bluuebunny/crossref_metadata_2025_split huggingface dataset:
Third-generation laser balloon ablation for atrial fibrillation treatment: a multicenter experience
Authors: Rovaris G , Martignani C , Miracapillo G , Colella A , Giaccardi M , Forleo G.B , Giomi A , Giacopelli D , Grassini D , Pozzi M , Montemerlo E , Ziacchi M , Schiavone M , Biffi M 
Published: October 2021

Abstract

Background
Laser balloon ablation is a promising option for performing pulmonary vein isolation (PVI) which is the cornerstone of invasive atrial fibrillation (AF) treatment.

Purpose
We aimed to investigate the acute efficacy and safety of the novel third-generation of the laser balloon system in an initial multicenter experience.

Methods
First and consecutive patients who underwent PVI with LB3 for drug-resistant paroxysmal or persistent AF at 7 Italian sites were included in this analysis. Study endpoints were acute procedural efficacy, defined as successful isolation of all identified PVs without radiofrequency touch-up, total and fluoroscopy times, and periprocedural complications.

Results
Our population included 86 patients (81% males, mean age 60.6±9.5 years) who underwent a procedure of PVI using LB3 between June 2020 and March 2021.
Most patients had paroxysmal AF (74%) and were in sinus rhythm at the beginning of the procedure. The mean procedure time was 138±60 min; fluoroscopy time was 22±17 min and the mean ablation time was 44±40 min. Of the 313 targeted PVs, 311 (99.4%) could be isolated with first-pass LB3 application, while 2 (0.6%) required radiofrequency touchup. At the end of the procedure, all patients were in sinus rhythm and 26 (32%) received electrical cardioversion to achieve stable sinus rhythm.
The total rate of major compilations was 1.2% (1/82 patients): one pericardial tamponade requiring epicardial puncture. No surgical intervention was necessary, and the patient recovered without any sequalae. There were no vascular access complications or phrenic nervy palsy. Three pinhole balloon raptures (3.5%) were observed during energy applications that required replacement of the whole system but had no effect on patient safety.

Conclusions
In a first multicenter experience, the LB3 system for PVI was safe with excellent acute efficacy.

Funding Acknowledgement
Type of funding sources: None.
Pulmonary veins reconnection pattern differences after failed radiofrequency ablation and cryoballoon ablation for atrial fibrillation
Authors: Antoun I , Sihdu B , Mavilakandy A , Merzaka L , Stafford P , Sandilands A , Somani R , Ng G.A 
Published: October 2021

Abstract

Point-by-point radiofrequency ablation (RF) and one-shot cryoballoon ablation (CRYO) electrically isolate pulmonary veins (PVs) in atrial fibrillation (AF) using different techniques and energies. This study aimed to examine differences in PVs reconnection pattern and ablation lesions required to re-isolate PVs after failed RF and failed CRYO.

Methods
Twenty-four patients who had their repeat ablation between January 2017-December 2020 were studied with six months of learning curve for CRYO. Fourteen patients had paroxysmal atrial fibrillation (PAF). Failed first ablations were defined by electrocardiogram (ECG) documented AF within twelve months following three months blanking period. Repeat ablations were performed using CARTO3® mapping system, which was utilized to locate ablation lesions and impedance drop details.

Results
2,260 lesions were collected from 63 reconnected PVs (31 isolated after RF vs 32 isolated veins after CRYO). 849 lesions were targeted towards triggers. Repeat ablation procedure time was similar between both cohorts. However, repeat ablation after failed CRYO had longer fluoroscopy time (19.8±2 vs 12.4±2.1 minutes, P=0.019). The right lower pulmonary vein (RLPV) was reconnected after failed CRYO for AF in 92% of patients and 100% in PAF patients.
Although PV reconnection pattern was similar between both cohorts, RLPV and left upper pulmonary vein (LUPV) required more ablation lesions after failed CRYO. Left lower pulmonary vein (LLPV) and right upper pulmonary vein (RUPV) required more ablation lesions after failed RF. Impedance drop was similar in both cohorts.

Conclusion
After failed CRYO for PAF, RLPV was reconnected in all patients. RUPV and LLPV required more ablation lesions after failed RF, while RLPV and LLPV required more ablation lesions after failed CRYO.

