bluuebunny/crossref_metadata_2025 huggingface dataset:
Wearable self-powered ballistic signal detectors with ferroelectric composites arrays for cardiovascular and diabetic complication
Authors: Lee K H , Kim Y R , Yoon N S , Park H W
Published: May 2024

Background

Flexible and wearable electronic devices with lightweight are needed to monitor and guide treatment in patients with cardiovascular disease and diabetic complication. We aimed to develop self-powered wearable bio-signal sensing arrays for cardiovascular and diabetic complication diagnosis and continuous monitoring.

Methods

Ferroelectric composites were designed to have piezoelectric property and high flexibility. Detection of arterial pulse as ballistogram (BCG) was simultaneously compared with electrocardiogram (ECG) in 20 controls. Heart rate and components of ECG was compared with those of BCG. Then, 9 ferroelectric BCG sensors as a square type array with self-power generation were fabricated to attachable thin film. Pressure distribution with BCG sensor array attached to socks were compared between 20 controls and 20 patients with diabetic neuropathy or vasculopathy during standing and ambulation for gait pressure distribution. Pressure distribution pattern was compared to neuropathy and vasculopathy parameters.

Results

Heart rate between BCG and ECG was significantly correlated (interclass correlation coefficient, ICC 0.99, 95% CI 0.98-0.99, p<0.001). QRS and T wave in ECG were correlated to second and third wave in BCG. Radial artery augmentation index by blood pressure monitoring was significantly correlated to BCG pressure (ICC 0.76, 95% CI 0.38-0.90, p=0.002). Analysis of foot pressure distribution demonstrated the highest pressure point at the anterolateral plantar area below a little tow. However, pressure gradient between anterolateral and anteromedial plantar area in diabetic patients was greater than that in controls (42.3±10.2 mV vs. 31.2±8.5 mV, p=0.024). Pressure gradient in diabetic patients was correlated to ankle-brachial index (ICC 0.62, 95% CI 0.32-0.90, p=0.036), but not to neuropathy parameters.

Conclusion

Wearable BCG sensor could accurately detect heart rate, blood pressure index and significantly correlated to ABI. Pressure distribution pattern and gradient analysis in diabetic patients by wearable BCG sensor arrays might predict diabetic complications. Gait remedial training guided by wearable BCG sensor arrays might aid to prevent diabetic complications.
Source-sink mismatch and conduction block: simulation study
Authors: Oh S , Ahn H J , Choi E K , Shim E B
Published: May 2024

Background

Source-sink mismatch is one of the key concepts in arrhythmia mechanism such as relationship between pulmonary veins and the left atrium in atrial fibrillation. We sought to find the condition for conduction block in various geometries.

Methods

To simulate cardiac atrial tissue, the finite element method was used to discretize the governing equation in a 2D mesh. We evaluated under the following conditions: 6 sizes of source width (0.1, 0.2, 0.3, 0.4, 0.5 and 0.6 mm), 64 types of angle (θ) at the junction (30-330 degrees), 3 conditions of conduction velocity (CV) (x0.5, x0.75, and x1 of normal CV of atrial myocardium).

Results

Conduction block was not observed with source width > 0.5 mm in any settings. In reduced CV condition, conduction block was not observed in θ < 300 degrees when source width > 0.3 mm. The higher CV, conduction block was observed in the narrower θ. In cases of CV of x1.0 and x0.75, conduction block was observed in θ < 180 degrees when source width < 0.3 mm. The smaller source width, conduction block was observed in the narrower θ. The wider θ, the easier conduction block occurred.

Conclusion

Conditions for conduction block due to source-sink mismatch are as follows: smaller source width, higher CV, and wider θ. Source with width > 0.5 mm may not be associated with source-sink mismatch in the atrial tissue. CV slowing by antiarrhythmic drugs can be effective in the aspect of source-sink mismatch.
Clinical risk factors associated with cardiac events in children with BrS-SCN5A
Authors: Cruzalegui J , Martinez Barrios E , Greco A , Diez-Escute N , Cerralbo P , Cesar Diaz S , Zschaeck I , Chipa Ccasani F , Brugada J , Campuzano O , Sarquella Brugada G
Published: May 2024

Introduction

between 20-30% of patients with Brugada syndrome (BrS) are carriers of deleterious genetic variants in the SCN5A gene. However, the risk factors for cardiac events in these patients remain under consideration, especially in the paediatric population, with many risk factors being still undetermined.

Objectives

to investigate and evaluate individual clinical risk factors associated with cardiac events in children with BrS-SCN5A.

Methods

a Spanish retrospective single-centre paediatric cohort study was conducted including 41 BrS patients under 21 years of age carrying rare variants in the SCN5A gene. Demographic, clinical, genetic, and therapeutic variables were collected. Descriptive and univariate analyses were performed to identify independent risk factors for cardiac events. Outcomes were defined as cardiac syncope, ventricular tachycardia/fibrillation (VT/VF), sudden cardiac death (SCD), and appropriate shock in ICD.

Results

Nearly 20% of BrS-SCN5A patients presented with cardiac events. Five patients showing cardiogenic syncope, 4-SCD, 3-VT and 2 appropriate shocks in the ICD. The presence of bradycardia and bradyarrhythmia in baseline EKG (P<0.05), AV block type 1 (P<0.02), type 1 Brugada pattern in fever EKG (P<0.02), atrial fibrillation(P<0.05), arrhythmias in febrile episodes (P<0.05), progressive cardiac conduction defect (PCCD; P<0.001), sick sinus syndrome (SSS; P=0.001) and overlap phenotype (P<0.001) were predictor of cardiac events in this cohort.

