bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increasing use of amiodarone in Norway
Authors: Anfinsen O.-G , Lima K , Nouri Sharikabad M 
Published: October 2021

Abstract

Background
Amiodarone may be used against ventricular arrhythmias to reduce ICD-shocks, and for rhythm control in patients with atrial fibrillation. The 2020 ESC atrial fibrillation guidelines upgraded the recommendation for amiodarone in rhythm control to class I, level of evidence A, although still with a caution to consider other antiarrhythmic drugs first. Amiodarone is the most potent antiarrhythmic drug in clinical use, but it has frequent and potentially severe side effects affecting several organ systems. We have seen an increasing number of patients with amiodarone-induced thyrotoxicosis.

Purpose
We wanted to study the prescription rate of amiodarone in Norway, which indications were most prevalent, and whether there had been any changes over time.

Methods
From the Norwegian Prescription Registry, we have collected data on how many patients had received amiodarone, and the number of defined daily doses delivered (DDDs), related to various reimbursement categories.

Results
From 2010 to 2019, the number of individuals receiving amiodarone from a pharmacy in Norway increased from 5359 to 7789 (45% increase), and the number of DDDs delivered from 994905 to 1412796 (42% increase) (Figure). With an atrial fibrillation-related reimbursement code, we found during the same period an increase of individuals from 3616 to 5776 (60% increase) and number of DDDs from 661531 to 1061601 (60% increase). The dispenses for ventricular arrhythmia-related reimbursement codes were close to unchanged during the same period of years (Figure). The fraction of amiodarone use related to atrial fibrillation increased from 66% in 2009 to 75% in 2019.

Conclusion
We observed a 42–45% increase in the total use of amiodarone over 10 years, and almost the whole increase was related to atrial fibrillation. In 2019, atrial fibrillation-related diagnoses accounted for 75% of the total amount of amiodarone dispensed in Norway. Due to the several side effects of amiodarone, we are concerned if the threshold for use of amiodarone diminishes.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Norwegian Institute of Public HealthOslo University Hospital, Rikshospitalet Number of patientsNumber of DDDs
Recurrences of atrial fibrillation in patients with heart failure without reduced ejection fraction: a role for CA125
Authors: Perez Rivera J A , Merino-Merino A , Saez-Maleta R , Gundin-Menendez S 
Published: October 2021

Abstract

Background
Atrial fibrillation (AF) and heart failure (HF) without reduced ejection fraction often occur together, and their combination is associated with increased morbidity and mortality compared with each disorder alone. Sinus rhythm maintenance seems to be beneficial but challenging in these patients.

Purpose
We studied the possible value of CA125 to predict recurrences in patients with persistent AF and HF without reduced ejection fraction who underwent electrical cardioversion (ECV).

Methods
We designed a prospective cohort study by consecutively including all the patients who underwent ECV in our hospital with symptomatic persistent non-valvular AF and a concomitant diagnosis of HF without reduced ejection fraction. We excluded patients with clinical instability or ejection fraction &lt;40%. We defined HF as the presence of diastolic dysfunction in echo (left atrium indexed volume &gt;34 ml/m2 or e/e' &gt;8) or ejection fraction between 40 and 50%. We followed-up them during 6 months for detecting AF recurrences with an ECG-Holter 3 months after ECV and an ECG at 6th month. We considered a recurrence as any AF documentation in ECG or ECG-Holter after the ECV. A peripheral blood sample was extracted just before ECV and CA125 was determined. Kaplan-Meyer analysis was used to study the possible relationship between CA125 plasmatic levels, dichotomized according to the median value, and AF recurrence.

Results
We included 95 patients with a medium age of 64±9 years old. Of them, 31 (32.6%) were women, 14 (14.7%) had diabetes and 56 (58.9%) hypertension. The medium ejection fraction was 58.14±10.27% and the median CA125 was 10.98±8.97 U/ml. We detected 54 (57.4%) recurrences in 6 months. In patients with AF recurrences, CA125 values were higher than in patients who maintained sinus rhythm (19.28±29.11 U/ml vs. 14.98±17.02 U/ml). CA125 was significantly related with AF recurrences (log-rank 5.37; p=0.021).

