bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6543Screen-detected atrial fibrillation in a one-minute single-lead ECG predicts mortality in elderly subjects
Authors: Zink M D , Mischke K , Keszei A , Rummey C , Freedman B , Neumann G , Tolksdorf A , Frank F , Wienstroer J , Kuth N , Schulz J B , Marx N 
Published: October 2019

Abstract

Background
Atrial fibrillation (AF) is the most common arrhythmia associated with increased morbidity and mortality. Current guidelines recommend opportunistic screening for AF but the prognostic impact of screen-detected AF is unclear.

Methods
We performed a 4-week, prospective, pharmacy-based AF screening study in 7107 elderly citizens (≥65 years) using a hand-held, automated, one-minute single-lead ECG (SL-ECG) recording device. Prevalence and incidence of AF was assessed, and data on all-cause death and hospitalization for cardiovascular (CV) causes were collected over a median follow-up of 401 (372; 435) days.

Results
Automated SL-ECG analyses revealed heartbeat irregularities suspicious of AF in 432 (6.1%) participants with newly diagnosed AF in 3.6% of all subjects. During follow-up, 62 participants (0.9%) died and 390 (6.0%) were hospitalised for CV causes. Total mortality was 2.3% in participants with a SL-ECG suspicious of AF and 0.8% in subjects with a normal SL-ECG (HR 2.93; 95% CI: 1.49, 5.77; P=0.002, Figure 1A); hospitalization for CV causes occurred in 10.6% and 5.5%, respectively (HR 2.08; 95% CI: 1.52, 2.84; P<0.001, Figure 1B). Compared with subjects without a history of AF at baseline and a normal SL-ECG, participants with newly diagnosed AF or known AF had a significantly higher mortality risk with HRs of 2.63 (95% CI: 1.04, 6.63; p=0.04) and 2.68 (95% CI: 1.45, 4.98; p=0.002), respectively. After multivariable adjustment, a SL-ECG recording suspicious of AF remained a significant predictor of death or hospitalization for CV causes.
Figure 1

Conclusions
Pharmacy-based, automated, one-minute SL-ECG screening in elderly citizens identified subjects with unknown AF and an excess mortality risk over the next one year.

Acknowledgement/Funding
Unrestricted research grant by Pfizer/BMS. Matthias Zink received a DGK electrophysiology grant (funded by St. Jude Medical).
P6545Pacing as new predictor for atrial high rate episodes in patients with dual-chamber pacemakers and no history of atrial fibrillation
Authors: Benezet Mazuecos J , Devesa Arbiol A , Garcia Talavera C S , Iglesias J A , Serrano E , Rubio J M , Sanchez-Borque P , Miracle A 
Published: October 2019

Abstract

Introduction
Both atrial and ventricular pacing (AP/VP) have been related to a higher risk of clinical atrial fibrillation (AF) documented on ECG. Subclinical AF is detected as atrial high rate episodes (AHRE) by cardiac implantable electronic devices and is related to a higher risk of stroke.

Purpose
The aim of this study was to determine whether the percentage of AP and/or VP in patients with pacemakers and no history of AF is related with the future development of subclinical AF (AHRE) and/or clinical AF (ECG documented).

Methods
From February 2012 to September 2015 we recruited patients with dual chamber pacemakers and no prior history of AF. Patients were followed at 3 months and every year then after. Subclinical AF, clinical AF and cardiovascular events were registered. AHRE (subclinical AF) was defined as an episode of atrial rate ≥225 bpm with a minimum duration of 5 min. Clinical AF was defined as ECG documented AF. Percentage of AP/VP was determined as the mean AP/VP during the first three visits. Mortality and cardiovascular events (including AF, stroke and hospitalization for heart failure) were also recorded.

Results
249 patients (57% men; 75±9 years-old) were included. Mean time from pacemaker implantation was 9 months and the main indication was AV-block in 53% of the patients. Mean CHA2DS2-VASc score was 3.5±1.5. After a mean follow-up of 33±11 months, 38.5% of patients developed subclinical AF and 10.4% clinical AF. Patients with AP≥50% presented significantly higher risk of AHRE (62.5% vs 32.3%, OR 3.48; 95% CI [1.93–6.4] p<0.01) and clinical AF (18.7% vs 8.6%, OR 2.4; 95% CI [1.05–5.52] p<0.05). Patients with VP≥50% presented significantly higher risk of AHRE (46.4% vs 31.6%, OR 1.87; 95% CI [1.10–3.24] p<0.05) and clinical AF (25.9% vs 9.7%, OR 2.7; 95% CI [1.13–7.72] p<0.05). The percentage of AP and VP were not related to a higher risk of cardiovascular events or mortality. Multivariate analysis showed that AP≥50% was an independent predictor for AHRE (OR 2.4; 95% CI [1.19–4.97] p=0.014).

