bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of tissue thickness on thermal latency during high-power short-duration radiofrequency ablation with proactive esophageal cooling
Authors: Kulstad E , Mercado-Montoya M , Gomez-Bustamante T , Berjano E , Mickelsen S , Daniels J , Hernandez-Arango P , Schieber J
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Thermal latency, or delayed heating, is increasingly recognized as an important factor in the formation of both intentional and unintentional lesions during radiofrequency (RF) ablation for the treatment of atrial fibrillation (AF). High-power short-duration (HPSD) ablation appears to have greater thermal latency than low or medium power ablation. Proactive esophageal cooling (PEC) has been shown to reduce esophageal lesion formation under a variety of conditions by directly reducing the effects of thermal latency, but the influence of anatomic dimensions on the protective efficacy of cooling during HPSD ablation has not been investigated.

Purpose

Determine the impact of changes in pericardial tissue thickness on thermal latency in order to quantify the protective efficacy of PEC across a range of anatomic dimensions.

Methods

We created a mathematical model of the left atrium undergoing HPSD ablation, both with and without a PEC device in place, using a range of pericardial tissue thicknesses (0.5, 0.75, and 1 mm). HPSD ablation was set at 50 W for 10 s, or 90 W for 4 s. We then examined the temperature dynamics at a range of thickness, focusing on the layer of mostly fatty tissue between the atrial and esophageal walls by varying the thickness of this layer while quantifying the degree of esophageal damage using the Arrhenius equation to determine the fraction of damage after peak heating has occurred.

Results

Under control conditions, the growth of lesions from RF ablation at both 50 W and 90 W was found to continue for greater than 10 seconds beyond the cessation of RF energy application. Esophageal lesion formation ranged from 71% to 96% transmurality after 50 W ablation for 10 s, and from 50% to 72% transmurality after 90 W ablation for 4 s. With PEC in place, esophageal lesion transmurality was markedly reduced, with a maximum transmurality ranging from 12% to 32% with 50 W ablation, and from 2% to 20% with 90 W ablation (Figure). Increasing thickness of pericardial tissue (with simulations of 0.5, 0.75, and 1 mm) resulted in decreasing esophageal lesion transmurality (67%, 74%, and 83% at 50 W power, and 72%, 82%, and 96% at 90 W power, respectively, with the 0.5, 0.75, and 1 mm simulations).

Conclusions

Thermal latency with HPSD ablation contributes to lesion growth and can cause esophageal injury. Proactive esophageal cooling counteracts this effect across a range of pericardial tissue thicknesses, and reduces esophageal lesion transmurality by an average of 79%.
Catheter ablation of atrioventricular nodal reentry tachycardia and quality of life
Authors: Erkabayev SH , Amirkulov B , Amirkulov R , Sultanov B
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Objective

To present the results of radiofrequency catheter ablation of patients with atrioventricular nodal reentry tachycardia (AVNRT).

Materials and methods

Catheter ablation was performed in 488 patients with AVNRT. The age of patients is from 14 to 66 (mean age 40.2±14.7 years). Comorbidities such as ischemic heart disease and hypertension were in 234 (48%) patients, in 83 (17%) patients chronic myocarditis was detected. No organic pathology from the cardiovascular system was detected in 171 (35%) patients. In the anamnesis, tachycardia attacks were observed from 2 to 29 years (on average, 18.7 ± 4.9 years). After confirming the diagnosis of typical "slow-fast" AVNRT on the intracardiac electrophysiological investigation, an ablation catheter was inserted into the heart of the patient. Then radiofrequency ablation of "slow paths" of AV-connection was performed.

Traditionally, the quality of life associated with health is considered as an integral characteristic of a person’s physical, mental (emotional) and social well-being, based on his subjective perception of these attributes. We assessed the quality of life of patients with AVNRT using the SF-36 questionnaire and The Hospital Anxiety and Depression Scale (HADS) before and after performing of catheter radiofrequency ablation.

Results

In 488 patients, the criteria for the effectiveness of the destruction of the "slow pathways" were obtained and the effectiveness of the procedure was 99.38%.

During the study of indicators of QOL according to the SF-36 questionnaire, wich was obtained 6 months after Radiofrequency Ablation (RFA), the most significant improvement was noted in terms of role functioning RF (by 48.6%), physical functioning PF (by 25.5%) and GH general health (19.7%). The BP bodily pain index, although increased (by 13.8%), but not reliably. After 12 months, we observed a significant improvement in QOL in all indicators of the physical component of health, which did not differ from those in the control group.

Clinically manifested anxiety was observed in a reliably larger number of patients (63.6%). The total indicator of the anxiety level was 11.1±2.4 points and corresponded to clinically manifested anxiety. The majority (66.7%) of patients had a subclinical form of depression. The total value of the depression level was 9.8±1.8 points and corresponded to the indicator of subclinically manifested disorders. Testing on the hospital anxiety and depression assessment scale after 12 months showed that all patients had no significant symptoms of anxiety and depression. The total score of anxiety was -2.8±1.1 points (p<0.0001), depression - 2.4±1.4 (p<0.0001).

