bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of cardiac telerehabilitation as standard care on quality of life
Authors: Van Mierlo R F R , Houben V , Rikken A O F , Van 'T Hof A W J
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): EIT Health education grant.

Background

Cardiac telerehabilitation (CTR) is a continuously developing cardiac rehabilitation (CR) format that might offer a solution to some of the challenges centre-based CR programs face. CR centres continue to face suboptimal participation in their provided CR program. The COVID-19 pandemic encouraged CR centres to implement their own CTR program to tackle practical challenges and to improve participation in CR. Multiple centres have since then developed a CTR program in accordance to (inter)national guidelines. CTR aims to improve the quality of life of patients, therefore analyses of quality of life is essential.

Purpose

Our study aims to analyse quality of life changes over a period of three months after program initiation for patients choosing to participate in either centre-based CR or CTR.

Methods

Our study included (N)STEMI patients eligible for CR between November 2021 and November 2022. Patients were invited by the cardiac rehabilitation nurse during intake to participate in CR. Patients were offered the choice between centre-based CR and CTR. The centre-based CR exercise program typically lasted for 6-8 weeks and the CTR program for a total of 48 weeks. CTR offers remote-access, digital platform for patients to interact with their healthcare professionals. The digital platform monitors physical activity and progress, which can be access by both patients and coaches. Coaches provide remote-access feedback. The SF-36 questionnaire was send out right after the CR intake procedure (T0) and three months after the CR intake procedure (T1). We only analysed data from participants who completed both T0 and T1 questionnaires, using the paired sample T-test for both CTR and centre-based CR.

Results

Until now, 173 patients have been included in the study of which 42 patients (24%) participated in CTR. 143 patients reached T1. 84 (59%) participants completed both T0 and T1 questionnaires, of which 24 (29%) participate in CTR (92% male, mean age 60) and 60 (71%) participate in centre-based CR (80% male, mean age 64). Participants from the centre-based CR program improved on both physical (score: +11,12; p < 0,001) and emotional (score: +9,30; p = 0,028) role functioning over a three month period. Participants in the CTR program improved on physical role functioning (score: +18,75; p = 0,002) and social functioning (score: + 13,54; p = 0,019).

Conclusion

Our preliminary show that patients were able to improve quality of life in both CTR and centre-based CR. Therefore, CTR can be used as an alternative to centre-based CR as standard care. Future research should focus on long term effects on quality of life.
Nursing protocol for heart failure remote monitoring in patients with ICD/CRT with a 5 variable multiparametric tool
Authors: Flores Soler J , Garcia-Torrent M , Casas De La Cal L , Herreros Gil M , Garcia Gonzalez F , Canadas-Godoy V , Salgado Aranda R , Perez-Villacastin Dominguez J , Perez-Castellano N
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Many patients with heart failure (HF) suffer from decompensation that sometimes leads to hospitalizations, harming prognosis and quality of life. Some cardiac implantable electronic devices (CIEDs) allow the transmission of clinical data online, providing helpful information without the patient having to go to a face-to-face consultation, which usually takes no less than 25 minutes. Moreover, a 5-variable multiparametric tool (S1 and S3 heart sounds, pulmonary congestion through a thoracic impedance, volume and respiratory rate, night heart rate) expresses a heart failure index (HM-5) incorporated into some CIEDs, capable of predicting 34 days before HF decompensation episodes when the reported index is ≥16, with a sensitivity of 70%. According to this warning, transmissions with a potential risk of HF exacerbation should be classified. Ideally, reviewing these warnings should not take more time than is invested in the face-to-face follow-up.

Purpose

Create a protocol with a risk classification according to the heart failure index and compare the duration of face-to-face and remote online follow-up performed by the same nursing staff in patients with CIEDs with a heart failure index activated in the arrhythmia consultation in a tertiary hospital.

Methods

First, we created a colour scale protocol (red alert: urgent event, yellow alert: important event and green alert: normal state) classifying heart failure index alerts during one year (January – December 2021) (See figure 1). Patient clinical characteristics, and duration of face-to-face & remote monitoring follow-ups were registered, quantifying the time spent reviewing each patient.

Results

Twenty-two patients with CIEDs and HM-5 tool activated were included; 28% were female, 72% had hypertension, 40,9% had diabetes mellitus, 22,7% had chronic kidney disease, and the mean left ventricle ejection fraction was 36,18%, half of them has ischaemic cardiomyopathy. The annexed protocol was followed with the help of the medical health record platform that classified the transmissions according to a colour scale. The rate of alerts/patient-year was 0.97; 22% of yellow alerts were related to HF. The mean time nursing review face-to-face versus remote was 16.55 min vs 3.05 min (p<0.001) (table 1).

Conclusion

Remote follow-up by the nursing staff of patients with HF and ICD provided with a 5-variable multiparametric tool is strict and protocolized in our hospital. It requires less time compared to face-to-face review.
Atrial fibrillation is an independent risk factor for heart failure progression and pump failure mortality in HFpEF:: a propensity score matched analysis of the TOPCAT Americas study
Authors: Nagarakanti R , Slee A , Shah D , Lewalter T , Karcnik J , Galgocy S , Rochotte M , Saksena S
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation (AF) is associated with excess mortality and cardiovascular (CV) hospitalizations in HF patients (pts) with preserved systolic function (pEF) but the contributing factors to these outcomes are not known..

Purpose

To analyze the independent impact of AF on clinical outcomes of HFpEF pts in the TOPCAT AMERICAS study using propensity score matched (PSM) cohorts to account for confounding by other comorbidities.

