bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative analysis of classical artificial intelligence and deep learning models for atrial fibrillation detection in electrocardiograms
Authors: Mota D , Filho F N B , Sousa E B , Chagas R A , Sassaki E M , Candoti M W , Kuster G W , Lopes J H
Published: May 2024

Background/Introduction

Early diagnosis of atrial fibrillation (AF) presents a challenging yet critical task for appropriate interventions aimed at reducing disease-related burden. In this context, strategies employing classical artificial intelligence (CAI) and deep learning (DL) have emerged as promising approaches to optimize cardiac disorder screening and detection.

Purpose

This study aimed to compare a CAI model and a DL model for the detection of AF in patients undergoing electrocardiographic (ECG) examinations in tertiary healthcare centers.

Methods

Between December 2022 and November 2023, a total of 135,476 ECGs were performed, comprising 5,067 with AF and 130,409 without AF. The ECGs were analyzed using both artificial intelligence models. The obtained results were then compared to the gold standard (cardiologist's report). In the CAI model, signals were extracted from ECG images, analyzing five key parameters: cardiac rhythm, atrial depolarization, atrioventricular conduction, ventricular depolarization, and ventricular repolarization (figure 1A). These parameters were benchmarked against the standard values from the Brazilian Society of Cardiology guidelines for detecting cardiac anomalies. Conversely, the DL model utilized a one-dimensional ResNet-based Convolutional Neural Network (CNN). This model was trained using ADAM optimization and binary cross-entropy loss, enabling the learning of complex patterns in the data (figure 1B).

Results

The mean age was 54.6 years (71.9 years with AF and 53.9 without AF). In the AF population, 52.2% were male (46% were male in the overall sample). In the analysis conducted, the CAI model showed a sensitivity and specificity of 90% and 62%, respectively, while the DL model had 90% and 69%, respectively. ROC curves were generated for both models, demonstrating the superior performance of the DL model (figure 2A).

Conclusions

Although the sensitivity remained similar between the models, the DL model distinguished itself with higher specificity. These results suggest that artificial intelligence, particularly the deep learning approach, holds promise as a supportive resource in AF diagnosis. However, further studies are needed to evaluate the models more thoroughly and determine their clinical applicability in a broader context.Artificial intelligence modelsROC curves
Association between amount of biventricular pacing and heart failure status measured by a multisensor implantable defibrillator algorithm
Authors: Santini L , Calo L , Bianchi V , Manzo M , Dello Russo A , Savarese G , Pecora D , Amellone C , Santobuono V E , Calvanese R , Viscusi M , Pisano E , Pangallo A , Valsecchi S , Boriani G
Published: May 2024

Background

Achieving a high biventricular pacing percentage (BiV%) is crucial for optimizing outcomes in cardiac resynchronization therapy (CRT). The HeartLogic index, a multiparametric heart failure (HF) risk score, incorporates implantable defibrillator (ICD)-measured variables and has demonstrated its predictive ability for impending HF decompensation.

Purpose

This study aimed to investigate the relationship between daily BiV% in CRT ICD patients and their HF status, assessed using the HeartLogic algorithm.

Methods

The HeartLogic algorithm was activated in 306 patients across 26 centers, with a median follow-up of 26 months (25th–75th percentile: 15-37).

Results

During the follow-up period, 619 HeartLogic alerts were recorded in 186 patients. Overall, daily values associated with the best clinical status (highest first heart sound, intrathoracic impedance, patient activity; lowest combined index, third heart sound, respiration rate, night heart rate) were associated with a BiV% exceeding 99%. We identified 455 instances of BiV% dropping below 98% after consistent pacing periods. Longer episodes of reduced BiV% (hazard ratio: 2.68; 95% CI: 1.02-9.72; P=0.045) and lower BiV% (hazard ratio: 3.97; 95% CI: 1.74-9.06; P=0.001) were linked to a higher risk of HeartLogic alerts. BiV% drops exceeding 7 days predicted alerts with 90% sensitivity (95% CI [74%-98%]) and 55% specificity (95% CI [51%-60%]), while BiV% ≤96% predicted alerts with 74% sensitivity (95% CI [55%-88%]) and 81% specificity (95% CI [77%-85%]).

Conclusions

A clear correlation was observed between reduced daily BiV% and worsening clinical conditions, as indicated by the HeartLogic index. Importantly, even minor reductions in pacing percentage and duration were associated with an increased risk of HF alerts.Time to event
Right ventricular pacing-evoked left ventricular dysfunction is exaggerated by sustained left ventricular pressure overload in a rat model
Authors: Ruppert M , Balint T , Nagy D , Lakatos B K , Olah A , Sayour A A , Barta B A , Osztheimer I , Merkely B , Radovits T
Published: May 2024

Introduction

A growing body of evidence suggests that in the presence of left bundle branch block-induced electromechanical dyssynchrony, the function of the left ventricle (LV) becomes extremely sensitive to arterial afterload. However, data is scarce whether right ventricular pacing (RVP) also sensitizes the LV to alterations in afterload.

Purpose

Hence, in the present translational study we aimed to characterize the acute effect of RVP on LV hemodynamics under standard laboratory conditions using a rat model of chronic LV pressure overload (PO).

Methods

Transverse aortic constriction (TAC group) was carried out in male Wistar rats to evoke sustained LV PO for six weeks. Age- and sex-matched sham-operated animals served as controls (Sham group). LV hemodynamics was assessed in anesthetized rats by pressure-volume analysis using a pressure-conductance micro-catheter (SPR-838) introduced to the LV via the right carotid artery. To evoke RVP, the right jugular vein was cannulated and an ultra-miniature octopolar electrophysiology catheter (EPR-800) was placed into the right ventricle. Pressure-volume loops were registered in the TAC and the Sham groups during intrinsic narrow QRS rhythm (termed as TAC-Vsense and Sham-Vsense) as well as during RVP (termed as TAC-Vpace and Sham-Vpace).

