bluuebunny/crossref_metadata_2025_split huggingface dataset:
Olfactory loss and aging: connections with health and well-being
Authors: Papazian Emily J , Pinto Jayant M 
Published: October 2021

Abstract
Age-related olfactory dysfunction, or presbyosmia, is a common sensory impairment in aging adults. People in this demographic group with comorbid conditions or exposure to viral, traumatic, or environmental insults remain at the greatest risk for impairment. Several methods for assessing olfaction exist, but they are only available in special settings and require consideration of age, sex, ancestry, and cognition. Perhaps most importantly, olfactory dysfunction has been suggested as an early sign of Alzheimer’s and Parkinson’s disease and therefore may serve as a tool in the diagnosis and prognosis of these neurodegenerative conditions. Outside of this context, olfactory loss also impacts nutrition, safety, and social relationships, and even predicts mortality itself. This review covers the detection and manifestations of olfactory decline in aging individuals and the myriad ways in which olfactory impairment is connected to their health and well-being.
A case report: intracoronary acetylcholine testing without a pacemaker may be one option in the left coronary artery
Authors: Sueda Shozo , Sakaue Tomoki 
Published: October 2021

Abstract

Background
The intracoronary acetylcholine (ACh) and ergonovine (ER) test is employed as a pharmacological spasm provocation test. ACh causes vasoconstriction in patients with coronary endothelial dysfunction such as coronary atherosclerosis, while ER induces coronary vasoconstriction through the activation of coronary smooth muscle.

Case summary
An 84-year-old Japanese man was admitted to our hospital due to resting angina and syncope. Computed tomography coronary angiography (CTCAG) revealed severe proximal left anterior descending (LAD) coronary artery stenosis, but hybrid images of CTCAG and thallium-adenosine myocardial scintigraphy revealed no ischaemia. During syncope, inverted T waves on V5, V6 leads were recognized. After coronary arteriography, mild atherosclerotic stenosis (50%) was found at the proximal LAD artery, and we administered intracoronary ER 104 µg and 80 µg into the left and right coronary arteries because of suspected coronary spasm. However, no provoked spasm was obtained in either vessel. We administered 20, 50, and 100 µg intracoronary ACh into the left coronary artery (LCA) for 30 s without a pacemaker, because neither bradycardia nor cardiac arrest has occurred. Diffuse distal spasm was provoked after the administration of 100 µg ACh and the patient complained of typical chest pain and prodrome before syncope. The patient was diagnosed with coronary spastic angina by the ACh test but not the ER test.

Discussion
Different coronary responses between ACh and ER were observed in this case. Intracoronary ACh testing without a pacemaker may be one option in the LCA if no bradycardia or arrest occurs.
The association of stroke rate with low density lipoprotein and statin exposure in patients with atrial fibrillation (AF)
Authors: Shweikialrefaee B , Abdel-Qadir H , Pang A , Austin P , Singh S , Jackevicius C , Tu K , Dorian P , Lee D , Ko D 
Published: October 2021

Abstract

Background
There are limited data on the association between cholesterol levels and stroke risk in atrial fibrillation (AF).

Objective
To quantify the association of stroke rate in AF with low-density lipoprotein (LDL) levels and statin use.

Methods
Using linked administrative databases in Ontario, Canada, we conducted a population-based retrospective cohort study of patients aged ≥66 years, diagnosed with AF between 2009–2019. We used cause-specific hazard regression to determine the association of statin use with stroke rate. We developed a second cause-specific regression model for patients with at least one lipid profile measurement in the year before AF diagnosis to study the association of LDL levels with stroke rate, while adjusting for statin use. LDL levels were modeled using restricted cubic splines (RCS). Both models were adjusted for age, sex, heart failure, hypertension, diabetes, stroke or transient ischemic attack, and vascular disease at baseline, plus anticoagulation as a time-varying covariate.

Results
We studied 261,659 qualifying patients (median age 78 years, 49% female), of whom 3,954 (1.5%) developed a stroke during one-year follow-up. A total of 142,834 (54.6%) patients were treated with statins and 145,775 (55.7%) had lipid measurements before AF diagnosis. The adjusted RCS analyses (see Figure) indicated increasing hazard ratios (HRs) for stroke with increasing low-density lipoprotein (LDL) values above 1.5mmol/L. Statin use was associated with a lower stroke rate relative to non-users (hazard ratio 0.87, 95% confidence interval 0.81–0.93, p-value &lt;0.0001).

