bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of modifiable risk factors and related poor cardiovascular outcomes following atrial fibrillation ablation
Authors: Stout K , Adomako R , Almerstani M , Shin D , Tandon H , Schleifer J , Payne J , Easley A , Khan F , Windle J , Tsai S , Anderson D , Naksuk N 
Published: October 2022

Abstract

Background
Atrial fibrillation (AF) has become a global epidemic. Early catheter ablation and therapies modifying risk factors (RF) have been shown to improve outcomes of AF ablation. However, the time invested in pursuing risk factor modification may delay ablation, which could negate the procedural benefit.

Purpose
This study sought to investigate the prevalence and impact of potentially modifiable RF among AF patients undergoing catheter ablation in clinical practice.

Methods
This retrospective study included 724 consecutive patients undergoing AF ablation at a tertiary care center from 2012–2019. Pre-specified modifiable risks were examined, including the time from AF diagnosis to ablation, fluctuation/increase in BMI &gt;5% prior to ablation, mean systolic/diastolic blood pressure &gt;125/80 mmHg, obstructive sleep apnea with CPAP noncompliance, hyperlipidemia without statin therapy, tobacco use, excessive alcohol use, and diabetes mellitus with hemoglobin A1c (HbA1c) &gt;6.5%. The primary outcome was a composite of recurrent atrial arrhythmias, cardiovascular (CV) hospitalizations and mortality following AF ablation. A multivariate analysis was performed.

Results
The mean age was 61±10 years old, 32.5% were female and 72.2% had persistent AF. Many study patients had modifiable RF, ranging from 4.7% with excessive alcohol use to 64.0% experiencing delayed AF ablation. The mean time from AF diagnosis to ablation was 4.7 years. During a mean follow-up of 1.6 years after ablation, 467 (64.5%) patients met the primary outcome. Independent RF for the primary outcome were an increase/fluctuation in BMI &gt;5% (adjusted hazard ratio [AHR] 1.31, 95% confidence interval [CI] 1.07–1.60; P=0.008), diabetes with HbA1c &gt;6.5% (AHR 1.50, 95% CI 1.09–2.03; P=0.014) and hyperlipidemia without statin therapy (AHR 1.30, 95% CI 1.08–1.57; P=0.005). Delayed AF ablation over 1.5 years did not alter the outcome, Figure 1.

Conclusion
Substantial portions of patients undergoing AF ablation have potentially modifiable RF. Increased or fluctuating BMI, diabetes with HbA1c &gt;6.5%, and hyperlipidemia not treated with statin therapy portend an increased risk of recurrent atrial arrhythmia, CV hospitalizations and mortality. These findings underscore an importance pursuing RF management in patients with AF to reduce adverse outcomes after ablation.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Jensen Family Research Sponsorship at the University of Nebraska Medical Center
Dronedarone as early rhythm control: post-hoc analysis of the ATHENA trial using EAST-AFNET4 criteria
Authors: Kirchhof P , Camm A J , Crijns H J G M , Piccini J P , Torp-Pedersen C , McKindley D , Stewart J , Wieloch M , Hohnloser S H 
Published: October 2022

Abstract

Introduction
The EAST-AFNET4 study found that early, systematic rhythm control reduced cardiovascular (CV) outcomes in patients with early atrial fibrillation/atrial flutter (AF) of ≤12 months compared to guideline-recommended usual care.

Purpose
This post-hoc analysis aimed to assess whether antiarrhythmic drug therapy alone (i.e. dronedarone 400 mg BID) improved CV outcomes compared to placebo in patients with early AF in the ATHENA trial (NCT00174785; Ref 2) applying the EAST-AFNET4 criteria.

Methods
All patients in the randomised, placebo-controlled ATHENA trial with ≥2 CV conditions as defined in the EAST-AFNET 4 inclusion criteria and known AF duration at baseline were identified. Patients were split into early AF (≤12 months duration) and late AF (&gt;12 months duration) subgroups. Outcomes were collected over a mean follow-up of 21 months and included a composite of CV death, stroke, or hospitalisation with worsening of heart failure or acute coronary syndrome; nights spent in hospital per year; and a safety composite endpoint comprising death, stroke, or pre-specified serious adverse events. All analyses were conducted in the intention-to-treat population.

