bluuebunny/crossref_metadata_2025 huggingface dataset:
A - 17 Fear of Falling in Older Adults with mTBI
Authors: LM Manderino , A Kissinger-Knox , A Colorito , A Mucha , A Puskar , MW Collins , AP Kontos , N Sherry
Published: May 2021

Objective

To evaluate the use of an assessment of fear of falling (i.e., Short Fall Efficacy Scale [SFES]) in the evaluation and management of mild traumatic brain injury (mTBI) in older adults.

Methods

Fifty-two older adults (40% male) aged 60–76 (66.44 ± 4.74) years were included in the study; 27 older adults diagnosed with mTBI within three months of injury (33.07 ± 18.86 days) and 25 age-group and sex-matched controls. All participants completed the SFES, Vestibular/Ocular-Motor Screening (VOMS), Post-Concussion Symptom Scale (PCSS), Generalized Anxiety Disorder- 7 Item (GAD-7), and Geriatric Depression Scale- 5 Item (GDS5). Statistical comparisons were performed using paired t-tests and Pearson correlations.

Results

There were no significant differences on demographic factors, with the exception of participants in the mTBI group being more likely to have a history of a sleep disorder (χ2 = 10.26, p = 0.001). T-tests revealed higher concern for falling on SFES and higher total symptoms on the VOMS, GAD-7, and PCSS (p < 0.01) in mTBI versus controls. Those with mTBI who sustained a fall, compared to other mechanisms of injury, did not differ in their report of fear of falling post-injury (p = 0.74). SFES scores were moderately correlated with VOMS total score (r = 0.40, p < 0.01), PCSS total score (r = 0.64, p < 0.01), GAD-7 (r = 0.65, p < 0.01), and GDS-5 (r = 0.60, p < 0.05).

Conclusions

Older adults with mTBI endorse greater fear of falling on the SFES and more symptoms on mTBI assessment tools relative to healthy controls. Future studies should include objective measures of balance to evaluate the relationship between fear of falling and postural stability.
A - 18 Parent-Ratings of Patient Depressive Symptoms Are Predictive of Concussion Care Outcomes in a Pediatric Sample
Authors: LM Manderino , A Trbovich , H Bitzer , B Gillie , AP Kontos
Published: May 2021

Objective

The present study aims to examine how parental perception and child self-perception of depressive symptoms influence key clinical outcomes post-concussion, including symptom burden, treatment time, and treatment retention.

Methods

Participants 10–18 years (14.3 ± 2.2, 44.3% female, 3.8% history of depression) were recruited from a specialty clinic within 30 days of concussion (n = 106). The Mood and Feelings Questionnaire-Short (MFQ) Parent and Child versions and the Post-concussion Symptom Scale (PCSS) were completed at initial (Time 1) and second (Time 2) visits. Scores ≥8 indicate clinically significant depression on the MFQ, producing child-rated depression (CRD) and parent-rated depression (PRD) scores. Time in treatment was calculated as days between initial and clearance visits.

Results

Results of linear regression demonstrated higher PRD predicted longer treatment, B = 0.21, t(103) = 2.07, p < 0.05. CRD was not predictive of treatment time, B = -0.0, t(103) = −0.1, p = 0.99. Another regression using Time 2 PCSS score as the outcome demonstrated that CRD at Time 1 predicted PCSS score at Time 2, B = 0.29, t(94) = 2.85, p < 0.01, while PRD did not, B = 0.14, t(94) = 1.41, p = 0.16. Results of a logistic regression predicting return for formal clearance indicated that higher PRD predicted increased likelihood of being lost to follow-up, B = 0.21, p < 0.05, 95% CI = 1.05–1.44.

Conclusions

Patients whose parents perceived them as being more depressed were in treatment longer and were less likely to be formally cleared after concussion. However, child rated depression at initial visit was more useful in predicting concussion symptom burden at follow up. Future research should further investigate how parental perceptions may influence pediatric concussion recovery.
A - 25 Screening for Anxiety and Depression Symptoms using the Post-Concussive Symptom Scale Among Varsity Athletes
Authors: SD Roberts , C Champigny , S Feldman , DB Flora , M Wojtowicz
Published: May 2021

Objective

Symptoms of anxiety and depression are prevalent among athletes and often overlap with symptoms of a concussion. Clinical screeners of anxiety and depression are infrequently used by athletic teams despite the relationship between affective symptoms and protracted post-concussion recovery. The study objective was to examine associations between individual symptoms on the post-concussive symptom scale (PCSS) and gold standard measures of anxiety and depression.

Methods

Pre-season baseline data was collected for 296 varsity athletes from York University, Toronto. Participants were between the ages of 17 and 25 (M = 20.01 yrs, SD = 1.69 yrs; 52% male). The PCSS from the SCAT-5 was used to assess baseline symptoms. Generali.

Results

Moderate to strong correlations were noted between specific items of the PCSS and the GAD-7 and PHQ-9. Feeling anxious (r = 0.55), concentration problems (r = 0.40), irritability (r = 0.39), trouble falling asleep (r = 0.38), fatigue (r = 0.36), and mental fog (r = 0.35) were the highest correlations with the GAD-7 (ps < 0.001). Trouble falling asleep (r = 0.46), fatigue (r = 0.44), concentration problems (r = 0.41), memory problems (r = 0.37), feeling slowed down (r = 0.36), anxious (r = 0.36), and irritability (r = 0.36) were the highest correlations with the PHQ-9 (ps < 0.001).

