bluuebunny/crossref_metadata_2025 huggingface dataset:
Covid 19 pandemic: the final boost for remote monitoring of implantable cardiac devices? : analysis from the nationwide remote monitoring registry (Covid-19 rm-spain)
Authors: Garcia Fernandez F , Calvo Simal S , Cano O , Calvo D , Villagraz L , Martin J , Cantero D , Aguilar Iglesias L , Fernandez Lozano I , Pombo M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Remote monitoring of implantable cardiac devices (CIEDs) has proven to be reliable, more efficient and even safer than conventional in-office follow-ups

However, its implementation has not been as desired. The COVID 19 pandemic and the need to keep patients away from hospitals may have been the final boost for this form of monitoring.

Purpose

We sought to evaluate the pre and post-pandemic trends in CIEDs remote monitoring activations from a large nationwide database in order to determine the global effect of the COVID-19 pandemic on CIEDs implants in Spain.

Methods

The Covid-19 Remote Monitoring Spain Registry (Covid-19 RM-Spain) is a survey supported by the Heart Rhythm Association of the Spanish Society of Cardiology to request the whole national data, regarding the number of CIED´s implants and remote monitoring activations from the five main manufacturers classified according to each autonomous community (not by institutions).All data were aggregated and anonymized to analyse the total sample. Appropriate permissions were granted to use the data and a confidentiality agreement was signed in order to avoid any transmission of sensitive information.

Results

The percentage of devices for which remote monitoring was activated was 24.5%; 28.4%, 42% and 49% in 2018, 2019 ,2020 and 2021, which implies that remote monitoring is now activated on more than twice as many devices in Spain as in 2018.

The table shows the differences in the percentages of remote monitoring activation between three different periods for each type of device. (Period 1 /pre-lockdown January 2018-February 2021; Period 2/ lockdown: March-June 2020 and Period 3/ lockdown: July 2020-December 2021.

Footnotes: Period A vs. B p<0,001 :1 ; Period A vs. C p<0,001:2; Period B vs. C p<0,001:3

Abbreviations : CRT-D: Cardiac resynchronization Therapy -Desfibrillator; CRT-P: Cardiac resynchronization Therapy -pacemaker; ICD: Implantable cardiac defibrillators; ILR: Implantable Loop recorders; LLPM: Leadles Pacemakers; PM: Pacemakers; S-ICD: Subcutaneous Implantable cardiac defibrillator.
Improving efficiency, confidence, and readability in ECG interpretation; the role of signal processing
Authors: Easlea H , Mccord N , Wallace E , Mckenna S , Gibbs A
Published: May 2023

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Project privately funded by B-Secur Ltd

Background

Electrocardiogram (ECG) interpretation is a crucial component in the cardiac clinical pathway that enables the triaging, diagnosis, and treatment of numerous medical conditions. However, noise contamination during signal acquisition can hinder clinical interpretation by hiding or distorting the pathology of the underlying ECG. By removing noise to uncover the true beat morphology, signal processing algorithms maximize the diagnostic value of the acquired ECG and reduce clinical burden by eliminating the need for costly and time-consuming repeat investigations.

Purpose

To evaluate the impact of robust signal processing software on the clinical interpretation and diagnosis of lead I ECGs. Additionally, to investigate whether signal processing could streamline the diagnostic process by revealing pathologies not previously seen in the ECG, improving the speed of diagnosis, and enhancing the readability of the ECG.

Methods

ECG strips (42 x 10 s) representative of a variety of beat morphologies, arrhythmias, and noise types were taken from a proprietary database and provided to healthcare professionals (N = 35) pre- and post-signal processing. Participants possessed varying degrees of experience (12 x Junior (<5 years), 10 x Experienced (5-10 years), 13 x Senior (>10 years)) and specialization in cardiology. Participants were asked to provide a rhythm annotation and corresponding confidence score for each strip when provided in a blinded, randomized order. Participants then provided an additional rhythm annotation when the raw and processed signals were presented side by side, in addition to answering three subjective questions on the impact of signal processing on the ECG interpretation process.

Results

Across all participants, 80.2% of processed ECG strips were able to be given a confident diagnosis. This increased to 86% when pre- and post-processed signals were provided alongside one another – an improvement of 10.8% over the raw signals (75.2%). In response to the questions, participants agreed that the processed signal had a positive or very positive impact on; i) helping to reveal a pathology not previously seen in the raw ECG (57% of strips), ii) speeding up the diagnosis (71% of strips), and iii) improving the readability of the ECG (80% of strips).

Conclusion

By effectively removing noise whilst retaining true beat morphology, signal processing increased the amount of clinically diagnostic ECG data and allowed clinicians to make a more efficient, confident diagnosis. With the positive impacts observed across all participant experience levels, the results suggest that robust signal processing has the potential to streamline the clinical interpretation of ECGs.
Association between CHARGE-AF risk score and LA mechanics: LA reservoir strain can be a single parameter for predicting AF risk
Authors: Tan Kurklu T S T , Korkmaz K , Akbulut Koyuncu I M , Akin K , Yamanturk Y Y , Kurklu H A , Kozluca V , Esenboga K , Dincer İ
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Aims

Atrial fibrillation (AF) is a prevalent arrhythmia and the leading preventable cause of car-

dioembolic stroke. Scoring systems for predicting AF risk do not use imaging modalities. We sought to determine whether LA longitudinal strain could be used as a single parameter for predicting the risk of AF.

