bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of the Covid-19 related lockdown on physical activity, heart rate and arrhythmia burden in a large prospective cohort of CHF patients
Authors: Schmitt J , De Sousa J , Bulava A , Golovchiner G , Hatala R , Anguera I , Reinke F , Wenzel B , Noelker G 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): BIOTRONIK SE & Co. KG

OnBehalf
BIO|STREAM.HF
Background
At the beginning of the Covid-19 pandemic in spring 2020, governments around the world issued curfews and other stay at home orders (‘lockdown’) to limit the spread of the SARS-CoV19 virus. This may have forced people to decrease their physical activity. Physical inactivity as well as social stress is known to be especially deleterious for heart failure (HF) patients. The BIO|STREAM.HF study enrolled such HF patients into a prospective registry with Home Monitoring.

Purpose
We aimed to evaluate the impact of the lockdown during the first Covid-19 pandemic wave on physical activity and arrhythmia burden of heart failure patients.

Methods
We analysed daily transmitted data of patients enrolled into a large international registry (BIO|STREAM.HF) being implanted with a cardiac resynchronization therapy (CRT) devices. Patients with NYHA ≥ II and LVEF ≤ 40% before CRT implantation were selected.
Intra-individual weekly mean and median values were calculated for the following daily transmitted parameters: physical activity (measured as % of the day during which the patient moves), atrial arrhythmia burden, mean heart rate (at rest), PP variability, PVC burden, and rate of biventricular pacing. Values were calculated for 12 weeks before and 12 weeks after the country-specific effective date of most rigorous restrictions in spring 2020 to visualize the general trend of parameter changes. Moreover, values for intra-individual changes between three 28-days periods (before, during, and after the lockdown) were calculated.

Results
Of 444 patients, 76% were male. They had a mean age of 69 ± 10 years and LVEF of 28.2 ± 6.7%. HF was of ischemic etiology in 42% of cases and they were in NYHA class II (47.5%), III (50.0%) or IV (2.5%).
On average, patients were active for 9% of the day (2 h 10 min). The physical activity decreased by approx. 10% with the onset of the lockdown (figure 1) and recovered within the following eight weeks.
Comparison of the 28-days periods before, during and after the lockdown showed a statistically significant intra-individual decrease in physical activity (mean decrease 9 min per day) during the lockdown compared to pre- and post-lockdown values and a trend toward reduced mean heart rates. In parallel, a significant increase in device detected atrial arrhythmia burden (mean increase 17 min per day) was observed. All other parameters did not change significantly.
Conclusion
Our results show that patients reduced their physical activity during the Covid-19 related lockdown in spring 2020. This was associated with an increase in atrial arrhythmia burden and a reduction of the mean heart rate. Prognostic implications of these results will further be analysed. Abstract Figure.
CIED guided HF management : a prospective cohort study
Authors: Garner D , Leung WY , Llewellyn J , Goode R , Lunt L , Hughes S , Kahn M , Wright DJ , Rao A 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Liverpool Clinical Commissioning Group
Background
Heart failure (HF) is associated with significant morbidity and mortality. (1) Cardiac Implantable Electronic Devices (CIED) generated Heart Failure Risk Score (HFRS) alerts may guide management in this complex cohort and help direct resources to appropriate patients. (2)
Aim
To develop and evaluate an integrated, multidisciplinary approach to HF management for patients with CIED by sharing HFRS alerts directly with the HF teams.

