bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atrial fibrillation screening to prevent stroke in patients with high NT-proBNP - a post-hoc analysis of the randomized LOOP study
Authors: Diederichsen S Z , Xing L Y , Haugan K J , Hoejberg S , Krieger D , Brandes A , Koeber L , Frikke-Schmidt R , Svendsen J H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The Innovation Fund Denmark

Background and aims
Stroke is a leading cause of mortality and disability, and atrial fibrillation (AF) is an important and potentially modifiable risk factor for stroke. AF screening can substantially increase the amount of patients diagnosed and treated, but randomized trials have yet to demonstrate a significant decrease in strokes following screening. N-terminal prohormone of brain natriuretic peptide (proBNP) is an established biomarker for AF and could potentially be used to select patients for screening.
We a used randomized trial of AF screening vs usual care to investigated the usefulness of proBNP as a tool to select patients for screening to prevent outcomes.

Methods
The LOOP Study randomized AF-naïve individuals aged &gt;70 years with additional stroke risk factors in a 1:3 ratio to either continuous AF screening using implantable loop recorder (ILR) with initiation of anticoagulation upon detection of AF, or usual care. In this post-hoc analysis, study participants with a baseline measurement of proBNP were included, and the effect of screening vs usual care was compared in groups according to proBNP tertiles.

Results
Of 6004 participants randomized, 5819 (97%) had proBNP measured. The tertiles of proBNP were at &lt;11, 11-22, and 22 pmol/L (Figure 1).
A total of 1014 participants (17.4%) were diagnosed with AF (ILR 32.1% vs Control 12.5%), and 310 (5.3%) endured a stroke or systemic arterial embolism (SAE) (ILR 4.5% vs Control 5.6%). In the lower two tertiles of proBNP, 13% were diagnosed with AF (ILR 26.6% vs Control 8.3%), and 4.6% endured a stroke or SAE (ILR 4.6% vs Control 4.6%), whereas in the highest tertile of proBNP, 25.9% were diagnosed with AF (ILR 42.9% vs 20.3%), and 6.73% endured a stroke or SAE (ILR 4.4% vs Control 7.5%).
In the lower two tertiles of proBNP, there was no protective effect from AF screening as compared with usual care (hazard ratio (HR) 1.00 (95% CI 0.71-1.41), p=0.999), whereas in the highest tertile of proBNP there was a significant effect of screening (HR 0.59 (95% CI 0.37-0.93), p=0.021) (Figure 2).
More details including proBNP cutoffs, and the impact on stroke subtypes, disability and mortality will be presented at the Congress.

Conclusions
In a population at increased risk of stroke, proBNP pose a useful biomarker to select individuals for AF screening to prevent stroke. In persons with increased proBNP, the effect of screening could be significant, whereas there is no signal towards effects from screening in people with normal proBNP levels.
Renal outcomes of early rhythm control in patients with atrial fibrillation and chronic kidney disease
Authors: Kim D , Yang P S , You S C , Jang E , You H T , Kim T H , Pak H N , Lee M H , Lip G Y H , Sung J H , Joung B 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): The Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea

Background
Atrial fibrillation (AF) is associated with development of impaired renal function and chronic kidney disease (CKD). Early rhythm control initiated within 1 year of AF diagnosis is associated with a lower risk of adverse cardiovascular outcomes compared to usual care among patients recently diagnosed with AF.

Purpose
This study aimed to assess the effects of early rhythm control on renal function in patients with AF and CKD, compared with rate control

Methods
This population-based cohort study included 4,151 patients with AF and CKD, from the Korean National Health Insurance Service database, undergoing rhythm control (antiarrhythmic drugs or ablation) or rate control therapy, initiated within 1 year of AF diagnosis in 2005–2015. A composite renal outcome of ≥30% decline in estimated glomerular filtration rate (eGFR), acute kidney injury (AKI), and kidney failure was compared using propensity score overlap weighting.

