bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left common trunkus pulmonary veins have genetic background and poor rhythm outcome after atrial fibrillation catheter ablation
Authors: Choi S , Yang S Y , Oh J K , Kim D , Park J W , Yu H T , Uhm J S , Joung B , Lee M H , Hwang C , Pak H N 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
There is a genetic background in pulmonary vein (PV) development and atrial fibrillation (AF). However, the genetic trait of PV variations and their rhythm outcome after AF catheter ablation (AFCA) is unclear.

Objective
We explored the genetic and clinical characteristics and long-term rhythm outcomes of AF patients with PV variation or left common trunkus (LCT)-PV.

Methods
We included 2,897 AF patients (74.0% male, age 59.0 ± 10.7 years, 66.3% paroxysmal AF) with available genome-wide association study results, cardiac computed tomogram data, and protocol-based regular rhythm follow-up from the Yonsei AF ablation cohort database. We defined LCT-PV when the upper and lower PV separate at &gt;10 mm distal to the left PV antrum margin. PV variations included both LCT-PV and accessory PVs. We analyzed the polygenic risk score (PRS) of 12 AF-associated genes (DSP, GJA1, HCN4, KCNQ1, NPPA, PITX2, RYR2, SCN5a, SHOX2, ATP2A2, TBX3, and TBX5) and long-term rhythm outcomes after AFCA.

Results
We found PV variation in 296 (10.2%) and LCT-PV in 102 (3.5%). PRS of 1,227 single nucleotid polymorphisms (SNPs) was significantly higher in PV variation patients (p=4.93e-08) and LCT-PV patients (p=1.95e-20). The patients with LCT-PV had higher CHA2DS2VASc scores (p=0.024) and lower atrial epicardial adipose tissue volume (p=0.034). During 39.7 ± 34.8 months follow-up period, LCT-PV patients had a significantly higher recurrence rate than their counter part in the paroxysmal AF sub-group (Log-rank p=0.036), but not in overall PV variations. LCT-PV with the highest 10% PRS was independently associated with AF recurrence after AFCA (HR 2.10, 95% CI 1.21-3.63, p=0.008).

Conclusions
Among the patients who underwent AFCA, PV variation, including LCT-PV, has a significant genetic background. The post-AFCA recurrence rate was significantly higher in patients with LCT-PV and high PRS, especially in paroxysmal AF.
Outpatient atrial fibrillation ablation: feasibility, safety and economic implications
Authors: Jimenez-Candil J , Hernandez J , Morinigo J L , Sanchez Garcia M , Cruz A , Oterino A , Sanchez P L 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Catheter ablation of atrial fibrillation (CA-AF) is the most common ablation procedure in Spain.

Purpose
To analyze the feasibility of performing this procedure on an outpatient approach among patients undergoing scheduled to CA-AF.

Methods
We compared prospectively the results of all programmed CA-AF procedures in two consecutive periods: from April 1, 2018 to March 31, 2019 (conventional strategy CON-E]: discharge after at least one day of hospitalization, n=100) and from April 1, 2019 to December 31, 2021 (same-day discharge strategy [SDD-E] in which patients were referred for an outpatient procedure by intention to treat, n=320). We established a Primary Efficacy Objective (percentage of patients discharged on the same day in SDD-E), a Primary Safety Objective (cumulative incidence of urgent/unplanned care [UUC] in the 10 days following discharge) and a Secondary Objective (average cost per procedure including day hospital stay, hospitalization and UUC in the 10 days following discharge, using the most recent fees of the Spanish Public Health System).

Results
Primary Objective of Efficacy: in 358/380 procedures (94%) the patient was discharged within 12 hours after their arrival at the hospital (range of length of hospital stay: 7-10 hours). There was no difference in the early discharge rate between cryoablation vs. radiofrequency (94% vs. 95%; p=0.8). The reasons for patients being hospitalized after ablation in the same-day discharge strategy are displayed in Figure 1. Primary Objective of Safety: Twelve patients (12%) of the CON-E required urgency care within 10 days of discharge, compared to 53(14%) of the SDD-E (p=0.6), most of them due to recurrence of AF. Figure 2. Among SDD-E patients, one was hospitalizated due to severe groin haematoma on day 3 after discharge. The remaining 52 patients with UUC were discharged within 8 hours of arrival at the Medical Center. Secondary Objective: The SDD-E reduced hospital stays: 0 [Interquartilic Range: 0-0] vs. 1 [1-1] (p&lt;0.001), resulting in lower cost per procedure: 552 euros (95% CI: 486-618) vs. 1738 euros (95% CI: 1172-1805) (p&lt;0.001).

