bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relations between voltage mapping and diagnosis and genetics in patients with arrhythmogenic right ventricular cardiomyopathy
Authors: Delasnerie H , Mandel F , Domain G , Voglimacci Q , Mondoly P , Rollin A , Maury P 
Published: November 2020

Abstract

Introduction
Relations between voltage mapping and diagnosis or genetic background in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) have not been investigated so far.

Objective
We investigate if diagnosis or genetic background were linked to voltage mapping in ARVC.

Method
70 patients with proved or suspected ARVC undergoing 3D endocardial mapping and genetic testing have been retrospectively included. Localisation and extension of bipolar low voltage areas were correlated to ARVC diagnosis and presence of a culprit mutation.

Results
44/70 fulfilled ARVC Task Force criteria and 25/70 had culprit mutations. Endocardial (38/44 vs 16/26, p=0.02) and especially infero-lateral scars (31/44 vs 9/26, p=0.003) were more often present in patients fulfilling Task force criteria vs suspected ARVC, with larger scars (area 23±27 vs 8±11 cm2, p=0.04, perimeter 17±10 vs 11±7 cm, p=0.03) (sensitivity 86%). Mutated patients had more infero-lateral (19/25 vs 21/45, p=0.01), multiple (12/20 vs 11/34, p=0.04) and larger scars (perimeter 21±10 vs 12±7 cm, p=0.01) vs non mutated patients. In patients with ARVC diagnosed according to the Task Force criteria, there was a trend toward more infero-lateral (p=0.09) and larger scars (p=0.08) in mutated cases. PKP2-mutated cases tended to have less ourflow tract (p=0.08) and less multiple scars (p=0.09) vs other mutations.

Conclusion
3D endocardial mapping could have an important role for ARVC diagnosis and may be able to detect minor forms with otherwise insufficiant criteria for diagnosis. More frequent and larger infero-lateral scars are present in mutated patients with bordeline differences according to the mutated genes.

Funding Acknowledgement
Type of funding source: None
Efficacy and safety of dronedarone vs placebo in patients with atrial fibrillation or atrial flutter across a spectrum of renal function: post hoc analyses of the EURIDIS-ADONIS trials
Authors: Thind M , Zareba W , Atar D , Crijns H , Zhu J , Pak H.-N , Reiffel J , Ludwigs U , Wieloch M , Stewart J , Kowey P 
Published: November 2020

Abstract

Background/Introduction
The use of antiarrhythmic drugs in patients with chronic kidney disease (CKD) is complex because impaired renal clearance can cause increased drug levels, and risk of intolerance or adverse events. Since CKD commonly co-occurs with atrial fibrillation/atrial flutter (AF/AFL), it is important to establish efficacy and safety for such drugs when used in AF/AFL patients with CKD.

Purpose
To evaluate the efficacy and safety of dronedarone in patients with AF or AFL across different levels of renal function.

Methods
This post hoc analysis evaluated pooled data from two multicentre, double-blind, randomised (2:1) trials of rhythm control with dronedarone 400 mg twice daily vs placebo. Primary endpoint was time to first recurrence of AF or AFL. Renal function (estimated glomerular filtration rate [eGFR]) was assessed with the CKD-Epidemiology Collaboration equation. Patients were grouped by eGFR strata. Log-rank testing and Cox regression were used to compare time to events between treatment groups.

Results
Most (85%) patients had mild or mild-to-moderate decrease in eGFR (Table 1). Median time to first AF recurrence was significantly longer in the dronedarone vs placebo group for all eGFR subgroups except the 30–44 mL/min group (Figure 1), where the trend was consistent; however, the small population size may have precluded meaningful analyses in this subgroup. Serious adverse events, deaths, and treatment discontinuations did not differ notably between each group irrespective of eGFR strata.

