bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictive capacity of combined P-wave-indices-CHA2DS2-VASc Score in sinus node dysfunction patients without atrial fibrillation
Authors: Dong H , Zhang Y , Yang Y , Wang S , Wei Y , Liu F , Li Z , Zhang J , Xia Y , Yang X 
Published: November 2023

Abstract

Background and Aims
Isolated sinus node dysfunction (ISND) is sinus node dysfunction without atrial fibrillation. A high risk of ischemic stroke (IS) has been reported in western ISND populations, but its epidemiology in Chinese populations remains unknown. Moreover, anticoagulation therapy is not recommended in ISND management under current guidelines, partially due to the lack of a precise predictive score to evaluate IS risk. In Chinese ISND patients, IS incidence and IS-risk prediction capacity of a new score incorporating P-wave indices (PWIs) should be investigated.

Methods
In this longitudinal cohort study with prospective design, 1185 ISND patients were analyzed. Hazard ratios (HRs) and 95% CIs of PWIs for IS were estimated by Cox proportional hazards models. Based on HRs of significantly abnormal PWIs and CHA2DS2-VASc score, new score was constructed. IS prediction improvement was assessed by discrimination, calibration, and clinical effectiveness. The cutoff value of the new score was explored by restricted cubic spline analysis.

Results
124 (10.46%) ISND patients developed IS (yearly rate: 1.63%; 95% CI: 1.49%-1.78%) after a median follow-up time of 3.02 years. In them, P-wave terminal force in ECG-lead V1 (PTFV1) was the only significantly abnormal PWI (adjusted HR: 2.56; 95% CI: 1.72–3.80). We incorporated PTFV1 results with the CHA2DS2-VASc score to generate a P-combined score. For 5-year IS risk, P-combined score improved the area under the receiver operating characteristic curve (95% CI) from 0.647 (0.590-0.703) to 0.706 (0.652-0.760) and improved Harrell's C-statistic (95% CI) from 0.678 (0.618-0.738) to 0.716 (0.657-0.774). The categorical net reclassification improvement and the relative integrated discrimination improvement were 0.248 (0.120-0.363) and 0.021 (0.008-0.035), respectively. The calibration and decision curve analysis shown improvement at the same time. The cutoff value (P-combined score=3) by restricted cubic spline analysis was confirmed.

Conclusions
Chinese ISND patients have a higher IS risk than the general population. Incorporating PWIs into a P-combined score increased IS prediction capacity for ISND patients. Accurate stratification of IS risk should facilitate anticoagulation therapeutic strategies in ISND patients after further randomized trials with P-combined score-predicted high-risk ISND patients.Structured Graphical Abstract
Prevalence and awareness of vasovagal syncope in a large cohort study
Authors: Tajdini M , Bijar A R E F , Sadeghian S A E E D , Vasheghani-Frahani A L I , Bozorgi A L I , Mehrani M E H D I 
Published: November 2023

Abstract

Background
Despite the important nature of vasovagal syncope, the true prevalence of this disorder is not fully determined. Based on the limited data available in the literature, among young medical students less than 21 years, the prevalence of vasovagal syncope has been estimated to be 39%, increasing to 50% in life time for all subjects. There are no robust studies with adequately powered sample size to assess the prevalence of this disorder in the general population.

Purpose
In this study, we aimed to determine the prevalence of vasovagal syncope in a large general population by conducting a cross-sectional survey.

Methods
A systematic sampling method was used to enroll a representative sample of adults from all metropolitan areas. A total of 4,215 households including 9,170 adults over 35 years were invited for interviews and 8,296 individuals (90.5%) participated in the study. The participants were interviewed using comprehensive questionnaire, detailed history, 12 leads electrocardiogram and physical examination. Participants with a history of transient loss of consciousness were asked to complete detailed assessments based on the Calgary Syncope Symptom Score.

Results
Of the 8,296 subjects, 447 (5.4%) reported transient loss of consciousness and 406 (4.9%) had a score greater than -2 on the Calgary Syncope Symptom Score in favor of vasovagal syncope. The overall prevalence of vasovagal syncope was 4.9% (73.7% were female). The percentage was 2.9 and 6.5 in men and women respectively. Although 53% of the patients had 2 or more syncopal attacks in their lifetime and 23% of all attacks were traumatic, only 26 percent of patients were aware of the diagnosis and consulted a physician. The age distribution of vasovagal syncope in women after 25 years follows a decreasing pattern. In men, the prevalence of syncope increases until the age of 50 and decreases thereafter (Figure). There were no differences between patients with vasovagal syncope and other participants in terms of ECG findings and cardiovascular risk factors (Table).

