bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of long-term atrial fibrillation recurrence after catheter ablation: non-linear analytical approach for individualized prognostic stratification
Authors: Herman R , Hlivak P , Bernat V , Svetlosak M , Demolder A , Palus T , Urban L , Hatala R 
Published: October 2022

Abstract

Background
Recurrences are common in patients with atrial fibrillation (AF) during long-term follow-up after catheter ablation (CA) for pulmonary vein isolation (PVI). Recently, machine learning (ML) models identifying non-linear relationships among various patient parameters have been applied for prognostic stratification in different cardiac diseases.

Aim
This is a retrospective study aimed to determine whether ML-based models can identify non-linear relationships in individual clinical baseline characteristics and CT-quantified volumetric parameters of epicardial fat tissue (EFT) to aid in prognosing outcome of catheter ablation for PVI in patients with paroxysmal AF.

Methods
A cohort of 92 patients (median age 60.2 [51.9–64.0]; 74% male) with paroxysmal AF (a single persistent AF episode was accepted) undergoing catheter ablation targeting PVI was analysed. All patients underwent cardiac CT imaging and were fitted with implantable loop recorder (ILR) prior to CA. For PVI, radiofrequency CA with electro-anatomical mapping was used in 79 patients, cryoballoon ablation in 13 patients. AF recurrence, defined as AF burden &gt;0.1% after the blanking period (90 days), was continuously assessed by ILR. Feature selection on 23 baseline parameters was performed using random forest models (XGBoostRegressor). Mean absolute Shapley values (|mSHAP| – Shapley Additive expLanations) were used to quantify the relative discriminative power of analysed parameters.

Results
During a follow-up of 3-years, AF recurrence was detected in 58 (63%) patients, 29 (50%) of them underwent a repeat ablation. Five most important predictors of AF recurrence during 3-year follow-up were upper epicardial fat volume, BMI, baseline AF burden, age and pericardial volume (lower segment) (Fig. 1). Upper EFT volume was twice as important for males than females (0.44 and 0.21 |mSHAP| respectively). For a patient with no AF recurrence, low age (41 years) and low upper EFT volume (13.2 ml) were the most important drivers predicting positive ablation outcome (Fig. 2A). In contrast, in a patient with AF recurrence post CA, an above-average EFT volume of 55.5 ml and a high BMI had the most significant net contribution for predicting his failed CA outcome (Fig. 2B).

Conclusion
Non-linear ML analysis applied to our limited cohort of patients with paroxysmal AF undergoing CA suggests: i) a significant association of high EFT volume with ILR determined AF recurrence during a 3-year follow-up; ii) potential role of such analyses for a more granular and highly individualized prediction of outcome of planned CA. However, these results need further testing, and validation in prospective trials.

Funding Acknowledgement
Type of funding sources: None.
Left atrial function parameters as predictors of atrial fibrillation recurrence after pulmonary vein isolation
Authors: Kiliszek M , Uzieblo-Zyczkowska B , Krzyzanowski K , Jurek A , Wierzbowski R , Smalc-Stasiak M , Krzesinski P 
Published: October 2022

Abstract

Background
The aim of the study was to test the relationship between left atrial (LA) function parameters and the results of the pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF).

Patients and methods
Consecutive patients undergoing first time PVI in years 2019–2021 were qualified to the study. The patients underwent radiofrequency ablation using contact-force catheters and electroanatomical system. LA pressure was measured directly just after transseptal puncture. Follow-up was based on ambulatory visits/televisits and 7-day holter monitoring (6 and 12 month after ablation). On the day of ablation all the patients underwent transesophageal and transthoracic echocardiography. The primary endpoint was any atrial tachyarrhythmia recurrence during follow-up period.

Results
A total of 210 patients were included in the study. Median of follow-up was 12 months, AF recurrence was observed in 71 patients (33.8%) after mean of 1.03 procedures per patient. In univariate Cox regression analysis several echocardiographic parameters were significant predictors of AF recurrence after catheter ablation: left and right atrial area, LA volume, average e' and average E/e' values, LA reservoir strain, LA conduit strain, LA appendage emptying velocity. AF recurrence was also predicted by mean LA pressure, age, body mass index and calculated eGFR. Interestingly, LA contraction strain and LA emptying fraction were not predictors of results of AF ablation. In multivariate Cox regression analysis (that included all parameters significant in univariate analysis) LA reservoir strain (hazard ratio (HR) 1.076, 95% confidence interval (CI) 1.014–1.141; p=0.014) and LA appendage emptying velocity (HR 0.968, 95% CI 0.947–0.988; p=0.002) were significant predictors of AF ablation results.