Conclusions

We have identified several statistically significant independent risk factors associated with cardiac events and worse phenotype severity in BrS-SCN5A children from a single-centre Spanish cohort. These results may help to improve prognosis assessment, establish accurate risk stratification, and prevent SCD in children with BrS-SCN5A. Future studies in large cohorts of different ethnicities are crucial to strengthen our risk factors in paediatric cohorts at high risk of malignant arrhythmias.
Intra-operative ultra high-frequency ECG in relation to left ventricular reverse remodelling after cardiac resynchronization therapy
Authors: Zegard A , Walton J , Begum R , Stegemann B , Hall P , Brown P , Patel P , Leyva F
Published: May 2024

Aims

Ultra-high-frequency electrocardiography (UHF-ECG) has evolved as a potential tool for the assessment of ventricular dyssynchrony. We sought to determine whether changes in ventricular dyssynchrony at the time of cardiac resynchronization therapy (CRT) device implantation, measured using UHF-ECG, relate to post-implantation left ventricular reverse remodelling (LVRR).

Methods and Results

Patients undergoing CRT (n = 46; aged 70.3 ± 11.2 years; 37/46 male) underwent intra-operative UHF-ECG assessment of ventricular dyssynchrony before and after CRT. Multiple frequency bands (n=16) within the 150 to 1000Hz range were used to create ventricular depolarization maps (Figure). Ventricular dyssynchrony (e-DYS) was assessed using the maximum time difference in ms between the QRS complex centres of mass of leads V1 to V6. Left ventricular reverse remodelling was defined in terms of a reduction in left ventricular end-systolic volume (LVESV) at 3 months post-implantation. During implantation, CRT led to a 103% reduction in e-DYS from 36.6 ms during AAI pacing to 1.4 ms during CRT (P<0.001). CRT also led to a reduction in QRS duration (from 156.3 ms during AAI pacing to 119.9 ms during CRT [P<0.001]) and QRS area (from 100.5 ms*mV (or µVs) during AAI pacing to 65.6 ms during CRT [P<0.001]). In regression analyses, intra-operative Δ e-DYS (ms) was associated with ΔLVESV at 3 months (Figure). In contrast, no associations were observed between intra-operative ΔQRS duration or ΔQRS area and ΔLVESV.

Conclusion

Intra-operative Δ e-DYS derived from UHF-ECG, relates to LVRR after CRT. In contrast, no such relationship emerged for ΔQRS or ΔQRS area.
Electrocardiographic imaging to guide ablation of ventricular arrhythmias shows a higher benefit in patients with low intraprocedural burden
Authors: Parreira L , Carmo P , Nunes S , Mesquita D , Quintal J , Chambel D , Marques L , Machado P , Ferreira A , Seixo F , Adragao P
Published: May 2024

Background and aims

Electrocardiographic imaging (ECGI) provides a non-invasive activation map of focal ventricular arrhythmias that has shown good accuracy regardless of the type of cardiac source used. Pre-procedure diagnosis in cases that are expected to be difficult and management of infrequent or poorly tolerated or multiple arrhythmias are some situations that may benefit the most from having an ECGI performed before the procedure. This study aimed to assess the benefit of the ECGI in patients with low intraprocedural burden.

Methods

We performed 81 ECGI procedures in 64 consecutive patients referred for ablation of ventricular arrhythmias (VAs). Ablations were performed with remote magnetic navigation or manually. The localization of the VAs based on the ECGI and invasive electroanatomic mapping was performed using a segmental model of the ventricles. A perfect match (PM) was defined as a predicted location within the same anatomic segment, whereas a near match (NM) was defined as a predicted location within the same segment or a contiguous one. The agreement between the ECGI and the invasive map was evaluated. The benefit of the ECGI in the subgroup of patients with intraprocedural infrequent VAs, defined as less than 1 VA complex /min, was assessed in terms of the success of the procedure.

Results

The ECGI was performed with the AMYCARD 01 only, in 26 patients, with the VIVO only, in 21 patients, and with both systems in 17 patients. Fifty-one patients underwent ablation. 65 ECGI procedures were performed before ablation in those 51 patients, 37 with Amycard with a rate of PM of 79% and NM of 97%, and 28 ECGI procedures with VIVO with 82% of PM and 93% of NM, not significantly different, respectively, p=0.764 and 0.573. The overall success rate was 80%. The low intraprocedural burden group included 28 patients (2 examples shown in the figure). The success rate was 86%, higher than the overall success rate, and much higher than the previously reported in the literature for this group of patients.

Conclusions

The ECGI was useful in predicting the location of the VA in general but was especially helpful in cases that are usually challenging, like patients with intraprocedural infrequent VAs.
Evolution of the ECG in idiopathic ventricular fibrillation survivors: results from a single-centre UK registry
Authors: Scrocco C , Lee D , Ensam B , Bastiaenen R , Specterman M , Behr E R
Published: May 2024

Background

Idiopathic ventricular fibrillation (VF) is a diagnosis of exclusion in subjects with an unexplained cardiac arrest and no evidence of overt structural or electrical cardiac abnormalities (1). It can be associated with an early repolarisation pattern (ERP)(2). Data on the evolution of the ECG in this population are lacking.

Purpose

To compare the baseline ECG characteristic of idiopathic VF survivors and age and gender matched controls, and investigate if the presence of an ERP at ECG is a predictor of risk.

