bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of permanent pacemaker implantation following transcatheter aortic valve implantation upon survival
Authors: Soulaidopoulos S , Drakopoulou M , Stathogiannis K , Xanthopoulou M , Oikonomou G , Toskas P , Kouroutzoglou A , Synetos A , Papanikolaou A , Latsios G , Sideris S , Tousoulis D , Toutouzas K 
Published: November 2020

Abstract

Purpose
Transcatheter aortic valve implantation (TAVI) is often followed by conduction abnormalities, leading to a permanent pacemaker implantation (PPI). Data regarding the clinical impact of PPI following TAVI is yet to be established.

Methods
Patients with severe and symptomatic aortic stenosis [effective orifice area (EOA) ≤1cm2] referred for TAVI at our institution were consecutively enrolled. Prospectively collected demographic, laboratory and echocardiographic data were retrospectively analyzed. Patients were stratified into two groups according to the need for PPI after TAVI and were followed up postoperatively with clinical and echocardiographic assessment. Primary clinical endpoint was all-cause mortality, as defined by the criteria proposed by the Valve Academic Research Consortium 2.

Results
In total, 292 patients were included (male: 50.2%, mean age: 80±7.6 years) in our study. Of these, 109 (37.5%) underwent PPI simultaneously or shortly after TAVI. The median follow-up period was 27.3 In this period, all-cause mortality showed no significant difference between patients with and those without PPI after TAVI (log-rank p=0.756), even after excluding patients with a pre-existing pacemaker from the analysis. Subgroup analysis also showed no difference in survival between patients with low ejection fraction (&lt;50%) and those with preserved (≥50%) receiving a permanent pacemaker after TAVR (log-rank p=0.269). Taking into consideration factors that were found to associate to PPI in univariate analysis (pre TAVI - ejection fraction, pulmonary artery systolic pressure and New York Heart Association functional class) in a multivariate model, pre TAVI pulmonary artery systolic pressure was found to be an independent predictor of peri-procedural PPI [Exp(B): 0.977, 95% Confidence Interval: 0.957–0.998, B=−0.023, p=0.029]. Pre-TAVI conduction abnormalities and the degree of aortic annulus calcification, as assessed by computed-tomography, were not found to predict PPI after TAVI.

Conclusion
PPI following TAVI was not associated with survival at 27 months of follow-up, independently from the pre TAVI ejection fraction.
Figure 1

Funding Acknowledgement
Type of funding source: None
Abnormal coronary anatomy in patients with atrial switch: a predictor of serious cardiac adverse event?
Authors: Perreux Y.P , Chaix M.C , Fongeon F.P , Di Filippo S , Boussel L , Khairy P , Bessiere F 
Published: November 2020

Abstract

Introduction
Sudden death and heart failure are severe long-term complications after atrial switch for D-transposition of the great arteries (D-TGA). Mechanisms and factors of long-term complications are poorly known. Right ventricle ischemia may be involved in these complications. Since coronary malformations are present in about 30% of D-TGA, we aimed to look for an association between these complications and the presence of coronary anomalies.

Methods
The study is an observational international study in two tertiary centers. Adults with history of atrial switch and severe rhythmic or hemodynamic complications, history of heart transplantation or cardiovascular death were included. Patients under 18 years old and/or with corrected transposition of great arteries were excluded. A χ2 test was used to compare the proportion of coronary anomalies in this cohort to the one from population of D-TGA reported in previous studies.

Results
Forty-two patients were included: 11 women (26.2%) and mean age at the time of the study was 43.3±6.4 years. Eight patients (19.0%) died at a mean age 41.3±9.0 years. No ablation for ventricular tachycardia was reported while 15 (35.7%) patients underwent ablation for a SVT (supraventricular tachycardia). Thirty three patients (78.6%) suffered from heart failure and/or severe right ventricle dysfunction and 4 patients (9.5%) were transplanted at a mean age of 29.3±8.3 years. Ten (23.8%) patients suffered from both arrhythmic events and heart failure. Twelve patients (28,6%) had abnormal coronary anatomy. The χ2 test showed no significant difference of coronary anatomy between our population and a pooled population of 647 D-TGA from previous studies (28.7%, p=0.9804). By multivariate analysis, severe pulmonary hypertension and severe tricuspid regurgitation were significantly associated with cardiovascular death and/or heart transplantation (respectively: p=0.0323, OR= 2.5, and p=0.0494, OR= 4.0). SVT ablation tended to be associated to survival (p=0.0928 with OR= 2.2).