Conclusions
LA reservoir strain and LA appendage emptying velocity are predicting factors of AF ablation results. LA contraction strain and LA emptying function were not predictors of effective AF ablation.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Statutory Grant of Military Institute of Medicine
Sex differences in terms of recurrent atrial fibrillation after catheter ablation according to the history of heart failure: insights from the Kansai Plus Atrial Fibrillation (KPAF) registry
Authors: Tanaka N , Inoue K , Hirao Y , Koyama Y , Okamura A , Iwakura K , Okada M , Tanaka K , Kobori A , Kaitani K , Morimoto T , Morishima I , Kusano K , Kimura T , Shizuta S 
Published: October 2022

Abstract

Background
There are significant differences in the prevalence and prognosis of cardiovascular diseases between male and female. We previously reported that catheter ablation (CA) of atrial fibrillation (AF) was less effective in female than male, but whether their history of heart failure influence the recurrence after CA of AF remains still unknown.

Purpose
We sought to clarify sex differences in terms of AF recurrence after RFCA of AF according to the history of heart failure.

Methods
We conducted a large-scale, prospective, multicenter, observational study (Kansai Plus Atrial Fibrillation Registry). We enrolled 5010 consecutive patients who underwent an initial RFCA of AF at 26 centers (64±10 years; 1369 [27.3%] females; non-paroxysmal AF, 35.7%). The median follow-up duration was 2.9 years.

Results
Fourteen % of female had a history of heart failure prior to CA, while 12.8% of male had a history of heart failure at baseline (p=0.29). The 3-year cumulative incidence of AF recurrence after a single procedure was 43.3% in female and 39.0% in male (log rank P=0.0046). In patients with the history of heart failure, AF recurrence rates were 42.2% in female and 45.8% in male (log rank P=0.51). On the other hand, in patients without history of heart failure, more females experienced AF recurrence (female vs. male, 43.5% vs. 38.0%, log rank P=0.001).
The rate of AF recurrence after multiple procedures was higher in female (24.2% vs. 19.6%, log rank P&lt;0.0001). AF recurrence rates were similar between sexes in patients with history of heart failure (female vs. male, 26.0% vs. 26.7%, log rank P=0.86), while AF recurrence rates were higher in female without history of heart failure than those in male (females vs. males, 23.9% vs. 18.5%, log rank P&lt;0.0001).

Conclusion
The Kansai Plus Atrial Fibrillation Registry revealed a distinct sex difference in terms of the AF recurrence after CA of AF. Females had higher recurrence rates compared with males in patients without history of heart failure, while recurrence rates were similar between sexes in patients with history of heart failure.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Research Institute for Production Development in Kyoto, Japan.
Comparison of embolism and bleeding risk profile in patients with atrial fibrillation and chronic kidney disease
Authors: Parada Barcia J , Raposeiras Roubin S , Abu Assi E , Dominguez Erquicia P , Lizancos Castro A , Ledo Pineiro A , Noriega V , Iglesias Otero C , Gonzalez Garcia A , Iniguez Romo A 
Published: October 2022

Abstract

Introduction
Clinical decision-making on anticoagulation in chronic kidney disease (CKD) patients with atrial fibrillation (AF) is challenging. Current strategies are based on small observational studies with conflicting results. A better comprehension of patients' risk profiles is therefore needed.

Purpose
The present study explores the impact of glomerular filtration rate (GFR) in the embolic–haemorrhagic balance among a large cohort of AF patients.

Methods
The study cohort included all patients from the health area of Vigo (Galicia, Spain) diagnosed with AF between January 2014 and April 2020. Subjects without data regarding to glomerular filtration rate were excluded. The final population of the study consisted of 15,457 patients. The risk of ischaemic stroke and major bleeding was determined by competing risk regression using the Fine and Gray model, considering death as a competing risk.

