bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamics of myocardial global longitudinal strain in patients with COVID-19 without significant baseline cardiovascular pathology
Authors: Iakovlev S , Dukhin O , Ryzhkova E , Andreeva E , Kalinskaya A
Published: October 2021

Background/Introduction

SARS-CoV-2 is notorious for its ability to cause damage to the respiratory system and myocardium, which can result in the development of acute respiratory distress syndrome and myocardial dysfunction.

Purpose

The aim of our study was to assess the interaction between the severity of COVID-19 and echocardiographic parameters of myocardial dysfunction, as well as lung ultrasound data.

Methods

47 COVID-19 patients without signs of cardiovascular pathology were included in our study (33 in the moderate severity subgroup and 14 in the severe subgroup). All patients underwent comprehensive transthoracic echocardiography, including global longitudinal strain (GLS) of both ventricles, and lung ultrasound at days 1 and 9 of the disease. We used GLS cut-off values of 16% and 20% for LV and RV respectively. We performed the lung ultrasonography using an 8-zone protocol for each lung. The EACVI lung ultrasound scoring system for each region and ultrasound pattern was used.

Results

At day 1, patients in the severe subgroup had a greater tricuspid gradient (22,0 [21,0; 26,0] vs. 30,0 [24,0; 34,5], p=0,04) and systolic pulmonary artery pressure (22,0 [21,0; 26,0] vs. 30,0 [24,0; 34,5], p=0,02). Moreover, we noted a decrease in the GLS RV index in COVID-19-patients in comparison with the generally accepted reference values (18,45 [15,8; 21,0]). During the course of the disease, an increase in GLS RV was noted in both subgroups, which was especially pronounced among severe patients (18,5 [15,2; 21,1] vs. 20,2 [15,8; 22,0], p=0,038).

Assessing the LV function, we noted a difference in the E/e (LV) ratio among severe and moderate subgroups (7,5 [6,8; 9,34] vs. 9,5 [7,7; 10,2], p=0,03). The GLS LV didn't differ between patient subgroups at day 1. We noted an increase in GLS LV at day 9 in both subgroups, but the difference reached significance among moderate patients (17,9 [15,8; 20,1] vs. 19,5 [17,1; 21,8], p=0,038).

We observed a greater number of points assessing the B-lines among severe subgroup compared to moderate subgroup (19,5 [17,5; 26,5] vs. 13,0 [7,0; 18,0], p<0,01).

Conclusion

Among COVID-19 patients without an underlying cardiovascular pathology the transient decrease in LV and RV function assessed via GLS was observed even among patients with moderate disease severity.

Funding Acknowledgement

Type of funding sources: None.
Impact of comorbidities and ablation strategy on outcome after pulmonary vein isolation with cryo-balloon in patients with non- paroxysmal atrial fibrillation
Authors: Berkowitsch A , Hutter J , Zaltsberg S , Tomic M , Kahle P , Hain A , Kuniss M , Neumann T
Published: October 2021

Background

Presence of several comorbidities in patients with atrial fibrillation is well known, but impact of them on outcome after pulmonary vein isolation with cryo-balloon is not enough investigated. First aim of the study was analysis of the impact of comorbidities on long term outcome after PVI with cryo-balloon new generation (CBA) and secondary goal was evaluation of the impact of additional posterior roof ablation (PRA) in these patients.

Methods

Patients with non-paroxysmal AF ablated with CBA in our institution since May 2012 and completed follow up >3 months were enrolled in the study. The history of AF, cardiac comorbidities (CAD, Non ischemic-cardiomyopathy, heart insufficiency, right ventricular dysfunction) diabetes mellitus, and renal failure were assessed at admission, all patients received echocardiographic examination and blood test.

After a single trans-septal access and PV angiography PVI was performed using a 28-mm CBA. Mapping of PV signals before, during, and after each cryo application was performed with a 3F lasso catheter. The procedural endpoint after PVI was defined as complete elimination of all fragmented signals at the PV antrum with verification of entrance and exit block. In some patients PRA was performed additionally to PVI at discretion of physician. The primary endpoint of this study was the first documented recurrence of atrial tachyarrhythmia (>30 sec.), hospitalization due to cardio-vascular cause, re-do procedure or re-administration of anti-arrhythmic drugs.

Results

Among 560 patients 78 (13.9%) had no comorbidity and 299 (53.4%) were lasted with >1 comorbidity. A total of 260 (46.4%) recurrences were obtained within median follow up of 28 (12–57) months. Female gender, long time from first diagnosis >12 months and cardiac comorbidity were revealed to be independent predictors for long term recurrences whereas additional PRA performed in 176 pts independently improved outcome (61.9% vs 49.7%).

Conclusion

Cardiac comorbidities increased probability of post ablation recurrences, but performing of additional posterior roof ablation improved outcome in our cohort. These results should be confirmed in multi-center randomized study

Funding Acknowledgement

Type of funding sources: None.
Catheter contact angle influences local impedance drop during radiofrequency catheter ablation: insight from a porcine experimental study
Authors: Matsuura G , Fukaya H , Ogawa E , Kawakami S , Saito D , Sato T , Arakawa Y , Kobayashi S , Shirakawa Y , Ishizue N , Oikawa J , Kishihara J , Niwano S , Ako J
Published: October 2021

Background

Local impedance (LI) at a distal tip of the ablation catheter can indirectly measure catheter contact and tissue temperature during radiofrequency catheter ablation (RFCA). LI decreases by RFCA, and a degree of LI drop is correlated with lesion size. However, data on the effects of catheter contact angle on lesion size and LI drop were scarce. This study aimed to evaluate the influence of catheter contact angle on lesion size and LI drop in a porcine experimental study.

