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2. Abstract 10259: Better Prediction of Stroke in Atrial Fibrillation with Incorporation of Malignancy in Cha2ds2vasc Score: Mcha2ds2vasc Score

Author

Rohit Moudgil, Brandon Bungo, Pulkit Chaudhury, Michael Arustamyan, Rishi Rikhi, Muzna Hussain, Patrick H Collier, Mohamed H Kanj, Alok Khorana, and Amgad Mentias

Subjects
Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract

Introduction: Atrial fibrillation (AF) is associated with an increased risk of stroke. Despite a large body of evidence linking malignancy and thrombosis, malignancy is not part of the scoring system. Hypothesis: Malignancy is an independent risk factor for the development of thromboembolic stroke in patients with AF. Methods: SEER database was utilized to identify patients with lung, colon, breast, and prostate cancers with AF and no prior diagnosis of stroke. These patients were compared to controls within the dataset. The primary endpoint was ischemic stroke. Rates of stroke per 100 person-years were calculated for each group. Cox regression modeling and a nested model comparing CHA 2 DS s VASc score (Model 1) with a complete model including cancer diagnosis (Model 2) were performed. Models were compared using Akaike Information Criterion (AKI) and Net Reclassification Index (NRI). A propensity matched cohort with equivalent CHA 2 DS 2 VASc scores determining stroke-free survival was also performed. Results: A total of 101,185 patients were included in the analysis, with 48,242 in the Cancer Group and 52,943 in the Non-cancer Group. Stroke rate per 100 person-years was significantly higher in the Cancer Group (2.962) compared with the Non-cancer Group (2.377) (IRR 1·25, 95% CI [1·18-1·31]). The CHA 2 DS 2 VASc model (Model 1) was compared against a model including cancer (Model 2) showing an improved predictability as assessed by both NRI (12·2, 95% CI [10·7-13·7, p 75, female sex, and diabetes. Propensity matched Kaplan-Meier curve demonstrated decreased probability of stroke-free survival in the Cancer Group (p=0·00045). Conclusion: Cancers increase the risk of stroke in patients with AF. Consideration should be given for the addition of malignancy to the clinical scoring systems.

Published
2021
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3. List of Contributors

Author

Amin Al-Ahmad, Jason G. Andrade, Elad Anter, Rishi Arora, Samuel J. Asirvatham, Javier E. Banchs, Mohamed Bassiouny, Tina Baykaner, Francis Bessière, Deepak Bhakta, Frank Bogun, Chad Brodt, Eric Buch, J. David Burkhardt, David J. Callans, Jien-Jiun Chen, Jong-Il Choi, Thomas C. Crawford, Gopi Dandamudi, Mithilesh K. Das, James P. Daubert, Farah Z. Dawood, Luigi Di Biase, Sanjay Dixit, Marc Dubuc, Srinivas R. Dukkipati, Andris Ellims, Gregory K. Feld, Doni Friadi, Carola Gianni, Mario D. Gonzalez, Lorne J. Gula, David E. Haines, Haris M. Haqqani, Gordon Ho, Kurt Hoffmayer, Rodney P. Horton, Patrick M. Hranitzky, Jonathan Hsu, Shoei K. Stephen Huang, Mathew D. Hutchinson, Atsushi Ikeda, Warren M. Jackman, Rahul Jain, Jonathan M. Kalman, Mohamed H. Kanj, G. Neal Kay, Paul Khairy, Houman Khakpour, Young-Hoon Kim, Yun Gi Kim, Andy C. Kiser, Peter M. Kistler, George J. Klein, Jacob S. Koruth, Christopher A.B. Kowalewski, David E. Krummen, Kwang-No Lee, Peter Leong-Sit, Bruce B. Lerman, Jackson J. Liang, Jiunn-Lee Lin, Lian-Yu Lin, Ting-Tse Lin, Deborah Lockwood, Steven M. Markowitz, Gregory F. Michaud, John M. Miller, Marc A. Miller, Jay A. Montgomery, Talal Moukabary, J. Paul Mounsey, Koonlawee Nademanee, Hiroshi Nakagawa, Niyada Naksuk, Sanjiv M. Narayan, Andrea Natale, Akihiko Nogami, Suk-Kyu Oh, Hakan Oral, Santosh K. Padala, Deepak Padmanabhan, Hee-Soon Park, Bhupesh Pathik, Thomas Paul, Basilios Petrellis, Vivek Y. Reddy, Sukit Ringwala, Jaime Rivera, Jason Roberts, Miguel Rodrigo, Yuichiro Sakamoto, Javier E. Sanchez, Pasquale Santangeli, William H. Sauer, J. Philip Saul, Richard K. Shepard, Jaemin Shim, Kalyanam Shivkumar, Konstantinos Siontis, Allan C. Skanes, Wilber W. Su, Edward Sze, Hiroshi Tada, Taresh Taneja, Patrick J. Tchou, John K. Triedman, Roderick Tung, Mohit K. Turagam, Wendy S. Tzou, Mohan N. Viswanathan, Tomos E. Walters, Paul J. Wang, William Whang, Takumi Yamada, Raymond Yee, and Junaid A.B. Zaman

