bluuebunny/crossref_metadata_2025 huggingface dataset:
Multimodality imaging predictors of appropriate ICD shock and mortality in adults with cardiac sarcoidosis
Authors: Hutt E , Vega Brizneda M , Aguilera J , Wang T K M , Taimeh Z , Culver D , Callahan T , Tang W , Jaber W A , Cremer P , Ribeiro M , Jellis C
Published: October 2022

Background

Identifying patients with cardiac sarcoidosis (CS) who are at increased risk of sudden cardiac death (SCD) is imperative. Current guideline recommendations for implantable cardioverter-defibrillator (ICD) implantation in patients with CS are based on small observational studies and have not been validated in contemporary cohorts using multimodality cardiac imaging.

Purpose

The aim of this study was to characterize a cohort of patients with tissue-proven cardiac sarcoidosis who underwent multimodality cardiac imaging and identify predictors of appropriate ICD shock and mortality.

Methods

We retrospectively identified subjects with a diagnosis of CS established by clinical/imaging criteria, and tissue biopsy (N=273) seen at our tertiary care center between 2001 and 2021. Clinical characteristics and outcomes were collected from electronic medical records. The primary endpoint of interest was a composite of appropriate ICD shock and all-cause mortality. Secondary endpoints were individual rates of appropriate ICD shock and all-cause mortality. Cox proportional hazard regression analysis was used to identify independent predictors of the outcomes.

Results

Mean age was 59±11 years and 40% were female. Isolated CS was found in 49 subjects (17.9%). The prevalence of traditional cardiovascular risk factors was low. Atrial fibrillation prevalence was high (41%). After a median follow-up of 7.9 years, the rate of appropriate ICD shock and all-cause mortality was 29% (N=79). The 5-year overall survival rate of 97.5%. Age, left ventricular ejection fraction (LVEF), and delayed gadolinium enhancement (DGE) in cardiac magnetic resonance (CMR) were independent predictors of the primary composite endpoint; LVEF and DGE in CMR were independent predictors of appropriate ICD-shock; and LVEF and baseline serum NT proBNP were independent predictors of overall mortality. An LVEF of 47% was identified as the optimal cutoff in predicting the primary composite endpoint. Presence of scar, inflammation or mismatch pattern in positron emission tomography were not significant predictors of the outcomes.

Conclusion

In this large cohort of subjects with CS, we found that the presence of DGE in CMR was the strongest independent predictor of the composite endpoint of appropriate ICD-shock and mortality and of appropriate ICD-shock individually; LVEF by echocardiogram was an independent predictor of the primary and secondary endpoints with an optimal LVEF cutoff for predicting the composite endpoint of 47%.

Funding Acknowledgement

Type of funding sources: None.
Macrovascular and microvacular changes in diabetes mellitus type 1 are modified by the gene for connexin 37 in men but not in women
Authors: Pitha J , Pithova P , Dlouha D , Hubacek J A
Published: October 2022

Introduction

Diabetes mellitus type 1 (DMT1) is a strong risk factor for macrovascular and microvascular disease. These vascular pathologies can be strongly modified by genetic factors. One of intensively investigated candidate genes is the gene for connexin37 (Cx37) (C1019>T (Pro319>Ser). The role of this gene in cardiovascular disease and diabetes mellitus had been already described in several different populations, but not in patients with DMT1.

Purpose

To determine whether the presence of macrovascular and microvascular changes is modified by Cx37 gene polymorphism in middle aged men and women diagnosed with DMT1 of similar age and with similar duration of DMT1.

Methods

In 253 men (mean age 43.0±14.5 years; mean duration of diabetes 22.6±14.0 years) and 245 women (mean age 43.9±12.9 years; mean duration of diabetes 21.3±10.5 years) macrovascular disease was measured by duplex B-Mode ultrasound and classified as Belcaro score (1–4) in carotid and femoral arteries. Microvascular disease was assessed by the presence of retinopathy, nephropathy, neuropathy and diabetic foot. Cx37 gene polymorphism was established by PCR.

Results

In men, in CC homozygotes we observed more advanced macrovascular changes in carotid arteries (Belcaro score more than 2) than in CT heterozygotes/TT homozygotes (7.5 vs. 15.2%; p=0.031). No significant differences were found in changes of carotid arteries in women and in changes of femoral arteries both in men and women. Regarding microvascular changes, in men, in CC homozygotes, the diabetic foot was diagnosed more frequently than in CT heterozygotes/TT homozygotes (7.4 vs. 16.1%; p=0.046). No significant differences were found in women and in other types of microvascular disease both in men and women.

Conclusion

These results indicate that macrovascular and microvascular changes in DMT1 can be modified by Cx37 gene polymorphism in men, but not in women.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Ministry of Health of the Czech Republic, grant No. NU20-01-00083 and by Ministry of Health of the Czech Republic under its conceptual development of the research organization program (Institute for Clinical and Experimental Medicine–IKEM, IN 00023001. All rights reserved.
Immune status comparison in patients with atrial fibrillation or flutter on the base of arterial hypertension
Authors: Ilchyshyna O Y A , Sychov O S , Talaieva T V , Tretiak I V , Stasyshena O V
Published: October 2022

Aims

Atrial fibrillation (AF) and atrial flutter (AFl) take the second place between supraventricular arrhythmias and lead to severe complications such as stroke and heart failure. Mostly these arrhythmias occur on the background of arterial hypertension (AH). The inflammatory theory of arrhythmogenesis in AF and AFl has attracted researcher's attention in recent years. The aim of our work is to compare the immune status of patients with paroxysmal and persistent forms of AF and AFl in patients with AH.

