bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1371Catheter-induced premature ventricular complexes (pvc) may aid in the determination of optimal timing for clinical pvc ablation
Authors: Demir S , Akgun T , Gulsen K , Kup A , Uslu A , Kayan F , Kepez A 
Published: June 2020

Abstract

Background
There is significant interpatient variability regarding the timing of the earliest local activation relative to surface QRS during premature ventricular complex (PVC) ablation. The aim of the present study is to evaluate whether catheter-induced premature ventricular complexes (PVCs) produced at the presumptive ablation site may aid in the identification of the optimal timing of the earliest local activation for the successful ablation of clinical PVCs.

Methods
Sixty-three consecutive patients (35 males, age: 53.5 ± 14.4 years) without any exclusion criteria who had undergone PVC ablation between 01/07/2018 and 01/07/2019 constituted our study population. Catheter-induced PVCs were generated at the site with presumptive PVC origin according to the ECG criteria during the procedure of PVC ablation. Five PVCs were induced by mechanical stimulation in separate points, and the time interval between the beginning of EGM at catheter tracing and the beginning of the QRS complex of each catheter-induced PVC was noted. The mode of five time intervals (Cath EGM-ECG) was used in the analysis. The time interval between the beginning of local EGM of clinical PVCs at the earliest site and the beginning of the QRS complex of clinical PVCs (PVC earliest EGM-ECG) was also noted. The value of Cath EGM-ECG as a reference for procedural success of ablation was evaluated by examining the relationship between Cath EGM-ECG and PVC earliest EGM-ECG.

Results
Fifty-two patients had successful ablation, and 43 of them (82.7%) had PVC earliest EGM-ECG values greater than or equal to Cath EGM-ECG. Eleven patients had procedural failure, and all of them had PVC earliest EGM-ECG values lower than Cath EGM-ECG (Table 1). A PVC earliest EGM-ECG value -1.5 ms greater than Cath EGM-ECG predicted successful ablation with a sensitivity of 90.4% and a specificity of 100.0% in the general patient population (Figure 1).

Conclusion
The results of the present study indicate that catheter-induced PVCs generated at the site of the presumptive source of origin of clinical PVCs may guide the timing of the earliest site during clinical PVC ablation. Further studies are required to validate our results and test the predictive value of Cath EGM- ECG interval for long-term success of PVC ablation.
Table 1 PVC earliest EGM-ECG &lt; Cath EGM- ECG PVC earliest EGM-ECG ≥ Cath EGM- ECG Ablation successful (n:52) 9 (17.3%) 43 (82.7%) Ablation not successful (n:11) 11 (100.0%) 0 (0%) Outcome of ablation in general patient population according to the relationship between PVC earliest EGM-ECG and Cath EGM- ECG
Abstract Figure 1
P1059Recurrence of AF after pulmonary vein isolation: how many times?
Authors: Silverio Antonio P , Cortez-Dias N , Nunes-Ferreira A , Lima G , Aguiar-Ricardo I , Rigueira J , Santos R , Rodrigues T , Cunha N , Couto Pereira S , S Morais P , Sobral S , Carpinteiro L , J Pinto F , De Sousa J 
Published: June 2020

Abstract

Introduction
Ablation of atrial fibrillation (AF) by catheter is an effective therapy, particularly in cases of refractoriness to medical therapy. Pulmonary vein isolation (PVI) has a significative long-term recurrence rate of AF, but the recurrence factors after this procedure are poorly defined.

Purpose
To characterize the causes of AF recurrence after PVI and to evaluate complementary strategies that can optimize the therapeutic efficacy.

Methods
A single centre prospective study of patients (pts) with AF submitted consecutively to PVI since September 2004. The variables responsible for the recurrence of AF, the complementary strategies of optimization of AF ablation and the occurrence of other dysrhythmias were evaluated.