Methods

Lesions were created on porcine myocardial left ventricles by the LI-sensing ablation catheter (IntellaNav MiFi OI®). Contact force (CF) was measured using pressure to current transducer (load cell). Radiofrequency ablation was performed with a power of 30 Watt and a duration of 30 seconds. CF (0g, 5g, 10g, 20g, and 30g) and catheter angle (30°, 45°, and 90°) were changed in each set (total 120 lesions, n=8 each). LI rise, LI drop by RF application, and lesion size (maximum lesion width, maximum surface width, and maximum lesion depth) were evaluated.

Results

There was no angular dependence in LI rise in all CF. The values of LI rise increased as CF increased. The LI drop also increased as CF increased in all contact angles. Regarding the difference of catheter angles, LI drop with 90° was lower than those with 30° and 45°in CF 10g, 20g, and 30g, respectively. Maximum lesion width and surface width were larger in 30° and 45° than those in 90°, whereas there were no differences in maximum lesion depth.

Conclusion

LI drop in 90° were significantly lower than those in 45° and 30°. Although lesion depths were not different among the three angles, the absolute values of LI drop were different. Caution should be exercised to comprehend the LI drop with catheter angles.

Funding Acknowledgement

Type of funding sources: None.
Benefits of early intervention with catheter ablation in patients with atrial fibrillation
Authors: Mohanty S , Trivedi C , Della Rocca D G , Gianni C , MacDonald B , Mayedo A , Bassiouny M , Gallinghouse G J , Burkhardt J D , Horton R , Al-Ahmad A , Di Biase L , Natale A.N.D.R.E.A
Published: October 2021

Background

Radiofrequency catheter ablation, a widely recognized therapeutic option for atrial fibrillation (AF) has limited success rate as it is influenced by several factors including duration of AF.

Purpose

We evaluated the ablation success in AF patients intervened early versus late in the disease course.

Methods

Consecutive AF patients undergoing their first catheter ablation in 2015–16 at our center were included in the analysis. Patients were classified into two groups based on the time to ablation after AF diagnosis; 1) early: ≤12 months and 2) late: >12 months.

All received PV isolation plus isolation of posterior wall and superior vena cava. Additionally, in non-paroxysmal AF cases, non-PV triggers were identified with isoproterenol-challenge and ablated. Patients were prospectively followed up for 3 years with regular rhythm monitoring.

Results

A total of 752 and 1248 patients were included in the “early” and “late” group respectively. Baseline characteristics of the study population is provided in Table 1 A. At 4 years of follow-up, overall success rate off-antiarrhythmic drugs was significantly higher in the “early” group (65.4% vs 57%, p<0.001). After stratification by AF type, “early” group was still associated with significantly higher success rate compared to the “late” group (Table 1B).

Conclusion

In this large series with standardized ablation strategy, early intervention with catheter ablation was associated with higher success rate in all AF types.

Funding Acknowledgement

Type of funding sources: None. Table 1
Utilization and complications of catheter ablation for ventricular arrhythmias in patients with mechanical valves
Authors: Rozen G , Elbaz-Greener G , Andria N , Heist E K , Ruskin J N , Wijeysundera H C , Carasso S , Birati E , Amir O , Marai I
Published: October 2021

Background

Catheter ablation (CA) for ventricular arrhythmias (VAs) is increasingly utilized in the recent years. Ablation for VAs in patients with mechanical valves (MVs), can be challenging due to the chronic anticoagulation therapy, limitations in accessing the cardiac chambers, the risk for entrapment of mapping or ablation catheters between the leaflets of MVs and more.

Purpose

To investigate the nationwide trends in utilization and complications of CA for VAs in patients with prior MVs.

Methods

We drew data from the US National Inpatient Sample database to identify cases of VA ablations, including premature ventricular contraction (PVC) and ventricular tachycardia (VT) ablations, in patients with MVs between 2003 and 2015. Sociodemographic and clinical data were collected, and incidence of catheter ablation complications, mortality, and length of stay were analyzed. We compared the outcomes to a propensity matched cohort of patients without prior valve surgery.

Results

The study population included a weighted total of 647 CA cases in patients with prior MVs. The annual number of ablations almost doubled, from 34 ablations on average during the “early years” (2003–2008) to 64 annual ablation procedures on average during the “late years” (2009–2015) of the study (p=0.001). Length of stay at the hospital did not differ significantly between patients with MVs and 649 matched patients without prior MVs (5.4±0.4, 4.7±0.3 days respectively, p=0.12). The incidence of complications was higher among patients with and without MVs (12.6% vs. 7.5% respectively, p=0.14), however, not reaching statistical significance. Moreover, the data revealed a trend toward higher mortality among patients with MVs undergoing CA compared to matched control patients without MVs (3.7% vs. 0.7% respectively, p=0.087).

Conclusion

The utilization of catheter ablations for ventricular arrhythmias in patients with mechanical valves increased substantially over the years. The data show a trend towards increased incidence of morality and complications in the study population, requiring further investigation in larger population cohort.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Padeh Medical Center Research Fund
Utility of left atrial strain imaging for the determination of diastolic dysfunction in patients with STEMI
Authors: Ohtaroglu Tokdil K , Ongen Z , Ikitimur B , Durmaz E , Tokdil H , Koca D , Raimoglu U , Incesu G , Pirdal B Z , Verdiyev H , Gulfidan A , Karpuz H
Published: October 2021

Introduction

Since echocardiographic parameters indicating increased left ventricular filling pressure were validated in patients with stable coronary artery disease and patients with acute coronary syndrome were excluded, the utility of these parameters in ACS patients is not clarified. Recent studies suggest that left atrial strain imaging is a reliable method for the assessment of left ventricular diastolic dysfunction.