Results
During a mean follow-up of 4.29±1.82 years, 3,678 patients died (23.80%), 850 had an ischaemic stroke (5.50%) and 961 had a major bleeding (6.22%). The incidence of stroke and bleeding increased as baseline GFR declined. GFR &lt;30 mL/min/1.73 m2 was associated with increased stroke and major bleeding (Figure 1). Interestingly, below GFR &lt;30 mL/min/1.73 m2, bleeding risk was clearly higher than the embolic risk (Figure 2).
As glomerular filtration rate decreased, anticoagulation was associated with an increased bleeding risk (sHR 1.72, 95% CI 1.15–2.56; P=0.01 for patients with GFR 30–59 mL/min/1.73 m2 and 2.05, 95% CI 0.80–5.28; P=0.13 for subjects with &lt;30 mL/min/1.73 m2 in comparison with those with GFR &gt;60 mL/min/1.73 m2, respectively), but it was not associated with a reduction in embolic risk in patients with GFR &lt;30 mL/min/1.73 m2 (sHR 1.91, 95% CI 0.73–5.04; P=0.19)

Conclusions
In advanced chronic kidney disease (GFR &lt;30 mL/min/1.73 m2), the increase of major bleeding risk was higher than the increase of ischaemic stroke risk, with a negative anticoagulation balance (greater increase in bleeding than reduction in embolism).
In this setting, left atrial appendage occlusion appears to be an alternative to consider.

Funding Acknowledgement
Type of funding sources: None.
Screening for atrial fibrillation to prevent stroke in elderly individuals with or without preexisting cardiovascular disease
Authors: Xing L Y , Diederichsen S Z , Hojberg S , Krieger D W , Graff C , Olesen M S , Brandes A , Kober L , Haugan K J , Svendsen J H 
Published: October 2022

Abstract

Background
Previous research has showed that various cardiovascular diseases (CVD) are associated with increased risks of atrial fibrillation (AF) and stroke. However, data on the interaction between CVD and AF screening efficacy are lacking.

Purpose
To evaluate the influence of preexisting CVD on the effects of AF screening with long-term continuous monitoring.

Methods
The LOOP Study (Atrial Fibrillation detected by Continuous ECG Monitoring using Implantable Loop Recorder to prevent Stroke in High-risk Individuals) randomized AF-naïve individuals aged ≥70 years and with additional stroke risk factors to either long-term screening with implantable loop recorder (ILR) and subsequent anticoagulation initiation upon detection of AF episodes ≥6 minutes, or usual care (the control group). In the current study, all participants from the LOOP Study were divided into two risk groups according to the presence of CVD (defined as ischemic heart disease, heart failure, previous stroke, valvular heart disease, or peripheral artery disease). The relative risks of outcomes in groupwise comparisons, as indicated by hazard ratio (HR), were assessed in the cause-specific Cox proportional-hazards model with death as competing risk.

Results
Of 6004 participants included, 1997 (33.3%) had ≥1 CVD at baseline. Compared with no CVD, the presence of CVD was associated with increased risks of AF diagnosis in the ILR group (adjusted HR 1.32 [1.09–1.59]) and of stroke or systemic arterial embolism in the entire study cohort (adjusted HR 1.34 [1.06–1.69]). For ILR screening versus usual care, there was no decrease in stroke or systemic arterial embolism among participants with preexisting CVD (adjusted HR 1.13 [0.76–1.68]), whereas a significant risk reduction was obtained by screening among those without CVD (adjusted HR 0.64 [0.44–0.93]). The interaction was significant (adjusted p-value for interaction 0.041).

