bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chronic follow-up from the pilot study of a novel substernal extravascular implantable cardioverter-defibrillator
Authors: Kotschet E , Crozier I , Haqqani H , Alison J , Thompson A , Portway B , Sawchuk R , Sherfesee L , Liang S , Lentz L , Degroot P , O'Donnell D 
Published: November 2020

Abstract

Background
The investigational Extravascular Implantable Cardioverter Defibrillator (EV ICD) is an implantable defibrillator with defibrillation and pacing therapies, including the potential for antitachycardia pacing (ATP).

Purpose
To characterize chronic EV ICD system performance through 12 months of follow-up.

Methods
The first-in-human EV ICD Pilot study was prospectively conducted at four centers in Australia and New Zealand. Patients with Class I or IIa indications for ICD were enrolled between July and December of 2018. A defibrillation lead was inserted into the substernal space under radiologic guidance and a device was positioned close to the left midaxillary line. Figure 1 illustrates the implanted EV ICD. Defibrillation testing was conducted at implant and chronically in 5 patients. Follow-ups were conducted at pre-hospital discharge, 2 weeks, 4–6 weeks and 3 months post-implant, and every 6 months thereafter.

Results
A total of 26 patients were enrolled and 21 underwent the EV ICD implant procedure with no intraprocedural complications. Median energy for defibrillation at implant was 15 J; mean R-wave amplitude was 3.4±2.0 mV; mean pacing capture threshold was 5.1±2.0 volts. Seventeen of 21 implanted patients entered into chronic follow-up after successful system placement and implant testing, and 14 patients continue to be followed, representing &gt;180 patient-months of total follow-up.
Multiple episodes of spontaneous ventricular tachycardia (VT) were detected in one patient and either self-terminated or successfully cardioverted following unsuccessful ATP. One patient received an inappropriate shock secondary to lead tip displacement with subsequent P-wave oversensing. Elective chronic defibrillation testing was performed at physician discretion and converted 5 of 5 patients with ≤40 J (maximum energy of device). Three patients had the system electively removed due to 1) inappropriate shock after lead displacement, 2) recurrent VT without ATP termination, and 3) inadequate chronic safety margin for defibrillation.

Conclusions
The EV ICD is a novel platform for delivering high voltage therapy. Chronic system performance has generally remained stable during 12 months of follow-up and the device has demonstrated the ability to detect and treat VT.
Fluoro images of implanted system

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Medtronic plc
Impact of left atrial appendage morphology on the silent cerebral infarction after cryoballoon ablation for atrial fibrillation
Authors: Yakabe D , Aso A , Fukuyama Y , Araki M , Nakamura T 
Published: November 2020

Abstract

Aims
Cryoballoon ablation (CBA) is effective for atrial fibrillation (AF), however acute silent cerebral infarction (SCI) is not uncommon after CBA. This study aimed to clarify the relationship between the morphology of LAA and SCI.

Methods and results
From 2015 to 2019, 207 consecutive patients (65.1±11.4 years, 26.6% of female, 31.4% of persistent AF) who underwent CBA for AF at our hospital were enrolled. All patients were evaluated with computed tomography for LAA before CBA and divided into two groups as chicken wing (CW) group and non-CW group. SCI was evaluated with magnetic resonance imaging at the following day after CBA. As a result, 18.4% of patients have occurred SCI after CBA. Although the patients' background didn't differ between the two groups, the Hounsfield scale (LAA/Aorta ratio) was lower (non-CW vs. CW = 0.68±0.12 vs. 0.73±0.11, p=0.004), and LAA orifice size tended to be larger (16.9±4.6 vs. 15.8±4.1, p=0.053) in non-CW group. SCI significantly occurred in non-CW group (29.5% vs. 11.6%, p=0.003), especially in cauliflower shape of 45.0%. In multivariate analysis, non-CW (p=0.002, Odds ratio 3.2, 95% of CI 1.5–7.0), skipped DOAC before CBA (p=0.04, Odds ratio 6.1, 95% of CI 1.1–115.4), and touch-up ablation in left atrium (p=0.02, Odds ratio 2.8, 95% CI 1.2–6.5) were independent predictors of SCI.

