bluuebunny/crossref_metadata_2025_split huggingface dataset:
A rare and reversible cause of third-degree atrioventricular block: a case report
Authors: Lee Gino , Badertscher Patrick , Sticherling Christian , Osswald Stefan 
Published: October 2021

Abstract

Background
Cardiac involvement of Lyme disease (LD) typically results in atrioventricular (AV) conduction disturbance, mainly third-degree AV block.

Case summary
A 54-year-old patient presented to our emergency department due to recurrent syncope. Third-degree AV block with a ventricular escape rhythm (33 b.p.m.) was identified as the underlying rhythm. Transthoracic echocardiography (TTE) was normal. To rule out common reversible causes of complete AV block, a screening test for Lyme borreliosis was carried out. Elevated levels for borrelia IgG/IgM were found and confirmed by western blot analysis. Lyme carditis (LC) was postulated as the most likely cause of the third-degree AV block given the young age of the patient. Initiation of antibiotic therapy with ceftriaxone resulted in a gradual normalization of the AV conduction with stable first-degree AV block on Day 6 of therapy. The patient was changed on oral antibiotics (doxycycline) and discharged without a pacemaker. After 3 months, the AV conduction recovered to normal.

Discussion
Lyme carditis should always be considered, particularly in younger patients with new-onset AV block and without evidence of structural heart disease. Atrioventricular block recovers in the majority of cases after appropriate antibiotic treatment.
The effect of mental health conditions on the use of oral anticoagulation therapy in patients with atrial fibrillation: the FinACAF study
Authors: Jaakkola Jussi , Teppo Konsta , Biancari Fausto , Halminen Olli , Putaala Jukka , Mustonen Pirjo , Haukka Jari , Linna Miika , Kinnunen Janne , Tiili Paula , Aro Aapo L , Hartikainen Juha , Airaksinen K E Juhani , Lehto Mika 
Published: October 2021

Abstract

Aims
Little is known about the effects of mental health conditions (MHCs) on the utilization of oral anticoagulation (OAC) therapy in atrial fibrillation (AF) patients. We aimed to assess whether MHCs affect initiation of OAC therapy among AF patients with special focus on non-vitamin K antagonist oral anticoagulants (NOACs).

Methods and results
The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) registry included all 239 222 patients diagnosed with incident AF during 2007–18 in Finland identified from national registries covering primary to tertiary care and drug purchases. Patients with previous depression, bipolar disorder, anxiety disorder, or schizophrenia diagnosis or a fulfilled psychiatric medication prescription within the year preceding the AF diagnosis were classified to have any MHC. The main outcome was OAC initiation, defined as first fulfilled OAC prescription after AF diagnosis. The patients’ mean age was 72.7 years and 49.8% were female. The prevalence of any MHC was 19.9%. A lower proportion of patients with any MHC compared with those without MHCs were initiated on OAC therapy (64.9% vs. 73.3%, P &lt; 0.001). Any MHC was associated with lower incidence of OAC initiation [adjusted subdistribution hazard ratio (aSHR) 0.867; 95% confidence interval (CI) 0.856–0.880], as were depression (aSHR 0.868; 95% CI 0.856–0.880), bipolar disorder (aSHR 0.838; 95% CI 0.824–0.852), anxiety disorder (aSHR 0.840; 95% CI 0.827–0.854), and schizophrenia (aSHR 0.838; 95% CI 0.824–0.851), during the entire follow-up. Any MHC remained associated with impaired incidence of OAC initiation also in the NOAC era during 2015–18 (aSHR 0.821; 95% CI 0.805–0.837).

Conclusion
MHCs are common among AF patients, and they are associated with a lower rate of OAC initiation even during the NOAC era.
Application of local gentamicin in the treatment of deep sternal wound infection: a randomized controlled trial
Authors: Vos Roemer J , van Putte Bart P , de Mol Bas A J M , Hoogewerf Marieke , Mandigers Tim J , Kloppenburg Geoffrey T L 
Published: October 2021

Abstract

OBJECTIVES
In patients with deep sternal wound infection (DSWI), primary closure of the sternal bone over high negative pressure Redon drains has shown to be a safe and feasible treatment method. Addition of local gentamicin could accelerate healing and improve clinical outcomes.

