bluuebunny/crossref_metadata_2025_split huggingface dataset:
Off-label underdosed apixaban use in Asian patients with non-valvular atrial fibrillation
Authors: Lee SR , Choi EK , Park SH , Jung JH , Han KD , Lip GYH 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In Asian patients with atrial fibrillation (AF), off-label underdosed prescriptions of direct oral anticoagulants (DOACs) are common

Purpose
We aimed to compare the effectiveness and safety of off-label underdosed apixaban with on-label standard dose apixaban in Asian patients with AF.

Methods
Using the Korean nationwide claims database, we identified patients who prescribed apixaban and did not fulfill the dose reduction criteria of apixaban between January 2015 and December 2017. Multivariable Cox hazard regression model was performed and hazard ratios (HRs) for ischemic stroke, major bleeding (MB), all-cause death, and the composite clinical outcome were analyzed.

Results
Compared to patients prescribed on-label standard dose apixaban (n = 4,194), patients prescribed off-label underdosed apixaban (n = 2,890) were associated with higher risks of ischemic stroke (adjusted HR [aHR] 1.38, 95% confidence interval [CI] 1.06-1.81), all-cause death (aHR 1.19, 95% CI 1.01-1.39) and the composite clinical outcome (aHR 1.17, 95% CI 1.03-1.34), but with no significant differences in MB between the two groups (Figure). In patients without any dose reduction criteria, off-label underdosed apixaban use was associated with a significantly higher risk of ischemic stroke than on-label standard dose apixaban use (aHR 1.85, 95% 1.25-2.73); however, in patients who had single dose reduction criteria (age ≥80 years, serum creatinine ≥1.5mg/dL, or bodyweight ≤60 kg), off-label underdosed apixaban use did not show a significant overall benefit in the composite clinical outcome compared with on-label standard dose apixaban, but was associated with a higher risk of all-cause death (aHR 1.32, 95% CI 1.07-1.64).