Conclusions
This analysis confirms the efficacy and safety of dronedarone in patients with AF across a wide spectrum of renal function.
Figure 1

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Sanofi
Ventricular premature contractions coupling interval behavior and efficacy of anti-arrhythmic drugs
Authors: Abdel-Wahed A , Abdel-Wahed A , Maekynen H , Raatikainen P 
Published: November 2020

Abstract

Introduction
The Idiopathic ventricular arrhythmias are special type of arrhythmia that occurs in the absence of clinically apparent structural heart. They have different pattern of recurrence sporadic, bigeminy, trigeminy, couplets and Ventricular tachycardia runs. They have special behavior of relatively constant coupling interval and recurrence depending on heart rate variability and autonomic nervous system dominance.Objectives: To assess the effect of Coupling interval on the efficacy of different anti-arrhythmic drug.

Methods
Each subject among 125 consecutive patients with high ventricular premature contractions burden, 24 h ambulatory electrocardiograms were recorded in the absence of anti-arrhythmic drug (control), and during treatment with various anti-arrhythmic drugs. The ratio of the coupling interval (CI) to the preceding R-R intervals was calculated.Patients were treated by different anti-arrhythmic therapy. Efficacy of anti-arrhythmic therapy was documented by ambulatory electrocardiogram for 24 hour by estimating the reduction of Ventricular arrhythmia burden.

Results
The burden of ventricular premature contractions was reduced effectively (&gt;70% reduction of PVCs burden) in patients receiving BB with RR interval &lt;680 ms, CI/RR &lt;0.4, (P=0.002) (relative tachycardia), while in patients receiving CCB it was effective with RR 650- 830 ms, CI/RR 0.4–0.7, (P=0.04) (average heart rate). While in patients receiving Flecanide were found to have effective therapy with RR &gt;900 ms, CI/RR&gt;0.7, (relative bradycardia) (P=0.005).

Conclusion
The coupling interval of ventricular premature contractions can predict the efficacy of anti-arrhythmic drugs. The efficacy of anti-arrhythmic therapy may be dependent on the ventricular arrhythmia behavior of the coupling interval and RR interval of the preceding sinus rhythm.
Efficacy of different anti-arrhythmic

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Egyptian Ministry of Higher Education
All-cause mortality and cardiac resynchronization therapy with or without defibrillation in primary prevention
Authors: Bisson A 
Published: November 2020

Abstract

Aims
Cardiac resynchronization therapy with (CRTD) or without (CRTP) defibrillator is recommended in selected patient with systolic chronic heart failure and wide QRS. There is no guideline firmly indicating choice between CRTP and CRTD in primary prevention, particularly in older patients.

Methods
Based on the French administrative hospital-discharge database, information was collected from 2010 to 2017 for all patients implanted with CRTP or CRTD in primary prevention. Outcomes analyses were undertaken in the total study population and in propensity-matched samples.

Results
A total of 45,697 patients were analyzed (19,266 with CRTP and 26,431 with CRTD). The nationwide numbers of implantations increased between 2010 and 2017 (+29.6% for CRTD, +28.8% for CRTP). Proportion of CRTP implantation over CRTD remained similar over these years. During follow up (913 days, SD 841, median 701, IQR 151–1493), incidence rate (%patient/year) of all-cause mortality was higher in CRTP (11.6%) than in CRTD patients (6.8%) (Hazard Ratio [HR] 1.70, 95% CI 1.63–1.76, p&lt;0.001). After propensity-matched analyses, mortality of patients over 75 years-old with non-ischemic cardiomyopathy (NICM) was not different with CRTP and CRTD (HR 0.93, 95% CI 0.80–1.09, p=0.39). CRTP patients under 75 yo with NICM had a higher mortality than CRTD patients (HR 1.22, 95% CI 1.08–1.37, p=0.01). Mortality rate was also higher with CRTP than with CRTD irrespectively of age in patients with ischemic cardiomyopathy (ICM) (&lt;75 yo: HR 1.13, 95% CI 1.04–1.33, p&lt;0.01; ≥75 yo: HR 1.22, 95% CI 1.08–1.37, p=0.01).

