bluuebunny/crossref_metadata_2025_split huggingface dataset:
Performance of automated single-lead ECG atrial fibrillation screening is associated with patient characteristics
Authors: Zink MD , Freedman B , Mischke K , Keszei A , Rummey C , Marx N 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The investigators received and unrestricted research grant by Pfizer/BMS. Pfizer/BMS was not involved in the planning, conduction, analysis, or interpretation of the data.

Introduction
Screening for atrial fibrillation (AF) with a single-lead electrocardiogram device is on the rise. However, little is known about influence of automated AF screening performance related to patient characteristics.

Aim
We tested the accuracy of automated AF detection of a single-lead ECG device and identified factors associated with diagnostic performance.

Methods
In 6482 subjects of community-pharmacies a single-time point AF screening was performed. All ECGs were analyzed by blinded human overread and compared to the automated results in context of patient characteristics.

Results
Automated screening showed good prediction of AF with an area under the receiver operating curve of 0.89; sensitivity 80%; specificity 98%; positive predictive value 71%; negative predictive value 99%. Good ECG signal quality was highly associated with correct measurement, while low signal quality leads to incorrect measurements. In a multivariate model we determined factors associated with excellent signal quality and as counterexample incorrect automatic AF identification. The Odds’ ratio (OR) for excellent signal quality was strongly associated with female sex, lower age, lower height, and higher body weight index (table).