Conclusions
SCI was not rare after CBA for AF. Morphology of LAA was strongly associated with SCI.

Funding Acknowledgement
Type of funding source: None
First clinical experience with KODEX-EPD: a novel dielectric imaging and navigation system for catheter ablation
Authors: Abeln B.G.S , Simmers T.A , Maarse M , Van Dijk V.F , Wijffels M.C.E.F , Balt J.C , Boersma L.V.A , Dekker L.R.C 
Published: November 2020

Abstract

Background
Current electroanatomic mapping systems for catheter ablation often require pre-procedural cardiac imaging, and special catheters. KODEX-EPD is a novel open-platform system that uses dielectric imaging to provide real-time, high-resolution cardiac images, with a potential for tissue characterisation and wall thickness to guide ablation.

Purpose
We report our initial experience with the KODEX-EPD system.

Methods
The KODEX-EPD uses body surface patches (“sensors”) to emit and receive radiofrequency waves across the thorax. Anatomical structures cause gradients in the electrical field, which are measured by a standard electrophysiology catheter and used to generate an anatomical shell of the cardiac chambers. The system requires no direct physical surface contact or fluoroscopy to acquire anatomical information. If direct physical surface contact is added, a voltage map can be created. After mapping with the KODEX-EPD, ablation was continued according to standard of care using radiofrequency or cryoablation.

Results
Since November 2019, 26 patients were included (mean age 57.7 (±13.2), 16 (61.5%) male). Ablations were performed for atrial fibrillation in 13 (50.0%) patients, atrial flutter in 10 (38.5%), atrial tachycardia in 1 (3.8%), AVNRT in 1 (3.8%), AVRT in 2 (7.7%) and ventricular extrasystole in 2 (7.7%). The median procedure time was 99.5 [68.8; 112.3] minutes, and fluoroscopy time 14.4 [10.0; 16.9] minutes. All procedures were successful. No adverse events occurred during follow up.

Conclusion
KODEX-EPD is a novel electroanatomic system for cardiac mapping as well as anatomical imaging that can be safely and effectively utilised for a variety of cardiac arrhythmia ablations. Future versions will allow wall thickness measurement and lesion quality to optimise the ablation process.
KODEX-EPD CTI Ablation

Funding Acknowledgement
Type of funding source: None
Increased left ventricular stiffness assessed by diastolic wall strain causes symptoms in patients with premature ventricular contraction
Authors: Fukuhara E , Mine T , Kishima H , Ishihara M 
Published: November 2020

Abstract

Background
Premature ventricular contraction (PVC) is one of common arrhythmias and only some patients complain of PVC-related symptoms, however the mechanisms which cause the symptoms remain unclear in patients with PVCs.

Purpose
We investigated whether the left ventricular (LV) stiffness assessed by diastolic wall strain (DWS) relate symptoms or not in patients with PVC.

Methods
We studied 109 patients (48 males, age 60±19) with frequent monomorphic PVCs who underwent 12-leads electrocardiogram (ECG), signal-averaged electrocardiogram (SAECG), 24h-Holter ECG recording, and transthoracic echocardiography (TTE). Patients with structural heart disease or other arrhythmias such as atrial fibrillation were excluded. Clinical factors, blood samples for atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), and filtered QRS duration (f-QRS) and root mean square voltage of the terminal 40ms of the QRS complex (RMS40) obtained by SAECG were evaluated. We assessed PVC-SV (stroke volume during PVC), PVC-CI (CI between the previous sinus beat and VPC), and left ventricular (LV) stiffness assessed by diastolic wall strain (DWS). DWS was calculated from the M-mode echocardiographic measurement of the LV posterior wall thickness at end-systole (PWs) and end-diastole (PWd) during sinus rhythm, and DWS was defined as (PWs − PWd)/PWs.

Results
31patients (28%) had PVC-related symptoms (18 palpitation and 13 pulse deficit). Patients with PVC-related symptoms showed shorter PVC coupling interval index (52±10 vs. 58±11%, p=0.0140), reduced PVC-SV (21±12 vs. 29±17ml, p=0.0103) and decreased DWS (0.38±0.06 vs. 0.42±0.06, p=0.0011). Meanwhile, the level of BNP and ANP, f-QRS, RMS40, QRS morphology of PVC and the total number of PVC per day were not associated with PVC-related symptoms. On multivariate analysis, decreased DWS was only independently associated with PVC-related symptoms (p=0.0357, OR 2.3629 for each 0.1 decrease in DWS 95% CI 1.0583–5.5815).