Conclusions
In our sample of patients with persistent AF and HF without reduced ejection fraction, CA125 plasmatic levels are related with AF recurrences after ECV. CA125 has been associated with the clinical severity of HF and the symptoms and signs of fluid congestion. This probably means more ventricular and atrial myocardial damage that might predispose to AF. Sinus rhythm maintenance is specially challenging in patients with HF so those with higher levels of CA125 probably need a closer surveillance and a more aggressive rhythm control.

Funding Acknowledgement
Type of funding sources: None.
Accuracy and acute efficacy of a novel occlusion tool to guide cryoballoon-based pulmonary vein isolation
Authors: Rottner L , Moser F , Schleberger R , Weimann J , Moser J , Lemoine M , Muenkler P , Dinshaw L , Risius T , Kirchhof P , Ouyang F , Reissmann B , Metzner A , Rillig A 
Published: October 2021

Abstract

Background
Cryoballoon (CB)-based pulmonary vein isolation (PVI) currently requires to verify occlusion of each pulmonary vein (PV) using fluoroscopy and dye injection.

Objective
The current study evaluated whether the novel CB-occlusion tool integrated into the wide-band dielectric imaging system KODEX-EPD reliably verifies occlusion of PV according to a novel dye-injection based algorithm.

Methods
Consecutive patients suffering from symptomatic atrial fibrillation (AF) underwent CB-based PVI using the KODEX-EPD and the novel occlusion-tool (group I). To confirm accurate display of the PVs, selective PV-angiography was performed in the first half of the patients of group I (group Ia) in addition to a three-dimensional left atrial (LA) map using a spiral mapping catheter (Achieve, SMC1, Medtronic, MN, USA). PV-angiographies were waived for the following patients (group Ib). Procedural duration and radiation exposure were compared to a control group of patients undergoing conventional CB-based PVI.

Results
CB-based PVI was successful in 50/50 patients of group I (mean age 63±11 years, 18 paroxysmal (36%)) and 25/25 patients of group II (66±10 years, 9 paroxysmal (60%)). Concordance of PV-occlusion as assessed by either PV-occlusion-angiography or KODEX-EPD, was documented in 237/272 (87%) occlusion-analyses among 198 PVs (95% for left superior PV, 93% for left inferior PV, 86% for right inferior PV and 77% for right superior PV).
In the final evaluation phase (group Ib) LA fluoroscopy times and dose area products were comparable to the conventional CB-ablation group (10.5±5 vs 8.8±4 minutes (p=0.23) and 403±425 vs 321±202 cGycm2 (p=0.44), whereas the amount of dye could be significantly reduced (group Ib: 31±10 ml vs group II: 70±20 ml, p&lt;0.0001).

Conclusion
The novel KODEX-EPD PV-occlusion tool allows for accurate PV-occlusion assessment in the majority of PVs and a high acute success rate. The system has the potential to reduce dye and radiation exposure. This should be evaluated in controlled clinical trials.

Funding Acknowledgement
Type of funding sources: None.
Antiarrhythmic drug therapy after catheter ablation for atrial fibrillation has no impact on recurrences, cardiovascular events and mortality – insights from the German Ablation Registry
Authors: Schleberger R , Metzner A , Kuck K H , Andresen D , Willems S , Hoffmann E , Deneke T , Eckardt L , Brachmann J , Hochadel M , Senges J , Rillig A 
Published: October 2021

Abstract

Background
Data on the optimal treatment strategy for antiarrhythmic drug therapy (AAD) after atrial fibrillation (AF) catheter ablation are inconsistent. While AAD potentially stabilizes sinus rhythm, it also increases the patients' treatment burden.

Methods
Patients from the prospective German Ablation Registry (n=3275) discharged with or without AAD after AF catheter ablation were compared regarding long-term success, cardiovascular events and patient reported outcome.

Results
In patients with paroxysmal AF (n=2138) recurrence and rehospitalization rates did not differ when discharged with (n=1051) or without (n=1087) AAD (recurrence: adjusted odds ratio (OR) 1.13, 95% confidence interval (CI) [0.95–1.35]; rehospitalization: OR 1.08, 95% CI [0.90–1.30]). The reablation rate was higher and reduced treatment satisfaction was reported more often in those discharged with AAD (reablation: OR 1.30, 95% CI [1.05–1.61]; reduced treatment satisfaction: OR 1.76, 95% CI [1.20–2.58]).
Similar rates of recurrences, rehospitalisations, reablations and treatment satisfaction were found in patients with persistent AF (n=1137) discharged with (n=641) or without (n=496) AAD (recurrence: OR 1.22, 95% CI [0.95–1.56]; rehospitalization: OR 1.16, 95% CI [0.90–1.50]; reablation: OR 1.21, 95% CI [0.91–1.61]; treatment satisfaction: OR 1.24, 95% CI [0.74–2.08]).
The incidence of cardiovascular events and mortality did not differ at follow-up in paroxysmal and persistent AF patients discharged with or without AAD.

