bluuebunny/crossref_metadata_2025_split huggingface dataset:
Electrophysiological findings in patients undergoing left atrial appendage occlusion following previous electrical isolation
Authors: Della Rocca D , Magnocavallo M , Gianni C , Mohanty S , Vetta G , Bassiouny M , Al-Ahmad A , Horton R , Lavalle C , Burkhardt D , Gallinghouse J , De Asmundis C , Chierchia G B , Di Biase L , Natale A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left atrial appendage electrical isolation (LAA) is an important adjunctive ablation strategy in patients with nonparoxysmal atrial fibrillation. If impaired mechanical function following isolation is observed, long-term oral anticoagulation (OAC) or, as an alternative, LAA occlusion are required. Although focal electrical potentials from the LAA do not result in normalization of appendage mechanical function, they may potentially be a source of arrhythmogenic triggers. Those focal areas might be challenging to ablate after LAA occlusion device implantation.

Purpose
We sought to report the incidence of focal electrical potentials in patients with a previously isolated LAA and transesophageal echocardiography (TEE) evidence of severely impaired LAA mechanical function undergoing endocardial LAA occlusion.

Methods
In 124 patients undergoing LAA occlusion following LAA isolation, a circular mapping catheter (CMC) was used before occlusion to document any residual LAA electrical activity.

Results
At preprocedural TEE, the median LAA contraction velocity was 0.13 m/s (IQR: 0.05-0.19) and was significantly impaired in all patients. Of the 124 patients (mean age: 69±8 years; 71.7% males), 61 (49.2%) did not display any evidence of residual LAA electrical activity.
In the remaining 63 (50.8%) patients, residual electrical potentials resulting in LAA reconnection were recorded on the CMC positioned into the appendage. On average, 4.9±1.7 radiofrequency energy applications (45W, mean duration of each RFA: 14.2±3.4s) were required to re-achieve complete isolation. Subsequent appendage occlusion was successful in all patients. No leaks ≥5mm and 3 (2.4%) 3-4mm-leaks were documented at 45day-TEE.

Conclusions
Focal electrical activity from the LAA was documented in approximately half of our patients. Although focal electrical potentials do not result in normalization of LAA mechanical function, they may potentially act as arrhythmogenic triggers. Since it may be challenging after device implantation, assessment and ablation of those areas should be considered before occlusion device deployment.
Lower dose direct oral anticoagulation or warfarin in atrial fibrillation. Which one is the best when time on therapeutic range information is available?
Authors: Luojus A , Lehto M , Halminen O , Haukka J , Aro A L , Putaala J , Linna M , Mustonen P , Kinnunen J , Niemi M , Hartikainen J , Airaksinen J E K 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Helsinki and Uusimaa Hospital District (TYH2019309) and The Finnish Foundation for Cardiovascular Research

Background and aims
Elderly patients with atrial fibrillation (AF) and patients with renal failure – for example – are recommended to use reduced doses of direct oral anticoagulants (DOACs) to minimize risk of ischemic stroke and hemorrhagic complications. However, it is not known whether DOACs used with reduced doses are better than warfarin when the quality of warfarin treatment is available by means of time in therapeutic range (TTR).

Methods
The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) is a nationwide study of AF patients that combines data from several Finnish health care registers. Here all new-onset AF patients from 2011 to 2018 on reduced dose DOAC in Finland and patients on warfarin with TTR data were analyzed.
Comorbidities, concomitant medications and CHA2DS2-VASc -scores were recorded until date of AF diagnosis. OAC purchases from diagnosis of AF to the end of study were analyzed. ICD-10 diagnoses for stroke (ischemic or hemorrhagic) or transient ischemic attack during OAC-use were analyzed until maximum follow-up of 730 days. Crude rates of stroke as well as weighted rates are provided. To avoid confounding by baseline characteristics as well as medications, an inverse probability of treatment weighted analysis was made.
For warfarin users with sufficient laboratory data, time in therapeutic range (TTR) was calculated and patient quartiles by TTR were assigned.

