bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6548Left bundle branch area pacing in patients with atrioventricular block
Authors: Su L , Huang W J , Wu S J 
Published: October 2019

Abstract

Background
The application of His bundle pacing (HBP) on patients with distal AV block should be of concern.Left bundle branch Aera pacing (LBBA pacing), pacing immediately beyond the site of block will be considered.

Purpose
To access the clinical benefits and safety of LBBA pacing in patients with atrioventricular (AV) block.

Methods
One hundred and thiry nine patients diagnosed with AVB were included. The Select Secure lead (model 3830; Medtronic) was used. Characteristics of LBB capture are summarized as following: 1) The paced QRS morphology of RBBB pattern during unipolar tip pacing; 2) Usually, LBB potential could be recorded; 3) If higher output pacing shortened the times abruptly and the times remain constant. Pacing parameters (threshold, R-wave amplitude and impedance) and Echocardiographic measurements were assessed during follow-up.

Results
All patients were success achieved LBBA pacing. The detailed baseline characteristic and follow-up were shown in the Table. Threshold, R-wave amplitude and impedance remained stable during follow -up. Echocardiographic measurements showed that LBB pacing did not affect the cardiac function. There was no LV septum penetration and dislodgment.

Conclusion
LBBA pacing had ideal pacing parameters and preserve cardiac function and may be an excellent alternative to HBP or RVP.

Acknowledgement/Funding
Key R&D Program of Zhejiang (2019C03012), Major Project of the Science and Technology of Wenzhou (ZS2017010)
P6566Noninvasive Panoramic Mapping of Phase Singularities with Signal Complexity Analysis in Patients with Persistent Atrial Fibrillation
Authors: Chmelevsky M , Budanova M , Zubarev S , Potyagaylo D , Sohns C , Lemes C , Kivelitz D , Metzner A , Kuck K H 
Published: October 2019

Abstract

Background
An assessment of positive outcome probability of ablation therapy based on the comprehensive signal complexity analysis is a promising working hypothesis while electrocardiographic imaging (ECGI) can detect and visualize zones of phase singularities (PS) associated with stable sources of atrial fibrillation (AF).

Methods
Ten consecutive patients with persistent AF (three female, median (min–max) – 63.5 (45–75) years) underwent ECGI using “Amycard 01C EP lab” system with cardiac MRI (1.5-T Magnetom Avanto) followed by pulmonary vein isolation. Each T-Q segment with a length >800 ms during AF was processed to find PS. Sites with rotations around stable pivot points were considered as PS and then marked and visualized on the reconstructed anatomical 3D atrial model. Finally, a signal complexity cluster analysis was performed to define and depict phase-aggregation zones.

Results
ECGI analysis identified a total number of 410 PS, with 196 (47.8%) occurring in the LA and 214 (52.2%) in the RA. The median (25–75% IQR) number of revealed PS per patient was n=20 (14–30) for RA and n=20 (11–22) for the LA. The majority of the PS in the LA was located on the inferior wall n=66 (min-max 1–17). In eight patients, comprehensive signal complexity analysis revealed stability of phase-clustered zones over time. The mean number (min-max) of PS in a clustered area was 10 (6–15). In two patients, PS were distributed disordered on the entire LA and RA surface.
Distribution of phase singularities

Conclusions
This is the first clinical study demonstrating signal complexity analysis capability of clustering noninvasively mapped PS and relating them to specific atrial anatomical regions. Thereby obtained clusters may be a potential zones of conduction block, and could contribute to a better understanding of the temporal AF complexity.
P6577Isolated systolic hypertension versus combined systolic-diastolic hypertension as predictors of atrial fibrillation: data from a 8-year-follow-up study
Authors: Konstantinidis D , Tsioufis C , Dimitriadis K , Kasiakogias A , Liatakis I , Koutra E , Leontsinis I , Kouremeti M , Iliakis P , Vogiatzakis N , Karaminas N , Thomopoulos K , Tousoulis D 
Published: October 2019

Abstract

Background/Introduction
Isolated systolic hypertension (ISH) and combined systolic-diastolic hypertension (CH) are related with increased cardiovascular risk.

Purpose
The aim of the present study was to compare the predictive role of ISH and CH for the incidence of atrial fibrillation (AF) in a cohort of essential hypertensive patients.

