bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bleeding risk prediction in a large cohort of patients with atrial fibrillation and cancer: a nationwide cohort study
Authors: Pastori D , Marang A , Bisson A , Herbert J , Cuzol F , Lip G Y H , Fauchier L 
Published: October 2022

Abstract

Introduction
The association between cancer types and specific bleeding events in atrial fibrillation (AF) patients has been scarcely investigated. Also, the performance of bleeding risk scores in this high-risk subgroup of patients is unclear.

Purpose
We investigated the rate of intracranial haemorrhage (ICH), major (MB) and gastrointestinal bleeding (GB) according to cancer types in AF patients. We also tested the predictive value of HAS-BLED, ATRIA and ORBIT bleeding risk scores.

Methods
Observational retrospective cohort study including 399,344 AF patients with cancer (mean age 77.9±10.2 years; 63.2% men). MB was defined according to Bleeding Academic Research Consortium (BARC) definitions.

Results
The highest ICH rates were found in leukaemia (1.89%/year), myeloma (1.52%/year), lymphoma and liver (1.45%/year) and pancreas cancer (1.41%/year). GBs were highest in liver (7.54%/year), pancreas (7.42%/year) and gastric (5.51%/year). Receiver operating characteristic (ROC) analysis showed that an ORBIT score ≥4 had the highest predictivity for MBs (AUC 0.805) followed by HAS-BLED and ATRIA (AUC 0.716 and 0.700, respectively). HAS-BLED and ORBIT performed best for ICH (AUC 0.744 and 0.742, respectively), better than ATRIA (AUC 0.635). For GB, ORBIT ≥4 had the highest predictivity (AUC 0.756), followed by the HAS-BLED (AUC 0.702) and ATRIA (AUC 0.662).

Conclusions
Some cancer types carry a greater bleeding risk in AF patients. The identification and management of modifiable bleeding risk factors is crucial in these patients, as well as to flag up high bleeding risk patients for early review and follow-up

Conclusions
Some cancer types carry a greater bleeding risk in AF patients. The identification and management of modifiable bleeding risk factors is crucial in these patients, as well as to flag up high bleeding risk patients for early review and follow-up.

Funding Acknowledgement
Type of funding sources: None.
Sex-differences in oral anticoagulation therapy in patients hospitalised with atrial fibrillation: a nationwide cohort study
Authors: Lee K , Doudesis D , Bing R , Astengo F , Perez J , Anand A , McIntyre S , Bloor N , Sandler B , Lister S , Pollock K , Qureshi A , McAllister D , Shah A , Mills N 
Published: October 2022

Abstract

Background
Important disparities in the treatment and outcomes of women and men with atrial fibrillation are well recognized. Whether introduction of direct oral anticoagulants has reduced disparities in treatment is uncertain.

Methods
All patients who had an incident hospitalization from 2010 to 2019 with non-valvular atrial fibrillation in Scotland were included in this cohort study. Community drug dispensing data were used to determine prescribed oral anticoagulation therapy and comorbidity status. Logistic regression modelling was used to evaluate patient factors associated with treatment with vitamin K antagonists and direct oral anticoagulants.

Results
A total of 172,989 patients (48% women [82,833/172,989]) had an incident hospitalization with non-valvular atrial fibrillation in Scotland between 2010 and 2019. The proportion of patients with thromboembolic risk factors (CHA2DS2VASc score &gt;0 in men and &gt;1 in women) treated with oral anticoagulation therapy increased from 36.8% to 66.3% over this 10-year period. By 2019, factor Xa inhibitors accounted for 83.6% of all oral anticoagulants prescribed, while treatment with vitamin K antagonists and direct thrombin inhibitors declined to 15.9% and 0.6%, respectively. Women were less likely to be prescribed any oral anticoagulation therapy compared to men (adjusted odds ratio, aOR 0.68 [95% CI, CI 0.67–0.70]). This disparity was mainly attributed to vitamin K antagonists (aOR 0.68 [95% CI 0.66–0.70]), whilst there was less disparity in use of factor Xa inhibitors between women and men (aOR 0.92 [95% CI 0.90–0.95]). At 1 year following hospitalization with atrial fibrillation, patients not prescribed oral anticoagulation therapy were more likely to have subsequent major adverse cardiovascular events compared to those prescribed with oral anticoagulation therapy (38.8% [15,380/39,608] versus 17.0% [6,761/39,671] in women and 35.2% [12,977/36,868] versus 16.4% [7,395/45,093] in men).

