bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5656Heart failure clinical phenotypes and outcomes in patients with atrial fibrillation: an analysis from the eurobservational research programme in atrial fibrillation long-term general registry
Authors: Proietti M , Laroche C , Tello-Montoliu A , Lenarczyk R , Dan G A , Maggioni A P , Lip G Y H , Boriani G 
Published: October 2019

Abstract

Introduction
Heart failure (HF) is a well-known risk factor for atrial fibrillation (AF). Moreover, HF is associated with worse clinical outcomes in patients with known AF. Recently, phenotypes of HF have been redefined according to the level of ejection fraction (EF). New data are needed to understand if a differential risk for outcomes exists according to the new phenotypes' definitions.

Purpose
To evaluate the risk of major adverse outcomes in patients with AF and HF according to HF clinical phenotypes.

Methods
We performed a subgroup analysis of AF patients enrolled in the EORP-AF Long-Term General Registry with a history of HF at baseline, available EF and follow-up data. Patients were categorized as follows: i) EF<40%, i.e. HF reduced EF [HFrEF]; ii) EF 40–49%, i.e. HF mid-range EF [HFmrEF]; iii) EF ≥50%, i.e. HF preserved EF [HFpEF]. Any thromboembolic event (TE)/acute coronary syndrome (ACS)/cardiovascular (CV) death, CV death and all-cause death were recorded.

Results
A total of 3409 patients were included in this analysis: of these, 907 (26.6%) had HFrEF, 779 (22.9%) had HFmrEF and 1723 (50.5%) had HFpEF. An increasing proportion with CHA2DS2-VASc ≥2 was found across the three groups: 90.4% in HFrEF, 94.6% in HFmrEF and 97.3% in HFpEF (p<0.001), while lower proportions of HAS-BLED ≥3 were seen (28.0% in HFrEF, 26.3% in HFmrEF and 23.6% in HFpEF, p=0.035). At discharge patients with HFpEF were less likely treated with antiplatelet drugs (22.0%) compared to other classes and were less prescribed with vitamin K antagonists (VKA) (57.0%) and with any oral anticoagulant (OAC) (85.7%). No differences were found in terms of non-vitamin K antagonist oral anticoagulant use. At 1-year follow-up, a progressively lower rate for all study outcomes (all p<0.001), with an increasing cumulative survival, was found across the three groups, with patients with HFpEF having better survival (all p<0.0001 for Kaplan-Meier curves). After full adjustment, Cox regression analysis showed that compared to HFrEF, HFmrEF and HFpEF were associated with risk of all study outcomes (Table).
Cox Regression Analysis HR (95% CI) Any TE/ACS/CV Death CV Death All-Cause Death HFmrEF 0.65 (0.49–0.86) 0.53 (0.38–0.74) 0.55 (0.41–0.74) HFpEF 0.50 (0.39–0.64) 0.42 (0.31–0.56) 0.45 (0.35–0.59) ACS = Acute Coronary Syndrome; CI = Confidence Interval; CV = Cardiovascular; EF = Ejection Fraction; HF = Heart Failure; HR = Hazard Ratio.

Conclusions
In this cohort of AF patients with HF, HFpEF was the most common phenotype, being associated with a profile related to an increased thromboembolic risk. Compared to HFrEF, both HFmrEF and HFpEF were associated with a lower risk of all major adverse outcomes in AF patients.
P5664Trends in incidence and mortality from atrial fibrillation across europe, 1990 - 2017
Authors: Al-Khayatt B , Salciccioli J , Marshall D , Shalhoub J , Sikkel M 
Published: October 2019

Abstract

Background
Atrial fibrillation (AF) is one of the most common arrhythmias found in the general population, carrying risk of associated cardiovascular and cerebrovascular complications, and presenting a significant global health burden. Better understanding of its epidemiology may have public health implications.

Purpose
To describe trends in AF incidence and mortality throughout Europe from 1990 to 2017.

Methods
We performed a temporal analysis of data deposited in the Global Burden of Disease Study Database for countries across the European Union. We extracted age-standardised incidence and age-standardised death rates from the database and graphically inspected the data, as well as summarised the changes in trends using percentage change from the beginning of the observation period (1990) to the end of the observation period (2017).