Conclusion
Off-label underdosed apixaban use was associated with higher risks of ischemic stroke, all-cause death, and composite clinical outcome and comparable risk of MB compared with on-label standard dose apixaban use. Label-adherence of apixaban dosing should be emphasized to achieve the best clinical outcome for Asian patients with non-valvular AF, especially in those without any dose reduction criteria. Abstract Figure.
Assessing atrial fibrillation ablation priority during COVID-19 -does use of patient questionnaires help in stratification above physician assessment?
Authors: Pius C , Ahmad H , Snowdon R , Ashrafi R , Waktare J , Borbas Z , Luther V , Mahida S , Modi S , Hall M , Gupta D , Todd D 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Catheter ablation for atrial fibrillation (AF) is largely offered for symptomatic relief. The ORBIT registry has shown that patients with a higher EHRA class and lower quality of life (QoL) scores (AFEQT score &lt;65.7) are more likely to suffer emergency hospital admissions. To help prevent unplanned AF admissions and to best utilise the reduced capacity for elective work during the COVID-19 pandemic, it has become even more important to prioritise the most symptomatic AF patients for ablation. Purpose: To evaluate the accuracy of a subjective symptom-based clinician prioritisation schema compared to objective patient-completed quality of life (QoL) scores. Methods: In July 2020, all elective cases awaiting AF ablation at our institution were categorised by their cardiologist as either category 1 (C1-urgent), category 2 (C2–priority, procedure to be done during the ongoing COVID-19 pandemic) or category 3 (C3–routine, procedure may be delayed until post pandemic). This categorisation was based on review of clinic letters where EHRA AF symptom class or PROMS are not routinely recorded. All patients in C2 and C3 were then posted an AF specific (AFEQT) and a generic (EQ5D) QoL questionnaire to complete. Physicians were blinded to patient responses on the QoL questionnaires. Results: Details of physician prioritisation and completed questionnaires were available for 85 patients (62 ± 10 years, PAF in 61%, males 66%). The 18 patients that had been categorised in C2 (priority) group were found to have a significantly lower AFEQT score (30.4, IQR 17.2-51.9) compared to the 67 patients classed in C3 (routine) group (56.5, IQR 32.1-74.1; p &lt; 0.01)(Figure 1a). EQ5D scores also tended to be lower in the C2 patients (0.7, IQR 0.4-0.8) compared to C3 (0.8, IQR 0.6-0.9; p = 0.056) (Figure 1c). 16 (89%) patients in C2 had significant AF-related impact on QoL (as defined as AFEQT score &lt;65.7) compared to 42 (63%) of patients in C3. However, there was significant overlap between groups (Figure 1b). 4 patients in C3 had unplanned AF related hospital admissions while awaiting ablation, as compared to none in C2. The median AFEQT score of these 4 patients was 23.3, indicating that they were highly symptomatic despite being classified in C3 by their cardiologist. Conclusion : Physician assessments are moderately accurate in prioritising patients awaiting AF ablation. The addition of formal patient-completed QoL assessment such as with AFEQT, helps to identify the most symptomatic patients at risk of emergency hospital admission, and physicians should consider using these as part of routine assessment, especially during the COVID pandemic. Abstract Figure 1
Oral anticoagulant therapy at hospital admission associates with lower mortality in older COVID-19 patients with atrial fibrillation. An insight from the Covid Registry
Authors: Fumagalli S , Trevisan C , Del Signore S , Pelagalli G , Volpato S , Gareri P , Mossello E , Malara A , Monzani F , Coin A , Bellelli G , Zia G , Antonelli Incalzi R 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
the GeroCovid Investigators
Introduction. Atrial fibrillation (AF), the arrhythmia most frequently diagnosed in older patients, associates with serious, thrombo-embolic, complications and high mortality. COVID-19 severely affects aged subjects, determining an important prothrombotic status.
Purpose. Aim of this study was to evaluate mortality-related factors in older AF patients with COVID-19.
Methods. We included 806 in-hospital COVID-19 patients aged 60 years or more hospitalized between March 1st and June 6th 2020 and enrolled in a multicenter observational study.
Results. The prevalence of AF was 21.8%. In-hospital mortality was higher in the AF group (36.9 vs. 27.5%; p = 0.015). Among AF patients, those who survived were younger (81 ± 8 vs. 84 ± 7 years; p = 0.002), had a lower CHA2DS2-VASc score (3.9 ± 1.6 vs. 4.4 ± 1.3; p = 0.02) and were more frequently treated with oral anticoagulants at admission (63.1 vs. 32.3%; p &lt; 0.001) than those who died in hospital. At multivariable logistic regression analysis, lower age (p = 0.042), a better functional profile (p = 0.007), less severe COVID-19 manifestations at admission (p = 0.001), and the use of Vitamin K antagonists (OR = 0.16, 95%CI: 0.03-0.84; p = 0.031) or DOACs (OR = 0.22, 95%CI: 0.08-0.56; p = 0.002), compared to antiplatelet therapy or no treatment at all, were associated with a lower chance of in-hospital death.
Conclusions. AF is a prevalent condition and a severity factor in older COVID-19 patients. Advanced age, dependency and severe clinical manifestations of disease characterized older AF subjects with a worse prognosis. Interestingly, pre-admission anticoagulant therapy correlated positively with in-hospital survival.
Supraventricular arrhythmia in tetralogy of Fallot repair
Authors: Vincze V , Kardos A , Kornyei L , Balint H 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Gottsegen National Cardiovascular Center
BACKGROUND
With aging morbidity related to arrhythmias in adult patients with Tetralogy of Fallot repair (TOFr) is increasing.
OBJECTIVE
We aimed to analyze the prevalence of supraventricular tachycardia in these patients using our prospective database.
METHODS
TOFr data were collected from our prospective database conducted since 2010. Supraventricular arrhythmias (intraatrial reentrant tachycardia (IART), atrial fibrillation, AFib) related complications and therapies were documented.
RESULTS
Among those with TOFr (n = 296, mean age 34 ± 11) supraventricular tachyarrhythmias (SVT) were present in 41 patients (14%), as following: n = 12 AFib, and n = 29 IART. At the univariate analysis predictors of atrial fibrillation and IART were: age at last follow-up (p &lt; 0,0001), age at first repair (p &lt; 0,0001), number of surgeries (p = 0,014), and tricuspid regurgitation (p = 0,013). Supraventricular tachycardia was a strong predictor of death (OR 3.0).
Twenty-five patients had radiofrequency ablation, and after a mean follow-up of 61 ± 56 months, the rate of recurrence for SVT was 32 %. In the non-ablated cohort (treated with amiodarone) 73 % recurrence was detected.