Funding Acknowledgement
Type of funding sources: None. PVs reconnection patternLesions number and percentage comparison
Socioeconomic status and trends in utilization of catheter ablation in patients hospitalized with atrial fibrillation in united states
Authors: Rojulpote C , Patil S , Gonuguntla K , Kharbanda P , Karambelkar P , Kela K , Singh V , Nadadur S , Kumar M , Buch T 
Published: October 2021

Abstract

Introduction
Atrial fibrillation (AF) is the most common arrhythmia encountered in a hospital setting. However, there is little data on the relationship of socioeconomic status (SES) and the utilization of catheter ablation amongst patients admitted with AF.

Methods
The National Inpatient Sample database was queried from 2003 to 2014 using ICD 9 revised diagnosis codes to identify patients who were hospitalized with a primary diagnosis of AF. SES was determined by median household income (MHI) and divided into quartiles (0–25th, 26–50th, 51–75th, and 76–100th). Trends were analyzed using Cochran Armitage test.

Results
We analyzed 3,618,133 patients with AF that were admitted from 2003 to 2014 (median age: 72 [IQR 61 – 81], female 52.6%). Trends stratified by MHI to compare catheter ablation rates of all 12 years revealed significant differences (Figure 1). A multivariable logistic regression accounting for sociodemographic factors revealed an increasing trend of catheter ablation utilization with higher MHI (Figure 1).

Conclusion
Over a 12-year period, patients admitted to the hospital with AF with higher MHI were found to have increasing rates of catheter ablation utilization due to AF. Conversely, a decline in catheter ablation rates were noted in patients with lower MHI.

Funding Acknowledgement
Type of funding sources: None.
Effectiveness and safety of edoxaban in atrial fibrillation patients from the ETNA-AF global registry
Authors: De Caterina R , Wang R , Shi L , Pecen L , Ye X , Reimitz P.-E , Chen C , Unverdorben M , Giugliano R.P 
Published: October 2021

Abstract

Background/Introduction
ETNA-AF (ETNA) is a multinational, prospective, observational study evaluating the experience with edoxaban in the clinical practice of patients with atrial fibrillation (AF). ENGAGE AF-TIMI 48 was a randomized double-blind trial that tested the clinical benefits of edoxaban versus warfarin. The recommended dose is 60 mg, dose-reduced to 30 mg daily in patients with at least 1 of 3 label-indicated criteria (renal impairment [creatinine clearance: 15–≤50 mL/min], weight ≤60 kg, or concomitant use of potent P-glycoprotein inhibitors).

Purpose
We assessed whether the effectiveness and safety of edoxaban in clinical practice were consistent with findings from the pivotal randomized clinical trial.

Methods
We obtained patient-level data from ETNA and ENGAGE AF-TIMI 48. We initially extracted patients from similar geographic regions, and then used propensity-score matching (PSM) to adjust key baseline characteristic differences between studies. The primary effectiveness endpoint was all stroke or systemic embolism (SSE) and mortality; the safety endpoint was major bleeding (MB). We used Cox proportional hazards models to compare event rates for the clinical outcomes between ETNA and ENGAGE AF-TIMI 48.

Results
8,615 AF patients with CHADS2 score ≥2 received the 60 mg edoxaban recommended dose (5,462 ETNA; 3,153 ENGAGE AF-TIMI 48). After PSM, key baseline characteristics were well-balanced between the studies: mean age 71.0 years (SD: 9.07); for both ETNA and ENGAGE AF-TIMI 48 median CHA2DS2-VASc score and median HAS-BLED score were 4 and 2. The annualized incidence rate of SSE was 1.65% in ETNA vs 1.53% in ENGAGE AF-TIMI 48 (HR 0.98; 95% CI 0.49, 1.93; p=0.94). ETNA had similar annualized mortality, 2.81%, compared with ENGAGE AF-TIMI 48, 2.34%, (HR 1.49; 95% CI 0.84, 2.63; p=0.17). MB was less frequent in ETNA vs ENGAGE AF-TIMI 48 (1.10% vs 3.56%; HR 0.25; 95% CI 0.14, 0.44; p&lt;0.05). Findings were similar for the recommended 30 mg edoxaban reduced dose.