Conclusions
Pacing is related to a higher risk for developing subclinical and clinical AF in patients with dual-chamber pacemakers and no history of previous AF. Our data suggest, that patients presenting a high percentage of AP and VP should be closely followed during routinely pacemaker check-ups assessing for subclinical AF, especially in those with AP ≥50%.
P6549Conventional single lead ventricular pacemaker against leadless pacemaker system in real-world patients: prospective one center study. CARDIOCHUS Registry
Authors: Martinez Sande J L , Garcia-Seara J , Gonzalez-Melchor L , Rodriguez-Manero M , Lopez-Canoa J N , Alvarez-Rodriguez L , Romero-Roche L , Fernandez-Lopez X A , Abou-Jokh-Casas C , Vidal-Perez R C , Gonzalez-Juanatey J R 
Published: October 2019

Abstract

Background
As more experience is obtained with leadless pacemakers systems (LPM), a great group of patients is considered for its implantation. There are issues that cannot be completely avoided with conventional transvenous pacemaker (VVI-PM) such as infectious or pocket related complications in which LPM are clearly superior.

Purpose
The aim of the study was to compare the clinical and device performance between LPM and VVIPM in the same period of time in a “real-world” population.

Methods
We performed a prospective, observational, one center study, including all patients with a single chamber pacemaker implantation within 3 years (June 2015-December 2018) and its mid-term follow-up. All clinical, electrical and echocardiographic characteristics, as well as implantation characteristics and complications, were described.

Results
We included a total of 339 patients with transvenous pacemakers, 195 patients with VVI-PM and 144 LPM. There were no significant differences in mortality between both groups during the follow-up (12,3±10 months), Figure 1. Although there were no significant differences in major complications (P-value 0,54), the number of total complications was lower in the LPM group (P-value 0,01) at the expense of fewer minor ones (P-value 0,02), Table 1.
Table 1. Complications TVP (195) LPM (144) P value Major complications 11 (5.6%) 6 (4.2%) 0.54 Minor complications 10 (5.1%) 0 (0.0%) 0.01 Total Complications 21 (10.7%) 6 (4,2%) 0.02
Figure 1

Conclusions
In our study, during the med-term follow-up, there were no significant differences in terms of mortality and the major complications between LMP and VVI-PM. Although, the number of minor complications were less with the LMP.
P6558Novel predictor of newly atrial high rate episode in the population of dual chamber devices
Authors: Nishinarita R , Niwano S , Oikawa J , Saito D , Matsuura G , Arakawa Y , Shirakawa Y , Kobayashi S , Horiguchi A , Nakamura H , Ishizue N , Igarashi G , Kishihara J , Fukaya H , Ako J 
Published: October 2019

Abstract

Background
Among patients who underwent dual chamber devices (DDD) implantation, new occurrence of atrial fibrillation (AF) is higher compared to general population. However, it is unclear which factors affect new onset AF. Previous studies reported that the prolonged P wave dispersion (PWD) in sinus rhythm could be considered as an index for progression of conduction disturbance as the arrhythmogenic state for AF. In this study, we sought to elucidate the clinical factors including PWD associated with silent atrial high rate episode (AHRE) in the population of DDD.

Methods
The study population consisted of 101 patients with DDD from 2010 to 2014. All patients were measured PWD at the time of implantation. AHRE was defined as any episode of sustained atrial tachyarrhythmia (>170 bpm). AHREs were evaluated during initial 1 year after the implantation. They were divided into AHRE group (n=34) and non-AHRE group (n=67) and various clinical parameters were compared.

