bluuebunny/crossref_metadata_2025_split huggingface dataset:
P400Spatial relationship between atrial fibrillation drivers identified by dipole density mapping and left atrial fibrosis
Authors: Ammar-Busch S , Forkmann M , Tose Costa Paiva B , Mitlacher M , Mahnkopf C 
Published: June 2020

Abstract

Background
Atrial fibrillation (AF) is a complex arrhythmia and several mechanisms that might coexist have been proposed. Recent technical advances opened the way to better mapping possibilities and might contribute to target more specific components of the AF substrate.

Objective
The aim of this study was to evaluate a spatial correlation between AF drivers as determined by a novel non-contact unipolar high-resolution system and atrial fibrosis assessed by cardiac magnetic resonance imaging (MRI).

Methods
Patients undergoing a first ablation procedure for persistent AF were included. Prior to ablation, a Late Gadolinium-Enhancement (LGE) MRI was performed to detect the fibrotic atrial tissue. The procedure was performed using a new non-contact unipolar high-resolution system allowing a 3D anatomy reconstruction with a continuous dipole density mapping.
Three different wave front patterns were analyzed in the left atrium (LA): 1) focal activity (FA), 2) localized rotational activation (LRA) and 3) localized irregular activation (LIA). The spatial distribution of these AF drivers was analyzed prior to AF ablation.

Results
A total of 49 patterns in 6 patients were identified, among them 22 FA, 14 LRA and 13 LIA. The posterior (n = 14), anterior wall (n = 13) and roof (n = 8) were identified as predominant driver sites. 31/49 (59%) drivers had a strong correlation with late enhancement in MRI. Most of the LIA, LRA and FA were embedded infibrotic areas (LIA 10/13 (77%); LRA 9/14 (64%) and FA 12/22 (54%). The postero-inferior LA showed the best correlation between drivers and fibrosis, the antero-septal LA the weakest one.

Conclusion
There is a significant overlap between AF driver regions identified by dipole density mapping and atrial fibrosis assessed by MRI. Most of AF drivers are embedded in fibrotic areas, particularly in case of localized irregular activity and at the posterior LA.
Abstract Figure.
P1504Monitoring of TLE procedure using TEE practical utility Experience from 927 procedures
Authors: Nowosielecka D , Tulecki L , Tomkow K , Kleinrok A , Jachec W , Polewczyk A , Kutarski A 
Published: June 2020

Abstract

Background
Monitoring of the process of transvenous lead extraction using continuous TEE was delivered for the purpose of earlier recognition of cardiac or venuos wall tear (behind hemodynamic and respiratory monitoring etc). But our experience indicates that it may be providing much more very important information for operator about present occurrences invisible for fluoroscopy monitoring and to warm about threatening disaster.

Objective
The goal of this study was to describe frequency of menaces visible in TEE before after effects will reveal.

Methods
During last 4,5 years 1019 TLE were performed but due to different reasons complete TEE monitoring was performed in 910 patients; 1705 leads (1-4 leads, aver 1,66, with mean implant duration 100,7 mth) were extracted using as first line non-powered mechanical tools. There were 20 major complications (2,0%) but no procedure related death. We obtained 98,7% procedural and 97,9% clinical success. Results are presented in the table.

Conclusions
TEE cautioned about dangerous poling or torsion of the heart structures and permitted immediate explanation of the reasons of drop of blood pressure, brought information about arising cardiac tamponade, about rapid blood clothing in epicardial space and the onset of cave-in RV wall before significant drop of blood pressure. Uncomplicated course after rescue sternotomy seems be result of timeous it execution.
Abstract Figure.
P1087Prevalence and significance of mitral regurgitation in atrial fibrillation coexisting with HFpEF and HFmEF
Authors: Lupasteanu I , Vijan A , Delcea C , Stanescu C , Bari S , Daha I , Dan G A 
Published: June 2020

Abstract

Background
Recent data has acknowledged atrial induced functional mitral valve regurgitation (MR) in the setting of atrial fibrillation (AF) and/or heart failure with preserved ejection fraction (HFpEF) as a distinct type of secondary MR, holding prognostic significance. However, evidence on its prevalence is still scarce, especially in the phenotype of mid-range ejection fraction heart failure (HFmEF).