Results
A population of 521 pts were submitted to PVI as a primary strategy for AF treatment - 36.1% for paroxysmal AF, 32.5% for persistent AF &lt;1 year, 14.5% persistent AF&gt; 1 year.
Eighty-three pts needed to perform 2 ablations and 10 pts performed 3 ablations. The higher the number of AF ablations, the higher the incidence of atypical atrial flutter (2% in the 1st AF ablation, 17% in the 2nd and 44% after 3 ablations).
In the pts with recurrence of AF undergoing the 2nd ablation, it was verified that most of the pulmonary veins (PV) were not isolated, with an isolation rate of only 34.1% for the right inferior PV; 29.4% for superior PV right, 29.4% lower left VP, 28.2% upper left PV. In this group, in addition to a new PVI in the pts with re-conduction of PV, 45% performed complementary ablation strategies such as: ablation of the cavo-tricuspid isthmus (52.6%); ablation of the left atrium roof line (29%); mitral isthmus ablation line (26%); applications in the scar zone (26%); posterior atrial left line (8%), atrioventricular nodal reentrant atrioventricular ablation (5%), atrial tachycardia ablation (2.6%).
In the pts submitted to the 3rd ablation, again a low PV isolation rate was confirmed: only 44.4% for the both left PV and upper right PV, and 55.6% for the right lower VP. 33.3% also performed cavo-tricuspid isthmus ablation, 22.2% lower mitral isthmus isolation and 22.2% re-isolation of gaps in the roof or intracicritricial line.

Conclusion
This prospective study demonstrates a high rate of PV re-conduction after PVI and its role in AF recurrence. Therefore, the need for a more effective and definitive IVP technique is evident.
P1392Next generation sequencing in lone atrial fibrillation patients
Authors: Rudaka I , Rots D , Kalejs O , Gailite L 
Published: June 2020

Abstract
Background. Minor part of atrial fibrillation (AF) patients develops the disease without any well-known risk factors, which is a particular form of the disease, known as a lone AF. Rare genetic variants were described as causative for lone AF. The aim of this study was to investigate occurrence of rare genetic variants in lone AF patients.
Material and Methods. We performed Mendeliome sequencing for 21 lone AF patients. Lone AF was defined as AF in individuals younger than 65 years in the absence of cardiovascular or structural heart disease, endocrinologic or pulmonary disease, chronic kidney disease, obesity and excessive alcohol consumption. Data analysis was performed by current laboratory pipeline. We analyzed 453 cardiomyopathy, arrhythmias and sudden cardiac death related genes.
Results. In eight out of 21 (38%) lone AF patients rare likely pathogenic variants were found (Table 1.). Seven rare truncating TTN variants and one LMNA missense variant were observed. Four unrelated patients were positive for the same TTN variant c.13696 C &gt; T; p.(Gln4566Ter). The same variant was previously found in ARVC patient in our laboratory. Segregation analysis and phenotyping of relatives is ongoing.
Conclusions. Rare genetic variants are common causes of the lone atrial fibrillation. TTN gene variant c.13696C &gt; T; p.(Gln4566Ter) is a potential founder variant in the Baltic population.
Table 1. Genetic variants in lone AF Gender Age of AF onset Genetic variant Family history Male 53 LMNA: p.(Ser326Thr) AF in mother Male 11 TTN: p.(Trp31854Ter) AF in father Male 30 TTN: p.(GLn4566Ter) AF in uncle Female 45 TTN: p.(GLn4566Ter) Negative Male 37 TTN: p.(GLn4566Ter) AF in father Male 25 TTN: p.(GLn4566Ter) AF in father, maternal and paternal grandmother Female 60 TTN: p.(Arg27414Ter) Sudden cardiac death at the age of 50 in grand father Female 52 TTN: p.(Arg1012Ter) AF in mother
P1379Fluoroscopy requirement reduction using an esophageal cooling protocol during left atrial ablation
Authors: Zagrodzky J , Bailey S , Shah S , Kulstad E 
Published: June 2020

Abstract

Background
Ablation of the left atrium with radiofrequency (RF) energy is associated with some risks to the esophagus. Cooling the esophagus has been used as one approach to reducing esophageal injury, most commonly with direct instillation of cold liquid via gastric tube placed in the esophagus. A new esophageal cooling device avoids the risks of free liquid instillation by using a closed-loop system, and avoids the need for frequent repositioning or stopping of the procedure often required when utilizing luminal esophageal temperature (LET) monitoring. This in turn may reduce fluoroscopy requirements for the procedure.

