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Yazaki K, Ejima K, Kataoka S, Higuchi S, Kanai M, Yagishita D, Shoda M, Yamaguchi J. Comparative analysis of recurrence predictors and outcomes for atrial tachyarrhythmia following atrial fibrillation ablation: high-power short-duration vs. conventional pulmonary vein isolation. Heart Vessels 2025; 40:149-160. [PMID: 39305318 DOI: 10.1007/s00380-024-02454-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 08/21/2024] [Indexed: 01/28/2025]
Abstract
Atrial fibrillation (AF) is a common cardiac arrhythmia, with structural and electrical remodeling being significant risk factors for recurrence post-catheter ablation. The advent of high-power short-duration pulmonary vein isolation (HPSD-PVI) presents a novel approach, potentially enhancing procedural success rates through the creation of transmural lesions without overheating. This study investigates the predictors of atrial tachyarrhythmia (ATA) recurrence and compares outcomes between HPSD-PVI and conventional PVI techniques. A total of 1005 patients undergoing radiofrequency catheter ablation (RFA) for AF were retrospectively analyzed in this study. The cohort was divided based on the ablation strategy: conventional PVI from February 2013 to September 2018, and HPSD-PVI from October 2018 onwards. The primary objective was to compare the predictors of ATA recurrence and the outcome between the two groups. Among 969 patients analyzed after exclusions, independent predictors of recurrence differed between groups; higher CHADS2/CHA2DS2-VASc scores and lower left ventricular ejection fraction (LVEF) were significant in the HPSD-PVI group, while non-paroxysmal AF, larger left atrial volume index (LAVI), and longer AF history were predictors in the conventional PVI group. The HPSD-PVI group showed a trend toward lower ATA recurrence rates compared to the conventional PVI group in the propensity-score-matched (PSM) cohort (log-rank test, p = 0.06). Higher CHADS2/CHA2DS2-VASc scores and lower LVEF were also independent predictors of ATA recurrence in the PSM cohort.
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Affiliation(s)
- Kyoichiro Yazaki
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Koichiro Ejima
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Tokyo, Japan.
- Minamino Cardiovascular Hospital, 1-25-1 Hyoe, Hachioji-shi, Tokyo, Japan.
| | - Shohei Kataoka
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Satoshi Higuchi
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Miwa Kanai
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Daigo Yagishita
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Tokyo, Japan
- Department of Cardiology, Clinical Research Division for Heart Rhythm Management, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Tokyo, Japan
- Department of Cardiology, Clinical Research Division for Heart Rhythm Management, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Kasemsarn C, Porapakkham P, Wathanawanichakun S, Lerdsomboon P, Chanpa K. Long-Term Outcomes of Concomitant Modified Cox-Maze and Mitral Surgery. Ann Thorac Cardiovasc Surg 2025; 31:24-00119. [PMID: 40128947 PMCID: PMC11931737 DOI: 10.5761/atcs.oa.24-00119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 02/09/2025] [Indexed: 03/26/2025] Open
Abstract
PURPOSE There are limited data on outcomes of combined Maze and mitral valve procedures beyond 10 years. This study analyzed the efficacy of this operation. METHODS Between June 2004 and December 2022, 406 patients underwent mitral surgery concomitant with Maze procedure were evaluated. Rhythm outcomes, predictors of recurrence, and survival were assessed. RESULTS The median follow-up period was 100 months. Rheumatic disease was present in 58%. Mitral valve repair was performed in 57.1%. Freedom from atrial fibrillation (AF) at 5, 10, and 15 years was 82.5%, 70.8%, and 52.7%, respectively. Overall survival rates were not different between patients in sinus rhythm (SR) and those who remained in AF (p = 0.172). However, patients in SR experienced fewer neurological complication (p = 0.001). Predictors of AF recurrence included preoperative AF duration (p = 0.005), left atrial diameter (LAD) >50 mm (p <0.001), concomitant tricuspid valve surgery (p = 0.049), and the presence of AF on postoperative day 7 (p <0.001). Factors influencing survival were age >60 years (p <0.001) and a postoperative left ventricular ejection fraction <40% (p <0.001). CONCLUSIONS The combined Maze and mitral valve surgery provides significant benefits in managing AF with mitral disease. Predictors of recurrence included AF duration, LAD size >50 mm, associated tricuspid valve disease, and AF on day 7. SR patients had fewer neurological complications.
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Affiliation(s)
- Choosak Kasemsarn
- Department of Cardiothoracic Surgery, Central Chest Institute of Thailand, Nonthaburi, Thailand
| | - Pramote Porapakkham
- Department of Cardiothoracic Surgery, Central Chest Institute of Thailand, Nonthaburi, Thailand
| | | | - Piyawat Lerdsomboon
- Department of Cardiothoracic Surgery, Central Chest Institute of Thailand, Nonthaburi, Thailand
| | - Krisulang Chanpa
- Department of Cardiothoracic Surgery, Central Chest Institute of Thailand, Nonthaburi, Thailand
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Lee HJ, Lee SH, Kim J, Kim JY, Park SJ, Park KM, On YK. Ablation therapy following unsuccessful electrical cardioversion in patients with persistent atrial fibrillation. Sci Rep 2024; 14:23289. [PMID: 39375426 PMCID: PMC11458593 DOI: 10.1038/s41598-024-73989-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 09/23/2024] [Indexed: 10/09/2024] Open
Abstract
Electrical cardioversion (ECV) a widely utilized intervention for persistent atrial fibrillation (AF) aimed at restoring sinus rhythm. However, ECV can be ineffective, raising questions about subsequent treatment options. This study aimed to compare the outcomes of non-ablation therapy versus ablation therapy following unsuccessful ECV. A total of 125 consecutive patients with persistent AF who underwent unsuccessful ECV between November 2017 and August 2023 was included in this retrospective analysis. Of these, 51.2% received only medical therapy (non-ablation therapy group, n = 64), while 48.8% underwent AF ablation (ablation therapy group, n = 61). Various ablation methods were employed, including catheter and thoracoscopic ablation. Ablation therapy was associated with significantly better AF-free survival compared to non-ablation therapy [hazard ratio (HR), 0.37; 95% confidence interval (CI) 0.22-0.61; p < 0.01]. There was no difference of AF-free survival between catheter ablation and thoracoscopic ablation groups (HR 0.79, 95% CI 0.34-1.83; p = 0.58). AF duration > 5 year (HR 1.51; 95% CI 0.930-2.437; p = 0.10), BMI ≤ 25 kg/m2 (HR 1.61; 95% CI 1.004-2.581; p = 0.05) and diabetes (HR 2.38; 95% CI 0.902-6.266; p = 0.08) were considerable as predictor of AF recurrence. Ablation therapy following unsuccessful ECV was associated with maintaining sinus rhythm, regardless of the specific ablation method utilized.