Methods

Forty-nine subjects with idiopathic VF evaluated in our tertiary centre from 1997 to 2022, and followed-up for at least 3 months were included in this study. The first representative ECG available after cardiac arrest was evaluated and compared with that of an age and gender matched control with no symptoms, family history of sudden cardiac death and normal cardiac tests; moreover, comparison was made with a follow-up ECG off antiarrhythmic medications (quinidine, amiodarone and verapamil). Medical notes were reviewed to investigate the presence of events at f-up (SCD/appropriate ICD shock).

Results

The mean age at presentation was 33±7 years; 63% of patients were males, and 16% had previous syncope. Twelve cases (24%) and 6 controls (12%) showed ERP on the resting ECG (P=NS). Only resting heart rate (HR) and QRS duration differed between the two groups (Table 1). Follow-up ECGs in 46 idiopathic VF survivors indicated that resting HR, QRS axis and QTc values were significantly different compared to the baseline ECG. In addition, 4 subjects with ERP at baseline did not exhibit it on the most recent ECG, and 6 subjects without ERP at baseline showed it on the most recent ECG. Over a median follow-up of 3.3 years (IQR 6), 13 subjects experienced appropriate ICD shocks. Kaplan-Meyer survival estimates showed no differences in events between subjects showing ERP or not (log rank p=0.092).

Conclusions

Subjects with idiopathic VF show baseline ECGs similar to those of age and gender matched healthy controls from the general population. ECG parameters tend to change only slightly over long-term follow up. The ERP in idiopathic VF survivors is dynamic and thus its relationship with events may be underestimated.Table 1 Table 2
Long-term QT interval analysis for real world patients with Insertable cardiac monitors taking antiarrhythmic drugs
Authors: Deus M , Rajagopal G , Sarkar S , Landman S , Koehler J
Published: May 2024

Background

The QT interval serves as a surrogate biomarker for ventricular repolarization. Variance in QT intervals can clinically lead to pro-arrhythmia and sudden cardiac death. An insertable cardiac monitor (ICM) device capable of continuously monitoring the QT interval over a long period can provide diagnostic value for evaluating physiologic or drug induced variations in QT interval.

Objective

To analyze feasibility of continuous QTc interval monitoring in patients with ICM and evaluate the QTc interval changes in patients taking antiarrhythmic drugs.

Methods

Patients QT intervals detected from daily ICM ECG data from real-world patients taking antiarrhythmic drugs such as sotalol, amiodarone and dofetilide during hospitalization while implanted with ICM were analyzed from the de-identified Electronic Health Record (EHR) database linked with ICM device data warehouse. The ICM ECG was processed through the previously defined QT detection algorithm which calculates the QTc interval for every beat to generate continuous long term QTc trends. A patient contributed to the prescription group if they were prescribed antiarrhythmics drugs prior to hospitalization in the EHR database otherwise they contributed to the non-prescription group. Patients from the prescription group who were administered antiarrhythmic drugs via injection or IV during hospitalization were removed from the analysis. A 30-day median QTc interval from 30-60 days prior to hospitalization was used as baseline. Wilcoxon signed-rank test was used to compare the paired difference from days 1-5, 1-10, 30-60, and 60-90 after hospitalization to their respective baseline.

Results

441 patients (avg. age: 70±11, 50.5% female) were included with 220 prescription and 221 non-prescription. The baseline QTc intervals were 414 and 417.3 msec for non-prescription and prescription groups, respectively. There was a significant increase in QTc on days 1-5, 1-10, 30-60, and 60-90 after hospital admission compared to the baseline (all p < 0.001) for the non-prescription group. The prescription group showed increase in QTc only on days 30-60 after hospitalization when compared to baseline (p<0.05). A larger QTc increase was observed in non-prescription receiving anti-arrhythmic loading on days 1-5 after hospitalization compared to patients on prescription prior to hospitalization (P<0.05).

Conclusion

Utilizing a QT interval detection algorithm from an ICM can provide long term QT trends for patients with an ICM. Continuous monitoring of QT can help to detect sudden changes in QT due to antiarrhythmic drugs which may lead to increased risk of arrhythmias or cardiac arrest.
Feasibility and diagnostic yield of a photoplethysmography-based arrhythmia screening and integrated management pathway in a chronic obstructive pulmonary disease outpatient clinic
Authors: Hereijgers M , Van Der Velden R , Reinders L , Weerts Z , Luermans J , Chaldoupi M , Vernooy K , Hermans A , Posthuma R , Franssen F , Simons S , Linz D
Published: May 2024

Background

Guidelines recommend opportunistic screening for atrial fibrillation (AF) in high-risk populations, including chronic obstructive pulmonary disease (COPD) patients.

Purpose

We aimed to assess the feasibility and yield of a photoplethysmography (PPG) smartphone app-based pathway for AF detection within a COPD outpatient clinic.

Methods

Ninety-nine eligible patients from the COPD outpatient clinic at the Maastricht University Medical Center+ underwent a 14-days PPG app-based AF screening. PPG-based AF detection triggered an electrocardiogram (ECG) for AF diagnosis and initiation of a comprehensive AF management. Patients’ adherence and system usability were assessed.

