bluuebunny/crossref_metadata_2025 huggingface dataset:
The evolution of brood parasitism from host egg predation
Authors: Mouginot Pierick , Galipaud Matthias , Reichard Martin
Published: May 2024

Obligate brood parasites pass all their parental duties to foster parents of a host species. While best understood in birds and hymenopteran insects, obligate brood parasitism has evolved independently at least 59 times across many lineages. The ancestors of brood parasites often provided no parental care to their offspring. Instead, a trophic association with their eventual hosts commonly appears to precede the origin of a brood parasitic strategy. Here, we used a game theoretical model to explore the conditions under which brood parasitism can evolve from predation and be maintained in the population. Our model was inspired by the relationship between the cuckoo catfish (Synodontis multipunctatus) parasitizing mouthbrooding cichlid fishes in the African Lake Tanganyika. Our model demonstrates the facilitatory role of host egg predation on the origin and evolutionary maintenance of brood parasitism through the exploitation of the host response to egg predation by brood parasites. We found no conditions under which brood parasitism as a pure strategy is evolutionarily stable, but we describe a range of evolutionarily stable equilibria when predators and parasites coexist. While our model is tailored to the cuckoo catfish, it generally applies to other systems where brood parasitism has evolved from other antagonistic behavior.
Improve-RRBS: a novel tool to correct the 3′ trimming of reduced representation sequencing reads
Authors: Fóthi Ábel , Liu Hongbo , Susztak Katalin , Aranyi Tamas
Published: May 2024

Motivation

Reduced Representation Bisulfite Sequencing (RRBS) is a popular approach to determine DNA methylation of the CpG-rich regions of the genome. However, we observed that false positive differentially methylated sites (DMS) are also identified using the standard computational analysis.

Results

During RRBS library preparation the MspI digested DNA undergo end-repair by a cytosine at the 3′ end of the fragments. After sequencing, Trim Galore cuts these end-repaired nucleotides. However, Trim Galore fails to detect end-repair when it overlaps with the 3′ end of the sequencing reads. We found that these non-trimmed cytosines bias methylation calling, thus, can identify DMS erroneously. To circumvent this problem, we developed improve-RRBS, which efficiently identifies and hides these cytosines from methylation calling with a false positive rate of maximum 0.5%. To test improve-RRBS, we investigated four datasets from four laboratories and two different species. We found non-trimmed 3′ cytosines in all datasets analyzed and as much as >50% of false positive DMS under certain conditions. By applying improve-RRBS, these DMS completely disappeared from all comparisons.

Availability and implementation

Improve-RRBS is a freely available python package https://pypi.org/project/iRRBS/ or https://github.com/fothia/improve-RRBS to be implemented in RRBS pipelines.
A survey of BWT variants for string collections
Authors: Cenzato Davide , Lipták Zsuzsanna
Published: May 2024

Motivation

In recent years, the focus of bioinformatics research has moved from individual sequences to collections of sequences. Given the fundamental role of the Burrows–Wheeler transform (BWT) in string processing, a number of dedicated tools have been developed for computing the BWT of string collections. While the focus has been on improving efficiency, both in space and time, the exact definition of the BWT used has not been at the center of attention. As we show in this paper, the different tools in use often compute non-equivalent BWT variants: the resulting transforms can differ from each other significantly, including the number r of runs, a central parameter of the BWT. Moreover, with many tools, the transform depends on the input order of the collection. In other words, on the same dataset, the same tool may output different transforms if the dataset is given in a different order.

Results

We studied 18 dedicated tools for computing the BWT of string collections and were able to identify 6 different BWT variants computed by these tools. We review the differences between these BWT variants, both from a theoretical and from a practical point of view, comparing them on eight real-life biological datasets with different characteristics. We find that the differences can be extensive, depending on the datasets, and are largest on collections of many similar short sequences. The parameter r, the number of runs of the BWT, also shows notable variation between the different BWT variants; on our datasets, it varied by a multiplicative factor of up to 4.2.

Availability and implementation

Source code and scripts to replicate the results and download the data used in the article are available at https://github.com/davidecenzato/BWT-variants-for-string-collections.
Pulse pressure modifies the association between diastolic blood pressure and decrease in kidney function: the Japan Specific Health Checkups Study
Authors: Tamaki Hiroyuki , Eriguchi Masahiro , Yoshida Hisako , Uemura Takayuki , Tasaki Hikari , Nishimoto Masatoshi , Kosugi Takaaki , Samejima Ken-ichi , Iseki Kunitoshi , Fujimoto Shouichi , Konta Tsuneo , Moriyama Toshiki , Yamagata Kunihiro , Narita Ichiei , Kasahara Masato , Shibagaki Yugo , Kondo Masahide , Asahi Koichi , Watanabe Tsuyoshi , Tsuruya Kazuhiko
Published: May 2024

Background

Unlike systolic blood pressure (SBP), the prognostic value of diastolic blood pressure (DBP) in kidney function has not been established. We hypothesized that pulse pressure (PP), which is associated with arteriosclerosis, would affect the prognostic value of DBP.

Methods

This longitudinal study used data from the Japan Specific Health Checkups Study was conducted between 2008 and 2014. The participants were stratified into three PP subgroups (low PP ≤39, normal PP 40–59 and high PP ≥60 mmHg). The exposures of interest were SBP and DBP, and the association between SBP/DBP and kidney outcomes (30% decline in the estimated glomerular filtration rate from baseline) was examined in each PP subgroup using a Cox proportional hazards model.