Conclusions

Radiofrequency catheter ablation is an effective, drastic and safe method of treating AVNRT, the effectiveness of the procedure reaches up to 100% and allows patients to improve their quality of life, get rid of the lifelong intake of antiarrhythmic drugs.
Gender differences in arrhythmias and psychological discomfort management
Authors: Giaccardi M , Strisciuglio T , Turreni F , Marinigh R , Carreras G , Pelargonio G , Bisceglia C
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Palpitations and/or syncope are common in patients with psychoneurological disorders [1]. Arrhythmias may be associated to psychological discomfort as well [2]. Psychiatrics, epidemiology and commonplace agree that gender may lead to difference in symptom perception, and management [3-4]

Purpose

To investigate the abovementioned association we realized a retrospective multicentric registry including, after definite instrumental diagnosis, patients with previous mental disorder diagnosis, referring to arrhythmology ambulatories.

Results

64 pts (48 F, 75%), mean age 54±18y, were enrolled in 7 centers. Psychiatric diagnoses were: anxiety-depression disorder (N=50), panic attack (N=5), behavioural disorder (N=4), epilepsy (N=3), psychosis (N=1), diagnosed in 83% by General Practitioners and in 14% by Psychiatrists. 55 pts (86%) were on drug therapy: benzodiazepines (67%), SSRI (22%), neuroleptics (3%), antidepressants (2%), and natural products (5%). Among these, 89% reported no symptoms relief. 57 pts complained palpitations, 17 extrasystoles and 19 reported syncope. EPS study was performed in 48%, 24 h Holter ECG in 28%, and LR implantation in 5% of patients. We diagnosed AF (N=11), typical AFL (N=4), AT (N=8), AVNRT (N=16), AVRT (N=4), PAC (N=1), PVC (N=10), AV block (N=4), VT (N=3) and unspecified SVT (N=3). 44 pts underwent ablation. 62 pts (96,8) experienced strong symptoms reduction or resolution, and 42 psychiatric drugs withdrawal. One pt underwent PMK implantation.

Conclusions

In our series of cardiac symptoms ascribed to psychiatric disorders, women markedly prevailed. Psychologic discomfort could be caused by arrhythmias, as resolved or dramatically ameliorated by diagnosis and treatment. Further investigation in Psychiatric context is warranted.
Validation of the peak frequency of bipolar electrograms for detection of residual conduction in atrial scar tissue
Authors: Merino JL , Kim S , Relan J , Sanroman M , Castrejon S , Cervantes C , De La Vieja Alarcon JJ , Martinez Cossiani M , Rivero Santana B , Carton A , Tauber Molina P
Published: May 2022

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Abbott

Background

Activation and voltage (Bi-V) maps (Panel A) based on conventional bipolar electrograms (EGMs) are influenced by both near-field (NF) and far-field (FF) EGM components. This represents a limitation in the accurate detection of residual conduction within regions of scar. Peak frequency (PF) EGM analysis may better distinguish NF from FF activation vs conventional detection methods. (Panels B & C)

Purpose

1. To validate the use of PF to detect residual conduction in a well-defined model of narrow isthmus of conduction such as subacute pulmonary vein (PV) reconnection following atrial fibrillation ablation. 2. To compare discrimination value of PF and conventional Bi-V to detect such isthmuses.

Methods

Bi-V and activation maps were acquired during redo PV isolation (PVI) procedures using a rectangular 16-pole catheter (HD-Grid). LA-PV conduction was assessed during coronary sinus (CS) pacing (500ms cycle length). Any conduction gap (GAP) site at which PVI was established using ≤3 focal radiofrequency applications was analyzed. (Panel A) EGMʼs ≤1cm from the site of PVI were classified as GAP (vs EGMʼs ≥1cm - No-Gap). (Panel B)

Results

28 GAPs were found in 12 of 14 consecutive patients in the study. 3,976 EGMʼs (1,547 GAP vs 2,429 No-GAP) were analyzed. GAP regions showed significantly higher PF than No-GAP regions (345 ±135 vs 181±116 Hz, P<0.0001) (Panel E). GAP regions also showed significantly higher BiV than No-GAP regions

(1.86±2.11 mV vs 0.62±1.22 mV, P<0.0001) (Panel D). ROC curves for GAP vs No-GAP discrimination were better for PF (AUC 0.84) than for Bi-V (AUC 0.74) with optimal cutoffs of 240 Hz and 0.2 mV, respectively. (Panel F)

Conclusion

PF better detects residual conduction within an atrial scar region than conventional Bi-V. The PF cutoff value for gap discrimination in the PV antra is 240 Hz.
Electrode tissue coupling is a new main determinant of RF lesion creation, experience from a cardiac animal model
Authors: Wachter A , Bahlke F , Popa M , Foerschner L , Krafft H , Maurer S , Englert F , Telishevska M , Lengauer S , Kottmaier M , Lennerz C , Reents T , Hessling G , Deisenhofer I , Bourier F
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Radiofrequency (RF) current is a classic ablation technology used in the EP lab. By now it is assumed that RF lesion size is mainly determined by RF power, duration and contact force. This ex vivo animal model study shows that a new parameter - "electrode tissue coupling" (ETC) - plays an additional major role in RF lesion creation. The ETC level describes the amount of electric contact between the RF electrode and cardiac tissue: In minor ETC levels, only the distal electrode connects to tissue. In full ETC levels, the whole RF electrode is embedded in cardiac tissue.

