bluuebunny/crossref_metadata_2025_split huggingface dataset:
A cardiac rehabilitation and those effects using cardiopulmonary exercise testing in patients undergoing catheter ablation for atrial fibrillation
Authors: Maeda S , Kamata T K , Yonai R Y , Kawashima T K , Kawabata M K , Okishige K O , Atarashi H A , Hirao K H 
Published: November 2023

Abstract

Background
Patients with atrial fibrillation (AF) are more likely to have impaired social and physical function, impaired general health and mental and reduced quality of life and exercise tolerance (ET). From the AHA guideline, the indications of cardiac rehabilitation (CR) are for the patients with heart failure, coronary artery disease including coronary artery bypass graft surgery and percutaneous coronary intervention, after valve replacement, a pacemaker or implantable cardioverter defibrillator, however, the patients undergoing catheter ablation (CA) for AF is not included.

Purpose
The relationships between burden of AF and ET, and CR and those effects in patients undergoing CA for AF are unclear.

Methods
To evaluate ET, exercise intensity (METs) and oxygen consumption (VO2/W) at peak and anaerobic threshold (AT) points were measured using cardiopulmonary exercise testing (CPX) at 3 and 12 months later after the ablation procedure.

Results
This study included 50 consecutive patients (mean age: 68±12 y.o.) undergoing 1st ablation procedure for paroxysmal (PAF: n=28) or persistent AF (PEF: n=22), and all patients kept sinus rhythm after the procedure. Before ablation and after ablation 3 months later, value of exercise intensity and oxygen consumption were significantly lower in PEF patients at AT point ([Before] PAF vs. PEF = 3.3±0.7vs. 2.8±0.6 METs, p=0.02, 12.0±2.6 vs. 9.8±2.1 ml/kg/min, p=0.01, [3 months later] PAF vs. PEF = 3.7±0.9vs. 3.1±0.7 METs, p=0.04, 13.0±3.4 vs. 10.4±3.1 ml/kg/min, p=0.03, Figure 1). However, there were no significant differences between 2 groups at 12 months later. On the other hand, twenty patients received CR at hospital for 3 months (group-R) and 30 patients were recommended exercise at home (group-E). Interestingly, at 12 months after the ablation procedure, the value of exercise intensity at AT point was improved in 100% of patient in group-R versus those of 68% in group-E (+0.5±0.4 vs. +0.3±0.6 METS, p=0.02), and value of oxygen consumption at AT point was also improved in 100% of patient in group-R versus those of 68% in group-E (+2.4±2.4 vs. +1.3±3.0 ml/kg/min, p=0.02) (Figure 2).

Conclusion
This study demonstrates that AF is associated with ET and CA is effective for the improvement of their capacity. In patients with PEF, ET recovers close to PAF patients at 12 months. In addition, a CR is effective for further improvement of their capacity of ET in patients undergoing CA for AF.Figure 1Figure 2
Paradigm shift of catheter ablation of atypical atrioventricular nodal tachycardia: 3D mapping-based ablation of exits of slow pathway
Authors: Kawabata M , Maeda S , Kamata T , Kawashima T , Yonai R , Okishige K , Atarashi H , Hirao K 
Published: November 2023

Abstract

Background
In current practice, the ablation target of atypical atrioventricular nodal tachycardia (AVNRT) is the earliest atrial activation site in the coronary sinus (CS) or conventional slow pathway (SP) region.

Objectives
The purpose of this study was to map the site of earliest retrograde atrial activation using electroanatomic 3D mapping during atypical AVNRT and to evaluate successful ablation sites.

Methods
Forty-two patients with a total of 49 AVNRTs (slow/fast 30; fast/slow 15; slow/slow 4) underwent EP study and ablation. Among them there were 14 patients (10 women, 60±19 y/o) in whom 19 atypical AVNRT (fast/slow 15; slow/slow 4) were induced.

Results
The intracardiac electrocardiograms or 3D mapping of the exit site during tachycardia revealed that 7 patients had exit sites solely inside the CS (left inferior extension=LIE), 3 solely in the right postero-septal tricuspid annulus (TA) (right inferior extension=RIE), and 4 had both LIE and RIE exits. The distance from the CS ostium to LIE exits was 14±6 mm. RIE exits were located on the TA posterior to the CS ostium (between 5 and 6 o’clock in the LAO projection). Ablation targeting these exits or traditional SP succeeded in long term elimination of AVNRT in 13 of the 14 patients (93%). There were no complications.

