bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1833The c-fos mRNA expression reveals persistent myocardial stretch in the right ventricle during asphyxiated cardiac arrest
Authors: Kadowaki S , Yamazaki S , Kotani Y , Tsuji T , Sakoda N , Kobayashi Y , Horio N , Goto T , Muraoka G , Ozawa S , Suezawa T , Kuroko Y , Tateishi A , Shimizu S , Kasahara S 
Published: October 2019

Abstract

Background
Donation after circulatory death (DCD) heart transplantation has been debated over the past decades because of the shortage of donor. The right ventricular dysfunction is one of the remaining problems for clinical implication of DCD heart transplantation. DCD hearts suffering from the volume overload have a potential to aggravate the right ventricular dysfunction after heart transplantation. The c-fos mRNA is one of the “immediate” response genes to mechanical stresses, such as myocardial cell stretch, without neural and humoral factors. In this study, we assessed myocardial stretch during asphyxiated cardiac arrest using c-fos mRNA expression.

Purpose
The purpose of this study is to reveal the impact of right ventricular volume overload during asphyxiated cardiac arrest.

Methods
Male Wistar rats (8 weeks of age, n=18) were anesthetized with paralyzed ventilation. The trachea was dissected and ligated to initiate asphyxiation. Hearts were harvested at 3 time points: 0, 15 and 30 minutes after termination of the ventilation. Free walls of right and left ventricle were sectioned and immersed in RNA stabilization solution as soon as possible. Total RNA was extracted from these tissues using a guanidine thiocyanate-phenol-chloroform method and cDNA was synthesized using a reverse transcriptase. Next, we measured the quantified expression level by using the droplet digital PCR method with a probe and primers for c-fos gene. Expression of c-fos level was divided by extracted TATA binding protein (TBP) level as a control marker, the ratio of c-fos and TBP was used in analysis.

Results
In the left ventricle, the expression of c-fos rapidly increased by 15 minutes (0.81±0.24 (c-fos/TBP), p<0.05 by one-way ANOVA followed by the Dunnett's test) compared to at 0 minutes (0.21±0.06), but the expression level recovered to the baseline level at 30 minutes after termination of the ventilation (0.19±0.03). On the other hand, in the right ventricle, the c-fos expression was gradually elevated and peaked at 30 minutes (0.88±0.20, p<0.05 by the Dunnett's test) compared to at 0 minutes (0.22±0.05).

Conclusion
These results suggest that the volume overload to the right ventricle during asphyxiated cardiac arrest prolongs compared to that to the left ventricle, which may cause the right ventricular dysfunction after DCD heart transplantation.
P1862Phrenic nerve damage after atrial fibrillation ablation using second generation cryoballoon
Authors: Yorgun H , Oksul M , Sener Y Z , Canpolat U , Evranos B , Ates A H , Aytemir K 
Published: October 2019

Abstract

Background
Cryoballoon (CB) ablation is a safe alternative to radiofrequency ablation in the treatment of atrial fibrillation (AF). However, phrenic nerve damage (PND) is a bothersome complication of the procedure.

Purpose
In this study, we aimed to establish the incidence of PND during CB and define the characteristics of affected patients.

Methods
In this retrospective analysis, all patients with AF that underwent CB ablation between 2013 and 2018 were included into the study. Characteristics and outcomes of patients complicated with PND were evaluated. PND was detected by palpation of diaphragma contractions or observation of reduced diaphragma motility by fluoroscopy during the procedure.

Results
Totally 653 patients were included in the study. PND was detected in 3.5% (23/653) of the patients. Median age of the patients with PNP was 56 (25–78) years and 10 patients (43.4%) were male. The most common ablation site related with PND was right superior pulmonary vein (RSPV) (18 patients, 78%). Transient PND was observed in 16 patients (69%) of the patients which resolved within 24 hours after the procedure. In the remaining 5 patients (21%) diaphragmatic contraction was recovered at the 6th month control visit. In 2 patients (10%), phrenic nerve paralysis was still present >1 year visit.
Table 1. Baseline characteristics of patients with PND Age (years), median (min–max) 56 (25–78) Gender, n (male %) 10 (43.4%) Hypertension, n (%) 9 (39.1%) LA (mm), (mean ± sd) 38.5±5.8 EF (%), (mean ± sd) 60.8±6.5 Structrual heart disease, n (%) 3 (0.13%) – HCMP 2 (0.087%) – DCMP 1 (0.043%) DCMP: Dilated cardiomyopathy; HCMP: Hypertrophic cardiomyopathy; EF: Ejection fraction; LA: Left atrium; PND: Phrenic nerve damage.