Conclusions
The effectiveness of edoxaban in clinical practice from a large registry was consistent with efficacy findings from the randomized controlled trial. We observed a lower rate of bleeding events in the ETNA observational study compared with the ENGAGE AF-TIMI 48 trial.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This study was sponsored by Daiichi Sankyo Inc.
Reversed apico-basal myocardial relaxation sequence during exercise in related to impaired diastolic function and attenuated stroke volume response in LQTS mutations carriers
Authors: Charisopoulou D , Koulaouzidis G , Rydberg A , Henein M.Y 
Published: October 2021

Abstract

Background
Speckle-tracking echocardiography studies in inherited long QT syndrome (LQTS) have recently shown myocardial relaxation disturbances at rest in the form of delayed onset of relaxation as a result of prolonged and dispersed mechanical contraction.
The aim of this study was to assess disturbances in left ventricular regional myocardial relaxation sequence during exercise.

Methods
Forty seven (age 45±15 years, 25 female, LVEF: 65±6%, 36 LQT1 and 11 LQT2 whereof 20 symptomatic) patients underwent cardiac exercise test using Bruce protocol. ECG and echo parameters were recorded at rest, during peak exercise (p.e.) and at were compared with 35 healthy individuals. All time intervals were calculated from onset of R wave on superimposed ECG and were corrected to R-R interval.

Results
LQTS patients had longer QTc interval than controls at all the three exercise phases. LV longitudinal tESR, a reflector of relaxation delay was examined separately in the LV basal, mid and apical segments. At rest, no significant differences were noted between the two groups at the basal (490±59 vs. 486±36, p=0.6) and mid LV cavity regions (488±45 vs. 498±39, p=0.3); whereas in patients were seen more prolonged tESR in the apical regions (467±52 vs. 512±44, p&lt;0.0001).
At peak exercise, patients had longer tESR at all three LV segments; basal (394±67 vs. 316±30, p&lt;0.0001), mid cavity (363±64 vs. 340±32, p=0.03) and apical (348±60 vs. 368±28, p=0.03). The apico-basal relaxation dispersion (Δt ESRbase-apex) was significantly more pronounced in patients than in controls both at rest (49±43 vs. −29±19, p&lt;0.0001) and at p.e. (46±38 vs. −40±22, p&lt;0.0001). Moreover, the longitudinal relaxation sequence was reversed in patients (positive values for Δt ESRbase-apex); the early relaxation phase at the base was more delayed than at the apex, opposite to controls in whom the early relaxation onset occurred earlier in LV base than at apex. The magnitude of this apico-basal relaxation dispersion (Δt ESRbase-apex) correlated with longer QTc interval (r=0.9, p&lt;0.0001), lower ESR (r=−0.8, p&lt;0.0001) and attenuated LV stroke volume (r=−0.9, p&lt;0.0001). This difference in Δt ESRbase-apex was more pronounced in symptomatic patients at p.e. than in asymptomatic (69±44 vs. 32±26, p&lt;0.0007).

Conclusion
Our results showed reversed longitudinal relaxation sequence with more delayed early relaxation contraction phase at LV base than at LV apex in LQTS mutation carriers opposite to controls. These disturbances worsened at peak exercise and were related to longer QTc intervals and symptomatic patients.

Funding Acknowledgement
Type of funding sources: None.
Out-of-hospital cardiac arrest in COVID-19 era. A single center experience
Authors: Aschieri D , Villani M , Lanati M , Didio M.T , Pellizzoni V , Villani G.Q 
Published: October 2021

Abstract

Introduction
In the COVID-19 pandemic several adverse cardiovascular sequelae (myocarditis, AMI and heart failure) has been reported but it is unclear whether there is an influence of COVID-19 on incidence of out-of-hospital sudden death (OHCA) and its management by emergency medical services (EMS)

Aim
The aim of the study was to evaluate these items comparing OHCA during COVID-19 pandemic to that of pre-COVID era using the Progetto Vita Registry.

Method
We compared (OHCA) that occurred in Piacenza province during the first three months of COVID-19 outbreak (from February to April 2020, Period A) with those that occurred during the same period in 2019 (from February to April 2019, Period B) We collected data from the electronic database of the emergency medical system to identify patients affected by COVID-19, including both patient with symptoms suggestive of infection (history of fever before out-of-hospital cardiac arrest, with cough, dyspnea, or both) and patients with positive results of pharyngeal swabs test to detect SARS-CoV-2 obtained before the event or after death.