Purpose

In this study, we aimed to investigate the clinical utility of left atrial strain imaging for the detection of increased LVFP.

Methods

We prospectively included patients diagnosed with ST-segment elevation myocardial infarction who were treated with primary percutaneous intervention (pPCI). Left ventricular end-diastolic pressure was measured following the procedure. Comprehensive echocardiographic evaluation was performed within 24 hours of pPCI. Patients with atrial fibrillation and severe valvular heart disease were excluded. Normal LV end-diastolic pressure was accepted as <18 mmHg.

Results

76 patients were enrolled. Patients were divided into two groups according to LVEDP value. Group 1 patients included patients with normal LVEDP (42 patients) and the rest of the patients included into group 2 (27 patients). Comorbidities including hypertension (p: 0.408), diabetes (p: 0.696) and dyslipidaemia (p: 0.336) were similar between groups. Anterior myocardial infarction was more prevalent in group 2 patients (p: 0.012). Troponin and pro-BNP values were significantly higher in group 2 patients (p: 0.001 and p: 0.03 respectively). Left ventricular ejection fraction and left ventricular global strain values were significantly lower in group 2 patients (p: 0.048 and p: 0.025 respectively). Table 1 represents the comparison of strain values between groups. Left atrial reservoir strain rates were lower in group 2 patients (p: 0.09). Correlation analyses revealed that there is a statistically significant relationship between left atrial strain values and LVEDP (p: 0.003 and r: 0.238).

Conclusion

In conclusion, our study has demonstrated that left atrial strain imaging is a useful non-invasive method for the assessment of increased LVEDP in patients with STEMI.

Funding Acknowledgement

Type of funding sources: None. Echocardiographic variables
Feasibility and efficacy using the KODEX-EPD imaging system in right atrial flutter ablation: a single center experience
Authors: Schillaci V , Stabile G , Shopova G , Arestia A , Agresta A , Salito A , Solimene F
Published: October 2021

Background

Isthmus-dependent right atrial flutter is the most frequently encountered atrial flutter in clinical practice (80–90% of atrial flutters).

Purpose

The aim of our study was to assess as first experience the feasibility and safety of radiofrequency catheter ablation (RFCA) of cavo-tricuspid isthmus (CTI) guided by KODEX-EPD imaging system in patients presenting with typical atrial flutter (AFL).

Methods

16 consecutive patients (mean age 68,46±7,8 years, 80% males) with diagnosis of AFL underwent RFCA guided by KODEX-EPD imaging system. In 15 patients the analysis performed during tachycardia showed a counter-clockwise activation. In 1 patient no tachycardia could be induced and the ablation was performed in sinus rhythm with fixed pacing from the coronary sinus. The KODEX-EPD imaging system was also used to guide ablation and to confirm persistent bidirectional block after ablation.

Results

Mean procedural time was 37,6±8,2 min, mean radiofrequency ablation time was 7,8±3,4 min, and mean fluoroscopy time was 2,1±1,2 min. All procedures were acutely successful with interruption of AFL during RFCA along the inferior CTI in 15 patients and achievement of the bidirectional conduction block in 16 patients proven by atrial pacing medial and lateral to the ablation line. There were no major procedural and 30-day complications. Over a mean follow-up of 18 months, we observed no recurrence of arrhythmia and no complications.

Conclusions

Our study shows that RFCA for AFL using the KODEX-EPD imaging system is feasible, safe, and effective.

Funding Acknowledgement

Type of funding sources: None.
Left atrial appendage size is a marker of atrial fibrillation recurrence after radiofrequency catheter ablation in patients with persistent atrial fibrillation
Authors: Simon J , Mahdiui M E , Smit J M , Szaraz L , Herczeg S Z , Van Rosendael A R , Zsarnoczay E , Nagy A I , Kolossvary M , Szilveszter B , Szegedi N , Geller L , Bax J J , Maurovich-Horvat P , Merkely B
Published: October 2021

Background

Catheter ablation is an established therapy for rhythm control in patients with drug-refractory atrial fibrillation (AF), however, recurrence is frequent particularly in persistent AF. There are no consistently confirmed predictors of AF recurrence after catheter ablation. The left atrial appendage (LAA) potentially plays an important role in AF recurrence, although the exact mechanism and pathophysiology are still unclear.

Purpose

We aimed to study whether LAA volume (LAAV) and function influence the long-term recurrence of AF after point-by-point radiofrequency catheter ablation, depending on AF type.

Methods

AF patients who underwent point-by-point radiofrequency catheter ablation after preprocedural cardiac computed tomography (CT) and transthoracic and transesophageal echocardiography (TEE) were included in this retrospective analysis. LAAV and LAA orifice area were measured by CT and LAA flow velocity assessed by TEE and was used as a surrogate marker of LAA function. Uni- and multivariable Cox proportional hazard regression models were performed to determine the predictors of AF recurrence.

Results

In total, 561 AF patients (61.9±10.2 years, 34.9% females) were included in the study. Recurrence of AF was detected in 40.8% of the cases (34.6% in patients with paroxysmal and 53.5% in those with persistent AF) with a median recurrence-free time of 22.7 [9.3–43.1] months. Patients with AF recurrence had significantly higher body surface area-indexed left atrial volume (iLAV), LAAV and LAA orifice area, as compared to those without recurrence. Moreover, patients with persistent AF had significantly higher iLAV, LAAV, LAA orifice area and lower LAA flow velocity, than those with paroxysmal AF. After adjustment for the main cardiovascular risk factors and comorbidities left ventricular ejection fraction (LVEF) <50% (HR=2.17; 95% CI=1.38–3.43; p<0.001) and LAAV (HR=1.06; 95% CI=1.01–1.12; p=0.029) were independently associated with AF recurrence in persistent AF, while no independent predictors could be identified in paroxysmal AF.