Conclusions

These findings allow for better delineation of symptoms of the PCSS that aid in identification of athletes with symptoms of anxiety or depression, who may be at risk for endorsing persistent symptoms following a concussion.
Electrocardiographic markers of incident atrial fibrillation in patients with cryptogenic stroke
Authors: Couto Pereira S , Silverio Antonio P , Valente Silva B , Brito J , Rodrigues T , Alves Da Silva P , Veiga A , Ferro J , Pinto FJ , Fonseca C , Almeida AG
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Prolonged screening of AF in patients (pts) with cryptogenic stroke (CS) is recommended and electrocardiographic markers of atrial remodeling, like p-wave dispersion, have been described in literature. Electrocardiographic changes in pts with CS to predict AF in the follow up are not well-established.

Purpose

To identify ECG predictors of AF in a subset of pts with cryptogenic stroke.

Methods

We prospectively included consecutive pts admitted with CS. A surface 12-lead ECG was performed at admission, recorded at 25 mm/second and 10 mV/cm with commercially available imaging system. P-wave analysis of maximum (P max) and minimum (P min) duration, p-wave dispersion (PWD, defined as the difference between the P max and P min, being abnormal if > 40 msec) and amplitude were evaluated by a two independent operator. P-wave axis was determined by an automated mode available in the equipment. ROC curve was analyzed to determine the optimal cut-off values.

Results

We enrolled 105 pts (55.2% males), with mean age of 68.18 ± 8.83 years, 79% had hypertension, 18.1% had diabetes, 44.8% with dyslipidemia, 21% current smokers.

During follow up period, 18 pts (17.1%) developed AF. We found that only PWD (AUC 0.706, IC95%: 0.564-0.848, p = 0.006) and P-wave axis (AUC 0.715, IC95%: 0.870-0.860, p = 0.004) were strong predictors of AF. PWD cut-off of 47.50 presented a sensitivity of 77.8% and specificity of 59.8% and P-wave axis cut off value of 75.50 had a specificity of 95.4%. Age (p = 0.032) and current smoking (p = 0.014) were associated with occurrence of AF during the follow up.

  Conclusion: PWD and P-wave axis predicted incident AF in this subset of pts with cryptogenic stroke. The ECG may be a toll to identify pts at risk of developing AF, although larger studies are needed to confirm these results. Abstract Figure.
Reducing clinical review burden for insertable cardiac monitors
Authors: Gardner RS , Quartieri F , Betts TR , Afzal M , Manyam H , Badie N , Dawoud F , Sabet L , Davis K , Qu F , Ryu K , Ip J
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

The insertable cardiac monitor (ICM) is an essential tool for the ambulatory diagnosis of arrhythmias. However, definitive diagnoses still rely on time-consuming, manual adjudication of electrograms (EGMs) transmitted to the patient care network. This EGM review burden may be minimized by automatically selecting a subset of EGMs for fast review without delaying the diagnosis.

Purpose

Develop EGM selection strategies to reduce the EGM review burden without delaying diagnoses.

Methods

A retrospective analysis of 1,000 randomly selected Abbott Confirm Rx devices with 90+ days of remote transmission history was performed, regardless of transmission frequency, and all EGMs were adjudicated as either true or false positive (TP, FP). Up to 3 EGMs per day per arrhythmia type were prioritized for review based on ventricular rate and episode duration, with rules specific to each arrhythmia type: atrial fibrillation (AF), tachycardia, bradycardia, and pause. The resulting reduction in EGM review burden and TP days (patient-days with at least 1 TP EGM), as well as any diagnostic delay from the first transmitted TP, were calculated relative to reviewing all transmitted EGMs.

Results

In this population and transmission period, at least one AF, tachycardia, bradycardia, and pause EGM was transmitted by 424, 343, 190, and 325 unique devices, respectively, with a total of 35,723, 12,239, 19,752, and 28,002 EGMs, and a total of 6,163, 1,572, 1,438, and 646 TP days. For these patients with ≥1 EGM, the median [IQR] EGM transmission rate was 2.6 [0.7, 11.6], 1.1 [0.4, 4.7], 2.1 [0.6, 10.7], and 3.4 [0.6, 29.9] EGMs/patient/month, respectively. The optimal EGM selection strategy reduced this EGM review burden by 43%, 67%, 76%, and 50%, while only missing 3.4%, 2.2%, 0.3%, and 0.2% of TP days, respectively. Ultimately, 97%, 99%, 99%, and 99% of devices with a TP AF, tachycardia, bradycardia, or pause EGM exhibited no diagnostic delay vs. reviewing all transmitted EGMs.

Conclusion

EGM prioritization rules for selecting up to 3 episodes/day significantly reduced EGM burden across all patients, not just "frequent fliers," with no delay-to-diagnosis in >97% of patients who exhibited a true arrhythmia. Implementing these rules on the patient care network may improve clinical workflow and ICM patient management. Abstract Figure.
The role of ablation index-guided pulmonary vein isolation in high-sensitivity TrThe role of ablation index-guided pulmonary vein isolation in high-sensitivoponin I and atrial fibrillation recurrence
Authors: De Campos D , Puga L , Sousa P , Antonio N , Elvas L
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Ablation Index (AI) software has been associated with better freedom from atrial arrhythmias after pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF). There is conflicting data regarding the relationship between high sensitivity cardiac Troponin I (Hs-cTnI) and arrhythmia recurrence. The objective was to evaluate the impact of AI on Hs-cTnI level and on ablation effectiveness quotient (AEQ) and to assess if these markers are predictors of arrhythmia recurrence. 

Methods

Prospective observational study of consecutive patients referred for PVI for paroxysmal AF ablation from October 2017 to June 2018 according to a pre-specified AI protocol. Procedural endpoints and 2-year follow-up outcomes were assessed and compared to a retrospective cohort of conventional PVI contact-force-guided group . 

