bluuebunny/crossref_metadata_2025_split huggingface dataset:
1269The SADS heart of the matter: a review of the sudden arrhythmic death syndrome (SADS) biobank - the cornerstone of a national strategy
Authors: Carron J , O"brien J , Heverin K , Gallagher M , Fitzgibbon M , Fabre A , Mcgorrian C , Galvin J 
Published: June 2020

Abstract

Background
Sudden cardiac death (SCD) in the young (age 1-35) is commonly attributed to structural and arrhythmogenic syndromes, for which there is often an underlying genetic basis. Expert recommendation emphasises the importance of genetic testing in such cases, however to date this remains the first and only national programme in Europe to facilitate this.

Aim
To review detection rates of genetic variants in samples tested via the SADS BioBank and possibly demonstrate the merits of this novel resource for primary prevention for family members.

Methods
Family screening and consent for genetic testing was carried out in the Family Heart Screening Clinic. Result analysis of samples sent for molecular autopsy via the BioBank from its induction in January 2015 was performed. Genetic analysis was conducted via the same internationally accredited next generation sequencing lab.

Results
From January 2015 to July 2019, 161 samples had been stored in the SADS BioBank following confirmed SADS death on autopsy; 33% female and 67% male. Of these, 24 (14.9%) samples were sent for genetic testing: 21 for a 380 gene molecular autopsy and 3 for a targeted hypertrophic cardiomyopathy panel (173 genes). Of 24 samples tested, 10 (42%) yielded positive genetic variants: 4 American College of Medical Genetics (ACMG) Class IV or V mutations considered pathogenic, and 6 ACMG class III variants of uncertain significance (VUS). Familial cascade screening following confirmed pathogenic mutations resulted in detection of 3 (33.3%) positive genotypes in 9 first-degree relatives. Screening of relatives of Class III positive probands resulted in diagnosis of an Inherited Cardiac Condition (ICC) in 25% of first-degree relatives. 8.2% of first-degree relatives of probands with negative gene testing were given an ICC diagnosis following clinical screening.

Conclusions
This short study demonstrates the unique potential the SADS BioBank has to offer in terms of identifying those most at risk and optimising prevention strategies for relatives, thus highlighting the role for such a resource in terms of preventative screening in the future.
Pathogenic Variant (ACMG Class IV & V) Variant of Uncertain Significance(ACMG Class III) No Gene Variant Identified Number Detected (n = 24) 4 6 14 1st Degree Relatives Screened (n = 86) 17 20 49 2nd Degree Relatives Screened (n = 46) 4 23 19 Genotype Detected (n = 4) 3 1 0 Phenotype Detected (n = 10) 1 5 4 Breakdown of clinical and genetic results of family screening by ACMG class.
Abstract Figure.
P962Circumferential pulmonary vein ablation in combination with a linear lesion at the left atrial roof for catheter ablation of persistent atrial fibrillation (8.5-year follow-up)
Authors: Kettering C 
Published: June 2020

Abstract

Background
Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation. Circumferential pulmonary vein ablation is still the standard approach in these patients. However, the results are not very favourable and more complex ablation strategies are the subject of current controversy. Therefore, we have evaluated the effect of an additional linear lesion at the roof of the left atrium on the long-term outcome.

Methods
A total of 220 patients (114 men, 106 women; mean age 69 years (SD ± 14 years)) with symptomatic persistent atrial fibrillation underwent a circumferential pulmonary vein ablation procedure in combination with an additional linear lesion at the roof of the left atrium (group A). After discharge, patients were scheduled for repeated visits at the arrhythmia clinic at 1, 3, 6, 12, 24, 36, 48, 60, 72, 84, 96 and 102 months after the ablation procedure. The long-term follow-up data was compared to 220 patients who underwent circumferential pulmonary vein ablation without an additional linear lesion at the roof of the left atrium (group B).