Conclusions
CA-AF can be performed with less than 12 hours of hospital stay in 94% of patients. Compared with the conventional strategy, SDD-E does not increase the rate UUC within 10 days of discharge and is associated with a significant reduction in cost per procedure.
Re-do ablation procedure characteristics after pulmonary vein isolation using pulsed field ablation for atrial fibrillation
Authors: Neven K , Fueting A , Hartl S , Reinsch N 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulsed field ablation (PFA) has recently been introduced as a novel routine ablation technology for paroxysmal atrial fibrillation (PAF). A few small clinical studies and registries have reported an initial clinical success rate of approx. 80% after 1 year. Here, we present the results from re-do ablation after PVI using PFA for AF.

Methods
In symptomatic AF patients, re-do ablation in conscious sedation using a contact force sensing catheter and 45W RF energy was performed. In all patients, pre- and post-ablation high-density bipolar voltage 3D maps using a pentaspline diagnostic catheter were performed. Procedural parameters and acute success were assessed.

Results
Eighteen patients (age 67 years; 17% female; 56% PAF) from a total of 304 patients (age 67 years; 42% female; 47% PAF) (6%) treated with PFA as initial AF therapy underwent a re-do ablation 212 days after the index procedure. Mean CHA2DS2-VASc-score was 1,7 in the re-do group vs. 2,5 in the index procedure group. Mean duration since first AF diagnosis and BMI were not significantly different. In 12/18 (67%) patients, reconnection of at least 1 PV was found (LSPV 2x; LIPV 4x; RSPV 2x; RIPV 2x, left carina 4x; right carina 2x). All reconnected PVs were successfully reisolated. In 11/18 (61%) of patients, an atrial flutter (AFL) or tachycardia (AT) was identified (roof 5x; mitral isthmus 5x; anterior/septal 3x; cavotricuspid isthmus 5x). In 5/12 (42%) of patient with reconnection of at least 1 PV, AT/AFL occurred. In contrast, in all 6 patients (100%) with persistently isolated PVs AT/AFL occurred. All tachycardias were successfully ablated.

Conclusions
Re-do ablation rate after PFA for AF was relatively low (6%), involving mostly male patients. PV reconnection rate was 67%, site of PV reconnection was predominantly left-sided. In 61%, predominantly left-sided AT/AFL occurred. Notably, in all patients with persistently isolated PVs AT/AFL was observed.
Improved prognosis with integrated care management including early rhythm control and healthy lifestyle modification in patients with concurrent atrial fibrillation and diabetes mellitus
Authors: Ahn H J , Lee S R , Choi E K , Lee S W , Han K D , Oh S , Gregory L I P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Patients with concurrent atrial fibrillation (AF) and diabetes mellitus (DM) [AF-DM] have a high risk of cardiovascular and diabetes-related complications, but are less engaged in a comprehensive treatment approach.

Purpose
We evaluated the association of early rhythm control (ERC), lifestyle modification (LSM), and a combination of ERC and LSM with cardiovascular or diabetes-related complication risk in patients with AF-DM.

Methods
From the National Health Information Database, 47,940 patients diagnosed with AF-DM in 2009–2016 were included. We defined ERC as rhythm control therapy within two years of AF diagnosis and LSM as adherence to ≥2 of the healthy behaviors among non-current smoking, non-drinking, and regular exercise. We compared the primary (ischemic stroke) and secondary (macro- and microvascular complications, glycemic emergency, and all-cause death) outcomes in four groups: non-ERC and non-LSM (group 1), LSM only (group 2), ERC only (group 3), and both ERC and LSM (group 4).

Results
Of total, 10,617 (22%), 26,730 (55.8%), 2,903 (6.1%), and 7,690 (16.0%) were classified into groups 1 to 4, in sequence. The mean duration from AF diagnosis to ERC was 25.6±75.5 days. During 4.0 (interquartile range: 2.5–6.2) years’ follow-up, groups 2 and 3 were associated with 23% and 33% lower risks of stroke than group 1, respectively. Group 4 was associated with the lowest risk of stroke: hazard ratio (HR) 0.58, 95% confidence interval (CI) 0.51–0.67, p&lt;0.001. Regarding secondary outcomes, the lowest risks were also observed in group 4; macro- and microvascular complications, glycemic emergency, and all-cause death had HRs (95% CIs) of 0.63 (0.56–0.70), 0.88 (0.82–0.94), 0.72 (0.62–0.84), and 0.80 (0.73–0.87), respectively, all p&lt;0.001.

