| 1. |
- Anselmino, Matteo, et al.
(författare)
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Atrial fibrillation ablation long-term ESC-EHRA EORP AFA LT registry : in-hospital and 1-year follow-up findings in Italy
- 2020
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Ingår i: Journal of Cardiovascular Medicine. - : Ovid Technologies (Wolters Kluwer Health). - 1558-2027 .- 1558-2035. ; 21:10, s. 740-748
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To report the Italian data deriving from the European Society of Cardiology-EURObservational Research Program atrial fibrillation ablation long-term registry.Methods and results: Ten Italian centers enrolled up to 50 consecutive patients undergoing atrial fibrillation ablation. Of the 318 patients included, 5 (1.6%) did not undergo catheter ablation, 1 had ablation partially done and 62 were lost at 1-year follow-up. Women were less represented (23.6%) and the median age was 60.0 years. A total of 195 patients (62.3%) suffered paroxysmal atrial fibrillation, whereas only 9 (2.9%) had long-standing persistent atrial fibrillation. Most Italian patients (92.3%) were symptomatic but suffering fewer symptomatic events than patients enrolled in other countries (median of two events in the month preceding the ablation vs. three, respectively; P<0.0001). The main finding of the study is that the success rate at 1 year, with and without antiarrhythmic drugs, was 76.4%, consistently with other participating countries (73.4%). This result was obtained however, with a significantly lower prevalence of 1-year adverse events (7.3 vs. 16.6%, P<0.0001). Procedure duration and fluoroscopy total time resulted as being shorter in Italy (145 vs. 160, P=0.0005 and 16.9 vs. 20.0 min, P=0.0018, respectively); however, the radiation dose per BSA was greater (37.5 vs. 26.0mGy/cm(2), P=0.0022).Conclusion: The demographic characteristics of patients undergoing atrial fibrillation ablation are similar to those reported in other countries. The success rate in Italy is consistent with those in other countries, whereas the complications rate is lower.
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| 2. |
- Anselmino, Matteo
(författare)
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Diabetes mellitus in patients with coronary artery disease : cardiovascular risk assessment and impact of available treatments
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A majority of patients with coronary artery disease have abnormal glucose regulation and as many as 30% overt diabetes mellitus. Despite considerable improvements in the management of cardiovascular diseases, patients with diabetes have not benefited to the same extent as those without this disease. Possible explanations are poor glycaemic control and inferior efficacy or insufficient use of available treatments in these patients. Aims: 1. To investigate diagnostic and therapeutic strategies in patients with coronary artery disease by diabetic state; 2. To assess clinical practice in relation to existing guidelines; 3. To compare the impact of evidence-based medications and revascularisation procedures on mortality and major cardiovascular events in patients with coronary artery disease with and without diabetes mellitus; 4. To describe glucose lowering therapy in relation to cardiovascular prognosis; 5. To, at an early stage, identify coronary artery disease patients at a high risk of future cardiovascular events. Management of coronary artery disease: Diabetes mellitus was reported in 1,524 (31%) of 4,961 patients enrolled, all with coronary artery disease. Among the 1,872 patients with acute coronary syndromes the diabetic status did not influence the propensity to use different pharmacological agents (except renin-angiotensin-aldosteron system blockers; odds ratio 1.33, p = 0.03) or coronary interventions. In patients with stable coronary artery disease (n = 2,854) secondary prevention guidelines were poorly adhered to: only 30% achieved blood pressure targets (< 140/90 mmHg) and lipid control was adequate in a minority of diabetic and non-diabetic patients (total cholesterol below 5 mmol/L: 55 versus 47%; LDL cholesterol below 3 mmol/L: 57 versus 51%). Implementation of available tools: Of the eligible patients 44% and 43% of those with and without diabetes received evidence-based medications while 34% and 40% were revascularised. The use of evidence-based medications or of revascularisation in patients with diabetes mellitus provided an independent protective effect on one year mortality (HR 0.37, 95%CI 0.20-0.67; p = 0.001 and 0.72, 95%CI 0.39-1.32; p = 0.275) and cardiovascular events (HR 0.61, 95%CI 0.40- 0.91; p = 0.015 and 0.61, 95%CI 0.39-0.95; p = 0.025 respectively) compared to the