Methods
We undertook a prospective, single centre cohort study of patients who generated high risk HFRS alerts. These alerts were shared with community HF teams responsible for routine care of patient, prompting patient contact and appropriate intervention by the team. Impact of the pathway was evaluated by review of outcomes including hospitalisation and clinical intervention within 4- 6 weeks of the alert and mortality during the follow up period. Ongoing education was provided to help teams deal with alerts. A validated user questionnaire was completed by the stake holders to obtain user feedback.
Results
365 "High risk" alerts were noted in 188 patients in a 2 year period (November 2018 - November 2020). The mean number of alerts per patients was 1.9 and 44 (23%) of patients had &gt;3 "high risk" alerts in the follow up period. Having three or more alerts significantly increased the risk of hospitalisation for heart failure (HR 2.5, CI 1.1–5.6 p = 0.03) but not mortality (HR 2.1 CI 0.6-7.2 p = 0.23). Overall 75 (39%) of patients were hospitalised in the 4-6 week period of the alert – 53 (28%) of these were unplanned of which 24(13%) were for decompensated HF. A further 24(13%) had planned admissions for care to improve therapy (AV node ablation, device and lead replacement) and reduce morbidity (LA appendage occlude, IV Iron therapy). 33(18%) of patients died in the follow up period. 15(8%) received therapy from the device. 18(10%) of patient underwent deactivation of ICD therapy.
Contact was established in 176 (94%) of patients, and alerts actioned appropriately. 55 patients reported being asymptomatic, and in 45 the trends were improving so no further clinical action was taken. 76 patients had an onward referral made for further management including; 32 to a Cardiologist, 20 to primary care, 13 referrals to community HF teams and 11 referrals to palliative care. 23 patients had medications changes instituted. The feedback on the pathway was positive.
Conclusions
An integrated approach to HF for patients with CIEDs in situ can facilitate timely risk stratification and intervention in this cohort of patients and potentially reduce unplanned health care utilisation. Intervention in these patients is not limited to HF alone and provides the opportunity for holistic management of this complex cohort Abstract Figure.
Monitoring of QTc interval in patients with COVID-19. First experience with a portable EKG-recording device
Authors: Abellas Sequeiros M , Lozano Granero C , Garcia Sebastian C , Franco Diez E , Hernandez Madrid A , Moreno Planas J , Sanmartin M , Zamorano JL 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Off-label use of drugs with potential for QT interval prolongation was common in COVID-19 patients. We tested a portable EKG recording device to measure and monitor corrected QT (QTc) intervals in a cohort of COVID-19 patients treated with azithromycin, hydroxychloroquine, lopinavir/ritonavir, or combinations of these drugs.

Methods and results
Sixty-nine patients hospitalized with pneumonia and confirmed SARS-CoV 2 infection were included in an observational single-centre study. Six-lead EKG recordings were obtained using a KardiaMobile6L® at physicians’ discretion. In a subgroup of 16 patients with early discharge, a device was provided for at-home daily monitoring. Significant QTc interval prolongation was observed in patients taking a combination of 2 or 3 drugs (426 ± 33 vs 408 ± 33 ms, p = 0,002; and 435 ± 30 vs 394 ± 31 ms, p = 0,001, respectively). The use of the device prompted a change in the treatment of 9 patients (13%) because of prolongation of QTc interval and anticoagulation was started in one patient because of atrial fibrillation diagnosis. In the subgroup of patients with daily recording, QTc interval prolongation peaked at day 2 ± 1,8, with a shorter final QT interval than that recorded before drug initiation (350,0 ± 31,4 vs 381,0 ± 21,2; p = 0,019), pointing to a possible role of the disease itself in QT interval modification.
To assess the consistency of measurements of QTc interval, a random sample of 120 EKG recordings were analyzed by two different physicians. Inter-operator intraclass correlation coefficient was 0,702, 95% CI (0,578-0,789).

