bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiac arrhythmias in COVID-19: Mechanisms, outcomes and the potential role of proarrhythmia
Authors: Merino JL , Caro J , Rey JR , Castrejon S , Martinez-Cossiani M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Cardiac arrhythmia seems to be a risk factor for mortality in coronavirus disease 2019 (COVID-19). However, the mechanisms, risk factors and outcomes of new arrhythmic events (NAEs) in this disease are unclear.

Methods
All patients with confirmed COVID-19 were retrospectively included in this single centre study. Patients who were alive and admitted &lt;30 days before the database lock were excluded.

Results
3416 consecutive patients were reviewed and 1476 finally enrolled (65.9 ± 20.9 years, 57.3% male). 76 (5.1%) patients had NAEs. Most of them were new atrial fibrillation episodes (48 patients, 3.2%), mostly seen in patients with no previous arrhythmia (38 patients, 79.2%). Atrial flutter (AFL) accounted for 20% of all NAEs. Ventricular arrhythmias were seen in 9 (0.6%) patients. Multivariable analysis showed that prior AFL, heart failure, dyslipidaemia, lopinavir/ritonavir, and combined hydroxychloroquine and azithromycin were independently associated with NAEs. 66 (86.8%) patients with NAEs died. The Kaplan-Meier analysis showed a lower survival of patients with NAEs (P &lt; 0.001). Eight out of 9 (88.9%) and 41 out of 48 (85.4%) patients with ventricular arrhythmias and atrial fibrillation respectively died. Older age, male gender and NAEs were independently associated with death. NAEs and other outcomes, such as heart failure, thromboembolism, and bleeding independently predicted death.

Conclusions
NAEs are relatively uncommon in COVID-19 patients and mainly have an atrial mechanism. AFL is particularly frequent in this disease. The use of hydroxychloroquine, azithromycin and lopinavir/ritonavir, is associated with them, especially when used in combination. NAEs are independently and strongly associated with death. Abstract Figure.
Does the volume of atrial epicardial adipose tissue predict the likelihood of postoperative atrial fibrillation?
Authors: Van Der Heijden CAJ , Olsthoorn JR , Mihl C , Heuts S , Bidar E , Maessen J , Verheule S , Maesen B 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial Epicardial Adipose Tissue (EAT) is involved in the early pathophysiological process of atrial fibrillation (AF). Its role in the occurrence of post-operative AF (POAF) is less well investigated. The transient occurrence of POAF suggests that surgery-induced triggers unmask a pre-existing AF substrate.

Purpose
As EAT induces structural changes in the atria, it is interesting to evaluate whether EAT also contributes to the substrate underlying the occurrence of early POAF (&lt;30 days). We hypothesized that patients with high EAT volumes are more likely to develop POAF after cardiac surgery than patients with low EAT volumes.

Methods
Retrospective quantification of left atrial (LA) EAT was performed on pre-operative coronary computed tomography (CT) angiography scans of patients who underwent cardiac surgery between 2009 and 2017. Patients with a history of AF or with mitral valve disease were excluded, as well as thoracic CT scans. Analysis was based on the Hounsfield Units using custom made software.

Results
Of the 52 included patients 28 developed POAF. Neither the percentage of EAT in the left atrial (LA) wall nor normalized EAT volumes differed between the POAF and sinus rhythm group (all P &gt; 0.05). After multivariate analysis, age was the only independent predictor for early POAF (OR:1.087 [1.000–1.181]).

