bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of leukocyte telomere length with cardiac conduction disease and sick sinus syndrome
Authors: Park J , Yang P S , Kim D , Sung J H , Jang E , Yu H T , Kim T H , Uhm J S , Pak H N , Lee M H , Joung B 
Published: May 2024

Abstract

Background
Cardiac conduction disease (CCD) and sick sinus syndrome (SSS) may be related to a degenerative process. Leukocyte telomere length (LTL) is associated with the aging process and age-related degenerative diseases. We aimed to investigate the association between LTL and the risks of CCD/SS, and to explore whether LTL is related with cardiovascular imaging and electrocardiographic (ECG) changes.

Methods
This is a population-based cross-sectional study of UK Biobank participants without history of CCD/SSS recruited from 2006 to 2010. LTL was measured using a quantitative polymerase chain reaction method. Cardiovascular measurements were derived from cardiovascular magnetic resonance using machine learning. The median (IQR) duration of follow-up was 12.0 (11.3-12.7) years. The associations of LTL with imaging and ECG measurements and incident CCD/SSS were evaluated by multivariable regression models.

Results
Among the 412,452 white participants, 188,891 (45.8%) were male, with a mean age of 57.3 years. Longer LTL was independently associated with positive cardiac remodeling, including higher left ventricular mass, larger atrial volume, and increased atrial stroke volumes. However, no significant associations were observed with ECG findings including PR interval and P-wave duration. 11991 (2.6%) participants developed CCD and 984 (0.2%) developed SSS. Longer LTL was not associated with younger age. However, longer LTL was not associated with a lower risk of incident CCD (LTL fourth quartile vs. first quartile: hazard ratio, 0.98; 95% CI, 0.97-1.0; P = 0.057) or SSS (LTL fourth quartile vs. first quartile: hazard ratio, 0.98; 95% CI, 0.92-1.05; P = 0.554).

Conclusions
In this cross-sectional study, longer LTL was associated with a larger atrial size with better atrial function in middle age, but not with ECG changes. However, longer LTL was not associated with a lower risk of incident CCD and SSS.
Clinical findings and outcomes of Brugada syndrome in women
Authors: Kruska M K , Perez J P , Wuerfel S W , Tueluemen E T , Fastner C F , Kuschyk J K , Borggrefe M B , Duerschmied D D , Akin I A , Liebe V L , Boris Rudic B R 
Published: May 2024

Abstract

Introduction
Brugada syndrome (BrS) is a genetic disorder characterized by typical ECG changes and association with spontaneous ventricular tachyarrhythmia (VTA) and sudden death in young patients. BrS has been widely established to be particularly prevalent in men, however less information exists regarding female patients and their long-term risk.

Objectives
The purpose of this study was to investigate the clinical characteristics and long-term prognosis of women with BrS.

Methods
This study includes a retrospective analysis of a single-center cohort of patients followed and observed for relevant clinical outcomes. The data collected included demographic data, severity of symptoms (e.g. syncope, VTA), cardioverter-defibrillator logs and occurrence of sudden cardiac death.

Results
317 patients were diagnosed with BrS between 1998 and 2023. Among those, 112 (36%) were female. At presentation, 5 patients (4%) were symptomatic with history of survived cardiac arrest and/or documented VTA. 29 (26%) had history of unexplained syncope and 78 (70%) were asymptomatic. The average age at diagnosis was 42.1±15.1 yrs. as opposed to 40.1±14.2 yrs. in men. Females presented less frequently with a type 1 ECG pattern (5% vs 21%; p&lt;0.01), had a trend to a higher rate of family history of sudden cardiac death (31% vs 25%; p=n.s.), and had less sustained VTA during programmed ventricular stimulation (4% vs 19%; p&lt;0.01). Genetic testing was performed in 89 females (79% of the sample) and pathogenic variants were present in 36 (40%) women. An implantable cardioverter defibrillator was inserted in 24 (31%) females for primary prevention. During mean follow-up of 138±72 months, 11 women had cardiovascular events (syncope, VT/VF or death). Syncope was most common and occurred in 8 cases. No VTA were documented in any female patient. In the group of ICD patients, 8 shocks have occurred. None of these were deemed appropriate by medical controls. There were 3 deaths. Two were considered non-arrhythmic due to pulmonary embolism and breast carcinoma. One ICD patient died suddenly during sleep. Unfortunately, no device interrogation data was available.