Conclusion
The performance of automated AF screening is influenced by sex, age, height and body mass index. Potential target population groups, with high AF prevalence, have a higher chance of incorrect automatic measurement. We recommend an expert over-read, at least for all AF positive ECG recordings. Table 1 Excellent signal quality Incorrect measurement Univariate analysis Multivariate analysis Univariate analysis Multivariate analysis Parameter OR 95% CI P OR 95% CI P OR 95% CI P OR 95% CI P Sex [Female] 2.33 1.97-2.75 &lt;0.001 1.92 1.53-2.41 &lt;0.001 0.64 0.49-0.84 0.001 0.57 0.43-0.76 &lt;0.001 Age [years] 0.97 0.96-0.98 &lt;0.001 0.97 0.96-0.98 &lt;0.001 1.07 1.04-1.09 &lt;0.001 1.06 1.04-1.09 &lt;0.001 Height [cm] 0.96 0.95-0.97 &lt;0.001 0.98 0.97-0.99 0.003 1.01 0.99-1.03 0.068 Weight [kg] 0.99 0.99-1.00 0.418 0.99 0.98-0.99 0.003 BMI [kg/cm2] 1.04 1.03-1.06 &lt;0.001 1.04 1.03-1.06 &lt;0.001 0.91 0.88-0.95 &lt;0.001 0.91 0.87-0.94 &lt;0.001 CHADSVASC 1 0.95-1.06 0.912 1.06 0.97-1.17 0.205 Heart failure 0.62 0.41-0.93 0.022 1.86 1.13-3.05 0.015 Hypertension 0.96 0.83-1.11 0.58 1.06 0.80-1.39 0.689 Diabetes mellitus 0.85 0.68-1.07 0.159 0.82 0.54-1.25 0.359 Stroke / TIA 0.82 0.66-1.01 0.066 1.19 0.83-1.69 0.341 Vascular disease 0.89 0.75-1.07 0.213 1.31 0.98-1.77 0.70 OR – odd’s ratio, CI – confidence interval
Prediction of left atrial thrombus in patients with nonvalvular atrial fibrillation referred to catheter ablation or cardioversion: comparison of different risk scores
Authors: Zaigraev IA , Yavelov IS , Drapkina OM , Bazaeva EV 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Left atrial thrombus (LAT) is the main source of cardiac emboly in patients with non-valvular atrial fibrillation (NAF). Several risk scores – mostly modified CHADS2 and CHA2DS2-VASc – were offered to predict LAT in patients with NAF. However, their relative predictive value requires further evaluation.
Purpose. Compare the ability of different risk scores to predict LAT before catheter ablation or cardioversion in patients with NAF.
Methods. In a retrospective single-center study, medical records of 1994 patients with NAF who underwent transesophageal echocardiography before catheter ablation or cardioversion were analyzed. LAT was identified in 33 (1.6%) of them. For the control group 167 patients without LAT were randomly selected from this database. Logistic regression analysis and C-statistic were used for evaluation and comparison of predictive values of CHADS2, R2CHADS2, CHA2DS2-VASc, R-CHA2DS2-VASc, R2CHA2DS2-VASc, CHA2DS2-VASc-RAF, mCHA2DS2-VASc and CHA2DS2-VASc-AFR scores.
Results. The mean age of studied patients was 60.3 ± 10.9 years, 110 (55%) of them were males. The mean CHA2DS2-VASc score was 2.54 ± 1.79.
Results of univariate analysis and C-statistic for above mentioned risk scores are presented in the table. Each of them was associated with LAT. In comparison with a CHA2DS2-VASc score C-statistic was significantly higher for CHA2DS2-VASc-RAF and CHA2DS2-VASc-AFR scores (p values 0.03 and 0.001 respectively).
In multivariate analysis only CHA2DS2-VASc-RAF score was associated with LAT (OR 1.37; 95% CI 1.21-1.55, p &lt; 0.0001). OR for LАT in patients with CHA2DS2-VASc-RAF &gt;3 was 12.8 (95% CI 3.75-43.9; p &lt; 0.0001) with sensitivity, specificity, positive and negative predictive values 90.6%, 57.1%, 33.3% and 58.9% respectively.
Conclusion. In a group of patients with NAF and relatively low incidence of LAT all studied scores were associated with LAT and CHA2DS2-VASc-RAF score has appeared the most informative. Predictors of LAT in patients with NAF Risk stratification models OR (95% CI) p-value C-statistic (95% CI) CHADS2 2.12 (1.55-2.91) &lt;0.0001 0.77 (0.68-0.85) R2CHADS2 2.00 (1.53-2.62) &lt;0.0001 0.78 (0.69-0.87) CHA2DS2-VASc 1.65 (1.36-2.05) &lt;0.0001 0.74 (0.65-0.84) R-CHA2DS2-VASc 1.64 (1.34-2.03) &lt;0.0001 0.76 (0.66-0.85) R2CHA2DS2-VASc 1.59 (1.32-1.92) &lt;0.0001 0.76 (0.66-0.85) CHA2DS2-VASc- RAF 1.35 (1.27-1.52) &lt;0.0001 0.84 (0.76-0.91) mCHA2DS2-VASc 1.83 (1.42-2.35) &lt;0.0001 0.75 (0.65-0.85) CHA2DS2-VASc-AFR 1.75 (1.41-2.17) &lt;0.0001 0.80 (0.71-0.88)
Sex-related differences in self-reported treatment burden in patients with atrial fibrillation
Authors: Mihajlovic M , Simic J , Marinkovic M , Kovacevic V , Kocijancic A , Mujovic N , Potpara T 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Treatment burden (TB) is defined as the patient’s workload of health care and its impact on patient functioning and well-being. High TB can lead to nonadherence, higher risk of adverse outcomes and lower quality of life. We have previously reported a higher TB in patients with atrial fibrillation (AF) vs. those with other chronic conditions. In this analysis, we explored sex-related differences in self-reported TB in AF patients.

Methods
A single-centre, prospective study included consecutive patients with AF under drug treatment for at least six months before enrolment from April to June 2019. Patients were asked to voluntarily and anonymously answer Treatment Burden Questionnaire (TBQ). All patients signed the written consent for participation.

Results
Of 331 patients (mean age 65.4 ±10.3 years, mean total AF history 6.41 ±6.62 years), 127 (38.4%) were females. The mean TB was significantly higher in females compared to males (53.7 vs. 42.6 out of 170 points, p &lt; 0.001), also females more frequently reported TB ≥59 points than males (37.8% vs 20.6%, p = 0.001). Item-specific sex-related differences in self-reported TB questionnaire are showed in Figure. Sex-related differences in TB on multivariable regression analyses of the highest TB quartile (≥59 points) are showed in Table.