Methods

Study cohorts were PSM matched for 20 clinical, demographic & ECG variables. 3 matched cohorts based on baseline rhythm status at study entry were compared viz. subjects in sinus rhythm (SR), subjects in AF on baseline ECG & subjects with Any AF event by history or ECG. We analyzed CV mortality, adjudicated modes of death & morbidity during a mean follow up period of 2.9 yrs.

Results

418 subjects in SR (SR cohort) were PSM with 418 subjects in AF on baseline ECG (AF on ECG cohort) & 418 pts with any AF event by history or ECG (Any AF cohort) at study entry. Any AF increased the risk of CV death (D), pump failure death (PFD), CV and HF hospitalization (H) and HF progression. AF on ECG increased risk of CVD, CVH, HFH and PFD (Tables). Neither AF cohort increased risk of sudden death (SD) {Figure}.

Conclusion

1. AF is an independent risk factor for worsening CV outcomes in HFpEF.

2. This increased risk is due to a selective increase in symptomatic HF progression from early to advanced HF, HFH and PFD in advanced HF rather than SD.

3. Loss of AV synchrony & rate control in AF can independently impact HF progression in HFpEF with consequent HFH and PFD. Restoration of SR may offer benefits for CV outcomes in HFpEF & warrants evaluation.
QT prolongation-related ventricular arrhythmia associated with atrial fibrillation electrical cardioversion
Authors: Rav Acha M , Tovia-Brodie O T B , Bayya F B , Michowitz Y M , Glikson M G
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Atrial fibrillation (AF) is the most common arrhythmia, a leading cause of strokes, and associated with an increased mortality. Although electrical cardioversion of AF is considered a relatively safe procedure, post cardioversion QT prolongation-related ventricular arrhythmias (VA) may appear due to the combination of QT-prolonging anti-arrhythmic drugs, acute heart rate change from rapid AF into sinus bradycardia, electrolyte imbalance, etc. To date, there is still no consensus regarding the actual prevalence of this complication. Given the global tendency for early discharge during the same day of AF cardioversion, there is a crucial need to define the true prevalence of this phenomenon and the characteristics of these patients.

Purpose

Evaluate the prevalence of post AF cardioversion prolonged QT-related VA, and describe the characteristics of patients developing this complication.

Method

Single center retrospective analysis of all AF electrical cardioversions, during the last 3 years, which were followed by documented prolonged QT-related VA or sudden cardiac death (SCD) within 72 hours from cardioversion. Post cardioversion VA was detected by a computerized search of hospitalization records, 24-hour Holter recordings, and EMS strips.

Results

Out of 950 AF electrical cardioversions performed at our hospital during the last 3 years there were 4 cases with Torsades de Pointes (TdP) and 1 case of SCD occurring within 72 hours from cardioversion (5/950; 0.5%). All five patients were females, 3/5 with low LVEF and 4/5 on class III anti-arrhythmic drug (Amiodarone or Sotalol). Electrolyte abnormalities (including hypokalemia, hypomagnesemia, and hypocalcemia) were found in 3/5 patients and post cardioversion sinus bradycardia in 2/5 patients.

Conclusion

The incidence of post-AF cardioversion life threatening VA is low although non-negligible. Prolonged ECG monitoring and cautious follow-up of QTc should be recommended among patients, especially females with low LVEF, treated by class III anti-arrhythmic drugs. Post AF cardioversion same day discharge should be discouraged in these patients.
Timing of clinically relevant recurrence or true blanking period?
Authors: Mendsaikhan P , Park Y J , Kim D , Yu H T , Kim T H , Uhm J S , Joung B , Lee M H , Pak H N
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Ministry of Health and Welfare of Korea

The National Research Foundation of Korea (NRF) which is funded by the Ministry of Science, ICT & Future Planning (MSIP)

Background

Although early recurrence (ER) within 3 months after atrial fibrillation catheter ablation (AFCA) is reportedly considered as a reliable predictor of late recurrence (LR), those ERs are still counted as benign events. There is no large-scale study showing the time limit of true blanking period, nor the potential mechanisms of clinically relevant recurrences within 3 months.

Purpose

To explore temporal association of ERs with LRs and the presence of extra-pulmonary vein (ExPV) triggers.

Methods

This retrospective, single center study included 2,788 patients undergoing de novo AFCA (median 60 years old, 37.4% persistent AF [PeAF]) with isoproterenol provocation at the procedures. ER and LR were defined as any documented atrial arrhythmia >30s occurring (≤3 months), (>3months) after AFCA respectively. We evaluated the risk factors for ER and LR and compared the risk for LR and existence of ExPV triggers according to different timing of ER.

Results

ER was detected in 783 (28.1%) patients. During a median follow-up of 40 months, LR occurred in 945 (33.9%) patients. PeAF (OR 1.79, 95% CI 1.36-2.34), a larger left atrial (LA) diameter (OR 1.03 per 1 mm increase, 95% CI 1.00-1.05), and the existence of ExPV-triggers (OR 3.02, 95% CI 2.08-4.38) were independently associated with ER. ER (HR 2.55, 95% CI 2.15-3.03); the existence of ExPV-triggers (HR 1.63, 95% CI 1.28-2.08), PeAF (HR 1.39, 95% CI 1.16-1.66), and a larger LA diameter (HR 1.02 per 1 mm increase, 95% CI 1.01-1.04) were independent predictors for LR. When stratified according to the days of ER occurrence, ER occurring earlier showed trends toward higher rates of LR (P for trend=0.047) (Figure 1A). Patients with ER occurring within 1 month after AFCA had a higher incidence of LR than those with ER occurring between 2 and 3 months after AFCA (57.5% vs. 49.6%; log-rank P=0.020) (Figure 2B). ER occurring within 1 month after AFCA, compared with no ER, was independently associated with the existence of ExPV triggers (OR 3.99, 95% CI 2.65-6.02) whereas ERs occurring at different timing were not (Figure 1B).

