bluuebunny/crossref_metadata_2025_split huggingface dataset:
Substrate guided ablation of idiopathic right ventricular outflow tract premature ventricular contractions in patients with low arrhythmia burden during the procedure
Authors: Parreira A.L , Marinheiro R , Carmo P , Mesquita D , Amador P , Farinha J , Chambel D , Marques L , Marques A , Fonseca M , Cavaco D , Adragao P 
Published: November 2020

Abstract

Background
Ablation of premature ventricular contractions (PVCs) is currently based on activation mapping. This strategy is impaired by the absence or paucity of PVCs on the day of the procedure. Frequently, isolated diastolic potentials (DP) are present at the successful ablation site in sinus rhythm (SR), although their meaning is still a matter of debate.

Objective
Evaluate the feasibility and results of a substrate-based approach for ablation of idiopathic right ventricular outflow tract (RVOT) PVCs, in patients that present with a low PVC burden during the procedure.

Methods
We included 12 consecutive patients referred for ablation of frequent (&gt;10000/24 hours) idiopathic PVCs from the RVOT that present with less than 2 PVCs/min in the beginning of the procedure. The ablation was based on fast mapping of the RVOT in SR looking for DPs, defined as isolated small amplitude potentials occurring after the T wave of the surface ECG in SR (Figure). The area with DPs was marked and a reduced activation mapping of the PVCs was done in that area. We evaluated the procedure time, mapping, fluoroscopy and radiofrequency (RF) application times. The number of points used for the maps, the area of DPs, local activation time and success rate. Values are presented as median (Q1-Q3). Electroanatomical mapping of the RVOT in SR was also performed in a control group of 10 subjects that underwent ablation of supraventricular arrhythmias, to evaluate the prevalence of DPs in subjects without PVCs.

Results
The number of PVCs during the procedure was 1 (0.1–1.6)/min. Both groups did not differ in relation to age or gender. Median age 45 (34–65) years, 6 males in the PVC group and 40 (33–65) years, 6 males in the control group, p=0.821 and p=0.231 respectively. The number of points sampled per RVOT map in SR was 400 (193–500) in the PVC group and 330 (277–425) in the control group, p=0.539. All patients in the study group had DPs in the RVOT. None of the control group subjects had DPs in the RVOT. Ablation data is presented in the Table. The acute success rate was 100%. After a median follow-up time of 4 (3–6) months one patient had recurrence.

Conclusion
In these group of patients with very low PVC burden during the procedure, this approach partially based on substrate mapping, made ablation of the PVCs feasible, in a fast and efficient way.

Funding Acknowledgement
Type of funding source: None
The cholesterol paradox in atrial fibrillation: results from the LIPIDOGRAM 2015 study
Authors: Harrison S , Lip G.Y.H , Lane D.A , Mastej M , Kasperczyk S , Banach M , Jozwiak J.J 
Published: November 2020

Abstract

Background
High blood lipid levels are known risk factors for atherosclerotic cardiovascular events, but associations between lipid levels and atrial fibrillation (AF) are unclear. Some previous studies have suggested an inverse association between lipid levels and AF referred to as the “cholesterol paradox”.

Purpose
To examine the prevalence of AF by differing lipid levels in a large population-based study of almost 14,000 adults in Poland.

Methods
The LIPIDOGRAM 2015 study is a cross-sectional study of adults aged 18 years and older recruited in Poland in 2015/2016 by 438 family physicians. Poisson regression models with robust variance were used to estimate prevalence ratios (PRs) for AF with 95% confidence intervals (CIs) for participants with differing lipid profiles. Lipid measures including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), total cholesterol (TC) and LDL/HDL ratios were grouped into quartiles with the lowest quartile as the reference group. Models were adjusted for potential confounding factors including age, sex, waist-to-hip ratio, smoking, alcohol intake, regular physical activity, hypertension, antihypertensive medication use and treatment of dyslipidaemia.

Results
13,724 participants were recruited to the study, the median (interquartile range: IQR) age was 58.0 (47.7–65.8) years and 5.2% (n=708) had a diagnosis of AF, with a median (IQR) 3 (1–8) years since diagnosis. After adjusting for potential confounding factors, a statistically significant lower prevalence of AF was estimated for participants in the highest quartile for LDL-C (PR (95% CI): 0.60 (0.48, 0.75) p&lt;0.001), HDL-C (0.58 (0.46, 0.74), p&lt;0.001), TC (0.61 (0.49, 0.75), p&lt;0.001) and LDL/HDL ratio (0.75 (0.61, 0.94), p=0.010). No statistically significant difference in prevalence of AF was observed for participants in the highest quartile for TG levels compared to the lowest quartile for TG levels.

