bluuebunny/crossref_metadata_2025_split huggingface dataset:
Speckle tracking-derived left atrial stiffness predicts adverse events after successful electrical cardioversion
Authors: Kupczynska K , Miskowiec D , Michalski B , Kasprzak J D 
Published: October 2021

Abstract

Background
Atrial fibrillation (AF) impairs cardiac mechanics and leads to adverse remodelling. Increased left atrial (LA) stiffness reflecting LA reservoir function and left ventricular (LV) filling pressure is one of the symptoms of LA remodelling.

Purpose
To analyse LA stiffness within 24 hours after successful electrical cardioversion and its prognostic value during 2-years follow-up.

Methods
Prospective study involved 71 patients with nonvalvular AF (mean age 64±13 years, 61% male). All patients underwent echo during 24 hours after conversion to sinus rhythm. We analysed standard echocardiographic and Doppler parameters. Using speckle-tracking method we assessed peak LA longitudinal strain in 4- and 2-chamber view. LA stiffness was calculated as the quotient of peak LA longitudinal strain (LA reservoir function) and mean E/E' ratio. The clinical endpoints were predefined as AF recurrence and cardiovascular hospitalization.

Results
Median time of current AF episode was 2 (IQR 0.4–5) months. Standard echo measurements revealed median of LV ejection fraction 55% (IQR 45–58) and median of LA volume indexed to body surface area 42 ml/m2 (IQR 34–51). During follow-up we noticed AF recurrence in 48 (68%) patients and cardiovascular hospitalization in 43 (61%) patients. Median time-to-event was 2.4 (IQR 1 to 6.9) and 7 (IQR 2.1–11) months, respectively. Receiver operating characteristic curve analysis revealed that LA stiffness &gt;0.53 (AUC=0.821; p&lt;0.0001) and &gt;0.95 (AUC=0.788; p&lt;0.0001) were the optimal cut-off values for predicting AF recurrence and cardiovascular hospitalization. Figure presents Kaplan-Meier survival analysis for AF recurrence (A) and for hospitalization (B). Moreover LA stiffness remain statistically significant in multivariate Cox regression analysis even after adjustment for betablockers, antiarrhythmic drugs, coronary artery disease, heart failure and mitral regurgitation. Relative risk was 1.51 (95% CI 1.09–2.09), p=0.01 for AF recurrence and 1.49 (95% CI 1.05–2.13) for cardiovascular hospitalization.

Conclusions
Speckle tracking-derived LA stiffness assessed early after the restoration of sinus rhythm independently predicts AF recurrence and cardiovascular hospitalization.

Funding Acknowledgement
Type of funding sources: None.
Characteristics and long-term ablation outcomes of supraventricular arrhythmias in hypertrophic cardiomyopathy: a 10-year, single-center experience
Authors: Zhang H D , Ding L , Weng S X , Zhou B , Ding X T , Hu L X , Qi Y J , Yu F Y , Feng T J , Zhang J T , Fang P F , Zhang S , Tang M 
Published: October 2021

Abstract

Background
A variety of supraventricular arrhythmias (SVAs) may occur in patients with hypertrophic cardiomyopathy (HCM). The characteristics and long-term ablation outcomes of different types of SVAs in HCM have not been comprehensively investigated.

Methods
We retrospectively enrolled 101 consecutive symptomatic HCM patients with suspected arrhythmia from May 2010 to October 2020. The clinical features and ablation outcomes of patients with SVAs were further analyzed.

Results
Seventy-eight patients had SVAs, consisting of 50 (64.1%) atrial fibrillation (AF), 16 (20.5%) atrial flutter (AFL), 15 (19.2%) atrioventricular reentrant tachycardia (AVRT), 11 (14.1%) atrial arrhythmia (AT), and 3 (3.8%) atrioventricular nodal reentrant tachycardia (AVNRT). Thirty-four patients underwent catheter ablation including 14 for AF, 9 for AVRT, 6 for AFL, 3 for AVNRT, 1 for both AF and AFL, and 1 for both AF and AVRT. They were followed up for a median (interquartile range) of 58.5 (82.9) months. There were no recurrences for patients with non-AF SVAs. For patients with AF, the 1- and 7-year AF-free survival were 87.5% and 49.5%, respectively. A ROC analysis revealed that a greater left ventricular end-diastolic dimension (LVEDD) was associated with higher recurrence of AF with an optimum cutoff value of 47mm (c-statistic = 0.91, p=0.011, sensitivity = 1.00, specificity = 0.82). In Kaplan-Meier analysis, patients with LVEDD ≥47mm had worse AF-free survival (log-rank p=0.014).