Conclusion
Women typically present less symptomatic and demonstrate a reduced incidence of life-threatening arrhythmias during follow-up , often experiencing a frequent occurrence of inappropriate implantable defibrillator therapy. The less frequent prevalence of the BrS ECG pattern in women adds complexity to the diagnostic process. Further studies are still needed to elucidate gender differences for risk stratification of BrS.
Association of sex with heart rate variability in atrial fibrillation patients
Authors: Hammerle P , Schier J , Schlageter V , Knecht S , Aeschbacher S , Paladini R E , Coslovsky M , Conen D , Krisai P , Osswald S , Kuhne M , Meyer-Zurn C 
Published: May 2024

Abstract

Background
Sex-specific differences in cardiac autonomic tone have not been thoroughly investigated in patients with atrial fibrillation (AF) but may play a relevant role.

Purpose
We aimed to investigate cardiac autonomic function of female compared to male AF patients by means of short-term heart rate variability (HRV) analysis.

Methods
In this cross-sectional analysis, we enrolled 1150 patients from the Swiss-AF cohort study with 5-minute resting ECG recordings in sinus rhythm. We calculated the following HRV parameters: HRV triangular index (HRVI), standard deviation of NN intervals (SDNN), root mean square of successive differences, mean heart rate, power in the high frequency and low frequency range. We fitted linear regression models to analyze the association between gender and HRV variables adjusted for age, intake of betablockers, hypertension, diabetes and heart failure.

Results
361 patients (29%) were female (mean age 72.9±7.8 years), 789 (68.6%) were male (mean age 69.8±8.5 years). In the multivariable adjusted models, female sex was associated with significantly lower values of HRVI (β = -0.74; 95% CI -1.44- -0 04, p=0.039) and SDNN (β = 8.95; 95% CI 0.162-17.7, p=0.046). This association persisted in all three age tertiles (&lt;68 years, 68-75 years and ≥ 75 years of age).

Conclusions
In an elderly AF cohort, female sex is associated with reduced global autonomic activity. Whether this is associated with an adverse prognosis has to be investigated.
Morphological identification of brugada type 1 pattern using loop recorder: a feasibility study
Authors: Dinatale A , Crocamo A , Bearzot L , Gonzi G , Guidorossi A , Giacopelli D , Bassini M , Grassini D , Niccoli G , Ardissino D , Notarangelo M F 
Published: May 2024

Abstract

Introduction
The presence of spontaneous type 1 Brugada pattern (BP1) is associated with an elevated risk of arrhythmic events. Diagnosis of this condition is often underestimated due to its intermittent nature. While periodic ambulatory ECG monitoring can distinguish patients with pharmacologically induced patterns from those with spontaneous patterns, the diagnostic capabilities of this method are limited. Implantable cardiac monitors (ICM), designed to continuously record heart rhythm, may offer higher sensitivity in detecting patients with intermittent patterns. However, the ICM's ability to morphologically identify the ST segment elevation associated with BP1 remains uncharted.

Purpose
This study aimed to assess the ICM's capacity to morphologically identify the ST segment elevation associated with BP1.

Methods
We enrolled all patients who underwent ajmaline testing (AT) between November 2022 and September 2023 in our centre. For positive patients, the external simulator of a loop recorder was utilized to evaluate four positions (I-II left intercostal space at a 45° tilt, II-III left intercostal space at a 45° tilt, II-III right parasternal intercostal space, and II-III left parasternal intercostal space). These positions were selected to capture the trace with the most significant ST segment elevation at the J point during the peak positivity of the ECG during the ajmaline test. Measurements from the recorded traces were acquired using dedicated software.