Results

Patient onboarding was easy, and patients demonstrated good adherence to the protocol (101% [82%-123%]). The usability of the PPG app was satisfactory with a high score in the System Usability Score questionnaire (80.0 [55.0-92.5]). Among 99 patients (mean age 66±9 years; 54% female), 8% had a prior AF diagnosis. Premature beats were common, with 96% of patients showing isolated premature beats (<6 in 960 PPG recordings) and 32% frequent premature beats (≥6 in 210 PPG recordings). The PPG algorithm suspected paroxysmal AF in 6 new cases. AF could be confirmed in 2 patients through resting 12-lead ECG and 1-lead handheld ECG device. One patient who was lost to follow-up. In the remaining 3 patients with suspected AF PPG recordings, analysis of 24-hour, 48-hour and 7-day Holter recordings revealed high burden premature (supra)ventricular beats. Two of these patients manifested self-terminating short episodes of supraventricular tachycardia.

Conclusion

14-days opportunistic PPG app-based screening is feasible in COPD outpatient care and results in the detection of new AF cases and premature beats. This novel digital approach offers a practical method to implement recommended AF screening in COPD patients.
Real-world validation of smartphone-based photoplethysmography for heart rate monitoring in atrial fibrillation
Authors: Gruwez H , Ezzat D , Van Puyvelde T , Dhont S , Meekers E , Wouters F , Kellens M , Bruckers L , Van Herendael H , Rivero-Ayerza M , Nuyens D , Haemers P , Pison L
Published: May 2024

Introduction

Photoplethysmography (PPG) based smartphone applications facilitate heart rate monitoring that may enable physicians to guide rate control in patients with atrial fibrillation (AF). Despite extensive validation of PPG-derived heart rate, validation studies in the presence of AF are lacking, particularly in unsupervised free-living conditions.

Purpose

To evaluate the accuracy of PPG-derived heart rate using a smartphone application in patients with an established diagnosis of AF, both during sinus rhythm and AF, in a real-world setting.

Methods

Consecutive patients undergoing AF ablation were enrolled four weeks prior to the procedure. They were instructed to assess their heart rate twice daily during eight weeks with a one-minute finger-over-the-camera smartphone-PPG recording. The reference heart rate was obtained from two 30-seconds handheld single-lead electrocardiogram (ECG) recordings performed immediately before and after the PPG recording. Measurements were valid if the heart rate did not change by more than 10% between the first and second ECG and maintained sinus rhythm or AF consistently.

Results

In total, fifty patients (age 63 ±11 years, 68% male) performed 3407 high-quality PPG measurements accompanied with two high-quality ECGs measurements both in sinus rhythm or AF. After excluding 223 measurements due to inconsistent heart rate between the first and second ECG, 3184 measurements remained. The mean heart rate (71.5 ± 17.3 beats per minute (bpm)) was significantly higher during AF (94.7 ± 19.4 bpm) compared to sinus rhythm (65.7 ± 10.7 bpm) (p-value < 0.001). The heart rate assessment was accurate within a 10% margin in 93.8% of PPG measurements. Inaccurate heart rate assessments were more frequent in AF (161/637; 25.3%) compared to sinus rhythm (35/2547; 1.4%) (p-value < 0.001). PPG underestimated the heart rate in sinus rhythm with 0.4 bpm (95% CI: -0.3 to -0.5 bpm) and in AF with 6.6 bpm (95% CI: -5.8 to -7.4 bpm). The deviation of PPG-derived heart rate from the ECG-derived true heart rate was significantly greater during AF (root mean square error (RMSE) = 11.8 bpm) compared to sinus rhythm (RMSE = 2.2 bpm) (p-value < 0.001). The heart rate correlation plots and corresponding Bland-Altman plots demonstrate a skewed underestimation of the heart rate in AF with PPG, particularly for high heart rates.

Conclusions

Heart rate can accurately be derived from PPG recordings using a smartphone application in real-world conditions. However, PPG measurements may underestimate high heart rates in the presence of AF.Heart Rate in Sinus RhythmHeart Rate in Atrial Fibrillation
Non-invasive detection of cardiac arrhythmias using photoplethysmography signals
Authors: Jeanningros L , Van Zaen J , Le Bloa M , Teres C , Herrera C , Porretta A , Domenichini G , Pascale P , Luca A , Solana Munoz J , Vesin J M , Thiran J P , Lemay M , Pruvot E , Braun F
Published: May 2024

Cardiac arrhythmias (CAs) are associated with critical heart-related complications such as stroke or heart failure. Because of the intermittent and asymptomatic presentation of some CAs in their early stages, the screening remains limited using traditional methods based on ECG. Recent advances in photoplethysmography (PPG) have revealed substantial potential for wearable devices to detect CAs within large populations. Although PPG has demonstrated efficiency in discriminating atrial fibrillation (AF) from normal sinus rhythm, it remains unclear whether AF detection methods remains effective in the presence of CAs other than AF.

In this study, we applied a recurrent neural network on a dataset containing eight different types of CAs (Table 1). The classifier processes sequences of interbeat intervals (IBIs) as input and discriminates between normal and abnormal rhythms. The algorithm was evaluated on 64 patients (45 males and 19 females , with a mean age of 55.9 ± 16.0) undergoing a diagnostic or therapeutic electrophysiological procedure. This dataset includes simultaneous recordings of PPG signals from a wrist-bracelet and 12-lead ECG, with the latter used as the gold-standard for annotating cardiac rhythms.

The classifier achieved 84% accuracy, 77% sensitivity and 88% specificity in detecting abnormal rhythms. Table 1 shows that AF (99.6%), atrial tachycardia (100%) and AVRT (96.4%) were well classified as abnormal rhythm, whereas the reliability of the detection decreased for atrial flutter (65.4%), atrial or ventricular bigeminy (72.4%) and ventricular tachycardia (80.2%). Undetected abnormal rhythms were often characterized by a rather regular rhythm (illustrated by VT in Figure 1) and CAs for which PPG heartbeat detection was initially not optimal (Bigeminy in Figure 1).