Conclusions
Portable EKG-recording device was useful for QTc interval monitoring in COVID-19 patients receiving drugs with QTc prolonging potential, allowing physicians to adapt management. Significant QT prolongation was observed in these patients. Characteristics of the three groups.Group 1(one drug)N= 9 (13,0%)Group 2(two drugs)N= 37 (53,6%)Group 3(three drugs)N= 23 (33,3%)p-valueClinical characteristicsAge (years)55,0 ± 18,366,0 ± 16,258,0 ± 15,8p = 0,248Male sex (%)6 (66,7%)25 (67,6%)18 (78,3%)p = 0,643Dislipidaemia (%)5 (55,6%)9 (24,3%)7 (30,4%)p = 0,749Diabetes (%)7 (77,8%)4 (10,8%)5 (21,7%)p = 0,525Hypertension (%)3 (33,3%)16 (43,2%)8 (34,8%)p = 0,387Previous cardiopathy (%)6 (66,7%)11 (29,7%)3 (13,0%)p = 0,305COPD (%)7 (77,8%)6 (16,2%)1 (8,7%)p = 0,679COPDchronic obstructive pulmonary disease.Abstract Figure. Baseline and maximum QTc intervals
Virtual reality to improve patient information and reduce anxiety towards atrial fibrillation ablation in times of remote patient care (and after)
Authors: Hermans ANL , Van Duijnhoven P , Verhaert DVM , Philippens S , Lahaije M , Clerx K , Debie L , Den Uijl DW , Vernooy K , Linz D , Weijs B 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Nowadays frequently deployed invasive catheter ablation therapy in patients with symptomatic atrial fibrillation (AF) is unfortunately associated with distress such as preoperative anxiety. Improving preoperative patient information may lower anxiety towards AF ablation procedures.
Purpose. To evaluate whether a lifelike 360˚ virtual reality (VR) patient information video decreases anxiety levels and improves patient preparation towards AF ablation as compared to standard preoperative patient information.
Methods. Consecutive patients planned for AF ablation were recruited from the outpatient AF clinic and were randomized into two groups: the control group and the intervention group (VR group). The control group received standard preoperative information through oral counselling and information leaflets, the VR group received the standard information as well as a short dedicated 360˚ VR video (via in-hospital VR headset and disposable cardboard VR glasses for home use). Online questionnaires (aimed at information provision, anxiety and procedural experience) were administered both pre- and post-ablation.
Results. A total of 103 patients (39.8% female, age 64 [58-71] years) were included in the analysis. The VR group (n = 58) reported to be clearly better informed about catheterization laboratory environment (78% vs. 73%) and the course of the procedure (82% vs. 78%), indicated fewer concerns about the procedure (47% vs. 55%) and were eager to learn even more (82% vs. 74%) as compared to controls (n = 45). However, there was no significant difference in the anxiety scores between the VR group and controls (10 [8-12] vs. 10 [8-14], p = 0.548). Home use of the video was satisfactory and resulted in discussion with relatives. Patient overall satisfaction was higher in VR group as compared to controls (84% vs. 81%).
Conclusions. This study shows that a dedicated 360˚ VR video reduces concerns but does not reduce anxiety scores. Though, it easily improves procedural knowledge, patient information and patient satisfaction. Especially in times of remote patient care, this new way of informing patients may be of added value.
Desmosomal vulnerability renders left atria more susceptible to detrimental effects of androgenic anabolic steroids
Authors: Sommerfeld L , Holmes AP , Kavanagh DM , Pike JA , O Shea C , Cardoso VR , Kabir SN , Pavlovic D , Gehmlich K , Stoll M , Gkoutos GV , Kirchhof P , Fabritz L 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): CATCH ME Foundation Leducq

BACKGROUND
In cardiac myocytes, desmosomal proteins and ion channels form macromolecular complexes important for maintaining cell adhesion and electrical integrity. High serum levels of androgenic anabolic steroids (AAS) promote cardiac muscle growth, but any detrimental impact on atrial gene transcription and/or electrophysiological function is unknown.

PURPOSE
To investigate the effects of chronic AAS exposure on atria in a mouse model with desmosomal impairment.

METHODS
Young (8-10 week) male wild-type (WT) and heterozygous plakoglobin-deficient (plako+/-) mice were challenged with the AAS dihydrotestosterone (DHT) or placebo for 6 weeks by osmotic mini pumps. RNA sequencing (n = 3-6 atria/group) revealed effects of genotype and DHT on left atrial (LA) transcription. Membrane-localised cardiac sodium channels (Nav1.5) were visualised using direct STochastic Optical Reconstruction Microscopy (dSTORM, n = 5-11 LA/group, 122 cells in total) and clustering of individual molecules was quantified using persistence-based clustering. Patch clamping of LA cardiac myocytes was used to record whole cell sodium currents (n = 4-5 LA/group, 77 cells in total). LA action potentials and conduction velocity were evaluated using microelectrode and optical mapping techniques (n = 5-9 LA/group).

RESULTS
DHT increased expression of pro-hypertrophic transcripts, e.g. Igf1, Mtpn, fibrosis-associated transcripts, e.g. Col1a1, Col3a1, Lox and pro-inflammatory transcripts, e.g. Ccl6, C7, in both WT and plako+/- LA. Despite Scn5a transcript levels being maintained, dSTORM identified a 29% reduction (p = 0.042) in the number of Nav1.5 localisations at the membrane of plako+/- DHT LA cardiomyocytes, and 25% fewer localisations (p = 0.005) were found within Nav1.5 clusters, compared to WT DHT. Electrophysiological methods revealed a significant reduction in peak sodium current density, decreased action potential amplitude and conduction slowing in plako+/- LA after exposure to DHT.