Conclusions
Catheter ablation targeting the exit sites of LIE or RIE mapped at the CS or TA holds promise as an effective and safe alternative approach to the current targets of ablation for atypical AVNRT cases.Distribution of exit sites during atypicthe circuit of atypical AVNRT：the exit s
Recurrence after resolution of symptomatic atrioventricular block and correction of transient causes, should we keep an eye on everyone?
Authors: Grade Santos J , Ferreira B , Martinho M , Cunha D , Da Luz J , Ilchyshyn N , Baltasar O , Briosa A , Sebaiti S , Miranda R , Almeida S , Brandao L , Pereira H 
Published: November 2023

Abstract

Introduction
Atrioventricular block (AVB) can be associated with secondary causes, some of which are potentially reversible. Permanent Pacemaker (PPM) implantation is not recommended in transient causes that can be corrected and prevented. However there is a high rate of recurrence which eventually warrant PPM implantation.

Purpose
Our aim was to characterize the population which had recurrence of symptomatic AVB after having recovered from an index event and having corrected secondary causes.

Methods
We performed a retrospective analysis between February 2011 and November 2022 of all patients admitted with symptomatic second degree AVB (including 2:1 and high-grade), third degree AVB and atrial fibrillation with AVB who had a reversible cause capable of being corrected and had a recovery of rhythm without PPM implantation, in a single expert centre. AVB secondary to Acute Coronary Syndromes and patients who required PPM to tolerate bradycardia inducing drugs were excluded from analysis. Medical records were analysed for demographics, clinical data and outcomes.

Results
Of the 135 patients analysed, 25 fulfilled all inclusion criteria and were analysed. The mean age at analysis was 77±8 years with a male preponderance (52%).
The rhythm of presentation had been complete AVB for most of the cohort (68%). A prior ECG was obtained for most patients (92%), with atrioventricular (AV) conduction abnormalities identified in 28% of patients and intraventricular (IV) conduction abnormalities identified in 56% of patients. At index admission, bradycardic drug therapy was the most identified reversible cause (92%) and significant hyperkalaemia (categorized as above 5,5 mmol/L) was identified in 40% of patients.
In 20 patients (80%) there was recurrence of symptomatic AVB during follow-up (median time to recurrence of 11,5 months, minimum less than a month and maximum 130 months) which warranted a PPM implantation.
The independent predictors of recurrence were the presence of hyperkalaemia as a causal factor at index admission and of non-recurrence the dual therapy with bradycardic drugs at index admission (Qui square test for both p&lt;0,05).
The age, sex, prior of chronic kidney disease (with or without dialysis) prior AV or IV conduction abnormality, high dose bradycardic drug therapy at index admission, association between hyperkalaemia and bradycardic drug therapy and presentation rhythm different from complete AVB were non-significant.

Conclusions
Patients with a transient cause for symptomatic AVB which recovers with its correction have a high rate of recurrence in follow-up, particularly if the transient cause was hyperkalaemia , and only the initial presence of dual bradycardic drug therapy which was suspended predicted sustained recovery.
First month global longtudinal strain for predicting early pacemaker-induced left ventricular dysfunction (PIVD) six month after pacemaker implantation
Authors: Istananda V , Iqbal M , Hasan M 
Published: November 2023

Abstract

Background
Pacemaker-induced ventricular dysfunction (PIVD) and pacemaker-induced cardiomyopathy (PICM) emerged as a complication following right ventricular permanent pacemaker (PPM) implantation, showing a great occurrence in the first year. Finding an early predictor of PIVD and PICM is crucial in order to alleviate mortality, morbidity, and increase health-care cost efficiency.

Purposes
to find new predictor by analyzing effect of first month GLS using 2D-speckle tracking echocardiography and reduction of left ventricular ejection fraction (LVEF), known as PIVD, in the first 6 month after PPM implantation.

Methods
A single center, prospective cohort study was conducted to all patients with normal LVEF, indicated for PPM implantation. Data of GLS was measured before and after one month of PPM implantation. Data of LVEF was measured before and six month after PPM implantation. The change of GLS in one month after PPM implantation was measured as delta GLS, and the change of LVEF in six month was measured as delta EF.