Conclusion
PND is not a rare complication of CB ablation despite all the preventive maneuvers during the procedure and technological developments. However, most of the PND recovered during the follow-up.
P1865Incidence and predictors of invasively-treated pericardial effusion during catheter ablation of atrial fibrillation in Japan
Authors: Murakawa Y , Yamane T , Goya M , Inoue K , Naito S , Miyauchi Y , Morita N , Nogami A , Shoda M , Okumura K , Hirao K 
Published: October 2019

Abstract

Purpose and method
Japanese Heart Rhythm Society requested electrophysiology centers to register the data of patients who underwent catheter ablation for atrial fibrillation (AF) in designated eight months from 2011 to 2017. We assessed the incidence and predictors of pericardial effusion (PE) as an early complication of AF ablation.

Results
More than two hundred EP centers reported the data of 13,233 AF ablation cases (age; 64.2±10.7 years, male; 72.6%, paroxysmal AF; 63.4%). Clinically significant complications occurred in 601 subjects (4.5%). Critical PE occurred in 116 patients (0.8%), while six of them required open-chest surgery. Overall complication rate did not show significant changes. In contrast, incidence of PE declined over time (2012:1.2%, 2017:0.5%, p=0.003). Multiple logistic regression analysis showed that seven factors were related with higher incidence of PE. Among these factors, primary extra-PV ablation and hypertrophic cardiomyopathy (HCM) were more remarkably associated with higher rate of PE (PVI[−] vs. PVI[+]= 9.0% vs. 0.8%, OR 12.3, p<0.001; HCM: [+] vs. [−] = 2.6% vs. 0.8%, OR 3.26, p=0.001). Comorbidity of coronary artery disease (CAD) and use of CARTO system were related with lower PE rate (CAD: [+] vs [−] = 0.2% vs. 0.9%, OR 0.22 [p=0.034], CARTO: [+] vs [−] = 0.7% vs. 1.2%, OR 0.52 [p=0.001]). None of cryobaloon ablation, gender, type of AF, center volume, periprocedural oral anticoagulant, or left atrial diameter was significantly related with the occurrence of PE.

Conclusions
Incidence of critical PE decreased recently. HCM and primary extra-PV ablation were outstanding predictors of critical PE.
P1866Catheter-ablation of paroxysmal atrial fibrillation is associated with improvement of maximal cardiopulmonary exercise capacity
Authors: Mujovic N , Marinkovic M , Nedeljkovic I , Banovic M , Markovic N , Potpara T 
Published: October 2019

Abstract

Background and purpose
Catheter-ablation (CA) of paroxysmal atrial fibrillation (AF) is associated with improvement in symptoms and quality of life (QoL), whilst the effects on functional capacity are underreported. We studied the change in cardiopulmonary exercise testing (CPET) indices of functional capacity from baseline to follow-up in patients undergoing their first CA for paroxysmal AF.

Methods
Consecutive patients who underwent their first CA for paroxysmal AF in our center during 2015, with a >12-month post-procedural follow-up were included. All patients completed the CPET and SF-36 (Short Form Health Survey) questionnaire to evaluate maximal functional capacity and QoL, respectively, at baseline (prior to CA) and 1 year post-CA. The follow-up 24h-Holter-monitoring was performed at 1, 3, 6 and 12 months after CA; finding of any atrial tachyarrhythmia lasting >30 sec was considered the arrhythmia recurrence.

Results
Study group consisted of 50 patients (the mean age 57±12 years, males 76%). The mean left ventricular ejection fraction and left atrial diameter were 61±8% and 41±6 mm, respectively. All patients were free of heart failure; the commonest comorbidities were hypertension (65%) and diabetes mellitus (21%). The follow-up CPET 1 year post CA demonstrated an improvement in maximal functional capacity compared to baseline values, with significant increase in maximal load (123±38 vs. 134±33 W, p=0.012), peak oxygen consumption (VO2max, 18±5 vs. 20±4 mL kg–1 min–1, p=0.001) and peak breathing equivalent (EQ-O2, 28±4 vs. 29±4, p=0.020). The AF-free patients (n=40) had a greater 1-year improvement in work time (22±129 vs. −71±123 sec, p=0.008) and maximal load (15±24 vs. −6±26 W, p=0.005) compared with those expiriencing AF recurrence post-CA (n=10). There was a significant correlation between the 1-year change in SF-36 score and the increase in maximal load (ρ=0.26, p=0.018) and between the 1-year change in SF-36 score and the prolongation of work time (ρ=0.27, p=0.017).