Conclusions

The current study demonstrates that beyond left ventricular systolic dysfunction, LAA enlargement is associated with higher rate of AF recurrence after catheter ablation in persistent AF, but not in patients with paroxysmal AF. Our results suggest that preprocedural assessment of LVEF and LAAV might contribute to optimal patient selection and aid to improve long-term results of ablation procedures in patients with persistent AF.

Funding Acknowledgement

Type of funding sources: None.
Accuracy comparison of the new and previous Kodex occlusion tool software versions to assess pulmonary vein occlusion in atrial fibrillation cryoablation
Authors: Cauti F M , Rossi P , Iaia L , Polselli M , Pecere A , Bianchi S
Published: October 2021

Background

Atrial fibrillation (AF) is the most frequent sustained arrhythmia worldwide and Cryoballoon ablation (CB) has become a consolidated alternative to the radiofrequency pulmonary vein (PV) isolation. However, CB requires fluoroscopy and dye injections to verify the occlusion grade. The accuracy of the earlier version of the Kodex Occlusion Tool software has been studied.

Purpose

The purpose of this study was to verify the accuracy of the second generation Kodex Occlusion Tool Software of a new dielectric system imaging compared to its first generation to detect PV occlusion during CB ablation in patients with AF.

Methods

15 consecutive patients with paroxysmal AF were enrolled in the study and underwent the procedure with the guidance of the first generation version (1.4.6) of the Kodex Occlusion Tool software. The Kodex recorded procedural data were used to replay the case using the Kodex second generation version (1.4.7) of the Occlusion Tool software when clinically available. After transseptal access, a detailed image reconstruction of left atrium and PVs was achieved with an octa-polar circular mapping catheter, PV occlusion was assessed with the Occlusion Tool Software and compared with standard dye injection and angiography, the cryoablation was then performed with a cryoballoon catheter.

Results

A total of 74 PVs CB occlusions were tested. The old version showed 90.7% sensitivity and 74.2% specificity in assessing a complete PV occlusion verified with contrast medium injection. The positive predictive value was 82.9%, and the negative predictive value was 85.2%. The new version showed 94.8% sensitivity and 93.7% specificity in assessing a complete PV occlusion verified with same contrast medium injection data. The positive predictive value was 98.2%, and the negative predictive value was 93.7%. Acute isolation was achieved in all PVs and no 30-day complication was observed.

Conclusion

This study demonstrates an increased accuracy of new Occlusion Tool software of the Kodex dielectric imaging system to assess the degree of PV occlusion during a CB ablation.

Funding Acknowledgement

Type of funding sources: None.
Long-term implications of pacemaker insertion in younger adults: a single centre experience
Authors: Shirwaiker A , William J , Mariani J , Kistler P , Patel H , Voskoboinik A
Published: October 2021

Background

The long-term implications of pacemaker insertion in younger adults are poorly described in the literature.

Methods

We performed a retrospective analysis of consecutive younger adult patients (18–50 years) undergoing pacemaker implantation at a quaternary hospital between 1986–2020. Defibrillators and cardiac resynchronisation therapy devices were excluded. All clinical records, pacemaker checks and echocardiograms were reviewed.

Results

81 patients (39.5±9.6 years, 53% male) underwent pacemaker implantation. Indications were complete heart block (41%), sinus node dysfunction (33%), high grade AV block (11%) and tachycardia-bradycardia syndrome (7%). During a median 7.6 (IQR=0.6–14.8) years follow-up, 9 patients (11%) developed 13 late device-related complications (generator or lead malfunction requiring reoperation (n=11), device infection (n=1) and pocket revision (n=1)). Five of these patients were <40 years old at time of pacemaker insertion. At long-term follow-up, a further 9 patients (11%) experienced significant symptoms from inadequate lead performance managed with device reprogramming. Sustained ventricular tachycardia was detected in 2 patients (2%). Deterioration in ventricular function (LVEF decline >10%) was observed in 14 patients (17%) and 7 of these patients required subsequent biventricular upgrade. Furthermore, 4 patients (5%) developed new tricuspid regurgitation (≥ moderate-severe). Of 69 patients with available long-term pacing data, minimal pacemaker utilisation (pacing <5% at all checks) was observed in 13 (19%) patients.

Conclusions

Pacemaker insertion in younger adults has significant long-term implications. Clinicians should carefully consider pacemaker insertion in this cohort given risk of device-related complications, potential for device under-utilisation and issues related to lead longevity. In addition, patients require close follow-up for development of structural abnormalities and arrhythmias.

Funding Acknowledgement

Type of funding sources: None.
Subcutaneous ICD combined with VT ablation for the secondary prevention of sudden cardiac death: pilot data from the prospective multinational SICD-VTAbl study
Authors: Goldenberg I , Maury P , Sacher F , Clementy N , Huang D T , Mulpuru S , Friedman P , Meyer C , Benshushan A D , Tiefenbrun N L , Nof E ,   The SICD-VTAbl Investigators
Published: October 2021

Background

The aim of the Subcutaneous ICD Combined with Ventricular Tachycardia Ablation (SICD-VTAbl) Study is to provide preliminary data on the safety and efficacy of a management strategy that incorporates S-ICD implantation and VT ablation among patients with a secondary prevention indication for an ICD. We hypothesize that VT ablation for the prevention of monomorphic VT recurrence combined with S-ICD implantation for termination of life-threatening VT/VF is safe, while reducing the need for device interventions and systemic complications associated with conventional transvenous ICD implantation for secondary prevention.

