bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical treatment for obstructive sleep apnea prevents arrhythmic events: a nationwide population-based study
Authors: Jung L , Kim S H , Kim D H 
Published: May 2024

Abstract

Background/Introduction
Obstructive sleep apnoea (OSA) is a well-established risk factor for the development and exacerbation of cardiac arrhythmias. Continuous positive airway pressure therapy is recommended as the primary non-invasive treatment for OSA. However, suboptimal patient compliance remains a common challenge.

Purpose
This study explores the benefits of surgery in reducing the occurrence of arrhythmias associated with OSA. The study aims to investigate the impact of surgery in managing OSA-associated arrhythmias.

Methods
Data from the Korean Health Insurance, from January 2009 to December 2020, were retrospectively compiled and analysed to investigate the clinical outcomes of 359,851 individuals with OSA. Propensity score matching (PSM) at a 1:4 ratio was employed to compare patients who underwent surgery with those who did not. A final cohort of 117,665 participants (85.4% men, aged 60 years old or younger: 94.2%) was established, with 23,533 having undergone surgery for OSA and 94,132 receiving non-surgical management. Over a five-year follow-up period, the occurrence rates of atrial fibrillation (AF), premature beats (premature atrial contractions or premature ventricular contractions), ventricular arrhythmias, sudden cardiac arrest, atrioventricular block, and sinus node dysfunction were evaluated.

Results
Across the six types of arrhythmias, the cohort that underwent surgery for OSA consistently exhibited a lower incidence of arrhythmias than the non-surgical cohort. In the PSM analysis, a statistically significant reduction in the incidence of AF, premature beats, and sudden cardiac arrest was observed in groups of patients who underwent surgery for OSA. Among those who developed AF, the group that underwent surgery for OSA had a fivefold higher incidence than the non-surgical group (hazard ratio [HR] 5.384, 95% confidence interval [CI] 3.459-8.381). The incidence of premature beats was more than four times higher in the non-surgical group (HR 4.284, 95% CI 2.96-6.177, p&lt;0.0001), and sudden arrest was more than 24x higher in the non-surgical group (HR 24.089, 95% CI 3.348-173.312).

Conclusion
This study suggests a potential causative relationship between OSA and arrhythmias. Additionally, surgical intervention for OSA may be considered an effective strategy for preventing arrhythmias in young patients. Further clinical research is warranted to validate and refine these observations.Figure 1Figure 2
Impact of environment and ethnicity on prognosis in AF patients: does the 'where' matter more than the 'who'?
Authors: Bisson A , Romiti G F , Fawzy A M , Calvert P , Proietti M , Fauchier L , Lip G Y H 
Published: May 2024

Abstract

Background
Atrial fibrillation (AF) is increasing worldwide and disparities are known between different geographically defined populations. However, populations are more and more multi-racial/multiethnic and less is known about the impact of geographical locations on various racial/ethnic populations.

Purpose
To study the influence of geographical location and race/ethnicity on the characteristics and the prognosis in AF patients.

Methods
From phase II/III of the GLORIA-AF registry, Asian and Caucasian patients from Western and Asian countries were included. The associations between geographical locations, race/ethnicity and a composite outcome composed of all-cause death, stroke and major bleeding were evaluated using Cox regression analyses.

Results
The study included 21,450 AF Caucasian and Asian patients from Western and Asian countries (mean±SD age 70.2±10; 44.3% female) with a median [IQR] follow-up of 3 years [2.3-3.1]. Among Caucasian patients, those living in Western countries (97.3%) were older, had less hypertension, congestive heart failure and coronary artery disease but more often lifestyle disorders (smoking, alcohol drinking) than those living in Asia (2.7%). Among Asian patients, those living in Western countries (2.6%) had more hypertension, diabetes mellitus, metabolic syndrome, coronary artery disease but less alcohol abuse than those living in Asia (2.6%). Regarding the composite outcome, Caucasian patients living in Asia had less adverse events than Asian patients living in Asia and Caucasian patients living in Western countries (adjusted hazard ratio on age, sex and CHA2DS2-VASc score (aHR): 0.53 (95% confidence interval (CI): 0.34-0.83), p=0.005) and aHR: 0.54 (95% CI: 0.35-0.83, p=0.005) respectively). Asian patients living in Asia had a better prognosis than Asian patients living in Western countries (aHR: 0.55 (95% CI: 0.35-0.85), p=0.007) and Caucasian patients living in Western countries when compared to Asian patients living in Western countries (aHR: 0.61 (95% CI: 0.40-0.94), p=0.025).

Conclusion
Geographical location has an impact on characteristics and prognosis of AF patients regardless of race/ethnicity. However, the gap in prognosis between Caucasian and Asian patients remains unchanged.Table 1.Baseline characteristics.Figure 1.Kaplan-Meier curves.
Exploring smartphone ownership, patient behaviour, and potential bias in wearables research for atrial fibrillation
Authors: Ahluwalia N , Butcher C , Saengkrajang G , Yu Y , Schilling R J 
Published: May 2024

Abstract

Background
Wearable sensors enable patient-led atrial fibrillation (AF) monitoring after catheter ablation (CA). Investigating smartphone ownership and patient behavior may provide insights into wearables research applicability. Understanding engagement and preferences could inform study design and care pathways.

Objective
To explore smartphone ownership, socio-economic factors, and behavior among individuals screened for the AFFU-AW study; a randomized controlled trial evaluating Apple Watch (AW)-based follow-up after AF CA. The impact of AW provision on patient behavior was also assessed.

Methods
Patients with AW-compatible iPhone-Operating System (iOS) devices were invited to participate (case arm), while non-enrolled patients served as controls. Demographics, race, and socio-economic status were surveyed at screening. Engagement and perceived impact were assessed in the case arm.

Results
Of 197 patients screened, 90 (46%) were ineligible due to smartphone incompatibility, 9 (5%) had no household smartphone. Controls were older (62.4±9.2 vs 57.4±9.8, p&lt;0.01) but exhibited no significant gender or ethnicity differences. (table 1) Among AW users, 7 (17%) required additional assistance for device setup, and all subsequently recorded ECGs independently. 23 (57.5%) participants recorded daily ECGs. 30 (73.2%) reported reduced likelihood of seeking medical attention for AF. However, 2 (4%) reported increased likelihood. Participants in the control arm used blood pressure monitors for AF self-monitoring (33.3%). (fig 1).

Conclusion
Smartphone ownership is prevalent among AF CA patients. Cross-platform compatibility for wearable interventions is important to address potential biases. A majority of patients felt AW monitoring reduced medical attendances, highlighting the potential for wearables to enhance patient-led care. However, a small proportion reported increased health anxiety, indicating a need for tailored support and education.Figure 1:AF monitoring strategyTable 1:Baseline Characteristics
Spontaneous atrial fibrillation occurrence following transesophageal atrial burst pacing in rats
Authors: Scridon A , Balan A I , Halatiu V B , Cozac D A , Mutu C C , Comsulea E , Aspru I , Miklosi M , Pacurar D , Perian M 
Published: May 2024

Abstract

Purpose
Animal models play a crucial role in elucidating the complex pathophysiology of atrial fibrillation (AF) and in identifying and testing novel antiarrhythmic strategies. We aimed to develop and characterize a new experimental rat model of AF, induced by long-term transesophageal atrial electrical stimulation, and to investigate whether the "AF begets AF" concept applies to small rodent hearts.

Method
Twelve adult male Wistar rats were randomized into two groups: Sham (n = 5) and AF (n = 7). All rats were implanted at the beginning of the study with ECG radiotelemetry devices and underwent continuous ECG monitoring throughout the study. To induce AF, the rats in the AF group underwent atrial pacing for 10 consecutive days (15 successive cycles of stimulation/day, 20 s each, with a free interval of 5 min between cycles; 4,000 stimuli/min, stimulus duration 6 ms, voltage 3 V above the diastolic threshold). A similar procedure was applied to the Sham group, but without performing the actual electrical stimulation. The number and duration of spontaneous AF episodes were evaluated based on continuous ECG monitoring prior to, during, and for one week after transesophageal atrial pacing. The inducibility of AF and the occurrence and duration of spontaneous AF episodes were evaluated and compared between the two groups.

Results
Atrial fibrillation was induced in 85.7% of the rats subjected to atrial electrical pacing (Figure, A), with an average global inducibility of 44.0% ± 16.9% and a mean AF duration of 123.2 ± 96.3 s. No induced or spontaneous AF episodes were recorded in any of the Sham animals. In the AF group, none of the animals presented spontaneous AF before transesophageal atrial pacing. However, in the AF rats, after atrial electrical stimulation initiation, the number of atrial premature beats significantly increased (21.3 ± 6.8 / 24-h post-stimulation vs. 7.3 ± 6.5 / 24-h at baseline; p&lt; 0.01; Figure, B), and all rats presented spontaneous AF episodes (Figure, C). At the end of the study, AF rats presented a total number of 23.9 ± 2.3 AF episodes / 24-h (Figure, D), with a mean AF burden of 337.7 ± 25.06 s / 24-h.

Conclusions
Our data demonstrate that, despite the small size of the atria, the "AF begets AF" concept is applicable in small rodents. The study presents a novel rat model of AF, in which spontaneous AF occurs following long-term atrial electrical stimulation. Given that the model is relatively rapid and easy to implement, it provides a setup for further investigation of AF pathophysiology, and for identifying and testing novel therapeutic strategies for AF.Figure 1
Neural control of ventricular electrophysiology: the role of the posterior descending ganglionated plexus
Authors: Kahle A K , Klatt N , Scherschel K , Jungen C , Kuklik P , Alken F A , Kloecker N , Willems S , Weber E , Boeken U , Lichtenberg A , Bernhardt A , Hakmi S , Pauza D H , Meyer C 
Published: May 2024

Abstract

Background
The autonomic nervous system plays an integral role in cardiac physiology. While the atrially located ganglionated plexus have been studied in several species, there is limited knowledge regarding the functional characterization of ventricular ganglionated plexus.

Purpose
The aim of the present study was to assess the role of the posterior descending ganglionated plexus (PD-GP) for neural control of ventricular electrophysiology.

Methods
First, to investigate whether the mouse may be useful as an animal model, a review of whole-mount immunohistological stained murine hearts (n=43) was conducted. Second, functional studies were performed in an ex-vivo retrograde-perfused porcine model (n=3) at baseline (pacing with a cycle length of 600 ms), during PD-GP high-frequency and local nicotine stimulation (Figure 1A). Wave propagation characteristics were determined by epicardial activation mapping. Activation recovery intervals (ARIs) were analyzed with a multi-electrode sock placed around the epicardium (Figure 1B). Finally, morphological analysis of explanted human hearts was conducted to determine the potential of translation into clinical practice.

Results
In murine hearts, ventricular ganglionated plexus were present in only 10% of hearts. In porcine hearts, dispersion of conduction velocity was increased during PD-GP high-frequency (8.52±2.24 radian vs. 2.79±0.89 radian; p=0.018) and nicotine stimulation (19.79±6.49 radian vs. 2.79±0.89 radian; p=0.044) compared to paced rhythm (Figure 1C). High-frequency stimulation prolonged ARIs in the posterior (257.8±6.7 ms vs. 244.8±1.9 ms; p=0.044) and basal (258.1±4.2 ms vs. 244.8±1.9 ms; p=0.039) right ventricle compared to the posterior left ventricle, while nicotine did not affect ARIs (right ventricle: 255.7±29.0 ms vs. left ventricle: 245.0±29.3 ms; p=0.677) (Figure 1D). Analysis of explanted human hearts confirmed the presence of the PD-GP in close relationship to the posterior descending coronary artery within epicardial adipose tissue (Figure 2).

Conclusions
While we demonstrate functional relevance of the PD-GP in explanted porcine hearts, important species-related differences might exist.Ex-vivo retrograde-perfused swine modelAnalysis of explanted human hearts
Role of inflammation in atrial fibrillation: specific biomarkers of tissue damage, atrial remodelling and dysregulation of angiogenesis
Authors: Quesada-Ocete J , Castillo Martinez P , Garcia Gonzalez M , Cervera Vidal R , Simarro De Pascual S , Quesada-Ocete B , Palanca Gil V , Jimenez Bello J , Paya-Chaume A , Paya Serrano R , Tebar Fernandez R , Vidal-Vanaclocha F , Quesada Dorador A 
Published: May 2024

Abstract

Introduction and Objectives
The relationship between inflammation and atrial fibrillation (AF) has been poorly studied with common inflammatory markers and limited to analysing one or two markers. Given the large number of pathways in the inflammatory process and the complexity of their relationship with AF, we set out to study a broad panel of more specific biomarkers that attempt to cover as many inflammatory interactions and mechanisms as possible.
Our objetive was to evaluate which biomarkers were elevated in AF patients compared to the general population.

Methods
We studied 74 patients who were to undergo an ablation procedure (53 with AF and 21 controls -microscopic substrates-), drawing a blood sample before the procedure.
Exclusion criteria were: cancer, inflammatory diseases, heart failure or major echocardiographic alterations including mild ventricular hypertrophy.
Baseline characteristics, basic analytical parameters and levels of 20 specific inflammatory biomarkers were collected and compared in patients with and without AF.

Results
Figure 1 shows the baseline characteristics of the sample. The usual analytical parameters in clinical practice showed no relevant differences between the two groups.
Of the 20 specific inflammatory parameters, significant differences were found in 4: biomarkers of cardiomyocyte damage (NT-proBNP: (AF)130.8 +- 208.0 pg/mL vs (control) 80.3 +- 66.5 pg/mL; p=0.041), of atrial remodelling (Endostatin: 95.0 +- 28.8 ng/mL vs 80.1 +- 17.2 ng/mL; p&lt;0.01), angiogenesis dysregulation (MCAM: 241.8 +- 51.9 ng/mL vs 197.1 +- 96.4 ng/mL; 0.033) and hepato-inflammatory cardiovascular risk markers (SAP; 7426.6 ± 2641.0 ng/mL vs 9406.9 ± 3904.1 ng/mL; p&lt;0.011).
In addition to these individual differences, multiple correspondance analysis (figure 2) allowed grouping most of the patients without arrhythmia using information from the biomarker set.

Conclusions
In patients with AF, several specific parameters of inflammation are elevated compared to controls, supporting the presence of an activation of inflammation in these patients.
Due to the large number of factors involved in the inflammatory process and the variability with which they can be activated, future research evaluating the clinical implication of these findings is essential.Baseline CharacteristicsMultiple correspondance analysis
Molecular mechanism for the interaction of MOG1 with the intracellular Loop II of cardiac sodium channel Nav1.5 and its role in Brugada syndrome
Authors: Bai X , Wang Q I N G 
Published: May 2024

Abstract

Background
SCN5A encodes the cardiac sodium channel a-subunit Nav1.5 with an essential role in generation and conduction of cardiac action potential. Mutations in SCN5A cause Brugada syndrome (BrS) and long QT syndrome (LQTS). The function of Nav1.5, including its cell membrane trafficking and clustering in caveolae, is regulated by MOG1. We recently showed that gene therapy with AAV9-MOG1 reversed disease phenotypes of BrS, dilated cardiomyopathy, cardiac conduction disease and sick sinus syndrome associated with SCN5A mutations. MOG1 is a small chaperon that interacts with multiple sites of Nav1.5, including intracellular Loop I between transmembrane domain I and II and Loop II between domain II and III. We previously characterized the interaction between MOG1 and the intracellular Loop I of Nav1.5, and defined amino acids D24, E36, D44, E53, and E101A of MOG1 as critical residues for its interaction with Nav1.5 Loop I. However, the mechanistic understanding of the interaction between MOG1 and intracellular Loop II of Nav1.5 is needed.

Purpose
The aim of this study is to perform systematic mutational and electrophysiological studies to identify the key structural elements involved in the interaction between MOG1 and Nav1.5 Loop II and determine the significance of this interaction to the pathogenesis of BrS.

Methods
Patch-clamping was used to record sodium currents. Glutathione S-transferase (GST) pull-down were used to characterize protein-protein interactions.

Results
Nav1.5 Loop II contains 765 amino acids, and the domain between amino acids 1157 and 1200 was shown to be the interaction domain for MOG1. Six serial deletions were created, including LoopII△940-982, LoopII△983-1025, LoopII△1026-1068, LoopII△1069-1112, LoopII△1113-1156, and LoopII△1157-1200. GST-pull-down showed that only LoopII△1157-1200 failed to interact with MOG1. MOG1 enhanced sodium current densities all Nav1.5 deletion mutants except for LoopII△1157-1200. Further deletions by every 10-11 amino acids defined the MOG1-interacting domain to 1190-1200. Point mutation analysis defined the MOG1-Nav1.5 Loop II interaction domain to an 8-amino-acid domain of R1193-Y1200 of Nav1.5 Loop II. Mutations R1193W, L1194M and Y1199S associated with BrS reduced the interaction between MOG1 and Nav1.5. MOG1 enhanced sodium current densities from wild type Nav1.5, but not from mutant Nav1.5 with mutations R1193W, L1194M and Y1199S.

Conclusions
This study identifies the critical elements of Nav1.5 Loop II for interaction with MOG1, and reveals the molecular mechanism by which Nav1.5 mutations R1193W, L1194M and Y1199S cause BrS. Mutations R1193W, L1194M and Y1199S weaken the interaction between Nav1.5 and MOG1, and reduce MOG1-enhanced cardiac sodium current densities.
CineECG demonstrates abnormal electrical activity in preclinical plakophilin-2-pathogenic variant carriers with a normal 12-lead ECG
Authors: Van Der Schaaf I , Kloosterman M , Van Dam P M , Loh P 
Published: May 2024

Abstract

Background/introduction
Arrhythmogenic cardiomyopathy (ACM) is an inherited cardiac disease. The presence of a pathogenic variant (PV) of the plakophilin-2 (PKP2) gene increases the likelihood of developing this disease. Although cardiac screening is routinely performed, early detection of ACM remains challenging.
CineECG as a tool for analysis of the 12-lead electrocardiogram (ECG) can provide a 3D-reconstruction of the average pathway of electrical activation. With the emergence of this technique, a new insight in ventricular activation patterns can be obtained. CineECG might therefore be of aid in identifying early signs of disease in preclinical PKP2-PV carriers with a normal 12-lead ECG.

Purpose
This study aimed to analyze the ECG’s of preclinical PKP2-PV carriers with CineECG to determine the ventricular electrical activation patterns and to compare these patterns to the normal CineECG trajectory.

Methods
The 12-lead ECG’s of 19 preclinical PKP2-PV carriers were selected and evaluated by three experts on depolarization abnormalities.
CineECG analysis was conducted in all preclinical PKP2-PV carriers to ascertain the average location and direction of the ventricular electrical activation. The resulting CineECG trajectory was then compared to the normal CineECG, which was previously determined from normal ECG’s from the PTB-XL database. The CineECG was considered abnormal if more than 15% of the CineECG trajectory was outside the normal distribution.

Results
Expert analysis of the ECG’s revealed no depolarization abnormalities (e.g. abnormal electrical heart axis, pathological Q-waves or low voltage, and ECG Task Force Criteria were absent).
The CineECG trajectory was abnormal in most cases (11 out of 19 PKP2-PV carriers), while the other eight carriers exhibited normal CineECG trajectories. Figure 1 shows three examples of A) a normal case, B) a PKP2-PV carrier with a normal CineECG and C) a PKP2-PV carrier with an abnormal CineECG. In example C, the activation pattern is abnormal as the latest activation is aimed towards inferior and far to the left basal area of the heart.

Conclusions
CineECG analysis of the normal 12-lead ECG’s of preclinical PKP2-PV carriers resulted in the finding of abnormal electrical activation patterns in the majority of carriers. CineECG could therefore be a sensitive tool to unveil subtle and early abnormalities in the depolarization that would otherwise not be easily detected.Figure 1
Real-world utility of implantable loop recorders
Authors: Plappert C , Lacour P , Boldt L H , Parwani A , Baehr F , Wieland L , Schoeppenthau D , Dagres N , Hindricks G , Blaschke F 
Published: May 2024

Abstract

Background
Implantable loop recorders (ILRs) allow prolonged and continuous single-lead electrocardiogram recording and have significantly shortened time to electrocardiographic diagnosis and appropriate therapy of many bradyarrhythmias and tachyarrhythmias.

Purpose
The aim of this retrospective single center study was to evaluate ILR indications, diagnostic yield and ILR-guided interventions.

Methods
We retrospectively analyzed 388 patients (223 male / 165 female), who underwent Medtronic and Biotronik ILRs implantation at a heart center. Demographic and clinical data were obtained from the medical records. Remote monitoring was analyzed when no data of in-hospital follow up could be acquired.

Results
The mean age at ILR implantation was 63.4 ± 14.9 years with a mean follow-up of 20.7±17.6 months from ILR implantation. In total, 152 (39.2%) patients were followed by a remote monitoring system. Number of patients with ILR indication due to syncope (n=171; 44.1%) was significantly higher compared to patients with monitoring after ablation of atrial fibrillation or atrial flutter (n=108; 27.8%), cryptogenic stroke (n=50; 12.9%) and presyncope and dizziness (n=21; 5.4%) (p&lt;0.05).
After 12 months, arrhythmia was detected in 198 cases (79.2% out of 250 patients with detected arrhythmias). The most common type of arrhythmia was paroxysmal atrial fibrillation (31.7%) with a significantly higher prevalence compared to atrial tachycardias (16.5%) and supraventricular premature beats (9.8%) (p&lt;0.05). Noteworthy, in 132 (52.8% out of 250) patients, ILR diagnosis corresponded to the suspected arrhythmia, whereas in 118 patients unexpected arrhythmias were detected. ILR diagnosis of arrhythmia lead in 147 (58.8%) patients to initiation of a new therapy or to a change of current medication. Changes of current medication occurred in 72 patients (28.8%), electrophysiology study/ablation in 66 patients (26.4%), pacemaker/ICD implantation in 46 (18.4%), electrical cardioversion in 6 patients (2.4%), and closure of the left atrial appendage in 1 patient.

Conclusion
Our study shows, that ILRs are an important diagnostic tool, providing clinical relevant data in about two thirds (65%) of the patients. About half (52.8%) of the detected arrhythmia correlated with the symptoms leading to ILR implantation (number needed to treat was around 2). Remote monitoring improves the diagnostic timing with a potential reduction of costs for health care. However, patient selection is critical and ILRs benefits needs to be proven in larger randomized trials.