Methods and results

Consecutive patients diagnosed with diastolic dysfunction between December 2019 and March 2020 were included. Two-dimensional, colour flow, continuous pulsewave, and tissue Doppler transthoracic echocardiography (TTE) were performed using a Vivid E9 imaging system (GE Medical Systems, Chicago, USA). Measurements were obtained in the standard manner recommended by the American Society of Echocardiography. Moreover, LA longitudinal strain was measured using 2D speckle tracking echocardiography in the four-chamber view to evaluate left atrial function. The CHARGE-AF scoring system was used to predict AF risk.

Methods and results

A total of 148 patients (mean age: 57.6 ± 11.9; male: 53%) with feasible views for LA strain measurement were divided into two groups based on a 10% CHARGE-AF cut-off score. The >10% group (48 patients; 32%) was defined as having a predicted 5-year AF risk >10%, and the 10% group (100 patients; 68%) was defined as having a predicted risk <10%. In the multivariate analysis, LA reservoir strain (LASr) was independently associated with CHARGE-AF score. Furthermore, using the Pearson correlation method, LASr was found to be highly correlated with CHARGE-AF score (r 1⁄4 –0.74, p < 0.0001).

Conclusions

LASr was highly correlated with CHARGE-AF risk score and may be used as a parameter to predict atrial myopathy and hence AF risk.
The connection between systemic inflammation activity and the state of renin-angiotensin system with the course of cardiac arrhythmias
Authors: Marchenko O , Sychov O , Talaieva T , Romanova O , Stasyshena O , Tretiak I
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): NSC "Institute of cardiology, clinical and regenerative medicine named after acad. Strazhesko" NAMS of Ukraine

The purpose of the work is to compare the clinical course of paroxysmal and persistent forms of atrial fibrillation and flutter, depending on the systemic­ inflammation­ activity and the renin-angiotensin system state.

Materials and methods

The study involved 147 patients, including 103 people with rhythm­ disturbances, who werer divided into three main groups (with paroxysmal atrial fibrillation, persistant atrial fibrillation and persistant atrial flutter). Systemic inflammation activity was determined by the level of highlysensitive C-reactive protein in the serum. Renin-angiotensin activity ­ system was characterized by the angiotensin-converting factor level.The activity of ACE in blood plasma was determined by an express method using FAPGG as a substrate ("Sigma", USA), tris(oxymethyl)-aminoman, sodium chloride, EDTA ("Merck", Germany).

Results

The level of highlysensitive C-reactive protein in patients with Af and AFl was significantly elevated in 6. 7 times and was (8. 31±0. 42) against (1. 25±0. 01) mg/l is normal (p<0. 001). In the group with the persistent form of AF, the content of CRP was higher than in the group with paroxysmal form of AF, by 8. 5%, although the difference between the groups was unreliable.

ACE activity in the blood plasma of the pts with arrhythmia was likely elevated, as the rateof ACE was 45. 10±2. 26 μkat/L and exceeded the nominal value by 180 %. 86 patients with rhythm disturbances, which was 83%, there was a significant increase of CRP level . Among patients with paroxysmal FP, it was 31 patients (88%), in the group with a persistent form of FP - 30 patients (78%) and in the presence of TP - 25 patients (83%, respectively). In contrast, in patients without rhythm disturbances who had hypertension and relatively healthy people, the number of patients with elevated levels is highly sensitive th CRP was only 9%, i.e. 4 patients. Comparing the data strong statistical significance was revealed. (p< 0.005).

Conclusions

An increased level of highlysensitiveC-reactive protein as a marker of systemic inflammation is observed in groups of patients with arrhythmias compared with patients with hypertension without rhythm disturbances, indicating a higher intensity of systemic inflammation. Serum ACE levels in 82 % of patients with arrhythmias were higher than normal compared to 27 % of patients without rhythm disturbances (p<0. 05), which may indicate hyperactivation of RAAS.
Etiological and molecular determinants of atrial endomysial fibrosis: results from the CATCH ME consortium
Authors: Winters J , Kawczynski M , Zeemering S , Isaacs A , Casadei B , Fabritz L , Kirchhof P , Chua W , Guasch E , Sinner M F , Kaab S , Hatem S , Verheule S , Stoll M , Schotten U
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): CATCH ME: Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly

Background

We recently demonstrated that in human atria, endomysial fibrosis causes conduction disturbances during atrial fibrillation (AF), while overall connective tissue content (over-all fibrosis) has no effect. Etiological and molecular determinants of endomysial fibrosis are largely unknown.

Methods

We quantified over-all and endomysial atrial fibrosis using staining with WGA in left (LA, n=95) and right (RA, n=76) atrial appendages sampled from a European cohort (CATCH ME) of patients undergoing cardiac surgery. The contributions of AF, heart failure (HF), sex, age, and 4 principal components accounting for confounding clinical characteristics to over-all and endomysial fibrosis were determined in a multivariate model. RNA sequencing was performed to explore biological pathways associated with the two types of fibrosis.

