bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of epicardial fat tissue in atrial fibrillation onset in patients with hypertension
Authors: Tarzimanova A , Podzolkov V.I , Pisarev M.V , Gataulin R.G , Oganesian K.A 
Published: November 2020

Abstract

Aim
To study the influence of epicardial fat tissue (EFT) on atrial fibrillation (AF) occurrence in hypertensive patients.

Materials and methods
The study included 195 patients with hypertension aged from 38 to 72 years (mean age was 61.5±1.8 years). All patients were divided into two groups: group I included 95 hypertensive patients with paroxysmal AF; 100 patients with hypertension in sinus rhythm were enrolled into group II. Echocardiography was performed to evaluate the thickness of EFT in a parasternal long-axis view. The EFT volume was assessed with computed tomography (CT) scan. The plasma concentration of tissue inhibitor of metalloproteinase-1 (TIMP-1) and metalloproteinase-9 (MMP-9) was measured to evaluate the myocardial fibrosis process.

Results
There was no significant difference between the studied groups of patients in body mass index: 34.43±1.2 kg/m2 in group I vs 31.97±1.67 kg/m2 in the group II. Waist circumference was significantly higher in group I in comparison with the group II patients: 118.9±3.3 cm vs 110.2±1.4 cm, respectively (p=0.038). EFT thickness was significantly higher in patients with paroxysmal AF (11.6±0.8 mm) in comparison with the patients in sinus rhythm (8.6±0.4 mm) (p&lt;0.001). In group I patients a significant increase of EFT volume (4.6±0.4) in comparison with II group (3.5±0.25) (p=0.002) was noted. A significant positive correlation was revealed in hypertensive patients with paroxysmal AF between EFT volume and left atrial (LA) volume (r=0.7, p=0.022). Also, the plasma concentrations of TIMP-1 and MMP-1 were significantly higher in patients with paroxysmal AF and hypertension. There was a strong positive correlation between EFT volume and plasma concentration of TIMP-1 (r=0.72; p=0.01) and between the EFT volume and the LA volume (r=0.7, p=0.022) in group I patients. Multivariate regression analysis revealed the significant influence of increased EFT thickness more than 10 mm (prevalence ratio (PR) 4.1; 95% CI 1.1; 15.6) and EFT volume more than 6 ml (PR 3.7; 95% CI 1.0; 14.2) on AF occurrence.

Conclusion
Increased EFT thickness (more than 10 mm) and EFT volume (more than 6 ml) are predictors of AF onset in hypertensive patients.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): The complex subject of the Department
A novel diagnostic algorithm for the identification of different supraventircular tachycardias
Authors: Solis Cancino M , Pacheco Bouthillier A.D , Moreno Ruiz L.A 
Published: November 2020

Abstract

Background
Supraventricular arrhythmias represent a diagnostic challenge. Its prevalence and causes are not well established, given the impossibility to differentiate between all different types of supraventricular tachycardias (SVT). There are several supraventricular arrhythmias, but we focus on: 1) Atrial tachycardia (AT) 2) Junctional tachycardia (JT) 3) Atrial fibrillation (AF) 4) Atrial flutter (AA) 5) Atrioventricular nodal reentrant tachycardia (AVNRT), and 6) Atrioventricular reentrant tachycardia (AVRT). The electrocardiographic diagnosis is based on the presence of P-waves, its morphology and relationship with the QRS complex, and the relationship between the atrial and ventricular frequency.

Purpose
The purpose of this study was to create a helpful clinical tool that could serve the physician as a guide to determine a diagnosis and initial treatment. Additionally, we wanted to establish the sensitivity and specificity of the algorithm.

Methods
It is a diagnostic test study. We include 190 electrocardiograms of different SVT of patients undergoing electrophysiological studies. The data consists of 760 observations from two different readings of the electrocardiograms.