In conclusion, this study shows the capability of PPG-based technology to detect various CAs extending beyond AF. It highlights the merits and limitations of IBI-based detection of abnormal rhythms, highlighting the need for a better comprehension of the peripheral hemodynamic signature of CAs.
Feasibility and determinants of short-term heart rate variability in patients using photoplethysmography-based wearable devices - data derived from TeleCheck-AF
Authors: Hillmann H , Hermans A , Gawalko M , Mueller-Leisse J , Betz K , Van Der Velden R , Pluymaekers N , Evens S , De Cooman T , Sultan A , Gruwez H , Hendriks J , Manninger M , Linz D , Duncker D
Published: May 2024

Background

Heart rate variability (HRV), especially short-term HRV, is known to be associated with development of atrial fibrillation (AF). Nevertheless, it is not known if short-term HRV can be feasibly derived from digital devices in patients at risk for AF. In this analysis, we aimed to evaluate the feasibility and determinants of short-term HRV using non-continuous photoplethysmography (PPG) recordings derived from digital hand-held device.

Methods

TeleCheck-AF is a project implementing an on-demand app-based infrastructure for the management of AF. Briefly, one week prior to the scheduled teleconsultation, patients were provided with a smartphone app to assess heart rate/rhythm three times a day and in case of symptoms. Patients from the project with at least one PPG recording in sinus rhythm (SR) during the study period were analyzed. For every recording in SR, the short-term HRV parameter, root mean square of successive normal-to-normal interval differences (RMSSD), was calculated. The PPG parameters, heart rate and RMSSD, were compared between groups (men vs women, presence vs absence of previous AF, atrial flutter, atrial tachycardia, pulmonary vein isolation (PVI) within 12 months).

Results

Overall, 855 patients [60.5% men, median age 63 (56;70) years] with a total number of 13465 recordings were included in the analysis. Median number of recordings per patient was 15 (7;20) with a median heart rate of 66 (59;75)bpm and a RMSSD of 39.7 (30.6 ;56.1)ms. Results revealed a significant difference in RMSSD for gender and previously known AF, whereas no difference was seen e.g., for patients with known atrial flutter or atrial tachycardia (table 1). In patients with previously known AF, patients who underwent PVI within the last 12 months had a reduced RMSSD in comparison to patients without previous PVI (36.7 (31.8; 47.0)ms vs 42.2 (34.4; 54.3)ms, p<0.001).

Conclusion

Assessing short-term HRV based on RMSSD using PPG recordings is feasible. Short-term HRV recorded by digital hand-held devices may be especially helpful in patients after PVI as such patients were shown to have a reduced HRV in this analysis.

Table 1: Differences in short-term heart rate variability in patients at risk for atrial fibrillation. AF = Atrial fibrillation.Table 1
The effect of antiphospholipid antibodies on the frequency of extrasystoles in men with coronary heart disease and and myocardial infarction
Authors: Nazarova M , Burdeina L , Stanislavchuk M , Ivankova A
Published: May 2024

Background

Coronary heart disease (CHD) is one of the most socially significant diseases of the cardiovascular system. Acute myocardial infarction (MI) develops 10 years earlier in men than in women. Manifestation of MI in young men quite often happen without clinically significant stenosis of coronary vessels. And fatal arrhythmias are one of the main causes of death in patient with cardiovascular diseases.

Purpose

To evaluate the clinical and pathogenetic significance of antiphospholipid antibodies (aPL) in patients with MI and disorders of rythm.

Methods

107 patients men (average age 51.2 ± 6.15 years) with CHD and MI were examined. The content of aPL IgG - antibodies to cardiolipin, phosphatidylserine, phosphatidylinositol, phosphatidylacetate in the blood serum were determined by enzyme-linked immunosorbent assay and electrocardiography Holter monitor 24 hours tests were done.

Results

aPL IgG were detected in 56 patients (52,3% of the total number of patients with MI), it concentration threshold 10 GPL U/ml in blood serum. The median age of first acute MI in men 56 years, according to the literary data. In our investigation average age of aPL positive patients is 44.8 ± 5.47 years. They had first MI on average 12 years earlier than general population.

The level of aPL IgG in blood serum was higher in 1,7 times (19,3 ± 7,32 GPL U/ml and 11,4 ± 5,41 GPL U/ml (p <0.05) in patients with recurrent MI compared to one MI. Also the results of the study showed that the highest prevalence of polytopic extrasystoles is observed among aPL positive CHD patients with recurrent MI (68,3%) compared to one MI in anamnesis (26,3%). Moreover, 23.2% of people who had recurrent MI had ventricular extrasystole of high gradations.

It is important to note, that іn patients with first Q-MI levels of aFL IgG were in 1.27 times higher (p<0.05) than in patients with first non-Q-MI. And the frequency of the polytopic extrasystoles was on 38% higher (p<0.01) іn patients with first Q-MI compared to patients with first non-Q-MI.