Results
The ablation procedure could be performed as planned in all patients. Fifty-one out of 220 patients (23.2 %) in group A and 53 out of 220 patients (24.1 %) in group B experienced an arrhythmia recurrence within the first 3 months after ablation requiring an electrical cardioversion. At 102-month follow-up, analysis of a 168-hour ECG recording revealed no evidence for an arrhythmia recurrence in 125/220 patients (56.8 %) in group A and in 103/220 patients (46.8 %) in group B. In 66/220 patients (30.0 %) in group A and 59/220 patients (26.8 %) in group B, only short episodes of paroxysmal atrial fibrillation were documented. In 29 patients (13.2 %) in group A, a recurrence of persistent atrial fibrillation (&gt; 48 hours) was revealed by the long-term recordings (group B: 58 patients (26.4 %)). The lower arrhythmia recurrence rate in group A was partially due to a lower incidence of atypical atrial flutter after catheter ablation. The rate of repeat ablation procedures was significantly lower in group A than in group B. There were no major complications.

Conclusions
Catheter ablation of persistent atrial fibrillation comprising a circumferential pulmonary vein ablation and an additional linear lesion at the roof of the left atrium provides more favourable results than circumferential pulmonary vein ablation alone. The effect is more pronounced during long-term than during short-term follow-up.
P95412 lead Holter monitoring in Brugada syndrome
Authors: Carvalho P , Gravinese C , Previti A , Varalda G P , Montagna L 
Published: June 2020

Abstract

Background
12 lead-Holter monitoring is commonly used for the assessment of type 1 Brugada repolarization"s burden. However, data considering the prevalence and morphology of premature ventricular contractions (PVC) in these patients is lacking.
Purpose. We investigated the prevalence of PVCs in subjects with Brugada syndrome (BRs) phenotype during 24-hour 12 lead-Holter monitoring (12-L Holter), trying to identify their origin according to morphology.
Methods. From January 2013 to September 2018, a total of 156 patients with type 1 BRs phenotype (spontaneous or drug induced) were screened for PVCs. In these patients we placed the right precordial leads at the second (V1-V2) and the forth (V3-V4) intercostal spaces.
Results. 83 subjects (53%) displayed PVCs. Their mean age was 50 years (range 21-73) and 63 (76%) were male. 14 subjects (17%) had a spontaneous type 1 repolarization whereas 69 (83%) presented a drug induced type 1. One patient had implanted an ICD as secondary prevention after an aborted sudden cardiac death. The others were mostly asymptomatic as only five of them (6%) had history of suspected cardiac syncope. 17 subjects (20%) had performed an electrophysiological study, which resulted positive in 3 cases (4%). The population without PVCs had similar baseline characteristics.
In 59 (71%) patients PVCs were monomorphic, in the other 29% we analyzed the prevalent morphology.

PVCs were classified according to their morphology as follows
(i) left bundle branch block (LBBB)/inferior axis suggesting an origin from the right ventricular outflow tract (RVOT), that was shown in 40 (48%) subjects; (ii) right bundle branch block (RBBB)/left axis suggesting an origin close to the posterior fascicle of the left bundle branch in 36 (43%). The other 7 patients presented several morphologies.
According to their number during the 24-hour monitoring, PVCs were arbitrarily classified as follows: (i) 1-59,present in 62 patients (75%); (ii) 60-749, present in 16 patients (19%); (iii) 750-9000, present in 4 patients (5%); (iv) &gt;9000, in only one patient (1%).
Conclusions. In our population of subjects with BRs phenotype the prevalence of PCVs is similar to that of the general population. Their morphologies suggest an origin from the RVOT or close to the posterior fascicle of the left bundle branch.
P492Estimation of no-flow duration and survival in patients with an initial shockable rhythm after out-of-hospital cardiac arrest
Authors: Goto Y , Funada A , Maeda T , Okada F , Goto Y 
Published: June 2020

Abstract

Funding Acknowledgements
Japan Society for the Promotion of Science (KAKENHI Grant No. 18K09999)

Background
In patients with unwitnessed out-of-hospital cardiac arrest (OHCA), the actual no-flow duration (the time with no organ perfusion) is unclear. However, when these patients have a shockable rhythm as an initial recorded rhythm, the no-flow duration may be relatively short as compared with other initial rhythms, and some patients can obtain a good functional outcome after OHCA.