Results

RVP was associated with impaired diastolic function (active relaxation time constant [τ]: 8.6±0.3 vs. 9.6±0.3ms, Sham-Vsense vs. Sham-Vpace and 8.0±0.3 vs. 9.6±0.4ms, TAC-Vsense vs. TAC-Vpace; P<0.001 for both comparisons) and decreased LV contractility (preload recruitable stroke work [PRSW]: 139±9 vs. 114±9mmHg, Sham-Vsense vs. Sham-Vpace and 255±23 vs. 169±17mmHg, TAC-Vsense vs. TAC-Vpace; P<0.001 for both comparisons) in both the TAC and the Sham groups. Nevertheless, the extent of RVP-evoked active relaxation prolongation (Δτ: 12±2 vs. 20±2%, Sham vs. TAC, P=0.005) and LV contractility reduction (ΔPRSW: -18±4 vs. -34±3%, Sham vs. TAC, P=0.007) was found to be more robust in rats with sustained LV PO compared to controls.

Conclusion

Our experimental results indicate that RVP-induced LV dysfunction is exaggerated in case of sustained LV PO.
Spatial relationship between left peri-atrial fat with underlying arrhythmogenic substrate in patients with atrial fibrillation - innocent bystander or culprit?
Authors: Vickneson K , Tonko J , Gharaviri A , Williams M C , Dweck M , Vigneswaran V , Baptiste T , Alonso Solis Lemus J , Corrado C , Niederer S , O'neill M , Whitaker J , Williams S E
Published: May 2024

Introduction

Peri-atrial fat may have pro-inflammatory and pro-fibrotic effects on atrial myocardium and increase the risk of developing atrial fibrillation. Consistent with prior evidence, we have previously shown that peri-atrial fat volume, but not fat attenuation (an imaging biomarker of inflammation), was associated with prevalent atrial fibrillation. Whether this association is secondary to "outside-to-inside" tissue cross talk with local adverse electrical remodelling of adjacent atrial cardiomyocytes is not known.

Purpose

In this novel proof of concept study, we aimed to identify a spatial relationship between left peri-atrial fat and potentially arrhythmogenic substrate (low voltage areas and slow conduction pathways) in the left atrial myocardium.

Methods

Contrast-enhanced cardiac computed tomography (CT) imaging and electroanatomic mapping, during coronary sinus pacing, were performed pre-ablation in atrial fibrillation patients (n=27). The left atrium and surrounding peri-atrial fat were segmented and quantified using seg3D2 and CEMRGapp. We performed registration of the electroanatomic map onto the CT-derived left atrial mesh using OpenEP and EP Workbench. Mean fat volume and attenuation around each electroanatomic point (within a 3mm radial region of interest) were correlated with local voltage and conduction velocity.

Results

A total of 24,839 electroanatomic points were registered onto the 3D CT-derived left atrial mesh, with a median of 935 points (range 673 to 1150) per patient. The average bipolar voltage and conduction velocity in the left atrium was 1.92±1.91 mV and 0.66±0.47 ms-1 respectively. In comparison to areas with little/no surrounding periatrial fat (Quartile 1, ≤0.93 mm3 fat per electroanatomic point), areas with the highest burden of fat (Quartile 4, ≥17.6 mm3) had significantly lower bipolar voltage (1.69±1.7 vs 2.09±2.0 mV, p<0.001) and conduction velocity (0.627±0.43 vs 0.700±0.47 ms-1, p<0.001). However, the overall correlation between periatrial fat volume with bipolar voltage (r=-0.06, p<0.001) and conduction velocity (r=-0.07, p<0.001) was weak. High, not low, fat attenuation (Quartile 4; >-46.5HU vs Quartile 1; ≤-75.5HU) was associated with increased bipolar voltage (2.23±2.1 vs 1.63±1.6 mV) and conduction velocity (0.703±0.42 vs 0.623±0.39 ms-1 respectively).

Conclusion

There is a weak correlation between periatrial fat and localized adverse electrical remodelling. The relationship between fat attenuation and electrophysiological properties was inverted. These findings confirm an association between peri-atrial fat burden but call question as to whether peri-atrial fat inflammation is implicated in atrial fibrillation pathogenesis.
Exercise-induced regional heterogeneity of myocardial left ventricular contraction in hereditary long QT syndrome
Authors: Wiedenhofer J M , Weiss K , Denzler S , Gerds-Li J H , Tscholl V , Scherr D , Parwani A S , Will J , Zhang K , Heinzel F R
Published: May 2024

Background

Hereditary long QT syndrome (LQTS) is characterized by prolonged ventricular repolarization and an increased risk for ventricular arrhythmias (VA) and sudden cardiac death. Dispersion of ventricular repolarization in LQTS may be more pronounced during exercise and not only impacts the heart’s electrical functions but also the pattern of mechanical contraction. Little is known about the intraventricular heterogeneity of wall motion abnormalities in LQTS patients.

Methods

In this cross-sectional study we quantify regional, transmural, and longitudinal alterations in left ventricular (LV) contraction at rest, during exercise, and recovery in genetically confirmed LQTS patients and healthy controls to evaluate their value in differentiating high risk patients as defined by a history of VA. ECG and echocardiographic assessments were conducted during rest, peak ergometer activity (105 to 125 bpm), and four minutes into recovery phases. Longitudinal strain (LStr) parameters were measured for each LV segment separately. We differentiated LStr variations as heterogeneity of LStr amplitude (hetLStr; standard deviation [SD] or mean range) and dispersion of time-to-peak LStr (disLStr; SD or mean range). Here, we present the analyses of disLStr.

