bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of environment and ethnicity on prognosis in AF patients: does the 'where' matter more than the 'who'?
Authors: Bisson A , Romiti G F , Fawzy A M , Calvert P , Proietti M , Fauchier L , Lip G Y H
Published: May 2024

Background

Atrial fibrillation (AF) is increasing worldwide and disparities are known between different geographically defined populations. However, populations are more and more multi-racial/multiethnic and less is known about the impact of geographical locations on various racial/ethnic populations.

Purpose

To study the influence of geographical location and race/ethnicity on the characteristics and the prognosis in AF patients.

Methods

From phase II/III of the GLORIA-AF registry, Asian and Caucasian patients from Western and Asian countries were included. The associations between geographical locations, race/ethnicity and a composite outcome composed of all-cause death, stroke and major bleeding were evaluated using Cox regression analyses.

Results

The study included 21,450 AF Caucasian and Asian patients from Western and Asian countries (mean±SD age 70.2±10; 44.3% female) with a median [IQR] follow-up of 3 years [2.3-3.1]. Among Caucasian patients, those living in Western countries (97.3%) were older, had less hypertension, congestive heart failure and coronary artery disease but more often lifestyle disorders (smoking, alcohol drinking) than those living in Asia (2.7%). Among Asian patients, those living in Western countries (2.6%) had more hypertension, diabetes mellitus, metabolic syndrome, coronary artery disease but less alcohol abuse than those living in Asia (2.6%). Regarding the composite outcome, Caucasian patients living in Asia had less adverse events than Asian patients living in Asia and Caucasian patients living in Western countries (adjusted hazard ratio on age, sex and CHA2DS2-VASc score (aHR): 0.53 (95% confidence interval (CI): 0.34-0.83), p=0.005) and aHR: 0.54 (95% CI: 0.35-0.83, p=0.005) respectively). Asian patients living in Asia had a better prognosis than Asian patients living in Western countries (aHR: 0.55 (95% CI: 0.35-0.85), p=0.007) and Caucasian patients living in Western countries when compared to Asian patients living in Western countries (aHR: 0.61 (95% CI: 0.40-0.94), p=0.025).

Conclusion

Geographical location has an impact on characteristics and prognosis of AF patients regardless of race/ethnicity. However, the gap in prognosis between Caucasian and Asian patients remains unchanged.Table 1.Baseline characteristics.Figure 1.Kaplan-Meier curves.
Exploring smartphone ownership, patient behaviour, and potential bias in wearables research for atrial fibrillation
Authors: Ahluwalia N , Butcher C , Saengkrajang G , Yu Y , Schilling R J
Published: May 2024

Background

Wearable sensors enable patient-led atrial fibrillation (AF) monitoring after catheter ablation (CA). Investigating smartphone ownership and patient behavior may provide insights into wearables research applicability. Understanding engagement and preferences could inform study design and care pathways.

Objective

To explore smartphone ownership, socio-economic factors, and behavior among individuals screened for the AFFU-AW study; a randomized controlled trial evaluating Apple Watch (AW)-based follow-up after AF CA. The impact of AW provision on patient behavior was also assessed.

Methods

Patients with AW-compatible iPhone-Operating System (iOS) devices were invited to participate (case arm), while non-enrolled patients served as controls. Demographics, race, and socio-economic status were surveyed at screening. Engagement and perceived impact were assessed in the case arm.

Results

Of 197 patients screened, 90 (46%) were ineligible due to smartphone incompatibility, 9 (5%) had no household smartphone. Controls were older (62.4±9.2 vs 57.4±9.8, p<0.01) but exhibited no significant gender or ethnicity differences. (table 1) Among AW users, 7 (17%) required additional assistance for device setup, and all subsequently recorded ECGs independently. 23 (57.5%) participants recorded daily ECGs. 30 (73.2%) reported reduced likelihood of seeking medical attention for AF. However, 2 (4%) reported increased likelihood. Participants in the control arm used blood pressure monitors for AF self-monitoring (33.3%). (fig 1).

Conclusion

Smartphone ownership is prevalent among AF CA patients. Cross-platform compatibility for wearable interventions is important to address potential biases. A majority of patients felt AW monitoring reduced medical attendances, highlighting the potential for wearables to enhance patient-led care. However, a small proportion reported increased health anxiety, indicating a need for tailored support and education.Figure 1:AF monitoring strategyTable 1:Baseline Characteristics
Spontaneous atrial fibrillation occurrence following transesophageal atrial burst pacing in rats
Authors: Scridon A , Balan A I , Halatiu V B , Cozac D A , Mutu C C , Comsulea E , Aspru I , Miklosi M , Pacurar D , Perian M
Published: May 2024

Purpose

Animal models play a crucial role in elucidating the complex pathophysiology of atrial fibrillation (AF) and in identifying and testing novel antiarrhythmic strategies. We aimed to develop and characterize a new experimental rat model of AF, induced by long-term transesophageal atrial electrical stimulation, and to investigate whether the "AF begets AF" concept applies to small rodent hearts.

Method

Twelve adult male Wistar rats were randomized into two groups: Sham (n = 5) and AF (n = 7). All rats were implanted at the beginning of the study with ECG radiotelemetry devices and underwent continuous ECG monitoring throughout the study. To induce AF, the rats in the AF group underwent atrial pacing for 10 consecutive days (15 successive cycles of stimulation/day, 20 s each, with a free interval of 5 min between cycles; 4,000 stimuli/min, stimulus duration 6 ms, voltage 3 V above the diastolic threshold). A similar procedure was applied to the Sham group, but without performing the actual electrical stimulation. The number and duration of spontaneous AF episodes were evaluated based on continuous ECG monitoring prior to, during, and for one week after transesophageal atrial pacing. The inducibility of AF and the occurrence and duration of spontaneous AF episodes were evaluated and compared between the two groups.

