bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atrial fibrillation in unexplained syncope: observations from the Reveal LINQ registry
Authors: Del Greco M , Natale A , Kusano K , Verma A , Beinart S , Diener H.-C , Amin A , Kasner S , Pouliot E , Noreli F , Mittal A ,   Reveal LINQ Registry Investigators
Published: October 2021

Abstract

Background
Implantable loop recorders (ILRs) have come to play an important role in the workup of patients with recurrent syncope of uncertain origin. In addition to detecting bradyarrhythmias related to syncope, which is the main diagnostic focus in these patients, ILRs are also capable of uncovering subclinical atrial fibrillation (AF).

Purpose
We sought to determine the percentage of patients monitored with an ILR for unexplained syncope who have AF detected and to describe clinical actions taken in these patients.

Methods
Patients enrolled in the Reveal LINQ Registry who received an ILR for unexplained syncope and had at least one follow-up form were included. The device automatically detects AF episodes lasting ≥2 minutes. Patients were considered to have AF based on an AF diagnosis made by the treating physician during follow-up or if device-detected AF was adjudicated as true AF by an external reviewer. AF detection rates were calculated using Kaplan-Meier methods.

Results
In total, 498 patients (aged 61.8±20.0 years, 49.6% female, CHA2DS2VASc score 2.2±1.7) were included and followed for 22±12 months. A history of AF was present in 97 (20%) patients, while 401 patients had no history. By 18 months, the incidence of AF was 70.9% (95% CI, 60.8%, 80.3%) in patients with a history of AF and 21.4% (95% CI, 17.4%, 26.1%) in patients without (Figure). AF detection in those with (30.4%) and without (30.1%) syncope during follow-up was similar. By the end of follow-up, and among patients with newly detected AF, 29/86 (33.7%) were on oral anticoagulation, 7 (8.1%) underwent AF ablation, 6 (7.0%) underwent other type of ablation, and 2 (2.3%) received cardioversion. Other actions among the whole cohort included implant of an IPG, ICD, or CRT in 98/498 (19.7%).

Conclusion
Among patients monitored with ILRs to determine the cause of recurrent syncope episodes, approximately 1 in 5 patients had new AF detected. In addition to improving the management of patients with syncope, ILR data served to support AF-related clinical decisions.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Medtronic Inc Incidence of AF according to baseline AF
Left atrial reservoir strain is reduced in patients with myocardial infarction with non-obstructive coronary arteries
Authors: Malaty M , Chen H H L , Gan G 
Published: October 2021

Abstract

Background
Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a management conundrum given the poorly understood pathogenic mechanisms. In recent years, novel echocardiographic measures such as deformation/strain analysis have enabled early identification of left atrial (LA) remodelling and dysfunction which take place prior to structural alterations. LA dysfunction is an important biomarker of cardiovascular disease and an independent predictor of atrial arrhythmias which may play a fundamental role in the pathogenesis of MINOCA.

Purpose
The goal of our study was to evaluate and characterise LA function by speckle tracking strain echocardiography in patients with MINOCA.

Methods
Patients admitted to our institution with acute myocardial infarction were assessed and those diagnosed with MINOCA who underwent transthoracic echocardiogram (TTE) within 48-hours of their coronary angiogram were included. Diagnosis of MINOCA was based on the 2017 ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. Two-dimensional speckle tracking strain analysis of the LA and left ventricle (LV) was performed offline using vendor independent software (TomTec Arena). Clinical and echocardiographic measures were compared to healthy controls identified from our echocardiography database. We excluded patients with history of atrial fibrillation, heart failure and LV dysfunction (LVEF &lt;50%).

Results
The cohort consisted of 82 patients; 41 patients with MINOCA were compared to 41 age and sex matched controls (61% male, mean age 51±12.8 years). At baseline, patients with MINOCA had a higher prevalence of modifiable vascular risk factors including smoking, hypertension and diabetes (p&lt;0.001 for all). Of the echocardiographic parameters, no differences in left ventricular (LV) parameters including LV global longitudinal strain (p=0.463), indexed LV mass (p=0.084) and the E/e' (p=0.391) was appreciated. Though there was no difference in LA volumes or volumetric parameters of LA function (LAEF; p=0.328), patients with MINOCA had a lower LA reservoir strain (29.7±8.5% vs 33.2±6.5%; p=0.04; 95% CI 0.32–5.33).

Conclusion
Patients with MINOCA demonstrated lower LASr despite normal LV and LA volumes. This suggests that LA dysfunction may play a role in the pathogenesis of MINOCA. Further studies are required to evaluate the significance of our findings.