Results

A total of 56 patients were included: 29 patients the AI group and 27 patients in the control group. The mean age was 60.5 ± 10.3 years, 48% males. Left ventricular ejection fraction (60 ± 6 % AI vs 61 ± 5 % control, P = 0.07) and left atrium diameter (43 ± 7 mm AI vs 44 ± 6 mm control, P = 0.58) were comparable between groups. First-pass isolation was shown to be higher in the AI group (79% AI vs 44%, p= 0.01). Mean number of radiofrequency applications was lower in the AI group (93 ± 24 vs 111 ± 30, P = 0.02). Average contact-force was similar between groups (17.6 ± 4.1 g vs 22.6 ± 10.7 g, P =0.166). Patients that performed PVI guided by the AI had lower Hs-cTnI (1815 ± 1146 ng/L vs 3274 ± 1696 ng/L, p < 0.001) and lower AEQ (1.01 ± 0.7 ng/L/s vs 1.51 ± 0.7 ng/L/s, P = 0.011) compared to patients in the control group. During a mean follow-up of 26 ± 11 months, AF recurrence was documented in 10.3% of patients in the AI group and 22.2% in the control group (P = 0.223). Neither Hs-cTnI nor AEQ levels were predictors of arrhythmia recurrence. 

Conclusions

These data suggest that AI-guided catheter ablation is associated with reduced levels of of Hs-cTnI and AEQ. Neither Hs-cTnI and AEQ should be used to predict arrhythmia recurrence. Abstract Figure.
Ablation in patients with Ebstein Anomaly and Wolff Parkinson White Syndrome
Authors: Cueva-Parra A , Bustillos-Garcia G , Fernandez-Domenech JA , Gomez-Flores J , Marquez MF , Levinstein M , Iturralde-Torres P , Nava S
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background - Introduction: Ablation in patients with Ebstein Anomaly (EA) and Wolff Parkinson White syndrome (WPW) is challenging due to the complex anatomy and the presence of multiple accessory pathways (AP).

Objectives

Report the results of our recent experience of ablation in patients with EA and WPW syndrome.

Methods

We conducted a retrospective review of the cases of EA and WPW syndrome, which were taken to ablation in our center between 2015 and 2020.

Results

We found that in the indicated period 30 electrophysiological studies and ablations had been performed in 26 patients, 53.8% were males and the mean age at the time of the study was 20.6 ± 9.1 years, the mean tricuspid septal valve attachment was 44.5 ± 17.7%.

Regarding the procedures, 15 were conventional studies (50%) and 15 (50%) were performed with electroanatomical mapping. We used intracardiac echocardiogram (ICE) in 10 cases (33.3%). The acute success rate was 85.7% and in the follow-up 3 patients (10%) presented recurrence. Only one patient presented a major complication, which was a complete AV block. There was a tendency to improve the acute success with the use of electroanatomical mapping in comparation with conventional studies (93.3% vs 66.6%, p = 0.068), and with the use of ICE acute success was significantly improved (100% vs 70%, p = 0.04).

Seven patients presented multiple accessory pathways (26.9%). The most frequent location was the right posterolateral with 61.53%, followed by the right posteroseptal with 26.9% and the right lateral with 19.2%.

Conclusions

The ablation in patients with EA and WPW syndrome constitutes a challenge, we found that the use of electroanatomical mapping and the use of ICE could improve the acute success rate. New studies are needed to demonstrate the usefulness of these techniques to improve the acute success rate and to reduce the recurrence rate. ProceduresProcedures (N = 30)N%Conventional procedures1550.0Electroanatomical mapping1550.0Intracardiac echocardiogram1033.3Acute success2485.7Recurrence310.0Major complication13.3Descriptive table of our experience in ablation of patients with ED and WPW syndrome.Abstract Figure. Location of the accessory pathways
First insight into a novel irrigated radiofrequency ablation balloon
Authors: Bordignon S , Tohoku S , Chen S , Bologna F , Throm C , Urbanek L , Hilbert M , Chun KRJ , Schmidt B
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

A novel irrigated RF balloon (RFB) for pulmonary vein isolation (PVI) was recently released in selected centers . It is a 28 mm open irrigated balloon with 10 unipolar electrodes on its surface to deploy a circular ostial lesion set around the PVs. An inner lumen spiral catheter allows for real time PVI visualization during the ablation.

Methods

Data from consecutive RFB procedures were collected and analysed. After a single transseptal puncture and selective PV angiograms a 3D map of the left atrium was acquired. Sequential PVI was performed using the RFB: each application lasted 60 seconds, the posterior electrodes were identified to stop the energy delivery after 20 seconds. Real time to isolation data were acquired. A 3D bipolar remap was finally performed to observe the level of isolation. A temperature probe was used to monitor the local esophageal temperature (LET) with a cut off of 39°C. Acute procedural data and complication were collected. Endoscopy was scheduled the day after procedure.

Results

Data from 10 consecutive RFB procedures were analyzed: 6/10  patients were male, 67 ± 9 years old, 8/10 with history of paroxysmal AF. A total of 36 PVs were targeted and isolated with the RFB, with a mean of 7,3 ± 4,0 applications per patient and 2,0 ± 1,2 applications per PV. First pass "single shot"  isolation was achieved in 22/36 (61%), time to isolation during the first application was observed in 29/36 (80%) PVs, but an acute reconnection was observed in  10/29 (35%) isolated PVs. Mean time to sustained isolation was 13 ± 5 sec., mean time to non-sustained isolation was significantly longer (29 ± 17 sec; p = 0,001). Procedure time was 57 ± 16 min., left atrial dwell time 50 ± 14 min, ablation phase time 29 ± 14 min and fluoroscopy time was 10 ± 4 minutes. An esophageal temperature above 39°C was recorded in 2/36 PVs. No phrenic nerve palsy was recorded. 7/10 patients underwent endoscopy and no thermal lesions were detected. No other complications were recorded.

