bluuebunny/crossref_metadata_2025_split huggingface dataset:
HD grid versus circular mapping catheter for assessment of pulmonary vein (pv) reconnections
Authors: Manoharan K , Amin R A , Julia Calvo J J C , Mann I M , Mccready J M C , Silberbauer J S 
Published: October 2024

Abstract

Background
Traditionally, circular mapping catheters (CMC) have been considered superior to other designs for mapping pulmonary vein reconnections due to the circular shape of the PV ostium. The grid multipolar catheter produces higher definition maps potentially overcoming the disadvantage of being rectangular.

Purpose
We assessed the acute procedural results, comparing Grid versus CMC in the setting of PV re-isolation to understand if one was superior to the other.

Methods
In this multicentre randomised controlled trial, 169 patients (62% male; median age 66 years [22-83) underwent repeat ablation, between July 2021 and March 2023, for recurrent symptomatic atrial arrhythmias. We undertook two LA maps for patients, utilising the Grid and the CMC. Blinded maps were collected with both catheters, followed by randomisation to one map for analysis and ablation. The primary outcome was the radiofrequency time required to isolate the pulmonary veins. Secondary outcomes include LA mapping time and density for both catheters, ability to identify pulmonary vein sleeves and duration of the ablation procedure.

Results
126 patients had PV reconnections. 66 patients (64% male; median age 65 years [22-83]) in the Grid arm and 60 patients (68% male; median age 65.5 years [31-83]) in the CMC arm. There was one pericardial effusion and one TIA. There was no significant difference (p=0.202) found in the RF time required to achieve PV isolation in both Grid (mean RF time 200 ± 232 secs) vs CMC (mean RF time 169 ± 298 secs) arms. There was no significant difference (p=0.407) found between LA mapping time for the CMC (mean 1047 ± 454 seconds) and the Grid (Median 1080 ± 440 seconds). There was no significant difference (p=0.411) found in the total procedure time for the CMC (mean 122.7 minutes) and the HD grid (130 minutes). There were significantly more (p&lt;0.001) PV mapping points identified with the grid (mean 354±213 points) than the CMC (mean 234±154 points) arm. There was no significant difference in PV sleeve reconnections found (p=0.106) between the grid (120 PV sleeve reconnections with a mean 1.4±0.71 reconnections) and the CMC (98 PV sleeve reconnections with a mean 1.52±0.72 reconnections). Both maps were analysed to assess reconnections on opposing catheter arms. The grid identified 20 PV sleeve reconnections not visible on the CMC, whilst 9 were visible on the CMC and not the grid.

Conclusion
There was no significant difference found in RF time, mapping time and overall procedure time. The Grid identified more reconnections not seen with the CMC and had an overall improved mapping density suggesting that this configuration could be superior for LA mapping.
Cardioneuroablation for the treatment of carotid sinus syndrome
Authors: Minguito Carazo C , Martinez Alday J D , Rodriguez Manero M , Martinez Sande J L , Garcia Seara J , Gonzalez Ferrero T , Elices Teja J , Fernandez Lopez X A , Garcia Rodeja F , Gonzalez Juanatey J R 
Published: October 2024

Abstract

Introduction
Carotid sinus syndrome (CSS), characterized by exaggerated vagal responses leading to asystolic pauses with carotid sinus massage (CSM), often necessitates pacemaker implantation. This study investigates cardioneuroablation (CNA) as an alternative management strategy for CSS.

Methods
Prospective study of consecutive patients referred for CNA. All patients underwent CSM, atropine test, 24-hour Holter monitoring and SF-36 quality of life questionary before the procedure and at 6 months. The objective of the study was to assess syncope free survival, grade of cardioinhibition with CSM and heart rate variation (HRV) and quality of life after the procedure.

Results
A total of 13 patients (84.6% male, mean age 63.8 ± 12.3 years) were included. After a median follow-up of 11.2 (10.6-16.3) months, none of the patients experienced syncope (0%) and none of the patients required pacemaker implantation. After the procedure all the patients had a negative CSM and only one patient (7.7%) had a positive CSM at 6 months (Figure 1). There was an improvement in the energy and health change items in the SF-36 quality of life questionary (Figure 2). There was a reduction in HR increase in the atropine test at 6 months (pre-CNA: 66% (52-84) vs. post-CNA 27.4% (21.9-90.9); p=0.027) and in most of the 24-hour Holter monitoring HRV parameters.

