bluuebunny/crossref_metadata_2025_split huggingface dataset:
The reinvented old player – an antazoline is effective in pharmacological cardioversion of atrial fibrillation
Authors: Miskowiec D , Dembowski T , Cwiek-Rebowska E , Qawoq H D , Zycinski P , Kupczynska K , Michalski B , Kasprzak J D 
Published: October 2021

Abstract

Introduction
Antazoline (ANT) is an old antihistaminic medication with antiarrhythmic properties. After intravenous administration ANT exerts rapid antiarrhythmic effect often resulting in conversion of atrial fibrillation (AF) to sinus rhythm (SR) and is widely used in Poland for this purpose in the last years. However, published data on its effectiveness, safety and clinical utility for rapid AF termination are limited and ANT is not recognized as a cardioversion drug.

Aim
To assess the real-world efficacy of ANT for pharmacological cardioversion of paroxysmal and persistent non-valvular AF.

Methods
Our single center, retrospective, observational study included patients (pts) with history paroxysmal or persistent AF episode lasting less than 6 months, in stable cardiopulmonary condition who were qualified for elective pharmacological cardioversion with intravenous ANT. The primary end-point was the conversion of AF to SR confirmed in electrocardiography (ECG) during the 6-hours observation.

Results
A total of 176 pts (mean age 68.4±12.0 years, 49% male) were enrolled into the study. In 93 patients (52%) AF duration was shorter than 48 hours and median AF duration time was 24 (7–432) hours. The overall success rate of pharmacological cardioversion of AF with intravenous ANT was 45.5% (80/176 pts). The mean used dose of ANT was 250.9±65.4mg. The subgroup analysis, regarding the AF duration, suggested the effectiveness of ANT mainly in in short-lasting AF (effectiveness of antazoline based cardioversion for AF lasting &lt;48h vs others: 75.3% vs 12.0%, p&lt;0.001). In multivariable logistic regression model AF duration (for every 24h in AF – OR=0.97; 95% CI 0.96–0.98), the left atrium antero-posterior diameter (OR=0.92; 95% CI 0.86–0.99) and the serum creatinine level (OR=0.15; 95% CI 0.03–0.73) were identified as independent predictors of antazoline based pharmacological cardioversion effectiveness, even after adjustment for comorbidities. The ROC curves revealed that the optimal cut-off value for AF duration time predicting ANT's effectiveness was 48h (AUC=0.876; 95% CI 0.815–0.922) – Figure 1. There were only one episode of bradycardia &lt;45 bpm related to ANT administration.

Conclusions
Antazoline is effective and safe in rapid pharmacological cardioversion of paroxysmal AF, especially in the short-lasting AF (&lt;48 hours) and in patients without the left atrium enlargement and significant renal disease.

Funding Acknowledgement
Type of funding sources: None. Figure 1. ROC curve analysis
Characterization of superresponders to cryoballoon ablation
Authors: Marti Almor J , Casteigt B , Jimenez-Lopez J , Conejos J , Valles E , Cladellas M 
Published: October 2021

Abstract

Background
Isolation of pulmonary veins is the cornerstone in the treatment of symptomatic atrial fibrillation rather with radiofrequency or cryo balloon. Recurrence rate is quite common in the long term follow up, clearly related to previosly described factors. Nevertheless some patients maintain sinus rhythm forever after the index ablation. The aim of this study is characterize this kind of patients (so called superresponders).

Methods
This is a Unicentric, retrospective, consecutive study including all patients summited for cryoablation in our hospital from January 2011 to September 2020. We looked for clinical, electrical, echocardiographic variables and those linked to the ablation procedure. A transversal FU to discard recurrences was done. A univariate and multivariate logistic regression was performed.

Results
We included 422 patients, 193 of them were finally excluded: 21 lost in the FU, 30 got radiofrequency ablation and 142 did not reach a minimum 5 years FU. About the 229 finally included, 85 (group 1) didn't have any recurrence during the FU, in front of 144 (group2) with recurrences. The univariate analysis showed that grup 1 patients were younger, the rate of hypertension, CHA2DS2VASc score, moderate sleep apnea, body mass index (BMI), p wave duration, and the size of left atrial was lower in grup 1 in front of patients of grup 2. Left ventricular ejection fraction was higher and the number of pulmonary veins in whom the temperature was lower than −40°C in grup 1 in front to grup 2. In the multivariate analysis the p wave duration: OR 0.92; 95% CI [0.89–0.94]; p&lt;0.001, BMI kg/m2: OR 0.74; 95% CI [0.65–0.85]; p&lt;0.001, a temperature &lt;−40°C in all the targeted veins: OR 3.52 95% CI [1.45–8.54]; p=0.005 and SR on the ablation index day OR: 7.29; 95% CI [1.53–34.71]; p=0.012, maintained statistical significance.