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Affiliation(s)
- Hyo Jin Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Su Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Juwon Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Ju Youn Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Kyoung-Min Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Young Keun On
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Wu Y, Fan F, Yu J, Zhou J, Xie X, Xia G, Zhong D, Cheng D, Zhang B, Wang X, Chen Z, Wang S, Li X, Yang B. Effect of Prolonged Use of Dronedarone on Recurrence in Patients with Non-Paroxysmal Atrial Fibrillation After Radiofrequency Ablation (DORIS): Rationale and Design of a Randomized Multicenter, Double-Blinded Placebo-Controlled Trial. Cardiovasc Drugs Ther 2024; 38:1047-1052. [PMID: 37155004 DOI: 10.1007/s10557-023-07460-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Prolonged use of anti-arrhythmic drugs (AAD) beyond the post-ablation blanking period to maintain sinus rhythm has been adopted in clinical practice but without sufficient evidence. Dronedarone is an AAD valid for maintaining sinus rhythm with fewer side effects than other AAD for long-term use. OBJECTIVE We sought to investigate the effect of prolonged use of dronedarone on the recurrence of non-paroxysmal AF patients beyond 3 months within the first year after ablation. METHODS Non-paroxysmal AF patients will receive dronedarone for 3 months after radiofrequency ablation. Patients without drug side effects and atrial tachyarrhythmia (AT) recurrence will then be randomly divided into dronedarone and placebo groups and followed up until 1 year after ablation. The primary endpoint is the cumulative nonrecurrence rate post 3 months to 1 year after ablation. Patients will receive 7-day Holter monitoring (ECG patch) at 6, 9, and 12 months after ablation to evaluate AT recurrence. Secondary endpoints include dronedarone withdrawal due to side effects or intolerance of AT recurrence, time to the first recurrence, repeat ablation, electrical cardioversion, unscheduled emergency room visit, or re-hospitalization. CONCLUSION This trial will evaluate whether prolonged use of dronedarone effectively reduces the recurrence rate after ablation in non-paroxysmal AF patients. The result of this trial will provide evidence for optimizing post-ablation anti-arrhythmic therapy. TRIAL REGISTRATION ClinicalTrials.gov ; NCT05655468, 19-December-2022.
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Affiliation(s)
- Yizhang Wu
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fenghua Fan
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jinbo Yu
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jian Zhou
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xin Xie
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guang Xia
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dongxiang Zhong
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dian Cheng
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Baowei Zhang
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuecheng Wang
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zijun Chen
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shuo Wang
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaorong Li
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Bing Yang
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Li A, Zhang M, Ning B. Predictive value of the left atrioventricular coupling index for recurrence after radiofrequency ablation of paroxysmal atrial fibrillation. J Cardiothorac Surg 2024; 19:552. [PMID: 39354511 PMCID: PMC11443840 DOI: 10.1186/s13019-024-03070-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 09/15/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Although patients with paroxysmal atrial fibrillation (PAF) are preferred to undergo catheter ablation (CA), the high possibility of recurrence following surgery is still concerning. We aimed to evaluate the ability of the left atrioventricular coupling index (LACI), which is the ratio of the left atrium end-diastolic volume to the left ventricle end-diastolic volume, to predict PAF recurrence after CA. METHODS Patients with PAF undergoing CA for the first time between January 2018 and June 2021 were admitted and grouped by recurrence within a year. LACI was measured before CA using ultrasonography. Risk factors identified by multivariable logistic regression analysis, and the area under the receiver operating characteristic (ROC) curve was used to assess the ability of LACI to predict PAF recurrence after CAP. RESULTS Among the 204 patients treated at our hospital, 164 patients were included in the research after eliminating those who were lost to follow-up. Among them, 56 individuals had recurrence following a 90-day blanking period. Recurrence is more likely in elderly patients with high blood pressure. Patients who suffered recurrence exhibited lower left atrial ejection fraction and increased LACI, left atrial volume minimum, and left atrium volume index maximum. LACI was an independent risk factor for postoperative recurrence (OR: 1.526, 95% CI: 1.325-1.757, P < 0.001), and ROC displayed remarkable predictive value [area under the curve (AUC) = 0.868]. CONCLUSIONS High LACI is significantly associated with postoperative recurrence in PAF patients, and LACI has incremental prognostic value to predict recurrence.
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Affiliation(s)
- Aoshuang Li
- Department of Cardiology, Fuyang People's Hospital, Anhui Medical University, 236000, Fuyang, China
| | - Mingyang Zhang
- Department of Cardiology, Fuyang People's Hospital, Anhui Medical University, 236000, Fuyang, China
| | - Bin Ning
- Department of Cardiology, Fuyang People's Hospital, Anhui Medical University, 236000, Fuyang, China.
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Farghaly AAA, Ali H, Lupo P, Foresti S, De Ambroggi G, Atta S, Abdel-Galeel A, Tohamy A, Cappato R. Early versus Late Radiofrequency Catheter Ablation in Atrial Fibrillation: Timing Matters. J Clin Med 2024; 13:4643. [PMID: 39200784 PMCID: PMC11354874 DOI: 10.3390/jcm13164643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 08/05/2024] [Accepted: 08/05/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Despite the progressive course of atrial fibrillation (AF), the optimal timing of radiofrequency catheter ablation (RFCA) during disease course is still unknown. We aimed to investigate the impact of early RFCA within a year after AF diagnosis on procedural outcomes. Methods: A single-center retrospective study was conducted on symptomatic AF patients (n = 130) referred for RFCA with a 16-month median follow-up. Patients were stratified based on the diagnosis-to-ablation time (DAT) into early (≤1 year) and late (>1 year) RFCA groups. Atrial arrhythmia recurrence after single RFCA was the primary outcome. Secondary outcomes included cardiovascular hospitalizations, AF progression, and antiarrhythmic drug (AAD) use. Results: Within a year of AF diagnosis, 33 patients (25.4%) underwent RFCA. In the early-RFCA group, 84.4% of patients did not have recurrent atrial arrhythmia, in contrast to 60.8% in the late-RFCA group (p = 0.039). Late RFCA (HR = 2.74, 95% CI = 1.062-7.052, p = 0.037) and AF recurrence during the blanking period (HR = 4.57, 95% CI = 2.38-8.57, p < 0.0001) were independent predictors of atrial arrhythmia recurrence on multivariate analysis. Compared to the late-RFCA group, the early-RFCA group had significantly lower rates of cardiovascular hospitalizations (18% vs. 42%, p = 0.023), AF progression (0.0% vs. 11.3%, p = 0.044), and AAD use (45.4% vs. 81.4%, p < 0.001). Conclusions: Early RFCA within a year of AF diagnosis is associated with less atrial arrhythmia recurrence, fewer cardiovascular hospitalizations, less AF progression, and less AAD use. DAT of more than one year and AF recurrence during the blanking period are independent predictors of atrial arrhythmia recurrence after single RFCA.