Results
Fifty-three patients from May 2018 until October 2020 was enrolled for this study based on inclusion and exclusion criteria. Patient’s baseline characteristics show 62±14 years of age, most of them had hypertension (54.7%) and had single chamber pacemaker implantation (81.1%). Study analysis reveals that ejection fraction (EF) reduce significantly after six months pacemaker implantation (66,5±5,6% become 60,7±10.7%; p= &lt;0,00001). There were 6 patients (11.3 % ) suffering PICM. Correlation analysis between the change of GLS in the first month and the change of LVEF in the first six months after PPM implantation was statistically significant with moderate correlation (p&lt;0.00001; r= -0.486). Linear regression analysis shows that every 1 point decrease of first month GLS, affecting 1.83 point decrease of sixth month LVEF (b= -0.1837, p=&lt;0.00001).

Conclusion
There is significant moderate correlation between the change of GLS in the first month and early reduction of LVEF in the first 6 months after PPM implantation.The Scheme of Research Sampling Method
Procedure feasibility and mid-term follow-up of left bundle branch area pacing using stylet-driven pacing leads with a fixed-curve delivery sheath in patients with structural heart disease
Authors: Lee S R , Ahn H J , Kwon S , Choi E K , Oh S 
Published: November 2023

Abstract

Background
Recently, left bundle branch area pacing (LBBAP) has been performed using style-driven extendable screw-in leads with newly introduced pre-shaped delivery sheath in South Korea. There are limited data on the feasibility of LBBAP in patients with structural heart disease (SHD).

Purpose
To evaluate LBBAP procedure feasibility and mid-term follow-up data of LBBAP lead profile in pateints with SHD

Methods
Patients, in which LBBAP was attempted, were consecutively enrolled at the Seoul National University Hospital from January 2021 to December 2022. LBBAP was performed with stylet-driven lead (Solia S60, Biotronik) delivered through a delivery sheath (Selectra 3D, Biotronik). Procedure feasibility, LBBAP success rate, and mid-term LBBAP lead threshold were evaluated in patients with or without various type of SHD.

Results
A total of 121 patients were enrolled (mean age 73.5±12.2 years). Atrioventricular block was the most common indication (n=94, 77.7%), followed by atrial fibrillation with slow ventricular rate (n=12, 9.9%), sick sinus syndrome (n=10, 8.3%), and heart failure indicated cardiac resynchronized therapy (n=5, 4.1%). LBBAP success rate was 89.3% of total study population, deep septal pacing was achieved in 4.1%, and right ventricle apex pacing were performed in 6.6%. Fifty-one patients (42.1%) were accompanied by SHD (Figure). Patients with SHD had significantly lower left ventricular ejection fraction than those without SHD (54±13% vs. 62±5%, p&lt;0.001). Baseline QRS duration was longer in patients with SHD (107±26 ms vs. 135±35 ms, p=0.005). Although LBBAP success rate was significantly lower in patients with SHD than those without in total study population (80.4% vs. 95.7%, p=0.007), LBBAP success rate was not differ between two groups after excluding first 30 cases (98.1% in patients without SHD vs. 97.4% in patients with SHD, p=0.811) (Figure). Among patients with successful LBBAP, total procedure time was longer in pateints with SHD, but there was no significant difference of fluoroscopic time, bipolar V sensing, V pacing threshold, and V impedance between the two groups (Figure). Pateints with SHD had longer left ventricular activation time (LVAT) (80±13ms vs. 72±9 msec, p=0.003), but there was no statistically significant difference in the final QRS duration between the two groups (104±14 ms in patients without SHD vs. 111±14 msec in patients with SHD, p=0.955). During mean 19±6 months follow-up, there was no significant V threshold increase in both groups.

Conclusion
LBBAP using stylet-driven pacing leads in patients with SHD is feasible and safe as in patients without structural heart disease, even by an early experienced operator with LBBAP procedure.
Exploring underlying reasons for the difference in sex-specific survival following out-of-hospital cardiac arrest - a mediation analysis
Authors: Miedel C , Jonsson M , Rawshani A , Riva G 
Published: November 2023

Abstract

Background
Previous studies have indicated a poorer survival among women following out-of-hospital cardiac arrest (OHCA), but the mechanisms explaining this difference remains largely uncertain. This study aimed to assess the survival after OHCA among women men and explore the role of potential mediators, such as resuscitation characteristics, prior comorbidity, and socioeconomic factors.