Results
Dronedarone treatment was associated with significantly (p=0.014) fewer CV events vs placebo in patients with early AF (Fig 1). There was no interaction with AF duration (p=0.64). Patients on dronedarone spent numerically fewer nights in hospital vs placebo in early (13.4 vs 14.0) and late AF (13.9 vs 16.3), with no treatment interaction between subgroups (p=NS). Dronedarone was associated with more sinus rhythm (SR) at 12 months vs placebo (early AF: 79.9% vs 70.3%; late AF: 60.6% vs 54.0%), and similar rates of SR at 24 months (early AF: 65.8% vs 65.7%; late AF: 54.7% vs 54.1%). For the safety composite endpoint, estimated events/patients were as follows for the early AF group (dronedarone: 153/135; placebo: 182/165) and the late AF group (dronedarone: 86/81; placebo: 95/89).

Conclusions
The clinical benefit of early rhythm control found in the EAST-AFNET4 trial can be replicated in this analysis of patients with early AF treated in the ATHENA trial comparing dronedarone to placebo. These data support the use of dronedarone as part of early rhythm control.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Sanofi
Amiodarone and lung toxicity in a real-life contemporary population
Authors: Tsaban G , Gordon M , Omari Y , Kezerle L , Alnsasra H , Buturlin K , Bareza S , Wagshal A , Konnstantino Y , Novack V , Haim M 
Published: October 2022

Abstract

Background
Amiodarone-induced lung toxicity (ALT) is severe and potentially fatal. Most data on ALT are derived from previous decades when amiodarone was administrated chronically in higher doses, while currently, low-dose amiodarone 200 mg is routinely used. Whether low-dose amiodarone treatment is associated with ALT remains untested.

Methods
This is a retrospective study among patients from the Southern district of Clalit Health Services (CHS) in Israel between 1st January 1999 and 1st July 2021. The study population comprised solely of patients with atrial fibrillation since this is the most prevalent condition for prescribing amiodarone. Patients treated with amiodarone were matched in a 1:1 manner with controls not exposed to amiodarone based on age, sex, living area, and atrial fibrillation diagnosis duration. To avoid immortal time bias, follow-up times of the matched controls were left adjudicated to truncate the amiodarone-free period of their matched cases. Patients with prior interstitial lung disease (ILD) were excluded. The primary outcome was the incidence of any ILD. We performed survival analyses using multivariable Cox regression controlling for potential confounders.

Results
During the study period, 7,048 patients who initiated amiodarone treatment were identified, of whom 6,449 were matched with controls. The mean age was 71.5 years, and 46.4% were women among the matched population. The amiodarone-treatment group had higher rates of smoking (30.3% vs. 26.8%, p&lt;0.001), rheumatic disease (4.5% vs. 3.5%, p=0.003), background myocardial infarction (31.6% vs. 19.6%), renal failure (17.2% vs. 10.8%) and congestive heart failure (33.8% vs. 20.7%; p&lt;0.05 for all). During the study, with a mean follow-up time of 5.6 years, ILD occurred in 357 (5.5%) patients in the amiodarone group and 289 (4.5%) patients in the control group [adjusted hazard ratio: 1.09 (confidence interval 95%: 0.91, 1.3), p=0.4].

Conclusion
In a large contemporary real-life population, the incidence of ILD during 5.6 years was relatively low, and treatment with low-dose amiodarone was not associated with an increased risk of ILD. These results, if confirmed by other cohorts, may call for a change in the surveillance policy of patients treated with amiodarone

Funding Acknowledgement
Type of funding sources: None.
Amiodarone therapy and risk of primary lung cancer; insights from a real-life contemporary population study
Authors: Tsaban G , Gordon M , Omari Y , Kezerle L , Alnsasra H , Buturlin K , Bareza S , Wagshal A , Novack V , Konnstantino Y , Haim M 
Published: October 2022

Abstract

Background
Amiodarone is the most effective antiarrhythmic therapy to maintain sinus rhythm in atrial fibrillation (AF) patients. There is a controversy regarding the association of amiodarone therapy with an increased risk of lung cancer. We aimed to assess the relationship between amiodarone treatment and primary lung cancer (PLC) incidence in a contemporary population of AF patients.

Methods
This is a retrospective study among patients from the Southern district of Clalit Health Services in Israel between 1st January 1999 and 1st July 2021. The study population comprised solely of patients with atrial fibrillation since this is the most prevalent condition for prescribing amiodarone. Patients treated with amiodarone were matched in a 1:1 manner with controls not exposed to amiodarone based on age, sex, living area, and atrial fibrillation diagnosis duration. To avoid immortal time bias, follow-up times of the matched controls were left adjudicated to truncate the amiodarone-free period of their matched cases. Patients with prior PLC were excluded. The primary outcome was the incidence of any PLC. We performed survival analyses using multivariable Cox regression controlling for potential confounders.