Results
Out of 50 patients, 21 (male-to-female ratio 1.62:1, mean age 43.4±13.1 years) had a positive AT result. Seventeen patients exhibited ST segment elevation in the simulator trace during the highest ajmaline dose. Among these patients, the optimal recording position was in the I-II left intercostal space at a 45° tilt in 66.7% of cases. The median ST segment elevation recorded by the simulator was 0.9 mm (interquartile range 0.6-1.1 mm). Notably, there was no observed correlation between the extent of ST segment elevation in the ECG and that recorded by the simulator trace (Pearson linear coefficient = 0.09).

Conclusions
ICM may offer the potential to record BP1, a finding that holds significant diagnostic and prognostic implications for asymptomatic patients with pharmacologically induced BP1. Further research is needed to develop useful programming algorithms for the automatic recording of this pattern.
Validation of bidirectional cavotricuspid isthmus block using electrocardiographic imaging
Authors: Serrano-Campaner J , Pellicer-Sendra B , Reventos-Presmanes J , Hernandez-Romero I , Althoff T , Regany Closa M , Invers-Rubio E , Borras R , Guasch E , Porta-Sanchez A , M. Climent A , S. Guillem M , Roca-Luque I , Mont L , Guichard J B 
Published: May 2024

Abstract

Background
The validation of bidirectional cavotricuspid isthmus (CTI) block following catheter ablation for typical atrial flutter (AFL) involves endocavitary manoeuvres using multiple catheters. The diagnostic capacity of electrocardiographic imaging (ECGi) as a non-invasive tool to confirm bidirectional CTI block may simplify the procedure but its benefit has not been investigated so far.

Purpose
To evaluate the diagnostic capacities of a novel imageless ECGi system in detecting bidirectional CTI block during AFL catheter ablation.

Methods
A total of 34 patients were consecutively included in a prospective single-centre study. Atrial activation maps were derived from a novel imageless ECGi system when pacing the septal and lateral aspects of the CTI, gauging the technology's capacities to detect bidirectional block by measuring transisthmic intervals (TII) and observing wave-front collision patterns. TII reflects the time taken for electrical activation to cross the CTI during pacing and we measured both the absolute value and the increase relative to its baseline value. The bidirectional CTI block was assessed by endocavitary manoeuvres using a multipole catheter as the gold-standard. We conducted a blind assessment of the diagnostic capacities of ECGi over endocavitary manoeuvres considering maps from the septal and lateral pacing to determine clockwise and counterclockwise CTI block, respectively.

Results
Our study established clear benchmarks for diagnosing CTI block using ECGi (Figure 1). Regarding the assessment of clockwise CTI block, the presence of a wave-front collision pattern at the CTI yielded a positive predictive value (PPV) of 91% and negative predictive value (NPV) of 69%. Furthermore, ROC analysis pinpointed 100 ms and 30 ms as the optimal threshold for TII absolute value (PPV=89%, NPV =78%) and TII increase from baseline (PPV=91%, NPV =65%), respectively. Taking together, the combination of these three parameters offered high diagnostic capacities (PPV=87%, NPV=90%). Regarding counterclockwise CTI block, the TII absolute value alone was a reliable predictor, with a threshold derived from ROC analysis of 115 ms providing a PPV of 77% and a NPV of 83% (Graphical abstract).

Conclusion
These results highlight the efficacy of ECGi in CTI block assessment, promising a streamlined and accurate diagnostic approach (Graphical abstract). The use of a single ablation catheter coupled with ECGi to assess the bidirectional CTI block offers a simplified and efficient alternative to traditional dual catheter techniques.ECGi-based CTI block assessment methodGraphical abstract
31 vs 35 mm: a randomized comparison of the pentaspline pulsed field ablation catheter sizes
Authors: Schaack D , Tohoku S , Bordignon S , Urbanek L , Hirokami J , Ebrahimi R , Plank K , Chen S , Chun K R J , Schmidt B 
Published: May 2024

Abstract

Background
Pulsed-Field ablation (PFA) is a non-thermal tissue-selective energy source which is increasingly used for pulmonary vein isolation (PVI). A commercially available pentaspline PFA catheter can be transformed between different configurations and is available in two different sizes – 31 and 35 mm of diameter. No clear recommendations for when to choose which catheter size are available to date.