Methods
This was a population-based cohort study including all emergency medical service-treated OHCA reported to the Swedish Registry for Cardiopulmonary Resuscitation in 2010-2020, linked to nationwide Swedish healthcare registries. The relative risks (RR) of 30-day survival were compared among women (exposure) and men (comparison) using modified Poisson regression and third variable effect analysis to investigate the importance of potential mediators in a stepwise approach.

Results
A total of 43,226 OHCAs were included, of which 14,249 (33.0%) were women. The crude 30-day survival among women was 6.2% compared to 10.6% for men (RR 0.58, 95% CI=0.54-0.62). Stepwise adjustment for shockable initial rhythm attenuated the association to RR 0.85 (95% CI=0.80-0.92), and further adjustments for age and resuscitation factors (witness status, emergency medical service response time, and location) attenuated the survival difference between sexes to null (RR 0.98; 95% CI=0.92-1.05). Third variable effect analysis showed that shockable initial rhythm explained approximately 50% of the negative association of female sex on survival. Older age and lower disposable income were the second and third most important variables. Previously known comorbidities explained only a very small portion of the sex difference in survival.

Conclusion
Women have a lower 30-day survival following OHCA compared to men. The poor prognosis is largely explained by the absence of shockable initial rhythm, older age at presentation and lower disposable income.Results from regression analyses
Coronary artery disease and the risk of life-threatening cardiac events after age 40 in long QT syndrome
Authors: Barsheshet A , Goldenberg I , Bjelic M , Buturlin K , Erez A , Goldenberg G , Chen A Y , Polonsky B , Mcnitt S , Aktas M , Zareba W , Golovchiner G 
Published: November 2023

Abstract

Background
Long QT syndrome (LQTS) and coronary artery disease (CAD) are both associated with increased risk of ventricular tachyarrhythmia. However, there are limited data on the incremental risk conferred by CAD in adult patients with congenital LQTS.

Objective
We aimed to investigate the risk associated with CAD and life threatening events (LTEs) in patients with LQTS after age 40 years.

Methods
The risk of LTEs (comprising aborted cardiac arrest, sudden cardiac death, or appropriate defibrillator shock) from age 40 through 75 years was examined in 1020 subjects from the Rochester LQTS registry, categorized to CAD (n=137) or no-CAD (n=883) subgroups.

Results
Survival analysis showed that patients with CAD had a significantly higher rate of LTEs from 40 through 75 years (35%) compared with those without CAD (7%; p&lt;0.001 for the overall difference during follow-up [figure]). Consistently, multivariate analysis showed that the presence of CAD was associated with a 2.5-fold (HR=2.47; p=0.02) increased risk of LTEs after age 40 years. Subgroup analyses showed that the presence of CAD vs. no CAD was associated with a pronounced &gt;4-fold (p=0.008) increased risk of LTEs among LQTS patients with a lower-range QTc (&lt;500 msec). The increased risk of LTEs associated with CAD was not significantly different among the 3 main LQTS genotypes.

Conclusions
Our findings suggest that CAD is associated with incremental risk of life threatening cardiac events in patients with LQTS. The incremental risk associated with the presence of CAD is pronounced in lower risk LQTS patients with QTc&lt;500 msec.
Novel scoring system for predicting mortality in patients with ventricular arrhythmias: Analysis from a 24,000 patient cohort
Authors: Deb B , Rogers A J , Tjong F V Y , Somani S , Desai Y , Azizi Z , Chang H J , Bhatia N K , Clopton P , Narayan S M 
Published: November 2023

Abstract

Background
Several scoring systems have been developed to predict mortality in ventricular tachycardias (VT) in selected populations (for example, patients undergoing ablation) with limited follow-up times. We aimed to develop a simple scoring system to predict all-cause mortality in a large cohort of VT patients followed up for &gt;10 years.

Methods
We mined electronic data from 2008 to 2022 from a large suburban academic and community healthcare system, for the endpoint of all-cause mortality in adults diagnosed with ventricular tachycardia using the ICD 10 code of I47.2. We related the endpoint to covariates including sex, race, socioeconomic factors and comorbidities identified with standard ICD codes (prior to the diagnosis of VT) using cox-proportional hazards model. We then tested a scoring system using coefficients developed in the training cohort (70%) in an independent test cohort.