Conclusions
The prevalence of AF was lower for people with higher levels of LDL-C, HDL-C, TC and higher LDL/HDL ratios; some of the difference in prevalence was explained by controlling for confounding factors, but in multivariable models the association remained statistically significant. This research adds to the body of evidence which suggests an inverse relationship between cholesterol levels and AF-the “cholesterol paradox” for AF.

Funding Acknowledgement
Type of funding source: None
Improved adherence to anticoagulant therapy with once-daily regimen: a real-world study in patients with atrial fibrillation in Germany
Authors: Yeh Y , Wang R , Marston X.L , Zimmermann L , Ye X , Gao X 
Published: November 2020

Abstract

Background
Adherence and persistence to non-VKA oral anticoagulants (NOACs) are important to achieve optimal clinical outcomes in patients with atrial fibrillation (AF). Dosing frequency may play a role in adherence and persistence to NOAC therapy. Among the NOACs that are currently available, edoxaban and rivaroxaban are given once daily (QD) while dabigatran and apixaban are given twice daily (BID).

Purpose
The objective of the study was to compare the adherence and persistence in AF patients receiving QD versus BID NOAC regimens in Germany.

Methods
Using an administrative database from our institution (Deutsche Analysedatenbank für Evaluation und Versorgungsforschung) between January 2013 and December 2017, a retrospective cohort study was conducted to compare the 6-month adherence in NOAC-naïve AF patients who initiated anticoagulant therapy. Continuous enrolment for 12 months before anticoagulant initiation was required to assess baseline characteristics. Adherence was measured using proportion of days covered (PDC) and medication possession ratio (MPR). Proportions of patients with PDC ≥80% and MPR ≥80% were also measured. Treatment discontinuation was defined as a prescription supply gap of ≥90 days. Inverse probability treatment weighting using propensity score was applied to control for differences in baseline characteristics.

Results
A total of 8249 (1236 edoxaban, 7013 rivaroxaban) and 7359 (6053 apixaban, 1306 dabigatran) patients who received QD and BID regimens were included. The two regimen groups were well balanced after weighting. Patients who received QD regimens had a significantly higher mean PDC at 6 months compared to those who received BID regimens (0.78 vs. 0.72, p&lt;0.05). The proportion of patients with PDC ≥80% was significantly higher for QD versus BID regimens (65.3% vs. 49.6%, p&lt;0.05). Similarly, the mean MPR was higher for QD versus BID regimens (0.81 vs. 0.74, p&lt;0.05), with more QD patients having MPR ≥80% than BID patients (69.5% vs. 53.3%, p&lt;0.05). Six-month persistence rates were comparable between the two regimen groups (73.4% vs. 74.2%, p=0.13).

Conclusions
Adherence to once-daily regimens of NOAC was significantly higher compared to adherence to twice-daily NOAC regimens. Future research is needed to examine the relationship between adherence to NOAC treatment and clinical outcomes in AF patients, and factors affecting persistence.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): This study was sponsored by Daiichi Sankyo Inc
Long-term clinical outcome of chronic structural remodeling in atrial fibrillation patients with preserved left ventricular ejection fraction
Authors: Baek Y.S , Choi S.H , Park S.D , Kwon S.W , Shin S.H , Woo S.I , Kim D.H , Kwan J 
Published: November 2020

Abstract

Background
Patients who have progressed to chronic atrial fibrillation (AF) usually presented both atrial remodeling coexisting elevated pulmonary arterial pressure without other secondary causes.

Purpose
The aim of our study was to assessed the impact of progression to chronic structural remodeling in AF patients with preserved left ventricular ejection fraction (LVEF) on long-term clinical outcome including all-cause mortality or hospital admission.

Methods
We enrolled 5,585 consecutive AF patients (≥19 years, mean age 66±13 years, 41.1% female) in a tertiary hospital from 2007 to January 2017. Chronic AF structural remodeling (CAFR) was defined as both atrial enlargements including left atrial antero-posterior diameter ≥50mm, pulmonary arterial pressure ≥35mmHg and LVEF ≥50% on transthoracic echocardiography. AF patients with preserved LVEF were divided into two groups: group 1 (1,102 patients with CAFR) and group 2 (1,661 patients without CAFR).

