bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of brain infarcts and cardiac autonomic dysfunction using entropy functions in patients with atrial fibrillation
Authors: Meyer-Zurn C , Schier J , Schlageter V , Knecht S , Aeschbacher S , Paladini R E , Coslovsky M , Conen D , Krisai P , Osswald S , Kuhne M , Hammerle P 
Published: May 2024

Abstract

Background
Cardiac autonomic dysfunction after brain infarcts is a strong predictor of adverse outcome.

Purpose
The aim of this study was to investigate the association of large cortical or non-cortical brain infarcts (LNCCI) with multiscale (MSE) and sample entropy (SE), which characterize the complexity of RR interval time series in atrial fibrillation patients.

Methods
In this cross-sectional analysis, we enrolled 1085 patients (mean age 72±9 years, 29% female) from the Swiss-AF cohort study with baseline brain MRI and without a paced rhythm on a 5-minute resting 12-lead ECG (61% in SR and 39% in AF). We constructed linear regression models to analyze the association between presence of LNCCI and entropy markers, adjusted for age, gender, intake of betablockers, diabetes and heart failure.

Results
On brain MRI, LNCCI were present in 220 patients (20.3%). 53% of these brain infarcts were clinically silent. Patients with LNCCI had a higher MSE (median 11.4 (IQR 6.5-13.3) vs. 8.5 (IQR 5.2-12.6), p&lt;0.001) and SE (median 2.6 (IQR 1.0-3.4) vs. 1.6 (IQR 0.8-3.2), p&lt;0.001) compared to patients without LNCCI. After adjustment for possible confounders, the presence of LNCCI was independently associated with a higher MSE (β=0.77; 95% CI 0.19-1.35, p=0.010). This association persisted when patients with a history of stroke/TIA were excluded.

Conclusions
Brain infarcts, irrespective if clinically overt or silent, are associated with higher entropy markers in AF patients, which indicates cardiac autonomic disturbances.
Definition and management of arrhythmia-induced cardiomyopathy: findings from the EHRA SIC survey
Authors: Serban T , Badertscher P , Du Fay De Lavallaz J , Providencia R , Migliore F , Mugnai G , Penela D , Perrotta L , Kuehne M , Sticherling C , Chun K R J 
Published: May 2024

Abstract

Background
Arrhythmia-induced Cardiomyopathy (AiCM) represents a subtype of heart failure (HF) in the context of a sustained arrhythmia. However, clear definitions and management recommendations for AiCM are lacking.

Purpose
The European Heart Rhythm Association Scientific Initiatives Committee (EHRA SIC) conducted a survey to determine the current definitions and management of patients with AiCM among European and non-European electrophysiologists.

Methods
A 25-item online questionnaire was developed and distributed among EP research network centres between September 4th and October 5th 2022.

Results
Out of the 206 respondents, 16% were females and the most (33%) were between 40-49 years old. Most of the respondents were EP-Specialists (81%) working at a University Hospital (47%). While most participants (67%) agreed that AiCM should be defined as a left ventricular ejection fraction (LVEF) impairment after new onset of an arrhythmia and/or LVEF recovery after treatment of the culprit arrhythmia, only 35% identified a specific LVEF drop/improvement to diagnose AiCM, the majority (50%) agreeing with a 10% change in LVEF (Figure) but with the rest of the experts choosing a wide range of values (from 5 to 20% LVEF drop). Most respondents used all available therapies in AiCM patients: catheter ablation was chosen by 93%, electrical cardioversion by 83%, antiarrhythmic drugs by 76% and adjuvant HF treatment were used by 76%. 83% of respondents indicated that adjuvant HF treatment should be started at first diagnosis of HF prior to antiarrhythmic treatment and 84% agreed that the therapy should be stopped within six months after LVEF normalization. Responses for the optimal time point for the first reassessment of LVEF during FU varied markedly (1 day to over 6 months after antiarrhythmic treatment).

Conclusion
This EHRA Survey reveals varying practices in defining and managing AiCM among European and non-European physicians. There is an unmet need for a consensus in the definition and management of AiCM patients to improve patient care.Figure
Clinical impact of catheter ablation for atrial fibrillation on heart failure parameters
Authors: Hashiguchi N , Tamura N , Matsuyama T , Hattori K , Tachibana M , Matsuoka T , Ohno Y , Aoki Y 
Published: May 2024

Abstract

Background
Catheter ablation for atrial fibrillation have already been an established therapy to maintain sinus rhythm in patients with or without heart failure. Atrial fibrillation is often associated with functional valve regurgitations, left ventricular dysfunction and biomarkers of HF. However, it is still unclear how often such parameters improve after catheter ablation.

