bluuebunny/crossref_metadata_2025 huggingface dataset:
Mapping computational thinking mindsets between educational levels with cognitive network science
Authors: Stella M , Kapuza A , Cramer C , Uzzo S
Published: May 2021

A significant aspect of computational thinking is as a way of reasoning about the world in terms of data. This mindset channels number-crunching toward an ambition to discover knowledge through logic, models and simulations. Here we show how computational cognitive science can be used to reconstruct and analyse the structure of computational thinking mindsets (forma mentis in Latin) through complex networks. As a case study, we investigate cognitive networks tied to key concepts of computational thinking provided by (i) 159 high school students enrolled in a science curriculum and (ii) 59 researchers in complex systems and simulations. Researchers’ reconstructed knowledge highlighted a positive mindset about scientific modelling, semantically framing data and simulations as ways of discovering nature. Students correctly identified different aspects of logic reasoning but perceived ‘computation’ as a distressing, anxiety-eliciting task, framed with math jargon and lacking links to real-world discovery. Students’ mindsets around ‘data’, ‘model’ and ‘simulations’ critically revealed no awareness of numerical modelling as a way for understanding the world. Our findings provide evidence of a crippled computational thinking mindset in students, who acquire mathematical skills that are not channelled toward real-world discovery through coding. This unlinked knowledge ends up being perceived as distressing number-crunching expertise with no relevant outcome. The virtuous mindset of researchers reported here indicates that computational thinking can be restored by training students specifically in coding, modelling and simulations in relation to discovering nature. Our approach opens innovative ways for quantifying computational thinking and enhancing its development through mindset reconstruction.
Malleability of food values amid the COVID-19 pandemic
Authors: Cerroni Simone , Nayga, Jr Rodolfo M , Pappalardo Gioacchino , Yang Wei
Published: May 2021

Food values are supposed to be stable. This paper tests this assumption by comparing food values before and during the coronavirus-19 pandemic. While the ranking of food values remains very similar, there are some interesting differences in the relative importance that consumers attached to food values before and during the pandemic. A substantial decrease in the importance that consumers attach to food safety was observed during the pandemic, while there was a moderate increase in the importance attached to taste, nutrition, appearance, convenience and origin. The changes in food values vary across sociodemographic groups. Implications of the results are discussed.
May Measurement Month 2019: an analysis of blood pressure screening results from Slovenia
Authors: Božič Ješe Nina , Knez Judita , Dolenc Primož , Beaney Thomas , Clarke Jonathan , Poulter Neil R , Brguljan Hitij Jana
Published: May 2021

Accounting for an estimated 10.4 million deaths each year, arterial hypertension is a worldwide epidemic. However, it is a treatable condition that can be readily recognized with cost-effective blood pressure (BP) measurements. Alongside continuous improvements in BP control and treatment, worldwide strategies aim to achieve a high level of hypertension awareness. May Measurement Month (MMM) is a global campaign initiated by the International Society of Hypertension to raise awareness of high BP. Slovenia began with yearly cost-free BP measurements and awareness campaigns in 2005 when World Hypertension Day was announced by the World Hypertension League and in 2017, we joined the MMM initiative. In May 2019, we performed a cross-sectional survey following the standardized MMM protocol. Healthcare personnel obtained BP measurements in a sample of adult subjects (≥18 years) across all regions of the country, mostly in healthcare facilities and pharmacies. In total, 4974 individuals (61.1% female), with a mean age of 59.6 years, were screened. After multiple imputation for missing data, 3037 (61.1%) participants had hypertension. Of individuals not receiving antihypertensive medication, 973 (33.4%) were hypertensive. Of those who reported receiving antihypertensives, 1110 (53.8%) had uncontrolled BP. MMM19 was the largest BP screening campaign undertaken in Slovenia so far. We again identified a substantial number of participants with possible hypertension and uncontrolled BP despite taking antihypertensive medication, which were then referred to their general practitioners or dedicated hypertension centres for further evaluation and management. Taken together, our findings underline the importance of opportunistic screening programmes.
May Measurement Month 2019: an analysis of blood pressure screening results from Tunisia
Authors: Haj Amor Sina , Beaney Thomas , Saidi Olfa , Clarke Jonathan , Poulter Neil R , Ben Alaya Nissaf , Ben Romdhane Habiba ,   MMM Tunisian Working Group, Hamdi Yahia Nada , Hammoud Hedi ben , houssem Houda , Telmoudi Wafa , Bouraoui Faouzia Ben , Azzoun Nadia Ben , Mansour Ali , Tabbal Amor , Bouaoun Taher , Arfa Hajer , Jallouli Amel , Dhaher Adel , Borni Moncef , Mhamdi Mouna , Balali Ikram , Louti Salma , Mchirgui Hassen , Aloui Nawel el , Mili Maroua , Mekki
Published: May 2021