Results

Among 725 022 participants, 20 414 (2.8%) developed kidney outcomes during a median follow-up period of 34.6 months. Higher SBP was consistently associated with a higher incidence of kidney outcome in all PP subgroups. Although DBP had a positive linear association with the incidence of kidney outcome in low- and normal-PP subgroups, both lower (≤60 mmHg) and higher (≥101 mmHg) DBP were associated with a higher incidence of kidney outcome in the high-PP subgroup, with a U-shaped curve. Hazard ratios (95% confidence intervals) of ≤60 mmHg (reference: 61–80 mmHg in normal-PP subgroup) and ≥101 mmHg were 1.26 (1.15–1.38) and 1.86 (1.62–2.14), respectively.

Conclusions

In this large population-based cohort, DBP was differently associated with kidney outcome by PP level; lower DBP was significantly associated with a higher incidence of kidney outcome in the high-PP subgroup but not in the low- and normal-PP subgroups.
MSGD: a manually curated database of genomic, transcriptomic, proteomic and drug information for multiple sclerosis
Authors: Wu Tao , Hou Yaopan , Xin Guanghao , Niu Jingyan , Peng Shanshan , Xu Fanfan , Li Ying , Chen Yuling , Yu Yifangfei , Zhang Huixue , Kong Xiaotong , Cao Yuze , Ning Shangwei , Wang Lihua , Hao Junwei
Published: May 2024

Multiple sclerosis (MS) is the most common inflammatory demyelinating disease of the central nervous system. ‘Omics’ technologies (genomics, transcriptomics, proteomics) and associated drug information have begun reshaping our understanding of multiple sclerosis. However, these data are scattered across numerous references, making them challenging to fully utilize. We manually mined and compiled these data within the Multiple Sclerosis Gene Database (MSGD) database, intending to continue updating it in the future. We screened 5485 publications and constructed the current version of MSGD. MSGD comprises 6255 entries, including 3274 variant entries, 1175 RNA entries, 418 protein entries, 313 knockout entries, 612 drug entries and 463 high-throughput entries. Each entry contains detailed information, such as species, disease type, detailed gene descriptions (such as official gene symbols), and original references. MSGD is freely accessible and provides a user-friendly web interface. Users can easily search for genes of interest, view their expression patterns and detailed information, manage gene sets and submit new MS-gene associations through the platform. The primary principle behind MSGD’s design is to provide an exploratory platform, aiming to minimize filtration and interpretation barriers while ensuring highly accessible presentation of data. This initiative is expected to significantly assist researchers in deciphering gene mechanisms and improving the prevention, diagnosis and treatment of MS.

Database URL: http://bio-bigdata.hrbmu.edu.cn/MSGD
Extensive coronary artery thrombosis in a paediatric patient with Kawasaki disease: a case report
Authors: Kasap Tilbe , Voges Inga , Rinne Katy , Langguth Patrick
Published: May 2024

Background

Kawasaki disease (KD) is a paediatric multi-system vasculitis. Mainly, the coronary arteries become affected due to acute inflammation and formation of coronary artery aneurysms (CAAs) may occur. As the size of the CAA increases, so does the risk of clinical complications and serious cardiac outcomes. These patients may experience life-threatening thrombotic coronary artery occlusion and myocardial ischaemia unless antiplatelet and anticoagulation therapy is not initiated in a timely manner.1

Case summary

This case report presents a 12-year-old patient with KD who developed CAAs in two coronary arteries despite initial administration of intravenous immunoglobulins and acetylsalicylic acid, followed by extensive thrombosis of both coronary arteries, although antithrombotic therapy was started after the diagnosis of CAAs.

Discussion

Our case is notable because of the severity of the clinical manifestation despite the administration of antiplatelet agents and anticoagulants. It could be speculated that the development of coronary thrombosis in this case might be strongly correlated with the late initiation of oral anticoagulation. The high-quality images of the affected coronary arteries in such a young patient could be of educational value.
Early structural valve deterioration of balloon expandable transcatheter aortic valve leaflets due to intrinsic and extrinsic nodular calcifications in a haemodialysis patient: a case report
Authors: Onishi Kyohei , Mizutani Kazuki , Sato Yu , Nakazawa Gaku
Published: May 2024

Background

Several reports have shown that transcatheter aortic valves are comparable in durability to surgical aortic valves. However, early structural valve deterioration (SVD) is rarely reported to occur, especially in haemodialysis patients.

Case summary

We present a case of rapidly progressive bioprosthetic aortic valve stenosis in a patient with end-stage renal disease secondary to diabetic nephropathy in an 83-year-old female admitted due to progressive dyspnoea and orthopnoea. A 23 mm sized SAPIEN3 bioprosthetic aortic valve showed normal function for the first year after transcatheter aortic valve implantation (TAVI), but then rapidly developed stenosis and required acute hospitalization for heart failure a year and a half after surgery. Emergent surgical aortic valve replacement with a 19 mm On-X valve (CryoLife, Kennesaw, GA, USA) was performed. Pathological examination of the explanted SAPIEN 3 valve demonstrated severely degenerated bioprosthetic pericardial leaflets with severe intrinsic and extrinsic nodular calcifications, which could limit the leaflet motion.

Discussion

There is a lack of reports on the long-term procedural outcomes of TAVI in haemodialysis patients. The development of SVD in patients undergoing dialysis is multifactorial and has yet to be fully elucidated. In the presented case, the removed TAVI valve had severe extrinsic calcified nodules alongside a fibrin thrombus. Considering these pathological findings, antithrombotic therapy to prevent fibrin thrombus from adhering to the TAVI valve may be important to avoid early SVD.
Cost-effectiveness analysis of a cardio-oncology rehabilitation framework compared to an exercise intervention for cancer survivors with high cardiovascular risk
Authors: Viamonte Sofia G , Tavares Aida , Alves Alberto J , Joaquim Ana , Vilela Eduardo , Capela Andreia , Costa Ana João , Duarte Barbara , Rato Nuno Dias , Afreixo Vera , Fontes Carvalho Ricardo , Santos Mário , Ribeiro Fernando
Published: May 2024

Aims

A cardio-oncology rehabilitation model among cancer survivors showed superior results compared with those of a community-based exercise intervention. However, questions remain about its cost-effectiveness. This study aims to assess the cost-effectiveness of a centre-based cardiac rehabilitation (CBCR) programme when compared to usual care encompassing a community-based exercise training (CBET), among cancer survivors with high cardiovascular risk.

