bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pulsed field ablation for all types of atrial fibrillation single centre experience with individualized approach and medium-term outcome
Authors: Fiala M , Cernosek M , Bulkova V , Bahnik J , Rybka L , Funasako M , Lehar F , Manousek J , Toman O , Kala P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulsed field ablation (PFA) is a promising method to reduce procedure time and improve ablation safety and efficacy in all types of atrial fibrillation (AF).

Purpose
To present ablation approach and medium-term outcomes of PFA in all AF types.

Methods
Between 9/2021-10/2022, PFA using Farawave catheter was performed in 250 patients (63±11 years, 65 females). Patients with paroxysmal AF were basically scheduled for simple pulmonary vein isolation (PVI) (Farawave, ICE), patients with longstanding AF (LSPAF) underwent complex left atrial (LA) PFA (Farawave, CS 10-pole catheter, ICE); ablation extent varied in persistent AF.

Results
Paroxysmal AF (n=131; 115 ablated in SR), persistent AF (n=39; 11 ablated in SR), and LSPAF (n=64) were ablated with procedure times 58±20, 105±28, and 116±32 minutes, respectively, and fluoroscopy times 9±5, 14±7, and 17±7 minutes, respectively. Additional 16 patients underwent PFA for atrial tachycardia (AT). Ongoing AF was terminated by PFA in 13/16 (81%), 16/28 (57%), and 23/64 (36%) patients with paroxysmal AF, persistent AF, and LSPAF, respectively. In groups of paroxysmal AF ablated in SR, paroxysmal AF ablated in AF, persistent AF ablated in SR, persistent AF, and LSPAF, simple PVI was performed in 100%, 50%, 73%, 11%, and 0 patients respectively; and freedom from AF/AT was present in 86/99 (87%), 11/14 (79%), 7/10 (70%), 11/12 (92%), and 40/52 (77%) patients, respectively, of total 187 patients with follow-up ≥3 months (≥6 months in 139 patients). In 8 patients with repeat ablation post-PFA for paroxysmal AF (n=4), persistent AF (n=2), LSPAF (n=2), extra-PV AF/AT sources dominated in all groups. Complications included one tamponade with pericardiocentesis, and prolonged ST elevation with negative coronary angiography.

Conclusion
PFA using Farawave catheter was associated with reduced procedure times and favourable medium-term outcome for all AF types. Early experience specifically suggests improved outcome after extensive LA ablation for persistent AF/LSPAF.
Hybrid ablation of atrial fibrillation: long-term outcomes from a single center prospective experience
Authors: Mouram S , Pannone L , Della Rocca D , Gauthey A , Sorgente A , Del Monte A , Overeinder I , Bala G , Almorad A , Stroker E , Sieira J A , La Meir M , Brugada P , Chierchia G B , De Asmundis C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/introduction
Hybrid ablation of atrial fibrillation (AF) is emerging as a new technique for rhythm control with good clinical outcomes, especially in patients with non-paroxysmal AF. However, the role of hybrid AF in redo procedures is not clear. Moreover, long term clinical outcomes studies are lacking.

Purpose
The aim of this study is to define the long-term clinical outcomes of hybrid AF ablation in a large cohort from a single high-volume center. Furthermore, a correlation between the timing of hybrid AF and the outcomes is aimed.

Methods
All consecutive patients undergoing to hybrid AF ablation between 2014 and 2020 were enrolled in a prospective fashion. Hybrid ablation was performed in a one-step procedure consisting of: 1) Bilateral thoracoscopic epicardial ablation and 2) Percutaneous mapping and ablation. Pulmonary veins and posterior wall isolation was performed in all patients. Additional lesion set was performed based on physician judgement and clinical indication, including the following: superior vena cava isolation, bicaval line, anterior or posterior mitral line, cavotricuspid isthmus. Hybrid ablation time was analyzed as first hybrid procedure or redo hybrid after previous failed percutaneous procedure.
The primary endpoint was defined as freedom from any atrial tachyarrhythmias (ATas) ≥ 30 seconds after a 90-day post-ablation blanking period.