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Affiliation(s)
- Ahmad A. A. Farghaly
- Arrhythmia & Electrophysiology Center, IRCCS MultiMedica, Sesto San Giovanni, 20099 Milan, Italy; (A.A.A.F.); (P.L.); (S.F.); (G.D.A.); (R.C.)
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Faculty of Medicine, Assiut University, Assiut 71526, Egypt; (S.A.); (A.A.-G.); (A.T.)
| | - Hussam Ali
- Arrhythmia & Electrophysiology Center, IRCCS MultiMedica, Sesto San Giovanni, 20099 Milan, Italy; (A.A.A.F.); (P.L.); (S.F.); (G.D.A.); (R.C.)
| | - Pierpaolo Lupo
- Arrhythmia & Electrophysiology Center, IRCCS MultiMedica, Sesto San Giovanni, 20099 Milan, Italy; (A.A.A.F.); (P.L.); (S.F.); (G.D.A.); (R.C.)
| | - Sara Foresti
- Arrhythmia & Electrophysiology Center, IRCCS MultiMedica, Sesto San Giovanni, 20099 Milan, Italy; (A.A.A.F.); (P.L.); (S.F.); (G.D.A.); (R.C.)
| | - Guido De Ambroggi
- Arrhythmia & Electrophysiology Center, IRCCS MultiMedica, Sesto San Giovanni, 20099 Milan, Italy; (A.A.A.F.); (P.L.); (S.F.); (G.D.A.); (R.C.)
| | - Salah Atta
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Faculty of Medicine, Assiut University, Assiut 71526, Egypt; (S.A.); (A.A.-G.); (A.T.)
| | - Ahmed Abdel-Galeel
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Faculty of Medicine, Assiut University, Assiut 71526, Egypt; (S.A.); (A.A.-G.); (A.T.)
| | - Aly Tohamy
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Faculty of Medicine, Assiut University, Assiut 71526, Egypt; (S.A.); (A.A.-G.); (A.T.)
| | - Riccardo Cappato
- Arrhythmia & Electrophysiology Center, IRCCS MultiMedica, Sesto San Giovanni, 20099 Milan, Italy; (A.A.A.F.); (P.L.); (S.F.); (G.D.A.); (R.C.)
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Tsai PC, Ko AMS, Chen YL, Chiu CH, Yeh YH, Tsai FC. Exosomal miRNA Changes Associated with Restoration to Sinus Rhythm in Atrial Fibrillation Patients. Int J Mol Sci 2024; 25:3861. [PMID: 38612670 PMCID: PMC11011649 DOI: 10.3390/ijms25073861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
We aimed to identify serum exosomal microRNAs (miRNAs) associated with the transition from atrial fibrillation (AF) to sinus rhythm (SR) and investigate their potential as biomarkers for the early recurrence of AF within three months post-treatment. We collected blood samples from eight AF patients at Chang Gung Memorial Hospital in Taiwan both immediately before and within 14 days following rhythm control treatment. Exosomes were isolated from these samples, and small RNA sequencing was performed. Using DESeq2 analysis, we identified nine miRNAs (16-2-3p, 22-3p, 23a-3p, 23b-3p, 125a-5p, 328-3p, 423-5p, 504-5p, and 582-3p) associated with restoration to SR. Further analysis using the DIABLO model revealed a correlation between the decreased expression of miR-125a-5p and miR-328-3p and the early recurrence of AF. Furthermore, early recurrence is associated with a longer duration of AF, presumably indicating a more extensive state of underlying cardiac remodeling. In addition, the reads were mapped to mRNA sequences, leading to the identification of 14 mRNAs (AC005041.1, ARHGEF12, AMT, ANO8, BCL11A, DIO3OS, EIF4ENIF1, G2E3-AS1, HERC3, LARS, NT5E, PITX1, SLC16A12, and ZBTB21) associated with restoration to SR. Monitoring these serum exosomal miRNA and mRNA expression patterns may be beneficial for optimizing treatment outcomes in AF patients.
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Affiliation(s)
- Pei-Chien Tsai
- Department of Biomedical Sciences, Chang Gung University, Taoyuan City 33302, Taiwan; (P.-C.T.); (A.M.-S.K.); (Y.-L.C.)
- Healthy Aging Research Center, Chang Gung University, Taoyuan City 33302, Taiwan
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan
| | - Albert Min-Shan Ko
- Department of Biomedical Sciences, Chang Gung University, Taoyuan City 33302, Taiwan; (P.-C.T.); (A.M.-S.K.); (Y.-L.C.)
- Healthy Aging Research Center, Chang Gung University, Taoyuan City 33302, Taiwan
- Cardiovascular Department, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan
| | - Yu-Lin Chen
- Department of Biomedical Sciences, Chang Gung University, Taoyuan City 33302, Taiwan; (P.-C.T.); (A.M.-S.K.); (Y.-L.C.)