Methods

RF-lesions were created using an ex vivo porcine cardiac model. The experimental setup consisted of a saline-filled container, a dispersive electrode, a heated thermostat and a circulation pump to imitate in vivo conditions. Global impedance was kept at 120 Ohm as well as the temperature at 37°C. RF-lesions were created using identic values of RF duration and contact force. A RF power of 20W, 30W, 40W, and 50W was used. The ETC levels were systematically varied between minor and full coupling. All parameters (power, temperature, global and local impedance, contact force, ETC, lesion size) were measured constantly during application of RF-current, enabling real-time correlation of RF parameters and lesion size.

Results

In total, 1923 measurements during application of RF-current were analyzed. In ETC III (full tissue coupling), lesions became significantly wider and deeper. In 20W ablations, lesion diameters were significantly (1.68 fold) larger when applying ETC III instead of ETC I. This relation was found in variations of RF parameters (Table 1).

Interestingly, baseline local impedance and local impedance drop showed a high correlation with selected ETC levels. The average baseline local impedance in ETC I was 207.2 Ohm, compared to 267.3 Ohm in ETC III (p < 0.01).

Discussion

In addition to by now known parameters (power, duration, contact force), electrode tissue coupling is a main determinant of lesion size. Higher ETC levels result in higher amounts of RF current going into adjacent tissue instead of current dissipation into the blood pool. In clinical practice, the ETC level can be predicted by baseline local and global impedance. Observation of these parameters should become clinical practice during RF ablation.
Characterization of the circumferential cevel of the pulmonary vein isolation area using pulsed-field catheter ablation: Spatial distribution and extent of insufficient and excessive isolation areas
Authors: Bohnen M , Weber R , Eichenlaub M , Jadidi A , Neumann FJ , Arentz T , Lehrmann H
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

The cornerstone of pulmonary vein isolation (PVI) is a wide area circumferential ablation (WACA) resulting in an isolation area encompassing the PV antrum. Pulsed field ablation (PFA) is a new non-thermal "single-shot" PVI device with promising success rates. However, the circumferential level of its PV isolation area is still unknown.

Objective

To characterize the circumferential acute PV isolation area by assessing the spatial distribution (qualitative analysis) and extent (quantitative analysis) of insufficient PV antral and excessive LA isolation areas.

Methods

In this study, patients with paroxysmal or persistent atrial fibrillation (AF) underwent PVI with a pentaspline PFA catheter. Before and immediately after PVI, ultra-high-density (UHD) voltage maps using a 20-polar circular mapping catheter were created. The insufficient isolations areas per antral PV segment (10-segment model) and excessive isolation areas per LA region (8-region model) were quantified.

Results

Between November – December 2021, in forty consecutive patients (age 62 ± 6 years, 28/40 [70%] male, LA 41 ± 4 mm) acute PVI using PFA was achieved and pre (5469 ± 1822 points) and post mapping (6809 ± 2769 points) was performed. The anterior antral PV segments of the left PVs were the most frequent locations of insufficient isolation areas (Table 1, Figure 1). The largest extent of insufficient isolation areas at the PV antral level was located again on the anterior parts of both left PVs (Figure 2A), but also in the anterior lower segment of the right inferior PV (Figure 2B). The posterior wall and roof region of both LA sides were the most frequent locations of excessive isolation areas (Figure 4). The extent of this excessive isolation at the roof and the posterior wall on both LA sides even resulted in a connection of the both-sided low voltage areas in 18% and 8%, respectively.

Conclusion

When using PFA to achieve a circumferential antral PVI, efforts should be made to enhance anterior antral PV segment and prevent excessive posterior wall and roof ablation. For further optimizing the procedure, full integration of PFA catheter visualization into 3D-mapping systems is needed.
Occurrence and predictors of severe arrhythmia in patients with myocarditis
Authors: Krisai P , Ruperti-Repilado FJ , Goeldi A , Kraus D , De Alencar B , Sticherling C , Balestra G
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Patients with myocarditis are at risk for severe, life-threatening arrhythmia. However, predictors to identify high-risk patients are lacking.

Purpose

We investigated the occurrence and potential risk factors of severe arrhythmia in myocarditis patients.

Methods

212 myocarditis patients that were hospitalized for arrhythmia monitoring at a tertiary university hospital were retrospectively enrolled. Non-sustained ventricular tachycardia (VT), sustained VT, ventricular fibrillation or cardiac arrest were considered as severe arrhythmia. We used a stepwise logistic regression model to investigate potential predictors. These included age, sex, clinical presentation (chest pain, palpitations, dyspnea, syncope, cardiac murmur, edema, pericardial friction, arrhythmia at presentation, Killip-class), comorbidities (hypertension, diabetes, coronary heart disease), imaging parameters (left ventricular ejection fraction [LVEF], pericardial effusion, edema and LGE on MRI), ECG variables (PQ depression, ST elevation, ST depression) and maximum levels of blood biomarkers (CRP, leukocytes, Troponin T, CK-MB).

Results

Mean age was 40.8 years, 73.1% were male and mean LVEF was 52.9%. During the hospital stay, 40 (18.9%) patients experienced severe arrhythmia: 33 (15.6%) non-sustained VT, 9 (4.2%) sustained VT, 1 (0.5%) ventricular fibrillation and 3 (1.4%) cardiac arrests (arrhythmia not mutually exclusive). Most arrhythmia occurred in the first 72h of monitoring (Figure). Significant predictors selected by the stepwise model (OR [95% CI]) for severe arrhythmia were LVEF (per 1% increase 0.95 [0.92; 0.99], p=0.005), syncope at presentation (7.9 [1.5; 40.4], p=0.01), any arrhythmia at first presentation (6.5 [1.3; 32.7], p=0.02) and CK-MB (per 10-unit increase 1.2 [1.1; 1.3], p=0.001).