Results
In the study population (39.1% female; median age: 70 years), a total of 628 composite renal outcome occurred during the median follow-up of 2.3 years. Early rhythm control, compared with rate control, was associated with lower risks of the composite renal outcome (weighted incidence rate: 4.1 vs. 5.3 per 100 person-years; weighted HR 0.78, 95% CI 0.65-0.94) and kidney failure (weighted HR 0.73, 95% CI 0.56-0.95). Trends toward lower risks of eGFR decline (weighted HR 0.89, 95% CI 0.58-1.37) and AKI (weighted HR 0.88, 95% CI 0.66-1.17) were observed in patients undergoing early rhythm control, compared with those undergoing rate control.

Conclusion
Among patients with AF and CKD, early rhythm control was associated with a lower risk of progression of kidney disease, compared with rate control, highlighting the need for future randomized studies evaluating the benefits of early rhythm control on renal outcome among patients with AF.
Cardioversion strategy impacts quality of rate control during recurrences of atrial fibrillation
Authors: Van Der Velden R , Pluymaekers N , Dudink E , Luermans J , Meeder J , Lenderink T , Widdershoven J , Bucx J , Rienstra M , Van Gelder I , Crijns H , Linz D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Netherlands Organization for Health Research and Development

Introduction
In the Rate Control versus Electrical Cardioversion Trial 7–Acute Cardioversion versus Wait and See, patients with recent-onset atrial fibrillation (AF) were randomised to either early or delayed cardioversion.

Purpose
This pre-specified sub-analysis aimed to evaluate heart rate during AF recurrences after an emergency department (ED) visit identified by an electrocardiogram (ECG)-based handheld device.

Methods
After the ED visit, included patients (n=437) were asked to use an ECG-based handheld device to monitor for recurrences during the four-week follow-up period. 335 patients used the handheld device and were included in this analysis. Recordings from the device were collected and assessed for heart rhythm and rate. Optimal rate control was defined as a target resting heart rate of &lt;110 bpm.

Results
In 99 patients (29.6%, mean age 67±10 years, 39.4% female, median 6 [3-12] AF recordings) a total of 314 AF recurrences (median 2 [1-3] per patient) were identified during the follow-up. The average median resting heart rate at recurrence was 100±21 bpm in the delayed vs 112±25 bpm in the early cardioversion group (p=0.011). Additionally, the maximum heart rate was also significantly lower in the delayed cardioversion group (115 [94-131] vs 136 [118-147], p=0.001). Optimal rate control was seen in 68.4% [21.3-100%] of the performed recordings per patient in the delayed, and 33.3% [0-77.5%] of the performed recordings per patient in the early cardioversion group (p=0.01). Randomisation group (coefficient -12.09 (-20.55 - -3.63, p=0.006) for delayed versus early cardioversion) and heart rate on index ECG (coefficient 0.46 (0.29-0.63, p&lt;0.001) per bpm increase) were identified as multivariable adjusted factors associated with lower median heart rate during AF recurrences.

Conclusion
A delayed cardioversion strategy translated into lower median heart rates as well as lower peak heart rates during AF recurrences. Apart from the randomized treatment, heart rate at recurrence was influenced by the intrinsic heart rate on presentation.
Personalized rate control treatment for atrial fibrillation: a prospective case-control study on the use of diltiazem
Authors: Spadotto A , Massaro G , Amadori M , Damaschin L , Martignani C , Ziacchi M , Biffi M , Galie N , Boriani G , Diemberger I 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Recent ESC Atrial Fibrillation guidelines introduced some changes in the options for rate control, such as the possibility to combine beta-blockers (BB) and non-dihydropyridine calcium channel blockers (NDCC), to address the need of personalized pharmacologic rate control strategy for AF. However, there are limited data on this topic.

Purpose
The aim of our study was to explore the prognostic impact of a personalized therapy (PT) for rate control, including the use of NDDC in patients with heart failure (HF) or in combination with BB, compared to standard rate control therapy (ST) as defined by previous ESC guidelines.

Methods
This is a single centre prospective observational registry on patients referred to our University Hospital for the management of AF between October 2013 and February 2019.