Results

Atrial fibrillation was induced in 85.7% of the rats subjected to atrial electrical pacing (Figure, A), with an average global inducibility of 44.0% ± 16.9% and a mean AF duration of 123.2 ± 96.3 s. No induced or spontaneous AF episodes were recorded in any of the Sham animals. In the AF group, none of the animals presented spontaneous AF before transesophageal atrial pacing. However, in the AF rats, after atrial electrical stimulation initiation, the number of atrial premature beats significantly increased (21.3 ± 6.8 / 24-h post-stimulation vs. 7.3 ± 6.5 / 24-h at baseline; p< 0.01; Figure, B), and all rats presented spontaneous AF episodes (Figure, C). At the end of the study, AF rats presented a total number of 23.9 ± 2.3 AF episodes / 24-h (Figure, D), with a mean AF burden of 337.7 ± 25.06 s / 24-h.

Conclusions

Our data demonstrate that, despite the small size of the atria, the "AF begets AF" concept is applicable in small rodents. The study presents a novel rat model of AF, in which spontaneous AF occurs following long-term atrial electrical stimulation. Given that the model is relatively rapid and easy to implement, it provides a setup for further investigation of AF pathophysiology, and for identifying and testing novel therapeutic strategies for AF.Figure 1
Neural control of ventricular electrophysiology: the role of the posterior descending ganglionated plexus
Authors: Kahle A K , Klatt N , Scherschel K , Jungen C , Kuklik P , Alken F A , Kloecker N , Willems S , Weber E , Boeken U , Lichtenberg A , Bernhardt A , Hakmi S , Pauza D H , Meyer C
Published: May 2024

Background

The autonomic nervous system plays an integral role in cardiac physiology. While the atrially located ganglionated plexus have been studied in several species, there is limited knowledge regarding the functional characterization of ventricular ganglionated plexus.

Purpose

The aim of the present study was to assess the role of the posterior descending ganglionated plexus (PD-GP) for neural control of ventricular electrophysiology.

Methods

First, to investigate whether the mouse may be useful as an animal model, a review of whole-mount immunohistological stained murine hearts (n=43) was conducted. Second, functional studies were performed in an ex-vivo retrograde-perfused porcine model (n=3) at baseline (pacing with a cycle length of 600 ms), during PD-GP high-frequency and local nicotine stimulation (Figure 1A). Wave propagation characteristics were determined by epicardial activation mapping. Activation recovery intervals (ARIs) were analyzed with a multi-electrode sock placed around the epicardium (Figure 1B). Finally, morphological analysis of explanted human hearts was conducted to determine the potential of translation into clinical practice.

Results

In murine hearts, ventricular ganglionated plexus were present in only 10% of hearts. In porcine hearts, dispersion of conduction velocity was increased during PD-GP high-frequency (8.52±2.24 radian vs. 2.79±0.89 radian; p=0.018) and nicotine stimulation (19.79±6.49 radian vs. 2.79±0.89 radian; p=0.044) compared to paced rhythm (Figure 1C). High-frequency stimulation prolonged ARIs in the posterior (257.8±6.7 ms vs. 244.8±1.9 ms; p=0.044) and basal (258.1±4.2 ms vs. 244.8±1.9 ms; p=0.039) right ventricle compared to the posterior left ventricle, while nicotine did not affect ARIs (right ventricle: 255.7±29.0 ms vs. left ventricle: 245.0±29.3 ms; p=0.677) (Figure 1D). Analysis of explanted human hearts confirmed the presence of the PD-GP in close relationship to the posterior descending coronary artery within epicardial adipose tissue (Figure 2).

Conclusions

While we demonstrate functional relevance of the PD-GP in explanted porcine hearts, important species-related differences might exist.Ex-vivo retrograde-perfused swine modelAnalysis of explanted human hearts
Role of inflammation in atrial fibrillation: specific biomarkers of tissue damage, atrial remodelling and dysregulation of angiogenesis
Authors: Quesada-Ocete J , Castillo Martinez P , Garcia Gonzalez M , Cervera Vidal R , Simarro De Pascual S , Quesada-Ocete B , Palanca Gil V , Jimenez Bello J , Paya-Chaume A , Paya Serrano R , Tebar Fernandez R , Vidal-Vanaclocha F , Quesada Dorador A
Published: May 2024

Introduction and Objectives

The relationship between inflammation and atrial fibrillation (AF) has been poorly studied with common inflammatory markers and limited to analysing one or two markers. Given the large number of pathways in the inflammatory process and the complexity of their relationship with AF, we set out to study a broad panel of more specific biomarkers that attempt to cover as many inflammatory interactions and mechanisms as possible.

Our objetive was to evaluate which biomarkers were elevated in AF patients compared to the general population.

Methods

We studied 74 patients who were to undergo an ablation procedure (53 with AF and 21 controls -microscopic substrates-), drawing a blood sample before the procedure.

Exclusion criteria were: cancer, inflammatory diseases, heart failure or major echocardiographic alterations including mild ventricular hypertrophy.

Baseline characteristics, basic analytical parameters and levels of 20 specific inflammatory biomarkers were collected and compared in patients with and without AF.

Results

Figure 1 shows the baseline characteristics of the sample. The usual analytical parameters in clinical practice showed no relevant differences between the two groups.

Of the 20 specific inflammatory parameters, significant differences were found in 4: biomarkers of cardiomyocyte damage (NT-proBNP: (AF)130.8 +- 208.0 pg/mL vs (control) 80.3 +- 66.5 pg/mL; p=0.041), of atrial remodelling (Endostatin: 95.0 +- 28.8 ng/mL vs 80.1 +- 17.2 ng/mL; p<0.01), angiogenesis dysregulation (MCAM: 241.8 +- 51.9 ng/mL vs 197.1 +- 96.4 ng/mL; 0.033) and hepato-inflammatory cardiovascular risk markers (SAP; 7426.6 ± 2641.0 ng/mL vs 9406.9 ± 3904.1 ng/mL; p<0.011).