effects that these two approaches produced in the non-diabetic patients. Glucose lowering treatment: Out of 1,425 patients with known diabetes mellitus 378 were on insulin and 675 on oral glucose lowering drugs only. Insulin treated patients had an adjusted one year hazard ratio for mortality of 2.23 (95% CI 1.24-4.03; p = 0.006) and for cardiovascular events of 1.27 (95% CI 0.85-1.87; p = 0.230) compared to those on oral glucose lowering drugs. Within the 452 patients with newly detected diabetes 77 (17%) were started on glucose lowering drugs. None of them died compared to 25 (p = 0.002) among those without such treatment and their one year cardiovascular event hazard ratio was 0.22 (95% CI 0.05-0.97; p = 0.041) compared to untreated patients. Predicting cardiovascular events: Based on easily available clinical variables (fasting plasma glucose, high density lipoprotein-cholesterol, and age) a single hidden layer Artificial Neural Network model reached a cross-validated misclassification rate of 37.8% compared to the glucose tolerance profile assessed by an oral glucose tolerance test. By the artificial network criterion1,283 patients with complete one year follow-up concerning cardiovascular events were divided in low and high risk groups within which the events were respectively 5.0 and 10.3% (p = 0.005). Adjusting for confounding variables patients in the high risk group had a one year cardiovascular event hazard ratio of 2.11 (95% CI 1.21- 3.67) compared to 1.37 (95% CI 0.79-2.36) for those assessed as diabetic by the oral glucose tolerance test. Conclusions: European patients with diabetes mellitus admitted for acute coronary syndromes receive, when taking into account baseline characteristics, a comparable acute in-hospital management to their non diabetic counterparts. Secondary prevention of coronary artery disease is unsatisfactory both in patients with and without diabetes. Patients with diabetes benefit to a great extent from evidence-based medications or revascularisation procedures and the choice of glucose lowering modality seems prognostically important. Early institution of glucose lowering drugs seems beneficial in patients with newly detected diabetes mellitus. The Artificial Neural Network criterion, based on easily available clinical variables, has shown interesting risk stratification capacities.
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| 3. |
- Saglietto, Andrea, et al.
(författare)
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AFA-Recur : an ESC EORP AFA-LT registry machine-learning web calculator predicting atrial fibrillation recurrence after ablation
- 2023
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Ingår i: Europace. - : Oxford University Press. - 1099-5129 .- 1532-2092. ; 25:1, s. 92-100
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Atrial fibrillation (AF) recurrence during the first year after catheter ablation remains common. Patient-specific prediction of arrhythmic recurrence would improve patient selection, and, potentially, avoid futile interventions. Available prediction algorithms, however, achieve unsatisfactory performance. Aim of the present study was to derive from ESC-EHRA Atrial Fibrillation Ablation Long-Term Registry (AFA-LT) a machine-learning scoring system based on pre-procedural, easily accessible clinical variables to predict the probability of 1-year arrhythmic recurrence after catheter ablation.Methods and results: Patients were randomly split into a training (80%) and a testing cohort (20%). Four different supervised machine-learning models (decision tree, random forest, AdaBoost, and k-nearest neighbour) were developed on the training cohort and hyperparameters were tuned using 10-fold cross validation. The model with the best discriminative performance on the testing cohort (area under the curve-AUC) was selected and underwent further optimization, including re-calibration. A total of 3128 patients were included. The random forest model showed the best performance on the testing cohort; a 19-variable version achieved good discriminative performance [AUC 0.721, 95% confidence interval (CI) 0.680-0.764], outperforming existing scores (e.g. APPLE score: AUC 0.557, 95% CI 0.506-0.607). Platt scaling was used to calibrate the model. The final calibrated model was implemented in a web calculator, freely available at http://afarec.hpc4ai.unito.ti/.Conclusion: AFA-Recur, a machine-learning-based probability score predicting 1-year risk of recurrent atrial arrhythmia after AF ablation, achieved good predictive performance, significantly better than currently available tools. The calculator, freely available online, allows patient-specific predictions, favouring tailored therapeutic approaches for the individual patient.