CONCLUSION
Supraventricular arrhythmias are common in TOFr patients and are associated with increased mortality risk, but arrhythmia control with catheter ablation is superior to anti-arrhythmic drug therapy in this patient population.
First Vs Recurrent Syncope In Patients With Structural Heart Disease Or Bundle Branch Block
Authors: Francisco Pascual J , Rivas Gandara N , Santos Ortega A , Perez Rodon J , Benito B , Roca I , Cantalapiedra Romero J , Maldonado J , Jordan Marchite P , Herrador Galindo L , Ferreira Gonzalez I 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitari Vall d"Hebron - Vall d"Hebron Institut de Recerca. CIBERCV

BACKGROUND
Patients with structural heart disease (SHD) or bundle branch block (BBB) are at high risk of having an arrhythmic syncope (AS). In patients with recurrent syncope episodes (RSE) complete work-up including electrophysiological study (EPS) and/or implantation of a loop recorder (ILR) is recommended, however patients with their first episode may also be at risk of an AS.

AIM
To determinate if the patients with SHD or BBB with a single syncope episode (SSE) are at high risk of having an AS and compare it with patients with recurrent episodes (RSE).
METHODS Cohort study carried out in a tertiary hospital that is a reference centre for syncope. From January 2008 to August 2020 patients with SHD or BBB with syncope of unknown origin after the initial evaluation and without direct indication of an ICD were included. They were managed according the current ESC guidelines.

RESULTS
417patients were included (74 ±11 y. o; 39% female). Mean follow up was 2.5 ±1 y. 223 patients were diagnosed from an AS [113 (53%) in SSE group and 110 (54%) in RSE group, p = 0.9], 210 were due to bradyarrhythmia (AV block or sinus arrest). No differences in baseline characteristics where found comparing both groups, except that BBB was slightly more prevalent in patients with RSE (81% vs 90%, p = 0.01) (FIGURE- PANEL A). Risk of AS was 53% in patients with SE and 54% (p = 0.9). RSE were not associated with an increased risk of AS in univariate analyses (OR 1.01 IC95% 0.7-1.5) neither in the multivariate (FIGURE- PANEL B). EPS and ILR diagnostic yield was 45% / 32% respectively in SSE group and 44% / 33% in RSE group (p = 0.8) (FIGURE - PANEL C). After appropriate treatment, recurrence syncope rate was 10% in SSE group and 9% in RSE group (p = 0.8). No significant differences in mortality rate were found.

CONCLUSIONS
Patients with SHD or BBB and single syncope episode are at a high risk of having AS, and similar to those with RSE. EPS and ILR offer a similar diagnostic yield in both groups. Complete syncope work-up must be recommended in these patients despite having had only a single episode. Abstract Figure
Ventricular repolarization homogeneity in transthyretin cardiac amyloidosis
Authors: Kochav S , Coromilas E , Lavelle M , Bohnen MS , Maurer MS , Yarmohammadi H , Dizon J 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Non-sustained ventricular tachycardia is frequently observed in patients with transthyretin cardiac amyloidosis (TTR-CA); however, the incidence of sudden tachyarrhythmic death is low. Homogeneity of amyloid fibril deposition within the myocardium and conduction system may mitigate against sustained ventricular tachyarrhythmias. In contrast, myocardial scar heterogeneity is an established predictor of sudden cardiac death in conditions such as hypertrophic cardiomyopathy (HCM), as evidenced by increased myocardial dispersion of repolarization. Whether such indices of arrhythmogenesis are evident in TTR-CA has not been established.

Purpose
To compare ventricular repolarization indices in TTR-CA to HCM and controls without known cardiovascular disease.

Methods
We identified TTR-CA and HCM patients from our single center respective registries, and control patients from our clinical ECG database. Only patients in normal sinus rhythm without bundle branch block, cardiac pacing or artifact were included for analysis. Demographic and clinical data were abstracted. ECGs were analyzed at 25 mm/s paper speed and 10 mm/mV amplitude. ECG parameters included QT interval, QT dispersion, and T peak to T end (TpTe) using the tangent method. All measurements were performed by two blinded independent cardiologists.