Results
A total of 120 patients were included, 92 (76.7%) patients with persistent or long-term persistent AF and 28 patients (23.3%) with paroxysmal AF. Hybrid ablation was the first procedure in 85 (70.8%) patients and the second or third procedure (redo or re-redo) in 35 (29.2%) patients. Compared to patients with a second or third hybrid procedure, patients with a first hybrid procedure had more often persistent AF [81 patients (95.3%) vs 11 patients (31.4%), p&lt;0.001].
At a mean follow-up of 52.1 months ± 29.0 there were 36 (30%) ATas recurrences, Figure 1. There was no significant difference in ATas free survival between patients with a first hybrid procedure and patients with a second or third hybrid procedure (69.4% vs 71.4%, Log-Rank p=0.81), Figure 2. Patients with a second hybrid procedure had higher ATas free survival compared to patients with a third hybrid procedure (86.4% vs 46.2%, Log-Rank p=0.01)

Conclusion
In a large cohort undergoing to hybrid AF ablation, the recurrence rate was 30% at a long-term follow-up of more than 4 years. Timing is of utmost clinical importance as delaying hybrid approach might be associated with worse clinical outcome.
Optimal anticoagulation intensity with warfarin for the prevention of thromboembolism with minimal bleeding in Asian patients with atrial fibrillation: multi-center, randomized controlled trial
Authors: Lee K H , Shin S S Y , Koh K J S , Park Y M , Lee J M , Kim S S , Kim J H , Kim D M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Korean Society of Cardiology

Background
Anticoagulation with warfarin in Korean patients with atrial fibrillation (AF) often has been decreased as an international normalized ratio (INR) of prothrombin time between 1.6 to 2.6 for the fear of bleeding, although universal criteria recommends to adjust it between 2.0 to 3.0.

Methods
In this randomized, open-label trial, we compared low intensity anticoagulation (INR 1.6 to 2.6) with standard intensity anticoagulation (INR 2.0 to 3.0) with warfarin in 616 patients with AF and at least 1 risk factor for stroke. The per-protocol, intension-to-treatment analysis was designed to determine whether low-intensity anticoagulation (n=308) was non-inferior to standard-intensity anticoagulation (n=308) with warfarin for the primary end point of net clinical outcomes defined as the sum of stroke, systemic embolism, major bleeding and death.

Results
The median follow-up duration was 1.8 years. Baseline characteristics of the two groups were comparable. Median value of INR was significantly higher in standard-intensity group than low-intensity group (2.19 vs. 2.07, p=0.002), whereas that of time in the therapeutic range was comparable between the 2 groups. The rate of primary outcome was 1.55% per year in low-intensity anticoagulation, as compared with 2.46% per year in standard-intensity anticoagulation (hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.22 to 1.74, p for non-inferiority &lt;0.001, p for superiority = 0.365). New-onset stroke occurred in 2 patients (0.52% per year) in low-intensity group and in 5 patients (1.23% per year) in standard-intensity group (HR 0.42, 95% CI 0.08 to 2.17, p for non-inferiority &lt;0.001, p for superiority = 0.297). Major bleeding occurred in 4 patients (0.88% per year) in low-intensity group and 5 patients (1.23% per year) in standard-intensity group (HR 0.84, 95% CI 0.22 to 3.17, p for non-inferiority &lt;0.001, p for superiority = 0.796). Major and minor bleeding occurred in 37 patients (9.58% per year) in low-intensity group and in 40 patients (9.85% per year) in standard-intensity group (HR 0.97, 95% CI 0.59 to 1.58, p for non-inferiority &lt;0.001, p for superiority = 0.899).