Purpose
The purpose of the present study was to estimate the no-flow duration and to determine the relationship between no-flow duration and neurologically intact survival in patients with an initial shockable rhythm after OHCA.

Methods
We reviewed 82,464 patients with OHCA (aged ≥18 years, non-traumatic, witnessed, and without any bystander interventions) who were included in the All-Japan Utstein-style registry from 2013 to 2017. The study end point was 1-month neurologically intact survival (Cerebral Performance Category scale 1 or 2). No-flow duration was defined as the time from emergency call to emergency medical services (EMS) arrival at the patient site.

Results
The rate of 1-month neurologically intact survival in the patients with an initial shockable rhythm (n = 10,384, 12.6% of overall patients) was 16.5% (1718/10,384). No-flow duration was significantly and inversely associated with 1-month neurologically intact survival (adjusted odds ratios for 1-minute increments: 0.85, 95% confidence interval: 0.84–0.86). The proportion of patients with a shockable rhythm to the overall patients (y, %) had a high correlational relationship with no-flow duration (x, min), depicted by y = 21.0 - 0.95 × x, R² = 0.935. In this analytical model, the number of patients with shockable rhythm reached null at 22 minutes of no-flow duration. The no-flow durations, beyond which the chance for initial shockable rhythm diminished to &lt;10%, &lt;5%, and &lt;1%, were 12, 13, and 17 minutes, respectively. The rate of neurologically intact survival in the patients with shockable rhythm (y, %) and no-flow duration (x, min) were also found to have a strong correlation, depicted by y = 0.16 × x² - 5.12 × x + 45.0, R² = 0.907. The no-flow durations, beyond which the chance for 1-month neurologically intact survival diminished to &lt;10%, &lt;5%, and &lt;1%, were 10, 11, and 15 minutes, respectively.

Conclusions
In OHCA patients without any bystander interventions before EMS personnel arrival, when a shockable rhythm is recorded by EMS personnel as an initial rhythm, the no-flow duration after cardiac arrest is highly likely to be &lt;17 minutes regardless of the layperson witness status. The limitation of no-flow duration to obtain a 1-month neurologically intact survival after OHCA may be 15 minutes when the patients have an initial shockable rhythm.
75Safety and efficacy of rivaroxaban in combination with anti-arrhythmic drugs in patients with non-permanent atrial fibrillation
Authors: Chiou W R , Chuang J Y , Huang C C , Lin P L , Lee Y H 
Published: June 2020