Conclusion(s)

Myocarditis patients with low LVEF, presenting with arrhythmia and syncope and with increased CK-MB are at increased risk for severe arrhythmia and should be closely monitored. Further studies are needed to define, if patients without these risk factors might be safely discharged early.
Gender-sensitive analysis of ICD indications in European heart failure guidelines
Authors: Rilo I , Beramendi Calero JR , Quintas Ovejero LAURA , Rengel Jimenez AINHOA , Cea Primo DANIEL , Hernandez De Alba LEIRE , Nunez Rodriguez ALVARO , Calvo Chumillas SERGIO , Querejeta Iraola RAMÓN
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Although there is evidence that women do not benefit as much as men from ICD implantation and receive a greater number of inappropriate discharges, the clinical practice guidelines for heart failure do not contemplate a different attitude taking into account gender.

Objective

The aim of this study is to analyze the clinical trials and registries on which the recommendations of the guidelines are based.

Methods

We selected in the bibliography of the 2021 European heart failure guidelines the registries and clinical essays and analyzed them attending to gender perspective according to the following questions:

Is gender treated as a primary variable? Is gender treated as a secondary variable?

Is there a differentiated analysis by sex? Are side effects described differently by sex ?

What is the proportion of women in the study?

Results

We analyzed 16 articles. The proportion of women is between 15 and 25%. Only 6 in 16 articles reported a differentiated analysis by sex and there was only one article that differentiated side effects according to sex. Among the studies that reported differentiated analysis by sex, two of then show that women didn`t benefit of the implantation of ICD.

Conclusions

Gender analysis should be mandatory in all the clinical essays carried out in the future. Guidelines should consider different recommendations according to gender. Being excluded or infrarrepresented in studies could conditionate a discrimination to women not only now but also in the future when the algorithms of artificial intelligence condition the decisions we make in the different pathologies
Local conduction heterogeneities promoted by premature atrial contractions in patients with and without atrial fibrillation
Authors: Van Schie MS , Razavi Ebrahimi P , Ramdat Misier NL , Bogers AJJC , Taverne YJHJ , De Groot NMS
Published: May 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): NWO-Vidi

Medical Delta

Background

The atrial conduction velocity (CV) provides important information about the underlying myocardium and is therefore widely used to identify potential mechanisms for arrhythmogenesis. Loss of cell-to-cell communication, which results in enhanced non-uniform anisotropy, contributes to local conduction disorders and conduction heterogeneity (CH). However, it remains challenging to clinically measure CV. Using discrete velocity vectors, areas of local CHs can be most accurately identified without smoothing of wavefront propagation.

Purpose

To quantify local CH using CV vectors and to examine differences between sinus rhythm (SR) and spontaneous premature atrial contractions (PAC) in patients with and without history of atrial fibrillation (AF).

Methods

Intra-operative epicardial mapping (128 or 192 electrodes, interelectrode distance 2mm) of the right and left atrium (RA, LA), Bachmann’s Bundle (BB) and pulmonary vein area (PVA) was performed in 228 patients (158 male, 68±10 years, 54 history of AF). PACs were defined as abnormal atrial contractions with at least 25% shortening of cycle length as compared to the previous SR cycle length. CV vectors were computed at each electrode using a discrete velocity vectors method. Direction and speed of these vectors were compared to the surrounding electrodes to identify local CH.

Results

In total, 503 PACs were included with a prematurity index of 45±12%. Compared to SR beats, PACs had decreased CV (89.9 [80.7–99.3] cm/s vs 80.1 [70.7–89.6] cm/s, P<0.001) and, in 96% of the PACs, more CH (3.3 [1.6–5.9] % vs 12.1 [8.5–16.3] %, P<0.001). During SR, most CH were found at BB and LA (5.6 [3.4 – 8.6] % and 5.0 [2.7–6.4] %). Compared to SR, the largest increase in CH during PAC was found at BB and PVA (+8.7 [5.4–13.6] % and +8.9 [4.8–12.6] %, all P<0.001). During PAC, CV decreased particularly at BB, PVA and LA (-8.4 [-20.3–-0.6] cm/s, -10.4 [-19.3–0.3] cm/s and -10.1 [-19.1–0.3] cm/s, all P<0.001). Compared to patients without AF, more CH were found during SR in AF patients at BB (P<0.001), while there was no difference in CH increase during PAC between both patient groups.

Conclusions

Intra-operative high-resolution mapping showed that PACs are characterized by decreased CV and an increased amount of local CH, particularly at BB and PVA. Patients with history of AF are characterized by considerable CH already present during SR at BB. These differences indicate local enhanced non-uniform anisotropy and hence possibly arrhythmogenic substrates underlying AF.
The features of atrial fibrillation occurrence in patients who have undergone COVID-19
Authors: Hazarapetyan LG , Grigoryan S , Ter-Markaryan AA , Drampyan MF
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

COVID-19 pandemic has a rather negative effect on patients with cardiovascular pathology, also in patients without cardiovascular disease because its pathogenesis is based on generalized vascuities of the microvasculature with the development of multiple thrombosis and thromboembolism. Atrial fibrillation (AF) is one of the major cardiac arrhythmias and accounts for almost one third of all arrhythmias. Changes in electrical, structural, and contractile properties of cardiac tissue that are thought to underlie AF maintenance and progression are reviewed. The aim of this study is to identify the features and predictors that contribute to the onset or development of AF in patients who have had COVID -19.