Conclusion
The reduced diastolic wall strain relates with PVC-related symptoms. The increased left ventricular stiffness might cause symptoms in patients with PVC.

Funding Acknowledgement
Type of funding source: None
High bodyweight variability and increased risk of atrial fibrillation in patients with type 2 diabetes mellitus
Authors: Lee H.J , Choi E.K , Han K.D , Kim D.H , Lee E , Lee S.R , Oh S , Lip G.Y.H 
Published: November 2020

Abstract

Background
Bodyweight variability is a risk factor for atrial fibrillation (AF), but this has not been studied with a focus on patients with diabetes mellitus (DM).

Methods
A nationwide population-based cohort of 670,797 patients with type 2 DM from the Korean National Health Insurance Service database without a history of AF and with ≥3 measurements of body weight over a 5-year period were followed up for AF development. Intra-individual bodyweight variability was calculated using variability independent of mean (VIM), and high bodyweight variability was defined as the quintile with the highest variability with the lower four quintiles as reference.

Results
During a median of 7.0 years of follow-up, 22,019 patients (3.3%) were newly diagnosed with AF. Risk of incident AF was increased in those in the highest quintile of bodyweight variability, after adjustment for baseline body mass index (BMI), age, sex, lifestyle factors, comorbidities, number of oral anti-diabetic medication, insulin use, duration of DM, and fasting glucose (HR 1.16, 95% CI 1.12–1.20). High bodyweight variability was significantly associated with AF development regardless of baseline BMI group and direction of overall weight change. This association was stronger in subjects with lower BMI, those on insulin, and those with a DM duration of greater than 5 years.

Conclusions
High bodyweight variability was associated with AF development, independently of traditional cardiovascular risk factors and baseline BMI. This association was stronger in underweight patients and in advanced diabetic stage.

Funding Acknowledgement
Type of funding source: None
Impact of new onset atrial fibrillation on long-term prognosis in patients with acute ST-segment elevation myocardial infarction
Authors: Baturova M.A , Demidova M.M , Carlson J , Erlinge D , Platonov P.G 
Published: November 2020

Abstract

Introduction
New onset AF is a known complication in patients with acute ST-segment elevation myocardial infarction (STEMI). However, whether new-onset AF affects the long-term prognosis to the same extent as pre-existing AF is not fully clarified and prescription of oral anticoagulants (OAC) in patients with new-onset AF remains a matter of debates.

Purpose
We aimed to assess the impact of new-onset AF in STEMI patients undergoing primary percutaneous intervention (PCI) on outcome during long-term follow-up in comparison with pre-existing AF and to evaluate effect of OAC therapy in patients with new-onset AF on survival.

Methods
Study sample comprised of 2277 consecutive patients with STEMI admitted to a tertiary care hospital for primary PCI from 2007 to 2010 (age 66±12 years, 70% male). AF prior to STEMI was documented by record linkage with the Swedish National Patient Register and review of ECGs obtained from the digital archive containing ECGs recorded in the hospital catchment area since 1988. SWEDEHEART registry was used as the source of information regarding clinical characteristics and events during index admission, including new-onset AF and OAC at discharge. All-cause mortality was assessed using the Swedish Cause-of-Death Register 8 years after discharge.

Results
AF prior to STEMI was documented in 177 patients (8%). Among patients without pre-existing AF (n=2100), new-onset AF was identified in 151 patients (7%). Patients with new-onset AF were older than those without AF history (74±9 vs 65±12 years, p&lt;0.001), but did not differ in regard to other clinical characteristics. Among 2149 STEMI survivors discharged alive, 523 (24%) died during 8 years of follow-up. OAC was prescribed at discharge in 45 (32%) patients with new onset AF and in 49 (31%) patients with pre-existing AF, p=0.901. In a univariate analysis, both new-onset AF (HR 2.18, 95% CI 1.70–2.81, p&lt;0.001) and pre-existing AF (HR 2.80, 95% CI 2.25–3.48, p&lt;0.001) were associated with all-cause mortality, Figure 1. After adjustment for age, gender, cardiac failure, diabetes, BMI and smoking history, new-onset AF remained an independent predictor of all-cause mortality (HR 1.40, 95% CI 1.02–1.92, p=0.037). OAC prescribed at discharge in patients with new-onset AF was not significantly associated with survival (univariate HR 0.86, 95% CI 0.50–1.50, p=0.599).

