bluuebunny/crossref_metadata_2025_split huggingface dataset:
P337Homozygous polymorphism of gene transcription factor SP4 is associated with hereditary sick sinus syndrome
Authors: Chernova A , Nikulina S , Shulman V , Voevoda M , Maksimov V 
Published: June 2020

Abstract

PURPOSE
The human transcription factor SP4 has functional polymorphism on А80807Т. Our study aimed to confirm that gene transcription factor SP4 polymorphism affect hereditary sick sinus syndrome.

METHODS
Polymerase chain reaction-restriction fragment length polymorphism was used to screen for А80807Т. We genotyped polymorphism А80807Т of the transcription factor SP4 in 109 patients with hereditary sick sinus syndrome, 59 their healthy relatives and 196 control subjects. Structure of primers was as follows: 1) 5’-aaatgaggacaatgaaaagcaca-3’- direct (A) 2) 5’-gcctaagctgctactatttcagtg3’- reverse(A - com) 3) 5’-catttctcaattgcctgctataga-3’ – reverse (T) 4) 5’-actgttgccctttgttgcca-3’ – direct (T - common),

RESULTS
Patients with the T80807Т genotype shaved associate with hereditary sick sinus syndrome more frequently than in controls and those with А80807Т and А80807A (P &lt; 0.05). Presence of a T80807Т genotype was associated with an increased odds of having hereditary sick sinus syndrome.

CONCLUSIONS
Our data suggest that patients with the T80807Т genotype of the gene transcription factor SP4 are at increased risk to develop hereditary sick sinus syndrome.
70Autonomic dysfunction in atrial fibrillation (AF) patients: absent vasomotor reflex to decreased cardiac venous return during af in comparison to sinus rhythm; implications for earlier rhythm control
Authors: Malik V , Mishima R , Elliott A , Emami M , Roberts-Thompson K , Mahajan R , Arnolda L F , Lau D H , Sanders P 
Published: June 2020

Abstract

Funding Acknowledgements
Dr Malik is supported by an Australian Postgraduate Award Scholarship from the University of Adelaide.

OnBehalf
Centre for Heart Rhythm Disorders, University of Adelaide & Royal Adelaide Hospital

Background
A bi-directional relationship exists between AF and the autonomic nervous system (ANS). Patients with AF studied in sinus rhythm (SR) have impaired vasomotor responses to decreased cardiac volume. Whether autonomic dysfunction worsens during AF itself, is unknown.

Purpose
We examined haemodynamic responses to lower body negative pressure (LBNP) in patients with persistent AF compared to AF studied in SR. LBNP decreases cardiac volume, deactivates atrial stretch receptors and induces a reflex to maintain blood pressure by increasing systemic vascular resistance (SVR).

Methods
21 consecutive patients with paroxysmal or persistent AF were studied; during AF (n = 8) or SR (n = 13). Anti-arrhythmic and anti-hypertensives were withheld for 5 half-lives. Patients underwent LBNP using a custom-made chamber sealing both lower limbs. Negative pressure at sham (-0 mmHg), low (-20 mmHg) and high level (-40 mmHg) was applied for 5 minutes each. Finger photo plethysmography was used for beat-beat-blood pressure. Computation of SVR during AF is not feasible with this method. Therefore, the right forearm was used to perform venous occlusion plethysmography (VOP); non-invasive, well validated with LBNP and impervious to AF: to estimate forearm blood flow (FBF) and SVR (inversely proportional).

Results
Baseline characteristics and responses to LBNP are presented in Table 1. MAP was maintained, and HR rose slightly, in the SR group. MAP and HR decreased in the AF group. VOP demonstrates a reduction in FBF in the SR group (vasoconstriction); whereas the vasomotor response to LBNP was absent during AF. Figure 1 (Panels A-C).