Results
A total of 24 member states were included. In 1990, the overall median male incidence and mortality from AF were 81.4 cases per 100,000 and 5.0 deaths per 100,000 respectively. The corresponding female median incidence and mortality in 1990 were 66.3 cases per 100,000 and 7.3 deaths per 100,000 respectively. Mortality rates in 2017 were highest in Sweden and Germany. There was an increasing trend in all countries between 1990 and 2017 for both incidence and mortality. For men, the countries with the greatest percentage increases in incidence were Slovenia (+77%) and Poland (+71%). For women, the greatest increases in AF incidence were in Poland (+58%) and Estonia (+48%). The greatest percentage increases in AF related mortality were, in men, Estonia (+195%) and Sweden (+145%), and, in women, Greece (+151%) and Bulgaria (+147%).

Conclusion
AF represents a significant health burden in an aging population; general increases in incidence rates may suggest improvement in detection throughout Europe. However, AF associated mortality is more pronounced in Western Europe.
P5667A clinical risk score for predicting incident atrial fibrillation in Asians: derivation in 7,220,654 Taiwan subjects with 438,930 incident atrial fibrillation
Authors: Chao T F , Chen S A 
Published: October 2019

Abstract

Background
The patient number of atrial fibrillation (AF) is continuously increasing all over the world. No risk score for predicting incident AF has been specifically developed using a nationwide dataset for Asians. Our aim was to investigate risk factors for incident AF in Asians and to combine them to develop a clinical risk scheme.

Method
From January 1st 2000 to December 31st 2000, 7,220,654 subjects aged >40 years without past history of cardiac arrhythmia were identified from the Taiwan National Health Insurance Research Database. Cox regression analysis was performed to identify significant clinical predictors of incident AF which were then incorporated together to develop a scoring scheme.

Results
During a follow up of 16 years, 438,930 patients experienced incident AF. The significant predictors and the calculation rule of the scoring scheme are shown in Figure A. The score ranged from −3 to 25, and the risk of incident AF ranged from 0.06%/year for patients with a score −3 to 7.99%/year for those with a score >19. The AUC in the prediction of 1-year risk of incident AF was 0.86 and was 0.75 for 16-year risk of AF (Figure B), which was higher than that of CHADS2, CHA2DS2-VASc and C2HEST scores.

Conclusion
A clinical risk score has been developed based on a large nationwide database which could be used to identify patients at a high risk of incident AF.
P5671Risk factors associated with recurrence of syncopal episodes in patients admitted to a syncope care unit
Authors: Camiletti A , Ferreira De Souza O F S , Bronchtein A I C B , Oliveira Junior N A O J , Pinheiro M V T P , Abufaiad B A , Rangel R A L R , Nascimento E M , Pereira B B , Oliveira G M M 
Published: October 2019

Abstract

Introduction
Recurrent syncope takes a serious toll on quality of life, being compared to chronic diseases, particularly on the elderly.

Objectives
Identify recurrence predictors in patients treated attended at syncope units (SU).

Method
Study involving patients attended at SUs in the emergency care units of 11 hospitals over the period from May 2015 to July 2017. The SUs were provided around-the-clock dedicated phone support by specialists and a set of standardized protocols (SP) for diagnostic guidance and risk stratification based on current guidelines. In our statistical analysis, we implemented the parametric model for logistic regression (LR) and the non-parametric classification tree (CART) model. All 45 SP variables were included and subsequently selected through the use of elastic net regularization. In the LR, we considered significances of 5 and 10% for the recurrence outcome. These final variables were used to develop the classification trees (CART).

Results
We observed 1189, the majority of them (57.4%) were woman and the average age was 59 years old, with a wide range of variation (14–103). Cardiovascular and neurological diseases, as well as diabetes were more prevalent in men. The cause of syncopal episodes were diagnosticated in 81.1% of the patients, being reflex syncope the most common finding (59.4%). Episodes of recurrence were reported by 45.8%, with women representing 62.9% of this group, and 54.7% of them were younger than 59. In describing symptoms, 18.0% reported trauma associated with syncope, 38.2% showed no trigger incidents and 27.0% showed no prodromal symptoms. Women showed more prodromal symptoms, particularly dizziness, blurry vision, nausea and excessive sweating. In the variable analysis process, the LR highlighted: gender, diastolic blood pressure (DBP) and the incidence of: excessive sweating, blurry vision, palpitations, neurological diseases, changes in the conduction system detected by electrocardiogram and pacemakers (PM) as risk factors for recurrence. The CART classified the most relevant among these factors: age, DBP, sweating, blurry vision, neurological diseases and PM. Following the CART, it was detected that in female patients with signs of excessive sweating and normal DBP, the chance of recurrence was 59.6%, and when DBP ≤60 mmHg, that probability rose to 94.4%. In male patients with neurological diseases, the probability was 59%, but the chance of recurrence rose to 80% in patients with PM, even without concurrent neurological diseases.