Conclusions
Cardioneuroablation emerges as a promising and effective alternative to pacemaker implantation in managing cardioinhibitory CSS. Further research is warranted to solidify these findings and explore the long-term effects of CNA in this scenario.Figure 1Figure 2
Comparative study of the effects of preferential left ventricular and biventricular pacing on echocardiographic and cardiorespiratory indices and clinical status of heart failure patients: preliminary
Authors: Xydis P , Dilaveris P , Chrysohoou C , Kordalis A , Laina A , Sideris S , Kalantzis C , Tsiachris D , Vouliotis A , Tsioufis K 
Published: October 2024

Abstract

Introduction
Nonresponse to cardiac resynchronization therapy (CRT) has been related with right ventricular dysfunction. Preferential left ventricular pacing (pLV-P) can achieve left ventricle resynchronization allowing for intrinsic activation of the right side, and benefit cardiac output while reducing atrial fibrillation occurrence. Moreover, the AdaptivCRT® algorithm also automatically adjusts interventricular (V-V) delay every minute.

Methods
We evaluated the effects of a pLVP algorithm on 100 systolic heart failure patients ( all Caucasians, 49% male; 67 +/- 8 years old; 51% ischemic cardiomyopathy; 44% diabetics; NYHA II-III) following randomization to standard biventricular pacing and pLVP, on echocardiographic and cardiopulmonary exercise test indices of functional status. Device programming was based on echocardiography-evaluated maximization of stroke volume and subsequent interventricular and atrioventricular delay adjustments delegated to the device. The follow-up consisted of 6 and 12-months visits; after the 1rst month of optimizing maximum CRT response.

Results
Significant comparative effects of pLV-P over optimized CRT were noted regarding right ventricle systolic velocity in TDI at 12-months from baseline (mean (SE); 4.5(0.8), p=0.035); decrease in end-diastolic volume of left ventricle (mean (SE); 11.33(7), p=0.035); decrease in right ventricle strain mean ((SE); 9.2(2.1), p=0.03). According to other echocardiographic indices, again taking into account baseline levels, patients in pLV-P group exhibited lower E/e value at 6-months (mean (SE); 8.390(4,3), p=0.04), and at 12 -months (mean (SE); 7.45(3.9), p=0.035); improved values in left atrium contractility strain at 12-months (mean (SE); 8.390(0.8), p=0.04); a borderline improvement in left ventricular ejection fraction (mean (SE); 8.7(433), p=0.05) at 12-months; and borderline improvement in left ventricular longitudinal strain at 6-months (mean (SE); 4.9(2.6), p=0.035), compared to optimized CRT. In CPET, taking into account baseline levels, patients in the pLVP group showed higher METs at 12-months (mean (SE); 1,16(0.8), p=0.03) compared to opt CRT group; higher predicted Ventilation rate (%) even from 6-months (mean (SE); 8.167(5,7), p=0.03) and higher predicted peak VO2 (%) at 6 months (mean (SE); 34,13(14), p=0.03) and borderline significance at 12 months (mean (SE); 4.88(3), p=0.08), compared to opt CRT.

Conclusions
In the preliminary findings of READAPT study, it seems that pLVP optimized by a standardized echocardiographic protocol in patients with preserved AV conduction and LBBB, can achieve improvement in parameters of right ventricular and left atrium structure and function, as well as in survival-predictive parameters of CPET compared to optimized CRT during the 12-months of follow-up.
Clinical validation of the 2021 European Society of Cardiology guidelines on pre-existing right bundle branch block patients undergoing transcatheter aortic valve replacement
Authors: Salis M , Badertscher P , Papa A , Knecht S , Nestelberger T , Kaiser C , Leibundgut G , Schaer B , Krisai P , Kuehne M , Sticherling C 
Published: October 2024

Abstract

Introduction
The management of patients with right bundle branch block (RBBB) undergoing transcatheter aortic valve replacement (TAVR) remains challenging. In these patients, the 2021 ESC guidelines recommend early pacemaker (PM) implantation in case of PR prolongation, QRS axis change or transient high-degree atrioventricular block (HAVB). However, evidence for the proposed criteria is scarce.

Purpose
Our aim was to evaluate the ESC recommendation for risk stratification of RBBB patients undergoing TAVR.

Methods
We retrospectively analyzed patients with pre-existing RBBB undergoing TAVR at our institution between 2011-2023. A surface 12-lead electrocardiogram (ECG) was available before and after procedure in all patients. The following, proposed ESC criteria were validated: ΔPR interval ≥ 20ms, QRS axis change or transient HAVB &lt; 24 hours after TAVR.