Conclusions
Vasovagal syncope has a notable prevalence in the general population and women are mostly affected. Recurrences (even traumatic ones) happen but only a few of patients know their diagnosis and basic treatments such as life style modifications. This is the first study to report the prevalence of vasovagal syncope in the general population and population-based educational programs are strongly recommended given the high recurrence rate, risk of trauma and decreased quality of life.
Atrioventricular-synchronous leadless pacemakers: a single center experience
Authors: Reis Santos R , Gomes D , Cavaco D , Carmo J , Paiva M S , Lopes P M , Matos D , Rodrigues G R , Carvalho M S , Costa F M , Santos P G , Carmo P , Morgado F B , Adragao P 
Published: November 2023

Abstract

Background
Leadless pacemakers allow atrioventricular (AV) synchronous pacing using a new software to detect atrial contraction with a 3- axis accelerometer. Notwithstanding, evidence supporting its use is still scarce and only limited real-world data have been reported.

Aim
To evaluate the feasibility and to describe pacing outcomes of AV-synchronous leadless pacemakers.

Methods
Consecutive patients with AV block referred to leadless pacemaker MicraTM at single center between June 2020 and November 2022 were retrospectively included. Patients were evaluated at two distinct times during follow-up and parameters from sensed atrial tracking were calculated: tracking index (atrial mechanical sense followed by ventricular pace [AM-VP] divided by total VP) and total AV synchrony (sum of AM-ventricular sense [AM-VS], AM-VP, and AV conduction mode switch).

Results
A total of 43 patients (mean age 78 ± 11 years; 72% male) were included. Pacing indication was complete AV block in 29 patients (67%) and high-grade AV block in the remaining 14 (33%). Mean implantation and fluoroscopy times were 48 ± 22 minutes and 4.5 ± 3.9 minutes, respectively. One major peri-procedural complication was reported: a cardiac tamponade, treated with pericardiocentesis. The first outpatient visit occurred at a mean follow-up of 3.2 ± 4.1 months after the implantation procedure. Overall, at the first screening, 47% of patients required at least 50% pacing; mean tracking index was 65 ± 16% and mean total AV synchrony was 80 ± 18%. Specific pacemaker parameters were adjusted according to physician’s discretion, namely A3 and A4 thresholds and A3 window. Thirty-seven patients performed 2 follow-up visits, 8 ± 5 months after the first visit. In comparative analysis between both follow up times, mean total AV synchrony remained stable (80 ± 17% vs. 80 ± 15%, p=0.970) and there was a numerical improvement of tracking index by 6 ± 13% (65 ± 15% vs. 71 ± 16%, p=0,059). During the follow-up, 7 patients (16%) died, none related to the procedure nor the device.

Conclusions
Implantation of AV-synchronous leadless pacemakers is feasible and safe. In our cohort, there was a numerical increased of atrial tracking and a stability of AV synchrony during follow-up.
The number of screwing attempt and predictors for the success of left bundle branch area pacing : A multicenter experience with standard stylet-driven pacing leads
Authors: Kim T H , Yu G I , Yu H T , Uhm J S , Kim D , Joung B , Pak H N , Lee M H 
Published: November 2023

Abstract

Objectives
Although Left Bundle Branch Area Pacing (LBBAP) is emerging conduction system pacing modality, it is unclear which parameters are predictive of procedural success and how many screwing attempts are acceptable. This retrospective observational study sought to assess predictors of successful LBBAP, left bundle branch (LBB) capture, and factors associated with the number of screwing attempts.

Methods
We performed a multicenter retrospective analysis of 120 patients who underwent LBBAP with stylet driven lead. We analyzed factors affecting the number of screwing attempts and procedural success. Procedural, 12-lead ECG, echocardiographic parameters and clinical variables were used in multivariate analyses.

Results
LBBAP success rate was 95.8% (115/120), and LBB capture success rate was 86.1% (99/115). Few screwing attempts was associated with procedural success (2.1 ± 1.2, 2.7 ± 1.2, and 3.5 ± 1.3 in LBBAP with LBB capture, LBBAP without LBB capture and failed LBBAP group, respectively) (p for trends=0.03). 4 or more screwing attempt was independently associated with higher complication rate compared to fewer screwing attempt (n≤3) (p&lt;0.05). The larger RA size (B = 1.901, 95% confidence interval [CI] 1.07 - 2.73, p &lt;0.001), smaller RV size (B = -0.995, 95% CI -1.88 - -0.31, p = 0.007), and intraventricular conduction delay (IVCD) at pre-implant ECG were independently associated with more screwing attempts. Larger RA size (4th quartile) was associated with larger final sheath size and frequent sheath size change to larger sheath when compared to others.