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| 4. |
- Stabile, Giuseppe, et al.
(författare)
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Atrial fibrillation history impact on catheter ablation outcome : Findings from the ESC-EHRA atrial fibrillation ablation long-term registry
- 2019
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Ingår i: Pacing and Clinical Electrophysiology. - : Wiley. - 0147-8389 .- 1540-8159. ; 42:3, s. 313-320
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Atrial fibrillation (AF) promotes atrial remodeling that in turn promote AF perpetuation. The aim of our study was to investigate the impact of AF history length on one-year outcome of AF catheter ablation in a cohort of patients enrolled in the Atrial Fibrillation Ablation Registry.METHODS: We described the real-life clinical epidemiology, therapeutic strategies and the short- and mid-term outcomes of 1948 patients (71.9% with paroxysmal AF) undergoing AF ablation procedures, stratified according to AF history duration (< 2 years or ≥ 2 years).RESULTS: The mean AF history duration was 46,2±57,4 months, 592 patients had an AF history duration < 2 years (mean 10,2±5,9 months), and 1356 patients ≥ 2 years (mean 75,5±63,5 months) (P < 0.001). Patients with AF history duration < 2 years were younger, had a lower incidence of hypertension, coronary artery disease, hypertrophic cardiomyopathy and had a lower CHA2 DS2 -VaSc Score. At one year, the logrank test showed a lower incidence of AF recurrence in patients with AF history duration < 2 years (28.9%) than in patients with AF history duration ≥ 2 years (34.0%) (P = 0.037). AF history duration ≥ 2 years, overall ablation procedure duration, hypertension and chronic kidney disease were all predictors of recurrences after the blanking period.CONCLUSIONS: In this multicenter registry, performing catheter ablation in patients with an AF history ≥ 2 years was associated with higher rates of AF recurrences at one year. Since cumulative time in AF in not necessarily equivalent to AF history, its role remains to be clarified.
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| 5. |
- Trines, Serge A., et al.
(författare)
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Influence of risk factors in the ESC-EHRA EORP atrial fibrillation ablation long-term registry
- 2019
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Ingår i: Pacing and Clinical Electrophysiology. - : Wiley. - 0147-8389 .- 1540-8159. ; 42:10, s. 1365-1373
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Tidskriftsartikel (refereegranskat)abstract
- Background: The influence of risk factors on atrial fibrillation (AF) ablation recurrence is increasingly recognized. We present a sub-analysis of the European Society of Cardiology-European Heart Rhythm Association-European Society of Cardiology AF ablation long-term registry on the effect of traditional risk factors for AF on postablation recurrence, reablation, and complications using real-world data.Methods: Risk factors for AF were defined as body mass index >= 27 kg/m(2), hypertension, chronic obstructive pulmonary disease, diabetes, alcohol >= 2 units/day, sleep apnea, smoking, no/occasional sports activity, moderate/severe mitral or aortic valve disease, any cardiomyopathy, peripheral vascular disease, chronic kidney disease, heart failure, coronary artery disease/infarction, and previous pacemaker/defibrillator implant. Patients were divided in two groups with >= 1 or without risk factors. Primary outcomes were arrhythmia recurrence after blanking period, reablation, and adverse events or death. Differences between the groups and the influence of individual risk factors were analyzed using multivariate Cox regression.Results: Three thousand sixty nine patients were included; 217 patients were without risk factors. Risk factor patients were older (58.4 vs 54.1 years), more often female (32% vs 19.8%) and had more often persistent AF (27.2% vs 23.5%). In a multivariate analysis, patients without risk factors had a hazard ratio of 0.70 (95% CI 0.49-0.99) for recurrence compared to risk factor patients. The multivariate hazard ratios for reablation or adverse events/death were not different between the two groups. Hypertension and body mass index were univariate predictors of recurrence.Conclusions: Patients with >= 1 risk factor had a 30% higher risk for arrhythmia recurrence after ablation, but no differences in risk for repeat ablations and adverse events or death.
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