Results
During the study period, 7,048 patients who initiated amiodarone treatment were identified, of whom 6,449 were matched with controls. The mean age was 71.5 years, and 46.4% were women among the matched population. The amiodarone-treatment group had higher rates of smoking (30.3% vs. 26.8%), prior non-lung-related malignancy (14.9% vs. 13.5%), rheumatic disease (4.5% vs. 3.5%), diabetes (38.3% vs. 32.6%), history of myocardial infarction (316% vs. 19.6%), renal failure (17.2% vs. 10.8%) and congestive heart failure (33.8% vs. 20.7%); p&lt;0.05 for all. During the study, with a mean follow-up time of 5.7 years, PLC occurred in 94 (1.5%) patients in the amiodarone group and 79 (1.2%) patients in the control group [adjusted-hazard-ratio (aHR) 1.10 (confidence-interval 95% (CI95%, 0.78,1.55), p=0.6]. Factors independently associated with increased PLC risk were smoking [aHR 4.25 CI95% (3.01,5.99), p&lt;0.001], non-lung-related malignancy [aHR 1.56, CI95% (1.00,2.42), p=0.050], and peripheral vascular disease [aHR 1.77, CI95% (1.16,2.71), p=0.008]

Conclusion
Chronic amiodarone treatment is not associated with increased risk for PLC. Smoking and prior non-lung-related malignancy and peripheral vascular disease were independently associated with increased PLC risk, suggesting that such patients should undergo closer surveillance for early detection of PLC.

Funding Acknowledgement
Type of funding sources: None.
Predictors of successful cardioversion of recent-onset atrial fibrillation to sinus rhythm with orally inhaled flecainide
Authors: Ruskin J , Dufton C , Maupas J , Crijns H , Elvan A , De Jong J , Oosterhof T , Tuininga Y , Badings E , Aksoy I , Nuyens D , Van Dijk V , Camm A J , Kowey P , Belardinelli L 
Published: October 2022

Abstract

Background
Height, weight, and body mass index (BMI) are well established risk factors for atrial fibrillation (AF) but whether they are also predictors of successful pharmacological cardioversion of AF is unknown. Data from the open-label INSTANT study of flecainide acetate oral inhalation solution (FlecIH) for acute cardioversion of recent-onset symptomatic AF were examined to determine if these anthropometric measures are predictors of successful cardioversion of AF to sinus rhythm (SR) with FlecIH.

Methods
Logistic regression was performed on a broad array of patient and disease characteristics to identify predictors of cardioversion success at 90 minutes post-dose, and potential interactions were examined by boundary restriction analysis. Data are presented for patients receiving 120 mg FlecIH.

Results
Data from 81 patients (32.1% female) with a mean age of 59.8 years (range: 26.0, 84.0) were included in the analysis. This cohort had a mean weight of 87 kg (range: 57, 150), a mean height of 180 cm (range: 156, 199), and a mean BMI of 26.8 kg/m2 (range: 17.2, 37.9). A logistic regression model identified height, weight, and BMI as significant predictors of cardioversion success (p&lt;0.01) and a boundary restriction analysis revealed a negative correlation between BMI and conversion rate across the entire dataset (see Figure 1). Clinically significant conversion rates were observed for patients with BMI values that were considered normal (BMI &lt;25 kg/m2 = 53%; 95% CI: 36, 70), overweight (BMI ≥25 and &lt;30 kg/m2 = 47%; 95% CI: 29, 64), and obese (BMI ≥30 and &lt;35 kg/m2 = 43%; 95% CI: 17, 69); however, none of the severely obese patients (BMI ≥35 mg/m2) had their AF successfully converted to sinus rhythm (see Figure 2).

Conclusions
Successful cardioversion of recent onset AF with 120 mg FlecIH was observed in normal, overweight, and obese patients with BMI values &lt;35 kg/m2; however, conversion rate decreases with increasing BMI. Further evaluation of FlecIH dosing in severely obese patients is warranted.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): InCarda Therapeutics
Feasibility of simultaneous multichannel magnetocardiographic mapping, multiple monophasic action potential recording and laser photocoagulation of isolated and perfused rabbit ventricular myocardium
Authors: Brisinda D , Fenici P , Fenici R 
Published: October 2022

Abstract

Background
Multichannel magnetocardiographic mapping (MCG) has been validated as an accurate non-invasive method for 3D localization of arrhythmogenic substrates suitable for ablation treatment and of intracardiac electrophysiology catheters (1,2). High resolution (HR) MCG-guided multiple simultaneous monophasic action potential (multi-MAP) recording and pacing with a single patented amagnetic catheter (AC) detects local arrhythmogenic mechanisms (3). Laser photocoagulation (LP) providing more controlled and homogeneous myocardial lesions (4), may be an alternative to radiofrequency (RF) ablation, without unwanted electromagnetic noise effect during real-time MCG.