In addition to these individual differences, multiple correspondance analysis (figure 2) allowed grouping most of the patients without arrhythmia using information from the biomarker set.

Conclusions

In patients with AF, several specific parameters of inflammation are elevated compared to controls, supporting the presence of an activation of inflammation in these patients.

Due to the large number of factors involved in the inflammatory process and the variability with which they can be activated, future research evaluating the clinical implication of these findings is essential.Baseline CharacteristicsMultiple correspondance analysis
Translational exploration of fully biological restoration of cardiac rhythm via ion channel gene therapy
Authors: De Coster T , Ordog B O , De Vries A A F , Panfilov A V , Pijnappels D A
Published: May 2024

Background

Recently it was demonstrated how the heart itself could be enabled to quickly restore its rhythm by realizing a biologically-integrated cardiac defibrillator (BioICD) through modification and subsequent expression of ion channels in cardiomyocytes [1]. By incorporating these frequency-dependent depolarizing ion channels, abnormal cardiac rhythm could be rapidly detected and terminated to restore sinus rhythm in a fully biological and shock-free manner. However, from a translational point of view, it remains unclear how such rhythm restoration can be realized via ion channel gene therapy.

Purpose

To explore and understand the importance of the distribution and number of BioICD-expressing cardiomyocytes in realizing fully biological restoration of cardiac rhythm.

Methods

To this purpose, two different realistic gene therapy configurations, i.e. those corresponding to systemic and local transgene delivery, were tested in a digital twin of human ventricular cardiac monolayers. For the systemic delivery group, BioICD-expressing cells were homogeneously distributed over the tissue with fixed total expression percentage. For the local delivery group, circular areas were given BioICD-expressing cells, randomly patterned in a Gaussian distribution. In both groups spiral waves were initiated and subsequently studied for 10 seconds. For systemic delivery, an additional set of simulations was performed for an adapted BioICD ion channel with a slower opening and faster closing rate.

Results

Upon comparing both gene therapy methods, the systemic approach showed a gradually increasing arrhythmia termination chance with increasing BioICD-expression percentage, while local delivery did not result in termination. Instead, local delivery resulted in islands of ionic heterogeneity, causing attraction and anchoring of the spiral waves in a size and distance-dependent manner. Building on the results of the systemic approach, different ion channel parameters were tried, which resulted in normal rhythm being restored in all cases for >50% BioICD expressing cells. Time till termination was inversely related to the percentage, resulting in only 4.3s and 2.5s for 50% and 100%, respectively. Regarding termination, it was observed that conduction blocks appeared throughout the tissue and subsequently connected to force arrhythmic waves to terminate, while this process remained incomplete in the <50% groups.

Conclusion

This study reveals that wide-spread distribution of BioICD-expressing cardiomyocytes is required for the realization of fully biological self-restoration of cardiac rhythm, of which the efficiency is ion-channel-dynamics- and dosage-dependent. Local expression, however, results in stabilization of spiral wave activity. Further exploration of this emerging concept of biological cardioversion may not only expand our understanding of cardiac arrhythmias, but also pave the way to breakthrough advances in arrhythmia management.
Molecular mechanism for the interaction of MOG1 with the intracellular Loop II of cardiac sodium channel Nav1.5 and its role in Brugada syndrome
Authors: Bai X , Wang Q I N G
Published: May 2024

Background

SCN5A encodes the cardiac sodium channel a-subunit Nav1.5 with an essential role in generation and conduction of cardiac action potential. Mutations in SCN5A cause Brugada syndrome (BrS) and long QT syndrome (LQTS). The function of Nav1.5, including its cell membrane trafficking and clustering in caveolae, is regulated by MOG1. We recently showed that gene therapy with AAV9-MOG1 reversed disease phenotypes of BrS, dilated cardiomyopathy, cardiac conduction disease and sick sinus syndrome associated with SCN5A mutations. MOG1 is a small chaperon that interacts with multiple sites of Nav1.5, including intracellular Loop I between transmembrane domain I and II and Loop II between domain II and III. We previously characterized the interaction between MOG1 and the intracellular Loop I of Nav1.5, and defined amino acids D24, E36, D44, E53, and E101A of MOG1 as critical residues for its interaction with Nav1.5 Loop I. However, the mechanistic understanding of the interaction between MOG1 and intracellular Loop II of Nav1.5 is needed.

Purpose

The aim of this study is to perform systematic mutational and electrophysiological studies to identify the key structural elements involved in the interaction between MOG1 and Nav1.5 Loop II and determine the significance of this interaction to the pathogenesis of BrS.

Methods

Patch-clamping was used to record sodium currents. Glutathione S-transferase (GST) pull-down were used to characterize protein-protein interactions.

Results

Nav1.5 Loop II contains 765 amino acids, and the domain between amino acids 1157 and 1200 was shown to be the interaction domain for MOG1. Six serial deletions were created, including LoopII△940-982, LoopII△983-1025, LoopII△1026-1068, LoopII△1069-1112, LoopII△1113-1156, and LoopII△1157-1200. GST-pull-down showed that only LoopII△1157-1200 failed to interact with MOG1. MOG1 enhanced sodium current densities all Nav1.5 deletion mutants except for LoopII△1157-1200. Further deletions by every 10-11 amino acids defined the MOG1-interacting domain to 1190-1200. Point mutation analysis defined the MOG1-Nav1.5 Loop II interaction domain to an 8-amino-acid domain of R1193-Y1200 of Nav1.5 Loop II. Mutations R1193W, L1194M and Y1199S associated with BrS reduced the interaction between MOG1 and Nav1.5. MOG1 enhanced sodium current densities from wild type Nav1.5, but not from mutant Nav1.5 with mutations R1193W, L1194M and Y1199S.