Results
We identified 24278 adult patients diagnosed with VT. Of these, 2921 (12%) died within 249 (23,1095) days of diagnosis. Figure 1 shows factors associated with mortality, adjusted for race, gender and ethnicity, which were: congestive heart failure [HR:1.78; (1.62,1.96)] chronic kidney disease [HR:1.75; (1.60,1.91)] ,atrial fibrillation[HR:1.53; (1.40,1.67)], diabetes [HR:1.47; (1.35,1.61)] , coronary artery disease [HR:1.57; (1.43, 1.72)] , peripheral arterial disease [HR:1.29; (1.17,1.42)] , hypertension [HR:1.39; (1.26,1.54) , COPD [HR:1.21,1.50)] , and hyperlipidemia [HR:-.87; (0.80 -0.95)] . The novel 9-point (CKAD(ICV)SHL) score predicts mortality with a C-index of 0.66.

Conclusions
In a population of over 20 thousand patients with ventricular arrhythmias, a scoring system based on heart failure, CKD, AF and other factors predicts mortality. This may form a basis for revised efforts for screening, risk stratification and trial design for ICD placement and guideline directed medical management.
AMplitude Spectral Area (AMSA) is associated with one-year survival with good neurological outcome in out-of-hospital cardiac arrest
Authors: Gentile F R , Fasolino A , Aramendi E , Isasi I , Compagnoni S , Baldi E , Contri E , Palo A , Quilico E , Vicini Scajola L , Lopiano C , Primi R , Bendotti S , Currao A , Savastano S 
Published: November 2023

Abstract

Background
Patients resuscitated from Out-of-Hospital Cardiac Arrest (OHCA) with shockable rhythms are reported to have better survival rates. Amplitude spectral area (AMSA) of ventricular fibrillation (VF), a surrogate for the metabolic status of the myocardium, can predict shock success and return of spontaneous circulation (ROSC). There is minimal evidence regarding its role in predicting survival from OHCA, and the evidence that exists is limited to survival at discharge.

Purpose
To test the hypothesis that the first, the maximum, the minimum and the average values of AMSA are associated with one-year survival with good neurological outcome in OHCA patients.

Methods
All the OHCAs with at least one shockable rhythm, that occurred from January 2015 to December 2020 and collected from an Utstein-style database, were considered. AMSA values were calculated by retrospectively analyzing the data collected by the monitors/defibrillators used and by using a 2-second pre-shock ECG interval. The first, the maximum, the minimum and the average AMSA values during resuscitation were computed. Data were analyzed by using Cox regression analysis.

Results
250 patients (84% male, median age 67 [57-77] years) with at least one computable AMSA value were included; 12% achieved ROSC and 9.4% survived at one year with good neurological outcome, defined as Cerebral Performance Category (CPC) ≤ 2. The first, the maximum, the minimum and the average values of AMSA were higher in patients alive one year after OHCA with CPC≤2 (first: 11.6 [9.9-14.7] vs 7.8 [5.1-11.8]; max: 15.4 [12-20] vs 9.9 [6.2-14.4]; min: 9.9 [8.5-12.2] vs 6.1 [4.3-9.6]; avg: 12.5 [10.7-15.2] vs 8.3 [5.5-12]; all p &lt;0.01). These values showed similar areas under the curve of the receiver operating characteristic (ROC) curve for one-year survival with good neurological outcome (first: 0.77; max: 0.76; min: 0.78; avg: 0.78, p=ns). In univariable model, the survival probability with good neurological outcome was significantly lower in the first tertile (T1) of AMSA compared to the third one (T3; p&lt;0.05; figure). In multivariable analysis, after correction for sex, presence of bystander CPR, age, EMS arrival time, witnessed status, OHCA location, the use of mechanical CPR and the total amount of epinephrine administrated, AMSA was significantly associated with probability of death or poor neurologic outcome [HR 0.5 (95%CI 0.3-0.9), p=0.03].

Conclusions
This is the first study to evaluate the association between AMSA values and one-year survival with good neurological outcome. We found that AMSA is independently associated with one-year survival with­ good neurological outcome in OHCA patients and that the first, the maximum, the minimum and the average of AMSA values all have similar prediction power in survival rate with CPC≤2.