bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pulmonary artery injury in left atrial appendage closure device implantation: a systematic review of a potentially fatal complication
Authors: Hanna B , Desai R , Sachdeva S , Singh S , Gangani K , Taha Y , Echols M , Paul T.K , Berman A , Bloom H , Kumar G , Sachdeva R 
Published: November 2020

Abstract

Background
Pulmonary artery (PA) injury is a rarely reported complication following percutaneous left atrial appendage closure (LAAC). This study aims to systematically review all reported cases of PA injury associated with LAAC.

Methods
PubMed/Medline, SCOPUS, EMBASE, Google Scholar and the MAUDE databases were searched to find studies reporting PA injury during or after LAAC with the Amplatzer Amulet (AA), Amplatzer Cardiac Plug (ACP) or Watchman device through October 2019. Categorical data were reported in terms of numbers and/or percentages (%).

Results
We found 13 cases (mean age 71.4 yrs) with reported PA injury associated with LAAC. Of these, 9 were case reports, 3 were reported in observational studies, and 1 was in the MAUDE database. Most cases (n=8) were reported in Europe followed by Australia (n=2) and Asia (n=2). The indication for device implantation in all patients was a high bleeding risk with anticoagulation for atrial fibrillation. Five cases were reported with the ACP (1/5 patients died), 5 with AA (2/5 patients died), and 3 with the Watchman (1/2 patients died). Acute and late presentations following implantation were reported for all three devices. 69.2% of cases (9/13) occurred acutely (during or within 24 hours of intervention). Of these, 3/9 occurred during device implantation. 2/4 of the delayed cases occurred &gt;2 weeks following implantation. The mortality rate for acute and delayed cases was 22% (2/9 patients) and 50% (2/4 patients), respectively. A majority of the cases were attributable to barb/strut/hook injury of the PA. PA injury was associated with a mortality rate of approximately 31%. All surviving patients were managed with surgical intervention.

Conclusion
PA injury is an infrequently reported complication following LAAC and is associated with high mortality. Cases can present acutely (intra-procedurally or within 24 hours) or delayed (&gt;24 hours post-implantation). A majority of cases are due to direct injury of the PA by the struts/hooks/barbs of the device. Practitioners should be cognizant of this life-threatening complication, which requires a high index of suspicion for diagnosis and can occur weeks after device implantation.

Funding Acknowledgement
Type of funding source: None
Unravelling the black box of machine learning for atrial fibrillation forecast: role of heart rate variability and of premature beats
Authors: Gregoire J.M , Gilon C , Carlier S , Bersini H 
Published: November 2020

Abstract

Background
The identification of patients still in sinus rhythm who will present one month later an atrial fibrillation episode is possible using machine learning (ML) techniques. However, these new ML algorithms do not provide any relevant information about the underlying pathophysiology.

Purpose
To compare the predictive performance for forecasting AF between a machine learning algorithm and other parameters whose pathophysiological mechanisms are known to play a role in the triggering of arrhythmias (i.e. the count of premature beats (PB) and heart rate variability (HRV) parameters)

Material and methods
We conducted a retrospective study from an outpatient clinic. 10484 Holter ECG recordings were screened. 250 analysable AF onsets were labelled. We developed a deep neural network model composed of convolutional neural network layers and bidirectional gated recurrent units as recurrent neural network layers that was trained for the forecast of paroxysmal AF episodes, using RR intervals variations. This model works like a black box. For comparison purposes, we used a “random forest” (RF) model of ML to obtain forecast results using HRV parameters with and without PB. This model allows the evaluation of the relevance of HRV parameters and of PB used for the forecast. We calculated the area under the curve of the receiving operating characteristic curve for the different time windows counted in RR intervals before the AF onset.