Conclusion
The presence of AF is associated with autonomic dysfunction from impaired cardiac volume regulation. This novel finding may contribute to the known risk of falls and syncope due to AF. Further studies are needed to evaluate whether abnormal cardiac reflexes are involved in atrial remodelling and AF progression.
Table 1 Baseline Characteristics During AF During SR P Value Age 65 ± 5 59 ± 3 0.4 AAD & Anti-HTN medications withheld (%) 75 85 0.6 Resting mean arterial pressure (MAP) 109 ± 9 93 ± 6 0.1 Resting heart rate (HR) 94 ± 6 60 ± 4 0.0001* Haemodynamic response to LBNP % Δ MAP due to LBNP -9 ± 5 +0.5 ± 3 0.2 % Δ HR due to LBNP -6 ± 3 +5 ± 3 0.03* % Δ FBF due to LBNP +75 ± 59 -27 ± 8 0.02* AAD Anti-arrhthmic. HTN: Hypertension. Mean +/- SEM.
Abstract Figure. Vasomotor response to LBNP: in AF vs SR
P1064Using Data Mining to Predict Bleeding Events caused by Novel Oral Anticoagulants
Authors: Chiou W R , Hsieh M C , Chuang H N , Huang C C , Chuang J Y , Lin P L , Lee Y H 
Published: June 2020

Abstract

Background
Novel oral anticoagulants (NOAC) is important in preventing thromboembolism in atrial fibrillation (AF) patients. Bleeding risk was evaluated by HAS-BLED score traditionally. Data mining is a relatively new discipline that has sprung up at the confluence of several other disciplines, driven primarily by the growth of large databases.

Purpose
This study aimed to find a useful predictive model by data mining to assess the risk of rivaroxaban, an antithrombotic drug that causes bleeding in AF patients. The seven parameters of the HAS-BLED score were used to predict the effect of rivaroxaban on bleeding tendency in AF patients and may provide clinicians with appropriate treatments to avoid complications from bleeding events and reduce the incidence of health damage.

Methods
Through conducting a multicenter retrospective study, we identified patients with AF who were treated with rivaroxaban for more than 1 month between December 1, 2011 and November 30, 2016. After preprocessing, the established data were used for training and testing of data mining models. This study evaluated four models, including association rules, neural networks, Bayesian classification, and decision trees.

Result
Of the 872 enrolled cases, 432 were in any of the bleeding groups and 432 were in the non-bleeding randomized control group. After comparing the overall classification accuracy, omission error and over-prediction error, the decision tree proved to be the most accurate model for bleeding prediction. The overall classification accuracy is 77%, the omission error is 15%, the over-prediction error is 21.9%, and the AUC score is 0.84. The results show that the model has good discriminative ability and visibility of decision rules.

Conclusion
Among several data mining models, decision tree proved to be the most accurate model for bleeding prediction. The conclusion of this study can be used as a reference for supporting decision making before anticoagulation treatment and suggest future research to compare efficacy of bleeding prediction between HAS-BLED score and decision tree.
Data mining comparison Model Omission error Commission error Overall accuracy AUC score Ranking Decision tree 15.0% 21.90% 77.00% 0.84 1 Association rules 16.8% 27.20% 76.50% 0.81 2 Neural networks 12.0% 26.40% 78.20% 0.83 3 Bayesian classification 16.1% 27.50% 76.50% 0.83 4
1256Monitoring of TLE procedure using TEE does it influences for procedure efficacy ? The comparison of two large populations (1058 and 2068 patients)
Authors: Nowosielecka D , Tulecki L , Tomkow K , Kleinrok A , Jachec W , Polewczyk A , Kutarski A 
Published: June 2020

Abstract

Background
To improve safety of lead extraction monitoring by using continuous TEE was proposed and introduced recently (after the introduction of cardiac surgeon presence, optimal venue such as hybrid room, arterial line etc). However, until now it is not proved that it works in practice.

Objective
The goal of this study was to compare TLE effectiveness and safety between two large group with TLE performed with and without TEE monitoring.

Methods
During last 15 years 3126 TLE were performed; 5183 leads (1-6 leads, aver 1,65, with mean implant duration time 95,7 mth) were extracted using - as first line - non-powered mechanical tools.

Results
In spite of the fact that the group which was monitored with TEE was sicker (Carlson’s index, lower EF), had more TLE risk factors (implant duration) and TLE procedure was much more difficult (more technical problems) – the TLE effectiveness was better (more radiological, clinical and procedural success, less partial radiological success) and major complications was even slightly less frequent. Unexpected differences in mid-term mortality can be explained by different rate of infective indications or lead remnant influence.

