bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thoracoscopic ablation for symptomatic atrial fibrillation improves quality of life
Authors: Vos L.M , Vos P.W.K , Nieuwkerk P.T , Vos R , Havenaar H , Hofman F.N , Boersma L.V.A , Van Putte B.P 
Published: October 2021

Abstract

Background
Rhythm control has become an essential part of adequate management in atrial fibrillation (AF) to reduce symptoms and ultimately to improve health related quality of life (HRQoL). Totally thoracoscopic ablation has been established over the last years as an effective and safe rhythm control strategy, especially for persistent AF, but quality of life data are lacking.

Purpose
To assess the impact of totally thoracoscopic ablation on HRQoL in patients with symptomatic AF.

Methods
Consecutive patients with symptomatic AF undergoing totally thoracoscopic ablation at a referral centre in the Netherlands (July 2016 – October 2019) were included. The primary outcome was quality of life. Short Form 36 and Atrial Fibrillation Effect on Quality-of-Life (AFEQT) health surveys were collected at baseline, 1, 3, 6 and 12 months. Clinical improvement was measured as the relative increase of the QoL-score at 1 year compared to the baseline score (in %). Multilevel regression modelling was used, coupled with fractional polynomials for adjustment of age differences and nonlinear time trends, to investigate the one-year clinical trajectories of sex differences in QoL subscales. Secondary outcomes included rhythm success (freedom from any recurrence of atrial tachyarrhythmia&gt;30 sec), mortality and stroke.

Results
191 patients were included (63.9±8.6 years, 68% male, 22.5% paroxysmal AF, 69.6% persistent AF and 7.9% long-term persistent AF, 66.5% having at least one previous failed catheter ablation, with median Cha2ds2 Vasc score of 2 [IQR 1–3]). AFEQT sum scores (52.6 points at baseline) substantially improved after three months (49.8%; p&lt;0.001) and remained stable up to 1-year (54.2%; p&lt;0.001) despite adverse events. Patients with recurrent AF also showed significant improvement at 3 months which remained stable up to 1-year, but patients who remained in sinus rhythm had significantly more increase (61.3% vs 26.9%, p&lt;.001). The SF36 physical and mental summary composite scores significantly improved after 3 months (12.3% and 11.9% respectively; p&lt;.001) and remained stable up to 1-year (16.9% and 16.4% respectively; P&lt;.001). Although female patients had significantly lower AFEQT and physical subscales at baseline, similar improvement in scores were observed over time compared to men, adjusted for age and sex interactions (P&lt;.001). One-year stroke rate was 1.6 per 100 patient-years with an oral anticoagulation rate of 63%. One-year survival was 99.5%.

Conclusions
This study reveals significant improvement of HRQoL three months after thoracoscopic ablation that persisted up to 1-year, also when adjusted for sex and age differences. Despite AF recurrence or adverse events AF related QoL still improved. Trials are necessary to confirm these data.

Funding Acknowledgement
Type of funding sources: None.
Cancer incidence during follow-up in patients with new-onset atrial fibrillation treated with DOACs and its impact on bleeding risk
Authors: Angeli F , Bartoli L , Fabrizio M , Bergamaschi L , Magnani I , Paolisso P , Armillotta M , Sansonetti A , Chiti C , Stefanizzi A , Toniolo S , Foa A , Rinaldi A , Galie N , Pizzi C 
Published: October 2021

Abstract

Background
Cancer is increasingly recognized as strictly related to atrial fibrillation (AF). In patients with AF, the relationship between cancer and cardioembolic or bleeding risk during oral anticoagulant therapy is unknown.

Purpose
To assess the bleeding and ischaemic burden of a baseline or newly diagnosed cancer in patients treated with direct oral anticoagulants (DOACs) for non-valvular atrial fibrillation (NVAF).

Methods
All consecutive patients treated with DOACs were enrolled among those with new-onset atrial fibrillation and indication for oral anticoagulant between January 2017 and March 2019. During follow-up, bleeding events, newly diagnosed primitive or metastatic malignancy and major cardiovascular events (MACE) were evaluated. At baseline, CHA2DS2-VASc, HAS-BLED, ATRIA, and ORBIT scores were used to assess the hemorrhagic and ischaemic risk. Major bleedings (MB) were defined according to the ISTH definition. Anemia was defined as haemoglobin levels below 11 g/dL in women and 12 mg/dL in men.