Purpose
Measure the difference in fluoroscopy time required during RF ablation using an esophageal cooling device protocol, and compare this to standard LET monitoring using single or multi-sensor temperature probes.

Methods
We obtained total fluoroscopy time per patient from records of RF ablation procedures performed by a two operators over a 12 month period. We compared fluoroscopy times between patients treated with an esophageal cooling device to control patients who were treated with LET monitoring using either single-sensor or multi-sensor temperature probes.

Results
Fluoroscopy times were available for a total of 179 patients treated with an esophageal cooling device, and 118 patients treated with LET monitoring over the 12 month study period. Mean fluoroscopy time for patients treated with esophageal cooling was 4.0 minutes (SD 4.9 minutes) with a median of 2.0 minutes (IQR 1.3 to 3.8 minutes). Mean fluoroscopy time for patients undergoing LET monitoring was 5.5 minutes (SD 5.7 minutes) with a median of 3.0 minutes (IQR 1.9 to 8.4 minutes). This difference represents a 27% reduction in mean fluoroscopy time, and a 33% reduction in median fluoroscopy time in the esophageal cooling group (p&lt;.001, Mann-Whitney U test).

Conclusions
Fluoroscopy requirements were reduced by 27% with an esophageal cooling device when compared to standard LET monitoring.
P373Arterial stiffness changes in patients with obesity and atrial fibrillation
Authors: Tarzimanova A , Podzolkov V I , Bragina A E , Pisarev M V , Gataulin R G , Oganesian K A 
Published: June 2020

Abstract
Objective To study the changes in arterial stiffness in patients with obesity and paroxysmal atrial fibrillation (AF).
Materials and methods The study included 82 obese patients. Forty-two of them (group I) had paroxysmal AF, their mean age was 60.9 ± 6.2 years. The control group (group II) included 40 obese patients in sinus rhythm with the mean age of 57.2 ± 6.5 years.
We studied arterial stiffness using cardio-ankle vascular index (CAVI) measured by the VaSera device (VS-1000) in all the patients. Patients from group I were evaluated after 3 days of sinus rhythm restoration and maintenance. We also measured the anthropometric indicators which included body mass index, waist circumference, abdominal sagittal diameter, waist-to-hip and waist-to-height ratios.
Results There were no significant differences in body mass index between 2 groups. The waist-to-hip ratio was significantly higher in patients with obesity and paroxysmal atrial fibrillation than in obese patients in sinus rhythm and was 1.37 ± 0.09 and 0.84 ± 0.06, respectively (p = 0.002). The mean value of CAVI was 9.61 ± 1.51 and 6.42 ± 0.18 in group I and group II respectively; this difference was significant (p = 0.001). There was a strong positive correlation between CAVI and waist-to-hip ratio in the group I patients (p = 0.02). The results show that vascular stiffness is significantly higher in obesity patients with paroxysmal form AF.
Conclusion Positive correlations between increased arterial stiffness and anthropometric indicators confirm the role of visceral obesity in the development of AF.
P427Influence of ranolazine on cardioversion rate in patients with new onset atrial fibrillation and ischemic disease of the heart
Authors: Alyavi B , Uzokov J K , Abdullaev A X , Payziev D D 
Published: June 2020

Abstract

Background
Ranolazine is a piperazine derivative, mainly used as antianginal drug in patients with ischemic disease of the heart (IDH). Despite its antianginal effect, it has an antiarrhythmic effect by inhibiting of late sodium and rapid potassium rectifier current. Aim of the study was to assess the additional antiarrhythmic efficacy of ranolazine in patients with new onset atrial fibrillation (AF) and IDH.