Results

At present, 15 patients with genetically confirmed LQTS (LQT1: 8, LQTS 2: 7; mean QTc 475 ± 46 ms) have been included of which 9 had a history of VA. In addition, we collected data from 8 age- and gender-matched control patients (mean QTc 401 ± 18 ms). LV ejection fraction and LStr were not significantly different between the LQTS and control groups. However, LQTS patients exhibited a significantly lower mean LStr in both the endocardial and epicardial layers across all phases compared to control. We observed a significantly more pronounced disLStr across all segments in the LQTS group during the rest and recovery phases in the endocardial layer and during all phases in the epicardial layer. Regional differences (apical vs. basal) were found in all LQTS patients only endocardially at rest. Globally, disLStr showed transmural differences (epicardial vs. endocardial) in both asymptomatic and symptomatic LQTS patients during peak exercise and recovery. Upon segmental analysis, it was observed that symptomatic patients exhibited these transmural differences apically already at rest (p=.004), as well as in the basal region during peak exercise (p=.01), and in the apical region during recovery (p=.02).

Conclusion

LQTS patients show regional (base to apex) and transmural (endocardial to epicardial) heterogeneities in myocardial contraction at rest, during exercise, and recovery as compared to healthy patients. These regional variations in myocardial contraction patterns may be more pronounced in high risk LQTS patients. Ongoing analyses of hetLStr are in progress to corroborate our findings.
P-wave duration and interatrial block as predictors of ischemic stroke: a systematic review and meta-analysis
Authors: Nedios S , Lioutas V , Koutalas E , Zagoridis K , Intzes S , Symeonidou M , Dilk P , Seewoester T , Bode K , Bollmann A
Published: May 2024

Introduction

Ischemic stroke-risk has been associated with clinical characteristics, atrial remodeling and P- wave changes, like P-wave duration (PWD) or interatrial block (IAB). Despite the increasing evidence though, their use in risk-stratification remains limited.

Purpose

The aim of this review and meta-analysis was to examine the predictive value of PWD/IAB for stroke and offer practical implications.

Methods

Publication databases were systematically searched and studies reporting PWD and/or morphology at baseline and thromboembolic events (TEs) during follow-up (FUP) were included. IAB was defined as partial (pIAB) if PWD≥120 ms or advanced (aIAB) if the P-wave was biphasic in the inferior leads. After quality assessment and data extraction, random-effects analysis calculated odds ratio (OR) and confidence intervals (CI). Subgroup-analysis was performed to address heterogeneity.

Results

Among 180.997 patients (17 studies, mean 66 years old), including primary care patients (n=152.759), 15.578 (9%) had a new TE during 4 years of FUP. The pIAB was significant TE-risk predictor for non-primary care patients (OR:1.7; 95% CI:1.4-2.1) and those with prior TE (OR:1.8; 95% CI:1.4-2.2), but not for primary-care (OR:1.0) or those without prior TE (OR:1.3). The aIAB was significant TE-risk predictor both for primary (OR:1.6; 95% CI:1.4-1.9) and nonprimary care (OR:2.5; 95% CI:1.8-3.4) as well as those without (OR:2.2; 95% CI:1.1-4.4) or with prior TE (OR:2.6; 95% CI:1.4-4.7). There was heterogeneity but no publication bias in the subgroup-analysis.

Conclusion

Interatrial block is an independent predictor of TE-risk. The association is stronger for non-primary care patients or those with prior TE. Thus, PWD and IAB could be used as selection criteria for intensive screening, follow-up or interventions.
Heart rate from intermittent home measurements within an atrial fibrillation screening program is associated with mortality
Authors: Van Der Velden R , Linz D , Svennberg E
Published: May 2024

Introduction

A high resting heart rate is a predictor of cardiovascular disease and cardiovascular mortality. Studies on the association between heart rate and outcomes often measure heart rate at a single time point, even though multiple measurements may be a stronger predictor of cardiovascular risk. Indeed, the association between short-term home heart rate measurements and outcomes has not been extensively studied.

Purpose

This sub study of the STROKESTOP trial explores the association of baseline and home resting heart rate measurements with all-cause and cardiovascular mortality.

Methods

The STROKESTOP randomised controlled trial consisted of an atrial fibrillation (AF) screening program among the 75- and 76-year-old inhabitants of two Swedish regions. Participants in the intervention group were invited to a two week intermittent screening program, consisting of twice daily measurements with an ECG-based handheld device. For this sub analysis, baseline heart rate, the median of 5 home morning heart rates and the median of 5 home evening heart rates were evaluated. Associations were evaluated by heart rate quintiles (41-63 bpm, 64-70 bpm, 71-76 bpm, 77-84 bpm and ≥85 bpm), with 64-70 bpm as the reference category. Hazard rations were obtained by Cox regression analysis. The full multivariable model included demograhic factors such as sex and educational level, medical history of several diseases and the use of cardiovascular medication. Both all-cause mortality and cardiovascular mortality were evaluated.