Conclusions

ER, regardless of the timing, and the existence of Ex-PV triggers were independently associated with long-term AF recurrence. Especially, ER occurring earlier within 1 month after AFCA, which was associated with Ex-PV triggers, had the worst rhythm outcome.
Temporal relation of disease onsets in patients with acute myocardial infarction and atrial fibrillation - results from a nationwide registry study
Authors: Karlsson E , Kiviniemi T , Halminen O , Lehtonen O , Haukka J , Mustonen P , Putaala J , Linna M , Hartikainen J , Airaksinen K E J , Lehto M
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Helsinki and Uusimaa Hospital District TYH2019309 and The Finnish Foundation for Cardiovascular Research

Background/Introduction

Acute myocardial infarction (AMI) and atrial fibrillation (AF) are commonly seen in a same patient. It is not unusual that patients are diagnosed with new-onset AF as a complication of AMI. Nevertheless, little is known about the temporal relations of these two diagnoses.

Purpose

We evaluated the temporal relations of AMI and new-onset AF in the Nationwide Finnish Anticoagulation in Atrial Fibrillation (FinACAF) comprising all patients with AF during 2004-2018 in Finland.

Methods

Patients with AF and AMI in Finland during 2010 to 2017 were analyzed, and individual patient data from the different registries were merged.

Results

Of the 157,658 patients with new-onset AF, a total of 16,971 (10.8%) patients were diagnosed with AMI at any point. The mean-age was 77.5 years (SD 10.6) and 72.3 years (SD 13.2), and the proportion of females 7,864 (46.3%) and 70,873 (50.4%) in AF patients with and without AMI, respectively.

Altogether 8,889 (52.4%) of the AMI-AF patients had a history of established AMI diagnosis; whereas 4,278 (25.2%) were diagnosed with AMI during the same hospitalization period as new-onset AF or within 30 days; and 3,804 (22.4%) over 30 days after new-onset AF. A total of 6,928 (40.83%) of all AMI diagnoses were diagnosed within 1 year from new-onset AF. The temporal relation between new-onset AF and AMI are described in the Figure.

Conclusions

AMI-AF patients are older than AF patients without AMI at the time of new-onset AF. The diagnoses of AMI and AF tend to accumulate close to one another. One fourth of all AMI-AF patients were diagnosed with both diseases occurring same hospitalization period or within 30 days from new-onset AF.
Left atrial dimensions and left atrial appendage morphology: differences in paroxysmal versus persistent atrial fibrillation patients
Authors: Pongratz J , Riess L , Dorwarth U , Wankerl M , Straube F , Hoffmann E
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Pulmonary vein isolation (PVI) is an effective treatment strategy in symptomatic atrial fibrillation (AF) patients. However, this approach shows worse long-term results in individuals suffering from persistent compared to the paroxysmal type.

Purpose

The objective was to investigate differences of left atrial (LA) as well as left atrial appendage (LAA) anatomy in persistent AF (persAF) and paroxysmal (PAF) and patients.

Methods

An observational single center study with a blinded retrospective analysis of cardiac computed tomography angiography (CCTA) images was conducted. Dimensions of LA, posterior wall box, pulmonary veins (PV) as well as LAA size and morphology were assessed and statistically analyzed. All important measures are depicted in the attached figure.

Results

From 2012 to 2016 a total of 1.103 patients underwent second generation cryoballoon PVI. Prior to PVI, CCTA was available for 725 (65.7%) patients with sufficient quality for measuring in 473 (65.2%). Mean age was 66.3±9.5 years; PAF was present in 277 (58.6%) participants. In persAF LA volume [mL] (111.8; 128.8; p<0.001), posterior wall box area [cm2] (11.9; 13.3; p<0.001) and pulmonary vein ostial dimensions were significantly larger compared to PAF. LAA volume [mL] (9.0; 10.0; p=0.01) and LAA ostial perimeters (66.5; 70.0; p=0.003) were also identified to be larger in persAF. However, there was no difference in LAA morphology (overall distribution: "windsock" 51%; "chicken-wing" 20%; "cauliflower" 15% and "cactus" 13%).

Conclusion

Compared to PAF, persAF patients had significantly larger LA volumes, posterior wall box areas, PV ostial dimensions as well as LAA volumes and LAA ostial perimeters. LAA morphological types were distributed equally in both groups.
The role of biomarkers, sleep apnea and echocardiography as predictors of atrial fibrillation in a pacemaker population
Authors: Santos Sanchez A , Roldan Sevilla A , Gonzalez Recio P , Garcia Fernandez J
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Sleep apnea, dilated left atrial has been related to a higher possibility to develop atrial fibrillation (AF). Some pacemakers are able to detect periods of apnea during the sleeping time obtaining a respiratory disturbance index (RDI) related to sleep apnea (SA), as well as atrial high rate episodes (AHREs) that are also predictors of AF. Another possible predictor of AF is galectin-3, a biomarker related to fibrotic phenomena.

This study aims to evaluate the relationship between ARI and AHRE detection, as well as the relationship between left atrial size measured by echocardiography and some biomarkers with the development of AHREs.

