bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiovascular risk factor profile in patients admitted to a community-based cardiac rehabilitation program after one year: what risk factors are not being controlled?
Authors: Salgueiro D , Borges M , Pires M , Guerreiro C , Pinto F , Abreu A , Pinto R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac rehabilitation (CR) is a multidisciplinary intervention designed to reduce cardiovascular (CV) risk, encourage healthy behaviors, reduce physical impairment, and promote an active lifestyle. After completing a phase II CR program, it is important to maintain long-term CV risk factor control. However, many patients do not achieve or maintain lifestyle and risk factor targets on a long-term basis. Therefore, it is of interest to understand which risk factors are not reaching the targets to better understand and personalize long-term community-based CR programs.

Purpose
To characterize the modifiable CV risk factors profile in coronary artery disease (CAD) patients admitted to a community-based phase III CR program, including lipid profile, overweight/obesity, physical activity (PA) and sedentary behaviour (SB), at the beginning and after completing the first year of the CR program.

Methods
This retrospective cohort study included CAD patients that attended for 1-year a community-based phase III CR program. At the beginning (M0) and after one year (M1) of the CR program, all patients performed a risk profile assessment including: Lipid profile [total cholesterol (total-c), high density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL)], body mass index (BMI), PA and SB. BMI was assessed with the patient's weight in kilograms divided by the square of height in meters and lipid profile values were obtained from blood testing. PA and SB were objectively measured by using an accelerometer. All participants attended supervised exercise sessions, 3x week, 60 mins, including aerobic and resistance exercises, 3 educational sessions and a nutritional counseling consultation per year.

Results
In the sample of 159 patients at baseline (81.8% male, mean age 61±10 years, BMI: 28.3±4.3 kg/m²), overweight and obesity proved to be the most prevalent risk factor (80.7%), followed by uncontrolled LDL levels (74.8%). After a 1-year intervention (n=48, 90% male, mean age 62±10 years), LDL levels were kept above the targets (M0: 73.3±28.9 mg/dL and M1: 68.6±19.6 mg/dL, p=0.186), BMI did not change (M0: 27.5±3.9 kg/m² and M1: 27.8±4.0 kg/m², p=0.168) and SB remained high (M0: 11.50±2.90 hours/day and M1: 11.58 ± 2.71 hours/day, p=0.908). Although, moderate to vigorous PA (MVPA) decreased (M0: 343±195 mins/week and M1: 293±164 mins/week, p&lt;0.001), participants were still on target, between 150 to 300 mins MVPA week.

Conclusion
Our findings show that after a 1-year of a phase III CR program intervention CVD patients maintained MVPA recommended levels, but did not reach body composition, lipid profile, and SB targets. Future strategies should be implemented in long-term CR programs to better control LDL, body composition and SB.
Overview of Cardiac Rehabilitation (OCRE) in European Society of Cardiology (ESC) Member Countries
Authors: Ruivo J R , Trine Moholdt T M , Abreu A A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Despite unambiguous guideline recommendations, the implementation of Cardiac Rehabilitation (CR), a cost-effective strategy of secondary prevention with the potential to reduce cardiovascular morbi-mortality, remains heterogeneous, mostly suboptimal, in Europe. A previous "Overview of CR in ESC member countries" (OCRE) analysis reported on diverse national uptake rates and singled out possible common CR provision and quality surrogates contributing to the distinct performances. However, an integrated understanding of the overall status and concomitancy of the provision and quality indicators (or the lack thereof) in each country was still lacking.

Purpose
The present OCRE analysis aimed to further characterize and compare ESC affiliated national CR settings, by scoring the national overall provision and quality status, and to describe the matching between both.

Methods
An online survey concerning key CR provision and quality indicators was sent to the network of National CVD Prevention Coordinators of ESC member states, whose answers were supported by published evidence and/or national expert consensuses. To summarize the findings from the OCRE study, we assigned participating countries based on their provision of CR and their CR quality, to three different categories: lacking, average, and good. Provision was rated considering the following indicators: uptake rate, dropout rate, average start time, average duration, and public funding. CR quality was sought by scoring the presence of: guidelines, guidance documents, coordination by cardiology, mandatory rotation in cardiology training, national accreditation, and electronic database registry.

Results
The data suggested that although provision of CR is at an encouraging level in Europe (Fig.1), it often is of suboptimal quality (Fig.2), signalling the need for improvement in the allocation of human and monetary resources.

