bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anticoagulation status and left atrial appendage occlusion indications in hospitalized cardiology patients with atrial fibrillation: a Hellenic Cardiorenal Morbidity Snapshot (HECMOS) sub-study
Authors: Tsioufis P , Tsiachris D , Botis M , Doundoulakis I , Antoniou C K , Kordalis A , Argiriou N , Laina A , Dimitriadis K , Koutsopoulos G , Gatzoulis K , Tsioufis K 
Published: October 2024

Abstract

Background
Proper use of oral anticoagulants is crucial in the management of non-valvular atrial fibrillation (NVAF) patients. Left atrial appendage occlusion (LAAC) may be considered for stroke prevention in patients with NVAF and contraindications for long-term anticoagulant treatment.

Purpose
We aimed to assess the anticoagulation status and LAAC indications in patients with NVAF from HECMOS (Hellenic Cardiorenal Morbidity Snapshot) survey.

Methods
HECMOS was a nationwide snapshot survey of cardiorenal morbidity in hospitalized cardiology patients. HECMOS used an electronic platform to collect demographic and clinically relevant information from all patients hospitalized on March 3, 2022, in 55 different cardiology departments. In this substudy, we included patients with known AF without mechanical prosthetic valves and moderate to severe mitral valve stenosis. Patients with poor adherence to anticoagulants, high bleeding risk, previous major bleeding, and previous stroke were considered candidates for LAAC.

Results
Two hundred fifty-six patients (mean age 76.6±11.7, 148 males) were included in our analysis. Most of them (n=159; 62%) suffered from persistent AF. Mean CHA 2 DS 2 - VASc score was 4.28±1.7, while mean HAS-BLED score was 1.47±0.9. Three out of 3 patients with a CHA 2 DS 2 -VASc 0 or 1 (female) received improperly anticoagulants. Sixteen out of 18 patients with a CHA 2 DS 2 -VASc 1 or 2 (female) received anticoagulants. Thirty-three out of 235 patients with a CHA 2 DS 2 -VASc &gt; 1 or 2 (for female) did not receive improperly anticoagulants. Among 221 under anticoagulant therapy, 191 (86.4%) received non-vitamin K antagonist oral anticoagulants (NOACs) and 30 (13.6%) received vitamin K antagonists. Relative indications for LAAC were present in 77 patients with NVAF (53 had only one risk factor, while 22 had two and 2 patients had three concurrent risk factors). In detail, 15 reported poor or no adherence to the anticoagulant therapy, 17 patients had a history of major bleeding, 36 had a prior stroke and 35 had a HAS-BLED score ≥3. No LAAC treatment was recorded.

Conclusion
Αnticoagulation status was nearly optimal in a high thromboembolic risk population of cardiology patients, mainly treated with NOACs. Three out of ten AF patients should be screened for LAAC.Anticoagulation by thrombotic riskPotential LAAC candidates
The occurrence of atrioventricular nodal reentrant tachycardia requires not only the electrophysiological substrate but also the electro-anatomical characteristics in the triangle of Koch
Authors: Mine T , Terao S , Sugitani M , Kogame T , Fukuhara E , Ishihara M 
Published: October 2024

Abstract

Background
Some patients do not develop atrioventricular nodal reentrant tachycardia (AVNRT) clinically despite having the electrophysiological substrate for AVNRT; however, the cause remains unclear. Recently, the conduction to the slow pathway has been reported to be visualized using high-density mapping in the triangle of Koch (ToK) during sinus rhythm.

Purpose
To investigate whether the conduction to the slow pathway is associated with the occurrence of AVNRT.

Methods
We studied 83 patients (55 males, 67 ± 13 years, 10 with typical AVNRT, 66 atrial fibrillation; AF, 5 atrioventricular reentrant tachycardia; AVRT, and 2 Atrial Flitter) who received electrophysiological test and high-density mapping in the ToK during sinus rhythm. The conduction pattern to the slow pathway, rotating around the end (pivot point: PP) of the functional block line (FBL), was evaluated using the Advisor HD Grid mapping catheter.

