Pulmonary vein isolation only for atrial fibrillation with heart failure
Bibliographic record
Abstract
Abstract Background Atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) are associated with increased morbidity and mortality. Radiofrequency ablation-based rhythm control has demonstrated clinical benefit by reducing all-cause mortality and heart failure events. However, no prospective data exist evaluating a pulmonary vein isolation (PVI)-only approach in patients with HFrEF or comparing ablation efficacy between patients with and without HFrEF. Methods This prospective, investigator-initiated, single-center, non-inferiority, observational study with propensity score matching aimed to assess whether a PVI-only approach using cryoballoon ablation in patients with HFrEF (LVEF ≤40%) is non-inferior to PVI-only in patients without HFrEF. The primary efficacy end point was the first documented recurrence of an atrial arrhythmia following a 90-day blanking period. The pre-specified non-inferiority margin was a hazard ratio of 1.39. Safety endpoints included all-cause death, cerebrovascular events, and procedure-related complications. Results A total of 1402 patients were enrolled and underwent PVI. After propensity score matching, 972 patients were analyzed in a 1:5 ratio. Over a mean follow-up of 2 years, the primary efficacy endpoint occurred in 75 of 162 patients with HFrEF and in 338 of 810 without HFrEF (Kaplan–Meier event rate estimates, 46.3% and 41.7%; HR 1.03; 90%CI, 0.83-1.28; P=0.01 for non-inferiority). All-cause mortality was higher in patients with HFrEF (8% vs. 3.7%, P=0.002), while no difference was observed in the incidence of procedure-related safety endpoints between patients with and without HFrEF (3.7% vs. 5.1%, P=0.50). Conclusion In patients with AF and HFrEF undergoing ablation, a PVI-only approach achieves comparable rhythm control efficacy to that in patients without HFrEF. While all-cause mortality is higher among patients with HFrEF, procedural safety is comparable between both groups. (POLAR-HF, ClinicalTrials.gov number NCT 04461691)
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".