Methods
We followed up 1605 essential hypertensives with office systolic blood pressure (BP)≥140 mmHg [mean age 58.1 years, 842 males, office BP=153/92 mmHg] for a mean period of 8 years. All subjects had at least one annual visit and at baseline underwent echocardiographic study and blood sampling for estimation of metabolic profile. Patients with baseline ISH exhibited office systolic BP ≥140 mmHg and office diastolic BP <90 mmHg, while those with CH had office systolic BP ≥140 mmHg and office diastolic BP ≥90 mmHg. Moreover, new-onset AF was defined as hospitalization for AF or compatible electrocardiographic tracings.

Results
The incidence of new-onset AF over the follow-up period was 3.4% (n=55). Patients with ISH (n=510) compared to those with CH (n=1095) were older (65±10 vs 55±11 years, p<0.0001), had at baseline lower waist circumference (95.5±12 vs 98±12 cm, p<0.0001), office systolic BP (149±10 vs 155±13 mmHg, p<0.0001), office diastolic BP (80±5 vs 98±7 mmHg, p<0.0001), while did not differ regarding left ventricular mass index and lipid levels (p=NS for all). Univariate Cox regression analysis revealed that baseline ISH (hazard ratio=4.612, p=0.013) and CH (hazard ratio=1.794, p=0.036) predicted new-onset AF. However, in multivariate Cox regression model, age (hazard ratio=1.078, p<0.001), left ventricular mass index (hazard ratio 1.012, p=0.014), left atrium diameter (hazard ratio=1.102, p<0.001) and ISH (hazard ratio=1.551, p=0.035) but not CH turned out to be independent predictors of new-onset AF episodes.

Conclusions
In essential hypertensive patients, ISH but not CH exhibits independent prognostic value for AF. These findings support that ISH constitutes a hypertensive phenotype of particularly increased arrhythmia risk needing careful evaluation and treatment.
P6578Development of the novel program to diagnose atrial fibrillation using automated blood pressure monitor
Authors: Ishizawa M , Noma T , Ishikawa S , Matsunaga K , Kawakami R , Miyake Y , Ishikawa K , Tsuji T , Murakami K , Minamino T 
Published: October 2019

Abstract

Background
Atrial fibrillation (AF) is often asymptomatic and contributes to an increased risk of strokes. The development of proper screening device of AF is unmet medical needs worldwide. Recently, we had reported that multiple measurements using Omron automated blood pressure (BP) monitor with irregular heartbeat detection showed high sensitivity and specificity for AF detection in general cardiac patients, however, this method had limitations in discriminating between AF and other arrhythmias.

Purpose
The aim of this study is to develop a novel program that can accurately diagnose AF by discriminating it from other arrhythmias using the pressure pulse waveform data outputted from Omron automated BP monitor.

Methods
In our previous clinical research, BP measurements were performed 3 times each for 303 general cardiac patients (mean age: 72.2 years, 69.8% male) with recording the real-time single lead ECG, and a total of 909 pressure pulse waveforms were obtained. Among them, 840 pressure pulse waveforms from 280 patients (include 40 AF patients) used for further analysis. We developed a program to analyze and visualize uniquely the characteristics of AF waveform through the autocorrelation-based waveform processing system produced by Melody International Ltd, Kagawa, Japan. All visualized results were judged and classified into Sinus, Non-AF and AF by two individuals blinded to the results. For each patient who obtained 3 results, a two by two contingency table was created and sensitivity, specificity, and accuracy for diagnosing AF were calculated.

Results
Among 840 pressure pulse waveforms, only 21 (2 Sinus and 19 Non-AF) out of 720 Sinus and Non-AF waveforms were judged as AF, and 7 out of 120 AF waveforms were judged as Non-AF. None of AF waveforms was absolutely misjudged as Sinus. In analysis for each patient, when one or more AF judgements were found in 3 waveforms, the diagnosis of AF has sensitivity and specificity of 100% and 95.8%, respectively. When two or more AF judgements were found in 3 waveforms, the diagnosis of AF has sensitivity and specificity of 100% and 97.9%, respectively. In this rule, the diagnostic accuracy of AF reached up to 98.8%, and no sinus patients were misjudged as AF.

Conclusion
The novel program, which applied autocorrelation methods uniquely to analysis of the pressure pulse waveforms recorded by automated BP monitor, showed high sensitivity and high specificity for AF diagnosis in general cardiac patients. This program is expected to be useful for early diagnosis for asymptomatic AF patients.