Methods

This was a three-center prospective study, conducted in the coronary care unit during the period of February 2020 to June 2021. This study included 196 patients with AF who underwent COVID-19 at different times of this period (I group). For comparison, the data of similar 203 AF patients without COVID (II group) were analyzed in the period from February 2018 to February 2019 from the same centers... Medical history, clinical, instrumental and laboratory data, including troponin-1, tissue factor (TF), and hsCRP were studied in all patients. The data obtained was analyzed for statistical significance including multivariable logistic regression using analyses by SPSS 16.

Results

The compared results showed that the first-onset AF in patients from first group was observed in 18.7% compared with 8.1% in second group. In intensive care units, AF were registered in 44.2% of patients in I group vs. 7.1% of patients in II group. In first group among patients with ACS, AF occurred in 12.7% of cases vs. similar patients in II group- 8.4%. In first group hypokalemia was observed in 67.8% of cases vs. 28.6% in II group... Multivariable logistic regression was shown that among tested biomarkers, hsCRP, troponin-I and TF were more higher in patients undergoing COVID in compared patients with AF without COVID (odds ratio, 3.48; p<0.001, 2.36 p<0.017 and 2.48 p<0.01 accordingly).

Conclusions

Some features of the onset or development of AF were identified in patients undergoing COVID. So, In these patients compared with AF patients without COVID, AF more often occurs in clinically severe patients, with ACS, as well as in patients with severe hypokalemia, higher hsCRP, TF and troponin values.
Interatrial block as a prognosticator of new-onset atrial fibrillation: prospective observational study of 8012 adults
Authors: Abdovic E
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

There has been an increasing interest in Interatrial block (IAB) in recent years, especially regarding its role in atrial fibrillation (AF). The aim of the present study was to compare the characteristics of inpatients and outpatients who developed new-onset AF versus those who did not.

Material and methods

This single-centre, prospective observational cohort study on consecutive inpatients and outpatients referred to our institution for routine evaluation. ALl participants (n=8012) aged ≥18 years (mean 69.6±13.3 years, male 51.1%) underwent 12-lead ECG and transthoracic echocardiography. Patients were scheduled for the followup visits and new-onset AF was documented as an outcome. Enrollment lasted from June 2000 to June 2013, with the mean follow up time of 7.3 years. AF was defined as irregular RR intervals without any distinct detectable P-waves for at least 30 seconds. New onset AF is defined as a new onset or a first detectable episode of AF whether symptomatic or not. IAB was diagnosed when P-wave duration was ≥120 ms and positive in inferior leads (partial IAB) or biphasic (advanced IAB).

Results

The frequency of new-onset AF was 9.8%. IAB was found in 1251 patients (15.6%); advanced and partial IAB were found in 1.3% and 14.3%, respectively. IAB was more common in AF than in the sinus rhythm (33.1%; n=255 vs. 13.8%; n=996) as AF was more common in patients with IAB than without it (20.4%; n=255 vs. 7.8%; n=525). In the multivariate model, both advanced (OR 7.45, 95% CI 4.97-11.17) and partial IAB (OR 2.75 95% CI 2.31-3.37) were associated with increased risk of AF.

Conclusion

Both partial and advanced IAB are associated with increased risk of AF; however, the risk of AF was lower for partial than advanced IAB.
Role of epicardial adipose tissue volume as predictor of atrial fibrillation recurrence
Authors: Fernandes S , Cruz I , Ladeiras-Lopes R , Diaz S , Silva M , Barros A , Saraiva F , Faria R , Almeida J , Fonseca P , Goncalves H , Oliveira M , Ferreira N , Primo J , Fontes-Carvalho R
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Several studies have demonstrated the relation between general obesity and atrial fibrillation (AF). Epicardial adipose tissue (EAT), due to its local paracrine effect and the intimate relation with the atrium, could influence AF recurrence rates, but very few studies have explored this association.

Purpose

In this study we aimed to evaluate if EAT could be a predictor of AF recurrence after an AF ablation procedure.

Methods

We included all consecutive patients submitted to AF ablation (2017-2019) who performed a computed tomography scan prior to the procedure. EAT volume was semi-automatically reconstructed by manually tracing the pericardium. Adipose tissue was defined in the range between -150 and -50 Hounsfield units. Recurrence was defined as any documented (ECG/Holter) episode of AF, atrial flutter or atrial tachycardia after 3 months of the procedure. Logistic regression with a restricted cubic polynomial transformation was used to model the non-linear relationship between recurrence and EAT volumes. Inspection of the partial effect curves suggested that a cutoff for EAT volume ≥80mL could stratify patients at risk of recurrence and a Time-to-event analysis was carried.