Conclusions
AF is the most common SVA in HCM, with AFL, AVRT, AT, and AVNRT ranking the second to the last according to the prevalence. The long-term catheter ablation outcome for non-AF SVAs in HCM is satisfying. A greater LVEDD predicts AF recurrence after catheter ablation in patients with HCM.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): National Natural Science Foundation of China Figure 1Figure 2
Long-term outcomes of 265,737 patients hospitalised with atrial fibrillation and atrial flutter from 2008 to 2015
Authors: Ngo L , Woodman R , Walters T , Denman R , Yang I , Ranasinghe I 
Published: October 2021

Abstract

Background
Atrial fibrillation/atrial flutter (AF/AFL) hospitalisations are common, however, little is known about the long-term outcomes of these episodes.

Objective
To examine the incidence of mortality, all-cause and cause-specific re-hospitalisations at up to 8 years after a hospitalisation for AF/AFL.

Methods
Unique patients hospitalised with a primary diagnosis of AF/AFL from 2008–2015 were identified using nation-wide hospitalisation data from Australia and New Zealand. All-cause mortality was the primary outcome. Secondary endpoints included all-cause and cause-specific re-hospitalisations. Results were reported as incident rate per 100 patient-years.

Results
We included 265,737 patients (mean age 69.9±13.9y, female 45.2%, elective 28.7%). The median length of stay was 1 day (Interquartile range [IQR] 0–4 days) and the median CHA2DS2-VASc score was 2 (IQR 1–2). During the index hospitalisation, 9,837 (3.7%) patients underwent catheter or surgical ablation and 52,634 (19.8%) underwent cardioversion. During the median follow-up time of 3.4 years (range 0–8.0 years), 53,669 patients died (incident rate of 5.7/100 patient-years) with a survival probability gradually decreasing from 92.8% (95% CI 92.7–92.9%) at 1-year to 65.4% (95% CI 64.9–65.8%) at 8-years post-discharge (Table 1 and Figure 1). All-cause re-hospitalisations occurred in 210,118 patients (incident rate of 22.2/100 patient-years) with a rehospitalisation-free survival probability of 7.1% (95% CI 6.9—7.3%) at the end of follow-up. Unplanned re-hospitalisations occurred more frequently than planned episodes (incident rate of 17.2 vs. 16.6/100 patient-years respectively). AF/AFL accounted for 25.1% of all-cause re-hospitalisations (incident rate of 8.9/100 patient-years) and the probability of freedom from re-hospitalisations for AF/AFL was 55.4% (95% CI 55.0–55.8%) at 8-years. Incident rates of re-hospitalisations for catheter ablation (1.5/100 patient-years), stroke (1.6/100 patient-years), heart failure (2.7/100 patient-years), and acute myocardial infarction (1.0/100 patient-years) were low. In subgroup analyses, worse survival was observed in female patients, older age groups, patients with comorbid heart failure, hypertension, diabetes, and those who did not undergo ablation during the index hospitalisation.

Conclusion
Nearly two-thirds of patients were surviving by 8-years following an AF/AFL hospitalisation with a low rate of re-hospitalisations for stroke, heart failure, and myocardial infarction. However, re-hospitalisations for recurrent atrial arrhythmia were common. Efforts to reduce re-hospitalisations, especially unplanned encounters, are required to improve patient outcomes.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): National Heart Foundation of Australia
Activity levels influence frequency of premature atrial contractions
Authors: Johnson L S B , Napiorkowski N , Grotek A , Dziubinski M , Healey J S , Engstrom G 
Published: October 2021

Abstract

Background
Frequent premature atrial contractions (PACs) are associated with substantially increased risk of atrial fibrillation (AF) and stroke, but PAC count varies substantially day-to-day. With the emergence of potential therapies for primary prevention of AF reliable estimation of PAC frequency is increasingly relevant, as is an understanding of PAC determinants.

Purpose
To determine the effect of daily activity and heart rate on an individuals' daily PAC count.

