bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interim analysis of a prospective randomized comparison of pulsed field ablation vs. radiofrequency ablation for longstanding persistent atrial fibrillation
Authors: Fiala M , Cernosek M , Bulkova V , Lehar F , Funasako M , Bahnik J , Rybka L , Manousek J , Toman O , Kala P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Benefits of pulsed field ablation (PFA) compared to radiofrequency ablation (RFA) are not known in patients with longstanding persistent atrial fibrillation (LSPAF).

Purpose
To present interim procedural and short-term clinical results of an ongoing prospective randomized comparison of PFA vs. RFA in patients with LSPAF.

Methods
In 9/2021-10/2022, 125 patients underwent catheter ablation for LSPAF using PFA (n=64, 69±8 years, 11 F, continuous AF 32±20 months) vs. RFA (n=61, 68±8 years, 17 F, continuous AF 29±23 months). PFA included pulmonary vein isolation (PVI) and extra-PV left atrial (LA) ablation. RFA included stepwise PVI, electrogram-guided LA ablation, CS isolation, and electrogram-guided right atrial ablation. Intermediate endpoints were PVI, mitral isthmus, LA roof and CTI blocks); sinus rhythm (SR) restoration by ablation was the desired procedural endpoint. Follow-up included 7-day ECG monitoring every 3 months during the first year, and every 6 months afterwards.

Results
In groups PFA vs. RFA, procedure and fluoroscopy times were 116±32 vs. 204±44 minutes, and 17±5 vs. 8±2 minutes, respectively (both p&lt;0.001). AF termination (into intermediate AT or directly into SR) and SR restoration by ablation were achieved in 30 (47%) vs. 42 (69%) patients (p=0,19), and in 23 (36%) vs. 35 (57%) patients (p=0,15). Of those 48 vs. 50 patients with follow-up ≥3 months (≥6 months in 37 vs. 39 patients), freedom from any AF/AT (&gt;30 s) was achieved in 38 (79%) vs. 23 (46%) patients.

Conclusion
Interim results of ongoing comparison suggest procedure time reduction and improved AF/AT free survival after PFA as compared to RFA in patients with LSPAF.
Visualizable vs. non-visualizable steerable sheaths for AF procedures: randomized tiral
Authors: Kupo P , Janosa B , Debreceni D , Bocz B , Simor T , Janosi K F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ÚNKP-22-4 New National Excellence Program of the Ministry for Culture and Innovation from the source of the National Research, Development and Innovation Fund.
Steerable sheaths (SSs) are frequently used to improve catheter stability during atrial fibrillation (AF) procedures. A new type of visualizable (by electroanatomical mapping system) SS has become available in clinical treatment.

Purpose
We aimed to compare procedural and follow up data of visualizable vs. non-visualizable SS assisted pulmonary vein isolation procedures in patients with AF.

Methods
In this single-centre randomized study, we enrolled a total of 100 consecutive patients who underwent PVI due to AF.

Results
100 consecutive patients were enrolled and randomized into 2 groups (visualizable SS group: 50; non-visualizable SS group: 50). With the use of visualizable SS, left atrial (LA) procedure time (53.1 [41.3; 73.1] min vs. 59.5 [47.6; 74.1] min.; p = 0.04), LA fluoroscopy time (0 [0; 0] s vs. 17.5 [5.5; 69.25] s; p &lt; 0.01) and LA fluoroscopy dose (0 [0; 0.27] mGy vs. 0.74 [0.16; 2.34] mGy; p &lt; 0.01) was significantly less, however, there was no difference in the total procedural time (90 ± 35.2 min vs. 99.5 ± 31.8 min; p = 0.13), total fluoroscopy time (184 ± 89 s vs. 193 ± 44 s; p = 0.79), and total fluoroscopy dose (9.12 ± 1.98 mGy vs. 9.97 ± 2.27 mGy; p = 0.76). Compared to standard SS group total ablation time was reduced (1049 sec. [853; 1175] vs. 1265 sec. [1085; 1441]; p &lt; 0.01) using visualizable SS, and the number of radiofrequency ablations was fewer (69 [58; 80] vs. 79 [73; 86); p &lt; 0.01) in this group. There was no difference between the groups regarding acute ablation success (both group 100%) and first pass isolation rate (92% vs. 89%; p = 0.88). No major complications occurred in either group. During the 6 months follow up period there was no difference either in blanking period (visulaizable SS: 3/50, standard SS: 4/50; p=0.70) or at 6 months after the ablation (visulaizable SS: 3/50, standard SS: 5/50; p=0.46).

