bluuebunny/crossref_metadata_2025_split huggingface dataset:
Obesity paradox in catheter ablation of atrial fibrillation: analysis of national inpatient sample 2016-2018
Authors: Thyagaturu H , Shah K , Li S , Thangjui S , Shrestha B , Naik R 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Obesity is a common cardiovascular risk factor and have been associated with favorable outcomes in congestive heart failure, coronary artery disease and atrial fibrillation (Afib), the so-called obesity paradox.

Purpose
To study the phenomenon of obesity paradox for in-hospital and procedural outcomes in catheter ablation of Afib hospitalizations.

Methods
We queried January 2016 to December 2018 National Inpatient Sample (NIS) to identify adult (≥18 yrs) hospitalizations with a primary diagnosis of Afib. Patients with appropriate ICD-10 PCS codes for catheter ablation were identified. Obese patients were compared with non-obese patients. We used the Chi-square tests to evaluate the differences between binary or categorical variables, and Student’s t-tests for continuous variables. Multivariate logistic regression was used in outcomes analysis to adjust for potential hospital and patient-level confounders.

Results
We identified 53,524 weighted catheter ablation of Afib procedural hospitalizations across three years. Of which, 13,335 (25%) of them were associated with obesity. The obese hospitalizations were associated with younger age (mean age 64.0 vs 69.3 yrs; P &lt; 0.01), higher persistent Afib (46.6% vs 37.5%; P &lt; 0.01), higher comorbidity burden (% of &gt;3 Elixhauser comorbidity score 96.8% vs 72.6%; P &lt; 0.01) and had more OSA (43.6% vs 14.7%; P &lt; 0.01). After adjusting for patient and hospital-level characteristics, we observed statistically significant decrease in odds of in-hospital mortality in obese Afib patients undergoing catheter ablation compared to non-obese [Odds Ratio (OR): 0.000004; P &lt; 0.01]. We also observed the obese group had statistically significant association with longer LOS [4.1 vs 3.8 days; P &lt; 0.01], lower total hospitalization charges [US$ 144,882 vs 157,412; P &lt; 0.01] and increased odds of post-operative respiratory failure [OR: 1.97 (1.03 – 3.7); P = 0.04] compared to non-obese group.

Conclusion
In this large retrospective study of catheter ablation of Afib hospitalizations, higher BMI and obesity was associated with decreased in-hospital mortality consistent with the obesity paradox phenomenon. However, it was associated with longer LOS. The vascular complications and other procedural outcomes except respiratory failure were comparable between both groups. Further prospective studies are necessary to verify our study findings.
Catheter ablation of atrial fibrillation without pulmonary vein isolation
Authors: Futyma P , Zarebski L , Wrzos A , Futyma M , Kulakowski P 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary vein isolation (PVI) is a cornerstone for catheter ablation (CA) of atrial fibrillation (AF), however, long-term efficacy of PVI is frequently below expectations. PVI is invasive, expensive and may be associated with devastating complications. It has been postulated that vagally-mediated AF can be treated by attenuation of parasympathetic drive to the heart using cardioneuroablation by means of radiofrequency CA (RFCA) of the right anterior ganglionated plexus (RAGP), however, data in literature and guidelines are lacking.

Purpose
To examine the efficacy of RFCA targeting RAGP without PVI in management of vagal AF.

Methods
We included consecutive 9 male patients with vagal AF who underwent RFCA of RAGP without PVI. RAGP was targeted anatomically from the right atrium (RA) at the postero-septal area below superior vena cava (SVC) and from the left atrium (LA) if needed. The aim was to achieve &gt;30% increase in heart rate (HR) . The follow up consisted of regular visits and Holter ECG conducted every 3 months.