Methods and results

The CORE study was a single-centre, prospective, randomized controlled trial; 80 adult cancer survivors with previous exposure to cardiotoxic cancer treatment and/or with previous cardiovascular disease were assigned (1:1 ratio) to an 8-week CBCR or CBET, twice/week. Cost-effectiveness was a pre-specified secondary endpoint. Outcomes included healthcare resource use and costs, quality-adjusted life-years (QALYs), and cost-effectiveness; the incremental cost-effectiveness ratio (ICER) was computed from a societal perspective. A total of 75 patients completed the study (CBCR n = 38; CBET n = 37). The CBCR group had a significantly higher cost per patient (477.76 ± 39.08€) compared to the CBET group (339.32 ± 53.88€), with a significant between-group difference of 138.44€ [95% confidence interval (CI), 116.82–160.05€, P < 0.01]. A between-group difference of 0.100 points in QALYs was observed, favouring CBCR (95% CI, −0.163 to −0.037, P = 0.002). When CBCR was compared with CBET, the ICER was €1383.24 per QALY gained; at a willingness-to-pay threshold of €5000 per QALY, the probability of CBCR being cost-effective was 99.9% (95% CI, 99.4–100.0).

Conclusion

The CORE trial shows that CBCR is a cost-effective intervention in the management of cancer survivors with high cardiovascular risk, reinforcing the potential benefits of this multidisciplinary approach in supportive care of this specific subset of cancer patients.

Registration

ClinicalTrials.gov: NCT05132998
Atrial fibrillation is perpetuated by human heart secretome in ex-vivo langendorff-perfused hearts
Authors: Boegner M , Bock M , Huettemeister J , Jeising T , Schallopp L , Eggert-Doktor D , Falk V , Hindricks G , Gerds-Li J H , Hohendanner F
Published: May 2024

Introduction

Atrial fibrillation (AF) confers high morbidity and mortality, yet parts of the underlying pathophysiology remain elusive. Left atrial (LA) pressure is altered by the presence of AF and vice-versa. The cardiac secretome might be influenced by LA pressure and potentially alters the susceptibility of the atria to AF. We investigated the effect of the human cardiac secretome on atrial electrophysiology in a translational ex-vivo setting.

Methods

We obtained venous (coronary sinus) serum samples during AF and in sinus rhythm (SR) in patients hospitalized for pulmonary vein isolation (PVI). Moreover, LA tissue was collected from patients undergoing cardiac surgery and coronary sinus serum samples were collected before (CTRL) and after intraoperative volume challenge (VC). Single cardiomyocytes were isolated from human LA tissue and Ca2+ dependent excitation-contraction coupling (ECC) was studied using confocal line-scan imaging with CTRL or VC. Moreover, a modified Langendorff-Setup with the ability to monitor and control intra-cardiac pressure was utilized to perfuse mouse hearts with AF and SR serum. A multielectrode array (MEA) was placed on the epicardial aspect of the left atrium to measure electrical signals in a spatiotemporal fashion. External bipolar burst pacing protocols were applied to test AF inducibility.

Results

Ca2+ dependent ECC (i.e. Ca2+ amplitude and release) in human cardiomyocytes was unaltered with exposure to VC serum. Upon introducing a modified version of the Langendorff setup with the ability of linear pressure adjustment, a burst pacing protocol to test for AF inducibility was successfully implemented in mice atria. Atria perfused with human AF serum showed significantly increased AF inducibility as compared to SR serum. Moreover, both, total AF duration as well as number of AF episodes (i.e. AF burden) were increased in AF vs. SR serum upon several different pacing protocols.

Conclusion

Cardiac secretome during increased LA pressure had no significant effect on Ca2+ dependent ECC in human cardiomyocytes. However, secretome during AF conferred pro-arrhythmogenic properties as compared to SR, further strengthening the concept of "AF begets AF". Ongoing experiments test the hypothesis of potential differences in the multi-level omics profile of AF serum as the underlying mechanism.
The circadian pattern of atrial fibrillation onset
Authors: Van Den Broek M , Gottlieb L A , Vermeer J R , Overeem S , Dekker L R C
Published: May 2024

Background/Introduction

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia affecting 2% of the population. Within the broad spectrum of AF symptomatology, there is a particular subset of patients that show a predominant or even exclusive nocturnal onset of paroxysmal AF.

Purpose

The aim of this study is to assess the timing of onset of AF in the 24-hour cycle and to assess whether a circadian rhythm is present in the onset of AF.

Methods

The MEDLINE, EMBASE, and CENTRAL databases, searched from inception to September 2023, provided 18 studies detailing the onset of AF in a 24-hour cycle. Patients had either paroxysmal or persistent AF. Studies performed in ICU populations (n=3) were omitted due to different triggers for AF. Time of AF onset was determined either by Cardiac Implantable Electronic Device (CIED) (n=5), Holter (n=7) or minute history taking (n=3).

The presence and statistical significance of a 24-hour periodicity is tested using the cosinor analysis: Y(t)= A ⋅ sin(2πft + α) + β where the amplitude, frequency, phase and error (A, f, α and β, respectively) are computed by single harmonic regression using a nonlinear least-squares method. Goodness of fit is estimated using R2, the statistical significance of the model is tested using a zero-amplitude test.