Conclusions

This study identifies the critical elements of Nav1.5 Loop II for interaction with MOG1, and reveals the molecular mechanism by which Nav1.5 mutations R1193W, L1194M and Y1199S cause BrS. Mutations R1193W, L1194M and Y1199S weaken the interaction between Nav1.5 and MOG1, and reduce MOG1-enhanced cardiac sodium current densities.
CineECG demonstrates abnormal electrical activity in preclinical plakophilin-2-pathogenic variant carriers with a normal 12-lead ECG
Authors: Van Der Schaaf I , Kloosterman M , Van Dam P M , Loh P
Published: May 2024

Background/introduction

Arrhythmogenic cardiomyopathy (ACM) is an inherited cardiac disease. The presence of a pathogenic variant (PV) of the plakophilin-2 (PKP2) gene increases the likelihood of developing this disease. Although cardiac screening is routinely performed, early detection of ACM remains challenging.

CineECG as a tool for analysis of the 12-lead electrocardiogram (ECG) can provide a 3D-reconstruction of the average pathway of electrical activation. With the emergence of this technique, a new insight in ventricular activation patterns can be obtained. CineECG might therefore be of aid in identifying early signs of disease in preclinical PKP2-PV carriers with a normal 12-lead ECG.

Purpose

This study aimed to analyze the ECG’s of preclinical PKP2-PV carriers with CineECG to determine the ventricular electrical activation patterns and to compare these patterns to the normal CineECG trajectory.

Methods

The 12-lead ECG’s of 19 preclinical PKP2-PV carriers were selected and evaluated by three experts on depolarization abnormalities.

CineECG analysis was conducted in all preclinical PKP2-PV carriers to ascertain the average location and direction of the ventricular electrical activation. The resulting CineECG trajectory was then compared to the normal CineECG, which was previously determined from normal ECG’s from the PTB-XL database. The CineECG was considered abnormal if more than 15% of the CineECG trajectory was outside the normal distribution.

Results

Expert analysis of the ECG’s revealed no depolarization abnormalities (e.g. abnormal electrical heart axis, pathological Q-waves or low voltage, and ECG Task Force Criteria were absent).

The CineECG trajectory was abnormal in most cases (11 out of 19 PKP2-PV carriers), while the other eight carriers exhibited normal CineECG trajectories. Figure 1 shows three examples of A) a normal case, B) a PKP2-PV carrier with a normal CineECG and C) a PKP2-PV carrier with an abnormal CineECG. In example C, the activation pattern is abnormal as the latest activation is aimed towards inferior and far to the left basal area of the heart.

Conclusions

CineECG analysis of the normal 12-lead ECG’s of preclinical PKP2-PV carriers resulted in the finding of abnormal electrical activation patterns in the majority of carriers. CineECG could therefore be a sensitive tool to unveil subtle and early abnormalities in the depolarization that would otherwise not be easily detected.Figure 1
Real-world utility of implantable loop recorders
Authors: Plappert C , Lacour P , Boldt L H , Parwani A , Baehr F , Wieland L , Schoeppenthau D , Dagres N , Hindricks G , Blaschke F
Published: May 2024

Background

Implantable loop recorders (ILRs) allow prolonged and continuous single-lead electrocardiogram recording and have significantly shortened time to electrocardiographic diagnosis and appropriate therapy of many bradyarrhythmias and tachyarrhythmias.

Purpose

The aim of this retrospective single center study was to evaluate ILR indications, diagnostic yield and ILR-guided interventions.

Methods

We retrospectively analyzed 388 patients (223 male / 165 female), who underwent Medtronic and Biotronik ILRs implantation at a heart center. Demographic and clinical data were obtained from the medical records. Remote monitoring was analyzed when no data of in-hospital follow up could be acquired.

Results

The mean age at ILR implantation was 63.4 ± 14.9 years with a mean follow-up of 20.7±17.6 months from ILR implantation. In total, 152 (39.2%) patients were followed by a remote monitoring system. Number of patients with ILR indication due to syncope (n=171; 44.1%) was significantly higher compared to patients with monitoring after ablation of atrial fibrillation or atrial flutter (n=108; 27.8%), cryptogenic stroke (n=50; 12.9%) and presyncope and dizziness (n=21; 5.4%) (p<0.05).

After 12 months, arrhythmia was detected in 198 cases (79.2% out of 250 patients with detected arrhythmias). The most common type of arrhythmia was paroxysmal atrial fibrillation (31.7%) with a significantly higher prevalence compared to atrial tachycardias (16.5%) and supraventricular premature beats (9.8%) (p<0.05). Noteworthy, in 132 (52.8% out of 250) patients, ILR diagnosis corresponded to the suspected arrhythmia, whereas in 118 patients unexpected arrhythmias were detected. ILR diagnosis of arrhythmia lead in 147 (58.8%) patients to initiation of a new therapy or to a change of current medication. Changes of current medication occurred in 72 patients (28.8%), electrophysiology study/ablation in 66 patients (26.4%), pacemaker/ICD implantation in 46 (18.4%), electrical cardioversion in 6 patients (2.4%), and closure of the left atrial appendage in 1 patient.