Published
2019
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4. Contributors

Author

Philip Aagaard, Dominic James Abrams, Hugues Abriel, Wayne O. Adkisson, Esperanza Agullo-Pascual, Francisco J. Alvarado, Ahmad S. Amin, Charles Antzelevitch, Justus M.B. Anumonwo, Luciana Armaganijan, Arash Arya, Samuel Asirvatham, Felipe Atienza, Peter H. Backx, Lisa M. Ballou, Elise Balse, Sujata Balulad, Andrea Barbuti, Gust H. Bardy, Guillaume Bassil, David G. Benditt, Omer Berenfeld, Donald M. Bers, Ofer Binah, Frank Bogun, Rossana Bongianino, Noel G. Boyle, Patrick M. Boyle, Günter Breithardt, Marisa Brini, Peter R. Brink, Pedro Brugada, Eric Buch, Feliksas F. Bukauskas, Hugh Calkins, David J. Callans, Sean M. Caples, Ernesto Carafoli, William A. Catterall, Marina Cerrone, Arnaud Chaumeil, Caressa Chen, Lan S. Chen, Peng-Sheng Chen, Jianding Cheng, Nipavan Chiamvimonvat, David J. Christini, Aman Chugh, Andreu M. Climent, Ira S. Cohen, Stuart J. Connolly, Lebron Cooper, Eric M. Crespo, Lia Crotti, Thomas A. Csepe, Frank Cuoco, Anne B. Curtis, Ralph J. Damiano, Dawood Darbar, Mithilesh K. Das, Andre d’Avila, Mario Delmar, Eva Delpón, Marco Denegri, Arnaud Denis, Nicolas Derval, Isabelle Deschênes, Abhishek Deshmukh, Luigi Di Biase, Timm M. Dickfeld, Hans Dierckx, Borislav Dinov, Sanjay Dixit, Dobromir Dobrev, Remi Dubois, Lars Eckardt, Andrew G. Edwards, Kenneth A. Ellenbogen, Patrick T. Ellinor, N.A. Mark Estes, Larissa Fabritz, Vadim V. Fedorov, Antonio B. Fernandez, Elvis Teijeira Fernández, David Filgueiras-Rama, Michael C. Fishbein, Glenn I. Fishman, David S. Frankel, Paul Friedman, Antonio Frontera, Apoor S. Gami, Paul Garabelli, Alfred L. George, Edward P. Gerstenfeld, Sigfus Gizurarson, Michael R. Gold, Jeffrey J. Goldberger, Andrew Grace, Guido Grassi, Ruth Ann Greenfield, Wendy L. Gross, Blair P. Grubb, María S. Guillem, Sándor Györke, Michel Haïssaguerre, Johan Hake, Henry R. Halperin, Brian J. Hansen, Stéphane Hatem, David L. Hayes, Jordi Heijman, Todd J. Herron, Gerhard Hindricks, Mélèze Hocini, Stefan H. Hohnloser, David R. Holmes, Masahiko Hoshijima, Thomas J. Hund, Mathew D. Hutchinson, Leonard Ilkhanoff, Jodie Ingles, James E. Ip, Warren M. Jackman, Nicholas Jackson, Pierre Jaïs, José Jalife, Bong Sook Jhun, Roy M. John, Monique Jongbloed, Luc Jordaens, Jonathan M. Kalman, Timothy J. Kamp, Mohamed H. Kanj, Suraj Kapa, Beverly Karabin, Ioannis Karakikes, Demosthenes G. Katritsis, Kuljeet Kaur, Paulus Kirchhof, André G. Kléber, George J. Klein, Peter Kohl, Jayanthi N. Koneru, Jacob S. Koruth, Andrew D. Krahn, Trine Krogh-Madsen, Karl Heinz Kuck, Saurabh