Results
Altogether, 52 204 new-onset AF patients with OAC therapy (46.1 % male, mean age 75.7 years, 43 549 on warfarin - with mean TTR 66%, median TTR 72%) were followed for 91 549 patient-years (py). Rate of stroke among patients on lower dose DOACs was 5.2/100 patient years (py) for dabigatran (n=2 672), 4.3/100 py for apixaban (n=3 936), 3.9 /100 py for rivaroxaban (n=1 866). In the TTR-quartiles of patients on warfarin, the rates of stroke were 9.3, 7.2, 5.5 and 4.3 /100 py from the lowest (mean TTR 32%) to the highest quartile (mean TTR 90%), respectively. The weighted rates of stroke were 5.1, 3.5 and 3.1/100 py for dabigatran, apixaban and rivaroxaban, respectively and for warfarin from the lowest to the highest quartile: 8.7, 7.0, 5.4 and 4.1/100 py. Figure provides survival probabilities of the OAC groups with confidence limits.

Conclusion
In AF patients treated with OAC, the rates of stroke were highest among patients on warfarin at the lowest TTR quartiles, while the differences between high TTR groups and lower dose DOACs were only modest.
Effects of sodium-glucose cotransporter-2 inhibitors on cardiovascular outcomes in patients with atrial fibrillation and type 2 diabetes mellitus
Authors: Choi Y , Seung J H , Park S Y , Kim S H , Kim S H , Kim H J , H Y M , Kim J H , Kim T S , Jang S W , Oh Y S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
A sodium-glucose cotransporter-2 inhibitor (SGLT2i) improves clinical outcomes in patients with type 2 diabetes (T2DM) and cardiovascular disease. Also use of SGLT2i was associated with a reduction of atrial fibrillation (AF) burden.

Purpose
We investigated the effect of SGLT2is on clinical outcomes in patients with T2DM and AF

Methods
This was a retrospective study using a clinical data warehouse (CDW) constructed from 7 medical centers. We analyzed 11,043 patients with AF and T2DM. The patients were classified to the SGLT2i group and the control group according to the SGLT2i use. We performed 1:2 propensity score matching analysis. The primary endpoint was a composite of all-cause death or hospitalization due to heart failure events. The secondary endpoints were acute myocardial infarction, stroke, renal function decline and an initiation of dialysis.

Results
The propensity score matched population consisted of 467 patients in the SGLT2i group and 848 patients in the control group. During a mean follow up of 31.8 (± 21.0) months, the incidence of the primary endpoint was significantly lower in the SGLT2i group (9.6% vs. 16.9%, hazard ratio [HR] 0.624 [0.446 – 0.873]). SGLT2i was associated with reduced all-cause death (HR 0.292 [0.144 – 0.591]) and non-significantly lower risk of heart failure hospitalization (HR 0.734 [0.509 – 1.060]). There was no significant difference in the incidence of myocardial infarction, ischemic stroke, CKD progression or initiation of dialysis between the two groups. In multivariate analysis, age, renal dysfunction, prior heart failure, and the absence of SGLT2i were independent predictors for the worse outcome.

Conclusion
SGLT2 inhibitor was associated with a lower incidence of all-cause mortality or heart failure hospitalization in patients with AF and T2DM.
Brain lesions and cognitive decline in patients with atrial fibrillation
Authors: Hennings E , Bhend K , Paladini R E , Aeschbacher S , Coslovsky M , Rodondi N , Beer J H , Auricchio A , Moschovitis G , Chocano P , Sinnecker T , Conen D , Kuehne M , Bonati L H , Osswald S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation

Background
In addition to clinical stroke, atrial fibrillation (AF) is associated with a high burden of various vascular brain lesions, the majority of which are silent. However, the impact of these lesions on cognitive performance remains unclear.

Purpose
Our aim was to assess the association between vascular brain lesions and cognitive decline in clinically asymptomatic AF patients.

Methods
In a prospective multicentre cohort trial, we included 1536 clinically stable AF patients aged ≥65 years and a limited number of patients aged 45–64 years (90% on oral anticoagulation therapy). Patients underwent brain magnetic resonance imaging (bMRI) for the detection of any brain lesions at baseline (ischemic brain lesions and microbleeds) and yearly cognitive assessment using different standardized tests. Cognitive decline was defined as a measurement &gt;1 standard deviation of the age-education standardized baseline population, compared with individual baseline levels. Multivariable adjusted Cox regression analyses were performed to assess the relationship of baseline brain lesions presence with cognitive decline during follow-up.