| | - Cheng-Hsun Chiu
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan
| | - Yung-Hsin Yeh
- Cardiovascular Department, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan
- School of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
| | - Feng-Chun Tsai
- Department of Surgery, College of Medicine, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung City 80708, Taiwan
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Wang Z, He H, Xie Y, Li J, Luo F, Sun Z, Zheng S, Yang F, Li X, Chen X, Chen Y, Sun Y. Non-insulin-based insulin resistance indexes in predicting atrial fibrillation recurrence following ablation: a retrospective study. Cardiovasc Diabetol 2024; 23:87. [PMID: 38419016 PMCID: PMC10902970 DOI: 10.1186/s12933-024-02158-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 02/07/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Insulin resistance (IR) is involved in the pathophysiological processes of arrhythmias. Increasing evidence suggests triglyceride and glucose (TyG) index, metabolic score for insulin resistance (METS-IR), triglyceride glucose-body mass index (TyG-BMI), and triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio are simple and reliable surrogates for IR. Although they have been associated with atrial fibrillation (AF), evidence supporting this is limited. Here, this is the first study to investigate the association between TyG-BMI index and AF recurrence following radiofrequency catheter ablation (RFCA). The performance of the four non-insulin-based IR indexes in predicting AF recurrence after ablation was explored. METHODS A total of 2242 AF patients who underwent a de novo RFCA between June 2018 to January 2022 at two hospitals in China were included in this retrospective study. The predictive values of IR indexes for AF recurrence after ablation were assessed. RESULTS During 1-year follow-up, 31.7% of patients experienced AF recurrence. The multivariable analysis revealed that TyG index, METS-IR, and TyG-BMI index were independent risk factors for AF recurrence. Restricted cubic spline analysis revealed a connection between METS-IR, TyG-BMI index, and AF recurrence (P < 0.001). Furthermore, incorporating the METS-IR or TyG-BMI index to the basic risk model with fully adjusted factors considerably enhanced the forecast of AF recurrence, as demonstrated by the C-statistic, continuous net reclassification improvement, and integrated discrimination improvement. CONCLUSIONS TyG index, METS-IR, and TyG-BMI index were independently associated with AF recurrence following ablation. Among the four non-insulin-based IR indexes, TyG-BMI had the highest predictive value, followed by METS-IR.
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Affiliation(s)
- Zhe Wang
- Department of Cardiology, China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, No.2 East Yinghua Road, Chaoyang District, Beijing, 100029, China
| | - Haoming He
- Department of Cardiology, China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, No.2 East Yinghua Road, Chaoyang District, Beijing, 100029, China
| | - Yingying Xie
- Department of Cardiology, China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, No.2 East Yinghua Road, Chaoyang District, Beijing, 100029, China
| | - Jiaju Li
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fangyuan Luo
- Department of Cardiology, China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, No.2 East Yinghua Road, Chaoyang District, Beijing, 100029, China
| | - Zhaowei Sun
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuwen Zheng
- Department of Cardiology, Beijing University of Chinese Medicine China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Furong Yang
- Department of Cardiology, Beijing University of Chinese Medicine China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Xuexi Li
- Department of Cardiology, China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, No.2 East Yinghua Road, Chaoyang District, Beijing, 100029, China
| | - Xiaojie Chen
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingwei Chen
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yihong Sun
- Department of Cardiology, China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, No.2 East Yinghua Road, Chaoyang District, Beijing, 100029, China.
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Yang J, Song Y, Bian S, Zhang B, Zhang Y, Wang X, Cheng L, Fan Y, Liu C, Tan H. Evaluation of the effectiveness and safety of a novel substrate-based radiofrequency ablation for persistent atrial fibrillation: a prospective, randomised, parallel-controlled, single-blinded study protocol. BMJ Open 2024; 14:e080539. [PMID: 38417952 PMCID: PMC10900394 DOI: 10.1136/bmjopen-2023-080539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/06/2024] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Pulmonary vein isolation (PVI) is the cornerstone of radiofrequency (RF) ablation for atrial fibrillation (AF). However, a single ablation strategy does not always achieve the desired therapeutic effect in all patients with persistent AF, and individualised strategies are required for different clinical characteristics. METHODS AND ANALYSIS This study aimed to determine the optimal catheter ablation strategy for persistent AF by comparing the efficacy of PVI and BCXL (BC: big circles encircling pulmonary vein isolation; XL: unfixed number of lines based on the left atrial substrate). The BCXL-AF study (clinical trial no. ChiCTR2200067081) was designed as a prospective, randomised, parallel-controlled, single-blinded clinical trial. Overall, 400 patients with persistent AF were randomised in a 1:1 ratio into PVI-only and BCXL-individualised ablation groups. Patients randomised to the individualised ablation group will be further categorised into risk strata according to their clinical condition using the actual ablation method determined by the strata. Seven postoperative visits were conducted from discharge to 24 months of age. The primary observation endpoint will be the incidence of atrial tachyarrhythmia (including AF, atrial flutter and atrial tachycardia with a duration of ≥30 s) without using antiarrhythmic drugs after a blank period of 3 months following a single ablation procedure. The BCXL-AF study will assess an optimal approach for persistent AF RF ablation and evaluate the effectiveness of individualised RF ablation strategies in reducing the recurrence rate of AF. ETHICS AND DISSEMINATION The study protocol was reviewed, and ethical approval was obtained from the Army Medical University Human Ethics Committee (approval number: 2022-484-01). All the participants provided written informed consent. This study was conducted according to the principles of the Declaration of Helsinki and its amendments. The results of this study will be disseminated through manuscript publication and conference presentations. TRIAL REGISTRATION NUMBER ChiCTR2200067081.
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Affiliation(s)
- Jie Yang
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yuanbin Song
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Shizhu Bian
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Bo Zhang
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yi Zhang
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xia Wang
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Li Cheng
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yu Fan
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Changsong Liu
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Hu Tan
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
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10
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Liu T, Li M, Long D, Yang J, Zhao X, Li C, Wang W, Jiang C, Tang R. Predictive value of valvular calcification for the recurrence of persistent atrial fibrillation after radiofrequency catheter ablation. Clin Cardiol 2024; 47:e24176. [PMID: 37934927 PMCID: PMC10826787 DOI: 10.1002/clc.24176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/25/2023] [Accepted: 10/16/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Valvular calcification (VC) is an independent risk factor for cardiovascular diseases. The relationship between VC and atrial fibrillation is not clear. HYPOTHESIS We treated the aortic valve, mitral valve, and tricuspid valve as a whole and considered the possible association between VC and recurrence of persistent atrial fibrillation (PsAF) after radiofrequency catheter ablation (RFCA). METHODS This study involved 2687 PsAF patients who underwent RFCA. Data were collected to explore the relationship between VC and outcome. VC was defined by echocardiography in aortic valve, mitral valve, or tricuspid valve. After 1 year follow-up, subgroup analysis, mixed model regression analysis, and score system analysis were performed. The external validation of 133 patients demonstrated the accuracy of this clinical prediction model. RESULTS Overall, 2687 inpatients were assigned to the recurrence group (n = 682) or the no recurrence group (n = 2005) with or without VC. Compared to patients with no recurrence, the incidence of VC was higher in recurrence patients. Recurrence was present in 18.5%, 34.9%, 39.3%, and 52.0% of the four groups, which met VC numbers of 0, 1, 2, and 3, respectively. After adjustment for potential confounding factors, VC was an independent risk factor for AF recurrence in several models. For multivariable logistic regression, a scoring system was established based on the regression coefficient. The receiver operating characteristic area of the scoring system was 0.787 in the external validation cohort. CONCLUSIONS VC was an independent risk factor for AF recurrence in PsAF after RFCA. The scoring system may be a useful clinical tool to assess AF recurrence.