Results
1. Demographic characteristics of patients were similar in both periods (Period A 70/156 Female, mean age 79.2±5 yrs, Period B 39 Female, mean age 81.5±4 years,)
2. An higher number of OHCA were observed in the Period A vs Period B (A 156 cases vs B 78 cases, p 0.005). 68 cases (43%) of OHCA were associated with a COVID-19 disease
3. The EMS response time was longer in Period A vs B (A 16.4±4 min, vs B 11.1±3 min, p 0.05)
4. Initial cardiac rhythm was shockable in 10 subjects in the Period A (6,4%) and in 15 subjects in Period B (19.2%, p 005), possibly related to longer EMS response time
5. The global survival rate was higher in Period B vs A (B 5 patients, 6.4% vs 0 patients 0% p 0.05)
6. No one received cardiopulmonary resuscitation from bystanders in Period B.

Conclusion
During COVID-19 pandemic in Piacenza there was an increase in OCHA compared to the pre-COVID era. The COVID 19 Pandemic influences the bystanders attitude to practice an early cardiopulmonary resuscitation intervention and the performance of EMS, worsening the outcome of patients.

Funding Acknowledgement
Type of funding sources: None.
Performance of the multisensory cardiac implantable electronic device algorithm HeartLogic in a real-world ambulant chronic heart failure population
Authors: Feijen M , Egorova A.D , Treskes R.W , Schalij M.J , Beeres S.L.M.A 
Published: October 2021

Abstract

Background
Early detection of an upcoming episode of decompensated heart failure (HF) and timely adjustment of medical therapy may prevent a HF hospitalization. The novel multisensory cardiac implantable electronic device (CIED) based algorithm entitled HeartLogic™ (HL) aims to alert in case of upcoming fluid retention. This study investigates the performance of an HL alert in chronic HF patients in an ambulant HF care-path.

Methods
All chronic HF patients with a CIED and an activated HL algorithm implanted in our centre since 2018 were included. Patients were followed from 01–01–2018 until 01–02–2021 according to the HL-based care-path (Figure 1). The HL index was automatically generated from sensors assessing S3, S3/S1, thoracic impedance, respiratory- and night heartrate. Indexes were monitored continuously and an alert was issued when the pre-set threshold of 16 was surpassed. An alert was classified as true positive when the patient had at least two symptoms and/or signs of congestion during the alert episode. An alert was considered false positive when the patient had not more than one symptom or sign of congestion during the alert episode. If a patient had at least two symptoms and/or signs of congestion without an HL alert, the episode was classified as false negative.

Results
In total, 100 patients (median age 69 years [IQR 60–77], 78% male) were included. The etiology of HF was ischemic in 45% and 71% had a CRT-D device. Median follow-up was 13 months [IQR 6–23] and in total the follow-up comprised 126 patient-years. In 56 patients, there were 132 alerts, mean alert rate was 1.05 per patient-year. As it was unfeasible to strictly follow the specific HL care-path in 13 alert episodes, these alerts were excluded from further analyses. Based on the remaining 119 alert episodes, the positive predictive value for early detection of congestion was 77% and the negative predictive value was 97%. Sensitivity was 79% and specificity 97%.

Conclusion
In a real-world HF population, the HL algorithm can accurately predict an upcoming episode of decompensated heart failure.

Funding Acknowledgement
Type of funding sources: None. Overview of the HL based care-path
Walking in a straight line–the early detection of cardiomyopathy by the general physician
Authors: Ker J 
Published: October 2021

Abstract

Introduction
The orientation of muscle fibers in the left ventricle is sophisticated. This peculiar orientation causes the left ventricle to contract in three directions–longitudinal, radial and circumferential. Normal myocardial mechanics is essential for systolic and diastolic function. For the clinician an impairment in longitudinal function is of utmost importance, as it has been shown to be an early marker of left ventricular dysfunction, be that systolic or diastolic. Longitudinal function of the left ventricle can be quantified with tissue velocity imaging (TVI), mitral annular plane systolic excursion (MAPSE) and global longitudinal strain (GLS), as measured by speckle-tracking.
GLS measured by speckle-tracking is more technically challenging than measuring MAPSE and furthermore, in a setting with limited resources, not always widely available. Surprisingly, there is a paucity of data on the correlation of GLS to MAPSE. As GLS is the latest modality used to quantify longitudinal function of the LV and TVI is also more technically challenging than MAPSE, MAPSE was the chosen modality to compare to GLS. Furthermore, not all echocardiography systems are equipped for TVI and GLS, whereas that is not the case for MAPSE. MAPSE is therefore an easily acquired skill and widely available.

