bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical outcome for heart failure hospitalizations in patients with leadless pacemaker
Authors: Nagashima M , Hiroshima K , Katsuki T , Ando K 
Published: November 2023

Abstract

Background
Leadless pacemaker has a low risk of complications such as infection, pneumothorax, and skin erosion, and it is good adaptation for elderly patients. While ventricular pacing induces ventricular desynchronization, and that is causes of heart failure. The aim of the present study, therefore, was to investigate the association between heart failure hospitalization and leadless pacemaker implantation.

Methods
Between September 2017 and January 2022, 929 consecutive patients were implanted pacemakers. The patients were divided according to types of pacemakers: leadless pacemaker (LPM group, n=368), and conventional pacemaker (PM group, n=561). The clinical outcome was heart failure hospitalization. Hospitalization was considered when patients presented with sign and symptoms consistent with heart failure and required intravenous therapy, and the indication of heart failure hospitalization was at the discretion of the physician. Follow-up visit was planned at 1, 3, 12, 24, and 36 months after pacemaker implantation. Clinical follow-up data were obtained from medical records and/or by telephone contact with the patients, families, or referring physicians.

Results
The median follow-up duration was 1.7 years (interquartile range 0.8-2.6 years). Hospitalization rate for heart failure in the LPM group was 9.3% at 1 year, 15.6% at 2 years, and 21.6% at 3 years, respectively. Adjusted heart failure hospitalization risk in the LPM group was significantly higher than the risk in the PM group (hazard ratio [HR] 1.70, 95% confidence interval [CI] 1.09-2.64, P=0.01). Patients with symptomatic bradycardia caused by sinus node dysfunction (SND) in the LPM group (n=150) were more admitted to the hospital for heart failure, compared with in the PM group (n=219) (HR 2.02, 95%CI 1.04-3.90, P=0.03), while no significant difference was observed between the two groups in the patients with bradycardia caused by atrial fibrillation (LPM group, n=71; PM group, n=18) or atrioventricular block (LPM group, n=147; PM group, n=324).

Conclusions
Hospitalization risk for heart failure was higher in patients with leadless pacemakers, compared with conventional pacemakers. The greater risk was mainly driven by older patients and patients with SND.
Clinical outcomes of cardiac devices in heart failure patients hospitalized with COVID-19: insights from the united states national inpatient database
Authors: Moras E , Gandhi K , Correa A , Mahmood K 
Published: November 2023

Abstract

Background
COVID-19 has caused global impact especially in patients with cardiac devices(CD). Moreover, since the onset of the COVID-19 pandemic, physicians have suspended nonurgent procedures. Scarce date is available with respect to CD implantations in patients with active COVID-19.

Purpose
We aimed to investigate the impact of COVID-19 on implantation rates and clinical outcomes in heart failure (HF) patients hospitalized for COVID-19.

Methods
Data from National Inpatient Sample database from 2020 was used to identify hospitalizations for COVID in HF patients. Clinical outcomes of CD implantations were compared using univariate and multivariate logistic regression analysis.

Results
From March-December 2020, a total of 20,426 CD were performed in HF patients in the United States, of which 0.9 % were among those with active COVID-19 infection. Patients with COVID were younger, more hispanic and black population, and had a higher prevalence of comordities such as ventricular fibrillation and complete heart block when compared to patients without COVID. CD implantation in patients with COVID had significantly increased in-hospital mortality, longer lengths of stay, higher hospitalization costs, and outcomes such as incidence of acute stroke, thromboembolism, and sepsis. Device related complications and the need for revisions were comparable in the two cohorts. After adjustment for baseline characteristics, COVID cohort had increased odds of in-hospital mortality.

Conclusion
Patients with active COVID-19 infection who underwent device implantation had increased in-hospital mortality, longer lengths of stay and higher hospitalization costs with comparable outcomes of device complications.Figure 1Figure 2
Clinical impact of permanent pacemaker implantation following surgical ablation of atrial fibrillation concomitant to mitral valve surgery: a multicenter study
Authors: Pyo W , Lee S H , Lee S 
Published: November 2023

Abstract

Background
Permanent pacemaker (PPM) implantation is a common adverse event following arrhythmia surgery. However, the epidemiology and clinical impact of PPM has been shown in only few studies in heterogeneous population, and the results are controversial.