Methods

SICD-VTAbl is an uncontrolled, prospective, multinational observational study, conducted in France, Germany, US (Rochester NY, and Rochester MN) and coordinated in Israel. We aim to prospectively enroll 30 patients presenting with scar-related VT/VF who will undergo VT ablation/substrate modification followed by S-ICD implantation. The primary endpoint is the first occurrence of S-ICD therapy (appropriate and inappropriate). Secondary endpoints include separate occurrence of appropriate and inappropriate ICD therapies, peri-procedural complications, and adverse clinical outcomes.

Results

We provide clinical, arrhythmia, and outcome data on the first 15 patients enrolled in the SICD-VTAbl Study through February 2021. Mean age was 59±12 years, 78% were males, 60% had New York Heart Association (NYHA) Class ≥II symptoms, 20% had renal insufficiency, and 33% were treated with an antiarrhythmic medication (all amiodarone). Periprocedural, arrhythmia, and long-term outcome data are provided in Table 1. There were no major complications associated with the VT ablation and the S-ICD implantation procedures. During a median follow-up of 6 months (interquartile range: 2–12 months), 2 patients (13%) received S-ICD therapy: one patient (7%) experienced VF terminated by the S-ICD and one patient experienced a single episode of inappropriate S-ICD therapy. Adverse events during follow-up, unrelated to study procedures, occurred in 3 patients (20%): hospitalization for heart failure exacerbation (N=1) and non-cardiovascular hospitalizations (N=2). None of the patients died during follow-up (Table 1).

Conclusions

Our preliminary data from the SICD-VTAbl Study suggest that a management approach that incorporates VT ablation followed by S-ICD implantation is safe and may lead to improved arrhythmia and clinical outcomes in patients presenting with a secondary prevention indication for an ICD.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Research grant to Sheba Medical Center from Boston Scientific
Implantable defibrillator-computed respiratory disturbance index predicts new-onset atrial fibrillation: the DASAP-HF study
Authors: Boriani G , Pisano' E.C.L , Pieragnoli P , Locatelli A , Capucci A , Talarico A , Zecchin M , Rapacciuolo A , Piacenti M , Indolfi C , Arias M.A , Diemberger I , Checchinato C , D'Onofrio A ,   DASAP-HF
Published: October 2021

Introduction

Sleep apnea (SA), as measured by polysomnography, is a risk factor for atrial fibrillation (AF). The DASAP-HF study previously demonstrated that the Respiratory Disturbance Index (RDI) computed by an implantable cardioverter defibrillator (ICD) algorithm accurately identifies severe SA, is associated with cardiovascular events, and independently predicts death.

Purpose

In the present analysis we tested the hypothesis that device-detected RDI could also predict AF burden.

Methods

Patients with left ventricular ejection fraction ≤35% implanted with an ICD were enrolled and followed-up for 24 months. One month after implantation, patients underwent a polysomnographic study. The weekly average RDI value was considered, as calculated by the algorithm during the entire follow-up period and over a 1 week period preceding the sleep study, and patients were stratified according to an RDI value ≥ or <30 episodes/hour. The endpoints were: daily AF burden of ≥5 minutes, ≥6 hours, ≥23 hours.

Results

164 enrolled patients had usable RDI values during the entire follow-up period. Severe SA (RDI≥30 episodes/h) was diagnosed in 92 (56%) patients at the time of the polysomnographic study. During a median follow-up of 25 months, AF burden ≥5 minutes/day was documented in 70 (43%), ≥6 hours/day in 48 (29%), and ≥23 hours/day in 33 (20%) patients. Device-detected RDI≥30 episodes/h at the time of the polysomnographic study, as well as the polysomnography-measured apnea hypopnea index ≥30 episodes/h, were not associated with the occurrence of the endpoints, using a Cox regression model. However, using time-dependent Cox model continuously measured weekly average RDI≥30episodes/h was independently associated with AF burden ≥5 minutes/day (HR: 2.13, 95% CI: 1.24–3.65, p=0.006), ≥6 hours/day (HR: 2.75, 95% CI: 1.37–5.49, p=0.004), and ≥23 hours/day (HR: 2.26, 95% CI: 1.05–4.86, p=0.037), after correction for history of AF, left atrial diameter, and gender.

Conclusions

In heart failure patients implanted with an ICD, device-diagnosed severe SA is associated with a higher risk of AF. In particular, severe SA on follow-up data review identifies patients who are from two- to three-fold more likely to experience an AF episode, according to various thresholds of daily AF burden.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Promoted by the Italian Heart Rhythm Society (AIAC).Supported by a research grant from Boston Scientific.
Exploring the temporal relationship between atrial fibrillation and heart failure development. Analysis from nationwide database
Authors: Cottin Y , Ben Messaoud B.M , Yao H , Laurent G , Bisson A , Eicher J.C , Bodin A , Herbert J , Juilliere Y , Zeller M , Fauchier L
Published: October 2021

Background

Atrial fibrillation (AF) and heart failure (HF) often coexist and are closely intertwined, each condition worsening the other. The temporal relationships between these two disorders have not yet been fully explored. We assessed, on a nationwide scale, the prognosis of patients hospitalized with HF and AF, based on the timing of AF and HF development.

Methods

From the administrative database covering hospital care for the whole French population, we identified 1,349,638 patients diagnosed with both AF and HF between 2010 and 2018: 956,086 of these AF patients developed HF first (prevalent HF) and 393,552 developed HF after AF (incident HF). The outcome analysis (all-cause death, cardiovascular [CV] death, ischemic stroke or hospitalization for HF) was performed with follow-up starting at the time of last event between AF or HF in the whole cohort and in 427,848 propensity-score-matched patients (213,924 with incident HF and 213,924 with prevalent HF).