Purpose of this study
To determine whether MAPSE, when compared to GLS, is an accurate way to quantify longitudinal function of the left ventricle. If this is shown to be the case, then MAPSE will be a proven, readlily available and easily acquired skill to detect cardiomyopathy, whether primary or secondary to a wide variety of systemic diseases.

Methods
175 patients who presented with a variety of primary cardiac diseases and/or systemic diseases with the potential for cardiac involvement were included into the study.
175 patients with normal cardiac function were also included into the study.
Left ventricular longitudinal function of the left ventricle was quantified in each patient by means of MAPSE, as well as GLS measured by speckle-tracking. In order to correct MAPSE to body size, MAPSE:LV length was measured.
The correlation of MAPSE with GLS was assessed by means of a two-by-two table.

Results
In this group of 350 patients, split into 2 equal groups-175 with cardiomyopathy, either primary or secondary due to systemic disease, and 175 with no cardiomyopathy, the distinction is clear. The exposore, a GLS &lt;−20% and a MAPSE:LV-lenghth &lt;20% versus no exposure – a GLS &lt;−20% and a MAPSE: LV-length &gt;20% leads to a likelihood ratio of 485 (p=0) and a Pearson correlation of 525 (p=0) that impaired LV-longitudinal function is present.

Conclusion
A MAPSE: LV-length &lt;20% correlates reliably with an impaired GLS. This is a reliable substitute for GLS and for the general physician who screens for early cardiomyopathy this is a skill that will be cheaper and more easily learned than GLS.

Funding Acknowledgement
Type of funding sources: None. GLSMAPSE
Left atrial conduit flow rate at baseline and during exercise: an index of impaired relaxation in patients with heart failure and preserved ejection fraction
Authors: Marino P , Zanaboni J , Degiovanni A , Patti G , Fraser A 
Published: October 2021

Abstract

Introduction
In healthy subjects, adrenergic stimulation augments left ventricular (LV) long-axis shortening/lengthening, and increases left atrial (LA) to LV intracavitary pressure gradients in early diastole. Lower increments are observed in patients with heart failure with preserved ejection fraction (HFpEF).

Purpose
We hypothesized that exercise in HFpEF would similarly impair passive LV filling in early-mid diastole, during conduit flow from pulmonary veins.

Methods
Twenty HFpEF patients (67.8±9.8 years; 11 women), diagnosed according to 2007 ESC recommendations, underwent ramped semi-supine bicycle exercise to submaximal target heart rate (∼100) or symptoms. Seventeen asymptomatic subjects (64.3±8.9 years; 7 women) served as controls. Simultaneous LA and LV volumes were measured from pyramidal 3D echocardiographic full-volume datasets acquired from apical window at baseline and during stress, together with brachial arterial pressure. LA conduit function was computed, from minimum LV volume to ECG P wave, as [LV volume (time) – LV minimum volume] – [LA maximum volume – LA volume (time)] and expressed as average flow rate. The slope of the single-beat preload recruitable stroke work (PRSW) quantified LV inotropic state.

Results
There were divergent responses in conduit flow rate, which increased by 40% during exercise in control subjects (+17.8±37.3 ml/s) but decreased by 18% in patients with HFpEF (−9.6±42.3 ml/s) (p=0.046); increments during stress correlated with PRSW slope changes (p=0.003).

Conclusion
In HFpEF conduit flow rate decreases when diastolic dysfunction develops during exercise, in parallel with LV inotropic state changes, thereby contributing to impaired stroke volume reserve. Conduit flow can be measured as a marker of LV relaxation.

Funding Acknowledgement
Type of funding sources: None.