Methods
We included a random sample of patients 18–85 years without AF who recorded an ambulatory ECG for 7–31 days in the U.S.A during 2019 using a full-disclosure mobile cardiac telemetry device, and who had ≥500PACs on at least one recording day. PACs were algorithmically detected and manually verified. PAC count and activity was sampled for each individual and each recording day during daytime (06–22h). The effect of activity on daily PAC count was assessed in a negative binomial regression model including age, sex and with a random effect for individual, to account for confounding due to inter-individual differences.

Results
The study population consisted of 2,094 patients, of which 48% were men (Fig 1). Mean time spent in activity was 32% (standard deviation (SD 10%) for men and women 31% (SD 10%) for women (Fig 2). The median PAC count was 592 (inter-quartile range 1280). Beyond age, sex and intra-individual differences PAC frequency was determined by activity levels, (intercept 629 PACs; incidence rate ratio per 10 minute increase in activity 1.03, p&lt;0.0001). A 1-hour increase in daily activity was associated with a 20% increase in daily PACs count.

Conclusions
Physical activity is associated with increased PACs counts, implying both that a reliable diagnosis of PAC frequency needs to be conducted during a person's habitual level of activity and that PAC frequency is modifiable. In-hospital assessments of PACs while patients are mainly inactive may underestimate PAC frequency.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): the Swedish Society For Medical Researchthe Swedish Heart and Lung Foundation Age and sex distributionActivity levels by sex
Arrhythmia patterns in patients with COVID-19 infection during and post hospitalization detected via a patch-based mobile cardiac telemetry system
Authors: Reynbakh O , Braunstein E D , Hsu M , Ellis J , Crosson L , Lenane J , Krumerman A , Di Biase L , Ferrick K J 
Published: October 2021

Abstract

Background
Coronavirus infection (COVID-19) is the cause of the current world-wide pandemic. Cardiovascular complications occur in 20–30% of patients with COVID-19 infection including myocardial injury and arrhythmias. Current understanding of specific arrhythmia type and frequency is limited. In response to COVID-19 pandemic and overwhelmed hospital critical care and telemetry recourses, patch-based cardiac monitoring system received emergency Food and Drug Administration (FDA) approval for inpatient monitoring. A patch-based cardiac telemetry system has been shown to be useful for patient management during the COVID-19 pandemic and provides detailed analysis of cardiac rhythms.

Purpose
To analyze arrhythmia type and frequency in patients with COVID-19 infection, identifying arrhythmia patterns over time during hospitalization and after discharge.

Methods
A prospective cohort study during the COVID-19 pandemic was performed. We included patients hospitalized with COVID-19 infection who had a patch-based mobile telemetry device placed for cardiac monitoring. A quantitative analysis including type, frequency and duration of detected arrhythmias was performed at the end of the monitoring period.

Results
A total of 103 patients hospitalized with COVID-19 diagnosis underwent monitoring. Quantitative reports for 59 patients were available for analysis, among those 59% were males, median age 65 (IQR 56–76) yrs. Mean wear time was 6.8±5.0 days. Arrhythmias were detected in 72.9% of patients. Majority of arrhythmias were SVT (59.3% of patients) and AF (22.0%). Episodes of AF duration &gt;30 min were detected in 12 patients. New onset AF was noted in 15.0% of patients and was significantly associated with age (OR 1.4 for 5 yrs difference; 95% CI 1.01–2.05). Brady arrhythmias (2nd degree, 3rd degree AV bock, pause≥3 seconds) were seen in 18.7% of patients. Arrhythmias were consistently detected throughout the monitoring period in 52.9%-89.5% of patients daily (Figure 1). In 9 patients who were discharged with continued patch monitoring, 3 patients (33.3%) had arrhythmic events during their outpatient monitoring period.

Conclusion
A majority of patients hospitalized with COVID-19 infection had arrhythmias detected by patch cardiac monitor. Arrhythmias were observed throughout hospitalization with a consistent daily frequency. Patients continued to exhibit cardiac arrhythmias after hospital discharge of a type similar to that seen during hospitalization. New onset AF often occurred and was associated with older age. Inpatient application of a patch cardiac telemetry with continued monitoring as outpatient is feasible and effective in detecting occult arrhythmias in patients with COVID-19 infection.