Conclusion
In Korean patients with AF, low-intensity anticoagulation with warfarin as INR 1.6 to 2.6 was non-inferior to standard-intensity anticoagulation with warfarin as INR 2.0 to 3.0 for the prevention of net-clinical outcome, and stroke or systemic embolism. There was no significant difference for the risk reduction of major bleeding.
Long-term effectiveness and safety of non-vitamin K antagonist anticoagulant in real world practice
Authors: Roh S Y , Kim D Y , Yoon E L , Lee H , Lee K N 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Backgrounds
Novel oral anticoagulants (NOACs) are effective to prevent stroke in patients with atrial fibrillation. Real world long-term data on the efficacy and safety of NOACs compared to warfarin in Asians are lacking.

Purpose
We aimed to explore the effectiveness and safety of NOAC in Asian patients with atrial fibrillation.

Methods
The medical records were reviewed in registry of four tertiary referral hospitals between January 1, 2012, and December 31, 2020. The primary outcome was the composite of thromboembolism, major bleeding and all caused mortality.

Results
Data were analyzed for 19,994 participants with oral anticoagulant and atrial fibrillation (median age, 72 years; female, 41.5%; warfarin, 35.5%; median CHA2DS2-VASc score, 3). The rate of the primary outcome was 5.5% per year in the NOAC group, as compared with 6.0% per year in the warfarin group (HR with NOAC, 0.70; 95% confidence interval [CI], 0.63 to 0.77; P&lt;0.001 for superiority). The rate of ischemic event was 2.2% per year in the NOAC group, as compared with 2.8% per year in the warfarin group (HR, 0.56; 95% CI, 0.48 to 0.65; P&lt;0.001). The rate of major bleeding was 1.9% per year in the NOAC group, as compared with 2.2% per year in the warfarin group (HR, 0.69; 95% CI, 0.58 to 0.82; P&lt;0.001), and the rates of all caused death were 1.9% and 3.2%, respectively (HR, 0.85; 95% CI, 0.71 to 1.02; P=0.08).

conclusion
In Asian patients with atrial fibrillation, NOAC was effective and safe to prevent thromboembolic events with less bleeding compared to warfarin.
Acute kidney injury following percutaneous left atrial appendage occlusion: results from an international multicentre registry
Authors: Della Rocca D , Magnocavallo M , Gilhofer T , Van Niekerk C , Ha G , D'ambrosio G , Galvin J , Urbanek L , Schmidt B , Lakkireddy D J , Mansour M , Saw J , Horton R , Gibson D , Natale A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Acute kidney injury (AKI) is a serious complication after invasive cardiac procedures and has been associated with a higher incidence of periprocedural complications and increased mortality. Data on the occurrence of AKI associated with left atrial appendage occlusion (LAAO) are very limited.

Purpose
To report the incidence, predictors, and clinical implications of AKI following percutaneous LAAO.

Methods
This multicenter registry included 2124 patients with successful Watchman implantation. AKI was defined according to the AKI Network criteria as an increase in serum creatinine of ≥0.3 mg/dL or of ≥50% over the course of 48 hours post-procedure. Patients meeting this definition were further categorized in three stages: stage 1, increase in serum creatinine ≥ 0.3 mg/dl (≥ 26.4 μmol/l) or of 1.5 to 2 times compared to baseline; stage 2, increase in serum creatinine of 2 to 3 times compared to baseline; stage 3, increase in serum creatinine of &gt; 3 times compared to baseline or serum creatinine ≥ 4.0 mg/dl [≥ 354 μmol/l] with an acute increase of at least 0.5 mg/dl [44 μmol/l].