Funding Acknowledgement
Type of funding sources: None.
The photoplethysmography dictionary: practical guidance on signal interpretation and clinical scenarios from TeleCheck-AF
Authors: Van Der Velden R M J , Verhaert D V M , Hermans A N L , Gawalko M , Duncker D , Manninger M , Hemels M , Pisters R , Lodzinski P , Steven D , Sultan A , Crijns H J G M , Pluymaekers N A H A , Hendriks J M , Linz D ,   The TeleCheck-AF investigators
Published: October 2021

Abstract

Introduction
During the coronavirus disease 2019 (COVID-19) pandemic, numerous centres in Europe used on-demand photoplethysmography (PPG) technology to remotely assess heart rate and rhythm in conjunction with teleconsultations within the TeleCheck-AF project.

Purpose
To develop an educational structured stepwise practical guide on how to interpret PPG signals and to study typical clinical scenarios how on-demand PPG was used in the TeleCheck-AF project.

Methods
During an online conference, the structured stepwise practical guide on how to interpret PPG signals was discussed and further refined during an internal review process. We provide the number of respective PPG recordings and number of patients managed within a clinical scenario during the TeleCheck-AF project.

Results
To interpret PPG recordings, we introduce a structured stepwise practical guide and provide representative PPG recordings. In the TeleCheck-AF project, 2522 subjects collected 90.616 recordings. The majority of these recordings was classified by the PPG algorithm as sinus rhythm (57.6%), followed by atrial fibrillation (AF) (23.6%). In 9.7% of recordings the quality was too low to interpret. Other observed rhythms were tachycardia (1.4%), extra systoles (4.7%), bigeminy episodes (1.8%), trigeminy episodes (0.6%) and atrial flutter (0.2%). The most frequent clinical scenario where PPG technology was used in the TeleCheck-AF project was follow-up after AF ablation (1110 patients) followed by heart rate and rhythm assessment around (tele)consultation (966 patients), sometimes including remote PPG-guided adaption of rate or rhythm control. 275 patients were followed around cardioversion, either (semi-)acute or elective. Other possible scenarios are assessment of palpitations, assessment of symptom-rhythm correlation and monitoring during up-titration of heart failure medication.

Conclusion
We introduce a newly developed structured stepwise practical guide on PPG signal interpretation developed based on presented experiences from TeleCheck-AF. The present clinical scenarios for the use of on-demand PPG technology derived from the TeleCheck-AF project will help to implement PPG technology in the management of arrhythmia patients.

Funding Acknowledgement
Type of funding sources: None. TeleCheck-AF clinical scenariosClassification of PPG recordings
Utility of miR-155, miR-21 and miR-16 in plasma as biomarkers of atrial fibrillation
Authors: Ortega-Hernandez J A , Escobar-Alvarado J , Sanchez-Munoz F , Amezcua-Guerra L M , Sanchez-Gloria J L , Toledo-Lugo A , Gonzalez-Pacheco H , Marquez-Murillo M , Springall R 
Published: October 2021

Abstract

Background
Atrial fibrillation (AF) is associated with increased morbidity and mortality. MicroRNAs (miRs) are post-transcriptional regulators that could be useful in the study of AF.

Purpose
To investigate whether miR-16, miR-21 and miR-155 may differentiate between AF and sinus rhythm.

Methods
29 controls and 42 AF (June 2019-May 2020). Lipid profile, hsCRP were measured. Serum RNA extraction was performed. Hsa-miR-21, hsa-miR-16, hsa-miR-155, and cel-miR-39 were amplified RT-PCR. Quantitative results for miR levels were generated according to the 2-ΔCt method using cel-miR-39 for normalization. Correlations were assessed by Spearman rank test. Logistic regression analysis was adjusted by age, sex, and BMI vs miR's. A p&lt;0.05 was set for significance.