Purpose
The present study aimed to investigate the clinical impact of PPM implantation following surgical ablation of atrial fibrillation (AF) concomitant to mitral valve (MV) surgery.

Methods
We identified 721 patients (aged 60.2±11.0 years, 437 females) who underwent surgical ablation of AF along with MV repair or replacement at five representative institutions in Korea between 2005 and 2017. Of these, 56 had PPM implanted (PPM group) and the remainder (n=665) did not receive a PPM (No-PPM group). The clinical outcomes were compared between the groups, and multivariable Cox proportional hazard analysis with time-varying covariate was conducted to determine the impact of PPM implantation on mortality and stroke.

Results
The patients in the PPM group were older, and had a higher CHAD2S2-VASc score than those in the No-PPM group (Table). During follow-up of 68.3 months (interquartile range 44.5-105.4 months), no significant survival difference was evident between the groups, however, the PPM group presented a significantly higher incidence of stroke than No-PPM group (p&lt;0.001) (Figure). On time-varying multivariable analysis, the PPM was not a risk factor for mortality (hazard ratio [HR], 0.44; 95% confidence interval [CI], 0.18-1.08; p=0.072), however, old age (HR, 1.10; 95% CI, 1.07-1.13; p&lt;0.001), chronic kidney disease (HR, 1.61; 95% CI, 1.01-2.58; p=0.046) and previous cardiac surgery (HR, 1.86; 95% CI, 1.01-3.21; p=0.027) were independent predictors of mortality in this subset of patients. The only significant risk factor for stroke was CHAD2S2-VASc score (HR, 1.27; 95% CI, 1.01-1.61; p=0.044), and PPM was not associated with risk of stroke (HR, 1.87; 95% CI, 0.71-4.90; p=0.202).

Conclusion
PPM implantation following surgical ablation of AF concomitant to MV surgery was not associated with an increased risk of mortality or stroke. This study result provides a supporting evidence for an active attempt in surgical ablation despite of inherent risk of PPM implantation.
ABC (Atrial fibrillation Better Care) pathway in asian patients: an analysis from the prospective Asia-Pacific Heart Rhythm Society Atrial Fibrillation Registry
Authors: Bucci T , Shantsila A , Romiti G F , Teo W S , Park H W , Shimizu W , Tse H F , Proietti M , Lip G Y H , Chao T F 
Published: November 2023

Abstract

Introduction
The "Atrial fibrillation Better Care" (ABC) has been proposed as an integrated approach to improve management in patients with atrial fibrillation (AF) based on 3 pillars: "A" Avoid stroke with Anticoagulation; "B" Better symptom optimisation through rate or rhythm control; "C" Cardiovascular risk factor management. There are limited prospective data on the clinical outcomes associated with ABC pathway adherence from Asian countries.

Purpose
To investigate the beneficial effect of ABC pathway adherence in the prospective multi-country Asia-Pacific Heart Rhythm Society (APHRS) Atrial Fibrillation registry.

Method
We investigated 4013 AF patients prospectively enrolled in the APHRS registry. Cox-regression analyses were performed to investigate the association between ABC adherence and clinical outcomes. Primary outcome was a composite of all-cause death, any thromboembolic events, acute coronary syndrome or percutaneous interventional procedures and new/worsening heart failure. Secondary outcomes were each component of the composite outcome and major bleeding.

Results
In the whole population, 1549 (38.6%) patients were ABC adherent (mean age 66±12 years; 33% female). After 1-year of follow-up, ABC pathway adherent patients had a lower incidence of composite outcome (4.0% vs 8.5%, p&lt;0.001), all-cause death (1.4% vs 4.0%, p&lt;0.001), cardiovascular death (0.3% vs 0.9%, p=0.013) and new/worsening heart failure (1.7% vs 2.7%, p=0.010), when compared to those ABC non-adherent. On multivariable Cox regression ABC pathway adherence was associated with a lower risk for composite outcome (Hazard Ratio 0.72, 95% Confidence Interval 0.53-0.97) and the reduction of the risk increased progressively with the number of the ABC criteria fulfilled. There was no statistically significant interaction in the clinical benefit seen between the different participating countries in the APHRS registry (pint=0.217).