Results
A total number of 9 patients (age 52 ± 13) with vagally-mediated AF underwent RFCA of RAGP (mean RAGP RF time 147 ± 85, max power 34 ± 8W). The mean procedure time was 60 ± 29min. HR increase &gt;30% was achieved in 8 (89%) patients (pre-RF vs post-RF: 58 ± 8bpm vs 87 ± 12bpm, p = 0.00002) . Transseptal to reach RAGP also from the LA was needed in 2 (22%) patients. There were no major complications during the procedures. The follow up lasted 6 ± 2 months. Antiarrhythmic drugs were discontinued in 8 (89%) patients. There was 1 (11%) AF recurrence in the patient in whom targeted HR acceleration during RFCA was not achieved. B-blockers were administered in 6 (67%) patients due to increased HR and such treatment was well tolerated by all.

Conclusions
Catheter ablation of RAGP without performing PVI is feasible and can be effective in majority of patients with vagally-mediated AF. Increased HR after such cardioneuroablation can be well controlled using b-blockers and is usually associated with mild symptoms. The role of cardioneuroablation for treatment of vagally-mediated AF needs to be determined in prospective trials. Abstract Figure. Cardioneuroablation in vagal AF
Extent of atrium with 1:1 electrogram activation predicts response to ablation of atrial fibrillation
Authors: Ganesan P , Bhatia N , Rogers AJ , Krummen D , Wang P , Clopton P , Rappel WJ , Narayan S 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): US National Institutes of Health

Background
Mechanisms associated with successful termination of persistent atrial fibrillation (AF) are still under debate. We sought to study the association between spatial extent of atrium with organized conduction and AF ablation success. We hypothesized that patients with large areas of atrium having 1:1 electrogram activation akin to ‘atrial tachycardia’ may have a higher likelihood of AF termination by ablation.

Methods
In n = 40 AF patients, n = 20 had termination by ablation ("Term"), and the remaining did not have AF termination by ablation ("Non-term"). Basket catheters (64 poles) were used to record unipolar electrograms (EGMs) in one or both atrium. Ablation targeted localized rotational/focal regions, after which pulmonary vein isolation was performed. Unipolar EGMs of 4sec duration at each 2x2 electrode neighborhood within 8x8 catheter grid were processed using a statistical correlation technique to identify the duration of 1:1 activations. Any EGM activation cycle that had a correlation above 80% was considered to be 1:1. Duration of contiguous 1:1 cycles was determined as percentage of total duration (4 sec).

Results
Spatial area of atrium (percentage of mapping field) and the corresponding 1:1 durations were assessed for patients in Term and Non-term groups. Fig A shows spatial 1:1 maps of a Term and a Non-term patient. Fig B shows examples of 1:1 and non-1:1 EGMs. Patients in Term group had higher average 1:1 atrial area than non-term group for any 1:1 duration (Fig C, 15 ± 22% vs 2 ± 4% with ≥70% 1:1 duration, p = 0.03). Positive and negative predictive values of duration≥70% for AF termination were 64.7%, and 75%, with specificity 60% and sensitivity 78.6%, exceeding clinical risk scores.

Conclusion
Persistent AF atrium shows areas of organized 1:1 conduction. Larger 1:1 atrial areas were identified in patients in whom AF terminated by ablation. Future studies should investigate mechanistic bases of organized conduction in AF. Abstract Figure.
Comparison of bleeding risk scores in patients with atrial fibrillation and cancer
Authors: Pastori D , Marang A , Bisson A , Herbert J , Lip GYH , Fauchier L 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Cancer may increase bleeding risk in atrial fibrillation (AF), but the association between cancer type and specific bleeding events has been scarcely investigated. Furthermore, the performance of bleeding risk scores in this high-risk subgroup of patients is unclear.
Purpose. To describe the incidence rate (IR) of major (MB), gastrointestinal (GI) bleeding and intracranial haemorrhage (ICH) according to cancer types. We also investigated the performance of HAS-BLED, ATRIA and ORBIT scores.