Results

In total, 5873 individuals were included in this analysis. Overall, 55.6% were women and the median baseline heart rate was 73 [65-81] bpm, whereas the median of morning heart rates was 71 [64-78] bpm and that of evening heart rates 71 [65-79] bpm. Having a baseline heart rate in the highest quintile compared to the reference quintile, showed a hazard ratio (HR) for all-cause mortality in unadjusted analysis of 1.39 (1.11-1.73) (p=0.004), and of 1.51 (1.20-1.90) in the fully adjusted analysis (p<.001). For cardiovascular mortality, HRs were 1.78 (1.21-2.63) (p=0.004) and 2.13 (1.42-3.20) (p=<.001), respectively. The association between the highest heart rate and all-cause mortality and cardiovascular mortality were substantially strengthened when median morning heart rates were considered (HR 2.03 (1.61-2.56) and 2.18 (1.72-2.76), p<.001 for all-cause mortality on univariable and multivariable analysis, HR 2.35 (1.57-3.51) and 2.59 (1.72-3.92), p<.001) for cardiovascular mortality). Associations between home evening heart rates and all-cause and cardiovascular mortality were not substantially stronger compared to the associations with baseline heart rate.

Conclusion

Our study shows that home-measured morning heart rate is more strongly associated with all-cause and cardiovascular mortality compared to a single time-point office heart rate.Hazard ratios for mortality
Real-world evaluation of the treatment yield of implantable loop recorders (ILR) in the Netherlands
Authors: Samuel M , Van Der Stoel M , Van Dijk V , Maass A
Published: May 2024

Background

Implantable loop recorders (ILRs) are invasive and expensive diagnostic tools used to determine the underlying arrhythmias associated with syncope and palpitations as well as capture atrial fibrillation (AF). The diagnostic and treatment yield from ILRs is uncertain. Prior studies indicated that 26-52% ILR patients were diagnosed with arrhythmias and 11-30% received subsequent treatment.

Purpose

Our primary aim was to determine the incidence of pacemaker and ICD implants within 1- and 3- years of ILR implantation. The secondary aims include 1) an evaluation of the incidence of AF ablation, 2) the identification of predictors for treatment, and 3) safety.

Methods

Adult patients who underwent an ILR implant in the Netherlands Heart Registration (NHR) Pacemaker and ICD registry (2018-2021) were included. The NHR device registry was linked to the ablation registry to determine the incidence of AF ablation after ILR. Incidence rates for pacemaker implants, ICD implants, AF ablations, and complications among ILR patients were reported as a proportion of ILR patients over 1- and 3- years. Predictors for treatment following an ILR were determined from multivariable logistic regression models.

Results

From 2018 to 2021, 11,961 patients underwent an ILR implant in the Netherlands. Patients who underwent ILR implantation were a median age 69 (IQR 56-77) years, 46.9% female, and 24.9% had AF. The most frequent indication for ILR implantation was syncope (76.2%), followed by palpitations (15.2%). At 1- and 3-years post-ILR implantation, 12.0% and 14.6% of ILR patients underwent a pacemaker implant, respectively (Figure 1). Fewer patients underwent ICD implants (0.9% and 1.3%) and AF ablation (1.3% and 1.8%) at 1- and 3-years post-ILR implantation, respectively (Figure 1). Compared to males, females were 28% and 70% less likely to undergo a pacemaker and ICD implant following ILR, respectively (Figure 2). Additional predictors for pacemaker implantation included older age, AF, and syncope (p<0.05 for all, Figure 2a). In addition to female sex, AF was a predictor of ICD implantation (Figure 2b). The incidence of complications was relatively low (0.3%). Infection was the most frequent complication (0.2%), followed by device dislocation (0.06%), bleeding (0.02%), and device defect (0.01%).

Conclusion

Despite the benefits of ILRs for long-term remote monitoring, the therapeutic yield of ILRs is relatively low with 14.6%, 1.3%, and 1.8% of ILR patients undergoing implantation for pacemakers, ICDs, and AF ablation at 3-years follow-up. As an expensive and invasive diagnostic tool, a more targeted approach for referrals is warranted to increase the therapeutic yield of the ILRs. Further investigations are warranted to determine the diagnostic yield of ILRs, regardless of subsequent invasive therapy.
Volume-weighted unipolar voltage identifies diffuse fibrosis in patients with non-ischemic cardiomyopathy
Authors: Omara S , Kimura Y , Wijnmaalen A P , Van Der Geest R , Zeppenfeld K
Published: May 2024

Background

Late-gadolinium enhanced cardiac magnetic resonance imaging (LGE-CMR) is currently used to identify non-ischemic scar. However, the distribution of non-ischemic fibrosis related to ventricular arrhythmia (VA) may vary between patients and cannot be accurately delineated by LGE-CMR. Myocardial extracellular volume fraction (ECV) is a promising tool to estimate the amount of diffuse fibrosis in non-ischemic cardiomyopathies (NICM). Novel intra-cardiac mapping derived tools, such as volume-weighted unipolar voltage (vwUV), may allow intraprocedural quantification of diffuse fibrosis.

Purpose

To evaluate the performance of vwUV to determine the segmental amount of non-ischemic fibrosis defined by whole-heart T1 mapping.

Methods

Consecutive patients with a left dominant NICM referred for ablation of VA, who underwent 3D LGE-CMR, whole-heart pre- and post-contrast T1 mapping and high density electroanatomical voltage mapping (EAVM) were included. CMR images were segmented and merged with the 3D EAVM data. The 16-segment AHA model was applied and vwUV and ECVs were determined per segment.

Results

Twenty-one patients (age 54 years [49-60], 18 males [87%], LVEF 47% [37-57%], LGE 7.7% (2.8-18.2%) of LV myocardium) were included and 305 segments analysed. The median ECV per patient was 30.3% (28.8-35.2%). The median segmental vwUV was 1.8mV (1.2-2.3mV). The basal septal and basal inferolateral segments tended to have higher ECV. However there was important variation between patients (figure 1). Of note, the segmental vwUV correlated well with segmental ECV (r = -0.53, p < 0.001) (figure 2).