Material and methods

The study involved 103 patients with hypertension and arrhythmias, who were divided into three main groups according to the form of AF/AFl: group 1 (n=35) – with paroxysmal form of AF, group 2 (n=38) - with persistent form of AF, group 3 (n=30) – with persistent form of AFl. For comparison, 2 control groups were formed: 4 (n=23) – patients with hypertension, but without a history of arrhythmias and 5 (n=21) – almost healthy people. The immune status of these patients was assessed by determining the level of monocytes (Mc), lymphocytes subpopulations and T-regulatory cells (T-reg) in the peripheral blood using flow cytometry.

Results

It was noted that the number of classical CD14++CD16- and intermediate CD14++CD16+ Mc was significantly higher in patients with persistent AF and AFl comparing with patients without arrhythmias and healthy people (p<0.005). This fraction of Mc is able to produce proinflammatory cytokines and activate the local renin-angiotensin system, thus triggering the processes of fibrosis in the myocardium. Amount of non-classical CD14+CD16++ Mc was significantly lower in the second group both quantitatively and in percentage (p<0.005). The count of T cells with natural killer (TNK) activity was higher in all groups comparing to normal value, so statistical significance was observed only in comparison with the fifth group. The highest quantity of T-reg cells was found in healthy people comparing to other groups and a strong mathematical significance was obtained in all cases (p<0.005), both comparing the values in percentage and in μl.

Conclusions

Patients with AF and AFl on the hypertension background comparing to hypertensive patients without arrhythmias or healthy people have an increased activity of proinflammatory subpopulation of monocytes, higher amount of T-cells with natural killer activity and reduced T-regulatory cells, whose main function is to control the immune response.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): NSC “M.D. Strazhesko Institute of Cardiology” NAMS of Ukraine
Spectrum of rare and common genetic variants in arrhythmogenic cardiomyopathy
Authors: Lippi M , Chiesa M , Ascione C , Pedrazzini M , Mushtaq S , Rovina D , Riggio D , Di Blasio A , Biondi M L , Pompilio G , Colombo G I , Novelli V , Casella M , Sommariva E
Published: October 2022

Background

Arrhythmogenic cardiomyopathy (ACM) is a rare inherited cardiac disorder, whose genetic cause is elusive in about 50% of cases. ACM pathogenic mutations mainly involve desmosomal genes (PKP2, JUP, DSP, DSG2, DSC2). ACM presents a variable disease course, spanning from mild electrocardiographic alterations and/or contractile dysfunctions, to malignant ventricular arrhythmias and heart failure.

Purpose

In an attempt to broaden etiological diagnosis for ACM patients, this work was aimed at finding potential rare high-impact variants in genes not previously associated with ACM. Secondarily, we meant to assess the impact of genetic polymorphisms on the disease clinical severity.

Methods

We clinically characterized 82 consecutive ACM probands and performed next-generation sequencing, exploring a panel of 174 genes associated with inherited cardiovascular diseases. We evaluated the pathogenicity of rare variants, according to the American College of Medical Genetics / Association for Molecular Pathology guidelines, to select candidates with potential ACM causative role. Further, a genotype-phenotype correlation analysis between common polymorphisms and clinical variables was performed to find genetic factors associated with specific ACM phenotypes. Finally, we carried out event-free survival analyses, linking specific variants to arrhythmias in 8,6±0,7 years follow-up, to estimate their possible impact on arrhythmic risk.

Results

We identified 141 rare genetic variants, of which 23 were classified of high impact, including variants in genes never associated with ACM (e.g. ABCC9, APOB, MIB1). These genes deserve future studies as they could participate in ACM pathogenesis. In addition, we found 69 genotype-phenotype significant associations (p≤0.005) between common variants and clinical parameters. Variants associated to arrhythmic phenotypes were found with genes linked to arrhythmias (e.g. KCNQ1, HCN4) and other cardiomyopathies (e.g. MYBPC3, MYL2). Associations involving substrate impairments were found with genes linked to muscle dysfunctions (e.g. LAMA2, SGCD). Arrhythmia-associated polymorphisms, included in survival analyses, were found to be associated with an increased occurrence of arrhythmic events during patients' follow-up.

Conclusion

The identification of rare high impact variants in novel genes potentially associated with ACM and the observation of genotype-phenotype correlations constitute the starting point to address the current lack of knowledge of the genetic landscape of ACM.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministero Italiano della Salute - Ricerca corrente
Functional analysis of novel SCN5A mutations related to Brugada syndrome
Authors: Namgoong H , Kim S J , Choi S W
Published: October 2022

Brugada syndrome (BrS) is an arrhythmogenic disorder that has been linked to mutations in SCN5A, the gene encoding for the pore-forming α-subunit of the cardiac Na+ channel. Recently, novel SCN5A missense mutations (A385T and R504T) were identified in a BrS patient. Since the mutations are in the loop connecting transmembrane segments 5 and 6 in domain 1 (S5-S6 in DI) and segments 6 and 1 between domain 1 and 2 (DI-DII linker), it can lead to dysfunctional property of the Na+ channel. Here we aimed to characterize the electrophysiological properties of A385T and R504T. The wild-type (WT) and mutant SCN5A were transiently transfected in HEK293 cells, and the Na+ channel was analyzed using the whole-cell patch-clamp technique. WT, A385T, R504T, and double mutant (A385T/R504T) showed no significant differences in the current density and the voltage-dependent activation. Unexpectedly, a rightward shift of the voltage-dependent inactivation was identified in the three groups of mutation. Besides, the recovery from inactivation of double mutant was faster than that of WT. These results suggest that, contrary to the expected mechanism of BrS, the mutations cause a gain-of-function of NaV1.5. However, the current densities of R504T and double mutant transfected with β-subunit SCN1B were significantly suppressed but A385T was not different from WT. The voltage dependent activation and inactivation of all mutants were not significantly different from WT. The recovery from inactivation of all mutants were slower than that of WT. These results suggest that R504T mutation of α-subunit SCN5A interacting with β-subunit SCN1B is responsible to pathophysiological function of novel BrS.