We performed a May Measurement Month (MMM) screening campaign among adult volunteers aged 18 years old and over in Tunisia. The objective was to raise awareness, and to estimate the prevalence, awareness, treatment, and control of hypertension, one of the main cardiovascular risk factors. Following the MMM protocol, three blood pressure (BP) measurements were taken by physicians and standard interviewing procedures were used to record medical history, socio-demographic, and cardiovascular disease risk factors. Hypertension was defined as a systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or treatment with antihypertensive medication. From 11 271 adults screened, the prevalence of hypertension was 38.1%. Among those with hypertension, 72.5% were aware of their diagnosis, and 67.5% were treated. BP control was achieved in only 38.2% of all those with hypertension. The study highlights the magnitude of hypertension in Tunisia. There is an urgent need for implementing a comprehensive integrated population-based intervention programme to ameliorate the growing problem of hypertension.
May Measurement Month 2019: an analysis of blood pressure screening results from Lebanon
Authors: Najem Robert N , Halawi Ahmad , Tanios Bassem , Ambriss Rasha , Bikai Rana El , Partington Giles , Beaney Thomas , Poulter Neil R , Alfa Ali K Abu
Published: May 2021

Hypertension is an important public health concern of high prevalence among adults. It is associated with an increased mortality rate. The prevalence of hypertension in Lebanon has increased during the last decades, affecting around one-third of the Lebanese population. Since diagnosis and treatment of hypertension is associated with a better prognosis, annual screening and raising awareness about this ‘silent killer’ disease is of extreme value. We conducted a cross-sectional survey in various Lebanese cities in 2019. We recruited adults (≥18 years old) from different sites, through an opportunistic sampling method. For each participant, three blood pressure (BP) readings were recorded and the average of the last two was analysed. In addition, data on lifestyle factors and comorbidities were collected. Participants were considered hypertensive if they had at least one of the following: systolic or diastolic BP ≥140 and/or ≥90 mmHg, respectively, or taking antihypertensive medication. Blood pressure was measured in 7019 participants. The mean age was 46.0 (SD 16.6) years. In total, 2572 participants (36.6%) had hypertension among whom only 64.1% were aware of their disease and 62.3% were on treatment. Blood pressure was controlled in 62.6% of participants taking antihypertensive medications. This study is the largest on hypertension prevalence in Lebanon. The results demonstrated that around one-third of the hypertensive population were not aware of their disease, and that a high percentage was not being treated. These results suggest the need for rapid interventions aimed at raising awareness regarding hypertension in the Lebanese population.
May Measurement Month 2019: an analysis of blood pressure screening results from Zambia
Authors: Goma Fastone , Syatalimi Charity , Tembo Penias , Mukupa Musawa , Chikopela Theresa , Kaluba Longa , Henry Malory , Partington Giles , Beaney Thomas , Poulter Neil R
Published: May 2021

In Zambia, hypertension accounts for the highest proportion of deaths due to cardiovascular diseases causing 3.3% of all deaths, killing an average of 670 people per year. May Measurement Month (MMM) is an annual global screening campaign aiming to improve awareness of blood pressure (BP) at the individual and population level. Adults (≥18 years) recruited through opportunistic sampling were screened at multiple sites within Lusaka during May and June 2019. Ideally, three BP readings were measured for each participant, and data on lifestyle factors and comorbidities were collected. Data were analysed centrally by the MMM project team and multiple imputations were performed where necessary. Of the total of 9232 enrolled, 8.7% of them had never had their BP measured, 2.5% had diabetes mellitus, 1.9% had had a myocardial infarction, 1.5% had had a stroke, 10.6% were current smokers, and 10.0% consumed alcohol once or more per week. Blood pressure fell from a mean of 128.6/82.9 mmHg for the 1st reading to a mean of 123.2/80.0 mmHg for the 3rd reading. The lowest proportion of participants with hypertension was identified by the 3rd reading alone (30.0%). Of all the participants, 30.7% had hypertension, though only 42.6% of them were aware of their diagnosis. Seven hundred and eighty-three (27.6%) were on antihypertensive medication though only 35.0% of them had controlled BP (systolic BP <140 mmHg and diastolic BP <90 mmHg). Compared with MMM17 data, there is deterioration of the monitored parameters calling for urgent and accelerated public health policy and clinical practice interventions. We think that the MMM campaign should continue annually to raise awareness of this treatable condition.
May Measurement Month 2019: an analysis of blood pressure screening results from Ulaanbaatar, Mongolia
Authors: Myanganbayar Maral , Boldbaatar Khatantuul , Tuvdendarjaa Khulan , Beaney Thomas , Partington Giles , Baatarsuren Uurtsaikh , Bayarsaikhan Nomin-Erdene , Davaadamdin Orkhonselenge , Bungert Andreas , Campbell Norm R C , Poulter Neil R , Dashdorj Naranjargal
Published: May 2021

Mortality from haemorrhagic stroke and ischaemic heart disease per 10 000 people in Mongolia ranks among the highest in the world. The main risk factor being hypertension. We aimed to screen hypertension for the working people in their workplace who rarely visit primary clinics. Two hundred health care volunteers were trained for blood pressure (BP) measuring technique and providing healthy lifestyle advice. Screening was performed at 80 sites, the majority were workplaces, over a period of 60 days when the May Measurement Month (MMM) campaign launched in May 2019. Hypertension was defined by the standard MMM guidance, as systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg (based on the mean of the second and third measurement), or taking anti-hypertensive medication. Blood pressure measuring digital devices (Omron-M3, Microlife A6 PC) were all clinically verified and approved for clinical use. A total of 6522 individuals (majority 67.8% male and mean age 37.0 ± 10.4) were screened. The proportion of hypertensive adults was 32.5%, of whom, 62.2% were aware of their hypertension, and 50.1% were on medication. The control rate for those on treatment was 27.1%. Non-communicable disease risk factors were 51.2% (3342) overweight/obese (19.5% obese), 38.7% (2523) smoking, 64.4% (4200) alcohol consumption, 4.5% (294) previously diagnosed with diabetes, and 1.3% and 1.1% with a heart attack or stroke, respectively. We conclude that hypertension management needs to be prioritized and increased awareness is required in the population.
May Measurement Month 2019: an analysis of blood pressure screening results from Cape Verde
Authors: Azevedo Vanda , Dias Luis , Garcia Glenda , Soares Irenita , Silva Marlinda , Delgado Isaulina , Lima Florentina , Sanches Nilson , Beaney Thomas , Partington Giles , Poulter Neil R
Published: May 2021