Results
The mean age was 75±11 years old. The AHRE groups showed higher rate of diagnosis of sick sinus syndrome (p=0.05) and longer PWD (62.6±13.1 versus 38.2±13.9 ms, p<0.0001) in comparison with non-AHRE group. Multivariate analysis revealed that the PWD was significant independent factors for the prediction of new appearance of AHRE (OR: 1.12; 95% CI, 1.07–1.17; p<0.0001). Cut-off value for parameter was determined by ROC curves achieving highest sensitivity and specificity, 48 mm was the best point of PWD (sensitivity of 73.8%, specificity of 77.9%, AUC 0.78).
ROC curve

Conclusion
PWD were significant predictor for new appearance of AHRE in patients with DDD.
P6560Delayed ablation of atrioventricular nodal reentry tachycardia as a risk factor for future atrial fibrillation
Authors: Ferreira Fonseca M , Parreira L , Farinha J , Marinheiro R , Esteves A , Pinheiro A , Mesquita D , Amador P , Lopes A , Caria R 
Published: October 2019

Abstract

Introduction
Atrioventricular nodal reentry tachycardia (AVNRT) is the most common type of supraventricular tachycardia. Most of the patients experience recurrent symptoms for years before electrocardiographic documentation and AVNRT ablation. The effects of these ongoing episodes of AVNRT on atrial structure and function, and their influence on new-onset atrial fibrillation (AF) in patients with delayed AVNRT ablation are unknown.

Purpose
To assess if delayed ablation of AVNRT was associated with the development of AF.

Methods
We retrospectively evaluated patients subjected to AVNRT ablation between 2009 and 2016. Patients with history of AF previous to ablation were excluded. We evaluated age at the time of AVNRT ablation, the presence of cardiovascular risk factors, left atrial (LA) dilatation and the presence of frequent premature atrial contractions (PACs) (by 24-hour holter monitoring, defined as >30/h). During follow-up we assessed the occurrence of sustained AF episodes and age at the time of the first AF episode.

Results
We studied 130 patients that underwent AVNRT ablation. Mean follow-up time was 75±27 months and seventeen patients (13%) had new-onset AF during follow-up. Patients who developed AF were more often males (35% vs. 22%, p=0,015), older at the time of AVNRT ablation (60±16 vs. 50±15, p=0,01), had a higher prevalence of hypertension (64% vs. 35%, p=0,03), diabetes mellitus (35% vs. 6%, p=0,02), LA dilation (41% vs. 7%, p=0,01) and frequent PACs (24% vs. 2%, p=0,03). In Univariable Cox regression analysis all these available variables were associated with AF occurrence during follow-up. However, in Multivariable Cox regression analysis, only age at the time of the ablation procedure was independently associated with AF occurrence (Table 1).
Multivariable Analysis HR 95% CI P value Age at ablation 8.762 3.308–23.20 <0.001 Age at the time of the first AF episode 0.113 0.043–0.302 <0.001 LA dilation 0.408 0.113–1.472 0.171 Frequent PACs 1.016 0.156–6.611 0.987

Conclusion
In this group of patients the occurrence of new-onset AF during follow-up was independently associated with delayed AVNRT ablation. These findings suggest that longer atrial exposure to AVNRT episodes before ablation may be associated with LA structural and functional changes leading to higher occurrence of AF.
P6568Forecasting atrial fibrillation using machine learning techniques
Authors: Gregoire J.-M , Subramanian N , Papazian D , Bersini H 
Published: October 2019

Abstract

Background
Forecasting atrial fibrillation (AF) a few minutes before its onset has been studied, mainly based on heart rate variability parameters, derived from 24-hour ECG Holter monitorings. However, these studies have shown conflicting, non-clinically applicable results. Nowadays, machine learning algorithms have proven their ability to anticipate events. Therefore, forecasting AF before its onset should be (re)assessed using machine learning techniques. A reliable forecasting could improve results of preventive pacing in patients with cardiac electronic implanted devices (CEID).

Purpose
To forecast an oncoming AF episode in individual patients using machine learning techniques.
To evaluate the effect if the onset of an AF episode can be forecasted on longer time frames.

Methods
The totality of the raw data of a data set of 10484 ECG Holter monitorings was retrospectively analyzed and all AF episodes were annotated. Onset of each AF episode was determined with a precision of 5 msec. We only took AF events into consideration if they lasted longer than 30 seconds. Of all patients in the dataset, 140 presented paroxysmal AF (286 recorded AF episodes). We only used RR intervals to predict the presence of AF. We developed two different types of machine learning algorithms with different computational power requirements: a “dynamic” deep and recurrent neural net (RNN) and a “static” decision-tree with adaboost (boosting trees) more suitable for embedded devices. These algorithms were trained on one set of patients (around 90%) and tested on the remaining set of patients (around 10%).