Conclusion
The SUs and use of the SP allowed for the identification of high-risk patients and factors associated with higher probability of recurrence, improving overall approach towards syncope treatment.

Acknowledgement/Funding
OWN FINANCIAL SUPPORT
P5676Implementing a syncope pathway
Authors: Saurer G , Mezler-Andelberg M , Weihs W 
Published: October 2019

Abstract

Background
Syncope is a common presenting symptom in emergency departments (0.8–2.4%) and is associated with high health care costs. In up to 40% of cases, etiology remains unidentified after initial evaluation.

Purpose
To assess the increase in diagnostic yield and the time to diagnosis by implementing a structured pathway in syncope evaluation according ESC- Guidelines in a secondary hospital.

Methods
In the study, we compared 2 groups of patients with T-LOC. We evaluated the diagnostic yield and the time to diagnosis. The first group comprised all patients with T-LOC referred to the emergency department (ED) of the hospital from January to March 2016. The work-up was done according to existing clinical practice.
After implementation of a structured pathway in syncope evaluation according to ESC-Guidelines, we reevaluated the diagnostic yield and the time to diagnosis in all patients referred to ED with T-LOC from July to September 2017. The implementation consisted of an initial evaluation (careful history taking with a checklist, physical examination, ECG, orthostatic challenge test carried out by nurses), risk assessment and instructing the medical staff.

Results
There were 169 vs. 85 patients presenting with suspected T-LOC in the ED. 130 (77%) vs. 65 (76.5%) were classified as having a syncope. The diagnostic yield in the syncope patients was 60% vs. 80% (p=0.013). The rate of correct diagnosis within 14 days increased from 55 to 80%.

Conclusion
By implementing a structured pathway and educating the staff, we succeeded in increasing diagnostic yield from 60 to 80%. This could be achieved in a reduced referral to diagnosis time.
P5682Cardiac resynchronization therapy with a single left ventricular septal pacing electrode: acute hemodynamic and electrophysiological effects
Authors: Salden F , Luermans J G , Westra S W , Cornelussen R , Ghosh S , Prinzen F W , Vernooy K 
Published: October 2019

Abstract

Background
Cardiac resynchronization therapy (CRT) is usually performed with a right (RV) and left ventricular (LV) lead. In a previous patient study, pacing the interventricular septum permanently on the LV endocardial side (LV septum) proved feasible in patients with sinus node dysfunction.

Objective
To investigate the effects of LV septal pacing as compared to conventional biventricular (BiV) pacing with respect to acute hemodynamic and electrophysiological effects in CRT indicated heart failure patients.

Methods
Temporary LV septal pacing (transarterial approach) and pacing in the conventional BiV mode using the implanted leads was performed in 26 patients (QRS duration 163±17 ms, 23 left bundle branch block patients) undergoing CRT implantation. Acute hemodynamic response (relative to baseline AAI pacing) was assessed by LVdP/dtmax. Multi-electrode body-surface mapping, what has been used previously to characterize electrical dyssynchrony in CRT patients, was evaluated using the standard deviation of activation times (SDAT) (figure, right panel).

Results
LV septal pacing resulted in a significant LV dP/dtmax increase, that was comparable to conventional BiV pacing (figure, left panel). Combined RV and LV septal pacing did not provide an additional increase. LV septal pacing resulted in a significantly larger reduction in SDAT than RV plus LV septal pacing and conventional BiV pacing (figure, middle panel).

Conclusions
LV septal pacing results in acute hemodynamic improvement and electrical resynchronization that is at least as good as conventional BiV pacing. These results suggest that LV septal pacing with a single ventricular lead may serve as an alternative to conventional BiV pacing for cardiac resynchronization.