Conclusions
Women with non-valvular atrial fibrillation were significantly less likely to be prescribed vitamin K antagonists compared to men. Most patients admitted to hospital in Scotland with incident non-valvular atrial fibrillation are now treated with factor Xa inhibitors and this is associated with less treatment disparities between women and men.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This study was supported by the British Heart Foundation through a Clinical Research Training Fellowship (FS/18/25/33454), Intermediate Clinical Research Fellowship (FS/19/17/34172), Senior Clinical Research Fellowship (FS/16/14/32023) and a Research Excellence Award (RE/18/5/34216), and a research grant to NHS Lothian from Bristol Myers Squibb Pharmaceuticals Ltd and Pfizer UK Ltd.
Causes of death in patients with atrial fibrillation and a recent acute coronary syndrome or percutaneous coronary intervention: insights from the AUGUSTUS trial
Authors: Guimaraes P , Wojdyla D M , Alexander J H , Goodman S G , Aronson R , Windecker S , Mehran R , Granger C B , Lopes R D 
Published: October 2022

Abstract

Background
Patients with atrial fibrillation (AF) and concomitant coronary artery disease are at increased risk for poor outcomes. Less is known about specific causes of death in this population.

Methods
We describe specific causes of death among patients with AF and acute coronary syndrome and/or percutaneous coronary intervention included in the AUGUSTUS trial and followed for 6 months. An independent clinical events committee, blinded to treatment assignment, adjudicated cause of death according to pre-defined criteria. The association between baseline factors and all-cause death was evaluated using Cox proportional hazards modeling.

Results
A total of 151 deaths occurred in 4614 patients and were adjudicated as follows: 111 (73.5%) deaths due to cardiovascular (CV) causes and 40 (26.5%) due to non-CV causes. The most common cause of CV death was sudden death (n=39 [35.1%]), followed by myocardial infarction (n=29 [26.1%]) and heart failure (n=24 [21.6%]). The most common causes of non-CV death were infection (n=11 [27.5%]), bleeding (n=8 [20.0%]), and malignancy (n=5 [12.5%]). Increasing age, African American race, history of heart failure, treatment with diuretics, and lower body weight were associated with an increased risk of all-cause death (Table).

Conclusions
Among patients with AF and coronary artery disease, cardiovascular causes were responsible for the majority of deaths within 6 months. Our findings provide relevant information to inform the design of future studies in this population.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): AUGUTUS was funded by Bristol Myers Squibb and Pfizer.
Decreased device related thrombus and enhanced neo-endocardial tissue maturation with a new generation left atrial appendage closure (LAAC) device. An anticoagulation and antiplatelet free canin study
Authors: Saliba W , Wazni O , Kanj M , Shah M , Herbst T , Peelukhana S , Suttom B , Kopesky E , Jaber W 
Published: October 2022

Abstract

Introduction
Device related thrombus (DRT) has been reported in up to 7% of patients post LAAC even while on anticoagulation. Clinical predictors of DRT are poorly understood and may be related to patient, procedural and device factors. A next generation WATCHMAN LAAC device (NG) is identical in shape and geometry to the current WATCHMAN FLX device (CW) but has a device coating designed to make it hemocompatible and less thrombogenic.

Objective
To evaluate the incidence and burden of WM surface thrombus formation as detected longitudinally by TEE and at necropsy in a canine model implanted with the NG device.

Methods
The study included 12 canine (6 implanted with CW and 6 implanted with NG) that underwent serial TEE follow up at 14, 28 and 45 days to evaluate surface thrombus on WM face. This was a challenged canine model designed to induce thrombus with no anticoagulation or antiplatelet use throughout the study. D-dimer levels were measured at 7 days and 45 days and compared to baseline measurements.

Results
All devices were successfully implanted. TEE follow up at 14 days showed noticeably reduced thrombus burden on the NG device compared to CW (fig.1) with even further diminution by 28 days in the NG (6/6) as compared to only in 1/6 in the CW group (fig.2). After 45 days in-life, the post-fixation trim en-face images show a smooth, glistening neoendocardial covering (absence of acute thrombus material) in all (6/6) NG compared to only 2/6 in the CW (fig.3). The CW had 3/6 devices with exuberant, bulging calcified thrombus mass one of which was considered to be a mobile DRT. D Dimer levels at 7 and 45 days were significantly lower relative to baseline in the NG compared to CW.