Purpose
This study aimed to experimentally test the feasibility of simultaneous multi-MAP recording and LP guided by real-time MCG.

Methods
An unshielded 36 channels SQUID system (sensitivity of 30 fT/Hz1/2, at 1 Hz) (CMI, USA) was used to study Langendorff-perfused isolated rabbit heart with MCG (Figure 1A). Four epicardial MAPs were simultaneously recorded (inter MAP distance: 1 mm) with a single multi-MAP AC (bandpass: DC-500 Hz; sampling frequency: 2 kHz) (GE-Prucka Cardiolab). LP was performed with a NdYAG laser (Dornier Medilas 5100) and a catheter system for safe myocardium LP (5). The study was carried out according to NIH guidelines for animal care and use.

Results
MCG imaging of rabbit ventricular magnetic field distribution and inverse source localization with the magnetic dipole model are shown in Figure 1B. The difference in morphology of local HR ventricular multi-MAP signals was compatible with myocardial anisotropy (Figure 1C). With appropriate cooling of the optic fiber-tissue interface, no epicardial damage was induced by LP, whereas deeper well defined intramural myocardial lesions were appreciable, of different size as a function of the energy delivered (Figure 1D). Multi-MAP recording was not significantly disturbed by LP. Keeping the Medilas unit at least 5 meters away from the MCG sensors, no electromagnetic artifacts were observed during MCG.

Conclusion
MCG, single catheter multi-MAP recording and well-defined LP lesions of ventricular myocardium were simultaneously feasible on Langendorff-perfused isolated rabbit heart, without major electromagnetic interferences, in an unshielded catheterization laboratory. With appropriate technological developments, safe MCG-guided single-catheter laser ablation of focal arrhythmogenic substrates is foreseen as a possible minimally invasive alternative to current interventional approaches.

Funding Acknowledgement
Type of funding sources: None.
Predictors of the presence of typical atrial flutter in patients undergoing atrial fibrillation ablation
Authors: Ulus T , Yilmaz A S , Al A , Sener E , Durmaz F E 
Published: October 2022

Abstract

Background
Typical cavotricuspid isthmus (CTI) dependent atrial flutter (Afl) may develop spontaneously in patients undergoing atrial fibrillation (AF) ablation and it is also responsible for a significant portion of recurrences after AF ablation. In this situation, the second ablation for typical Afl is frequently needed. If the predictors of typical Afl can be known in such patients, CTI ablation for typical Afl can also be performed in the same session as AF ablation. Thus, the risks and increased costs of the second ablation procedure can be avoided. There is insufficient data related to the predictors of typical Afl in patients undergoing AF ablation.

Purpose
In this study, we aimed to investigate the predictors of typical Afl in patients undergoing catheter ablation for AF.

Methods
In this retrospective study, we consecutively enrolled 135 patients with AF undergoing index catheter ablation. Patients who did not come regular follow-up after ablation were excluded. Thus, 131 patients were included. The patients were divided two groups according to spontaneous typical Afl development before or after AF ablation. They were compared in terms of baseline characteristics and procedural features.

Results
The mean age of the patients was 58 (48–62), 65 of them (49.6%) were male, typical Afl was observed in 20 patients (15.2%). The frequency of male gender was higher (80.0% vs 44.1%, p=0.003), the left ventricular (LV) ejection fraction was lower (56.2±10.9% vs 60.7±6.7%, p=0.015), LV end-diastolic diameter was higher [50.0 (48.2–53.0) vs 47.0 (44.0–49.0), p&lt;0.001), the left atrium diameter was higher (41.4±4.5 vs 38.4±4.5, p=0.008), and the right atrium (RA) diameter was higher (41.6±3.5 vs 36.8±3.7, p&lt;0.001) in patients with typical Afl than in those without it (Figure 1a). Laboratory measurements, drug use, and procedural characteristics were similar between groups. A logistic regression analysis demonstrated that male gender [OR: 4.5, 95% CI: 1.01–20.03, p=0.048) and the RA diameter [OR: 1.57, 95% CI: 1.22–2.02, p&lt;0.001] were independent predictors of the presence of typical Afl (Figure 1b). A Receiver Operating Characteristic curve showed that optimal cut-off value of the RA diameter to predict the presence of typical atrial flutter was 40.5 mm (AUC: 0.843, sensitivity %80, specificity %85, p&lt;0.001) (Figure 2).