Purpose
The aim of this study is to clarify the clinical impact of catheter ablation on heart failure in patients with atrial fibrillation.

Methods
We retrospectively analysed 139 consecutive patients who underwent catheter ablation for atrial fibrillation and cardiac echocardiography before and one-year after catheter ablation. Patients who underwent hemodialysis or previous valve surgery were excluded.

Results
Mean age was 69.8±9.5 years and 84(60.4%) patients had persistent atrial fibrillation before ablation procedure. Fourteen (10.1%) patients had severe left ventricular dysfunction (EF&lt;40%). Thirty-four (24.5%) and 37(26.6%) patients had moderate or greater mitral and tricuspid valve regurgitation (MR and TR), respectively. BNP or NTproBNP was significantly elevated in 93(66.9%) patients before catheter ablation.
During one-year follow-up, 11 (7.9%) patients underwent second procedure and atrial fibrillation were remained in 2 (1.4%) patients. Additional medications for heart failure were prescribed in 19 (13.7%) of patients after initial procedure.
One year after catheter ablation, 19/34(55.9%) and 20/37(54.1%) of moderate or greater functional MR and TR improved to mild or less. Furthermore, 5/14 (35.7%) patients with severe left ventricular dysfunction improved to normal with combined optimal medical treatment. In 64/93 (68.8%) with elevated BNP or NTproBNP, the increase was no longer significant. Even in patients with still elevated BNP or NTproBNP one-year after catheter ablation, their values were decreased by more than 50% in 17/29 (58.6%) patients.

Conclusion
Catheter ablation for atrial fibrillation can improve heart failure parameters including valve function, systolic ventricular function and biomarkers.
AV nodal ablation in atrial fibrillation: long term outcomes
Authors: Sogandji N , Ding W , Fynn S P , Heck P M , Begley D A , Virdee M S , Gajendragadkar P , Mellor G , Zachariah D , Agarwal S 
Published: May 2024

Abstract

Background
Ablation of the atrioventricular (AV) node, following the insertion of a permanent pacemaker, is a treatment option for symptomatic atrial fibrillation (AF) where rate control is poor, despite maximally tolerated pharmacological intervention or percutaneous AF ablation [1], and yet there is limited data on long-term outcomes.

Purpose
The purpose of this study is to investigate post AV node ablation follow up outcomes, including the incidence and timeframe of conversion of paroxysmal to persistent AF; incidence and timeframe of upgrade to biventricular pacemakers; and mortality.

Methods
This observational descriptive study looked at the post-procedure follow-up outcomes of patients who underwent AV node ablation at our centre between March 2015 and June 2019. Retrospective analysis of prospectively collected data was analysed. The demographics of the patients, including their age, gender, co-morbidities, pre-ablation left ventricular ejection fraction (LVEF) and medications were recorded. The follow up outcomes investigated included the change in LVEF, the proportion of patients whose AF converted from paroxysmal to persistent, the proportion of patients requiring upgrade to biventricular devices, and deaths within 6 months of ablation. Outcomes were compared between those who had a biventricular pacemaker pre-ablation and those who had single/dual chamber pacemakers.

Results
296 patients with a mean age of 72.7± 8.5 years and a female to male ratio of 54.1% : 45.9% were included. 94 patients (31.8%) had paroxysmal AF pre- ablation. 51.6% of those who had paroxysmal AF pre-ablation converted to persistent AF over a median period of 3 years (interquartile range, 3 years). Among those who had a biventricular pacemaker pre-ablation, 56.5% of those with paroxysmal AF converted to persistent, compared to 47.4% of those with a dual pacemaker pre-ablation p=ns Among patients with dual chamber pacemakers, those who remained in paroxysmal AF post-ablation had a mean CHADVASC score of 3.2 (range of 1-6) compared to 3.7 (range of 2-6) in those whose AF converted to persistent (p=0.19). 9 patients (3%) died within less than 6 months of the procedure, with 1 patient dying within 6 days. 13% of the patients originally having a single or dual chamber pacemaker required an upgrade to a biventricular pacemaker over a median period of 1.25 years (interquartile range 1.1 years). All the patients who required an upgrade to a biventricular pacemaker had normal LVEF pre-ablation except for one patient who had mild LV impairment.