Conclusion
Visualizable SS significantly can reduce the left atrial procedure time, total ablation time and fluoroscopy exposure without compromising its safety or mid-term success in patients undergoing PVI procedures for AF.
Statin use improves the outcomes in patients with atrial fibrillation: A population-based study
Authors: Huang J , Wu M Z , Ren Q W , Tse H F , Lip G Y H , Yiu K H Y 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Sanmin project, Shenzhen, China

Background
There is inconclusive evidence regarding the impact of statins on the risk of atrial fibrillation (AF) related outcomes. The current study investigated whether statin use would improve outcomes among patients with non-valvular AF.

Purpose
To assess the association between statin use and AF-related outcomes among patients with AF.

Methods
Patients newly diagnosed with AF (n = 51,472) between 2010-2018 were divided into statin users (n =11,866) and statin nonusers (n =39,606), according to whether they received statin therapy after their first diagnosis of AF. The primary outcomes included ischaemic stroke (IS) and systemic embolism (SE), haemorrhagic stroke (HS), and transient ischaemic attack (TIA). An inverse probability of treatment weighting was used to balance baseline covariates between the two groups. The Fine and Grey competing risks model was applied, with death defined as the competing event.

Results
The median age of the cohort was 74.9 years, and 47.7% were female. During the median follow-up of 5.1 years, previous statin use was significantly associated with a lower risk of IS/SE compared with statin nonusers (subdistribution hazard ratio [SHR] = 0.83, 95%CI: 0.78-0.89). Similar patterns were found in the association between previous statin use and HS (SHR = 0.93, 95%CI: 0.89-0.98) and TIA (SHR = 0.85, 95%CI: 0.80-0.90, P &lt;0.01). Moreover, ≥6 years of statin use predicted a lower risk of IS/SE, HS and TIA (IS/SE: SHR = 0.57, 95%CI: 0.54-0.61; HS: SHR = 0.56, 95%CI: 0.53-0.60; TIA: SHR = 0.58, 95%CI: 0.52-0.64) compared to those with short-term (3 months to &lt;2 years) statin use. Stratified analyses demonstrated that the lower risk of IS associated with statin use was consistent.

Conclusion
Statin use was associated with a lower risk of incident IS/SE, HS and TIA in a duration-dependent manner among AF patients.
How good is time-in-therapeutic-range defined warfarin treatment compared to standard dose direct oral anticoagulants? Incidence of stroke in atrial fibrillation in a nationwide registry study
Authors: Lehto M , Luojus A , Halminen O , Haukka J , Aro A L , Putaala J , Linna M , Mustonen P , Kinnunen J , Niemi M , Hartikainen J , Airaksinen K E J 
Published: May 2023

Abstract

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

Background and aims
Direct oral anticoagulants (DOACs) have largely replaced warfarin in patients with atrial fibrillation (AF) to reduce risk of stroke. However, it is not known whether DOACs are more efficacious in preventing stroke or safer than good-quality warfarin treatment with high 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. We analyzed all new-onset AF patients in Finland from January 2011 to December 2018 with laboratory data available.
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. Confounding factors by baseline characteristics as well as medications were taken in account by use of an inverse probability of treatment weighted analysis.
For warfarin users, time in therapeutic range (TTR) was calculated and patient quartiles by TTR were assigned. Rate of stroke in different TTR quartiles for warfarin users were compared to standard dose dabigatran (150 mg bd.), apixaban (5mg bd.) and rivaroxaban (20mg od.).

Results
Altogether, 74 008 new-onset AF patients with OAC therapy (50.4 % male, mean age 73.0 years, 43 549 on warfarin, with mean TTR 66% and median TTR 72%) were followed for 109 143 patient years (py). Rate of stroke among patients with standard dose direct oral anticoagulants was 6.0/100 py for dabigatran (n=4545), 6.2/100 py for apixaban (n=12 426) and 4.0/100 py for rivaroxaban (n=12 950). In the TTR quartiles of patients on warfarin, 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 6.3, 6.1 and 4.5/100 py for dabigatran, apixaban and rivaroxaban, respectively, and for warfarin from the lowest to the highest quartile: 8.8, 7.0, 5.5 and 4.2/100 py, respectively. The Figure provides survival probabilities (crude rates) of stroke with confidence intervals of the analysed OAC groups.

