bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age-related and age-independent complications in atrial fibrillation ablation: insights from the Japan ablation registry
Authors: Inoue I , Nakai M , Yamane T , Kusano K , Takatsuki S , Satomi K , Iwanaga Y , Kanaoka K , Tonegawa T R , Sumita Y , Takegami M , Nakao M Y , Miyamoto Y , Shimizu W 
Published: October 2024

Abstract

Background
The growing prevalence of atrial fibrillation (AF) has intensified the focus on managing this condition in the elderly. Catheter ablation, a popular treatment option, requires more detailed examination due to limited data on its efficacy and risks in this age group.

Aim
To identify the types of complications of AF ablation correlated with advanced age and to differentiate them from age-independent complications.

Method
We conducted a prospective analysis of 170,017 AF ablation procedures from the Japan ablation registry, conducted across 482 facilities between 2017 and 2020. Complications in patients aged 80 and above (elderly group, n=14,389) were compared with those under 80 (control group, n=155,628). The overall complication rate was 2.77%, with a higher occurrence in the elderly group (elderly group vs. control group, 3.62% vs. 2.69%, p&lt;0.001). Notably, the elderly experienced more cardiac tamponade/pericardial effusion (0.95% vs. 0.6%, p&lt;0.001), symptomatic cerebral infarction or transient ischemic attacks (0.27% vs. 0.15%, p=0.001), and sick sinus syndrome (0.31% vs. 0.05%, p&lt;0.001). While in-hospital mortality in the elderly group was relatively low (0.16%), it was significantly higher compared to the control group (0.06%, p&lt;0.001). However, incidences of other complications like puncture-site complications (0.49% vs. 0.42%, p=0.28), non-puncture-site bleeding, esophagus-related complications (0.22% vs. 0.22%, p=0.72), and phrenic nerve palsy (0.44% vs. 0.43%, p=0.69) showed no significant age-related differences.

Conclusion
Elderly patients undergoing AF ablation are at a higher risk of overall complications, with particular susceptibility to cardiac tamponade/pericardial effusion, symptomatic cerebral infarction/transient ischemic attacks, and sick sinus syndrome. This highlights the need for careful monitoring of these specific complications in the elderly. Additionally, it is noteworthy that the risk of certain complications appears to be independent of age.
Prevention of thromboembolic events in atrial fibrillation patients with persistent leaks following the watchman implantation
Authors: Mohanty S , Gigante C , Torlapati P , La Fazia V M , Gianni C , Della Rocca D G , Macdonald B , Mayedo A , Allison J , Gallinghouse G J , Burkhardt J D , Horton R , Di Biase L , Al-Ahmad A , Natale A 
Published: October 2024

Abstract

Introduction
Peri-device leak is not uncommon after percutaneous occlusion of left atrial appendage using the Watchman device. Prior studies have reported the clinical relevance of small leaks (&lt;5mm) as they were associated with a significant increase in ischemic events.

Purpose
We evaluated the prevalence of stroke in patients with post-watchman leaks on half-dose non-vitamin K oral anticoagulants (HD-NOAC) vs antiplatelet therapy (APT).

Methods
This consecutive series included post-watchman cases that had a residual leak of ≤5 mm at the 45-day echocardiogram and were unwilling to undergo any leak-closure procedure. Based on their subsequent antithrombotic therapy, they were classified into group 1: HD-NOAC and group 2: dual-APT for 6 months followed by Aspirin only. Patients were closely monitored for thromboembolic (TE) events via telemedicine. Stroke/transient ischemic attacks that occurred while the patients were in full compliance with the anti-thrombotic therapy, were counted as the reportable TE events.

