bluuebunny/crossref_metadata_2025_split huggingface dataset:
Higher coronary calcium score is associated with increased risk of atrial fibrillation recurrence
Authors: Fernandes S , Ladeiras-Lopes R , Cruz I , Silva G , Diaz S , Barros A , Saraiva F , Faria R , Almeida J , Fonseca P , Goncalves H , Oliveira M , Ferreira N , Primo J , Fontes-Carvalho R 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Patients with atrial fibrillation (AF) referred for catheter ablation routinely undergo cardiac computed tomography (CCT) for procedure planning. An opportunistic evaluation of coronary artery calcium score (CACS) can be an important tool to improve clinical care. It is already known that CACS is associated with a high risk of AF development, particularly if values are above 100, but few data are available regarding the impact of CACS in AF recurrence after ablation.

Purpose
To assess the impact of CACS on atrial fibrillation recurrence following catheter ablation.

Methods
Retrospective, single-centre cohort study of consecutive patients with AF undergoing CCT for ablation procedure planning, from 2017 to 2019. Baseline clinical and demographical data were collected. Patients with known history of coronary artery disease (CAD) and moderate to severe valvular heart disease were excluded. CACS was assessed using the Agatston method. Recurrence was defined as any documented episode of AF, atrial flutter or atrial tachycardia after 3 months from procedure. Patients were stratified in CACS&lt;100 and CACS≥100. Explorative analysis incorporated Kaplan-Meier survival curves and Cox regression.

Results
A total of 354 patients were included, with a mean age of 56 ± 12 years, 66% male and 21% with persistent AF. More than half of the patients had a CACS&gt;0 (n=185, 52%) and 63 patients (18%) had a CACS≥100. Patients with CACS≥100 were older (63 ± 7 vs 54 ± 12 years, p&lt;0.001), had higher prevalence of hypertension (68% vs 43%, p&lt;0.001) and diabetes mellitus (21% vs 10%, p=0.012) and higher left atrial volume (39 ± 9 vs 35 ± 9 ml/m2, p=0.018). After a median observation time of 34 months (IQR 24-43), 117 patients (33%) had AF recurrence.
CACS≥100 was associated with increased risk of AF recurrence (unadjusted Cox regression: hazard ratio [HR] 1.85; 95% confidence interval [CI], 1.23-2.79, p=0.003) (Fig. 1). After covariate adjustment (age, gender, hypertension, diabetes mellitus, obesity, thyroid disease, AF type and left atria enlargement) CACS≥100 remained an independent predictor of the risk of AF recurrence (HR, 1.68; 95% CI, 1.05-2.70, p=0.03) as well as persistent AF (HR, 1.91; 95% CI, 1.23-3.00, p=0.004) (Fig. 2).

Conclusion
In patients with AF undergoing catheter ablation, without previous history of CAD, a CACS≥100 was independently associated with a 68% increase in the risk of AF recurrence.
Gender gap in study inclusion: Insights from the STAR-FIB cohort study
Authors: Tanner H , Goulouti E , Lam A , Elchinova E , Nozica N , Servatius H , Noti F , Seiler J , Baldinger SH , Haeberlin A , Franzeck F , Asatryan B , Reichlin T , Roten L 
Published: May 2022

Abstract

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

Background
The underrepresentation of women in cardiovascular clinical trials is well described but cannot be fully explained by sex-specific differences in the prevalence of cardiovascular diseases. Data on potential sex- and gender-related differences in study exclusion reasons are scarce.
The STAR-FIB cohort study aimed to estimate the age and sex-specific prevalence of screening-detected atrial fibrillation (AF) in 800 hospitalized patients aged 65-84 years using serial seven-day ECGs. Recruitment for study inclusion was stratified by sex (female/male, as stated in the patient’s records) and age (four age bands, ≥65 to &lt;70, ≥70 to &lt;75, ≥75 to &lt;80, and ≥80 to &lt;85 years), and was truncated for each subgroup after the inclusion of 100 participants.

Purpose
To assess sex and gender differences in patient recruitment for inclusion in the STAR-FIB cohort study.

Methods
A screening log containing sex-category, age, and reasons for exclusion was maintained. Exclusion criteria are shown in the figure. For the purpose of the present study, an explorative analysis of all exclusion criteria with respect to sex category was done.