Purpose
The aim of this study is to evaluate the occurrence of left atrial (LA) enlargement and MR in AF patients with or without heart failure with preserved or mid-range ejection fraction.

Methods
This retrospective study included 750 consecutive patients with AF admitted to a tertiary hospital from January 2018 to June 2019. We excluded patients with primary valvular disease and HF with reduced EF. MR presence and severity were assessed by evaluating the valve morphology, colour flow imaging and, when feasible, vena contracta and PISA methods. We measured LA anteroposterior diameter and used LA dilatation as a surrogate marker for mitral annulus dilatation.

Results
We evaluated 584 AF patients: mean age 72.22 ± 10.10 years; 58,73% females; 79.75% had HF: 73.13% of them had HFpEF and 26.87% had HFmEF.
Compared to those without HF, patients with HF had a relative risk (RR) of associating LA enlargement of 5.37 (95%CI = 3.05-9.48, p &lt; 0.001) and a RR of associating MR of 1.47 (95%CI 1.08-2.00, p = 0.01). Mean LA diameter was higher in the HF group, compared to non-HF (47.06 ± 7.26 mm vs 40.91 ± 7.10 mm, p &lt; 0.001). MR severity was more likely associated with HF (RR = 1.68, 95%CI = 1.46-1.94, p &lt; 0.001).
When comparing results between the two HF subgroups, patients with HFmEF had a higher mean LA diameter than those with HFpEF (48.52 ± 5.68 mm vs 46.36 ± 7.57 mm, p = 0.011), without associating a significant difference in the MR prevalence (72.97% vs 73.98%, p = 0.94).
The presence of a dilated LA was directly correlated with MR in the HF group (RR = 1.94, 95%CI = 1.18-3.20, p = 0.023), but not in those without HF (RR = 1.04, 95%CI = 0.57-1.90, p = 0.89).
In HF patients, permanent AF associated the highest prevalence of LA dilatation (96.67%) and MR (81.73%) in contrast to paroxysmal AF (81.10%, p &lt; 0.01, respectively 63.43%, p = 0.0002).

Conclusions
LA dilatation, the presence and severity of MR correlated with AF and HF, especially in permanent AF patients. In patients without HF, LA dilatation did not correlate with the presence of MR.
MR prevalence was similar in patients with HFmEF and HFpEF, irrespective of a higher degree of LA dilatation in HFmEF.
Our results suggest that the pathophysiological mechanisms involved in LA enlargement and MR are different for different phenotypes of AF in patients with or without HF.
P341Life-threatening events in patients with non-compaction cardiomyopathy and mutations in ion channel genes
Authors: Rineiska N , Komissarova S , Chakova N , Niyazova S 
Published: June 2020

Abstract

Purpose
to analyze life-threatening events during follow-up in patients with non-compaction cardiomyopathy (NCCM) who have mutations in the genes responsible for the functioning of ion channels.

Methods
the study included 64 unrelated pts (aged 38.63 ± 14.72 years, 34/53.12% male, LVEF 43.02 ± 8.65%) with criteria of NCCM confirmed by imaging techniques (echocardiography (Jenni) and cardiovascular magnetic resonance (Petersen). Mutation search was carried out by the next generation sequencing (NGS). Pathogenic mutations or rare substitutions with possible clinical significance were found in 12 unrelated pts in the ion channel genes: KCNH2, KCNJ2, CACNA1C, RYR2, HCN4, TRPM4, PKP2, TRPM4. Mutations in other genes (PLN, DSP, NOTCH1, RBM20) were detected in 4 pts (1 pathogenic and 3 VUS).