Funding Acknowledgement

Type of funding sources: None.
Genetic variation rs6795970 of the SCN10A gene is associated with PR interval in young population of Republic of Moldova
Authors: Butovscaia C , Buza A , Galea-Abdusa D , Curocichin G
Published: October 2022

Background/Objectives

The electrocardiographic PR interval reflects atrial and atrioventricular nodal conduction time. Prolongation of the PR interval increase risk of atrial fibrillation (AF) and heart block. Genome-wide association studies (GWAS) have identified association of a nonsynonymous single nucleotide polymorphism (SNP), rs6795970, in the SCN10A gene with PR interval in individuals of European and Asian ancestry. The aim of the study was to determine distribution of the genetic variants of rs6795970, associated with PR interval in young population of Republic of Moldova.

Methods

1380 young participants from Republic of Moldova aged between 19–25 years, were genotyped for rs6795970 in the SCN10A gene, using TaqMan SNP Genotyping Assay.

Results

The genotype G/G, A/G, A/A distributions of rs6795970 among participants were 37%, 48%, 15%, respectively (χ2=0.086, p=0.770). The allele frequencies for G and A, in young participants were 61% and 39%, respectively. We observed association between rs6795970_A and a prolongation of the PR interval (p=0.003).

Conclusions

In our study, we determined that distribution of the genetic variants of rs6795970, associated with PR interval in young population of Republic of Moldova was consistent with 1000 Genomes data in the European population. Therefore, our data demonstrate that the A allele is associated with prolongation of the PR interval and at least 15% of all participants (the A/A genotype), may have an increased risk of conduction abnormalities.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National project “Study of molecular genetic polymorphism of metabolic risk factors in young population of the Republic of Moldova National project “Identification and validation of genetic and epigenetic biomarkers in chronic non-communicable diseases with major impact on public health”
Clinical role of genetic testing for overlapping between Brugada syndrome and arrhythmogenic right ventricular cardiomyopathy
Authors: Jeong J , Choi J I , Kim Y G , Choi Y Y , Min K J , Roh S Y , Shim J M , Kim J S , Kim Y H
Published: October 2022

Background/Introduction

Brugada syndrome (BrS) and arrhythmogenic right ventricular cardiomyopathy (ARVC) are inherited arrhythmias that may predispose to sudden cardiac arrest. Although its pathogenetic mechanisms differ, overlapping features between BrS and ARVC have been demonstrated previously. However, it remains to be determined whether genetic testing for ARVC-related gene is needed in patients with BrS.

Purpose

This study is aimed to analyze genetic profiles of BrS patients using next generation sequencing (NGS) based multigene panel including ARVC related genes.

Methods

Patients who were confirmed as BrS or clinically suspected as BrS with type 2 or 3 Brugada pattern electrocardiography were studied. Genetic testing using NGS panels (Illumina Inc., San Diego, CA, USA) included 30 genetic variants associated with inherited arrhythmia and genetic cardiomyopathy.

Results

Among the total 119 patients from BrS registry, 63 patients were confirmed as BrS and 56 patients were clinically suspected as BrS without fulfilling diagnostic criteria. One-hundred-fourteen patients (95.8%) were male, and mean age of onset was 43.6 year-old. Genetic variants were identified in 25 of 42 patients who received genetic testing. Six out of 25 patients (24.0%) showed ARVC-related genotypes (2 PKP2, 1 DSG2, 1 TMEM43, 1 JUP, and 1 DSP) (Figure 1 and Table 1). None of the patients showed structural or electrocardiographic features that fulfill diagnostic criteria of ARVC. It is notable that ARVC-related genotypes were mostly frequently accounted for BrS patients, following SCN5A and SCN10A.

Conclusion

In the clinic setting, ARVC-related genetic variants were identified in significant proportion of BrS patients, supporting that genetic testing of ARVC-overlapping is needed. This study suggests that follow-up including imaging study should be considered in BrS patients with ARVC-related genotypes to monitor disease progression as ARVC.

Funding Acknowledgement

Type of funding sources: None.
Atrial fibrillation in patients with Graves disease: incidence, risk factors and outcomes
Authors: Naser J , Pislaru S V , Stan M N , Lin G
Published: October 2022

Background

Graves' disease (GD) is associated with atrial fibrillation (AF) with a prevalence ranging between 16% and 60%, but its risk factors are not well-defined. We aimed to describe the incidence, risk factors and outcomes of GD-related AF.

Methods

Patients diagnosed with GD between 2009 and 2019 were included retrospectively. We defined GD-related AF as AF diagnosed within 30 days before or any time after diagnosis of GD. Late onset AF was defined as GD-related AF diagnosed more than 90 days after GD diagnosis. Observed AF events were compared to the expected events in the general population utilizing published data of age and sex-specific rates of AF.