Conclusion

Our study shows, that ILRs are an important diagnostic tool, providing clinical relevant data in about two thirds (65%) of the patients. About half (52.8%) of the detected arrhythmia correlated with the symptoms leading to ILR implantation (number needed to treat was around 2). Remote monitoring improves the diagnostic timing with a potential reduction of costs for health care. However, patient selection is critical and ILRs benefits needs to be proven in larger randomized trials.
Mobile ECG devices in pediatric cardiology: efficacy and accuracy of smart watch and hand-held device in healthy children
Authors: Kurath-Koller S , Manninger M , Will J , Scherr D , Sallmon H
Published: May 2024

Background and Aim

Pediatric arrhythmias require accurate electrocardiogram (ECG) assessment for diagnosis and management. Mobile ECG devices, such as smart watch based and hand-held devices, offer potential advantages in terms of portability and accessibility. This study aimed to compare the efficancy and diagnostic accuracy of ECG tracings obtained using a smart watch and a hand-held device with standard 12-lead ECG tracings in healthy children.

Methods

ECG data were acquired from healthy pediatric subjects (n=30) aged 4 to 18 years using the smart watch, hand-held device, and standard 12-lead ECG. Single leads were acquired sequentially. The time required for ECG acquisition was recorded for each device. Subsequently, ECG leads were analyzed for voltage, duration, and morphology of waves and intervals, as well as ST segments. Qualitative assessment of leads included morphology comparison of waves and complexes to standard 12-lead ECG and using a physician based quality rating scale. Assessment was performed by two blinded pediatric electrophysiologists.

Results

We found significant differences in the time required to acquire ECG tracings between the smart watch, standard 12-lead ECG, and hand-held device, with the smart watch being notably slower (median 15 min, 4 min, 1 min, respectively). ECG leads obtained with the smart watch and hand-held device demonstrated comparability to standard 12-lead ECG tracings in terms of quantitative key parameters, including voltage (mV) and duration (ms) of waves and intervals. Qualitative assessment revealed good correlation of the hand-held device with standard 12-lead ECG, while the smart watch performed less well.

Conclusions

This study suggests that mobile ECG devices offer a diagnostic accuracy comparable to that of standard 12-lead ECGs in healthy children. While the smart watch may be slower in ECG acquisition, acquisition of all 12 standard ECG leads is feasible in this population. The potential of both included mobile devices for pediatric usage in specific clinical scenarios, such as remote monitoring or emergencies, is promising.Graphical Abstract
Diagnostic yield of a smartphone-operated, 6-lead device in Brugada syndrome
Authors: Berne P , Lopez H , Rodriguez-Manero M , Villuendas R , Casu G , Bisbal F
Published: May 2024

Background

The spontaneous type 1 ECG pattern (ECG-T1) is diagnostic of Brugada syndrome (BrS) and implies an increased arrhythmic risk, while pharmacologically-induced ECG-T1 without other clinical features only makes the diagnosis possible, according to ESC guidelines. Given the dynamic nature of the ECG patterns in BrS, tools to increase the detection of ECG-T1 are needed to improve BrS diagnosis and adequately assess the arrhythmic risk.

Purpose

To assess the diagnostic yield of a smartphone-operated, 6-lead device (6L-mobile ECG) in BrS.

Methods

Eighteen patients with spontaneous or drug-induced ECG-T1 (Figure 1-a), 18 patients with type 2 ECG pattern (ECG-T2, figure 2-a) and 18 controls were included. A 12-lead ECG and a 6L-mobile ECG were obtained by placing leads V1 and V2 in 2nd, 3rd and 4th intercostal space (ICS). The 6L-mobile ECG was placed with the 2 frontal electrodes in contact with the patients’ chest. Each 12-lead ECG and 6L-mobile ECG recording was classified as ECG-T1, ECG-T2 or non-diagnostic (ND), by considering the lead/ICS with the most evident pattern for analysis.

Results

Sixteen 6L-mobile ECG recordings were diagnostic of ECG-T1 (figure 1-b), 18 of ECG-T2 (figure 2-b) and 20 were ND. Unipolar 6-L mobile ECG recordings at any ICS had a 77% sensitivity and 94% specificity for the diagnosis of ECG-T1 (NPV 89%, PPV 88%, p<0.0001). For ECG-T2, the 6L-mobile ECG showed a 89% sensitivity and 94% specificity (NPV 94%; PPV 89%, p<0.0001).

Conclusions

The 6-L mobile ECG device showed a high diagnostic yield for type 1 and type 2 ECG patterns and may emerge as a new diagnostic and monitoring tool in BrS.
Arrhythmia during gestation: from diagnosis to follow-up
Authors: Smagulova A , Ainabekova B , Albaev R , Abdrakhmanova Z H , Suleymen Z H , Abdrakhmanov A
Published: May 2024

Background

Although arrhythmia is common cardiac complication during gestation, data on perinatal and neonatal outcomes in pregnant women with different arrhythmia management is limited.

Purpose

To explore clinical characteristics and outcomes of different management strategies in pregnant women with arrhythmias.

Methods

In this single-center, prospectively study we consequently included 87 cases of arrhythmias in pregnant (mean age 26.7±3.5 years, mean gestation age 24.6 ±3.3 weeks). Clinical characteristics, obstetric and neonatal outcomes were compared due to different arrhythmia management strategies: dynamic observation (the 1st group), antiarrhythmic therapy (the 2nd group) and catheter ablation (the 3rd group) within 12 month follow-up.