Conclusion
The NG device compared to the CW device was associated with markedly less thrombus formation at 14 days and no thrombus formation at 28 days post implant on no anticoagulant and no antiplatelet therapy along with a more mature uniform tissue coverage at 45 days. The WATCHMAN FLX Pro device coating is a promising step to reduce DRT even without the use of anticoagulation and antiplatelets and merits further investigation in human studies.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Boston Scientific
Increased risk of incident atrial fibrillation in young adults with mental health disorders: a nationwide population-based study
Authors: Ahn H , Lee S , Choi E , Bae N , Ahn H , Kwon S , Lee S , Han K , Oh S , Lip G 
Published: October 2022

Abstract

Background
Mental health disorders and cardiovascular diseases are closely associated. The impact of mental health disorders on cardiovascular disease risk could be related to associated smoking, high blood pressure, and high cholesterol. Despite shared risk factors, there remains a paucity of information on incident atrial fibrillation (AF) incidence in patients with mental health disorders.

Purpose
To assess the association between mental health disorders and the risk of AF, especially amongst young adults aged 20 to 39 years.

Methods
Using the Korean National Health Insurance database between 2009 and 2012, we identified young adults aged 20 to 39 years without a history of AF and who have been diagnosed with mental diseases. Mental health disorders were defined as having one of the following diagnoses: schizophrenia (ICM-10 code F20), bipolar disorder (ICM-10 codes F30, F31), depression disorder (ICM-10 codes F32, F33), insomnia (ICM-10 codes G470, F510), and anxiety disorder (ICM-10 codes F40, F41). The primary outcome was new-onset AF during follow-up. We compared the risk of AF between those with mental health disorders and those without.

Results
A total of 6,576,582 people between the ages of 20–39 years old (mean age, 30.9±5.0 years; male, 59.6%) were included in this study. Among the total population, 668,683 patients (10.2%; mean age, 31.4±5.0 years; female, 53.9%) were diagnosed with mental health disorders: schizophrenia 7,575 (1.1%), bipolar disorder 10,956 (1.6%), depression disorder 184,061 (27.5%), insomnia 173,365 (25.9%), and anxiety disorder 413,914 (61.9%). During a 7.4±1.1 year of median follow-up, 8,932 AF events occurred (1,235 in those with mental health disorders and 7,697 in those without). Patients with mental health disorders showed a higher AF incidence than those without (25.4/100,000 PY vs. 17.7/100,000 PY). After adjusting with multivariate variables, patients with mental health disorders still showed a significantly higher risk of AF (Hazard ratio (HR) 1.507, 95% confidence interval (CI) 1.418–1.601). When analyzed according to each mental health disorder, patients with bipolar disorder or schizophrenia had 2 times higher risk of AF (HR 2.105, 95% CI 1.461–3.031; and HR 2.006, 95% CI 1.307–3.079, respectively), and those with depression, insomnia and anxiety showed an approximately 50% higher risk of AF compared to those without mental health disorders (HR 1.553, 95% CI 1.397–1.727; HR 1.635, 95% CI 1.47–1.818; and HR 1.478, 95% CI 1.372–1.592, respectively). Subgroup analyses were generally consistent with the main result.

Conclusions
Young adults diagnosed with mental health disorders, ie. depression, insomnia, anxiety, bipolar disorder, or schizophrenia are associated with a higher risk of incident AF. Awareness and screening for AF in these high-risk populations should be considered.

Funding Acknowledgement
Type of funding sources: None.
Bleeding and thrombotic events in patients with atrial fibrillation and cancer: a systematic review and meta-regression analysis
Authors: Pastori D , Menichelli D , Di Rocco A , Farcomeni A , Sciacqua A , Pignatelli P , Fauchier L , Lip G Y H 
Published: October 2022

Abstract

Background
Atrial fibrillation (AF) and cancer are frequently coexisting in elderly patients. Pooled metanalytic data on the impact of cancer on outcomes in AF patients are lacking.

Purpose
We want to investigate the impact of cancer in patients with AF, particularly in relation to the incidence of bleeding and ischemic events

Methods
Systematic review and meta-regression analysis of clinical studies retrieved from Medline (PubMed) and Cochrane (CENTRAL) databases according to PRISMA guidelines. Safety endpoints included any, major, gastrointestinal (GI) bleeding and intracranial haemorrhage (ICH). Efficacy endpoints included myocardial infarction (MI), ischemic stroke/systemic embolism (IS/SE), cardiovascular (CV) and all-cause death.