Results
mutations in genes associated with long QT syndrome (LQTS) were found in 5 pts with NCCM: c.3107G &gt; A (p.Gly1036Asp), с.2653С&gt;T (p.Arg885Cys) in KCNH2 gene (16.7%); c.T28076 (p.F936C) in CaCNA1C gene (8.3%); c.1165G &gt; C (p.Asp389Asn) in KCNJ2 gene (8.3%). There was no prolongation of the QTc interval &gt; 480 msec on ECG; frequent episodes of nonsustained ventricular tachycardia (VT) were recorded on 24-hour ECG-monitoring.
During the follow-up period (median follow-up of 2.4 years), two pts with mutations in KCNH2 genes with suddenly developed sustained VT were implanted with ICD. A 32-year-old patient with a mutation in CACNA1C gene and ST-elevation myocardial infarction of thromboembolic genesis underwent PCI. 58-year-old patient with widening of QRS &gt; 130 msec and frequent paroxysms of nonsustained VT was implanted with CRT-D. An ICD was implanted in a 60-year-old patient with a mutation c.12665_12667del(p.4223del) in the RYR2 gene and suddenly developed a sustained VT. In the remaining two pts with RYR2 gene mutations c.12272C &gt; T (p.Ala4091Val), c.12944G &gt; A(p.Gly4315Glu), frequent episodes of nonsustained VT were recorded, which were corrected medically. Orthotopic heart transplantation and Accucinch transcatheter direct mitral valve annuloplasty system implantation were performed in two pts with ventricular tachyarrhythmias and severe systolic and diastolic dysfunction of the left ventricle with mutations c.3224T &gt; C (p.Leu1075Pro), c.1459_1494del36 (p.Lys487_Leu498del) in the TRPM4 gene. In other pts with mutations in HCN4 (8.3%), DPP6 (8.3%), PKP2 (8.3%) genes ventricular tachyarrhythmias were treated with antiarrhythmic drugs.

Conclusion
the presence of mutations in the genes controlling the functioning of ion channels is an additional risk factor for adverse events in patients with NCCM.
P468Pre-diabetes a new risk factor for stroke in non-valvular atrial fibrillation
Authors: Kezerle L , Tsadok M A , Akriv A , Feldman B , Leventer-Roberts M , Ohana R , Haim M 
Published: June 2020

Abstract

Funding Acknowledgements
Pfizer Israel

Background
Diabetes mellitus is a well-established independent risk factor for embolic complications in patients with non-valvular atrial fibrillation (NVAF). The association between prediabetes and risk of ischemic stroke, however, has not been studied separately in patients with NVAF.

Purpose
To evaluate whether pre-diabetes is associated with increased risk of stroke and death in patients with NVAF

Methods
We conducted a prospective, historical cohort study using the Clalit Health Services (CHS) electronic medical records database. The study population included all CHS members ≥ 21 years old, with a first diagnosis of NVAF between January 1 2010 to December 31 2016 and a minimal follow-up period of 1 year. We compared three groups of patients: prediabetes, those with established DM, and normoglycemic individuals

Results
A total of 44,451 cases were identified. The median age was 75 years and 52.5% were women. During a mean follow up of 38 months, the incidence of stroke per 100 person-years in the three study groups was: 1.14 in non-diabetics, 1.40 in pre-diabetics and 2.15 in diabetics. In both univariate and multivariate analyses, pre-diabetes was associated with an increased risk of stroke compared with non-diabetics (Adjusted Hazard Ratio (HR) = 1.19 {95% CI 1.01-1.4}) even after adjusting for CHA2DS2-VASC individual risk factors and use of oral anti-coagulants while diabetes conferred an even higher risk (vs non-diabetics { HR = 1.56, 95% CI ;1.37 - 1.79}). The risk for mortality was higher for diabetics (HR =1.47, 95% CI ;1.41, 1.54}) but not for pre-diabetics (HR = 0.98 ,CI 95%; 0.92 - 1.03). Conclusion: In this observational cohort of patients with incident newly diagnosed patients with NVAF, pre-diabetes was associated with an increased risk of stroke even after accounting for other recognized risk factors.
Abstract Figure. Kaplan-Meier for stroke-free survival
73Hemoglobin a1c levels and the risk of ischemic stroke and mortality in individuals with diabetes mellitus and atrial fibrillation
Authors: Kezerle L , Tsadok M A , Akriv A , Feldman B , Leventer-Roberts M , Ohana R , Haim M 
Published: June 2020