Results

Supraventricular tachycardia (n=47; 54%) was the most common arrhythmia in pregnant. Premature contraction was detected in 34 cases (39%). Cases of ventricular tachycardia (n=6; 7%) was rare during gestation. Benign course of arrhythmia was in 15 cases (17.2%) and do not require drug therapy or intervention. Antiarrhythmic drug was used for symptomatic patients with haemodynamic instability (n=28, 32.2%). Catheter ablation performed in cases of drug refractory and severe arrhythmias (n=44, 50.5%). The procedure performed under the guidance of CARTO (n=21; 47.7%) and Ensite Precision systems (n=23; 52.3%) without fluoroscopy and were successful in all cases (100%). The further course of gestation characterized by occurring increased incidence of uterine contractile activity (n=2, 4.5%, p=0.464) and placental abruption (n=2, 4.5%, p=0.464) only after catheter ablation while other complications were in all groups: uterine blood flow violation (n=6, 40% vs. n=4, 14.3% vs. n=6, 13.6%, p=0.168) and preeclampsia (n=1, 6.7% vs. n=1, 3.6% vs. n=2, 4.5%, p=0.730). Obstetric outcomes characterized by prevalence of vaginal delivery in all groups (n=13, 86.7% vs. n=22, 78.6% vs. n=37, 84%, p=0.465). Neonatal outcomes characterized by normal range of fetal birth weight and 5 minute Apgar score in all groups (3140.7±321.2 vs. 3265,3±290,1 vs. 3312,3±209,8 grams, p=0.701 and 8,6±1,1 vs. 8,5±1,2 vs. 8,6±1,2, p=0.721 respectively). There was no incidence of maternal and fetal mortality and arrhythmia recurrence after ablation in follow-up.

Conclusions

Supraventricular tachycardia is common in pregnancy. Arrhythmias in pregnant characterized by benign gestation course and outcomes regardless different management.
Key influences of VDD (DX) ICD selection: results from a prospective, national survey
Authors: Vamos M , Nemeth M , Kesoi B , Papp R , Polgar B , Ruppert M , Mikler C S , Liptak A , Selley T , Balazs T , Szili-Torok T , Zima E , Duray G
Published: May 2024

Background

To preserve the benefit of atrial sensing without the implantation of an additional lead, a single-lead ICD system with a floating atrial dipole (VDD or DX ICD) has been developed.

Purpose

The purpose of this nationwide survey was to provide an overview of the current key influences of device selection focusing on DX ICD systems and to test the applicability of a previously published decision-making flowchart of ICD type selection in the daily clinical practice.

Methods

An online questionnaire was sent to all implanting centers in Hungary. In total, 10 centers participated in the survey and reported data from 361 DX ICD and 10 CRT-DX systems implantations between February 2021 and May 2023.

Results

The most important influencing clinical factors indicated by the participating doctors were elevated risk of atrial fibrillation/stroke (56%), risk of sinus/supraventricular tachycardias (42%), and a potential need for CRT upgrade in the future (36%). The DX ICD was considered in the majority of cases instead of the VVI system (87%), and only in a small proportion instead of a DDD ICD (13%). 60% of the patients with DX ICDs were also included into remote monitoring-based follow-up. In 83% of the cases, good (>2 mV) or excellent (>5) atrial signal amplitude was recorded within 6 weeks after the implantation.

Results

In the current nationwide survey, the most important influencing clinical factors indicated by the responding doctors for selecting a DX ICD were the elevated risk of stroke or sinus/supraventricular tachycardias and a potential need for CRT upgrade in the future. These findings support the use of a previously published decision-making flowchart.Graphical abstract
Clinical and electrophysiological characteristics and long term outcomes of catheter ablation for right and left atrial tachycardias
Authors: Kilic S , Coteli C , Yorgun H , Aytemir K
Published: May 2024

Background

Atrial tachycardias (AT) are complex supraventricular tachycardias which are refractory to antiarrhythmic drugs that require catheter ablation.

Purpose

In this trial, we aimed to evaulate the outcomes of catheter ablation in patients with symptomatic atrial tachycardia, define the acute procedural success and the recurrence rates in long-term follow-up and determine the clinical and electrophysiological features that affect these outcomes.

Methods

A total of 666 [mean age: 55 ±16, gender: 344 (51.7%) female] symptomatic patients with AT were enrolled. Prior catheter or surgical ablation history for ATa was present in 199 (29.9%) and 18 (2.7%) of these patients, respectively. Activation mapping was performed during tachycardia in all patients as well as entrainment mapping when needed. Voltage mapping were performed in sinus rhythm in both atriums, late potential mapping was also performed in some patients. Low voltage areas and signals with continuous-fragmented morphology were tagged.

Results

Macroreentry was the primary mechanism in right and left atrium (70.2% and 52.8%, respectively). Cavotricuspid isthmus (CTI) dependent macroreentry was the most frequent mechanism in right ATs and perimitral reentry and roof-dependent macroreentry were the most common mechanisms in left ATs. A total of 59 (7.5%) complications were observed in 780 procedures.(2.1% major and 5.5% minor) Acute procedural success was 95.9%. Freedom from ATa was 72.8 % during a mean follow-up of 39±23 months. Freedom from ATa after index procedure was 82.3% at 12 months and 75.9 % at 24 months. After multiple procedures, freedom from ATa was 90% at 12 months and 86% at 24 months during the follow-up. In multivariate Cox regression analysis, atrial fibrillation (AF) [(HR) 2.43, 95% c(CI) 1.78-3.30; p<0.001] , history of cardiac surgery [(HR) 1.68, 95% c(CI) 1.22-2.30; p=0.001] and moderate to severe tricuspid regurgitation [(HR) 1.47, 95% c(CI) 1.08-2.01; p=0.014] were significant predictors of ATa recurrence.

Conclusion

Our findings demonstrated that tailored catheter ablation of ATs especially guided by high density mapping has a high acute success rate and favourable long-term outcomes in patients with symptomatic AT episodes.
Impact of different ablation strategies during very high power short duration ablation: insights from the multicentric AIR HPSD registry
Authors: Poggi S , Lepiliier A , Grimaldi M , Scaglione M , Zucchelli G , Iacopino S , Rossi L , Mantovan R , Pandozzi C , Giomi A , Strisciuglio T , Stabile G , Solimene F
Published: May 2024

Background

The very high power short duration ablation by mean of the QDOT Micro catheter was demonstrated to be safe and effective to achieve pulmonary vein isolation (PVI) in atrial fibrillation (AF) patients. Data from large multicentric registries are still lacking.