Conclusions
For AF-DM patients, ERC and LSM exert a synergistic effect in preventing cardiovascular and diabetes-related complications with the greatest lowered risk of stroke. A comprehensive treatment approach should be pursued in AF-DM patients.
Impact of concomitant proton pump inhibitor during oral anticoagulant treatment
Authors: Lee K N , Kim D Y , Roh S Y , Kim H Y , Hwang K S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Proton pump inhibitor is commonly used for gastroprotective effect in patients with a combination of antiplatelets and anticoagulants. However, data quantifying the concomitant proton pump inhibitor for clinical adverse outcomes other than gastrointestinal bleedings of oral anticoagulant is lacking.

Purpose
We aimed to explore the effect of concomitant proton pump inhibitor on the effectiveness and safety of oral anticoagulant in patients with atrial fibrillation.

Methods
The medical records were retrospectively reviewed from four tertiary referral hospitals between January 1, 2012, and December 31, 2020. Concomitant use of drug was quantified as the overlapping proportion over the duration of oral anticoagulant therapy. Primary endpoint was the time to occurrence of ischemic stroke, systemic embolism, intracardiac thrombus, major bleeding events, or death.

Results
Data were analyzed for 20,750 episodes with oral anticoagulant and atrial fibrillation (median [IQR] age, 71 [63-78] years; female, 42.5%; warfarin, 37.3%; median [IQR] CHA2DS2-VASc score, 3 [2-5]). The risk of primary endpoint was greatest in the group of persistent use (80% or more of overlapping proportion) of proton pump inhibitor among the other groups with less overlapping proportion (adjusted hazard ratio, 1.88; 95% confidence interval, 1.63–2.16; P for groups, &lt;0.001). Concomitant proton pump inhibitor was not associated with the risk of major bleeding from the gastrointestinal tract.

Conclusion
Among patients with atrial fibrillation receiving oral anticoagulant, concomitant use of proton pump inhibitor increased the rate of thromboembolism, major bleeding, or death in proportion of overlapping period.
Racial differences in atrial fibrillation-related strokes and mortality
Authors: Kang D S , Yang P S , Kim D H , Jang E S , Yu H T , Kim T H , Sung J H , Pak H N , Lee M H , Lip G Y , Joung B Y 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background and Aims
Adverse outcomes associated with atrial fibrillation (AF) in Asians have not been fully elucidated. In a patient-level comparative analysis of UK Biobank and Korean National Health Insurance Service-Health Screening data, we evaluated the race-specific associations of AF with stroke and mortality.

Methods
This study enrolled 425,805 Asians (mean [SD] age, 56.0 [9.3] years; 55.3% of men) and 372,851 Whites (mean [SD] age, 57.1 [8.0] years; 47.6% of men). The main outcomes were total, ischemic, and hemorrhagic strokes and all-cause death.

Results
During the follow-up period (mean [SD], 7.3 [1.4] years in Asians; 11.7 [1.5] years in Whites), the incident rates (IR) of AF per 1000 person-years were 2.6 (95% CI, 2.5–2.7) in Asians and 4.4 (95% CI, 4.3–4.5) in Whites. The IR of total, ischemic, and hemorrhagic strokes were greater in Asians with AF than in Whites with AF. The rate difference (IR of the outcome in those with AF minus IR of the outcome in those without AF) for total stroke was 15.2 (95% CI, 13.4–17.0) in Asians and 4.5 (95% CI, 4.0–5.0) in Whites. For ischemic and hemorrhagic strokes, the rate differences were 2.5- to 3.5-fold higher in Asians than in Whites. Asians had a rate difference of 26.3 (95% CI, 24.2–28.4) for all-cause death, whereas Whites had a rate difference of 20.7 (95% CI, 19.7–21.7).

Conclusion
Despite the higher incidence of AF in Whites, the outcomes of AF-related rates of total, ischemic, and hemorrhagic strokes and all-cause death was greater in Asians than Whites.
Integration of preprocedural computed tomography scan findings into atherosclerotic cardiovascular disease risk estimation in patients with atrial fibrillation scheduled for catheter ablation
Authors: Verhaert D V M , Kerperien M , Habibi Z , Westra S W , Lankveld T A R , Chaldoupi S M , Den Uijl D , Luermans J G L M , Schotten U , Knackstedt C , Vernooy K , Linz D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation (AF) and atherosclerosis often coexist due to a shared risk profile. Prior to an AF ablation, computed tomography (CT) scans are routinely performed to assess pulmonary vein anatomy. Often coronary plaques are described as incidental findings. According to current guidelines, patients with coronary plaques on CT are classified as being at very high risk of developing cardiovascular atherosclerotic events, potentially resulting in a redefinition of treatment targets for comorbidities.