Results

The 15 studies included 2.080 patients with 11.886 onsets of AF. The blue bars in Figure 1 represent the total of AF onsets from all studies per hour. The pattern of onset AF can be approximated well by a single sine function (Onset(t)= 95.7915 ⋅ sin((2π ⋅ 0.0417 ⋅ t) – 1.8386) + 510.5500, R2 0.77, P = 0.03) with a 24-hour period, clearly establishing the 24-hour rhythmicity in the onset of AF (Figure 1, red line). Hours with significantly more onset of AF compared to the mean, assessed by residual Chi2 testing, are exclusively nocturnal (22.00-7.00, indicated by a moon symbol in Figure 1) while hours with significantly less onset are exclusively during daytime (7.00-22.00, indicated by a sun symbol in Figure 1).

Conclusion

Despite the potential limitations due to the methods used, such as arrhythmia discrimination in CIED-studies and asymptomatic episodes in case of history taking, the overall picture of predominance of nocturnal AF onset is clearly established. Multiple pathophysiological mechanisms might underlie this circadian pattern and nocturnal predominance, like obstructive sleep apnea and increased vagal tone, which should be subject of further research.time of onset of AF over a 24h period
Dietary sodium intake and atrial myopathy
Authors: Johnson L S , Lundeberg J E , Mcintyre W F , Conen D , Healey J S , Platonov P , Arnlov J , Engstrom G
Published: May 2024

Background

Diagnostic markers associated with atrial cardiomyopathy, a precursor state to atrial fibrillation (AF), include premature atrial complex (PACs) frequency, left atrial volume index (LAVi) and p-wave indices. Life-style factors associated with atrial myopathy markers are insufficiently studied. Sodium intake is a modifiable risk factor for hypertension, cardiovascular disease and AF.

Purpose

We aimed to study the association between sodium intake and atrial myopathy markers in the population-based multicenter Swedish CArdioPulmonary bioImage Study.

Methods

We included 5,309 randomly invited 50–65-year-olds at the Malmö (n=1,125,) and Uppsala sites (n=4,184) without AF who had contributed a 24hECG and a fasting morning urine sample, from which daily sodium intake was estimated using the Kawasaki formula. At the Malmö site resting ECGs from which P-wave indices could be measured were available in 1,066 individuals, and LAVi was available in a random subsample (n=357). The association between sodium intake and atrial myopathy markers was modeled adjusted for age, sex, body mass index, smoking, systolic blood pressure, antihypertensive treatment, coronary artery disease, and heart failure using negative binomial regression for PAC frequency, linear regression for P-wave duration and LAVi and logistic regression for P-wave terminal force in V1, all using sodium intake as a continuous variable and strata at <2, 2.0-2.99g, 3.0-3.99g, 4.0-4.99g and ≥5 g/day, with 3.0-3.99 as the reference category. We also modeled the association between sodium intake and PACs using restricted cubic splines.

Results

The mean age was 58.1 (±4.1) years, and 52.7% were female. The mean estimated sodium intake was 3.3 (±1.4) g/day. Mean 24h PAC count was 27, 4.7% had ≥500 PACs. High sodium intakes were associated with increased PAC frequency, of 14% (95% confidence interval (CI 1-29% p=0.03)) for 4.0-4.99g/day and 25% (95%CI 8-45%, p=0.002) for intakes ≥5.0g/day, compared to sodium intakes of 3.0-3.99 g/day. There was no significant association between low sodium intakes (<3.0 g/day) and PACs, Figure 1. Sodium intakes of 4.0-4.99 g/day were associated with increased P-wave duration, ß-coefficient 2.4 (95%CI 0.3-4.1, p=0.03), compared to 3.0-3.99g/day, but there was no association between sodium intakes and LAVi, or P-wave terminal force in V1, either as a continuous variable or in strata.

Conclusion

High dietary sodium intake is associated with PAC frequency, a known prediction of AF and stroke. Whether reduced sodium diets could reduce PAC frequency, and whether that would impact AF and stroke risk needs further study.Sodium intake and PAC frequency
Quality of life when switching from a vitamin K antagonist to non-vitamin K antagonist oral anticoagulation in frail older patients with atrial fibrillation
Authors: Van Doorn S , Joosten L P T , Kohlen B T G , Nierman M C , Koek H L , Hemels M E W , Huisman M V , Kruip M , Faber L M , Wiersma N M , Buding W F , Adriaansen H J , Rutten F H , Geersing G J
Published: May 2024

Background

Many older patients with atrial fibrillation (AF) are frail, putting them at high risk of adverse outcomes including mortality, hospitalization, functional decline, and dependency on others. In this special population, management strategies – such as anticoagulation for stroke prevention – need special consideration. To what extent the type of anticoagulation influences the quality of life (QoL) in frail patients with AF is unclear.

Purpose

To assess QoL in frail older patients with AF switching from a vitamin K antagonist (VKA) to a non-VKA oral anticoagulant (NOAC), as compared to patients continuing a VKA.

Methods

We used data from the FRAIL-AF trial that randomized frail older AF patients between continuing VKA treatment or switching to any NOAC. At baseline, after six months and twelve months of follow-up, QoL was assessed using the EQ-5D-5L questionnaire. For every timepoint, the mean EQ-5D-5L score was calculated with corresponding 95% confidence intervals (CI), missing data were imputed using ten-fold multiple imputation. Absolute differences in EQ-5D-5L score were calculated between patients switching to a NOAC and patients continuing with a VKA, with corresponding 95% CI. The distribution of the scores on each domain of the EQ-5D-5L was compared using a chi-square test.