Material and Methods
168 eligible patients with IDH and short duration of new onset AF were enrolled in this study. Among them, 92 were treated additionally ranolazine to the standart therapy – Group I while 76 only with standart therapy – Group II. The choice of antiarrhythmic drug for cardioversion was either amiodarone or propafenone at the discretion of the doctor. Primary endpoint was recovering of sinus rhythm. All statistical analysis were performed using student t-test.

Results
Mean age of patients was 66 ± 11.5 years, male 48% in ranolazine group (Group I) and 64.5 ± 12.0 years, male 46% in Group II, and there were no statistically significant differences between two groups. Both groups of patients were characterized by median AF episode duration of 12 (4; 24) hours. Amiadoron was administered in 70 % (n = 65) of patients in Group I and in 77% (n = 59); propafenon in 30% (n = 17) of patients in Group I and 23% (n = 17) in Group II. Cardioversion rate was significantly higher in Group I than Group II (87% vs. 74%, P &lt; 0.05;). There were not observed safety endpoints in Group I whereas 3 safety endpoints (severe bradycardia and arterial hypotension) were observed in Group II (P &gt; 0.05).

Conclusion
Adding ranolazine to the standard therapy in patients with IDH seems to have a beneficial role in restoring sinus rhythm in recent new onset AF.
666Impact of local left atrial wall thickness on the incidence of acute pulmonary vein reconnection after ablation index-guided ablation
Authors: Mulder M J , Kemme M J B , Hopman L H G A , Hauer H A , Tahapary G J M , Gotte M J W , Van Rossum A C , Allaart C P 
Published: June 2020

Abstract

Background/Introduction
Pulmonary vein reconnection is considered a major determinant of atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). Ablation Index (AI)-guided ablation allows for the creation of ablation lesions of consistent depth and may reduce the incidence of pulmonary vein reconnection after PVI. However, anatomical and imaging studies have demonstrated an important inter- and intra-patient variability of left atrial wall thickness, which can result in non-transmural ablation lesion formation in thicker segments.

Purpose
The present study aimed to investigate the impact of local left atrial wall thickness on the incidence of acute pulmonary vein reconnection after AI-guided AF ablation.

Methods
Consecutive AF patients who underwent cardiac computed tomography (CT) imaging prior to AI-guided ablation between December 2017 and September 2019 were studied. AI targets were 500 for anterior/roof and 380 for posterior/inferior segments with a maximum interlesion distance of 6 mm. Occurrence of acute pulmonary vein reconnection after initial PVI was assessed after a 30-minute waiting period. Ablation procedures were analysed offline to determine minimum AI, force-time integral, contact force, ablation duration, power, impedance drop and maximum interlesion distance for each segment according to a 16-segment model. Pulmonary vein antrum wall thickness was assessed for each segment on reconstructed CT images based on patient-specific thresholds in Hounsfield Units, using a previously described method.

Results
Seventy patients (63% paroxysmal AF, 67% male, mean age 63 ± 8 years) who underwent preprocedural CT imaging and AI-guided AF ablation were studied. Acute reconnection (AR) occurred in 27/1152 segments (2%, 15 anterior/roof, 12 posterior/inferior) in 17/70 (24%) patients. Anterior/roof segments were thicker than posterior/inferior segments (1.48 [1.23-1.80] vs. 1.13 [1.00-1.30] mm; p &lt; 0.01). Reconnected segments were characterised by a greater local atrial wall thickness, both in anterior/roof (1.83 [1.60-2.00] vs. 1.47 [1.20-1.80] mm; p &lt; 0.01) and posterior/inferior (1.38 [1.25-1.50] vs. 1.13 [1.00-1.27] mm; p &lt; 0.01) segments (Figure 1). Minimum AI, force-time integral, contact force, ablation duration, power, impedance drop and maximum interlesion distance were not associated with acute pulmonary vein reconnection.