Conclusion
Our study was first to explore the sex-specific determinants of TB in AF patients. Females had significantly higher TB compared with males. Approximately 2 in 5 females and 1 in 5 males reported TB ≥59 points, previously shown to be an unacceptable burden of treatment for patients. Using a NOAC rather than VKA in females and a rhythm control strategy in males could decrease TB to acceptable values. Table.Multivariable Logistic Regression analysis of the highest TB quartile (TB ≥59)VariableOR95% CIP valueFemalePPI therapy5.3541.97-14.560.001NOAC0.3190.12-0.830.019Diuretic therapy0.3180.13-0.760.010CHA2DS2-VASc score0.7000.49-0.990.045MaleAblation and/or ECV0.3830.18-0.810.012Supraventricular arrhythmias0.2220.05-0.980.047VKA Vitamin K antagonist; ECV: electrical cardioversion; AF: Atrial fibrillation; PPI: Proton pump inhibitor; PCI: Percutaneous coronary intervention; NOAC: Non-vitamin k antagonist oral anticoagulant.Abstract Figure.
Achieving acute mitral isthmus block with catheter ablation with vein of marshall ethanol infusion
Authors: Andronache M , Pastorcici A , Massoulie G , Blendea D , Boudias A , Catalan PA , Jean F , Dauphin C , Eschalier R , Costea A , Rosu R , Cismaru G , Puiu M , Souteyrand G , Motreff P 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Achieving bidirectional mitral isthmus block during radiofrequency (RF) ablation for persistent atrial fibrillation (AF) is still challenging. The conventional ablation method involves RF applications on the endocardial aspect of the Mitral Isthmus (MI), and for a majority of patients, in the distal coronary sinus (CS).

Purpose
We have evaluated the acute success of obtaining mitral isthmus block by adding another epicardial component using ethanol infusion in the vein of Marshall (EIVOM) in addition to endocardial MI and epicardial CS ablation.
Methods
We studied 121 patients (pts.) with a mean age of 65 years (range 40-83) 73% men; 119 with longstanding persistent AF (98%) and 2 with perimitral flutter (2%). The mean duration of AF was 53 months (12-244 months). In the majority of patients, additional endocardial (on the ventricular aspect of the MI) and/or epicardial (distal CS) (RF) ablation was performed in order to achieve MIB. The ablation procedure was performed under general anesthesia (GA) for 81 pts (67%). EIVOM was perform with a mean 6 ml ethanol (range 2-10ml)

Results
Bidirectional MIB was obtained in 114 pts. (94,2%). The 7 patients without MIB were scheduled for another ablation procedure (4 pts under GA during the first procedure). The average RF delivery time to block was 160 seconds (range 42-480 seconds) for the endocardial MI RF ablation (point-by-point application with a power of 50W and an Ablation Index of 450-500, contact force 10-20g) and 156 seconds (range 55-438) for the epicardial MI RF ablation (applications with a power of 20W). Bidirectional endocardial and epicardial MIB was confirmed by conventional pacing maneuvers performed in sinus rhythm. No major complications were observed. The parameters associated with failure for MIB were AF duration, Left Atrial dilatation &gt;200 ml, MI thickness (epicardial endocardial distance on the CARTO maps &gt;15mm).

Conclusion
Ethanol infusion in the vein of Marshall is a safe approach and is associated with a higher success rate of obtaining acute bidirectional endocardial and epicardial mitral isthmus block when compared with the conventional method. Abstract Figure. Bloc Mitral Endo; Bloc Mitral Epi;
Usefulness of the angiographic anatomy of the vein of marshall for ablation procedures for persistant atrial fibrillation
Authors: Pastorcici A , Andronache M , Blendea D , Massoulie G , Dauphin C , Boudias A , Catalan PA , Jean F , Costea A , Escalier R , Mihai PA , Rosu R , Cismaru G , Souteyrand G , Motreff PA 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Ethanol Infusion in the Vein of Marshall (EIVOM) was recently proposed as an efficient adjunctive technique for obtaining mitral isthmus block during catheter ablation for persistent atrial fibrillation.