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Affiliation(s)
- Tong Liu
- Department of Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Meng‐Meng Li
- Department of Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - De‐Yong Long
- Department of Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Jie Yang
- Department of Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Xin Zhao
- Department of Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Chang‐Yi Li
- Department of Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Wei Wang
- Department of Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Chen‐Xi Jiang
- Department of Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Ri‐Bo Tang
- Department of Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
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11
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Liu M, Li Q, Zhang J, Chen Y. Development and Validation of a Predictive Model Based on LASSO Regression: Predicting the Risk of Early Recurrence of Atrial Fibrillation after Radiofrequency Catheter Ablation. Diagnostics (Basel) 2023; 13:3403. [PMID: 37998538 PMCID: PMC10670080 DOI: 10.3390/diagnostics13223403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/16/2023] [Accepted: 11/03/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Although recurrence rates after radiofrequency catheter ablation (RFCA) in patients with atrial fibrillation (AF) remain high, there are a limited number of novel, high-quality mathematical predictive models that can be used to assess early recurrence after RFCA in patients with AF. PURPOSE To identify the preoperative serum biomarkers and clinical characteristics associated with post-RFCA early recurrence of AF and develop a novel risk model based on least absolute shrinkage and selection operator (LASSO) regression to select important variables for predicting the risk of early recurrence of AF after RFCA. METHODS This study collected a dataset of 136 atrial fibrillation patients who underwent RFCA for the first time at Peking University Shenzhen Hospital from May 2016 to July 2022. The dataset included clinical characteristics, laboratory results, medication treatments, and other relevant parameters. LASSO regression was performed on 100 cycles of data. Variables present in at least one of the 100 cycles were selected to determine factors associated with the early recurrence of AF. Then, multivariable logistic regression analysis was applied to build a prediction model introducing the predictors selected from the LASSO regression analysis. A nomogram model for early post-RFCA recurrence in AF patients was developed based on visual analysis of the selected variables. Internal validation was conducted using the bootstrap method with 100 resamples. The model's discriminatory ability was determined by calculating the area under the curve (AUC), and calibration analysis and decision curve analysis (DCA) were performed on the model. RESULTS In a 3-month follow-up of AF patients (n = 136) who underwent RFCA, there were 47 recurrences of and 89 non-recurrences of AF after RFCA. P, PLR, RDW, LDL, and CRI-II were associated with early recurrence of AF after RFCA in patients with AF (p < 0.05). We developed a predictive model using LASSO regression, incorporating four robust factors (PLR, RDW, LDL, CRI-II). The AUC of this prediction model was 0.7248 (95% CI 0.6342-0.8155), and the AUC of the internal validation using the bootstrap method was 0.8403 (95% CI 0.7684-0.9122). The model demonstrated a strong predictive capability, along with favorable calibration and clinical applicability. The Hosmer-Lemeshow test indicated that there was good consistency between the predicted and observed values. Additionally, DCA highlighted the model's advantages in terms of its clinical application. CONCLUSIONS We have developed and validated a risk prediction model for the early recurrence of AF after RFCA, demonstrating strong clinical applicability and diagnostic performance. This model plays a crucial role in guiding physicians in preoperative assessment and clinical decision-making. This novel approach also provides physicians with personalized management recommendations.
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Affiliation(s)
- Mengdie Liu
- Medicine School, Shenzhen University, Shenzhen 518000, China;
| | - Qianqian Li
- Department of Cardiovascular Medicine, Peking University Shenzhen Hospital, Shenzhen 518000, China; (Q.L.); (J.Z.)
| | - Junbao Zhang
- Department of Cardiovascular Medicine, Peking University Shenzhen Hospital, Shenzhen 518000, China; (Q.L.); (J.Z.)
| | - Yanjun Chen
- Department of Cardiovascular Medicine, Peking University Shenzhen Hospital, Shenzhen 518000, China; (Q.L.); (J.Z.)
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12
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Fan X, Li Y, He Q, Wang M, Lan X, Zhang K, Ma C, Zhang H. Predictive Value of Machine Learning for Recurrence of Atrial Fibrillation after Catheter Ablation: A Systematic Review and Meta-Analysis. Rev Cardiovasc Med 2023; 24:315. [PMID: 39076446 PMCID: PMC11272879 DOI: 10.31083/j.rcm2411315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/03/2023] [Accepted: 07/17/2023] [Indexed: 07/31/2024] Open
Abstract
Background Accurate detection of atrial fibrillation (AF) recurrence after catheter ablation is crucial. In this study, we aimed to conduct a systematic review of machine-learning-based recurrence detection in the relevant literature. Methods We conducted a comprehensive search of PubMed, Embase, Cochrane, and Web of Science databases from 1980 to December 31, 2022 to identify studies on prediction models for AF recurrence risk after catheter ablation. We used the prediction model risk of bias assessment tool (PROBAST) to assess the risk of bias, and R4.2.0 for meta-analysis, with subgroup analysis based on model type. Results After screening, 40 papers were eligible for synthesis. The pooled concordance index (C-index) in the training set was 0.760 (95% confidence interval [CI] 0.739 to 0.781), the sensitivity was 0.74 (95% CI 0.69 to 0.77), and the specificity was 0.76 (95% CI 0.72 to 0.80). The combined C-index in the validation set was 0.787 (95% CI 0.752 to 0.821), the sensitivity was 0.78 (95% CI 0.73 to 0.83), and the specificity was 0.75 (95% CI 0.65 to 0.82). The subgroup analysis revealed no significant difference in the pooled C-index between models constructed based on radiomics features and those based on clinical characteristics. However, radiomics based showed a slightly higher sensitivity (training set: 0.82 vs. 0.71, validation set: 0.83 vs. 0.73). Logistic regression, one of the most common machine learning (ML) methods, exhibited an overall pooled C-index of 0.785 and 0.804 in the training and validation sets, respectively. The Convolutional Neural Networks (CNN) models outperformed these results with an overall pooled C-index of 0.862 and 0.861. Age, radiomics features, left atrial diameter, AF type, and AF duration were identified as the key modeling variables. Conclusions ML has demonstrated excellent performance in predicting AF recurrence after catheter ablation. Logistic regression (LR) being the most widely used ML algorithm for predicting AF recurrence, also showed high accuracy. The development of risk prediction nomograms for wide application is warranted.