Funding Acknowledgement
Type of funding sources: None. Daily frequency of arrhythmias detected
Local areas of earlier repolarization cause epicardial repolarization heterogeneity in patients with apparently idiopathic ventricular fibrillation
Authors: Van Rees B , Stoks J , Nguyen Y C , Ter Bekke R M A , Mihl C , Cluitmans M , Volders P G A 
Published: October 2021

Abstract

Background
Sudden cardiac arrest is often due to ventricular fibrillation (VF). In 5–10% of cases, no cause can be identified despite extensive cardiac examination, hence the designation idiopathic VF. Early repolarization with down sloping ST segments has been previously identified in patients with idiopathic VF. Early repolarization may increase repolarization heterogeneity with steep local repolarization time gradients, and thus form a substrate for idiopathic VF.

Purpose
To study the presence of local earlier repolarization and increased repolarization dispersion in idiopathic VF patients with noninvasive electrocardiographic imaging (ECGI).

Methods
A validated, non-commercial, potential-based formulation of ECGI was performed in 17 patients with idiopathic VF and 10 controls with no structural or electrical abnormalities. The ECGI measurement consisted of a body surface potential map with 184–256 electrodes in combination with a CT scan to obtain the torso and heart geometries. ECGI provided local epicardial repolarization times (RT) and RT isochrones. We determined the 1st (RT1%) and 99th percentile (RT99%) of RTs, the total epicardial RT dispersion (ERD: RT99%-RT1%), and the mean RT. Heart-rate corrected QT (QTc), TpTe intervals, and presence of the ER pattern were determined from the 12-lead ECG. All metrics were normalized to the body-surface Q.

Results
QTc and TpTe did not differ between the two groups (P=0.40 and P=0.83, respectively, Figure 1, panel A). One (10%) control subject and three (17.6%) idiopathic VF patients showed an ER pattern on the 12-lead ECG, with a down sloping ST segment only in 2/4 of the latter. With ECGI, the mean RT was similar between the groups (P=0.31), but the ERD was significantly increased in patients with idiopathic VF (P=0.01, figure 1, panel B). Moreover, RT1% was significantly lower in idiopathic VF patients in comparison to the controls (P=0.002), whereas the RT99% did not differ significantly (P=0.40). Subgroup analysis between ER positive and negative patients did not yield significantly different RT results.

Conclusion
Noninvasive ECGI, in contrast to the 12-lead ECG, revealed a wider range of epicardial RTs in patients with idiopathic VF, implying increased repolarization heterogeneity. This heterogeneity is caused by areas of earlier repolarization. Our data indicate the value of noninvasively diagnosing these repolarization abnormalities, and suggest promising potential value of the 1st percentile of RT to identify idiopathic VF patients with true early repolarization.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation Figure 1
Differences in ventricular tachycardia inducibility in patients with Tetralogy of Fallot depending on the clinical indication for the electrophysiologic study
Authors: Herrador Galindo L , Francisco Pascual J , Santos Ortega A , Perez Rodon J , Benito B , Cantalapiedra Romero J , Jordan Marchite P , Dos Subira L , Pijuan Domenech A , Miranda Barrios B , Gonzalez Fernandez V , Gordon Ramirez B , Carbonell Prat B , Ferreira Gonzalez I , Rivas Gandara N 
Published: October 2021

Abstract

Introduction
The arrhythmic risk stratification of patients with repaired Tetralogy of Fallot (TOF) is still controversial. The performance of an electrophysiologic (EP) study before pulmonary valve replacement (PVR), regardless of patient's risk factors, is an extended practice in some centers that is not recommended in current guidelines. The aim of our study was to explore the differences in ventricular tachycardia (VT) inducibility in patients with TOF during programmed ventricular stimulation (PVS) depending on the clinical indication.

Methods
All patients with repaired TOF who underwent an EP study with PVS between January 2001 and October 2020 were included. EP studies performed in the context of ventricular or supraventricular tachycardia ablations that had been previously diagnosed were excluded. We defined two clinical scenarios for performing the EP study: pre-PVR (performed previous to pulmonary valve replacement) or diagnostic EP study (performed due to high risk symptoms which included palpitations, syncope or presyncope). Baseline clinical information, electrocardiogram, echocardiogram and cardiac MRI parameters were retrospective recorded.

Results
A total of 139 EP studies with PVS were included; 87 in the pre-PVR group and 52 in the diagnostic EP study group. There was a greater incidence of palpitations, syncope and presyncope in the “Diagnostic EP study” group. Moreover, there were statistical significant differences in right ventricle dimensions and function between groups. The repair surgical approach was similar in both groups. It was detected a statistical significant difference in VT induction between the pre-PVR group and the diagnostic indicated group (16,1% vs 34,6%, p=0,012).