Results
Overall, 11’470 patients were identified for eligibility, 795 patients (49% women; mean age 75 years) were enrolled, and 10’675 patients (52% women vs. 48% men, p =0.13) were not enrolled. The two major exclusion reasons were unwillingness to participate, which was more frequent in women (27.9% of women vs. 18.4% of men, p &lt; 0.01), and the presence of clinical AF, which was more prevalent in men (27.1% of men vs. 20.5 % of women, p &lt; 0.01). A detailed analysis of all exclusion criteria analysed by sex category is provided in the figure.

Conclusions
Clinical AF was more frequent in men, in accordance with the well described sex-driven (biological) higher prevalence of AF in men. In contrast, we found a higher percentage of women unwilling to participate in this study, which may represent a more gender-based (sociocultural) phenomenon. A further exploration of these findings should be performed and may help to identify and potentially overcome modifiable obstacles for study participation.
Atrial fibrillation is associated with an increased risk of ventricular arrhythmias and sudden death in the general population
Authors: Fawzy AM , Bisson A , Bodin A , Herbert J , Lip GYH , Fauchier L 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation (AF) has been linked to an increase in the risk of ventricular arrhythmias.

Purpose
We aimed to investigate whether AF is associated with an increased risk of ventricular tachycardia (VT), ventricular fibrillation (VF) and sudden death (SD).

Methods
Hospitalised patients from 2013 with and without AF were identified from the French National database and included if they had at least 5 years of follow-up.

Results
Over a median follow-up period of 5.4 years (interquartile range (IQR) 5.0-5.8 years), a total of 3345638 patients were identified. Of these, 312226 had AF and 3033412 did not have AF. After multivariable analysis, the predictors significantly associated with VT, VF and SD included age, sex, hypertension, diabetes mellitus, heart failure, history of pulmonary oedema, valve disease, dilated cardiomyopathy, coronary artery disease, vascular disease, AF, smoking, dyslipidaemia, obesity, alcohol related diagnoses, chronic kidney disease, lung disease, liver disease, inflammatory diseases, anaemia, previous cancer, poor nutrition, cognitive impairment, and frailty.
The incidence of VT, VF and SD was higher in those with AF compared to those without AF (2.23%/year vs. 0.56%/year). AF was associated with a higher risk of incident outcomes compared to no AF, hazard ratio (HR) 3.657 (confidence interval (CI) 3.604-3.711). After adjustments were made for confounders (Figure 1), this increased risk was still significant HR 1.167 (CI 1.111-1.226). A 1:1 propensity score matched analysis was also performed (n=289,332 in each group), demonstrating the significantly increased risk of ventricular arrhythmias and SD in patients with AF compared to those without AF, HR 1.339 (CI 1.313-1.366).

Conclusion
The findings from our study AF indicate that AF is associated with an increased risk of VT, VF and sudden death in the general population.
Is there clinical utility to replacement of an implantable loop recorder in patients who have previously undergone cryoballoon pulmonary vein isolation?
Authors: Musat D , Milstein N , Saberito M , Bhatt A , Habibi M , Preminger M , Sichrovsky T , Shaw R , Mittal S 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Implantable loop recorders (ILRs) are used for long-term ECG monitoring following catheter ablation in patients (pts) with atrial fibrillation (AF) to guide clinical management. However, little is known about what do when the ILR reaches end of service (EOS).

Purpose
To identify pts who underwent replacement of their ILR and determine the diagnostic yield and clinical utility of the replacement device.

Methods
We enrolled 222 consecutive pts with AF who underwent cryoballoon pulmonary vein isolation (CB PVI) and had an ILR. We identified pts who subsequently underwent ILR replacement. The diagnostic and clinical utility of the newly replaced ILR was determined.

Results
The cohort included 56 pts (64 + 9 years; 35 [63%] male; 27 [48%] PAF; CHA2DS2-VASc 2.3 ± 1.5) in whom the initial ILR reached EOS. They were followed for 3.7 ± 2.1 years. Recurrent AF was observed in 41 (73%) of these pts; this triggered an intervention in 17 (41%) pts (Figure). Of the other 15 (27%) pts without any documented AF, anticoagulation was withheld in 13 [87%] pts. Following ILR replacement, 33 (80%) of the 41 pts had more AF (n=11 [33%] required an intervention) and 5 additional pts had AF for the first time.