Results
1258 patients constituted the study population and followed for a mean time of 21.6±9.5 months. Overall, 66 patients (5.2%) were affected by malignant neoplasia at baseline, whereas 59 (4.7%) were diagnosed with a malignancy during follow-up. Among baseline characteristics, anemia was associated with cancer at enrolment (43.9% vs 22.5%, p&lt;0.001) but not at follow up (29.3% vs 23.4%, p=0.341). MACEs were not associated with cancer at baseline (5.3% vs 5.2%, p=1.0) and at follow up (5% vs 4.9%, p=1.0). No association was observed between major ischaemic events and cancer at enrolment or follow up (5.3% vs 4.4%, p=0.83 and 4.4% vs 5%, p=0.82). Despite no statistically significant differences in haemorrhagic risk at baseline, the overall bleeding events and MB were associated with newly diagnosed cancer (9.2% vs 3.9%, p=0.001 and 13.8% vs 4.5%, p=0.001, respectively) but not at baseline (5.2% vs 5.5%, p=0.82 and 9.2% vs 5.2%, p=0.162). At multivariate analysis adjusted for age, hypertension and renal function, anemia and a newly diagnosed cancer during follow up remained independent predictors of MB (respectively, HR 1.27, 95% CI 1.52–1.06, p=0.009 and HR 3.53, 95% CI 7.71–1.62, p=0.001).

Conclusion
Bleeding risk assessment is an ongoing challenge in patients with NVAF on DOACs. During follow-up, newly diagnosed primitive or metastatic cancer is a strong predictor of bleeding regardless of baseline haemorrhagic risk assessment. In contrast, such association is not observed with malignancy at baseline. A proper diagnosis and treatment could therefore decrease cancer-related bleeding risk. On the contrary, our study shows that cancer is not an ischaemic risk modifier, either diagnosed at baseline or follow-up.

Funding Acknowledgement
Type of funding sources: None.
Blunted heart rate reserve with dobutamine stress echocardiography predicts outcome in diabetes and/or chronic kidney disease
Authors: Bellagamba C.C.A , Quevedo N.M , Torres M 
Published: October 2021

Abstract

Background
A blunted heart rate reserve (HRR) during dobutamine stress echo (DSE) is an index of the altered cardiac sympathetic reserve, which is frequently present in diabetes mellitus (DM) or chronic kidney disease (CKD).

Aim
To assess the prognostic value of HRR during DSE.

Methods
We recruited 280 patients (mean age 62.9±13.1 years; 128 (45.7%) male; 28.2% on beta-blockers at the time of testing) who underwent DSE for known or suspected coronary artery disease and/or heart failure and were followed-up. Four subsets were identified: Group 1 (111 pts without DM or CKD); group 2 (37 with DM without CKD); group 3 (90 with CKD with or without DM); and group 4 (42 with CKD on dialysis). HRR was calculated by EKG as the peak/rest HR ratio.

Results
Ischemia was identified in 34/280 (12.1%) pts. During a median follow-up time of 40.3±30.5 months, 120 events occurred: 46 deaths, 15 non-fatal myocardial infarctions, 23 hospital admissions for acute decompensated heart failure, and 36 myocardial revascularizations. Multivariable comparison of HRR among the 4 groups using post hoc test showed a blunted HRR in group 3 (1.66±0.32) and 4 (1.65±0.27) when compared with group 1 (HRR 1.85±0.35), p&lt;0.01. Group 2 (1.73±0.28) was not different from any group (p=ns). Groups 3 and 4 were not different between them (p=ns). A post hoc Tukey test for HRR separated in tercils, 1st: HRR &lt;1.59, 2nd: 1.59 &lt; HRR &lt;1.86 and 3rd: HRR &gt;1.86 (p&lt;0.000). Kaplan-Meier curves showed blunted HRR as an independent predictor of event-free survival in the overall group - 1st: 66.08±5.9 months, 95% CI 54.3–77.7; 2nd: 69.52±6.5, 95% CI 56.6–82.3; 3rd: 90.05±5.3, 95% CI 79.5–100.5. See Figure. HRR was comparable in patients with and without inducible ischemia and off or on beta-blockers.