Acknowledgement/Funding
The present research is supported by a grant through the SCOPE from the Ministry of Internal Affairs and Communications, Japan.
P6579Genetic profile and predictors of positive genetic test in Brugada syndrome
Authors: Faria B , Ribeiro S , Calvo L , Miltenberger-Miltenyi G , Oliveira M , Hafe P , Dias G , Cardoso F , Sanfins V , Lourenco A 
Published: October 2019

Abstract

Introduction
Brugada syndrome (BS) is a channelopathy with autosomal dominant transmission, incomplete penetrance and variable expression. There are 18 different gene mutations described in association with this syndrome, however 70% of patients remain without identifiable genetic cause. Genetic testing is appropriated for patients with clinical diagnosis but it is also a very important tool in familiar screening.

Aim
We aim to characterize genetic profile of patients with clinical diagnosis of BS and identify differences between patients with and without causative mutation.

Methods
We included patients followed by the arrhythmology department of our hospital with diagnosis of BS and that have performed genetic test (or patients who were identified through familiar screening and with negative genetic test in the index case). Patients identified through familiar screening with positive genetic test but no spontaneous electrocardiographic pattern, still awaiting pharmacologic provocative test at the time of enrolment – no clinical diagnosis - were excluded. Genetic test was considered positive when we found a pathogenic or probably pathogenic mutation. Mutations in PKP, SLMAP, CACNA, CACNB, SCN10A and CLASP genes considered of uncertain clinical relevance were not included as positive genetic test. We analysed differences between subset of patients with and without causative mutation regarding clinical and electrocardiographic variables. We performed multivariate analysis to find predictors of positive genetic test.

Results
From our 173 patients, 140 met the inclusion criteria and none exclusion criteria so they were enrolled. Patients were 61% male with mean age of 50±15 years old. Mean follow-up was 26±28 months; 24,4% of index cases were positive for causative mutation, 6,8% patients with pathogenic mutation in SCN5A gene and 17,6% with probably pathogenic mutation in SCN5A.
We haven't found significant differences between the 2 groups (negative and positive genetic test) in any clinical variable included. Regarding electrocardiographic variables, patients in whom a mutation was identified had longer PR interval (192±36 vs 170±28, p=0.001), longer QRS (121±19 VS 111±18 p=0.017), particularly when QRS>110ms (p=0,002), and longer QT (398±25 VS 370±45 p=0.015) In multivariate analysis, PR interval (p=0.032) and QRS>110ms (p=0,041) were independent predictors for positive genetic test.

Conclusion
In our BS population, there were no clinical differences between patients with and without causative mutation, also concerning events rate. Patients with positive genetic test have significantly longer PR interval and QRS>110ms than in patients with genetic test negative. Those results can be interpreted in relation to sodium channel disfunction in patients with SCN5A mutation.
P6586Brugada syndrome risk stratification - Evaluation of clinical and ECG risk markers in a multicenter international primary prevention cohort
Authors: Honarbakhsh S , Providencia R , Garcia-Hernandez J , Martin C A , Hunter R J , Lim W Y , Kirkby C , Sharifzadehgan A , Waldmann C , Marijon E , Munoz-Esparza C , Lacunza J , Gimeno-Blanes J R , Lambiase P D 
Published: October 2019

Abstract

Background
Risk stratification for sudden cardiac death (SCD) in Brugada syndrome (BrS) is a significant challenge.

Purpose
To evaluate the importance of clinical and ECG factors in the likelihood of developing significant ventricular arrhythmias (VAs)/SCD in BrS patients.

Methods
VA occurrence during follow-up were assessed and the role of 16 proposed clinical or ECG risk markers evaluated in a multicenter international study of BrS patients and no history of cardiac arrest. Markers with predictive power were identified and incorporated into a risk score model.