Conclusion
The rates of recurrences, cardiovascular events and mortality did not differ between patients discharged with or without AAD after AF catheter ablation. However, AAD should be considered carefully in patients with paroxysmal AF, in whom it was associated with a higher reablation rate and reduced treatment satisfaction.

Funding Acknowledgement
Type of funding sources: None.
Dyssynchronous cardiomyopathy in patients with WPW syndrome and its reversibility after RFA of accessory pathway
Authors: Svintsova L , Plotnikova I , Dzhaffarova O , Kartofeleva E 
Published: October 2021

Abstract

Introduction
In some cases accessory pathway-mediated ventricular preexcitation can be associated with electro-mechanical dyssynchrony and, consequently, with dyssynchrony-related dilated cardiomyopathy, even in the absence of supraventricular tachycardia (SVT). Sometimes rapid progression of ventricular dysfunction developed in such patients after birth.

Methods and materials
8 patients with asymptomatic WPW and dyssynchronous cardiomyopathy were examined in our Institute from 2017 till 2019. Four patients of the group were observed in other clinics with dilated cardiomyopathy (DCM) and prescribed appropriate therapy without significant clinical effect. The absence of complaints of heartbeat and episodes of tachycardia at the scheduled Holter monitoring allowed eliminating incessant tachycardia as a possible cause of cardiomyopathy. After radiofrequency ablation (RFA) all patients were performed ECG to assess QRS duration, Holter monitoring, echocardiography (Echo) for assessment of heart chamber volume and left ventricle (LV) contractile function and Speckle tracking – Echo with LV longitudinal strain assessment. The average age of the patients was 9.5 years (from 2 to 14 years). 6 children had heart failure (NYHA Class II).

Results
According to Echo all patients had widened QRS complex. Dilatation and enlargement of LV volume were marked in 6 pts. According to Echo7 patients had decrease of LV contractile function. According to Speckle tracking – Echo all patients had intraventricular dyssynchrony, decrease of longitudinal strain indices. At intracardiac electrophysiology study right-sided accessory pathways was diagnosed in all patients, successful RFA was performed. Preexitation relapsed, and the repeated RFA was performed in 2 pts. Complications caused by RFA were not marked.
After RFA all patients showed a regular normalization of QRS duration. At the 5th day after RFA Echo was performed to all patients. The patients with initially decreased LV ejection fraction had it increased. The patients with initial dilatation and LV volume enlargement had normalization of the given indices. According to Speckle tracking – Echo normalization of global and regional myocardial function, LV longitudinal strain, disappearance of intraventricular and interventricular dyssynchrony were marked in all patients. The index of longitudinal strain was 17,0±0,64% before RFA, after RFA - 23,75±0,92% (p=0,ehab724.035946).

Conclusion
As a result of RFA of accessory pathways electromechanical resynchronization causes LV demodeling and restoration of its contractile ability. The presented clinical examples are an additional indication for RFA of accessory pathways even in the absence of SVT in patients regardless of age.

Funding Acknowledgement
Type of funding sources: None.
Linear increase in the number of non-pulmonary vein triggers from paroxysmal to persistent and long-standing persistent AF in patients undergoing repeat procedure after successful isolation of pulmona
Authors: Mohanty S , Trivedi C , Della Rocca D G , Gianni C , MacDonald B , Mayedo A , Burkhardt J D , Bassiouny M , Gallinghouse G J , Horton R , Al-Ahmad A , Di Biase L , Natale A 
Published: October 2021

Abstract

Introduction
This study evaluated the prevalent triggers responsible for recurrence following successful PVI in different types of atrial fibrillation (AF).