Abstract
Background
Rivaroxaban is useful for stroke prevention in atrial fibrillation (AF) patients. Most patients with non-permanent AF also treated with anti-arrhythmic drugs (AADs) to prevent the recurrence of arrhythmia. But there are limited data regarding drug-drug interactions between rivaroxaban and AADs despite its high clinical relevance.
Purpose
To compare the bleeding risks and ischemic events between the use of rivaroxaban alone and the concomitant use of AADs.
Methods
This is a multicenter retrospective study, which identified patients with a diagnosis of non-permanent AF who received rivaroxaban more than 1 month between December 1, 2011 and November 30, 2016. The study divided patients into 4 groups : rivaroxaban alone, combined with amiodarone, dronedarone and propafenone. We compared the clinical events and cumulative incidences to compare the endpoints including efficacy endpoint (new ischemic stroke, intracranial hemorrhage, or new
embolism), safety endpoints (Hb fall more than 2g/dL or transfusion more than 2U PRBC, critical site bleeding, or fatal bleeding.) and major adverse cardiovascular events (MACE), including cardiovascular death, myocardial infarction, new ischemic stroke, new embolism, or intracranial hemorrhage.
Results
Of 1777 enrolled patients, the rivaroxaban alone was 1205 cases, 177 in amiodarone group, 231 in dronedarone group and 164 in propafenone group. There was no statistically significant difference on efficacy endpoints, safety endpoints and MACE between the 4 groups. The average dosage of rivaroxaban was insignificantly the lowest in the group combined with dronedarone (12.3mg, p = 0.146). The rate of new embolism (0%, p = 0.029), recurrent heart failure admission rate (3.9%, p &lt; 0.001), and all-cause mortality (3.0%, p = 0.013) in dronedarone group showed a significant lower occurrence rate. The occurrence rate of new ischemic stroke (0.9%, p = 0.549), new hemorrhagic stroke (0.4%, p = 0.546), efficacy endpoints (1.7%, p = 0.369) and MACE (3.9%, p = 0.72) in dronedarone droup were the lowest but insignificant. The cumulative incidences of efficacy endpoints, safety endpoints and MACE during follow-up period were also similar in these four groups.(Picture 1)
Conclusions
In patients with non-permanent atrial fibrillation, this real-world study showed that there were no significant differences between using rivaroxaban alone or concomitant with an AAD (dronedarone/amiodarone/propafenone) on events such as new ischemic stroke, intracranial hemorrhage, GI bleeding and MACEs. The happening of new embolism was lower especially in the group combined with dronedarone. The safety and efficacy between rivaroxaban alone and combined with rhythm control using AADs proved to be the same. Relative low dose rivaroxaban combined with dronedarone did not increase the bleeding risk, and may decrease the probability of thromboembolism.
Abstract Figure. Picture 1
P1055Reduction of radiation exposure using an optimized fluoroscopy protocol in cryoballoon ablation does not compromise clinical outcome
Authors: Holl M J M , Bhagwandien R E , Firouzi M , De Ruiter W A , Szili-Torok T , Yap S C 
Published: June 2020

Abstract

Background/Introduction
Pulmonary vein isolation (PVI) using cryoballoon (CB) ablation is associated with an increased radiation exposure compared to radiofrequency ablation. Previous studies showed that radiation exposure in CB PVI can be reduced by optimizing the fluoroscopy protocol without comprising acute efficacy and safety.

Purpose
We evaluated the mid-term outcome of an optimized fluoroscopy protocol in patients undergoing CB PVI.
Methods
The study population comprised 90 consecutive patients who underwent second generation CB-based PVI. The first 46 patients underwent CB PVI with conventional fluoroscopy settings (Group A). In the following 44 patients (Group B) an optimized fluoroscopy protocol was applied consisting of 1) using fluoroscopy instead of filming for determining the pulmonary vein occlusion grade; and 2) optimal collimation of the area of interest. Primary endpoints were the total dose area product (DAP), fluoroscopy time and freedom from documented recurrence of atrial fibrillation (AF) after a single procedure.

Results
Group B had a lower median DAP (1393 cGycm2 vs. 3232 cGycm2, P &lt; 0.001) and median fluoroscopy time (20 min vs. 24 min, P &lt; 0.001) as compared to group A. The 1-year freedom from documented recurrence of AF after a single procedure was similar among groups (74% in Group A vs. 77% in Group B, P = 0.71). There were no significant differences between both groups for the secondary endpoints, including procedure duration, proportion of patients with complete electrical isolation, and complications.

Conclusion
Using an optimized fluoroscopy protocol in CB PVI radiation exposure could be reduced with a similar 1-year clinical outcome.
304Cryoablation versus Radiofrequency Ablation of the Atrioventricular Node in Patients with His-bundle Pacing
Authors: Zweerink A , Bakelants E , Stettler C , Burri H 
Published: June 2020

Abstract

Background
Atrioventricular node (AVN) ablation in the setting of His bundle pacing (HBP) may be challenging due to risk of compromising the function of the His lead. Cryoablation (CRYO) may offer theoretical advantages over conventional radiofrequency ablation (RFA), due to absence of shunting of current to the His lead, more discrete lesions, and potential reversibility in case of transient elevation of capture thresholds. However, CRYO has never been tested for AVN ablation in this setting.