The Cabo Verdean population is aging and, consequently, non-communicable diseases, namely cardiovascular diseases, are increasing, with hypertension being an important risk factor. Following Cabo Verde's engagement with the May Measurement Month (MMM) campaign, in 2019, it was possible to improve the screening capacity, at the same time that a major social mobilization campaign was carried out to improve the population's knowledge about raised blood pressure (BP) and its consequences. With activities on nine islands, telemedicine was used to train researchers and volunteers. The MMM app was used to collect participant data. Individuals aged ≥18 years were recruited through opportunistic sampling. Each participant completed a questionnaire on demographic, lifestyle and environmental factors and had three BP measurements and weight and height measurements. Hypertension was defined as a systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg (mean of the second and third readings), or when using antihypertensive medication. When respondents did not provide three BP readings, multiple imputation using chained equations was used to calculate the mean of the second and third readings. A total of 17 627 individuals [mean age of 42.7 (SD 16.2); 63.8% women] were screened. After multiple imputation, 5990 (34.0%) had hypertension, of which 68.4% knew the diagnosis previously and 51.3% used antihypertensive drugs. The reported use of antihypertensive medication and a previous diagnosis of hypertension were strong predictors of higher levels of systolic and diastolic BP. Corrective actions were taken with an updated national protocol for hypertension treatment in primary health care. The II Non-Communicable Diseases Survey corroborated MMM national data that we see as an ideal initiative to reach the public, raising awareness about this important cardiovascular risk factor and providing political decision instruments.
May Measurement Month 2019: an analysis of blood pressure screening results from Spain
Authors: Molinero Ana , Calvo Eva , Beaney Thomas , Day Emily , Prats-Mas Rosa , Fornos José A , Mera-Gallego Inés , Tous Salvador , de Andrés Nicanor F , Rodilla Enrique , Gijón Teresa , Pérez-Manchon David , Poulter Neil R , Ruiz-Hurtado Gema , Ruilope Luis Miguel
Published: May 2021

The aim of the May Measurement Month (MMM) is devoted to better understanding the awareness, treatment, and control rates of hypertension in Spain. Presented here are the data corresponding to 2019 campaign. In 2019, a total of 4433 patients (61.5% males) with a mean age of 54.8 years were included. Of all, 96.0% were Caucasian, and 3294 were recruited in pharmacies. The mean values of systolic blood pressure (BP) were 125.6 and of diastolic 76.7 mmHg in the whole population. The most recent previous BP measurement took place more than 1 year before in 27.6% of participants. A total of 1883 were hypertensive (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg or taking antihypertensive medication), of whom 77.2%/were aware and 71.1% were on medication. Of all, 64.9% of those on medication and 46.1% of all hypertensive participants had a BP controlled to <140/90 mmHg. These data from MMM 2019 continue to indicate the need for an improvement in the awareness, treatment, and control of hypertension in Spain.
May Measurement Month 2019: an analysis of blood pressure screening results in the Philippines
Authors: Diaz Alejandro Bimbo F , David-Ona Deborah Ignacia , Mercado-Asis Leilani B , Atilano Alberto A , Vilela Gilbert C , Bonzon Dolores D , Chua Carlos L , Balmores Benjamin A , Castillo Rafael R , Beaney Thomas , Clarke Jonathan M , Poulter Neil R ,   the Philippine MMM19 Investigators
Published: May 2021

The Philippine Society of Hypertension (PSH) took part again in the annual May Measurement Month 2019 (MMM19) blood pressure (BP) measurement campaign to raise awareness of hypertension especially in those who are not aware of their condition. The MMM19 standard protocol designed by the International Society of Hypertension was used during screening. These included the collection of basic data on demography, lifestyle, and environmental factors. Standardized sitting BP measurements were taken two to three times, using an automated BP apparatus and were inputted either in the MMM19 app or data were recorded in paper form and manually transferred to Excel spreadsheets by encoders supervised by the PSH. A total of 89 941 participated through opportunistic convenience sampling. After multiple imputation, a total of 47 925 (53.3%) participants had hypertension (≥140/90 mmHg or on antihypertensive medication). Of this number, 31 151 (65%) were aware that they had high BP and 30 120 (62.8%) were on antihypertensive medications. Of the 30 120 participants on antihypertensive medications, only 18 373 (61.1%) had controlled BP (<140/90 mmHg). Being overweight or obese were significant predictors of high BP. Other predictors of high systolic BP and diastolic BP were alcohol intake, smoking, and a previous history of hypertension in pregnancy, while pregnant participants had significantly lower BP. The MMM19 campaign succeeded in raising awareness of high BP in our country, and the opportunistic sampling enhanced a sense of people empowerment by their knowing how easy it is to detect high BP and thereby enabling the prevention of long-term health complications. The higher BP control in the MMM19 hypertensive individuals possibly attests to the success of the previous MMM17 and MMM18 campaigns.
A new electrocardiographic marker with higher sensitivity and specificity for epicardial location of posteroseptal accessory pathway
Authors: Badiul A , Iorgulescu C , Bogdan S , Radu A , Paja S , Ene E , Cojocaru C , Nastasa A , Vatasescu R
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

  Catheter ablation of accessory pathways (AP) located in the posterior pyramidal space are often challenging due to its anatomical complexity. Scarce of data are available about the ECG features that might indicate when an epicardial approach is required in the ablation of the posteroseptal AP.