Methods

This is a single-centre, prospective, non-randomized, descriptive study carried out in a tertiary hospital, including patients with dual-chamber pacemaker able to detect SA, initially in sinus rhythm. Patients were included at the implantation date, between November 2015 and November 2018, and medium follow-up was 2 years. Those with a previous diagnosis of AF were not included. In a baseline visit, clinical, anthropometric characteristics, as well as echocardiography and analytical parameters were obtained, including NTproBNP, galectin-3 and ST-2. In addition to the baseline visit, device interrogation visits at six months, one year and tho years in order to obtain atrial activity and SA registers were performed. Those whose apnea recordings were illegible were excluded from the analysis.

We performed a descriptive statistical analysis with Microsoft Excel.

Results

102 patients with dual chamber pacemaker were included. 79 of the pacemakers provided legible apnea and atrial activity recordings. 22 of them showed an RDI>20 in more than 75% of the nights, and 38 of them recorded AHRE longer than 6 minutes in 24 hours. Tables 1 and 2 show baseline characteristics and the AHRE (episodes with duration >6 minutes) and RDI recordings suggestive of severe SA (RDI>20 in more than 75% of the nights). Differences in AHRE between both RDI groups did not reach statistical significance. After univariate analysis, the multivariate analysis showed significant relationship between AHRE >6 minutes and the galectin-3 level at baseline as well as between AHRE>6 minutes and the left atrial indexed volume at baseline.

Conclusion

In our study, 48% of the pacemakers registered AHRE longer than 6 minutes in 24 hours. No statistical relationship between RDI and AHRE was found. Baseline galectin-3 level and left atrial indexed volume appeared to be related to the development of AHRE in the follow-up.
New parameter of the second part of the P-wave predict atrial fibrillation: comparison with P-wave signal-averaged electrocardiography
Authors: Lee Y , Kim J , Lee J
Published: May 2023

Funding Acknowledgements

Type of funding sources: Private hospital(s). Main funding source(s): Kyung Hee University

Background

A study to predict the risk of AF by analyzing the P-wave of the electrocardiogram in detail has been attempted for a long time, and P-wave signal-averaged ECG is also known to be helpful. Recently, the P-wave was analyzed by dividing it into two parts, and when the latter part is extended, it suggests left atrium dilatation or delayed conduction, and it is suggested that this may be a slightly more sensitive parameter.

Objective

The purpose of this study was to find the best predictor of atrial fibrillation by comparing the characteristics of the P-wave in the subjects with AF and healthy controls using 12-lead ECG and signal-averaged ECG (SAECG).

Methods

We recruited 58 paroxysmal atrial fibrillation patients in AF group and 57 people in the control group. All subjects underwent 12-lead ECG, P-wave signal-averaged ECG, and transthoracic echocardiography. The total P-wave duration (PWD), the second part of the P-wave were measured with an electronic caliper in lead II.

Results

The second part of the P-wave was higher in the AF group, which was statistically significant (70.8 ± 20.6 vs. 60.5 ± 12.3ms, respectively, p<0.01). Filtered PWD and the integral of the P-wave were significantly higher in the AF group. The second part of the P-wave, filtered PWD, and the integral of P-wave were univariate and multivariate predictors of AF. The second part of the P-wave showed ROC (Receiver operating characteristic curves) area of 0.635, and the cut-off value was 61.5ms with 59.6% sensitivity and 59.6% of specificity. Of the SAECG parameters, the longer filtered PWD predicted a history of AF with an AUC (Area under the ROC curve) of 0.669.

Conclusions

We confirmed that second part of the P-wave which reflects the electrophysiological status of the left atrium is a valuable marker for predicting AF. Also, Filtered PWD and the integral of the P-wave among the SAECG parameters were useful predictors of AF.
Extended use of preprocedural data to detect expiratory airflow limitation in patients with atrial fibrillation scheduled for ablation
Authors: Hereijgers M J M , Van Der Velden R , Verhaert D V M , Habibi Z , Betz K , Gawalko M , Hermans A N L , Gietema H , Mihl C , Schotten U , Vernooy K , Simons S , Linz D
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

In patients with atrial fibrillation (AF), expiratory airflow limitation adds to overall morbidity and may impair the response to heart rhythm control strategies.

Purpose

We aimed to determine the prevalence of expiratory airflow limitation in patients scheduled for AF ablation and evaluated whether routine preprocedural cardiac analyses can detect occult lung disease.

Methods

Consecutive AF patients scheduled for catheter ablation were systematically screened for expiratory airflow limitation with handheld (micro)spirometry devices. As part of routine preprocedural care, patients underwent cardiac computed tomographic angiography (cCTA), transthoracic echocardiography and respiratory polygraphy. Qualitative analyses of cCT was performed for emphysema, airway abnormalities and lymphadenopathy. Sleep apnea severity and nocturnal desaturation were derived from polygraphy. Multivariate logistic regression was performed to assess if routinely preprocedural studies were associated with expiratory airflow limitation.