Results
The performance figures are summarized in the table. Both algorithms can be tuned to increase their specificity (at a loss of sensitivity) or vice versa, depending on the objective.
Performance of forecasting algorithms RR-distance Boosting trees AUC RNN AUC 30–1 RR-Interval(s) before an AF event 97.1% 98.77% 60–31 RR-Intervals before an AF event 97.5% 99.1% 90–61 RR-Intervals before an AF event 96.9% 99.1% 120–91 RR-Inervals before an AF event 98.2% 98.9% AUC for Area Under ROC Curves.

Conclusion
Based upon this retrospective study, we show that AF can be forecasted on an individual level with high predictive power using machine learning algorithm, with little drop-off of predictive value within the studied distances (1–120 RR intervals before a potential AF episode). We believe that the embedding of our new algorithm(s) in CEID's could open the way to innovative therapies that significantly decrease AF burden in selected implanted patients.
P6573Adenosine plasma levels may determine tilt table test outcome in syncopal patients with prodromal symptoms
Authors: Sotiriadou M , Antoniadis A , Vergopoulos S , Lazaridis C , Konstantinidis P , Bakogiannis C , Virgiliou C , Gkika E , Theodoridis G , Mpalaouri I , Mpougiouklis D , Gerou S , Papadopoulos C , Fragakis N , Vassilikos V 
Published: October 2019

Abstract

Background/Introduction
Head-up tilt table test (HUTT) and Adenosine test (ADT) are tools frequently used in the diagnostic workup of syncope. It has been suggested that patient responses to HUTT and ADT can be related to the plasma levels of Adenosine (ADPL) and Adenosine receptors (ADR). However, the exact type of association and the role of (ADPL) and ADR levels in the risk stratification and management of patients with syncope has not yet been clarified.

Purpose
We sought to assess the ADPL and ADR levels in patients without structural heart disease who underwent HUTT and ADT tests as part of the diagnostic workup of syncope. We specifically investigated differences with regards to the presence of a history of prodromal symptoms.

Methods
HUTT and ADT were performed as per the standard protocols. ADT was considered positive in the event of asystole >6 seconds or heart block for >10 seconds after intravenous Adenosine administration in a supine position at a dose of 0.15 mg/kg. ADPL were assessed at three timepoints during the HUTT: in the supine position, immediately after bed tilt and, in cases of a positive test, at the time of syncope. Furthermore, we assessed the A2A ADR of monocytes in the study patients.

Results
We prospectively analyzed 77 patients (48 women, age 47.05±21.10 years). ADT was positive in 16.7% of patients and HUTT in 49.4% of patients. ADPL in the supine position did not differ between patients with negative vs. positive ADT but showed a significant correlation with the body mass index (p=0.002). There was a trend for reduced ADPL at the tilt phase in patients with positive HUTT (0.32±0.89 vs. 0.42±0.77 ppm/Um/L, p=0.09). Of all patients, 60 (77.9%, 41 women, age 46.80±21.83 years) had reported a history of prodromal symptoms at syncope. In the subset of patients with prodromal symptoms, the ADL at the tilt phase were lower in patients with positive vs. negative HUTT (0.15±0.23 vs. 0.51±0.89, p<0.05). ADR did not differ among groups but showed a significant correlation with the ADL during syncope in patients with prodromal symptoms (p<0.05).

Conclusion(s)
Patients with prodromal symptoms and a positive HUTT demonstrate reduced ADPL at the tilt phase of HUTT preceding syncope. In these patients, ADPL in syncope correlate with the ADR. Adenosine plasma levels and receptors warrant further investigation and may predict the response to HUTT thereby contributing to the diagnostic evaluation and risk stratification of patients with syncope.
P6576Use of atrioventricular nodal ablation after atrial fibrillation ablation failure: a nationwide cohort study
Authors: Bisson A , Mondout F , Bodin A , Clementy N , Pierre B , Babuty D , Brignole M , Deharo J C , Fauchier L 
Published: October 2019

Abstract

Atrial fibrillation (AF) catheter ablation is a validated therapy for patients with symptomatic AF after failure or intolerance to antiarrhythmic drug therapy. Despite improvements in ablation technique, 30 to 50% of the patients may have AF recurrences. The APAF-CRT trial recently demonstrated that atrio-ventricular node ablation (AVNA) and cardiac resynchronization pacing was superior to pharmacological therapy in reducing HF and hospitalization in patients with permanent AF. The purpose of the study was to quantify the use of AVNA after AF catheter ablation and to find independent predictors factors associated with AVNA in this setting.