Conclusions
Differences in VT induction are observed during PVS performing in TOF patients depending on the clinical indication. Symptomatology is an important parameter that must be taken into account in order to decide whether to perform an EP study in this population.

Funding Acknowledgement
Type of funding sources: None.
Risk of dementia according to smoking cessation after newly diagnosed atrial fibrillation: a nationwide cohort study
Authors: Lee H J , Lee S R , Choi E K , Jung J H , Han K D , Oh S I , Lip G Y H 
Published: October 2021

Abstract

Background
Incident atrial fibrillation (AF) is associated with an increased risk of dementia. There are limited data about the impact of smoking cessation after AF diagnosis on the risk of incident dementia.

Purpose
To evaluate the association between changes in smoking status after newly diagnosed AF and the risk of dementia.

Methods
Among patients with new-onset AF between 2010 and 2016, those who received a national health checkup exam within 2 years before and after the AF diagnosis were included. Patients who had prevalent dementia were excluded. Subjects were categorized into 4 groups according to the status of smoking before and after AF diagnosis: (1) never smoker; (2) ex-smoker; (3) quit-smoker after AF diagnosis; and (4) current smoker. The primary outcome was incident dementia during follow-up.

Results
A total of 126,252 patients were included (mean age 63, SD 12.0; men 62%; mean CHA2DS2-VASc 2.7). During a median 3 years of follow-up, dementia occurred in 5,925 patients (1.11 per 1000 person-years [1000PY]) (Alzheimer's dementia 1.5 per 1000 PY and vascular dementia 0.24 per 1000 PY, respectively). Never smokers, ex-smokers, quit-smokers, and current smokers were 52%, 27%, 7%, and 14% of the total study population, respectively. After multivariable adjustment, quit-smokers showed a higher risk of dementia than never smokers (hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.03–1.32), but the risk was significantly decreased when compared to current smokers (HR 0.83, 95% CI 0.72–0.95). Alzheimer's dementia and vascular dementia showed consistent results as main (Figure).

Conclusion
All types of smoking were associated with a significantly higher risk of dementia in patients with new-onset AF. Smoking cessation after AF diagnosis showed a lower risk of dementia compared to patients smoking persistently. These findings may support the promotion of smoking cessation to lower the risk of dementia in patients with new-onset AF.

Funding Acknowledgement
Type of funding sources: None.
Lower risk of stroke after alcohol abstinence in patients with incident atrial fibrillation: a nationwide population-based cohort study
Authors: Lee S R , Choi E K , Jung J H , Han K D , Oh S , Lip G Y H 
Published: October 2021

Abstract

Background
In a recent study, alcohol abstinence reduced the atrial fibrillation (AF) recurrence in patients with AF. However, the relationship between alcohol consumption and incident stroke in patients with AF per se remains unclear.

Purpose
To evaluate the association between alcohol consumption status (and its changes) after newly diagnosed AF and the risk of ischaemic stroke.

Methods
Using the Korean nationwide claims and health examination database, we included subjects who were newly diagnosed with AF between 2010 and 2016. Patients were categorized into three groups according to the status of alcohol consumption before and after AF diagnosis: non-drinkers; abstainers from alcohol after AF diagnosis; and current drinkers. The primary outcome was incident ischaemic stroke during follow-up.

Results
Among a total of 97,869 newly diagnosed AF patients, 51% were non-drinkers, 13% were abstainers, and 36% were current drinkers. After inverse probability of treatment weighting, baseline characteristics of three groups were well-balanced. Compared to current drinkers, abstainers and non-drinkers were associated with a lower risk of ischaemic stroke (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.77–0.96 for abstainers and HR 0.75, 95% CI 0.70–0.81 for non-drinkers, respectively). Amongst current drinkers, there was a dose-response relationship between the amount of alcohol consumption and the risk of ischaemic stroke.

Conclusion
Current alcohol consumption was associated with an increased risk of ischaemic stroke in patients with newly diagnosed AF, and alcohol abstinence after AF diagnosis could reduce the risk of ischaemic stroke. Lifestyle intervention, including attention to alcohol consumption, should be encouraged as a part of a comprehensive approach to AF management to improve clinical outcomes.

Funding Acknowledgement
Type of funding sources: None.