Results
15 studies were included in the metanalysis: 4 prospective, 3 randomized clinical trials and 8 retrospective studies with 2,868,010 AF patients, of whom 479,571 (16.7%) had cancer. The pooled HR for cancer was 1.43 (95% CI 1.42–1.44) for any bleeding, 1.27 (95% CI 1.26–1.29) for major bleeding, 1.17 (95% CI 1.14–1.19) for GI bleeding, and 1.07 (95% CI 1.04–1.11) for ICH. The risk of major bleeding increased with the proportion of breast cancer. Cancer increased the risk of all-cause death (HR 2.00, 95% CI 1.99–2.02) whereas no association with MI (HR 0.97, 95% CI 0.94–1.01) and CV death (HR 1.01, 95% CI 0.99–1.03) was found. Patients with AF and cancer were less likely to suffer from IS/SE (HR 0.91, 95% CI 0.89–0.94).

Conclusion
The presence of cancer modifies the clinical history of AF patients, mainly increasing the risk of bleeding. Further analyses according to the type and stage of cancer is necessary to better stratify bleeding risk in these patients.

Funding Acknowledgement
Type of funding sources: None.
Higher risk of adverse outcomes and need for pacemaker among patients undergoing radiofrequency ablation due to ectopic atrial tachycardia – a nationwide registry-based Danish study
Authors: Middelfart C , Toennesen J T , Zoerner C Z , Gislason G G , Pallisgaard J P , Ruwald M R , Hansen M L H 
Published: October 2022

Abstract

Introduction
Atrioventricular nodal reentry tachycardia (AVNRT), Wolf-Parkinson-White syndrome (WPW), and Ectopic atrial tachycardia (EAT) are common arrhythmias and associated with lower quality of life. The use of radiofrequency ablation (RFA) treatment has increased over time, however long-term risk of adverse outcomes after RFA in patients with AVNRT, WPW, or EAT is unknown.

Purpose
To examine the long-term risk of adverse outcomes and need for pacemaker after RFA in AVNRT-, WPW-, and EAT-patients.

Methods
Using Danish nationwide registries, patients of 18 years or older who underwent RFA for AVNRT, WPW, or EAT between January 1st 2001 and January 1st 2019 were included. Comorbidities and use of antiarrhythmic drugs were analyzed.
The cumulative incidences of pacemaker implantation and a combined endpoint of death, thromboembolism (TE), ischemic heart disease (IHD), and heart failure (HF) were estimated at 5-year follow-up using the Aalen-Johansen estimator, taking death as competing risk into account.

Results
A total of 10.439 patients were enrolled in the study. 6187 patients were treated for AVNRT. The median age was 55 [42, 65] and 40% were male. The WPW group consisted of 2872 patients. The median age was 42 [29, 55] and 61% were male. The EAT group consisted of 1380 patients. The median age was 57 [44, 67] and 47% were male.
The comorbidity burden was generelly higher in EAT patients especially regarding heart failure and hypertension. Use of antiarrhythmic drugs was higher in EAT patients compared to patients with AVNRT and WPW.
Figure 1 shows the cumulative incidence of a composite endpoint of death, TE, IHD, and HF 5 years after RFA treatment and depicts that the cumulative incidence was 22.1%, 13.9% and 8.2% for EAT-, AVNRT- and WPW-patients respectively. Figure 2 shows the 5-year cumulative incidence of pacemaker implantations which was 9.0%, 4.4% and 3.1% for EAT-, AVNRT- and WPW-patients respectively.

Conclusion
At long-term follow-up patients with RFA for EAT have a higher risk of death, TE, IHD and HF compared to patients treated for AVNRT and WPW. EAT patients also have the highest risk of pacemaker implantation.

Funding Acknowledgement
Type of funding sources: None.
Catheter ablation of atrial arrhythmias by using a multipolar grid-patterned high density mapping catheter in patients with congenital heart disease: a single-center experience
Authors: Kerst G , Gulgun M , Ozcan S , Ostenmayer S , Hartmann L , Hanten J , Vazquez-Jimenez J 
Published: October 2022

Abstract

Objective
Catheter ablation of arrhythmias in patients with congenital heart disease (CHD) remains challenging and time-consuming. A novel diagnostic catheter with a multipolar grid-patterned electrode configuration for high density mapping may reduce mapping time and enhance ablation success. Here we describe our experience of catheter ablation by using a multipolar grid-patterned mapping catheter in patients with CHD suffered from atrial tachycardia.