Results

During follow-up (mean follow-up 1.6±1.9 year), matched patients with prevalent HF had a higher risk of all-cause death (21.6 vs 19.2%/year), CV death (7.6 vs 6.5%/year) as well as non-cardiovascular death (13.9 vs 12.7%/year) than those with incident HF. The risk for ischemic stroke was lower in the prevalent HF group (1.2 vs 2.4%/year).

Conclusion

In patients hospitalized with both AF and HF, we identified two distinct clinical entities based on the chronological sequence of the two disorders. Patients in whom HF preceded AF (prevalent HF) had higher mortality and higher risk of rehospitalization for HF.

Funding Acknowledgement

Type of funding sources: None.
Burden of atrial fibrillation in influenza hospitalizations: analysis from 2018 national inpatient sample
Authors: Thyagaturu H , Shah K , Li S , Kumar A
Published: October 2021

Introduction

Influenza infection could cause systemic inflammatory response and lead to increase sympathetic tone. The association and impact of atrial fibrillation (AF) on Influenza has not been well studied.

Purpose

To evaluate the association of atrial fibrillation with mortality and resource utilization in influenza hospitalizations.

Methods

We queried 2018 National Inpatient Sample (NIS) database to identify influenza and AF hospitalizations using appropriate ICD-10 codes. Influenza with AF group was compared to influenza without AF. Chi-square test and linear regression were used for categorical and continuous variables, respectively. Multivariate logistic regression was used to adjust for potential hospital and patient confounders (age, sex, race, diabetes, systolic heart failure, chronic kidney disease, obesity, charlson co-morbidity index, hospital location, teaching status, bed size and income status). Discharge weights provided in the database was used to calculate the national estimates. STATA 16.1 was used to perform all statistical analysis.

Results

345,419 weighted influenza hospitalizations were identified. Of which, 78,824 (22.8%) of them had atrial fibrillation. Influenza patients with AF were older (mean age: 77 vs. 65 yrs; p<0.01) but had similar number of female (52% vs 48%; p<0.01) compared to influenza patients without AF. After adjusting for potential hospital and patient level confounders, we observed statistically significant increase in mortality [Adjusted Odds Ratio (aOR): 1.5 (1.4–1.7); p<0.01], length of stay [6.5 vs 5.4 days; p<0.01], total hospitalization charges [USD: $65,302 vs $54,149; p<0.01], right heart failure [aOR: 2.4 (1.6–3.6); p<0.01], cardiogenic shock [aOR: 1.9 (1.5–2.5); p<0.01] in influenza patients with AF when compared to those without AF.

Conclusion

Presence of AF is an independent predictor of mortality, length of stay, hospitalization charges, right heart failure and cardiogenic shock in hospitalized patients with influenza. This study helps to assume prognosis and raise awareness on the intensity of care needed toward these patients.

Funding Acknowledgement

Type of funding sources: None.
Population screening for atrial fibrillation in subjects with sleep apnea
Authors: Guo Y , Zhang H , Chen Y ,   mAFA investigators
Published: October 2021

Background

Sleep apnea is highly associated with atrial fibrillation (AF), resulting in increased risk of mortality. However, early identification and intervention of AF is limit among subjects with sleep apnea as often asymptomatic.

Objective

The present study aimed to investigate the occurrence of AF in subjects at high risk for sleep apnea with smart technology.

Methods

The photoplethysmographic (PPG)-based smart devices (wristband: Huawei Band B6, Honor Band 6); wristwatch: Huawei Watch GT2, Huawei Watch FIT, Honor Watch GS Pro, Honor Watch ES, Honor MagicWatch2, Huawei Technologies Co., Ltd., Shenzhen, China) were used for screening AF across China, which has been validated in Pre-mAFA (Huawei Heart Study). The PPG-based detecting sleep apnea has been developed. High-risk sleep apnea was defined as more than 80% monitoring measures with Apnoea–Hypopnoea Index (AHI) ≥30 during the sleep, monitored by PPG-based smart devices. The identified AF and high-risk sleep apnea were further confirmed by health providers with clinical evaluation, electrocardiogram, 24-hour Holter, or polysomnograph, respectively.

Results

There were 187,933 subjects (38.18±10.77 years, 90.88% male) who recruited for screening sleep apnea between December 2019, and December 2020. Among these, 9088 (4.84%,42.62±9.27 years, 98.13% male) were identified as high-risk sleep apnea, with average AHI of 27.99 (interquartile range [IQR]: 19.27–36.40).

Among those, 184,970 (of 187,933, 98.42%)subjects monitored sleep apnea and pulse rhythm with PPG-smart devices, with 8837 subjects of high-risk sleep apnea. Ninety-three (93/8837, 1.05%) AF were identified among those at high-risk sleep apnea, which was higher compared to those without sleep apnea (203/54916, 0.37%, p<0.001). With the increased risk for sleep apnea, identified AF raised (normal-, low-, moderate-, high-risk: 0.37%, 0.72%, 0.95%, and 1.05%, p<0.001, Figure 1).

Compared with non-AF subjects, subjects with identified AF were at much high -risk sleep apnea (8744/183736, 4.76% vs. 93/1234, 7.54%, p<0.001).

In multivariate analysis, high-risk sleep apnea increased 5.36 (95% CI: 3.43–8.37)fold risk of AF, after adjustment of age, sex, body mass index, hypertension, diabetes mellitus, coronary artery disease, heart failure, and hyperthyroidism.