Conclusions
In our series patients with a p wave duration, BMI, SR the ablation index day and achieving a temperature &lt;−40°C in all the targeted veins, resulted as protective factors to maintain SR in the long term FU. An adequate selection of patients can improve results and optimize resources.

Funding Acknowledgement
Type of funding sources: None.
Location of sinoatrial artery and atria
Authors: Jantraprapavech K , Boonyapisit W 
Published: October 2021

Abstract

Background
Clinically manifested injury to the coronary arteries during catheter ablation procedures for atrial arrhythmias is rare. Injury to sinoatrial artery can cause sinus arrest and lead to permanent pacemaker implantation. Previous studies only described the anatomy of the artery but not the relation with atrium.

Objective
Our study aims to illustrate the course of the sinoatrial artery in relation to the atrium.

Methods
The images of coronary computed tomography angiography (CCTA) of 110 patients performed from June to September 2019 were reviewed.

Results
The sinus node was supplied by either single artery (98.18%) or dual blood supply (1.82%). Sinoatrial artery mostly originates from right coronary artery (56.25%), followed by left circumflex artery (42.85) and the aorta (0.90%).
When sinoatrial artery originated from right coronary artery or the aorta, it ran medially to the right atrium which its course vertically lied within 0.35±0.51 cm above and 1.45±0.63 cm below the superior vena cava-right atrium junction. The artery then passed between left atrium and right atrium, which 21.88% of the course ran within 0.5 cm from the right upper pulmonary vein ostium.
When sinoatrial artery arises from left circumflex artery, 95.83% of this pathing were anterior to left atrial appendage. Only 4.17% went along anteriorly to the left upper pulmonary vein. Most of sinoatrial artery that arises from left circumflex artery (97.92%) ran pass the upper one-third of left atrium, then ran toward posteroseptum of right atrium. This course vertically lied within 0.51±0.73 cm above and 0.67±0.83 cm below the superior vena cava-right atrium junction. Additionally, we found that 39.58% of sinoatrial artery arises from left circumflex artery course lied within 0.5 cm from right upper pulmonary vein ostium.

Conclusion
Exceeding precaution while performing radiofrequency ablation at anterior upper one-third left atrium, base of left atrium appendage, upper part septal wall of right atrium and right upper pulmonary vein ostium should be established to prevent sinoatrial artery injury.

Funding Acknowledgement
Type of funding sources: None.
A mixed-reality holographic viewing platform enabling interaction with 3D electroanatomical maps using the HoloLens
Authors: Malaweera A , Jogi R , Wright M , O'Neill M , Williams S 
Published: October 2021

Abstract

Introduction
Three dimensional (3D) electroanatomical maps (EAMs) created during electrophysiology procedures are traditionally displayed on 2D monitors connected to mapping systems. This has limitations, such as the lack of interaction with EAMs, the need for another user to control them, and the size of EAM displayed, which is limited by the resolution of these monitors. To overcome these, we created a novel technology to display EAMs on a mixed reality (MR) platform.

Methods
We used the Microsoft® HoloLens to create this MR platform. Studies from patients who had already undergone catheter ablation for atrial fibrillation, where EAMs of the left atria had been generated using different mapping systems (CARTO®, Rhythmia™ and EnSite Precision™) were utilised. These EAMs consisting of 3D coordinates and annotations (e.g. voltage & activation times) were exported from the mapping system. EAMs were then compiled and transferred to the HoloLens using custom-developed functions on Unity©, Microsoft® C# and VisualStudio. Subsequently, feedback was obtained from 3 independent electrophysiologists on this technology.

Results
We successfully exported the EAMs generated on CARTO®, Rhythmia™ and EnSite Precision™ mapping systems as holograms on to the HoloLens (Figure). Positive feedback included themes such as 1) the ability to use hand gestures and voice commands to interact with EAMs independent of another user unlike traditional cardiac mapping systems 2) offering an interactive 3D holographic experience whilst preserving the operators' physical interaction in the cardiac catheter lab 3) the capacity to better appreciate 3D geometry of EAMs in comparison to 2D monitors. The challenge of wearing a headset during long procedures was perceived as a disadvantage.