Methods
All patients with CHD underwent catheter ablation for atrial tachycardia by using multipolar grid-patterned high density mapping catheter between 04/2018 and 12/2021 were enrolled. Primary success was defined as non-inducibility of atrial tachycardia. Only the first catheter ablation was included in the study.

Results
A total of 37 consecutive patients (median age 34.2±33.0 years (range 7–65), female n=20) underwent 37 ablation procedures with initial high density mapping. The underlying heart defects were s/p ASD-closure (n=2), ASD-closure and corrected partial anomalous pulmonary venous return (n=2), corrected unroofed coronary sinus (n=1), pulmonary valve commissurotomy (n=2), repaired Tetralogy of Fallot (n=2), tricuspid and pulmonary valve replacement in PA/IVS (n=1), mitral valve replacement (n=1), Hypoplastic right heart syndrome (n=1), atrial switch procedure for dTGA (n=7), TA with Glenn shunt (n=1), Ross operation (n=1), Fontan palliation (tricuspid atresia n=6, DILV n=5, HLHS n=1, DORV n=1, dTGA n=1, criss-cross heart n=1, single ventricle n=1). A history of previous ablation was positive in 8 patients. During mapping of the cardiac chambers, the mean value of total collected points and used points were 32657.8±46171 and 3851.6±3295.5 respectively. Mean mapping and fluoroscopy time were 62.1±40.7 minute (range 3–178) and 11.4±8.5 minutes (range 0–32.2), respectively. There were 69 atrial tachycardia substrates in the 37 patients (median 2, range 1–4 per patient). All tachycardia substrates were completely ablated in 33/37 (89.2%) patients and partially in 4/37 (11.8%) patients. Acute success was achieved with successful ablation of 65 of 69 (94.2%) atrial substrates. During a median follow-up time of 20 months (range 5–49), recurrence rate was 5/65 (7.7%) atrial substrates in 5/37 (13.5%) patients. Comparison of 16 patients with Fontan palliation to the 23 patients without Fontan operation showed higher partially success rate in the patients with Fontan palliation (4/16 vs. 0/21, p=0.028).

Conclusion
In this series, high density mapping allowed elucidation of the tachycardia mechanism in all patients with a high primary ablation success, a limited radiation exposure and a low rate of arrhythmia recurrence.

Funding Acknowledgement
Type of funding sources: None.
Utility of open window mapping using high-density mapping approach in accessory pathways ablation
Authors: Martinez Sande J L , Gonzalez-Melchor L , Garcia-Seara J , Minguito-Carazo C , Rodriguez-Manero M , Otero-Garcia O , Fernandez-Lopez J A , Gonzalez-Ferrero T , Gonzalez-Juanatey J R 
Published: October 2022

Abstract

Introduction and purpose
We sought to described a new protocol of open window mapping (OW) utilizing high-density mapping in accessory pathways (AP) in CARTO® 3 system. This protocol automatically map conventional electrophysiology criteria for AP location, as shorter local EGM AV interval (extended early meets late tool), earliest local activation time (LAT)and annotation at unipolar signal (wavefront annotation).

Methods
This was a single center, prospective and observational trial of 21 consecutive patients who underwent an AP catheter ablation.

Results
We included 16 men and 5 women, with a mean age of 32.6±17.9 years. The characteristics of AP, including mapping and ablation were described in Table 1. Twelve AP were of left location and 9 in right location. Mapping was performed in anterograde conduction in 17 patients (80.9%), retrograde in 9 patients (42.9%) and orthodromic tachycardia in 7 patients (33.3%). Mean mapping points were 3205±2034, with 29.2 min±12.5 min of mapping. All 21 patients had a successful ablation after OW mapping and mean radiofrequency time until complete AP elimination was 2.76 s.
We present an example of a Left lateral AP OW mapping in antegrade and retrograde conduction in Figure 1, which shows EEML mapping tool, targeting shorter interval EGM AV or VA and color adjust to determine earliest LAT in chamber of exit.

Conclusions
In our experience, automatically mapping of conventional electrophysiology criteria for AP diagnostic is feasible to localize AP insertion, suggesting an increasing in effectiveness of procedure, and reducing mapping time, ablation time and X-ray exposure time. More studies should be performed to corroborate these conclusions.

Funding Acknowledgement
Type of funding sources: None.