Results

Over-all and endomysial fibrosis were moderately correlated (LA: r=0.69, RA: 0.61, both p<0.001) and more pronounced in RA than in LA samples (p<0.001). In LA, persistent AF, female sex, and HF were independently associated with endomysial fibrosis, while over-all fibrosis was only associated with sex and HF. Likewise, in RA, persistent AF was associated with endomysial fibrosis, while over-all fibrosis was not. Expression of 18 genes was univariately associated with endomysial fibrosis in LA but only 1 in RA. There were no genes associated with over-all fibrosis. After correction for relevant clinical traits, BMP10 showed the strongest association with endomysial fibrosis amongst coding genes (p=3.16E-04, LA). In an independent validation cohort (RACE V Tissue Bank Project, n=162 pts undergoing cardiac surgery), out of 11 biomarkers reflecting inflammation, fibrosis, vascular dysfunction, or ischemia, BMP10 plasma levels were most strongly associated with endomysial fibrosis (p<0.001), but not with over-all fibrosis.

Conclusions

Taken together, female sex, HF, and AF are the main drivers of fibrosis in human atria. However, endomysial fibrosis is independently associated with AF whereas over-all fibrosis is not. BMP10 is a specific marker of endomysial fibrosis. Our findings suggest that distinct mechanisms are involved in the development of over-all versus endomysial fibrosis in human atria and may provide an explanation for the recently reported predictive value of BMP10 biomarkers levels for AF recurrences after AF ablation and for stroke.
Heart failure, female sex and atrial fibrillation are the main drivers of atrial cardiomyopathy in cardiac surgery patients: results from the CATCH ME consortium
Authors: Winters J , Zeemering S , Isaacs A , Kawczynski M , Casadei B , Fabritz L , Kirchhof P , Guasch E , Chua W , Hatem S , Sinner M F , Kaab S , Verheule S , Stoll M , Schotten U
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): CATCH ME: Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly

Background

Atrial cardiomyopathy is emerging as independent prognostic factor in cardiovascular disease. Fibrotic remodeling, cardiomyocyte hypertrophy and a reduction in capillary density are histological hallmarks of atrial cardiomyopathy. The contribution of etiological factors to atrial cardiomyopathy has not been robustly quantified.

Purpose

To quantify the relation between histological features of atrial cardiomyopathy and the clinical profile of patients.

Methods

We examined left (LA, n=91) and right (RA, n=75) atrial appendages sampled from a European cohort of patients undergoing cardiac surgery. Quantification of histological cardiomyopathy features was performed a recently developed and validated imaging analysis algorithm following myocardial triple staining with wheat germ agglutinin (WGA), CD31 and vimentin. The contributions of AF, heart failure (HF), sex, age, and 4 principal components accounting for confounding clinical characteristics to over-all and endomysial fibrosis were determined in a multivariate model. K-means clustering of 6 atrial histological features was performed to identify different types of remodeling.

Results

LA samples showed less fibrosis (p<0.001), a higher capillary density (p<0.05), a smaller capillary size (p<0.05), and larger cardiomyocytes (p<0.01) than RA samples. In both LA and RA, persistent AF was associated with endomysial fibrosis, while over-all fibrosis was not. Men had larger cardiomyocytes (LAA), while women had a higher degree of endomysial fibrosis (LA). Heart failure patients had more endomysial and over-all fibrosis (LA), a higher capillary density (LA) and capillary size (LA/RA).

Samples clustered into 2 distinct clusters. One cluster showed fibrotic cardiomyopathy, with more endomysial (p<0.001) and overall fibrosis (p<0.001), more fibroblasts (p<0,001) and a higher capillary density (p<0.001). The other cluster showed hypertrophic cardiomyopathy, with hypertrophic cardiomyocytes (p<0.001). Patients with fibrotic cardiomyopathy were more often female (LA and RA, p<0.003) and had more often persistent AF (LA, p=0.031) or heart failure (LA, p<0.001). Patients with hypertrophic cardiomyopathy were more often male (LA and RA, p<0.003).

Conclusions

Fibrotic cardiomyopathy is associated with female sex, persistent AF and heart failure while hypertrophic cardiomyopathy more often occurs in men. More research is needed to establish whether treatment of AF and heart failure prevents the development of atrial cardiomyopathy.
Decreasing microtubule detyrosination by parthenolide restores sodium current in mdx cardiomyocytes
Authors: Casini S , Nasilli G , De Waal T , Dekkers Y , Van Amersfoorth S , Marchal G A , Rothenberg E , Delmar M , Remme C A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The cardiac sodium channel Nav1.5 is transported to the membrane by the microtubule network. Alterations in microtubule dynamics are known to impact on ion channel trafficking. Pathophysiological conditions such as heart failure and Duchenne muscular dystrophy (DMD) are associated with an increase in microtubule detyrosination as well as a decreased sodium current (INa) and pro-arrhythmia. Parthenolide, a compound that decreases the fraction of detyrosinated microtubules, has been shown to have beneficial effects on cardiac function in DMD mice, but its impact on INa has not been investigated.