Conclusions

For the first time, a segmental comparison has been performed between ECV and vwUV. There are important segmental variations of ECV between patients with a NICM referred for VA ablation. The novel intra-cardiac mapping-derived tool of vwUV can localize non-ischemic fibrosis and may facilitate substrate based ablation approaches in this challenging patient population.Figure 1.Segmental ECV valuesFigure 2.Segmental ECV and vwUV
Comparative analysis of pulsed-field and cryoballoon ablation in octogenarians with atrial fibrillation: a multicenter study
Authors: Nakasone K , Della Rocca D G , Magnocavallo M , Betancur A , Pannone L , Mene R , Sorgente A , Sieira J , Almorad A , Stroker E , Sarkozy A , Rossi P , Boveda S , De Asmundis C , Chierchia G B
Published: May 2024

Background

The prevalence of atrial fibrillation (AF) increases with advancing age, and AF contributes to higher rates of stroke, dementia, heart failure, and mortality. Catheter ablation is recognized as an effective treatment for AF; however, data regarding its efficacy in octogenarians are limited. Cryoballoon ablation (CBA) has been reported to be safe and effective in this age group. Recently, single-shot devices using pulsed-field energy have been developed, offering a tissue-specific effect. However, data on the safety and effectiveness of this novel pulsed-field ablation (PFA) in octogenarians are still insufficient.

Purpose

This study aims to evaluate the procedural outcomes and complications of PFA in octogenarians with AF, in comparison to CBA, from 3 high-volume European centers.

Methods

We retrospectively enrolled patients who underwent PFA via the FarapulseTM system from January 2022 to June 2023, and those who underwent second-generation CBA from January 2015 to June 2023.

Results

A total of 176 patients (PFA group: 63, CBA group: 113) were included. The PFA group had a higher proportion of patients with persistent AF (p=0.03) and undergoing a repeat procedure (p<0.01). (Table 1) Unlike CBA, PFA procedures involved additional extrapulmonary targets, such as posterior wall and mitral isthmus. Nonetheless, procedure time was similar between groups. There were no significant differences in complications but phrenic nerve palsy was not observed in the PFA group (Table 2).

Conclusions

PFA for octogenarians provides the possibility to target additional extrapulmonary sites with equivalent procedural times and safety compared to CBA, without the concern of phrenic nerve palsy.Table 1Table 2
Implementation of nurse administered propofol sedation for same-day discharge pulsed field ablation of atrial fibrillation is safe and has excellent patient reviews
Authors: Gybel C , Madsen M , Nielsen J M
Published: May 2024

Background

In June 2022, we introduced Pulsed Field Ablation (PFA) for de novo pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). Simultaneously, deep sedation with propofol undertaken by trained nurses from the cath lab was introduced.

Purpose

To evaluate feasibility, safety and patient reported experience for same-day discharge AF ablations performed with PFA on propofol sedation.

Methods

Patients with an ASA physical status classification of 1 or 2 referred for de novo AF ablation were planned for PFA in propofol sedation. Three nurses with previous experience from the intensive care unit planned and undertook the sedation. In addition, two nurses were trained locally.

The initial 200 consecutive patients were included in the observational cohort study after signing consent to participate in follow-up after the procedure. Study data were collected and managed using REDCap electronic data capture tools. In addition to procedure related data, patient-reported quality measures were acquired 30 days after the procedure by an internet based questionnaire including scaling and open questions.

Results

96% of the procedures were successfully completed using only propofol while 4% were scheduled for general anesthesia, mainly because of sleep apnea and high BMI. The average procedure time for the first 100 procedures was 57 min (95% CI, 54.1-62.9) and 45 min (95% CI, 42.6-47.4) for the following 100 procedures. Acute PVI was achieved during all procedures. No sedation related adverse effects were observed. One patient experienced pericardial tamponade requiring prolonged hospitalization. 87% were discharged on the same day as planned while 12% remained hospitalized one additional day for reassurance and social reasons. 93% (186/200) completed the questionnaire. 56% of patient only responded "very little" or "not at all" to all questions about adverse symptoms during and after the procedure. For each specific symptom, 80 to 95 % were only experienced "very little" or "not at all" (Fig 1). In general, patients felt safe about the preparation for and handling of the sedation (Fig 2).

Conclusions

Nurse administered deep sedation with propofol, provides excellent pain relief for PFA procedures, facilitates an efficient workflow and can safely be implemented and administered by nurses from the cath lab. Propofol sedation constitutes an important alternative to general anesthesia that is not widely available.Figure 1Figure 2
Innovations in arrhythmia management in pregnant woman: catheter ablation without using fluoroscopy
Authors: Smagulova A , Ainabekova B , Albaev R , Abdrakhmanova Z H , Suleymen Z H , Abdrakhmanov A
Published: May 2024

Background

The latest data of effectiveness and safety of catheter ablation without using fluoroscopy in general population suppose wide using of this technology. However, data on pregnant population is limited.

Purpose

To investigate efficacy and safety of catheter ablation without using fluoroscopy in pregnant women with analyzing obstetric and neonatal outcomes.

Methods

We studied 47 cases of catheter ablation in pregnant (mean age 25.3±3.9 years, mean gestation age 23.7 ±3.1 weeks) within 24 month follow-up. Ablation was performed under the guidance of CARTO (n=21; 44.7%) and Ensite Precision systems (n=26; 55.3%) without using fluoroscopy in all cases.