Purpose
This study estimated individual 10-year risks of developing atherosclerotic cardiovascular disease (CVD) events according to the 2021 ESC guideline on CVD prevention before and after the integration of CT-derived coronary plaque information in the risk assessment of AF patients scheduled for catheter ablation.

Methods
Consecutive AF patients scheduled for catheter ablation were included in the ISOLATION registry (NCT04342312). Patients were excluded from this subanalysis if no preprocedural CT was performed. Each patient was classified as being at low-to-moderate, high, or very high risk of developing CVD in the coming 10 years according to the 2021 ESC guideline on CVD prevention (Figure 1). This classification was based on previous CVD, chronic kidney disease, diabetes mellitus, or the Systematic Coronary Risk Estimation 2 (SCORE2) or SCORE2-Older Persons (SCORE2-OP) risk estimation. The impact of pre-AF ablation CTs on CVD risk was assessed by comparing risk classifications excluding and including information on coronary plaques on CT.

Results
A total of 1022 patients (age 64 ±9, 664 [65%] male, 686 [67%] paroxysmal AF) was included. Overall CVD risk was high, with 86% of patients at a high (n=190, 19%) or very high (n=693, 68%) 10-year risk of developing CVD events. Coronary plaques were observed in 59% (n=606) of pre-AF ablation CTs. Integration of the CT-derived information on coronary plaques resulted in reclassification of 364 patients (36%) towards the very high risk category (Figure 2). Previous CVD events were observed in 161 very high risk patients (16%).

Conclusion
In AF patients scheduled for catheter ablation, integration of the information on coronary plaques derived from the pre-AF ablation CT resulted in reclassification of one in three patients towards the very high risk category, which impacted treatment targets for lipid levels and blood pressure.
Is epicardial adipose tissue, quantified before cardiac surgery by computed tomography, able to predict postoperative atrial fibrillation?
Authors: Perrotta L , Genovese F , Pradella S , Bugetti M , Ricciardi G , Girasole T , Bambagioni G , Checchi L , Bevilacqua S , Gabrielli E , Letteriello M , Miele V , Stefano P L , Pieragnoli P , Michelucci A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery (CS) associated with prolonged hospitalization and increased risk of future adverse events. Epicardial adipose tissue (EAT), defined as adipose tissue between the myocardium and the visceral pericardium, has been recently recognized as a potential contributor to AF pathogenesis.

Purpose
to evaluate the role of EAT, measured by preoperative CT, in predicting the occurrence of POAF after CS.

Methods
All patients without prior AT/AF history who underwent CS at our centre were prospectively enrolled and retrospectively analyzed. All the included patients had performed a cardiac CT for the evaluation of the pre-operative coronary arteries. Baseline and surgical characteristics were systematically collected along with pre-operative echocardiographic parameters (LA diameter and area; EF) and CT EAT values. For the evaluation of the EAT we selected the area delimited superiorly from the center of the right pulmonary artery and inferiorly to the end of the pericardial sac. The adipose tissue between the myocardium and the pericardium was manually delimited and the total EAT volume was expressed in mL (total EATV; Fig. 1). Also the thickness (mm) of the EAT at the level of the free wall of the right ventricle (RV EAT) and posterior to the left atrium in a 4-chamber plane (LA EAT) were reported. All the measured EAT were indexed for BSA. Multivariate logistic regression analysis was used to identify independent predictors of the study endpoint: the occurrence POAF during the early postoperative period.

Results
A total of 117 patients (age 65±15 years old; M= 71%) were enrolled. Soon after surgery, POAF was observed in 55 patients (47%). Patients with POAF were significantly older, with higher comorbidities burden (diabetes; CHA2DS2-VASc score ≥1) than patients without POAF. No other significant differences for clinical features or surgical procedures were observed. Echocardiographic and CT parameters did not significantly differ between the two groups however older patients who developed POAF had elevated levels of indexed total EATV (96.1±46.6 cm3/m2) (Fig.2). At multivariate logistic regression analysis the only indipendent predictor of POAF remained age (OR: 1.053; 95% CI: 1.018-1.089; p=0.003).