Conclusion
A blunted HRR during DSE is frequent in patients with DM and CKD, independent of inducible ischemia and use of beta-blockers, and is a useful non-imaging predictor of adverse events.

Funding Acknowledgement
Type of funding sources: None.
Feasibility of preprocedural LAA occluder sizing
Authors: Brenner C , Haber T , Melichercik J , Ismer B , Haas N.A 
Published: October 2021

Abstract

Background
Implantation of occluders in the left atrial appendage (LAA) has been established to prevent patients with atrial fibrillation (AF) from stroke and embolisation. Currently, the individual occluder sizing will be done intraprocedurally using fluoroscopy and/or transesophageal echo (TEE) imaging.

Purpose
Development of a new approach allowing preprocedural occluder sizing and its validation by conventional intraprocedural methods.

Methods
The CARTO electro-anatomical mapping system was used in 62 consecutive patients (40 m, 22 f, age: 69.8±8.4 years) to preprocedurally predict the size of Watchman (n=34) or Amplatzer Amulet (n=28) devices. During device implantation, 23 of the patients (37.1%) were in AF. LAA morphologies were Chicken Wing (40.0%), Cauliflower (31.7%), Windsock (20.0%) and Cactus (8.3%). CHA2DS2-VASc Score was 3.7±1.9 and HAS-BLED-Score was 3.6±1.3. Preprocedurally, routine cardiac CT scans were imported into the CARTO segmentation tool for segmentation of the left atrium. The resulting volume images (VI) and slice images (SI) were adjusted in their 3-dimensional orientation to fit the manufacturer's sizing recommendations. Subsequently, the match between pre- and intraprocedural sizing was compared with the actually implanted device size.

Results
In the Watchman group, preprocedural VI corresponded with 38.1% (8/21) and SI with 42.3% (11/26), while intraprocedural fluoroscopy corresponded with 29.6% (8/27) and TEE with 40.0% (12/30) of all actually implanted devices. According to clinical routine an aberration of one size is common practice. After including one additional size to the estimation, VI corresponded with 81.0% (17/21), SI with 84.6% (22/26), while fluoroscopy corresponded with 85.2% (23/27) and TEE with 80.0% (24/30) of all actually implanted occluders.
In the Amplatzer Amulet group, VI corresponded with 37.0% (10/27), SI with 57.1% (16/28) and fluoroscopy with 71.4% (20/28) of all actually implanted devices. After including one additional size to the estimation, VI corresponded with 66.7% (18/27), SI with 85.7% (24/28) and fluoroscopy with 100% (28/28) of all actually implanted occluders. The remaining were selected empirically.

Conclusion
In this study cohort of 62 patients, feasibility of a preprocedural sizing using the CARTO segmentation tool was demonstrated for Watchman occluders providing results comparable with conventional intraprocedural fluoroscopy and/or TEE based intraprocedural sizing. Possibly due to the different manufacturer measuring recommendation, 10 to 12 mm away from the LAA ostium, results for the Amplatzer Amulet system were found to be less accurate. Nevertheless, the proposed approach offers the advantage of preoperative visualisation of the individual LAA anatomy and morphology.

Funding Acknowledgement
Type of funding sources: None.
Leadless pacemaker implant with concomitant atrioventricular node ablation: experience in a single center study with longterm followup
Authors: Martinez-Sande J.L , Garcia-Seara J , Gonzalez-Melchor L , Rodriguez-Manero M , Perez-Poza M , Fernandez-Lopez X.A , Garcia-Vega D , Torrelles-Fortuny A , Gonzalez-Juanatey J.R 
Published: October 2021

Abstract

Introduction
Feasibility of concomitant leadless-pacemaker (LP) implantation plus atrioventricular node ablation (AVNA) is unknown. Moreover, safety issues in the long run are also undetermined. It seems theoretically attractive since it could avoid one additional procedure and catheter could be introduced through the same sheath employed for the LP. On the contrary, risk of dislocation/electrical variations could represent a shortcoming.

Objective
We aim to report 1) feasibility of concomitant AVNA after a LP implantation and 2) long-term outcomes.

Methods
Single center, prospective and observational study of 256 consecutive patients with an indication for single-chamber pacemaker placement. The implantation procedure was carried out using a femoral approach and conventional technique. Successful implantation was accomplished in 255/256 patients referred for leadless implantation. In one patient, a complete obstruction of the inferior vena cava was documented, and a conventional unicameral pacemaker was implanted.