Results
As shown in the table, the forecasting value of the deep neural network model (ML) was not superior to the random forest algorithm. Prediction value of both decreased when analyzing the RR intervals further away from the onset of AF

Conclusions
These results suggest that HRV plays a predominant role in triggering AF episodes and that premature beats could add minor information. Moreover, the closer the window from AF onset, the better the accuracy, regardless of the method used. Such detection algorithms once implemented in pacemakers, might prove useful to prevent AF onset by changing pacing sequence while patients would still be in sinus rhythm, however this remains to be demonstrated

Funding Acknowledgement
Type of funding source: None
Blood pressure lowering treatment for prevention of cardiovascular events in patients with atrial fibrillation: an individual-participant data meta-analysis
Authors: Pinho-Gomes A.C , Azevedo L , Copland E , Canoy D , Nazarzadeh M , Remakrishnan R , Berge E , Sundstrom J , Kotecha D , Woodward M , Rahimi K 
Published: November 2020

Abstract

Background
Randomised evidence showing that pharmacological blood pressure (BP) lowering can reduce cardiovascular risk of patients with atrial fibrillation (AF) is limited.

Purpose
This study aimed to compare the effect of BP-lowering treatment on fatal and non-fatal cardiovascular outcomes in patients with and without AF overall and by major drug classes.

Methods
We extracted individual participant data from all trials with over 1,000 person-years of follow-up that had randomly assigned patients to different classes of BP-lowering drugs, BP-lowering drugs vs placebo, or to more vs less intensive BP-lowering regimens. We investigated the effects of BP-lowering treatment on a composite endpoint of major cardiovascular events (stroke, ischaemic heart disease or heart failure) according to AF status at baseline using fixed-effect one-stage individual participant data meta-analyses based on Cox proportional hazards models stratified by trial.

Findings
Twenty-two trials were included with 188,570 patients, of whom 13,266 (7%) had AF at baseline. Patients with AF had lower BP at baseline than patients without AF (143/84 mmHg, SD 21/12mmHg) versus 155/88 mmHg, SD 21/13 mmHg, respectively). Meta-regression showed that relative risk reductions were proportional to trial-level intensity of BP lowering, both in patients with and without AF. The hazard ratio for major cardiovascular events was 0.91 in patients with AF (95% confidence interval [0.83–1.00]) and 0.91 without AF (95% confidence interval [0.88–0.93]) for each 5-mmHg reduction in systolic BP, with no difference between subgroups (p=0.91) (Figure 1). Similar patterns were observed for individual components of the composite primary outcome. In patients with AF, there was no evidence that treatment effects varied according to baseline systolic BP or use of specific drug classes.

Conclusion
This study demonstrated that BP-lowering treatment reduces the risk of major cardiovascular events in patients with AF to a similar extent to that of patients without AF, even when baseline BP is below recommended treatment thresholds. Owing to their higher absolute cardiovascular risk, treatment in patients with AF is likely to result in greater absolute risk reduction than in patients without AF. Guidelines should be updated to clearly recommend pharmacological BP lowering for prevention of cardiovascular events in patients with AF.
Figure 1. Forest plot

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): British Heart Foundation
Clinical impact of regression from sustained to paroxysmal atrial fibrillation: the Fushimi AF registry
Authors: Fujino A , Ogawa H , Ikeda S , Doi K , Hamatani Y , An Y , Ishii M , Iguchi M , Masunaga N , Esato M , Tsuji H , Wada H , Hasegawa K , Abe M , Akao M 
Published: November 2020

Abstract

Background
Atrial fibrillation (AF) commonly progresses from paroxysmal type to sustained type in the natural course of the disease, and we previously demonstrated that the progression of AF was associated with increased risk of clinical adverse events. There are some patients, though less frequently, who regress from sustained to paroxysmal AF, but the clinical impact of the regression of AF remains unknown.

Purpose
We sought to investigate whether regression from sustained to paroxysmal AF is associated with better clinical outcomes.

Methods
Using the dataset of the Fushimi AF Registry, patients who were diagnosed as sustained (persistent or permanent) AF at baseline were studied. Conversion of sustained AF to paroxysmal AF during follow-up was defined as regression of AF. Major adverse cardiac events (MACE) were defined as the composite of cardiac death, stroke, and hospitalization for heart failure (HF). Event rates were compared between the patients with and without regression of AF. In patients with sustained AF at baseline, predictors of MACE were identified using Cox proportional hazards model.