Results
At the time of inclusion, 1030 (67%) of 1536 patients (mean age 72±8 years, 73% male) had one or more vascular brain lesions on baseline MRI. Based on the Montreal Cognitive Assessment score (MoCA), cognitive decline developed in 159 (10%) patients during a mean follow-up of 4.8 years. The incidence rate (per 100 person-years) for cognitive decline (MoCA score) was 3.64 and 1.82 in patients with and without brain lesions, respectively. After multivariable adjustment, the hazard ratio (95% CI) for cognitive decline (MoCA score) was 1.29 (0.85-1.96). The association of brain lesions with cognitive decline was 1.57 (1.02-2.40) for the Digit Symbol Substitution Test (DSST), 1.28 (1.01 to 1.63) for the semantic fluency test (SFT), and 0.91 (0.69-1.21) for the Trail Making Test Part A (TMT-A).

Conclusion
In our contemporary AF cohort, two thirds of patients had brain lesions on baseline MRI, and these lesions were predictive of worse cognitive outcomes in the mid-term on some of the tests used. The full effects on cognitive outcome will be obtained during even longer follow-up.
JK07 prevents atrial fibrosis and atrial fibrillation inducibility in a porcine DOCA model
Authors: Tubeeckx M R L , Goovaerts B , Van Fraeyenhove J , De Meyer G , De Keulenaer G , Heidbuchel H , Segers V 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Geconcerteerde Onderzoeksactie (GOA) grant 499 of the University of Antwerp
Industrieel OnderzoeksFonds/Strategisch Basisonderzoek 498 (IOF/SBO) research grant of the University of Antwerp

Background
Atrial fibrosis is a substrate of atrial fibrillation (AF), and higher burdens of fibrosis are associated with resistance to therapy and worse prognosis. Currently, no therapies exist that target atrial fibrosis. JK07 is a long-acting neuregulin-fusion protein that has been shown to decrease ventricular fibrosis in models of heart failure through selective stimulation of the ErbB4 receptor.

Purpose
To test the ability of JK07 to reduce atrial fibrosis and AF inducibility in minipig model of deoxycorticosterone acetate (DOCA, an aldosterone agonist) induced hypertension.

Methods
18 Aachener minipigs were randomized into 3 groups: control (CTRL), DOCA + Vehicle (DOCA+VEH) and DOCA+JK07. The control group did not undergo a therapeutic intervention. To induce hypertension and atrial fibrosis, pellets releasing 10 mg/kg DOCA over a period of 60 days were implanted in minipigs in the DOCA+VEH and DOCA+JK07 groups. The DOCA-implanted animals underwent weekly treatment with JK07 (0.3 mg/kg; DOCA + JK07) or its vehicle (DOCA + VEH), starting at the day of implantation (total of 9 administrations). After 60 days, arterial blood pressure was measured invasively and a decapolar catheter was placed in the right atrium. AF inducibility was tested by performing 50 burst pacing episodes and quantified as the percentage of successful episodes where an AF run ≥ 5 sec could be induced after the burst, out of the 50 attempts. Atrial fibrosis was quantified using ImageJ software on Masson trichrome staining of left atrial specimens, isolated after euthanizing the animals.

Results
Mean arterial pressure was significantly higher in the DOCA+VEH (142 ± 10 mmHg) and DOCA+JK07 (132 ± 15 mmHg) groups than in the CTRL group (105 ± 8 mmHg, p&lt;0.01), without an effect of JK07.
AF inducibility in the DOCA+VEH group was significantly higher than in the CTRL group (66/250 vs. 9/300, p&lt;0.001), and the DOCA + JK07 group (66/250 vs. 8/300, p&lt;0.001). Likewise, the degree of atrial fibrosis was significantly higher in the DOCA+VEH group compared to CTRL (14.18 ± 1.81 vs. 8.30 ± 2.52, p&lt;0.001) and compared to DOCA+JK07 (14.18 ± 1.81 vs. 10.65 ± 1.59, p=0.0049).