Conclusion
This technology, which can be used with any mapping system, is currently optimised for offline display. Our software will be made available as an opensource teaching and simulation tool. Users will be able to explore EAMs for research, planning complex cases and immersive learning. The future directions will include extending this toolkit for real-time cardiac mapping with catheter localisation, and could potentially be translated to other cardiac imaging modalities.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Cardiovascular diseases charitable fund (CDCF) at Guy's and St Thomas' NHS Foundation Trust. Process of creating Holograms of EAMsVoltage map of left atrium as a Hologram
Peripheral vascular access from the arms for invasive cardiac investigation using ultrasound guidance
Authors: Kadiwar S , Griffiths J , Ailoaei S , Barton B , Samchkuashvili N , Adams L , Browne S , Paynter A , Kempny A , Ernst S 
Published: October 2021

Abstract

Introduction
Vascular access for invasive cardiac investigations has traditionally been gained from the femoral vessels, however, a “radial-first” approach has become increasingly popular for coronary interventions [1]. Transradial access has shown lower complication rates, shorter admission times, and reduced healthcare costs for coronary interventions [4]. A “superior” approach via the jugular and subclavian veins have been reported for electrophysiology (EP) studies and radiofrequency catheter ablation (RFCA) but is associated with an increased risk of complications such as pneumo- and haemothorax [9].

Purpose
EP procedures often require the use of both venous and arterial catheters, and the potential advantage of non-femoral peripheral access is yet to be investigated. This study was performed to provide comprehensive anatomical evidence that the vessels of the arms are suitable for use during EP procedures, as assessed by vascular ultrasound.

Methods
A portable ultrasound device was used to measure the diameter of the brachial artery, brachial vein, basilic vein & cephalic vein on the left and right upper limbs of 63 healthy adult volunteers. Measurements were also taken of the circumference at the elbow and at the mid-bicep level on both arms. A subgroup of 15 volunteers had additional measurements taken of the same veins and artery on both arms with a tourniquet at the upper bicep level.

Results
The basilic vein was found to have the largest diameter with a median of 4.6 mm and 4.5 mm (right and left diameter, respectively), followed by the cephalic (median of 3.1 and 3.0 mm) and the brachial vein (median of 2.8 mm for both arms). 100% of volunteers had at least one vein that was equal to a 3 mm diameter (which would allow for a 8F sheath insertion), with 98% having 2 suitable veins and &gt;80% having 3 suitable venous vessels. More than 90% had a suitable diameter of more than 3 mm for both the right and left brachial artery. There was significant correlation between gender, and basilic vein and brachial artery diameters. There was no correlation between BMI, height, weight and elbow or bicep circumference.

Conclusion
To our knowledge, this is the first study to investigate the feasibility of adopting peripheral access in the electrophysiology lab. 100% of volunteers examined had one vein which was at least 3mm in size and would be suitable for 8F sheath insertion. We demonstrate the anatomic evidence that the vessels in the arm are capable of housing the size of sheath and catheters commonly used in the EP lab.

Funding Acknowledgement
Type of funding sources: None. Figure 2. measurementsFigure 3. Vessel diameters
Comparing predictors of permanent pacemaker insertion after TAVR in new-generation versus early generation heart valves
Authors: Gupta R , Mahajan S , Malik A , Mehta S , Patel N 
Published: October 2021

Abstract

Introduction
Transcatheter Aortic Valve Replacement (TAVR) has emerged as the standard of care for patient with severe aortic stenosis. Conduction abnormalities leading to permanent pacemaker (PPM) implantation is one of the most common complication after TAVR. Newer generation valves (NGV) such as Sapien S3, XT and Evolut are widely being used in real time practice. The aim of this analysis is to compare the predictors associated with increased risk of PPM implantation after TAVR in newer generation valves (NGV) as compared to older generation valves (OGV).

Methods
A comprehensive literature search was performed in PubMed, Embase, and Cochrane to identify relevant trials. Summary effects were calculated using a DerSimonian and Laird random-effects model as odds ratio with 95% confidence intervals for all the clinical endpoints.

Results
18 observational studies with 16,004 patients were identified. The incidence of PPM implantation after TAVR in our analysis was 8.9%. For the NGV, right bundle branch block (RBBB) and atrioventricular (AV) block were independent predictors of PPM insertion after TAVR. Baseline heart rate, presence of atrial fibrillation, and baseline intraventricular conduction delay were not significant predictors. However, for the OGV, risk of PPM implantation after TAVR was higher in presence of RBBB, depth of implant, valve size/annulus size, presence of atrial fibrillation and post-procedure AV block.

Conclusions
Our analysis identified 2 factors that were significantly associated with increased risk of PPM insertion after TAVR in NGV compared to 6 factors with OGV. With the increasing physician expertise with TAVI and use of NGV, the incidence of post TAVR PPM insertion has reduced but baseline RBBB and AV conduction block still continue to be significant predictors of increased PPM insertion after TAVR.