Results

The most common arrhythmia was atrioventricular nodal reentrant tachycardia (n=21; 44.7%), which was followed by Wolff–Parkinson–White syndrome (n=15; 31.9%). Cases of combination of accessory pathways with slow conduction ways (n=3, 6.4%), ventricular tachycardia (n=3, 6.4%) and premature ventricular contraction (n=5; 10.6%) were rare. Ablation without using fluoroscopy was successful in all cases, mean procedural time was 71.9±14.5 minutes. There was one case of complication after ablation procedure: ileofemoral thrombosis, which was treated successfully without termination of gestation (2.1%). We found increased uterine contractile activity and placental abruption in pregnant after ablation in 4.54% and 2.3% cases respectively. Cases of uterine blood flow violation was more frequent: in 15.9% cases. Obstetric outcomes characterized by prevalence of vaginal delivery and delivery in term: in 76.6% and 95.7% cases. There were live births in all pregnant women with normal range of fetal birth weight and Apgar score (3207.4±485 grams and 8.4±1.6 respectively). There were no incidence of mortality and arrhythmia recurrence at follow up.

Conclusions

Catheter ablation without using fluoroscopy can be effectively and safety performed during gestation with good neonatal and obstetric outcomes.
First-time catheter ablation outcomes for atrial fibrillation are dependent on low-voltage areas rather than paroxysmal vs. persistent classifications: a REAL-AF study
Authors: Nguyen A , Pulaski M , Thorne C , Nauffal V , Osorio J , Singleton M J , Zadeh A , Zei P , Ho I , Rajendra A , Mareddy C , Lee K , Metzl M , Zaman J A B
Published: May 2024

Background

Left atrial low-voltage areas (LA LVA) measured at time of catheter ablation for atrial fibrillation (AF) have been increasingly recognized as an indicator of atrial fibrosis [1]. However, little is known whether first-time catheter ablation outcomes differ between paroxysmal AF (PAF) and persistent AF (PerAF) in patients with higher LA LVA, which may indicate a more advanced substrate independent of clinical subtype.

Purpose

To evaluate whether outcomes of first-time catheter ablation for AF are dependent on LA LVA rather than PAF vs. PerAF types in a multicenter registry of patients.

Methods

The Real-world Experience of Catheter Ablation for the Treatment of Symptomatic PAF and PerAF Using Novel Contact Force Technologies registry (REAL-AF) is a prospective, observational multicenter registry of patients undergoing catheter ablation. We evaluated 4181 patients undergoing first-time catheter ablation for both PAF and PerAF to determine AF recurrence within 12 months. Contact maps were created using a 5-spline high-density catheter. LA LVA was calculated using these contact maps based on a bipolar voltage of <0.50 mV. LA LVA was categorized into low (<5%) vs. high (≥5%) based on preliminary data. Risk of recurrence was analyzed using Cox proportional hazard models.

Results

Patients with LA LVA ≥5% who underwent first-time catheter ablation for AF (both PAF and PerAF) experienced a higher risk of AF recurrence within 12 months (Hazard ratio (HR): 1.95, p<0.001), see Figure 1. Overall, 82.0% of patients were free of AF in the LA LVA <5% group compared to 69.1% in the LA LVA ≥5% group. This association remained significant in a subpopulation of patients presenting in normal sinus rhythm (N = 2463) at time of ablation (HR: 1.90, p<0.001). 12-month ablation outcomes between PAF and PerAF in patients with LA LVA ≥5% (N = 1590) were not statistically significant (71.0% vs 67.3% respectively, HR: 1.15, p=0.30), see Figure 2. Finally, in the LA LVA <5% group (N = 2591), patients with PerAF had a 1.42 times higher risk for AF recurrence within 12 months after catheter ablation (p=0.04).

Conclusion

This is the largest real-world registry to date demonstrating that LA LVA ≥5% is associated with a higher risk of AF recurrence within 12 months in patients undergoing first-time catheter ablation for AF. Among patients with LA LVA ≥5%, AF recurrence was not associated with AF type. These findings motivate further studies into using LA LVA as a prognostic tool for patients undergoing first-time catheter ablation for AF and using non-invasive methods to assess this in order to stratify patients further.
Nationwide burden of sudden cardiac death among patients with a psychiatric disorder
Authors: Mujkanovic J , Warming P E , Winkel B G , Lynge T H , Tfelt J
Published: May 2024

Background and aim

Patients with psychiatric disorders have increased all-cause mortality compared to the general population. Previous research has shown that they have a 4-fold increased risk of sudden cardiac death (SCD) among the young. However, the risk across all age groups remains unknown.

Purpose

To investigate the incidence of SCD in patients with psychiatric disorders aged 18-90 years in the Danish population by systematically reviewing all deaths in one year.

Methods

We examined all deaths in Denmark among residents aged 18-90 years in 2010 by reviewing death certificates and autopsy reports. All deaths were categorized as non-SCD, or SCD, based on the available information. Psychiatric disorder was defined according to ICD-10 criteria, or by redemption of a prescription for psychotropic medication within one year prior to death.

Results

Out of 4.3 million residents in 2010 aged 18-90 years, we observed 45 703 deaths of which 6 002 were SCD. Overall, the incidence of SCD was 4.35 times (CI: 4.20-4.50, p-value <0.001) higher among patients with psychiatric disorders than in the general population and was age dependent (p-value <0.001). When adjusting for age, sex, and comorbidities, psychiatric disorders were independently associated with SCD, with a hazard ratio (HR) of 2.46 (2.33-2.60, p-value: <0.001), with highest SCD risk among patients suffering from schizophrenic disorders with a HR of 5.27 (4.23-6.56 p-value <0.001). Furthermore, patients with psychiatric disorders had an expected 10-year excess loss of life of which 13% was caused by SCD.