Conclusion
Our study suggests that CA of paroxysmal AF favourably affects the maximal functional capacity, especially in patients with stable sinus rhythm following the procedure. The increase in functional capacity is followed by QoL improvement. This should be considered in treatment decision-making.
P1870Predicting mortality and mode of death by clinical score systems for patients with atrial fibrillation
Authors: Fauchier L , Bisson A , Bodin A , Clementy N , Pierre B , Angoulvant D , Babuty D , Hanon O , Lip G 
Published: October 2019

Abstract

Atrial fibrillation (AF) is associated with a higher mortality, but modes of death may vary and their respective predictors have been insufficiently defined. Charlson comorbidity index (CCI) is a tool to measure comorbid disease status and a strong estimator of mortality. The quantifiable frailty phenotype is also predictive of mortality and disability and claims data can be used to classify individuals as frail and non-frail using the Claims-based Frailty Index (CFI). We evaluated whether these tools may help to predict mortality and the different modes of death in AF.

Methods
All patients with AF seen in an academic institution were identified and followed up for mortality. CHA2DS2VASc score, CCI and CFI were calculated for each patient. Predictive abilities of the scores were compared using the c-statistic.

Results
Among 8962 consecutive patients with AF, 1294 patients died during a follow-up of 929±1082 days (median 456), (yearly rate 5.5%) and 97% of causes of death were identified (54% cardiovascular and 43% non-cardiovascular). Death occurred more often in patients with higher CHA2DS2VASc scores, CCI and CFI. CFI was a better predictor of total mortality than CCI and CHA2DS2VASc score (table). CFI was also a better predictor of cardiovascular mortality than CCI and CHA2DS2VASc score. Finally, CFI was also a better predictor of non-cardiovascular mortality than CCI and CHA2DS2VASc score. The predictive performances of the 3 tools were better for cardiovascular death than for non-cardiovascular death.
Prediction of mode of death ROC area (95% C) p vs CHA2DS2VASc/Charlson Total mortality CHA2DS2VASc 0.651 (0.636–0.665) – / 0.0001 CHARLSON (CCI) 0.687 (0.672–0.702) 0.0001 / – Frailty index (CFI) 0.714 (0.700–0.729) <0.0001 / <0.0001 Cardiovascular death CHA2DS2VASc 0.673 (0.654–0.692) – / 0.004 CHARLSON (CCI) 0.707 (0.688–0.726) 0.004 / – Frailty index (CFI) 0.737 (0.719–0.756) <0.0001 / <0.0001 Non cardiovascular death CHA2DS2VASc 0.590 (0.567–0.612) – / 0.0008 CHARLSON (CCI) 0.637 (0.614–0.659) 0.0008 / – Frailty index (CFI) 0.650 (0.628–0.672) <0.0001 / 0.008

Conclusion
Frailty assessed with CFI demonstrated better performances in predicting total mortality, cardiovascular mortality and non-cardiovascular mortality than CHA2DS2VASc score and Charlson comorbidity index in AF patients. Identifying the risk of non-cardiovascular death with simple tools remains a more difficult challenge in these patients.
P1871Bodyweight variability and atrial fibrillation development
Authors: Lee H , Choi E K , Han K D , Oh S 
Published: October 2019

Abstract

Background
Bodyweight fluctuation is a risk factor for cardiovascular events and death. We investigated whether bodyweight variability is also a risk factor for atrial fibrillation (AF) development.

Methods
A nationwide population-based cohort of 8,091,401 adults from the Korean National Health Insurance Service database without previous history of AF and with at least 3 measurements of bodyweight over a 5-year period was followed up for incident AF. Intra-individual bodyweight variability was calculated using variability independent of mean, and high bodyweight variability was defined as the quartile with highest bodyweight variability (Q4) with Q1–3 as reference.