Results
Post-procedural AKI was documented in 68 (5.5%) of 1234 patients with creatinine determination between 24 and 48 hours post-LAAO. Among them, 63 (92.6%) patients had AKI stage 1, 4 (5.9%) had AKI stage 2, and 1 (1.5%) had AKI stage 3.
AKI was associated with higher CHA2DS2-VASc (5.3 ± 1.4 vs. 4.8 ± 1.4; p=0.001) and HAS-BLED (3.8 ± 0.9 vs. 3.5 ± 1.0; p=0.01) scores at baseline, as well as a higher prevalence of diabetes mellitus (p=0.04) and CHF (p&lt;0.001).
At multivariate analysis (Table 1), independent predictors of AKI were CKD stage 4/5 (OR: 1.998; 95% CI: 1.018 – 3.923; p=0.04), and CHF (OR: 2.286; 95% CI: 1.328 – 3.934; p=0.01).
The average follow-up was 13 ± 7 months. The annualized rates of cardiovascular mortality were 5.5% in AKI and 1.0% in non-AKI patients (p=0.01). The annualized rates of overall mortality were 15.1% in AKI and 3.4% in non-AKI patients (p&lt;0.001).

Conclusion
AKI was an infrequent complication following percutaneous LAAO and a powerful predictor of cardiovascular and overall mortality during follow-up.
Brady- and tachyarrhythmias in paroxysmal atrial fibrillation: results from long-term continuous electrocardiographic monitoring in RACE V
Authors: Park Frausing M H J , Van De Lande M , Maass A H , Nguyen B O , Hemels M E W , Tieleman R , Koldenhof T , De Melis M , Linz D , Schotten U , Weberndorfer V , Crijns H J G M , Van Gelder I C , Nielsen J C , Rienstra M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Netherlands Cardiovascular Research Initiative: an initiative with support of the Dutch Heart Foundation, and grant support from Medtronic to the institution. MHJPF was funded by a grant from the Karen Elise Jensen Foundation. JCN was supported by a grant from the Novo Nordisk Foundation

Background
Atrial fibrillation (AF) has been associated with adverse events and constitutes a significant, global healthcare challenge. Paucity exists on the occurrence of brady- and ventricular tachyarrhythmias.

Purpose
The aim of this predefined sub-analysis of the Reappraisal of Atrial Fibrillation: interaction between hyperCoagulability, Electrical remodelling, and Vascular destabilization in the progression of AF (RACE V) study was to examine the prevalence of brady- and tachyarrhythmias using continuous rhythm monitoring in patients with paroxysmal self-terminating AF (PAF).

Methods
We identified 417 patients with PAF and at least two years of follow-up in RACE V; 25 patients with pacemakers at baseline were excluded. All remaining patients (n=392) received an implantable loop recorder and performed daily automated and weekly manual transmissions. Throughout follow-up, all detected episodes of tachycardia ≥182 BPM (cycle length ≤330ms) of ≥24 beats, bradycardia ≤30 BPM (cycle length ≥2000ms) of ≥12 beats, and pauses ≥5 seconds were adjudicated by three cardiologists.

Results
Over 1,272 patient years of continuous rhythm monitoring, we validated 1,940 episodes in 175 patients with paroxysmal self-terminating PAF (45%); 106 (27%) patients experienced AF or atrial flutter (AFL) with a rapid rate, pauses ≥5 seconds or bradycardias ≤30 BPM occurred in 47 (12%) patients (figure 1), and in 22 (6%) patients, both rapid AF/AFL and bradyarrhythmias were observed. No sustained ventricular tachycardias occurred. In the multivariable analysis, age &gt;70 years (HR 2.4, 95% CI 1.4-3.9), longer PQ interval (HR 1.9, 1.1-3.1), CHA2DS2-VASc score ≥2 (HR 2.2, 1.1-4.5), and treatment with verapamil or diltiazem (HR 0.4, 0.2-1.0) were significantly associated with bradyarrhythmia episodes. For tachyarrhythmia episodes, age &gt;70 years was associated with a significantly lower tachyarrhythmia risk (HR 0.4, 95% CI 0.2-0.7) in the multivariable analysis.