Methods
Observational retrospective cohort study including 399,344 patients with AF and cancer.
Results. Mean age was 77.9 ± 10.2 years and 63.2% were men. During 2.0 years follow-up, the IR of MB was as high as 8.41%/y, GI bleeding was 3.61%/y and ICH 1.33%/y. MBs were more frequent in liver (12.68%/y), leukaemia (12.39%/y), pancreas (11.71%/y), bladder (11.67%/y) and myeloma (11.64%/y). GI bleedings were highest in liver (7.54%/y), pancreas (7.42%/y) and gastric (5.51%/y). ICH was highest in leukaemia (1.89%/y), myeloma (1.52%/y), lymphoma/liver (1.45%/y) and pancreas (1.41%/y) cancer.
The Table shows the hazard ratio and AUC values for each bleeding score. All the three scores significantly associated with bleeding outcomes, with the HAS-BLED score performing better than others for ICH prediction, and the ORBIT score predicting MB and GI bleedings (p &lt; 0.0001 for all AUC comparisons).
Conclusions. Cancer increases the risk of bleeding in patients with cancer, with specific differences according to each cancer type. HAS-BLED score showed the best predictive value for ICH and the ORBIT score for MB and GI bleeding. MB GI bleeding ICH Hazard Ratio (95%CI) HASBLED score≥3 6.575 (6.390-6.765) 5.735 (5.502-5.978) 5.803 (5.416-6.218) ATRIA score≥5 5.372 (5.241-5.506) 3.617 (3.499-3.739) 1.469 (1.403-1.538) ORBIT score≥4 13.326 (12.977-13.686) 7.453 (7.202-7.712) 2.578 (2.463-2.699) AUC (95%CI) HASBLED score≥3 0.716 (0.714-0.718) 0.702 (0.699-0.704) 0.698 (0.694-0.702) ATRIA score≥5 0.700 (0.698-0.702) 0.662 (0.659-0.665) 0.563 (0.557-0.568) ORBIT score≥4 0.805 (0.804-0.807) 0.756 (0.753-0.758) 0.641 (0.635-0.646) AUC Difference (95% CI) HASBLED≥3 vs ATRIA≥5 0.016 (0.014-0.018) 0.040 (0.037-0.042) 0.136 (0.133-0.138) HASBLED≥3 vs ORBIT≥4 -0.089 (-0.091–0.087) -0.054 (-0.056–0.052) 0.057 (0.055-0.059) ATRIA≥5 vsORBIT≥4 -0.106 (-0.108–0.104) -0.094 (-0.095–0.092) -0.078 (-0.080–0.076)
Cerebral perfusion responses to active standing are attenuated in patients with vasovagal syncope
Authors: Perez-Denia L , Claffey P , O"reilly A , Delgado-Ortet M , Rice C , Kenny RA , Finucane C 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Irish Research Council (IRC): Government of Ireland Postgraduate Scholarship Programme 2018, Dublin, Ireland Fundació Universitària Agustí Pedro i Pons, Universitat de Barcelona, Barcelona, Spain

Background
Syncope is a transient loss of consciousness due to cerebral hypoperfusion. While traditionally peripheral haemodynamics are monitored during clinical assessment of syncope, relatively little is known about cerebrovascular haemodynamics during orthostasis in patients with syncope.

Purpose
Here we investigated whether young patients with syncope present an altered cerebral perfusion when compared to healthy controls. Given potential hyper-reactivity of the autonomic nervous system previously reported in these patients, we hypothesise that an overly active cerebral autoregulation will be present in patients with syncope.

Methods
Consecutive patients were prospectively recruited from a National Falls and Syncope Unit, and a convenience sample of young healthy community dwelling adults was recruited from a local university (16-30 years). Participants performed a 3 minute active stand test with continuous measurement of beat-to-beat peripheral haemodynamics (blood pressure (BP), heart rate (HR)) and changes in concentration of oxygenated Δ[O2Hb] and deoxygenated Δ[HHb] haemoglobin were derived from a near-infrared spectroscopy (NIRS) monitor. Baseline, steady state and other time domain features were derived for Δ[O2Hb] (nadir, overshoot, overshoot-to-nadir, overshoot-to-nadir recovery rate) and Δ[HHb] (peak, trough, peak-to-trough, peak-to-trough recovery rate) and multiple linear regression was used to compare differences between the two groups correcting for covariates (p &lt; 0.05 significant).