Purpose
To compare procedural characteristics and outcome of CRYO compared to RFA for AVN ablation in patients with HBP.

Methods
Thirty-five patients (age 76 ± 8 yrs, 23% male) with HBP underwent AVN ablation for an "ablate and pace" indication. CRYO was performed in the first 22 pts and RFA in the following 13 pts. Procedure and fluoroscopy times, change in His threshold and success rates were compared between groups.

Results
The acute procedural success rate was 100% for both strategies without any major complications. There were no significant differences in procedure characteristics and outcome between CRYO and RFA, except for significantly shorter application times with RFA and a trend to more frequent reconduction and requirement for a redo procedure with CRYO (see table). All recurrences occurred within one month after ablation.

Conclusion
CRYO does not seem to offer any advantage over RFA for AVN ablation in patients with HBP, and does not avoid rise of His capture thresholds. Moreover, the recurrence rate may be higher with CRYO leading to more redo procedures.
Table Parameter CRYO (22 pts) RFA (13 pts) P-value Total procedure time (min) 50 [38 - 63] 40 [33 - 53] 0.257 Fluoroscopy time (min) 5.0 [2.2 - 5.4] 3.5 [1.9 - 9.0] 0.578 Expo Rx (mcGy.cm2) 237 [110 - 525] 139 [65 - 721] 0.468 Number of applications (n) 6 [3 - 11] 4 [1 - 15] 0.371 Total application time (min) 17 [9 - 29] 3 [1 - 9] 0.001 His threshold pre-ablation (V) 1.63 [0.75 - 3.44] 0.75 [0.53 - 1.63] 0.180 His threshold post-ablation (V) 1.88 [0.75 - 3.81]* 1.25 [0.63 - 3.50] 0.389 His threshold change (V) 0.00 [0.00 - 0.31]* 0.00 [0.00 - 0.75] 0.933 His threshold rise ≥1 volt (n) 4 (18%)* 3 (23%) 0.726 Acute procedural success (n) 22 (100%) 13 (100%) 1.000 AV reconduction during follow-up (n) 5 (23%) 1 (8%) 0.254 AV reconduction needing redo procedure (n) 3 (14%) 0 0.146 Interquartile range is shown in square brackets. *one loss of capture.
P991Pattern of rapid activity is preserved in persistent AF in selected locations after pulmonary vein isolation
Authors: Nagy S , Kasi P , Afonso V , Mann I , Kim S , Linton N , Lefroy D , Whinnett Z , Ng F S , Koa-Wing M , Kanagaratnam P , Peters N S , Qureshi N A , Lim P B 
Published: June 2020