CONCLUSION
This data suggests that a reduction in plakoglobin expression predisposes atrial cardiomyocytes to detrimental electrophysiological effects of high testosterone levels. This is characterised by a perturbed spatial organisation of Nav1.5, decreased sodium current density and conduction slowing. Abstract Figure. Abstract Picture
Impact of epicardial fat on the duration of radiofrequency energydelivery during catheter ablation of atrial fibrillation
Authors: Oudin V , Marcus C , Faroux L , Espinosa M , Metz D , Lesaffre F 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Aims
This study aimed to determine the impact of the volume of epicardial fat on the duration of radiofrequency (RF) energy delivery during the procedure of ablation of atrial fibrillation (AF).

Methods
The volume of epicardial fat was measured from spiral computerized tomography scan. The primary endpoint was the duration of RF delivery for pulmonary vein isolation (PVI), and the overall total duration of RF application. Secondary endpoint was conversion of AF to sinus rhythm or organisation of the arrhythmia after PVI.
Results
From March 2015 to May 2018, 222 patients (45,5% with persistent AF) underwent a first RF catheter ablation procedure for AF. The total duration of RF delivery, and the duration of RF delivery specifically for PVI were significantly associated with higher total volume of epicardial fat (p = 0,0002; p = 0,009 respectively), periatrial (p = 0,003; p = 0,045) and periventricular epicardial fat (p = 0,001; p = 0,012). In multivariate analysis, total epicardial fat volume was not significantly associated with total RF delivery duration (p = 0,743). For patients with arrhythmia at the time of the procedure, patients who achieved conversion or organisation of their arrhythmia after PVI had similar levels of total epicardial fat to those whose arrhythmia persisted (65 ± 35,2 vs 74,5 ± 31,2 ml ; p = 0,192).
Conclusion We observed a significant relation between total, periatrial, and periventricular epicardial fat, and the duration of RF delivery during ablation of AF. This relation was not significant by multivariate analysis meaning that epicardial fat maybe a marker, but not an independent factor,of ablation complexity.
Autonomous initiation of pacemaking by L-type Cav1.3 calcium channels in mouse sino-atrial myocytes
Authors: Louradour J , Bidaud I , Le Guennec JY , Mangoni M , Mesirca P 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Ecole doctorale

Background
Cardiac pacemaking relies on the spontaneous electrical activity in the right atrium of sino-atrial myocytes (SANCs). Automaticity in SANCs results from a robust interplay of membrane ion channels activity and intracellular calcium dynamics. However, only a fraction of isolated SANCs exhibit rhythmic firing, whereas most SANCs show irregular (dysrhythmic) firing or remain dormant.

Purpose
To study the capability of L-type Cav1.3 calcium channels to initiate automaticity in dormant SANCs under β-adrenergic stimulation, we used a knock-in mouse strain in which the sensitivity of Cav1.2 α1 subunits to dihydropyridines (DHP) was inactivated (Cav1.2DHP-/-).

Methods
We performed current and voltage-clamp recordings on isolated SANCs under isoprenaline (ISO, 100 nM) and in the absence or presence of the DHP blocker Nifedipine (Nife, 3 µM).

Results
Nife significantly reduced the spontaneous firing under ISO perfusion in all rhythmic SANCs (ISO: 447 ± 12, ISO + Nife: 233 ± 25 bpm) and 60% of dysrhythmic SANCs (ISO: 386 ± 12, ISO + Nife: 188 ± 47 bpm) whereas it completely stopped it in the remaining 40% (295 ± 29 bpm to 0). On 25 dormant SANCs, 50% started firing after ISO perfusion (0 to 320 ± 46 bpm). Strikingly, in 75% of them, Nife totally blocked this ISO-induced firing. Interestingly, these cells exhibited a significantly slower rate and a slower slope of the diastolic depolarization under ISO perfusion compared to the remaining 25% dormant SANCs in which Nife only reduced the ISO-induced firing. Moreover, dormant SANCs showed a statistically significant increase in action potential (AP) threshold under ISO compared to dysrhythmic and rhythmic SANCs (dormant: -30.1 ± 2.5, dysrhythmic: -43.3 ± 2.3, rhythmic: -41.2 ± 2.1 mV). No significant difference was observed in the other AP parameters between dormant, dysrhythmic and rhythmic SANCs under ISO.