Results
(controls vs AF): age (56 [52–63] vs 60 [64–67] years, p=0.122), BMI (30.52 [27.69–32.67] vs 29.65 [26.3–32.9] kg/m2 p=0.779), female 17 (58.6%) vs 19 (45.2%), p=0.268; total cholesterol (198.4 [17.2–215] vs 171.3 [150.3–216.8] mg/dL, p=0.066), LDL (126.6 [114.7–141.6] vs 99.2 [80.7–124] mg/dL, p=0.005) HDL (40.4 [36.8–45.8] vs 43.8 [36.9–48.5] p=0.326) and CRP (2.69 [1.22–4.72] vs 2.92 [1.4–4.76] mg/L p=0.835). The CHA2DS2VASC score in AF was &lt;2=11 (45.2%) and ≥2= 26 (54.8%).
MicroRNA levels (controls vs AF): miR-21 0.0195 (0.0095–0.0275) vs 0.042 (0.028–0.098) p&lt;0.001; miR-155 0.0178 (0.0108–0.0309) vs 0.01 (0.0056–0.0169) p&lt;0.001, and miR-16 0.5238 (0.2618–1.992) vs 0.1652 (0.0765–0.3816) p&lt;0.001.
In the logistic regression miR-21 had a positive correlation with AF, c=0.851 p=0.002, Wald=9.89. miR-16 and miR-155 a negative relation (c=0.76,0.72; p=0.036, 0.043, Wald=4.39, 4.085; respectively) (Fig. 1A, B, C).
For multivariable analysis we used miR-16, miR-21, and miR-155 as previous analysis demonstrated significance with an overall model c=0.90 p=0.028 (Wald=14.2) and significance was seen in the miR-21 Wald= 9.33 (p=0.002); and miR-155 Wald=4.7 (p=0.03); miR-16 was not significant (Wald=2.7, p=0.1). A ternary plot was performed using the predicted outputs of the model. (Fig. 2)

Conclusion
miR-16, miR-21 and miR-155 are useful for the discrimination of AF vs sinus rhythm and may be part of important physiopathological pathways in AF.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Instituto Nacional de Cardiología Ignacio Chávez Figure 1. Logistic regression curvesFigure 2. Multivariate ternary plot of miRs
Increased FDG uptake in AF individuals suggesting atrial inflammation visualized by FDG PET/CT with glucose uptake suppression protocols
Authors: Kupusovic J , Weber M , Kessler L , Pesch E , Riesinger L , Wakili R , Dobrev D , Rischpler C , Rassaf T , Siebermair J 
Published: October 2021

Abstract

Background
Pathophysiology of atrial fibrillation (AF) is multifactorial. Attention has been drawn towards atrial inflammation underlying arrhythmogenic remodeling. The aim of our study was to evaluate if a specific preparation protocol for positron emission tomography/computed tomography (PET/CT) with 18Fluor-labelled fluorodeoxyglucose (18F-FDG) was capable of detecting atrial hypermetabolism as surrogate for inflammation in AF, with the specific hypothesis that protocols specifically aiming to suppress physiologic glucose metabolism (fasting protocols: inflammation and malignancy preparation) were superior to non-fasting protocols.

Methods
We conducted a single-center study including n=75 patients with a history of AF and n=75 controls without AF (matched for age, sex and left ventricular systolic function) undergoing three different preparation protocols (each n=25 per group): i.) inflammation, ii.) malignancy and iii.) viability protocol before 18F-FDG-PET/CT. We performed visual analysis of local detectable atrial uptake (figure 1A) and assessed quantitative uptake in predetermined loci of the atria and endocrine adipose tissue (EAT), using maximum standardized uptake values (SUVmax) and target to background ratios (TBR).

Results
Our analysis of visual atrial 18F-FDG uptake revealed that atrial uptake was exclusively observed in AF patients using the malignancy (13/25 patients) and inflammation (10/25 patients) protocol, while the viability preparation revealed atrial uptake both in AF (n=6 patients) and non-AF patients (n=5 patients).
With respect to quantitative measures between AF and non-AF individuals using the inflammation protocol, patients with AF showed significantly higher uptake values in the right atrium (SUVmax: 2.54±0.75 vs. 2.03±0.66, p=0.01); TBR 1.51±0.44 vs. 1.18±0.20, p&lt;0.01), right atrial appendage (SUVmax: 2.44±0.71 vs. 2.02±0.64, p=0.03; TBR: 1.47±0.47 vs. 1.20±0.26, p=0.02) and also in EAT (SUVmax: 1.39±0.46 vs. 1.13±0.40, p=0.04), figure 1B. Despite a trend of higher tracer uptake related to the presence of AF in left atrial structures, no statistical significances could be observed between AF and non-AF individuals.

Conclusion
This retrospective study demonstrates that protocols specifically designed to suppress physiologic glucose uptake seem to be superior in detecting atrial FDG uptake, which could be indicative of atrial inflammation in AF patients. Based on our results the right atrium seems to be more affected from these changes. These results point towards a potential role of right atrial inflammatory processes in AF pathophysiology besides the established left atrial ectopic triggers.

