on the basis of the disease subtype. However, this characterization does not capture the full heterogeneity of AF. This study was performed to evaluate whether the remodeling of heart, treatment of AF, and clinical outcome is different according to the symptom of AF.

Patients and Methods
In the prospective, multicenter study of AF registry, we identified 10,210 patients with non-valvular AF (mean age, 66.7 years; 35.3% were women) enrolled between June 2016 and March 2022 with eligible follow-up visits. The patients were classified into two groups according to the presence of AF symptoms. Clinical factors related with AF symptoms were analyzed. The primary outcome was defined as a composite of all cause death, ischemic stroke, transient ischemic attack, systemic embolism, myocardial infarction, and hospitalization for heart failure.

Results
Among 10,210 patients, 4,327 (42%) were symptomatic AF, and 5,883 (58%) were asymptomatic AF. The asymptomatic group had older age, more male sex, comorbidities such as hypertension and diabetes mellitus, larger LA AP diameter (43.6 vs. 42.2, P &lt;0.001), and higher E/E’(10.4 vs. 10.0, P &lt;0.001). During median follow-up of 32.9 (29.5 ∼ 36.4) months, incidence of the primary outcome in Asymptomatic vs. Symptomatic were 1.44 and 1.45 per 100 person-year, respectively. In multivariable Cox regression analysis, AF symptoms were not associated with an increased risk of the primary outcome (HR 1.02; 95% CI, 0.81 ∼ 1.29, P = 0.871). In linear regression, symptom of AF was negatively associated with LA AP diameter (β coefficient -0.43, 95% CI -0.76 ∼ -0.11, P = 0.009).

Conclusions
In the multicenter prospective AF registry, the presence of AF symptoms was not related to cardiovascular outcomes. However, AF symptoms were related to LA remodeling.Cumulative incidence for primary outcomeLinear regression for LA AP diameter
Coffee consumption and adverse outcome events in patients with atrial fibrillation
Authors: Iten V , Coslovsky M , Hennings E , Reichlin T , Rodondi N , Mueller A , Beer J , Conte G , Chocano P , Bonati L , Kuehne M , Osswald S , Aeschbacher S , Zuern C 
Published: November 2023

Abstract

Background/Introduction
Moderate coffee consumption has been associated with a lower risk of major adverse cardiovascular events (MACE) in the general population. However, there are some concerns that coffee consumption might be harmful for patients with atrial fibrillation (AF).

Purpose
The aim of this study was to investigate the association of coffee consumption with MACE and other adverse outcome events in AF patients.

Methods
Data of AF patients from two large prospective, multicenter cohort studies (yearly based follow-up data from Swiss-AF and Beat-AF) were used for this analysis. Coffee consumption was assessed and categorized into two main groups "not-daily" and "daily" consumers and subcategories (&lt;1, 1, 2-3 and ≥4cups/day). The primary endpoint was defined as a composite of stroke or systemic embolism, myocardial infarction, hospitalization for acute heart failure and cardiovascular death (MACE). We performed time-updated multivariable adjusted Cox regression analyses to investigate the association of coffee consumption with MACE and other adverse outcome events.

Results
Among 3,835 patients (mean age 71.4 years, 28.0% females), 3,095 (80.7%) reported daily coffee consumption. The incidence rate for MACE was 5.09 in daily and 7.49 per 100py in not-daily consumers. Cumulative incidence curves are presented in Figure 1. After comprehensive multivariable adjustment, daily coffee consumption was associated with a 23% relative risk reduction for MACE compared to not-daily consumption (hazard ratio (HR) (95% confidence interval (CI)) 0.77 (0.67-0.89), p&lt;0.001;). Compared to patients with not-daily coffee consumption, patients with moderate coffee consumption (2-3 cups/day) had the lowest hazard for MACE (HR (95%CI) 0.73 (0.62; 0.85), p&lt;0.001). The associations between coffee consumption and all adverse outcome events are presented in Figure 2.

Conclusion
In a population of AF patients, daily coffee consumption was associated with a lower risk of MACE and other adverse outcomes. These findings seem to be similar to those in the general population.
Risk differences between atrial fibrillation patients with different clinical phenotypes: insights from the French population
Authors: Fawzy A M , Bisson A , Bentounes S A , Bodin A , Herbert J , Lip G Y H , Fauchier L 
Published: November 2023

Abstract

Background
Atrial fibrillation (AF) patients represent a clinically complex, heterogeneous population comprising multiple homogeneous cohorts.

Purpose
We aimed to identify the common clinical phenotypes of AF patients and compare clinical outcomes between these subgroups.

Methods
A 1% representative sample of all AF patients hospitalized between 2010 and 2019 was identified from the French national database. Agglomerative hierarchical cluster analysis was performed using Ward’s method and squared Euclidian distance , to derive 4 distinct clusters of patients (Figure 1) using 31 clinical variables. Cox regression analyses were used to evaluate outcomes including all-cause death, cardiovascular death, non-cardiovascular death, ischaemic stroke, hospitalisation for heart failure (HF) and composite of ventricular tachycardia, ventricular fibrillation and cardiac arrest (VT/VF/CA).