Abstract

Funding Acknowledgements
Our research group receives an educational grant from Abbott Inc.
Introduction. There is evidence to suggest that structural remodelling in psAF potentially gives rise to areas of rapid cycle length activity that may act as driving mechanisms. We describe a new method to compare rapid activity (RA) in psAF prior to and after pulmonary vein isolation, in extended AF segments (EAFS). We focus on patterns of RA, based on the hypothesis that AF drivers are transient but recur in the same locations.
Methods. Five patients (61 ± 8 years of age, 3 male) for catheter ablation of psAF were included. 3D maps were collected with a double spiral 20 pole catheter. In stable locations, pre and post PVI, 37s EAFS were recorded using 8s segments, automatically every 1s, creating a 7s overlap between segments. Dominant cycle length (DCL) was determined for every 8s segment by a fully automated algorithm. RA was defined as the rapidest 20th percentile for each patient. RA episodes consisted of continuous segments with rapid DCL (black lines in Fig 1) and terminated with a non-rapid segment (red lines on Fig 1). Episodes were truncated where overlap occurred (Box 1 and Box 2 in Fig 1). The pattern of RA was assessed by the number, cumulative duration and mean duration of RA episodes within an EAFS pre and post PVI.
Results. Mean DCL of EAFS increased significantly in 4/5 patients after PVI, the number of EAFS with rapid activity showed a reduction in all patients. The percentage of new sites with RA post PVI was 27%. The number of sites that retained RA post PVI was 14 ± 11.3 (58.3%; Table 1). Of these, number and cumulative duration of RA did not change in 4/5 patients, and mean duration of RA remained stable in 5/5.
Conclusion. An automated DCL algorithm shows that, in most cases, global AFCL prolongs significantly with PVI overall, but selected foci retain RA and RA patterns. These may represent active drivers, as their activity appears to be independent of their surroundings.
Table 1 Patient ID Number of segments Mean AFCL ± SD of all segments Number of EAFS with rapid activity Pre-PVI Post-PVI P Pre-PVI Post-PVI New sites 1 145 135 ± 8.9 141 ± 9.8 &lt;0.001 94 62 15 2 121 154 ± 12.9 162 ± 15.0 &lt;0.001 94 72 11 3 172 148 ± 13.7 160 ± 16.6 &lt;0.001 108 82 25 4 301 172 ± 22.9 174 ± 21.5 0.418 198 189 58 5 200 177 ± 9.9 215 ± 18.1 &lt;0.001 87 43 14 Pre and Post PVI cycle length and EAFS with rapid activity. (AFCL: AF cycle length; EAFS: Extended AF segments; PVI: Pulmonary vein isolation)
Abstract Figure.
P938Regulation of the delayed rectifier potassium current during the adrenergic adaptation of cardiomyocytes
Authors: Kiss D , Hezso T , Kurtan B , Veress R , Baranyai D , Kovacs Z S , Dienes C S , Szentandrassy N , Banyasz T , Magyar J , Nanasi P P , Horvath B 
Published: June 2020

Abstract

Funding Acknowledgements
Supported by the ÚNKP-19-3 New National Excellence program of the Ministry for Innovation and Technology

Introduction and aims
Adaptation of the human heart to physical activity is a complex mechanism that includes the change of heart rate, morphology of the action potential (AP) among others. Stimulation of β-adrenergic receptors (β-AR) causes the shortening of the AP duration of ventricular cardiomyocytes. This is caused by the regulation of the potassium currents by the β-adrenergic signaling pathway.
Our aim was to investigate the role of protein kinase A (PKA) and calcium/calmodulin-dependent protein kinase II (CaMKII) in the regulation of the slow component (IKs) of the delayed rectifier potassium current under β-AR activation.

Methods
Our experiments were performed on isolated canine cardiomyocytes from the left ventricle. The IKs current profile was determined under a ventricular AP. We used "AP voltage clamp" conditions in six experimental groups:
Control (CTRL),
β-AR stimulation with isoproterenol (ISO),
CaMKII inhibition with KN-93 (KN-93),
PKA inhibition with H-89 (H-89)
β-AR stimulation with inhibited CaMKII (KN-93 + ISO),
β-AR stimulation with inhibited PKA (H-89 + ISO).
β-AR stimulation with inhibited CaMKII and PKA (KN-93 + H-89 + ISO)

Results
The highest current density of IKs was approximately 6 times higher and the charge delivered by IKs was about 8 times larger in the ISO group than in CTRL or KN-93 conditions. In the KN-93 + ISO group, IKs amplitude was about 60% smaller and delivered about half the total charge compared to the ISO group. In the H‑89 + ISO group, IKs was about 30% smaller and delivered 40% less total charge than in the ISO group. In the KN-93 + H-89 + ISO group the IKs did not changed sicnificantly.

Conclusion
Based on our results, CaMKII plays an important role in regulating IKs by β-AR stimulation.