Funding Acknowledgement
Type of funding sources: None.
Patients with symptomatic permanent atrial fibrillation show quantitative signs of pain sensitisation
Authors: Jackson A , Frobert O , Boye Larsen D , Arendt-Nielsen L , Bjorkenheim A 
Published: October 2021

Abstract

Background/Introduction
Most patients with atrial fibrillation (AF) report symptoms, while around one-third are asymptomatic. We hypothesized that sensory processing, in particular pain, differs in patients with symptomatic and asymptomatic AF.

Purpose
To assess differences in pain sensitisation in patients with symptomatic and asymptomatic AF.

Methods
Thirty individuals with permanent AF (15 symptomatic, 15 asymptomatic) completed the AF6 and SF-36 questionnaires and underwent quantitative pain sensitisation testing using pressure algometry at the sternum (referred pain area) and the tibialis anterior muscle (generalized pain area). The primary objective was to assess differences in pressure pain thresholds (PPT), temporal summation of pain (TSP), and conditioned pain modulation (CPM) in the two groups. The secondary objective was to determine association of demographic and clinical parameters to quantitative measures of pain sensitisation.

Results
The symptomatic group had lower PPTs at both tibialis (p=0.004) and sternum (p=0.01), as well as impaired CPM (p=0.025) and facilitated TSP (p=0.008) at the tibialis but not sternum, compared to the asymptomatic group. The AF6 sum score was negatively correlated to PPT on both tibialis (r=−0.50, p=0.005) and sternum (r=−0.42, p=0.02) and positively correlated to TSP of both tibialis (r=0.57, p=0.001) and sternum (r=0.45, p=0.01), but not to CPM. The physical component summary score was positively correlated to the PPT on both tibialis (r=0.52, p=0.003) and sternum (r=0.40, p=0.03) and negatively to TSP on the tibialis (r=−0.53, p=0.003) but not sternum.

Conclusions
Patients with symptomatic AF exhibit lower pain tolerance than patients with asymptomatic AF, as well as impaired pain inhibitory control and facilitated summation of pain, indicating that pain sensitisation may be of importance in symptomatic AF.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Department of Cardiology, Örebro University, Sweden PPTs tibialis anterior musclePPTs sternum
Lower heart rates and beta-blockers are associated with new-onset atrial fibrillation
Authors: Habel N , De Lavallaz J , Koehler J , Ziegler P , Infeld M , Lustgarten D.L , Meyer M 
Published: October 2021

Abstract

Background
Lower heart rates (HRs) prolong diastole, thereby raising filling pressures and wall stress (1,2), slowing myocardial relaxation (3), and increasing central blood pressure via superposition of reflected peripheral pressure waves onto systole (2,4). As a result, lower HRs may be associated with higher brain natriuretic peptide (BNP) levels and incident atrial fibrillation (AF). Beta-blockers (BBs) may thereby increase the risk for AF.

Purpose
Examine the relationships of HR, BNP, BB use and new-onset AF in the REVEAL-AF and SPRINT cohort of subjects at risk for developing AF.

Methods
In REVEAL-AF, 383 subjects (52% male, mean age 71.5±9.8 years) without a history of AF and a mean CHA2DS2VASC score of 4.4±1.3 received an insertable cardiac monitor and were followed up to 30 months. Baseline HRs were averaged between 8AM and 8PM for the first week post-implantation. Adjudicated AF lasting ≥6 minutes was defined as new-onset AF.
In SPRINT, 7595 patients (64% male, mean age 67.5±9.2 years) without prior history of AF and a mean CHA2DS2VASC score of 2.3±1.2 were followed for up to 60 months. Baseline average HR was derived from three seated measurements taken at the initial clinical visit. 12-lead ECG at baseline, 2 years, 4 years and close-out visit were used to determine presence of AF. Based on longitudinal medication inventories BB use was categorized into “on BB” vs “never on BB” for the duration of the trial.

Results
The median daytime HR in the REVEAL-AF cohort was 75bpm [interquartile range, IQR 68–83]. Subjects with below median HRs had 2.4-fold higher BNP levels when compared to subjects with above median HRs (median BNP [IQR]: 62pg/dl [37–112] vs. 26pg/dl [13–53], p&lt;0.001). Below median HRs were associated with a higher incidence of AF: 37% vs. 27%, p=0.047. This was validated in the SPRINT cohort after adjusting for AF risk factors (age, HR, sex, body mass index, coronary artery disease, intensive vs standard blood pressure therapy, chronic kidney disease). Both a HR&lt;75bpm and BB use were independently associated with a higher rate of AF: 1.9 vs 0.7%, p&lt;0.001 and 2.5% vs. 0.6%, p&lt;0.001, respectively. The hazard ratio for patients on BB to develop AF was 3.72 [CI 2.32, 5.96], p&lt;0.001.