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Affiliation(s)
- Xingman Fan
- Graduate School, Hebei North University, 075000 Zhangjiakou, Hebei, China
- Department of Cardiology, Air Force Medical Center, Air Force Medical
University, PLA,100142 Beijing, China
| | - Yanyan Li
- Department of Cardiology, Air Force Medical Center, Air Force Medical
University, PLA,100142 Beijing, China
| | - Qiongyi He
- Air Force Clinical medical college, Fifth Clinical College of Anhui
Medical University, 230032 Hefei, Anhui, China
| | - Meng Wang
- Graduate School, Hebei North University, 075000 Zhangjiakou, Hebei, China
- Department of Cardiology, Air Force Medical Center, Air Force Medical
University, PLA,100142 Beijing, China
| | - Xiaohua Lan
- Graduate School, Hebei North University, 075000 Zhangjiakou, Hebei, China
| | - Kaijie Zhang
- Graduate School, Hebei North University, 075000 Zhangjiakou, Hebei, China
| | - Chenyue Ma
- Air Force Clinical medical college, Fifth Clinical College of Anhui
Medical University, 230032 Hefei, Anhui, China
| | - Haitao Zhang
- Graduate School, Hebei North University, 075000 Zhangjiakou, Hebei, China
- Department of Cardiology, Air Force Medical Center, Air Force Medical
University, PLA,100142 Beijing, China
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13
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Joseph C, Nazari J, Zagrodzky J, Brumback B, Sherman J, Zagrodzky W, Bailey S, Kulstad E, Metzl M. Improved 1-year outcomes after active cooling during left atrial radiofrequency ablation. J Interv Card Electrophysiol 2023; 66:1621-1629. [PMID: 36670327 PMCID: PMC10359433 DOI: 10.1007/s10840-023-01474-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Active esophageal cooling during pulmonary vein isolation (PVI) with radiofrequency (RF) ablation for the treatment of atrial fibrillation (AF) is increasingly being utilized to reduce esophageal injury and atrioesophageal fistula formation. Randomized controlled data also show trends towards increased freedom from AF when using active cooling. This study aimed to compare 1-year arrhythmia recurrence rates between patients treated with luminal esophageal temperature (LET) monitoring versus active esophageal cooling during left atrial ablation. METHOD Data from two healthcare systems (including 3 hospitals and 4 electrophysiologists) were reviewed for patient rhythm status at 1-year follow-up after receiving PVI for the treatment of AF. Results were compared between patients receiving active esophageal cooling (ensoETM, Attune Medical, Chicago, IL) and those treated with traditional LET monitoring using Kaplan-Meier estimates. RESULTS A total of 513 patients were reviewed; 253 received LET monitoring using either single or multi-sensor temperature probes; and 260 received active cooling. The mean age was 66.8 (SD ± 10) years, and 36.8% were female. Arrhythmias were 60.1% paroxysmal AF, 34.3% persistent AF, and 5.6% long-standing persistent AF, with no significant difference between groups. At 1-year follow-up, KM estimates for freedom from AF were 58.2% for LET-monitored patients and 72.2% for actively cooled patients, for an absolute increase in freedom from AF of 14% with active esophageal cooling (p = .03). Adjustment for the confounders of patient age, gender, type of AF, and operator with an inverse probability of treatment weighted Cox proportional hazards model yielded a hazard ratio of 0.6 for the effect of cooling on AF recurrence (p = 0.045). CONCLUSIONS In this first study to date of the association between esophageal protection strategy and long-term efficacy of left atrial RF ablation, a clinically and statistically significant improvement in freedom from atrial arrhythmia at 1 year was found in patients treated with active esophageal cooling when compared to patients who received LET monitoring. More rigorous prospective studies or randomized studies are required to validate the findings of the current study.
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Affiliation(s)
| | - Jose Nazari
- NorthShore University Health System, Evanston, IL, USA
| | - Jason Zagrodzky
- Texas Cardiac Arrhythmia Institute, St. David's South Austin Medical Center, 901 W Ben White Blvd, Austin, TX, 78704, USA
| | - Babette Brumback
- Department of Biostatistics, College of Public Health & Health Professions, College of Medicine, University of Florida, Gainesville, USA
| | - Jacob Sherman
- Washington University in Saint Louis, 1 Brookings Dr, MO, 63130, St. Louis, USA
| | - William Zagrodzky
- Colorado College, 14 E Cache La Poudre St, Colorado Springs, CO, 80903, USA
| | - Shane Bailey
- Texas Cardiac Arrhythmia Institute, St. David's South Austin Medical Center, 901 W Ben White Blvd, Austin, TX, 78704, USA
| | - Erik Kulstad
- University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
| | - Mark Metzl
- NorthShore University Health System, Evanston, IL, USA
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Chen G, Li G, Zhang D, Wang X, Guo X. Blanking period antiarrhythmic drugs after catheter ablation for atrial fibrillation: a meta-analysis of randomized controlled trials. Front Cardiovasc Med 2023; 10:1071950. [PMID: 37547248 PMCID: PMC10397410 DOI: 10.3389/fcvm.2023.1071950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Background Antiarrhythmic drugs (AADs) are frequently prescribed following catheter ablation (CA) for atrial fibrillation (AF). However, to date, there is a lack of large-scale, multicenter controlled studies that have confirmed the efficacy of AADs in reducing the incidence of late recurrence of AF after CA. Furthermore, the optimal duration of short-term use of AADs after CA remains a controversial topic. Methods PubMed, Embase, Cochrane Library, CNKI, and ClinicalTrials.gov were searched until April 25, 2022. We conducted a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy of blanking period AADs in predicting both early and late recurrence of AF. In addition, Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the quality of evidence in this meta-analysis. Results 12 RCTs with 3,625 patients were included in this meta-analysis. Short-term use of AADs after AF ablation reduced the risk of early recurrence of AF compared with the no-AADs group. In the subgroup analysis of AADs use time, it was found that only using AADs for more than 2 months can reduce the early recurrence of AF after CA. However, when compared with the no-AADs group, short-term use of AADs after CA did not reduce the incidence of late recurrence of AF. Conclusions Short-term use of AADs (more than 2 months) can reduce the early recurrence but not the late recurrence of AF after CA.