Results
10 out of 10 AVNRT (100%), 17 of 66 AF (26%), and 1 of 4 AVRT showed PP and FBL (p&lt;0.0001). 21 out of 21 (10 AVNRT and 11 AF) with the jump-up phenomenon in atrioventricular conduction indicated PP and FBL (100%), meanwhile 7 of 62 without jump-up phenomenon showed PP and FBL (11%) (p&lt;0.0001). Among patients (10 AVNRT and 9 AF) who had the electrophysiological substrate for AVNRT (jump-up phenomenon and retrograde ventriculoarterial conduction), patients with AVNRT had a longer distance from PP to the tricuspid annulus; TA (16.9mm vs, 13.4mm, p=0.0116) than patients with non-AVNRT. There were no differences in the length of FBI, distance and conduction time from His to PP, distance and conduction time from PP to CS ostial, and the area size of ToK. All AVNRT patients underwent linear ablation from PP to TA and showed loss of atrial potential in the region between PP, TA, and His, AVNRT was no longer provoked, and in 8 out of 10 patients, a jump-up phenomenon disappeared.

Conclusion
Patients with AVNRT showed a functional block line and a longer distance from the pivot point to the tricuspid annulus. The occurrence of AVNRT requires not only the electrophysiological substrate but also the electro-anatomical characteristics, especially in the triangle of Koch.
Sex-specific syncope characteristics in the early diagnosis of cardiac syncope
Authors: Kaplan E , Du Fay De Lavallaz J , Zimmermann T , Lopez-Ayala P , Strebel I , Badertscher P , Nestelberger T , Miro O , Christ M , Cullen L , Than M , Martin-Sanchez F J , Manka R , Breidthardt T , Mueller C 
Published: October 2024

Abstract

Background
The Lancet women and cardiovascular disease commission requested evaluating sex-specific approaches in the diagnosis and management of acute cardiovascular disease.

Purpose
We aimed to explore 1) the utility of sex-specific syncope characteristics in the early diagnosis of cardiac syncope 2) sex-related differences in the management and outcomes of patients with a cardiac syncope.

Methods
Thirty-one syncope characteristics were prospectively assessed in women and men presenting with syncope to the emergency department (ED) in an international multicenter study. The final diagnosis of cardiac syncope was centrally adjudicated by two independent cardiologists. Sex-specific differences in the prevalence of syncope characteristics and their positive likelihood ratio (pLR) for cardiac syncope were the primary diagnostic endpoints. Sex-specific differences in hospital admission, diagnostic procedures performed in patients with a cardiac syncope and adverse events in patients directly discharged from the ED during one-year follow-up were secondary endpoints.

Results
Among 2661 patients (median age 71 years, 1099 women and 1562 men), 14.6% of women and 18.2% of men (p=0.02) were adjudicated to have a cardiac syncope. Eleven syncope characteristics showed diagnostic utility (statistically significant pLRs) in assessing cardiac syncope in the overall population. However, none of the syncope characteristics demonstrated significant sex interaction. Women adjudicated as having a cardiac syncope were as likely to be hospitalized as men (OR 1.12; 95% CI: 0.61-2.08, p=0.7) and to receive telemetry (40% vs 41%, p=0.9), ergometry (3.1% vs 6.3%, p=0.4), a holter (21% vs 17%, p=0.3), a loop recorder (0.6% vs 3.9%, p=0.06) and an echocardiogram (69% vs 65%, p=0.4). Among the 591 women and 796 men directly discharged from the ED, 18 women (3%) and 36 men (5%) were finally adjudicated as cardiac syncope. Noteworthy, within this cardiac syncope subgroup, 28% of women experienced major adverse cardiac events (MACE) during the 365-day follow-up period, in comparison to 67% men (OR 0.20; 95% CI: 0.06-0.68, p=0.011, Figure).

Conclusion
Syncope characteristics contributed to the early diagnosis of cardiac syncope, however, none had a significant sex interaction. Women with a cardiac syncope had a similar likelihood of being hospitalized and receiving diagnostic testing. Compard to men, women had a significantly decreased risk of MACE when not hospitalized after a cardiac syncope.Kaplan-Meier curves for 1 year MACE
Early discharge following cardiac implantable electronic device implantation: a systematic review and meta-analysis
Authors: Devesa Neto V , Costa G , Teixeira R , Costa A , Santos L F 
Published: October 2024

Abstract

Background
As the demand for cardiac implantable electronic device (CIED) placement rises, healthcare expenses, including the post-procedure hospital stay costs, have been on the increase. This systematic review and meta-analysis were undertaken to evaluate the safety and viability of same-day discharge (SDD) following cardiac device implantations.