Conclusions
More screwing attempts was associated with failed LBBAP procedure and failed LBB capture, and 4 or more screw attempts was associated with higher complication rate. Larger the RA size, smaller the RV size, and IVCD in pre-implant ECG are predictive of more screwing attempt.
Prediction of sinus tachycardia after cardioneuroablation: the utility of atropine test
Authors: Stiavnicky P , Haskova J , Peichl P , Stojadinovic P , Borisincova E , Jansova H , Cihak R , Kautzner J , Wichterle D 
Published: November 2023

Abstract

Background
Acceleration of sinus rhythm (SR) due to parasympathetic denervation of sinus note is a favourable sign during cardioneuroablation (CNA) for the treatment of functional bradyarrhythmias. On the contrary, a faster heart rate may be symptomatic in some patients.

Purpose
We investigated predictors of sinus tachycardia at the 3-month post-CNA visit.

Methods
An atropine test (2 mg IV) was performed before the procedure. The endpoint of CNA was complete denervation of the sinus node as assessed by extracardiac vagus nerve stimulation. Sinus tachycardia was defined as a sinus rate ≥100 bpm at the 3-month post-CNA outpatient visit. Factors independently associated with post-CNA SR were investigated by multivariate analysis. Using regression coefficients, a composite continuous-scale index (CCSI) estimating the post-CNA SR was constructed and used for sinus tachycardia prediction.

Results
The study included 160 patients aged 40 ± 12 years, 56% men, with baseline SR of 63 ± 15 bpm, post-atropine SR of 107 ± 21 bpm, and SR 3-month post-CNA SR of 83 ± 15 bpm. Nineteen patients had sinus tachycardia at a 3-month visit after CNA. Age, gender, baseline SR and post-atropine SR were significantly (and the latter two independently) associated with 3-month post-CNA SR. The CCSI (defined as 36 + 0.32 * baseline SR + 0.25 * post-atropine SR) correlated with 3-month post-CNA SR (Figure) and provided an area under the curve of 0.87 in the analysis of receiver operating characteristic. The CCSI &gt;90 predicted the 3-month post-CNA sinus tachycardia with a sensitivity of 74% and specificity of 86%.

Conclusion
Sinus tachycardia at 3 months after CNA can be predicted by the baseline and post-atropine sinus rate. This can help to select patients who may benefit from less rigorous sinus nodal denervation to avoid potentially symptomatic sinus tachycardia after the CNA.
Homozygous or compound heterozygous variants in DSG2 are mainly causative of Japanese arrhythmogenic right ventricular cardiomyopathy
Authors: Sonoda K , Nagase S , Aiba T , Kato K , Fukuyama M , Kikuchi N , Shiga T , Horie M , Ohno S 
Published: November 2023

Abstract

Background
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy mainly caused by desmosomal gene variants. Previously, we showed that the genetic backgrounds of ARVC in Japanese was different from those in Caucasian and that DSG2 was the most common causative gene.

Purpose
We aimed to confirm the inheritance mode of Japanese ARVC caused by pathogenic variants in DSG2. Furthermore, we reassessed the difference of phenotypes depending on the genotype.