Results
104 of 112 AF, were correctly identified using the algorithm, with a sensitivity and specificity of 92.9% and 99.1%, respectively (95% CI: 0.86–0.96). 76 of 760 were AA, and 62 were correctly diagnosed, with a sensitivity and specificity of 81.6% and 95.5%, respectively (95% CI 0.71–0.88). 50 of the 72 AT were correctly classified, with a sensitivity of 69.4% and specificity of 97.4% (95% CI 0.58–0.78). 99 of 152 AVNRT were identified with a sensitivity and specificity of 64.5% and 87%, respectively (95% CI 0.84–0.89). 254 of 344 AVRT were diagnosed correctly with a sensitivity of 73.8% and specificity of 88.2% (95% CI 0.68–0.78). Finally, 1 of 4 JT were identified, with a sensitivity and specificity of 25% and 99.1% respectively (95% CI 0.04–0.69).

Conclusion
The algorithm is an excellent diagnostic tool to identify atrial flutter, atrial fibrillation and atrioventricular reentrant tachycardia.
SVT algorithm

Funding Acknowledgement
Type of funding source: None
Non Type-1 Brugada pattern, diagnostic yield of 5 ECG criteria in a young adult cohort
Authors: Carrington M , Creta A , Young W , Pais J , Rocha A.R , Santos A.R , Melo J , Henriques J , Teixeira R , Goncalves L , Lambiase P , Providencia R 
Published: November 2020

Abstract

Introduction
Distinguishing between non-Type 1 Brugada pattern (non-T1BrP) and an athlete's ECG remains challenging and may have important prognostic implications. We aimed to study prevalence and the diagnostic yield of experts and non-experts for the electrocardiographic non-T1BrP criteria in the young adults from the Sudden Cardiac Death-Screening Of risk factorS (SCD-SOS) cohort.

Methods
We performed a cross-sectional study in which we reviewed 14662 ECGs of SCD-SOS survey participants and selected 2494 that presented a rSr'-pattern in V1-V2. Among these, 98 were classified by experts in hereditary arrhythmic syndromes for the presence of non-T1BrP and by non-experts who performed manual measurements of the diagnostic criteria based on triangle formed by r'-wave. We estimated intra and interobserver concordance for each criterion, and used logistic regression and receiver operating characteristics (ROC) analysis and C-statistics for diagnostic accuracy and definition of the most appropriate cut-off values.

Results
We detected a rSr'-pattern in V1-V2 in 17% of the individuals and found that it was associated with higher PQ and QTc intervals, male gender and lower BMI. The manual measurements of non-T1BrP criteria were reproducible: we had high intraobserver concordance coefficients (CC) ranging from 0.90 to 0.94 (except for d(B) that had 0.66), but interobserver CC were lower (0.45–0.68). The measurements performed were highly correlated with non-T1BrP diagnosis and the criteria with higher discriminatory capacity were the distance d(B) (AUC 0.77; 95% CI0.69–0.84) and the degree of ST-ascent (AUC 0.79; 95% CI 0.72–0.86). The cut-offs defined by other authors had very low sensitivity (8–12%), despite high specificity (98%), so we defined new cut-offs: d(A) ≥2mm, d(B) ≥1.25mm, d(B)/h ≥0.38, β-angle ≥19° and ST-ascent ≥1mm. The addition of the degree of ST-ascent to a model with these 4 parameters presented an increase in C-statistics from 0.77 (95% CI: 0.68–0.86) to 0.83 (95% CI: 0.75–0.91) for the diagnosis of non-T1BrP by an expert in Sudden Arrhythmic Death and Channelopathies.