Results

A total of 354 patients (66% male, median age 57 years [IQR 48–65] and 21% persistent AF) were included. During a median follow-up of 34 months [IQR 24-43], 117 patients (33%) had AF recurrence. These patients had a significantly greater EAT volume (76 mL [IQR 55-111] vs 72 mL [IQR 48-95], p=0.03) when compared to those without recurrence. Also, patients with higher EAT volume (≥ 80mL) had a higher risk of recurrence compared to patients with lower volume (Figure 1, log-rank test p=0.007). After adjusting for clinical risk factors (age, gender, hypertension, diabetes mellitus, obesity, thyroid disease, AF type and left atrial enlargement), higher EAT volume did not remain an independent predictor of AF recurrence (Figure 2, HR 1.25 [95% CI, 0.83-1.86] p=0.3).

Conclusion

In this cohort of patients with AF submitted to catheter ablation, EAT volume ≥80mL was associated with increased risk of AF recurrence. However, it was not an independent predictor of AF recurrence after adjustment to clinical risk factors.
Supraventricular arrhythmias in MINOCA patients
Authors: Santos M , Paula SB , Santos H , Almeida I , Almeida S , Tavares J , Santos L , Almeida ML
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

De novo atrial fibrillation (AF) is a frequent complication of acute coronary syndromes (ACS). However, 5-15% of patients (pts) admitted with suspected acute myocardial infarction have no significant lesions on coronary angiography (>50%) (MINOCA). Contrary to initial beliefs, MINOCA is not a benign disease, given that mortality and incidence of adverse events is similar to ACS.

Objective

To evaluate predictors and prognosis of AF in the setting of MINOCA.

Methods

Based on a multicenter retrospective study, data collected from admissions between 2013 and 2020. Pts without data on cardiovascular history or uncompleted clinical data were excluded. We included 7590 pts with non-ST elevation myocardial infarction (NSTEMI). Between those, 1561 (19.2%) were MINOCA. We divided MINOCA pts in 2 groups (G): GA – MINOCA with de novo AF; GB – MINOCA without de novo AF during in-hospital stay.

Results

MINOCA pts’ mean age was 65±13, 62% were male and 2.1% had de novo AF. GA pts were older (76±10 vs 65±13, p<0.001), had higher rates of Killip-Kimball class (KKC) >I (27.8% vs 9.7%, p=0.027) and kidney function impairment (50% vs 10.2%, p<0.001), lower haemoglobin at admission (13±1.5 vs 13.7±1.8, p=0.038), higher rates of diuretics (56.3% vs 17.6%, p<0.001) and amiodarone usage during hospitalization (31.3% vs 3.6%, p<0.001) and higher rates of left ventricle ejection fraction (LVEF)<50% (47.1% vs 19.1%, p=0.009). The Gs were similar regarding gender, times from symptoms to admission, cardiovascular risk factors and past history of heart failure, stroke or ACS, and heart rate and systolic arterial tension at admission. In the global population, older age (p=0.001, OR 1.87, CI 1.23-2.72), KKC>I (p=0.004, OR 1.76, CI 1.19-2.61) and LVEF<50% (p<0.001, OR 2.25, CI 1.5-3.38) were predictors of AF during hospitalization. In MINOCA pts, only older age (p=0.014, OR 4.2, CI 1.34-13.2) and LVEF<50% (p<0.001, OR 7.44, CI 2.17-25.47) were predictors of de novo AF. Regarding 1 year-prognosis, the occurrence of AF in MINOCA pts was associated with worse outcomes, namely 1year-mortality (log rank=0.002) and 1-year all cause readmission (log rank 0.028)

Conclusion

As expected, AF in the setting of MINOCA is associated with poorer prognosis. Pts with older age and LV dysfunction are at higher risk of de novo AF in this population.
Post-operative atrial fibrillation: not just a transient phenomenon
Authors: Swinn T , Pezard-Snell M , Dimitropoulos G , Sammut E , Barman P
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

A high proportion of patients undergoing cardiac surgery develop atrial fibrillation (AF) in the immediate post-operative period. To assess whether this translates into long-term AF, studies have used incidence of stroke as a surrogate marker, however the rhythm has not been directly measured. Our study retrospectively reviewed device checks of patients with permanent cardiac devices who underwent cardiac surgery in order to directly measure AF up to 18 months post cardiac surgery.

Purpose

To assess whether the development AF in the immediate post-operative period relates to the prevalence of longer-term AF after cardiac surgery.

Methods

Patients who had undergone a coronary artery bypass graft (CABG) or valve surgery between January 2011 and March 2020 and who had a pre-existing device or a device inserted within 1 year after surgery were identified. Patients were excluded if they had a congenital cardiac condition or a diagnosis of AF pre-operatively. Patients were categorised as having AF in the immediate post-operative period if AF was coded in the electronic ICU observation chart, mentioned on the discharge summary, or found in a device check <6 weeks post-surgery. Device checks were analysed up to 18 months post-surgery and AF was confirmed if lasting >6 minutes and documented on atrial electrogram (EGM). Comorbidities and operation details were gathered from institutional surgical database and medical notes.

Results

359 patients at our institution met initial criteria. 94 had device checks available and were used for final analysis. Mean follow up duration was 377 days. In total 41 (44%) patients developed AF in the immediate post-operative period. Patients developing post-op AF were older (69 vs. 64 years old, p=0.01) and had a different spread in operation type (CABG only 27% vs. 28%, valve only 51% vs. 68%, combined CABG & valve 22% vs. 4%, p=0.02) but there was no difference in other relevant characteristics (see Table 1). In total, 24 (26%) patients developed longer term AF, with significantly higher proportion in those who developed immediate post-operative AF (see Figure 1). Immediate post-operative AF and hypertension demonstrated a significant association with longer-term AF on univariate regression analysis using a significance value of 0.1. On multivariate analysis only immediate post-operative AF remained significant (odds ratio 3.75 (95% confidence interval 1.38-10.22), p=0.01).