Results
Patients (n = 40) were younger (20(5.5) vs 23(1) years, p = 0.003) than controls (n = 17) and were well matched in gender, weight, height, BMI and resting haemodynamics. Patients had a smaller Δ[O2Hb] overshoot-to-nadir difference (β: -0.749, CI:(-1.593 0.094), p = 0.08), a slower Δ[O2Hb] recovery rate (β: -0.186, CI:(-0.388 0.016), p = 0.071), and smaller Δ[HHb] peak-to-trough difference (β: -0.530, CI:( -0.921 0.138), p = 0.018) and slower Δ[HHb] recovery rate (β: -0.151, CI: (0.244 0.057), p = 0.008).

Conclusion
Patients with syncope had signs of an attenuated cerebral oxygenation response to an AS when compared to controls. We hypothesise that this is due to hyper-reactive cerebral autoregulation mechanism, which might be related to a hyper-sensitive autonomic system. Furthering our understanding of vasovagal syncope physiology can help inform future interventions and treatments. This study shows the clinical value of measuring cerebral perfusion using NIRS, an easy to use and readily applicable tool, in the assessment of syncope. Abstract Figure. Cerebral oxygenation upon standing
Association of incident fragility fractures in patients hospitalised due to unexplained syncope and orthostatic hypotension
Authors: Johansson M , Rogmark C , Sutton R , Hamrefors V , Fedorowski A 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The study was funded by The Swedish Heart-Lung Foundation, The Greta and Johan Kock Foundation, and an Agreement for Medical Education and Research (ALF) grant by Swedish Research Council funding for clinical research in medicine.

Background
Fragility fractures are caused by low-energy insults such as falls from standing height or less and pose a growing health challenge as their incidence rises with increasing age. Impaired orthostatic blood pressure response and a number of cardiovascular biomarkers have been previously identified as risk factors for fractures. It is likely that severe episodes of syncope and orthostatic hypotension increase the risk of subsequent fragility fractures, however this relationship has not been thoroughly examined.

Purpose
To investigate the relationship of hospital admissions due to unexplained syncope and OH with incident fragility fractures in a middle-aged population.

Methods
We analysed a large population-based prospective cohort of 30,446 middle-aged individuals (age, 57.5 ± 7.6; men, 39.8%). We included patients hospitalised due to unexplained syncope and OH. Cox regression analysis adjusted for age, sex, prevalent fractures, body mass index (BMI) were applied to assess the impact of unexplained syncope/OH hospitalisations on subsequent incident fragility fractures. Prevalent fractures occurring before syncope/OH hospitalisation were excluded (n = 39) as well as cases with no follow-up time after the event of syncope/OH (n= 8).

Results
The mean follow-up from baseline to first incident fracture or end of follow-up was 17.8 + 6.5 years, and 8201 (27%) suffered incident fracture. The mean age of patients with unexplained syncope (n = 493) and OH patients (n = 406) at baseline was 61.5 ± 7.1 years (50.1%, male) and 62.6 ± 6.6 years (49.8% male), respectively. The mean time between baseline and first admission for syncope and OH was 12.3 ± 4.5 years, and the mean age at first hospitalisation was 74.4 ± 7.6 years. In the multivariable-adjusted Cox regression, the risk of subsequent incident fractures was increased among patients hospitalised due to unexplained syncope (HR: 1.20; 95% CI 1.03–1.40; p &lt; 0.02) and OH (HR: 1.40; 95% CI 1.20–1.64; p &lt; 0.001), respectively (Kaplan-Meier curves; Figure 1).

