bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic impact of renal function trajectories and temporal variability amongst anticoagulated atrial fibrillation patients: a subgroup analysis of the SPORTIF III and V trials
Authors: Proietti M , Gumprecht J , Romiti G.F , Lip G.Y.H 
Published: November 2020

Abstract

Background
Renal function is a major determinant of major adverse outcomes in patients with atrial fibrillation (AF). Scarce data are available about the impact of renal function trajectories and creatinine clearance (CrCl) temporal variability, on prognosis.

Aim
To evaluate the progression and impact of renal function impairment and variability on outcomes over a long-term follow-up observation in a cohort of anticoagulated AF patients.

Methods
We included warfarin-treated AF patients in SPORTIF trials with available creatinine clearance (according to Cockroft-Gault) at baseline and at least 4 evaluations throughout their follow-up. Patients with a BMI ≥45 kg/m2 were excluded from the analysis. Average successive variability (ASV) was used as measure of variability.

Results
Among 3665 original patients, 3366 (91.8%) were included in this analysis. Median [IQR] CHA2DS2-VASc score was 3 [2–4] and HAS-BLED was 3 [2–4]. At baseline, 876 (26.0%) patients had CKD (CrCl &lt;60 mL/min), with 14 (0.4%) patients having severe CKD (&lt;30 mL/min), with a mean (SD) CrCl of 86.7 (47.4) mL/min. Over a mean (SD) 577.1 (122.1) days of follow-up, a total of 521 new CKD cases were found with an overall incidence of 13.1 per 100 patient-years, with 91 new severe CKD cases (1.71 per 100 patient-years). Across follow-up, prevalence of CKD and severe CKD increased progressively (both p&lt;0.001) [Figure]. Mean (SD) AVS was −0.567 (±2.803) mL/min. According to AVS, patients were divided into quartiles: i) Q1: +34.012/+0.450; ii) Q2: +0.449/−0.443; iii) Q3: −0.443/−1.503; Q4: −1.505/−19.750. While no difference was found in stroke/systemic embolism, rate of major bleeding was higher in Q4 (4.5%) and Q1 (4.0%) than in other quartiles (Q2 2.5%, Q3 2.0%; p=0.009) as well as all-cause death (Q4: 6.7%; p=0.003 compared to other quartiles). A Cox multivariate adjusted model documented that AVS Q1 and Q4 were independently associated with a higher risk of major bleeding, while Q4 was associated with a higher risk of all-cause death (Table).

Conclusion
In a cohort of AF patients treated with warfarin, characterized by a progressive increase in the proportion with CKD and severe CKD, the largest reduction in CrCl throughout follow-up was associated to an increased risk of major bleeding and all-cause death.
Renal Function Trajectories

Funding Acknowledgement
Type of funding source: None
Downregulation of growth hormone in postural orthostatic tachycardia syndrome: insights from the SYSTEMA cohort
Authors: Johansson M , Schulte J , Ricci F , Persson M , Sutton R , Hamrefors V , Fedorowski A 
Published: November 2020

Abstract

Background
Postural orthostatic tachycardia syndrome (POTS) is a variant of cardiovascular autonomic disorder occurring predominantly in young women. POTS is characterized by an excessive heart rate increase when assuming upright posture accompanied by symptoms of orthostatic intolerance. The pathophysiology of POTS has not been fully established and is believed to be multifactorial.

Purpose
We aimed to investigate the alterations in circulating growth hormone level in POTS.

Methods
We conducted an age-matched case-control study enrolling 42 patients with POTS (age 31±9 years; 36 women) verified by positive head-up tilt testing and cardiovascular autonomic tests, and 46 controls (32±9 years; 35 women) with negative active standing test and no history of syncope, orthostatic intolerance and endocrine disease. We measured plasma levels of growth hormone using a high-sensitivity chemiluminescence immunoassay in relation to presence of POTS diagnosis. All study participants completed the validated Orthostatic Hypotension Questionnaire (OHQ), consisting of two components: the symptoms assessment scale (OHSA) and daily activity scale (OHDAS) to evaluate the burden of symptoms. We applied standard statistical tests for group differences. Growth hormone values were log-transformed and standardized before the group comparison.