Methods and Results

Cardiomyocytes (CMs) from wild type (WT) and mdx (DMD) mice were used to investigate the effect of parthenolide. Cells were incubated with either 10 µM parthenolide or DMSO for 3-5 hours. INa and action potential (AP) characteristics were assessed using the patch-clamp technique, while immunofluorescence and stochastic optical reconstruction microscopy (STORM), were used to investigate microtubule detyrosination and Nav1.5 cluster density, respectively. In accordance with previous studies, we observed increased levels of detyrosinated microtubules and decreased INa in mdx CMs compared to WT. Treatment with parthenolide decreased the fraction of detyrosinated microtubules and significantly increased INa magnitude in mdx CMs, but had no effect on INa in WT CMs. Accordingly, parthenolide significantly increased AP maximal upstroke velocity in mdx CMs, without affecting other AP properties. Parthenolide did not affect INa gating properties, indicating that it increased INa by enhancing Nav1.5 membrane trafficking. Indeed, STORM analysis showed that parthenolide increased Nav1.5 cluster density at both the lateral membrane (crest) and intercalated disc region in mdx CMs while it had no effect on WT CMs.

Conclusions

Parthenolide restores INa and Nav1.5 membrane expression in mdx CMs, and may be of potential benefit in other pathophysiological conditions associated with increased microtubule detyrosination and reduced INa. Further elucidation of the impact of microtubule dynamics on Nav1.5 may identify additional therapeutic targets for restoring conduction and preventing arrhythmias.
The relationships between the plasma metabolome and orthostatic blood pressure responses
Authors: Zambach C , Jingxue P , Gerward S , Fedorowski A , Smith G , Engstrom G , Hamrefors V
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): the Swedish Heart-Lung Foundation

Objective

Impaired orthostatic blood pressure responses may be an indicator of cardiovascular autonomic dysfunction, which can be seen in the metabolic syndrome. Whereas autonomic dysfunction and the metabolic syndrome are clinically associated, the relationships with the plasma metabolome is unknown.

We explored the association between orthostatic blood pressure responses and over 800 plasma metabolites in middle-aged subjects from the general population.

Methods

We included 3,803 subjects (mean age, 57 years; 52 % women) with information on smoking habits, diabetes, antihypertensive drug treatment, anthropometrics, hemodynamic measurements and 818 plasma metabolites (mass-spectrometry). The associations between each metabolite and orthostatic systolic blood pressure responses as well as orthostatic hypotension were determined using multivariable linear regression analysis. The Bonferroni corrected p-value was used in this study (p value < 6.11×10-5 (0.05/818) and 2.273×10-3 (0.05/22) respectively).

Results

We identified five amino acids, five vitamins, co-factors and carbohydrates, nine lipids and two xenobiotics that were associated with orthostatic blood pressure responses. After additional adjustments for BMI, diabetes, smoking and antihypertensive treatment, the association remained significant for six lipids, four amino acids and one xenobiotic, with the most significant relationships for lipids in the dihydrosphingomyelin and sphingosine pathways.

Conclusions

In this exploratory study, we found that 22 out of 818 plasma metabolites were associated with orthostatic blood pressure responses. Eleven metabolites, including lipids in the dihydrosphingomyelin and sphingosine pathways, were independently associated with orthostatic systolic blood pressure responses after additional adjustment for markers of cardio-metabolic disease.
Electrocardiographic markers of subclinical atrial fibrillation detected by implantable loop recorder
Authors: Xing L Y , Diederichsen S Z , Hojberg S , Krieger D W , Graff C , Olesen M S , Nielsen J B , Brandes A , Kober L , Haugan K J , Svendsen J H
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): The LOOP Study was funded by Innovation Fund Denmark [grant number 12-1352259], The Research Foundation for the Capital Region of Denmark, The Danish Heart Foundation [grant number 11-04-R83-A3363-22625], Aalborg University Talent Management Program, Arvid Nilssons Fond, Skibsreder Per Henriksen, R og Hustrus Fond, the European Union’s Horizon 2020 program [grant number 847770], Læge Sophus Carl Emil Friis og hustru Olga Doris Friis’ Legat, and an unrestricted grant from Medtronic.

Background

Atrial fibrillation (AF) is a well-known and treatable risk factor for stroke, which has sparked a substantial interest in AF screening. However, further insights into subclinical AF development are warranted to inform strategies of screening and subsequent clinical management upon AF detection.

Purpose

This study sought to identify 12-lead electrocardiogram (ECG) parameters associated with the onset, burden and progression of subclinical AF detected by long-term continuous monitoring.

Methods

We included AF-naïve individuals aged 70-90 years with ≥1 additional stroke risk factors (hypertension, diabetes, heart failure, or prior stroke) who underwent implantable loop recorder (ILR) monitoring in the LOOP Study. Using data from daily ILR recordings and computerized analysis of baseline ECG, we studied empirically selected ECG parameters for AF detection (≥6 minutes), cumulative AF burden, long-lasting AF (≥24 hours), and AF progression.

Results

Of 1370 individuals included, 419 (30.6%) developed AF during follow-up, with a mean cumulative AF burden of 1.5% [95% confidence interval (CI): 1.2-1.8%]. Several P-wave-related and ventricular ECG parameters were associated with new-onset AF as well as with cumulative AF burden in AF patients. P-wave duration (PWD), P-wave terminal force in lead V1, and interatrial block (IAB) further demonstrated significant associations with the risk of AF episode ≥24 hours. Among AF patients, we observed an overall reduction in cumulative AF burden over time (incidence rate ratio 0.70 [95% CI: 0.51-0.96]), whereas IAB was related to an increased risk of progression to AF episodes ≥24 hours (hazard ratio 1.86 [95% CI: 1.02-3.39]). Further spline analysis revealed longer PWD to also be associated with this progression in AF duration.