Purpose
We aimed to assess procedural and outcome differences of the two different catheter sizes.

Methods
We prospectively included all-comer patients between 07/2022 and 01/2023 who had paroxysmal or persistent atrial fibrillation (AF) and were scheduled for PVI with PFA. There were no exclusion-criteria. 100 patients were randomly assigned to be ablated with either the 31 mm or the 35 mm pentaspline PFA catheter. Patients were routinely scheduled for follow-up visits 6 and 12 months after the ablation.

Results
Each group consisted of 50 patients and baseline characteristics were comparable. For the 31 mm vs 35 mm group respectively: Mean age 68.5 years vs 68.2 years, mean BMI 28.0 vs 30.3 kg/m², male sex 60% vs 68%, paroxysmal AF 59.6% vs 53.1%, mean LA diameter 40.9 vs 40.3 mm.
Acute procedural efficacy defined as accomplishing PVI with the pentaspline PFA catheter was 100% in both groups. The procedural skin-to-skin time was numerically shorter in the 31 mm group (31.4 vs 34.3 minutes, p=0.11), which was attributed to a shorter ablation time (12.5 vs 15.1 minutes, p=0.052). Fluoroscopy time was significantly shorter (5.9 vs 7.1 minutes, p=0.015).
The overall freedom of arrhythmia at 180 days was 82,1%. The groups show a numerical difference in freedom of arrhythmia (31 mm: 91,9% vs 35 mm: 73,4%), but no statistically significant difference using the log rank test (p=0.14, Figure 1).
A total of 8 repeat procedures were performed in this patient collective for recurrent atrial arrhythmia - 3 in the 31 mm group, 5 in the 35 mm group. While the 3 repeat procedures in the 31 mm group showed no PV reconnections, 4 of the 5 patients in the 35 mm group had reconnected PVs (Fisher exact test p-Value=0.14). Overall, 25% (8/32) of PVs were reconnected, with the RSPV and RIPV being the most commonly reconnected veins (3 times each).

Conclusion
To the best of our knowledge, we provide the first randomized comparison of the two pentaspline PFA catheter sizes. Our data show longer procedure times and fluoroscopy times using the 35 mm device as well as a higher rate of PV reconnections especially at the septal PVs. Most importantly, we observe a trend towards worse clinical outcomes using the larger catheter. Longer follow-up times will be available at the time of presentation.Freedom from arrhythmia recurrence
Comparative analysis of clinical outcomes in repeat ablation for recurrent atrial tachyarrhythmia following initial pulmonary vein isolation with pulsed-field ablation and cryoballoon ablation
Authors: Tohoku S , Bordignon S , Schaack D , Hirokami J , Urbanek L , Chen S , Schmidt B , Chun J 
Published: May 2024

Abstract

Background
While pulsed-field ablation (PFA) holds promise for the initial catheter ablation performing pulmonary vein (PV) isolation (PVI) in patients with atrial fibrillation (AF), a repeat procedure remains necessary for those experiencing recurrent atrial tachyarrhythmia (ATA). This study aimed to evaluate the clinical outcomes of repeat procedures following the initial PFA in patients with recurrent ATA by comparing that following the initial CBA.

Methods
Patients who underwent a second ablation for recurrent ATA following initial PVI with pentaspline PFA or cryoballoon ablation (CBA) were included. Repeat ablation utilized radiofrequency current ablation with three-dimensional mapping guidance, involving repeat PVI combined with linear ablations when necessary. Acute data, such as documented arrhythmia before the repeat procedure, the number of reconnected PVs, procedural characteristics, and clinical follow-up, were analyzed.