Results

(Micro)spirometry was performed in 110 consecutive patients and expiratory airflow limitation was detected in 25% of patients (previously unknown in 24 of 28 patients; Figure 1). Patients with expiratory airflow limitation more often presented with pulmonary abnormalities on cCTA, such as mild-to-severe emphysema (odds ratio [OR] 4.2, 95% confidence interval [CI] 1.12-15.1, p < 0.05), lymphadenopathy (OR 3.6, 95% CI 1.1-11.3, p < 0.05) and bronchial wall thickening (OR 2.6, 95% CI 1.0-6.5, p < 0.05; Figure 2). The negative predictive value of the absence of pulmonary abnormalities on cCTA to identify patients with normal lung function was 85%. Polygraphy-derived sleep apnea status and nocturnal desaturation was less severe in patients with expiratory airflow limitation compared to patients with normal lung function (32% vs 48% moderate-to-severe sleep apnea, p = 0.23; oxygen desaturation index 3.0 [2.4-6.5] vs. 6.7 [3.4-11.4], p = 0.03). Echocardiography data did not differ between patients with compared to patients without expiratory airflow limitation.

Conclusions

Spirometry detected expiratory airflow limitation in 25% of patients scheduled for AF ablation. Routine preprocedural cCTA includes pulmonary features which may help in triage referral for formal pulmonary assessment.
The relationship of plasma catestatin concentrations with the extension of left atrial fibrosis
Authors: Katic J , Sikirc I , Breskovic T , Jurisic Z , Borovac J A , Anic A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Atrial fibrosis is increasingly considered an important part of vulnerable substrates, with an essential function in the induction of left atrial (LA) conduction abnormalities underlying the transition from paroxysmal (PAF) to persistent atrial fibrillation (PeAF), contributing to disease continuation. A substantial number of studies suggest a correlation between atrial fibrosis and low voltage zones (LVZ) (1). Previous studies have shown that catestatin (CST) regulates cardiac remodeling. The CST inhibition of catecholamine inhibits the Ang II-induced cell proliferation, and the extracellular matrix (ECM) downregulation to protect the heart from fibrosis produces similar results inhibition of catecholamine and the regulation of the beta-adrenergic receptors (β-ARs) (2). From the results, it is clear that CST inhibits cardiac fibrosis by regulating nitric oxide (NO) and the reactive oxygen species (ROS) pathways via inhibiting catecholamine release and influencing the production of the downstream molecule (2).

Purpose

This study investigated the potential association of serum catestatin level and LA fibrosis in AF patients.

Methods

The current study enrolled 18 consecutive patients with PeAF who had undergone bipolar voltage mapping of the left atrium before catheter ablation. The proportion of the mapped LA surface exhibiting low voltage (<0.5mV) was expressed as a percentage of the overall mapped LA surface area. In all participants, fasting laboratory tests were drawn at admission. The primary outcome measure of the current study was the association of serum CST and low-voltage zones (%LVZ ≥ 10% as a reference for severe LVZ).

Results

The patient characteristics were summarized in Table 1. The LA was mildly dilated, and the median %LVZ was 4 (IQR 0.75-31.25). The lower degree of cardiac fibrosis (LVZ < 10%) is significantly associated with higher levels of catestatin compared to severe LVZ >10% (8.6 (interquartile range-IQR 4.6 – 25.0) vs. 21.9 (IQR 11.1-100.0), p= 0.040)(Figure 1).

Conclusion

The higher catestatin level was associated with the lower extension of atrial fibrosis (low LA voltage zones).
Benefit of integrated care in patients with atrial fibrillation- a predictive heterogeneous treatment effect analysis of the ALL-IN trial
Authors: Trinks-Roerdink E M , Geersing G J , Van Den Dries C J , Rutten F H , Hemels M E W , Rienstra M , Van Smeden M , Van Klaveren D , Kent D M , Van Doorn S
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Integrated care is effective in reducing all-cause mortality in patients with atrial fibrillation (AF) in primary care. Although this overall effect is undisputed, some individual patients may benefit more than others. The aim of this post-hoc analysis of the cluster-randomized ALL-IN trial, performed in primary care, is to explore heterogeneity of the effect of integrated AF care.

Methods

A model was developed and validated to predict the outcome all-cause mortality using the CHA2DS2-VASc items as predictors. The hazard ratio and absolute risk reduction were plotted as a function of this predicted mortality risk using the ALL-IN data. The interaction between treatment and predicted risk was tested for significance to identify treatment heterogeneity.

Results

Among 1,240 AF patients included in the ALL-IN trial (median 77 years (range 65-104), 49.4% female) the model for predicted mortality showed a c-statistic of 0.72 [95% CI 0.66-0.78] with good calibration. The hazard ratio for the intervention across all risk levels ranged from 0.28 to 0.81, yet without a significant interaction effect (p for interaction=0.93). However, the absolute risk reduction of integrated AF care was greatest in patients with the highest predicted risk.

Conclusion

Independent of the risk of mortality related to comorbidities, all AF patients benefit from integrated care in the primary care setting. Importantly, on an absolute scale, the effect is greatest in patients with a high-risk profile of comorbidities. These results stress the need for integrated AF care, including patients at high-risk of mortality and with multimorbidity.
Clinical application of virtual antiarrhythmic drug test using digital twins in patients who recurred atrial fibrillation after catheter ablation
Authors: Hwang T , Kwon O , Lim B , Jin Z , Yang S , Kim D , Park J , Yu H , Kim T , Uhm J , Joung B , Lee M , Hwang C , Pak H
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

We previously reported a proof-of-concept study that digital twins can test antiarrhythmic drug (AAD) effects on atrial fibrillation (AF) after integrating the patients’ cardiac CT imaging and electroanatomical map (EAM). In this study, we evaluated the reproducibility of the virtual AAD test (V-AAD) in the clinical setting in patients who recurred after AF catheter ablation (AFCA) and took AADs.

