Abstract Funding Acknowledgements Type of funding sources: None. Purpose We compared the efficacy, safety, and heart rate variability (HRV) after cryo-balloon (Cryo-PVI), high-power short-duration (HPSD-PVI) or conventional radiofrequency pulmonary vein isolation (conventional-PVI) in patients with atrial fibrillation (AF). Methods In this retrospective analysis of single-center cohort, we included 2,975 patients who underwent AF catheter ablation (74.1% male, median 60 years old, 74.1% paroxysmal AF). We compared the procedural factors, rhythm outcomes, complication rates, and post-procedural heart rate variability (HRV) between the Cryo-PVI (n=493), HPSD-PVI (n=638), and conventional-PVI (n=1,844). Results In spite of significantly shorter procedural time in the Cryo-PVI group (73 min for Cryo-PVI vs 110 min for HPSD-PVI vs 153 min for conventional-PVI, p<0.001), major complication (2.8% for Cryo-PVI vs 2.4% for HPSD-PVI vs 2.5% for conventional-PVI, p=0.875) or freedom from late recurrence (log-rank, p=0.357) did not differ among the three ablation groups. Cryo-PVI showed significantly lower risk for AF recurrence in patients with paroxysmal AF (weighted hazard ratio [WHR] 0.62, 95% confidence interval [CI] 0.41-0.93), but worse rhythm outcome in those with non-paroxysmal AF (WHR 1.47, 95% CI 1.06-2.05, p for interaction=0.002) as compared with conventional-PVI. In the subgroup analysis for HRV (n=1,429), Cryo-PVI group showed significantly higher low-frequency to high-frequency ratio at post-procedure 3 month (p<0.001), 1-year (p<0.001), and 2-year (p=0.023). Conclusion Cryo-PVI showed better rhythm outcome in patients with paroxysmal AF, but worse outcome in those with non-paroxysmal AF with higher long-term post-procedural sympathetic nervous activity as compared with conventional-PVI.
Abstract Background Although active rhythm control by atrial fibrillation (AF) catheter ablation (AFCA) reduces left atrial (LA) dimension, blunted atrial reverse remodeling can be observed in patients with significant atrial myopathy. We explored the characteristics and long-term outcomes of AF patients who showed blunted atrial reverse remodeling despite no AF recurrence within a year after AFCA. Methods Among a total of 2,756 patients with AFCA, we included 1,685 patients (74.8% male, 60.2±10.1 years old, 54.5% paroxysmal AF) who underwent both baseline and 1-year follow-up echocardiogram, baseline LA>40mm, and did not recur within a year. We divided them into tertile groups (T1–T3) based on one-year percent change of LA dimension after propensity matching for age, sex, AF type, and baseline LA dimension. We also investigated the patients' genetic characteristics with blunted LA reverse remodeling (T1) using a genome-wide association study (GWAS). Results Patients with blunted LA reverse remodeling (T1, n=424) were independently associated with body mass index (OR 1.082 [1.010–1.160], p=0.025), LA peak pressure (OR 1.010 [1.002–1.019], p=0.019), LA wall thickness (OR 0.448 [0.252–0.789], p=0.006), LA voltage (OR 0.651 [0.463–0.907], p=0.012), and pericardial fat volume (OR 1.004 [1.001–1.008], p=0.014). Throughout 65.9±37.4 months of follow-up, the incidence of AF recurrence a year after the procedure was significantly higher in the T1 group than in T2 or T3 groups (Log-rank p<0.001). Among 894 patients with GWAS, ATXN1, XPO7, KRR1_PHLDA1, ZFHX3, and their polygenic risk score were associated with blunted LA reverse remodeling. Conclusions Patients with blunted LA reverse remodeling after AFCA were independently associated with low LA voltage, thin wall thickness, high LA pressure, and fat volume, and have a genetic background. Long-term clinical recurrence a year after AFCA was higher in this patient group with suspicious atrial myopathy. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health and WelfareNational Research Foundation of Korea
To evaluate the short- and long-term efficacy and safety of abciximab and cilostazol in patients with acute MI and unstable angina undergoing intracoronary stenting.Acute-phase (7 and 30 days), 6-month and long-term composite outcomes involving death, myocardial infarction or urgent target vessel revascularization (TVR) together with other outcomes (composite outcomes involving death, MI and elective TVR with restenosis and stroke) were evaluated retrospectively in a total of 175 patients. Safety outcomes were assessed using data on the incidence of bleeding and thrombocytopenia at Day 7 and Day 30.Of 175 patients, 83 (47.4%) patients received abciximab. At 7 and 30 days, the composite outcome for the group treated with cilostazol alone and that treated with abciximab in combination with cilostazol did not differ significantly. The composite outcomes at 6 months and 1 year were significantly lower in the abciximab plus cilostazol group (relative risk 0.35, 95% Cl 0.13 - 0.90, relative risk 0.28, 95% CI 0.10 -0.78, respectively). The incidence of major bleeding at the access-site and in the gastrointestinal tract and minor bleeding were significantly higher in the group receiving abciximab plus cilostazol group at 7 days (relative risk 3.33, 95% CI 1.66 - 6.65, relative risk 9.98, 95% CI 1.29 - 77.07, relative risk 1.96, 95% CI 1.06 - 3.62, respectively) and at 30 days (relative risk 3.33, 95% CI 1.66 - 6.65, relative risk 5.54, 95% CI 1.25 - 24.56, relative risk 1.96, 95% CI 1.06 - 3.62, respectively).The combination of abciximab and cilostazol showed an improvement in major cardiac incidents at 6 months and 1 year of the treatment when compared to the group receiving cilostazol alone. However, abciximab did not improve the incidence of death but increased the risk of bleeding complications.