Kumar, Alexander Kushnir, Neal K. Lakdawala, Zachary W.M. Laksman, Rakesh Latchamsetty, Dennis H. Lau, Bruce B. Lerman, Richard Z. Lin, Shien-Fong Lin, Mark S. Link, Bin Liu, Christopher F. Liu, Deborah J. Lockwood, Anatoli N. Lopatin, Steven A. Lubitz, Rajiv Mahajan, Jonathan C. Makielski, Marek Malik, Francis E. Marchlinski, Steven M. Markowitz, Barry J. Maron, Martin S. Maron, Steven O. Marx, Stéphane Massé, Andrew D. McCulloch, Pippa McKelvie-Sebileau, Spencer J. Melby, Andreas Metzner, Anushka P. Michailova, Gregory F. Michaud, John M. Miller, Jyotsna Mishra, Raul D. Mitrani, Peter J. Mohler, Fred Morady, Robert J. Myerburg, Hiroshi Nakagawa, Chrishan Joseph Nalliah, Kumaraswamy Nanthakumar, Carlo Napolitano, Sanjiv M. Narayan, Andrea Natale, Stanley Nattel, Saman Nazarian, Thao P. Nguyen, Akihiko Nogami, Sami F. Noujaim, Karine Nubret Le Coniat, Brian Olshansky, Jin O-Uchi, Gavin Y. Oudit, Feifan Ouyang, Cevher Ozcan, Douglas L. Packer, Sandeep V. Pandit, Alexander V. Panfilov, David S. Park, Bence Patocskai, Dainius H. Pauza, Neringa Pauziene, Jonathan P. Piccini, Geoffrey S. Pitt, Sunny S. Po, Abhiram Prasad, Silvia G. Priori, Przemysław B. Radwański, Wouter-Jan Rappel, Michelle Reiser, Alejandro Jimenez Restrepo, Richard B. Robinson, Dan M. Roden, Michael R. Rosen, Raphael Rosso, Yoram Rudy, Kristina Rysevaite-Kyguoliene, Hani N. Sabbah, Frederic Sacher, Frank B. Sachse, Ardan M. Saguner, Prashanthan Sanders, Michael C. Sanguinetti, Pasquale Santangeli, Mohammad Sarraf, Jonathan Satin, Martin Jan Schalij, Benjamin J. Scherlag, Matthew R. Schill, J. William Schleifer, Richard B. Schuessler, Peter J. Schwartz, Timon Seeger, Christopher Semsarian, Gino Seravalle, Ashok J. Shah, Robin M. Shaw, Mark J. Shen, Win–Kuang Shen, Shey-Shing Sheu, Kalyanam Shivkumar, Jennifer N.A. Silva, Allan C. Skanes, Kyoko Soejima, Virend K. Somers, Dan Sorajja, Stavros Stavrakis, Christian Steinberg, Lynne Warner Stevenson, William G. Stevenson, Michael O. Sweeney, Charles Swerdlow, Masateru Takigawa, Juan Tamargo, Harikrishna Tandri, Usha B. Tedrow, Nathaniel Thompson, Paul D. Thompson, Gordon F. Tomaselli, Jeffrey A. Towbin, Natalia A. Trayanova, Martin Tristani-Firouzi, Zian H. Tseng, Akiko Ueda, Héctor H. Valdivia, Virginijus Valiunas, Christian van der Werf, George F. Van Hare, David Vidmar, Sami Viskin, Niels Voigt, Edward P. Walsh, Paul J. Wang, Xander H.T. Wehrens, Mark S. Weiss, Arthur A.M. Wilde, Bruce L. Wilkoff, Y. Joseph Woo, Joseph C. Wu, Raymond Yee, Junaid A.B. Zaman, Manuel Zarzoso, Emily P. Zeitler, Katja Zeppenfeld, Tarek Zghaib, Xiao-Dong Zhang, and Douglas P. Zipes