Conclusion
LDL levels above 1.5mmol/L were independently associated with higher stroke rates in patients with AF, while statins were associated with lower stroke rates independent of anticoagulation. This suggests that LDL measurements may improve stroke risk stratification in AF, while statins may offer an underutilized pathway to lower stroke risk in AF.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): 1) Heart and stroke foundation of Canada HR for Stroke and LDL level
Left atrial dysfunction still exists in patients who obtain normal left atrial volume after successful ablation of atrial fibrillation
Authors: Kawakami H , Inoue K , Nagai T , Fujii A , Sasaki Y , Shikano Y , Sakuoka N , Miyazaki M , Takasuka Y , Ikeda S , Yamaguchi O 
Published: October 2021

Abstract

Introduction
Atrial fibrillation (AF) promotes left atrial (LA) remodeling and vice versa. LA volume index (LAVI) ≥34 mL/m2 is an established cut-off value for identifying an enlarged left atrium. Catheter ablation has become an established therapy for AF and provides a reduction of LA volume by maintaining sinus rhythm (reverse remodeling). However, the definition of LA reverse remodeling after AF ablation is undetermined.

Purpose
We hypothesized that patients with LA dilatation who obtain normal LA volume (LAVI &lt;34 mL/m2) after AF ablation would have better long-term outcomes than those who do not. Furthermore, we investigated whether patients with a normal LA volume could also obtain normal LA function with AF ablation.

Methods
We enrolled 140 AF patients with baseline LAVI ≥34 mL/m2, without AF recurrence for 1 year after the initial AF ablation. We acquired conventional and speckle-tracking echocardiographic parameters within 24 h and at 1 year after the procedure. Late recurrence was defined as AF recurrence &gt;1 year after the initial ablation. To define the normal range of LA function, age-and sex-matched 140 controls without a history of AF were also enrolled.

Results
After restoration of sinus rhythm, overall LA structural and functional parameters were significantly improved, and 75 patients (54%) had normal LA volume at the time of follow-up (Table). During a median follow-up of 44 (31–61) months, 32 patients (23%) experienced a late recurrence of AF. Patients who obtained normal LA volume after AF ablation had fewer late recurrences than those who did not (P&lt;0.01) (Figure). However, LA functional abnormalities still existed in AF patients, even if LA volume was normalized as in controls (Table).

Conclusion
Patients who obtain normal LA volume have better long-term outcomes of AF ablation than those who do not. Although AF ablation promotes beneficial effects on LA structure and function, LA function cannot be normalized even in patients who obtain normal LA volume after successful ablation. Thus, physicians should carefully consider long-term follow-up and residual AF risks, regardless of sinus rhythm restoration by catheter ablation.

Funding Acknowledgement
Type of funding sources: None.
Differences in quality of life improvement with pulmonary vein isolation alone vs. more extensive ablation of persistent atrial fibrillation: insights from the EARNEST-PVI trial
Authors: Kanda T , Masuda M , Inoue K , Furukawa Y , Hirata A , Egami Y , Watanabe T , Minamiguchi H , Miyoshi M , Matsuda Y , Sunaga A , Sotomi Y , Dohi T , Hikoso S , Sakata Y 
Published: October 2021

Abstract

Background
Improving the quality of life (QoL) is one of the main purposes of catheter ablation (CA) of persistent atrial fibrillation (AF). QoL improvement in persistent AF patients has not been fully clarified. The EARNEST-PVI trial was a multi-center randomized trial comparing clinical outcomes of pulmonary vein isolation (PVI) alone and more intensive ablation in addition to PVI including complex fractionated atrial electrogram (CFAE) and linear ablation (PVI plus).

Purpose
To investigate the QoL change after persistent AF ablation and the differences between the PVI-alone strategy and the PVI plus strategy.