Abstract Background Atrial fibrillation (AF) is associated with a higher risk for cognitive impairment and dementia, with or without a history of clinical stroke. There are a paucity of data on the associations of hypertension duration and blood pressure (BP) level with risk of dementia in patients with AF. Purpose We examined associations of duration of hypertension and secondly, systolic blood pressure (SBP) levels with incidence of dementia among patients with AF. Methods We enrolled a total 196,388 patients aged ≥50 years who were newly diagnosed as AF and undergoing hypertension treatment from the Korean National Health Insurance Service database (2005–2016). Starting from AF diagnosis, participants were followed up until the date of dementia, death, or December 31, 2016. To incorporate the effect of BP level and hypertension duration changes over time on dementia incidence, we constructed time-updated multivariable Cox models in which BP levels and hypertension duration were updated at each participants' regular national health examination visits (at 0–7 years of follow-up). Similarly, age, BP medications, and health-related behaviors were included as time-varying covariates in these models. Results During 1,016,744 person-years of follow-up, there were 32,692 dementia events. A cubic spline curve using continuous hypertension duration measures suggested a linear association between increase of hypertension duration and dementia risk. One-year increase of hypertension duration increased the adjusted risk of dementia with a hazard ratio (HR) of 1.17 [95% confidence interval (CI) 1.13–1.22]. In patients with hypertension duration <6 years, SBP of ≥140 mmHg was significantly associated with higher dementia risk, compared to SBP of <130 mmHg (in patients with hypertension duration <3 years: adjusted HR 1.08, 95% CI 1.01–1.16; and in those with 3 ≤ hypertension duration <6 years: adjusted HR 1.13, 95% CI 1.07–1.20), whereas no significant association between SBP and dementia risk in those with hypertension duration ≥6 years. SBP and dementia in different duration Conclusion In patients with AF, the increase of hypertension duration was strongly associated with increased risk of dementia. Uncontrolled SBP was also associated with higher dementia risk. But, this effect of SBP might be attenuated in patients with longer hypertension duration. These findings suggest more emphasis needed on BP control in AF patients with earlier phase of hypertension (duration <6 years). Acknowledgement/Funding The Korean Ministry of Education, Science and Technology (NRF-2017R1A2B3003303) and the Korean Ministry of Health & Welfare (HI16C0058, HI15C1200)
Abstract Funding Acknowledgements Type of funding sources: None. Background Adverse outcomes associated with atrial fibrillation (AF) in Asians have not yet been fully elucidated. This study was designed to study racial differences in the risk for bleeding and the effect of new-onset AF on bleeding and mortality. Methods This study is based on a patient-level comparative analysis of UK Biobank and Korean National Health Insurance Service-Health Screening data. The primary outcome was intracranial hemorrhage (ICH). The secondary outcomes were major bleeding and gastrointestinal (GI) bleeding. Five-year incidence rates (IR), rate difference (IR in those with AF minus IR in those without AF) and rate ratio (IR in those with AF divided by IR in those without AF) of the outcomes were calculated. Results Between 2005 and 2012, we identified 422,121 Asians (mean [SD] age, 55.1 [8.4] years; 54.2% of men) and 380,763 Whites (mean [SD] age, 57.1 [8.0] years; 45.1% of men). During the five-year follow-up period, the IR of AF per 1000 person-years were 2.29 (95% CI, 2.22–2.35) in Asians and 3.55 (95% CI, 3.46–3.63) in Whites. The IR of ICH was greater in Asians with and without AF than in corresponding White groups. The rate difference for ICH was 1.84 (95% CI, 1.18–2.51) in Asians and 0.80 (95% CI, 0.56–1.04) in Whites. For major bleeding, the IR of Asians were not only higher than those of Whites, but also the rate difference was 1.3-fold higher in Asians than in Whites. However, different tendencies were observed for GI bleeding. Conclusion Despite the higher incidence of AF in Whites, Asians with AF have a worse prognosis in terms of ICH and major bleeding. However, further studies are needed to explain the different trends of gastrointestinal bleeding.