Results
We enrolled 1112 patients on exclusive rate control treatment, 125 (11.2%) were identified as patients with PT and 987 (88.8%) were on ST. In the PT group, 93/125 (74.4%) patients were prescribed BB + NDCC (±digoxin), while 85/125 (68.0%) were HF patients prescribed with NDCC, diltiazem in all cases. The mean age of patients was 73.5±12.0 years and 72.5±12.7 years in ST and PT groups, respectively. The two cohorts were homogeneous in terms of male prevalence, left ventricular ejection fraction and CHA2DS2-VASc score; while, HF was more frequent in PT group both in terms of patients with NYHA class ≥2 (41.3% in ST vs. 64.8% in PT, p&lt;0.001) and prescription of diuretics (72.2% in ST vs. 88.0% in PT, p&lt;0.001). Patients treated with PT had no difference in one-year overall survival compared to those with a ST (Figure 1 A). Notably, patients with HF in ST had a worse prognosis (p&lt;0.001). (Figure 1 B)

Conclusions
Our results suggest a potential outcome benefit of NDCC for rate-control in AF patients, either alone or in combination with BB, also in selected patients with HF. Future controlled studies are needed to confirm our findings, and to identify subjects with higher benefit from such personalized rate-control strategies.
His bundle pacing and AV nodal ablation for non-controlled atrial arrhythmia: a technical challenge with major clinical benefits
Authors: Chaumont C , Auquier N , Milhem A , Mirolo A , Savoure A , Eltchaninoff H , Anselme F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
His bundle pacing (HBP) is an appealing alternative to right ventricular pacing in patients referred for permanent ventricular pacing and AV nodal ablation (AVNA) as it preserves physiological ventricular activation. Only limited amount of data is available in the literature regarding HBP combined with AVNA.

Purpose
To provide further evidence on the feasibility and efficacy of this therapeutic approach in patients with uncontrolled atrial arrhythmia.

Methods
We prospectively included all patients who underwent AVNA after HBP in three different hospitals between 2017 and 2022.

Results
AVNA following HBP lead implantation was performed in 75 patients. A complete AV block was obtained in 58 patients (77%) whereas significant modulation of the AV node conduction (heart rate &lt; 60bpm) was obtained in 12 (16%). AVNA failure was observed in 5 (7%). The recording of an atrial signal by the HBP lead was more frequently observed in patients with AVNA modulation/failure compared to patients with complete AV block (11/17 vs 5/58; p &lt; 0.001). There was no lead dislodgment during the AVNA procedures. Acute HB capture threshold increase &gt; 1V occurred in 11 patients (15%) with return to baseline value at day one in 9. NYHA class and LVEF significantly improved from baseline to last follow-up (3.0 ± 0.7 vs 1.6 ± 0.5, p &lt; 0.001; 47 ± 14% vs 60 ± 9%; p &lt; 0.0001, respectively),

Conclusion
AVNA combined with HBP for non-controlled atrial arrhythmia was feasible and clinically efficient. Implanting the HB lead on the ventricular aspect of the tricuspid annulus avoiding atrial signal recording can facilitate AVNA.
The role of atrial electro-mechanical coupling as predictor of catheter ablation efficiency: EPs and clinicians working together
Authors: Barletta V , Parollo M , Gentile F , Canu A , Sbragi S , Mazzocchetti L , Di Cori A , Segreti L , De Lucia R , Grifoni G , Bongiorni M G , Zucchelli G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation (AF) results in electrical and structural remodeling of the atria, and the extent of remodeling has already been found to be associated with higher AF recurrence rate after catheter ablation (CA). Recently, a novel echocardiographic parameter derived from tissue Doppler imaging (TDI), called PA-TDI, has been introduced to assess the total atrial activation time, as a non-invasive surrogate of fibrosis and atrial cardiomyopathy. The aim of the study was to investigate the role of PA-TDI interval as predictor of AF ablation efficacy.

Methods
Consecutive patients with persistent or paroxysmal symptomatic AF referred to our Center to perform radiofrequency ablation or cryoablation procedures were prospectively enrolled. In these patients, a complete transthoracic echocardiographic examination was performed before and after the ablation procedure, including assessment of the PA-TDI interval.