Conclusion
New-onset AF developed during hospital admission with STEMI is common and independently predicts all-cause mortality during long-term follow-up after STEMI with risk estimates similar to pre-existing AF. The effect of OAC on survival in patients with new-onset AF is inconclusive as only one third of them received OAC therapy at discharge.
Kaplan-Meier survival curve

Funding Acknowledgement
Type of funding source: None
Telomere length is associated with atrial fibrillation
Authors: Sinner M , Kupka D , Wilfert W , Waldenberger M , Peters A , Holdt L , Kaab S 
Published: November 2020

Abstract

Background
Atrial Fibrillation (AF) is common and is caused and predisposed to by a complex pathophysiology. Aging is among the most important risk factors for AF. Yet, some individuals develop AF in early years, whereas elderly individuals may remain free of AF. Aside from measurable concomitant risks, we hypothesized that a pathophysiologically relevant biological age exists, which outweighs a patient's calendar age. Telomere length is a measurable marker of age, which might reflect biological age. AF and telomere length have previously been associated, but results remained controversial. Here, we tested the relation between AF and telomere length in a well-characterized and so far largest cohort.

Methods
Since 2005, we enrolled 2475 patients with AF from the prospective AFLMU cohort, preferentially if they developed AF before age 65 years, and 3077 control individuals free of AF from the community-based KORA Study between 2006–08. All participants received a detailed clinical characterization, an electrocardiogram, and a blood draw for biomarker analyses. In all participants, we determined telomere length using a qPCR-based method. In a 384 well format, we employed a multiplex TaqMan assay to determine both telomere length and the single copy gene 36B4. Telomere length was expressed by the delta-CT method and was reformatted to have lower CT values indicate shorter telomere length. We compared telomere length between cases and controls using multi-variably corrected logistic regression models.

Results
Our cohort's mean age was 58 years in AFLMU and 56 years in KORA F4. Men were enrolled more commonly, with 72.3% in AFLMU and 51.7% in KORA F4. For consistency with available information, we confirmed that telomere length is continuously decreasing with age and that men have shorter telomere length compared to women. As a main result we found that AF patients have significantly shorter telomere length compared to controls (controls: telomere length 13,10 [12.60, 13.63] versus AF: 9.81 [5.98, 13.1], p&lt;0,001). This relation remained significant following multi-variable adjustment for sex, body mass index, hypertension, and diabetes. The odds ratio per unit longer telomer length was 0.77 [95% confidence interval 0.74–0.77], p&lt;0.001. We also calculated a propensity-score matched model of cases with and without AF confirming our main results (controls: telomere length 13.21 [11.65, 13.67] versus AF: 9.03 [5.35, 12.54], p&lt;0.001). The multi-variable adjusted model revealed an odds ratio of 0,75 [95% confidence interval 0.73–0.76], p&lt;0.001.

Conclusion
AF is significantly associated with telomere length in one of the largest cohorts to date. Assessment of telomere length may adjudicate patients with AF due to premature biological aging. The underlying reasons for such premature aging remain to be identified.

Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): European Commission - Horizon 2020
Is implantable loop recorder the answer to reduce the increased risk of stroke in cancer patients?
Authors: Ali H , Tahir M.W , Rai D , Tahir Z , Dawdy J , Kabashneh S , Lieberman R 
Published: November 2020

Abstract

Introduction
Recent epidemiologic data suggests increased risk of ischaemic stroke in cancer patients. The etiology of increased ischaemic stroke is unknown. Atrial fibrillation (AF) is among the potential etiologies. The risk of AF has not been studied among cancer patients in the United States.

Purpose
Ascertain the association of AF in cancer patients in the USA by using the largest database i.e. National Inpatient Sample (NIS).