Conclusion
A rSr'-pattern in precordial leads V1-V2 is a frequent finding and the detection of non-T1BrP by using the aforementioned 5 measurements is reproducible and accurate. In this study, we describe new cut-off values that may help untrained clinicians to identify young individuals who should be referred for provocative drug testing for Brugada Syndrome.
Accuracy of non-T1 BrP criteria

Funding Acknowledgement
Type of funding source: None
Changes of QT interval in the acute phase after pulmonary vein isolation for paroxysmal atrial fibrillation
Authors: Chikata A , Kato T , Ududa K , Fujita S , Otowa K , Maruyama M , Tsuda T , Hayashi K , Takamura M 
Published: November 2020

Abstract

Introduction
Pulmonary vein isolation (PVI) affects ganglionated plexi (GP) around the atrium, leading to a modification of the intrinsic cardiac autonomic system (ANS). In animal models, GP ablation has a potential risk of QT prolongation and ventricular arrhythmias. However, the impact of PVI on QT intervals in humans remains unclear.

Purpose
This study aims to evaluate the Impact of PVI on QT interval in patients with paroxysmal atrial fibrillation.

Methods
We analyzed consecutive 117 PAF patients for their first PVI procedures. 12-lead ECG was evaluated at baseline, 4 hr, day 1, 1 month, and 3 months after ablation. Only patients with sinus rhythm on 12-lead ECG at each evaluation point without antiarrhythmic drugs were included.

Results
Heart rate significantly increased at 4 hr, day 1, and 1 month. Raw QT interval prolonged at 4 hr (417.1±41.6 ms, P&lt;0.001) but shortened at day 1 (376.4±34.1 ms, P&lt;0.001), 1 month (382.2±31.5 ms, P&lt;0.001), and 3 months (385.1±32.8 ms, P&lt;0.001) compared to baseline (391.6±31.4 ms). Bazett- and Fridericia- corrected QTc intervals significantly prolonged at 4hr (Bazett: 430.8±27.9 ms, P&lt;0.001; Fridericia: 425.8±27.4 ms, P&lt;0.001), day1 (Bazett: 434.8±22.3 ms, P&lt;0.001; Fridericia: 414.1±23.7 ms, P&lt;0.001), 1M (Bazett: 434.8±22.3 ms, P&lt;0.001; Fridericia: 408.2±21.0 ms, P&lt;0.05), and 3M (Bazett: 420.1±21.8 ms, P&lt;0.001; Fridericia: 407.8±21.1 ms, P&lt;0.05) compared to baseline (Bazett: 404.9±25.2 ms; Fridericia: 400.0±22.6 ms). On the other hand, Framingham- and Hodges- corrected QTc interval significantly prolonged only at 4hr (Framingham: 424.1±26.6 ms, P&lt;0.001; Hodges: 426.8±28.4 ms, P&lt;0.001) and at day1 (Framingham: 412.3±29.3 ms, P&lt;0.01; Hodges: 410.6±40.2 ms, P&lt;0.05) compared to baseline (Framingham: 399.2±22.7 ms; Hodges: 400.7±22.8 ms). At 4 hr after ablation, raw QT and QTc of all formulas significantly prolonged than baseline. Raw QT and QTc prolongation at 4hr after ablation were more frequently observed in female patients. Multiple regression analysis revealed that female patient is a significant predictor of raw QT and QTc interval prolongation of all formulas 4hr after PVI.

Conclusions
Raw QT and QTc prolonged after PVI, especially in the acute phase. Female patient is a risk factor for QT prolongation in the acute phase after PVI.

Funding Acknowledgement
Type of funding source: None
Near zero fluoroscopy cryoballoon catheter ablation in patients with atrial fibrillation using a novel dielectric imaging system
Authors: Schillaci V , Stabile G , Arestia A , Shopova G , Agresta A , Solimene F 
Published: November 2020

Abstract

Background
Fluoroscopy is commonly used in cryoballoon catheter ablation for pulmonary vein (PV) isolation procedures in patients with atrial fibrillation (AF).

Purpose
The purpose of this study was to verify the feasibility of a new dielectric imaging system in reducing the radiation exposure during cryoballoon ablation in patients with AF.