Conclusions
Our data show that after CB PVI, ILRs help guide decisions regarding rhythm management and oral anticoagulation. When the initial ILR was replaced by a second ILR, AF was detected (often for the first time) in some patients; the findings were used to guide clinical decision making in the entire cohort. Thus, at this time, it remains undefined when ECG monitoring of these pts can be stopped because it is no longer clinical meaningful.
Comparison of various late gadolinium enhancement magnetic resonance imaging methods to high-definition voltage and activation mapping for detection of atrial cardiomyopathy
Authors: Eichenlaub M , Mueller-Edenborn B , Minners J , Hein M , Ruile P , Lehrmann H , Schoechlin S , Allgeier J , Bohnen M , Trenk D , Neumann F-J , Arentz T , Jadidi A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Medtronic

Background/Introduction
Atrial cardiomyopathy (ACM) is associated with the progression from paroxysmal through persistent to permanent atrial fibrillation (AF) and increased arrhythmia recurrence rates after pulmonary vein isolation (PVI).

Purpose
We compare the most common left atrial (LA) late gadolinium enhancement magnetic resonance imaging (LGE-MRI)-methods (Utah-method and image-intensity-ratio (IIR)-methods) and endocardial voltage mapping for ACM-detection and outcome prediction after PVI for AF.

Methods
In this prospective study, 37 ablation-naive patients (66±9 years, 84% male) with persistent AF were included and electrically cardioverted into sinus rhythm. Subsequently, they underwent LA-LGE-MRI and high-definition voltage and activation mapping (2129±484 sites) in sinus rhythm prior to PVI. MRI-post-processing-analyses were performed by two independent expert laboratories (Marrek for the Utah segmentation as describers of this methodology and Adas 3D medical as developers of the Adas software for the IIR-methods) which were blinded to any clinical data. Arrhythmia recurrence was recorded within 12 months following PVI.

Results
The global ACM-extent was highly variable: median LA low-voltage substrate (LA-LVS) was 12.9% at &lt;1.0mV and 2.7% at &lt;0.5mV; median LA-LGE-extent using the Utah-method was 18.3% and 0.03%-93.1% using the IIR-methods. LA activation time was significantly correlated with LA-LVS (r=0.76 at &lt;0.5mV and r=0.82 at &lt;1.0mV, both p&lt;0.0001), but not with LA-LGE-extent.
The highest regional matching between LA-LVS &lt;0.5mV and LA-LGE was found for the anterior wall in 57% of patients using the Utah-method and in 59% using IIR 1.20. The corresponding values for the posterior wall were 19% and 38%, respectively.
Arrhythmia recurrence occurred in 15 (41%) patients. Freedom from arrhythmia was significantly lower in those with relevant LA-LVS (≥2cm2 at 0.5mV) but not in those with relevant LGE (Utah-stages III&IV): 43% versus 81%, p=0.009 and 50% versus 67%, p=0.338, respectively. Furthermore, relevant
LA-LVS was the only predictor for arrhythmia recurrence in multivariate regression analysis.

Conclusion
The different LA-LGE-MRI methods have large dicrepancies regarding extent and distribution of ACM and are different to the extent and regional distribution of LA-LVS as assessed in endocardial high-definition voltage mapping in sinus rhythm. Further improvements of the LA-LGE-MRI-methods are required to enable correct diagnosis of ACM and for future evaluation of MRI-guided ablation protocols.
Healthy lifestyle and atrial fibrillation recurrence after pulmonary vein isolation
Authors: Krisai P , Knecht S , Badertscher P , Voellmin G , Spiess F , Schaer B , Osswald S , Sticherling C , Kuehne M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background/Introduction: Data on the relationship of a healthy lifestyle at the time of atrial fibrillation (AF) ablation with AF recurrence is limited.

Purpose
We investigated the association of healthy lifestyle markers with AF recurrence after ablation.

Methods
In 1439 patients undergoing AF ablation at a tertiary university hospital, a lifestyle score was built. The score included categories of BMI, smoking, blood pressure, fish intake, fruits/vegetable intake, alcohol consumption and physical activity. A higher score indicated a healthier lifestyle and patients were grouped into tertiles. Follow-up included 24h-Holter ECGs at 3 and 6 months and 7d-Holter ECGs at 12 months. Survival analyses and Cox-regression models were used to assess associations of individual factors and score-tertiles with AF recurrence.