Purpose
Given these considerations the objective of this research was to delineate the angiographic anatomy of the Vein of Marshall (VOM).

Methods
Fluoroscopy images were obtained retrospectively in 124 patients with persistent atrial fibrillation who underwent coronary sinus angiography for EIVOM (96 patients) or cardiac resynchronization implant (18 patients). The measurements were performed using Osirix DICOM reader using the known diameter of the angiographic catheter for calibration. The distance between the ostium of the coronary sinus (CS) and the ostium of the VOM was measured in the anteroposterior view. Additionally, the angle at which the ostium of VOM opens in the CS was obtained.

Results
The diameter of the VOM ostium was 1.8 ± 0.6mm. The length of the VOM was 18.6 ± 9.1mm. The distancebetween the CS ostium and VOM ostium was as follows: less than 10mm for 1 patient (1%), between 11-20mm for 10 patients (10.41%), between 21-30mm for 38 patients (39.58%), 31-40mm for 31 patients (32.29%), between 41-50mm for 15 patients (15.62%) and &gt;50mm for 1 patients (1%) (53mm).
The average takeoff angleof the VOM from the CS between the main branch of the VOM and the CS was measured at 140 degrees (range 90-175 degrees). No correlation could be made between the takeoff angle and the distance between CS ostium and VOM ostium.
In the group of patients undergoing cardiac resynchronization the takeoff angle from the CS was 153°±17° and it correlated significantly with the left ventricular systolic diameter and the left ventricular ejection fraction determined by echocardiography(r = 0.52; p = 0.008 and respectively r = 0.50; p = 0.009).

Conclusions
Understanding the anatomy of the Vein of Marshall (VOM) is crucial in helping operators efficiently exploit the therapeutic potential of ethanol injection after accurate localization of such an important branch of the left atrial venous system. Abstract Figure. 1 Fig 1 Angle CS-VOM
Catheter ablation with ethanol infusion in the vein of marshall for persistent atrial fibrillation: safety and procedure duration
Authors: Massoulie G , Andronache M , Pastorcici A , Dauphin C , Costea A , Blendea D , Catalan PA , Lizet T , Jean F , Eschallier R , Puiu M , Rosu R , Cismaru G , Souteyrand G , Motreff PA 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Ethanol Infusion in the Vein of Marshall (EIVOM) has been recently introduced as an efficient technique that helps achieving mitral isthmus block during ablation procedures for persistent atrial fibrillation (PAF) or peri-mitral atrial flutter.

Purpose
We have evaluated the safety of EIVOM and the duration required to perform this procedure.
Methods
We performed EIVOM in 121 patients for PAF (mean age of 65 years (range 40-83, 73% men; Mean EF 50%. The main steps of the EIVOM were as follows: the procedure commenced with catheterization of the coronary sinus, followed by the subsequent introduction of an angiography catheter that allowed for iodine contrast injection and vein of Marshall (VOM) localization, 1.5-2.5 mm angioplasty balloon over 0.014" guidewire placement and finally the ethanol injection up to 10 ml.

Results
No major complications were observed during the ablation procedure or before hospital discharge.
In 62 patients in whom procedure duration data was available the mean EIVOM procedure time was 41 min (range from 13 to 105 min).
After the first 20 procedures, where the learning curve for the operators has to be taken into consideration, a reduction in the time required to achieve EIVOM was consistently noted, with an average of less than 30 min. and for the last 20 procedures less than 20 min. Factors which increase the time required for successful EIVOM include: difficulty in visualizing the ostium of the VOM, a VOM ostium located proximally, difficulty in advancing the angioplasty wire into the VOM and balloon displacement and repositioning.