Conclusions
A significant proportion of patients with paroxysmal AF converted to persistent AF following AV node ablation and having a biventricular pacemaker did not offer benefit in keeping people in paroxysmal AF.A considerable number of people required an upgrade to biventricular pacemaker over a short time frame even though they had normal LVEF pre AV nodal ablation.
Prediction of the success of electrical cardioversion in patients with atrial fibrillation using parameters obtained by spectral and vectorcardiographic analysis of the ECG
Authors: Hassouna S , Herman D , Hozman M , Osmancik P , Vesela J , Plesinger F , Bures Z 
Published: May 2024

Abstract

Introduction
Electrical cardioversion (ECV) still presents a treatment option for atrial fibrillation (AF). Despite the great success rate in the acute setting, its long-term success rate is low. The aim of the study was to find predictors of SR maintenance after ECV using spectral and vectorcardiographic (VCG) analysis of the ECG curve.

Methods
Consecutive patients with AF referred for elective ECV were prospectively enrolled. The digital ECG recording obtained before the ECV was analyzed using spectral and VCG analysis. All patients had Holter monitoring and clinical follow-up three months after cardioversion to assess SR maintenance. Atrial fibrillation activity was analyzed by spectral analysis, determining the dominant frequency (DF), RI (regularity index) and OI (organization index). QRS complexes were analyzed by vectorcardiography and dXmean, dYmean and dZmean (derivation of VCG signals) parameters were determined. Using logistic regression (LR) with backward parameter reduction, separate and combined predictive models of SR maintenance were calculated based on both the analysis from the VCG data and the spectral analysis data. Additional models with a forward selection of clinical variables were also calculated. The efficiency of the models was evaluated on a separate test subset of the data (N=32).

Results
A total of 80 patients were enrolled (age 70+10 years, 48 (64%) men, CHADSVASc 3.17+1.5, BMI 29.75kg/m2). At the 3-month follow-up, AF recurrence was present in 36 patients (45%). Using only vectorcardiographic parameters, dXmean (OR 3.07, 95 %CI 1.14- 8.63), p=0.001) and dYmean (OR 0.26, 95% CI 0.09-0.72), p &lt;0.001) best predicted the SR maintenance (AUC of 0.72).
Using only spectral analysis parameters, the best predictor was DF (OR 3.07, 95%CI 1.14-8.63), p=0.012) with AUC of 0.66. By combining the results of spectral analysis and vectorcardiography, an AUC of 0.78 was achieved. Among the clinical parameters, the most significant predictors were insufficiently controlled arterial hypertension and previous history of stroke.

Conclusion
Digital analysis of ECG curves using deeper mathematical models provides a better predictive model than classical clinical and echocardiographic models. The combination of spectral analysis of fibrillation atrial activity and vectorocardiographic analysis of QRS complexes revealed more accurate predictive information compared to both analyses alone.
Extended period rhythm outcomes of posterior box isolation of left atrium during pan-spectrum of atrial fibrillation catheter ablation in 4 randomized clinical trials
Authors: Lee S , Yu H T , Choi S H , Kim D H , Kim T H , Uhm J S , Joung B Y , Lee M H , Pak H N 
Published: May 2024

Abstract

Background
Catheter-based electrical posterior box isolation (POBI) in addition to circumferential pulmonary vein isolation (CPVI) did not improve rhythm outcome of atrial fibrillation (AF) catheter ablations (AFCA). We analyzed the long-term rhythm outcomes of previously conducted our 4 randomized controlled trials (RCTs) comparing CPVI vs. additional POBI by intention to treat.

Methods
We analyzed 575 AF patients who were included in 4 RCTs (PAF [paroxysmal AF], PEACEFUL [persistent to paroxysmal AF]; POBI [persistent and long-standing persistent AF]; and RILI [repeat procedures] trials) comparing the usefulness of additional POBI after further long-term protocol-based rhythm follow-up. We compared the primary endpoint as clinical recurrence after index procedure and major adverse cardiac event, and the secondary endpoint as procedure time, procedure-related complication rate, recurrence as atrial tachycardia (AT), and cardioversion or repeat procedure rates. We also conducted Cox regression analysis to evaluate the efficacy of POBI.