Conclusion
A RA diameter greater than 40.5 mm may predict the presence of spontaneous typical Afl in patients undergoing catheter ablation for AF. This information can help to identify patients who would benefit from CTI ablation in the same session as AF ablation.

Funding Acknowledgement
Type of funding sources: None.
The efficacy of general anesthesia during pulmonary vein isolation compared with conscious sedation
Authors: Kikuchi M , Aizawa N , Furuya T , Tanno K 
Published: October 2022

Abstract

Background
Catheter ablation (RFA) is significantly more effective in terms of arrhythmia recurrence rate than antiarrhythmic medication. For the duration of the procedure, the patient needs to remain motionless on the operation table. General anesthesia (GA) is widely used during atrial fibrillation (AF) ablation in all over the world, however RFA of AF is performed under conscious sedation (CS) in the most centers in Japan.
It remains controversial whether cardiac anesthesiologists are best suited to manage anesthesia in the electrophysiology lab.

Objective
The aim of this study was to report the efficacy and safety of GA during AF ablation.

Methods
297 patients (67.3±11.7 years, 208 men, 128 paroxysmal, mean follow up 443 days±306) with AF undergoing RFA in our department from January 2018 to December 2021 were retrospectively analyzed. 113 assigned to the GA group, 184 patients to the CS group.
The primary efficacy end point was radiofrequency time, ablation index, force time integral. The secondary end points defined AF recurrence and the complications.

Result
There was no difference in the baseline characteristics between the two groups. There was no difference between groups in AF recurrence (22.1% vs. 14.1%, P=0.103) and complications.However, Patients in GA had shorter radiofrequency times (66.9±3.7 minute vs 79.0±2.9 minutes P=0.01)Ablation index (376±18.6 vs 371±22.6 P&lt;0.05), Force time integral (136±22.3 vs 111.4±45.3).

Conclusion
General anesthesia is superior to conscious sedation with shorter radiofrequency times and higher than Force time integral, ablation index. Moreover, it is not inferior in regard to arrhythmia recurrence or complication rates of catheter ablation of atrial fibrillation.

Funding Acknowledgement
Type of funding sources: None.
Cryoballoon ablation in obese patients: it is worth it, let us work it
Authors: Boehmer A A , Rothe M , Nussbaum E , Dobre B C , Kaess B , Ehrlich J R 
Published: October 2022

Abstract

Background
Obesity is a major risk factor for atrial fibrillation (AF) development and of increasing prevalence in western countries. Safe and effective treatment methods for obese patients with AF are therefore important. Cryoballoon pulmonary vein isolation (CryoPVI) is a well-established therapy for symptomatic AF but data regarding obese patients are lacking.

Objective
To prospectively compare efficacy, safety and periprocedural parameters of CPVI in normal-weight and obese (Body-Mass-Index (BMI) ≥30kg/m2) patients.

Methods
We analyzed consecutive patients who underwent CryoPVI in a single-center cohort between 2018 and 2020. CryoPVI was performed in a standardized fashion. Follow-up was performed at 3, 6, 12, 18 and 24 months after CryoPVI. Endpoints were: symptomatic AF relapse for efficacy and bleeding, phrenic nerve injury, stroke or death for safety. Periprocedureal parameters were observed.

Results
We included 464 patients into the analysis, of these 331 patients had normal BMI (mean BMI 25.5±2.8 kg/m2, age 70±10 years, CHA2DS2-VASc 2.7±1.5, 56% male) while 133 patients (28.7%) suffered from obesity (mean BMI 33.2 kg/m2, age 67±9 years, CHA2DS2-VASc 2.7±1.4, 55% male). After 24 months freedom from AF relapse was similar for normal-weight and obese patients (58.8% vs. 61%, P=0.78, Figure 1A). Primary safety end point occurred in form of pericardial effusion or phrenic nerve injury in five patients with normal BMI (1.5%) and none obesity group. No deaths or strokes were observed in either group. Compared with control left-atrial dwell time (39.7±14.6 min vs. 44.8±18.7 min, P=0.002, fluoroscopy time (7.3±3.6 min vs. 8.3±4.1 min, P=0.013), contrast dye use (64.6±34.3 ml vs. 74.5±39.5 ml, P=0.009), and radiation dose (224.8±164.2 cGy·cm2 vs. 533.3±655.6 cGy·cm2, P&lt;0.001) were significantly higher in obese patients (Figure 1B–E).

Conclusion
CryoPVI is safe and effective in obese patients but achievement of PVI is associated with longer procedure times, higher radiation exposure and contrast dye use.

Funding Acknowledgement
Type of funding sources: None.