Results
33 out of 255 patients underwent immediate AV ablation. Mean age was 75.2±8.3 years. Were predominantly females: 25 (75.7%) and indication was fast conduction atrial fibrillation (n=25), atypical flutter or atrial tachycardia (n=8). Mean acute “R wave” was 11.3mV, threshold of 0.55Vx0.24ms and impedance of 833Ω. Uneventful AV node ablation was performed in all of them immediately after LP implantation. Additional mean fluoroscopic time was 3.0 minutes.
There were no vascular or arrhythmic complications after the implantation. After a mean follow-up of 27.9±12 months, all patients remained alive without notable event, and electrical parameters remained unchanged (Figure 1). Actuarial survival was shown in Figure 2.

Conclusions
Conconmitant AVN ablation after LP implantation seems feasible without remarkable complications in the long run. In our experience, this approach appears more comfortable for the patients and less time-consuming than conventional pacemaker implantation with sequential AV node ablation. There were no device macrodislodgements or unexpected device malfunctions in the follow-up period.

Funding Acknowledgement
Type of funding sources: None. Electrical performanceSurvival
Real-world experience on the safety and effectiveness of Micra TPS in patients with pre-existing in situ CIEDs
Authors: Garweg C , Bordachar P , Boveda S , Roberts P.R , Johansen J.B , Iacopino S , Clementy N , Winter S , Anderson C , Butler K , El-Chami M.F 
Published: October 2021

Abstract

Background
The Micra pre-market study showed that the Micra transcatheter pacing system could be safely implanted in patients with pacing indications. Patients with pre-existing cardiac implantable electronic devices (CIED) were excluded from this clinical trial; however, this group of patients might benefit from a leadless pacemaker especially when a lead fails or after incidence of system-related infections.

Objective
To determine the outcome of patients with a pre-existing CIED or lead that remains in situ at the time of Micra implant attempt.

Methods
Patients who had a pre-existing CIED and/or lead at the time of Micra implantation attempt were identified from the Micra Post-Approval Registry and Micra Acute Performance studies. Baseline characteristics were summarized, and a Fine-Gray competing risk model was used to compare risk for major complication through 24 months for patients with and without a pre-existing CIED.

Results
Of the 2323 patients included in the analysis, 111 patients had a pre-existing CIED or lead at the time of Micra implantation attempt that remained in situ. Types of pre-existing devices included 81 pacemakers (45 single chamber, 32 dual chamber, 4 of unknown type), 10 ICDs (2 single chamber, 2 dual chamber, 6 unknown type), 10 CRT devices (6 CRT-P, 4 CRT-D), 3 generators of unknown type, and 7 patients had only leads remaining. Patients with pre-existing devices were younger and less likely to have a pacing indication of bradyarrhythmia with atrial fibrillation compared to patients without pre-existing devices (p&lt;0.001 for both). Patients with prior devices were more likely to have a condition precluding implant of a transvenous pacemaker (67.6% vs. 21.3%, p&lt;0.001). The presence of a pre-existing CIED did not impact the outcome of the Micra TPS implant procedure: implant success was &gt;99% for both cohorts. Mean follow-up duration was 21.2±14.3 months (range 0–56) for pre-existing devices patients and 23.3±15.8 months (range 0–62) for other patients. The rate of major complications through 24 months was 1.8% for patients with and 3.8% for patients without prior devices (p=0.36). There were no major complications related to device malfunction or device-device interaction. There were 6 system revisions in 4 patients with preexisting devices and 52 revisions in 51 patients without preexisting devices. Pacing thresholds for patients with and without prior devices were similar at implant (0.72 and 0.63, respectively; p=0.31) and remained stable through 12 months.

Conclusion
Micra can be safely and successfully implanted in patients with a pre-existing CIED remaining in situ. It should be considered a treatment option for patients in whom CIED extraction may be deemed high risk.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Medtronic, Inc. Risk of major complications
Exercise stress echocardiography with probe fixated on patient's chest
Authors: Wdowiak-Okrojek K , Lipiec P , Wejner-Mik P , Bednarkiewicz Z , Kasprzak J.D 
Published: October 2021

Abstract

Background
Stress echocardiography (SE) has been widely used in clinical practice for decades and recently has gained even more importance in diagnostic approach to ischemic heart disease. However, it still has numerous limitations. Despite advantages of physical exercise as most physiologic stressor, it is impossible to continuously monitor the cardiac function during treadmill test and difficult to maintain an optimal acoustic window during cycle ergometer exercise test. We aimed to assess the feasibility of probe fixation for the use during exercise echocardiography.