Conclusions
No difference of coronary anomalies ratio in complicated Mustard or Senning patients was seen in comparison with the coronary anomalies ratio of all D-TGA. These results plead against a role of abnormal coronary anatomy in right ventricle dysfunction. Ischemia may be more related with the alteration of micro vascularization and a mismatch between oxygen needs and supply.

Funding Acknowledgement
Type of funding source: None
Timing and degree of left atrial stunning and reverse functional remodeling following electrical cardioversion in patients with recent onset atrial fibrillation
Authors: Arvanitis P , Johansson A.K , Frick M , Malmborg H , Gerovasileiou S , Larsson E.M , Blomstrom Lundqvist C 
Published: November 2020

Abstract

Background
Atrial fibrillation (AF) results in left atrial electrical, structural and functional remodeling. Restoration of sinus rhythm hallmarks the beginning of reverse remodeling, the extent of which may depend on the type of AF.

Purpose
The aim of the study was to assess resumption of left atrial function after electric cardioversion in patients with recent onset AF and to explore the association between reverse remodeling and the type of atrial fibrillation.

Methods
Patients with AF duration &lt;48 hours were prospectively included. Trans-thoracic echocardiography was performed prior, immediately after (2–4 hours) and 7–10 days following CV. Left atrial volume index (LAVI), left atrial global longitudinal strain during reservoir (LAGLS-res), conduit (LAGLS-cond) and contractile (LAGLS-contr) phases, left atrial ejection fraction (LAEF) and left ventricular ejection fraction (LVEF) were measured.

Results
Forty-three patients (84% males) aged 55±9.6 years, (mean±SD), with median CHA2DS2-VASc score 1 (interquartile range 0–1) were included. Repeated measure analysis of variance revealed a statistically significant overall change for LAGLS-res F(2,78)=55.4, p&lt;0,001, LAGLS-cond F(2,78)=23.3, p&lt;0,001, LAGLS-contr F(2,78)=39.7, p&lt;0,001, LAEF F(2,80)=28.5, p&lt;0.001 and LVEF F(2,80)=8.4, p&lt;0.001. At 7–10 days, LAGLS-contr 12±4%, LAEF 53±9% and LVEF 60±6 (mean±SD) return within normal reference intervals. Notably left atrial recovery seems to precede left ventricular recovery. No statistical significant interaction with the type of atrial fibrillation could be shown.

Conclusion
Left atrial functional reverse remodeling occurs within ten days after successful electric cardioversion of patients with recent onset atrial fibrillation.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Swedish Heart-Lung Foundation, Correvio International Sárl (Geneva Switzerland), Selanders Stiftelse
Epicardial adipose tissue and atrial fibrillation: guilty as charged or guilty by association?
Authors: Sousa J , Matos D , Ferreira A , Abecasis J , Saraiva C , Freitas P , Carmo J , Carvalho S , Rodrigues G , Durazzo A , Costa F.M , Carmo P , Morgado F , Cavaco D , Adragao P 
Published: November 2020

Abstract

Background
Epicardial adipose tissue (EAT) has been linked to the presence and burden of atrial fibrillation (AF). However, it is still unclear whether this relationship is causal or simply a surrogate marker of other risk factors commonly associated with AF.

Purpose
The purpose of this study was to assess the relationship between these factors and EAT, and to compare their performance in predicting AF recurrence after an ablation procedure.

Methods
We assessed 575 consecutive patients (mean age 61±11 years, 62% male) undergoing AF ablation preceded by cardiac CT in a high-volume ablation center. EAT was measured on cardiac CT using a modified simplified method. Patients were divided into 2 groups (above vs. below the median EAT volume). Cox regression was used to assess the relationship between epicardial fat, risk factors, and AF relapse.