Methods
We conducted a systematic searched of PubMed, Embase and Cochrane database during November 2023 for studies comparing SDD versus discharge after overnight stay (OS) after CIED. Outcomes included all-cause mortality and complications after the procedure (lead/device dislodgment, re-hospitalization, pneumothorax, local hematoma and wound complications). Data from each study were combined using the random-effects model to calculate pooled odds ratio (OR) with 95% confidence interval (CI).

Results
Eleven studies, including two randomized clinical trials, were incorporated, with a total of 64,646 patients, providing 918 pooled death events (74 in SDD and 844 in OS). The meta-analysis revealed that SDD was associated with a significantly lower risk of all-cause mortality compared to OS (pooled HR 0.72; 95% CI: 0.55-0.93; I2=0%) and no difference was found regarding re-hospitalization (pooled HR 0.96; 95% CI: 0.88-1.05; I2 55%). SSD was not associated with higher lead/device dislodgement (pooled HR 0.93; 95% CI: 0.50-1.71; I2=0%), pneumothorax (pooler HR 1.04; 95% CI: 0.31-3.50; I2 0%) and wound complications (pooled HR 0.65; 95% CI 0.22-1.01; I2 0%). SSD was associated with more episodes of local hematoma (pooled HR 0.31; 95% CI 0.09-1.05; I2 0%).

Conclusion
Our meta-analysis suggests that SDD is associated with a decreased all-cause mortality compared to OS. Although associated with more episodes of local hematoma, SDD was not significantly different regarding lead/device dislodgment, pneumothorax, re-admissions and wound complications. SDD after CIED appears to be a safe and feasible alternative.
Clinical evidence of pacemaker implantation during gestation: a case series
Authors: Smagulova A , Ainabekova B , Albaev R , Abdrakhmanova Z H , Suleymen Z H , Abdrakhmanov A 
Published: October 2024

Abstract

Background
Although recommended avoid any intervention during gestation in cases of poor tolerance to high degree atrioventricular block, pacemaker implantation may be necessary in pregnant women.

Purpose
To present outcomes of pacemaker implantation during gestation.

Methods
This prospective, single center study included 10 cases of pacemaker implantation during gestation (median age of patient - 26 years old at 18 weeks of gestation). We evaluated the further course of gestation and obstetric outcomes after implantation in comparison with pregnant with tachyarrythmias (n=111).

Results
Among 121 pregnant women with varying arrhythmias high degree atrioventricular block was detected in 10 cases (8,3%). In 6 cases this bradyarrhythmia diagnosed for the first time in gestation (60%). All pregnant with high degree atrioventricular block had clinical signs: dizziness and weakness (100%), syncope (70%), episodes of low blood pressure (100%). Pacemaker implantation performed due to hemodynamic instability and poor tolerance of bradyarrhythmia in all cases. Using electroanatomical mapping (Ensite Precision system)and echocardiographic guidance helped to reduce fluoroscopy time. For one pregnant implanted leadless pacemaker (Micra) with achieved more than 80% atrio-ventricular synchronization. Outcomes: further course of gestation characterized by increased incidence of uterine contractile activity (30%) in cases of high degree atrioventricular block, that was significantly higher than in pregnant with tachyarrhythmias (2%) (p=0.007). There were no differences in the rate of other complication: uterine blood flow violation (20% vs 12%, p=0.520), placental abraption (10% vs 5%, p=0.237) and preeclampsia (10% vs 5%, p=0.237). Vaginal type of delivery was in the majority of cases in both groups (70% vs 86%, p=0.553). Neonatal outcomes characterized with normal range of fetal birth weight (median 3163 vs 3212 grams, p=0.981) and 5 minute Apgar score (median 8.6 vs 8.7, p=0.564). There was no incidence of maternal and fetal mortality. In 12 month follow-up all patient have optimal electrical parameters of devise and remained stable over time.

Conclusions
High degree atrioventricular block in pregnant characterized by increased rate of uterine contractile activity. Pacemaker implantation during gestation can be effectively performed and associated with benign outcomes.
Prognostic parameters predict cardiac events in Brugada syndrome: a meta-analysis
Authors: Siranart N , Pajareya P , Roongphornchai P , Rattanamanoonporn S , Chokesuwattanaskul R 
Published: October 2024

Abstract

Background
Brugada syndrome (BrS) is recognized as a cause of sudden cardiac death (SCD), ventricular tachycardia or ventricular fibrillation (VT/VF). However, the prognosis varies among the patients with Brugada electrocardiograph (ECG) pattern. Furthermore, there is no prognostic tool to predict the worsening cardiac outcomes in BrS.