Results
From October 2018 to May 2020, 221 consecutive patients (mean age 61 ± 9 years, 74% male, mean BMI 26.5 ± 3.6, mean Ejection Fraction 61 ± 6%) symptomatic for AF, undergoing the procedure ablation (first procedure or re-do) were enrolled. Out of the blanking period, 25% of patients experienced recurrence of arrhythmia during follow-up (mean 16 months). Compared to patients who did not relapse, patients with AF recurrence have a generally longer post-procedural PA-TDI interval (139.6 ± 22.1 msec vs 153.9 ± 33 msec, respectively). In the multivariable analysis only post-procedure PA-TDI and re-do interventions were found to be independent predictors of AF recurrence. A PA-TDI cut-off&gt;144msec identifies patients at risk of post ablation AF recurrence with sensitivity 58.7% and specificity 73.5% (AUC 0.697).

Conclusions
The PA-TDI interval is an independent predictor of AF recurrence after catheter ablation. This echocardiographic parameter is easily obtainable, low-cost, reproducible, and accessible even in peripheral centers.
Comparison of pulsed field ablation and cryoballoon ablation in atrial fibrillation
Authors: Schipper J , Dittrich S , Erlhoefer S , Scheurlen C , Woermann J , Van Den Bruck J , Filipovic K , Pavel F , Lueker J , Steven D , Sultan A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary vein isolation (PVI) using cryoballoon (CB) catheter ablation has emerged as a cornerstone for treatment of atrial fibrillation (AF). Recently pulsed field ablation (PFA) has been introduced for PVI. First data show high acute and favorable long-term outcome. So far, data comparing these "single shot" devices is sparse.

Objective
This analysis sought to provide procedural and outcome data comparing PFA to CB PVI. Furthermore, potentially postprocedural discomfort was evaluated.

Methods
A retrospective analysis of PVI procedures using PFA or CB was performed. Discomfort analysis was obtained by prescribed analgesic medication within first 48 h after PVI (fully digital patient file). During follow-up (FU) repeat outpatient visits and Holter ECG were performed.

Results
In all 108 patients with AF (54 PFA and 54 CB; PFA: 37 (69 %) men; CB: 38 (70 %) men) successful PVI was achieved. There were no significant differences regarding baseline characteristics. 17 (31 %) patients in the PFA group and 18 (33 %) patients in the CB group had paroxysmal AF. Procedure time trended to be shorter in the PFA group (PFA: 64.5±17.5 minutes; CB: 73.0±24.8 minutes; p=0.07). Sub-analysis of the PFA group revealed a significant shortening of procedure duration over time (first 27 PFA vs. second 27 PFA: 72.9±19.1 minutes vs. 56.1±10.7 minutes, p=0.001). Significantly less contrast medium was used for PFA PVI as compared to CB PVI (PFA: 12± 6 ml; CB: 51± 29 ml, p&lt;0.0001). Fluoroscopy time was significantly longer for PFA PVI (PFA: 15.3±4.7 minutes, CB: 12.3±5.3 minutes; p=0.001). Analysis of postprocedural analgesic medication demand did not differ between PFA and CB PVI (PFA: 7 patients; CB: 10 patients; p=0.59). After a FU of 234±127 days 79% of patients remained in SR after PFA and 78% after CB PVI (p=0.88). In the PFA group 2 non-device related cardiac tamponades occurred.

Conclusion
A comparison of PFA to CB PVI revealed a comparable efficacy and safety profile with a steep learning curve and potentially shorter procedure duration. Amount of contrast medium is significantly higher for CB PVI. So far, arrhythmia-free survival seems to be still equal between both techniques. However, PFA is a safe and effective alternative to CB for PVI.
Identifying (electrophysiological) predictors of atrial fibrillation recurrences after catheter ablation: first results from the ISOLATION registry
Authors: Habibi Z , Verhaert D V M , Hermans B M J , Kawczynski M , Philippens S , Westra S W , Chaldoupi S M , Maesen B , Isaacs A , Zeemering S , Linz D , Vernooy K , Schotten U 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): a.o. The European Union (ITN Network Personalize AF: Personalized Therapies for Atrial Fibrillation: a translational network, grant number 860974; MAESTRIA: Machine Learning Artificial Intelligence Early Detection Stroke Atrial Fibrillation, grant number 965286).