Results
POTS patients had significantly lower plasma levels of growth hormone (ng/mL) (median=0.53, IQR, 0.10–2.83 vs. median=2.33, IQR, 0.26–7.2, p=0.04) than controls. Levels of growth hormone were reversely related to OHDAS (p=0.049) among POTS patients. Supine heart rate was significantly higher in POTS patients (69.0±11.1 beats/min vs. 63.3±10.8 beats/min, p=0.02), as well as diastolic blood pressure (72.9±9.1 mmHg vs. 69.0±8.5 mmHg, p=0.04). We observed no significant difference in supine systolic blood pressure (116.6±13.3 mmHg vs. 115.2±10.0 mmHg, p=0.60). POTS patients had a significantly higher composite OHQ score than controls (60.0±18.6 vs. 4.2±7.5, p&lt;0.001), as well as OHSA (36.2±10.0 vs. 3.6±6.4, p&lt;0.001) and OHDAS (23.8±9.7 vs. 0.6±1.3, p&lt;0.001).

Conclusion(s)
Our study shows that patients with POTS have significantly reduced plasma levels of circulating growth hormone. Lower growth hormone levels among POTS patients are associated with increased impairment of daily life activities. Further studies are necessary to confirm our findings in the independent populations and explain the mechanisms behind this alteration.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Crafoord Foundation, Swedish Heart and Lung Foundation
The prevalence of familial form of atrioventricular nodal reentry tachycardia in south-eastern regions of Poland
Authors: Deutsch K.J , Ciurzynski M.C , Zienciuk-Krajka A.Z.K , Sledz J.S , Mazij M.M , Ludwik B.L , Lewandowski Z.L , Stec S.M.S 
Published: November 2020

Abstract

Introduction
Atrioventricular nodal reentry tachycardia (AVNRT) is one of the most common regular supraventricular arrhythmia referred for catheter ablation (CA). Although, several families with familial form of AVNRT (FAVNRT) in Subcarpathia province (SP, Poland), the comparison or prevalence of FAVNRT and comparison of their incidence in other provinces in Poland were not prospectively validated.

Methods
Data was derived from prospective multicenter registry of CA (ELEKTRO- ELMedica Network). Between year 2010 to 2018, the clinical data of 1544 patients with invasively documented AVNRT were verify for family history of FAVNRT. From December 2016 to March 2019 each patient with AVNRT were consulted with detailed family history and family residence origin with up to three-generation pedigree. Families with substantiate form of FAVNRT (at least two persons from the family after invasive validation of AVNRT and CA) divided into three groups according to their origin.

Results
From 1544 recruited patients 932 had origin in south-eastern provinces (SEP) of Poland [n=379, from SP; n=34, from Lubelskie; n=214, from Lesser Poland; and n=305 from Holy Cross]. The rest of the group (n=612) consisted of patients from other, not SEP parts of the country – other part of Poland (RPP). Finally, 45 (2,91%) patients from 24 families had diagnosed FAVNRT. The incidence of FAVNRT was significantly higher in SEP than RPP (4.02% vs 1.17%). Moreover, patients from SP has the highest prevalence of FAVNRT (6.33%) as compared to other provinces of SEP (2.47%). In SP and in bordering SEP provinces as well as the RPP appropriate risk (according to previous region) of FAVNRT was respectively 2.67 (95% CI: 1.36–5.23; P&lt;0.004), 2.14 (95% CI: 0.86–5.34; P&lt;0.10) according to reference RPP were observed.

Conclusion
Based on Hill's Criteria for Causality observed biological monotonic risk gradient of FAVNRT is proving geographical cause of increased prevalence of FAVNT. The closer they are the higher they is to the most endangered provinces in Poland- SP that also adjoined to Ucraine and Slovakia. Further, international, trans-border cooperation and genetic testing are required to validate genetic impact of FAVNRT in past Galicia region of Central Europe.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Study is funding by the research grant DI2015 021945 from budget resources in 2015 to 2017, as a research project in “Diamentowy Grant” program from “Narodowe Centrum Badan i Rozwoju (PL)”.
MAPping with fragmentation analysis in patients with atypical atrial FLUtter using the RHYthmia navigation system (MAP-FLURHY study)
Authors: Franco E , Lozano Granero C , Matia R , Hernandez-Madrid A , Sanchez-Perez I , Zamorano J.L , Moreno J 
Published: November 2020

Abstract

Background
Atypical atrial flutter (AAFL) circuits use areas of slow conduction which can be visualized as fragmented electrograms (fEGMs).

Purpose
To test an ablation strategy based on the identification and ablation of spots with fEGMs in AAFL.