Results
After a median follow-up of 48months, there was no significant difference in the clinical recurrence (42.9% vs. 41.3%; log-rank P=0.855) and major adverse cardiac event (4.5% vs. 3.7%; log-rank P=0.675). Procedure time was significantly longer (p=0.003) and AT recurrence rate was higher (6.6% vs. 12.6%; log-rank P=0.014) in the additional POBI group. In patients who experienced clinical recurrence, there were no significant differences in the rates of cardioversion (33.9% vs. 46.6%, P=0.059) or the need for a repeat procedure (30.4% vs. 31.7%, P=0.955) between the two groups. Catheter-based POBI did not improve AFCA outcomes (HR 1.07 [0.81~1.40], P=0.655), regardless of paroxysmal, persistent to paroxysmal, persistent AFs, or the 2nd procedures. In the redo mapping after RCTs (n=64), PV reconnection rate did not differ, but reentrant AT was more common in POBI than in CPVI alone group (46.7% vs. 10.7%, P=0.007), while extra-PV trigger was more common in CPVI alone than in POBI group (29% vs. 3.0%, P=0.012).

Conclusions
Additional-POBI to CPVI did not improve long-term rhythm outcomes. Additional-POBI to CPVI is related to the increase of AT recurrence and the decrease of extra-PV trigger.
Validation of the Castle HTx data in a real world scenario
Authors: Scheurlen C , Van Den Bruck J H , Filipovic K , Erlhoefer S , Woermann J , Dittrich S , Schipper J H , Pavel F , Ackmann J , Lueker J , Steven D , Sultan A 
Published: May 2024

Abstract

Background
Pulmonary vein isolation (PVI) is recommended in patients with symptomatic atrial fibrillation (AF) and reduced left ventricular ejection fraction (LVEF). Recently the Castle HTx (CHTx) trial showed a significant mortality reduction in end stage heart failure patients undergoing PVI in addition to optimized medical therapy (OMT) compared to OMT only.

Aim
Objective of this analysis is to validate results of Castle HTx study in a real world scenario.

Methods
All patients between September 2021 und September 2023 referred for PVI at our center with symptomatic AF und LVEF ≤35% were included in this retrospective analysis at the University Hospital Cologne.

Results
A total of 119 PVI in patients with LVEF≤35% were successfully performed (mean age 63.3±10.1 years, 96 patients (81%) male, 43 (36%) paroxysmal AF, 76 (64%) persistent AF) matching inclusion criteria used in CHTx. Cryo-PVI was used in 50 (42%), RF-PVI in 60 (50%) and PFA in 9 (8%) patients. Complete follow-up (FU) with a mean of 549.6±430.2 days was obtained in 108 patients, comparable to CHtx (540 days). During FU 11 patients (10%) died from any cause (CHTx 8 patients (8%)), 2 patients (2%) received a left ventricular assist device (CHTx 1 patient (1%)) and no patient had urgent heart transplantation (CHTx 1 patient (1%)). For 30 patients (28%) recurrence of AF was detected and 72% remained in sinus rhythm.
In 6 patients (5%) post-procedural complications occurred: 5 inguinal hematoma, 1 decompensation.
During FU LVEF was statistically significantly improved (EF initial 26.9±6.5%, EF FU (n=80) 37.1±12.8%, p&lt;0.001) (CHTx EF initial 29.0±6.4%, EF FU (n=92) 37.2±9.1%).

Conclusion
The findings of the Castle HTx patients have been validated in a real-world setting. PVI for rhythm control in end stage heart failure patients is safe and highly effective. Our patient cohort, matched to the Castle HTx ablation group, showed freedom from AF rate of 72% after mean FU time of 550 days. Furthermore, LVEF was improved significantly in our cohort echoing the results from CHTx.
Pulmonary vein isolation using pulsed field ablation versus high-power-short-duration radiofrequency ablation for paroxysmal atrial fibrillation: efficacy, safety, and long-term follow-up
Authors: Reinsch N , Hartl S , Fueting A , Neven K 
Published: May 2024

Abstract

Background
Pulsed field ablation (PFA) is a novel, nonthermal, cardiac tissue selective ablation modality. To date, radio-frequency (RF) guided high-power-short-duration (HPSD) ablation represents the gold standard for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). This study investigated the efficacy of PFA-PVI versus HPSD-PVI in terms of single-procedure arrhythmia-free outcome and safety.