Conclusions
Advanced age is a recognized risk factor for POAF following CS in patients without prior AF history. Older patients who developed POAF had elevated EAT values, however our study did not evidence any link between EAT and POAF.
Novel inflammatory biomarkers in postural orthostatic tachycardia syndrome
Authors: Nawaz S , Larsson A , Hamrefors V , Ruge T , Sutton R , Olshansky B , Fedorowski A , Johansson M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Postural Orthostatic Tachycardia Syndrome (POTS) is a disorder characterized by excessive orthostatic tachycardia and orthostatic intolerance. While traditional inflammatory biomarkers tend to be normal, a subclinical inflammatory process may be present in POTS.

Purpose
We aimed to analyse novel inflammatory biomarkers in POTS patients: Growth Differentiation Factor 15 (GDF15), Neutrophil Gelatinase Associated Lipocalin (NGAL), Intercellular Adhesion Molecule 1 (ICAM-1), Tumour Necrosis Factor Receptor 1 (TNFR1) and Tumour Necrosis Factor Receptor 2 (TNFR2) and compared them to healthy controls. These inflammatory biomarkers have been shown to be independent predictors of major adverse cardiovascular events in other populations.

Methods
An age- and sex-matched case-control study included 65 patients verified to have POTS by positive head-up tilt-testing and cardiovascular autonomic tests, and 65 healthy controls (mean age: 31.1 vs 31.5 years, 84% females) with negative active standing tests and no history of syncope, orthostatic intolerance, or endocrine disease. High-sensitivity chemiluminescence sandwich immunoassay was used to measure plasma levels of inflammatory biomarkers in a blinded fashion. Descriptive statistics compared groups and a univariate ANOVA was employed. Biomarker values were log-transformed. A score incorporating all biomarkers was generated to see if the totality of biomarkers discriminated POTS patients from controls.

Results
Baseline characteristics are displayed in Table 1. Mean levels of GDF15 (p=0.01), NGAL (p=0.003), ICAM-1 (p=0.04) and TNFR1 (p=0.03) were significantly higher in POTS vs controls, whereas TNFR2 (p=0.04) was significantly lower in POTS (p=0.04). The product of four upregulated biomarkers divided by TNFR2 produced a receiver operator curve (ROC) with an area under the curve (AUC) of 0.703 (p&lt;0.001) (Fig.1).

Conclusion
POTS patients had increased GDF15, NGAL, TNFR1 and ICAM-1 levels and reduced TNFR2 levels suggesting underlying, yet undefined, subclinical inflammatory processes involving neutrophil and endothelial activation.
Wave speed guided point-by-point cavo-tricuspid isthmus ablation to reduce ablation and fluoroscopy in typical atrial flutter
Authors: Rodriguez O R , Zaraket F Z , Gonzalez C G , Casteigt B C , Jimenez J J , Valles Gras E 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Ablation procedures for cavo-tricuspid isthmus (CTI) dependent typical atrial flutter (AFL) have traditionally been performed with conventional electrophysiology mapping guided by fluoroscopy. Three-dimensional electroanatomical mapping (EAM) systems have routinely been used to guide ablation of more complex arrhythmias, but in recent years, have been used for simple ablations with the aim of reducing irradiation. High voltage regions in the CTI have been described as a target in order to minimize procedure times, but there is a lack of knowledge regarding the utility of slow conduction zones for this purpose.

Methods
In a prospective cohort of patients undergoing 3D EAM assisted AFL ablation, we evaluated a novel strategy (NS) based on omnipolar vectors, using both wave speed and voltage information to focus radiofrequency (RF) lesions (see figure), and compared with a recent retrospective cohort of patients undergoing voltage-guided ablation (VG).

Results
A group of 26 consecutive patients with mean age 68±12 years and 88% male, underwent NS ablation, and were compared to 23 patients undergoing VG ablation, with no differences among patient characteristics. Of the 26 patients in group NS, 16 (53.9%) were successfully ablated targeting only 2 sites, representing the 2 most confluent areas of low wave speed and high voltage. A total of 24 (92.5%) were ablated successfully with targeting all sites of low wave speed. Only a single patient in the NS group required the completion of a classic CTI line. Average fluoroscopy time and radiation dose were lower in the NS group compared to VG group (1.1±2.4 min 19.5±41.7 mGray vs 8.2±10.2 min and 64.4±76.5 mGray, p=0.0014 and p=0.013, respectively). Furthermore, RF time trended towards reduction in the NS group.

Conclusions
A strategy based on targeting only areas of low wave speed is effective, limiting the need to complete a traditional CTI line, and reducing fluoroscopy in patients undergoin CTI ablation.