Results
Patients with above-median EAT volume were older (p&lt;0.001), more often male (OR 1.7, p=0.002), had higher body mass index, and higher prevalence of smoking, hypertension, diabetes and dyslipidemia (p&lt;0.05). Non-paroxysmal AF was also more common in those with above-median EAT volume. During a median follow-up of 18 months, 232 patients (40.3%) suffered AF recurrence. After adjustment for BMI and other univariate predictors of relapse, three variables emerged independently associated with time to AF recurrence: non-paroxysmal AF (HR 2.1, 95% CI: 1.5–2.7, p&lt;0.001), indexed left atrial (LA) volume (HR 1.006 per mL/m2, 95% CI: 1.002–1.011, p&lt;0.001), and indexed epicardial fat volume (HR 1.87 per mL/m2, 95% CI: 1.66–2.1, p&lt;0.001). None of the classic cardiovascular risk factors were an independent predictor of AF recurrence (all p&gt;0.10).

Conclusion
Classic cardiovascular risk factors are more prevalent in patients with higher amounts of epicardial fat. However, unlike these risk factors, EAT is a powerful predictor of AF recurrence after ablation. These findings suggest that EAT is not merely a surrogate marker, but an important participant in the pathophysiology of AF.
EAT, cvrf and AF burden

Funding Acknowledgement
Type of funding source: None
Assessing endothelial function in patients with atrial fibrillation and hypertension using flow mediated dilatation: does atrial fibrillation add anything?
Authors: Khan A.A , Thomas G.N , Lip G.Y.H 
Published: November 2020

Abstract

Background
Atrial fibrillation (AF) and hypertension commonly co-exist and both are associated with endothelial dysfunction. A key consequence of normal endothelial function in vivo is the ability to release NO in response to physiological stimuli, such as increased flow, reflecting flow-dependent endothelium-mediated dilation (FMD). FMD measurement using a high-resolution ultrasound has become a reliable and reproducible technique for assessment of endothelial dysfunction.

Purpose
To investigate whether endothelium-dependent FMD is more abnormal in patients with AF and hypertension when compared to hypertension alone.

Design
In a cross-sectional comparison, we studied two patient groups: AF and hypertension (n=61) and hypertension control group (n=33). High-resolution ultrasound was used to measure brachial artery diameter at rest and during reactive hyperaemia (endothelium-dependent FMD). Data was analysed using SPSS software.

Results
Participants were matched for age, sex and BMI. There was no significant difference in FMD between permanent AF and hypertension group and hypertension control group (4.6%, 95% CI [2.6–5.9] vs 2.6%, 95% CI [1.9–5.3]; p=0.25). No variables were identified on univariate analysis and only heart rate was identified on multivariate analysis as an independent predictor of FMD (p=0.04).

Conclusion
First study investigating FMD in patients with permanent AF and hypertension together to assess whether presence of AF worsens the endothelial dysfunction seen in patients with hypertension. Endothelium-dependent FMD is impaired in patients with AF and hypertension. The presence of AF does not incrementally worsen endothelial dysfunction, nor was AF an independent predictor of endothelial dysfunction on multivariate analysis.

Funding Acknowledgement
Type of funding source: None
Factors affecting progression to permanent atrial fibrillation in an unselected population of patients with non-permanent form of atrial fibrillation
Authors: Malavasi V.L , Fantecchi E , Tordoni V , Melara L , Barbieri A , Valenti A.C , Menozzi M , Sgreccia D , Talarico M , Imberti J , Vitolo M , Boriani G 
Published: November 2020

Abstract

Background
Natural history of atrial fibrillation (AF) shows a progression of arrhythmia from non-permanent to permanent AF. Permanent AF was found associated with a worse prognosis than non-permanent one.

Aim
To assess the factors associated with progression to permanent AF in an unselected population of AF patients with non-permanent AF.

Methods
In this prospective study we enrolled in- as well as out-patients with non-permanent AF and age ≥18 years, with at least one episode of ECG-documented AF within 1 year. The patients were followed-up at 1 month and every 6 months thereafter.