Conclusions
Ethanol infusion in the Vein of Marshall is a safe and efficient technique that can be performed in an acceptable amount of time after an initial learning curve. Abstract Figure. Image 1 VOM
Digoxin and association with mortality in patients discharged from hospital with atrial fibrillation, with or without heart failure
Authors: Mpotis M , Kartas A , Samaras A , Akrivos E , Vrana E , Liampas E , Papazoglou A , Moysidis D , Papanastasiou A , Baroutidou A , Karvounis H , Tzikas A , Giannakoulas G 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
MISOAC- AF study group

BACKGROUND
Digoxin is widely used in atrial fibrillation (AF) and heart failure (AF). However, established evidence is conflicting regarding its association with clinical outcomes.
AIM
To investigate the relation between digoxin and adverse outcomes in patients with AF, with or without HF, in a contemporary AF cohort.

METHODS
We performed a retrospective analysis of data from 698 patients, originating from the MISOAC- AF (Motivational Interviewing to Support Oral AntiCoagulation Adherence in patients with non-valvular Atrial Fibrillation) trial, and followed over a median of 2.5 years. HF was denoted at baseline. The primary outcome was all-cause mortality and the secondary outcome was all-cause hospitalization, in a time-to-event analysis. Propensity scores were used to derive matched populations, balanced on key baseline covariates. To limit potential confounding, we also implemented inverse probability of treatment weighting (IPTW) analysis.

RESULTS
Among patients with HF, 10.5% (n = 39) were administered digoxin at baseline, whereas 89.5% (n = 331) were not. Digoxin administration was not associated with an increased risk of death (hazard ratio (HR) in the digoxin group, 1.21; 95% Confidence Interval (CI), 0.69 to 2.13, p = 0.5) or hospitalization of any cause (HR 1.15; 95% CI, 0.67 to 1.96; p = 0.6). Among patients without HF, 3.5% (n = 11) were administered digoxin, with neutral effects on all-cause mortality (HR: 3.25; 95% CI, 0.98 to 10.70), p = 0.06) and all-cause hospitalization (HR, 1.15; 95% CI, 0.67 to 1.96, p = 0.60). Consistent qualitatively results were observed using IPTW.

CONCLUSIONS
Among patients with AF, digoxin administration was not associated with an increased risk of death and hospitalization of any cause, irrespective of HF status. Abstract Figure.
Antiarrhythmic drug responders among patients with recurrent atrial fibrillation after catheter ablation
Authors: Park Y , Yu H , Kim TH , Uhm JS , Joung B , Lee MH , Pak HN 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): The Ministry of Health and Welfare The National Research Foundation of Korea (NRF)

Backgroud
Sinus rhythm (SR) can be maintained with antiarrhythmic drugs (AADs) in a considerable number of patients with recurrent atrial fibrillation (AF) after AF catheter ablation (AFCA).

Purpose
We explored the characteristics and long-term outcomes of patients who maintained clinically acceptable rhythm control with AADs for 2 years.

Methods
Among 2,935 consecutive AAD-resistant patients who underwent a de novo AFCA, we included 512 recurrent patients (73.0% men, 59.2 ± 10.5 years old, 56.4% paroxysmal AF) who were followed up for over 2 years under AAD medications.

Results
In total, 218 patients remained in SR (AAD-responders[2-yrs], 42.6%) and 294 had recurrent AF among whom, 162 underwent repeat procedures (redo-AFCA[AAD failure-2-yrs]). We also compared the AAD-responders[2-yrs] with 40 patients who underwent AFCA before AADs (redo-AFCA[Before AAD]). AAD-responders[2-yrs] were independently associated with an old age (odds ratio [OR] 1.02 [1.00-1.04] p = 0.037), paroxysmal AF (OR 1.51 [1.04-2.19] p = 0.003), and a delayed recurrence timing of &gt; 18 months (OR 1.52 [1.04-2.22] p = 0.032). When comparing the AAD-responder[2-yrs] and redo-AFCA[AAD failure-2-yrs] groups, the recurrence pattern showed a convergence after 7 years. The overall rhythm outcome was better in the redo-AFCA[Before AAD] group than AAD group (log rank p = 0.013).