Published
2018
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5. Pulmonary Vein Antral Isolation Using an Open Irrigation Ablation Catheter for the Treatment of Atrial Fibrillation A Randomized Pilot Study

Author

Mohamed H, Kanj, Oussama, Wazni, Tamer, Fahmy, Sergio, Thal, Dimpi, Patel, Claude, Elayi, Luigi, Di Biase, Mauricio, Arruda, Walid, Saliba, Robert A, Schweikert, Jennifer E, Cummings, J David, Burkhardt, David O, Martin, Gemma, Pelargonio, Antonio, Dello Russo, Michela, Casella, Pietro, Santarelli, Domenico, Potenza, Raffaele, Fanelli, Raimondo, Massaro, Giovanni, Forleo, and Andrea, Natale

Subjects
Adult, Aged, 80 and over, Male, Postoperative Care, Time Factors, Adolescent, Pilot Projects, Middle Aged, Risk Assessment, Severity of Illness Index, Echocardiography, Doppler, Survival Rate, Electrocardiography, Treatment Outcome, Pulmonary Veins, Atrial Fibrillation, Catheter Ablation, Linear Models, Humans, Female, Electrophysiologic Techniques, Cardiac, Therapeutic Irrigation, Aged, Follow-Up Studies, Probability
Abstract

ObjectivesWe sought to test how catheter ablation using an open irrigation catheter (OIC) compares with standard catheters for pulmonary vein antrum isolation.BackgroundOpen irrigation catheters have the advantage of delivering greater power without increasing the temperature of the catheter tip, which enables deeper and wider lesions without the formation of coagulum on catheters.MethodsCatheter ablation was performed using an 8-mm catheter (8MC) or an OIC. Patients were randomized to 3 groups: 8MC; OIC-1, OIC with a higher peak power (50 W); and OIC-2, OIC with lower peak power (35 W).ResultsA total of 180 patients were randomized to the 3 treatment strategies. Isolation of pulmonary vein antra was achieved in all patients. The freedom from atrial fibrillation was significantly greater in the 8MC and OIC-1 groups compared with the OIC-2 group (78%, 82%, and 68%, respectively, p = 0.043). Fluoroscopy time was lower in OIC-1 compared with OIC-2 and 8MC (28 ± 1 min, 53 ± 2 min, and 46 ± 2 min, respectively, p = 0.001). The mean left atrium instrumentation time was lower in the OIC-1 compared with the OIC-2 and 8MC groups (59 ± 3 min, 90 ± 5 min, and 88 ± 4 min, respectively, p = 0.001). However, there was a greater incidence of “pops” in the OIC-1 (100%, 0%, 0%, p < 0.001) along with higher incidences of pericardial effusion (20%, 0%, 0%, p < 0.001) and gastrointestinal complaints (17% in OIC-1, 3% in 8MC, and 5% in OIC-2, p = 0.031).ConclusionsAlthough there was a decrease in fluoroscopy and left atrium instrumentation time with the use of OIC at higher power, this setting was associated with increased cardiovascular and gastrointestinal complications.

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