Conclusion
This real-life study gives up-to-date information about unselected patients implanted with CRTP and CRTD in primary prevention, and provides additional data which may help physicians choosing between CRTP and CRTD at the time of implantation. Benefit of CRTD seemed clear for all-cause mortality in patients with ICM and in patients with NICM under 75 yo. Patients over 75 yo with NICM seemed less likely to benefit from primary prevention CRTD implantation.
Event free curves for mortality outcomes

Funding Acknowledgement
Type of funding source: None
Utility of novel Omnipolar activation mapping for the detection of ventricular premature contraction origin
Authors: Maeda S , Kawabata M , Yonai R , Tsuda Y , Kawashima T , Atarashi H , Hirao K 
Published: November 2020

Abstract

Background
Bipolar electrograms are significantly influenced by direction of the propagating wavefront in relation to the recording bipole. Omnipolar voltage mapping may be superior to standard bipolar mapping since it obtains maximum voltage of all possible bipolar electrode orientations without the need for catheter rotation. Therefore, omnipolar maps can provide voltage maps with larger voltages as well as better defined boundaries.

Purpose
Whether omnipolar activation maps also describe better activation maps versus traditional bipolar maps during ventricular premature contraction (VPC) catheter ablation is unclear.

Methods
A high-density mapping catheter was advanced to the ventricular outflow tract and a high-resolution activation map was created. Each electrode along and across the splines of the catheter are 4mm apart. Bipoles were calculated along (MAP 2), across (MAP 3) and bidirectional (MAP 4) the splines while omnipoles (MAP 1) were derived from a right triangle clique. Within a square area, four omnipolar and two bipolar values along, across and bidirectional values were defined.

Results
Though the earliest activation site was vague by along and across maps (arrow), white color became evident by bidirectional map, and the VPC origin became distinct with omnipolar mapping. RF lesions were given via an open-irrigated ablation catheter targeting a lesion size index 5.0. The VPC was eliminated by radiofrequency ablation.

Conclusion
Omnipolar activation mapping may be more accurate than traditional bipolar mapping during ventricular premature contraction (VPC) catheter ablation.
Figure 1

Funding Acknowledgement
Type of funding source: None
Novel occlusion tool software for pulmonary vein occlusion verification in atrial fibrillation cryoballoon ablation
Authors: Solimene F , Cauti F.M , Stabile G , Rossi P , Schillaci V , Polselli M , Arestia A , Iaia L , Shopova G , Bianchi S 
Published: November 2020

Abstract

Background
Optimal pulmonary vein (PV) occlusion, checked with selective contrast injection, is mandatory to obtain an effective PV isolation with a cryoballoon.

Purpose
The purpose of this study was to verify the feasibility of a new dielectric sensing system in assessing PV occlusion during cryoballoon ablation in patients with atrial fibrillation (AF).

Methods
We enrolled 25 consecutive patients with paroxysmal or persistent AF. After transseptal access a detailed image reconstruction of left atrium and PVs was achieved with a decapolar circular mapping catheter and a novel dielectric imaging system. The degree of PV occlusion with the inflated cryoballoon catheter was verified by a new occlusion tool software of the dielectric imaging system and compared to the angiography with dye injection in each PV.

Results
A total of 114 PV cryoballoon occlusion were tested. The new occlusion tool software showed a 91.7% sensitivity and 81.5% specificity in assessing a complete PV occlusion verified with dye injection. The positive predictive value was 84.6% and the negative predictive value was 89.8%. Acute isolation was achieved in all PVs. No 30 days complications were observed.

Conclusion
This is the first study that demonstrates the feasibility of a new occlusion tool software, using the novel dielectric imaging system, in verifying the degree of PV occlusion during cryoballoon ablation.

Funding Acknowledgement
Type of funding source: None
Quality of life measured in first-line therapy during the Cryo-FIRST study: a comparison between cryoballoon catheter ablation versus antiarrhythmic drug therapy
Authors: Chierchia G.B , Pavlovic N , Velagic V , Hermida J.S , Healy S , Arena G , Badenco N , Meyer C , Chen J , Iacopino S , Anselme F , Kuniss M 
Published: November 2020

Abstract

Background
By consensus statements, catheter ablation is a recommended treatment for patients with symptomatic drug-refractory paroxysmal atrial fibrillation (AF), as patients try to alleviate the burdensome AF symptoms that reduce the Quality of Life (QoL). Yet, first-line treatment of symptomatic patients via catheter ablation prior to initiation of antiarrhythmic drugs (AADs) is only a reasonable alternative (Class IIa). Clearly, more clinical data is necessary that compares catheter ablation to AAD therapy in treatment naïve patients.