Results
Among 2,253 patients who were diagnosed as sustained AF at baseline, regression of AF was observed in 9.0% (202/2,253, 2.0 per 100 patient-years) during a median follow-up of 4.0 years. Of these, 24.3% (49/202, 4.6 per 100 patient-years) of the patients finally recurred to sustained AF during follow-up. The proportion of asymptomatic patients was lower in patients with regression of AF than those without (with vs without regression; 49.0% vs 69.5%, p&lt;0.01). The percentage of beta-blocker use at baseline was similar between the two groups (37.2% vs 33.8%, p=0.34). The prevalence of patients who underwent catheter ablation or electrical cardioversion during follow-up was higher in patients with regression of AF (catheter ablation: 15.8% vs 5.5%; p&lt;0.01, cardioversion: 4.0% vs 1.4%; p&lt;0.01, respectively). The rate of MACE was significantly lower in patients with regression of AF as compared with patients who maintained sustained AF (3.7 vs 6.2 per 100 patient-years, log-rank p&lt;0.01). Figure shows the Kaplan-Meier curves for MACE, cardiac death, hospitalization for heart failure, and stroke. In patients with sustained AF at baseline, multivariable Cox proportional hazards model demonstrated that regression of AF was an independent predictor of lower MACE (adjusted hazard ratio [HR]: 0.50, 95% confidence interval [CI]: 0.28 to 0.88, p=0.02), stroke (HR: 0.51, 95% CI: 0.30 to 0.88, p=0.02), and hospitalization for HF (HR: 0.50, 95% CI: 0.29 to 0.85, p=0.01).

Conclusion
Regression from sustained to paroxysmal AF was associated with a lower incidence of adverse cardiac events.

Funding Acknowledgement
Type of funding source: None
Temporal changes in quality of life amongst European atrial fibrillation patients: relationship to all-cause mortality. A report from the ESC-EHRA EORP-AF General Long-Term Registry
Authors: Vitolo M , Proietti M , Harrison S , Fauchier L , Marin F , Potpara T , Lane D.A , Boriani G , Lip G.Y.H 
Published: November 2020

Abstract

Background
Atrial fibrillation (AF) significantly impacts on patients' quality of life (QoL). An impaired QoL has been associated with worse outcomes even in AF patients, but contemporary data in a large-scale pan-European population are limited.

Purpose
We aimed to assess temporal changes in AF patients' QoL across 2 years follow-up observation, and the relationship of QoL changes with all-cause death.

Methods
We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. The EQ-5D-5L questionnaire was used to assess QoL. A Health Utility Score (HUS), indicating the overall health state (1 equals perfect health), was derived. Differences throughout the follow-up (Baseline, 1-Y FU, 2-Y FU) observation were assessed. The study outcome was all-cause mortality.

Results
Out of a total of 11906 patients, 8097 (73.0%) were available for this analysis. Mean (SD) age was 69.1 (11.5) years; 60.8% males; median CHA2DS2-VASc and HASBLED scores were 3 (IQR 2–4) and 1 (1–2), respectively. The mean (SD) HUS at baseline was 0.815 (0.200) and 0.834 (0.196), 0.829 (0.195) at 1-year follow-up and 2-year follow-up, respectively (p&lt;0.0001 for changes over time). Patients with a higher CHA2DS2-VASc score (CHA2DS2-VASc 6–9) reported a significant reduction in the quality of life, compared to the other CHA2DS2-VASc strata, with a mean (SD) HUS decreasing from 0.754 (0.214) at baseline to 0.727 (0.238) at 2-year follow-up (F=6.538, p&lt;0.0001) (Figure). Multivariate analysis demonstrated that age [−0.001 (95% CI [−0.002, −0.121]) and coronary artery disease (CAD) [−0.016 (95% CI [−0.029, −0.004] were independently inversely associated with increasing QoL. Positive changes in HUS over time were inversely associated with an increase in the risk of all-cause death, even after adjusting for chronic kidney disease, liver disease, chronic obstructive pulmonary disease, oral anticoagulants and type of AF (OR:0.24, 95% CI: 0.13–0.45 for increasing HUS difference, as a continuous variable).