Conclusions

We identified several ECG parameters associated with new-onset AF detected by ILR. Especially PWD and IAB were robustly related to the onset and the burden of subclinical AF as well as progression over time.
Left atrium surface mesh reconstruction from cardiac MRI
Authors: Sharp A , Pope M T B , Wijesurendra R , Gala A , Betts T R , Banerjee A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The strive towards personalised medicine is universal across all aspects of healthcare. In the management of atrial fibrillation (AF), this can take the form of shape analysis tools to predict an individual’s outcome from catheter ablation (1–3), or electrophysiological simulations to plan an ablation strategy (4–6).

Fundamental to their application is our ability to derive accurate three-dimensional (3D) anatomical models of a patient’s left atrial geometry from cross-sectional imaging. MRI is widely utilised in this regard due to its excellent tissue characterisation. However, constructing surface meshes can be challenging given its relatively sparse two-dimensional (2D) image planes. A particular challenge exists in producing a mesh that balances concordance with left atrium segmentation and smoothing terms to eliminate sharp edges and artifact from the contouring process.

Objective

Here, we describe a novel method for left atrium surface mesh reconstruction from MRI contours.

Methods

Cardiac MRI was performed on ten patients with paroxysmal or persistent AF, on a 3T clinical MR scanner using phased-array receiver coils. Image sequences included respiratory and ECG-gated 15-minute post contrast late gadolinium enhancement, with a 1.3mm slice thickness and in-plane resolution of 0.66×0.66mm2. Seven individuals were in sinus rhythm, and three in AF at the time of MRI.

A single, custom, graphical interface tool implemented in Matlab R2014a enabled 3D mesh reconstruction from 2D MRI slices (7,8). Endocardial surfaces of the left atrium were manually segmented by an experienced clinician, with the pulmonary veins and left atrial appendage excluded at their ostia (Figure 1A). Our tool produced an initial sparse representation with vertices equally spaced along the contours (Figure 1B). Attractor points were defined along the contours, with subdivision and Laplacian smoothing applied to the mesh. This was balanced with a deformation step, which iteratively pulled the mesh towards the attractor points (Figure 1C), resulting in its final shape (Figure 1D).

Results

Reconstruction performance was evaluated by measuring the distance between heart contours and the reconstructed 3D surface for each case, producing the value for average misalignment 0.71 ± 0.58mm, which compares favourably to the in-plane resolution.

Conclusions

Our approach offers a highly accurate method for producing 3D anatomical models of the left atrium from MRI, which is fully automated following segmentation through an interactive graphical interface. The iterative optimisation between attractor-based deformation towards the original contours and the Laplacian smoothing enables us to create smooth geometries which remain true to their segmentations. Furthermore, our approach does not require the use of a template mesh, which can result in final geometries being biased towards the template.
Use of intracardiac echocardiography in Latin America: a case series
Authors: Mejia Lopez E , Matos C , Santana Mejia G , Joubert L M , Rivera C
Published: May 2023

Funding Acknowledgements: Type of funding sources: None.

The use of Intracardiac Echocardiography (ICE) for cardiac arrhythmia ablations has been associated with reductions in fluoroscopy dose and procedure time, while enabling operators to locate the ablation catheters more accurately in the setting of complex arrhythmias. The added cost of ICE per procedure is a significant barrier for its implementation in developing countries. Reprocessing ICE catheters could be the alternative that allows electrophysiologist working with limited resources to implement this state of the art tool.

Electrophysiology procedures using ICE in a private practice in the Dominican Republic that reprocess ICE catheters were retrospectively evaluated. Complications and reported compromise of the structural integrity or the quality of the images were recorded. The total cost of the catheters was distributed among the amount of cases where they were used to determine cost-per-use of each catheter.

In the evaluated period, 2 catheters were used for 26 procedures, submitting each catheter to 12 reprocessing cycles. There was no reported compromise of the structural integrity of the catheter or the quality of the image. The only complication reported was 2 pericardial effusion after an ablation of atrial fibrillation plus atrial flutter; notwithstanding, the events were not related to the performance of the ICE. Distributing the cost of each catheter among a total of 13 uses per catheter, the total cost per use of ICE catheter was US$265.38.

Reprocessing of ICE catheters was safe and effective in the series of patients evaluated. The complications reported were not attributed to the performance of the ICE catheter. A significant reduction of the cost of the catheter from original amount implies a potential increase in the use of this technology in the Dominican Republic, without compromise on the benefits. This could also serve as a model for the implementation of ICE in other developing countries of the region.
Quality of life and perception after pulmonary vein isolation and app-based mental training - Results from the randomized controlled MENTAL AF Trial
Authors: Lurz J A R
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): German Heart Foundation

Introduction

It was recently shown that app-based mental training (MT) reduces atrial fibrillation (AF) related symptoms as compared to usual care in patients undergoing catheter ablation for AF. We now report the effect of MT on quality of life (QoL) and AF burden.