Purpose
The Cryo-FIRST trial was designed to compare AAD treatment against pulmonary vein isolation (PVI) while using a cryoballoon catheter (Arctic Front Advance; Medtronic, Inc.). This current data analysis examines the QoL endpoints when comparing AADs to cryoballoon ablation in patients with symptomatic treatment naïve paroxysmal AF.

Methods
This randomized multicenter trial enrolled 220 patients from 18 sites in 9 countries (Europe, Australia, and Latin America) in a prospective open-blinded endpoint study design. Patients had not been administered a class I or III AAD for longer than 48 hours for inclusion into the study. Subjects were randomized (1:1) into a cohort that was administered AAD therapy or a cohort that received PVI via cryoablation. The prespecified QoL endpoint at 12 months was measured using the Atrial Fibrillation Effect on Quality of Life (AFEQT) scores, and QoL recordings were taken at baseline, 1, 3, 6, 9, and 12 months following the index treatment.

Results
Of the 218 patients randomized (age 52±13 years, 68% male) 86% completed the 12-month follow-up. Crossovers occurred in 9% of subjects (N=20), including: 1 subject in the cryoablation arm and 19 subjects in the AAD arm. At 12 months, 86.5% of the patients in the cryoablation arm and 70.4% of the patients in the AAD arm where without symptoms (EHRA score 1). The mean AFEQT summary score was more favorable in the catheter ablation group compared to the drug therapy group at 12 months (88.9 vs. 78.1 points, respectively). The adjusted difference was 9.9 points (95% CI: 5.5–14.2; P&lt;0.0001).

Conclusions
Cryoballoon ablation resulted in a significant improvement in QoL at 12 months compared to AAD therapy in treatment naïve patients with first-line symptomatic paroxysmal AF.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Medtronic International Trading Sàrl
Prognostic role of left ventricular late gadolinium enhancement (LV-LGE) in patients who received implantable cardioverter defibrillator (ICD) for secondary prevention
Authors: Mattesi G , Baldi E , Guerra F , Toniolo M , Cipriani A , Cauti F , Marcantoni L , Manfrin M , Lanzillo C , Savastano S , Zorzi A 
Published: November 2020

Abstract

Introduction
LV myocardial fibrosis detected as LGE on cardiac magnetic resonance (CMR) is a predictor of arrhythmic risk in primary prevention both in ischaemic and non-ischaemic cardiomyopathy. However, we still do not know the prognostic role of LV-LGE in patients who suffered cardiac arrest (CA).

Purpose
To evaluate the prognostic role of CMR, and in particular of LV-LGE suggesting myocardial scar, in predicting appropriate ICD interventions in secondary prevention patients.

Methods
Ninety-seven consecutive patients 1) aged ≥14 years 2) hospitalized for CA because of ventricular arrhythmias from 2009/01/01 3) who underwent/undergoing a CMR within one month from the event 4) who received/receiving an ICD for secondary prevention and 5) with at least 1 year-follow-up, were enrolled for this multicentric study.

Results
97 patients (68 males, 70%), mean age 46±16 years, were enrolled. Seventy-six percent of patients received bystander cardiopulmonary resuscitation (CPR) and ventricular fibrillation (VF) was the first rhythm in 86% of cases. ST elevation was present in 18% of cases at the admission; however, angiography was found negative in 80% of patients. Myocardial oedema and LGE were identified in 26% and 64% of patients respectively. A diagnosis was made in 83.5% of cases, while in the remaining 16.5% CA was considered idiopathic. During a four-year-follow-up, 25% of patients had appropriate ICD therapy (10% of which ATP only). A significant correlation between LGE and appropriate ICD intervention was not found (p=0.89).

Conclusions
One fourth of patients who received ICD for secondary prevention had appropriate ICD therapy during a four-year-follow-up. In this setting, LV-LGE does not provide a prognostic value.