Results
In total, 110 patients underwent initially successful PVI with PFA (N = 51) and CBA (N = 59), followed by a repeat procedure for recurrent ATA with a mean time interval of 365±299 days between the two procedures. The primary indication at the repeat procedure was atrial tachycardia (AT) in the PFA group (N = 27, 53%) and AF in the CBA group (N = 47, 80%).
The overall PV reconnection rate per vein was 22.1%, with no significant difference between the two groups (19.1% in PFA vs. 24.7% in CBA, P = 0.16). Repeat PVI was successfully performed in all patients with PV reconnection (41.2% in PFA vs. 55.9% in CBA, P = 0.12). PV reconnection was most commonly found at the right inferior PV in both groups (25.5% vs. CBA; 32.2%, P = 0.44). Additional substrate modification was conducted in 76.5% of the PFA group and 74.6% in the CBA group, respectively (P = 0.82).
The mean follow-up period was 349±280 days. The Kaplan-Meier curve indicated no statistical significance in the 1-year arrhythmia-free survival after the repeat procedure (62.4% in PFA vs. and 73.0% in CBA group, P = 0.54, Figure).

Conclusion
Comparable lesion durability between the initial PVI with PFA and CBA was unveiled during the repeat ablation. The second ablation for recurrent arrhythmia following initial PFA demonstrated a favorable clinical success rate at one year after the subsequent procedure, showing no significant difference compared to repeat ablation subsequent to CBA.arrhythmia-free survival after the repe
Radiofrequency catheter ablation for redo procedures after pulmonary vein isolation with the cryoballoon technique: 9-year outcome
Authors: Kettering K 
Published: May 2024

Abstract

Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation. Cryoablation has been shown to be a safe and effective technique for pulmonary vein isolation. However, there is a significant arrhythmia recurrence rate after cryoablation procedures and there are no established strategies for redo procedures in these patients. Therefore, we have summarized our experience with radiofrequency catheter ablation for redo procedures after pulmonary vein isolation with the cryoballoon technique (including an analysis of pulmonary vein conduction recovery patterns after procedures performed with the first or second generation cryoballoon).

Methods
Two hundred and twenty patients (paroxysmal AF: 140 patients, persistent AF: 80 patients) had to undergo a redo procedure after initially successful circumferential PV isolation with the cryoballoon technique (First generation: 110 patients (group A); second generation: 110 patients (group B)). The redo ablation procedures were performed using a segmental approach or a circumferential ablation strategy (three-dimensional mapping system) depending on the intra-procedural findings.

Results
During the redo procedure, a mean number of 1.6 re-conducting PVs were detected (using a circular mapping catheter; group A: 2.2 re-conducting PVs, group B: 1.0 re-conducting PVs). There was a slightly higher incidence of chronic PV reconnections related to the left-sided PV ostia than to the right-sided PVs in both groups. Furthermore, sites of chronic PV reconnection were found more frequently in the inferior parts of the PV ostia than in the superior parts. In 97 patients in group A, a segmental approach was sufficient to eliminate the residual PV conduction because there were only a few recovered PV fibers (1-3 reconnected PVs; group A1). In the remaining 13 patients in group A, a circumferential ablation strategy was used because of a complete recovery of the PV-LA conduction of all four pulmonary veins (group A2). In group B, a segmental approach was sufficient in nearly all patients (109/110) because there was only a minor reconnection of 1-2 PVs.
All recovered PVs could be isolated sucessfully again. At 108-month follow-up, 69.1 % of all patients were free from an arrhythmia recurrence (152/220 patients; group A: 72/110 patients (65.5 %), group B: 80/110 patients (72.3 %)). There were no major complications in both groups.

Conclusions
In patients with an initial circumferential PVI using the cryoballoon technique, a repeat ablation procedure can be performed safely and effectively using radiofrequency catheter ablation. In most cases only a few re-conducting PV fibers were found and therefore, a segmental re-ablation approach seems to be sufficient in the majority of patients (especially in patients treated with the second generation cryoballoon).