Results

Of 1371 patients with GD, AF occurred in 139 (10.1%) patients. Late onset AF occurred in 32 (23%), of which 50% had attained euthyroidism. The observed incidence of AF was higher in GD than that expected in the general population (p<0.001), Figure 1. When comparing the incidence of only late AF to that in the general population, late AF still happened more frequently in GD although not achieving statistical significance (p=0.06), Figure 1. Independent risk factors were age [HR 1.05 (1.03–1.06) per year], overt hyperthyroidism [HR 2.71 (1.35–5.44)], and male gender [HR 2.42 (1.57–3.71)] for early AF and age [HR 1.06 (1.02–1.09) per year], BMI [1.07 (1.01–1.12) per unit], COPD [3.33 (1.08–10.27)), heart failure [HR 4.19 (1.39–17.42)], and treatment with thionamide [vs. radioiodine ablation HR 2.94 (1.38–6.27)] for late AF. AF was associated with higher rates of mortality [HR 16.32 (4.66–56.58)], acute coronary syndrome/stable angina events [HR 3.89 (1.23–12.31)], and cardiac hospitalizations [HR 15.39 (8.17–29.00)] when adjusted to age, sex, and previous AF.

Conclusion

AF occurred in 10.1% of GD patients. Late onset AF is an important entity comprising a quarter of GD-related AF cases and requires surveillance even after restoring euthyroidism. Risk factors for AF in GD are similar to those in general population, although overt hyperthyroidism conferred the highest risk, especially for early AF. Treatment with thionamide was associated with late AF.

Funding Acknowledgement

Type of funding sources: None.
Factors associated with the presence of thrombus in the left atrial appendage and usefulness of the D-Dimer to rule out its presence
Authors: Irigaray Sierra P , Gayan Ordas J , Pueo Crespo E M , Fernandez-Rodriguez D , Pastor Pueyo P , Blanco Ponce E , Matute-Blanco L , Pueyo Balsells N , Barriuso Barrado I , Ramirez Martinez T , Papiol Morales E , Worner Diz F
Published: October 2022

Introduction

A transesophageal echocardiography (TEE) is recommended for non-anticoagulated patients with atrial fibrillation (AF) and >48 hours of evolution requiring electrical cardioversion (ECV) to rule out the presence of thrombus in the left atrial appendage (LAA). It has been proposed that the D-Dimer (DD) value is useful to rule out its presence with high sensitivity and negative predictive value (NPV).

Purpose

To evaluate the prevalence of thrombus in LAA in patients with AF, factors associated with its presence and diagnostic accuracy of different DD cut-off points to rule it out.

Methods

A retrospective observational study in which patients with AF who underwent a TEE prior to ECV were included consecutively.

Results

We included 104 patients (85.6% admitted) between June 2020 and February 2022. In 10 patients (9.6%) thrombus was evidenced in LAA. The mean age was 68.7±11 years and 59.6% were male. Most of the patients had hypertension (64.4%) and 19.2% diabetes. Only 3.8% had had previous stroke. Concerning the echocardiographic findings, the mean left atrial (LA) volume was 56.9±17ml/m2, LA diameter was 49.2±6.4mm and left ventricular ejection fraction (LVEF) was 47.5±17%. Only 12.5% had a CHADS2VASC2 scale ≤2. 69.2% of patients were not under antithrombotic therapy and only 27% had taken anticoagulant agents before (NOAC or antivitamin K). Neither the CHADS2VASC2 score nor the clinical or echocardiographic factors evaluated were significantly associated with the presence of thrombus (Figure 1). 68 patients had DD available (≤48 hours prior to TEE) and of them 8 (11.7%) had thrombus in the LAA. 12 patients (17%) had DD ≤150ng/mL, 42 (61.7%) DD≤500ng/mL and 48 (80%) DD≤10xAge. Figure 2 shows the ROC curve of the DD: AUC 0.72 (CI 0.55–0.9). NPV to rule out thrombus in LAA was 100% for DD≤150 ng/mL (Sensibility (Se) 100%, Specificity (Sp) 20%), 92% for DD≤500 ng/mL (Se 62.5%, Sp 65%), and 90% for DD≤10xAge (Se 37.5%, Sp 80%).

Conclusion

The prevalence of thrombus in LAA in TEE prior to ECV was similar to the previously described. The sample size was insufficient to identify any clinical or echocardiographic factor associated with thrombus. The NPV of a DD≤150ng/mL value was 100%. However, higher cut-off points (500 ng/mL or 10xAge) did not allow to rule out their presence.

Funding Acknowledgement

Type of funding sources: None.
Temporal sequence of atrial fibrillation and chronic obstructive pulmonary disease diagnosis is associated with mortality risk
Authors: Garcia R , Warming P E , Hansen C J , Torp-Pedersen C , Linz D , Tfelt-Hansen J
Published: October 2022

Background

Chronic obstructive pulmonary disease (COPD) is concomitantly present in 13% of atrial fibrillation (AF) patients and negatively impacts prognosis in AF patients (1). Nevertheless, the temporal sequence and time between diagnosis of each disease may vary between individuals (2).

Purpose

To describe whether the temporal sequence of diagnosis of AF and COPD is associated with mortality in patients with both AF and COPD diagnosed.

Methods

This nationwide study assessed all patients between 18 to 85 years diagnosed with both COPD and AF between 1999 and 2018 in Denmark. Follow up started at the time of the second diagnosis. Three groups were defined according to the temporal sequence of diagnosis: COPD diagnosed at least 1 year before AF (COPD-First), AF diagnosed at least 1 year before COPD (AF-First) and COPD and AF diagnosed within a one-year time frame (AF∼COPD).