Conclusion

The novel irrigated RFB seems to allow an effective, safe and fast pulmonary vein isolation. More studies are needed to optimize energy dosing to possibly increase the rate of durable single shot PVI.
The reduction of body mass index and risk of incidence of cardiovascular events in the elderly population
Authors: Park JW , Yang PS , Yu HT , Kim TH , Jang ES , Pak HN , Lee MH , Joung BY
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Obesity is known to be risk factor for incidence of cardiovascular (CV) events. However, the association between the reduction of body mass index (BMI) and incidence of cardiovascular event is not well established in elderly Asian population.

Methods

From the National Health Insurance Service-Senior (≥60 years) cohort from 2002 to 2013, 13,038 participants over 75 years old without baseline comorbidities (mean age: 78.4 ± 3.2 years 5243 (40.2%) male) were included in this study. We measured the change of BMI from first to second visit for health check-up within mean 23.6 ± 5.8months of follow-up. We categorized the reduction of BMI as five group according to the amount of change in BMI in overall patients (group 1: BMI change <-10%, group 2: -10%≤BMI change<-3%, group 3: -3% ≤ BMI change < 3%, group 4: 3% ≤BMI change < 10%, group 5: 10% ≤BMI change). We investigated the influence of change in BMI on the incidence of new-onset AF, stroke, acute myocardial infarction (MI), and CV mortality

Results

In the overall patients, new-onset AF, stroke, acute MI, and CV death was occurred in the 494 patients (3.5%), 775 patients (5.9%), 16 patients (0.1%), and 458 patients (3.5%) respectively. The Kaplan-Meier curve showed significant cumulative incidence rate of CV death in group 1 (Log rank p < 0.001). The multivariate cox regression after adjusting for compound clinical covariates showed the risk of stroke (HR 1.43, 95% CI [1.09-1.89], p = 0.01) and CV death (HR 2.06, 95% CI [1.49-2.84] were significant higher in the group 1 as compared with group 3. In the high BMI (≥25) group, the risk of AF was significant higher in the group 5 as compared with group 3 (HR 2.38, 95% CI [1.02-5.54], p = 0.04). In contrast, the risk of stroke (HR 1.70, 95% CI [1.07-2.71], p = 0.02) and CV death (HR 3.27, 95% CI [1.66-6.41], p < 0.001) was significant higher in the group 1 than in group 3.

Conclusions

In the elderly Asian population over 75 years old, the reduction of body weight affected worse effect on the incidence of stroke and CV death in overall patient and high BMI (≥25) group. It needs careful consideration to reduce BMI in the elderly Asian population even with high BMI (≥25) for purpose of CV events.
Early rhythm-control ablation therapy in preventing AF recurrences: insight from the CHARISMA Registry
Authors: Segreti L , De Simone A , Schillaci V , Pandozi C , Bongiorni MG , Stabile G , Arestia A , Giannotti Santoro M , Pelargonio G , Scaglione M , Rossi P , Pecora D , Stocco C , Malacrida M , Solimene F
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

An early and comprehensive rhythm-control therapy emerges as a need to treat AF in an effective way and to improve the ablation outcomes, in terms of arrhythmia-free survival.

Purpose

We aimed to investigate the importance of timing of ablation in preventing AF recurrences.

Methods

153 consecutive patients (pts) undergoing AF ablation from the CHARISMA registry at 8 Italian centres were included. Ablations were guided by a novel radiofrequency ablation catheter with local impedance (LI)-sensing capability through a dedicated algorithm (DirectSense, Boston Scientific). Pts were grouped as early treated (ET) if the procedure was performed within 1 year after the first AF episode and as delayed treated (DT) if admitted for ablation after more than 1 year. The ablation endpoint was PVI as assessed by entrance and exit block. Post-ablation follow-up was scheduled at 3, 6 and 12 months. AF and atrial tachycardia (AT) recurrences were considered as long-term endpoint.

Results

Of the 153 pts enrolled (69.9% male, 59 ± 10 years, 61.4% paroxysmal AF, 38.6% persistent AF), 123 (80.4%) met Class I indications, 23 (15%) Class IIa indications and 7 (4.6%) Class IIb indications according to current ESC AF guidelines. The mean time to ablation procedure from the first AF episode was 1034 ± 1483 days. Eighty pts (52.3%) were included in ET group, whereas 73 pts (47.7%) in DT group. No differences were found between AF type in terms of ablation strategy (53.3% of the cases -52 out 94- were classified as ET for paroxysmal AF vs 47.5% of the cases -28 out 59- were ET for persistent AF, p = 0.4346). At the end of the procedures, all PVs had been successfully isolated in all study pts. During a mean follow-up of 366 ± 130 days, 18 pts (11.8%) suffered an AF/AT recurrence after the 90-day blanking period. Recurrences occurred mostly in the DT group compared to the ET one (13 out 73 -17.8%- vs 5 out 80 -6.3%-, p = 0.042) and the time to AT/AF recurrence was longer in the ET group (HR = 0.2876, 95%CI: 0.1029 to 0.8038; p = 0.0181). On multivariate logistic analysis adjusted for baseline confounders, only hypertension (HR = 4.66, 95%CI: 1.5 to 14.48, p = 0.0081) was independently associated with recurrences. An early rhythm-control therapy was associated with a low risk of recurrences beyond the hypertension risk factor, ranging from 2% (no hypertension and an ET ablation therapy) to 30.3% (with hypertension and a DT procedure) (Figure 1).