Conclusion
Local atrial wall thickness is associated with acute pulmonary vein reconnection after AI-guided PVI. Individualised AI targets based on local wall thickness may be of use to create transmural ablation lesions and prevent pulmonary vein reconnection after PVI.
Abstract Figure. Impact of wall thickness on reconnection
P1001Efficacy of ranolazine for the prevention of atrial fibrillation in high-risk patients with chronic coronary syndrome and hypertension
Authors: Alyavi A L , Alyavi B A , Uzokov J , Abdullaev A X 
Published: June 2020

Abstract

Background
Ranolazine currently is used to relief angina symptoms in patients with chronic coronary syndrome (CCS). Additional its anti-angina effect it has been showing antiarrhythmic effect by predominantly inhibiting late sodium and rapid potassium rectifier current. We aimed to assess the efficacy of ranolazine for the prevention of atrial fibrillation (AF) in high-risk patients older than 60 years with CCS at least &gt;5 years and hypertension.

Methods
264 older high-risk patients (&gt;60 years) with CCS and hypertension were prospectively enrolled (mean age was 66 ± 11.5 years, male 48%). Among them 132 patients have received additional ranolazine to the standard therapy while control group patients (n = 132) have received only standard therapy. Mean follow-up period was 5.0 ± 4.6 years. All statistical analyzes was performed using one sample student t-test.

Results
Initial baseline characteristics of patients were not statistically different. During the follow-up period in 8.3 % (n = 11) of patents have occurred MACE (AMI, PCI, CABG, death) in ranolazine group vs. in 9.8% (n = 13) of patients in the control group (P &gt; 0.05). During the follow-up AF (paroxysmal and persistent) was developed significantly lower in ranolizine group than standard group (respectively: 13.6 % vs.18 percentage; P &lt; 0.05). Sinus rhythm was recovered in the higher percent of patients in ranolazine group than standard group after cardioversion (89% vs. 79%, P &lt; 0.05). Conclusion: Adding ranolazine to the standard treatment seems to have a beneficial role for the prevention of AF in high-risk patients with CCS and hypertension.
P1373Assessment of atrial fibrillation cryoablation outcomes in patients with diabetes
Authors: Sener Y Z , Oksul M , Akkaya F , Ates A H , Canpolat U , Yorgun H , Aytemir K 
Published: June 2020

Abstract

Background
Diabetes is related with both AF occurence and increased thromboembolic risk. There is scarce data about the outcomes of AF catheter ablation in patients with diabetes.

Purpose
We aimed to evaluate outcomes of AF catheter ablation in patients with diabetes.

Methods
All patients underwent AF cryoablation between January 2013 and January 2018 were included .

Results
A total of 493 patients were enrolled. Mean age was 59.6 ± 11.8 years and 253 (51.3 %) patients were female. Median follow up time was 28 (6-59) months. Recurrence occured in 61 (12.4%) patients. Diabetes was present in 78 (16%) cases. Mean HbA1c value of the diabetic patients was 6.79 ± 1.02 %. 50 (64.1 %) patients was under treatment with only oral antidiabetics while others were using insulin. Diabetic group was older (p &lt; 0.001) and hypertension prevalance was significantly higher in diabetics(p &lt; 0.001). Complication and recurrence rates were similar between the two groups (Table-1). Subgroup analysis revealed that there was not significant difference by AF recurrence between not only patients treated with OAD alone and treated with insulin but also patients with HbA1c value &lt;7 and HbA1c value ≥7 (p = 0.064).