Results

In total 661 patients continued VKA treatment, and 663 switched to a NOAC. The median age was 82.2 years (interquartile range (IQR) 78.7 – 86.5), 61.3% were male. Major bleeding or clinically relevant non-major bleeding occurred in 101 patients (17.8 per 100 person-years) switching to NOAC therapy, and 62 patients (10.5 events per 100 person-years) continuing with a VKA (hazard ratio 1.69, 95% confidence interval 1.23 – 2.32). Mortality occurred in 44 and 46 patients, respectively. In 25 patients data was missing. Table 1 shows the mean EQ-5D-5L scores at baseline, at 6 months follow-up and at 12 months follow-up. Scores were similar between patients switching to NOAC treatment or continuing with a VKA and did not change significantly during 12 months follow-up. Table 2 shows the distribution of the scores on all domains of the EQ-5D-5L, with no significant differences between groups.

Conclusion

Switching from a VKA to a NOAC in frail older patients with AF was associated with an increased risk of bleeding, yet without any effect on overall and different domains of QoL.
Predicting atrial fibrillation ablation success: a novel approach using pre-procedure sinus rhythm ecg and deep learning
Authors: Mohsen Y , Vatsaraj I , Loeffler S , Horlitz M , Stoeckigt F , Trayanova N
Published: May 2024

Introduction

Pulmonary vein isolation (PVI) has been the corner stone of the treatment of patients with atrial fibrillation (AF), yet its efficacy varies notably between patient groups. Specifically, it shows reduced efficacy in individuals with persistent AF and those with atrial fibrosis.

Recent advancements suggest that additional substrate modification could enhance outcomes in specific patient groups. Therefore, predicting the outcomes of lone PVI could help in stratifying patients who would benefit most from this additional substrate modification. Addressing this gap, our study explores the prognostication of PVI outcomes using pre-procedural 12-lead ECG recordings taken in Sinus rhythm, employing advanced deep learning techniques.

Methods

This retrospective study analyzed 209 patients with paroxysmal and persistent AF who underwent PVI. These patients were followed up for 12 months after the blanking period. Pre-procedural sinus rhythm 12-lead ECGs were processed using an innovative deep learning architecture, integrating Long Short-Term Memory and Convolutional Neural Networks with a cross-attention module. This multimodal deep learning model was trained using ECG and clinical covariates like age, sex, and BMI to predict binary outcomes – AF type (Paroxysmal or Persistent) and AF recurrence. The model's efficacy was evaluated through a 5-fold stratified cross-validation to ensure accuracy and reliability. Model was also tested using only ECG data.

Results

The multimodal deep learning model performed significantly better as compared to the model trained using ECG data only. The multimodal deep learning model achieved an accuracy of 75.56% and a sensitivity of 82% in prognosticating ablation outcomes. Additionally, the model demonstrated a significant capability in classifying AF into paroxysmal or persistent types with an accuracy of 86.67% and a recall of 89%.

Conclusion

Our deep learning approach in analyzing sinus rhythm ECG recordings shows promising results in predicting PVI outcomes and identifying AF types. This approach could offer a more accessible and cost-effective tool to stratify AF patients undergoing PVI, identifying those less likely to benefit from standard procedures. Such insights can assist physicians and patients in determining ablation candidacy and selecting the most appropriate ablation strategy and technique.Proposed StrategyDeep learning model approach
Secondhand tobacco smoke and risk of atrial fibrillation: an observational epidemiologic and gene-environment interaction analysis
Authors: Lee K , Rhee T M , Choi J M , Ahn H J , Kwon S , Lee S R , Choi E K , Oh S
Published: May 2024

Background

Second-hand tobacco smoke (SHS) is related to coronary artery disease and increases susceptibility to arrhythmia inducibility including atrial fibrillation (AF). However, epidemiologic evidence on the relationship between SHS and the risk of incident AF remains controversial.

Purpose

To evaluate the effect of SHS exposure on the long-term risk of AF and assess whether gene-environment interaction (synergism) exists by utilising the population-based data from the UK biobank.

Methods

We performed a nationwide population-based cohort study using the UK Biobank database. Participants with previous AF or current smokers were excluded. Participants were categorised into SHS-exposure and non-exposure groups. The risk of incident AF was assessed using the multivariable Cox proportional hazards model. We also evaluated the synergistic effect of SHS exposure and the polygenic risk score (PRS) of AF.

Results

Out of 400,493 participants, AF occurred in 23,471 (5.9%) during a median follow-up of 12.5 years. The SHS-exposure group (mean exposure 2.2 ± 5.2 hours/week) had a higher proportion of male participants with a younger age. The risk of incident AF was significantly increased in the SHS-exposure group (multivariable-adjusted hazard ratio [aHR] 1.06, 95% confidence interval 1.03-1.10, P <0.001) compared to the non-exposure group, suggesting a dose-dependent manner (aHR of severe SHS-exposure group, 1.11 [1.03-1.20], P = 0.005). The risk of AF increases regardless of the exposure location (home, outside, or workplace). When SHS-exposure was combined with the high genetic risk of AF, significant additive interaction was observed on the risk AF (Synergy Index of SHS-exposure with 3rdtertile of AF PRS, 1.13 [1.02-1.25], P = 0.024).