Conclusion

A LI-guided ablation strategy for PVI proved to be safe and effective and resulted in a very high recurrence-free rate. An early rhythm-control therapy in the absence of common risk factors was associated with the lowest rate of recurrences. Abstract Figure. AT/AF Recurrence
Novel cryoballoon ablation system for single shot pulmonary vein isolation: The prospective ICE-AGE-X Study
Authors: Tilz RRT , Meyer-Saraei RMS , Vogler JV , Fink TF , Sciacca VS , Kirstein BK , Delgado Lopez LDL , Phan HLP , Traub AT , Keelani AK , Kuck KHK , Eitel CE , Heeger CH
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

The arctic front cryoballon (AF-CB) provides effective and durable pulmonary vein isolation (PVI) associated with encouraging clinical outcome data. The POLARx cryoballoon incorporates unique features which may translate into improved efficacy and safety.

Purpose

To assess efficacy and safety of the novel POLARx cryoballoon in comparison to the fourth generation arctic front cryoballon (AF-CB4).

Methods

Twenty-five consecutive patients with paroxysmal or persistent atrial fibrillation (AF) were prospectively enrolled, underwent POLARx based PVI (POLARx group) and were compared to 25 consecutive patients treated with the fourth generation AF-CB (AF-CB4 group).

Results

A total of 100 (POLARx) and 97 (AF-CB4) pulmonary veins (PV) were identified and all PVs were successfully isolated utilizing the POLARx and AF-CB4, respectively. A significant difference regarding the mean minimal cryoballoon temperatures reached using the AF-CB4 and POLARx (-50 ± 6°C vs. -57 ± 7°C, p = 0.004) was observed. Real-time PVI was visualized in 81% of POLARx patients and 42% of AF-CB4 patients (p < 0.001). Despite a certain learning curve utilizing the POLARx a trend towards shorter median procedure time (POLARx: 45 (39, 53) minutes vs. AF-CB4: 55 (50, 60) minutes (p = 0.062) was found. No differences were observed for periprocedural complications.

Conclusions

The novel POLARx showed similar safety and efficacy compared to the AF-CB4. A higher rate of real-time electrical PV recordings and significantly lower balloon temperatures were observed using the POLARx as compared to AF-CB4.
Impact of pulmonary veins anatomy on outcome of cryoablation or radiofrequency catheter ablation for atrial fibrillation
Authors: Silva G , Queiros P , Silva M , Teixeira R , Almeida J , Fonseca P , Oliveira M , Goncalves H , Primo J , Fontes-Carvalho R
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

Pulmonary vein isolation is the cornerstone of interventional treatment of atrial fibrillation (AF). Pulmonary veins frequently display anatomic variants. If this influences the recurrence of AF after catheter ablation is still a matter of debate.

PURPOSE

Our aim was to determine if pulmonary vein anatomy variants influences the recurrence of AF after catheter ablation with radiofrequency or cryoablation.

METHODS

Retrospective analysis of patients with paroxysmal or persistent atrial fibrillation who underwent pulmonary vein isolation by radiofrequency (RF) or cryoablation (CA) in a single center between January 2017 and September 2019. All patients underwent computed tomography before AF ablation. Within each treatment group (RF or CA), patients were stratified according to their PV anatomy in: regular (2 left PVs and 2 right PVs) or variant (left common trunk, right common trunk, bilateral common trunk, right intermediate branch or other). The primary end-point was 1-year recurrence of AF. Recurrence was defined as electrical documented AF.

RESULTS

A total of 425 patients (RF = 300 and CA = 125), aged 56.6 ± 11.7 years, 277 men (65.0%) were enrolled. The majority of patients had paroxysmal AF (n = 343, 81.5%). Mean CHA2DS2-VASc score was 1.12 ± 1.28. Regular PV anatomy was identified in 357 patients (84.0%), a left common trunk in 53 patients (12.5%), a bilateral common trunk in 5 patients (1.2%), a right intermediate branch in 3 patients (0.7%) and other mixed variants in 7 patients (1.6%). There were no significant differences in the baseline clinical and echocardiographic characteristics between groups.

At 1-year follow-up, patients with atypical PV anatomy had more AF recurrence (regular 8.1% vs variant 16.2%; p = 0.037). Analyzing according to the ablation technique there was no difference in AF recurrence between PV anatomy groups in patients submitted to radiofrequency (regular 8.3% vs variant 13.0%; p = 0.224). On the other hand, in cryoablation group, patients with PV anatomic variant had significantly higher rates of 1-year AF recurrence (regular 7.8% vs variant 22.8%; p= 0.033).

CONCLUSION

The presence of atypical PVs anatomy seems to be associated with higher rates of AF recurrence at 1-year in patients undergoing cryoablation. Further prospective studies are needed to confirm the PV anatomy impact in the success of the procedure and if this needs to be accounted in the choice of ablation technique. Abstract Figure. Recurrence in AF after cryoablation
Do patients with syncope have a hyper-reactive autonomic nervous system?
Authors: Perez-Denia L , Claffey P , O"reilly A , Delgado-Ortet M , Rice C , Kenny RA , Finucane C
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Irish Research Council (IRC): Government of Ireland Postgraduate Scholarship Programme 2018, Dublin, Ireland Fundació Universitària Agustí Pedro i Pons, Universitat de Barcelona, Barcelona, Spain.

Background

The origin of syncope, a transient loss of consciousness due to cerebral hypoperfusion, remains unclear. Recent studies suggest that a hypersensitive autonomic nervous system might be involved in the pathophysiology of vasovagal syncope (VVS).

Purpose

Here we test the hypothesis that patients with VVS have a hyper-reactive autonomic nervous system by investigating the peripheral haemodynamic responses during a standing (AS) test in a group of young VVS patients vs a control group.

Methods

A prospective sample of consecutive patients from a National Falls and Syncope Unit was recruited, and a convenience sample of young healthy community dwelling adults was recruited from a local university (16-30 years). Participants performed a 3 minute AS with continuous measurement of beat-to-beat blood pressure (BP), heart rate (HR), and cerebral oxygenation measured with near infrared spectroscopy. Baseline, steady-state and other time domain features were obtained for systolic BP (SBP) (i.e. nadir, overshoot, overshoot-to-nadir, overshoot-to-nadir recovery rate) and for HR (i.e. peak, trough, peak-to-trough, peak-to-trough recovery rate). Multiple linear regression was used to compare these features between patients and controls while correcting for covariates (p < 0.05 significant).