Conclusion
Recurrence and complication rates were similar between diabetic and non-diabetic patients. Despite neuropathy is a well known manifestation of diabetes; phrenic nerve damage rate is similar in diabetic patients with non-diabetic counterparts.
Table-1 Diabetic group (n = 78) Non-diabetic group (n = 415) p value Age, (years) 64.38 ±10.12 58.91 ±11.84 &lt;0.001* Gender, female (%) 45 (57 %) 207 (49.8 %) 0.267 Follow up, (months) 29.5 (6-59) 28 (6-58) 0.987 Hypertension, n (%) 57 (73%) 191 (46 %) &lt;0.001 StrokeTIA, n(%) 4 (5.1 %) 8 (1.9 %) 0.104 Coronary artery disease, n (%) 39 (50 %) 176 (42.4 %) 0.242 AF type, Paroxysmal, (%) 65.7 % 71% 0.367 LV EF, % 59.81 ± 8.44 61.82 ± 6.89 0.027* LV end diastolic diameter, cm 4.90 ± 0.49 4.82 ± 0.46 0.160 LA diameter, cm 3.88 ± 0.51 3.81± 0.58 0.361 Recurrence 8 (10.2 %) 53 (12.7 %) 0.708 Phrenic nerve damage, n (%) 0 (0 %) 17 (4.1 %) 0.088 Inguinal hematoma, n (%) 7 (8.9%) 44 (10.6 %) 0.647 Pseudoaneurysm, n(%) 1 ( 1.2%) 3 ( 0.7 %) 0.502 Comparison of diabetic and non-diabetic patients
P320Prevalence of QRS 120 to 150 ms and QRS more than or equal to 150 ms from patients with left ventricular ejection fraction less than or equal to 35% in sinus rhythm and left bundle branch block
Authors: Beltejar L 
Published: June 2020

Abstract

Introduction
To date, no study in published literature has investigated the prevalence of patients with QRS ≥120 ms (ESC/EHRA Guidelines) and QRS ≥150 ms (ACC/AHA/HRS Guidelines) from patients with left ventricular ejection fraction (LVEF) ≤35% in sinus rhythm (SR) with left bundle branch block (LBBB) morphology, both said QRS durations were included in the criteria of Class I indication for cardiac resynchronization therapy (CRT) implantation.

Purpose
To determine the prevalence of patients with QRS 120-150 ms and QRS ≥150 ms from patients with LVEF ≤35% in SR and LBBB, to classify these patients to ischaemic cardiomyopathy (ICM) and nonischaemic cardiomyopathy (NICM), and to determine their demographics in terms of age, sex, and comorbidities

Methods
This is a cross-sectional study performed from January to September 2016. Data collection was performed which consists of 2-D echocardiogram with LVEF ≤35% in SR and LBBB, from which 2 groups of QRS 120-150 ms and ≥150 ms with their demographic profiles such as age, sex, and comorbidities will be identified and analyzed using percentage or proportion.

Results

The sample size in the study period was composed of 10,113 patients, of whom 1% (135) had LVEF ≤35% in SR. From 135 patients, 11% (15) had LBBB with QRS ≥120 ms. From 135 patients, 7% (9) had QRS 120-150 ms and also 7% (9) had QRS ≥150 ms. All patients who had QRS 120-150 ms were ICM while those with QRS ≥150 ms, 56% (5) were ICM and 44% (4) were NICM. Among patients with QRS 120-150 ms, youngest age was 50, median age was 67, and oldest age was 84, while among patients with QRS ≥150 ms, youngest age was 50, median age was 66, and oldest age was 82. Among those with QRS 120-150 ms, 67% (6) were males and 33% (3) were females whereas those with QRS ≥150 ms, 78% (7) were males and 22% (2) were females. Both groups of QRS 120-150 ms and ≥150 ms had the same identified comorbidities: coronary artery disease (CAD), hypertension (HTN), diabetes mellitus (DM), dyslipidemia and end stage renal disease (ESRD). Those with QRS 120-150 ms, 67% (6) had both CAD and DM, 56% (5) had HTN, 22% (2) had dyslipidemia and 11% (1) had ESRD, whereas those with QRS ≥150 ms, 78% (7) had CAD, 56% (5) had HTN, 44% (4) had DM, and 11% (1) had both dyslipidemia and ESRD.

Conclusions
There was both 7% prevalence of patients with QRS 120-150 ms and QRS ≥150 ms from patients with LVEF ≤35% in SR and LBBB. All patients with QRS 120-150 ms were ICM while majority of those with QRS ≥150 ms were ICM. In both groups of QRS duration, youngest age was 50; median age of QRS 120-150 ms was 67 whereas QRS ≥150 ms was 66; and with QRS 120-150 ms, patients who were affected were older (84 years old vs 82 years old). Both QRS 120-150 ms and ≥150 ms were predominantly males with CAD, HTN, and DM as identified important risk factors.