Results
A total of 112 patients (45 TTR-CA, 32 HCM, and 35 controls) were studied. Despite a longer QTc in TTR-CA (468.4 ms in TTR-CA vs. 424.6 in controls; p &lt; 0.001), patients with TTR-CA demonstrated similar repolarization indices as controls, including TpTE (93.0 ± 13.5 ms in TTR-CA vs 86.4 ± 12.2 ms in controls, p = 0.24), and TpTe/QTc (0.20 ± 0.03 in TTR-CA vs 0.2 ± 0.03 in controls, p = 0.99). In contrast, HCM patients demonstrated greater TpTe and TpTe/QTc compared with controls (Figure). and a trend toward increased QT dispersion in HCM vs. TTR-CA (p = 0.06).

Conclusion
Unlike HCM, patients with TTR-CA demonstrate a relative lack of myocardial repolarization heterogeneity compared with controls. This finding correlates with homogeneous distribution of myocardial amyloid fibrils and may explain the low observed incidence of sudden cardiac death in this population. Abstract Figure
Impact of high density mapping using a grid shaped catheter with orthogonal signal analysis on ventricular tachycardia ablation strategy
Authors: Roca I , Lorgat F , Haqqani H , Lacotte J , Roithinger F , Fiedler L , Miller A , Steven D 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Abbott

Background
Ventricular tachycardia (VT) in patients with structural heart disease (SHD) is related to scar and slow conduction areas. Substrate-based ablation has become the gold standard treatment in patients with SHD-related refractory VT. A new high-density grid shaped catheter that allows simultaneous analysis of adjacent orthogonal bipolar signals can allow better understanding of these slow conduction areas with the potential to improve ablation results.

Purpose
This was a prospective, multicenter observational study to characterize the utility of electroanatomical mapping with a high density grid-style mapping catheter (HD Grid) in subjects undergoing catheter ablation for ventricular tachycardia (VT) in real-world clinical settings.

Methods
During the study period, patients who underwent VT ablation using the HD Grid catheter as the primary mapping catheter were included. Comparisons both during the procedure and retrospectively were performed between conventional electrode configuration maps and simultaneous orthogonal bipole electrode configuration maps. The influence of these different configurations on ablation strategy was analyzed.

Results
During study period (January 2019 – April 2020) 57 maps were performed in 34 VT subjects (average age: 64.3yr, male: 85.3%, ischemic cardiomyopathy: 70.6%). The left ventricle was mapped in 94.1% of subjects, including left ventricular outflow tract and papillary muscles in 20.6% and 8.8% respectively, reporting minimal or no ectopic beats in 97.1% of the subjects. The total number of mapping points collected was 14172.0 ± 15174.8 in 24.3 ± 17.9 min per map.
Simultaneous orthogonal bipole mapping identified differences in 67.6% of maps compared to linear along-the-spline electrode configurations. The differences consisted mainly in the surface area (92%) and location of low voltage (40%). When compared during the procedure, simultaneous orthogonal bipole mapping was used to identify ablation strategy in 100% of cases. When compared to a standard along-the-spline configuration retrospectively, the ablation strategy identified with simultaneous orthogonal bipoles was different in 30.1% of cases. The ablation strategy used in these subjects was mainly substrate ablation (late potentials and low voltage areas in scar regions) with an acute success rate of 97.1%.

Conclusions
The use of the HD Grid catheter with the ability to analyze orthogonal signals is feasible and has the potential to change the ablation strategy in one third of VT patients with a high acute success rate.
Frequency of ventricular tachyarrhythmias in patients with different risk scores for sudden cardiac death in hypertrophic cardiomyopathy and cardioverter defibrilators implanted in primary prevention
Authors: Brankovic N , Radovanovic NN , Vujadinovic N , Kircanski B , Sajic V , Milasinovic A , Zivkovic M , Bisenic V , Pavlovic SU , Milasinovic G 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The European Society of Cardiology’s (ESC) risk calculator for sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathies (HCM) is currently a tool that facilitates the decision to implant a cardioverter defibrillator (ICD) in primary prevention, but doubts still exist in everyday clinical practice.