Results

Forty patients and 17 controls were included, the former group being younger ((20(5.5) vs 23(1) years, p = 0.003). During steady-state standing SBP was higher as compared to controls (β: 6.853, CI: (0.713 12.993), p = 0.029). Patient data trended toward lower steady-state HR (β: -5.262, CI:(-11.201 0.677), p = 0.081), together with a larger peak-to-trough difference (β: 7.212, CI:(1.329 -15.754), p = 0.096).

Conclusion

These results tend to support the hypothesis and previous literature suggesting the presence of autonomic hyper-reactivity in patients with syncope, presenting as an exaggerated peripheral circulatory response to standing. Understanding the pathophysiology of VVS can help us improve its assessment and develop better treatment pathways for these patients. Abstract Figure.
Steroid use for recovery of advanced atrioventricular block immediately after valvular surgery (survival): a randomized clinical trial
Authors: Masoudkabir F , Ghodsi S , Hosseini Z , Davarpasand T , Haj Hossein Talasaz A , Jalali A , Bagheri J
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Limited inconsistent evidence support use of steroids in recovery of atrioventricular block (AVB) after trans-catheter aortic valve implantation. However, there is no study to examine the efficacy of steroids in recovery of high-grade AVB following valvular surgery.

Purpose

 To assess the effect of high-dose dexamethasone on recovery of advanced AVB following valvular heart surgery.

Methods

In this randomized controlled trial, patients with advanced postoperative AVB (either Mobitz type II or third degree) were randomly assigned to receive either dexamethasone (0.4 mg /kg, maximum 30 mg /day in three divided doses) intravenously for three days or conservative care only. Primary endpoint was recovery rate in day five since randomization. Secondary endpoints were recovery rate in day 7 and day 10, cumulative AVB time, PPM implantation rate, length of stay in critical care units, and post-operative major adverse events (MAE) during one month. We defined MAE as composite of all-cause mortality, all-type infections, major bleeding, prolonged sternal dehiscence, new stroke, postoperative MI, complicated uncontrolled hyperglycemia and readmission for decompensated heart failure.

Results

We enrolled 139 subjects (48.9% male) with mean age of 59.9 years who were randomly allocated to intervention group (n= 69) and control group (n= 70). Dexamethasone led to higher recovery rates at day 5 (82.6% vs. 62.9%, P= 0.009) and day 7 (88.4% vs. 61.4%, P< 0.0001) respectively. Random 24-hours ECG Holter monitoring of patients at day 5 revealed the same results and confirmed the superiority of dexamethasone for recovery of AVB (80.5% vs 61.2%, respectively, P = 0.024). Although this benefit ceased at day 10 (83.05 vs 78.6 %, P = 0.547), Generalized Estimating Equation analysis for recovery over 10 days favored intervention (odds ratio: 2.56, 95% CI: 1.27- 5.15, P = 0.008). Median cumulative AVB time was shorter in dexamethasone group compared to control group (41 hours vs 64 hours, P = 0.044). PPM implantation rates were similar between the dexamethasone and control groups (15.9% vs 17.1 %, respectively, P = 0.849). Median length of stay in ICU (10 days vs 12 days, P= 0.03) and MAE (17.4 % vs 25.7%, P = 0.133) tended to be lower with dexamethasone.

Conclusion

Our findings suggest that dexamethasone may serve as a safe and effective medication to improve recovery of advanced AVB after valvular surgery. Further studies are needed to confirm these findings, particularly regarding subsequent PPM implantation rate.
Effect of general and local anesthesia on the vagal response characteristics during ganglionated plexus ablation
Authors: Aksu T , Yalin K , John L , Osorio J , Winterfield J , Aras D , Gopinathannair R
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

The effect of different anesthetics on the function of the autonomic nervous system (ANS) is not well known. As a relatively new treatment option, ganglionated plexus (GP) ablation aims to modify the behavior of the cardiac ANS to prevent some/all of the autonomic processes occurring in vasovagal syncope (VVS) by using endocardial ablation techniques.

Purpose

The purpose of this study was to determine the effects midazolam and propofol on the vagal response (VR) characteristics during GP ablation in patients with vasovagal syncope (VVS).

Methods

Forty consecutive patients undergoing GP ablation for VVS were divided to receive local anesthesia with midazolam (group 1, n = 29) or general anesthesia with propofol (group EA, n = 11). All GP sites were detected by using previously defined fragmented electrogram based strategy. VR was defined on 3 levels: 1) R-R interval increased by 50% (level 1); 2) R-R interval increased by 20-50% (level 2); and 3) R-R interval increase lower than 20% (level 3).

Results

Baseline characteristics and mean follow-up times were comparable between groups. In both groups, the left superior GP (LSGP) was the most common GP site at which a VR was observed. However, there was a significant difference between groups for level of VR. While ablation on the LSGP caused a level 1 VR in 89.6% of cases in group 1, level 1 VR was seen in 22.2% of cases in group 2 (p < 0.0001). Similarly, ratio of level 1 VR during ablation on the left inferior GP (LIGP) was significantly lower in group 2 (44.8% vs 9%, p = 0.034). Once cut-off for VR was decreased to level 2, the ratio of (+) VR increased to 90.9% during ablation on the LSGP in group 2. Level 2 VR was detected in 45.4% of cases during ablation on the LIGP. Ratio of positive VRs in any level was lower than 20% during ablation on the right superior and inferior GPs in both groups. During a mean follow-up time of 12.1 ± 7 months, all but 2 (5%) of 40 patients were free of syncope.