Conclusion
In a large contemporary cohort of Asian AF patients, ABC pathway adherence was associated with a reduction of the risk for the composite outcome of all-cause death and cardiovascular events. This benefit was seen irrespective of enrolling country.
Evaluation of risk factors for long-term atrial fibrillation development in patients undergoing typical atrial flutter ablation: a multi-center pilot study
Authors: Yumurtas A C , Pay L , Tezen O , Cetin T , Yucedag F F , Arter E , Kadioglu H , Akgun H , Ozkan E , Uslu A , Kup A , Saylik F , Cinar T , Hayiroglu M I 
Published: November 2023

Abstract

Background/Introduction
Atrial flutter (AFL) and atrial fibrillation (AF) are the most commonly detected supraventricular arrhythmia and share similar pathophysiological mechanisms (1). After the successful ablation of AFL, AF frequently occurs in such patients in the long-term follow up (2). As emphasized in some studies, some mechanisms seem to predispose to the development of AF in AFL patients and approximately 20% of such kind of patients have accompanying AFL (3).

Purpose
We aim to analyze independent risk factors that predict the development of AF in patients who underwent typical AFL ablation.

Methods
Our study was designed as multi-center, cross-sectional and retrospective. A total of 442 patients who underwent typical AFL ablation at 3 different centers between January 1, 2018 and January 1, 2022 were included retrospectively. The patients after the ablation procedure were divided into those who developed AF and those who did not. The patients were followed up for an average of 12 (4-20) months. In the post-procedure period, atrial arrhythmias were investigated with 24-hour Holter and ECG at 1st month, 6th month, 12th month and at 6-month intervals thereafter.

Results
AF developed in 206 (46.6%) patients in the long-term follow-up. Age, hypertension (HT), obstructive sleep apnea syndrome (OSAS), previous cerebrovascular accident (CVA), left atrium antero-posterior diameter, severe mitral regurgitation, hemoglobin, blood glucose and HbA1c values were found to be significant in univariable analysis. According to multivariable analysis, HT (p=0.014; HR: 1.483 (1.084 – 2.030)), OSAS (p=0.008; HR: 1.520 (1.117 – 2.068)) and previous CVA (p=0.038; HR: 1.749) (1,031 – 2,968)) were independently associated with the development of AF in AFL patients who underwent ablation procedure.

Conclusion
In the present study, we found that HT, OSAS and previous CVA were independently correlated with the development of AF in the long-term follow-up of patients who underwent typical AFL ablation. We consider that AFL patients with such risk factors should be followed-up closely following cavo-tricuspid isthmus ablation for the development of AF.
Univariable and Multivariable Analyzes Kaplan - Meier Curves
Integrated epigenomic and network analysis identifies novel DNA methylation signature in atrial fibrillation
Authors: Infante T , Pepin M E , Ruocco A , Mauro C , Napoli C 
Published: November 2023

Abstract

Background
CD4+ T cells are associated with atrial fibrillation (AF) pathogenesis but mechanistic insights as well as epigenetic phenomena underlying the onset and progression of AF are not fully understood.

Purpose
To identify differential methylation signature in circulating CD4+ T lymphocytes isolated from AF patients and HS enrolled in the DIANA clinical trial through epigenome and network medicine approaches.

Methods
DNA was extracted from CD4+ T lymphocytes obtained from patients diagnosed with AF (n = 10) vs patients with no known arrhythmias (n = 11). DNA was then used for paired-end reduced representation bisulfite sequencing to quantify differentially methylated regions (DMRs). NetworkAnalyst tool was interrogated in order to build a specific protein-protein interaction network and identify hub differentially methylated genes (DMGs) in AF. We considered the centrality degree as main network topological measure and defined hubs those DMGs with a centrality degree &gt; 10.