Objectives
Primary outcome was to assess the association between risks including patient history, ECG pattern, electrophysiology study (EPS) findings and cardiac events which is identified as VT/VF or SCD.

Method
We performed a meta-analysis of prospective and retrospective cohort studies which assessed the risks and cardiac events in patients with BrS. Pooled hazard ratios (HRs) was analyzed by using Random-effect model.

Result
A total of 27 studies involving 15,990 BrS patients. Of these, 17 were retrospective studies and 10 were prospective studies. In univariate analysis, the risks including male, aborted SCD, QRS duration≥120 msec, fragmented QRS (multiple spikes within the QRS complex in lead V1-V3), late potential (positive terminal filtered QRS complex of signal-averaged ECG), sinus node dysfunction or inducibility of ventricular tachyarrhythmias during EPS associated with a higher risk of cardiac events in BrS. In multivariate analysis, higher risks of cardiac events were associated in BrS patients with history of syncope (HR 2.65, 95% confidence interval (CI): 1.68-4.19, I2 = 54 %, p-value &lt;0.001), family history of SCD (HR 2.64, 95%CI:1.39-5.01, I2 = 0%, p-value = 0.003), prior VF (HR 14.52, 95%CI: 3.36-62.84, I2 = 62%, p-value &lt;0.001), type 1 Brugada ECG pattern (HR 2.07, 95%CI: 1.13-3.79, I2 = 0%, p-value = 0.018), spontaneous type 1 ECG pattern (HR 1.91, 95%CI: 1.01-3.61, I2 = 58%, p-value = 0.046), early repolarization pattern (HR 2.78, 95%CI: 1.9-4.07, I2 = 0%, p-value &lt; 0.001) and history of atrial fibrillation before BrS diagnosis (HR 1.82, 95%CI: 1.03-3.23, I2 = 49%, p-value = 0.039) (Table 1).

Conclusion
Our findings suggest that patient history, ECG pattern, EPS findings can predict the cardiac events. Introducing a risk prediction model could aid in early management of BrS.
Right ventricular outflow tract arrhythmias in patients with obstructive sleep apnea- electrophysiological insights
Authors: Negru A , Crisan S , Vacarescu C , Mihaicuta S , Frentz S M , Luca S A , Gaita D I , Luca C T , Bebec D L , Milko D , Iovanovici D , Cherif M , Fatmi H , Ivanica A E 
Published: October 2024

Abstract

Background
Obstructive sleep apnea (OSA) was associated with atrial fibrillation and heart failure. Furthermore, the arrhythmic sudden death during sleep in patients with OSA raises serious concerns. Non-ischemic ventricular arrhythmias arise frequently from the right ventricular outflow tract (RVOT). The involvement of obstructive sleep apnea in the genesis of arrhythmia (premature ventricular contraction or tachycardia) originating specifically in the RVOT is not yet coherently established.

Purpose
This study aims to demonstrate the possible relationship between untreated obstructive sleep apnea and the occurrence of RVOT arrhythmia and to follow the electrophysiological features and outcomes after radiofrequency catheter ablation (RFA) in patients carrying this double burden.

Methods
One-hundred-twelve (112) consecutive asymptomatic and symptomatic patients admitted with RVOT arrhythmia ((PVCs and VTs) underwent a sleep study (polysomnography). Apnea was set out as the cessation of breathing and hypopnea was defined as shallow, slow, and restricted breathing occurring in episodes of ten seconds or more. The patients had normal left and right ventricle ejection fractions and no structural cardiovascular disease or other known extracardiac arrhythmia predisposing conditions. No significantly elevated systolic pressure in the pulmonary artery was assessed at echocardiography. Every patient was investigated by electrophysiologic study (EPS) and RFA of the clinical ventricular arrhythmia was immediately performed. Practicing and former professional athletes were excluded.

Results
Seventy-eight (69 %) of the included patients had an apnea-hypopnea index &gt; 10/h. The included patients had the following characteristics: mean age 52 ± 8 years, 62% males, 81% had a BMI &gt;30kg/m². The cardiac electrophysiologic study did not induce sustained VTs. The distribution of the PVCs and non-sustained VTs evidenced a predilection for the superior, septal and anterior (68%) and also superior and anterolateral aspects of the RVOT (23%). Radiofrequency catheter ablation (RFA) guided by activation mapping, precocity (the site of earliest activation &gt; 30 ms before the setting of the QRS complex) and pace-mapping were performed in all patients. Immediate success was obtained in 98 patients (88%). After a mean follow-up of 24± 6 months, 28 patients (28%) from the success arm had a recurrence of the PVCs or the non-sustained VTs, 22 patients (22%) with and 6 patients (6%) without sleep apnea.