Results
During median 8.1 years of follow-up, AF was newly diagnosed in 158,347 (2.0%). Increasing bodyweight variability was associated with AF development after adjustment for baseline bodyweight, height, age, sex, lifestyle factors and comorbidities: each increase of 1-SD in bodyweight variability was associated with 5% increased risk of AF development (hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.04–1.05), and subjects with highest bodyweight variability (Q4) showed 14% increased risk of AF development compared to those in the quartile with lowest bodyweight variability (HR 1.14, 95% CI 1.12–1.15).
When the cohort was grouped by body mass index (BMI) into underweight, normal weight, overweight, obese (Figure 1A), subjects with high bodyweight variability showed a shallow U-shaped relationship of BMI with AF incidence, with the highest incidence rate of AF in the underweight group. On the other hand, subjects with reference bodyweight variability showed a proportional increase of AF incidence with BMI, with the highest AF incidence in the obese group. High bodyweight variability was significantly associated with AF development in all BMI groups except in the very obese (BMI≥30) in multivariable analysis, and this association was stronger in subjects with lower bodyweight. In underweight subjects, high bodyweight variability was associated with 16% increased risk of AF development (HR 1.16, 95% CI 1.08–1.24). Obese subjects with high bodyweight variability compared to those with reference variability showed lower crude AF incidence rates, but after multivariable analysis, AF risk was increased (obese stage I) or comparable (obese stage II).
When the cohort was grouped by total bodyweight change (Figure 1B), subjects with high bodyweight variability showed higher AF incidence and elevated AF risk on multivariable analysis in all weight change groups. Subjects with overall weight loss (≥-5%) and high bodyweight variability showed the highest AF incidence and AF risk (HR 1.12, 95% CI 1.09–1.15).
Figure 1

Conclusions
Fluctuation in bodyweight was independently associated with higher risk of AF development. The association of high bodyweight variability with AF development was especially stronger in subjects with lower bodyweight, and in subjects with overall weight loss (≥-5%)
P1878Long-term effect of atrial fibrillation on the evolution of mitral and tricuspid valve regurgitation
Authors: Pype L , Embrechts L , Cornez B , Van Paesschen C , Sarkozy A , Miljoen H , Heuten H , Saenen J , Van Herck P , Van De Heyning C , Heidbuchel H , Claeys M 
Published: October 2019

Abstract

Background
While severe mitral regurgitation is a well-established risk factor for atrial fibrillation (AF), it is less known whether atrial fibrillation induces mitral/tricuspid valve regurgitation (MR/TR). The present study aims to identify the long-term effects of permanent or non-permanent AF on atrial remodelling and on the progression of MR/TR.

Methods
The severity of MR/TR was assessed at baseline and after a period of 65±10 months in 37 patients with permanent AF, in 80 patients with non-permanent AF (of whom 43 were treated with ablation) and in 53 control patients with persistent sinus rhythm. MR/TR was qualitatively assessed by the multi-integrative approach, and quantitatively by measurement of the colour jet area.

Results
At baseline, AF patients had larger MR jet areas than control patients. At follow up, progression of MR, expressed as delta MR jet area, was 0.05±1.3 cm2 in the control group, 0.73±2.1 cm2 in the non-permanent AF group and 1.95±3.6 cm2 in the permanent AF group (p=0.001). Severe MR at follow up was observed in 0%, 2.5%, 8%, respectively. After adjustment for baseline clinical and echocardiographic parameters, permanent AF remained independently associated with the progression of MR. There was a significant positive correlation between a progression of MR and an increase in left atrial volume index (r=0.31, p<0.001). Although rhythm control in non-permanent AF patients was better with AF ablation than with medical treatment only, the MR evolution was similar (delta MR jet area: 0.85±2.05 cm2 vs 0.61±2.12 cm2, p=0.6). Comparable findings, albeit less pronounced, were observed for the association between of AF and TR progression.
MR jet area

Conclusions
The presence of longstanding AF is associated with a significant progression of MR/TR mainly due to atrial remodelling. Our data showed a beneficial effect of sustained rhythm control, either medically or by ablation, on MR/TR progression.
P1879Characterization of cardiac diagnostic care pathways by indication and physician specialty in a real-world dataset of 314,554 patients
Authors: Landman S , Sarkar S 
Published: October 2019

Abstract

Background
A variety of modalities exist for diagnosing cardiac arrhythmias via ambulatory ECG recording. These can range from short-term (i.e. ≤48 hours) holter monitoring, medium-term external monitoring for up to 30 days, and long-term monitoring via an implantable cardiovascular monitor (ICM).