Conclusion
A role for EAT in the occurrence of early POAF was not demonstrated. This might suggest that acute, surgical factors are more important in the onset of early POAF than chronic processes associated with EAT. More and larger trials are needed to confirm these results. EAT-V in the LA wallPOAF (n = 28)SR (n = 24)P-valueEAT-V (ml)0.77 (0.41 - 1.26)0.62 (0.36 - 1.13)0.425MYO-V (ml)3.24 (2.57 - 4.80)2.89 (2.14 - 3.76)0.121% EAT LA wall17.39 ± 8.2418.33 ± 8.400.687EAT-V (ml) / BSA (m&sup2;)0.42 (0.19 - 0.60)0.32 (0.22 - 0.73)1.000EAT-V (ml) / BMI (kg/m&sup2;) (%)2.67 (1.13 - 4.43)2.48 (1.66 - 4.56)0.927EAT-V (ml) / LAVI (ml/m&sup2;) (%)1.92 (1.00 - 4.43)1.51 (1.12 - 2.41)0.583EAT-V (ml) / MYO-V (ml) (%)21.63 (9.54 - 30.18)23.85 (16.75 - 32.79)0.244The percentage of EAT in the LA wall, EAT-V and indexed EAT-V to BSA, BMI, LAVI and MYO-V, based on post-operative rhythm outcome. Data are presented as median (interquartile range) or mean ± standard deviation. EAT-V: epicardial adipose tissue volume; MYO-V; myocardial volume; LA: left atrial; BSA: body surface area; BMI: body mass index; LAVI: left atrial volume index.Abstract Figure. EAT and MYO measurements
Acute atrial ischemia associates with early but not late new-onset atrial fibrillation in STEMI patients treated with primary PCI: relationship with in-hospital outcomes
Authors: Biccire FG , Cardillo I , Chianta V , De Luca AC , Ferrari I , Capone S , Torromeo C , Acconcia MC , Tanzilli G , Barilla F , Pastori D 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
N/A
Background. New-onset atrial fibrillation (NOAF) is known to be a common complication in STEMI patients undergoing primary percutaneous coronary intervention (PCI), which is associated with a negative short- and long-term prognosis. Recently, two distinct phenotypes of NOAF have been described, namely early (EAF) and late NOAF (LAF). However, whether EAF and LAF recognize different pathogenetic mechanisms is unknown.
Purpose. To investigate atrial branches occlusion and EAF or LAF onset in STEMI patients undergoing primary PCI.
Methods. Retrospective cohort study including 155 STEMI patients. Patients were divided into 3 groups: sinus rhythm (SR), EAF or LAF. Clinical characteristics, angiographic features including occlusion of atrial branches, namely ramus ostia cavae superioris (ROCS), atrio-ventricular node artery (AVNA), right intermediate atrial artery (RIAA) and left intermediate atrial artery (LIAA), were assessed. We also investigated in-hospital complications, death, and a composite of major post-NOAF adverse events (AEs) including cardiogenic shock, acute pulmonary edema, sustained ventricular tachycardia and ventricular fibrillation.
Results. Mean age was 63.8 ± 11.9 years; 78.7% of men. NOAF was detected in 22 (14.2%) patients: 10 (6.4%) EAF and 12 LAF (7.7%). Compared to EAF, LAF patients were older (p = 0.013), with higher GRACE risk score (p = 0.014) and Killip class (p = 0.015), depressed ejection fraction (p = 0.007), elevated filling pressures (p = 0.029), higher c-reactive protein (p = 0.014) and more TIMI flow &lt;3 (p = 0.015). As shown in Figure 1, EAF was associated with higher prevalence of occluded ROCS (p = 0.010), AVNA (p = 0.005) and RIAA (p &lt; 0.001), compared to SR. Moreover, EAF patients had more frequently ≥2 diseased atrial branches than SR (19.5%, p &lt; 0.001) and LAF (25%, p &lt; 0.030) patients. In LAF patients, a higher incidence of pre-PCI cardiogenic shock, post-PCI AEs (p = 0.019 vs SR; p = 0.029 vs EAF) and death (p = 0.004 vs SR) was found.
Conclusions. The occlusion of atrial branches is associated with early but not late NOAF following STEMI. LAF patients had worse in-hospital AEs and mortality. Abstract Figure.
Insights into electrophysiological mechanisms of atrial fibrillation propagation using simultaneous bi-atrial mapping
Authors: Pope M , Kuklik P , Banerjee A , Briosa E Gala A , Leo M , Mahmoudi M , Paisey J , Betts TIMOTH 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Oxford Biomedical Research Centre

Introduction
Early evidence of pulmonary vein triggers initiating AF has led to focus on the left atrium (LA). Little work has been done to characterise the role of the right atrium (RA) in AF maintenance.

Purpose
To characterise the relative roles of the LA and RA in maintenance of atrial fibrillation and explore mechanisms of AF propagation.