Conclusions
In a contemporary European-wide cohort of AF patients, significant temporal changes in QoL were found. Patients at higher stroke risk according to CHA2DS2-VASc score showed a significant reduction in the QoL. Age and CAD were independently associated with changes in QoL. A greater reduction in HUS (i.e. worsening QoL) over time was associated with a higher risk of all-cause death.
Temporal changes in HUS

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Since the start of EORP, several companies have supported the programme with unrestricted grants
Scar and arrhythmic isthmus characterization in patients with D-TGA treated with atrial switch surgery using a new high density mapping grid catheter
Authors: Francisco Pascual J , Llerena Butron S , Pascual Gonzalez G , Perez Rodon J , Santos Ortega A , Benito B , Rodriguez Garcia J , Roses Noguer F , Dos Subira L , Pijuan Domenech A , Subirana Domenech M.T , Miranda Barrio B , Garrido L , Ferreira Gonzalez I , Rivas Gandara N 
Published: November 2020

Abstract

Introduction
Patients with D- transposition of the great arteries (TGA) treated with Senning or Mustard surgeries have several atrial scars that predispose them to develop atrial tachycardias (AT). Identification of scar zones and possible arrhythmic isthmus in voltage mapping will help to guide the ablation.

Aim
To describe the feasibility of using a specific mapping catheter to identify possible arrhythmic isthmus in this set of patients.

Methods
Prospective observational study in patients with history of SVT and atrial switch surgery, that underwent electrophysiologic study (EP) and electroanatomic (EA) mapping with a new 8Fr deflectable, multipoint wavefront-activation-orientation independent Grid catheter, in a third level hospital since April 2018 until January 2020, with medium-term follow-up.

Results
A total of 9 EPs were performed in 8 patients (3 (37,5%) Female, median age 35.2 y.o. (IQI 29,2–37,6)). Figure 1A shows an example of an activation and substrate mapping. Figure 1B shows the localization and percentage of scar identified in both atria. A total of 7 tachycardias were induced. In this, an arrhythmogenic isthmus was identified and in all patients at least one non-arrhytmogenic isthmus was documented. Figure 1C shows anatomical and electrophysiological characteristics of the isthmus. Arrhythmogenic isthmus had slower conduction velocity than non-arrhytmogenic (mean 0,31m/s (IQI 0,14–0,63) vs 0,94 m/s (IQI 0,81–1,24) p=0.02) and fractionated potentials were detected more frequently (100% vs 55% p=0.05)

Conclusion
EA mapping with a new a multipoint, high-definition, Grid Cather allows the identification and electrophysiological characterization of arrhythmogenic and non-arrhytmogenic isthmus in patients with TGA treated with atrial switch surgery.
Figure 1

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Hospital Universitari Vall d'Hebron. VHIR
Takotsubo cardiomyopathy related complete heart block: a nationwide cohort analysis
Authors: Patil S.P , Gonuguntla K , Rojulpote C , Kumar M , Chen K.G 
Published: November 2020

Abstract

Background
Complete heart block (CHB) is considered to be a relatively rare complication of Takotsubo cardiomyopathy (TC), a condition characterized by transient left ventricular systolic dysfunction.

Purpose
We aim to investigate the incidence, in-hospital mortality and trends of permanent pacemaker (PPM) placement in patients with TC-related CHB.

Methods
We utilized the United States National Inpatient Sample (NIS) data from 2010–2014 to identify adult patients (≥18 years) with TC (ICD 9 code: 429.83). CHB cases were identified using ICD-9 code 426.0. Annual incidence of CHB, in-hospital mortality and trends of PPM placement were analyzed. Cochran-Armitage test was employed and p values were calculated for trend.

Results
A total of 56,431 patients with TC were identified, of which 495 (0.7%) had CHB (median age 71 years, 85% women). Incidence of TC-related CHB was 0.5% in 2010 and 0.8% in 2014.
However, trend analysis did not show an increase in the incidence (ptrend=0.12). In-hospital mortality was higher in patients with CHB (7.5% vs. 2.9%, aOR = 1.9, 95% CI= 1.29–2.8, p=0.001). Temporary transvenous pacemaker (TTVP) was used in 158 (40.1%) and PPM in 217 (54.9%) patients. Trend analysis showed a significant increase in the PPM placement from 41.9% in 2010 to 76.2% in 2014 and a simultaneous decrease in use of TTVP (ptrend&lt;0.001).
Median length of stay (4 vs. 3 days, p&lt;0.001) was prolonged and hospitalization cost ($92,731 vs. $35,905, p&lt;0.001) was higher in TC patients with CHB.

Conclusion
TC-related CHB is uncommon, but independently associated with increased in-hospital mortality. The majority of these patients required PPM, implicating a non-reversible feature of the conduction system abnormality.