Methods
Consecutive AF patients undergoing repeat catheter ablation with permanently isolated PV were included in the analysis. High-dose isoproterenol challenge (20- 30μg/min for 15–20min) was used to confirm PV reconnection and identify non-PV triggers.
Circular mapping catheter (CMC) was used to map the site of origin of significant ectopic activity by comparing the activation sequence of the sinus beat with that of the ectopic beat. For the coronary sinus (CS), ablation catheter was positioned at the level of the mitral valve annulus, parallel to the one positioned in the CS. Left atrial appendage (LAA) firing was detected by placing the CMC in the left superior PV and thus recording far-field potentials from the LAA.

Results
This prospective study included 1850 AF patients undergoing repeat AF ablation (Table 1), of which 573 (31%) had received one and the remaining 1277 patients had received 2 earlier ablations. Permanent PVI was confirmed with isoproterenol challenge.
Table 1 shows the distribution of non-PV triggers. A linear increase in the number of non-PV triggers was observed from PAF to PerAF to LSPAF. Significantly higher number of LSPAF patients had detectable non-PV triggers compared to PerAF and PAF cases.

Conclusion
We observed a linear increase in the number of non-PV triggers in PAF to PerAF and LSPAF patients experiencing recurrence with successful isolation of PVs. As non-PV triggers are often not targeted by operators, this could be the underlying mechanism for more frequent recurrences in non-paroxysmal AF.

Funding Acknowledgement
Type of funding sources: None. Table 1
Novel cryoballoon to isolate pulmonary veins in patients with paroxysmal atrial fibrillation: one-year outcomes in a multicenter study
Authors: Martin A , Breskovic T , Ouss A , Dekker L , Yap S C , Bhagwandien R , Cielen N , Albrecht E M , Richards E , Tran B , Lever N , Anic A 
Published: October 2021

Abstract

Background
Recently, a novel cryoballoon (CB; POLARx) has been developed with increased steerability which maintains size and pressure throughout the ablation. Initial clinical data has demonstrated acute procedural safety and efficacy in de novo pulmonary vein isolation (PVI) procedures in patients with paroxysmal atrial fibrillation (AF). However, there are limited studies demonstrating the long-term efficacy of the CB.

Purpose
To evaluate the long-term safety and efficacy of the novel CB in treating paroxysmal AF.

Methods
This was a non-randomized, prospective, multi-center study. Fifty-eight consecutive patients with paroxysmal AF were enrolled at 4 centers for de novo PVI procedures. Cryoablation was delivered for 180s if time to isolation was ≤60s. Otherwise a 240s cryoablation was performed. PVI was confirmed with entrance and exit block testing. Patients were followed for 1 year with 24-hour Holter monitoring at 3, 6, and 12 months. After a 3-month blanking period, recurrence was defined as having any documented, symptomatic episode(s) of AF or atrial tachycardia.

Results
Acute isolation with the CB was achieved in 230 of 231 pulmonary veins (99.6%) with 5.2±1.5 cryoapplications per patient (1.3±0.6 cryoapplications per vein). There were 4 patients (6.9%) with phrenic nerve injury (3 resolved during the index procedure; 1 resolved at 6 months follow-up). One serious adverse device event was reported: femoral arterial embolism event occurring 2 weeks post index procedure (1.7%). Of the 56 patients that had complete 12-month follow-up, 43 (76.8%) were free from recurrent atrial arrhythmias.

Conclusion
Initial multicenter clinical experience with the novel CB has demonstrated long-term safety and efficacy of PVI in patients with paroxysmal AF. Further studies are underway to confirm these findings.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Boston Scientific
Predictors of survival in patients submitted to typical atrial flutter ablation
Authors: Couto Pereira S , Rodrigues T , Cunha N , Silverio Antonio P , Brito J , Alves Da Silva P , Lima Da Silva G , Carpinteiro L , Cortez-Dias N , Pinto F J , De Sousa J 
Published: October 2021

Abstract

Introduction
Cavo-tricuspid isthmus ablation (CTA) is the first line procedure in patients with typical atrial flutter (AFL) for adequate rhythm and symptoms control with low complication rates and excellent results. Given its apparent simplicity, rarely do we take clinical factors in account before referral.

Aim
To identify predictors of survival after typical AFL ablation.

Methods
Single-center retrospective study of pts with typical AFL submitted to ablation between 2015 and 2019. Pts clinical characteristics were collected. Statistical analysis was performed using Cox regression (for multivariate analysis), Chi-square and Mann-Whitney (for univariate analysis) to identify predictors of survival.