Methods
We enrolled 40 consecutive patients with paroxysmal AF: 20 patients underwent the procedure under fluoroscopy guidance before the new system introduction, while 20 patient underwent the procedure under fluoroscopy and a new dielectric imaging system guidance with its occlusion tool software. After transseptal access a detailed image reconstruction of left atrium and PVs was achieved with an octapolar circular mapping catheter and the cryoablation was performed with a cryoballoon catheter.

Results
Total time of the procedure was comparable between the two groups (90.15±28.67 vs 80.77±17.17 using the dielectric imaging system, p=0.34), while fluoroscopy time was significantly lower in the group using the new dielectric imaging system (16.92±8.96 vs 5.54±2.06, p&lt;0.01). Acute isolation was achieved in all PVs. No 30 days complication was observed.

Conclusion
This is the first study that demonstrates the feasibility of a reduce fluoroscopy workflow using the novel dielectric imaging system in a cryoballoon procedure.

Funding Acknowledgement
Type of funding source: None
Impact of catheter ablation for atrial flutter on mortality and hospital readmission rates in patients with heart failure and reduced ejection fraction
Authors: Arora S , P Patel H , Jani C , Thakkar S , Gonzalez J , Deshmukh A , Patel R , D'Hoit B 
Published: November 2020

Abstract

Background
The effectiveness of catheter ablation as a management modality amongst patients with coexisting atrial flutter (AFL) and heart failure with reduced ejection fraction (HFrEF) is scarcely studied.

Methods
Appropriate ICD 10 codes were applied to the 2016 and 2017 National Readmission Database (NRD) to isolate patients having coexistent AFL and HFrEF including who had undergone an ablation. All-cause mortality at the end of 1 year was used as a primary outcome. Readmission due to AFL, heart failure (HF) and other causes were secondary outcomes. The hazard ratios were generated using Cox regression analysis while the time to event analysis was demonstrated with the Kaplan Meier curves.

Results
Out of a total of 9966 patients with AFL and HFrEF, 1980 (24.79%) patients underwent catheter ablation. The primary outcome, all-cause mortality (2.8% vs. 4.6%, HR: 0.610, 95% CI: 0.460–0.808, p=0.001) at the end of 1 year was significantly lower. Significant difference was also noted amongst two groups when it came to secondary outcomes such as readmissions due to AFL (1.6% vs. 6.3%, HR: 0.247, 95% CI: 0.173–0.354, p&lt;0.001), HF (8.2% vs. 11.4%, HR: 0.693, 95% CI: 0.587–0.819, p&lt;0.001) and other causes (29.4% vs. 37.1%, HR: 0.735, 95% CI: 0.673–0.804, p&lt;0.001)

Conclusion
Ablative intervention amongst AFL patients with concomitant HFrEF showed a significant reduction in all-cause mortality. It also leads to significant reductions in readmissions due to AFL, HF and other causes at the end of one year.
Outcomes of AFL and HFrEF

Funding Acknowledgement
Type of funding source: None
Hospital readmissions after catheter ablation for atrial fibrillation among patients with heart failure in the United States
Authors: Lima F , Kennedy K , Parulkar A , Sheikh W , Sharma E , Chu A 
Published: November 2020

Abstract

Background
Catheter ablation for atrial fibrillation may improve quality of life and long-term mortality among patients with heart failure.

Purpose
The rates of hospital readmission after catheter ablation for atrial fibrillation among patients with an established diagnosis of heart failure are largely unknown. We aimed to assess the rates and causes of 30-day readmission among patients with heart failure undergoing catheter ablation vs. medical therapy for atrial fibrillation in the United States.

Methods
The 2016 Nationwide Readmissions Database was screened for patients with diagnosis of heart failure and atrial fibrillation using the 10th Revision of International Classification of Diseases codes. Patients undergoing catheter ablation for atrial fibrillation were grouped separately from those treated medically for atrial fibrillation. Thirty-day readmissions were assessed for both groups.