Purpose
To quantify the prevalence of different diagnostic care pathways for cardiac arrhythmias in a large, real-world dataset.

Methods
A de-identified database of aggregated EHR data from 2015–2017 was used to identify patients with any procedure or service received for an ambulatory cardiac diagnostic monitor. Three categories of diagnostic monitoring technologies were identified: (1) Holter monitoring for up to 48 hours, (2) External ECG and event monitoring for up to 30 days via external loop recorder, mobile cardiac telemetry (MCT), or other external ECG recording device, and (3) ICMs. Patients with their first monitor in 2015 or later were selected. The number of patients that had their initial monitor in each of the different categories were quantified, as well as the number that followed a care pathway progression from shorter-term to longer-term monitoring. Patients were grouped by clinical history (syncope or ischemic stroke diagnosis codes in the 6 months prior) as well as by whether they had a clinical interaction with an electrophysiologist (EP) at any point in their care pathway.

Results
A total of 314,554 patients were identified with a mean follow-up duration of 340.1±232.5 days. The initial monitor type used across all patients was 68.8% holter, 27.7% extended holter/MCT/external loop recorder, and 3.5% ICMs. 5.1% of all patients received multiple categories of monitoring. 50,812 patients had a prior history of syncope, 46.4% of which were seen by an EP. 28,374 patients had a prior history of ischemic stroke, with 50.9% seen by an EP. The figure shows that patients seen by an EP are more likely to receive ICMs than those not seen by an EP (20.6% vs. 3.8% for syncope; 25.3% vs. 5.7% for stroke; both p<0.001). Patients seen by an EP are also more likely to receive multiple categories of progressively-longer monitoring than those not seen by an EP (10.4% vs. 4.6% for syncope; 8.3% vs. 4.0% for stroke; both p<0.001).

Conclusion
Cardiac diagnostic care pathways for syncope and ischemic stroke are significantly different between those patients that are seen by an EP versus those that are not. Relatively few patients overall received multiple types of cardiac diagnostic monitoring.

Acknowledgement/Funding
Medtronic
P1905Propofol suppresses atrial fibrillation in an experimental whole-heart model
Authors: Ellermann C , Koenemann H , Wolfes J , Eckardt L , Frommeyer G 
Published: October 2019

Abstract

Background
Many clinical studies suggest an impact of propofol on the occurrence of atrial arrhythmias.

Purpose
Since experimental data is sparse, purpose of this study was to investigate the influence of propofol on atrial electrophysiology and the vulnerability to atrial fibrillation in a sensitive whole-heart model of atrial fibrillation.

Methods
11 hearts of New Zealand white rabbits were isolated and Langendorff-perfused. Two catheters were placed on both atria to record atrial monophasic action potentials. Hearts were stimulated at three different cycle lengths (350ms, 250ms, 150ms), thereby obtaining cycle-length dependent atrial action potential durations (aAPD90) and effective refractory periods (aERP). Atrial post-repolarization (aPRR) refractoriness was defined as the difference between aERP and aAPD90.
To increase the occurrence of atrial fibrillation, hearts were perfused with a combination of acetylcholine (ACh, 1μM) and isoproterenol (Iso, 1μM) after obtaining baseline data. Vulnerability to atrial fibrillation was tested by a standardized protocol consisting of several trains of burst pacing.

Results
Acetylcholine/isoproterenol infusion reduced aAPD90 (−3ms), aERP (−16ms) and aPRR (−14ms). Additional treatment with propofol prolonged aAPD90 (+5ms), aERP (+24ms) and aPRR (+20ms).
Under baseline conditions, 13 episodes of atrial fibrillation lasting longer than 1s occurred. Additional treatment with acetylcholine/isoproterenol provoked more episodes of atrial fibrillation (33 episodes, p<0.05). Infusion of propofol on top of acetylcholine/isoproterenol significantly suppressed atrial fibrillation (2 episodes, p<0.05).

Conclusion
In this study, propofol prolonged aAPD90 and significantly reduced the occurrence of atrial fibrillation. Prolongation of effective refractory periods and especially of post-repolarization refractoriness protects the atrial myocardium against premature excitation and thereby prevents arrhythmias.