Results

Among 62,806 patients analyzed (75.0 [69.0–79.7] years; 56.5% males; mean follow-up 2.2 years) 27,809 (44.3%) were in the COPD-First group, 19,556 (31.1%) in the AF-First group and 15,441 (24.5%) in the AF∼COPD group. While age was similar across groups, the sex distribution differed, with the lowest proportion of males (53.1%) in the COPD-First group and the highest (61.2%) proportion of males in the AF-First group. Moreover, cardiovascular risk factors and diseases were more frequent in the AF-First group and the lowest in the COPD-First group.

After 5 years of follow up, 31,494 (58.6%) died. Males died more frequently than females (59.4% vs. 57.4%). Mortality was higher in the COPD-First group (61.8% for COPD-First, 55.1% for AF-First and 57.2% for AF∼COPD, Figure 1) and the causes of death were different among the 3 groups (38.8%, 24.1%, 27.0% for pulmonary cause and 26.1%, 32.8% and 36.6% for cardiac cause in the COPD-First, AF first and AF∼COPD respectively).

In a multivariable Cox-regression model adjusted for age, sex, type 2 diabetes, history of acute myocardial infarction, cancer, chronic kidney disease, stroke, AF∼COPD group (HR 1.14, 95% CI 1.11–1.17; P<0.0001) and COPD-First group (HR 1.26, 95% CI 1.23–1.29; P<0.0001) had a higher risk of death as compared to the AF-First group. Using time between diagnoses in a restricted cubic spline and adjusting for potential cofounders a COPD diagnosis preceding an AF diagnosis was associated with a higher risk of death than an AF diagnosis preceding a COPD diagnosis (Figure 2).

Conclusion

In patients with AF and COPD, the temporal sequence of diagnosis impacts prognosis, independently of other comorbidities. A concomitant diagnosis of AF in patients with already previously diagnosed COPD is associated with the worst prognosis.

Funding Acknowledgement

Type of funding sources: None.
Does body mass index affect atrial fibrillation ablation outcomes
Authors: Aleem S , Al-Sadawi M , Aslam F , Ijaz H , Cao K , Jacob R , Santore L , Almasry I , Fan R , Rashba E , Singh A
Published: October 2022

Background

There are conflicting reports in the literature regarding whether body-mass index (BMI) influences the success and procedural complication rates of atrial fibrillation (AF) ablation.

Purpose

To determine if differences in BMI affect AF ablation outcomes

Methods

At a single academic center, AF ablation procedures were reviewed from 2013 to 2021. Primary outcomes were AF recurrence (after a 90 day blanking period), procedure-related complications, emergency department visits or hospital admission (ED/HOSP). Patients had a minimum of 6 months follow-up

Results

We analyzed 1569 AF ablation consecutive procedures (1093 de novo, 476 repeat ablation) using either radiofrequency or cryoablation. The study population was 65% male with a mean age 62 years, with 28% persistent AF. BMI was separated into three cohorts: <25 kg/m2 (N=218), 25–30 kg/m2 (N=547), and >30 kg/m2 (N=804). There were no significant differences in the type of AF, left atrial diameter, or left ventricular ejection fraction in the BMI subgroups. There was a direct relationship between the prevalence of co-morbid conditions and increasing BMI: hypertension (49.1%, 59.9%, 60.2%; p 0.04), diabetes (6.4%, 13.5%, 21.3%; p 0.01), and obstructive sleep apnea (5.5%, 10.8%, 26.7%; p<0.01). There were no significant differences in AF recurrence, procedural complications or ED/HOSP among the BMI cohorts (p>0.05) (Figure 1). No gender related disparities were noted in outcomes (p>0.05).

Conclusion

Higher BMI was not associated with AF recurrence, complications, or ED/HOSP after AF ablation despite a higher prevalence of comorbid medical conditions

Funding Acknowledgement

Type of funding sources: None.
Heart rate during sinus rhythm predicts paroxysmal atrial fibrillation on 30-day mobile cardiac telemetry monitoring
Authors: Persson A , Ecounomou Lundeberg J E L , Dziubinski M D , Slusarczyk M S , Grotek A G , Johnson L J , Engstrom G E
Published: October 2022

Background

Low mean heart rate at ambulatory ECG monitoring and low resting heart rate are both predictors of later incident atrial fibrillation (AF). The aim of this study is to determine whether mean heart rate at ambulatory ECG is a predictor of paroxysmal AF that can be detected with extended ambulatory ECG registration.

Methods

We included all patients who recorded 2–30 full days of ambulatory ECG using a full disclosure mobile cardiac telemetry device in USA 2019–2020, and without AF on the first full day of registration (n=18,220, mean age 64.4 years, 57.2% women). The association between mean heart rate on the first day and the occurrence of paroxysmal AF (≥30 seconds duration) during subsequent up to 30 day ECG recording was analysed using logistic regression models adjusted for age, sex and duration of ECG recording, according to tertiles of mean heart rate (39–66, 67–76 and >77 beats per minute) as well as modelled using restricted cubic splines.

Results

During a median registration duration of 16 days there were 1,290 cases of paroxysmal AF (7.1%). More paroxysmal AF occurred in the lower tertiles of mean heart rate (11.2% in tertile 1, 6.2% in tertile 2, and 4.4% in tertile 3). After adjustment, low mean heart rate was associated with a higher risk of AF (OR 1.69, 95% CI 1.47–1.93 p<0.001 for tertile 1 vs tertile 2, and OR 1.84, 95% CI 1.58–2.15, p<0.001 for tertile 1 vs tertile 3). Cubic spline curves indicated that lowest risks of AF were seen among subjects with a mean heart rate ≈80 beats per minute.