Conclusions
Patients hospitalised due to unexplained syncope and OH demonstrate increased risk of subsequent fragility fractures. We suggest that patients who are hospitalised for unexplained syncope and OH should be clinically assessed for true syncope aetiology, systematically treated against fall risk, and evaluated for additional risk factors for fragility fractures. Abstract Figure 1. Kaplan-Meier curves
Ultrasound-guided extra-cardiac vagal stimulation during cardioneuroablationa-a pilot feasibility study
Authors: Piotrowski R , Zuk A , Baran J , Sikorska A , Krynski T , Kulakowski P 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
N/A
Background. Cardioneuroablation (CNA) is a promising method for treatment of vagally-induced vasovagal syncope or functional atrio-ventricular block. Extra-cardiac vagal stimulation (ECVS) from the internal jugular vein is used during CNA to document asystolic response prior to CNA and lack of effects of vagal stimulation on heart rate after CNA. The recommended technique is placing the pacing catheter under fluoroscopy in the internal right and left jugular vein up to the level of the upper wisdom tooth. However, this technique has several limitations such as increased radiation exposure, unselective cranial nerves stimulation and lack of visualization of vagal nerve. Ultrasound-guided (USG) approach may be an interesting option because it allows visualization of the vagal nerve and enables selective stimulation under visual control.
Purpose. To assess the utility of USG-guided ECVS during CNA procedures.
Methods. The study group consisted of 6 patients (4 males, mean age 35 ± 12-year-old) underwent CNA. Firstly, electrode for ECVS was introduced under fluoroscopy into the right and left jugular veins up to the level of the upper wisdom tooth and ECVS was performed. Next, the USG-guided examinations were performed in supine position with head extension. The probe was placed in the transverse plane above the medial edge of the sternocleidomastoid muscle. The course of vagal nerve was identified and place for imaging in the close neighborhood of the jugular vein was chosen. ECVS was performed when the electrode was in good contact with the vein wall and was in the vicinity of the vagal nerve. In both approaches vagal response (asystole and atrio-ventricular block) during ECVS was assessed before and after CNA.
Results. In all patients ECVS was performed from both right and left jugular vein. Localization of vagal nerve using USG was possible in all patients and took less than one minute (see Figure). The effects of ECVS were identical using standard fluoroscopic and USG-guided approach.
Conclusions. USG-guided ECVS during CNA is easy, results are comparable with standard fluoroscopic approach and is probably associated with less fluoroscopy. Since this non-invasive method is the only one which enables vagal nerve visualization, it should become a preferred approach when using ECVS during CNA procedures. Abstract Figure. A electrode position for USG-guided ECVS
Effect of aging on cerebral tissue oxygenation in relation to reflex syncope
Authors: Kharraziha I , Torabi P , Johansson M , Sutton R , Fedorowski A , Hamrefors V 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Swedish Heart and Lung Foundation, The Swedish Heart and Lung Association, ALF funds, Skåne University Hospital Funds, The Crafoord Foundation.

Background
There is an increased susceptibility to syncope with aging attributed to age-related physiological impairments. Cerebral oximetry non-invasively measures cerebral tissue oxygenation (SctO2) and has been shown to be valuable in syncope evaluation. SctO2 has been found to decrease with aging but it is unknown whether the decrease in SctO2 is related to increased susceptibility to syncope during orthostatic provocation. By measuring SctO2 during head up tilt test (HUT) we can study age-related differences in SctO2 and their impact on developing reflex syncope.

Purpose
To investigate the effect of age on the cerebral tissue oxygenation threshold for syncope and presyncope among patients with vasovagal syncope.

Methods
Non-invasive haemodynamic monitoring and near-infrared spectroscopy (NIRS) were applied during head-up tilt (HUT) in 139 vasovagal syncope patients (mean [SD] 45[17] years, 60% female), and 82 control patients with a normal response to HUT (45[18] years, 61% female). Group differences in SctO2 and systolic blood pressure (SBP) during HUT in supine position, after 3 and 10 min of HUT, 30 seconds prior to syncope ("presyncopal phase") and during syncope in different age groups (&lt;30, 30-60 and &gt;60 years) were compared using one-way ANOVA and Tukey"s multiple comparison test. Associations between age and SctO2 were studied using linear regression models adjusted for sex and concurrent SBP.