Objective

The purpose of this retrospective study was to describe the electrocardiographic features of posteroseptal AP which have been successfully ablated with epicardial approach and identify electrocardiographic predictors for epicardial AP location.

Methods

The 12 leads ECG of 75 patients with posteroseptal accessory pathways who were successfully ablated were retrospectively analyzed. ECG features for epicardial location described already in published studies have been considered (negative delta wave in DII, positive delta wave in aVR, high amplitude S wave in V6). Additionally the characteristics of the initial 40 ms of the delta wave in lead V1 (measured from the earliest QRS deflection in 12 leads) during full pre-excitation have been investigated.

Results

Of 75 patients with posteroseptal AP that undergone catheter ablation, 40 (53.3%) had successful epicardial ablation. An initial isoelectric or biphasic delta wave in lead V1 proved the highest sensitivity (82.5 %) respectively positive predictive value (97 %) and  specificity (97 %) for an epicardial location of the AP. Deep S wave in V6 proved lower sensitivity (37.5%) and positive predictive value (68%) but higher specificity (80%) for epicardial location of AP. The specificity and sensitivity for epicardial location of AP of negative delta wave in DII were lower, however it failed to reach statistical significance. 

Conclusion

This study shows that an initially isoelectric or biphasic delta wave aspect in lead V1 has a higher specificity, sensitivity and positive predictive value than previously described ECG markers for epicardial location of posteroseptal accessory pathways.
Non-algorithmic approach to accessory pathway localization based on a mobile app
Authors: Jastrzebski M , Moskal P
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Polish Cardiac Society - Section of Non-invasive Electrocardiology and Telemonitoring (PTK SENIT)

Background.

Electrocardiographical localization of accessory pathways (AP) in WPW syndrome remains an elusive goal. Despite several, often very complex algorithms that were developed over the last three decades, none of them is very accurate  - as demonstrated by several independent validation studies. Moreover, algorithms are difficult to remember, which further limits their usefulness. The accessory pathway regions are arbitrary and transitions between them are smooth, not binary. The same applies to ECG features such as QRS polarity – they are not binary. Moreover, even the most careful ECG lead placement cannot compensate for the variability in heart position within the chest. Therefore, it is unrealistic to expect that any ECG feature or feature set will precisely identify a particular location in a 0 vs. 1 fashion.

Aim

We intend to create a mobile app / web based localizing application, that would support a novel method for AP localization: a colour density map generator  - based on actual distribution of a sizable number of accessory pathway with a particular QRS features.

Methods

A total of 881 consecutive AP ablation procedures were reviewed and patients with successful ablation of an overt accessory pathway were included.  ECG with baseline and full preexcitation obtained during incremental atrial pacing were obtained. AP localization was based on stored fluoroscopic images in several projections and procedure description. Each AP localization, as well as QRS polarity in all 12 leads, separately for full and baseline preexcitation patterns, were coded and introduced into the application database. An application web-based, optimized for mobile devices was developed. This application enabled to graphically show changing localization of AP with regard to the introduced, at each step, QRS polarity in a particular ECG lead. User can choose his/her own steps or criteria; there is no need to adhere to the proposed steps.

Results

A total of 604 patients/ ECGs were available for density map generation. With each additional lead QRS information introduced into the application the user can appreciate more and more precise localization of the AP.  This quickly enables to pinpoint the area of maximum probability, i.e. the most likely/frequent location, followed by the immediate adjacent locations. Representative screen shots of to typical inital steps for left- and right-sided APs are provided below (Figure 1 and Figure 2). Limited prospective assessment was very favourable.

Conclusions

A novel method, easy to use, not requiring to remember any algorithmic steps, and based on an analysis of by far the largest cohort of over accessory pathways (in comparison with published algorithms) was developed. Prospective validation of the localization application seems warranted. Abstract Figure.
Anatomical localization and classification of bundle branch blocks using novel CineECG
Authors: Boonstra MJ , Hilderink BN , Locati ET , Asselbergs FW , Loh P , Van Dam PM
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Dutch Heart Foundation

Background

Ventricular conduction disorders can induce arrhythmias and impair cardiac function. Bundle branch blocks are diagnosed by 12-lead ECG, but discrimination between complete bundle branch blocks, incomplete bundle branch blocks and normal tracings can be challenging. CineECG computes the mean temporo-spatial isochrone (mTSI) trajectory of activation waveforms in a 3D-heart model from 12-lead ECGs. This trajectory represents the mean trajectory of the ventricular electrical activation at any time interval directly related to ventricular anatomy. In Brugada patients, CineECG has localized the terminal components of ventricular depolarization to right ventricle outflow tract (RVOT). Also, for the localization of bundle branch blocks, the region of latest activation contains the most information. Using CineECG, subject specific anatomically related information about the location of bundle branch blocks is obtained.