Funding Acknowledgement
Type of funding source: None
Are body mass index and age independent risk factors for new-onset atrial fibrillation after cardiac surgery regardless of left atrial size and left ventricular ejection fraction value?
Authors: Stefano P , Bugetti M , Michelucci A , Del Monaco G , Popescu G , Pieragnoli P , Ricciardi G , Perrotta L , Checchi L , Rondine R , Bevilacqua S , Marchionni N 
Published: November 2020

Abstract

Background
Obesity, advanced age and left atrium dimensions have been linked to atrial fibrillation (AF).

Purpose
This study aimed at evidencing if the above mentioned risk factors have a role among the others in conditioning the onset of post operative AF (PoAF) in patients undergoing cardiac surgery without previous AF.

Methods
This study evaluated 249 consecutive patients undergoing coronary artery by-pass surgery either isolated or in combination with aortic or mitral valve repair/replacement, or isolated valve repair/replacement. Prior to surgery, in all patients the following data were collected: age (yrs), body mass index (BMI, kg/m2), left atrium (LA) diameter (cm), LA area (cm2), left ventricular ejection fraction (LVEF, %), the presence/absence of arterial hypertension (AH) and diabetes, creatinine (mg/dL). To detect the presence of PoAF, cardiac rhythm was continouosly recorded during the first seven postoperative days.

Results
PoAF occurred in 127 patients (51%). We compared patients with and without PoAF. Mean values (±1 SD) of continuous variables and the frequency of dicothomic ones are reported in the table. No difference was observed for sex, LA diameter, LA area, LVEF and diabetes. Instead, patients with PoAF had higher values of age, BMI, creatinine and a greater prevalence of AH. According to multivariable binary logistic analysis the independent predictors of PoAF were: age (OR = 1.05, CI 95%: 1.026–1.074, p=0.018) and BMI (OR = 1.09, CI 95%: 1.015–1.171, p=0.0001).

Conclusions
Results suggest that advanced age and a higher value of BMI could be strong risk factors for PoAF in patients who undergo cardiac surgery without previous AF. This considering that in the present population the values of LA diameter, LA area and LVEF showed no statistically significant difference between patients with and without PoAF.

Funding Acknowledgement
Type of funding source: None
Chinese spirits consumption is an independent risk factor of left atrial appendage thrombosis in non-valvular atrial fibrillation patients
Authors: Yang L , Tian Y 
Published: November 2020

Abstract

Background
Alcohol consumption is often associated with an increased risk of atrial fibrillation; however, its association with left atrial appendage (LAA) thrombosis in patients with non-valvular atrial fibrillation (NVAF) remains undefined.

Purpose
To investigate the relationship between Chinese spirits consumption and LAA thrombosis in NVAF patients.

Methods
504 consecutive adult patients with NVAF undergoing first radiofrequency catheter ablation who were enrolled retrospectively from January 2016 to April 2019. LAA thrombosis was identified by transesophageal echocardiography before catheter ablation. Risk factors for LAA thrombosis were determined by uni-/multivariate analysis of data derived from a questionnaire on alcohol consumption and other risk factors for AF, and biochemical and imaging information.

Results
Of the 504 patients studied, 86 (17.1%) had a drinking habit, and 59 patients (11.7%) had LAA thrombosis. The proportion of alcohol drinking patients was 47.5% (28/59) in the thrombosis group and 12.7% (58/455) in the non-thrombosis group (P&lt;0.001). In multivariate analysis, Chinese spirits consumption (≥12g daily; OR 15.025, 95% CI 6.123–36.815, P&lt;0.001), non-paroxysmal AF (OR 8.301, 95% CI 3.946–17.460, P&lt;0.001), AF duration (OR 1.019, 95% CI 1.010–1.027, P&lt;0.001), CHA2DS2-VASc score (OR 2.078, 95% CI 1.625–2.658, P&lt;0.001), and effective anticoagulation (OR 0.348, 95% CI 0.132–0.921, P=0.033) were independently associated with LAA thrombosis.

Conclusions
Chinese spirits consumption was independently associated with LAA thrombosis in NVAF patients. Whether avoiding alcohol consumption might reduce the occurrence of LAA thrombosis and thromboembolism in NVAF patients requires further study.

Funding Acknowledgement
Type of funding source: None