Methods

This single-center retrospective study included 232 patients (71.6% male, 60.5±10.2 years of age, 40.9% paroxysmal AF) who were prescribed AADs after AFCA due to real or high chance of recurrence. Clinical AADs (C-AAD) were chosen at the discretion of the primary care physician blinded to V-AAD test. All those included patients underwent V-AAD test using digital twins reflecting the patients’ atrial anatomy, histology, and electrophysiology by integrating cardiac CT and EAM. The ion currents for each AAD (amiodarone, sotalol, dronedarone, flecainide, and propafenone; 2 doses for each drug) were defined based on previous publications. We defined the most efficient V-AAD as the V-AAD that terminated virtual AF the fastest. We evaluated the association between AF recurrence rate while using C-AAD and the most efficient V-AAD, which showed excellent termination/ defragmentation of AF in the digital twins.

Results

In the clinical setting, the most effective V-AAD was administered in 72 patients (31.0%), and not effective V-AADs in 61 patients (26.3%). During the median 782 (IQR 582-1047) days follow-up, AF recurrence was observed in 132 patients (56.9%) (under the class IC 44.4% and class III 57.4%). The recurrence rate within a year after using the effective V-AAD was 40.9%, and that of using the ineffective V-AAD was 54.1%, respectively (log-rank p=0.046). The recurrence rate within a year in patients with ≥2 effective V-AADs and those with 0 or 1 were 42.4% and 59.3%, respectively (log-rank p=0.056).

Conclusions

The digital twins-guided V-AAD test was feasible for evaluating the efficacy of multiple AADs in patients with AF who recurred after AFCA. We need a prospective randomization study to evaluate the prediction power of the V-AAD test.
Impact of the individual relationship between focal or rotational regions of interest and atrial cardiomyopathy in patients with chronic forms of atrial fibrillation
Authors: Guckel D , Kramer K , Bergau L , Piran M , El Hamriti M , Fink T , Sciacca V , Koerperich H , Isgandarova K , Khalaph M , Imnadze G , Friedrich S , Ruehl J , Sommer P , Sohns C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The mechanisms for the initiation and perpetuation of atrial fibrillation (AF) are still not completely understood. The CARTOFINDER module represents a novel approach for the visualisation of repetitive focal and rotational activations in patients with AF.

Purpose

The aim of this prospective observational study was to evaluate the potential relationship between findings from CARTOFINDER mapping and individual atrial arrhythmia substrates. Beyond that, the impact of atrial fibrosis on patients’ outcome was analysed.

Methods

A total of 20 consecutive patients (69 ± 9 years, 55 % male) underwent ablation for persistent AF (PERS) applying a 3D-mapping system with the integrated CARTOFINDER module. Regions of interest (ROIs) were identified before ablation. The individual amount and distribution of atrial fibrosis in the left atrium (LA) based on anatomical segments was determined by LGE CMR prior to the ablation procedure. 3, 6 and 12 month-follow-up data were assessed.

Results

In all patients, ablation procedures were performed successfully (n=20, 100%). LA mapping time was 09.30 ± 03.53 min, mean ablation duration was 26.40 ± 07.51 mi, mean fluoroscopy time amounted to 6.66 ± 1.85 min. Consistent with Utah classes II-III, LGE-CMR revealed an intermediate degree of 21.41 ± 6.16% LA fibrosis. Focal and rotational ROIs were identified in all patients (mean no ROIs per Patient n = 416.45 ± 204.57). Univariate logistic regression calculation documented no consistent correlation between the percentage of LA fibrosis and the probability for the occurrence of ROIs (posterior: regression coefficient (b) =0.36, p-value (p) =0.24; anterior: b=-0.08, p=0.54; lateral: b=0.31, p=0,39; septal:b=-0.12; p=0.66; right PVs: b=0.34, p=0.27; left PVs: b=0.07, p=0.79; LAA: -0.91, p=0.11). Between the degree of atrial cardiomyopathy and the number of ROIs no association was observed (b=10.86, p=0.15). 12 months AF-free survival amounted to 70% (n=14). The degree of LA fibrosis showed no significant correlation with AF-free survival (logistic regression: posterior: b=0.33, p=0.12; anterior: b=-0.03, p=0.83; lateral: b=0.31, p=0,35; septal:b=-0.07; p=0.79; right PVs: b=0.81, p=0.15; left PVs: b=0.37, p=0.25; LAA: -0.16, p=0.54).

Conclusions

This study reports on initial observations concerning the relationship between focal and rotational activations and atrial fibrosis in PERS AF. No evidence for a consistent correlation between the occurrence or number of ROIs and the degree of atrial arrhythmia substrates was revealed. Beyond that, the amount of LA fibrosis did not correlate with the 12 months AF-free survival rate. Larger studies are warranted to verify our first results.
Safety, feasibility and success rate of cryoballoon pulmonary vein isolation without pulmonary vein phlebography
Authors: Saleh A , Wieczorek M , Mulyono A , Koujan O , Hoeltgen R
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Catheter ablation is an effective therapy for recurrent, symptomatic atrial fibrillation (AF). Recent studies proved significantly lower rates of AF recurrence with catheter cryoballoon (CB) ablation compared to antiarrhythmic drug therapy.

Purpose

To evaluate the feasibility and success rate of CB pulmonary vein isolation (PVI) without pulmonary venography.

Methods

We enrolled a total of 200 patients undergoing PVI with CB. Among those 101 participants received pulmonary venography shortly after the transseptal puncture and before introducing the cryoballoon (group 1), the rest did not (group 2). Amount of injected radiocontrast, fluoroscopy time and dose, left atrium (LA) dwell time, procedure time and one year’s recurrence rate of AF were registered.