Methods
The MAP-FLURHY study prospectively included all AAFL ablations with Rhythmia in our Center from June 2016 to June 2019. Patients with non-mappable AAFL, frequent conversion to atrial fibrillation, or cavotricuspid isthmus-dependent flutters were excluded from analysis. The IntellaMap ORION catheter was used to detect fragmentation areas, arbitrarily defined as fEGMs &gt;70ms. Entrainment was used to check if these areas belonged to the AAFL circuit. Ablation targeted the longest fEGM within the circuit (return cycle &lt;30ms): focal ablation for microreentries, and lines including the fEGMs for macroreentries. Ablation success was defined as conversion to sinus rhythm or another flutter. Procedural success was defined as successful ablation of all inducible flutters. Follow-up included visits with 24h Holter ECG at 3–6-12 months.

Results
50 Patients received ablation (Figure). 27 Patients (70.6±13.1 years; 10 females; LVEF 57%±13%) with 44 mappable AAFLs were included in the analysis (Table). All AAFLs showed areas with fEGMs (106 areas; 2.4 areas per flutter). 42/44 AAFLs had fEGMs within the circuit, which were target of ablation. Ablation success: 34/36 AAFLs (94%); success could not be assessed in 6 circuits, due to mechanical conversion to sinus rhythm onto the target fEGM. Fragmented areas within the AAFL circuits (n=51) were longer (110±30 vs 90±15 ms, p&lt;0.001) but had similar voltage (0.34±0.25 vs 0.36±0.26 mV) than areas outside the circuits (n=45). A fEGM duration &gt;100ms/&gt;40% of the cycle length predicted to be a successful site for ablation with 72.3%/73.8% specificity. Procedural success was achieved in 24/27 patients (89%). Excluding a 2-month blanking period, mean survival free from atrial arrhythmias was 19 (95% CI: 12.6–25.5) months. 57% of the patients were free from atrial arrhythmias at 1 year.

Conclusions
Most AAFLs had detectable fEGMs which could be target of ablation with high efficacy.
Figure 1

Funding Acknowledgement
Type of funding source: None
The use of half normal saline during catheter ablation of typical atrial flutter has no impact on the time to achieve bidirectional block
Authors: Alhammad N.J.H , Redfearn D.R , Enriquez A.E , Chacko S.C , Hong K.H , Glover B.M.G 
Published: November 2020

Abstract

Background
Achieving bidirectional block (BB) is generally considered to be the endpoint in the ablation of typical atrial flutter (AFL), however acute reconnection is common. Recent data suggest that deeper ablation lesions may be created by decreasing the irrigant ionic concentration using half normal saline (HNS) delivered through an open irrigated ablation catheter compared with normal saline (NS). We sought to assess whether the use of HNS was associated with a more rapid achievement of BB and less reconnections compared with NS.

Methods
Patients were randomly allocated to catheter ablation with either NS or HNS using a 4-mm irrigated catheter at a power setting of 30 W. Ablation approach employing either a maximum voltage guided (MVG) or empiric cavo-tricuspid isthmus (CTI) line was performed aiming for BB that was confirmed by double potentials separated by an isoelectric line measuring ≥110 ms and evidence of conduction block using differential pacing. Study was powered to an endpoint of acute reconnection within 30 mins.

Results
A total of 60 patients underwent catheter ablation for typical AFL with either HNS (n=30) or NS (n=30). There were no significant differences between the two groups in terms of patient age (68±7 yrs HNS vs. 68±10 yrs NS) and BMI (31±7 HNS vs 31±5 NS). BB was achieved in all patients. The MVG approach was employed in 28/60 patients. Acute reconnection was observed in 11 patients (18%); 4 in HNS vs 7 in NS group (ns). The mean RF time to achieve BB was 386±262 seconds in HNS vs 456±270 seconds in NS (p=0.21). The approach to CTI ablation showed a significant difference in time to BB: Time to block in MVG cases was 264±143 seconds vs 567±273 in empiric CTI line cases. Figure 1 demonstrates the time to block in both approaches with the choice of irrigant not appearing to impact the time to BB. There were 4 steam pops in the HNS arm and 0 steam pops observed in the NS arm. There were no significant complications in either arm.

Conclusion
Irrigation with HNS resulted in no statistically significant reduction in duration of RF time or improvement in acute outcomes over NS in the atrial flutter population. Reduction in duration of RF time was driven by MVG approach. However, acute reconnections were higher in NS group, all 4 steam pops occurred in HNS arm.
Figure 1

Funding Acknowledgement
Type of funding source: None
Comparison catheter ablation versus permanent pacemaker implantation in patients with tachycardia-bradycardia syndrome: prospective, randomized trial
Authors: Choi K.J , Nam G.B , Zo J.H , Lee J.H , Cho M.S , Kim J , Kim Y.H 
Published: November 2020

Abstract

Background
Clinical outcomes after catheter ablation (CA) or pacemaker (PM) implantation for tachycardia-bradycardia syndrome (TBS) has not been well evaluated.