Results
Across 15 international centers, 1084 patients were included. During a follow-up of 5.3 years (IQR 2.7–9.0 years)- 110 patients had VA occurrence (10.1%) with an annual event rate of 1.7% (95% CI 1.4–2.0). Of the 16 proposed risk factors, diagnosis by family screening of sudden cardiac death (HR 4.65; p<0.001), probable arrhythmia related syncope (HR 3.88, p<0.001), type 1 spontaneous ECG (HR 3.56; p<0.001), Early Repolarisation (HR 3.15; p<0.001) and type 1 Brugada pattern in peripheral leads (HR 2.42; p<0.001) were associated with a higher VA occurrence risk during follow-up. These 5 variables were incorporated into a risk score model whereby each variable was allocated a point score based on the variable's predictive strength. The total points obtained from the model for a patient could then be translated into the predicted VA occurrence risk during follow-up (Figure 1). The model showed a sensitivity of 63.5% (95% CI 50.0–76.9) and specificity of 84.2% (95% CI 81.1–87.1) in predicting VA occurrence at 5-years follow-up. The model showed a greater discriminative power compared to an existing model (AUC 0.83 vs. 0.71; p<0.001).
Figure 1

Conclusions
This multicenter study with longest reported follow-up to date identified 5 risk markers for VA occurrence. Utilizing these markers in a risk score model can aid BrS risk stratification to enable individualized risk prediction and ICD prescription.
P6587The experience of a French specialized inherited arrhythmia center in the management of long QT syndrome patients
Authors: Probst V , Minier M , Mabo P , Clerici G , Babuty D , Mansourati J , Kyndt F , Thollet A , Sacher F , Gourraud J B 
Published: October 2019

Abstract

Introduction
Congenital long QT syndrome (LQTS) is a hereditary disease characterized by prolonged QTc interval and risk of ventricular tachyarrhythmias, which may lead to syncope, cardiac arrest, or sudden death in young people.

Objective
The aim of this study is to report the experience of the French referral center of inherited arrhythmia of the University Hospital of Nantes.

Methods
Consecutive patients affected with lonq QT syndrome were recruited in a multicentric prospective registry in France (15 centers) between 1997 and 2018. Clinical data and 12-lead ECG were collected. Genetic screening was performed using dHPLC-DNA sequencing, HRM or targeted sequencing for at least KCNQ1, KCNH2 and SCN5A.

Results
In this study, we enrolled a total of 741 patients affected by LQTS according to the Schwartz score (447 (60%) females, 404 (55%) index cases). Mean age at diagnosis was 33±21 years. In this cohort, 343 patients (46%) were symptomatic: 66 patients experienced resuscitated sudden cardiac death (SCD, 9%), 211 (28%) syncope and 66 (9%) ventricular arrhythmias. One hundred and two patients (14%) had history of familial SCD. At baseline, heart rate was 69±19 bpm, PR 149±39 mm, QRS 86±16 mm and QTc 479±62 mm.
Three hundred and eighty-six patients (52%) were treated with beta-blockers and 88 patients (12%) were implanted with an ICD.
Genetic screening was performed in 668 (90%) patients. Genetic screening for the 3 major genes of LQTS was positive for 411 patients (62%): 165 variants (25%) in KCNQ1, 178 variants (27%) in KCNH2, 68 variants (10%) in SCN5A. Moreover, we found variants in minor genes of LQTS for 22 patients (3%).
During a mean follow-up of 6.2±5.2 years, 64 patients (9%) underwent arrhythmic events (7 SCD (1%), 8 appropriate ICD therapy (1%) and 49 ventricular arrhythmias (7%). The rate of arrhythmic event was 1.39%/y. Mean age at the first event was 41.7±21.5 years. Sixteen patients (2%) died of non-arrhythmic causes.

Conclusion
Care in a specialized inherited arrhythmia center is associated with a low incidence of arrhythmic event (1.39%/y) in patients affected with LQTS.
P6597Long-term impact of catheter ablation on growth differentiation factor-15 and neutrophil-lymphocyte ratio in paroxysmal atrial fibrillation
Authors: Bin Waleed K , Xia Y L , Gao L J , Xiaomeng Y , Tse G , Yves D G , Wang L L , Shuling W , Wang J , Bo Z , Li Y C 
Published: October 2019

Abstract

Background
There is increasing evidence that inflammatory biomarkers growth differentiation factor 15 (GDF-15) and neutrophil-lymphocyte ratio (NLR) appear to be associated with stroke and adverse cardiovascular events in patients with atrial fibrillation (AF). However, long-term impact of catheter ablation (CA) on GDF-15 and NLR is still unknown.

Objective
To evaluate the long-term change in GDF-15 and NLR after CA in paroxysmal AF patients.

Methods
A total of 58 paroxysmal AF patients were consecutively enrolled to perform CA. The inflammatory biomarkers GDF-15 and NLR were measured at baseline and 6-months postablation.