Results
A total of 141 (age: 66.89± 8.76 years, male: 88 (62.4%), CHA2DS2-VASc score: 3.41 ± 1.56, HAS-BLED: 3.72 ± 1.01) and 154 (age: 72.45 ±7.05 years, male: 99 (64.3%), CHA2DS2-VASc score: 3.75 ± 1.61, HAS-BLED: 3.89 ± 1.05) patients were included in group 1 and 2 respectively. All leaks were between 3-5 mm.
TE events were reported in 2 (2/141, 2.12%) patients in group 1 and 9 (9/154, 5.8%) in group 2 while being on antithrombotic therapy (p=04). No residual neurological deficits were detected in the 2 patients from group 1 contrary to the 9 subjects in group 2 that had neurological deficits persistent at follow-up. Of note, 8 (5.6%) patients in group 1 experienced stroke after discontinuing the drug for other medical procedures or due to poor compliance.

Conclusion
Under full compliance, HD-NOAC is associated with significantly lower TE rate compared to the APT therapy in post-watchman cases with persistent leaks of ≤5 mm. However, discontinuation of the HD-NOAC increases the stroke-risk to a comparable level.
Cardiovascular etiologies and risk factors of survival outcomes after resuscitation for out-of-hospital cardiac arrest: data from the KoCARC registry
Authors: Choi J I , Jeong J H , Min K J , Kim S J , Rho S Y , Choi C U , Han G S , Song J H , Lee E J , Lee S W , Kim Y H 
Published: October 2024

Abstract

Background
The outcomes and characteristics of out-of-hospital cardiac arrest (OHCA) vary across geographic regions. The etiologies and prognoses of OHCA in Asian populations remain less established. This study aimed to investigate the etiologies and clinical characteristics of patients successfully resuscitated after OHCA and identify predictors of survival outcomes.

Methods
Data were extracted from a South Korean multicenter prospective registry of OHCA that included 64 tertiary hospitals from 2015 to 2018 (n=7577). The primary outcome was in-hospital mortality, and secondary outcome was the grade-1 cerebral performance category (CPC) score at discharge.

Results
Of the 7577 patients, 2066 achieved return of spontaneous circulation (ROSC) and were hospitalized and 915 (44·2%) presented with ventricular arrhythmia (VA) as their initial rhythm or on admission. The leading cause was obstructive coronary artery disease (n=413; 20·0%). Sudden unexplained death syndrome (SUDS) accounted for 67·5% of survivors, which were significantly lower with VA (82·7% vs. 48·3%, p&lt;0.001). VA was an independent predictor of in-hospital mortality (adjusted hazard ratio [aHR] 0·72, 95% confidence interval 0·60–0·87) and the grade-1 CPC score at discharge (aHR 3·63, 95% CI 2·56–5·15). Other predictors of the primary outcome included age, ROSC on arrival, total arrest time, alertness on admission, extracorporeal membrane oxygenation use, targeted temperature management, implantable cardioverter defibrillator use, and coronary vasospasm.

Conclusions
SUDS was common in patients with ROSC after OHCA and thus needs to be evaluated comprehensively. VA was independently associated with favorable survival outcomes at discharge. Further management may improve clinical outcomes in patients with OHCA, particularly those with VA.
Role of ventricular tachycardia cycle length in the outcomes after catheter ablation or antiarrhythmic drugs in the SURVIVE-VT trial
Authors: Avila Alonso P , Berruezo A , Jimenez-Candil J , Tercedor L , Arribas F , Fernandez-Portales J , Merino J L , Hernandez-Madrid A , Bermejo-Thomas J , Arenal A 
Published: October 2024

Abstract

Background
It has been suggested that antiarrhythmic drugs (AAD) are less effective and safe in slow ventricular tachycardia (VT) due to their effect on conduction velocity, which could stabilize reentry. Conversely, catheter ablation aims to disrupt the VT circuit. Because of the distinct mechanisms of action of AAD and catheter ablation on the VT circuit, VT cycle length (VT-CL) may play a crucial role in determining their therapeutic efficacy. Therefore, VT-CL could be important in selecting VT treatment.

Purpose
The aim of this study was to assess the impact of VT-CL on outcomes following catheter ablation or antiarrhythmic drugs in AAD-naïve patients with ischemic cardiomyopathy presenting with VT.