Conclusion
Rates of stroke were evidently the highest among patients on warfarin in the two lowest TTR quartiles, while the differences between high TTR groups and standard dose DOACs were only modest.
3D intracardiac echocardiography for left atrial appendage sizing and percutaneous occlusion guidance
Authors: Della Rocca D , Magnocavallo M , Gianni C , Mohanty S , Vetta G , Lavalle C , Santangeli P , De Asmundis C , Chierchia G B , Burkhardt J D , Di Biase L , Lakkireddy D J , Al-Ahmad A , Horton R P , Natale A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left atrial appendage (LAA) imaging is critical during percutaneous occlusion procedures. 3D-intracardiac echocardiography (ICE) features direct visualization of LAA from multiple cross-sectional planes at a time.

Purpose
To report procedural success of 3D-ICE-guided LAA occlusion and the correlation between pre-procedural transesophageal echocardiography (TEE) and intraprocedural 3D-ICE for LAA sizing.

Methods
Among 274 patients undergoing LAAO, periprocedural ICE guidance was achieved via a commercially available 2D-ICE catheter (220 patients) or a novel 3D-ICE one (54 patients; Fig.1).
Primary endpoint was a composite of procedural success and LAA sealing at follow-up TEE. Secondary endpoint was a composite of periprocedural device recapture/resizing plus presence of leaks≥3mm at follow-up TEE.

Results
3D-ICE measurements of maximum landing zone correlated highly with preprocedural TEE reference values [Pearson’s: 0.94; p&lt;0.001; bias: -0.06 (-2.39, 2.27)] (Fig.2).
The agreement between 3D-ICE-based device selection and final device size was 96.3% versus 79.1% with 2D-ICE (p=0.005).
The incidence of the primary endpoint was 98.1% with 3D-ICE and 97.3% with 2D-ICE (p=0.99). 2D-ICE patients had a trend towards a higher incidence of periprocedural device recapture/redeployment (31.5% vs 44.5%; p=0.09). The secondary endpoint occurred in 31.5% of 3D-ICE patients versus 45.9% of 2D-ICE ones (p=0.065).

Conclusions
ICE-guided LAAO showed a very high success, with no major adverse events. A very high level of agreement for LAA sizing was found between pre-procedural TEE and periprocedural 3D-ICE. 3D-ICE performed significantly better than 2D-ICE for device size selection and may provide better guidance during device deployment.
Size matters - body size and acute device-implantation failure after LAAC
Authors: Zweiker D , Sieghartsleitner R , Toth G , Stix G , Vock P , Schratter A , Fiedler L , Martinek M , Steinwender C , Binder R K , Adukauskaide A , Ablasser K , Verheyen N , Zirlik A , Scherr D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Patient-device mismatch in patients undergoing left atrial appendage closure (LAAC) may lead to failure to implant, dislocation, and cardiac tamponade. There is limited data about patient cohorts that are especially susceptible to these complications.

Objective
To analyse the association between body height, weight and acute complications due to probable device mismatch.

Methods
A retrospective analysis from a multicentre registry including consecutive patients undergoing LAAC was performed. Device related complications were defined as dislocation, failure to implant or cardiac tamponade requiring intervention.

Results
A total of 431 patients from 9 centres were included. Median age was 75 (interquartile range, IQR 70-79) years and 35.7% were female. Mean±SD body height was 171.3±8.8 cm and median weight was 80 (IQR 70-90) kg. Median CHADS-VASc score was 5 (IQR 3-5) and HAS-BLED score was 3 (IQR 3-4). Indications were bleeding (66.6%), stroke (9.7%) and other (23.6%). Acute device-related complications after LAAC occurred in 5.6% of cases (24/431): Failure to implant (3.0%), cardiac tamponade (2.1%), and dislocation (0.7%). Complications occurred significantly more often in the tercile with lowest body weight and highest body height (23.5% vs. 4.3%, p=0.01, Figure).