Results
Out of 523 patients, 314 (60%) were in non-permanent AF (80 [25.5%] paroxysmal AF, 165 [52.5%] persistent AF, 69 [2%] first diagnosed AF), mostly male (188, 59.9%), median age 71 years (IQ range 62–77), median CHA2DS2VASc 3 (1–4), median HATCH score 1 (1–2). After a median follow-up of 701 (IQ range 437–902) days, 66 patients (21%) showed permanent AF.
CHA2DS2VASc and HATCH scores were incrementally associated to progression to permanent AF (CHA2DS2VASc χ2 p=0.001; HATCH χ2 p=0.017; p for trend CHA2DS2VASc &lt;0.001, HATCH p=0.001).
At multivariable Cox proportional hazard regression the following variables were significantly associated with AF progression: age (hazard ratio [HR] 1.041; 95% CI: 1.004–1.079; p=0.028), at least moderate left atrial (LA) enlargement (&gt;42 ml/m2) (HR 2.092; 95% CI: 1.132–3.866; p=0.018), antiarrhythmics drugs after the enrollment (HR 0.087; 95% CI: 0.011–0.662; p=0.018), EHRA score &gt;2 (HR 0.351; 95% CI: 0.158–0.779; p=0.010) and Valvular HD (HR 2.161; 95% CI: 1.057–4.420; p=0.035). Adding LA dilation to HATCH score (HATCH-LA) and assigning 2 points based on multivariable Cox regression, HATCH-LA was statistically better in ROC curves in prediction of AF progression vs HATCH score (area under the curve 0.695 vs 0.636; DeLong p=0.0225). Survival-free curves on freedom from permanent AF using as discriminator HATCH-LA score ≤2 vs &gt;2 led to a statistically significant difference (χ2=16.080 p&lt;0.001), but the same was not found for HATCH score (χ2 =3.099; p=0.078).

Conclusions
In patients without permanent AF, progression of AF was independentely related to age, LA dilation, AF symptoms severity, antiarrhythmic drugs and Valvular HD. HATCH score predicted AF progression and adding to it LA dilation (at least moderate) improved patients stratification for the risk of evolution to permanent AF.

Funding Acknowledgement
Type of funding source: None
Paroxysmal and persistent atrial fibrillation; does the clinical classification match the substrate?
Authors: Van Der Does W.F.B , Heida A , Van Der Does L.J.M.E , Bogers A.J.J.C , De Groot N.M.S 
Published: November 2020

Abstract

Background/Introduction
The classification of atrial fibrillation (AF) currently is based on clinical characteristics, however classifying underlying electropathology would assist in selecting appropriate therapy. In this study, we measured atrial conduction parameters in sinus rhythm (SR) using an intra-operative high resolution epicardial mapping approach in paroxysmal (PAF) and persistent AF (persAF) patients.

Purpose
To study whether the clinical classification is related to the amount and severity of conduction disorders in SR.

Methods
We included 47 PAF and 24 persAF patients for intra-operative measurements of SR at the right atrium (RA), Bachmann's Bundle (BB), the left atrium (LA) and the pulmonary vein area (PV). Various conduction parameters were calculated, including number of continuous conduction delay and block (cCDCB) lines, total activation time (TAT), and orientation of conduction block (CB) lines at BB.

Results
After adjustment for confounders, only TAT of BB was significantly longer in persAF patients, 75 [53–92] ms vs 55 [40–76] ms. This can be attributed to more CB line parts orientated perpendicular to the conduction direction and a higher number of cCDCB lines. Other conduction characteristics at BB and other atrial areas showed no difference between PAF and persAF patients.

Conclusion(s)
Patients with persAF have a longer activation time at BB compared to patients with PAF. Other conduction parameters show significant overlap between these groups at BB and in other atrial areas, suggesting that, in SR, the clinical classification does not match the arrhythmogenic substrate.

Funding Acknowledgement
Type of funding source: None
Effect of prevalent atrial fibrillation on cardiovascular outcomes in patients with chronic kidney disease
Authors: Bhat A , Gan G , Chen H.H.L , Gu K , Denniss M , Burgess D.C , MacIntyre R , Tan T.C 
Published: November 2020

Abstract

Background
The global increase in incidence and prevalence of chronic kidney disease (CKD) is associated with a parallel rise in co-morbid atrial fibrillation (AF). Concurrent presence of both conditions increases clinical complexity and may portend poor outcomes in this population.

Purpose
The aim of our study was to assess the impact of prevalent AF on mortality and cardiovascular outcomes in patients with CKD.

Methods
Consecutive patients with CKD (Stages 2 to 5) attending the Nephrology outpatient clinics in our health district between Jan 2007-Dec 2017 were retrospectively evaluated. Detailed appraisal of patient demographics, anthropometrics, clinical co-morbidities (including aetiology, stage and management of CKD) and pharmacotherapeutics was undertaken. These patients were followed for up to ten years for the composite outcomes of all-cause death and major adverse cardiovascular events (MACE). We excluded patients with incomplete clinical data and patients with concomitant medical co-morbidity limiting lifespan to &lt;6 months.