Conclusion

Exposure to SHS is a significant predictor for an increased risk of AF, with a synergistic effect when combined with genetic predisposition. Minimising SHS exposure, especially in individuals with a heightened genetic susceptibility to AF, may hold potential benefits for reducing the future risk of AF.
Stroke risk assessment in different atrial fibrillation subtypes: CHA2DS2-VASc score and beyond
Authors: Cheng C C , Huang P S , Chen J J , Chang S N , Chiu F C , Wu C K , Hwang J J , Wang Y C , Tsai C T
Published: May 2024

Background

Patients with atrial fibrillation (AF) have been known to have an inhomogeneous risk of stroke, with several well-documented risk factors including hypertension, history of stroke, and diabetes mellitus that have been incorporated into the CHA2DS2–VASc score to stratify risk levels. Accumulating evidence has suggested that AF subtype, namely persistent AF and paroxysmal AF, also have an impact on stroke development.

Purpose

This study focused on the impact of AF subtype on stroke risk in a large, long-term follow-up cohort as to provide insight of the impact on ischemic stroke risks. Such findings may play a role in future ischemic stroke risk stratification in selected patients.

Methods

A total of 7346 AF patients were followed up for 10 years from January 2010 to December 2020 (mean follow-up time 2.74 years). Among these patients, 2460 (33.5%) had persistent or permanent AF (PerAF) and 4886 (66.5%) had paroxysmal AF (PAF). The study evaluated the risk of ischemic stroke between the two groups using Cox models adjusting for all components of the CHA2DS2–VASc score. Analyses were further stratified into the usage of oral anticoagulation (OAC) or no OAC.

Results

Comparing AF patients based on subtype, it was found that PerAF patients were older, had a higher prevalence of previous stroke, congestive heart failure, PAD, DM, and were more often prescribed anticoagulants. Univariate analysis found patients with PerAF at a higher risk for ischemic stroke (HR 1.262, p<0.001). The results remained significant after multivariate analysis with factors of the CHA2DS2–VASc score (HR 1.234, p<0.001). After stratifying patients according to anticoagulation prescription, PerAF and PAF patients were found to have similar rates of developing ischemic stroke in patients under DOAC.

Conclusions

Patients with PerAF have a higher risk of stroke during follow-up independent of components of the CHA2DS2VASc score. In patients with OAC use, there was no difference in stroke risk between AF subtypes.Stroke Risk in OAC-naive patientsStroke Risk in OAC-experienced patients
Assessment of mild cognitive dysfunction in patients with atrial fibrillation utilizing the R4Alz assessment test
Authors: Toumpourleka M , Meletidou M , Tachmatzidis D , Triantafyllou K , Antoniadis A P , Bakogiannis C , Giannopoulos G , Vassilikos V
Published: May 2024

Background/Introduction

The association between atrial fibrillation and cognitive dysfunction has accumulated a growing body of evidence in recent years. However, establishing such a diagnosis remains challenging, especially in mild oligosymptomatic patients. REMEDES for Alzheimer (R4Alz) is a novel test, designed to assess cognitive control decline at an early stage.

Purpose

We sought to evaluate the prevalence of early, mild cognitive dysfunction in patients with paroxysmal atrial fibrillation with the use of established and novel diagnostic tools.

Methods

This is a prospective cross-sectional study that enrolled consecutive patients with history of paroxysmal atrial fibrillation and matched healthy controls, from a tertiary cardiology department. Patients with history of stroke or known cognitive dysfunction of any type were excluded from the study. Demographic and clinical data were collected. All study participants were subjected to Montreal Cognitive Assessment (MoCA) and to R4Alz within the same day. Cognitive function and attention ability is assessed at three stages with R4Alz: working memory updating (R1), supervisory attention system (R2) and task/rule switching and control of inhibition (R3). The primary endpoint was the difference in cognitive function between patients with atrial fibrillation and controls. Secondary endpoints included the correlation between the two assessment tests in both groups. Statistical analysis was performed with R version 4.1.0 and a p-value<0.05 was considered statistically significant.

Results

Fifty-five patients with atrial fibrillation and thirty-four controls were enrolled in the study (Mean age: 62.6 y, Female gender: 62.9%). MoCA scores (25.4 ± 4.11 for patients with atrial fibrillation vs 22.3 ± 3.72 for healthy controls, p-value <0.001) (Figure 1) as well as scores of all stages of R4ALz {working memory (R1a, R1b, R1c), supervisory attention system (R2) and task/rule switching – inhibition control (R3a1, R3a2, R3b)} were indicative of mild cognitive dysfunction in patients with atrial fibrillation. The control group exhibited significantly better cognitive performance on all assessment tools (Table 1).Figure 1Table 1
A novel approach to invisible vein of Marshall: extending the utility of ethanol infusion into the vein of Marshall
Authors: Ishimura M , Yamamoto M , Kobayashi Y
Published: May 2024

Background

The utility of ethanol infusion into the vein of Marshall (EIVOM) is limited in patients without a visible vein of Marshall (VOM).

Methods

Our study included of 232 patients with atrial fibrillation undergoing MI ablation. We initially performed coronary sinus venography using a balloon catheter in all patients to assess VOM characteristics. EIVOM was attempt in those with adequately visible VOMs. In cases where the VOM was not visible, we utilized a guide-wire to locate its entrance, using the intravenous valve as a landmark.

Results

Venography initially identified the VOM in 140 of 232 patients (60%) (visible VOM group). Within this group, 68 patients (29%) did not require balloon inflation for VOM visualization, while 72 patients (31%), visibility was achieved through balloon inflation. In the remaining 92 patients (39%), the VOM remained invisible even after balloon inflation. Nevertheless, in 13 of these cases, the VOM was successfully located using a landmark technique (invisible VOM group). EIVOM was fully achieved in 96% (147 of 153 patients). Additionally, full MI line blocks were achieved in 91% of (A) the visible VOM group (122 of 134 patients), 92% of (B) the invisible VOM group (12 of 13 patients), and 81% in (C) the EIVOM (-) group (69 of 85 patients) (A vs. B, p = 0.88; A vs. C, p < 0.05; B vs. C, p = 0.32).