Purpose

This study aimed at exploring whether CineECG can improve the discrimination between complete left/right bundle branch blocks (LBBB/RBBB), and incomplete RBBB (iRBBB).

Methods

We utilized 400 12-lead ECGs from the online Physionet-XL-PTB-Diagnostic ECG Database with a certified ECG diagnosis. The mTSI trajectory was calculated and projected into the anatomical 3D-heart model. Five CineECG classes were established: "Normal", "iRBBB", "RBBB", "LBBB" and "Undetermined", to which each tracing was allocated. We determined the accuracy of CineECG classification with the gold standard diagnosis.

Results

A total of 391 ECGs were analyzed (9 ECGs were excluded for noise) and 240/266 were correctly classified as "normal", 14/17 as "iRBBB", 55/55 as "RBBB", 51/51 as "LBBB" and 31 as "undetermined". Average mTSI trajectories were calculated according to ECG diagnosis (Figure). The terminal mTSI contained most information about the BBB localization, as that part directs to the site of latest activation (Figure, red arrow).

Conclusion

CineECG provided the anatomical localization of different BBBs and accurately differentiated between normal, LBBB and RBBB, and iRBBB. CineECG may aid clinical diagnostic work-up, potentially also contributing to the difficult discrimination between normal, iRBBB and Brugada patients. Abstract Figure. Average CineECG trajectories
Remote magnetic navigation shows superior long-term outcomes in pediatric atrioventricular (nodal) tachycardia ablation compared to manual radiofrequency and cryoablation
Authors: Noten AME , Kammeraad JAE , Wijchers S , Van Beynum IM , Balinghaus M , Krasemann TB , Yap SC , De Groot NMS , Szili-Torok T
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction – Catheter ablation (CA) is a first-choice treatment for tachyarrhythmia in pediatric patients. The currently available CA techniques differ in manner of catheter steering technique and energy sources. There are no large studies comparing long-term outcomes between the available CA techniques in pediatric patients with atrioventricular reentry (also known as accessory pathway mediated) tachycardia (AVRT) or atrioventricular nodal reentry tachycardia (AVNRT) mechanisms.

Objective – The aim of this study was to compare procedural parameters and outcomes of remote magnetic navigation-guided radiofrequency (RF) ablation (RMN), manual-guided RF ablation (MAN) and manual-guided cryoablation (CRYO).

Methods – This single-center, retrospective study included all first consecutive CA procedures for AVRT or AVNRT mechanisms performed in pediatric patients with no structural heart disease from January 2008 until June 2019. Three study groups were defined by the ablation technique used: RMN, MAN or CRYO. Primary outcome was recurrence of tachyarrhythmia and/or pre-excitation on ECG. Baseline clinical parameters, procedure times and complication rates were also evaluated.

Results – In total, we included 223 patients, aged 13.8 ± 2.8 years, with a mean weight of 55.6 ± 14 kilograms. In total, 108 procedures were performed using RMN, 76 using MAN and 39 using Cryo. RMN had the lowest recurrence rates at a mean follow-up of 5.5 ± 2.9 years (AVRT ablation: 4% vs. 16% vs. 55%, P < 0.001; AVNRT ablation: 8% vs. 8% vs. 36%, P = 0.008; for RMN vs. MAN vs. CRYO respectively). In AVRT ablation, procedure and fluor times were comparable between groups. However, in AVNRT ablation, RMN and MAN had significantly lower fluoroscopy times compared to Cryo (10 (IQR 7-14) vs. 9 (IQR 6-26) vs. 15 (IQR 10-22) minutes respectively, P = 0.040). Moreover, procedure times were shortest in MAN and second in RMN ablation (101 (IQR 87-121) vs. 88 (IQR 62-99) vs. 120 (IQR 88-143) minutes respectively, P = 0.018). We observed minor complications in 3 patients (1%), which were comparable between groups and no major complications. Conclusion – In pediatric patients with no structural heart disease who underwent their first AV(N)RT ablation, RMN has the most favorable long-term outcomes, in addition to favorable fluoroscopy and procedure times. Abstract Figure. AVRT and AVNRT ablation recurrence rates
Final results from the EU focal impulse and rotor modulation (E-FIRM) registry
Authors: Sommer P , Spitzer S , Brachmann J , Janssen G , Lenz C , Luik A , Sarver A , Szili-Torok T
Published: May 2021

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Abbott

Background

The exact pathophysiology of how pulmonary vein (PV) triggers initiate or maintain episodes of atrial fibrillation (AF) has been elusive. Catheter ablation at relatively circumscribed areas of rapidly spinning rotors or very rapid focal impulse formation can significantly affect AF. Targeted ablation of these sources using Focal Impulse and Rotor Modulation (FIRM™) shows promise.

Purpose

To assess the safety and effectiveness of FIRM-guided procedures for the treatment of any type of symptomatic atrial fibrillation (AF).

Methods

Two hundred and ninety-nine subjects were enrolled in the E-FIRM Registry at 9 clinical sites in Germany and the Netherlands. Subjects were eligible if they had reported incidence of at least 2 documented episodes of symptomatic AF during the preceding 3 months and had failed at least Class I or III anti-arrhythmia drug. Data was collected at enrollment/baseline, procedure, and at 3-, 6-, and 12-month follow-up visits.