Methods
Simultaneous bi-atrial mapping was carried out in patients undergoing first time catheter ablation using 2 linked non-contact charge density mapping systems to obtain 30-second recordings during AF. The predominant channel of communication between chambers was identified and the time difference across this channel measured (see figure). The proportion of signals earlier in each chamber was calculated and a dominant chamber identified if preceding the opposite chamber for ≥60% of the recording. AF was characterised in each chamber according to frequency of specific propagation patterns (localised rotational activation (LRA) and focal firing (FF)). The difference in AF characteristics in the LA and RA according to acute procedural outcome (termination with ablation vs. DCCV) was measured using 2-way ANOVA and predictors of AF termination identified using binomial logistic regression.

Results
Twenty-one patients were included (16 persistent AF, 5 paroxysmal AF, 11 in sinus rhythm at baseline) with 41 maps obtained prior to ablation. A dominant chamber was identified in 11 maps (in 9 patients). Of these, 5 maps (in 4 patients) were LA dominant, and 6 maps (in 5 patients) were RA dominant. The remainder showed balanced interatrial propagation. For patients with persistent AF, in the RA, those needing DCCV had more LRA than those with termination with ablation (79 activations, (95% CI 65-93) vs. 51 (30-71); p = 0.025). There was no difference in the LA in the two groups (77 vs 59, p = 0.541). There were fewer FFs in the RA vs LA in patients needing DCCV (123 (106-140) vs. 155 (137-172), p = 0.012)(see panel F). No differences in distribution of LIA were observed. The frequency of LRA (p = 0.003) and FF (p = 0.004) in the RA, and RA AFCL (p = 0.041), were predictors of acute procedural outcome.

Conclusions
Our novel approach of simultaneous bi-atrial mapping revealed that mechanisms responsible for AF maintenance were evenly distributed between atria whilst acute AF termination with left atrial ablation was dependent on the contribution of right atrial substrate. Strategies incorporating right atrial mechanisms may result in improved outcomes from AF ablation. Abstract Figure.
Device-detected atrial fibrillation before and after acute cardiac events: insights from ASSERT
Authors: Mcintyre WF , Wang J , Belley-Cote EP , Roberts JD , Benz AP , Conen D , Devereaux PJ , Wong JA , Wang MK , Whitlock RP , Connolly SJ , Healey JS 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation (AF) that is first detected concurrently with or shortly after another cardiac event is often thought to be caused by acute cardiac injury, and therefore reversible.

Methods
ASSERT enrolled patients &gt;65 years old with hypertension and a pacemaker, but without known AF. We evaluated participants who had a cardiac event [angina/myocardial infarction (MI), cardiac catheterization/percutaneous coronary intervention (PCI), cardiac surgery or other (e.g. pericarditis, hypertensive crisis)] and compared the prevalence of device-detected AF before and after these events.

Results
Among 2580 participants, 178 (6.9%) had at least one cardiac event over a mean 2.5 years of follow-up. In the 30 days following a first cardiac event, the prevalence of device-detected AF &gt;6 min was 12.4% (95% confidence interval [CI] 7.9%-18.1%), which was higher than in the 30 days before the event (12.4% versus 4.5%, P = 0.004) (Figure 1). The prevalence of device-detected AF following the event was comparable across event subtypes (MI: 13.8%, 95%CI 7.9-18.1%; PCI: 6.9%, 95%CI 1.9-16.7%; Surgery: 20.0%, 95%CI 5.7-43.7%; Other: 18.5%, 95%CI 6.3-38.1%).
There was a significant association between device-detected AF in the 6 months before a cardiac event and device-detected AF in the 30 days after a cardiac event: odds ratio (OR, adjusted for CHA2DS2-VASc score) for episodes &gt;6 min 7.07 (95%CI 2.07-24.19; P = 0.002); adjusted OR for episodes &gt;24 hours: 11.41 (95%CI 1.47-88.43; p = 0.020).

Conclusions
Acute cardiac events are associated with an increase in the prevalence of device-detected AF. These episodes are associated with a prior history of device-detected AF. Abstract Figure 1
Simple clinical parameters could help to identify the patients with a high probability of new-onset atrial fibrillation in acute myocardial infarction
Authors: Raczkowska-Golanko M , Puchalski W , Gruchala M , Raczak G , Danilowicz-Szymanowicz L 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
New-onset atrial fibrillation (NOAF) is a significant complication of acute myocardial infarction (AMI) associated with a poor prognosis. The knowledge and understanding of risk factors of this arrhythmia are still the subjects of interest. Purpose: We aimed to investigate which clinical, routinely checked parameters could have the most predictive power on NOAF occurrence in AMI patients.