Results

Fifty five percent of the patients were male. Mean age of participants was 63 years. No significant difference in age, cardiac risk factors or BMI was noted between the two groups. Likewise, no difference was found regarding the procedure time (115 ± 30 minutes in group 2 vs. 116 ± 40 minutes in group 1). Fluoroscopy time was shorter in group 2 (23.9 ± 7 vs. 25 ± 11 minutes, P= 0,003). Fluoroscopy dose was lower in group 2 (579 ± 405 vs. 3310 ± 2408 µGy.m2 , P<0,001). We injected less radiocontrast during PVI in group 2 patients (41 ± 21 vs. 81 ± 31 ml, P<0,001). LA-dwell time was significantly shorter in procedures without venography (71 ± 26 vs. 82 ± 36 minutes, P=0,014). We observed comparable AF recurrence rates in both groups during follow-up (28% group 2 vs. 26% group 1). Four minor complications were noticed in the group 1 while five minor complications occurred in the group 2. Major complications were not elicited in both groups.

Conclusion

In our center, CB PVI without pulmonary venography was feasible and safe. It resulted in lower fluoroscopy dose and shorter fluoroscopy time. Amount of injected radiocontrast and LA-dwell time were significantly reduced, without an impact on AF recurrence rate or occurrence of procedure-related complications.
Bone morphogenetic protein 10 as a predictor for recurrent atrial fibrillation after catheter ablation
Authors: Hennings E , Aeschbacher S , Coslovsky M , Paladini R E , Spies F , Voellmin G , Conen D , Zuern C S , Krisai P , Badertscher P , Sticherling C , Osswald S , Knecht S , Kuehne M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation (AF) recurrence after catheter ablation (CA) poses a major challenge. The novel atrial-specific biomarker, bone morphogenetic protein 10 (BMP10), might aid in the selection of appropriate patients for CA.

Purpose

We aimed to assess the predictive value BMP10 for AF recurrence after CA in a large cohort of AF patients.

Methods

We measured baseline BMP10 concentrations in AF patients who underwent elective CA for the first time. Patients were enrolled in a single-center prospective cohort study. The primary outcome variable was AF recurrence during 12 months’ follow-up using 2 x 24h and 1 x at least 4-day Holter. We constructed Cox proportional hazard models to determine the association of BMP10 and AF recurrence. The multivariable model was adjusted for age, sex, body mass index, and cardiovascular risk factors.

Results

A total of 1,112 AF patients (74% male) with a mean age of 61 ± 10 years were included in our analysis (60% paroxysmal AF, 40% persistent AF). The 12-month follow-up examination revealed that AF recurred in 374 (33.6%) patients. Kaplan-Meier curves for recurrent AF according to BMP10 quartiles are shown in the Figure (BMP10 quartile I: 0.76-1.50 ng/mL, quartile II: 1.50-1.72 ng/mL, quartile III: 1.72-1.99 ng/mL, quartile IV: 1.99-3.75 ng/mL). In the unadjusted Cox proportional hazard model, a per-unit increase in log transformed BMP10 was associated with a hazard ratio (HR) of 2.28 (95% CI 1.43, 3.62; p < 0.001) for AF recurrence. After multivariable adjustment, the HR of BMP10 was 1.98 (95% CI 1.14; 3.42, p = 0.01) for AF recurrence.

Conclusion

The novel atrial-specific biomarker BMP10 was associated with AF recurrence after CA in our large cohort of AF patients.
Pulsed-field ablation based pulmonary vein isolation: reconnection pattern and comparison to cryoballoon ablation
Authors: Lemoine M , Obergassel J , Rottner L , Moser F , My I , Wenzel J P , Moser J , Reissmann B , Ouyang F , Kirchhof P , Rillig A , Metzner A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Pulsed-field ablation (PFA) integrated into a pentaspline catheter is a novel single shot device to perform pulmonary vein isolation (PVI) for treatment of atrial fibrillation (AF). While initial data demonstrated high safety and efficacy, long-term PVI durability and reconnection patterns are unknown. Here, we analyzed findings from repeat ablation procedures after index PFA compared to cryoballoon ablation (CBA) based PVI.

Methods

We prospectively included consecutive patients with index PVI applying PFA (n=161) or CBA (n=302) who underwent repeat ablation due to symptomatic recurrence of AF or atrial tachycardia (AT) after a blanking period of 3 months. All repeat procedures were performed with a 3D mapping system and RF energy.

Results

We identified a total of 14 patients after previous PFA and 23 patients after previous CBA. PV reconnection was detected in 9/14 (64%) patients after PFA and in 16/23 (70%) after CBA (p=1.000). A total of 24/55 (44%) vs. 34/92 (37%) initially isolated PVs demonstrated electrical reconduction (p=0.487) after PFA and CB ablation. In both groups the right inferior PV was reconnected most frequently (9/24 (38%) patients after PFA and 10/34 (29%; p=0.578) patients after CBA). Distribution of conduction gaps is shown in figure 1. All PVs were successfully reisolated. Repeat procedures after index PFA and CBA showed similar duration (115±32 min vs. 114±49 min; p=0.785), fluoroscopy time (13±4 min vs. 14±8 min; p=0.558) and number of RF applications (38±23 vs. 36±34, p=0.738).