Methods and results
Among 153 ARVC probands diagnosed with definite, borderline or possible by TFC2010 excluding the criteria of family history, 66 had one or more DSG2 variants (25 homozygous, 26 compound heterozygous, 11 multiple variants with unknown allele origin and 4 heterozygous). In the family screening, 62 relatives carried DSG2 variants (2 homozygous, 6 compound heterozygous, 54 heterozygous). All family members with a heterozygous DSG2 variant were not fulfilled ARVC diagnostic criteria. These results indicate that most of ARVC caused by DSG2 variants is an autosomal recessive disease. Therefore, 62 probands who have multiple DSG2 variants were included as pathogenic DSG2 variants carriers in following analysis. Figure A shows the genotypes in Japanese ARVC probands. We compared the clinical characteristics of the probands with DSG2 variants to those with PKP2 ones (N = 28). DSG2 variant carriers hospitalized for heart failure at younger age (42 ± 17 vs. 64 ± 13 years, P = 0.003) and had lower LVEF at diagnosis (51 [39 - 60] vs. 60 [55 - 65] %, P = 0.004). On the other hand, PKP2 variant carriers suffered atrial fibrillation more frequently (N = 7 (25%) vs. N = 5(8%), P = 0.04) and sustained VT at younger age though it was not statistically significant (38 ± 18 vs. 47 ± 15 years, P = 0.055). Finally, we analyzed the genotype effect on the incidence of lethal ventricular arrhythmia (LVA). The cumulative incidence in probands with each causative gene is shown in Figure B. Using multivariable analysis, we confirmed that PKP2 variant carriers had higher risk for LVA after adjusted by sex, medication, catheter ablation and device implantation (HR 2.904; 95% CI 1.530 – 5.513, P = 0.001).

Conclusion
DSG2 was the most common causative gene for ARVC in Japanese, and their mode of inheritance was mainly autosomal recessive. While DSG2 variants were associated with LV involvement and heart failure, PKP2 variants were risk for ventricular arrhythmia. Our findings would be helpful for diagnosis and prognosis for the ARVC patients.Genotype of Japanese ARVC probandsCumulative incidence of LVA
An online international survey study into the incidence and potential reasons of therapy non-adherence in catecholaminergic polymorphic ventricular tachycardia: preliminary results
Authors: Peltenburg P , Van Den Heuvel L M , Kallas D , Probst V , Blom N A , Wilde A A M , Clur S A , Van Der Werf C 
Published: November 2023

Abstract

Background
Since the first description of catecholaminergic polymorphic ventricular tachycardia (CPVT), a rare inherited cardiac arrhythmia, effective medical therapy to prevent the arrhythmic events – syncope, sudden cardiac arrest, sudden cardiac death – have been described. However, a significant proportion of patients experience breakthrough events despite optimal medical therapy, which are regularly associated with therapy non-adherence.

Purpose
To investigate the incidence of and potential reasons for therapy non-adherence in a large cohort of patients with CPVT.

Methods
An online survey was created in Dutch, English, and French and shared with CPVT patients at the outpatient clinic, through peer-recruitment, and on social media from November 1, 2022 onwards. Self-reported non-adherence was measured using the validated Medication Adherence Rating Scale (MARS, contains five 5-Point Likert scale questions, non-adherence was defined as a score &lt;22). The Beliefs about Medication Questionnaire (BMQ, eleven 5-Point Likert scale statements regarding concern and necessity of CPVT medication and eight 5-Point Likert scale questions regarding overuse and harm of medication in general) and Illness Perception Questionnaire (IPQ, statements rated with a scale from 0 to 10) were used to explore associations between patient beliefs and non-adherence.

Results
After three months, 85 patients had completed the survey, of whom 77 (91%) used medication (32 [42%] used a beta-blocker, 5 [6%] flecainide, and 40 [52%] beta-blocker and flecainide dual therapy). Of the patients using medication, current median age was 37 (interquartile range [IQR]: 26-55) years, 56 (73%) were female, and 15 (20%) suffered from syncope, aborted cardiac arrest or appropriate ICD shock after diagnosis. Ten (13%) of the patients were non-adherent. Clinical characteristics of non-adherent patients did not differ from adherent patients (Table). Non-adherent patients reported a significantly higher agreement with statements regarding concern about CPVT-related medication (17.5 [15.2-20.8] vs. 14.0 [12.0-18.0], p=0.039), specifically the statement about unpleasant adverse effects (4.0 [3.2-4.8] vs. 3.0 [2.0-4.0], p=0.008, Figure). The IPQ statements did not differ between non-adherent and adherent patients (Figure).

Conclusion
Preliminary data of this survey study shows that the rate of self-reported non-adherence is significant and is associated with concern regarding CPVT-related medication. This knowledge could assist in improving patient education aimed at therapy adherence. In addition, this preliminary data show that it is feasible and useful to study non-adherence in a CPVT population using online surveys.TableFigure
Long-term outcomes in carriers of the familial idiopathic ventricular fibrillation linked to the DPP6 locus
Authors: Bergeman A , Hoeksema W F , Van Der Ree M H , Postema P G , Wilde A A M , Van Der Werf C 
Published: November 2023

Abstract

Background
Idiopathic ventricular fibrillation (IVF) is a malignant condition with no clinical sequelae except for ventricular fibrillation. The genetic basis is ill-defined but in 2009 a Dutch founder variant - the DPP6 risk haplotype - was linked to a familial form of IVF characterized by a very high incidence of sudden cardiac arrest (SCA) and sudden cardiac death (SCD). Consequently, for more than a decade asymptomatic haplotype-carriers from the ages of 18 (male) and 25 (female) have had an implantable cardioverter-defibrillator (ICD) inserted. However, the associated long-term outcomes in these individuals is unknown.