Purpose

We sought to investigate whether different ablation approaches may impact procedural outcomes. First, the hybrid approach (Qmode+, 90 W for 4 sec, at the posterior wall of the left atrium and Qmode modality AI-guided at the anterior wall) was compared to the ablation performed exclusively with the Qmode+ modality. Second, we investigated the impact of the type of anesthesia.

Methods

The AIR HPSD registry is a multicentric real world data registry including patients undergoing AF ablation by mean of the QDOT Micro catheter. The ablation modality (hybrid/ Qmode+) and the type of anesthesia were left to operators’ preference.

Results

Overall, 330 patients were enrolled, 67% males, 71% had paroxysmal AF, the mean age was 61±11. Pulmonary vein isolation was reached in 100% regardless of the ablation modality or the anesthesia used. As for the first pass isolation (FPI) there was a trend toward higher rates in the hybrid group compared to the Qmode+ group (85% vs 74%, p=0.1). No differences in FPI were found between the general anesthesia/deep sedation group and the conscious sedation group (83% vs 81%, p=0.8), however when considering the Qmode+ group solely, the FPI was significantly higher in the general anesthesia/deep sedation group (84% vs 56%, p=0.006). As for the procedural time, this was significantly shorter in the general anesthesia/deep sedation compared to conscious sedation (82±21 vs 97±35 min, p<0.01), as well as in the Qmode+ group compared to the hybrid group (80±31 vs 102±30 min, p<0.01). Minor complications were observed in 1% of patients with no significant differences between groups.

Conclusions

The PVI can be safely and effectively obtained with both approaches, hybrid or Qmode+ solely, however the rate of FPI seems higher with the hybrid one. When adopting solely the Qmode+ modality the general anesthesia increases the rate of FPI.
Organized patterns of excitation during persistent atrial fibrillation in humans relate to tissue structure and activation rate
Authors: Testa Alonso D , Martinez Camblor P , Goni L , Salgado M , Sanchez C , Alvarez Velasco R , Martinez Leon A , Garcia Iglesias D , Filgueiras Rama D , Salgado R , Quintanilla J , Redondo A , Perez Villacastin J , Perez Castellano N , Calvo D
Published: May 2024

Background

The contribution of organized patterns of excitation as mechanisms maintaining persistent atrial fibrillation (PAF) is questioned.

Purpose

We aim to analyze the relationship of focal and reentrant activities, identified with the CARTO-Finder system, with tissue structure and activation rate to explain potential link with mechanisms and outcomes.

Methods

33 patients with PAF of at least 6 months (24±4 months) were admitted for right and left atrial (RA & LA) mapping with the CARTO-Finder system. The biatrial geometry, bipolar Penta-Ray`s signals (30 sec long) and activation patterns were exported for off-line analysis (MatLab environment). A fast-Fourier transform was computed on 30 sec bipolar signal length segments to compute dominant frequency (DF) and represented on atrial shells. Focal and reentrant patterns of activation were superimposed, and correlation with DF and bipolar voltage analyzed.

Results

Biatrial mapping was performed obtaining 15.3±5 Finder maps from the RA and 15.9±5 Finder maps from the LA. Focal activities (182±151 at the RA & 270±21 at the LA) were documented in all patients at both atria. Rotational activities (more than 2 consecutive) were documented in the left atria in 4 patients (22.5±16.8 rotations) and in the right atria in 9 patients (35.5±32 rotations). 30 sec long activation rate was higher at places with focal activities compared with areas without organized patterns (DF: 6.11±0.09 Hz vs 5.7±0.09 Hz; p<0.001). The higher the number of consecutive focal activities, the higher the tissue activation rate (DF no focal activities 5.7±0.09 Hz vs DF 1-5 focal activities 6.0±0.14 Hz vs DF>5 focal activities 6.2±0.14 Hz; p<0.001). In addition, DF at focal activities strongly correlates with DF at areas without organized patterns (Pearson 0.91; p<0.001). The bipolar voltage was higher at places with focal activities compared with areas without organized patterns (1.0±0.04 mV vs 0.5±0.04 mV; p<0.001). None of the previous were observed at places with rotational activities (DF: 5.9±0.16 Hz vs 5.7±0.09 Hz; p=0.204 & Volt: 0.6±0.08 mV vs 0.5±0.04 mV; p=0.364). During follow-up after ablation (24±7 months), a cox regression model including number of focal activities, number of rotations, mean tissue activation rate (mean DF) and bipolar voltage, identified bipolar voltage as a unique independent predictor of survival free of AF recurrence (p=0.04).

Conclusions

Focal activities identified with the CARTO Finder system during PAF in humans correlate with tissue structure and activation rate, suggesting a potential link with mechanisms.
Pulmonary vein isolation with the radiofrequency balloon catheter: long-term results and predictors of ablation success
Authors: Del Monte A , Almorad A , Della Rocca D G , Pannone L , Vetta G , Cespon Fernandez M , Doundoulakis I , Marcon L , Monaco C , Bala G , Stroker E , Sieira J , Sarkozy A , Chierchia G B , De Asmundis C
Published: May 2024

Background

The novel multielectrode radiofrequency balloon catheter (RFB) has been demonstrated to achieve safe and effective pulmonary vein isolation (PVI). However, data on long-term ablation outcomes is lacking.

Purpose

This single-centre study aimed to evaluate the efficacy of the RFB beyond 1-year follow-up and define predictors of arrhythmia recurrence.

Methods

All consecutive patients with symptomatic paroxysmal atrial fibrillation (AF) undergoing first-time PVI with the RFB between January 2021 and November 2022 were prospectively included. Post-ablation remapping was systematically employed to confirm PVI at the end of the procedure. Procedural failure was defined as any atrial tachyarrhythmias (ATas) lasting >30 s occurring during the follow-up after a 3-month blanking period (BP). Patient characteristics, procedural parameters, and ATas recurrence during BP were analysed with respect to ablation outcome.