Results
Mean age was 61.5 years, 25.9% were female and 59.1% had paroxysmal AF. In 941 patients all lifestyle score variables were available: 129, 675 and 137 patients were in the low, intermediate and high lifestyle group, respectively. Over increasing lifestyle groups, patients were more often female (9.3, 23.3, 38.7%; p&lt;0.0001), had less hypertension (70.5, 53.3, 32.9%; p&lt;0.0001), diabetes (15.5, 6.2, 3.7%; p=0.0002), a smaller left atrial diameter (44.1, 41.0, 37.6mm; p&lt;0.0001) and numerically more paroxysmal AF (56.6, 62.4, 69.4%; p=0.32) with no differences in anti-arrhythmic drugs. In survival analyses (Figure), we saw a trend of more recurrences in the healthiest group compared to the unhealthiest group (logrank p=0.06 for low vs high group). Individually, higher fish intake (logrank p=0.04) and lower blood pressure (logrank p=0.02) were associated with AF recurrence. In Cox-regression models the HR (95% CI) for increasing lifestyle groups was 1.21 (0.98; 1.50, p=0.07). In individual models only higher fish intake (1.25 [1.01; 1.55], p=0.045) was associated with AF recurrence.
Conclusion(s): AF recurrence was numerically more frequent in patients with a healthier lifestyle, despite less comorbidities and smaller LA diameters. This paradoxical relationship might be due to lifestyle changes after PVI, differences in PVI efficacy or residual confounding. Further studies are needed to better understand this association.
Pulsed field ablation for paroxysmal atrial fibrillation is safe for the brain
Authors: Reinsch N , Fueting A , Hoewel D , Bell J , Lin Y , Neven K 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
While symptomatic thromboembolic events are rare, silent cerebral emboli (SCL) or events (SCE) are a common observation after LA ablation for AF, using thermal ablation techniques. Pulsed field ablation (PFA) is a novel, non-thermal ablation modality that is able to ablate myocardial tissue with minimal e!ect on surrounding tissue. Preclinical data show absence of cerebral emboli after extensive PFA ablation. However, clinical data on SCL/SCE after PFA are rare.

Objective
We investigated neurological deficits and/or SCL/SCE after PFA in paroxysmal AF using National Institutes of Health Stroke Scale (NIHSS) scores to quantify cerebral impairment and cerebral MRI.

Methods
LA appendage thrombus exclusion was done by CT-angiography. PVI using PFA was performed with interrupted oral anticoagulation at the day of the procedure and heparin administered before single transseptal puncture (target ACT &gt;325 sec.). In all procedures, extensive high-density pre- and post-ablation 3D bipolar voltage maps were performed to document PVI. NIHSS scores were assessed at baseline, days 2 and 30 after PVI. One day after PVI, a cerebral 1.5 Tesla MRI using di!usion-weighted imaging (DWI) and FLAIR sequences to document occurrence of SCL/SCE was performed.

Results
In 30 patients (age 63 years; 47% male; CHA2DS2-VASc-Score 2), uncomplicated PFA was performed, with all PVs acutely isolated. Skin-to-skin procedure time was 120 min and LA dwell time was 109 min. In-hospital and 30-day clinical follow-up was uneventful. No patient showed neurological deficits. All NIHSS scores at all stadiums were the minimum value of 0. Cerebral MRI scans were normal in 29/30 (97%) patients. In 1/30 (3%) patient, a single 7-mm cerebellar lesion was observed. Forty days after the procedure, a follow-upMRI scan showed complete regression of the lesion. This origin of this single lesion could not be established. Air embolization after multiple catheter exchanges, or embolization of tissue debris after transseptal puncture cannot be ruled out.

Conclusion
PVI using PFA in patients with paroxysmal AF causes no neurological deficits and shows absence of SCL/SCE in 97% of patients. In one patient, a single small SCL/SCE of unknown origin occurred with complete regression after 40 days. PFA seems to be a safe ablation modality for the brain.
Novel cryoballoon system for pulmonary vein isolation: multicenter assessment of efficacy and safety - The ANTARCTICA study
Authors: Heeger CH , Pott A , Sohns C , Sommer P , Tondo C , Fassini G , Bohnen J , Dahme T , Rillig A , Wakili R , Metzner A , Tilz RR 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary vein isolation (PVI) either by balloon devices or point by point radiofrequency (RF) and 3D mapping based catheter ablation forms the cornerstone of invasive atrial fibrillation (AF) treatment and has demonstrated high procedural success and encouraging long-term outcomes. Although equally effective cryoballoon (CB) based PVI offers shorter procedure duration as well as lower complication rates compared to RF based PVI. Beside the worldwide established Arctic Front Advance (AFA) cryoablation system a novel CB ablation system, POLARx was recently introduced. The POLARx CB incorporates unique features which may translate into improved efficacy and safety of CB based PVI. However, multicenter assessment of periprocedural efficacy and safety is lacking up to date.