Conclusion

A novel approach to locating invisible VOM extends the clinical utility of EIVOM and potentially improves success rate of MI ablation.Guide-wire insertion into invisible VOM
Does a higher body mass index influence additional presence of low voltage areas in the left atrium in patients with persistent atrial fibrillation?
Authors: Haxhikadrija P , Kirsch K , Surber R , Schulze P C , Grosse A
Published: May 2024

Introduction

Pulmonary vein isolation (PVI) is recommended during all atrial fibrillation (AF) catheter ablation procedures. In nearly half of patients with persistent AF, low voltage areas (LVAs), commonly defined as areas in left atrium (LA) with a bipolar electrogram amplitude of < 0.5 mV, could be documented during electrophysiological study (EP). The remaining presence of these areas in LA after a PVI-only catheter ablation procedure is identified as a risk factor for recurrence of AF. Targeting and ablating (substrate modification) these areas reduces recurrency of AF. Pre-procedural identification of patients with additional LVAs is thus very important, until date very challenging and not established. Many markers are evaluated but it remains elusive. Extensive adipose tissue in obese patients leads to LA enlargement and remodeling via different mechanisms, leading to higher incidence of AF. The link between obesity and presence of LVAs in LA other than of pulmonary veins (PV) is to our knowledge not yet evaluated.

Aim of the study

Is to evaluate role of body mass index (BMI) in the presence of low voltage areas in left atrium besides pulmonary vein by comparing the BMI in patients with persistent AF with and without LVAs in LA, thus eventually identifying BMI as a possible pre-procedural marker of the presence of these areas.

Methodology

We analyzed data from 91 consecutive patients with persistent AF undergoing first time LA catheter ablation from 09/2021 until 10/2023 inside of the Jen-PACE study. In all patients a high-density 3D endocardial voltage mapping was carried out using EnSite Precision™/ Ensite X™ and the Advisor™ HD-Grid Mapping Catheter.

Results

The mean BMI was 29.6 ± 4.8, mean LV-EF was 53,4% ± 9.7, 24 patients (27%) were females, average age was 67 years. Depending on the presence of low voltage areas, the patients underwent either PVI only when no such areas were documented (61 patients, 67%) or PVI and substrate modification (30 patients, 33%) with documentation of LVAs. There was no statistical difference in the BMI between the two groups (29.9 ± 4.9 in patients with PVI only vs 29.0 ± 4.8 in patients with PVI + substrate modification; p=0.37). Furthermore, in a subgroup analysis of only adipose patients with a BMI higher than 30 (44 patients; 48%; mean BMI 33.8 ± 3.0), there was no significant difference in BMI between the two groups (34.2 ± 3.3 in PVI only vs 33.2 ± 2.4 in patients with PVI and substrate modification; p=0.2)

Discussion and conclusion

Even though a high BMI is generally related to a higher incidence of AF, a higher BMI was not observed in patients having additional low-voltage areas in LA compared to patients in whom such areas could not be identified. Electric remodeling caused by obesity could be rather diffuse than localized in specific areas in LA. BMI is not a pre-procedural marker for the presence of additional low voltage areas in LA.
Prevalence of diabetes mellitus diminished the efficacy of additional ablation following pulmonary vein isolation: a sub-analysis of the EARNEST-PVI trial
Authors: Matsuda Y , Masuda M , Mano T , Tsujimura T , Uematsu H , Higashino N , Tanaka N , Watanabe T , Inoue K , Hikoso S , Sunaga A , Nakatani D , Sotomi Y , Sakata Y
Published: May 2024

Introduction

Diabetes mellitus (DM) is a well-known cause of atrial remodeling in patients with atrial fibrillation (AF). Although additional left atrial ablation following pulmonary vein isolation (PVI) is a strategy to modify AF substrate, its efficacy has not been well elucidated in patients with DM. We hypothesized that the efficacy of additional ablation was different in patients with DM and in those without.

Purpose

The purpose of this study was to investigate the efficacy of additional ablation following PVI in patients with or without DM.

Methods

The EARNEST-PVI was a multicenter, prospective, randomized controlled trial. In this sub-analysis, 493 consecutive patients of persistent AF (age, 65 ± 9 years; female, 120 [24%] patients) who underwent the initial radiofrequency catheter ablation were analyzed. Patients were randomized to be treated with PVI only (PVI-alone) or PVI plus linear and/or complex fractionated atrial electrogram ablation (PVI-plus). Primary outcome measure was defined as AF recurrence during the 12 months follow-up periods.

Results

In total, 84 (17%) patients had DM. Primary outcome occurred in 120 (24%) patients. In patients without DM, freedom from AF recurrence was significantly higher in PVI-plus group than in PVI-alone group (80.0% versus 71.1%, p=0.03) (Figure 1A). Conversely, in patients with DM, freedom from AF recurrence was similar between PVI-plus group and PVI-alone group (75.4% versus 72.9%, p=0.70) (Figure 1B).

Conclusion

Additional ablation following PVI reduced AF recurrence after radiofrequency catheter ablation only in patients without DM.Figure 1
Feasibility and safety of left atrial roof ablation with the third-generation visually guided laser balloon
Authors: Yamasaki T , Kakita K , Pak M , Hattori T
Published: May 2024

Background

The roof area ablation beyond pulmonary vein (PV) isolation (PVI) using a cryoballoon has been widely performed for patients with atrial fibrillation (AF). However, the feasibility of roof area ablation using a visually guided laser balloon (VGLB) remains to be elucidated.

Purpose

This study aims to investigate the feasibility and safety of additional roofline creation by VGLB ablation alone in patients with AF.