Results

A majority (59.5%, 178/299) had a history of previous ablation, 81.1% (133/164) in the left side, with an average of 1.5 ± 0.8 [range 0, 5] prior ablations. The primary safety endpoint was defined as freedom from procedure related Serious Adverse Events (SAEs) through 7-days and at 12-months. At 7-days, freedom from procedure related SAEs was 94.8% (257/271). At 12-months, freedom from procedure related SAEs was 84.4% (184/218). There were no deaths. Acute effectiveness success, defined as the elimination of all identified rotors, occurred in 64.0% (165/258) of treated patients. All patients for which data was reported had at least 1 rotor identified. The most common regions to find rotors were the lateral wall of the right atrium, the anterior/septal wall of the left atrium, and the posterior inferior region of the left atrium. 75.2% (194/258) of patients had at least one rotor identified in the right atrium, and 84.1% (217/258) of patients had at least one rotor identified in the left atrium. Success was defined as two sequential endpoints: single procedure freedom from AF recurrence at 3-months and single procedure freedom from AF recurrence. At 12-months, success was achieved in 46.4% (13/28) Paroxysmal, 42.9% (87/203) Persistent, and 0% (0/9) Long Standing AF subjects. Conclusions: Since acute success was reported as being achieved in only ∼2/3 of the treated subjects, it is possible that the full potential benefit of the FIRM-guided ablation was hidden in this evaluation of the full cohort. Considering the previous ablation and disease history of subjects, a single-procedure success rate at 12-months over 40% was considered a positive result. Based on these results, FIRM-guided RF ablation in conjunction with conventional RF ablation practices is both a safe and effective treatment strategy for patients with symptomatic AF.
Pulmonary vein isolation by irreversible electroporation: an efficacy and safety study in 20 patients with atrial fibrillation
Authors: Loh P , Groen MHA , Taha K , Wittkampf FHM , Doevendans PA , Van Es R
Published: May 2021

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Abbott

Background

Irreversible electroporation (IRE) is a promising new non-thermal ablation technology for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). First in human studies demonstrated the feasibility and safety of IRE PVI.

Objective

Further investigate the safety of IRE PVI.

Methods

Twenty patients with symptomatic AF underwent IRE PVI under conscious sedation. Oral anticoagulation was uninterrupted and heparin was administered to maintain activated clotting time at 300-350 seconds. Non-arcing, non-barotraumatic 6 ms, 200 J IRE applications were delivered via a custom non-steerable 8 F, 14-polar circular IRE ablation catheter with a variable hoop diameter (16-27

mm). Voltage mapping  of the left atrium and the PVs was performed before and after ablation with a conventional circular mapping catheter. For both catheters a single transseptal access (8 F introducer, Agilis NxTTM) was used. Adenosine testing was performed after a 30-minute waiting period. On day 1 after ablation, patients underwent esophagoscopy and brain MRI (DWI/FLAIR). If abnormalities

were detected, examinations were repeated in due time.

Results

In 20 patients, all 80 PVs could be successfully isolated with a mean of 11,8 ± 1,4 IRE applications per patient. Average time from first to last IRE application was 22 ± 5 minutes, total procedure duration was 107 ± 13 minutes and total fluoroscopy time was 23 ± 5 minutes. One PV reconnection occurred during adenosine testing, re-isolation was achieved with 2 additional IRE pulses. No periprocedural complications

were observed. Brain MRI on day 1 after ablation showed punctate asymptomatic lesions in 3/20 patients (15%). At follow-up MRI the lesion disappeared in 1 patient while in the other 2 patients 1 lesion persisted. Esophagoscopy on day 1 showed an asymptomatic esophageal lesion in 1/20 patients (5%), at repeat esophagoscopy on day 22 the lesion had resolved completely.

Conclusion

Acute electrical PV isolation could be achieved safely and rapidly by IRE ablation under conscious sedation in 20 patients with symptomatic AF. Acute silent cerebral lesions were detected in 3/20 patients (15%) and may be due to ablation or to changes of therapeutic and diagnostic catheters over a single transseptal access.
Cardiac arrhythmias in COVID-19: Mechanisms, outcomes and the potential role of proarrhythmia
Authors: Merino JL , Caro J , Rey JR , Castrejon S , Martinez-Cossiani M
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Cardiac arrhythmia seems to be a risk factor for mortality in coronavirus disease 2019 (COVID-19). However, the mechanisms, risk factors and outcomes of new arrhythmic events (NAEs) in this disease are unclear.

Methods

All patients with confirmed COVID-19 were retrospectively included in this single centre study. Patients who were alive and admitted <30 days before the database lock were excluded.

Results

3416 consecutive patients were reviewed and 1476 finally enrolled (65.9 ± 20.9 years, 57.3% male). 76 (5.1%) patients had NAEs. Most of them were new atrial fibrillation episodes (48 patients, 3.2%), mostly seen in patients with no previous arrhythmia (38 patients, 79.2%). Atrial flutter (AFL) accounted for 20% of all NAEs. Ventricular arrhythmias were seen in 9 (0.6%) patients. Multivariable analysis showed that prior AFL, heart failure, dyslipidaemia, lopinavir/ritonavir, and combined hydroxychloroquine and azithromycin were independently associated with NAEs. 66 (86.8%) patients with NAEs died. The Kaplan-Meier analysis showed a lower survival of patients with NAEs (P < 0.001). Eight out of 9 (88.9%) and 41 out of 48 (85.4%) patients with ventricular arrhythmias and atrial fibrillation respectively died. Older age, male gender and NAEs were independently associated with death. NAEs and other outcomes, such as heart failure, thromboembolism, and bleeding independently predicted death.