Conclusion
Lower HRs and BB use are associated with higher BNP levels and incident AF, supporting the hypothesis that lower HRs mimic and/or exacerbate the hemodynamic effects of diastolic dysfunction and promote atrial myopathy. The effects of BBs on clinical outcomes in patient populations outside the context of heart failure with reduced ejection fraction will need to be reassessed.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Health
The need and duration of BB therapy in post MI patients with preserved left ventricular ejection fraction: a meta-analysis
Authors: Abdelmawgoud S , Shehata E 
Published: October 2021

Abstract

Background
Oral beta-blockers have beneficial effect on long-term mortality in high-risk as low left ventricular ejection fraction (LVEF) patients with MI, but the effect and duration of use of Beta-blockers in post-AMI patients with preserved LVEF is still unknown.

Methods
We performed a systematic search in Cochrane library, Embase, Medline, Pubmed, Scopus, Web of Science, clinical trial registries, and for eligible studies (26,431 patients). Data for outcomes were pooled as Hazard ratios (HRs), with 95% confidence interval, using RevMan software for windows.

Results
The pooled effect-estimate showed significant decrease in all cause mortality in beta-blocker group (HR 0.71, 95% CI 0.62–0.82). A subgroup analysis regarding duration of use of BB (≤1 year or &gt;1 year), age (≤65 or ≥65),sex, use of CCB, presence of HTN or DM, and LVEF (≥50 or ≥40) was done. No significant subgroup differences were detected: duration of use of BB (p=0.32), age (p=0.23), sex (p=0.84), CCBs (p=0.28), HTN (p=0.32), DM (p=0.92),and LVEF (p=0.06). No significant differences between bet-blocker vs. no beta-blockers in terms of cardiac death (HR 0.69, 95% CI 0.33–1.46), re-infarction (HR1.00, 95% CI 0.68–1.48), re-hospitalization (HR1.08, 95% CI 0.32–3.68), and revascularization (HR 0.94, 95% CI 0.76–1.16).

Conclusion
Beta-blockers might reduce mortality of post-AMI patients with preserved LVEF, but failed to prevent cardiac events. The upcoming trials (REBOOT, BETAMI, DANBLOCK, and ABYSS) will define the use of Beta-blockers in post AMI patients with preserved Left ventricular ejection fraction.

Funding Acknowledgement
Type of funding sources: None.
Low birth weight predicts impaired cardiac structure and function in mid-adulthood
Authors: Huynh Q , Magnussen C , Venn A , Marwick T 
Published: October 2021

Abstract

Aims
We sought to determine the relationship of low birth weight (LBW) with adult cardiac structure and function and investigate potential causal pathways.

Methods
We followed 925 Australians (41.3% male) from childhood (7–15 years) to young- (26–36 years) and mid-adulthood (36–50 years). Left ventricular (LV) global longitudinal strain (GLS, %), LV mass index (LVMi, g/m2.7), LV filling pressure (E/e') and left atrial volume index (LAVi, g/m2) were measured by echocardiography in mid-adulthood. Birth weight category was self-reported in adulthood and classified as low (≤5 pounds or ≤2270 g), normal (5–8 pounds or 2271–3630 g) and high (&gt;8 pounds or &gt;3630 g).

Results
7.5% (69/925) reported LBW. Compared with participants with normal birth weight, those with LBW had a 2.01-fold (1.19–3.41, p=0.009) higher risk of impaired GLS (GLS &gt;−18%) and 2.63-fold (0.89–7.81, p=0.08) higher risk of LV hypertrophy (LVMi &gt;48 g/m2.7 in men or &gt;44 g/m2.7 in women) in adulthood independent of age, sex and any measures of socioeconomic status. Participants with LBW significantly increased body fat from childhood to adulthood relative to their peers, which was associated with greater levels of triglycerides, fasting blood glucose and arterial stiffness in adulthood. These factors were the strongest mediators in the association of LBW with impaired GLS in adulthood and together, explained half of the LBW effect size. The remaining half of this association was independent of any measured factors.

Conclusions
LBW was associated with impaired cardiac structure and function in mid-adulthood. This association was only partially explained by known risk factors.

Funding Acknowledgement
Type of funding sources: None.