Methods
This is a post hoc analysis of the previously published Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia (SURVIVE-VT) trial. In summary, 144 patients with ischemic cardiomyopathy and symptomatic VT were randomized to receive either catheter ablation (N=71) or AAD (N=73) as first-line therapy. We analyzed VT recurrence, implantable cardioverter-defibrillator (ICD) therapies, and the incidence of slow/incessant VT/VT storm using Cox proportional hazard models, with treatment and VT-CL interaction terms, adjusted for age. Missing VT-CL data for five patients were imputed using the median value.

Results
In patients with chronic ischemic heart disease and VT treated with either AAD or catheter ablation, a significant interaction was observed between clinical VT-CL and treatment effect on VT recurrence (p=0.016 for the interaction). Specifically, slower VT cycle lengths were associated with higher rates of VT recurrence (hazard ratio per 10 ms [HR] 1.094, 95% confidence interval [CI] 1.015, 1.179; p=0.037) in patients treated with AAD, while no significant effect was observed in those undergoing catheter ablation (see Figure 1). Survival freedom from VT recurrence in patients with VT-CL ≥300ms was significantly higher in patients treated with catheter ablation (78.8% vs 58.1%, log-rank p=0.044, see Figure 2). As expected, VT-CL was significantly associated with a higher risk of slow/incessant VT/VT storm (HR per 10 ms 1.115, 95% CI 1.017-1.222, p=0.047) but was not associated with ICD therapies (HR per 10 ms 1.082, 95% CI 0.994-1.178, p=0.102).

Conclusion
VT-CL significantly influences treatment outcomes, with slower VT cycles associated with an increased risk of VT recurrence in patients treated with AAD, but not in those undergoing catheter ablation. Therefore, VT-CL should be taken into consideration when selecting the optimal therapy for patients with ischemic cardiomyopathy and VT.Figure 1Figure 2
Epicardial ablation in patients with Brugada syndrome: a single centre experience
Authors: Rafaj A , Peichl P , Krebsova A , Wichterle D , Stojadinovic P , Cihak R , Haskova J , Stiavnicky P , Borisincova E , Kautzner J 
Published: October 2024

Abstract

Introduction
Brugada syndrome (BrS) is a rare disease associated with an increased risk of ventricular fibrillation (VF), ventricular tachycardia (VT), and sudden cardiac death (SCD). The standard prevention of SCD in patients with BrS is the implantation of an implantable cardioverter-defibrillator (ICD), especially in patients who have previously suffered cardiac arrest or arrhythmogenic syncope. Catheter ablation is an effective method to prevent recurrences of VF/VT in these patients.

Purpose
Retrospective analysis of the results of catheter ablation by epicardial approach and genetic testing in patients with a diagnosis of BrS and repeated adequate ICD interventions.

Methods
In 2013-2024, catheter ablation by epicardial approach was performed in our centre in 9 patients diagnosed with Brugada syndrome (mean age 41±6 years, nine males, left ventricular ejection fraction 57±4%). All patients had an ICD implanted for secondary prevention of SCD and presented with adequate ICD therapies (mean 9±11 shocks/patient in the last six months before catheter ablation). Before catheter ablation, two patients were treated with quinidine. Patients underwent cardiogenetic testing by next-generation sequencing of 228 genes.

Results
Type 1 electrocardiogram (ECG) pattern was present at baseline ECG in four (44%) patients; in five (56%) patients, type 1 was induced after ajmaline administration. Genetic testing was performed in seven patients, and only one patient (14%) was found to have a relevant pathogenic mutation in the SCN5A gene. Prior to ablation, sustained VT/VF could be induced by programmed electrical stimulation in three patients (33%). Epicardial ablation was targeted at areas of abnormal electrograms located over the right ventricular outflow tract. No complications were noted. The mean follow-up period was 25±30 months. In one patient (11%), reablation was required to suppress ventricular arrhythmias successfully. After the last ablation, no recurrence of VT/VF was observed in any patient.