Conclusion

The results obtained by us indicate the possible involvement of the autoimmune factor, in particular aPL IgG, in the pathogenesis of CHD. Positive correlation of aPL IgG with the frequency of rhythm disorders indicates the severity of condition in men with CHD and MI in anamnesis and need for further research.
Imageless electrocardiographic imaging for atrial electrophysiological characterization: a validation study
Authors: Ros S , Reventos J , Fambuena C , Lundback D , Arenal A , Torrecilla E G , Avila P , Carta A , Bermejo J , Mombiela T , Delgado A , Climent A M , Guillem M S , Atienza F
Published: May 2024

Background

The mechanisms responsible for atrial fibrillation (AF) are not yet fully understood and treatment strategies remain suboptimal. Electrocardiographic imaging (ECGi) could provide new insights into the arrhythmogenic substrate’s characterization.

Objective

To validate a novel imageless ECGi technique against electroanatomical mapping (EAM) systems to evaluate its use in guiding therapeutic decisions.

Methods

Periprocedural ECGi was implemented on 12 patients submitted for pulmonary vein isolation with EAM arriving in sinus rhythm. As opposed to current methods requiring patient-specific torso-heart geometries from CT/MRI scans, the employed ECGi system computes a cardiac anatomical model from a 3D-camera torso reconstruction. Both ECGi signals and intracavitary recordings were acquired simultaneously during catheter stimulation from a single atrial site at two different pacing cycles and local activation time (LAT) maps were derived. As a result, an ECGi and an EAM map were obtained for both 300 and 600 ms distal coronary sinus pacing for each patient. These were then compared by splitting the left atrial geometries from both mapping methodologies into 7 predefined, clinically relevant regions and identifying the earliest and latest activation sites in each.

Results

For all 24 LAT maps under consideration, the pacing sites identified by non-invasive ECGi maps were consistent with those determined through EAM as 100% accuracy was obtained in terms of detecting the first activated region. As well as the correct stimulation area, according to the corresponding EAM instance, the earliest ECGi activations were also found in one of its immediate neighbours in 38% of the maps, indicating a broader region of interest. Regarding the latest activation sites, ECGi achieved an accurate localisation in 92% of the activation sequences and, similarly, other neighbouring regions showed the maximum LAT in one third of the studied maps.

Conclusions

Considering the spatial resolution constraints inherent to its non-invasive nature, imageless ECGi activation patterns are congruent with the gold-standard technique for substrate mapping without the need for prior medical imaging.
Impact of continuous positive airway pressure for severe sleep apnea on very late recurrence in patients receiving catheter ablation of atrial fibrillation
Authors: Tanaka N , Okada M , Tanaka K , Hirao Y , Harada S , Miyazaki N , Iwasa K , Koyama Y , Watanabe H , Iwakura K , Iwanaga Y , Okamura A
Published: May 2024

Background

Sleep apnea (SA) represents a risk for arrhythmia recurrence following catheter ablation (CA) of atrial fibrillation (AF). Continuous positive airway pressure therapy (CPAP) is the established standard treatment for moderate to severe SA. While CPAP exhibits promise in reducing AF recurrences post-CA, the evidence is not entirely consistent. The impact of CPAP for severe SA on very late recurrence post-CA of AF has not been elucidated.

Methods

This study employed a retrospective, single-center, observational design. Data were derived from SA screening tests routinely performed in patients scheduled for CA of AF in our facility. We defined severe SA as an apnea-hypopnea index (AHI)≥30 by a home sleep apnea test or polysomnography. After excluding patients already diagnosed with sleep apnea before CA, we enrolled 466 consecutive severe SA patients. We divided them into two groups according to whether they had more than 1-year usage of continuous positive airway pressure after CA (CPAP group) or not (non-CPAP group). CPAP usage was monitored through telemonitoring and regular follow-up visits at our outpatient clinic every three months. Very late AF recurrence was defined as AF recurrence more than 1-year after the index CA.

Results

The age was 65±10 years, 17.4% were females, and 60.3% had non-paroxysmal AF. The mean AHI was 38.0±15.2. The CPAP group included 33.7% (n=157) and non-CPAP group 66.3% (n=309). The AF recurrence rates within 1-year post-CA were similar between the two groups (CPAP group vs. non-CPAP group, 16.6% vs. 16.2%, log-rank p=0.91). However, the very late AF recurrence rate was lower in the CPAP group than non-CPAP group (CPAP group vs. non-CPAP group, 7.6% vs. 21.6%, log-rank p=0.0002).

Conclusion

Among the untreated severe sleep apnea patients at the time of the catheter ablation of AF, CPAP treatment during 1-year post-CA was associated with fewer AF recurrences beyond 1-year post-CA.KM curve according to CPAP group
Physical activity change after early rhythm control after new-onset atrial fibrillation and major adverse cardiovascular event risk
Authors: Lee S R , Ahn H J , Choi E K , Kim B S , Han K D
Published: May 2024

Background

There is paucity of information about major adverse cardiovascular event (MACE) related to physical activity change after early rhythm control (ERC) after new-onset atrial fibrillation (AF). We investigated the association between physical activity after ERC and clinical outcomes in new-onset AF patients.

Methods

This study was performed based on the Korean National Health Insurance Service database. We included adults with new-onset AF between 2009 and 2018. Patients who received national health screening examination before and after AF diagnosis within 2-year were finally included (n=161,379). Among these, 48,243 patients were received rhythm control within 2-year after AF diagnosis. Patients were categorized into 4 groups as follows: persistent non-exerciser, new exerciser (after AF diagnosis and ERC), exercise maintainer, and exercise quitter (after AF diagnosis and ERC). The primary outcome was MACE defined as the composite of ischemic stroke, myocardial infarction, and hospitalization for heart failure. Multivariable Cox analysis was performed.