Conclusion

Low mean heart rate at 24hECG predicts detection of paroxysmal AF during extended ≤30 day ambulatory ECG monitoring.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Swedish Heart Lung foundationSwedish Society for Medical Research
Very long-term outcomes of patients undergoing catheter ablation of atrial fibrillation: a systematic review and meta-analysis
Authors: Ngo L , Lee W , Elwashahy M , Arumugam P , Ranasinghe I
Published: October 2022

Background

The efficacy of catheter ablation of atrial fibrillation (AF) is reported to stabilise at 5-year, but most studies report up to 3-year-outcomes only.

Objective

To perform a systematic review and meta-analysis of outcomes at 5-years following AF ablation.

Methods

We searched PubMed and Embase for studies reporting on ≥5-year outcomes following AF ablation, including freedom from atrial arrhythmia, all-cause death, stroke, and major bleeding. All meta-analyses were performed using the “meta” package in R with pooled incidence calculated using log transformation.

Results

Among 5,764 studies screened, 58 (n=41,344 patients) were included for analysis. The pooled mean age was 60.3y, 68.7% male, 78.4% paroxysmal AF, and radiofrequency was the most common ablation energy (72.4%). Most (51.5%) patients had hypertension, but the pooled rates of other comorbidities were low (heart failure: 9.0%, coronary artery disease: 12.8%, diabetes: 11.0%, and previous stroke: 8.5%). Pooled incidence of freedom from atrial arrhythmia at 5-years was 47.6% (95% CI 43.8%-51.6%, I2=98.4%) after a single procedure and increased to 64.3% (95% CI 59.6%-69.3%, I2=98.3%) after multiple procedures (Figure 1). The incidence was higher among patients with paroxysmal compared with non paroxysmal AF (55.9% vs. 28.7% and 82.2% vs. 47.6% after single and multiple procedures respectively). Retrospective studies reported slightly higher incidence of arrhythmia freedom (single procedure: 51.2% vs. 46.7%; multiple procedures: 66.9% vs. 61.9%) than did prospective studies. Few studies reported outcomes other than atrial arrhythmia free survival at 5-years (n=14) and incidences of these outcomes could only be pooled for multiple procedures. Pooled incidences of death, stroke, and major bleeding at 5-years were 8.0% (95% CI 4.2%-15.2%, I2=95.8%), 2.3% (95% CI 1.4%-3.6%, I2=72.9%), and 1.1% (95% CI 0.6%-1.8%, I2=32.5%), respectively (Figure 2).

Conclusion

At five-years, only up to 65% of patients undergoing AF ablations remained free from atrial arrhythmia although there was significant heterogeneity among individual studies. Encouragingly, these patients had low risk of dying, experiencing a stroke or major bleeding (all incidences<10%).

Funding Acknowledgement

Type of funding sources: None.
COVID-19 associated Brugada pattern electrocardiogram: systematic review of case reports
Authors: Chen K C , Rathore A Z , Deol T , Liu K L , Wu E W , Su J S , Wannenburg T W , Catanzaro J N C
Published: October 2022

Objective

To summarize published case reports of patients diagnosed with COVID-19 infection and Brugada pattern electrocardiogram (ECG).

Background

Fever is a common clinical manifestation of COVID-19 infection. Fever has also been associated with unmasking Brugada pattern ECG in patients and may result in life-threatening arrhythmia. Little is known regarding COVID-19 associated Brugada pattern ECG. There is paucity of data and guidance in how to manage these patients.

Methods

To identify all published case reports, the latest Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was followed. A literature search was conducted using PubMed, EMBASE, and Scopus through September 2021. A systematic review was performed to identify the incidence, clinical characteristics, and management outcomes of COVID-19 patients with a Brugada pattern ECG.

Results

A total of 18 cases were collected. The mean age was 47.1 years and 11.1% were women. No patient had prior confirmed diagnosis of Brugada syndrome. The most common presenting clinical symptoms were fever (83.3%), chest pain (38.8%), shortness of breath (38.8%), and syncope (16.6%). All 18 patients presented with type 1 Brugada pattern ECG. Four patients (22.2%) underwent left heart catheterization, and none demonstrated the presence of obstructive coronary disease. The most common reported therapies included antipyretics (55.5%), hydroxychloroquine (27.7%), and antibiotics (16.6%). One patient (5.5%) died during hospitalization. Three patients (16.6%) who presented with syncope received either an implantable cardioverter defibrillator or wearable cardioverter defibrillator at discharge. At follow up, thirteen patients (72.2%) had resolution of type 1 Brugada pattern ECG.

Conclusion

COVID-19 associated Brugada pattern ECG is rare. Most patients may see resolution of the ECG pattern once their symptoms have improved. Increased awareness and timely use of antipyretics is warranted in this population.

Funding Acknowledgement

Type of funding sources: None.
Evaluation of five algorithms in predicting the sublocalisation of right ventricular outflow tract arrhythmia (RVOTA) when compared to 3D electroanatomical mapping origin
Authors: Sirbu Prisecaru R , Leatu C , Purcar O , Manitiu I
Published: October 2022

Introduction

The majority of idiopathic ventricular arrythmias arise from the right ventricular outflow tract (RVOT) and they represent nearly 10% of all ventricular tachycardia (VT) admissions. It is paramount to precisely predict the origin of RVOT arrhythmias to define the appropriate approach before the ablation procedure. Conventional 12-lead electrocardiogram (ECG) is a useful tool for analysing cardiac arrhythmias, and numerous ECG algorithms for predicting the origin of RVOT arrhythmias have been reported.