Patients and methods
This single-center, retrospective study was conducted on 954 consecutive patients admitted to our university clinical center with AMI diagnosis from January 2017 to December 2018. Patients underwent routine clinical assessment and laboratory investigations. AF detected at the time of admission or during a hospital stay, without a prior history of persistent or paroxysmal AF, was diagnosed as NOAF. Detailed medical history, routinely checked laboratory and echocardiography parameters, invasive and pharmacological treatment, as well as complications and in-hospital mortality, were taken into consideration.

Results
NOAF was documented in 106 (11%) AMI patients at median age 74 (66 - 84) years old, and was significantly associated with in-hospital mortality [OR 4.53, p &lt; 0.001). There were some clinical factors significantly predicted NOAF in univariate logistic regression analysis: age ≥ 66 years old (odds ratio [OR] 3.09, p &lt; 0.001), B-type natriuretic peptide (BNP) ≥ 340 pg/ml (OR 5.28, p &lt; 0.001), C- reactive protein (CRP) ≥ 7.7 mg/l (OR 3.53, p &lt; 0.001), high-sensitivity troponin ≥ 1.85 ng/ml (OR 2.4, p &lt; 0.001), total cholesterol ≤ 195 mg/dl (OR 2.17, p &lt; 0.002), low-density lipoprotein ≤ 128.5 mg/dl (OR 2.03, p &lt; 0.007), potassium level ≤ 4.2 mmol/l (OR 1.92, p &lt; 0.002), hemoglobin ≤ 14 g/dl (OR 1.71, p &lt; 0.020), leucocytes ≥ 10.2 x10^9/l (OR 1.76, p &lt; 0.009), neutrophil to lymphocyte ratio ≥ 4.6 (OR 1.85, p &lt; 0.004), left atrium size ≥ 41 mm (OR 2.14, p &lt; 0.001), and left ventricular ejection fraction (LVEF) ≤ 44% (OR 2.99, p &lt; 0.001). Age, BNP, CRP, and LVEF at mentioned above pre-specified cut-off values turned out to be the most important independent predictors of NOAF development in multivariate analysis.

Conclusions
NOAF is a multifactorial, significant complication of AMI, leading to a worse prognosis. Older age, higher BNP and CRP level, and lower LVEF are independently associated with the probability of NOAF.
Predictors of perioperative atrial fibrillation in non cardiac elective surgery: the Hart score
Authors: Stronati G , Mondelli C , Principi S , Silenzi M , Urbinati A , Ciliberti G , Barbarossa A , Compagnucci P , Casella M , Dello Russo A , Guerra F 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
Postoperative atrial fibrillation (POAF) is defined as de novo onset of atrial fibrillation in the post operative period, in patients with no previous history of atrial fibrillation. It affects almost 3% of all over 45 year old patients undergoing non cardiovascular surgery and is associated with a higher risk of stroke and mortality.
PURPOSE
To assess independent predictors of POAF in elective non-cardiac surgery.
METHODS
Retrospective observational database including all patients attending a cardiological preoperative assessment from the 1st of January 2016 to the 31st of December 2019. The primary endpoint was the occurrence of POAF. Individual predictors of the primary endpoint were tested through a series of multivariable logistic regression models, including only those variables with a p&lt;.01 in the univariable models. Independent predictors were entered into a score, and assigned points according to their odd ratios. Performance of the risk score was tested with the receiver operating characteristic curve. A bootstrap procedure was employed for internal validation of both the multivariable logistic regression model and the risk score, using 10000 bootstrap samples and bias-corrected and accelerated confidence intervals.
RESULTS
A total of 2048 patients were enrolled (1350 men, age 71 ± 12 years). Fourty-four patients experienced POAF (2.1%) – median 3 days (1st-3rd quartile 2-3 days). Age (OR 1.03 for each year; 95% CI 1.01-1.07), hypertension (OR 3.43; 95% CI 1.22-9.63), thyroid dysfunction (OR 2.70; 95% CI 1.35-5.42) and intermediate or high risk surgery (OR 18.28; 95% CI 2.51-33.09) resulted as independent predictors of POAF (all p &lt; 0.05). We therefore created the HART score according to Table 1 (OR 2.59 for each point; 95% CI 1.79-3.75; p &gt; 0.001). A cut-off score ≥ 5 has a 70% sensitivity and a 72% specificity in detecting POAF in our population (AUC 0.74). Bootstrapping for internal validation confirmed the overall results.
CONCLUSIONS
A four items point-based risk score such as the HART score, could be effective in implementing effective POAF screening and improve management. The HART score Variable Points H Hypertension 1 point A Age (65-74 years) 1 point Age (75+ years) 2 points R Intermediate Risk surgery 3 points High Risk surgery 3 points T Thyroid dysfunction 1 point
P-wave beat-to-beat morphology analysis outperforms conventional P-wave indices in detecting patients with paroxysmal atrial fibrillation
Authors: Tachmatzidis D , Filos D , Tsarouchas A , Mouselimis D , Antoniadis A , Bakogiannis C , Chouvarda I , Lazaridis C , Triantafyllou C , Fragkakis N , Maglaveras N , Vassilikos V 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation (AF) - the most common sustained cardiac arrhythmia - while not a life-threatening condition itself, leads to an increased risk of stroke and high rates of mortality. Early detection and diagnosis of AF is a critical issue for all health stakeholders.