Results

Among 48,243 patients receiving ERC, 63% (n=30,540) was persistent non-exerciser, 13% (n=6260) was new exerciser, 11% (n=5102) was exercise maintainer, and 13% (n=6341) was exercise quitter. After multivariable adjustment, compared to persistent non-exerciser, new exerciser and exercise maintainer with ERC showed lower risk of MACE by 10% and 19%, respectively (adjusted hazard ratio [aHR], 95% confidence interval [95% CI], 0.903 [0.802-0.994] for new exerciser, and 0.810 [0.725-0.906] for exercise maintainer) (Table 1). However, exercise quitter did not show significant benefit compared to persistent non-exerciser (Table 1). To assess the synergistic effect of ERC and starting or maintaining physical activity, we performed exploratory analysis including patients who did not receive ERC. Compared to persistent non-exerciser without ERC, persistent non-exerciser with ERC was associated with a significantly lower risk of MACE (0.832 [0.797-0.868], Table 2). Patients who received ERC and started or maintained physical activity with ERC showed greatest risk reduction for MACE by 27% and 36%, respectively (0.732 [0.668-0.802] for new exerciser and 0.641 [0.576-0.713] for exercise maintainer) (Table 2).

Conclusion

Even in context with beneficial effect of ERC in patients with new-onset AF, maintaining or starting regular physical activity after ERC might bring greater reduction on the risk of MACE. Physician should emphasize healthy lifestyle behavior with rhythm control in patients with new-onset AF.
The best practices for safety and effectiveness in pregnant: zero-fluoroscopy arrhythmias catheter ablation
Authors: Smagulova A , Ainabekova B , Albaev R , Abdrakhmanova Z H , Suleymen Z H , Abdrakhmanov A
Published: May 2024

Background

Arrhythmias are common during gestation. While the safety and effectiveness of zero-fluoroscopy arrhythmias catheter ablation has been studied, the effects of it in pregnant poorly understood.

Purpose

The aim of our single-center, prospectively study is explore feasibility, efficacy and safety of zero-fluoroscopy catheter ablation in pregnant.

Methods

Characteristic, obstetric and neonatal outcomes of 47 cases of zero-fluoroscopy catheter ablation during gestation (main group) within 24 month follow-up were compared with group of pregnant with antiarrhythmic therapy (control group, p=54). Ablation was performed under the guidance of CARTO (n=21; 44.7%) and Ensite Precision systems (n=26; 55.3%) and intracardiac echocardiography without using fluoroscopy in all cases.

Results

Mean age of pregnant and mean gestation age were comparable in both groups (25.3±3.9 vs. 27.3±3.9 years, p=0.093 and 23.7 ±3.1 vs. 23.8 ±3.2 weeks, p=0.123). Atrioventricular nodal reentrant tachycardia was the most common indications for ablation during gestation (n=21; 44.7%), which was followed by Wolff–Parkinson–White syndrome (n=15; 31.9%). Cases of combination of accessory pathways with slow conduction ways (n=3, 6.4%), ventricular tachycardia (n=3, 6.4%) and premature ventricular contraction (n=5; 10.6%) were rare. Acute procedural success of zero-fluoroscopy ablation was in 100% with mean procedural time 71.9±14.5 minutes. Complication (ileofemoral thrombosis) was in one pregnant (2.1%). Further course of pregnancy characterized by occurring increased uterine contractile activity and placental abruption only in main group (4.54%, p=0.464 and 2.3%, p=0.414 respectively), while uterine blood flow violation and preeclampsia were in both groups (15.9% vs. 13%, p=0.234 and 4.55% vs. 3.7%, p=0.730 respectively). Obstetric outcomes characterized by prevalence of vaginal delivery and delivery in term in both groups (76.6% vs.81.5%, p=0.241 and 95.7% vs. 96.3%, p=0.743). There were live births in all cases with normal range of fetal birth weight in both groups (3207.4±485 vs 3142.2±214.1 grams and 8.4±1.6 vs. 8.6±1.3 respectively). There were no incidence of mortality and arrhythmia recurrence at follow up.

Conclusions

Zero-fluoroscopy ablation is feasible and can be safety performed during gestation with good outcomes.
The role of high density mapping in cathether ablation of paroxysmal atrial fibrillation - preliminary results
Authors: Kajdic N , Prolic Kalinsek T , Antolic B , Zizek D , Stublar J , Podlogar V , Irsic J , Jan M
Published: May 2024

Introduction

Despite technical progress and numerous approaches in ablation strategies, long-term success in paroxysmal atrial fibrillation (PAF) treatment is still suboptimal. Non-transmural ablation lesions in antral isolation lines, causing late electrical reconnection between pulmonary veins (PVs) and left atrium (LA) could present one of the potenital issues for reduced effectiveness of radiofrequency cathether ablation (RFCA). Potentially, these lesions can be identified with high-density (HD) mapping as low voltage, fragmented electrocardiograms (LFEGMs) representing gaps in antral isolation lines.

Purpose

To compare the long-term pulmonary vein isolation (PVI) durability of two PVI verification methods (circumferential vs high-density mapping catheter) after catheter ablation of PAF.