Results
There were no significant differences in age (p=0.330), female (p=0.609), LVEF (p=0.607) and the proportions of comorbidities including hypertension (p=0.226), diabetes mellitus (p=0.751) and heart failure (HF) (p=0.054) between two groups. Mean follow-up durations were 77.6±42.2 (group 1) and 65.6±35.7 (group 2) months, respectively. Kaplan-Meier estimates showed a significant difference in hospitalization for HF (Log-rank p&lt;0.001), but there was a significant difference in any cause death (Log-rank p=0.182) between two groups. In Cox proportional-hazards models, after adjusting relevant risk factors, chronic kidney disease (hazards ratio [HR] 1.89, 95% CI 1.48–2.41, p&lt;0.001) and CAFR (HR 1.33, 95% CI 1.11–1.59, p=0.001) with admission for HF.

Conclusion
This study suggests that progressive structural atrial remodeling in AF patients with preserved LVEF is independently associated long-term clinical worse outcome of hospitalization for HF.

Funding Acknowledgement
Type of funding source: None
Activation of inflammatory/coagulation system following electrical cardioversion of patient with recent onset atrial fibrillation: an explorative study of the relation to white matter hyperintensities
Authors: Arvanitis P , Johansson A.K , Frick M , Malmborg H , Larsson E.M , Blomstrom Lundqvist C 
Published: November 2020

Abstract

Background
White matter hyperintensities (WMH), assessed using Fazekas scale, are more prevalent in patients with atrial fibrillation (AF), although its pathophysiologic mechanism(s) is unclear.

Purpose
The study objective was to explore the association between cardiac, inflammatory and coagulation biomarkers and white matter hyperintensities in anticoagulant-naïve patients following electrical cardioversion (CV) of recent onset AF.

Methods
Patients with AF duration &lt;48 hours were prospectively included. Brain magnetic resonance imaging (MRI), C-reactive protein (CRP), high-sensitivity troponin T (hs-TNT), NT-proBNP, Interleukin 6, P-selectin, D-dimer, prothrombin fragment 1+2, von Willebrand factor Ag, coagulation factor VIII C and fibrinogen, were obtained sequentially prior, after (2–4 hours) and 7–10 days following CV. Repeated measure analysis of variance was performed.

Results
Forty-three patients (84% males), aged 55±9.6 years, (mean±SD) with median CHA2DS2-VASc score 1 (interquartile range 0–1) were included. Sequential MRI showed no new brain lesions after CV, while WMH were present at baseline in 21/43 (49%) patients. Repeated measure analysis of variance revealed a statistically significant overall change for hs-TNT: F(2,84)=6.056, p=0.03, NT-proBNP: F(2,84)=106.02, p&lt;0.001, P-selectin: F(2,84)=8.69, p&lt;0.001 and vWF:Ag: F(2,84)=4.078, p=0.02. CRP, IL-6, coagulation factor VIII-C and fibrinogen showed the same pattern, however none reached statistical significance. Patients with WMH had persistent higher values for CRP, hs-TNT, D-dimer, prothrombin fragment 1+2 and fibrinogen prior and after CV, as values at 7–10 days coincided; however, statistical interaction was not significant.

Conclusion
Transient activation of inflammatory and coagulation systems during atrial fibrillation subsides within 7–10 days after electric cardioversion of recent onset atrial fibrillation. A tendency of higher degree of activation during atrial fibrillation was observed in patients with white matter hyperintensities.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Swedish Heart-Lung Foundation, Swedish Research Council, Correvio International Sárl (Geneva Switzerland), Selanders Stiftelse
Compliance of atrial fibrillation treatment with the ABC pathway in patients with concomitant diabetes mellitus in the Middle East based on the Gulf SAFE registry
Authors: Domek M.G , Gumprecht J.J , Li Y.G , Rashed W , Al Qudaimi A , Amin H , Gumprecht J.M , Lip G.Y.H 
Published: November 2020

Abstract

Introduction
Atrial fibrillation (AF) and diabetes mellitus (DM) constitute a heavy burden on healthcare expenditure due to their negative impact on clinical outcomes in patients. DM is highly prevalent in the Middle East. The Atrial fibrillation Better Care (ABC) pathway provides a simple step-by-step strategy with an integrated, holistic approach to AF management: A, Avoid stroke (Anticoagulation); B, Better symptom management; C, Cardiovascular and comorbidity risk management.

Aim
Evaluation of the AF treatment compliance to ABC pathway regimen in patients with DM based on a large real-world registry from the Middle East region. We assessed the impact of ABC-pathway compliance on all-cause mortality and the composite outcome of stroke or systemic embolism, all-cause death and cardiovascular hospitalizations.