Conclusions
Results seem to indicate favourable effects of utility TEE for TLE procedure monitoring.
Abstract Figure.
P925Cardiac autonomic dysfuntion in adult patient with uncorrected atrial septal defect : a role of pulmonary arterial hypertension
Authors: Jomansyah U , Maharani E , Dinarti L K , Anggrahini D W , Hartopo A B 
Published: June 2020

Abstract

Background
Atrial Septal Defect (ASD) is a congenital heart disease that often under-diagnosed in youth. Atrial septal defect has a poor clinical manifestation at Pulmonary Arterial Hypertension (PAH) condition. Cardiac autonomic dysfunction may occur in PAH due to over sympathetic activation. This condition in general population is associated with increase risk of sudden cardiac death. Despite the case, there are only limited studies which associated cardiac autonomic dysfunction and PAH in adult patient with uncorrected ASD.
Purpose
This study aims to compare cardiac autonomic dysfunction, using heart rate variability, in adult patient with uncorrected ASD between PAH and non-PAH group.
Methods
Adult (18+) patient with uncorrected ASD who listed in ASD registry in Indonesia, were selected in this analytical observational study. Patients in whom no other congenital defect and atrial fibrillation in electrocardiogram were eligible for inclusion. Diagnose of PAH was established when mean pulmonary arterial pressure value from right heart catheterization is ≥ 25 mmHg. Arrhythmias and heart rate variability, using Standard Deviation of Normal-Normal (SDNN), High Frequency (HF) and Low Frequency (LF) parameters, were collected from holter monitoring. These procedures were performed on the same day.
Results
We enrolled 55 adult patients with uncorrected ASD (mean age: 33.3 ± 10.3 years, 89.1% women), consist of 51 secundum ASD, 3 sinus venosus ASD and 1 primum and secundum ASD patient. They were divided into PAH group (28 patients) and non-PAH group (27 patients). Patients in PAH group had a higher incidence of paroxysmal atrial fibrillation and ventricular extrasystole compare to those in non-PAH group (28.5% vs. 14.8% and 75% vs. 70%). All parameters of heart rate variability was significantly reduced in PAH group compare to non-PAH group (SDNN : mean difference 14.5 ± 2.98 ms, CI 95%, P &lt; 0.001; HF : median difference 99.5 ms2, P &lt; 0.001; LF : median difference 129.6 ms2, P &lt; 0.001).

Conclusion
A marked reduction in cardiac autonomic function occur in adult uncorrected ASD patient with PAH compare to patient with non-PAH, that might be the result of decreasing baroreceptor and increasing chemoreceptor function in PAH.
P1507Experience in chronical lead extraction with ablation catheter and snare via femoral route
Authors: Uslu A , Kup A , Demir S , Balaban I , Gulsen K , Karagoz A , Kepez A , Akgun T 
Published: June 2020

Abstract

Background
Transvenous lead extraction may become a complicated process and special sheath systems used for extraction may not be available in the laboratory. Transvenous lead extraction from femoral vein by using ablation catheter and snare may be an alternative and cost-effective method to transvenous lead extraction with specialized lead extraction sheaths. The aim of the present study is to evaluate the factors that may be associated with the use of transfemoral technique during extraction of chronically implanted leads.

Methods
We retrospectively analyzed consecutive patients who underwent transvenous extraction of pacemaker, cardiac resynchronization therapy (CRT) and intracardiac defibrillator (ICD) leads in our institution in between 01.01.2016 and 01.01.2019. The indications for lead extraction were based on the European Heart Rhythm Association recommendations. Manual traction was applied to all leads at the beginning of each case. If manual traction was not successful, a subclavian approach by using locking stylet (Liberator Universal Locking Stylet, Cook Medical) or femoral approach was used. Femoral approach was performed using the flexible 13F long sheath and a second sheath for ablation catheter. Ablation catheter was wrapped around the lead and the tip of the ablation catheter was caught with gooseneck snare. Downward traction was applied on the body of the lead by using ablation catheter and gooseneck snare complex to release either end of the lead.

Results
A total of 160 leads in 94 patients were extracted during the time interval between 01.01.2016 and 01.01.2019. The indications for extraction were cardiac device related pocket erosion and infection in 71 (75.6%) and lead failure in the 23 (24.4%) cases. Extracted system was ICD in 48 (51.1%), CRT in 9 (9.6%) and pacemaker in 37 (39.3%) cases. The median time from the preceding procedure was 62.5 (IQR:32.3- 95.3) months. Lead extraction was performed by manual traction in 35 (37.2%) patients, by locking stylet method in 7 (7.4%) and by femoral approach in 52 (55.3%) patients. Clinical success was achieved in 93 (98.9%) cases and all of the patients discharged uneventfully without a major complication as death, cardiac avulsion or tear requiring pericardiocentesis or emergent surgery. Procedural success with femoral approach was achieved in 51/52 (98%) patients (99 leads). Ordinal regression revealed the time from the preceding procedure as the only parameter that was significantly associated with the usage of femoral approach (OR:1.065 ( 95% CI 1.039-1.100) p &lt; 0.001).