Conclusions

NAEs are relatively uncommon in COVID-19 patients and mainly have an atrial mechanism. AFL is particularly frequent in this disease. The use of hydroxychloroquine, azithromycin and lopinavir/ritonavir, is associated with them, especially when used in combination. NAEs are independently and strongly associated with death. Abstract Figure.
Does the volume of atrial epicardial adipose tissue predict the likelihood of postoperative atrial fibrillation?
Authors: Van Der Heijden CAJ , Olsthoorn JR , Mihl C , Heuts S , Bidar E , Maessen J , Verheule S , Maesen B
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial Epicardial Adipose Tissue (EAT) is involved in the early pathophysiological process of atrial fibrillation (AF). Its role in the occurrence of post-operative AF (POAF) is less well investigated. The transient occurrence of POAF suggests that surgery-induced triggers unmask a pre-existing AF substrate.

Purpose

As EAT induces structural changes in the atria, it is interesting to evaluate whether EAT also contributes to the substrate underlying the occurrence of early POAF (<30 days). We hypothesized that patients with high EAT volumes are more likely to develop POAF after cardiac surgery than patients with low EAT volumes.

Methods

Retrospective quantification of left atrial (LA) EAT was performed on pre-operative coronary computed tomography (CT) angiography scans of patients who underwent cardiac surgery between 2009 and 2017. Patients with a history of AF or with mitral valve disease were excluded, as well as thoracic CT scans. Analysis was based on the Hounsfield Units using custom made software.

Results

Of the 52 included patients 28 developed POAF. Neither the percentage of EAT in the left atrial (LA) wall nor normalized EAT volumes differed between the POAF and sinus rhythm group (all P > 0.05). After multivariate analysis, age was the only independent predictor for early POAF (OR:1.087 [1.000–1.181]).

Conclusion

A role for EAT in the occurrence of early POAF was not demonstrated. This might suggest that acute, surgical factors are more important in the onset of early POAF than chronic processes associated with EAT. More and larger trials are needed to confirm these results. EAT-V in the LA wallPOAF (n = 28)SR (n = 24)P-valueEAT-V (ml)0.77 (0.41 - 1.26)0.62 (0.36 - 1.13)0.425MYO-V (ml)3.24 (2.57 - 4.80)2.89 (2.14 - 3.76)0.121% EAT LA wall17.39 ± 8.2418.33 ± 8.400.687EAT-V (ml) / BSA (m²)0.42 (0.19 - 0.60)0.32 (0.22 - 0.73)1.000EAT-V (ml) / BMI (kg/m²) (%)2.67 (1.13 - 4.43)2.48 (1.66 - 4.56)0.927EAT-V (ml) / LAVI (ml/m²) (%)1.92 (1.00 - 4.43)1.51 (1.12 - 2.41)0.583EAT-V (ml) / MYO-V (ml) (%)21.63 (9.54 - 30.18)23.85 (16.75 - 32.79)0.244The percentage of EAT in the LA wall, EAT-V and indexed EAT-V to BSA, BMI, LAVI and MYO-V, based on post-operative rhythm outcome. Data are presented as median (interquartile range) or mean ± standard deviation. EAT-V: epicardial adipose tissue volume; MYO-V; myocardial volume; LA: left atrial; BSA: body surface area; BMI: body mass index; LAVI: left atrial volume index.Abstract Figure. EAT and MYO measurements
Acute atrial ischemia associates with early but not late new-onset atrial fibrillation in STEMI patients treated with primary PCI: relationship with in-hospital outcomes
Authors: Biccire FG , Cardillo I , Chianta V , De Luca AC , Ferrari I , Capone S , Torromeo C , Acconcia MC , Tanzilli G , Barilla F , Pastori D
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

N/A

Background. New-onset atrial fibrillation (NOAF) is known to be a common complication in STEMI patients undergoing primary percutaneous coronary intervention (PCI), which is associated with a negative short- and long-term prognosis. Recently, two distinct phenotypes of NOAF have been described, namely early (EAF) and late NOAF (LAF). However, whether EAF and LAF recognize different pathogenetic mechanisms is unknown.

Purpose. To investigate atrial branches occlusion and EAF or LAF onset in STEMI patients undergoing primary PCI.

Methods. Retrospective cohort study including 155 STEMI patients. Patients were divided into 3 groups: sinus rhythm (SR), EAF or LAF. Clinical characteristics, angiographic features including occlusion of atrial branches, namely ramus ostia cavae superioris (ROCS), atrio-ventricular node artery (AVNA), right intermediate atrial artery (RIAA) and left intermediate atrial artery (LIAA), were assessed. We also investigated in-hospital complications, death, and a composite of major post-NOAF adverse events (AEs) including cardiogenic shock, acute pulmonary edema, sustained ventricular tachycardia and ventricular fibrillation.