METHODS
We conducted a randomized controlled trial to evaluate the effectiveness of local gentamicin in the treatment of DSWI. In the treatment group, collagenous carriers containing gentamicin were left between the sternal halves during sternal refixation. In the control group, no local antibiotics were used. Primary outcome was hospital stay. Secondary outcomes were mortality, reoperation, wound sterilization time, time till removal of all drains and duration of intravenous antibiotic treatment.

RESULTS
Forty-one patients were included in the trial of which 20 were allocated to the treatment group. Baseline characteristics were similar in both groups. Drains could be removed after a median of 8.5 days in the treatment group and 14.5 days in the control group (P-value: 0.343). Intravenous antibiotics were administered for a median of 23.5 days in the treatment group and 38.5 days in the control group (P-value: 0.343). The median hospital stay was 27 days in the treatment group and 28 days in the control group (P-value: 0.873). Mortality rate was 10% in the treatment group and 9.5% in the control group (P-value: 0,959). No side effects were observed.

CONCLUSIONS
This randomized controlled trial showed that addition of local gentamicin in the treatment of DSWI did not result in shorter length of stay.

Clinical trial registration number
2014-001170-33.
Outcomes of novel pacing technologies with right ventricular pacing as a primary strategy for patient undergoing transvenous permanent pacing regardless of pacing indication
Authors: Abdin A , Aktaa S , Vukadinovic D , Arbelo E , Boehm M , Burri H , Glikson M , Meyer C , Munyombwe T , Nielsen N C , Vernooy K , Ukena C , Gale C P 
Published: October 2021

Abstract

Background
Right ventricular pacing (RVP) may cause electrical and mechanical desynchrony leading to impaired left ventricular ejection fraction (LVEF). We investigated the outcomes of RVP with His bundle pacing (HBP) and left bundle branch pacing (LBBP) for patients requiring a de novo permeant pacemaker (PPM) irrespective of baseline pacing indication.

Methods and results
Systematic review of randomized clinical trials and observational studies comparing HBP or LBP with RVP for de novo PPM implantation between 01 January 2013 and 17 November 2020 using MEDLINE and Embase. Two independent reviewers extracted the data and assessed the risk of bias of included studies. Random and fixed effects meta-analyses of the effect of pacing technology on study outcomes (all-cause mortality, heart failure hospitalization (HFH), left ventricular ejection fraction, QRS duration, lead revision, atrial fibrillation and procedure and pacing metrics) were performed. Overall, 7 studies were included. HBP compared with RVP was associated with decreased mortality (risk ratio [RR] 0.76, 95% CI 0.59 to 0.98), preservation of LVEF (mean difference [MD] 1.2, 95% CI −1.37 to 3.8 vs. −5.22, 95% CI: −6.94 to −3.51), increased procedure duration (MD 15.17 min, 95% CI: 11.27 to 19.07) and more lead revisions (RR 6.30, 95% CI: 2.31 to 17.19). LBBP compared with RVP was associated with shorter paced QRS durations (MD 5.6 ms, 95% CI −6.4 to 17.6) vs. (51.0 ms, 95% CI 39.2 to 62.9) and increased procedure durations (MD 37.78 min, 95% CI: 20.04 to 55.51).

Conclusion
Of the limited studies published, this meta-analysis found that HBP and LBBP were superior to RVP in maintaining physiological ventricular activation as an initial pacing strategy. Well conducted comparative studies are required to understand the impact of such novel pacing strategies on clinical outcomes.

Funding Acknowledgement
Type of funding sources: None.
Prevalence and incidence rates of atrial fibrillation in Denmark 2004–2018
Authors: Hegelund E.R , Kjerpeseth L.J , Mortensen L.H , Igland J , Berge T , Anjum M , Tell G.S , Ariansen I 
Published: October 2021

Abstract

Background
Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with substantial morbidity and mortality. Its prevalence is currently rising partly due to population ageing. However, reported trends in incidence rates are conflicting, and the comparability of existing reports is limited due to methodological inconsistencies across studies.