Methods
From 2043 patients in the Gulf SAFE registry, 603 patients with DM were included in an analysis of compliance with components of the ABC pathway: A, oral anticoagulation (OAC) use in patients with CHA2DS2-VASc score ≥1 (≥2 in females); B, AF symptoms according to the European Heart Rhythm Association (EHRA) score; C, Optimized management of cardiovascular comorbidities e.g. blood pressure control, statins for vascular disease, etc.

Results
From 606 patients, 86 (14.3%) patients were treated in compliance with the ABC pathway. During 1-year follow-up, 207 composite outcome events and 87 deaths occurred. Mortality was significantly lower in the ABC-adherent group vs non-ABC compliant (5.8% vs 15.9%, p=0.0014, respectively) (Figure). On multivariate analysis, ABC-adherent management was associated with a lower risk of all-cause death and the composite outcome after 6 months (OR 0.18; 95% CI, 0.42–0.75 and OR 0.54; 95% Cl, 0.30–1.00, respectively) and at 1 year (OR 0.30; 95% Cl,0.11–0.76 and OR 0.57; 95% Cl, 0.33–0.97, respectively) vs the non-ABC group (Table).

Conclusions
Integrated AF care, according to ABC pathway, was independently associated with a lower risk of all-cause death and the composite outcome, in DM patients with AF. This highlights the importance of a comprehensive and holistic approach to AF management.
Events rates and outcomes odds ratio

Funding Acknowledgement
Type of funding source: None
Severe sleep apnea is associated with atrial fibrillation burden in pacemaker recipients
Authors: Bidegain N , Degand B , Bouleti C , Christiaens L , Tavernier M , Kerforne T , Ingrand P , Garcia R 
Published: November 2020

Abstract

Background
New generation pacemaker allow the assessment day by day of sleep disordered breathing (SDB) based on impedance measurement. A recent study demonstrated that incidence of AF is higher in case of severe SA monitored by pacemaker

Purpose
The aim was to compare the atrial fibrillation (AF) burden between patients with severe and non-severe sleep apnea (SA) detected with pacemakers monitoring (SDB).

Methods
This retrospective study was carried out at our University Hospital. We included all patients with Microport CRM pacemaker implanted from 2013 to 2016 at our university hospital. Exclusion criteria were inactivation of sleep apnea monitoring (SAM), history of sleep apnea, missing data or invalid data. AF burden was assessed according to Fallback mode switch (FMS) duration. Respiratory disturbance index (RDI) was calculated as the average number of events (ventilation pause and reductions) per number of hours of monitoring. Patients with RDI&lt;20/h were compared with patients with RDI≥20/h (considered as severe SA group).

Results
404 patients (mean age = 79.7±10 years; 52.0% men) were included. The most prevalent indication for cardiac pacing was atrioventricular block in 57%. Mean RDI was 18.9 events per hour. 234 (58%) of them had a mean RDI &lt;20 and 170 (42%) had a mean RDI ≥20. Compared to patients with mean RDI&lt;20, those with mean RDI ≥20 were youngers (78.6±10 years Vs 81.8±8 years; p=0.02), were more likely to be male (58.2% Vs 47.5%: p=0.035) and had more heart failure history (28.8% Vs 19.2%: p=0.03). BMI was not different between groups (26.3±5. vs 26.3±4; P=0.33). Mean follow-up was 27 months. Patients with RDI ≥20 had a mean Atrial fibrillation duration longer than patients with RDI &lt;20 (631 min Vs 291 min respectively; p=0.014). RDI was correlated with FMS (r=0.26; p=0.0004). The stroke rate tended to be higher in the RDI ≥20 group (2.1% vs 5.4%) (p=0.12).

Conclusion
Severe SA detected by pacemaker was associated with longer AF duration. We did not find higher occurrence of stroke in the severe SA group.

Funding Acknowledgement
Type of funding source: None
Advanced interatrial block precedes atrial fibrillation and stroke. The prospective interatrial Block And Yearly EventS (BAYES) registry
Authors: Martinez-Selles M , Elosua R , Ibarrola M , De Andres M , Diez-Villanueva P , Bayes-Genis A , Baranchuck A , Bayes De Luna A 
Published: November 2020

Abstract

Background
Advanced interatrial block (IAB), prolonged and bimodal P waves in surface ECG inferior leads, is an unrecognized surrogate of atrial dysfunction and a trigger of atrial dysrhythmias, mainly atrial fibrillation (AF). Our aim was to prospectively assess whether advanced IAB in sinus rhythm precedes AF and stroke in elderly outpatients with structural heart disease, a group not previously studied.