Purpose

To compare the predictive accuracy of five different algorithms as verified by successful ablation site using 3D electroanatomical non-contact mapping in patients with symptomatic and asymptomatic but high ventricular burden right ventricular outflow tract (RVOT) tachycardias.

Methods

28 consecutive patients admitted for radiofrequency catheter ablation for symptomatic and asymptomatic, but high ventricular burden idiopathic premature ventricular contractions (PVC) were recruited for this study. All patients had previous failed or intolerant to beta-blocker and/or at least one class IC anti-arrhythmic agents, and they had normal left ventricular ejection fraction. All patients had documented monomorphic PVC with left bundle branch block morphology and an inferior axis. Concordance of the arrhythmia origin based on ECG algorithm and 3D mapping system site were further evaluated. Of the five algorithms, two algorithms with easy-applicability and having a memorable design (Dixit and Joshi) and three algorithms with more complex and detailed design (Ito, Zhang, Pytkowski) were selected for comparisons.

Results

Assessment of the diagnostic accuracy showed that each of the five algorithms had only moderate accuracy, and the greatest accuracy was observed in the algorithm proposed by Pytkowski algorithm when assessed by a general cardiologist and Dixit and Pytkowski algorithms when evaluated by the electrophysiologist. However, when the algorithms were compared for their accuracy, specificity, sensitivity, no significant differences were found (p=0.99).

Conclusions

All the five published 12-lead ECG algorithms for RVOT location were similar in terms of the diagnostic accuracy, specificity, and sensitivity. In our study, Pytkowski algorithm exhibits the best accuracy and sensitivity among the algorithms, while predicting a precise location and when evaluation is performed by electrophysiologists and/or cardiologists.

Funding Acknowledgement

Type of funding sources: None.
Different underlying aetiologies in patients presenting with ventricular tachycardia fulfilling task force criteria for ARVC: initial suspicion based on the 12-lead electrocardiogram
Authors: Hoogendoorn J , Bosman L P , Van Der Heijden J F , Wilde A A , Van Den Berg M P , Yap S C , Riele A S J M , Zeppenfeld K
Published: October 2022

Background

The Task Force Criteria (TFC) for ARVC are highly sensitive, but lack specificity. Patients with atypical RV-involvement (aRVi) may have different underlying aetiologies and prognosis, requiring specific therapeutic interventions.

Purpose

We aimed to evaluate the role of the baseline ECG for initial suspicion of aRVi.

Methods

From the Netherlands Heart Institute Arrhythmogenic Cardiomyopathy (NHI-ACM) registry, patients were selected who 1) fulfilled TFC for definite ARVC, 2) presented with sustained VT, 3) underwent genetic testing. The first available ECG after VT was evaluated for AV-conduction and the presence and surface area (SA) of an R'-wave in V1-V3. ECGs with AV-conduction disturbances or an R'-wave with SA ≥1.65 mm2 were classified as suspicious for `atypical RV-involvement' (aRVi-ECG).

Patients with ARVC-related pathogenic/likely pathogenic variant (P/LP+) were classified as “typical ARVC”. Data of patients without an ARVC-related pathogenic/likely pathogenic variant (P/LP−) were reviewed by an expert panel and classified as either “typical ARVC” or “suggestive for another aetiology” based on consensus.

Results

In total 124 P/LP+ patients and 35 P/LP− patients were included. Nineteen patients had an aRVi-ECG, which appeared significantly more predominant in the P/LP− group (11 (9%) P/LP+ vs. 8 (22%) P/LP−, p=0.019). Of the P/LP− patients, seventeen (49%) were classified as “suggestive for another aetiology” (e.g. myocarditis, ischemia, sarcoid), including all 8 patients with an aRVI-ECG.

Among P/LP+ patients with an aRVi-ECG, 46% carried the Arg14del phospolamban variant and 64% died, versus 15% and 18% of P/LP+ patients without aRVi-ECG, respectively (Table 1).

Conclusion

For patients presenting with sustained VT and fulfilling the TFC for ARVC diagnosis, a baseline ECG suggestive for atypical RV-involvement should raise suspicion for a different underlying aetiology in patients without an ARVC-related P/LP variant. In P/LP+ patients, an aRVi-ECG may identify those with poor outcome.

Funding Acknowledgement

Type of funding sources: None.
Prevalence of unreported atrial fibrillation in electrocardiograms with ventricular-paced rhythm: a multicenter experience
Authors: Arcinas L , Seifer C M , Shaikh N
Published: October 2022

Introduction

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major preventable cause of stroke. The diagnosis of AF on electrocardiogram is through the recognition of absent p waves and an irregularly irregular ventricular rhythm. However, in ventricular-paced patients, the rhythm on electrocardiogram (ECG) is often regular and may obscure AF diagnosis. Thus, unrecognized AF on ECG poses a potential risk among untreated ventricular-paced patients. There is scant published data reporting the prevalence of underrecognized and untreated ECG-detected AF among ventricular-paced patients.

Objectives

In the first part of this study, we aim (1) to determine the prevalence of AF and unreported AF on ECGs with ventricular-paced rhythm obtained across all 6 hospitals in our city, Canada. Using data obtained from (1), we then aim (2) to report the rates of untreated and unreported ECG-detected AF among ventricular-paced patients with an indication for anticoagulation, (3) to describe the length of delay in AF recognition and treatment among patients who should be considered for anticoagulation at the time of ECG-detected AF and (4) to identify possible strategies that can improve reporting of AF on ECGs with ventricular-paced rhythm using our institutional ECG software.