Results
Of a total 1412 patients undergoing TAVR, 109 had pre-existing RBBB and were eligible for final analysis (mean age 83±5 years, 39% female). Of 109 RBBB patients, 36 (33%) developed persistent HAVB and received a permanent PM. Among the other 73 patients (67%), 17 patients (23%) suffered delayed HAVB during 30-days FU.
When applying the ESC Guidelines, PM placement would have been indicated in 52% (38/73) of patients with RBBB after TAVR: due to transient HAVB in 17 (23%), due to PR prolongation ≥ 20ms in 19 (26%) and due to QRS axis change in 20 patients (27%). The proposed ESC criteria identified 82% of patients (14/17) with delayed HAVB during 30-day FU, while missing 3 patients (18%, 2.8% of overall cohort, Figure).
This resulted in a sensitivity of 82% and a negative predictive value of 91%. Among the 17 patients with delayed HAVB, 12 patients (71%) displayed transient atrioventricular (AV) block within 24 hours after TAVR.

Conclusion
In this large cohort of RBBB patients undergoing TAVR with contemporary valves and techniques, the proposed ESC criteria of PR prolongation, QRS axis change or transient HAVB correctly identified 4/5 patients developing HAVB during 30-day FU. Prospective studies are warranted to confirm these findings.
Conduction system pacing and atrioventricular node ablation for atrial fibrillation - a systematic review and meta-analysis
Authors: Gin J , Ding Y C , Nalliah C , Farouque O , Lim H S , Kalman J , Wong G R 
Published: October 2024

Abstract

Background/Introduction
Biventricular pacing (BVP) has been shown to reduce the risk of heart failure following atrioventricular node ablation (AVNA) for the management of medically refractory atrial fibrillation (AF) when compared with conventional right ventricular pacing.[1] Conduction system pacing (CSP) is an emerging cardiac synchronization alternative to BVP[2], however, its evidence in AVNA for AF is limited.

Purpose
To evaluate the effect of CSP on left ventricular ejection fraction (LVEF), QRS duration (QRSd), pacing threshold and New York Heart Association (NYHA) class score following AVNA for AF.

Methods
We conducted a literature review of PUBMED, MEDLINE, EMBASE, Cochrane Library, and Web of Science for randomized clinical trials (RCTs) and observational studies evaluating CSP (His bundle pacing and left bundle branch pacing) post AVNA for AF. Out of 14 studies comprising 1112 patients, we conducted meta-analyses evaluating the impact of CSP on LVEF and QRS. Ten studies were pooled to assess outcomes pre- and post-implantation of CSP following AVNA. Three observational studies and one RCT were included in the meta-analysis comparing outcomes in CSP versus BVP post AVNA.

Results
CSP resulted in a significant QRSd reduction (-11.01 ms, 95% CI 5.07 - 16.95, p &lt;0.01), improved LVEF (+10.28%, 95% CI 7.03 - 13.52; p &lt;0.01) and improved NYHA score (-1.09; 95% CI -1.41 - -0.78; p &lt;0.01) during follow-up of 6-36 months (Figure 1) from baseline (peri-implantation). There was no significant pacing threshold rise (0.11V; 95% CI -0.14 - 0.36; p= 0.39) observed during the same period. CSP was associated with statistically significant shorter QRSd (-49.81ms; 95% CI, -70.57 - -29.06; p &lt;0.01) when compared to BVP. For LVEF, there was a statistically significant improvement of +8.96% (95% CI 2.55 - 15.37%; p &lt;0.01) with CSP versus BVP. Limited data prohibited comparison of threshold and NYHA outcomes between CSP and BVP.

Conclusion
Conduction system pacing appears effective in improving baseline LVEF, QRSd and NYHA score in AVNA for AF, and may be a viable alternative to further optimising LVEF and QRSd in comparison to BVP. Further studies are required to evaluate the long-term impact and clinical outcomes of CSP in post AVNA patients.
Impact of Pirfenidone on arrhythmic and clinical outcomes in patients with idiopathic pulmonary fibrosis
Authors: Im S I 
Published: October 2024

Abstract

Background
Atrial fibrosis is an important substrate in atrial fibrillation (AF), particularly in the setting of structural heart disease. Previous study reported that pirfenidone, an antifibrotic agent, was beneficial at reducing myocardial fibrosis. The objective of the present study is to evaluate the effects of pirfenidone on arrhythmic and clinical outcomes in patients with idiopathic pulmonary fibrosis (IPF).