Conclusions
This study provides a comprehensive characterisation of CR in Europe, generating important insights on the current provision and quality of CR in Europe, highlighting its sucesses and shortcomings, and discussing important strategies to overcome current obstacles.
Particularly, we consider that European CR programs need to be based upon the same minimal quality standards. However, we acknowledge the differences in economy, culture, religion, health system, climate, and literacy across the different countries. These need to be considered and respected, and a shared CR plan should contemplate the diver sity and promote adjustments for each country while also preventing it from falling short of the common set goals.
Baseline pr internal prolongation and elevated diastolic blood pressure are predictors of new-onset atrial fibrillation in hypertensive patients
Authors: Papakonstantinou P , Andrikou I , Konstantinidis D , Tsioufis K 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
One of the most significant risk factors for atrial fibrillation is hypertension (HTN) (AF). Although the PR interval is a factor in the Framingham risk score for AF, it has been linked to an elevated risk of incident AF. However, there is a lack of consistency in the findings identifying PR prolongation as a risk factor for AF.

Purpose
In a large cohort of HTN patients, we seek to assess the predictive value of the PR interval for the emergence of AF.

Methods
The average follow-up time for consecutive individuals with essential hypertension and no known AF at baseline was 5.3 years. Each patient underwent a 12-lead ECG, an echocardiogram examination, and a 24-hour Holter rhythm monitoring in the event of arrhythmia complaints. These tests were done at baseline and once a year. The European Society of Cardiology/European Society of Hypertension guidelines for HTN therapy were followed during the follow-up period, including routine clinical and paraclinical assessments and drug administration. The baseline ECG was used to determine the PR interval and P wave length.

Results
We included 1807 hypertensives (mean age 57±11 years; 49% men) with office systolic/diastolic blood pressure of 144±17/89±11 mmHg. A total of 65 occurrences of new-onset AF (3%) were reported during the follow-up period. P wave duration and PR internal time were longer at baseline in patients with new-onset AF (n=67) compared to those without AF (n=1740) (P wave, 115 vs 110 ms) (PR interval, 174 vs 157 ms). A multivariate Cox regression analysis showed that baseline P wave duration had no significant prognostic value for the occurrence of new-onset AF, but baseline PR internal was substantially linked with the development of AF (HR = 1.01, 95% CI = 1.01-1.02; p = 0.01). A greater incidence of AF was linked to baseline elevated diastolic blood pressure (HR 1.05, 95% 1.003-1.091; p=0.037).

Conclusions
Baseline PR internal and elevated diastolic blood pressure were significant predictors of new-onset AF in hypertensive patients. PR prolongation may be a marker for cardiovascular degenerative aging caused by vascular inflammation and myocardial fibrosis.
Clustering of cardiovascular and renal comorbidities and risk of incident atrial fibrillation in the community-based PREVEND cohort
Authors: Van Deutekom C , Geelhoed B , Van Munster B C , Bakker S J L , Gansevoort R T , Van Gelder I C , Rienstra M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The PREVEND study is supported by the Dutch Kidney Foundation and the Netherlands Heart Foundation.

Background
Atrial fibrillation (AF) is a condition that occurs in the presence of comorbidities. With the accumulation of comorbidities over time, certain comorbidities may more often occur together than others, i.e. clustering of comorbidities. Acknowledging clustering of certain comorbidities may have implications for diagnosing previously unrecognized comorbidities, and clusters of comorbidities may carry differential risks of diseases, like AF. Albeit that the individual cardiovascular risk factors and comorbidities are well known, information on the impact of clustering of these on incident AF is sparse.

Purpose
We aimed to investigate the presence of clusters of cardiovascular and renal comorbidities and study the association between comorbidity clusters and incident AF.

Methods
We used the community-based Prevention of Renal and Vascular ENd-stage Disease (PREVEND) cohort in which 8,592 individuals participated. We excluded individuals with prior AF or missing ECG data, leaving 8,265 individuals for analysis. Atrial fibrillation was diagnosed if either AF or atrial flutter was present on a 12-lead ECG during one of the study visits, or at an outpatient visit or hospitalization. Latent class analysis was performed to assess clustering of 10 cardiovascular and renal comorbidities. The optimum number of classes was determined by the number of classes for which the Bayesian information criterion (BIC) reached a minimum value. As secondary analysis, latent class analysis was repeated with additionally including age, sex, and ethnicity. Kaplan-Meier analysis was performed to calculate the cumulative probability of incident AF, stratified by the latent classes.

Results
In the total population, the mean age was 48.9±12.6 years and 50.2% were women. During 9.2±2.1 years of follow-up, 251 individuals (3.0%) developed AF. Latent class analysis resulted in a model with three clusters as the optimal model, with one cluster being young (44.5±10.8 years) and healthy, carrying a low (1.0%) risk of incident AF; one cluster being older (63.0±8.4 years) and multimorbid, carrying a high (16.2%) risk of incident AF and a third middle-aged (57.0±11.3 years), obese and hypertensive cluster carrying an intermediate risk (5.9%) of incident AF. When adding age, sex and ethnicity to the latent class analysis, similar results were observed.

Conclusion
We identified three clusters of individuals in the community-based PREVEND cohort. The three clusters contained different amounts of comorbidities carrying different risks of incident AF. However, there were no differences between clusters regarding specific combination(s) of comorbidities.
Effectiveness of electrical cardioversion for persistent atrial fibrillation in the ongoing protocolenergy: hawthorne effect trial
Authors: Jiravsky O , Rucki L , Spacek R , Szmek B , Ranic I , Hrosova M , Neuwirth R , Hudec M , Sknouril L , Chovancik J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Electrical cardioversion (DCCV) is a long-used and proven method for the acute termination of atrial fibrillation episodes. The methodology for optimal performance of DCCV with the highest level of effectiveness while maintaining maximum safety is still under investigation. To validate our proposed methodology for performing DCCV, we have initiated the PROTOCOLENERGY clinical trial, which is currently ongoing.

Objective
To test the effect of conducting a clinical trial on the effectiveness of cardioversion in patients who were not included in the study for any reason.

Methodology
A retrospective analysis of the DCCV registry from the indications of persistent atrial fibrillation (long-term persistent excluded) from 2015-8/2022. Statistical comparison of the demographics and overall effectiveness of the DCCV cohort before and after study initiation and comparison of the cohort, enrolled and not enrolled since study initiation (no interim analysis of the study cohort proper). Heart rate 1 min after the last discharge is assessed.

Cohort
A total of 2402 procedures were analyzed in 829 women (34.5%) and 1573 men (65.5%) aged 67 (+/-10) years, with CHADSVASC score of 3,0 (+/− 1), BMI 31.2 (+/-7.7).

Results
DCCV efficiency in the whole cohort was 91.1%. Before the study, SR was achieved in 90% of the 1981 patients; since the start of the clinical trial, DCCV efficacy increased to 96.4% (in a cohort of 421 patients) (p &lt;0.001). There was no statistically significant effect in efficacy between patients included in the clinical trial (312 pt.) and those not included (109 pt.) (96.5% vs. 96.3% p=0.944).

Conclusion
The presented data suggest an effect of developing and controlling the methodology of DCCV performance in a clinical trial on increasing the efficacy of DCCV, even in the cohort of patients not enrolled in the clinical trial. That phenomenon is called the HAWTHORNE effect and is related to the improvement of the outcome of the investigated phenomenon due to the influence of the actual investigation. In this case, probably due to strict adherence to the study protocol ( paddle pressure during DCCV, cardioversion in expiration, adherence to predetermined cardioversion energies, etc. even in patients not included in the study).
Using computed tomogram atrial myocardial thickness maps in high-power short-duration radiofrequency pulmonary vein isolation: a prospective randomized clinical study
Authors: Hwang T , Kwon O , Yang S , Kim D , Yu H , Kim T , Uhm J , Joung B , Lee M , Hwang C , Pak H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by a grant [HI21C0011] from the Ministry of Health and Welfare, a grant [NRF-2020R1A2B5B01001695] from the Basic Science Research Program run by the National Research Foundation of Korea (NRF) which is funded by the Ministry of Science, ICT & Future Planning (MSIP), and a grant [RS-2022-00141473] from Cross-ministerial tasks.

Background
High-power short-duration (HPSD) ablation generates wide and contiguous but shallow lesions by radiofrequency (RF) resistive heating. It is unknown whether RF energy titration has additional benefits depending on the atrial wall thickness.

Purpose
We aimed to compare the efficacy and safety of HPSD energy titration depending on left atrial wall thickness (LAWT) during circumferential pulmonary vein isolation (CPVI) in patients with paroxysmal atrial fibrillation (PAF).