Abstract Background Cardiac conduction disease (CCD) and sick sinus syndrome (SSS) may be related to a degenerative process. Leukocyte telomere length (LTL) is associated with the aging process and age-related degenerative diseases. We aimed to investigate the association between LTL and the risks of CCD/SS, and to explore whether LTL is related with cardiovascular imaging and electrocardiographic (ECG) changes. Methods This is a population-based cross-sectional study of UK Biobank participants without history of CCD/SSS recruited from 2006 to 2010. LTL was measured using a quantitative polymerase chain reaction method. Cardiovascular measurements were derived from cardiovascular magnetic resonance using machine learning. The median (IQR) duration of follow-up was 12.0 (11.3-12.7) years. The associations of LTL with imaging and ECG measurements and incident CCD/SSS were evaluated by multivariable regression models. Results Among the 412,452 white participants, 188,891 (45.8%) were male, with a mean age of 57.3 years. Longer LTL was independently associated with positive cardiac remodeling, including higher left ventricular mass, larger atrial volume, and increased atrial stroke volumes. However, no significant associations were observed with ECG findings including PR interval and P-wave duration. 11991 (2.6%) participants developed CCD and 984 (0.2%) developed SSS. Longer LTL was not associated with younger age. However, longer LTL was not associated with a lower risk of incident CCD (LTL fourth quartile vs. first quartile: hazard ratio, 0.98; 95% CI, 0.97-1.0; P = 0.057) or SSS (LTL fourth quartile vs. first quartile: hazard ratio, 0.98; 95% CI, 0.92-1.05; P = 0.554). Conclusions In this cross-sectional study, longer LTL was associated with a larger atrial size with better atrial function in middle age, but not with ECG changes. However, longer LTL was not associated with a lower risk of incident CCD and SSS.
Abstract Background To evaluate the ability of machine learning algorithms to predict incident atrial fibrillation (AF) from the general population using health examination items. Methods We included 483,343 subjects who received national health examinations from the Korean National Health Insurance Service-based National Sample Cohort (NHIS-NSC). We trained deep neural network model (DNN) of a deep learning system and decision tree model (DT) of a machine learning system using clinical variables and health examination items (including age, sex, body mass index, history of heart failure, hypertension or diabetes, baseline creatinine, and smoking and alcohol intake habits) to predict incident AF using a training dataset of 341,771 subjects constructed from the NHIS-NSC database. The DNN and DT were validated using an independent test dataset of 141,572 remaining subjects. C-indices of DNN and DT for prediction of incident AF were compared with that of conventional logistic regression model. Results During 1,874,789 person·years (mean±standard-deviation age 47.7±14.4 years, 49.6% male), 3,282 subjects with incident AF were observed. In the validation dataset, 1,139 subjects with incident AF were observed. The c-indices of the DNN and DT for incident AF prediction were 0.828 [0.819–0.836] and 0.835 [0.825–0.844], and were significantly higher (p<0.01) than conventional logistic regression model (c-index=0.789 [0.784–0.794]). Conclusions Application of machine learning using simple clinical variables and health examination items was helpful to predict incident AF in the general population. Prospective study is warranted to construct an individualized precision medicine.
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