Methods

MENTAL AF was a RCT with two parallel treatment groups enrolling patients undergoing catheter ablation for symptomatic AF during August 2019 and July 2021. Patients were randomized in a 1:1-ratio to app-based MT or usual care. The MT group gained access to a daily 10-minute app-based breathing, relaxation and meditation training, with a minimum requirement of 2 sessions/week.

A total of 183 patients were randomized of which 151 could be included in the final analysis (76 in the MT and 75 in the usual care group).

The primary outcome was the intergroup difference of the mean AF6 sum scores during the 3 months study period. Secondary outcomes included web-based QoL measures as assessed by the AF Effect on Quality of Life (AFEQT) and PROMIS Global Health as well as time in AF/atrial tachycardia documented on 7-day Holter.

Results

Baseline characteristics were well balanced between the MT vs control group, respectively: mean (SD) age 60.6 (8.7) vs 61.5 (8.7) years, female patients 42 vs 40%, paroxysmal AF 55 vs 55%, and left ventricular ejection fraction 58.0 (7.3) vs 57.5 (7.8) %. The primary outcome of AF6 sum score was 8.9 (6.9) points in the MT and 12.5 (10.1) in the usual care group (P = .011). The median difference of the AFEQT Global Score from baseline to 3 month was 18.3 (IQR 11.7 to 35) in the MT and 10.8 (IQR 1.7 to 31.7) in the usual care group (P = .026). The PROMIS Physical Health domain improved by 4.6 (IQR 0; 7.5) in the MT as compared to 0 (-2.6; 4.7) in the usual care group; P = .000. As for the Mental Health domain there was a trend towards a more pronounced improvement [2.9 (IQR 0 to 5.2) vs 0.8 (IQR -2.6 to 4.7); P = .061].

On 3-month follow-up 7-day-Holter 10 patients (16.9 %) in the MT vs 11 patients (14.3 %) in the usual care group exhibited AF/ atrial tachycardia (P = .67). During the registration period 35 patients (53.8 %) in usual care and 25 patients (35.7 %) in MT reported heart rhythm-related symptoms (P = .034).

Conclusion

MENTAL AF shows that an app-based mind & body intervention as an adjunctive treatment tool improves QoL despite an equal actual arrhythmia burden on 7-day Holter. These results suggest that mental training unfolds its effect by a modification of disease perception and coping.
Anterior mitral line in patients with persistent AF and anterior scar: a multicenter matched comparison. The MiLine Study
Authors: Bergonti M , Spera F R , Gonzalez Ferrero T , Nsahlai M , Saenen J , Huybrechts W , Miljoen H , Heidbuchel H , Valderrabano M , Rodriguez Manero M , Sarkozy A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The benefit of an anterior mitral line (AML) in patients with persistent atrial fibrillation (AF) and anterior atrial scar undergoing ablation has never been investigated.

Objective

to evaluate the outcomes of AML on top of standard treatment, compared to standard treatment alone (no-AML), in this subset of patients.

Methods

Patients with persistent AF and anterior low voltage zone (LVZ) treated with AML in three Centers were retrospectively enrolled. These patients were matched in a 1:1 fashion with patients with persistent AF and anterior LVZ, who underwent conventional ablation, in the same centers. Matching parameters were: age, LVZ burden, and repeated ablation. Primary endpoint was AF/atrial tachycardia (AT) recurrence.

Results

186 patients (66±9 years, 34% women) were selected and included into two matched groups. Bidirectional conduction block was achieved in 95% of AML. After a median follow-up of 2 years, AF/AT recurrence occurred in 29% of the patients in the AML-group, vs. 48% in the No-AML-group (log-Rank p=0.024) (Figure 1). At Cox-regression multivariate­-analysis left atrial volume (HR 1.03, p=0.006) and AML (HR 0.46, p=0.003) were significantly associated with the primary endpoint. At univariate logistic-regression, lower BMI, older age, extensive anterior LVZ and the position of the left atrial activation breakthrough away from the AML (Figure 2), were associated with first-pass AML block.

Conclusion

In this retrospective matched analysis of patients with persistent AF and anterior scar, AML on top of standard treatment was associated with improved AF/AT-free survival compared with matched patients treated with standard treatment alone.
Cryoballoon ablation for atrial fibrillation in octogenarians: a propensity-score matching comparison with a cohort of younger patients
Authors: Cecchini F , Mugnai G , Kazawa S , Bolzan B , Iacopino S , Maj R , Placentino F , Ribichini F , Sieira J , Sofianos D , Sorgente A , Tomasi L , De Asmundis C , Chierchia G
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation (AF) is the most frequent sustained cardiac arrhythmia in adults with a current estimated prevalence between 2-4% in the general population. AF prevalence increases with advancing age and it is estimated that nearly 10% of octogenarians may be affected by this arrhythmia. In terms of safety and efficacy Cryoballoon ablation (CB-A) has become a valid option for achieving pulmonary vein isolation (PVI) in patients affected by AF. However, data regarding CB-A in octogenarians are still scarce and limited to single center experiences, therefore the present multicenter study aimed to compare the outcomes and complications of index CB-A in patients older than 80 years-old with a cohort of younger patients.

