Machine learning model for predicting late recurrence of atrial fibrillation after catheter ablation

Catheter ablation for atrial fibrillation in patients with significant mitral regurgitation: A systematic review and meta-analysis

BACKGROUND

Atrial fibrillation (AF) is commonly associated with cardiac structural abnormalities including mitral regurgitation (MR). Contemporary guidelines recommend consideration of early rhythm control strategies including catheter ablation (CA) for AF. However, the long-term efficacy of CA is highly variable across studies and patient populations, and the effect of coexisting MR on AF recurrence remains unclear.

OBJECTIVE

A systematic review and meta-analysis was performed to determine the impact of significant MR (defined as ≥moderate) on AF recurrence rate after CA and whether CA for AF is associated with significant changes in the severity of MR.

METHODS

A systematic search of PubMed, Embase, Web of Science, and Cochrane databases for all English-language studies published to December 31, 2023, was performed.

RESULTS

A total of 17 studies (N = 2624 patients) were retained for meta-analysis. The pooled recurrence proportion of AF after CA in patients with baseline significant MR was 36% (95% CI, 27%-46%) compared with 27% (14%-41%) in patients without. The pooled hazard ratio (95% CI) for AF recurrence after CA in the presence of significant MR was 2.47 (1.52-4.01; P < .001; Egger test P value, .0583). The pooled proportion of patients who witnessed MR improvement to nonsignificant (ie,

CONCLUSION

Baseline significant MR was independently predictive of AF recurrence rate after CA. Despite the increased AF recurrence rates after CA associated with significant MR, CA with maintenance of sinus rhythm appeared to improve the severity of MR, suggesting a possible induction of reverse positive atrial and mitral valvular remodeling.

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Key Words

• Atrial fibrillation
• Catheter ablation
• Mitral regurgitation
• Pulmonary vein isolation
• Review

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Affiliation(s)

Ross A Okazaki Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
Lillian C Flashner Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
Scott Kinlay Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts; Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
Adelqui O Peralta Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts; Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
Peter S Hoffmeister Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts; Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
Hirad Yarmohammadi Department of Medicine, Columbia University, New York, New York
Jacob Joseph Department of Medicine, Brown University, Providence, Rhode Island; Department of Medicine, VA Providence Healthcare System, Providence, Rhode Island
Matthew F Yuyun Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts; Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts.

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Multidisciplinary management strategies for atrial fibrillation

There has been a significant increase in the prevalence of atrial fibrillation (AF) over the past 30 years. Pulmonary vein isolation (PVI) is an effective treatment for AF, but research investigations have shown that AF recurrence still occurs in a significant number of patients after ablation. Heart rhythm outcomes following catheter ablation are correlated with numerous clinical factors, and researchers developed predictive models by integrating risk factors to predict the risk of recurrence of atrial fibrillation. The purpose of this article is to outline the risk scores for predicting cardiac rhythm outcomes after PVI and to discuss the modifiable factors that increase the risk of recurrence of AF, with the hope of further improving catheter ablation efficacy through preoperative identification of high-risk populations and postoperative management of modifiable risk factors.

Development and trends in research on hypertension and atrial fibrillation: A bibliometric analysis from 2003 to 2022

BACKGROUND

This study aimed to comprehensively analyze research related to hypertension and atrial fibrillation, 2 common cardiovascular diseases with significant global public health implications, using bibliometric methods from 2003 to 2022.

METHODS

From the Web of Science Core Collection database, literature on the theme of hypertension and atrial fibrillation was retrieved. Subsequently, comprehensive bibliometric analyses were conducted across multiple dimensions utilizing software tools such as VOSviewer, Citespace, Pajek, Scimago Graphica, and ClusterProfiler. These analyses encompassed examinations of the literature according to country/region, institution, authors, journals, citation relationships, and keywords.

RESULTS

It revealed an increasing interest and shifting focus in research over the years. The analysis covered 7936 relevant publications, demonstrating a gradual rise in research activity regarding hypertension combined with atrial fibrillation over the past 2 decades, with a stable growth trend in research outcomes. Geographically, Europe and the Americas, particularly the United States, have shown the most active research in this field, while China has also gained importance in recent years. Regarding institutional contributions, internationally renowned institutions such as the University of Birmingham and the Mayo Clinic have emerged as core forces in this research direction. Additionally, Professor Lip Gregory, with his prolific research output, has stood out among numerous scholars. The American Journal of Cardiology has become a primary platform for publishing research related to hypertension and atrial fibrillation, highlighting its central role in advancing knowledge dissemination in this field. The research focus has shifted from exploring the pathophysiological mechanisms to investigating the treatment of complications and risk factors associated with hypertension and atrial fibrillation. Future research will focus on in-depth exploration of genetic and molecular mechanisms, causal relationship exploration through Mendelian randomization studies, and the application of machine learning techniques in prediction and treatment, aiming to promote the development of precision medicine for cardiovascular diseases.

CONCLUSION

In conclusion, this study provides a comprehensive overview of the developmental trajectory of research on hypertension and atrial fibrillation, presenting novel insights into trends and future research directions, thus offering information support and guidance for research in this crucial field of cardiovascular medicine.