Methods
In the EARNEST-PVI trial, patients with persistent AF who underwent an initial catheter ablation (n=512) were randomly assigned in a 1:1 ratio to either PVI alone or PVI plus. Quality of life was assessed at baseline and at 12 months after ablation for AF using the 36-Item Short Form Health Survey. Scores were also converted to a physical health component summary (PCS), a mental health component summary (MCS) and a role/social component summary (RCS).

Results
In the EARNEST-PVI trial, the PVI alone strategy was associated with higher recurrence rate compared with the PVI plus additional ablation strategy. After excluding 68 patients for whom preoperative or postoperative QoL assessment was not available, 222 patients were evaluated respectively. Overall, significant improvements in PCS (46.2±11.4 to 48.7±11.4]), MCS (50.1±8.8 to 54.3±8.6) and RCS (44.6±13.3 to 48.6±11.3) occurred 12 months after ablation (P&lt;0.001, respectively). Although significant QoL improvement occurred in both PVI alone and PLI plus strategies, the changes in PCS was greater in the PVI-plus than that in PVI-alone (3.5±10.3 vs 1.5±10.6, P=0.04).

Conclusions
Ablation for persistent atrial fibrillation improved both physical and mental quality of life. The PVI-plus strategy showed greater improvement in physical QoL.

Funding Acknowledgement
Type of funding sources: None. QoL improvement
Stepwise endo-/epicardial catheter ablation for atrial fibrillation: the Mediterranea approach
Authors: Compagnucci P , De Martino G , Mancusi C , Vassallo E , Calvanese C , Della Ratta G , Librera M , Franciulli M , Marino L , Dello Russo A , Casella M 
Published: October 2021

Abstract

Background
Outcomes of catheter ablation (CA) among patients with non-paroxysmal atrial fibrillation (AF) are largely disappointing.

Purpose
We sought to evaluate the feasibility, effectiveness, and safety of a single-stage stepwise endo-/epicardial approach in patients with persistent/longstanding-persistent AF.

Methods
We enrolled 25 consecutive patients with symptomatic persistent (n=4) or longstanding-persistent (n=21) AF and at least one prior endocardial procedure, who underwent CA using an endo-/epicardial approach. Our anatomical stepwise protocol included multiple endocardial as well as epicardial (Bachmann's bundle [BB] and ligament of Marshall ablations) components, and entailed ablation of atrial tachycardias emerging during the procedure. The primary outcome was freedom from any AF/atrial tachycardia episode after a 3-month blanking period. The secondary outcome was patients' symptom status during follow-up.

Results
The stepwise endo-/epicardial approach allowed sinus rhythm restoration in 72% of patients, either directly (n=6, 24%) or after AF organization into atrial tachycardia (n=12, 48%). BB's ablation was commonly implicated in arrhythmia termination. After a median follow-up of 266 days (interquartile range, 96 days), survival free from AF/atrial tachycardia was 88%. Antiarrhythmic drugs could be discontinued in 22 patients (88%). As compared to baseline, more patients were asymptomatic at 9-month follow-up (0% vs- 56%, p=0.02). Five patients (20%) developed mild medical complications, whereas one subject (4%) had severe kidney injury requiring dialysis.

Conclusion
A single-stage endo-/epicardial CA resulted in favorable rhythm and symptom outcomes in a cohort of patients with symptomatic persistent/longstanding-persistent AF and one or more prior endocardial procedures. Epicardial ablation of BB was commonly implicated in procedural success.

Funding Acknowledgement
Type of funding sources: None.
Predictors of early and late recurrence of atrial fibrillation after catheter ablation: two sides of the same coin?
Authors: Ribeiro Da Silva M , Santos Silva G , Ribeiro Queiros P , Teixeira R , Almeida J , Fonseca P , Oliveira M , Goncalves H , Rodrigues A , Primo J , Fontes-Carvalho R 
Published: October 2021

Abstract

Background
Recurrence of atrial fibrillation (AF) after catheter ablation (CA) is estimated to be between 20% and 45%. Recurrent AF early after ablation is generally classified as benign as a part of a blanking period, but recently has been associated with later recurrent AF. The prediction of early and late AF recurrence after CA remains challenging as well as the predictive value of early AF recurrence in the blanking period.