Abstract

Funding Acknowledgements
Pfizer Israel

Background
Diabetes mellitus (DM) is associated with increased risk of embolic complications in non-valvular atrial fibrillation (NVAF). Whether the risk of stroke in AF patients remains the same among the wide spectrum of disease is yet to be determined.

Aim
Among individuals with AF and DM, to assess the incidence rates and risk of ischemic stroke and mortality by baseline HbA1C levels.

Methods
We conducted a prospective, historical cohort study using the Clalit Health Services (CHS) electronic medical records database. The study population included all CHS members ≥ 21 years old, with a first diagnosis of NVAF between January 1, 2010 to December 31, 2016 and a minimal follow-up period of 1 year. Among those patients identified as diabetics, we compared three groups of patients according to HBA1C levels at the time of AF diagnosis: &lt;7.0%, between 7-9% and ≥ 9%.

Results
A total of 44,451 cases were identified. The median age was 75 years (IQR 65-83) and 52.5% were women. During a mean follow up of 38 months, the incidence of stroke per 100 person-years in the three study groups was: 1.9 in patients with HBA1C &lt;7%, 2.37 in the intermediary group and 2.72 in those with HBA1C &gt;9%. In both univariate and multivariate analyses, higher levels of HBA1C were associated with an increased risk of stroke compared with a dose-dependent response when compared to individuals with HBA1C &lt;7% (Adjusted Hazard Ratio (AHR) = 1.32 {95% CI 1.12-1.55}for levels between 7-9% and AHR 1.64 {95% CI 1.28-2.09}) even after adjusting for CHA2DS2-VASC individual risk factors and use of oral anti-coagulants. The risk for overall mortality did not differ significantly between groups, with a slight elevation in the HBA1C &gt;9% group after adjusted analysis {aHR = 1.17 (1.07- 1.28)} Conclusion: In this observational cohort of patients with incident newly diagnosed nonvalvular atrial fibrillation, HBA1C levels were associated with an increased risk of stroke in a dose-dependent manner even after accounting for other recognized risk factors for stroke in this population.
Abstract Figure. Kaplan-Meier for stroke-free survival
P1026Second-generation visually guided laser balloon ablation system for pulmonary vein isolation: Learning curve, safety and efficacy: The MERLIN registry
Authors: Heeger C H , Phan H L P , Meyer-Saraei R M S , Fink T F , Sciacca V S , Liosis S L , Brueggemann B B , Grosse N G , Fahimi B F , Sano M S , Kuck K H K , Ouyang F O , Vogler J V , Eitel C E , Tilz R R T 
Published: June 2020

Abstract

Funding Acknowledgements
Cardiofocus

Background
Radiofrequency (RF) based pulmonary vein isolation (PVI) results in favourable clinical outcome, although its complexity demands a long learning curve. Balloon-based systems, have been developed to possibly solve these limitations. The second-generation laser balloon (LB2) offers optimized features for improved tissue contact and visibility.

Purpose
We determined safety, efficacy and learning curve of the LB2 for PVI.

Method
A total of 45 consecutive patients (89% persistent AF) were prospectively enrolled and divided in three groups (T1, T2, T3) of n = 15 patients per group. All patients underwent PVI using the LB2 by two operators. The operators were experienced in RF and cryothermal procedures, but not in laser ablations.

Results
A total 174/177 PVs (98%) were successfully isolated. The median procedure time significantly declined from 132 (114, 158) to 119 (102, 127) and 91 (86, 105) min in T 1–3, respectively (P = 0.0009). Similarly, the median fluoroscopy time significantly decreased from T1 until T3 (22 (17, 27) vs. 21 (16, 24) vs. 13 (10, 17) min, respectively, P = 0.045. Adverse events occurred in 6.7% with a trend towards a lower complication rate with increasing experience.