The sensitivity analysis of the high-risk sleep apnea subjects (n=460,42.41±8.04 years, 98.70% male), which further confirmed with the diagnosis of sleep apnea by doctors and polysomnography, demonstrated the similar proportion identified AF (5/460, 1.09%).

Conclusions

In this population-based screening study, high-risk sleep apnea increased more than five-fold risk for AF, highlighting the compelling need for effective intervention of AF.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Health Care of China (20BJZ26)
The association between novel ST2, BNP, atrial fibrillation and heart failure
Authors: Al-Wahaibi K , Khan I , McAdam B , Leong T
Published: October 2021

Background/Introduction

ST2, a novel marker of fibrosis has been proposed as a novel biomarker for heart failure. There is paucity of data suggesting its association with Atrial Fibrillation (AF), in particular, with regards to the its independent effect after adjustment for clinical factors and traditional biomarkers such as BNP. There is increasing evidence that inflammation and fibrosis are important players in the pathogenesis of AF, the most common arrhythmia that is associated with considerable morbidity.

Purpose

We sought to examine the association of ST2 with AF and its possible incremental value in combination with traditional biomarkers already used in routine clinical practice such as BNP.

Methods

Unselected patients presenting to a Cardiology service who had BNP for clinical reasons, concomitantly had ST2 sent. These patients included those with heart failure, acute coronary syndromes and AF, as well as patients attending cardioversion and cardiac catheterisation. The association between ST2, BNP and clinical factors was examined. ST2 was examined in tertiles as its distribution was highly skewed. Raised BNP was defined as usual (≥100 pg/ml).

Results

Of the 619 patients, the mean age was 69 years and 66% were male. The prevalence of co-morbidities were: Coronary heart disease - CHD (41%), Atrial Fibrillation – AF (30%), Heart Failure - HF (20%), Chronic Kidney Disease – CKD (23%). The mean eGFR was 68 ml/h and the mean LV ejection fraction was 55%. Both ST2 and BNP levels were significantly higher in patients with heart failure, CKD and AF. Mean levels of ST2 were (in ng/ml): HF vs no HF (65 vs. 38, p=0.0001) and in CKD vs. no CKD (49 vs. 41, p=0.001), CAD vs no CAD (43 vs. 42, p=0.3). Mean levels of BNP were (in pg/ml): HF vs no HF (579 vs. 131, p=0.0001), CKD vs. no CKD (379 vs. 173, p=0.0001), CAD vs. no CAD (239 vs. 206, p=0.5).

In patients with AF, levels of both ST2 and BNP were higher, as were their mean ages and prevalence of co-morbidities (see Table 1). Both ST2 and BNP correlated with AF (Pearson r=0.2, p<0.0001 for ST2 and r=0.5, p<0.0001 for BNP). There was also a graded association of ST2 with AF (15%, 33% and 40% across tertiles of ST2, p=0.0001).

Both ST2 and raised BNP were significant associated with AF in both univariable and multi-variable regression models, and remained independent predictors when adjusted for HF, CHD, LV EF and eGFR (Table 2, Model 2 – Relative risk ratio of AF with ST2 across tertiles 1.5, p0.005, and Odds ratio of AF with raised BNP 7.4, p<0.001). However, ST2 loses significance when BNP is added to the model in combination (Table 2 – Model 3).

Conclusions

Both ST2 and BNP are independent predictors of AF even after adjustment for heart failure and other clinical factors. When ST2 is used in combination with BNP, raised BNP appears to be a stronger predictor of AF than ST2.

Funding Acknowledgement

Type of funding sources: None.
Risk of atrial fibrillation development of sodium-glucose co-transporter 2 inhibitor and thiazolidinedione treatment among patients with type 2 diabetes
Authors: Kim Y.R , Lee S.E , Kim K.A
Published: October 2021

Background

Type 2 diabetes is an independent risk factor for the development of atrial fibrillation (AF). Recently, SGLT-2i has been shown to decrease the incidence of AF through several mechanisms including reduction of atrial dilatation via diuresis and lowering body weight. On the other hand, the use of TZD was found to protect diabetic patients from new-onset AF in observational studies. Thus, we aimed to compare the effect of SGLT-2i and TZD on the risk of AF development.

Methods

Using the Korean National Health Insurance Service database, we included patients with type 2 diabetes who were prescribed SGLT-2i or TZD at least once from January 2014 to December 2018. Patients were followed until the outcome event, death, or 31 December 2018. Sensitivity analysis was performed only including patients who prescribed study drugs ≥90 days.

Results

A total of 206,986 patients were included (88,227 patients in SGLT-2i group and 118,759 in TZD group). Baseline characteristics were mean age was 57 years and 57.4% were male; mean body mass index was 26.3kg/m2 and 68.3% had hypertension. During follow-up, the incidence rates of AF were 1.36% in SGLT-2i-treated patients and 0.87% TZD-treated patients, respectively (p=0.0002). The hazard ratio (HR) of AF was 0.846 (95% confidence interval [CI]: 0.0.775–0.923) in SGLT-2i-treated patients compared with TZD-treated patients.

Conclusions

In this study, the risk of AF development was significantly lower in patients treated with SGLT-2i versus TZD. SGLT2 would be a good choice for the patients with high risk of AF development among diabetes mellitus.

Funding Acknowledgement

Type of funding sources: None.
Long term outcomes of patients with chronic inflammatory diseases after percutaneous coronary intervention
Authors: Marcusohn E , Zukermann R , Roguin A , Kobo O
Published: October 2021

Introduction

Patients with chronic inflammatory diseases are at increased risk for coronary artery disease.