Conclusions

The autonomic nervous tone might be affected in different ways by local and general anesthesia. Propofol may reveal a shift in the sympathovagal balance toward sympathetic predominance which may cause a blunting on VR during GP ablation. Further randomized, controlled and multicenter studies should be performed to confirm these findings.
Analysis of corrected QT dispersion, tp-e values in small heart syndrome patients
Authors: Ibisoglu E
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background and objectives

We aimed to evaluate the marker of ventricular arrhythmias such as Tp-e/QT, Tp-e/QTc, Tp-e/JT and Tp-e/JTc ratios in ‘Small Heart Syndrome’ female patients and also aimed to evaluate the association between ‘small heart syndrome’ and fibromyalgia in female patients.

Methods

A total of 94 female, including 47 small-heart and 47 normal-heart patients, who applied from March 2018 to February 2020 and who were examined by a physical therapy and rehabilitation specialist, were included in the study by calculating their cardiothoracic ratios (CTR) from the chest x-ray. QTmax, QTmin,QRS, JT and Tp-e intervals were measured. In addition, Tp-e/QTmax, Tp-e/QTc max, Tp-e/JT and Tp-e/JTc rates and QTc max, QTc min, cQTd and JTc intervals were calculated.

Results

cQTd (24,246 ± 9,046 ms vs. 35,495 ± 14,358 ms, p < 0.001), Tp-e (67,32 ± 11,661 ms vs. 72,67 ± 11,028 ms, p = 0.04), Tp-e/QTc max (0,166 ± 0.028 vs. 0.181 ± 0.027, p = 0,012), Tp-e/JTc (0,214 ± 0.038 vs. 0.232 ± 0.034, p = 0,022) values were significantly higher in small heart patient group. QT min (330,68 ± 26,611 ms vs. 323,04 ± 30,829 ms, p = 0,202) values were significantly lower in patient group.

Conclusion

Compared to control group potential ECG repolarization predictors were signiﬁcantly increased in ‘Small Heart Syndrome’ patients. TableElectrocardiographic findings o Control group(n = 47) Patient group(n = 47) P value Heart rate, bpm 87,81 + 15,532 83,81 + 14,372 0,223 QRS; ms 83,23 + 6,948 81,91 + 10,052 0,206 QT max; ms 354,93 + 26,796 358,54 + 28,434 0,528 QT min; ms 330,68 + 26,611 323,04 + 30,829 0,202 JT; ms 265,7 + 25,16 271,88 + 23,104 0,218 QTc max; ms 403,59 + 18,208 400,20 + 18,336 0,371 QTc min; ms 379,34 + 20,064 364,71 + 23,149 0,004* JTc; ms 314,37 + 21,325 313,55 + 22,526 0,856 cQTd; ms 24,246 + 9,046 35,495 + 14,358 <0,001* Tp-e; ms 67,32 + 11,661 72,67 + 11,028 0,040* Tp-e/QT max 0,190 + 0,034 0,203 + 0,031 0,063 Tp-e/QTc max 0,166 + 0,028 0,181 + 0,027 0,012* Tp-e/JT 0,255 + 0,047 0,267 + 0,036 0,295 Tp-e/JTc 0,214 + 0,038 0,232 + 0,034 0,022*
Direct capture of the left bundle branch compared to left bundle branch area pacing deteriorates interventricular synchrony but improves left ventricular lateral wall depolarization duration
Authors: Curila K , Jurak P , Waldauf P , Halamek J , Karch J , Plesinger F , Susankova M , Znojilova L , Viscor I , Vondra V , Smisek R , Leinveber P , Osmancik P
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): This paper was supported by the Charles University Research Centre program No. UNCE/MED/002 and 260530/SVV/2020

Background

Direct and indirect pacing of the left bundle branch are novel pacing techniques preserving LV synchrony. Aim of the study was to compare differences in ventricular activation between them using an UHF-ECG.

Methods

The left septal lead placement was done in 68 patients with bradycardia. Four distinct ventricular captures were described; nonselective LBBp (nsLBBp), selective LBBp (sLBBp), paraLBBp and left bundle branch area capture (LBBap). The timings of local ventricular activations and local depolarization durations were displayed by the UHF-ECG. e-DYS was calculated as a difference between the first and last activation.

Results

There were 35 nsLBBp, 21 paraLBBp, 12 sLBBp and 96 LBBap obtained in 68 patients.  The nsLBBp compared to LBBap caused worse interventricular synchrony (e-DYS -23 ms (-28;-18) vs -12 ms (-17;-8), p < 0.001), but improved LV lateral wall depolarization duration. The sLBBp, nsLBBp and paraLBBp differed in e-DYS; -31 ms (-38;-24) vs -23 ms (-28;-17) vs -13 ms (-20;-7), p < 0.01 between each of them. Their left ventricular depolarization durations were the same, but they were longer when pacing resulted in the left axis deviation. If the direct capture of the LBB was not confirmed (LBBap), LV depolarization duration was deteriorated irrespective of the QSR morphology in the V1 or RWPT in the V5. Examples of UHF-ECG maps during LBBap, paraLBBp and nsLBBp are shown in Figure 1.

Conclusions

The direct capture of the left bundle branch deteriorates interventriclar synchrony but improves the depolarization duration of the left ventricular lateral wall compared to left ventricular myocardial septal pacing. Abstract Figure 1
Predictors of all-cause mortality among patients with implantable cardiac defibrillators for nonischemic heart failure with reduced ejection fraction
Authors: Cinier G , Hayiroglu MI , Yumurtas AC , Kolak Z , Cetin T , Tezen O , Eren S , Pay L , Turkkan C , Ozcan KS , Ozbilgin N , Tekkesin AI , Alper AT , Gurkan K
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Implantable cardiac defibrillators (ICD’s) are recommended in patients with heart failure with reduced ejection fraction (HFrEF) of nonischemic etiology. Determining patients who are at high risk despite ICD implantation is of clinical value.