Acknowledgement/Funding
Medtronic is a subsidising party.
P5685Abnormal anatomy of the coronary sinus in congenitally corrected transposition of the great arteries (double discordance): a pitfall for transvenous cardiac resynchronization therapy?
Authors: Houyel L , Arribard N , Mostefa Kara M , Bessieres B , Bonnet D 
Published: October 2019

Abstract

Background
Congenitally corrected transposition of the great arteries (ccTGA) or double discordance is a rare congenital heart defect associating discordant atrioventricular and ventriculoarterial connections. Late prognosis depends on the progressive failure of the systemic right ventricle (RV). A possible cause for systemic RV dysfunction could be ventricular asynchrony. Cardiac resynchronization therapy (CRT) may thus be indicated in some cases. However, the cardiologists may experience some problems with the coronary sinus (CS) when implanting a 3-lead CRT transvenous system in these patients.

Aim of the study
To evaluate the anatomy of the CS and cardiac veins in specimens with ccTGA, in order to assess the feasibility of transvenous CRT.

Material and methods
Among the anatomic collection of the French Centre of Reference for complex CHD, 51 heart specimens had ccTGA with 2 ventricles. There were 33 post-natal and 18 fetal hearts. Hearts were reviewed with special attention paid to the course and drainage of the CS and cardiac veins. Segmental anatomy, location of the ventricular septal defect (VSD), status of the pulmonary outflow tract and anomalies of the atrioventricular valves were reviewed.

Results
Segmental anatomy was {S,L,L} in 46/51 hearts, {S,L,D} in 2 and {I,D,D} in 3. There was a VSD in 40 (outlet in 25, inlet in 11, both in 2, muscular in 2), pulmonary atresia in 13, subpulmonary stenosis in 6, abnormal tricuspid valve in 20/48 including Ebstein anomaly in 6, straddling in 9 (3 had replacement). The CS was always located behind the morphologically left atrium (LA). However, its anatomy was normal, with normal drainage into the morphologically right atrium, in only 25/51 (49% of cases). The CS was of reduced length with normal orifice in 17. Orifice was atretic with normal size CS in 2, and CS was completely absent in 6 with direct drainage of coronary veins into the LA. At least 1 available vein was found in all cases with patent CS orifice.

Conclusion
CS in ccTGA is always located behind the morphologically LA. However, its anatomy is abnormal in half of cases. The most frequent anomalies are reduced length (33%) and absent CS or atretic orifice (15.5%). The anatomy of CS should therefore be assessed by imaging techniques (multislice CT imaging or CS venography) before considering transvenous CRT in these patients.
P5692Catheter ablation of ventricular tachyarrhythmias in ischemic patients may contribute to better survival: a new clinical challenge
Authors: Garkina S , Tatarskii R , Mikhaylov E , Lebedeva V , Lyubimtseva T , Kamenev A , Orshanskaya V , Osadchiy A , Gureev S , Lebedev D 
Published: October 2019

Abstract

Background
Ventricular arrhythmias contribute to significant escalation of mortality rate in patients with ischemic cardiomyopathy (ICM). Risk of sudden cardiac death (SCD) could be reduced after implantation of a cardioverter-defibrillator (ICD), yet at the same time more frequent shock episodes are associated with poor life quality and higher hospitalization rate. Radiofrequency (RF) ablation of triggering ventricular premature beats or substrate-based catheter treatment are considered to be effective in patients with ICM but prognosis remains controversial.

Objective
To evaluate role of catheter treatment of ventricular tachyarrhythmias (VTA) and its effect on survival in patients with ischemic cardiomyopathy.

Methods
We enrolled 72 consecutive patients (mean age 64±13 years, 63 male) with prior myocardial infarction (more than 40 days ago) and documented ventricular tachycardia (VT) episodes, including 12 patients which underwent emergency electrical storm ablation. Considering number of VT recurrence episodes after catheter treatment all patients were divided into two groups. First group consisted of 27 patients (37%) with recurrent sustained VT (mean age 62±10 years) while second group included 45 patients (63%) without VT recurrence (mean age 63±12 years). During follow up most of VT episodes were registered in 13±9 years after acute myocardial infarction. Catheter treatment included mapping during hemodynamically tolerated clinically relevant VT and then ablation of VT triggers with subsequent homogenization of the scar. Patients with “fast” VT underwent primary scar homogenization.

Results
Effectiveness of clinically relevant VT ablation in patients with ICM was 63%. During follow-up period all patients were alive and remained relatively stable. Long-term effectiveness of ES elimination was 100% while freedom from clinically significant VTA was up to 79% due to repeated ablation procedures. We also observed improvement of NYHA functional class in 80% of patients.