Purpose
We aimed to determine the incidence of life-threatening ventricular arrhythmias
during long-term follow-up in patients with different ESC HCM risk scores for SCD
calculated on ICD implantation in primary prevention.

Methods
This retrospective, observational study was conducted in a tertiary center among
adult patients with HCM and ICD devices (ICD-VR, ICD-DR and CRT-ICD) implanted in
primary prevention from January 2008 to December 2019. The patients followed up for less than one year were excluded from the analysis. Study group was divided into three subgroups, according to the ESC 5 years risk score of SCD and based on it the estimated need for ICD implantation: group A
with risk &lt; 4%, where ICD is generally not indicated; group B with risk 4-6%, where ICD
may be considered; group C with risk ≥6%, where ICD should be considered. Regularly, ICD
was interrogated twice a year, while emergency controls were performed after delivering of
ICD therapy. Follow-up data including information about sustained ventricular tachicardia
(VT) and ventricular fibrillation (VF) episodes were collected from patients medical records.

Results
In the observed period, ICD devices were implanted in 60 adult patients with HCM.
Ten of them had history of sustained ventricular arrhythmias and 3 were lost to follow-up. Therefore, we analysed 47 patients (55.3% male, mean age 51.0 ± 15.7 years), 13 from group
A, 12 from group B and 22 from group C. Mean follow-up period was 80.6 ± 37.9 months.
During the follow-up period ventricular tachyarrhythmias (VT and VF, either in monitoring or
therapy zone) were recorded in one patient from group A (7.7%), in two patients from group
B (16.7%) and in 7 patients from group C (31.8%). Using Kruskal-Wallis analysis of
variance, we did not find a statistically significant difference in the occurrence of ventricular
tachyarrhythmias among the observed groups (p = 0.225).

Conclusions
Patients with HCM and a 5-year risk of SCD ≥ 6% calculated on ICD
implantation had more frequent life-threatening ventricular arrhythmias during long-term
follow-up, but not statistically significant. There should be an individual
approach when deciding on the need for device implantation in all patients with HCM.
Comparison of QRSarea and left ventricular activation time during left bundle branch pacing and left ventricular septal pacing
Authors: Heckman LIB , Luermans JGK , Curila K , Van Stipdonk AMW , Westra S , Prinzen FW , Vernooy K 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left bundle branch area pacing (LBBAP) has recently been introduced as a novel physiological pacing strategy. Within LBBAP, distinction is made between left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP, no left bundle capture).

Objective
To compare acute electrocardiographic (ECG) and vectorcardiographic (VCG) effects of LBBP and LVSP as compared to intrinsic conduction.

Methods
In 50 patients with normal cardiac function and pacemaker indication for bradycardia, ECG characteristics of LBBP and LVSP were evaluated during RVSP and pacing at various depths in the septum: starting at the RV side of the septum: the last position with QS morphology, the first position with r’ morphology, LVSP and – in patients where LBB capture was achieved – LBBP. From the ECG’s QRS duration and QRS morphology in V1, and the stimulus-LVAT interval were measured. After conversion of the ECG into VCG (Kors conversion matrix), QRS area was calculated.

Results
In LVSP, QRS area significantly decreased from 82 ± 29 µVs during RVSP to 46 ± 12 µVs during LVSP. In patients where LBB capture was achieved QRS area significantly decreased from 78 ± 23 µVs to 38 ± 15 µVs in LBBP. In patients with LBB capture, QRS area was significantly smaller during LBBP compared to LVSP (figure A), but LVAT was not significantly different (figure B, p = 0.138).
In patients with normal ventricular activation where LBBP was achieved (n = 20), QRS area was significantly larger during LVSP (48 ± 17) compared to LBBP (37 ± 16), the latter being not significantly different from normal intrinsic ventricular activation (35 ± 19 µVs).

Conclusions
ECG and VCG indices demonstrate that ventricular dyssynchrony is comparable but slightly more synchronous during LBBP compared to LVSP. Abstract Figure. QRS area and S-LVAT in LVSP and LBBP