Results. Mean age was 63.8 ± 11.9 years; 78.7% of men. NOAF was detected in 22 (14.2%) patients: 10 (6.4%) EAF and 12 LAF (7.7%). Compared to EAF, LAF patients were older (p = 0.013), with higher GRACE risk score (p = 0.014) and Killip class (p = 0.015), depressed ejection fraction (p = 0.007), elevated filling pressures (p = 0.029), higher c-reactive protein (p = 0.014) and more TIMI flow <3 (p = 0.015). As shown in Figure 1, EAF was associated with higher prevalence of occluded ROCS (p = 0.010), AVNA (p = 0.005) and RIAA (p < 0.001), compared to SR. Moreover, EAF patients had more frequently ≥2 diseased atrial branches than SR (19.5%, p < 0.001) and LAF (25%, p < 0.030) patients. In LAF patients, a higher incidence of pre-PCI cardiogenic shock, post-PCI AEs (p = 0.019 vs SR; p = 0.029 vs EAF) and death (p = 0.004 vs SR) was found.

Conclusions. The occlusion of atrial branches is associated with early but not late NOAF following STEMI. LAF patients had worse in-hospital AEs and mortality. Abstract Figure.
Insights into electrophysiological mechanisms of atrial fibrillation propagation using simultaneous bi-atrial mapping
Authors: Pope M , Kuklik P , Banerjee A , Briosa E Gala A , Leo M , Mahmoudi M , Paisey J , Betts TIMOTH
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Oxford Biomedical Research Centre

Introduction

Early evidence of pulmonary vein triggers initiating AF has led to focus on the left atrium (LA). Little work has been done to characterise the role of the right atrium (RA) in AF maintenance.

Purpose

To characterise the relative roles of the LA and RA in maintenance of atrial fibrillation and explore mechanisms of AF propagation.

Methods

Simultaneous bi-atrial mapping was carried out in patients undergoing first time catheter ablation using 2 linked non-contact charge density mapping systems to obtain 30-second recordings during AF. The predominant channel of communication between chambers was identified and the time difference across this channel measured (see figure). The proportion of signals earlier in each chamber was calculated and a dominant chamber identified if preceding the opposite chamber for ≥60% of the recording. AF was characterised in each chamber according to frequency of specific propagation patterns (localised rotational activation (LRA) and focal firing (FF)). The difference in AF characteristics in the LA and RA according to acute procedural outcome (termination with ablation vs. DCCV) was measured using 2-way ANOVA and predictors of AF termination identified using binomial logistic regression.

Results

Twenty-one patients were included (16 persistent AF, 5 paroxysmal AF, 11 in sinus rhythm at baseline) with 41 maps obtained prior to ablation. A dominant chamber was identified in 11 maps (in 9 patients). Of these, 5 maps (in 4 patients) were LA dominant, and 6 maps (in 5 patients) were RA dominant. The remainder showed balanced interatrial propagation. For patients with persistent AF, in the RA, those needing DCCV had more LRA than those with termination with ablation (79 activations, (95% CI 65-93) vs. 51 (30-71); p = 0.025). There was no difference in the LA in the two groups (77 vs 59, p = 0.541). There were fewer FFs in the RA vs LA in patients needing DCCV (123 (106-140) vs. 155 (137-172), p = 0.012)(see panel F). No differences in distribution of LIA were observed. The frequency of LRA (p = 0.003) and FF (p = 0.004) in the RA, and RA AFCL (p = 0.041), were predictors of acute procedural outcome.

Conclusions

Our novel approach of simultaneous bi-atrial mapping revealed that mechanisms responsible for AF maintenance were evenly distributed between atria whilst acute AF termination with left atrial ablation was dependent on the contribution of right atrial substrate. Strategies incorporating right atrial mechanisms may result in improved outcomes from AF ablation. Abstract Figure.
Device-detected atrial fibrillation before and after acute cardiac events: insights from ASSERT
Authors: Mcintyre WF , Wang J , Belley-Cote EP , Roberts JD , Benz AP , Conen D , Devereaux PJ , Wong JA , Wang MK , Whitlock RP , Connolly SJ , Healey JS
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation (AF) that is first detected concurrently with or shortly after another cardiac event is often thought to be caused by acute cardiac injury, and therefore reversible.

Methods

ASSERT enrolled patients >65 years old with hypertension and a pacemaker, but without known AF. We evaluated participants who had a cardiac event [angina/myocardial infarction (MI), cardiac catheterization/percutaneous coronary intervention (PCI), cardiac surgery or other (e.g. pericarditis, hypertensive crisis)] and compared the prevalence of device-detected AF before and after these events.

Results

Among 2580 participants, 178 (6.9%) had at least one cardiac event over a mean 2.5 years of follow-up. In the 30 days following a first cardiac event, the prevalence of device-detected AF >6 min was 12.4% (95% confidence interval [CI] 7.9%-18.1%), which was higher than in the 30 days before the event (12.4% versus 4.5%, P = 0.004) (Figure 1). The prevalence of device-detected AF following the event was comparable across event subtypes (MI: 13.8%, 95%CI 7.9-18.1%; PCI: 6.9%, 95%CI 1.9-16.7%; Surgery: 20.0%, 95%CI 5.7-43.7%; Other: 18.5%, 95%CI 6.3-38.1%).

There was a significant association between device-detected AF in the 6 months before a cardiac event and device-detected AF in the 30 days after a cardiac event: odds ratio (OR, adjusted for CHA2DS2-VASc score) for episodes >6 min 7.07 (95%CI 2.07-24.19; P = 0.002); adjusted OR for episodes >24 hours: 11.41 (95%CI 1.47-88.43; p = 0.020).

Conclusions

Acute cardiac events are associated with an increase in the prevalence of device-detected AF. These episodes are associated with a prior history of device-detected AF. Abstract Figure 1