Funding Acknowledgement
Type of funding sources: None.
Direct oral anticoagulants vs warfarin in non-valvular atrial fibrillation. Meta-analysis, includes all published trials
Authors: Arreaga-Perez C , Evangelista-Barragan D , Zarate-Zapata A , Penaherrera E , Zuniga-Bohorquez J J , Garcia-Matamoros F , Flores-Delgado M , Barrera-Rivera M , Bravo-Sanchez P , Tejada-Franco A , Gilbert-Orus M D , Morejon-Barragan P A 
Published: October 2021

Abstract

Introduction
Warfarin, despite its limitations, is still used as standard treatment in patients with Atrial Fibrillation, but it has been demonstrated that Direct Oral Anticoagulants (DOAC) offer many advantages over warfarin in the prevention of strokes.

Purpose
The goal was to determinate the safety and effectiveness in reducing systemic thromboembolism, ischemic stroke, hemorrhagic stroke, cerebral hemorrhage and cardiovascular mortalityof the direct oral anticoagulants (DOACs) over warfarin in patients with non-valvular atrial fibrillation, conducting an analysis of the studies of DOACs, including the ENGAGE study on the use of edoxaban, affirming its safety including the pivotal essays available.

Method
A systematic search of PubMed's bibliographic database was made for the selection of the articles.Clinical essays from less than 10 years, in phase III and multicentric studies were selected.

Results
The main objective was the significant reduction in the incidence of stroke/systemic thromboembolism with the use of DOACs vs. Warfarin (2,73% vs. 3,24%), the reduction of hemorrhagic stroke was (0.41% vs. 0.94%), ischemic stroke (3.12% vs. 3.5%), cardiovascular death with DOACs was 6.02% vs. Warfarin 6.84%, (compared with previous studies that demonstrated effectiveness with max doses affirming safety and effectiveness).

Conclusion
Our meta-analysis is the first to date to evaluate all the pivotal trials published,we include the ENGAGE trial. In non-valvular atrial fibrillation, the use of DOACs, in comparison with Warfarin, significantly reduced the risk of stroke/systemic thromboembolism by 16.3%, ischemic stroke by 11.1%, hemorrhagic stroke by 54.6%, cardiovascular mortality by 12.9%.

Funding Acknowledgement
Type of funding sources: None.
The effect of patient weight and amiodarone use on the energy of a successful shock in cardioversion of atrial arrhythmias – single-center experience study
Authors: Jiravsky O , Rucki L , Chovancik J , Spacek R , Svobodnik A , Stepanova R , Kubat T , Fiala M 
Published: October 2021

Abstract

Background
Electrical cardioversion (DCCV) is an effective method of sinus rhythm restitution. Recently published data suggest higher efficiencies of higher discharge energies. The influence of individual parameters on the success of cardioversion is still studying.

Purpose
To evaluate the influence of individual patient parameters on the energy of a successful external defibrillator shock during cardioversion of atrial arrhythmias

Methods
The retrospective analysis cohort of all patients treated by DCCV due to atrial arrhythmias between 10/2015 and 1/2020. To evaluate potential predictors for the choice of a higher initial discharge using one-dimensional logistic regression and to include parameters significant at the 10% level of significance (p&lt;0.1) in the multidimensional logistic regression model.

Results
1986 electrical cardioversions of 984 patients (382 repeated procedures of the same patients in a cohort). 1292 (65.1%) men and 694 (34.9%) women aged 67.0 (±10.2) years.
Mean energy of the first shock 118.9 (±19.2) J with a success rate of 77.8%, energy of the second shock 154.0 (±26.3) J, which increased the overall success to 80.0%, and mean high of the third shock 173.9 (±25.6) J, when the total efficacy of DCCV in sinus rhytm restitution reached 89.8%.
From the univariate binary regression, parameters significant at the 10% level of significance (p&lt;0.1) were selected and included in a multidimensional logistic regression model. Only the patient's weight and the use of amiodarone proved to be statistically significant. Weight with OR 1.21 and use of amiodarone with OR 1.43.

Conclusion
Patient weight and amiodarone use are predictors of the need to use higher energy electric cardioversion.

Discussion
Amiodarone medication does not appear to increase the defibrillation threshold, but rather is a feature that represents the group of patients treated with more aggressive antiarrhythmic therapy for advanced atrial arrhythmias with more significant structural impairment, but this attitude requires further study.

Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): VAVIA: IGS202009 - Racionální algoritmus při elektivní elektrické kardioverzi fibrilace síní.
Dynamics of myocardial global longitudinal strain in patients with COVID-19 without significant baseline cardiovascular pathology
Authors: Iakovlev S , Dukhin O , Ryzhkova E , Andreeva E , Kalinskaya A 
Published: October 2021

Abstract

Background/Introduction
SARS-CoV-2 is notorious for its ability to cause damage to the respiratory system and myocardium, which can result in the development of acute respiratory distress syndrome and myocardial dysfunction.