Conclusions
JK07 prevents atrial fibrosis and AF inducibility in a porcine DOCA model. The effect of JK07 is unrelated to effects on blood pressure, but probably related to reduced atrial fibrogenesis.
Early timing of ablation after diagnosis: a powerful way to reduce atrial fibrillation recurrence
Authors: De Greef Y , Bogaert K , Buysschaert I 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Diagnosis-to-ablation time (DAT) is a strong, modifiable predictor of AF recurrence after ablation. Referral time for ablation, and hence DAT became shorter over time.

Purpose
To search for the shortest DAT still impacting outcome and to look at the evolution of the "DAT-AF recurrence" relation over time in a wide range of DAT.

Methods and results
Two cohorts of 1000 AF patients (69% males, age 62±10 years) undergoing PVI (2006-2014 and 2017-2019) were followed for 3years. Clinical success, defined as freedom of documented AF was achieved in 61,7% of patients.
Independent predictors of clinical success were age (HR=1,01; 95%CI 1,01-1,02; p 0,003), AF type (HR=0.54; 95%CI 0.46-0.63; p&lt;0.0001), left atrial size (HR=1.05; 95%CI 1.03-1.06; p&lt;0.0001), DAT (HR=1.00; 95%CI 1.00-1.00; p=0.001) and ablation technique (p=0.01) in multivariable-adjusted analysis.
DAT decreased over time from 48±47 to 35±60months (p=0,001). Relation between the DAT (range 0-288months) and AF recurrence at 3 years was assessed in 1892 patients.
The adjusted AF recurrence rate rises steeply from 27 to 40% in the first 36months. With further lengthening of the DAT the curve flattens following a less steep rise up to 45% until 90months. Further flattening occurs after a DAT of 90months.

Conclusion
The AF recurrence rate starts to rise immediately after diagnosis and demonstrates a linear relation over time with increasing DAT times, most pronounced in the first 3 years after diagnosis and flattening thereafter. Our data advocate for ‘as early as possible’ PVI planning following diagnosis of AF to improve outcome.
Electrophysiological findings during re-do procedures after single-shot pulmonary vein isolation for atrial fibrillation with pulsed field ablation
Authors: Magni F T , Scherr D , Manninger M , Sohns C , Sommer P , Hovakimyan T , Blaauw Y , Mulder B A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulsed field ablation (PFA) is a novel non-thermal ablation modality which applies electroporation to destabilize the cell membranes, leading to selective ablation of the atrial myocardium whilst sparing surrounding tissues and structures. It’s discriminating nature and potential for minimal adnexal injury opens new, promising horizons into catheter ablation of AF. However, one of the major issues to address is long-term results of the technique.

Purpose
To investigate the electrophysiological findings and type of arrhythmias during redo-ablation in 15 patients who underwent pulmonary vein isolation (PVI) for atrial fibrillation (AF) using single-shot PFA.

Methods
We investigated patients who underwent redo-ablation due to occurrence of AF/ atrial flutter (AFL) or tachycardia (AT) following initial PVI with PFA. We report the electrophysiological findings and ablation strategy during redo-ablation.

Results
Out of 447 patients undergoing index PVI with PFA, 15 patients (age: 61.8±10.4 years; 8 (53%) males; left atrial volume index (n=10): 39.4±14.6 mL/m2) were referred for redo-ablation after index PFA. Indication for the index ablation was paroxysmal-AF in 8 patients, persistent-AF in 6 and long-standing-persistent-AF in one patient. Mean time-to-recurrence was 5.0±1.8months. Three patients received additional posterior-wall-isolation during index PFA. Thirteen (85%) patients suffered AF recurrence and 5/13 had concomitant AFL. In the remaining 2 patients, one had a recurrence of (box-dependent) AFL, and one had AT. No patients had all PVs reconnected. Reconnection in zero, one, two or three PVs was found in 33%, 20%, 20%, and 27% of patients, respectively. All 7 patients with zero or one reconnection with AF recurrence received additional/repeat posterior-wall-isolation during re-ablation, while in the others PVs were re-isolated. In 1/3 patients who had posterior-wall ablation during index PFA, durable isolation of the posterior wall was confirmed during re-do procedure. Patients with only AFL/AT had no reconnection of PVs, and the substrate was successfully ablated.