Results
Lower SctO2 in supine position was associated with increasing age among controls (B=-0.085, p = 0.010) but not among VVS patients (B=-0.036, p = 0.114). No age-related differences in SctO2 were found after 3 and 10 minutes of HUT and during syncope. Mean SctO2 (%) during the presyncopal phase decreased over the advancing age groups (&lt;30: 66.9 ± 6.2, 30-60: 64.5 ± 6.1, &gt;60: 62.2 ± 5.8; p = 0.009 for inter-group comparison). In contrast, mean SBP during the presyncopal phase did not differ by age groups (&lt;30: 85.6 ± 21.8, 30-60: 77.6 ± 19.7, &gt;60: 77.6 ± 20.8 mmHg, p = 0.133). Age was associated with lower SctO2 during the presyncopal phase after adjusting for sex and SBP (B = 0.096, p = 0.001).

Conclusion
Older VVS patients have lower cerebral tissue oxygenation in the presyncopal phase compared with younger patients independently of systolic blood pressure. These results suggest either that with imminent reflex syncope cerebral tissue oxygenation diminishes more with advancing age or that cerebral deoxygenation is better tolerated by older reflex syncope patients. Abstract Figure.
Myocardial fibrosis as a predictor of sudden death in patients with coronary artery disease
Authors: Zegard A , Okafor O , Debono J , Kalla M , Lencioni M , Marshall H , Hudsmith L , Qiu T , Steeds R , Stegemann B , Leyva F 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
BACKGROUND The ‘grayzone’ of myocardial fibrosis (GZF) on cardiovascular magnetic resonance may be a substrate for ventricular arrhythmias (VAs).
OBJECTIVES To determine whether GZF predicts SCD and VAs (ventricular fibrillation or sustained ventricular tachycardia) in patients with coronary artery disease (CAD) and a wide range of LVEFs.
METHODS In this retrospective study of CAD patients, myocardial fibrosis presence on visual assessment (MFVA) and GZF mass in patients with MFVA was assessed in relation to SCD and the composite, arrhythmic endpoint of SCD or VAs.
RESULTS Among 979 patients (age: 65.8 ± 12.3 yrs [mean ± SD]), 29(2.96%) suffered a SCD and 80(8.17%) met the arrhythmic endpoint over 5.82 years (median; interquartile range: 4.1-7.3). In the whole cohort, MFVA was strongly associated with SCD (hazard ratio [HR]:10.1, 95% CI 1.42-1278.9) and the arrhythmic endpoint (HR:28.0, 95% CI 4.07-3525.4). In competing risks analyses, associations between LVEF &lt; 35% and SCD (subdistribution HR [sHR]:2.99, 95% CI 1.42-6.31) and the arrhythmic endpoint (sHR:4.71, 95% CI 2.97-7.47) were weaker. In competing risks analyses of the MFVA subcohort (n = 832), GZF using the 3SD method (GZF3SD) &gt; 5.0 g was strongly associated with SCD (sHR:10.8, 95% CI 3.74-30.9) and the arrhythmic endpoint (sHR:7.40, 95% CI 4.29-12.8). Associations between LVEF &lt; 35% and SCD (sHR:2.62, 95% CI 1.24-5.52) and the arrhythmic endpoint (sHR:4.14, 95% CI 2.61-6.57) were weaker.
CONCLUSIONS In CAD patients, MFVA plus quantified GZF3SD mass was more strongly associated with SCD and VAs than LVEF. In selecting patients for implantable cardioverter defibrillators, assessment of MFVA followed by quantification of GZF3SD mass may be preferable to LVEF. Abstract Figure.