Conclusion
The LB2 was safe and effective for PVI even for operators without any previous experience in laser balloon based PVI. Procedure time LA dwelling time and fluoroscopy time decreased after a learning curve of 15 cases.
P1173Interlead electrical delay time as early predictor of the reverse myocardial remodeling in modern CRT devices
Authors: Lubimceva T , Lebedeva V , Aznauryan R , Kamenev A , Gureev S , Lebedev D 
Published: June 2020

Abstract

Funding Acknowledgements
Russian Science Foundation Grant №19-14-00134

Background
Cardiac resynchronization therapy (CRT) has undoubtedly shown a high role in the treatment of advanced heart failure (HF). Despite the quadripolar left ventricle (LV) lead widespread use, the problem of low response to CRT remains actual. The search for predictors of the CRT response is an important scientific and practical task.
The aim
To determine the relationship between the interlead electrical delay time and the CRT response during 12 month observational period.

Materials and methods
We evaluated the clinical status, the quality of life and echocardiographic response of 50 patients with HF treated for 1 year with quadripolar LV lead CRT devices implanted according to guidelines: 35 males/15 females with age 62.78 ± 11.58 years, 28 pts with history of ischemic cardiac disease, LVEF 27.42 ± 9.56%; QRS duration 157.34 ± 19.76 ms. The response to CRT was defined as 15% decrease of end-systolic left ventricle (LV) volume (LVESV), 10% relative increase of LV ejection fraction (LVEF), an improvement of at least 1 NYHA HF functional class. Interlead electrical delay time (EDT) was calculated automatically during CRT implantation, and subsequent 3-6-12 month FU. EDT values from 4 LV lead poles were evaluated according to LV sizes, volumes and LVEF.

Results
It was shown that the greater EDT value, the more pronounced was response to CRT. The first difference in EDT is observed after 6-month observational period. The EDT difference was determined using the delta formula for equalize. In 21 patients in whom the stimulation of the LV lead was carried out from a pole having a maximum EDT value, the response to CRT was observed earlier - at 6 months FU (24 pts with maximum EDT value vs. other 26 pts). In addition, the echocardiographic data of reverse myocardial remodeling (LVESD, LVEDD, LVESV, LVEDV and LVEF) correlated with a gradual decrease in the EDT values, r = 0.49, P = 0.008. There were no differences between the HF etiology (ischemic/ non-ischemic) and baseline rhythm. The mean EDT was initially 104.94 ± 44.22 ms, 6 month FU 98.91 ± 34.28 ms, 12 month FU 91.84 ± 32.78 ms.

Conclusion
The interlead electrical delay time in quadripolar CRT devices depends on reverse myocardial remodeling. EDT gradual decrease may be a predictor of the response to CRT.
Abstract Figure. Interlead Delay Time 12M Follow Up
P1015Left atrial sphericity as a marker of atrial remodeling: comparison of atrial fibrillation patients and controls
Authors: Mulder M J , Kemme M J B , Visser C L , Hopman L H G A , Van Diemen P A , Van De Ven P M , Gotte M J W , Danad I , Knaapen P , Van Rossum A C , Allaart C P 
Published: June 2020

Abstract

Background/Introduction
Left atrial (LA) sphericity has been proposed as a more sensitive marker of atrial fibrillation (AF)-associated atrial remodeling compared to traditional markers such as LA size. However, mechanisms that underlie changes in LA sphericity are not fully understood and studies investigating the predictive value of LA sphericity for AF ablation outcome have yielded conflicting results.

Purpose
The present study aimed to assess correlates of LA sphericity and to compare LA sphericity in subjects with and without AF.