Purpose
To assess the long-term outcomes of DPP6 risk haplotype-carriers who presented to our tertiary referral center and qualified for ICD insertion.

Methods
Clinical follow-up information of DPP6 risk haplotype-carriers, including the occurrence of SCD, SCA, appropriate ICD shocks, and ICD-related complications, was collected through February 2023. ICD-carriers were classified as either asymptomatic (primary prevention), or with previous sudden cardiac arrest (secondary prevention). Survival rates are presented using a survival curve and were compared with the log-rank test.

Results
A total of 118 haplotype-carriers (62 males) were included. One-hundred nine (92%) carriers had an ICD inserted, for primary (n=85) or secondary prevention (n=24), and 9 patients refused a primary prevention ICD. Among primary prevention ICD-carriers and those who refused implantation (n=94), 9 (10%) patients experienced a total of 28 appropriate shocks, there was 1 SCA and no deaths, during a median follow-up of 11 years (IQR 7-13; Figure). Of these, 9 patients were ever treated with quinidine and 5 still used quinidine at last follow-up. Among secondary prevention ICD carriers, 20 (83%) patients experienced a total of 225 appropriate shocks and one patient died, during a median follow-up of 13 years (IQR 10-16). Of these patients, 11 were ever treated with quinidine, of whom one patient discontinued quinidine due to adverse effects. Overall, 14 (13%) patients experienced inappropriate shocks and 16 (15%) experienced other ICD-related complications.

Conclusion
Predictive genetic testing of the DPP6 haplotype provides the unique opportunity to identify asymptomatic family members at risk for SCD and insert prophylactic ICDs just on the basis of carrying the risk haplotype. Approximately 10% of DPP6 haplotype-carriers who qualified for ICD insertion for primary prevention, predominantly males, experienced appropriate ICD shocks or SCA during 11 years of follow-up, indicating that our approach to ICD implantation has presumably saved several lives. In those with an ICD for secondary prevention the incidence of appropriate ICD shocks was high, often despite quinidine therapy.Survival until appropriate shock or SCA
Asthma and the risk of cardiac events among patients with long QT Syndrome after age 40
Authors: Golovchiner G , Goldenberg I , Buturlin K , Erez A , Goldenberg G , Chen A Y , Polonsky B , Mcnitt S , Aktas M , Zareba W , Barsheshet A 
Published: November 2023

Abstract

Background
The effect of asthma on the clinical course of long QT syndrome (LQTS) in the middle and old age population has not been studied.

Purpose
The present study was designed to investigate the association between asthma comorbidity, β2-agonist treatment and cardiac events among LQTS subjects after age 40 years.

Methods
The risk of cardiac events (comprising syncope, aborted cardiac arrest, implantable defibrillator shock, or sudden cardiac death) from age 40 through 75 years, by the presence of asthma and time-dependent β2-agonist use was assessed among 1020 LQTS patients from the LQTS Registry.

Results
Asthma was identified in 162 (16%) study patients and 63% of asthma patients received β2-agonist inhalers. Patients with asthma vs. no asthma had a higher cumulative rate of cardiac events during follow-up (44% vs. 26%, respectively; p&lt;0.001 [Figure: left panel]). Consistently, multivariate analysis demonstrated that asthma was a powerful predictor of cardiac events with an associated 2-fold (HR=1.97, p=0.001) increased risk for cardiac events as compared to patients with no asthma. β2-agonist inhalers use was associated with a similar increased risk for cardiac events (HR =1.90, p=0.035) among all study patients (Figure: right panel]). Subgroup analysis did not show a statistically significant difference in the association of asthma with cardiac events by risk subsets of LQTS patients, including QTc duration, syncope prior to age 40 years, beta-blocker use, sex, and the LQTS genotype (all p-values for risk subset-by-asthma interaction &gt;0.10).

Conclusion
The presence of asthma and β2-agonist treatment are associated with an increased risk of cardiac events among middle and old age patients with LQTS.