Purpose
This randomized controlled study compared the efficacy and safety outcomes of CA and PM implantation as an initial treatment for TBS with paroxysmal atrial fibrillation (AF).

Methods
A total of 70 patients with paroxysmal AF and TBS (mean 64 years, 64.3% male) underwent randomization, and received CA (CA group, n=35) or PM (PM group, n=35) as an initial treatment. The primary outcome was unexpected emergency room visit or hospitalization from any cardiovascular causes.

Results
The two groups were well-balanced with respect to the baseline characteristics except for difference in age (61.0±8.0 vs. 66.2±7.2, P=0.005). In the intention-to-treatment analysis, the rate of primary outcome was not significantly different between two groups at 2-years of follow-up (19.8% vs. 24.2%; HR 1.25, 95% CI 0.42–3.73, P=0.684). The same trend was noted when the result was adjusted for age (HR 1.16 95% CI 0.26–2.89, P=0.807). The rate of recurrent AF was significantly lower in CA group compared to PM group (24.0% vs. 100% at 2-yreas, P&lt;0.001). Four patients (11.4%) in CA group finally received PM implantation after CA due to syncope. The rate of major or minor procedure related complications was not significantly different between two groups (14.3% vs. 14.3%, P&gt;0.99).

Conclusion
In this randomized controlled study, CA was associated with a similar efficacy and safety with higher rate of sinus rhythm maintenance. CA could be considered a preferable treatment option over PM implantation in patients with paroxysmal AF and TBS.

Funding Acknowledgement
Type of funding source: None
Pacemaker implantation after balloon- or self-expandable transcatheter aortic valve replacement in patients with aortic stenosis
Authors: Bodin A , Bisson A , Herbert J , Lacour T , Saint Etienne C , Pierre B , Deharo P , Babuty D , Clementy N , Fauchier L 
Published: November 2020

Abstract

Background
The incidence of conduction abnormalities requiring permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) with different devices available in recent years remains a matter of debate.

Methods
Based on the administrative hospital-discharge database, we collected information for all patients treated with TAVR between 2010 and 2019 in France. We compared the incidence of PPI after TAVR according to the type and generation of valve implanted.

Results
A total of 49,201 patients with aortic stenosis treated with transcatheter aortic valve replacement (TAVR) using the balloon-expandable (BE) Edwards SAPIEN valve or the self-expanding (SE) Medtronic CoreValve were found in the database. Patients treated with early BE or SE valves had higher Charlson comorbidity and frailty indexes than those treated with later BE or SE valves, and slightly higher EuroSCORE II. Patients treated with SE valves had higher rates of previous pacemaker or defibrillator than those treated with BE valves. Mean (SD) follow-up was 1.2 (1.5 years) (median [interquartile range] 0.6 [0.1–2.0] years). PPI after the procedure was reported in 13,289 patients, among whom 11,010 (22.4%) had implantation during the first 30 days (figure 1). In multivariable analysis, using early BE TAVR as reference, adjusted OR (95% CI) for PPI during the first 30 days was 0.88 (0.81–0.95) for latest BE TAVR, 1.40 (1.27–1.55) for early SE TAVR and 1.17 (1.07–1.27) for latest SE TAVR. Compared to early BE TAVR, adjusted HR for PPI during the whole follow-up was 1.01 (0.95–1.08) for latest BE TAVR, 1.30 (1.21–1.40) for early SE TAVR and 1.25 (1.18–1.34) for latest SE TAVR.

Conclusion
In patients with aortic stenosis treated with TAVR, our systematic analysis at a nationwide level found higher rates of PPI than previously reported. BE technology was independently associated with lower incidence rates of PPI both at the acute and chronic phases than SE technology. However, this was less apparent than previously reported in this large analysis of unselected patients seen in “real life” practice. Recent generations of TAVR were not independently associated with different rates of PPI than early generations during the overall follow-up.

Funding Acknowledgement
Type of funding source: None
Outcomes of permanent pacemaker implantation following transcatheter aortic valve replacement
Authors: Fauchier L , Bodin A , Bisson A , Herbert J , Lacour T , Saint Etienne C , Clerc J.M , Quilliet L , Semaan K , Ivanes F , Pierre B , Deharo P , Babuty D , Clementy N 
Published: November 2020

Abstract

Background
Conduction abnormalities leading to permanent pacemaker (PPM) implantation are common complications following transcatheter aortic valve replacement (TAVR). Whether PPM implantation placement is associated with adverse outcomes is unclear. The purpose of this study was to evaluate the incidence, predictors, and clinical outcomes of PPI following TAVR.