Methods
Our database of patients diagnosed with IPF from 2008 to 2023 was used to obtain echocardiography, electrocardiogram (ECG), and 24hr-holter monitoring data. Inclusion criteria were all IPF patients with/without Pirfenidone. And we compared arrhythmic events including atrial fibrillation, atrial premature complex, atrial tachycardia, ventricular arrhythmia and clinical outcomes according to use of Pirfenidone.

Results
Among 257 patients with IPF (74.0±8.9 years), 106 (42.1%) patients took Pirfenidone. Difference in the baseline characteristics was not observed. During the median 36-month follow-up, a lower incidence of arrhythmic events (P=0.001) and diastolic dysfunction (P=0.025) was observed in the Pirfenidone group. In univariate analysis, hypertension, coronary artery disease, higher body weight, longer PR interval, QRS duration, and less use of Pirfenidone were associated with arrhythmic events. In multivariate analysis, higher body weight and less Pirfenidone use were independent risk factors for arrhythmic events.

Conclusions
The use of Pirfenidone was associated with less arrhythmic events and lower diastolic dysfunction compared with no use of Pirfenidone in the long-term follow-up. And obesity was associated with higher incidence of arrhythmic events in IPF patients.
Semaglutide and atrial fibrillation: a systematic review and meta-analysis of randomized clinical trials
Authors: Costa G , Resende B , Cunha G , Guimaraes J , Fernandes D , Monteiro E , Lopes V , Sousa P , Antonio N , Elvas L , Goncalves L , Teixeira R 
Published: October 2024

Abstract

Introduction
Semaglutide is a glucagon-like peptide-1 receptor agonist that has been highly recommended for glycemic controland weight reduction. Obesity can also increase the risk of developing atrial fibrillation (AF).

Aims
To assess the association of semaglutide with cardiac arrhythmias, primarily AF.

Methods
We performed a systematic searched Pubmed, Embase and Cochrane database, between November and December 2023, to identify semaglutide’s randomized controlled trials (RCTs) with or without diabetic patients that reported new-onset cardiac arrythmias. A Mantel-Haenszel method and a random-effects model was used to calculate the odds ratio (OR) and 95% confidence interval (CI).

Results
16 RCTs were included, 6 with oral semaglutide and 11 with subcutaneous semaglutide. A total of 19892 patients were included, providing 137 new-onset AF. Our meta-analysis revealed a lower incidence of new-onset AF in semaglutide patients (pooled odds ratio [OR], 0.54; 95% confidence interval [CI] 0.39, 0.77, P &lt; 0.01; I2 = 0%). Sub-analysis of oral and subcutaneous showed similar significant reduction (pooled OR 0.44; 95% CI [0.22, 0.87], P = 0.02, I2 = 0% and pooled OR 0.59; 95% CI [0.39, 0.88], P &lt; 0.01, I2 = 0%, respectively). Significant reduction was also observed, regardless diabetic status. However, semaglutide revealed similar atrial flutter incidence (pooled OR 0.78; 95% CI [0.30, 2.05], P = 0.62, I2 = 0%), ventricular arrhythmias (pooled OR 1.68; 95% CI [0.77, 3.6], P = 0.19, I2 = 0%) and sudden cardiac death (pooled OR 1.68; 95% CI [0.77, 3.66], P = 0.19, I2 = 0%).

Conclusion
Our study suggests that in patients with or without diabetes, semaglutide reduces the risk of new-onset atrial fibrillation. This analysis provides an additionalcardiovascular benefit of this drug besides the major adverse cardiovascular events.
Integrating single-cell sequencing and genetic lineage tracing reveals endothelial plasticity during atrial remodeling
Authors: Zeng Z , Liu H , Wang X , Zheng Z 
Published: October 2024

Abstract

Background
Atrial fibrillation (AF), as the most burdensome cardiac arrhythmia, could lead to the significant mortality and morbidity. Atrial fibrosis is a well-recognized pathophysiological factor of the development and progression of AF, which also hampers its treatment. However, the underlying mechanisms of this intricate process remain largely unknown.

Purpose
This study sought to reveal the cellular composition of AF substrate and investigate the vital contributors to atrial structural remodeling.