Methods and Results

We retrospectively enrolled 97 consecutive patients aged ≥ 80 years who underwent PVI by means of the second generation CB-A. This group was compared with a younger cohort of patients using a 1:1 Propensity score matching. After the matching, 70 patients of the elderly group were analyzed and compared with 70 younger patients (control group). Mean age was 81.4 ± 1.9 years among octogenarians and 65.2 ± 10.2 years in the younger cohort. The global success rate after a median follow up of 23 [18 - 32.5] months was 60.0% in the elderly group and 71.4% in the control group (p = 0.17) (Fig.1). Phrenic nerve palsy (PNP) was the most common complication occurring in a total of 11 patients (7.9%): in 6 (8.6%) patients for the elderly group and in 5 patients (7.1%) of the younger group (p = 0.51). PNP always recovered within the day after CB-A and did not hinder electrical isolation of any of the septal PVs. Only 2 (1.4 %) major complications occurred: 1 (1.4%) small femoral artery pseudoaneurysm in the control group, which resolved with a tight groin bandage without the need of surgical repair and 1 (1.4%) case of urosepsis in the elderly group with subsequent acute kidney failure and need of renal replacement therapy. Arrhythmia recurrence during the blanking period (BP) and need of electrical cardioversion (ECV) to restore sinus rhythm after PVI were found to be the only independent predictors of late arrhythmia relapses (Fig.2).

Conclusions

The present study showed that CB-A PVI is as feasible, safe and effective among octogenarians as it is in younger patients.
Efficacy and safety outcomes of early versus late cryoballoon ablation of atrial fibrillation - 24-months-results from the Cryo Global Registry
Authors: Lawin D , Stellbrink C , Chun K R J , Li C H , Kueffer F , Selma J , Oh I Y , Herzet J , Nitta J , Chang T Y , Lawrenz T
Published: May 2023

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Medtronic, Inc., Minneapolis, MN, USA

Introduction

Increasing evidence suggests early rhythm-control therapy in atrial fibrillation (AF) results in higher freedom from atrial arrhythmia (AA) recurrence and improved cardiovascular outcomes. However, the impact of specifically early cryoballoon ablation (CBA) is not well known.

Purpose

To assess the impact of early CBA of atrial fibrillation on efficacy and safety outcomes.

Methods

We evaluated AA recurrence (≥30 sec after a 90-day blanking period), repeat ablation, and serious procedure-related complications in patients with early vs. later CBA (≤12 vs. >12 months from diagnosis) in patients enrolled in the prospective, multicenter (121 centers in 37 countries). Subjects underwent CBA and were followed either 12 or 24 months per local standard of care.

Results

A total of 3447 subjects were followed through 12 months and a subset of 1220 through 24 months. In summary, 1573 patients (46%) had early CBA treatment at a median [IQR] of 0.3 [0.1 – 0.6] years from AF diagnosis (age 62±12 years, 35.8% female, 71.4% paroxysmal AF), and 1874 (54%) had later treatment at a median of 3.4 [1.9 – 6.7] years after diagnosis (age 61±11 years, 36.2% female, 75.0% paroxysmal AF). Early treatment patients were less hypertensive (53.5% vs 57.9%, p=0.01), had smaller left atrial diameters (41±7mm vs 42±7mm, p<0.01), lower BMI (27±5kg/m2 vs 28±5kg/m2, p<0.01), and less AF symptoms (1.5±1.1 vs 1.8±1.1, p<0.01). Early treatment was associated with higher acute procedural success (97.1% vs 95.2%, p<0.01). Freedom from AA recurrence in the early vs. later group was 86.0% (95% CI: 83.9-87.9%) vs. 81.0% (95% CI: 79.0-82.8%) at 12 months and 80.9% (95% CI: 77.9 – 83.5%) vs. 72.0% (95% CI: 69.0 – 74.7%) at 24 months (both P<0.01). Freedom from repeat ablation was high and not different between early and later treatment groups at 12 (93.6% vs 93.8%) and 24 months (90.2 vs. 89.2%), respectively (p=0.82). Serious procedure-related adverse events occurred in 2.4% and 3.5% of patients in the early and later treatment groups (p=0.045), respectively.

Conclusions

After AF diagnosis, early vs. later CBA results in higher freedom from AA recurrence and is associated with fewer safety events in a real-world evaluation. The difference in comorbidities at baseline between the two cohorts may contribute to the CBA being less effective in the later treatment cohort.
A single atrial stimulation resetting his bundle during tachycardia: a new diagnostic methods of atrial tachycardia distinguishing from other tachycardias
Authors: Inaba O , Nakata K , Michishita T , Isonaga Y , Kono T , Oya H , Takagi T , Inamura Y , Sato A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Backgrounds

Catheter ablation for paroxysmal supraventricular tachycardia (PSVT) is curative treatment. However, diagnosis of atrial tachycardia (AT) distinguishing from other PSVTs are often challenging, especially when the tachycardia terminates after pacing or does not sustain long enough for diagnostic maneuvers. We sought a new method for diagnosis of AT.