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Affiliation(s)
- Gang Chen
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Guangling Li
- Department of Cardiology, Lanzhou University Second Hospital, The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Demei Zhang
- Department of Cardiology, Lanzhou University Second Hospital, The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Xiaomei Wang
- Department of Cardiology, Lanzhou University Second Hospital, The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Xueya Guo
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
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Kushnir A, Barbhaiya CR, Aizer A, Jankelson L, Holmes D, Knotts R, Park D, Spinelli M, Bernstein S, Chinitz LA. Temporal trends in atrial fibrillation ablation procedures at an academic medical center: 2011-2021. J Cardiovasc Electrophysiol 2023; 34:800-807. [PMID: 36738147 DOI: 10.1111/jce.15839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/03/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Radiofrequency ablation technology for treating atrial fibrillation (AF) has evolved rapidly over the past decade. We investigated the impact of technological and procedural advances on procedure times and ablation outcomes at a major academic medical center over a 10-year period. METHODS Clinical data was collected from patients who presented to NYU Langone Health between 2011 and 2021 for a first-time AF ablation. Time to redo AF ablation or direct current cardioversion (DCCV) for recurrent AF during a 3-year follow-up period was determined and correlated with ablation technology and practices, antiarrhythmic medications, and patient comorbid conditions. RESULTS From 2011 to 2021, the cardiac electrophysiology lab adopted irrigated-contact force ablation catheters, high-power short duration ablation lesions, steady-pacing, jet ventilation, and eliminated stepwise linear ablation for AF ablation. During this time the number of first time AF ablations increased from 403 to 1074, the percentage of patients requiring repeat AF-related intervention within 3-years of the index procedure dropped from 22% to 14%, mean procedure time decreased from 271 ± 65 to 135 ± 36 min, and mean annual major adverse event rate remained constant at 1.1 ± 0.5%. Patient comorbid conditions increased during this time period and antiarrhythmic use was unchanged. CONCLUSION Rates of redo-AF ablation or DCCV following an initial AF ablation at a single center decreased 36% over a 10-year period. Procedural and technological changes likely contributed to this improvement, despite increased AF related comorbidities.
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Affiliation(s)
- Alexander Kushnir
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Chirag R Barbhaiya
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Douglas Holmes
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Robert Knotts
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - David Park
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Michael Spinelli
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Scott Bernstein
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
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Aragón-Herrera A, Couselo-Seijas M, Feijóo-Bandín S, Anido-Varela L, Moraña-Fernández S, Tarazón E, Roselló-Lletí E, Portolés M, Martínez-Sande JL, García-Seara J, Álvarez E, González-Juanatey JR, Rodríguez-Mañero M, Eiras S, Lago F. Relaxin-2 plasma levels in atrial fibrillation are linked to inflammation and oxidative stress markers. Sci Rep 2022; 12:22287. [PMID: 36566255 PMCID: PMC9789945 DOI: 10.1038/s41598-022-26836-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 12/21/2022] [Indexed: 12/25/2022] Open
Abstract
Relaxin-2 exerts many favourable cardiovascular effects in pathological circumstances such as atrial fibrillation (AF) and heart failure, but the mechanisms underlying its actions are not completely understood. Since inflammation and fibrosis are pivotal processes in the pathogenesis of AF, our aim was to study the relationship between relaxin-2 plasma levels in left atrium (LA) and peripheral vein with molecules implicated in fibrosis, inflammation and oxidative stress in AF patients, and to evaluate the anti-fibrotic ability of relaxin-2 in normal human atrial cardiac fibroblasts (NHCF-A). Peripheral vein relaxin-2 plasma levels were higher than LA relaxin-2 plasma levels in men while, in women, peripheral vein relaxin-2 levels were increased compared to men. AF patients with higher levels of relaxin-2 exhibited a reduction in H2O2 plasma levels and in mRNA levels of alpha-defensin 3 (DEFA3) and IL-6 in leucocytes from LA plasma. Relaxin-2-in-vitro treatment inhibited NHCF-A migration and decreased mRNA and protein levels of the pro-fibrotic molecule transforming growth factor-β1 (TGF-β1). Our results support an association between relaxin-2 and molecules involved in fibrosis, inflammation and oxidative stress in AF patients, and reinforce an anti-fibrotic protective role of this hormone in NHCF-A; strengthening the relevance of relaxin-2 in AF physiopathology, diagnosis and treatment.
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Affiliation(s)
- Alana Aragón-Herrera
- Cellular and Molecular Cardiology Unit and Department of Cardiology, Institute of Biomedical Research of Santiago de Compostela (IDIS-SERGAS), Travesía da Choupana s/n, 15706, Santiago de Compostela, Spain
- CIBERCV, Institute of Health Carlos III, C/ Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
| | - Marinela Couselo-Seijas
- Translational Cardiology Group, Institute of Biomedical Research of Santiago de Compostela (IDIS-SERGAS), Travesía da Choupana s/n, 15706, Santiago de Compostela, Spain
| | - Sandra Feijóo-Bandín
- Cellular and Molecular Cardiology Unit and Department of Cardiology, Institute of Biomedical Research of Santiago de Compostela (IDIS-SERGAS), Travesía da Choupana s/n, 15706, Santiago de Compostela, Spain
- CIBERCV, Institute of Health Carlos III, C/ Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
| | - Laura Anido-Varela
- Cellular and Molecular Cardiology Unit and Department of Cardiology, Institute of Biomedical Research of Santiago de Compostela (IDIS-SERGAS), Travesía da Choupana s/n, 15706, Santiago de Compostela, Spain
| | - Sandra Moraña-Fernández
- Cellular and Molecular Cardiology Unit and Department of Cardiology, Institute of Biomedical Research of Santiago de Compostela (IDIS-SERGAS), Travesía da Choupana s/n, 15706, Santiago de Compostela, Spain
- Cardiology Group, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), University of Santiago de Compostela and Health Research Institute, University Clinical Hospital of Santiago de Compostela, 15706, Santiago de Compostela, Spain
| | - Estefanía Tarazón
- CIBERCV, Institute of Health Carlos III, C/ Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
- Cardiocirculatory Unit, Health Institute La Fe University Hospital (IIS La Fe), Avda. de Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - Esther Roselló-Lletí
- CIBERCV, Institute of Health Carlos III, C/ Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
- Cardiocirculatory Unit, Health Institute La Fe University Hospital (IIS La Fe), Avda. de Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - Manuel Portolés
- CIBERCV, Institute of Health Carlos III, C/ Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
- Cardiocirculatory Unit, Health Institute La Fe University Hospital (IIS La Fe), Avda. de Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - José Luis Martínez-Sande
- CIBERCV, Institute of Health Carlos III, C/ Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
- Arrhytmia Unit, University Clinical Hospital of Santiago de Compostela, Travesía da Choupana s/n, 15706, Santiago de Compostela, Spain
| | - Javier García-Seara
- CIBERCV, Institute of Health Carlos III, C/ Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
- Arrhytmia Unit, University Clinical Hospital of Santiago de Compostela, Travesía da Choupana s/n, 15706, Santiago de Compostela, Spain
| | - Ezequiel Álvarez
- CIBERCV, Institute of Health Carlos III, C/ Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
- Institute of Biomedical Research of Santiago de Compostela (IDIS-SERGAS), Travesía da Choupana s/n, 15706, Santiago de Compostela, Spain
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela, 15782, Santiago de Compostela, Spain
| | - José Ramón González-Juanatey
- Cellular and Molecular Cardiology Unit and Department of Cardiology, Institute of Biomedical Research of Santiago de Compostela (IDIS-SERGAS), Travesía da Choupana s/n, 15706, Santiago de Compostela, Spain
- CIBERCV, Institute of Health Carlos III, C/ Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
| | - Moisés Rodríguez-Mañero
- CIBERCV, Institute of Health Carlos III, C/ Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain.