Conclusions
In a cohort exclusive to patients with self-terminating PAF, severe bradyarrhythmia episodes or AF/AFL with rapid ventricular rates occurred in 45% of patients. Our data highlight a higher than anticipated bradyarrhythmia risk in PAF.
Catheter ablation without fluoroscopy in pregnant with supraventricular tachycardia: substrate characterization and outcomes
Authors: Abdrakhmanov A , Ainabekova B , Nuralinov O , Smagulova A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Arrhythmia is a common extra genital pathology in pregnant. Catheter ablation without fluoroscopy demonstrated similar efficacy and safety to fluoroscopy-based procedure. However, data on pregnant population is limited.

Purpose
To evaluate the arrhythmias substrate and outcomes of catheter ablation without fluoroscopy in pregnant with supraventricular tachycardia.

Methods
44 pregnant with drug refractory supraventricular tachycardia (Mean age 26.4±3.1 years, mean gestation age 22.8±2.1 weeks) undergoing catheter ablation. The substrate characteristics, course of pregnancy, outcomes and arrhythmia recurrence documented during 24 months follow-up.

Results
Ablation was performed under the guidance of CARTO (n=20; 45.5%) and EnSite NavX mapping systems (n=24; 54.5%) without fluoroscopy in all cases. In the majority of cases ablated substrate was slow conduction way (n=21, 47.7%). Ablation of accessory pathways performed in 18 pregnant (40.9%).Combination of accessory pathways with slow conduction ways was present in 5 women (11.4%). Accessory pathways located at left free wall (n=8), in right free wall (n=5), right medioseptal (n=5) and posteroseptal (n=5). The median procedural time was 71 minutes (interquartile range 60-89). Acute success rate was 100%. Procedure related complication was observed in one women (2.3%), who developed an ileofemoral thrombosis. There was no termination of pregnancy after ablation. In two women (4.5%) was preterm delivery at 35 and 36 weeks of gestation. In the majority of cases was vaginal delivery (n=35; 79.5%). In two cases were placental abruption and preeclampsia (4.5%). There were 45 live births (in one case were twins) without any malformation. Neonatal outcomes: fetal birth weight was 3198.5±542.5 grams, 5 minute Apgar score was 8.4±1.1. There were no maternal and fetal mortality. At follow up period arrhythmia recurrence was not documented.

Conclusions
Pregnant mostly underwent catheter ablation for atrioventricular nodal reentrant tachycardia. Catheter ablation without fluoroscopy are safe and feasible in pregnant.
Cardiac implantable electronic devices and outcomes in heart failure patients with syncope
Authors: Rattanawong P , Chao C , Sriramoju A , Tagle-Cornell M , Farina J , Beirne E , Koepke L , Fatunde O , Ko Ko N , Shanbhag A , Barry T , Shen W K 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private hospital(s). Main funding source(s): Mayo Clinic

Background/Introduction
Syncope is a common presentation in heart failure (HF) patients. However, the associations between syncope and prognosis in HF patients with the cardiac implantable electronic device (CIED) have not been demonstrated. It is unclear whether syncope increases all-cause mortality in HF patients with CIED.

Purpose
We aimed to examine the association between syncope and all-cause mortality in the largest cohort of HF with reduced ejection fraction (HFrEF), mid-ranged ejection fraction (HFmEF), and preserved ejection fraction (HFpEF) patients with and without CIED.

Methods
A retrospective cohort of patients with HF and syncope at our hospital between 2010 and 2015 were identified, and 1:1 propensity was matched with a control group of HF patients without syncope. A chart review was conducted. The multivariate Cox regression model was applied to estimate the association between syncope and the all-cause mortality endpoint.