Methods
Left atrial appendages from three patients with AF undergoing surgical ablation and three individuals with sinus rhythm undergoing heart transplantation were subjected to 10X single-cell RNA sequencing (scRNA-seq). Another five public scRNA-seq or snRNA-seq datasets of potentially remodeled right or left appendages were retrieved across three publications. The vital contributors of atrial structural remodeling and their characteristics were identified by intercellular communication analysis and trajectory inference. Transverse aortic constriction (TAC) was used to induce atrial remodeling in Cdh5-CreERT2;RFP mice, followed by scRNA-seq of endothelial cells (ECs). Human primary atrial ECs and fibroblasts were isolated for cell-cell interaction experiments. ECs-specific mouse models of Transforming growth factor beta 1 (TGFB1) (knockout and overexpression) were generated. Electrophysiological and histology analyses were performed to determine the consequences of ECs-derived TGFB1 gain and loss of function in the atrium.

Results
The comprehensive analysis of different scRNA-seq datasets revealed that ECs played an important regulatory role in the homeostasis of atrial substrate and displayed remarkable mesenchymal activation during atrial remodeling, which was further confirmed by TAC mice. Immunofluorescence staining and high-content screening suggested that the complete transition from ECs to mesenchymal cells slightly contributed to atrial remodeling. However, TGFB1 secreted from mesenchymal activated ECs significantly promoted activation, proliferation, and collagen secretion of fibroblasts. We discovered that overexpression of TGFB1 in ECs of mice significantly increased atrial fibrosis, and thus prolonging AF duration. Besides, knockout of TGFB1 in ECs of mice underwent TAC significantly attenuated the atrial fibrosis and decreased the rate of AF.

Conclusion
Our work demonstrates that mesenchymal ECs-derived Tgfb1 plays an important role in atrial remodeling by regulating the fibroblast function. EC-specific interventions were suggested to facilitate the development of novel strategies for mitigating AF substrate remodeling.
Mechanisms of atrial-fibrillation-induced ventricular dysfunction and recovery in the human left ventricular myocardium
Authors: Stengel L , Riedl D , Koertl T , Tirilomis P , Schramm R , Gummert J , Maier L , Streckfuss-Boemecke K , Pabel S , Sossalla S 
Published: October 2024

Abstract

Background
Atrial fibrillation (AF) frequently occurs alongside heart failure (HF). Clinical studies indicate improved left ventricular (LV) function following rhythm restoration but the underlying myocardial processes remain unclear.

Purpose
This study investigated effects of AF and its termination on human LV myocardium as well as potential molecular mechanisms involved in the AF-induced LV dysfunction.

Methods
Human LV tissue slices obtained from HF patients were long-term cultivated in-vitro. AF was simulated by tachy-arrhythmic culture pacing at 100 bpm with 30% irregularity for 7 days and contractile LV function was compared to slices undergoing sinus rhythm (SR)-simulation (60 bpm/0%). After 7 days, rhythm restoration was simulated by switching to SR-simulation.
To elucidate cellular mechanisms involved in AF-induced LV dysfunction, human induced pluripotent stem cell-derived cardiomyocytes (iPSC-CM) were subjected to AF-simulation and examined via epifluorescence microscopy (FURA-2) and confocal microscopy (Fluo-4). Additionally, to investigate the impact of reactive oxygen species (ROS) on cardiomyocytes, iPSC-CM were subjected to treatment with the ROS-scavenger N-acetylcysteine (NAC).

Results
AF-simulation caused a progressive decline in systolic force of human LV myocardium (n=14 slices) with significantly reduced twitch amplitudes compared to SR-simulation (n=11). Within just 5 days of AF-termination, a significant recovery in LV function was observed, indicated by improved systolic contraction amplitudes. IPSC-CM measurements revealed a significant reduction in systolic Ca2+-transient amplitudes as well as an increased diastolic Ca2+ leak after AF-simulation (n=41) compared to SR-simulation (n=44). However, 5 days after SR-restoration, iPSC-CM exhibited no significant differences anymore, indicating a fast recovery of systolic Ca2+-cycling.
We further investigated the impact of ROS on LV function and could show that Ca2+-transient amplitude was preserved after AF-simulation in iPSC-CM when treated with NAC (n=35), suggesting an interplay of ROS with the Ca2+-homeostasis of cardiomyocytes.

Conclusions
This study demonstrates that AF impairs LV function in human HF myocardium. However, the involved changes in contractility and cardiomyocyte Ca2+ handling are reversible upon AF termination leading to improved LV function already within few days after AF cessation. Moreover, we provided an indication for an interplay of ROS with the Ca2+ homeostasis, endorsing an AF-induced LV-dysfunction, which merits further investigation.