Purpose
We aimed to determine the clinical and procedural factors associated with early and late recurrence of AF after CA.

Methods
Single-centre retrospective study that included all patients who underwent AF CA between January 2017 and October 2019. Ablation procedures included radiofrequency and second-generation cryoballoon CA. Early recurrence of AF (ERAF) was defined as any recurrence of AF &gt;30 seconds within 90 days after CA and late recurrence (LR) was defined as any recurrence of AF &gt;30 seconds after 90 days of CA. The independent association between clinical and procedural variables and AF recurrence was evaluated with logistic regression analysis.

Results
We included 399 patients, 64,7% male, with a mean age of 56,8±11,6 years, most of them had paroxysmal AF with a mean duration until CA of 3,5±3,4 years.
Early recurrence of AF occurred in 51 patients (12,8%). After multivariate logistic regression, we identify left atrium (LA) diameter [odds ratio (OR) 1,1, 95% confidence interval (CI) 1,03–1,18; p=0,007] as the only independent predictor associated with recurrent AF.
Late recurrence of AF was observed in 104 patients (26,1%), on average, 12,8±8,7 months after CA. After multivariable adjustment, LA diameter (OR 1,1, 95% CI 1,01–1,12; p=0,032) and intraprocedural electric cardioversion (OR 1,8, 95% CI 1,03–3,12; p=0,040) were independently associated with recurrent AF.
Regarding patients with ERAF, most of them also had late recurrent AF (64,7%), whereas in patients without ERAF, only 20,4% had LR (p&lt;0,001). After including ERAF in the multivariate logistic regression, we identify ERAF as the only independent predictor of late recurrence of AF (OR 5,23, 95% CI 2,56–10,72; p&lt;0,001).

Conclusions
In our cohort, late recurrence of AF after catheter ablation was significantly higher in patients with recurrence within the blanking period, which was the only independent predictor of AF late recurrence.

Funding Acknowledgement
Type of funding sources: None.
Defining the optimal blanking period duration after cryoballoon pulmonary vein isolation in patients with atrial fibrillation who have never been treated with an antiarrhythmic drug
Authors: Milstein N , Saberito M , Bhatt A , Habibi M , Sichrovsky T , Preminger M , Shaw R , Mittal S , Musat D 
Published: October 2021

Abstract

Background
Cryoballoon (CB) pulmonary vein isolation (PVI) is an approved method for ablation in patients with paroxysmal (PAF) or persistent (PeAF) atrial fibrillation (AF). Although the first 90 days post-ablation are considered within the blanking period (BP), the optimal duration of the BP remains undefined.

Purpose
To objectively define the BP duration in pts undergoing CB PVI by evaluating a cohort never treated with an antiarrhythmic drug (AAD).

Methods
We enrolled consecutive pts with either PAF or PeAF who underwent initial CB PVI; all pts had an implantable loop recorder (ILR) for long-term ECG monitoring. No pt received an AAD either before or after ablation. We determined the time to last AF episode within the first 90 days of ablation. We then correlated this to the likelihood a patient had recurrent AF between 91 and 365 days of ablation.

Results
There were 45 pts (67±8 years; 26 [58%] male; 40 [89%] PAF; CHA2DS2-VASc 2.6±1.3). We defined 4 distinct groups post ablation based on whether or not they had AF in the BP: (1) no AF days 0–90 (n=19 [42%]), (2) last AF days 0–30 (n=11 [24%]), (3) last AF days 31–60 (n=3 [7%]), and (4) last AF days 61–90 (n=12 [27%]). After the 90-day BP, 15 (33%) pts had AF recurrence. Pts with no AF and those with AF only within 30 days of ablation had similar long-term outcome; however, recurrent AF more than 32 days after ablation predicted long-term ablation failure (Figure).

Conclusion
The post CB PVI blanking period is just a month. AF recurrences beyond a month in patients not on an AAD are associated with AF recurrence in the majority of pts.