Methods

A total of 30 patients with AF (paroxysmal AF=15, persistent AF=15) who underwent VGLB ablation from March 2023 to August 2023 were analyzed retrospectively. VGLB ablation was performed using a third-generation VGLB. After initial circular ablation, VGLB was inflated to a larger size to extend and fuse the isolation area at the roof portion during the superior PVs occlusion. The complete conduction block of the left atrial (LA) roof was assessed by the differential pacing methods and the high-resolution mapping system at the end of the procedure.

Results

Acute success in complete roofline creation was achieved in 70% of patients. The PVI time was 21.6±5.5 minutes, and additional roof ablation time was 8.7±3.5 minutes, respectively. The anatomical LA roof length was significantly shorter in patients with successful roofline generation than without (30.4±7.2mm vs. 42.9±4.0mm, P<0.001). A cut-off value of 40.2mm for the LA roof length calculated by a receiver operating characteristic curve predicted a successful construction of the LA roofline with the highest sensitivity of 94.7%, specificity of 83.3%, and the area under the curve was 0.94 (95% confidence interval, 0.35-0.99). No complications occurred during laser energy titration at the roof area.

Conclusion

The roofline creation using a third-generation VGLB is possible with acceptable safety concerns. The length of the LA roof≤40.2mm was a predictor of the successful LA roofline generation.Fluoroscopic and endoscopic imageVoltage map after ablation
Impact of age on atrial arrhythmia recurrence following cryoballoon pulmonary-vein isolation
Authors: Boehmer A A , Rothe M , Wiedenmann L , Nussbaum E , Schneider K Y , Spork P , Keim C , Dobre B C , Kaess B M , Ehrlich J R
Published: May 2024

Background

Age is a major risk factor for development of atrial fibrillation (AF) and associated with increased recurrence rates in the setting of rhythm control. Current data tend to support catheter ablation in elderly patients, but it remains unclear whether there is an age limit for ablation and whether the potential benefits of catheter ablation justify the potentially increased complication rate in elderly.

Objective

To prospectively analyze the impact of age on efficacy and safety of cryoballoon ablation (CBA).

Methods

; We prospectively analyzed consecutive patients who underwent CBA in a single-center cohort between 2018 and 2023. Patients were stratified by age (<75yrs versus ≥75yrs) and AF type. Primary efficacy endpoint was recurrence of atrial arrhythmia after 90-day blanking period. Linear and spline regression were used to assess the association between age and primary efficacy endpoint. Safety endpoints were death, stroke or procedure-related complications.

Results

873 patients underwent CBA (525 paroxysmal, 348 persistent AF). Median follow-up was 18-months. At 1-year, primary efficacy endpoint occurred in 19.6% (71/363) of young (<75yrs) versus 27.8% (45/162) of elderly (≥75yrs) patients with paroxysmal AF (HR 0.62; 95%CI, 0.41-0.92; P=0.019; fig. 1A) and in 25.0% (57/228) of young versus 39.2% (47/120) of elderly patients with persistent AF (HR 0.57; 95%CI, 0.37-0.85; P=0.006; fig. 1B). A significant linear relationship between age and primary efficacy endpoint occurrence was found for both paroxysmal (P=0.01) and persistent AF (P=0.002; fig.2) while spline regression was non-significant (P=0.45/ P=0.12). No difference was observed regarding the incidence of safety endpoints between young and elderly patients (P=0.76).

Conclusion

Atrial arrhythmia recurrence rate after CBA increases linearly with age (thus not allowing determination of a clear "cut-off-age") and is highest in elderly patients (≥75 yrs) with persistent AF. Safety of CBA in elderly is comparable to patients of younger age.
Radiofrequency balloon ablation: 1-year outcomes of the AURORA registry
Authors: My I , Schmidt B , Rottner L , Lemoine M , Moser F , Ismaili D , Kirchhof P , Reissmann B , Ouyang F , Rillig A , Chun J , Metzner A , Bordignon S
Published: May 2024

Background and Objectives

A novel irrigated radiofrequency balloon (RFB) for pulmonary vein isolation (PVI) integrated into 3D mapping system was recently launched.

Methods

Patients ablated for paroxysmal atrial fibrillation (PAF) or persistent atrial fibrillation (persAF) at two German high-volume electrophysiology centers were included into the prospective AURORA registry. All patients underwent clinical follow-up (FU) at 90, 180 and 360 days following ablation including 24h Holter ECGs.

Results

A total of 101 patients were enrolled (50 from centre A, 51 from centre B) and 86 patients (48% male, 65 ± 11 years, 55% PAF, 59 ± 7% left ventricular ejection fraction (LVEF)) completed the follow-up. Mean ablation and procedure times were 26 ± 13 min and 71 ± 20 min, respectively. Dose area product was 1501 ± 1634 mGycm2. Acute PVI was achieved in 100%. Atrial fibrillation (AF) free survival after a mean FU of 361 (219-375) days was 78.4% for PAF and 75.4% for persAF. (p= 0.828). A multiple regression analysis did not reveal any clinical or procedural predictors of AF recurrence among sex, age, BMI, left atrial diameter, LVEF, ablation time, procedure time and single shot PVI. However, early recurrence of atrial tachyarrhythmia (ERAT) was an independent predictor for AF recurrence at 1-year (Hazard Ratio [HR]: 3.198; 95% confidence interval [95% CI]: 1.036 - 10.32, p value = 0.0433). Primary adverse events occurred in 3.5% of patients (1 postprocedural pharyngeal bleeding, 1 myocardial infarction, 1 non-cardiovascular death); no pericardial effusion, stroke or phrenic nerve paralysis were observed.

Conclusions

RFB-based PVI is clinically effective and safe. ERAT at the first follow-up visit is an independent predictor of late AF recurrence.