Methods
From August 5th to october 12th 2020, a total of 317 patients with paroxysmal or persistent atrial fibrillation (AF) underwent POLARx CB based PVI in 5 centers from Germany and Italy. Acute efficacy and safety were assessed.

Results
In 317 patients (mean age 64±12 years, 209/317 (66%) paroxysmal AF) a total of 1256 pulmonary veins (PV) were identified and 1252 (99,7%) PVs were successfully isolated utilizing the mainly the short tip POLARx CB (82%). The mean minimal cryoballoon temperature was -57.9±7 °C. Real-time PVI was visualized in 72% of PVs. The mean procedure time 92±41 minutes with a mean fluoroscopy time of 15±10 minutes.
Concerning periprocedural complications 1 (0.3%) cardiac tamponade successfully treated by pericardial puncture and 4 (1.3%) pericardial effusion without any intervention were detected. A total of 13 phrenic nerve injuries (4.1%) occurred during treatment of the right superior PV (9/13) and right inferior PV (4/13). Phrenic nerve injury recovered in 3/13 (23%) patients until discharge. Two minor bleeding of the groin (0.6%), 1 (0.3%) severe bleeding with intervention, 5 transient air embolism (1.6%) and 3 (0.9%) stroke / TIA has been observed.

Conclusions
In this large multicenter assessment the novel POLARx CB shows a promising efficacy and safety profile. Further studies are necessary to draw final conclusion.
Comparison of ostial versus very wide antral circumferential pulmonary vein isolation using pulsed field ablation
Authors: Tilz R , Heeger C , Eitel C , Vogler J , Phan L , Feher M , Keelani A , Kuck K , Kirstein B 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary vein isolation (PVI) is the gold standard for first-time atrial fibrillation (AF) ablation procedures. Wide antral circumferential ablation (WACA) in comparison to ostial PVI has been attributed to an improved rhythm outcome after AF ablation. Pulsed field ablation (PFA) is a novel energy source with promising safety and efficacy advantages over existing ablation methods due to its unique myocardial tissue specificity. Feasibility of PFA for very WACA has not been investigated so far.

Objective
To evaluate procedural characteristics and lesion formation during wide antral circumferential PVI in comparison to ostial PVI using a PFA system.

Methods
Thirty-seven consecutive AF patients underwent first-time PFA under deep sedation. Patients eighter received ostial (ostial group; N = 15: 66 % paroxysmal AF; age: 69 years; 66 % male) or very wide antral (vWACA group; N = 22: 59 % paroxysmal AF; age: 62 years; 73 % male) PFA. Pre and post ablation LA voltage maps were acquired using a 20-pole spiral catheter together with a 3-dimensional electroanatomic mapping system (voltage cutoff ≤0.5 mV). On post ablation maps, lesion size by encircling the ablated area was measured. In all patients, 8 pulse trains (2kV/2.5 sec, bipolar, biphasic, 4x basket/flower configuration each) were delivered to each pulmonary vein (PV). In the vWACA-group, extra pulse trains in flower configuration were added to each PV in a wide antral position continuous intraluminal esophageal temperatures (TESO) were monitored with an S-shaped esophageal temperature probe.

Results
A median of 8 [IQR 8;8] and 10 [IQR 10;11] pulse trains per PV for ostial and vWACA PVI were applied. vWACA PFA resulted in significant larger lesion formation (47.3 cm2 [IQR 39.1; 52.0]) in comparison to ostial PFA (35.5 cm2 [IQR 30.3; 38.1], p=0.013) with consecutive posterior LA wall isolation in 19/22 (86 %) patients (Figure 1). In the vWACA group, median TESO increased by 0.7 °C (TESOmax 36.5 °C [IQR 36.0;36.9]). However, the vWACA approach was not associated with a significant increase in procedure time, sedation dosage or exposure to radiation.

Conclusion
Very wide antral circumferential PFA of the PVs is feasible and was associated with significant larger lesion formation in comparison to conventional ostial PFA. Concomitant posterior LA wall isolation occurred in the majority of patient and did not result in a clinically significant increase of intraluminal esophageal temperatures, procedure time, sedation and radiation dosage.