- Arrhytmia Unit, University Clinical Hospital of Santiago de Compostela, Travesía da Choupana s/n, 15706, Santiago de Compostela, Spain.
| | - Sonia Eiras
- CIBERCV, Institute of Health Carlos III, C/ Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
- Translational Cardiology Group, Institute of Biomedical Research of Santiago de Compostela (IDIS-SERGAS), Travesía da Choupana s/n, 15706, Santiago de Compostela, Spain
| | - Francisca Lago
- Cellular and Molecular Cardiology Unit and Department of Cardiology, Institute of Biomedical Research of Santiago de Compostela (IDIS-SERGAS), Travesía da Choupana s/n, 15706, Santiago de Compostela, Spain
- CIBERCV, Institute of Health Carlos III, C/ Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
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17
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Zhao Z, Zhang F, Ma R, Bo L, Zhang Z, Zhang C, Wang Z, Li C, Yang Y. Development and Validation of a Risk Nomogram Model for Predicting Recurrence in Patients with Atrial Fibrillation After Radiofrequency Catheter Ablation. Clin Interv Aging 2022; 17:1405-1421. [PMID: 36187572 PMCID: PMC9521706 DOI: 10.2147/cia.s376091] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/06/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose This study aimed to develop and validate a risk nomogram model for predicting the risk of atrial fibrillation recurrence after radiofrequency catheter ablation. Patients and Methods A retrospective observational study was conducted using data from 485 patients with atrial fibrillation who underwent the first radiofrequency ablation in our hospital from January 2018 to June 2021. All patients were randomized into training cohort (70%; n=340) and validation cohort (30%; n=145). Univariate and multivariate logistic regression analyses were used to identify independent risk factors. The predictive nomogram model was established by using R software. The nomogram was developed and evaluated based on differentiation, calibration, and clinical efficacy by concordance statistic (C-statistic), calibration plots, and decision curve analysis (DCA), respectively. Results The nomogram was established by four variables including left atrial diameter (OR 1.057, 95% CI 1.010–1.107, P=0.018), left ventricular ejection fraction (OR 0.943, 95% CI 0.905–0.982, P=0.005), type of atrial fibrillation (OR 2.164, 95% CI: 1.262–3.714), and systemic inflammation score (OR 1.905, 95% CI 1.408–2.577). The C-statistic of the nomogram was 0.741 (95% CI: 0.689–0.794) in the training cohort and 0.750 (95% CI: 0.670–0.831) in the validation cohort. The calibration plots showed good agreement between the predictions and observations in the training and validation cohorts. Decision curve analysis and clinical impact curves indicated the clinical utility of the predictive nomogram. Conclusion The nomogram model has good discrimination and accuracy, which can screen high-risk groups intuitively and individually, and has a certain predictive value for atrial fibrillation recurrence in patients after radiofrequency ablation.
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Affiliation(s)
- Zhihao Zhao
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Fengyun Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Ruicong Ma
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Lin Bo
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Zeqing Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Chaoqun Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Zhirong Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Chengzong Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Yu Yang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
- Correspondence: Yu Yang, Tel +86-15651359875, Email
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18
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Orbán G, Salló Z, Perge P, Ábrahám P, Piros K, Nagy KV, Osztheimer I, Merkely B, Gellér L, Szegedi N. Characteristics of Very High-Power, Short-Duration Radiofrequency Applications. Front Cardiovasc Med 2022; 9:941434. [PMID: 35911564 PMCID: PMC9326019 DOI: 10.3389/fcvm.2022.941434] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Pulmonary vein isolation is the cornerstone of rhythm-control therapy for atrial fibrillation (AF). The very high-power, short-duration (vHPSD) radiofrequency (RF) ablation is a novel technology that favors resistive heating while decreasing the role of conductive heating. Our study aimed to evaluate the correlations between contact force (CF), power, impedance drop (ID), and temperature; and to assess their role in lesion formation with the vHPSD technique. Methods Consecutive patients who underwent initial point-by-point RF catheter ablation for AF were enrolled in the study. The vHPSD ablation was performed applying 90 W for 4 s with an 8 ml/min irrigation rate. Results Data from 85 patients [median age 65 (59–71) years, 34% female] were collected. The median procedure time, left atrial dwelling time, and fluoroscopy time were 70 (60–90) min, 49 (42–58) min, and 7 (5–11) min, respectively. The median RF time was 312 (237-365) sec. No steam pop nor major complications occurred. A total of 6,551 vHPSD RF points were analyzed. The median of CF, maximum temperature, and ID were 14 (10–21) g, 47.6 (45.1–50.4) °C, and 8 (6–10) Ohms, respectively. CF correlated significantly with the maximum temperature (p < 0.0001). A CF of 5 g and above was associated with a significantly higher temperature compared to those lesions with a CF below 5 grams (p < 0.0001). Bilateral first-pass isolation rate was 84%. The 6-month AF-recurrence rate was 7%. Conclusion The maximum temperature and CF significantly correlate with each other during vHPSD applications. A CF ≥ 5 g leads to better tissue heating and thus might be more likely to result in good lesion formation, although this clinical study was unable to assess actual lesion sizes.
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