Funding Acknowledgement
Type of funding source: None
The management of Atrioventricular Blocks in Tako-Tsubo Syndrome, a therapeutic dilemma?
Authors: Piroli F , Franchin L , Errigo D , De Filippo O , D'Ascenzo F , De Ferrari G 
Published: November 2020

Abstract

Introduction
Atrioventricular blocks (AVBs) are a rare complication of Tako-Tsubo syndrome (TTS). Acute management of these patients is still a matter of debate since the long-term outcomes are difficult to predict and a complete recovery after PPM implantation may occur.

Methods
A critical review of current literature focusing on PPM implantation time in this patients' cohort was performed after a patient with TTS and AVB received a PPM in our medical center with a subsequent complete recovery in one month.

Results
Twenty-four case-reports of TTS-related AVBs were collected. A total of five patients went through a complete AV conduction recovery within few days, while of nineteen patients receiving a PPM during hospitalization, three showed a complete recovery within one to three months and one after two years. In six cases an electrophysiology (EP) study was performed to assess the functional nature of the AVB, resulting in four supra-Hisian blocks and two infra-Hisian blocks. In the supra-Hisian group there was a conduction recovery in three cases in a period from few days to one month while only one patient didn't improve at three-months. On the other hand, in the infra-Hisian group only one patient recovered AV conduction after two years.

Conclusion
Infra-Hisian and supra-Hisian blocks appear to have different outcomes with the latter more likely to develop a faster recovery. EP study could be a useful tool for clinicians during decision-making process and a wait-and-see strategy may be considered to avoid unnecessary PPM implantations.

Funding Acknowledgement
Type of funding source: None
Incidence, characteristics, determinants and prognostic impact of recurrent syncope
Authors: Zimmermann T , Du Fay De Lavallaz J , Nestelberger T , Gualandro D , Badertscher P , Lopez-Ayala P , Widmer V , Freese M , Twerenbold R , Wussler D , Koechlin L , Walter J , Kuehne M , Reichlin T , Mueller C 
Published: November 2020

Abstract

Background
The incidence, characteristics, determinants, and prognostic impact of recurrent syncope are largely unknown, causing uncertainty for both patients and physicians.

Methods
We characterized recurrent syncope including sex-specific aspects and its impact on death and major adverse cardiovascular events (MACE) in a large prospective international multicenter study enrolling patients ≥40 years presenting with syncope to the emergency department (ED). Syncope etiology was centrally adjudicated by two independent and blinded cardiologists using all information becoming available during syncope work-up and 12-month follow-up. MACE were defined as a composite of all-cause death, acute myocardial infarction, surgical or percutaneous coronary intervention, life-threatening arrhythmia including cardiac arrest, pacemaker or implantable cardioverter defibrillator implantation, valve intervention, heart-failure, gastrointestinal bleeding or other bleeding requiring transfusion, intracranial hemorrhage, ischemic stroke or transient ischemic attack, sepsis and pulmonary embolism.

Results
Incidence of recurrent syncope among 1790 patients was 20% (95%-confidence interval (CI) 18% to 22%) within 24 months. Patients with an adjudicated final diagnosis of cardiac syncope (hazard ratio (HR) 1.50, 95%-CI 1.11 to 2.01) or syncope of unknown etiology even after central adjudication (HR 2.11, 95%-CI 1.54 to 2.89) had an increased risk for syncope recurrence (Figure). LASSO regression fit on all patient information available early in the ED identified more than three previous episodes of syncope as the only independent predictor for recurrent syncope (HR 2.13, 95%-CI 1.64 to 2.75). Recurrent syncope within the first 12 months after the index event carried an increased risk for all-cause death (HR 1.59, 95%-CI 1.06 to 2.38) and MACE (HR 2.24, 95%-CI 1.67 to 3.01), whereas recurrences after 12 months did not have a significant impact on outcome measures.

Conclusion
Recurrence rates of syncope are substantial and vary depending on syncope etiology. There seem to be no reliable patient characteristics available early on the ED that allow for the prediction of recurrent syncope with only a history of more than three previous syncope being associated with a higher risk for future recurrences. Importantly, recurrent syncope within the first 12 months carries an increased risk for death and MACE.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation