bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of escape mapping for roof line completion during BOX isolation for atrial fibrillation
Authors: Kaitani K , Kyo S , Oi M , Suenaga A , Onishi N 
Published: October 2024

Abstract

Background and Aim
The creation of complete roof line (RL) is often challenging due to the presence of epicardial myocardial bundle or fat interposition. The disconnecting the septopulmonary bundle from the Buchmann bundle arrays requires for RL completion. Therefore, the conduction time to the left atrial appendage (LAA) and the high right atrium (HRA) potentials under left superior pulmonary vein pacing (LSPVp), so-called •escape mapping•, should be significantly prolonged after the creation of the transmural RL. This study investigates whether the changes conduction times from LSPVp to LAA and HRA (∆LSPVp-LAA and ∆LSPVp-HRA) between before and after the creation of the line as the assessment of bi-directional RL block.

Methods
76 de-novo non-paroxysmal atrial fibrillation (nPAF) patients underwent BOXI strategy ablation. We initially intended single ring protocol BOXI for all patients. The activation times were measured at LAA and HRA under LSPV pacing at baseline and after application for the RL. Then we compared the change of activation time at LAA (∆LSPVp-LAA) and at HRA (∆LSPVp-HRA) between 2 groups; the group that completed BOXI with the first-pass roof line (fp-RL group) and the other group (Nfp-RL group).

Results
In 47 patients, the first-pass roof line was successfully obtained and in patients was done with additional application for gap(s) on the roof line to complete BOXI. There was a stepwise increase in mean ∆LSPVp-HRA not ∆LSPVp-LAA. Increased LA diameter, lower LVEF, and thinner LA wall were associated with the first-pass roof line. ∆LSPVp-HRA ≥33ms predict roof line block with high specificity and sensitivity.

Conclusions
Our findings suggest that the changes conduction times between LSPV and HRA during LSPV pacing help in the assessment of RL block.
Severity of anemia is correlated with the prevalence of left atrial low-voltage areas in patients with atrial fibrillation ablation
Authors: Matsuda Y , Masuda M , Uematsu H , Sugino A , Ooka H , Kudo S , Fujii S , Asai M , Okamoto S , Ishihara T , Nanto K , Tsujimura T , Hata Y , Higashino N , Mano T 
Published: October 2024

Abstract

Background
Although left atrial low-voltage areas (LVAs) are well-known indicator of atrial fibrosis and atrial fibrillation (AF) recurrence after catheter ablation, the association between anemia and prevalence of LVAs has not been clarified. We hypothesized that LVAs were more frequently found in patients with anemia than in those with normal hemoglobin levels.

Purpose
The purpose of this study was to investigate the association between hemoglobin levels and the prevalence of LVAs in patients with AF ablation.

Methods
In total, 1,473 (age, 68±10 years; female, 492 [33%]; persistent AF, 895 [61%]; CHA2DS2-VASc score, 2.5±1.5 points) consecutive patients who underwent initial AF ablation were enrolled in this study. Hemoglobin levels were measured before the ablation procedure, and anemia was defined as hemoglobin levels &lt; 13.5 g/dL in male and &lt; 12.0 g/dL in female. LVAs was defined as areas with bipolar voltage of &lt;0.5 mV covered ≥5 cm² of left atrial surface area.

Results
Of 1,473 patients, LVAs existed in 348 (24%) patients. Hemoglobin levels was significantly lower in patients with LVAs than those without (13.4 ± 1.7 vs. 14.2 ± 1.5 g/dL, p &lt;0.001). On classification by gender, only in male, hemoglobin levels were significantly lower in patients with LVAs than those without (Figure 1). The prevalence of LVAs increased with decreasing hemoglobin levels (Figure 2). On multivariate analysis including gender as a variable, anemia was an independent predictor of LVAs (odds ratio, 1.6; 95% confidence interval: 1.1–2.3; p=0.03).