Methods
48 subjects (47 men, mean age 42±17 years, 25 healthy volunteers, 23 patients with suspected coronary artery disease) were included in this study. All subjects underwent exercise stress test on treadmill (32 cases) or cycle ergometer (16 cases). Both sector and matrix probes were used (in 17 and 31 tests, respectively). We assessed semi-quantitatively the quality of acquired apical views at each stage using four-point grading system (0 = poor, 1 = suboptimal, 2 = acceptable, 3 = optimal).

Results
The mean time required for probe fixation was 9±2 min. At baseline, 10 patients had at least one apical window of quality precluding reliable analysis. 25 patients probe repositioning during exercise (more often on treadmill). During peak exercise quality of images in all views declined, but it remained sufficient in 29 patients for diagnostic purposes. Thus, 76% of performed tests (60% for all study population) were of sufficient image quality.

Conclusion
Probe fixation offers the possibility of continuous acquisition of echocardiographic images during physical exercise. However the device is suitable almost exclusively for male patients. Moreover, in some patients it requires repositioning.

Funding Acknowledgement
Type of funding sources: None.
Echocardiographic determinants of ventricular arrhythmia in sickle cell disease adults
Authors: Dupuy M , Saba J , Codiat R , Derumeaux G , Alassaad L , Abou Chakra L , Odouard S , Deux J.F , Guillet H , Savale L , De Luna G , Bartolucci P , D'Humieres T 
Published: October 2021

Abstract

Background
Unexplained sudden death remains one of the leading causes of death in sickle cell disease (SCD) adults. Ventricular arrhythmia is a well-known risk factor for sudden death but its prevalence and determinants in the context of SCD remain understudied.

Purpose
The aim of this study was to identify echocardiographic predictors of ventricular arrhythmia in SCD.

Methods
From January 2019 to March 2021, consecutive adult patients with SCD referred to ambulatory cardiology department for possible cardiac involvement were prospectively included (Drepacoeur cohort). All patients that had 24-hour ECG monitoring (24h-holter) and thransthoracic echocardiography (TTE) on the same day were analysed in this study. The primary end point was the occurrence of ventricular arrhythmia, defined as sustained or non-sustained ventricular tachycardia (VT), more than 500 premature ventricular contractions (PVC) on 24h-holter, or history of VT ablation.

Results
Overall, 90 patients were included and 54 (60%) were analysed. Mean age was 47.6±11.6 years (range 21–69), 53% were male. Heart function was mainly preserved with a mean left ventricular ejection fraction (LVEF) of 57.9±4.9% and a mean global longitudinal strain (GLS) of −18±2.8%. Mean tricuspid regurgitation velocity was 2.6±0.4m/s.
Ventricular arrhythmia was observed in 13 (24.1%) patients (4 non-sustained VT [range 4–121 consecutive PVC], 9 with more than 500 PVC [range 500–13000 PVC/24h] and 1 history of VT ablation). Regarding echocardiographic parameters, ventricular arrhythmia was associated with lower GLS (−15.8±1.8% vs. −19±2.7%, P&lt;0,001), lower tricuspid annular plane systolic excursion (TAPSE, 23±5.7mm vs. 26.9±4.6mm, P=0,02) and more dilated right ventricle assessed by tricuspid annulus diameter (38.2±6.1mm vs. 34.2±4.5mm, P=0,02). In multivariate analysis, GLS was independently associated with ventricular arrhythmia (OR=2,1 CI95% [1,3; 3,3], P=0,004) with a moderate exponential correlation with PVC load on 24h-holter (R=0,5, P&lt;0,001). Interestingly, ventricular arrhythmia was not associated with corrected QT interval nor with age or hemoglobin serum level.

Conclusion
In SCD adults with preserved LVEF, GLS was the only independent echocardiographic predictor of ventricular arrhythmia.

Funding Acknowledgement
Type of funding sources: None.