Conclusion

The rate of SCD in patients with psychiatric disorders was 4 times higher than in the general population. Having a psychiatric disorder is independently associated with SCD. Life-expectancy for an 18-year-old with a psychiatric disorder is projected to be 10-years shorter in comparison.Incidence rate of SCD by age groupExcess loss of life-years
Ventricular arrhythmia events in patients with implantable cardioverter-defibrillator before and after the treatment with sodium-glucose co-transporter 2 inhibitors
Authors: Giannotti Santoro M , Vecchi A , Lapira F , Puccioni E , Talini E , Menegato A , Okunuga B , Chiti C , Sardella S , Negro F , Genovesi Ebert A , Pasanisi E M G
Published: May 2024

Background

The role of sodium-glucose co-transporter 2 inhibitors (SGLT2i) in the treatment of chronic heart failure is expanding. However, the timing of implantable cardioverter-defibrillator (ICD) implantation for primary prevention in relation to the use of SGLT2i remains unclear. A small case series has described appropriate shocks from ICD in two patients following the initiation of SGLT2i, but a comprehensive analysis is lacking in the literature.

Methods

This study aimed to investigate the rate of ventricular arrhythmic burden and appropriate anti-tachycardia therapy from ICD before and after the initiation of SGLT2i therapy. We conducted a retrospective single-center analysis, comparing ventricular events from home monitoring reports three months before and three months after SGLT2i therapy initiation.

Results

Seventeen patients were enrolled in the study. At baseline, clinical characteristics were as follows: 13 (76%) were male, 9 (53%) had ischemic, 2 (12%) had valvular, and 6 (35%) had idiopathic cardiomyopathy. The mean end-diastolic volume (EDV) was 203 ± 90 ml, and the mean left ventricular ejection fraction was 0.36 ± 0.09. All patients were treated with beta-blockers, 14 (82%) with sacubitril-valsartan, 13 (76%) with aldosterone antagonists, 16 (94%) with furosemide, and 5 (29%) with amiodarone. SGLT2i started with dapagliflozin for 13 patients (76%), empagliflozin for 3 patients (18%), and canagliflozin for 1 patient (6%). Ten patients (59%) had single-chamber or dual-chamber ICDs, and 7 had implantable cardiac resynchronization therapy (CRT) defibrillators.

In the three months before SGLT2i treatment, 4/17 patients had non-sustained ventricular tachycardia (NSVT), compared to 8/17 (23% vs. 47%, p-value 0.23) patients with NSVT after treatment. Seven patients (41%) experienced an increase in the rate of NSVT events, with one patient having 28 NSVT events after treatment versus none before treatment. No patients had anti-tachycardia therapy in the three months before treatment, while in the three months after SGLT2i treatment, 1 patient had ventricular tachycardia treated with anti-tachycardia pacing (110 days after the beginning of the treatment), and 2 patients had ventricular tachycardia treated with appropriate shocks (2 and 25 days after the initiation of SGLT2i treatment).

Conclusion

This small retrospective analysis revealed an increase in ventricular arrhythmic events in the three months following the initiation of SGLT2i. These findings highlight the need for a more extensive analysis to establish a stronger statistical correlation.
Socioeconomic inequalities in the uptake of postpartum care at home across Dutch neighbourhoods
Authors: Daalderop Leonie A , de Vries Eline F , Steegers Eric A P , Been Jasper V , Struijs Jeroen N , Lagendijk Jacqueline
Published: May 2024

Background

Postpartum care focuses on prevention of health problems by performing medical check-ups and through enhancing maternal empowerment, the parent–infant interaction and knowledge about mother’s own health and that of her newborn. We aimed to investigate whether there was significant clustering within neighbourhoods regarding the uptake of postpartum care and to what extent neighbourhood-level differences are explained by individual socio-demographic factors, pregnancy-related factors and neighbourhood-level determinants (i.e. deprivation and urbanization).

Methods

A nationwide population-based observational study was carried out using linked routinely collected healthcare data from appropriate-for-gestational-age weight live-born term singleton deliveries (2015–18) in the Netherlands. We performed two-level multivariable logistic regression analyses, using three different models. Model 1 contained no explanatory variables and was used to assess clustering of postpartum care uptake within neighbourhoods. In model 2, individual-level determinants were added one by one and in model 3, neighbourhood-level determinants were added.

Results

About 520 818 births were included. Multilevel modelling showed that 11% of the total variance in postpartum care uptake could be attributed to the neighbourhood of residence. Individual characteristics explained 38% of the neighbourhood variance, of which income and migration background were the most important contributors. An additional 6% of the variation could be explained by neighbourhood-level determinants.

Conclusion

We found substantial neighbourhood differences in postpartum care uptake. These differences are influenced by a complex interplay between individual-level and neighbourhood-level determinants, highlighting the importance of addressing both individual and neighbourhood-level determinants to improve the uptake of postpartum care and therewith overall community health.
A comparative analysis reveals the genomic diversity among 8 Muscovy duck populations
Authors: Li Te , Wang Yiming , Zhang Zhou , Ji Congliang , Zheng Nengzhu , Huang Yinhua
Published: May 2024