Conclusion
Catheter ablation of VTA may be effective treatment both in acute period and long term follow up. It also may be effective in improvement of heart failure NYHA functional class in some patients and contributes to better survival in patients with ICM.
P5696The first results from multicentre study of noninvasive epi-endocardial panoramic mapping of ventricular arrhythmias
Authors: Chmelevsky M , Zubarev S , Budanova M , Potyagaylo D , Uecer E , Parreira L , Treshkur T , Fredersdorf S , Adragao P , Lebedev D 
Published: October 2019

Abstract

Background
A noninvasive epi-endocardial panoramic mapping is a promising ECG Imaging technology alternative to catheter-based invasive methods. Some unstable ventricular arrhythmias arising from complex anatomic sites render mapping and ablation difficulties with conventional approach.

Objective
To assess the use of a noninvasive panoramic mapping for diagnosis and localization of ventricular arrhythmias.

Methods
35 patients (20 male, median (25–75%) age – 35 (12–60) years) with polymorphic premature ventricular contractions (PVCs) and 3–5 different QRS morphologies (1500–19000 per day) or monomorphic ventricular tachycardia (VT) were enrolled in the study. Up to 224 body surface electrodes were connected to the noninvasive epi-endocardial electrophysiological system for multichannel ECG recording followed by computed tomography of the heart and torso. The body-surface ECG data were processed using inverse-problem solution software in combination with realistic 3D anatomical models of the heart and torso. The earliest site of activation were determined on isopotential maps for each QRS morphology. On the same day patients underwent catheter ablation of one or two dominant PVC morphologies using 3D electroanatomical mapping system. The site of successful catheter ablation served as final confirmation. Afterwards, electroanatomical maps were exported from Carto 3 system and compared with noninvasive maps using custom written Python-based software.

Results
In total 47 similar PVC morphologies in 30 patients were mapped using noninvasive and invasive electroanatomical mapping systems, 34 (72%) PVCs were correctly diagnosed and 13 (28%) did not accurately correspond with sites of radiofrequency ablation. In 2 patients with four PVC morphologies an early activation zones were determined as a breakthrough from epi and endocardial surface using noninvasive activation maps.

Conclusion
Non invasive epi-endocardial panoramic mapping technology is a novel diagnostic method which can be used as an additional pre-procedural tool for topical diagnosis of polymorphic PVCs.
P5697J-wave elevation in the inferior leads is a predictor of lethal ventricular arrhythmia initiated by premature ventricular contractions with right bundle branch block and superior axis
Authors: Munetsugu Y , Kawamura M , Ogawa K , Ochi A , Onishi Y , Ito H , Onuki T , Kobayashi Y , Shinke T 
Published: October 2019

Abstract

Background
Lethal-ventricular-arrhythmia (VA) could be sometimes initiated by idiopathic Premature Ventricular Contractions (PVCs) originated form inferior wall. Furthermore, J-wave elevation in inferior leads was sometimes associated with lethal-VA. However, it was unclear the relationship between these PVCs and J-wave elevation in patients with lethal-VA.

Purpose
The aim of this study was to investigate the relationship between PVCs and J-wave elevation.

Methods and results
We studied 32 patients who underwent radiofrequency (RF) ablation of idiopathic PVCs with RBBB and superior axis. These PVCs were originating from inferior wall of left ventricular. Lethal-VA was defined as ventricular fibrillation (VF) or ventricular tachycardia (VT) with loss of consciousness (LOC). Among 32 patients, 3 had VF and 2 had VT with LOC. Other 27 had non-lethal-VA. Baseline clinical characteristics were not significantly difference between lethal and non-lethal-VA. The ratio of J-wave elevation in lethal-VA was significant higher as compared to those with non-lethal-VA (5/5 (100%) vs. 3/27 (11.1%), p<0.0001). Furthermore, no patients had recurrence of lethal-VA with J wave elevation in inferior leads after RF ablation of these PVCs with RBBB and superior axis,

Conclusions
We speculated that J-wave elevation in inferior leads might be a predictor of lethal-VA initiated by PVCs with RBBB and superior axis. RF ablation of these PVCs were useful method of treating lethal-VA.

Acknowledgement/Funding
None