Methods

One-hundred and thirty-four PSVTs including 20 ATs, 84 atrioventricular nodal reentrant tachycardias (AVNRTs) and 30 orthodromic reciprocating tachycardias (ORTs) were studied. Single atrial stimulation was started at intervals of 20ms shorter than the tachycardia cycle length during the tachycardia and coupling interval was shortened by 10ms. The pacing was performed from the proximal coronary sinus, which was not the earliest excitatory site, and pacing continued until the His potential was reset or the tachycardia terminated. The incidence of tachycardia resetting and the patterns of tachycardia termination were examined.

Results

Resetting of His was obtained in all AT patients without tachycardia termination. All ATs were not reset despite of His resetting.(Figure 1A) In AVNRTs or ORTs patients, 31 tachycardias (27%) were terminated with AH block before His resetting. In the 83 AVNRTs or ORTs, tachycardia was also reset when His was reset simultaneously.(Figure 1B) When tachycardia resetting was not observed despite His resetting, the diagnostic power of AT was 100% in sensitivity, specificity, positive predictive value, and negative predictive value. All cases which PSVTs were terminated before His resetting were AVNRTs or ORTs.(Figure 2)

Conclusions

A single atrial programmed stimulation resetting His during tachycardia was effective for differentiating PSVT even in cases that tachycardia terminates by the pacing.
Catheter ablation of atrial fibrillation and atrial tachycardia in patients with pulmonary hypertension: a randomised study
Authors: Havranek S , Fingrova Z , Skala T , Reichenbach A , Dusik M , Jansa P , Ambroz D , Dytrych V , Wichterle D
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The study was supported by the Ministry of Health of the Czech Republic.

Background

Atrial fibrillation (AF) and other atrial tachycardias (ATs), including typical atrial flutter (AFL), are common in patients with pulmonary hypertension. Frequently, several supraventricular arrhythmias are successively observed in individual patients.

Purpose

We investigated the hypothesis of whether more extensive radiofrequency catheter ablation of the bi-atrial arrhythmogenic substrate instead of clinical arrhythmia ablation alone results in superior clinical outcomes in patients with PH and AF / AT.

Methods

Patients with combined post- and pre-capillary or isolated pre-capillary PH and AF / AT indicated to catheter ablation were enrolled in 3 centers and randomized 1:1 into two parallel treatments arms: (A) Clinical arrhythmia ablation and (B) Clinical arrhythmia plus substrate-based ablation. The primary endpoint was arrhythmia recurrence >30 s without antiarrhythmic drugs after the 3-month blanking period.

Results

A total of 77 patients (mean age 67 ± 10 years; 41 males) were enrolled. The presumable clinical arrhythmia was AF in 38 and AT in 36 patients, including typical AFL in 23 patients. During the median follow-up period of 13 (IQR: 12; 19) months, the primary endpoint occurred in 15 patients (42 %) vs. 17 patients (45 %) in the group B vs. A (hazard ratio: 0.97, 95% confidence interval: 0.49-2.0). There was no excess of procedural complications and clinical follow-up events including an all-cause death in group B.

Conclusion

Extensive ablation, compared with a limited approach, was not beneficial in terms of arrhythmia recurrence in patients with AF / AT and pulmonary hypertension.
A focus on pregnancy course and outcomes of women with zero-fluoroscopy catheter ablation during gestation: a 2-year follow-up study
Authors: Abdrakhmanov A , Ainabekova B , Nuralinov O , Smagulova A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Arrhythmias in pregnant are common clinical problem. Catheter ablation may be required in cases of drug refractory and hemodynamically unstable arrhythmias. Data on further course of pregnancy, perinatal outcomes and results of zero-fluoroscopy catheter ablation in pregnant patients is limited.

Purpose

we aimed to determine efficacy and safety of zero-fluoroscopy catheter ablation during gestation.

Methods

54 pregnant indicated for catheter ablation (Mean age of women was 26.2±3.2 years, mean gestation age 23.3 ±2.4 weeks) due to drug refractory. Further course of pregnancy, perinatal outcomes, complications and arrhythmia recurrence checked during 2-year follow-up.

Results

Atrioventricular nodal reentrant tachycardia was the most common arrhythmia (n=21; 38.9%). This was followed by Wolff–Parkinson–White syndrome (n=18; 33.3%). In five pregnant was combination of accessory pathways with slow conduction ways (9.3%). Cases of zero-fluoroscopy catheter ablation of ventricular tachycardia (n=2; 3.7%) and premature ventricular contraction (n=8; 14.8%) during gestation were rare. Zero-fluoroscopy catheter ablation successfully performed in all cases (median procedural time was 73±13 minutes). Procedural complication was in one cases (ileofemoral thrombosis). There was no termination of pregnancy after ablation. In five women were increased uterine contractility and uterine blood flow violation (n=5; 9.3%). Preterm delivery was in two cases (3.7%) at 35 and 36 weeks of gestation. Type of delivery was vaginal in the majority (n=42; 77.7%). There were three cases of placental abruption and preeclampsia (5.6%). There were 55 live births (in one case were twins). Fetal birth weight was 3238.7±559.2 grams, 5 minute Apgar was 8.5±1.1. There were no maternal and fetal mortality. At 2-year follow-up there were no arrhythmia recurrence.

Conclusions

Zero-fluoroscopy catheter ablation during gestation may be safe and effective. It is associated with benign pregnancy course, perinatal and neonatal outcomes.