Conclusion
We observed durable PVI in 62% of the PVs in patients with AF/AFL recurrence after PFA PVI. In one-third of patients all PVs were isolated. The predominant recurrent arrhythmia following PVI-only was AF. Concomitant (33%) or isolated (14%) AFL/AT recurrence was observed in 47% of patients.
Long term outcome in patients who refused radiofrequency ablation for atrial fibrillation
Authors: Kim S , Kim S H , Choi Y , Kim H , Jang S W , Hwang Y , Kim J H , Kim T S , Park S , Seung J , Oh Y S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Rhythm control is a therapeutic approach to restore sinus rhythm from atrial fibrillation (AF). Current studies have demonstrated efficacy of rhythm control with radiofrequency catheter ablation (RFCA) for survival, however there is lack of data regarding the long term outcome of patients who refused RFCA.

Purpose
This study was aimed to compare outcomes, consist of death and stroke, in patients who refused RFCA.

Method
Patients with AF who had been proposed for RFCA but refused and also any rhythm control strategy were enrolled. The primary outcome was all cause death and incidence of stroke, compared with patients with AF who had been treated with RFCA.

Results
A total 174 patients who refused AF, 175 patients treated with RFCA were enrolled. Median follow up duration was 1125.1 ± 799.0 days. Of refused AF group, 39 (22.3%) were paroxysmal AF at the time of diagnosis. During follow-up, 9 patients in refused RFCA and 11 patients treated with RFCA group had died (4.1% vs 6.1%, p=0.3 by log rank test). Incidence of stroke was significantly higher in patients who refused RFCA, compared with RFCA group (12.0% vs 1.1% , p =0.001 by log-rank test). Cox Regression model showed refusing RFCA was an independent risk factor for the incidence of stroke (Hazard ratio 6.7, 95% Confidence Interval 1.48 – 30.3, p=0.013).

Conclusion
In AF patient who had refused rhythm control, incidence of stroke was significantly higher in patients who refused RFCA and rhythm control, compared with who had been treated with RFCA. There was no difference in all-cause mortality between two groups.
Single-center outcome after ablation of atrial fibrillation using very high-power short duration pulmonary vein isolation
Authors: Rohrer U , Manninger M , Reischl A , Eberl A S , Kurath-Koller S , Andrecs L , Thonhofer N , Magg C , Zirlik A , Scherr D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Catheter ablation of atrial fibrillation is (AF) an established second line therapy for patients with symptomatic paroxysmal (PAF) and persistent AF (persAF). Novel ablation catheters with integrated thermocouples allow fast application of radiofrequency lesions with powers up to 90W.
We aimed to describe primary and secondary outcomes after very high-power short duration (vHPSD) ablation.

Methods
201 consecutive patients (127 PAF, 68 persAF, 6 longstanding persistent AF) underwent pulmonary vein isolation (PVI) using the QDOT Micro Catheter (Biosense Webster) with the ablation mode QMODE+ (90W, 4s, interlesion distance ≤4mm anterior, ≤6mm posterior).

Results
Mean age was 62±10 years, 38% were female, median CHA2DS2-VASc Score was 2 (0, 7). Median follow up duration was 196 (30, 461) days. 35% of patients had additional ablation of typical right atrial flutter.
Primary success rate to achieve pulmonary vein isolation was achieved in all patients, no catheter-related complications (e.g., charring, steam pop) occurred. First pass isolation of all 4 PVs was achieved in 53% of patients, re-ablations were necessary in the carina regions (right: 27% of cases, left: 20%), 34% at multiple regions including the ridge, 12% in other regions around the PVs. Median procedure for PVI only were 110 (36-344) minutes.
Arrhythmia-free survival was 79,3%. 21 patients underwent re-do procedures during follow-up showing most commonly showing gaps in the right PVs (RSPV 52%, RIPV 43%), the left inferior PV (48%), as well as the LSPV (38%) and the ridge (24%); with 91% of patients with recurrence showing more than one site reconnected.

Conclusion
Very high-power short duration ablation allows safe and quick pulmonary vein isolation. However, first pass isolation rate is low due to gaps in the carina regions. Arrhythmia-free survival is comparable to other pulmonary vein isolation techniques.