Conclusion
Acute device-related complications as sign of patient-device mismatch are most pronounced in patients with lowest body weight and highest body height.
Platelet count as a predictor of thrombotic events following left atrial appendage occlusion: the proof is in the platelet?
Authors: Aarnink E , Della Rocca D G , Cepas-Guillen P L , Benito-Gonzalez T , Polzin A , Branca L , Spoon D , Freixa X , Boersma L V A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Patients undergoing left atrial appendage occlusion (LAAO) often are at increased risk for bleeding or thromboembolic events, but no specific risk score for these events in patients after LAAO exists. Concurrently, biomarkers are of growing importance in risk stratification for AF-patients. Therefore, hemostatic biomarkers may have added value in predicting what patients are prone to develop thrombotic and bleeding events and aid in personalizing antithrombotic treatment strategy following LAAO.

Methods
Six implanting centers retrospectively gathered data on pre-procedural hemostasis markers (i.e. platelet count (PLC), mean platelet volume (MPV), and fibrinogen). Prespecified composite endpoints on thrombotic events (i.e. stroke, transient ischemic attack, systemic embolism and device-related thrombus) and bleeding (major, minor and intracranial hemorrhage) were collected.

Results
In total, 1315 patients were included (74±9 years, 64% male, 72% Watchman 2.5/FLX, 25% Amplatzer Cardiac Plug/AMULET, 4% other device). Patients were at increased risk for thrombotic and bleeding events with a CHA2DS2-VASc score of 4.3±1.5 and a HAS-BLED score of 3.3±1.1. Baseline data on PLC, MPV, and fibrinogen was available in 92%, 50%, and 21%, respectively. Over a total follow-up duration of 2682 patient years, 111 thrombotic events and 140 bleeding events occurred. Univariate Cox regression analysis showed increased thrombotic risk in patient with higher PLC (HR 1.16 [1.03-1.31] per 50*109 increment), while no statistically significant association with MPV was found (Table 1). Fibrinogen tended to be higher both in patients developing a thrombotic event (HR 1.30 [0.94-1.78] per fL increment) and bleeding event (HR 1.23 [0.98-1.54]). No association of MPV or PLC with bleeding was observed. An optimal PLC cut-off point of 200*109 was identified that was able to decently discriminate between patients developing a thrombotic event and those who did not (Figure 1).

Conclusion
PLC may be of added value in thrombotic risk stratification following LAAO. Validation of this biomarker by prospective studies and within multivariate prediction models is warranted.
Outcomes of ischemic stroke in patients with atrial fibrillation
Authors: Marrese A , Meola M , Fonderico C , Salucci A , Comparone G , Pergola V , Faccenda D , Addeo L , Cocchiara L , Ammirati G , Rapacciuolo A , Strisciuglio T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Patients with atrial fibrillation (AF) have higher risk of ischemic stroke.

Purpose
We investigated whether AF patients experiencing an ischemic stroke have worse outcomes.

Methods
AF patients admitted to the stroke unit from 2018 to 2021 were included. The NIHSS and the modified Rankin Scale (mRS) score were calculated at the admission and at discharge. The neurological improvement was calculated as delta NIHSS (NIHSS at admission - NIHSS at discharge =Δdis).

Results
Six-hundred patients (45% men), mean age 69±13 years. Of these 75 had previous history of atrial fibrillation (AF) and 86 had AF during the hospitalization (46 both). Overall 115 had one of the two. Patients with AF had higher NIHSSad (14.5±7 vs 9.6±7; p&lt;0.001) and NIHSS24 (10.4±8 vs 7.2±7; p&lt;0.001) than patients without, however the neurological improvement was greater (Δdis -8.4±8 vs -5.1±6; p=0.004), indeed the NIHSSdis was similar (5.6±7 vs 4.1±6; p=0.1). Patients with AF also had a more impaired mRS before the ischemic event and at discharge (1.34±1.3 vs 0.58±1.1, p&lt;0.001; 2.6±1.7 vs 1.8±1.9, p=0.005). Amongst AF patients with CHADVASC³2 in men and ³3 in women, 36% of them were taking antiplatelet therapy, 35% anticoagulants and 29% didn’t take any therapy. Of interest, no differences in the NIHSSad nor in the NIHSSdis were found between them and neither in the Δdis. As for the treatment of AF patients, patients who underwent to mechanical thrombectomy (MT) had higher NIHSSad (17± 5) compared to patients receiving intravenous thrombolysis (IV) or nothing (11± 7 and 12± 8) (p&lt;0.001). The NIHSSdis was similar between the three groups however the Δdis was significantly higher in patients treated with mechanical thrombectomy (-12.5±6 vs 3.6±4; vs 3.1±8; p=0.003 and p&lt;0.001 respectively).