The Muscovy duck (Cairina moschata) is a waterfowl indigenous to the neotropical regions of Central and South America. It has low demand for concentrated feed and strong adaptability to different rearing conditions. After introduced to China through Eurasian commercial trade, Muscovy ducks have a domestication history of around 300 years in the Fujian Province of China. In the 1990s, the commodity Muscovy duck breed “Crimo,” cultivated in Europe, entered the Chinese market for consumption and breeding purposes. Due to the different selective breeding processes, Muscovy ducks have various populational traits and lack transparency of their genetic background. To remove this burden in the Muscovy duck breeding process, we analyzed genomic data from 8 populations totaling 83 individuals. We identify 11.24 million single nucleotide polymorphisms (SNPs) and categorized these individuals into the Fujian-bred and the Crimo populations according to phylogenetic analyses. We then delved deeper into their evolutionary relationships through assessing population structure, calculating fixation index (FST) values, and measuring genetic distances. Our exploration of runs of homozygosity (ROHs) and homozygous-by-descent (HBD) uncovered genomic regions enriched for genes implicated in fatty acid metabolism, development, and immunity pathways. Selective sweep analyses further indicated strong selective pressures exerted on genes including TECR, STAT2, and TRAF5. These findings provide insights into genetic variations of Muscovy ducks, thus offering valuable information regarding genetic diversity, population conservation, and genome associated with the breeding of Muscovy ducks.
Limited impact of cancer-derived gangliosides on anti-tumor immunity in colorectal cancer
Authors: van der Haar Àvila Irene , Zhang Tao , Lorrain Victor , de Bruin Florance , Spreij Tianne , Nakayama Hitoshi , Iwabuchi Kazuhisa , García-Vallejo Juan J , Wuhrer Manfred , van Kooyk Yvette , van Vliet Sandra J
Published: May 2024

Aberrant glycosylation is a key mechanism employed by cancer cells to evade immune surveillance, induce angiogenesis and metastasis, among other hallmarks of cancer. Sialic acids, distinctive terminal glycan structures located on glycoproteins or glycolipids, are prominently upregulated across various tumor types, including colorectal cancer (CRC). Sialylated glycans modulate anti-tumor immune responses through their interactions with Siglecs, a family of glycan-binding receptors with specificity for sialic acid-containing glycoconjugates, often resulting in immunosuppression. In this paper, we investigated the immunomodulatory function of ST3Gal5, a sialyltransferase that catalyzes the addition of α2-3 sialic acids to glycosphingolipids, since lower expression of ST3Gal5 is associated with better survival of CRC patients. We employed CRISPR/Cas9 to knock out the ST3Gal5 gene in two murine CRC cell lines MC38 and CT26. Glycomics analysis confirmed the removal of sialic acids on glycolipids, with no discernible impact on glycoprotein sialylation. Although knocking out ST3Gal5 in both cell lines did not affect in vivo tumor growth, we observed enhanced levels of regulatory T cells in CT26 tumors lacking ST3Gal5. Moreover, we demonstrate that the absence of ST3Gal5 affected size and blood vessel density only in MC38 tumors. In summary, we ascertain that sialylation of glycosphingolipids has a limited influence on the anti-tumor immune response in CRC, despite detecting alterations in the tumor microenvironment, possibly due to a shift in ganglioside abundance.
Evolution of Maternal Provisioning and Development in the Ophiuroidea: Egg Size, Larval Form, and Parental Care
Authors: Byrne Maria , Cisternas Paula , O'Hara Timothy D , Sewell Mary A , Selvakumaraswamy Paulina
Published: May 2024

Synopsis

The Ophiuroidea is the most speciose class of echinoderms and has the greatest diversity of larval forms, but we know less about the evolution of development (evo-devo) in this group than for the other echinoderm classes. As is typical of echinoderms, evo-devo in the Ophiuroidea resulted in the switch from production of small eggs and feeding (planktotrophic) larvae to large eggs and non-feeding (lecithotrophic) larvae. Parental care (ovoviviparity or viviparity/matrotrophy) is the most derived life history. Analysis of egg data for 140 species (excluding viviparity and facultative planktotrophy) indicated a bimodal distribution in egg volume corresponding to planktotrophy and lecithotrophy + ovoviviparity, with three significant egg size groups due to the very large eggs of the ovoviviparous species. The marked reduction in fecundity in species with extremely large eggs is exemplified by the ovoviviparous species. Egg size in the two species with facultative planktotrophy was intermediate with respect to the two modes. Identifying the ancestral larval life history pattern and the pathways in the switch from feeding to non-feeding larvae is complicated by the two patterns of metamorphosis seen in species with planktotrophic development: Type I (ophiopluteus only) and Type II (ophiopluteus + vitellaria larva). The variability in arm resorption at metamorphosis across ophiuroid families indicates that the Type I and II patterns may be two ends of a morphological continuum. This variability indicates ancestral morphological plasticity at metamorphosis, followed by canalization in some taxa to the vitellaria as the metamorphic larva. Vestigial ophiopluteal traits in lecithotrophic ophioplutei and vitellaria indicate evolution from the ancestral (feeding larva) state. Parental care has evolved many times from an ancestor that had a planktonic ophiopluteus or vitellaria and is often associated with hermaphroditism and paedomorphosis. A secondary reduction in egg size occurred in the viviparous species.
Palestine as a Litmus Test for Transitional Justice
Authors: Sirleaf Matiangai V. S
Published: May 2024

ABSTRACT∞

We are currently witnessing another sustained and significant mobilization of people across the globe, coming on the heels of the racial justice uprising of 2020. This postscript of the International Journal for Transitional Justice’s (IJTJ) Special Issue on Race, Racism and Transitional Justice reflects on whether transitional justice as a field can offer meaningful avenues for rectifying past and ongoing racial injustices, by examining the concrete and pressing example of Palestine. It argues that transitional justice has never fully grappled with the ‘question’ of Palestine, which was a live one at its birth and remains a live one today. It concludes that it is an open question whether the appeal of transitional justice to the rule of law and universal principles in the current international context can be divorced from how the rule of law operates in practice and how it selectively applies to racialized others.