Purpose
The aim of this study is to compare the performance of standard P-wave indices with beat-to-beat P-wave morphological variability parameters in identifying patients with history of Paroxysmal Atrial Fibrillation (PAF).

Methods
Three-dimensional 1000Hz ECG digital recordings of 10 minutes duration were obtained from a total of 39 PAF patients and 60 healthy individuals. Following artifacts and ectopic beats removal, P‑wave morphology analysis was performed based on the dynamic application of the k‑means clustering process and main and secondary P-wave morphologies were identified. The percentage of P-waves following the main or the secondary morphology in each lead was calculated, as well as established indices such as Advanced Interatrial Block, P-wave duration, axis and area, P-wave Terminal Force in lead V1 and Orthogonal Leads Type 1, 2 or 3.

Results
9 out of 24 parameters studied, were found to be significantly different between the two groups. 7 of these indices were derived from morphology analysis and 2 from P-wave area. Logistic regression revealed that the percentage of P-waves allocated to main morphology in X axis performed better than all other indices in identifying patients with PAF history from healthy volunteers in terms of total accuracy and F1 measure.

Conclusion
P-wave beat-to-beat morphology analysis can identify PAF patients during normal sinus rhythm more efficiently than standard P-wave indices. Abstract Figure.
Impact of rate control in hospitalized patients with atrial fibrillation and sepsis: a systematic review and meta-analysis
Authors: Romiti GF , Proietti M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial Fibrillation (AF) is a common complication in patients with sepsis, and imposes a worse prognosis and challenging clinical management. Administration of antiarrhythmics is often needed, to achieve rate or rhythm control, especially in the occurrence of AF with rapid ventricular response; however, it is unclear whether different classes of antiarrhythmics are associated with better outcomes in patients with sepsis and AF.

Methods
We performed a systematic review and meta-analysis according to PRISMA Guidelines. Pubmed and EMBASE databases were systematically searched for studies reporting outcomes in patients with sepsis and AF, according to the use of Beta-blockers (BBs), calcium-channel blockers (CCBs), digoxin and amiodarone. Random-effect models were used to provide pooled estimates; fixed-effect models were also performed as a sensitivity analysis.

Results
Among 4,166 studies, 2 articles were included from the literature search, and an additional 1 from the author’s knowledge, yielding a total of 40,593 patients with sepsis and AF included. According to the data available from the included studies, the meta-analysis was performed only for in-hospital mortality. BBs were associated with a reduced risk of in-hospital mortality compared to amiodarone (OR 0.52, 95% CI: 0.46-0.58; I2 = 0%, Figure 1, Panel C), while no significant differences were observed for BBs. vs. CCBs (Figure 1, Panel A) and for BBs vs. digoxin (Figure 1, Panel B). In the pre-specified sensitivity analysis using a fixed-effect model, BBs resulted associated with a lower risk of in-hospital mortality compared with both CCBs and digoxin).

Conclusion
In patients with AF during sepsis, BBs were associated with reduced risk of in-hospital mortality, compared to amiodarone; inconclusive results emerged for the comparisons between BBs and CCBs or digoxin, although with a benefit of BBs observed in the fixed-effect models. Further studies are needed to provide definitive data and to guide physicians in the choice of the best rate control strategy in this clinical setting. Abstract Figure.