Methods

This is a retrospective multicenter review of ventricular-paced ECGs interpreted and reported by physicians using our institutional ECG software. ECGs were reviewed and confirmed by two independent cardiologists who were blinded from the reported interpretation of the ECGs.

Results

Of the sample of 1500 ECGs with ventricular-paced rhythm from 2017–2019, 2 independent cardiologists agreed that AF was present in 622 ECGs (41.5%). Of these, 251 (40.4%) were not reported to have AF by the interpreting physician.

Conclusions

Our study shows that there is a high prevalence of unreported AF on ECG in patients with ventricular-paced rhythm in our local hospitals. Further studies are warranted on describing whether this impacts treatment and outcomes among ventricular-paced patients. This study also highlights the importance of identifying possible strategies to improve reporting of AF on ECGs with ventricular-paced rhythm.

Funding Acknowledgement

Type of funding sources: None.
Phenocopia of brugada syndrome: an under-diagnosed entity?
Authors: Sanchez Contreras C , Juarez Escobar K Y
Published: October 2022

Introduction

Brugada phenocopy (BSF) presents as an electrocardiographic pattern similar to Brugada syndrome (BS), however, they differ in etiology, being that it will be found in association with any identifiable condition and when said condition is resolved, the electrocardiogram does not present the characteristic pattern. Since the recognition of the FSB, 122 cases have been registered worldwide, there are reports of ischemic heart disease, secondary to fluid and electrolyte imbalance, pulmonary thromboembolism, electrocution and inappropriate electrocardiographic filters, considering multiple nosological entities with a common electrocardiographic manifestation that has a different prognosis to BS Therefore, the recognition of the FSB requires a diagnostic study in order to establish specific treatment in a timely manner.

Purpose

To present 3 clinical cases of this little-known entity that did not present risk factors or family history in a cardiology reference center.

Methods

A search was carried out, finding three cases from 2015–2021, the first case a 22-year-old patient with a history of Duchenne familial dystrophy and hydroelectrolytic imbalance at admission with Brugada type 1 pattern (A) corrected after treatment (B), A 26-year-old female with pulmonary thromboembolism with a Brugada Type I pattern corrected after treatment, a 55-year-old female in the immediate postoperative period of revascularization surgery who, after 48 hours, corrected a Brugada type I pattern (C).

Conclusion

The differential diagnosis is based mainly on the fact that FBS is due to: secondary etiology, which, once resolved, will normalize the electrocardiographic pattern, negative challenge test with sodium channel blockers and low pretest for congenital BS, contrary to patients with BS that do not present these characteristics, so a differential diagnosis must be made in patients with a BS pattern.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Instituto Nacional de Cardiologia Ignacio Chavez
Effects of COVID-19 infection on ECG parameters in outpatients
Authors: Deniz H , Deniz F
Published: October 2022

Objective

Covid-19 infection has been declared as a pandemic disease by the World Health Organization (WHO) and has been associated with increased morbidity and mortality. More than 400 million people diagnosed with the disease has been reported until February 2022 [1]. Covid-19 infection mostly progresses with lung involvement and pneumonia, however, its effects on the cardiovascular system are also well-known. Studies have reported that Covid 19 infection can trigger cardiac events such as acute myocardial damage, acute myocarditis, acute coronary syndrome (ACS), ventricular arrhythmias, cardiogenic shock, and cardiac arrest [2]. Electrocardiogram (ECG) is an important tool to diagnose cardiac involvement. QTc interval, QT dispersion, Tp-e interval, Tp-e/QTc ratio are defined as ventricular repolarization parameters and these parameters are associated with increased risk of ventricular arrhythmia [3,4]. In our study, we aimed to evaluate to predict ventricular arrhythmia by ECG in Covid-19 patients.

Methods

Our study is a single-center, cross-sectional study. Patients diagnosed with Covid-19 in our center between July and October 2020 were included. 408 patients with positive SARS-CoV2 PCR test were detected and the ECGs of the patients were recorded at admission and 15 days after symptomatic recovery. After the exclusion criteria, remained 91 patients were analyzed. Conduction parameters (PR and QRS durations) and repolarization parameters (QTc interval, QT dispersion, Tp-e interval and Tp-e/QTc ratio) were evaluated in 12-lead ECG recordings.

Results

Ninety-one patients with Covid-19 infection were included. The group were consisted of 47 male (52%) and 44 female (48%). The mean age was 50.4 years. As a result of the statistical analysis, no significant difference was observed between the groups in terms of PR interval (142.2±21.4 ms vs. 140.1±19.0 ms; p=0.312). QRS duration was found significantly higher during active infection (91.4±12.2 ms vs. 88.8±10.9 ms; p=0.022). The mean QTc duration was detected longer in the first ECG, but no statistically significant difference was observed between the two groups (426.1±23.6 ms vs. 422.5±26.2 ms; p=0.237). QT dispersion (35.2±7.3 ms vs. 27.7±7.8 ms; p<0.001), Tp-e interval (86.7±10.1 ms vs. 76.1±9.9 ms; p<0.001) and Tp-e/QTc ratio (0.204±0.026 vs 0.180±0.025; p<0.001) were found significantly higher during active infection

Conclusion

In our study, QRS complex, QT dispersion, Tp-e interval, Tp-e/QTc ratio were significantly higher during active infection. We considered these parameters as a contributor of the increased mortality by inducing ventricular arrhythmia and sudden death in Covid-19 patients during active infection.

Funding Acknowledgement

Type of funding sources: None.