Results
Four clusters were generated from the 12,688 patients included. Cluster 1 (n=2375) was younger, with a low risk of cardiovascular disease (CVD) and risk factors such as hypertension, dyslipidaemia and diabetes, but had the highest cancer prevalence. Clusters 2 (n=6441) and 3 (n=1639) depicted moderate-risk groups for CVD, with the female majority and high rates of lung conditions being the distinct features respectively. Cluster 3 also had the highest degree of frailty, with clusters 2 and 4 following closely. Cluster 4 (n=2233) represented a high-risk cohort for CVD with a high prevalence of coronary artery and vascular disease. Over a follow-up period of 2.0±2.3 years (median 1.1, interquartile range 0.1-3.4), cluster 3 had the highest cumulative incidence of all outcomes except for cardiovascular death which was highest in cluster 4. Compared to cluster 1, cluster 3 had the highest risk for all-cause death, HR 1.24 (1.09-1.41), cardiovascular death, HR 1.56 (1.19-2.06), non-cardiovascular death, HR 1.20 (1.04-1.38), hospitalisation for HF, HR 2.07 (1.71-2.50) and VT/VF/CA, HR 1.74 (1.20-2.53).

Conclusion
Four main clusters of AF patients were identified, discriminated by the differential presence of comorbidities. Our findings suggest that AF patients with moderate CVD-risk may have a poorer prognosis compared to AF patients with high CVD-risk in the presence of lung pathology. Therefore, this subgroup of patients may require more stringent management of existing comorbidities such as chronic obstructive pulmonary disease and sleep apnoea, alongside their AF.
High levels of intermediate cd14++cd16+ monocytes predict incident atrial fibrillation in the general population
Authors: Sveen K A , Smith G , Goncalves I , Edsfeldt A , Engstrom G , Bjorkbacka H , Bengtsson E 
Published: November 2023

Abstract

Background
Atrial fibrillation (AF) is associated with increased inflammation and recent evidence also links inflammation to the pathogenesis of AF. However, studies of circulating immune cells and their contribution to AF are sparse. In particular, prospective studies of monocyte subsets and risk of developing AF are lacking. These studies are important to identify individuals at high risk of AF and further understanding of the pathogenesis of the disease.

Purpose
In the current study we compared differences in circulating monocyte subsets and incidence of AF in a large community-based cohort.

Methods
The study included 666 randomly selected individuals from the cardiovascular arm of the Malmö Diet and Cancer study. Among these, 145 individuals experienced incident AF during the follow up of 18.6 (11.5-21.7) years. To enumerate monocyte subsets (classical CD14++CD16-, intermediate CD14++CD16+, and non-classical CD14+CD16++) mononuclear leukocytes frozen at baseline were analyzed with flow cytometry. Monocyte subsets were determined as total numbers and percentages of total monocytes.

Results
Percentages of classical CD14++CD16- monocytes or non-classical CD14+CD16++ monocytes did not differ in subjects who developed AF compared to subjects without AF. However, intermediate monocytes displayed a trend towards increased percentages in subjects with incident AF. In addition, the number of intermediate CD14++CD16+ monocytes and classical CD14++CD16- monocytes were increased in subjects with incident AF. Both percentages and numbers of intermediate monocytes were associated with increased risk of developing AF during follow-up after adjustment for common risk factors.

Conclusions
This study shows that intermediate CD14++CD16+ monocytes are associated with incident atrial fibrillation independently of other common risk factors in the general population, supporting a role of inflammatory cells in AF.Figure 1
A multiple cut-off diagnostic meta-analysis to identify the atrial high-rate episodes threshold that better relates to thromboembolic events
Authors: Ballatore A , Saglietto A , Griffith Brookles C , Xhakupi H , De Ferrari G M , Anselmino M 
Published: November 2023

Abstract

Background
Despite the high prevalence of atrial high-rate episodes (AHRE) detected by cardiac implantable electronic devices (CIED), clinical guidelines and consensus documents have failed to agree on a universal AHRE definition. Clear evidence on the best management strategy is lacking.

Purpose
The present is a diagnostic test accuracy meta-analysis aiming to derive from available literature the optimal AHRE threshold to predict thromboembolic events.

Methods
PubMed/MEDLINE and EMBASE databases were screened for studies on CIED patients reporting incidence of thromboembolic events referred to at least one AHRE definition. A random-effect diagnostic test accuracy meta-analysis with multiple cut-offs was performed: duration of AHRE was the "diagnostic test" (positive test if the patients experienced an AHRE lasting at least as long as the time cut-off under examination) whose performance in predicting the "disease" (thromboembolic events) was evaluated across multiple cut-offs. Two analyses, according to AHRE definition (longest episode vs. cumulative burden), were performed.

Results
23 studies were included in the analyses (Fig. 1 Panel A), encompassing 46,189 patients: 19 considering the longest single AHRE and 4 the AHRE burden, respectively. Median follow-up was 40.75 (IQR 28.25-52.80) months. The analysis on the longest single AHRE indicated 0.07 minutes as the optimal cut-off to differentiate AHRE associated or not to thromboembolic events [sensitivity 65.4% (95% CI 48.8-79.0%), specificity 52.7% (95%CI 46.0-59.4%), area under the summary receiver operating characteristic curve (AUC-SROC): 0.62; Fig. 1 Panel B]. The analysis on AHRE burden indicated, instead, 1.4 minutes as the optimal cut-off [sensitivity 58.2% (95%CI 25.6-85.0%), specificity 57.5% (95% CI 42.0-71.7%), AUC-SROC 0.60; Fig. 1 Panel C]. PPV and NPV for 6 minutes and 24 hours cut-offs were similar in each analysis (Figure 2). Sensitivity analyses exclusively considering studies reporting data on patients without previous AF diagnosis and high-quality studies only yield similar results.

Conclusion
The present evidence-based approach suggests the presence (or not) of AHRE, rather than a specific duration, relates to an increased thromboembolic risk in CIED patients. A linear relationship between AHRE duration (both in terms of single longest episode than cumulative burden) and thromboembolic events was not observed.