Conclusion

Developing AF in the post-operative period appears to be an independent predictor of developing clinically significant AF up to 18 months after surgery. This is an important finding in identifying patients who may be at higher risk of thromboembolic events. Further research is required to determine the optimal approach, in particular consideration of anticoagulation in this patient group.
Effect of cardiorenal syndrome and its different subtypes on incidence of atrial fibrillation in a nationwide analysis
Authors: Fauchier L , Bisson A , Maisons V , Bodin A , Herbert JM , Angoulvant D , Halimi JM , Lip GYH
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiorenal syndromes (CRS) are associated with increased risks of all-cause and cardiovascular death, end-stage kidney disease (ESKD), myocardial infarction (MI), heart failure (HF) and ischemic stroke. Whether CRS (and different subtypes of CRS) are more prone to develop atrial fibrillation (AF) is unclear.

Methods

This longitudinal cohort study was based on the national hospitalization database covering hospital care from the entire French population. The analysis focused on those with at least 5 years of complete follow-up (or dead earlier) as described by others. We identified 439,787 consecutive patients hospitalized in France in 2012 who had heart failure (HF), chronic kidney disease (CKD) and/or CRS. We estimated incidences of clinical events (including incident AF) during follow-up. Analysis were adjusted for 1) age and sex and 2) all baseline characteristics except cardiac and renal comorbidities.

Results

Overall, 58.2% were male, 67.7% had hypertension, 31.6% had diabetes mellitus and their mean age was 75.3±13.2; 329,154 had isolated HF, 67,939 had isolated CKD, 15,695 had acute concomitant CRS (which could be type 1, 3 or 5 CRS), 15,699 had type 2 CRS (cardiorenal) and 11,300 had type 4 CRS (renocardiac). History of AF was present in 36.4 % of the patients: 39.9% in those with isolated HF, 13.3% in those with isolated CKD, 43.0% in those with concomitant CRS, 57.2% in those with type 2 CRS, 35.3% in those with type 4 CRS (overall p<0.0001).

Incidence and adjusted hazard ratios for of all-cause death, cardiovascular death and incident AF are in Table 1. CRS was associated with a higher risk of death and patients with type 2 CRS had the highest risk of all-cause and cardiovascular mortality. Isolated HF was associated with a higher risk of incident AF than isolated CKD (Table 1). Patients with CRS had higher risk of incident AF than those with isolated HF or isolated CKD. Among patients with CRS, those with concomitant CRS had the numerically highest 5-year risk of incident AF, which was not statistically different than those with type 2 or type 4 CRS in adjusted analysis.

Conclusion

The long-term prognosis of CRS subtypes is poor and may vary, some CRS subtypes being more closely associated with risk of all-cause death and cardiovascular mortality than others. Risk of incident AF is higher in CRS than in isolated HF or isolated CKD and is not statistically different among the various subtypes of CRS.
Neurophysiological status of patients with non-valvular atrial fibrillation
Authors: Shorikov E , Shorikova D , Shorikov P , Ismael A , Bordiyan V
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

The reduction of the risk of stroke in patients with AF is achieved with the help of continuous administration of oral anticoagulants (OAC). The presence of cognitive impairment in a patient may be a significant risk factor for low adherence to antithrombotic therapy, therefore, the medico-social significance of impaired cognitive functions in patients with AF is high. At the same time, it is still unclear which neurophysiological mechanisms and areas of the brain are responsible for the development of cognitive disorders in this pathology. Thus, further studies are needed to assess the state of higher cortical functions in patients with AF.

Materials and methods

The study included 50 patients with nonvalvular AF and a high risk of hemorrhagic and ischemic events, with a risk of thromboembolic complications on the CHA2DS2-VASc scale of at least 2 points and a risk of bleeding on the HAS-BLED scale of at least 3 points. The control group consisted of 17 relatively healthy individuals.

Research results

The analysis of indicators of extended neuropsychological testing made it possible to establish that, compared with healthy individuals of the same age, patients with AF perform worse on tests of neurodynamics, attention and short-term memory, Table. Patients with AF have a lower rate of complex sensorimotor reactions, a greater number of errors, especially in tests with biofeedback (brain performance test). Also, patients with AF have worse performance indicators and higher focused attention depletion (characterized by the number of characters processed in the 1st and 4th minutes of the proofreading test, respectively). As for the indicators of short-term memory, healthy subjects were superior to patients with AF in memorizing meaningless syllables and words, but not numbers.

The power indicators of the theta EEG rhythms at rest with eyes closed were taken. The factors were identified - GROUP (2 levels: patients with AF; healthy individuals), AREA (5 levels: (frontal, central, temporal, parietal, occipital) and LATERALITY (2 levels: left, right hemisphere). In patients with cardiac arrhythmias, the increase in the power of the theta-2 rhythm biopotentials in the direction from the anterior to the posterior cortex is significantly pronounced (p = 0.000001), while in healthy individuals the gradient curve is flatter (p = 0.009).