Conclusion
Based on our experience, transfemoral approach by using ablation catheter and gooseneck snare seems to be an effective and safe method for chronically implanted lead extraction. It may be particularly be useful when manual traction is unsuccessful and special toolkids are not available for extraction.
P536Reverse remodeling after cardiac resynchronization therapy is associated with improvement of contractile asymmetry in the area of left ventricular lead position
Authors: Zaremba T , Tayal B , Thogersen A M , Riahi S , Sogaard P 
Published: June 2020

Abstract

Background
One third of patients receiving cardiac resynchronization therapy (CRT) do not respond to the treatment, possibly due to suboptimal lead position and persistent dyssynchronous left ventricular (LV) contraction.

Purpose
To assess the influence of LV lead position on improvement of contractile asymmetry and its significance for LV reverse remodeling after CRT.

Methods
Patients with heart failure and left bundle branch block undergoing CRT implantation were studied retrospectively. Assessment of mechanical delay within the LV was assessed using a recently developed index of contractile asymmetry (ICA). ICA was calculated as standard deviation of differences in systolic strain rate in the opposing LV walls derived from curved anatomical M-mode plots. LV was divided into 12 equally sized 30-degree sectors. Spline interpolation was used to estimate ICA in six opposing sector pairs permitting quantification of regional contractile asymmetry in the entire LV. Position of LV lead tip was assessed by thoracic computed tomography (CT). Response to CRT was defined as a reduction of LV end-systolic volume (ESV) ≥15% after 6 months.

Results
Study population (n= 26) consisted of 65.4% males, 68 ± 10 years, ischemic etiology in 42.3%, LV ejection fraction 24.1 ± 5.8%, QRS duration 171 ± 22 ms. CRT response was present in 18 (69.2%) patients. Pre-implantation ICA in the LV sector containing LV lead was 0.75 ± 0.24 s-1 in responders vs. 0.46 ± 0.16 s-1 in non-responders (p = 0.003). Reduction of ICA in the LV sector with LV lead was directly correlated with reduction of LV ESV after CRT (r = 0.46, p = 0.02) (Figure 1). ICA reduction in the LV sector with LV lead was -0.24 ± 0.28 s-1 in responders and -0.05 ± 0.16 s-1 in non-responders (p = 0.03). Meanwhile, reduction of ICA in the LV sectors located 60 degrees clockwise and 60 degrees counterclockwise away from the LV sector with LV lead (remote LV sectors) did not differ significantly between responders and non-responders: -0.12 ± 0.15 s-1 vs. -0.06 ± 0.1 s-1 (p = 0.28). Likewise, no significant correlation between reduction of ICA in remote LV sectors and LV ESV reduction was observed (p = 0.11).

Conclusion
Pre-implantation contractile asymmetry in the LV lead target area is associated with a positive response to CRT. Simultaneously, the degree of LV reverse remodeling after CRT seems to correlate with the magnitude of improvement of contractile asymmetry specifically in the region of LV lead location.
Abstract Figure 1
P481The genetic background of sudden cardiac deaths caused by single vessel coronary artery disease and myocardial hypertrophy with fibrosis
Authors: Vahatalo J H , Holmstrom L T A , Pylkas K , Porvari K , Pakanen L , Kaikkonen K S , Perkiomaki J S , Huikuri H V , Junttila M J 
Published: June 2020

Abstract

Funding Acknowledgements
Sigrid Juselius Foundation, Finnish Foundation for Cardiovascular Research, Aarne Koskelo Foundation, The Finnish Medical Foundation

Background
Coronary artery disease (CAD) is the most common underlying cause of sudden cardiac death (SCD). Cardiac hypertrophy with varying amount of myocardial fibrosis is a common risk factor for CAD related SCD especially in young SCD victims where severity of CAD seems not to entirely explain the cause of SCD.

Purpose
The aim was to study the genetic background of hypertrophy and fibrosis among young, ischemic SCD victims with single vessel CAD.