Aim

We aimed to assess the long-term outcomes of patients with chronic inflammatory diseases who underwent percutaneous coronary intervention.

Methods

A Retrospective cohort study of all adult (>18 years) patients who underwent PCI in a large [1000 bed] tertiary care centerfrom January 2002 to August 2020.

Results

A total of 12,951 patients underwent PCI during the study period and were included in the cohort. The population of chronic inflammatory diseases includes 247/12,951 [1.9%]; 70 with IBD and 173 with AIRD. The composite endpoint of mortality, ACS or CHF admission was more frequent in the inflammatory disease group (77.5% in AIRD group, 72.9% in the IBD group and 59.6% in the non-inflammatory group, p<0.001). The adjusted cox regression model found a statistically significant increased risk of the composite primary endpoints of around 40% for patients both with AIRD and IBD. The increased risk for ACS was 61% for AIRD patients and 37% for IBD patients. Patients with inflammatory diseases were found to have a significant increased risk CHF admission, while both IBD and AIED patients had a non-significant increased risk for mortality.

Conclusion

Patients with AIRD and IBD are at higher risk for cardiovascular events also in long term follow up once diagnosed with CAD and treated with PCI.

Funding Acknowledgement

Type of funding sources: None.
Clinical significance of microRNA-126 in Coronary artery disease patients
Authors: Ali Sheikh M S
Published: October 2021

Background

Coronary artery disease (CAD) is major public health problem and the leading cause of premature death all over the world. Early diagnosis with adequate management of CAD patients can significantly reduce morbidity and mortality rate.

Purpose

The purpose of this study was to explore the clinical significance of plasma miR-126 as a biomarker of stable angina pectoris patients and investigated the protective effects of hypoxic exposed HUVEC cell injury.

Methods

Angiographically confirmed 127 stable coronary artery (CAD) patients, 55 healthy subjects and 18hours hypoxic (1% O2) HUVEC cells were included in this study.

Results

The expression of miR-126 levels were remarkably down-regulated in stable CAD patients and hypoxic exposed HUVEC cells as compared with controls (p<0.001). Circulating plasma miR-126 was able to accurately differentiated stable CAD patients from healthy subjects with high sensitivity and specificity (AUC 0.928). The caspase-3 activity, apoptosis rate, LDH levels and intracellular ROS generation were significantly increased in 24hours hypoxic exposed HUVEC cells than normal control cells (p<0.001). On the contrary, over expressions of miR-126 were evidently reduced caspase-3 activity, apoptosis rate, LDH levels, intracellular ROS production and significantly improved HUVEC cellular viability (p<0.001). Moreover, TNF receptor-associated factor 6 (TRAF6) expressions were markedly increased in Hypoxic induced HUVEC cells, whereas mimic expression of miR-126 significantly decreased TRAF6 expression.

Conclusion

Down-regulated miR-126 may consider as a potential risk factor for stable CAD patients and it may used as a possible biomarker for early evaluation of CAD patients. Mimic expression of miR-126 remarkably decreased caspase-3 activity, LDH secretions, ROS levels and markedly improved HUVEC cellular viability by down-regulating TRAF6 expression, suggesting a newer therapeutic target for CAD patients.

Funding Acknowledgement

Type of funding sources: None.
Feasibility of virtual fractional flow reserve derived from coronary angiography and its correlation with invasive functional assessment
Authors: Mano T , Ferreira V , Ramos R , Oliveira E , Santana A , Melo J , Reis J , Bras P , Teixeira B , Cardoso I , Castelo A , Cacela D , Cruz Ferreira R
Published: October 2021

Introduction

Invasive functional assessment (iFA) of coronary artery disease (CAD) needs expensive devices, has potential procedure-related complications and is still underutilized. Virtual Fractional Flow Reserve (vFFR) derived from invasive coronary angiography (ICA) has the potential to overcome these limitations.

Purpose

To investigate the feasibility of vFFR analysis and its correlation with iFA (iFR, RFR or FFR).

Methods

Retrospective analysis of consecutive patients (pts) who underwent iFA in a tertiary center between 2019 and 2020. vFFR was calculated using a dedicated software (CAAS Workstation 8.4) based on standard non-hyperaemic coronary angiograms acquired in ≥2 different projections, by operators blinded to iFA results. Diagnostic performance and accuracy of vFFR were evaluated. vFFR was considered positive when <0.80. FFR <0.8 and iFR/RFR <0.90 were classified as positive according to current clinical standards.

Results

Out of 113 coronary arteries of 102 pts, vFFR was successfully analysed in 106 (94%). Reasons for vFFR analysis failure were: vessel projection overlap (48%), <2 angiographic projections (28%) and table movement while acquisition (24%). From 106 coronary arteries of 95 pts with analysable vFFR (78% male, mean age 67.8±9.7 years), 90 (85%) showed agreement with the respective iFA result. The vFFR predicted which lesions were physiologically significant and which were not with accuracy, sensitivity, specificity, positive and negative predictive values of 73%, 73%, 83%, 53%, and 92% respectively. The mean difference between vFFR and iFA were −0.0484±0.096 and Pearson's correlation coefficient was 0.533 (p<0.001). The ROC area under the curve was 0.839 (0.751–0.928, p<0.001).

Conclusion

FFR were feasible in 94% of cases analysed retrospectively. As compared to gold-standard iFA, vFFR had an overall moderate accuracy in detecting ischemia-producing lesions and a negative predictive value >90%. vFFR has the potential to substantially simplify physiological coronary lesion assessment and thus improve its current uptake.

Funding Acknowledgement

Type of funding sources: None. Bland-Altman plot between vFFR and IFA