Conclusions
The prevalence of LVAs increased with decreasing hemoglobin levels in patients with AF ablation. In particular, hemoglobin levels &lt; 13.5 g/dL in male and &lt; 12.0 g/dL in female was an independent predictor of LVA presence.Hemoglobin levels and LVAs presenceHemoglobin and the prevalence of LVAs
Fewer redo procedures in catheter ablation of atrial fibrillation: data from the swedish national catheter ablation registry
Authors: Mannewald C , Platonov P G , Fengsrud E , Hoglund N , Karlsson L , Lonnerholm S , Ringborn M , Sigurjonsdottir R , Tabrizi F , Tapanainen J , Braunschweig F , Holmqvist F 
Published: October 2024

Abstract

Background
The number of patients undergoing catheter ablation of atrial fibrillation (AF) is continuously growing, and techniques are improving. However, AF recurrences are still common and demand frequent redo procedures that expose patients to repeat complication risks and cause extensive health care costs. Real-life data regarding redo rates is scarce. Using a national registry, we examined current trends in long-term outcomes as illustrated by the need for redo procedures.

Purpose
The purpose of this study was to investigate the long-term outcome of catheter ablation of AF as a function of when the initial procedure was performed.

Methods
The Swedish Catheter Ablation Registry covers virtually all (&gt;97%) catheter ablations performed in Sweden since 2005. Patients &gt;18 years of age undergoing pulmonary vein isolation (PVI) during January 1st 2006 until December 31st 2020 were included in the analysis. Follow up data was registered until December 31st 2021. The number of procedures performed, characteristics of patients, acute success (defined as all pulmonary veins isolated), and repeat ablation at 1 and 3 years were analyzed. Characteristics and periprocedural data were compared between 2006, 2015 and 2020 to find possible trends.

Results
A total of 23909 PVI were performed during the studied period. In 2006, 2015 and 2020, respectively, 352, 1861 and 2609 procedures were performed, constituting 18%, 40% and 48% of all ablation procedures. There was an increase in patient age (58, 62, 64 years) and more women were ablated (22%, 27%, 28%) over time. Acute success rate remained high at 98% during the study period. Repeat ablation at 1 and 3 years was 23% and 45% respectively for patients ablated in 2006, compared to 14% and 30% in 2015, and 10% and 23% in 2018 (p &lt;0.001 for both trends), see figure 1.

Conclusion
In a setting of a universal healthcare system, with a continuous increase in amount of catheter ablation of AF, in spite of an unchanged, high acute success throughout the study period, a continuous decrease of repeat ablation was observed indicating a substantial gain in patient value by AF ablation over time.Repeat ablation atrial fibrillation
Novel predictor of thrombosis after left atrial appendage closure -Neutrophil to Lymphocyte Ratio (NLR), platelet to LymPhocyte Ratio (PLR), and Lymphocyte to Monocyte Ratio (LMR)-
Authors: Ryuzaki S , Kondo Y , Nakano M , Nakano M , Kajiyama T , Ito R , Yoshino Y , Komai Y , Takanashi Y , Kobayashi Y 
Published: October 2024

Abstract

Background
Cardiogenic embolism by left atrial thrombi is one of the most important atrial fibrillation (AF)-related clinical problems. In a previous survey, 91% of nonrheumatic AF-related left atrial thrombi was originated in the left atrial appendage (LAA). The WATCHMAN device was developed as a permanent implantable device to seal off the LAA to prevent cardiogenic embolism. It has been used in Japan since September 2019. The WATCHMAN family is the only left atrial appendage closure (LAAC) device in Japan. After percutaneous left atrial appendage closure (LAAC), DRT is an important issue in some cases. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR) are known as cancer prognostic factors and indicators of immune status. There are few reports on the predictor for device related thrombosis (DRT), transient ischemic attack (TIA), and ischemic stroke. Finding novel biomarkers could help clinical decision in antithrombotic therapy post LAAC and follow-up intervals.

Purpose
To investigate the association of NLR, PLR, and LMR with device related thrombosis, transient ischemic attack, and ischemic stroke in patients with LAAC.

Methods
Our database of LAAC was respectively analyzed. All LAAC cases were performed between January 2020 and September 2023. Blood cell counts were sampled in three days before LAAC. Postoperative antithrombotic therapy was individualized based on the patient’s background. We examined their background and clinical events.

Results
A total of 116 consecutive patients underwent LAAC in our institution excepting for one case that could not be performed due to a huge LAA (follow-up period, 610±37 days; age, 75±1 years; male sex, 73%; left ventricular ejection fraction, 58±1%; CHAD2S2-VASc, 4.6±0.1; HAS-BLED, 3.4±0.1). The results are shown in the Figure. Receiver-operating characteristic curve analysis confirmed the best cut-off value of NLR, PLR, and LMR for composite of DRT, TIA, and ischemic stroke (AUC = 0.69; 0.70; 0.67). In the univariate analysis, NLR&lt;1.88, PLR&lt;144, and LMR&gt;3.40 are the independent predictor for the combination of DRT, TIA, and ischemic stroke (p-value = 0.02; 0.04; 0.05, respectively).

Conclusion
Low NLR, low PLR, and high LMR are the independent predictor for the combination of DRT, TIA, and ischemic stroke. These parameters can be useful in routine use because they can be easily calculated without additional costs.
Long-term changes in frailty and incident atrial fibrillation: multicenter prospective cohort study
Authors: Wang N , Cai L , Sun Y , Zhu J , Wang B , Tan X , Shi W , Xu D , Lu Y 
Published: October 2024

Abstract

Background
Atrial fibrillation is the most common sustained cardiac arrhythmia and is prevalent among the elderly. Previous findings indicated a higher prevalence of AF in frail adults and frailty prevalent in AF patients. However, the association between dynamic changes of frailty and risk of new-onset AF is unclear.

Purpose
We aimed to investigate the associations of long-term changes in frailty with incident AF. Its associations with heart failure (HF), coronary heart disease (CHD), and stroke were also evaluated as a secondary aim.

Methods
Over 50,000 participants from UK Biobank cohort were included, with available frailty index (FI) data and free of AF, HF, CHD or stroke in both baseline and final follow-up assessments. Participants were categorized into nonfrailty, prefrailty and frailty based on their FI scores. Changes of frailty status from baseline to final follow-up assessment included alleviation, maintenance, and aggravation. Thus, transitions of frailty status included 7 categories: nonfrailty maintenance, nonfrailty aggravation (nonfrailty to prefrailty or frailty), prefrailty alleviation (prefrailty to nonfrailty), prefrailty maintenance, prefrailty aggravation (prefrailty to frailty), frailty alleviation (frailty to prefrailty or nonfrailty), and frailty maintenance. FI in baseline and follow-ups are used to calculate the trajectories of frailty (ΔFI). Cox proportional hazard models were used.

Results
Compared with nonfrailty at baseline, the HRs (95% CI) of AF for prefrailty and frailty were 1.32 (1.29, 1.36) and 1.89 (1.83, 1.96) in the multivariable-adjusted model. During a median of 5.1 years of follow-up from the final assessment, 1729 cases of AF were recorded. Frailty trajectory analysis showed that even a 0.01 point/year increase in ΔFI was associated with 14% (95% CI 1.08-1.20) higher risk of AF, independent of baseline FI and the risk rose to 1.89 (1.45, 2.46) with per 0.05 point/year increase in ΔFI. This association was strengthened in low genetic risk of AF, but sex, age, smoking status, alcohol intake, obesity, hypertension, diabetes and cancer did not materially modify the associations. Moreover, compared with nonfrailty maintenance, sustained frailty had the highest risk of AF (HR 1.95, 1.61-2.36). Alleviation from frailty reduced the risk of AF by 30% (95%CI 0.53-0.94), compared to sustained frailty. These associations were similar in HF and CHD, however, not significant in stroke.

Conclusions
Middle aged and elderly people, including those with diabetes, obesity and hypertension, may gain substantial benefits in risk of AF, HF and CHD by becoming less frail or maintaining nonfrailty, irrespective of past frailty status and established risk factors, delivering public health implications for the necessity of early identification and timely interventions of frailty in heart health management.
Associations between heart rate, deformational echocardiographic parameters and clinical outcomes in patients with atrial fibrillation
Authors: Chao T , Liao J N , Hung C L , Lip G Y H 
Published: October 2024

Abstract

Background
The relationship between baseline heart rates and cardiac function in patients with atrial fibrillation (AF) remains unknown, as does its impact on long-term outcomes.

Methods
Patients with newly diagnosed AF and available echocardiography images were included. Conventional echocardiography measurement and myocardial deformation analyses using two-dimensional speckle-tracking echocardiography were performed during AF. Clinical endpoints included first-time hospitalization for ischemic stroke, heart failure (HF), all-cause mortality, and composite endpoint.

Results
Patients were categorized into groups according to baseline heart rates: 40-59, 60-69, 70-79, 80-89, 90-99, 100-109, 110-119, and ≥120 beats per minutes (bpm). As heart rates increased, there was a stepwise decrease of peak atrial longitudinal systolic strain (PALS: 14.6 ± 5.3%, 14.7 ± 5.5%, 14.1 ± 4.6%, 13.4 ± 4.7%,12.6 ± 4.9%, 12.1 ± 4.5%, 11.2 ± 5.2% and 10.8±4.1% in 40-59, 60-69, 70-79, 80-89, 90-99, 100-109, 110-119, and ≥120 bpm groups, respectively; P &lt; 0.001)) and LV strain (-13.8 ± 3.9%, -14.5 ± 4.0%, -13.4 ± 3.4%, -13.4 ± 3.6%, -12.5 ± 3.6%, -11.9 ± 3.8%, -10.3 ± 3.8%, and -10.2 ± 3.8%, in 40-59, 60-69, 70-79, 80-89, 90-99, 100-109, 110-119, and ≥120 bpm groups, respectively; P &lt; 0.001)(Figure). The lowest risk of composite endpoint was observed for patients whose heart rate between 60 to 69 bpm (Figure). Compared to the 60-69 heart rate group, faster heart rates were associated with increased risk of ischemic stroke (adjusted hazard ratios [aHR] 4.448 in the ≥120 bpm group), HF (aHR 1.909 in the ≥120 bpm group), mortality (aHRs 2.487, 2.810, 4.569, 4.760 in the 90-99, 100-109, 110-119, and ≥120 bpm groups, respectively), and composite endpoint (aHRs 2.034, 2.349, 3.492 in the 100-109, 110-119, and ≥120 bpm groups, respectively) (all P &lt; 0.05).

Conclusion
In patients with AF, heart rate is closely linked to cardiac function and plays a pivotal role in long-term prognosis. Faster heart rates were associated with worse LA/LV functions and increased risk of clinical events. Favorable outcomes were found at heart rates below 100 bpm, with even better LA/LV function noted at heart rates below 80 bpm.
Prevalence of cardiovascular comorbidities among hospitalized patients with hypertrophic cardiomyopathy and factors associated with a higher case-fatality rate
Authors: Shoar S , Shoar N , Mujahid Z , Cascoperez A , Esparham A , Azargoon S , Asadi S 
Published: October 2024

Abstract

Background
Hypertrophic cardiomyopathy (HCM) is proven to be a catalyst for sudden cardiac death among affected population. However, the prevalence of cardiovascular comorbidities (CVC) and their association with in-hospital mortality has not been established among hospitalized patients with HCM.

Methods
National Inpatient Sample (NIS) database was queried from 2016 to 2020 to identify hospitalized patients with a diagnosis of HCM. The prevalence of CVC and case-fatality rate was determined for this patient population using univariate analysis and multivariate logistic regression.

Results
Weighted data was analyzed for a total of 278,995 admission cases with HCM. Crude in-hospital mortality rate increased from 16.4% to 22.9% during the study period. Atrial fibrillation (42.1%), HFpEF (28.1%), and cardiorenal syndrome (16.6%) were the most common CVC among hospitalized patients with HCM. The case-fatality rate was the highest among HCM patients hospitalized due to cardiac arrest (41%) followed by cardiac tamponade (13.7%) and STEMI (10.2%). Increasing age (aOR: 1.02, 95%CI: 1.02-1.03, p&lt;0.0001), Asian/Pacific Islander race (aOR: 1.7, 95%CI: 1.1-2.4-, p=0.007), cerebrovascular accident (aOR: 2.3, 95%CI: 1.7-3.01, p&lt;0.0001), NSTEMI (aOR: 1.8, 95%CI: 1.3-2.4, p&lt;0.0001), peripheral vascular diseases (aOR: 1.3, 95%CI: 1.03-1.6, p=0.03), cardiorenal syndrome (aOR: 1.4, 95%CI: 1.2-1.8, p&lt;0.0001), and cardiac arrest (aOR: 26.6, 95%CI: 20.9-33.9, p&lt;0.0001). Among HCM patients with acute myocardial infarction requiring revascularization procedures, in-hospital mortality rate was significantly lower among those undergoing PCI than CABG (8.5% vs. 37.5%, p=0.008 for STEMI and 1.8% vs. 4.9%, p=0.04 for NSTEMI).