Methods
This French longitudinal cohort study was based on the national hospitalization database covering hospital care from the entire population. The data for all patients admitted in France from January 2010 to December 2015 were collected from the national administrative database, the PMSI (Programme de Médicalisation des Systèmes d'Information). We included all patients, over 18 years old, with AF and at least one AF catheter ablation. Routinely collected medical information includes the principal or secondary diagnoses and procedures performed. Items from the baselines characteristics were pooled into a multivariate Cox model to identify predictors of AV node ablation.

Results
Of 1,663,284 patients identified with AF, 28,018 patients were treated with AF ablation (28% female, mean age 60±10 yo, 22,837 with 1 procedure, 4,576 with 2 procedures and 605 with 3 procedures). Of those 28,018 patients, there were only 369 patients (1.3%) treated with AVNA after a mean follow-up of 374±488 days (median 210, interquartile 15–798). AVNA was less commonly performed than redo AF ablation with 3 procedures, and among these latter patients, only 3.8% were treated with AVNA during follow-up. Most powerful independent predictors of AV node ablation (HR >1.7) were age≥75 yo, heart failure at baseline, abnormal renal function and valve disease. Other independent predictors for AV node ablation (HR 1.2–1.7) were age 65–74 yo, female gender, obesity, coronary artery disease, thyroid disorders, lung disease and hypertension.

Conclusion
Our findings indicate that AVNA is rarely used after AF ablation failure and is probably an underrated strategy in these patients for now. Considering evidence from the APAF-CRT trial indicating a beneficial effect on mortality of this treatment in symptomatic AF patients, a wider use of AVNA should be more widely proposed in these patients. Its optimal timing during rate and rhythm control management still remains to be established.
P6583Prevalence of long QT interval in thailand and its association with all cause and cardiovascular mortality from a long-term cohort study
Authors: Trithiphen S , Vatesatogkit P , Vatesatogkit P , Ngarmukos T , Ngarmukos T , Chandanamattha P , Chandanamattha P , Apiyasawat S , Apiyasawat S 
Published: October 2019

Abstract

Background
Long QT interval elevates risks of life-threatening arrhythmias, cardiovascular mortality and all-cause mortality. The prevalence of prolonged QTc among Caucasians is approximately 8.7%. In Thai population, the prevalence and prognosis of prolonged QTc remain unexplored.

Objectives
1. To identify the prevalence of long QT interval in the Thai population without prior cardiovascular disease. 2. To evaluate the association between long QT interval and long-term cardiovascular (CV) event and all-cause mortality.

Materials and methods
A total of 2756 participants from the Electricity Generating Authority of Thailand (EGAT) study from 1997 to 2015 were studied. Among those, 2456 participants had completed EKGs and were included into the final analysis. The long QT interval was defined as QTc longer than 450 milliseconds (ms) in male and 460 ms in female respectively. Mortality endpoints included CV event and all-cause mortality were collected. Multivariable cox-proportional hazard model adjusted for all major CV risk factors was used to determine the association between prolonged QTc and outcomes.

Results
The majority of the population are male (N=1941, 79%). The mean QT interval calculated by Bazett's formula is 424±28.27 ms. Prolonged QTc was observed 12.5% in male and 17.7% in female. There were 509 (20.7%) deaths during the follow-up period. After 18 years of follow up, 10.5% of the prolonged QTc group had cardiovascular events, compared with 6.8% in the normal QTc group (P=0.09). All-cause mortality occurred in 30% of the prolonged QTc group and 19.3% in the normal QTc group (adjusted HR 1.33, 95% CI 1.05–1.68, P=0.018). After dividing QTc into deciles, the lowest mortality was observed in the 3rd to 7th deciles (17.6%, 19.7%, 16.3%, 23.2% and 18.9% respectively) and the highest mortality was observed in the 2nd deciles (22.09%) and the 8th to 10th deciles (22%, 27.15% and 28.38% respectively).
Hazard function of prolonged QTc

Conclusion(s)
1. In this worker cohort from Thailand, prolonged QTc was observed in 14% of the population.
2. During 18 years follow up, prolongation of QT interval is an independent risk factor for all-cause mortalities but not cardiovascular mortality.
3. There was a J-curve effect in association between the duration of QT interval and all-cause mortality.