Conclusions
In an elderly, high-risk population, ILR screening did not prevent stroke significantly in individuals with preexisting CVD, but it was associated with an approximately 40% risk reduction among those without CVD.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The LOOP Study was funded by Innovation Fund Denmark [grant number 12-1352259], The Research Foundation for the Capital Region of Denmark, The Danish Heart Foundation [grant number 11-04-R83-A3363-22625], Aalborg University Talent Management Program, Arvid Nilssons Fond, Skibsreder Per Henriksen, R og Hustrus Fond, the European Union's Horizon 2020 program [grant number 847770], Læge Sophus Carl Emil Friis og hustru Olga Doris Friis' Legat, and an unrestricted grant from Medtronic.
Management of atrial fibrillation by different medical specialties in the UK: AF-GEN-UK study
Authors: Shantsila A , Lip G Y H , Lane D A 
Published: October 2022

Abstract

Background
The AF-GEN-UK study is an extension of the EURObservational Research Programme (EORP) Long-term Registry on patients with atrial fibrillation (AF) in the UK (AF-GEN). The study aimed to establish a registry of the contemporary management of patients with AF by cardiologists, general practitioners, stroke, acute and emergency medicine physicians at baseline and 1-year of follow-up, to allow comparison between medical specialties.

Methods
Data on patients with AF diagnosed within the previous 12-months were collected using electronic case records from 101 sites, to permit comparison of patient characteristics and treatments between medical specialties. The impact of guideline-adherent oral anticoagulation (OAC) use on outcomes was assessed using Cox regression analysis.

Results
1595 patients (mean (SD) age 70.5 (11.2) years; 60.1% male; 97.4% white) with ECG-documented AF were included (recruited between June 2017 and June 2018) and followed-up for 1-year. Overall OAC prescription rates were 84.2% at baseline and 87.1% at 1-year follow-up, with NOACs predominating (74.9% at baseline and 79.2% at 1-year) Figure, mainly apixaban. Prescription of VKA was significantly higher in primary care, with NOAC prescription higher among stroke physicians. Guideline-adherent OAC (CHA2DS2-VASc ≥2) at baseline significantly reduced risk of composite endpoint of death and stroke at 1-year (adjusted hazard ratio 0.42; 95% confidence intervals 0.25–0.70). Rhythm control was evident in approximately one-quarter, with only 1.6% receiving catheter ablation. Most patients (56.6%) reported AF symptoms, but these were severe in only 17.9%. Symptomatic patients were mainly managed by cardiologists or acute/emergency medicine; among patients managed by stroke physicians, 81.5% were asymptomatic. Quality of life did not appear significantly impaired however there was a slight but significant improvement at follow-up (70.3% vs. 71.5%; p=0.044). Symptomatic patients reported poorer quality of life related to usual activities, mental health and overall quality of life.

Conclusion
Overall OAC use was high (&gt;80%) with NOAC prescription predominating but rates varied by specialty, with VKA prescription significantly higher in primary care. Guideline-adherent OAC therapy at baseline was associated with significant reduction in composite outcome of death and stroke at 1-year, regardless of specialty. Rhythm control management was only evident in around one-quarter despite AF symptoms being reported in 56.6%. This registry extends the knowledge of contemporary management of AF outside of cardiology by including other specialties and demonstrates good implementation of clinical guidelines for the management of AF, particularly in relation to stroke prevention.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This project was supported by the BMS/Pfizer European Thrombosis Investigator Initiated Research Program
Factors associated with prescription of oral anticoagulation for atrial fibrillation in older people living in care homes in Wales: a routine data linkage study 2003–2018
Authors: Ritchie L , Harrison S L , Penson P E , Akbari A , Torabi F , Hollinghurst J , Harris D , Oke O B , Akpan A , Halcox J P , Rodgers S E , Lip G Y H , Lane D A 
Published: October 2022

Abstract

Background
Prescription of oral anticoagulants (OAC) is paramount for stroke prevention in people with atrial fibrillation (AF), but treatment decisions in older care home residents are complicated by frailty, multi-morbidity and heightened stroke and bleeding risk. There is a paucity of data on factors influencing the decision to prescribe OAC in this high-risk population who are under-represented in research studies.

Purpose
To explore the factors associated with OAC prescription for care home residents aged ≥65 years with AF.

Methods
Nationwide retrospective cohort study of people aged ≥65 years entering a care home in Wales between 1 January 2003 and 31 December 2018, using anonymised individual-level electronic health record and administrative data sources available within the Secure Anonymised Information Linkage Databank. Unadjusted and adjusted logistic regression models were used to explore the association between resident characteristics and OAC prescription or non-prescription.