Methods

Between 2009-2019 patients who were implanted ICD due to nonischemic HFrEF were included to the present analysis. Baseline characteristics, laboratory parameters and echocardiographic findings were obtained from the electronic database. The primary outcome was all-cause mortality. Appropriate and inappropriate device therapies were also extracted from the database and was confirmed with patients’ reports. Predictors for long term all-cause mortality was determined by using Cox regression analysis.

Results

Overall, 1199 patients were screened and 238 were eligible for the analysis. ICD’s were implanted for primary and secondary prevention in 68 (28.6%) and 170 (71.4%) of patients respectively. Multivariate analysis revealed that increased pro-BNP [Hazard ratio (HR): 1.001, 95% Confidence interval (CI): 1.000 – 1.001, p = 0.024] and reduced left ventricle ejection fraction (HR: 0.950, 95% CI: 0.907 – 0.994, p: 0.026) predicted all-cause mortality during long term follow up. Pro-BNP > 425 pg/ml has sensitivity and specificity of 74% for each in predicting all-cause mortality.

Conclusion

Among patients who were implanted ICD for HFrEF of nonischemic etiology, higher pro-BNP prior to the implantation and lower LVEF predicted all-cause mortality during long term follow up. Table 1Univariate analysisP valueHR (95% CI)Multivariate analysisP valueHR (95% CI)Diabetes mellitus0.0062.587 (1.315 - 5.090)Diabetes mellitus0.1441.837 (0.812 - 4.153)Atrial fibrillation0.0023.080 (1.531 - 6.195)Atrial fibrillation0.1811.738 (0.774 - 3.903)NYHA > 20.0172.394 (1.168 - 4.908)NYHA > 20.2531.642 (0.701 - 3.847)RDW0.0441.191 (1.005 - 1.412)RDW0.6461.046 (0.862 - 1.270)Lymphocytes0.0220.616 (0.408- 0.932)Lymphocytes0.1650.683 (0.399 - 1.170)Blood urea nitrogen0.0381.015 (1.001- 1.030)Blood urea nitrogen0.1521.015 (0.995 - 1.036)Pro-BNP<0.0011.001 (1.000 - 1.001)Pro-BNP0.0241.001 (1.000 - 1.001)Albumin<0.0010.252 (0.143 - 0.444)Albumin0.0790.525 (0.256 - 1.079)Ejection fraction<0.0010.921 (0.885 - 0.959)Ejection fraction0.0260.950 (0.907 - 0.994)LVEDD0.0011.408 (1.017 - 1.079)LVEDD0.1521.078 (0.973 - 1.194)LVESD0.0041.038 (1.012 - 1.065)LVESD0.2890.957 (0.883 - 1.038)Appropriate shock in follow-up0.0102.407 (1.237 - 4.684)Appropriate shock in follow-up0.1561.768 (0.805 - 3.883)Univariate and multivariate Cox regression analyses for long-term mortality after ICD implantation Abstract Figure 1
Echocardiographic but not clinical response to CRT is an independent predictor of a better survival free from arrhythmic events
Authors: Valbom Mesquita D , Parreira L , Esteves A , Farinha J , Marinheiro R , Amador P , Fonseca M , Lopes C , Chambel D , Goncalves A , Caria R
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac resynchronization therapy (CRT) is of proven benefit in heart failure patients, improving mortality and reducing hospital admissions. There is however uncertainty if the arrhythmic risk is reduced in responders.

Purpose

We aimed to assess if patients with a CRT implanted for primary prevention had less arrhythmic episodes if they responded to this therapy and if echocardiographic and clinical responses to CRT differ regarding the occurrence of ventricular arrhythmias.

Methods

We prospectively enrolled patients that underwent CRT implant for primary prevention according to ESC guidelines. Patients were classified as responders if they fulfilled one of four criteria (echocardiographic or clinical) at six months after implant: a 5% absolute improvement in LV ejection fraction (LVEF), a 15% improvement in LVEF, a 15% decrease in LV end-diastolic volume or a decrease in NYHA class. During follow-up with device interrogation, arrhythmic ventricular events (AVE) were classified as appropriate ICD therapies or sustained ventricular tachycardia either occurring in ICD monitoring zones or undetected by the device due to a slower rare, but clinically documented. All patients were further classified according to type of pacing, biventricular or LV only. Demographic characteristics of patients were also assessed.

Results

We enrolled 73 patients, 58 (79.5%) male, median age of 72 (65-77) years. Median LVEF was 28 (22-35) % (p = 0.95 between groups), ischemic etiology in 36 (46.6%, p = 1.00). The two groups with and without AVE did not differ significantly regarding clinical, echocardiographic, and electrocardiographic characteristics (table). CRT echocardiographic response criteria were met by 50 (68.5%) of patients and clinical criteria by 53 (72.6%) patients. AVE occurred in 15 (20.5%) patients. In univariate regression analysis, echocardiographic response was associated with reduced AVE (OR 0,14; p = 0,005). Clinical response to CRT was not associated with AVE (p = 0.07). LV only pacing was associated with a higher probability of AVE (OR 5.1; p = 0.038). In Cox regression multivariate analysis, response to CRT was the only independent predictor of better survival free from AVE (HR 0.28;CI 95%, p = 0.044) and LV only pacing was not associated with more episodes of ventricular arrhythmias (p = 0.17). Conclusions: Echocardiographic, but not clinical response to CRT therapy, is the only independent predictor of a higher survival free from arrhythmic events. In spite controversies regarding the arrhythmogenic role of LV pacing, this was not associated with higher ventricular arrhythmic events. Abstract Figure.