Conclusions
RVOT arrhythmia genesis and relapse after successful RFA seem highly associated with sleep apnea. Furthermore, patients with sleep apnea are more prone to have recurrent arrhythmias after radiofrequency catheter ablation in the absence of appropriate control of OSA.
In-hospital outcomes of ventricular tachycardia catheter ablation in the presence of intra-cardiac thrombus
Authors: Margolis G , Aviad C , Barel M , Kazatsker M , Kobo O , Roguin A , Leshem E 
Published: October 2024

Abstract

Background
Ventricular tachycardia (VT) catheter ablation in the presence of intracardiac thrombi was evaluated in very few studies.

Objectives
To investigate in-hospital outcomes of VT ablation in the presence of an intracardiac thrombus, in a large inpatient US registry.

Methods
Using the National Inpatient Sample (NIS) database, patients who underwent non-elective VT catheter ablations in the US between 2016 and 2019 were identified using ICD-10 codes. Sociodemographic, clinical data, in-hospital procedures and outcomes as well as in-hospital mortality were collected. In-hospital outcomes were compared using propensity score (PS) matching analysis with a 1:3 ratio between patients with and without intracardiac thrombus.

Results
A weighted total of 15,725 admissions for non-elective VT ablation were included in the study, of which 190 (1.2%) had a discharge diagnosis of intracardiac thrombus. Patients with intracardiac thrombus had a higher comorbidity burden and were more likely to have ischemic cardiomyopathy and a diagnosis of cardiac aneurysm. In PS analysis, the presence of intracardiac thrombus was significantly associated with higher rates of any in-hospital complications (42.1% vs 19.3%, P&lt;0.009), driven by higher periprocedural cerebrovascular accident and vascular injury events. In-hospital mortality rates were not significantly different between the groups.

Conclusions
In patients undergoing non-elective VT ablation, intracardiac thrombus was associated with higher rates of in-hospital complications, but not higher in-hospital mortality. These findings suggest that intracardiac thrombus should not contraindicate VT ablation when deemed necessary, while efforts should be made to decrease potential complications.
Beat-to-beat measurement of R-wave peak time for left bundle branch area pacing: man versus machine using a novel automated algorithm
Authors: Spadotto A , Paamand R , Leonard O , Firth K , Burri H 
Published: October 2024

Abstract

Background
Assessment of stimulation spike to R-wave peak time (RWPT) in V6 and in aVL, and V6-V1 interpreak interval, may be used to evaluate presence of conduction system capture during left bundle branch area pacing (LBBAP). This is performed by manual measurements which is tedious and requires a skilled operator to limit variability in the measurements. Automatic beat-to-beat measurement of these intervals may streamline workflow during implantation, but such an algorithm has never been tested so far.

Purpose
To test the feasibility of performing beat-to-beat automatic measurement of RWPT using an algorithm designed to measure the interval between the stimulation spike and the peak positive voltage, and to compare the results with manual measurements.

Methods
ECG recordings from 50 patients (28% female, mean age 81.5 ± 9.0 years) undergoing LBBAP implantation were evaluated on a electrophysiology recording system by manually measuring RWPT in V6 and in aVL and the V6-V1 interpeak intervals . A single operator performed offline measurements on 10 consecutive beats in each patient. The same beats were subjected to the same measurements using an automatic algorithm after signal conditioning in a novel EP recording System. The correlation between manual and automatic measurements was calculated. Variability of the measurements (evaluated by standard deviation) in the 10 consecutive beats was also compared.

Results
Of the 500 beats measured, 3 were excluded due to obvious morphological differences affecting the interval measurement (e.g. due to fusion beats). The algorithm was unable to make a measurement in V6 in 20 beats and manual assessment of aVL was not possible in one patient, meaning that 1461/1500 (97.4%) measurements were compared between the manual and automatic methods. The results are shown in the figure. There was excellent correlation between manual and automatic measurements, with lower variability using the latter method.

Conclusion
Beat-to-beat automatic measurement of RWPT is feasible and provides excellent correlation with manual measurements, with less variability in the values. This algorithm may streamline the measurements during implantation. However, prospective evaluation is required to confirm operation of the algorithm in the clinical setting to include challenges such as electrical noise.