Conclusions

It was found that about half of the examined AF patients have syndrome mild cognitive impairment (MCI). The most significant cognitive decline in these patients compared with relatively healthy individuals was noted for the speed of sensorimotor response, performance control indicators, and short-term memory, while decreased cognitive test scores were associated with a greater representation of slow waves in the resting EEG, mainly in the posterior regions of the cerebral cortex.
Accuracy of AF burden detection with the new Confirm Rx with Sharp-sense technology
Authors: Briosa E Gala A , Pope MTP , Leo M , Ormerod J , Field D , Balasubramaniam R , Thomas H , Gardner RS , Hunter R , Gallagher MM , Wilson D , Paisey JR , Curzen NP , Betts TR
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Implantable cardiac monitors (ICMs) are increasingly used to monitor atrial fibrillation (AF) burden following catheter ablation. AF burden recorded by the Confirm Rx™ ICM cannot be modified even after adjudication of false-positive (FP) episodes. We sought to investigate accuracy of the AF burden detection in a UK cohort.

Methods

This multicentre retrospective study included patients with Confirm Rx™ and at least one episode >6 minutes across 9 UK hospitals. Each episode had a corresponding 120-second EGM (electrogram) and heart rate scatterplot which was considered representative of the whole episode. One cardiologist adjudicated all EGMs as ‘True AF’ or ‘False positive’ and a random sample of 10% was reviewed to account for intra and interobserver variability. AF burden was computed as the duration of all episodes classified as AF by the Confirm-Rx divided by the total duration of follow-up. ‘True-AF’ burden was calculated by dividing the duration of episodes adjudicated as ‘True-AF’ by the total duration of follow-up. We also investigated the accuracy of AF burden according to implantation indication and episode duration.

Results

A total of 16,230 individual AF episodes were included from 232 consecutive patients. Overall, 26,137 hours of AF were recorded and a total follow-up 315 patient-years which equates to an AF burden of 0.95%. However, only 24,404.7 (93.3%) hours represented time in ‘True-AF’ and a ‘True-AF’ burden for the whole cohort of 0.89% (Table 1). Patients with a Confirm-Rx™ for palpitations and suspected AF had the lowest proportion of ‘True-AF’ burden and had a modest contribution to the overall AF burden (Figure 1). Conversely, patients with known AF had the highest proportion of ‘True-AF’ burden recorded. Most AF (84.5%) episodes lasted less than 1 hour with approximately a quarter adjudicated as false-positive detections, but their contribution towards overall AF burden was very small (Figure 2A-2B). In contrast, AF >3 hours accounted for 76.4% of time in AF and the proportion of ‘True-AF’ burden was 98.5%.

Conclusion

The accuracy of the estimated AF burden for the whole cohort was excellent (93.3%), driven by the high proportion of ‘True-AF’ burden in AF>3 hours.
Diagnostic accuracy of the Confirm-Rx atrial fibrillation detection algorithm in real-world patients
Authors: Briosa E Gala A , Pope MTB , Leo M , Ormerod J , Field D , Balasubramaniam R , Hunter R , Thomas H , Gardner RS , Gallagher MM , Wilson D , Paisey JR , Curzen NP , Betts TR
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Continuous rhythm monitoring with implantable cardiac monitors (ICMs) is commonly used to detect and characterise atrial fibrillation (AF) episodes. The Confirm Rx™ with SharpSense™ technology offers four new discriminators and second pass analysis aimed at enhancing detection and improving accuracy for cardiac arrhythmias. This study sought to investigate the diagnostic accuracy of the Confirm Rx™ AF detection algorithm in a UK cohort of ‘real-world’ patients.

Methods

This multicentre retrospective study included patients with Confirm Rx™ and at least one episode of AF>6 minutes from August 2018 to August 2021 across 9 UK hospitals. Each episode had a corresponding 120-second electrogram (EGM) and heart rate scatterplot. One cardiologist manually adjudicated all EGMs as ‘True-AF’ or ‘False-positive. To assess for intra and inter-observer variability, 10% of the EGMs were reviewed. Diagnostic accuracy was determined by calculating the raw and patient-averaged positive predictive value (PPV) for AF episode of different durations and implant indications.

Results

During the study 232 patients met inclusion criteria with a total of 315 patient-years of follow-up. 16,320 individual AF episodes were adjudicated; intra- and interobserver variability was excellent (Cohen’s kappa 0.85 and 0.86, respectively). The rate of ‘True-AF’ detection was 3.19 episodes per month corresponding to a raw PPV of 74.5% for the whole cohort. The highest number of episodes per months was observed in patients with a Confirm-Rx for palpitations (5.1) and suspected AF (5.8) but only approximately half of these represented ‘True-AF’ episodes (Figure 1). Patients with known AF had the lowest rate of AF episodes (1.6 episodes per month) but the highest proportion of ‘True-AF’ episodes (PPV of 95.5%). A clear trend of improving diagnostic accuracy was seen with longer AF episodes (Table1). AF>3 hours had a PPV above 94% and all episodes lasting longer than 24 hours were ‘True-AF’. For AF episode of short duration, the PPV varied with the population being monitored; however, for longer AF episodes the PPV increased significantly and irrespective of implant indication (Figure 2).

Conclusion

Overall, the Confirm Rx™ ICM diagnostic accuracy was modest for all AF episodes lasting longer than 6 minutes (74.5%) but improved considerably for longer AF episodes irrespective of implant indication.