Methods
Prospective observational registry that included outpatients aged ≥70 years with structural heart disease and no previous diagnosis of AF. Patients were divided into three groups according to P-wave characteristics.

Results
Among 556 individuals, 223 had normal P-wave (40.1%), 196 partial IAB (35.3%), and 137 advanced IAB (24.6%). After a median follow-up of 694 days; 93 patients (16.7%) developed AF, 30 stroke (5.4%), and 34 died (6.1%). Advanced IAB was independently associated with AF (hazard ratio [HR] 2.9, 95% confidence interval [CI] 1.7–5.1, p&lt;0.001), stroke (HR 3.8, 95% CI 1.4–10.7, p=0.010), and AF/stroke (HR 2.6, 95% CI 1.5–4.4, p=0.001). P-wave duration (ms) was independently associated with AF (HR 1.05, 95% CI 1.03–1.07, p&lt;0.001), AF/stroke (HR 1.04, 95% CI 1.02–1.06, p&lt;0.001), and mortality (HR 1.04, 95% CI 1.00–1.08, p=0.021).

Conclusions
The presence of advanced IAB in sinus rhythm is a risk factor for AF and stroke in an elderly population with structural heart disease and no previous diagnosis of AF. P-wave duration was also associated with all-cause mortality. Figure. Age- and sex-adjusted linear and non-linear association between P-wave duration (msec) and atrial fibrillation (A), stroke (B), and atrial fibrillation or stroke (C) risk. Results of a generalized additive model with spline smoothing functions and 4 degrees of freedom.
Figure 1. Kaplan-Meyer curves of survival free of atrial fibrillation (A), stroke (B) and atrial fibrillation or stroke (C) in patients with normal P-wave, partial interatrial block (IAB) and advanced IAB.

Funding Acknowledgement
Type of funding source: None
Micro-embolic risks during radiofrequency and cryoballoon-ablation of atrial fibrillation -analysis from real-time carotid artery doppler monitoring-
Authors: Tonegawa R , Miyamoto K , Ueda N , Nakajima K , Kamakura T , Yamagata K , Wada M , Ishibashi K , Inoue Y , Noda T , Nagase S , Aiba T , Kusano K.F 
Published: November 2020

Abstract

Background
Catheter ablation of atrial fibrillation (AF) is associated with risks of silent cerebral events. However, the timing of intraprocedural micro-embolic events or differences between open-irrigated radiofrequency (RF) and cryoballoon (Cryo) ablation are unclear. Newly developed real-time carotid artery Doppler is a simple non-invasive method to detect micro-embolic signals (MESs) during ablation.

Objective
We investigated the timing of detecting MESs during RF and Cryo ablation of AF.

Methods
During the first pulmonary vein isolation (PVI) session of AF, MESs were monitored by real-time carotid artery Doppler monitoring throughout the procedure. The MES counts were collected and evaluated separately during the different steps of the procedure (Figure).

Results
Thirty-three AF patients (RF/Cryo: 22/11 cases, 9 females, 69.5±11.6 y.o) were included. PVI was successfully accomplished in all patients with no major complications. The MES count was significantly greater in the RF group than Cryo group (table). In both groups, left atrial (LA) access (interatrial puncture) and sheaths insertion to the LA generated a significant number of MESs (RF: 1690 of 9116 MESs [18.5% of the total MESs], Cryo: 793 of 2285 MESs [34.7%]). In the RF group, MESs were observed incessantly during PVI (Figure). The LA dwell time was significantly longer in the RF group than Cryo group (table). In the RF group, the MES count was significantly greater in the longer LA dwell time group (LA dwell time &gt;130min) than the shorter group (464.2±179.7 vs 302.6±138.2: P=0.049). During the cryo-applications in the Cryo group, the MESs were greatest during the first cryoballoon application (625 of 2285 MESs [27.4%]).

Conclusions
There were more MESs during RF ablation than cryoablation. MESs were recorded during a variety of steps throughout the procedure. In the RF group, most of MESs were recorded incessantly during radiofrequency ablation and greater number of MESs were recorded in patients with longer LA dwell time. In the Cryo group, most of MESs occurred during phases with a high probability of gaseous emboli.

Funding Acknowledgement
Type of funding source: None