Purpose
The main purpose of the current study was to investigate the prevalence of AF in the Danish adult population and time trends in incidence rates from 2004 through 2018. As a secondary purpose, the prevalence and incidence were compared to corresponding Norwegian estimates from 2004 through 2014 derived using the same methodology.

Methods
A register-based study was conducted including all individuals aged ≥18 years in Denmark from 2004–2018. AF cases were identified in the National Patient Register and the Cause of Death Register, which comprise information on all hospital contacts and deaths in Denmark, respectively. The prevalence of AF was calculated as the number of individuals alive at the end of the study period with at least one registered diagnosis from 1994 through 2018 divided by the number of Danish residents aged ≥18 years. Incidence rates were calculated as the number of annual AF cases with no previous diagnosis noted in the past 10 years divided by the person-time contributed by the population free of AF on 1 January in the same calendar year. All incidence rates were standardized according to a Nordic standard population. The comparison of the Danish and Norwegian incidence estimates focused solely on AF hospitalizations and deaths from 2004 through 2014.

Results
The cumulative prevalence of AF was 3.0% in the Danish adult population. The incidence increased from 391 per 100,000 person-years in 2004 to 481 per 100,000 person-years in 2015, after which it declined to 367 per 100,000 person-years in 2018 (Figure 1). On average, the incidence increased by 1.7% annually until 2015 (IRR: 1.017 (95% CI: 1.016–1.018); p&lt;0.001) and then declined by 8.5% (IRR: 0.915 (95% CI: 0.909–0.921); p&lt;0.001). Although the incidence rates generally were higher among men and older individuals, a similar time trend was observed in both men and women irrespective of age. Focusing solely on AF hospitalizations and deaths did not change the interpretation of the results. The comparable Norwegian estimates will be presented at the conference.

Conclusions
The prevalence of AF is currently around 3.0% in the Danish adult population, but the incidence rate has declined steeply since 2015. The observed decline in new cases is promising from a public health perspective and its underlying causes warrant further investigation.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Novo Nordisk Foundation Figure 1
High level of growth differentiation factor 15 and lower left ventricular ejection fraction as predictors of left atrial thrombosis in patients with nonvalvular atrial fibrillation
Authors: Belokurova A.V , Gizatulina T.P , Khorkova N.Y.U , Martyanova L.U , Petelina T.I , Shirokov N.E 
Published: October 2021

Abstract

Background
The presence of left atrial/left atrial appendage (LA/LAA) thrombus is used as a surrogate marker of potential stroke in patients (pts) with atrial fibrillation (AF).

Purpose
To assess the role of growth differentiation factor 15 (GDF-15) level, clinical and echocardiographic (EchoCG) data as predictors of LA/LAA thrombus in pts with nonvalvular AF.

Methods
Out of 158 pts with nonvalvular AF admitted to Cardiology Center for radiofrequency ablation or elective cardioversion in 2019–2020 2 groups were formed according to transesophageal EchoCG results: group 1 included pts without LA/LAA thrombus (n=102, mean age 59.5±6.0 years) and group 2 (n=42, mean age 60.9±8.8 years) – pts with LA/LAA thrombus. Arterial hypertension was found in 93 pts of group 1 (91%) and in 40 pts of group 2 (95%, p=0.42), coronary artery disease - in 53 pts (52%) and 29 pts (69%), respectively (p=0.06). Both groups did not differ in frequency and spectrum of oral anticoagulants administration. General clinical assessment, EchoCG, and laboratory tests were performed, including GDF-15 (pg/ml) levels using Human GDF-15/MIC-1 ELISA kit and NT-proBNP (pg/ml) in blood.