Results
The analytical cohort included 749,776 (national estimate of 1,421,673) patients with heart failure and atrial fibrillation. This included 2,204 patients that underwent catheter ablation. Patients treated with catheter ablation had lower 30-day readmissions compared to the medical therapy group (16.8% vs 20.1%, p&lt;0.001). Fifty-five percent of all readmissions among the catheter ablation cohort were related to cardiac events. Heart failure exacerbation (40%) and arrhythmia (36%) were the most common cardiac causes for readmission after catheter ablation (Figure).

Conclusions
In a contemporary nationwide analysis of patients with heart failure and atrial fibrillation, compared to medical therapy those treated with catheter ablation for atrial fibrillation had fewer 30-day readmissions after index hospital discharge. The most common cause for readmission among patients treated with catheter ablation was heart failure exacerbation and arrhythmia.
Causes of readmission

Funding Acknowledgement
Type of funding source: None
Acute detection of optical tissue changes in real-time during pulsed field ablation (PFA)
Authors: Hong K.L , Amirana O , Ransbury T , Glover B 
Published: November 2020

Abstract

Background
It has been established in previous animal and human studies that it is possible to assess lesion formation in real-time using optical means during the application of radiofrequency (RF) energy in cardiac ablation procedures. The optical interrogation was accomplished using a novel catheter and instrument system whereby the catheter has embedded optical fibers that transmit and receive light from the instrument.

Purpose
The aim of this study was to see if there are similar indications of lesion formation, detected by the same optical means, during the application of pulsed field ablation (PFA) energy to cause lesions through electroporation.

Methods
A series of 3 anesthetized pigs underwent PFA in the right atrium. An 8-electrode circular catheter was placed high in the right atrium, near the superior vena cava, to simulate pulmonary vein isolation as part of an AF ablation procedure. The optical catheter was placed adjacent to the circular catheter between stimulation electrode pairs. A bolus of adenosine was administered to create a window of asystole to avoid stimulation on the T-wave. Bipolar PFA was delivered immediately post drug infusion and the optical signature from the catheter was recorded and displayed in real-time. Electrograms were recorded and the mapping of the lesion was performed with the optical catheter at the following time intervals post PFA delivery: 0 min, 15 min, 1 hour, and 3 hours. Necropsy and histology followed the procedure.

Results
The optical signal is distinctly higher in intensity during the PFA pulse train. The optical signal showed an immediate significant decrease and a slow but steady decay over the mapping interval. Electrogram reduction accompanied PFA application and also showed a marked reduction over the mapping interval. The optical signal amplitudes were markedly lower when on the lesion compared to healthy non-ablated myocardium as predicted.

Conclusions
Preliminary results indicate that optical mapping detects immediate tissue changes during PFA at these energy levels and hence could be is a viable method of evaluating lesion formation during and after PFA energy application. The optical signal indicates that cell damage occurs immediately at these energy levels and continues to progress slowly in lesions made by PFA energy compared to those made by RF energy. The findings also suggest that optical mapping can identify acute lesions made with PFA energy in real-time implying that optical mapping could evolve as a PFA gap detector.

Funding Acknowledgement
Type of funding source: None
Relationship of particular matter and temperature on the risk of adverse events in atrial fibrillation patients
Authors: Rivera-Caravaca J.M , Roldan V , Vicente V , Lip G.Y.H , Marin F 
Published: November 2020

Abstract

Background
Ambient particulate matter (PM), is a principal component of air pollutant and the main culprit of the adverse effects of air pollution on humans' health. In particular, PM with aerodynamic diameter &lt;10 μm (PM10) has been shown to be associated with worse clinical outcomes. Similarly, cardiovascular risk increases during colder temperatures/seasons. Thus, both, air pollution and temperature fluctuations are examples confirming how the climate change is affecting our health. However, our knowledge about the impact of air pollution and temperature in anticoagulated atrial fibrillation (AF) patients is scarce.