Conclusions
Mortality rate among hospitalized patients with HCM has been slightly on the rise over the last half century. Although aging population might be a contributing factor, comorbid end-organ damages including CVA, NSTEMI, and cardiorenal syndrome have demonstrated substantial association with in-hospital mortality in addition to cardiac arrest. For HCM patients requiring revascularization procedures, PCI seems to be associated with a lower mortality rate than its competitor CABG.
Survivability of young sudden cardiac arrest by aetiology: insights from a state-wide adjudicated cardiac arrest registry
Authors: Fahy L , Rowe S , Nehme Z , Stub D , Pflaumer A , Connell V , Semsarian C , Ingles J , La Gerche A , Paratz E 
Published: October 2024

Abstract

Background
Identifying factors to improve survival following out-of-hospital cardiac arrest (OHCA) is important. Many OHCA registries do not document the underlying cause of OHCA and therefore cannot provide insights according to specific arrest aetiology. The aim of this study was to assess survivability of OHCA according to arrest aetiology.

Methods
A state-wide registry identified all patients aged 1 to 50 years who experienced OHCA in Victoria, Australia from April 2019 to April 2023. OHCA was ambulance-defined with cause of OHCA determined by adjudication against autopsy or hospital data. OHCA aetiology was classified into four categories; non-cardiac, coronary, cardiomyopathy or other cardiac (including unascertained cause).

Results
2686 patients experienced OHCA (non-cardiac=1305, 48.6%, coronary=585, 21.8%, cardiomyopathy=250, 9.3%, other cardiac=537(282 unascertained), 20.0%), of whom 250 (9.3%) survived. Patients in the coronary group were older (median 45 years [interquartile range 40-48 years], p=0.0001), more likely to be male (83.6%, p&lt;0.0001), have a witnessed arrest (44.6%, p&lt;0.0001) and have an initial shockable rhythm (48.2%, p&lt;0.0001) when compared to other categories. Using the non-cardiac group as the reference group, adjusted odds ratio of survival (95% CI) were 1.65 (0.86-3.19) for cardiomyopathy, 2.51 (1.55-4.07) for other cardiac and 4.03 (2.51-6.49) for coronary causes of OHCA.

Conclusion
Odds of survival to hospital discharge following OHCA were four times higher in OHCA of coronary aetiology when compared with non-cardiac OHCA. Ongoing research into OHCA according to aetiology is needed to define subgroups, benchmark resuscitation performance more appropriately and identify patterns according to specific aetiologies to improve survival outcomes.
Safety and efficacy of ultra-long intermediate-power ablation for outflow tract ventricular arrhythmia arising from the left ventricular summit
Authors: Futela P , Dai Q , Gupta A R , Ezzedine F M , Deshmukh A J , Garg L , Siontis K , Kowlgi G N 
Published: October 2024

Abstract

Background
Radiofrequency ablation (RFA) has been effective in managing premature ventricular contractions (PVCs). Despite improvement in ablation techniques, recurrence remains high for LV summit PVCs. Epicardial ablation here is often precluded due to fat and proximity to coronaries, thus, aggressive but safe endocardial options are needed.

Purpose
To evaluate the safety and effectiveness of ultra-long ablation (&gt;240 seconds) duration for refractory LV summit PVCs.

Methods
Patients with deep intramural LV summit PVCs were identified by lack of PVC elimination or late (&gt;60 s suppression) and recurrence post-lesion under the left aortic sinus of Valsalva. We included patients who received the longest RFA of at least 240 seconds (maximum 15 minutes). RFA power was titrated slowly from 20 to 35W, carefully ensuring that the impedance drop did not exceed 12 ohms. Acute procedure success was defined as clinical PVC suppression for ≥60 minutes after the last lesion. Short-term success was defined as symptom improvement, ejection fraction (EF) recovery, and drop in PVC burden at 3 months.

Results
Twenty patients (59.5 ± 16.4 years, 55% male) were included. Baseline features are shown in Table 1. All RFA were delivered endocardially. No steam pops were noted. PVC burden was significantly lower at 3-month follow-up (P&lt; 0.01), Figure 1A. Most patients had a normal ejection fraction (EF) at baseline; thus, no significant difference change in EF was observed (Figure 1B). One complication was recorded, which was tamponade likely caused by coronary sinus dissection requiring pericardiocentesis. Acute success was achieved in 95.0% of the cases, and all cases followed at 3 months (18/18) achieved short-term success.

Conclusion
Ultra-long duration RFA with lesions ≥ 240 seconds at 35W per lesion for LV summit PVCs appeared to be safe and effective in achieving acute and short-term success. The lack of acute suppression should not discourage operators, as there seems to be delayed suppression in some cases. Careful monitoring of biophysics is paramount when attempting this technique.