Results
The analysis provided 7,846 DMRs (P&lt;0.05), associated with 5,373 annotated genes, among which 7,075 hyper-methylated and 771 hypo-methylated regions were uncovered (Figure 1A). Among the identified DMRs, 3,601 were located within gene promoters of which 3,513 were hypermethylated while 88 hypomethylated. Network analysis including the 50 top hyper- and hypomethylated DMGs, according to the differential methylation values, provided a heart specific subnetwork with 56 nodes and 611 edges and 51 seeds (Figure 1B). Although the DNA methylation trend showed a predominant hypermethylation pattern in CD4+ T cells from AF patients (Figure 1A), network analysis demonstrated that hypomethylation was prevalent in the top 15 hub DMGs. In particular, GSTK1, WWP1, PSMD6, TFRC, CDK5R1, HSPG2, WDFY3, WT1, USP49, ACOT7, LAMB2, ITGB7, SHARPIN, and PLXNB2 emerged as hypomethylated hub DMGs, while AIFM1, PFDN1, LMO3, CDK5RAP2, COL4A1, SEPT8, and CYTH4 resulted hypermethylated hub DMGs. Interestingly, several genes are involved in pathological mechanisms of AF in cardiac tissues such as inflammation, fibrosis and cardiac remodeling.

Conclusions
Our preliminary data represent the first global methylation analysis in circulating CD4+ T cells in AF. The validation of specific genomic regions and the detection of molecular pathways characterized by aberrant DNA methylation changes may help to clarify pathological mechanisms underlying AF, thus providing an important translational impact for novel diagnostic biomarker discovery and therapeutic target identification.Figure 1
Local changes in conduction velocity in the left atrium of atrial fibrillation patients undergoing pulmonary vein isolation
Authors: Meijer I , Keshtar S K , Kong X , Jiang C , Chang-Sheng M , Camara O , Marquering H A , Arrarte Terreros N , De Groot J R 
Published: November 2023

Abstract

Background
Electro-anatomical maps are standardly used to visualize anatomy and electrophysiological properties of the left atrium (LA) during pulmonary vein isolation (PVI) in atrial fibrillation (AF) patients.

Purpose
We sought to describe local differences in atrial conduction velocities (CVs), as a proof-of-principle, to study its association with tissue heterogeneity. We hypothesize that the variation and heterogeneity in these velocities throughout the LA carry important prognostic and diagnostic information, reflect the extent of remodeling and, in the future, might discern different subtypes of AF and treatment outcome.

Methods
We included AF patients who underwent PVI for the first time during 2021-2022. Electro-anatomical maps (EAMs) during sinus rhythm were acquired during the procedure and single data-points were projected on the patient-specific EAM-derived mesh of the LA. Patients were classified as persistent (AF lasting longer than 7 days and usually requiring electrical cardioversion) and paroxysmal (self-terminating AF episodes, lasting shorter than 7 days, mostly shorter than 24 hours) and were followed-up for 6 to 12-months. We determined unipolar voltages, activation times and computed local CVs for these patients. The CVs were normalized for each patients and reported as the median CV for each region containing enough points.

Results
We included 12 patients: 6 with paroxysmal and 6 with persistent AF. Patients in the paroxysmal group had larger median activation times and median CVs compared to the persistent group. The variability in voltage, activation time and CV was twice as large in the paroxysmal group (Table 1). Figure 1 displays an example of an electro-anatomical reconstruction of the LA of a paroxysmal AF patient showing the local median conduction velocity from an anterior and posterior view (Figure 1A and 1B) and the variance and distribution of median CV (Figure 1C). In this patient, we observed large local CV differences, which might reflect tissue heterogeneity (e.g. fibrosis).

Conclusion
We provided a proof-of-principle demonstrating that, with the use of conventional electro-anatomical maps, important information on heterogeneity and variance in local CVs can be quantified. We found a large variability in CV within and between patients. This can help discern different AF subtypes and might contribute to understanding different arrhythmogenic substrates and treatment outcome differences.
Elucidating the role of leukocyte telomere length in the risk of atrial fibrillation
Authors: Ardissino M , Von Ende A , Murgia F , Casadei B , Van Duijn C , Hopewell J C 
Published: November 2023

Abstract

Background
Atrial fibrillation (AF) is strongly associated with older age. However, it is unclear whether, in addition to chronological age, more advanced biological ageing confers AF risk. Previous studies suggest AF and peripheral leukocyte telomere length (LTL, a measure of biological ageing) are associated, but this relationship and the causal relevance remains controversial.