Methods

Thirty-three patients with PAF were prospectively randomized to PVI verification by either circumferential mapping catheter (CM group) or HD mapping catheter (HD group). Patients in both groups underwent PVI according to the CLOSE protocol with PVI verification after a 30 minute waiting period. Additionally, in the HD group antral ablation lines were mapped to search for LFEGMs that were defined as fragmented signals (at least 3 deflections) and/or conduction to the LA during stimulation on the ablation line (10 mA at 1 msec) and/or voltage amplitude above 0.1 mV. If LFEGMs were found, additional ablations were performed until electrical inactivity was confirmed with the HD catheter. To monitor AF reccurence 6-day continuous holter ECG was performed after 3, 6, and 12 months after the initial procedure. ﻿Arrhythmia recurrence was defined as any atrial tachyarrhythmia lasting more than 30 seconds. Patients also underwent a mandatory second procedure 12 months after the initial PVI, during which HD re-mapping was performed to test durability of PVI and absence of conducting gaps in antral isolation lines.

Results

There were 16 patients in the CM group and 17 patients in the HD group. Baseline characteristics (gender, age, body mass index, LA volume index, left ventricular ejection fraction, CHA2DS2VASc score) did not significantly differ between the groups. Procedural characteristic are summarized in Table 1. There were significantly more isolated PVs at the remapping procedure in the HD group compared to the CM group (91.2% (62/68) vs 75.0% (48/64); P=0.021). There were also significantly more patients with all PVs durably isolated in the HD group (82.4% (14/17) vs 37.5% (6/16); P=0.008). However, arrhythmia recurrence rate was similiar between the CM and HD group (43.8% (7/16) vs 35.3% (6/17); P=0.640).

Conclusion

HD mapping improved PVI durability after 12 months compared to standard CM verification. However, lower number of isolated PVs in the HD group did not have an impact on arrhythmia reccurence.
Volumetric quantification of epicardial fat using semiautomated atrial CT segmentation in patients with atrial fibrillation: the Prospective AFAT study
Authors: Erhard N , Prommersberger S , Neuner B , Bahlke F , Englert F , Popa M A , Krafft H , Abdiu E , Reents T , Lennerz C , Telishevska M , Lengauer S , Hessling G , Deisenhofer I , Bourier F
Published: May 2024

Background

Epicardial fat or epicardial adipose tissue (EAT) is most commonly defined as adipose tissue between the myocardium and the visceral pericardium. Previous studies have suggested EAT to be an important contributor to the pathogenesis of atrial fibrillation (AF) as well as a plausible predictor for AF recurrences after ablation. However, data on EAT using precise volumetric quantification is limited.

Methods and Results

AFAT is a prospective observational study conducted at a heart centre in our city with 200 patients aimed to be included. We conducted an interim analysis of the first 75 patients enrolled in the AFAT study. All patients received delayed dual source cardiac computer tomography (CT) imaging which was analysed using semi-automated 3D segmentation (Figure 2) to quantify left atrial (LA) and right atrial (RA) EAT prior to ablation (52.5 % persistent AF). The mean age was 67 ± 8.7 years with 46.9 % (n=35) being female. Mean BMI was 28 ± 4.5. The Mean LA EAT was 33.1 ml ± 13.2 ml and RA EAT was 32.7 ml ± 12.2ml.

Median follow up after AF catheter ablation was 163 days. The optimal cut point for the total atrial EAT was estimated at 50.2 ml. In patients with total atrial EAT ≤ 50 ml recurrence of any atrial arrythmia after catheter ablation occurred in 8% (6 patients) compared to 25.3% (19 patients) recurrence rates in patients with a total atrial EAT > 50 ml. Kaplan-Meyer estimates showed no statistical difference between groups (log rank p=0.063) as this analysis is under-powered with more patients being enrolled for the final results (Figure 1).

Conclusion

The use of semi-automated CT based atrial segmentation presents a novel highly accurate and reproducible method to reliably identify atrial EAT. Increased atrial EAT is likely to play an important role for arrythmia recurrences after catheter ablation. Final results of the AFAT study will provide further evidence to this important subject.Arrhythmia recurrences depending on EATBiatrial 3D Segmentation of EAT
Pulmonary vein isolation durability in patients undergoing very high-power short-duration temperature-controlled ablation
Authors: Schillaci V , Poggi S , Strisciuglio T , Iuliano A , Spiniello G , Arestia A , Salito A M , Shopova G , Marano G , Agresta A , La Rocca V , Dicandia C D , De Simone A , Solimene F , Stabile G
Published: May 2024

Background

The very high-power short-duration (90W for 4 s) temperature-controlled ablation (vHPSD) improves the efficiency of pulmonary vein (PV) isolation procedures. However, atrial fibrillation (AF) recurrences directly related to PV reconnections are still a concern.

Purpose

The purpose of the current study was to assess PV lesion durability in patients undergoing a reablation procedure.

Methods

From September 2020 to July 2023, 327 patients with paroxysmal and persistent AF underwent first ablation aiming at PVI using vHPSD. During a mean follow-up of 25±11 months, 48 patients (14.7%) had an AF recurrence. Patients with reablation procedures were retrospectively consented and enrolled.

Results

Eighteen patients were included in this study. A PV reconnection was observed in 15/72 (21%) PVs, with a mean number of reconnected PV per patient of 0.8 ±0.7. In 7 patients no PV reconnection was observed, one PV reconnected was observed in 9 patients and 2 PVs in 3 patients. A PV reconnection was observed in 8/18 (44%) left superior PV, 1/18 (6%) left inferior PV, 3/18 (17%) right superior PV, and 3/18 (17%) right inferior PV (p=0.03).

Conclusions

PV isolation performed with vHPSD is highly effective and is associated with a low rate of late PV reconnection. A higher percentage of PV reconnection was observed in the left superior PV.