Results
2008 patients (63.61±17.17 yrs; 55.7% men) were assessed. The mean eGFR was 37.53±21.88 mL/min/m2. Patients with prevalent AF (n=440, 22%) were older (p&lt;0.01), with lower eGFR (p&lt;0.01) and higher rates of renal replacement therapy (p&lt;0.01). They also had a greater burden of coronary disease (p&lt;0.01), heart failure (p&lt;0.01), stroke (p&lt;0.01), obstructive sleep apnoea (p&lt;0.01), chronic obstructive pulmonary disease (p&lt;0.01), anaemia (p&lt;0.01) and obesity (p&lt;0.01). Over the mean follow-up period of 44.04±34.96 months, 832 patients met the composite outcome (410 all-cause death, 422 MACE). On log rank tests, prevalent AF was a predictor of the composite outcome (Figure 1; p&lt;0.01) and remained an independent predictor of all-cause death and MACE on multivariate analysis (HR 1.65; 95% CI 1.24–2.21, p&lt;0.01).

Conclusions
Prevalent AF is an independent predictor of all-cause death and MACE in patients with CKD.
Figure 1. Kaplan Meier Curve

Funding Acknowledgement
Type of funding source: None
New onset atrial fibrillation after dual chamber pacemaker implantation: long term predictors
Authors: Ferreira V , Portugal G , Viveiros Monteiro A , Oliveira M , Silva Cunha P , Cruz Coutinho M , Osorio P , Valente B , Covas S , Castelo A , Garcia Bras P , Mano T , Reis J , Cruz Ferreira R 
Published: November 2020

Abstract

Background
Preserving atrioventricular synchrony has been accepted as a significant advantage of atrial and dual-chamber (DDD) pacing. However, little is known about the incidence of atrial fibrillation (AF) after DDD implantation and its prognostic predictors in long term.

Purpose
To determine the incidence of new AF episodes and to identify risk factors and prognostic predictors for new-onset AF and all-cause mortality after implantation of dual-chamber pacemakers.

Population and methods
713 consecutive patients (P) who underwent colocation of DDD pacemaker, due to AV block (AVB) or sinus node disease (SND), with no prior history of AF, from 2011 to 2015. Through periodic PM interrogation, occurrence of AF (“automatic mode switch” episodes with documented AF), switch to ventricular pacing (VVIR), pacing site (apical or septal) and cumulative right ventricular (RV) pacing % were analysed.

Results
Follow-up data was available for 669 patients (93.8%) for a mean follow-up (FU) time of 47.8±22.7 months. Mean age was 72.9±10.8 years with 60.1% male. New occurrence of AF was observed in 345 P (51.6%) during the FU period; 45.7% of them were consequently anticoagulated (59.0% with NOACs). Median time to 1st AF episode since implantation was 21.6 months and in 50.9% of the cases it lasted ≥1h. In univariate analysis, 1st AF episode lasting more than 1 hour and existence of at least one episode longer than 24 hours were directly related to switch to VVIR (p&lt;0.0005; p&lt;0.0005; p&lt;0.0005) as well as prescription of anticoagulation (p=0.001; p=0.011; p&lt;0.0005).
Compared to non-AF P, those with AF were older (74.0±9.9 vs. 71.8±11.7 years; p=0.008), had higher prevalence of SND (50.0% vs 40.20%; p=0.015), had superior % of RV pacing (65.9±39.3% vs. 58.3±44.3%; p=0.021) and more frequently had RV apical pacing (70.1% vs 57.3%; p=0.001). The prevalence of hypertension, diabetes mellitus and dyslipidemia were similar in the two groups. With multivariable Cox-regression, age (HR 1.02; p=0.017), SND (HR 1.49; p=0.010), admission for HF (HR 1.55; p=0.012) and % RV pacing (HR 1.01; p=0.003) were significantly associated with the incidence of FA. Predictors of all-cause mortality in Cox regression were the occurrence of AF in 1st of FU (HR 1.67; p=0.018) and % RV pacing (HR 1.01; p=0.043).

Conclusions
New onset AF is a frequent finding after DDD pacemaker implantation and is associated with all-cause mortality in long term. Age, admission for heart failure, sinus node disease and % of RV pacing were independent predictors for AF during follow-up.

Funding Acknowledgement
Type of funding source: None