Background/Introduction
Noninvasive quantification of electrophysiological properties of the atria is increasingly used for outcome prediction in atrial fibrillation (AF) patients. Data on the added value of ECG parameters to predict AF recurrences in patients undergoing AF ablation are scarce.

Purpose
To investigate the predictive performance of clinical and echocardiographic characteristics as well as features extracted from extended surface electrocardiogram (extECG) recordings for AF recurrences in patients after AF ablation.

Methods
ISOLATION is a prospective, observational, multicenter registry of patients scheduled for AF catheter ablation, including cryoballoon and radiofrequency ablation. 178 patients (66.4%) patients used anti arrhythmic drugs at baseline. Clinical characteristics and results of routine blood tests were collected. In addition, an extECG was recorded (12 additional leads, 5 minutes recording) before ablation to analyze P-wave characteristics. The main study endpoint was ablation success after 12 months, defined as freedom from any episode of documented atrial arrhythmia after the blanking period recorded on holter or ECG.

Results
Currently, 627 of 650 scheduled patients have been included. In total, 268 patients completed the 1-year follow-up. 190 patients (70.9%) had paroxysmal AF and 75 patients (28.0%) had persistent AF. Median age was 65±9 years, 38.1% were female. 46 patients (17.2%) had a recurrence of AF after 12 months [figure 1]. Univariate analysis showed that higher age (64 years vs. 69 years, p=0.023, Mann-Whitney U-test), lower P-wave mean area (4.402 mV vs. 3.567 mV, p=0.034) and lower P-wave mean amplitude (0.087 mV vs. 0.081 mV, p=0.033), were associated with a higher recurrence rate of AF [figure 2]. However, multivariate analysis showed no significant independent prognostic factors so far.

Conclusion
Our first results show that patients with AF recurrences after catheter ablation are older, show lower P-wave mean area and lower P-wave mean amplitude. We need to wait for the completion of follow-up in more patients, before we can determine the predictive value of P-wave parameters derived from extECGs for the prediction of AF recurrence and to identify predictive factors with more subtle effects on risk for AF recurrences.
The impact of posterior wall ablation in conjunction with pulmonary vein isolation in patients with persistent atrial fibrillation: a meta-analysis comparing cryoballoon vs. radiofrequency energy
Authors: Musat D , Milstein N S , Shaw R , Bhatt A , Habibi M , Preminger M , Sichrovsky T , Mittal S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary vein isolation (PVI) remains the cornerstone of atrial fibrillation (AF) ablation. In patients with persistent AF (PeAF), additional posterior wall ablation (PWA) has been proposed to improve outcomes. Individual small series have included patients ablated with a cryoballoon (CB) and radiofrequency (RF) energy and have yielded controversial results. We conducted a meta-analysis of available data to assess the incremental impact of PWA based on type of energy used for ablation.

Objective
To evaluate whether PVI + PWA is a more effective approach for treatment of PeAF than PVI alone based on ablation energy used.

Methods
The online databases (Pubmed, Medline, Embase) were searched using the terms "pulmonary vein isolation", "posterior wall isolation", or "posterior wall ablation". Out of 1917 studies, eight met our strict criteria (Table). Specifically, patients were undergoing de novo ablation for treatment of PeAF using either CB or RF. Patients had PVI alone vs PVI + PWA; studies that delivered additional ablations (except for cavotricuspid isthmus) were excluded. The primary outcome was recurrence of any atrial tachyarrhythmia (AT).

Results
The cohort consisted of 1607 patients (66 ± 17 years, 75% male); 830 (52%) patients were ablated CB and 777 (48%) patients were ablated with RF (Table). In the CB group, AT recurrence was significantly higher in patients who underwent PVI alone as compared to those who also had additional PWA (OR 2.55, 95% CI [1.89, 3.42], P &lt; 0.0001, Figure). In contrast, in the RF group, outcome between the 2 groups (OR 1.40, 95% CI [0.81, 2.42], P = 0.22, Figure) was similar.

Conclusions
Addition of CB based PWA to PVI in patients with PeAF undergoing ablation was associated with improved long-term ablation success. However, RF based PVA did not appear to confer the same benefit. Additional randomized studies are needed to determine the impact of ablation energy in patients undergoing PWA during ablation of PeAF.