Results
Pts with LA/LAA thrombus more often had persistent AF, while paroxysmal AF was more common in pts without thrombus. There was a tendency to more significant congestive heart failure in group 2. Mean CHA2DS2-VASc score was higher in pts with LA/LAA thrombus, also there was a tendency to a larger proportion of pts with scores ≥3. According to EchoCG data, sizes and volumes of both atria, right ventricle, end-systolic volume, left ventricular (LV) size, pulmonary artery systolic pressure and LV mass index were higher in group 2; LV ejection fraction (LVEF) was normal in both groups, but it was significantly lower in pts with LA/LAA thrombus: 59.1±5.1 and 64.0±7.3, respectively (p&lt;0.001). GDF-15 and NT-proBNP levels were significantly higher in group 2 compared to group 1: p=0.00025 and p=0.ehab724.048801 respectively. According to ROC analysis cut-off were set at level &gt;935.0 pg/ml for GDF-15 (AUC=0.705, 95% CI 0.609–0.800, p&lt;0.001) and &gt;143 pg/ml for NT-proBNP (AUC=0.759, 95% CI 0.670–0.849, p&lt;0.001). Multivariate logistic regression revealed the following variables as independent predictors of LAAT: GDF-15 &gt;935.0 pg/ml (OR=4.132, 95% CI 1.305–13.084) and LVEF (OR=0.859, 95% CI 0.776–0.951). According to ROC analysis, the model had a good quality: AUC=0.776 (p&lt;0.001), sensitivity was 78.3%., specificity - 78.3%.

Conclusion
High level of GDF-15 (&gt;935.0 pg/ml) along with lower LVEF are independent predictors of LA/LAA thrombus in pts with nonvalvular AF.

Funding Acknowledgement
Type of funding sources: None.
Pulmonary congestion during exercise stress echocardiography in ischaemic, heart failure and valvular patients
Authors: Merli E , Zagatina A , Merlo P.M , Arbucci R , Borguezan Daros C , De Castro E Silva Pretto J.L , Amor M , Morrone D , D'Andrea A , Reisenhofer B , Rodriguez-Zanella H , Wierzbowska-Drabik K , Agoston G , Ciampi Q , Picano E ,   the Stress Echo 2020 study group of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI)
Published: October 2021

Abstract

Background
Lung ultrasound (LUS) detects pulmonary congestion as B-lines at rest and exercise stress echocardiography (ESE).

Aim
To assess the prevalence of B-lines during ESE in different cardiovascular diseases.

Methods
We performed ESE plus LUS (4-site simplified scan) in 4419 subjects referred for semi-supine bike ESE in 28 certified centers. B-lines score ranged from 0 (normal) to 40 (severely abnormal). Stress B-lines abnormal result was ≥2 units. Six different populations were evaluated: healthy controls (n=103); chronic coronary syndromes (CCS, n=3701); heart failure with reduced ejection fraction (HFrEF, n=395); heart failure with preserved ejection fraction (HFpEF, n=70); valvular heart disease (VHD) for ischemic mitral regurgitation ≥moderate at rest (n=123); repaired tetralogy of Fallot (ToF, n=27).

Results
Feasibility of B-lines was 100% at rest and peak ESE in all subjects. Imaging and analysis time were &lt;1 minute. B-lines (median) were not detectable in healthy subjects (rest=0.1 [0–1] vs 0.1 [0–1], p=ns) and TOF (rest=0.2 [0–2] vs 0.3 [0–4], p=ns), but were present in all other groups: see figure. During ESE, B-lines increased in CCS (rest=0.5 [0–24] vs ESE=1.3 [0–28], p&lt;0.001); HFrEF (rest=1.4 [0–35] vs ESE=2.9 [0–40], p&lt;0.001); HFpEF (rest=0.3 [0–2] vs ESE=3.4 [0–12], p&lt;0.001), VHD (rest=1.7 [0–12] vs ESE=4.3 [0–23], p&lt;0.001). Stress B-lines were correlated with stress-rest change in wall motion score index in CCS (r=0.325, p&lt;0.001), contractile reserve in HFrEF (r=−0.266, p&lt;0.001) and in VHD (r=−.0300, p=0.001), left atrial volume stress-rest change in HFpEF (r=0.287, p=0.043).