Results
Between 2003 and 2018, 14,493 people with AF aged ≥65 years became new residents in care homes in Wales and 7,057 (48.7%) were prescribed OAC (32.7% in 2003 compared to 72.7% in 2018), Figure 1. Increasing age and prescription of antiplatelet therapy were associated with lower odds of OAC prescription (adjusted odds ratio [aOR] 0.96 per one year age increase [95% confidence interval, 0.95 to 0.96] and aOR 0.91 [0.84 to 0.98], respectively). Conversely, prior venous thromboembolism (aOR 4.06 [3.17 to 5.20]), advancing frailty (mild: aOR 4.61 [3.95 to 5.38]; moderate: aOR 6.69 [5.74 to 7.80]; severe: aOR 8.42 [7.16 to 9.90]) and year of care home entry in the post-non-vitamin K antagonist oral anticoagulant (NOAC) era from 2011 onwards (aOR 1.91 [1.76 to 2.06]) were associated with higher odds of OAC prescription, Figure 2.

Conclusions
The proportion of care home residents prescribed OAC therapy has increased over time with the introduction of NOACs in 2011, but OAC prescription rates are still sub-optimal. Although there is an expected rise in OAC prescribing for increasingly frail people, further work is needed to investigate the interaction with deprivation and other socio-economic and demographic factors to assess potential inequalities in prescribing across these groups. Targeted educational tools for clinicians are needed to address barriers to OAC prescription for AF, such as older age and separate indications for antiplatelet therapy.

Funding Acknowledgement
Type of funding sources: None.
The association between dyslipidaemia treatment and the risk of clinical events in edoxaban-treated patients with atrial fibrillation: insights from the 2-year follow-up of ETNA-AF-Europe
Authors: De Vries T A C , Pecen L , Komen J J , De Groot J R , Kirchhof P , De Caterina R 
Published: October 2022

Abstract

Background/Introduction
Dyslipidaemia is a major risk factor for cardiovascular (CV) events. This increased risk can be attenuated with lipid-lowering therapies (LLT), such as statins, which are associated with a relative risk reduction of CV events of 22% for each 1 mmol/L reduction in low-density lipoprotein cholesterol.

Purpose
To explore the association between use of LLT and clinical outcomes in routine practice patients with atrial fibrillation (AF) receiving edoxaban.

Methods
ETNA-AF-Europe is a prospective, multi-centre, post-authorisation, observational cohort study conducted in 825 centres, enrolling routine practice patients with AF treated with edoxaban in 10 European countries. This registry is still ongoing and patients are to be followed-up annually for 4 years after enrollment. In the current sub-study, on the now available first 2 years of follow-up, patients were categorised by use of LLT at baseline. We used Cox proportional hazards models to determine the associations between LLT use and adverse clinical events, including the composite of any stroke and systemic embolic events (SEE), major bleeding, and death, after adjusting for confounding factors at baseline.

Results
Of 13,133 patients with AF, 36.3% (n=4761) used LLT at baseline. Among those receiving LLT, 90.7% received statins only and 3.6% received combination therapy with a statin. Most patients in both treatment groups were 65 years or older and had one or more CV-risk factors aside from a history of AF. Patients receiving LLT were older and had a higher prevalence of CV co-morbidities (including diabetes, hypertension, peripheral artery disease and coronary heart disease) than those who did not receive LLT (Table 1).
After correction for confounders, treatment with LLT was associated with a significantly lower rate of any stroke or SEE (HR: 0.61; 95% CI: 0.42–0.88), ischaemic stroke (HR: 0.54; 95% CI: 0.35–0.83), all-cause death (HR: 0.73; 95% CI: 0.63–0.85) and CV-death (HR: 0.73; 95% CI: 0.60–0.90), but not with bleeding events or myocardial infarction (Figure 1).

Conclusion
These findings suggest a protective effect of LLT on the risk of stroke in anticoagulated patients with AF, although an overall better CV risk management in these patients probably contributed to this reduced risk. Notably, both mono- and combination-LLT were seemingly underused in our cohort, highlighting the potential for further reductions of CV risks in the AF patients seen in our clinics.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This research was funded by Daiichi Sankyo Europe.