Methods
Measures of LA size (LA diameter, LA volume, LA volume index), LA sphericity and thoracic anteroposterior diameter (APd) at the level of the LA were determined in a total of 293 AF patients (62% paroxysmal AF) and 110 controls. Cardiac computed tomography (CT) images were analyzed offline by a reviewer blinded to clinical parameters. The AF cohort consisted of consecutive patients referred for cardiac CT imaging prior to first AF ablation procedure between January 2015 and January 2018. The control cohort consisted of subjects with no history of AF who underwent cardiac CT imaging between January 2012 and October 2014 to exclude coronary artery disease.

Results
LA diameter (40.1 ± 6.8 mm vs. 35.2 ± 5.1 mm; p &lt; 0.001), LA volume (116.0 ± 33.0 ml vs. 80.3 ± 22.6 ml; p &lt; 0.001) and LA volume index (56.1 ± 15.3 ml/m² vs. 41.6 ± 11.1 ml/m²; p &lt; 0.001) were significantly larger in AF patients compared to controls (Figure), also after adjustment for age and sex. LA sphericity did not differ between AF patients and controls (83.7 ± 2.9 vs. 83.9 ± 2.4; p = 0.642). A moderate correlation was noted between thoracic APd and LA sphericity in both females (R = 0.521, p &lt; 0.001) and males (R = 0.498, p &lt; 0.001). Multivariable linear regression analysis demonstrated that LA diameter, LA volume, female sex, body length and thoracic APd were independently associated with LA sphericity.

Conclusion
The present study suggests that thoracic constraints rather than the presence of AF determine LA sphericity, implying LA sphericity to be unsuitable as a marker of AF-related atrial remodeling.
Abstract Figure. Comparison of LA imaging characteristics
P980Evaluation of the outcomes of radiofrequency catheter ablation in patients with ischemic ventricular tachycardia
Authors: Oksul M , Yorgun H , Sener Y Z , Ates A H , Canpolat U , Aytemir K 
Published: June 2020

Abstract

Background
Ablation of ventricular tachycardia (VT) is an effective and safe treatment option in symptomatic patients under antiarrhythmic drugs or patients with frequent ICD therapies.

Purpose
We aimed to evaluate outcomes of VT catheter ablation in patients with ischemic VT.

Methods
All of the patients who underwent VT catheter ablation between June 2014 and November 2018 were included.

Results
128 patients (120 male, 8 female) were included and mean age was 65 ± 10 years. Mean ejection fraction was 28.6 ± 8.2 %. Baseline characteristics were listed in Table-1. Mean follow-up was 22.3 ± 6.4 months. 52 (46.6 %) patients were admitted with electrical storm. Acute success rate was 96.6%. Complications including transient ischemic attack, deep venous thrombosis, pericardial effusion and inguinal hematoma were developed in 6 patients. Recurrence of VT was occured in 44 (34.4 %) patients and the presence of PCI history and admission with electrical storm were predictors of recurrence. All cause mortality was occured in 39 patients and predictors of all cause mortality was detected as follows; diabetes, NYHA stage &gt;2, lower levels of EF and higher BNP levels. Cardiovascular mortality was developed in 28 patients and predictors were defined as, lower levels of EF, higher BNP levels and number of shock after index ablation. VT recurrence was not found to be related with both cardiovascular and all cause mortality.

Conclusion
VT ablation is a safe and effective option in patients with ischemic VT who are symptomatic despite optimal medical treatment. Admission with electrical storm and history of PCI were predictors of VT recurrence after ablation. Higher levels of BNP, lower EF values are related with both all cause and cardiovascular mortality.
Table-1 Gender, male, (%) 120(93,8) Age(year) 65,5 ± 9,7 HT 93(72,7) DM 35(27,3) AF 41(32,0) NYHA class(pre-ablation) IIIIII IV 71(55,5)27(21,1)25(19,5) 5(3,9) Previous PCI 83(64,8) Previous Cardiac surgery CABG AVR MVR 72(56,3) 70(54,7 1(0,8) 4(3,1) LV EF (%)≤3031-40 ≥41 28,6 ± 8,290(70,3)28(21,9) 10(7,8) Electrical storm 52(40,6) LV EDD (mm) 63,8 ± 8,5 Baseline characteristics