Funding Acknowledgement
Type of funding sources: None. Blanking Group by AF Recurrence
Association of female sexual hormones with QTc time in hypertensive subjects
Authors: Grubler M , Verheyen N.D , Meinitzer A , Tascharre M , Fiedler L , Roithinger F.X , Maerz W , Tomaschitz A , Pilz S 
Published: October 2021

Abstract

Background/Introduction
The rate corrected QT time (QTc) is the most commonly used ECG derived parameter to identify and risk-stratify inherited and acquired arrhythmia risk. Among the many potentially influencing factors, the female menstrual cycle has been described to lead to minor intra-individual changes, but the overall influence of sexual hormones on the QTc is incompletely understood. We therefore aimed to elucidate this relationship in hypertensive subjects.

Purpose
To identify confounding factors in QTc determination and elucidate potential endocrine causes of variable QTc time.

Methods
The Styrian Hypertension study is a cohort study aiming to identify novel cardiovascular risk factors. Subjects were recruited from a tertiary care center outpatient clinic. QTc was calculated according to Framingham and linear regression formulas adhering to the AHA/ACCF/HRS 2009 guideline for surface ECG interpretation. Plasma concentrations of estrone (E1), estradiol (E2), 17α-Hydroxyprogesterone and progesterone were measured by Biocrates AbsoluteIDQ Stero17 Kit. Patients on QTc altering medication were excluded from the present analyses.

Results
A total of 142 participants (mean [SD] age, 59.4 [11.7] years; 52% women, 80,1% post-menopause) were eligible for the present analyses. Linear regression analyses adjusted for potassium, HbA1c, NTproBNP and mean systolic blood pressure revealed only an association of QTc with progesterone (beta coefficient [95% CI]) of 0.38 [0.14 – 0.62] (P=0.002) in males. Detailed analyses revealed an U-shaped association. The other hormones showed no significant association in the present cohort of patients. Subgroups of premenopausal women and of patients without elevated blood pressure revealed no statistically significant results.

Conclusions
Contrary to previous evidence we found no sign. association between female sexual hormones and QTc time. We observed increased QTc time in males depending on their progesterone plasma concentrations, but the isolated finding may be a statistical outlier.

Funding Acknowledgement
Type of funding sources: None.
Mutation in a non-desmosomal gene is associated with poor outcome of endo-epicardial ventricular tachycardia ablation in patients with nonischaemic cardiomyopathy
Authors: Peichl P , Krebsova A , Wichterle D , Piherova L , Norambuena P , Stranecky V , Kmoch S , Macek M , Cihak R , Kautzner J 
Published: October 2021

Abstract

Background
Nonischaemic cardiomyopathy (NICM) represents a heterogenic disorder with a variable arrhythmogenic substrate. Its location is often epicardial and catheter ablation in this location proved to be an effective therapeutic modality in NICM patients with recurrent ventricular tachycardias (VTs).

Purpose
To determine the impact of the type of genetic mutation on the long-term outcome of endo-epicardial ablation in patients with NICM.

Methods
We investigated 82 patients (age 47±15 years, 10 women) with NICM who underwent endo-epicardial ablation for frequent VTs. Of them, 59% had a history of failed endocardial ablation. Patients had a left ventricular ejection fraction of 44±14% and all were implanted with cardioverter-defibrillator. One hundred candidate genes were examined using the new generation sequencing technique.

Results
Mutation in genes coding desmosomal complex (genes: PKP2, DSC, DSP, and DSG) was found in 30% of patients (“desmosomal” group). In 23% of patients, other gene mutations (genes: LMNA/C, MYH7, DES, TTN, RYR2, TPM1, MYPN, FLNC, and SCN5A) were detected (“non-desmosomal” group). In 46% of subjects no pathogenic mutation could be identified (“none” group). During a mean follow up of 34±33 months, patients in the “non-desmosomal” group were at significantly higher risk of VT recurrence and death/heart transplant compared to patients in the “desmosomal” group (Figure 1).

Conclusion
Potentially pathogenic mutation can be detected in about half of patients with NICM undergoing endo-epicardial VT ablation. Most commonly, mutations can be found in genes coding desmosomal complex and the endo-epicardial ablation is then associated with a satisfactory low VT recurrence rate and excellent survival in the long-term. On the other hand, patients with a mutation in non-desmosomal genes have poor outcomes despite endo-epicardial ablation.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Supported by Ministry of Health of the Czech Republic, grant nr. NV18-02-00237 Figure 1