Purpose
Herein, we investigated if PM10 and temperature are associated with an increased risk of adverse clinical outcomes in patients with AF taking vitamin K antagonists (VKAs).

Methods
We included AF patients who were stable on VKAs (INR 2.0–3.0) for 6 months in a tertiary hospital (Murcia, South-east Spain). During a median follow-up of 6.5 (IQR 4.3–7.9) years, ischemic strokes, major bleeds, adverse cardiovascular events, and mortality were recorded. From 2007–2016, data on average temperature and PM10 (PM with aerodynamic diameter &lt;10 μm) were obtained and related to clinical outcomes.

Results
1361 patients (48.7% male; median age 76, IQR 71–81 years) were included. High PM10 and low temperatures were associated with higher risk of major bleeding (adjusted Hazard Ratio, aHR 1.44, 95% CI 1.22–1.70 and aHR 1.03, 95% CI 1.01–1.05) and mortality (aHR 1.50, 95% CI 1.34–1.69 and aHR 1.04, 95% CI 1.02–1.06) (Table 1). PM10 was also significantly associated with ischemic stroke and temperature with cardiovascular events. The relative risk for cardiovascular events and mortality increased in months in the lower quartile (Q1) of temperature (&lt;12.74°C) (RR 1.12, 95% CI 1.04–1.21 and RR 1.41, 95% CI 1.15–1.74; respectively). Comparing seasons, there were higher risks of cardiovascular events in spring, autumn, and winter than in summer, whereas the risk of mortality increased only in winter.

Conclusions
In AF patients taking VKAs highPM10 and low temperature were associated with an increased the risk of ischemic stroke and cardiovascular events, respectively. Both factors increased major bleeding and mortality risks, which were higher during colder months and seasons.
Table 1. Univariate and Multivariate Cox

Funding Acknowledgement
Type of funding source: None
Prediction of mortality and mode of death by clinical risk score systems in 2.6 million patients with atrial fibrillation: a nationwide analysis
Authors: Fauchier L , Bisson A , Bodin A , Herbert J , Clementy N , Pierre B , Angoulvant D , Hanon O , Babuty D , Lip G 
Published: November 2020

Abstract

Atrial fibrillation (AF) is associated with a higher mortality, but modes of death may vary and their respective predictors have been insufficiently defined. Charlson comorbidity index (CCI) is a tool to quantify multimorbidity and a strong estimator of mortality. The quantifiable frailty phenotype is also predictive of mortality and disability and claims data can be used to classify individuals as frail and non-frail using the Claims-based Frailty Index (CFI). We evaluated whether these tools may help to predict mortality and the different modes of death in AF.

Methods
Based on the France nationwide administrative hospital-discharge database, we collected information for all AF patients treated between 2010 and 2019 in France. Adverse outcomes were investigated during follow-up. CHA2DS2VASc score, CCI and CFI were calculated for each patient.

Results
Among 2,641,626 patients with AF, 670,541 patients died during a follow-up of 2.0±2.3 years (median 1.1) (yearly rate 12.6%, 30.3% cardiovascular and 69.7% non-cardiovascular deaths). Death occurred more often in patients with higher CHA2DS2VASc, CCI and CFI scores. CCI was a better predictor of total mortality than CFI and CHA2DS2VASc score (see C-statistics in table); however, the CHA2DS2VASc score was a better predictor of cardiovascular mortality than CCI and CFI. By contrast, CCI was a better predictor of non-cardiovascular mortality than CFI and CHA2DS2VASc score. The optimal predictive performances were better for non-cardiovascular death than for cardiovascular death.

Conclusion
Multimorbidity assessed with CCI demonstrated better performances in predicting total mortality and non-cardiovascular mortality than CHA2DS2VASc score and Frailty assessed with CFI in AF patients. By contrast, CHA2DS2VASc score was a better predictor of cardiovascular mortality than CCI and CFI in these patients.

Funding Acknowledgement
Type of funding source: None