Conclusions
Epicardial ablation is an effective method that leads to the suppression of ventricular arrhythmias in patients with a diagnosis of BrS and repeated ICD interventions. Despite the malignant arrhythmic phenotype, patients in our cohort had a rather low prevalence of signs associated with a high risk of VT/VF, such as spontaneous ECG pattern of BrS, inducibility of VT/VF during electrical programmed stimulation, or the presence of a causative genetic mutation.
Health literacy challenges of young adults with rheumatic diseased in the transition to adult care
Authors: Scharmga A , Bakker M , Gorter S 
Published: October 2024

Abstract

Background
For young people living with a chronic illness (such as rheumatic diseases), transitioning from youth to adult care is a challenging process requiring adequate health literacy (HL). Insight into the specific HL-challenges of young people with rheumatic diseases could contribute to preventing loss to follow-up, and improving medication adherence, health outcomes, and social participation.

Methods
A mixed-methods study was conducted among young adults (16-25 years old) living with rheumatic disease in the Netherlands. Participants were recruited at two clinics and through social media of patient initiatives. Quantitative data were digitally self-reported using the Health Literacy Questionnaire (HLQ) and Medication Adherence Report Scale (MARS). Qualitative data were collected through semi-structured interviews. Hierarchical cluster analysis of HLQ-data was used to identify health literacy profiles, uncovering strengths and weaknesses. Interview transcripts were analysed using content analysis and used to explore health literacy needs and confirm the HLQ results.

Results
Sixty-two participants completed the questionnaire and ten participants were interviewed. Six HL-profiles were identified, representing diverse strengths and weaknesses. Having sufficient information, social support, and critical appraisal were challenging across profiles. Some participants (particularly in profile 3) reported difficulties in taking medication. The interviews confirmed the quantitative findings and unveiled HL needs across seven categories, particularly the need for in-depth information and support, with a focus on (social) aspects of having a chronic illness as a young person.

Conclusions
HL-challenges of young adults with rheumatic diseases are similar to adult populations, but age-specific needs exist. The results can inform development of HL-responsive rheumatology services, for example during consultations or at the transition clinic.
Research ethics implications in the development of personalised therapy for pediatric SIRS patients
Authors: Yankulovska S , Stolte F , Thiemicke P , Orzechowski M , Steger F 
Published: October 2024

Abstract

Background
Pediatric Systemic Inflammatory Response Syndrome (SIRS) presents diagnostic and therapeutic challenge that can be addressed through personalised therapy. Related ethical challenges are understudied. Our report aims at identification and analysis of research ethics implications within the bigger ERA PerMed funded project of development of tailored immunotherapy for paediatric SIRS patients (TIPS) coordinated by Prof. Catharina Schütz from Technic University Dresden.

Methods
A sample of 10 experts with different backgrounds was studied through semi-structured interviews. Systematic literature review grounded the interview questionnaire. The transcripts were subjected to thematic analysis by two independent researchers.

Results
Five classical research ethics issues were identified: respect for autonomy; informed consent; risk-benefits ratio; data protection; social justice. All experts favoured the empowerment of children (N = 10) and obtainment of informed consent rather than assent was seen as a common goal (N = 5). The emergency context of SIRS research impeded the informed consent. Despite favourable risk-benefits ratio, no direct benefits resulted to study participants. Data anonymisation though necessary (N = 10), hinders proper dealing with incidental findings. Social justice issues apparently accompanied research design in personalised medicine (N = 2) but should not extend to access to personalised therapy.

Conclusions
The classical framework of research ethics is challenged by the new fields of medical research. Traditional concepts, such as informed consent in minors, are subject to rethinking. Current ethical and legal guidelines fall short of proper practical instructions in the specific case of SIRS pediatric patients. Thus, ethical aspects of new technology development should always be studied in parallel to the biometrics within personalised medicine projects so as to the development of guidelines is more evidence-based than precautionary driven.