Results
A total of 476 pts (66±12 years, 80% males) underwent CTA. Regarding global clinical characteristics, median body mass index (BMI) 27.3 (IQ 24.5–30.4), median CHA2DS2-VASc score 2 (IQ 1–3), 27.3% with diabetes, 53.9% with dyslipidemia, 69.5% with hypertension, 12% with current tobacco abuse, thyroid disfunction in 10.9%, ischaemic cardiomyopathy in 13.7%, heart failure in 27.8% (3.6% of pts with reduced ejection fraction), chronic kidney disease (CKD) stage 3 or more in 17.7%, obstructive sleep apnea (OSA) in 11.9% and chronic obstructive pulmonary disease (COPD) in 9.5% of pts. Before CTA ablation, 444 pts were under anticoagulation, which was stopped in 293 pts after the procedure. The follow up period was 2.8 years.
In this population, COPD (p=0.005), CKD (p&lt;0.001), heart failure (p=0.0027) and BMI less than 25 (p=0.02) were associated with reduced survival on univariate analysis; patients with BMI between 25 and 30 had better prognosis. On multivariate analysis, CKD was the only independent predictor of reduced survival (HR 0.366; CI95%: 0.132–0.737, p=0.005). There was no difference between genders (p=NS).
A CHA2DS2-VASc score of ≥4 predicted higher mortality (HR: 3.0) in all three groups, although the anti-coagulation suspension had no impact on survival (p=NS).

Conclusion
In this subset of patients, the presence of COPD, heart failure, BMI less than 25 and CHA2DS2-VASc score ≥4 predicted reduced survival, being CKD stage 3 or more an independent predictor. The suspension of anti-coagulation didn't impact on survival. These results can help us to better select pts to the procedure and decide on whether to stop anti-coagulation, although larger studies are still needed.

Funding Acknowledgement
Type of funding sources: None. BMI impact on survivalCKD impact on survival
Carbon footprint as a marker of environmental impact in patients included in a remote monitoring pacemaker programme
Authors: Perez Diaz P , Jimenez Diaz J , Higuera Sobrino F , Bastante Diaz M C , Campos Perez De Madrid E , Fernandez Trujillo A , Cano Rosado L , Bermejo Calvillo N , Casas De Miguel A M ,   University General Hospital of Ciudad Real, Ciudad Real, Spain.
Published: October 2021

Abstract

Background
When patients fitted with pacemakers have to attend arrhythmia appointments, this often involves their caregivers having to take time off work, along with an increase in spending on transport and the amount of CO2 emissions into the atmosphere (carbon footprint). The remote monitoring of pacemakers implemented at our Arrhythmia Unit reduces the social, occupational, financial and environmental impact.

Purpose
We describe the impact of remote monitoring of pacemaker implemented by our Arrhythmia Unit in our patient's live and the reduction in social, occupational and financial impact on these patients, and we quantify the decrease in CO2 emissions.

Methods
Prospective observational study including 160 patients on the remote monitoring programme between 2016 and 2017. We handed a satisfaction survey to these patients after the face-to-face monitoring appointment, which analysed variables such as waiting time, attention and treatment received, need for accompaniment of a relative, method of travel and kilometres travelled, etc. Finally, we quantified the carbon footprint of each patient's journey and compared the level to the results if all the monitoring appointments had been in person.

Results
Patients spent a median of 60±30 minutes in remote monitoring, with a distance travelled of 1.4±4.9 km. In face-to-face appointments, most patients were accompanied (85.6%) and arrived by private car (66.3%), with 54% of family members needing to take time off work. The median time spent was 150±120 minutes, and the distance travelled was 63±105 km. The carbon footprint emitted by individuals included in the remote monitoring programme was 138±114, with an estimated saving of 15±33 kg of CO2 (9.6%) per remote monitoring cycle (Figure 1).

Conclusions
The remote monitoring pacemaker programme in the health district of our city has a very positive healthcare, social-occupational and environmental impact, which is manifested both from an objective point of view (greater independence, less time spent per appointment, less distance travelled, fewer healthcare transport needs, less workplace absenteeism by family members and approximately a 10% reduction in CO2 emissions per monitoring cycle) and a subjective point of view (lower impact of appointments on patients' lives and greater perception of satisfaction from the patients and their companions).

Funding Acknowledgement
Type of funding sources: None.