Conclusion
B-lines identify the pulmonary congestion phenotype at rest and more frequently during ESE in patients with different coronary, myocardial or valvular heart disease, all sharing the final common pathway of acute backward left heart failure through different disease-specific mechanisms. B-lines are absent in healthy subjects and in conditions inducing a mostly right-sided overload such as repaired ToF.

Funding Acknowledgement
Type of funding sources: None. Figure 1. B-lines at rest and during stress. Percentage (%) of rest (empty bar) and stress (full bar) B-lines abnormality (≥2 units) in six different study groups.
Pharmacological cardioversion of recent-onset atrial fibrillation in patients with chronic kidney disease: sub-analysis of the CANT study
Authors: Ceynowa-Sielawko B , Wybraniec M , Topp-Zielinska A , Maciag A , Miskowiec D , Krzowski B , Balsam P , Wojcik M , Wrobel W , Farkowski M , Kozinski M , Kasprzak J , Szwed H , Mizia-Stec K , Szolkiewicz M 
Published: October 2021

Abstract

Purpose
Pharmacological cardioversion (PCV) is commonly a primary option for termination of recent-onset atrial fibrillation (AF) at the emergency departments (ED), and there are reports proving that antazoline is a noteworthy agent to restore sinus rhythm. This is a sub-analysis of the CANT study evaluating the effectiveness and safety of antazoline in patients with AF at different stages of chronic kidney disease (CKD).

Methods
Total n=777 patients admitted to ED for the urgent termination of AF were included into this analysis. We analysed the results concerning effectiveness and safety of PCV with special consideration of antazoline, in patients at 3 stages of CKD defined on the basis of eGFR (CKD-EPI): Group I ≥60 mL/min (n=531), Group II 45–59 mL/min (n=149), and Group III &lt;45 mL/min (n=97). Primary end-point was the termination of AF, a restoration of a sinus rhythm and its persistence until discharge.

Results
Patients of group III were older and with higher prevalence of comorbidities, however, we have not found statistically significant differences in overall effectiveness of PCV in comparison with the other groups. In patients receiving amiodarone, the PCV success rate was similar in all the studied groups, but along with a renal function decline, it decreased in patients receiving antazoline (79.1 vs 35%; p&lt;0.001), and it increased close to a significant manner in patients receiving propafenone (69.9 vs 100%; p=0.067; Figure). In patients of Group I, antazoline restored a sinus rhythm as effectively as propafenone and amiodarone, however in patients of Group III, both antazoline and amiodarone became less effective in restoring a sinus rhythm than propafenone (p=0.002 and p=0.034, respectively). The rate of safety endpoint was highest in patients of Group III (eGFR&lt;45 mL/min), and it was significantly higher than in patients of Group I and II (p=0.008 and p=0.036, respectively). We have not observed antazoline-related adverse events in any of studied groups of patients.

Conclusion
This real-world registry analysis revealed a different influence of CKD on individual drug effectiveness, and while propafenone and amiodarone maintained their AF termination efficacy, antazoline became significantly less effective in restoring sinus rhythm. Its favourable safety profile has not changed.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): The study received no external funding
Maintaining sinus rhythm after electrical cardioversion
Authors: Menezes Fernandes R , Mota T.F , Costa H.A , Espirito Santo M , Bento D , Candeias R , Mimoso J , Jesus I 
Published: October 2021

Abstract

Introduction
Atrial fibrillation (AF) and atrial flutter (AFL) are commonly terminated by electrical cardioversion (EC) when a rhythm control strategy is adopted. However, the long-term success following EC is variable.

Purpose
To determine the clinical characteristics and independent predictors of sinus rhythm (SR) maintenance after EC due to AF/AFL.

Methods
We conducted a retrospective study enrolling patients with AF/AFL referred to EC in our Cardiology Department, from September 2011 to September 2020. Clinical characteristics and echocardiographic studies were analysed. Primary endpoints were the incidence of ischemic stroke, all-cause and cardiovascular (CV) mortality. Independent predictors of SR maintenance were identified through a binary logistic regression analysis, considering p=0,05.