Results

A total of 120 consecutive patients (50 female, 42%; mean age 65±12 years) were enrolled. After a mean follow-up of 16.1±7.9 months, ATas recurrence occurred in 30 patients (25%). ATas were adjudicated as AF in 25 patients (83.3%) and as atrial tachycardia/atrial flutter in 5 patients (16.7%). The mean time from the index procedure to ATas recurrence was 203±130 days. A redo procedure was performed in 17 patients (56.7%) and at least one PV reconnection was observed in 12 patients (70.6%). Patients with ATas recurrence presented higher values of body mass index (31.0 ±5.7 vs. 28.1±4.9 kg/m2, p=0.048), larger left atria (43±11 vs. 35±9 ml/m2, p=0.003), and increased rates of ATas recurrence during the BP (53.3% vs. 2.2 %, p<0.001) compared to patients with persistent sinus rhythm. At multivariable Cox regression analysis, left atrial end-systolic volume index and ATas recurrence during the BP were independently associated with procedural failure (HR 1.05, 95%CI 1.00-1.11, p=0.048 and HR 23.88, 95%CI 7.71-73.99, p<0.001, respectively).

Conclusion

At 16 months follow-up, PVI with the RFB resulted in freedom from arrhythmia relapse in 75% of patients. Left atrial end-systolic volume index and ATas recurrence during the BP were independent predictors of arrhythmia recurrence.ATas-free survivalPredictors of ATas recurrence
Impact of early atrial arrhythmia recurrence on long-term CryoPVI success
Authors: Rothe M , Boehmer A A , Nussbaum E , Wiedenmann L , Schneider K , Spork P , Keim C , Dobre B C , Kaess B M , Ehrlich J R
Published: May 2024

Background

According to current guidelines, the occurrence of atrial fibrillation (AF) recurrence within the first 90 days after pulmonary vein isolation (PVI) should not indicate re-do procedures. Accordingly, a 90-day blanking period is usually accepted. However, data suggests that early atrial arrhythmia relapses during the blanking period have an impact on the efficacy. The optimal period for indicating a re-ablation therefore remains unclear.

Methods

We prospectively analyzed consecutive AF patients who underwent cryoballoon PVI (CryoPVI) in a single-center cohort between 2018 and 2023. We divided patients into four groups according to arrhythmia recurrence (recurrence between 0-30 days, recurrence between 30-60 days, recurrence between 60-90 days and no recurrence within the first 90 days). CryoPVI was performed in a standardized procedure. At 3, 6, 12, 18, 24 and 36 months after CryoPVI follow up was performed. Efficacy endpoint was the occurrence of symptomatic atrial arrhythmia relapse.

Results

During the study period 1179 patients underwent a first CryoPVI. Of these, 84 patients (7.1%) had atrial arrhythmia relapse between 0-30 days, 38 patients (3.2%) had atrial arrhythmia relapse between 30-60 days, and 38 patients (3.2%) had a relapse between 60-90 days. Overall, 1019 (86.4%) patients didn’t have an atrial arrhythmia relapse between 0-90 days after CryoPVI. Primary efficacy endpoint incidence after 36 months was significantly higher in patients who experienced atrial arrhythmia relapse within the first 90 days (between 0-30 days 62.5% vs. between 30-60 days 70.1% vs. between 60-90 days 77.9% vs. no recurrence ≤ 90 days 41.6%, p<0.0001).

Conclusion

Atrial arrhythmia relapse within the first 90 days is associated with a reduced long-term efficacy of CryoPVI. Re-ablation should be indicated regardless of the time of recurrence.
Safety and efficacy of pulse field ablation of atrial fibrillation in patients aged over 75 years
Authors: Prevot A , Duthoit G , Badenco N , Waintraub X , Gandjbakhch E , Laredo M
Published: May 2024

Introduction

Pulse-field ablation (PFA) is an emerging atrial fibrillation (AF) ablation technology associated with a favorable safety profile and short procedural times. Elderly patients, in whom AF ablation indications are expanding, may be particularly suitable to PFA. However, in a recent large multicenter trial, patients older than 75 years were not included, so that data on PFA safety and efficacy in this population are scarce.

Methods

Consecutive patients who underwent PFA of AF at a single academic center were prospectively included in a local registry. Written informed consent was obtained. Clinical, imaging and procedural data was collected and routine care follow-up was performed locally.

Results

From 2022, out of 345 consecutive patients who underwent PFA of, 42 (13%) were aged ≥75 years. As compared to <75 years-old patients (mean age 61±3 years), elderly patients (mean age 78±4 years) were more frequently females (21 [51%] vs 121 [40%], P=0.02), had more frequently non-paroxysmal AF (27 [65%] vs 164 [54%], P=0.01), significant cardiac comorbidities (9 [21%] vs 33 [11%], P=0.01), and larger indexed left atrial volumes (65 mL/m2 [interquartile range (IQR) 54-76] vs 61 [IQR 54-68], P=0.04). With regards to procedural parameters, the total procedural length was comparable, while elderly patients received more frequently PFA applications outside the pulmonary veins. The rate of major complications was comparable, but 3 cardiac tamponades occurred in patients aged over 75 years, while none occurred in younger patients. After a median follow-up time of 185 days (IQR 65 – 202), the cumulative freedom from sustained atrial arrhythmia recurrence was not statistically different between patients aged over 75 years (75%, 95% confidence interval (CI) [62-84%]) and under 75 years (75%, 95% CI [62-84%], P=0.11).

Conclusions

PFA appear as a safe and effective technique for AF ablation in elderly patients, although there was an excess of cardiac tamponades in this group