Conclusion

During repeat AF/AT ablation after previous PFA- or CBA-based PVI a comparable incidence of PV reconduction gaps was found. Repeat procedure times and fluoroscopy exposure were similar. Randomized controlled trials and longer follow-up are necessary to draw further conclusions.
Pulmonary vein isolation with the novel radiofrequency balloon catheter: predictors of single-shot isolation
Authors: Del Monte A , Almorad A , Pannone L , Della Rocca D , Mouram S , Gauthey A , Overeinder I , Bala G , Sorgente A , Stroker E , Sieira J , Brugada P , La Meir M , Chierchia G B , De Asmundis C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Single-shot technologies have demonstrated comparable results to point-by-point ablation for pulmonary vein (PV) isolation (PVI). The novel multi-electrode radiofrequency (RF) Balloon catheter (RFB) has been developed to achieve safe and effective single-shot PVI.

Purpose

This single-centre study aimed to evaluate ablation parameters predictors of single-shot PVI with the novel RFB.

Methods

All consecutive patients with symptomatic paroxysmal or persistent atrial fibrillation (AF) undergoing first-time PVI with the RFB between August 2021 and November 2022 were prospectively included. Remapping was performed in all patients to confirm persistent intraprocedural PVI. Clinical, procedural and ablation parameters were systematically collected. First RF applications were categorized as follows: 1) single-shot PVI (SS-PVI), in case of PVI without acute intraprocedural reconnection and 2) non-single-shot PVI (NSS-PVI), if single-shot isolation was not obtained at first application or if isolation was followed by acute PV reconnection.

Results

A total of 492 first RF applications were analysed, 433 (88.1%) SS-PVI and 59 (11.9%) NSS-PVI. Overall, the mean impedance drop was 22.9 ± 5.4 Ω, and the mean temperature rise was 12.2 ± 3.3 °C. SS-PVI showed higher mean impedance drop and mean temperature rise compared to NSS-PVI (23.3 ± 5.3 Ω vs 20.1 ± 4.9 Ω, p<0.001; 12.4 ± 3.3 °C vs 10.8 ± 2.8 °C, p<0.001, respectively). SS-PVI showed higher values of mean impedance drop and temperature rise for all veins, except for the left superior PV. For the other PVs, impedance drop and temperature rise were significant predictors of SS-PVI (OR per 1 Ω increase, 1.22, 95% CI 1.13-1.32, p<0.001, and OR per 1 °C increase, 1.34, 95% CI 1.17-1.54, p<0.001, respectively). The best cut-offs to predict SS-PVI were: impedance drop >19.2 Ω (sensitivity 0.79, specificity 0.62, PPV 0.94, NPV 0.25, AUC 0.75) and temperature rise >11.1 °C (sensitivity 0.58, specificity 0.84, PPV 0.18, NPV 0.97, AUC 0.72); Figure 1.

Conclusion

Specific cut-offs of impedance drop and temperature rise are able to predict single-shot PVI with the novel RFB and may be implemented in the procedural workflow to optimize the ablation procedure.
Impact of different energy sources on the cardiac autonomic nervous system in the setting of single-shot pulmonary vein isolation
Authors: Del Monte A , Stroker E , Della Rocca D , Pannone L , Mouram S , Gauthey A , Overeinder I , Bala G , Sorgente A , Sieira J , Almorad A , La Meir M , Brugada P , Chierchia G B , De Asmundis C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The cardiac autonomic nervous system is an epicardial neural network composed of ganglionated plexi (GPs) and interconnecting neurons, which plays a significant role in the induction and maintenance of atrial fibrillation (AF). Targeted GPs ablation in addition to pulmonary vein isolation (PVI) has been associated with superior AF outcomes. Due to the anatomical proximity of the GPs with the pulmonary veins, PVI with cryoballoon catheter ablation (CBA) has shown to concomitantly affect the GPs, as documented by increased heart rates (HR) after ablation. Recently, pulsed-field ablation (PFA) has emerged as a safe and effective non-thermal alternative for single-shot PVI, with specific selectivity for the cardiac tissue. The impact of PFA on the cardiac autonomic nervous system is still to be elucidated.

Purpose

To assess the effect of PFA on the cardiac autonomic nervous system, evaluated with the variation in resting heart rate pre- and post-ablation.

Methods

We retrospectively included all consecutive patients with symptomatic paroxysmal AF undergoing first-time PVI with the multispline PFA catheter between January and September 2022. They were compared with consecutive patients undergoing PVI with CBA in the same study period. Patients not in sinus rhythm before ablation or with cardiac implantable electronic devices were excluded. All antiarrhythmic drugs were discontinued at least 3 days before ablation. Pre-ablation and 24-hour post-ablation ECGs in sinus rhythm were collected and analysed to assess HR.

Results

A total of 90 patients (PFA group, n=30 vs CBA group, n=60) were included in the analysis. Baseline patients’ characteristics were similar between the two groups (Figure 1). Pre-ablation HRs in the PFA and the CBA groups were 64.2 ± 10.3 bpm and 64.2 ± 12.8 bpm, respectively. Vagal reactions during ablation occurred more frequently with PFA than CBA (77% vs 38%, p=0.001). After 24h post-ablation, the HR increase in the PFA and CBA groups was 2.2 ± 5.4 bpm and 12.4 ± 11.9 bpm, respectively (p<0.001, Figure 2).

Conclusion

PVI with the novel multispline PFA catheter is associated with less increase in HR 24 hours after ablation compared to CBA. This effect may be the result of tissue selectivity of PFA for cardiomyocytes, which has minimal effect on extracardiac structures, including the cardiac autonomic nervous system.