Results
A total of 719 patients with a median age of 67 years-old were included, and EC was successfully performed in 93,2%. AFL was diagnosed in 21%, 57,3% had arterial hypertension and 34,6% were obese. 62,1% had persistent AF/AFL, 19,6% presented with first diagnosed AF/AFL and 17,2% had paroxysmal episodes. Left ventricular ejection fraction (LVEF) was preserved in 66,7%. Maintenance of SR after one-year was documented in 64,7% of patients with successful EC. They had lower prevalence of chronic kidney disease (CKD) (2,6% vs 10,7%; p&lt;0,001) and received less electrical shocks during EC (1,20 vs 1,39; p=0,005). There were no differences regarding antiarrhythmic therapy between both groups. Complete LVEF recovery after EC was more frequent in patients who maintained SR (58,8% vs 31,9%; p=0,008), with a greater prevalence of preserved LVEF after EC (88,8% vs 73,6%; p&lt;0,001). During a median follow-up of 1368 days, these patients performed less additional EC (0,26 vs 0,65; p&lt;0,001) and were less referred to ablation procedures (7,1% vs 15,1%; p=0,011). No differences were found regarding stroke rate, but all-cause mortality (12,8% vs 25%; p=0,002) and CV death (3,8% vs 10,9%; p=0,005) were significantly lower in patients who maintained SR. Absence of CKD (p=0,013), applying fewer electric shocks during EC (p=0,013) and preserved LVEF after EC (p=0,004) were independent predictors of SR maintenance.

Conclusion
In our study, most patients maintained SR one year after EC, which was associated with a lower all-cause and CV mortality. Absence of CKD, applying fewer electric shocks during EC and preserved LVEF after EC were independent predictors of SR maintenance.

Funding Acknowledgement
Type of funding sources: None.
The impact of abnormal conduction zone on outcomes after catheter ablation for atrial fibrillation
Authors: Mine T , Kishima H , Fukuhara E , Kitagaki R , Ishihara M 
Published: October 2021

Abstract

Background
The abnormal conduction zone (ACZ) in the left atrium (LA) has attracted attention as an arrhythmia substrate in atrial fibrillation (AF).

Purpose
We investigated whether the ACZ affects outcomes after catheter ablation (CA) for AF.

Methods
We studied 78 patients (42 Non-paroxysmal AF, 49 males, and 68±10 years) who received CA for AF. High-density LA mapping during high right atrial pacing was constructed gaining than 2000 points (average 4377±846 points). Isochronal activation maps created at 5-ms interval setting. ACZ was identified by locating a site with isochronal crowding of ≥3 isochrones, and ≥8 isochrones were defined as the conduction block zone (CBZ) in a 4-mm diameter tag (conduction velocity were calculated as ≤27 cm/s and≤10 cm/s, respectively).

Result
Recurrent AF was detected in 25/78 patients (32%) during the follow-up period (9.2±3.0 month). ACZ and CBZ were distributed linearly, and ACZ was observed in 73 of 78 patients and 8 of these 73 patients had the CBZ. Univariate analysis revealed that elevated body mass index (26.2±3.8 vs. 24.3±3.3 kg/m2, P=0.0303), the higher prevalence of non-paroxysmal AF (72% vs. 45%, P=0.0272), larger LA diameter (47.6±6.6 vs. 42.1±6.9 mm, P=0.0014), and longer length of ACZ (79.7±45.1 vs. 52.9±35.7 mm, P=0.0058) were associated with recurrent AF after CA. On multivariate analysis, longer ACZ was independently associated with recurrent AF. Moreover, patients with longer ACZ (cutoff value: 84 mm) had a higher risk of recurrent AF than shorter ACZ (12/22; 55% vs 13/56; 23%, log-rank P=0.0024).

Conclusion
The length of ACZ was associated with recurrent AF after CA.

Funding Acknowledgement
Type of funding sources: None.