Methods
The study population was derived from the Fingesture study consisting of all autopsy-verified sudden cardiac deaths in Northern Finland between years 1998-2017 (n = 5,869). CAD was determined to be the cause of SCD in 4,392 victims (74.8%). We carried out targeted next-generation sequencing using a panel of 174 genes associated with myocardial structure and ion channel function in 95 ischemic-SCD victims (mean [standard error] age, 63.6 [1.06] years; 88.4% males) with single-vessel CAD and cardiac hypertrophy in the absence of previously diagnosed CAD, and whose DNA passed the quality control for further analysis. Assessment for pathogenicity of detected variants was based on American College of Medical Genetics consensus guidelines.

Results
A total of 43 variants were detected in 43 of the study subjects (45.3 %). Five variants in eight subjects (8.4%) were classified as pathogenic or likely pathogenic. We observed 38 variants of uncertain significance in 39 victims (40.6 %). Variants were detected in myocardial structure protein coding genes, associated with arrhythmogenic right ventricular cardiomyopathy (13 variants), dilated cardiomyopathy (16 variants), hypertrophic cardiomyopathy (6 variants) and left ventricular non-compaction cardiomyopathy (3 variants). Five variants were detected in RYR2 associated with both cardiomyopathies and catecholaminergic polymorphic ventricular tachycardias. Seven variants were detected in multiple unrelated subjects. None of the subjects presented characteristic autopsy findings related to cardiomyopathies.

Conclusions
Variants associated with cardiomyopathies were common findings among CAD related SCD victims with single vessel disease and myocardial hypertrophy found at autopsies, suggesting that these variants may modulate the risk for fatal arrhythmias and sudden death in ischemic disease.
P347Physician-led, weight loss advice prior to atrial fibrillation ablation, overall weight change and clinical outcomes
Authors: Lau Y , Mackey W , Connelly D 
Published: June 2020

Abstract

Background
Randomised trial, controlled study and international guidelines have advocated weight loss in AF patients with obesity as a means of attaining better AF burden control and maintenance of sinus rhythm. However, previous study required patients to undertake a highly structured weight management programme, detailed counselling, meal plans and behaviour modification.

Aim
To assess if weight-loss can be attained through a 5-minute, target-driven, physician-led counselling amongst overweight/obese patients referred AF ablation, without the need for intensive weight management programme. Subsequently to assess this can lead to better clinical outcomes (reduction in AF recurrence and readmission).

Methods
All patients referred for AF ablation in a tertiary centre over a 6-month period were included. Baseline weight and BMI at initial encounter plus weight and BMI at day of AF ablation were recorded. Optional physician-led counselling was provided, with aim for target weight loss of &lt;10% or reduction of 3 point in BMI.
Initial contact to AF ablation is 6 months.
Clinical outcomes such as symptomatic AF &gt;3 months post AF ablation and readmission for symptomatic AF were recorded. Follow-up duration of 6 months post ablation.
Patients received counselling were designated Group 1, and those who did not were designated Group 2.

Outcomes
146 new AF referrals for ablation seen over the 6-month period. 105 (71.9%) are paroxysmal AF, 37 (25.3%) are persistent, 4 permanent AF.
Mean BMI 34.4 (+/- 5.1). Out of which, 76% have BMI &gt; 30 (Obese), 47.6% possess BMI &gt;35 (Morbidly obese), with 1 patient with BMI exceeding 50.
21.9% patients received physician-led counselling to lose weight. Basic demographics (age, gender), proportion of pAF and duration of AF, use of antiarrhythmic drugs were not statistically different between the two groups.
Among AF patients receiving weight-loss counselling (Group 1), they have higher mean weight and BMI, 108kg (+/- 14.3) and BMI 33.7 (+/-4.3), as compared to those who did not received counselling (Group 2), 87.5kg (+/- 16.2) and BMI 29.5 (+/-4.3).
At point of AF ablation, Group 1 has median weight loss of (-)4.5kg, mean reduction of BMI (-)2.0 points, while Group 2 has median weight gain of 3.6kg, increase of BMI 1.1 point. Overall statistically significant difference in weight change (p &lt;0.001).
Composite clinical outcomes at 6 months post ablation comprising recurrence of AF and readmission for symptomatic AF were higher in Group 2 as compared to Group 1, 38% vs 13% (p = 0.03).

Summary
This small cohort study suggests that concise physician-led weight loss counselling (without dietician-led meal plan or extensive weight loss programme) provided to AF patients with increased BMI can lead to significant weight loss and lower BMI in the run-up to AF ablation. This is also associated with statistically significant reduction in recurrence of AF and hospital re-admission.