Results
3,449 HF patients were diagnosed with syncope (mean age, 72.8±14.5 years; 41.5% women), and the propensity-matched control HF patients without syncope (n=3,449) aged 72.8±14.3 years, and 42.5% women were selected. Cardiac implantable electronic devices were implanted more in HF patients with syncope (32.5% versus 13.7%, p&lt;0.001). Implantable cardioverter defibrillators were implanted more in HF patients with syncope (15.6% versus 8.3%, p&lt;0.001) as well as pacemakers (16.9% versus 7.5%, p&lt;0.001) and cardiac resynchronization therapy devices (6.9% versus 4.8%, p=0.015). Among HF patients with CIED, syncope significantly increased the risk of all-cause mortality in HFrEF patients (hazard ratio [HR]=1.479, 95% confidence interval [CI]: 1.197-1.828, p&lt;0.001) but not in HFpEF (HR=0.980, 95%CI: 0.793-1.210, p=0.849)(Figure 1). Syncope also tended to increase the risk of all-cause mortality in HFmEF patients with CIED but was not significant (HR=1.193, 95%CI: 0.762-1.865, p=0.762)(Figure 1). Among HF patients without CIED, syncope did not increase the risk of all-cause mortality in HFrEF (HR=0.923, 95%CI: 0.806-1.057, p=0.247), HFmEF (HR=1.074, 95%CI: 0.848-1.360, p=0.554), or HFpEF (HR=0.964, 95%CI: 0.883-1.052, p=0.406).

Conclusions
Syncope significantly increased the risk of all-cause mortality in HFrEF patients but not in HFmEF or HFpEF patients with CIED. The association of syncope and increased mortality in HFrEF patients with CIED suggests that syncope may be a marker and a factor of mortality and warrants further investigation.
Prevalence and prognostic value of ventricular conduction delay in heart failure with preserved ejection fraction
Authors: Weerts J , Achten A , Ghossein M , Mourmans S G J , Barandiaran Aizpurua A , Van Stipdonk A M W , Vernooy K , Prinzen F W , Brunner-La Rocca H P , Knackstedt C , Van Empel V P M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation; Health Foundation Limburg

Background
The pathophysiology of heart failure (HF) with preserved ejection fraction (HFpEF) is heterogeneous and incompletely understood. Identifying phenotypes of HFpEF is a promising approach to determine the underlying pathophysiological mechanisms and to improve treatment. Patients with electrical ventricular conduction delay (VCD) may represent a separate phenotype.

Objectives
To identify a VCD phenotype in HFpEF through assessment of QRS duration and vectorcardiographic QRS area. Moreover, to determine how differences in these VCD indices relate to adverse outcomes.

Methods
Consecutive patients underwent a comprehensive diagnostic work-up at baseline and were diagnosed with HFpEF. Baseline QRS duration was obtained clinically from a standard 12-leads electrocardiography (ECG). QRS area was derived from vectorcardiography analyses of the baseline ECG. Presence of VCD was categorically defined as QRS duration ≥120ms or QRS area ≥69µVs. Adverse outcome comprised a composite of HF hospitalization and cardiovascular mortality. Patients with cardiac devices before and up until one year after baseline were excluded in prognostic analyses.

Results
From a total of 346 HFpEF patients included in this study, 71.3% had a QRS duration &lt;100ms compared to 20.1% with QRS duration 100-119ms and 8.6% with QRS duration ≥120ms. Only 3.8% of all patients had a QRS area ≥69µVs, indicating delayed left ventricular lateral wall activation. A history of coronary artery disease was more prevalent in patients with higher QRS duration or larger QRS area. Sex differences were mainly found in those with a QRS duration ≥100ms, which was present in 54.8% of all males and 17.5% of all females.
After a median of 2 years follow-up, 16.4% of the patients had an adverse outcome. Longer QRS duration but not larger QRS area was associated with more adverse outcomes on a categorical scale (Figure). In multivariable Cox-regression analyses adjusted for sex and age, QRS duration was an independent predictor of adverse outcomes (hazard ratio per 1ms increase = 1.017, 95% confidence interval 1.004-1.030, P = 0.012) (Table).

Conclusion
HFpEF patients have a low prevalence of a VCD phenotype, 8.6% have a QRS duration ≥120ms and 3.8% a QRS area ≥69µVs. However, QRS duration &gt;100ms was an independent predictor for adverse outcomes. Thus, future efforts are warranted to understand the biologic and mechanical mechanisms underlying the association of QRS duration and adverse outcomes, and to determine its clinical implications.