Purpose
The aim of our study was to assess the interaction between the severity of COVID-19 and echocardiographic parameters of myocardial dysfunction, as well as lung ultrasound data.

Methods
47 COVID-19 patients without signs of cardiovascular pathology were included in our study (33 in the moderate severity subgroup and 14 in the severe subgroup). All patients underwent comprehensive transthoracic echocardiography, including global longitudinal strain (GLS) of both ventricles, and lung ultrasound at days 1 and 9 of the disease. We used GLS cut-off values of 16% and 20% for LV and RV respectively. We performed the lung ultrasonography using an 8-zone protocol for each lung. The EACVI lung ultrasound scoring system for each region and ultrasound pattern was used.

Results
At day 1, patients in the severe subgroup had a greater tricuspid gradient (22,0 [21,0; 26,0] vs. 30,0 [24,0; 34,5], p=0,04) and systolic pulmonary artery pressure (22,0 [21,0; 26,0] vs. 30,0 [24,0; 34,5], p=0,02). Moreover, we noted a decrease in the GLS RV index in COVID-19-patients in comparison with the generally accepted reference values (18,45 [15,8; 21,0]). During the course of the disease, an increase in GLS RV was noted in both subgroups, which was especially pronounced among severe patients (18,5 [15,2; 21,1] vs. 20,2 [15,8; 22,0], p=0,038).
Assessing the LV function, we noted a difference in the E/e (LV) ratio among severe and moderate subgroups (7,5 [6,8; 9,34] vs. 9,5 [7,7; 10,2], p=0,03). The GLS LV didn't differ between patient subgroups at day 1. We noted an increase in GLS LV at day 9 in both subgroups, but the difference reached significance among moderate patients (17,9 [15,8; 20,1] vs. 19,5 [17,1; 21,8], p=0,038).
We observed a greater number of points assessing the B-lines among severe subgroup compared to moderate subgroup (19,5 [17,5; 26,5] vs. 13,0 [7,0; 18,0], p&lt;0,01).

Conclusion
Among COVID-19 patients without an underlying cardiovascular pathology the transient decrease in LV and RV function assessed via GLS was observed even among patients with moderate disease severity.

Funding Acknowledgement
Type of funding sources: None.
Impact of comorbidities and ablation strategy on outcome after pulmonary vein isolation with cryo-balloon in patients with non- paroxysmal atrial fibrillation
Authors: Berkowitsch A , Hutter J , Zaltsberg S , Tomic M , Kahle P , Hain A , Kuniss M , Neumann T 
Published: October 2021

Abstract

Background
Presence of several comorbidities in patients with atrial fibrillation is well known, but impact of them on outcome after pulmonary vein isolation with cryo-balloon is not enough investigated. First aim of the study was analysis of the impact of comorbidities on long term outcome after PVI with cryo-balloon new generation (CBA) and secondary goal was evaluation of the impact of additional posterior roof ablation (PRA) in these patients.

Methods
Patients with non-paroxysmal AF ablated with CBA in our institution since May 2012 and completed follow up &gt;3 months were enrolled in the study. The history of AF, cardiac comorbidities (CAD, Non ischemic-cardiomyopathy, heart insufficiency, right ventricular dysfunction) diabetes mellitus, and renal failure were assessed at admission, all patients received echocardiographic examination and blood test.
After a single trans-septal access and PV angiography PVI was performed using a 28-mm CBA. Mapping of PV signals before, during, and after each cryo application was performed with a 3F lasso catheter. The procedural endpoint after PVI was defined as complete elimination of all fragmented signals at the PV antrum with verification of entrance and exit block. In some patients PRA was performed additionally to PVI at discretion of physician. The primary endpoint of this study was the first documented recurrence of atrial tachyarrhythmia (&gt;30 sec.), hospitalization due to cardio-vascular cause, re-do procedure or re-administration of anti-arrhythmic drugs.

Results
Among 560 patients 78 (13.9%) had no comorbidity and 299 (53.4%) were lasted with &gt;1 comorbidity. A total of 260 (46.4%) recurrences were obtained within median follow up of 28 (12–57) months. Female gender, long time from first diagnosis &gt;12 months and cardiac comorbidity were revealed to be independent predictors for long term recurrences whereas additional PRA performed in 176 pts independently improved outcome (61.9% vs 49.7%).

Conclusion
Cardiac comorbidities increased probability of post ablation recurrences, but performing of additional posterior roof ablation improved outcome in our cohort. These results should be confirmed in multi-center randomized study

Funding Acknowledgement
Type of funding sources: None.