Key messages
• Current ethical and legal guidelines fall short of proper practical instructions in the specific case of SIRS pediatric patients.
• Ethical aspects of new technology development should always be studied within personalised medicine projects so as to the development of guidelines is more evidence-based than precautionary driven.
The role of communication in the successful implementation of the Slovenian NCCP
Authors: Plantosar K , Duratovic Konjevic A , Tomsic S , Zgajnar J , Zakotnik B , Torkar K 
Published: October 2024

Abstract

Issue
Cancer remains a significant global public health challenge, necessitating comprehensive strategies for effective control and management. Slovenian National Cancer Control Programme (NCCP) addresses this challenge by prioritizing proactive communication with various stakeholders engaged in cancer care planning, delivery and advocacy. The communication strategy within this programme plays a pivotal role in its successful implementation.

Description of the problem
Active engagement and collaboration among stakeholders is crucial for achieving the programme’s objectives. NCCP seeks to address this challenge through various communication activities by fostering dialogue, sharing best practices, and facilitating networking opportunities among oncology professionals throughout Slovenia. Additionally, it seeks to strengthen partnerships with sectors beyond health and prioritizes engagement with cancer patient advocacy groups.

Results
The programme has devised a long-term communication strategy, guiding annual communication plans to engage stakeholders and foster support for its objectives. Notable communication activities in the period 2022-2024 include: organizing annual meetings for different oncology stakeholders including cancer patient associations, hosting impactful professional events, conducting visits to regional cancer hospitals, distributing e-newsletters and managing a NCCP website. Initial outcomes indicate strengthened communication and collaboration among professionals and institutions in the field of oncology nationwide. Engagement with patient advocacy groups has facilitated discussions on topics important to patients.

Lessons
Effective communication with diverse stakeholders is crucial for comprehensive cancer control. Collaborating across sectors enhances the impact of cancer control initiatives. Enhanced networking fosters innovation and synergy among oncology professionals, positioning Slovenia for greater success in cancer control.

Key messages
• Slovenia’s NCCP prioritizes proactive communication, fostering collaboration among stakeholders. Annual events, newsletter, and partnerships strengthen awareness and drive comprehensive cancer control.
• Long-term communication strategy of Slovenia’s NCCP drives stakeholder engagement, and supports strategic objectives. This proactive approach strengthens comprehensive cancer control efforts.
Using artificial intelligence to support and streamline rapid systematic evidence reviews
Authors: Dobbins M , Traynor R , Clark E , Neil-Sztramko S 
Published: October 2024

Abstract

Issue
The Rapid Evidence Service, initiated by the National Collaborating Centre for Methods and Tools (NCCMT) during COVID-19, supports public health decision making by conducting rapid reviews on priority topics.

Description of issue
Integral to rapid reviews is an expedited timeline but the quantity of available literature for most public health review questions takes significant time to screen manually. NCCMT integrated 4 artificial intelligence (AI) features into the screening process. DAISY Rank applies predictions learned from manual screening patterns to re-order remaining studies, with most relevant appearing first. AI Screening automatically screens remaining studies based on prediction scores. Check for Screening Errors and Re-Rank Report use previous screening patterns to identify studies that were potentially falsely excluded and predict the total number of included studies, respectively. These features were tested by comparing results provided by AI with those produced manually for select test sets.

Results
NCCMT used AI to support and expedite screening, assess screening progress, and/or minimize risk of inappropriately excluding studies for 35 rapid reviews on 20 topics. Using DAISY Rank enabled one screener to review over 4000 references in 9 hours, compared to a different review, where the same amount of screening took 28 hours without DAISY Rank. AI Screening correctly excluded up to 80% of irrelevant search results across reviews. Check for Screening Errors identified 37 potential includes manually excluded in one review; these were reviewed and 3 were included. Re-Rank Report allowed NCCMT to re-allocate staff to subsequent steps in the review process when most included studies were identified.

Lessons
Integrating AI features into screening led to less time required, better anticipated timelines, more accurate staff allocation and reduced errors. More rigorous study of AI best practices is needed to continue to improve rapid review method efficiencies.

Key messages
• Rapid reviews can be an important source of evidence for decision makers if they can be completed quickly but maintain rigor and accuracy.
• AI holds promise as a way to improve screening efficiency.