Methods
Patients ≥18 years old were selected in the NIS database for years 2010 to 2014 and stratified based on presence or absence of any of four cancers (lung, colon, breast and prostate; 4CA) using ICD 9 codes. Atrial fibrillation and stroke/TIA were also identified using ICD 9 codes. Components of CHADS2 score (CHF, hypertension, Age&gt;75, diabetes and stroke/TIA) were identified using ICD 9 codes. χ2 tests performed for prevalence of AF in patients with or without these cancers stratified by CHADS2 score. Binary logistic regression was used to analyze individual components of CHADS2 score.

Results
AF and stroke/TIA were significantly higher among 4CA than non-4CA group (18.7% vs 12.0%, P&lt;0.001 and 5.4% vs 4.8%, P&lt;0.001 respectively). AF prevalence increased with CHADS2 and was significantly higher in 4CA group with CHADS2 score 0 to 4 (Table 1 and Figure 1). Logistic regression for the outcome of AF showed “Age &gt;75” OR (3.0), CHF (2.8), CVA (1.2), HTN (1.3) and DM (1.1).

Conclusion
This is the first study using a national database of USA patients to estimate prevalence of AF in cancer patients compared to non-cancer patients and reaffirms the higher burden of AF in cancer patients. Prevalence of both AF and stroke were greater in cancer patients when stratified by CHADS2 score. This may indicate not just an increased risk of AF but an increased risk of stroke/TIA for the same CHADS2 score. Stroke incidence was also higher in the 4CA group (5.4% vs. 4.8% P&lt;0.001). Cancer patients with CHADS2 score &gt;1 may benefit from screening with loop recorder to identify previously undetected AF and initiate anticoagulation therapy. Prospective longitudinal studies are needed to validate this retrospective study.

Funding Acknowledgement
Type of funding source: None
Risk of ischemic stroke in patients with acute myocardial infarction and new atrial fibrillation: a nationwide analysis
Authors: Fauchier L , Bisson A , Bodin A , Herbert J , Genet T , Ma I , Ivanes F , Clementy N , Pierre B , Babuty D , Angoulvant D , Danchin N 
Published: November 2020

Abstract

Background
In patients with acute myocardial infarction (AMI), history of atrial fibrillation (AF) and new onset AF during the early phase may be associated with a worse prognosis. Whether both conditions are associated with a similar risk of stroke and should be similarly managed is a matter of debate.

Methods
Based on the administrative hospital-discharge database, we collected information for all patients treated with AMI between 2010 and 2019 in France. The adverse outcomes were investigated during follow-up.

Results
Among 797,212 patients with STEMI or NSTEMI, 146,922 (18.4%) had history of AF, and 11,824 (1.5%) had new AF diagnosed between day 1 and day 30 after AMI. Patients with new AF were older and had more comorbidities than those with no AF but were younger and had less comorbidities than those with history of AF. Both groups with history of AF or new AF had less frequent STEMI and anterior MI, less frequent use of percutaneous coronary intervention but more frequent HF at the acute phase than patients with no AF. During follow-up (mean [SD] 1.8 [2.4] years, median [interquartile range] 0.7 [0.1–3.1] years), 163,845 deaths and 20,168 ischemic strokes were recorded.
Using Cox multivariable analysis, compared to patients with no AF, history of AF was associated with a higher risk of death during follow-up (adjusted hazard ratio HR 1.06 95% CI 1.05–1.08) while this was not the case for patients with new AF (adjusted HR 0.98 95% CI 0.95–1.02). By contrast, both history of AF and new AF were associated with a higher risk of ischemic stroke during follow-up compared to patients with no AF: adjusted hazard ratio HR 1.29 95% CI 1.25–1.34 for history of AF, adjusted HR 1.72 95% CI 1.59–1.85 for new AF. New AF was associated with a higher risk of ischemic stroke than history of AF (adjusted HR 1.38 95% CI 1.27–1.49).

Conclusion
In a large and systematic nationwide analysis, AF first recorded in the first 30 days after AMI was associated with an increased risk of ischemic stroke. Specific management should be considered in order to improve outcomes in these patients after AMI.

Funding Acknowledgement
Type of funding source: None