Conclusion
Among the patients with recurrent AF after AFCA, over 40% remained in SR with AADs for 2 years, especially those who were old, those with a paroxysmal type, and those who had a delayed recurrence timing of &gt;18 months after the de novo procedure. UnivariateMultivariateOdds Ratio(95% CI)p valueOdds Ratio(95% CI)p valueAge1.02 (1.00-1.04)0.0231.02 (1.00-1.04)0.037Female1.64 (1.11-2.42)0.0141.29 (0.85-1.95)0.236PAF1.58 (1.11-2.26)0.0121.51 (1.04-2.19)0.030Time to recurrence after the initial AFCA &gt;18mo*1.59 (1.11-2.30)0.0131.52 (1.04-2.22)0.032LA dimension, mm0.99 (0.96-1.02)0.360LV ejection fraction, %1.03 (1.01-1.06)0.0111.02 (0.997-1.046)0.081Heart failure0.65 (0.34-1.24)0.192Hypertension1.18 (0.83-1.67)0.358Diabetes1.01 (0.65-1.71)0.844Stroke or TIA0.96 (0.56-1.66)0.879Vascular disease1.43 (0.88-2.31)0.151Logistic regression analysis for AAD responders Abstract Figure. K-M analysis of AF-free survival rate
Polypharmacy and major adverse events in atrial fibrillation
Authors: Tsagkaris C , Kartas A , Samaras A , Papazoglou A , Moysidis D , Vrana E , Vouloagkas I , Papanastasiou A , Kotzampasis G , Baroutidou A , Karagiannidis E , Louka A-M , Matiashova L , Tzikas A , Giannakoulas G 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Polypharmacy has been defined as the daily use of more than 4 drugs, by an individual, regardless of the condition(s) they have been prescribed for and their efficacy. The burden of polypharmacy pertains to adverse drug reactions, disability, frequent and longtime hospitalization and long-term mortality. The prevalence of polypharmacy exceeds 10% in most adult age groups and particularly in the elderly. At the same time, atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia, afflicting more than 8% of the elderly and those with multiple comorbidities.

Purpose
The purpose of this study was to examine the association between the presence of polypharmacy and outcomes among AF patients.

Methods
This is a retrospective analysis among 1140 patients enrolled in the MISOAC-AF trial. All cause- and cardiovascular- mortality have been defined as primary endpoints. Independent clinical predictors of polypharmacy and of major adverse outcomes were identified via bootstrapped multivariate logistic and Cox regression analysis, respectively.

Results
The mean number of prescribed medications at patients’ discharge was 3.9 ± 1.6 and polypharmacy (use of more than 4 medications daily) was found in 36.9% of the patients. Smoking (p = 0.036), dyslipidemia (p &lt; 0.001), coronary artery disease (p &lt; 0.001), heart failure (HF; p = 0.003) and chronic kidney disease (p &lt; 0.001) were independent predictors of polypharmacy among AF paients. Kaplan–Meier survival analysis showed that AF patients with polypharmacy have significantly greater risk of CV death (p = 0.040), while Cox regression analysis indicated polypharmacy as an independent predictor for all-cause and CV- mortality [adjusted hazard ratios: 1.31(1.03 - 1.67) and 1.39(1.05 - 1.84), respectively] and for the composite outcome of AF- or HF- related hospitalization or CV death [adjusted hazard ratio: 1.31 (1.05 - 1.63)].

Conclusion
This study highlights the implications of polypharmacy in the context of AF, a prevalent, chronic, life-threatening condition. Investigating polypharmacy is quite relevant in the era of pharmacovigilance, contributing to rational pharmacotherapy with regard to cardiovascular conditions and beyond. Abstract Figure. Mortality rates by polypharmacy presence