Conclusion
Our results seem to point at a difference of expression in ionic channels (Cav1.3, HCN4) within isolated SANCs. Preliminary results on If density support this hypothesis with a lesser density in dormant SANCs compared to dysrhythmic SANCs. These results also tend to indicate that Cav1.3 channels can generate pacemaker activity autonomously, at least in a particular subpopulation of SANCs.
The influence of frailty syndrome on quality of life in patients with atrial fibrillation
Authors: Lomper K , Loboz-Rudnicka M , Uchmanowicz I , Jaroch J 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Atrial fibrillation (AF) is associated with decreased quality of life (QoL) compared to the general population and to other cardiovascular conditions. In addition, the co-occurrence of frailty syndrome (FS) affects the risk of developing adverse health outcomes including disability and rehospitalizations. This may further translate into a decreased subjective sense of QoL.

Purpose
To evaluate the prevalence of FS and its impact on subjective QoL in a group of patients with AF.

Methodology
116 patients (mean age 75.21 ± 8.19) with diagnosis of AF hospitalized at the Cardiology Department were included in the study. Medical record analysis and self-administered questionnaire were used to obtain basic sociodemographic and clinical data. The prevalence of FS was assessed using the Tilburg Frailty Indicator (TFI) questionnaire. The standardized Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA) assessing quality of life was used.

Results
FS was diagnosed in 67.24% of the patients. The group with FS was predominantly elderly (p &lt; 0.001), female (p = 0.03), less educated (p = 0.04), single (p= &lt;0.001), with coexisting heart failure (p = 0.015 ) and with higher EHRA classification (p = 0.014). Better QoL was demonstrated in the group of patients without FS in the total score (p = 0.004), psychological domain (p = 0.014) and physical domain (p = 0.004). There was a significant positive correlation of TFI total score with overall QoL (B = 0.383; p &lt; 0.001) and psychological (B = 0.355; p &lt; 0.001) and physical (B = 0.336; p &lt; 0.001) domains.

Conclusions
FS is common in patients with AF. Assessment of FS occurrence is important for everyday clinical practice because FS lowers QoL. The consequence of FS and decreased QoL may be worse patient prognosis and increased number of hospitalizations.
Soluble ST2 and renal function in ischemic heart failure with atrial fibrillation
Authors: Lashkul D 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Soluble ST2 (sST2) is a novel cardiac biomarker whose concentration rises in response to myocardial strain. The aim of this study was to analyse the relationship between soluble ST2 (sST2) level and renal function in heart failure (HF) patients with atrial fibrillation (AF).

Methods
The study involved 113 (83.2% men) patients with mean age 60.0 [54.0-67.0] years with II-IV functional class (recommendations of the New York Heart Association) is due to ischemic heart disease. Serum levels of N-terminal proBNP (NT-proBNP), sST2, TIMP-1 and Cystatine C (CysC) were quantified by ELISA of 33 patients with HF and AF and 80 patients with HF without AF. Echocardiography was performed according to the American Society of Echocardiography/European Association of Echocardiography recommendations. Estimated glomerular filtration rate (eGFR) was calculated by MDRD formula. Nonparametric Mann-Whitney U-test for independent data, Spearman’s rank correlation and multiple linear regression coefficients were calculated.

Results
Patients with HF and AF characterized significantly higher concentration of sST2 (1453.2 [1184.3-1945.7] vs 1279.7 [1110.9-1616.6] pg/ml, p = 0.05), as well as the marker of kidney dysfunction CysC (1375 [1111.7-1867.4] vs 1136.4 [955-1386.4] ng/ml, p = 0.02) and was significantly lower eGFR (67.7 [60.6-77.2] vs 79.3 [70.9-88.0] ml/min/1.73m2; p = 0.0002). sST2 correlated with TIMP-1 (r = 0.56; p = 0.004) E/e’ (r = 0.87; p = 0.002), as well as CysC with NT-proBNP (r = 0.56; p = 0.002), with age (r = 0.49; p = 0.009) in patients with HF and AF. At multivariate linear regression analysis, only TIMP-1 (β=0.63) and left atrial volume index (β=0.22) were independently associated with sST2 (R2 = 0.58; p = 0.002).

Conclusions
In patients with ischemic HF and atrial fibrillation elevation sST2, associated with high level cystatine C and correlated with TIMP-1, E/e’, markers which showed abnormal collagen homeostasis and significant diastolic dysfunction LV. Multivariate analysis shows, that sST2 independently associated with TIMP-1 and LAVi. Further studies are needed to clarify the prognostic role of marker renal function (CysC) and cardiovascular stress (sST2) in ischemic HF patients with atrial fibrillation.