Results
All patients except one could complete 6-Months follow up. Fifty (87.7%) patients maintained sinus rhythm (SR group) and seven (12.3%) patients sustained AF recurrence (AFR group). No significant difference was noted in clinical and procedural characteristics between two groups (p>0.05), except mean fluoroscopy time (minutes 22±11.7 vs. 13±5.3, p=0.001) significantly longer in AFR than SR group. The GDF-15 (pg/ml 195±57 vs. 216±88, p=0.398), and NLR (% 1.8 (1.3–3) vs. 2.6 (1.4–3.4), p=0.395) were comparable at baseline in both SR and AFR groups respectively. At 6-months postablation, GDF-15 (pg/ml 133±41 vs. 195±57, p<0.001), and NLR (% 1.6 (1.1–2) vs. 1.8 (1.3–3), p=0.004) were significant deceased compared to baseline levels in SR group. However, GDF-15 (pg/ml 139±86 vs. 216±88, p=0.064), and NLR (% 1.6 (1.2–3) vs. 2.6 (1.4–3.4), p=0.398) biomarkers remained comparable to baseline level in AFR group (p>0.05)

Conclusion
Inflammatory biomarkers; GDF-15 and NLR significantly decreased at long-term on successful maintenance of sinus rhythm by CA in paroxysmal AF patients.

Acknowledgement/Funding
None
P6598MicroRNA 21 and Hypoxia Inducible Factor 1 synchronize the impact of B lymphocytes on cardiac function after acute myocardial infarction
Authors: Sun Y , Pinto C , Loyer X , Duval V , Alayrac P , Gomez I , Vilar J , Lemitre M , Levoye A , Ait-Oufella H , Mallat Z , Silvestre J 
Published: October 2019

Abstract

Background
Myocardial infarction (MI) is a severe ischemic disease responsible for heart failure and sudden death. Mature B lymphocytes have been shown to exacerbate tissue injury and deterioration of cardiac function after MI. However, the cellular and molecular mechanisms governing B cell deleterious effects in the ischemic milieu remain to be defined.

Purpose
In this study, we speculate that endogenous activation of the miR21/HIFα-related pathways mediates the effect of B lymphocytes on post-ischemic cardiac remodeling.

Methods
Acute MI was induced by permanent ligation of the left anterior descending artery in mice. Cardiac function and remodeling was determined by echocardiography and immunohistochemistry. Inflammatory cell number and phenotype were defined by FACS analysis. To evaluate the role of HIFα isoforms in B cells, we generated mice with B cell lineage specific (Cd79aCre/+) conditional deletion of HIF1α (HIF1αflox/flox), HIF2α (HIF2αflox/flox), or both isoforms (HIF1α-HIF2αflox/flox).

Results
Acute MI increased miR21 levels in B cells. miR21 deficient mice showed reduced B cell numbers in the spleen, blood and subsequently in the injured cardiac tissue. Transplantation of bone marrow derived cells isolated from miR21-deficient mice (miR21−/−) improved cardiac function and remodeling when compared to administration of wild-type (WT) bone marrow cells. Similarly, in Rag1−/− immunodeficient mice with acute MI, re-supplementation with miR21−/− B lymphocytes restored cardiac repair and function when compared to injection of WT B cells. miR21 abrogated PTEN contents and subsequently enhanced HIF1α levels in cultured B cells. B cell deletion of HIF1α, but not that of HIF2α, reduced B cell accumulation and improved cardiac function after MI. Mice, which were equally deficient in HIF1α and HIF2α, also exhibited abrogation of adverse ventricular remodeling and showed recovery of cardiac function after MI. Toll like receptor agonist, CpG, fostered the release of the monocyte chemo-attractant protein, Ccl7, in cultured WT B cells but not in miR21- or HIF1α- deficient B cells. Ccl7 circulating levels were also reduced in miR21−/− and Cd79aCre/+/HIF1α flox/flox animals after acute MI. Ccl7 down-regulation hampered Ly6Chigh monocyte infiltration in the ischemic myocardium, leading to decreased infarct size and interstitial fibrosis, supporting cardiac repair.

Conclusion
This work reveals a novel function for miR21/HIF1α related pathways in B lymphocyte dependent effect on cardiac function and remodeling in the setting of acute MI.