Methods
Consecutive, paroxysmal AF patients who underwent PVI using PFA or HPSD were enrolled. In group PFA, PVI was performed using a 31/35-mm pentaspline PFA catheter. The ablation procedure in group HPSD was performed with HPSD-RF energy (45 watts), using Ablation Index (AI) and the CLOSE protocol. The CLOSE protocol combines AI and ≤6 mm interlesion distance using a 4-mm surround flow catheter.

Results
A total of 420 patients (group PFA: 211; group HPSD: 209) were included (55% men; age 67 ± 10 years). There was no difference between both groups with regard to age, gender and CHA2DS2-VASc-Score. Complete isolation of all PVs was achieved in 100% of patients. Procedure time was significantly shorter in group PFA (74 ± 41 min vs. 127 ± 34 min; p &lt; 0.001); fluoroscopy time and dose area product were significantly longer in group PFA (18 ± 7 min vs. 4 ± 3 min; p &lt; 0.01 and 555 ± 460 uGym2 vs. 213 ± 273 uGym2; p &lt;0.01). Overall procedural complications were 1,4% in group PFA and 5,2 % in group HPSD (p &lt; 0.01), driven by a higher tamponade rate in group HPSD. During a mean follow-up of 12 months after a single procedure, 170 (81%) patients of group PFA were free of arrhythmia recurrence versus 160 (76%) patients in group HPSD (p = 0.798) (Figure 1).

Conclusions
PVI using PFA compared to PVI using HPSD shows a similar acute efficacy but a significantly reduced complication rate and a shorter procedure time. One-year clinical success rates are favorable, but not different between groups.Figure 1
Cryoballoon ablation for atrial fibrillation in young adults: a propensity-score matching comparison with an older cohort
Authors: Cecchini F , Mugnai G , Di Vilio A , Almorad A , Del Monte A , Artale P , Filannino P , Petretta A , Colella J , Statuto G , Maj R , Sieira J , Chierchia G B , De Asmundis C , Iacopino S 
Published: May 2024

Abstract

Background
Cryoballoon ablation (CB-A) has proven to be a valid technology for achieving pulmonary vein isolation (PVI) in patients affected by symptomatic atrial fibrillation (AF). Data regarding CB-A in young adults are still scarce and mainly derived from studies performed without balancing comorbidities and echocardiographic parameters between the groups. The present study aimed to focus on the outcomes and complications of CB-A PVI in young adults (&lt; 50 years) compared to a propensity score-matched population of older individuals, seeking also to understand the true role of "age" as potential risk factor for arrhythmia recurrences.

Methods and results
We retrospectively enrolled 172 consecutive patients aged &lt; 50 years who underwent PVI employing the second-generation cryoballoon (CB-2). A 1:1 propensity score matching comparison with an older cohort of patients was performed and 290 patients (145 subjects aged &lt; 50 years vs. 145 patients aged ≥ 50 years) were then selected. The mean age was 43.3 ± 4.9 years in the younger group and 64.7 ± 8.7 years in the control group (p &lt; 0.001). After an overall median follow-up of 18 [12 - 29] months, the Kaplan-Meier curves showed a similar rate of freedom from arrhythmia relapses between the younger and the older cohorts (85.5% vs. 77.2% respectively, log-rank p = 0.31). The rate of major complications was low (2.8 %) and did not significantly differ between the groups, being 2.1% for the younger cohort and 3.5% for the older group (p = 0.50). Vascular complications and phrenic nerve palsy appeared to be the most common procedure-related adverse events, occurring in 8 (2.8%) patients. Arrhythmia recurrences during blanking period (ERAF) was found to be the only independent predictor of late AT/AF relapses.

Conclusions
Our propensity-score model demonstrates that CB-A PVI is equally safe and effective in young adults as it is in older individuals. Furthermore, our findings suggest that "age" itself does not appear to play a significant role in predicting recurrences after CB-A PVI. This result underscores the importance of controlling the modifiable risk factors (comorbidities) and emphasizes the value of early AF diagnosis and intervention.Survival Curve