Methods
Based on the administrative hospital-discharge database, we collected information for all patients treated with TAVR between 2010 and 2019 in France.

Results
A total of 49,201 patients with aortic stenosis treated with transcatheter aortic valve replacement (TAVR) using the balloon-expandable (BE) Edwards SAPIEN valve or the self-expanding (SE) Medtronic CoreValve were found in the database. Among them, 10,019 (20.4%) had prior PPM implantation, including 476 (4.8%) treated with cardiac resynchronization therapy (CRT). New PPM implantation was required within 30 days of TAVR in 11,010 patients (22.4%), which varied among those receiving self-expanding valves (24.7%) versus balloon-expanding valves (20.9%). There were 349/10,010 patients (3.1%) treated with cardiac resynchronization therapy (CRT) within 30 days following TAVR. In a multivariable analysis comprising 38 variables (including among others underlying conduction disorders, Euroscore 2, Charlson comorbidity index, frailty score and type of implanted valve), prior PPM implantation was associated with an increased risk of all-cause death (adjusted hazard ratio [HR]: 1.10 95% CI 1.04–1.16). New PPM implantation was associated with even higher risk of mortality (adjusted HR: 1.21 95% CI 1.15–1.28). By contrast, previous CRT was associated with a lower risk of death during follow-up (adjusted HR: 0.78 95% CI 0.63–0.96), while PPM with CRT within 30 days of TAVR was not associated with a different risk of death (adjusted HR: 1.00 95% CI 0.80–1.24). Prior PPM and new PPM implantation were also associated with an increased risk of rehospitalization for heart failure (adjusted HR: 1.26 95% CI 1.19–1.32 and 1.18 95% CI 1.12–1.24, respectively). Previous CRT was associated with a non-significant lower risk of rehospitalization for heart failure (adjusted HR: 0.92 95% CI 0.77–1.09).

Conclusions
Both previous PPM and early PPM implantation following TAVR are commonly seen in patients treated with TAVR, and they are associated with a higher risk of death and rehospitalisation for heart failure when compared to patients with no PPM. The fact that CRT when implanted before TAVR was associated with a better survival may deserve consideration when elaborating future optimal approaches for management of conduction disturbances in patients treated with TAVR.

Funding Acknowledgement
Type of funding source: None
Incidence of sudden cardiac death after heart transplantation
Authors: Bonnet G , Coutance G , Waldmann V , Aubert O , Asselin A , Raynaud M , Racape M , Bories M.C , Varnous S , Rouvier P , Bruneval P , Leprince P , Marijon E , Loupy A , Jouven X 
Published: November 2020

Abstract

Background
Sudden cardiac death (SCD) is a major contributor to the rate of mortality after heart transplantation. However, little is known about the incidence of SCD in heart recipients.

Objective
To assess the incidence of SCD after heart transplantation.

Methods
We enrolled consecutive patients transplanted between 2004 and 2017 in two French referral centers. We defined 7 main groups of causes of deaths: SCD, cardiovascular (including Cardiac allograft vasculopathy), infection, primary graft dysfunction, graft failure (including late graft dysfunction, rejection), malignancy and others. Causes of deaths were independently adjudicated by two senior cardiologists based on the analysis of death certificates and medical records. Discrepancies were resolved by discussion until a consensus was made. SCD was defined as an unexpected out-of-hospital cardiac arrest without obvious non-cardiac cause, in the first hour after initiation of symptoms.

Results
A total of 1,363 patients were included. The median follow-up post-transplant was 3.99 years (IQR=0.49–7.49). 450 patients (33%) deceased during the first year. The leading cumulative causes of death in the first year after transplantation were infection, primary graft failure, multiple organ failure during the period in intensiv car unit. Beyond the post-operativ high-risk period of the first year, the leading cumulative cause of death was SCD: among the 213 deaths that occurred beyond the first year, 44 patients (21%) died from SCD. In this period, the incidence rate of SCD reached 0,82 per 100 person-year (95% CI: 0.51–2.05).

Conclusion
In a large multicentric and highly phenotyped cohort of heart transplant recipients, the leading cumulative cause of death beyond the first-year post transplant was sudden cardiac death. Our results open discussion on management of heart recipient, such as the implementation of cardioverter-defibrillators.
Figure 1. Cumulative incidence of causes of death in heart transplant recipients beyond the first year (n=913).

Funding Acknowledgement
Type of funding source: None