Purpose
This study aims to explore the role of LTL in risk of AF through observational analyses and Mendelian randomisation (MR).

Methods
UK Biobank (UKB) is a large prospective study of individuals 40 to 69 years of age in which 393,018 participants have measured LTL and genetic data available. Observational associations between LTL and incident AF (ascertained in hospital admission data) were estimated using Cox proportional hazards models adjusted for potential confounders (age at LTL measurement, body mass index, physical activity, smoking status, alcohol intake, ethnicity, Townsend deprivation index, and sex). MR analyses included 195 SNPS previously shown to have conditionally independent genome-wide significant associations with measured LTL. In UKB, causal effects of genetically-predicted LTL for AF risk were estimated using the inverse-variance weighted approach. Validation was undertaken in independent data from the AFGen Consortium (Nielsen et al. 2015). Sensitivity analyses to consider the potential effects of pleiotropy were also conducted (weighted median MR, MR-Egger and Radial MR).

Results
Among 385,851 participants with available LTL measurements and without AF at baseline, 26,639 (6.9%) developed AF during follow-up. Longer measured LTL was associated with lower risk of AF (HR=0.98, 95%CI=0.97-0.99, p=0.002), with the cumulative incidence of AF by LTL quartile shown in Figure 1. However, MR analyses did not support a causal association between genetically-predicted LTL and AF (OR=1.04, 95%CI=0.96-1.14, p=0.36). Sensitivity analyses were consistent with the primary MR results, and did not suggest unbalanced pleiotropy (MR Egger intercept, p=0.54). Radial MR identified 4 outlier SNPs (associated with height, adiposity, and blood cell traits) but results remained consistent after exclusion of these variants (OR 1.00, 95%CI 0.93-1.08, p=0.90). Validation analyses in independent data were consistent with the non-significant association observed in UKB (OR=1.08, 95%CI=0.99-1.18, p=0.07; Figure 2).

Conclusion
This study combines conventional and genetic epidemiological approaches to explore the role of LTL in risk of AF. Large-scale observational analyses in UKB suggest an inverse association between LTL and AF. However, despite previous studies reporting associations between genetically-determined LTL and AF risk factors, our validated MR results do not support a causal relationship between LTL and AF, and potentially suggest observational associations are due to residual confounding.Figure 1Figure 2
Predicting post-operative atrial fibrillation after heart surgery: clinical profile and biomarkers
Authors: Iglesias D , Rodriguez-Manero M R M , Fu X F , Martinez-Cereijo J M C , Agra-Bermejo R A B , Veiras-Del Rio S V D R , Taboada-Muniz M T M , Fernandez-Gonzalez A F G , Rivera-Caravaca J M R C , Lahoz A L , Arribas J M A , Canovas S C , Marin F M , Gonzalez-Juanatey J R G J , Eiras-Penas S E P 
Published: November 2023

Abstract

Objective
Post-operative atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery, increasing the morbidity and mortality of this specific patient population. We investigated the association of clinical, biochemical and molecular markers on several tissues with the occurrence of POAF in patients undergoing coronary and/or valve surgery.

Methods
Between August 2020 and September 2022, patients undergoing cardiac surgery without previous history of AF were studied. Clinical variables were collected before the surgery, plasmatic samples and biological tissues (epicardial and subcutaneous fat) were obtained the day of surgery. We observed the development of POAF during the post-operative period. Logistic regression analyses were carried out in order to identify the predictors with better performance. Patients were followed-up until hospital discharge.

Results
Out of 123 consecutive patients without prior history of AF, 43 developed POAF during hospitalization. Significant clinical differences were associated with POAF, such higher EuroSCORE II, left atrial dimension and longer cardiopulmonary bypass times. Logistic regression analysis also showed orosomucoid (a biomarker associated with the inflammatory pathway) as the best predictor for POAF [odds ratio (OR) 7.175 (95% confidence interval (CI), 2.172-23.701), p=0,001].

Conclusions
In patients referred for open heart surgery, orosomucoid at the moment of surgery is an independent risk factor for the development of POAF and its addition to EuroSCORE II increased the predictive ability.