Conclusions
Patients with AF experience more severe stroke, however the neurological recovery is greater than in patients without the arrhythmia. The treatment with antiplatelets or anticoagulants before the event does not reduce the severity of the stroke and does not influence the improvement of the NIHSS at discharge. The mechanical thrombectomy is more effective in reducing the neurological impairment.
Catheter ablation of left atrial tachyarrhythmia: predictors of recurrence after catheter ablation
Authors: Marazzato J , Zhang X , Lin A , Varrias D , Nagraj S , Saouma S , Chowdhuri N , Chaudhary A , Velasco De La Cuesta A , Della Rocca D G , Santangeli P , Lakkireddy D , Natale A , Zou F , Di Biase L 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Differently from catheter ablation (CA) of atrial fibrillation (AF), outcome data on CA of atrial re-entrant arrhythmias are scarce.

Purpose
We sought to evaluate predictors of recurrence at follow up in this setting.

Methods
We analysed consecutive patients undergoing mapping and CA left atrial tachyarrhythmia. Three-dimensional high-density activation and voltage maps were created for each investigated tachycardia by means of CARTO® system. Left atrial (LA) size was measured as the anteroposterior diameter on parasternal long axis view on transthoracic echocardiogram. Severe LA enlargement was defined for LA diameter &gt;47 mm in women and &gt;52 mm in men in accordance with guidelines.

Results
Eighty-eight patients were considered (67 ± 9 years old, 45% males) undergoing 94 CA procedures (1.1 ± 0.3 per patient). Most patient had past medical history of pulmonary vein isolation (57%). In the investigated population, 120 tachycardia morphologies were mapped and ablated. Acute procedural success was achieved in 97% of cases without any major complication. After a mean follow-up of 17 ± 11 months, the overall freedom from atrial arrhythmia was 58% and 65% after single and repeat procedures, respectively. Severe LA enlargement was the only variable associated with arrhythmia recurrence at follow-up and it was consistent after single and repeat procedures (Figure 1 A-B).

Conclusion
CA of complex left atrial tachyarrhythmia is safe and effective, and the mid- and long-term outcome is improved when LA is not severely enlarged. CA of should therefore be considered early in this patient population to achieve better clinical outcome.
Identification of cavotricuspid isthmus conduction block, pitfall of differential pacing maneuver
Authors: Park S , Kim S H , Seung J H , Kim S H , Kim H J , Choi Y , Hwang Y M , Kim T S , Kim J H , Jang S W , Oh Y S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Differential pacing (DP) maneuver was generally used to assess bidirectional block of cavotricuspid isthmus (CTI) after catheter ablation.

Purpose
The purpose of the study is to identify limitation of DP maneuver and suggest continuous sequence (CS) maneuver as a complement of differential pacing.

Methods
Patients who were diagnosed to typical atrial flutter and underwent catheter ablation were enrolled. CTI conduction block was evaluated by two maneuver, DP and CS maneuver. We tried to identify CTI conduction block for each patient with both maneuvers. With CS maneuver, CTI conduction block was assessed with the recorded sequence of diagnostic catheter.

Results
Sixty two patients were investigated. Two maneuvers were performed in all patients. There were 8 cases (8/62, 12.9%) of discrepancy between the result of CS and DP maneuver. One of discrepancy cases, CTI conduction block was identified with CS maneuver, but insufficient conduction block with DP maneuver. The rest of discrepancy (11.2%) cases were the opposite.

Conclusion
DP could not guarantee bidirectional block of CTI because of anatomical complexity and catheter instability. CS maneuver found incomplete block over 10% of conventional maneuver. CS maneuver is simple and can be complement to overcome limitation of DP maneuver.