Methods
We prospectively randomized 224 patients with PAF (69.2% males, 59.3±12.0-years-old) into either the LAWT-guided CPVI group (WT, n=113) or the conventional CPVI group (Control, n=111). We delivered 15s of constant RF (contiguous lesion 2mm dots, FlexAbility) at 60W in the Control group but titrated the RF duration in the WT group (15 s at LAWT&gt;2.1mm, 13s at 1.4–2.1mm, and 11s at &lt;1.4mm) referencing the computed tomogram-myocardial thickness color map. The primary endpoints were safety and AF recurrence after a single procedure; the secondary endpoints were the procedure time, cardioversion rate, and response to anti-arrhythmic drugs (AADs).

Results
After a mean follow-up of 13.4±7.0 months, the clinical recurrence rate (13.3% vs. 8.1%, log-rank p=0.302) and the complication rate (8.0% vs. 4.5%, p=0.427) did not differ between the two groups. The total procedure time (p=0.391) and cardioversion rate (p=1.000) did not significantly differ between the two groups. During the final follow-up, sinus rhythm was maintained without AADs in 72.6% of the WT group and 80.2% of the Control group (p=0.237).

Conclusions
LAWT-guided energy titration resulted in efficacy and safety equivalent to that of constant 15s 60W-HPSD CPVI in patients with PAF.
Pulsed field ablation based pulmonary vein isolation utilizing a simplified approach
Authors: Tilz R R T , Feher M F , Kirstein B K , Vogler J V , Eitel C E , Phan H L P , Hatahet S H , Popescu S S P , Kuck K H K , Heeger C H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulsed field ablation (PFA) is a novel non-thermal energy source with promising safety and efficacy advantages compared to standard ablation technologies.

Purpose
We aimed to develop a safe, effective and fast pulmonary vein isolation (PVI) utilizing a single shot PFA catheter via a single femoral vein puncture and a venous closure system approach.

Methods
Forty-eight consecutive AF patients underwent first-time PVI via PFA under deep sedation. A single ultrasound guided femoral vein puncture and a single transseptal puncture was utilized for left atrial access. After pulmonary vein (PV) angiography eight pulse trains (2kV/2.5 sec, bipolar, biphasic, each 4x basket/flower configuration) were delivered to each PV. Extra pulse trains in the flower configuration (8x) were added to the posterior wall for very wide antral circumferential ablation (vWACA). Continuous intraluminal esophageal temperature (TESO) was monitored with a s-shaped esophageal temperature probe. A venous closure system was utilized on the single access site. A Donati suture was performed. The pressure bandage was removed after 1h.

Results
Patients (mean age: 64 +/-11 years) presented with AF (paroxysmal 58% or persistent AF (42%). A total of 192 PV were identified and isolated via PFA (100%). A mean of 40 pulse trains for PVI and vWACA have been used. The mean procedural time was 27 +/- 7 minutes, the mean catheter dwell time was 14 +/- 6 minutes and the median fluoroscopy time was 6 +/- 2 minutes. No relevant esophagus temperature rise occurred. One patient (2%) experienced a transient phrenic nerve palsy which recovered until the end of the procedure. Two patients (4%) experienced a superficial bleeding which was treated by a figure of eight suture. No severed hematoma, transfusion or intervention was necessary. No pericardial effusion or tamponade occurred.

Conclusion
The combination of a single vein single transseptal puncture approach resulted in a 100% rate of acute PVI and an extraordinary fast procedure and dwell time. The rate of periprocedural complications was low.
Effectiveness and safety of a time to isolation strategy of cryoballoon ablation of atrial fibrillation
Authors: Tsiachris D , Doundoulakis I , Antoniou C K , Sougiannis D , Zafeiropoulos S , Tsioufis P , Kordalis A , Gatzoulis K A , Chierchia G B , De Asmundis C , Tsioufis K 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Complete electrical isolation of all pulmonary veins is the cornestone of the ablation procedure.

Purpose
We conducted a systematic review and meta-analysis of randomized and observational studies with a control group to evaluate the effectiveness and safety of a time to isolation (TTI)-based strategy of cryoballoon ablation (CBA) in the treatment of atrial fibrillation (AF).

Methods
Three electronic databases (MEDLINE, Cochrane Central Register of Controlled Trials, and Embase) without language restrictions were searched. The intervention assessed was a TTI-based strategy of CBA in the treatment of AF. TTI was defined as the time from the start of freezing to the last recorded pulmonary veins' potential. The comparison of interest was intended conventional protocol of CBA. The primary endpoint was freedom from atrial arrhythmia.

Results
Nine studies were deemed eligible (N = 2289 patients). Eight studies reported freedom from atrial arrhythmia and pooled results showed a marginally similar success rate between the two protocols (odds ratio [OR]: 1.24; 95% confidence interval [CI]: 0.98-1.56). A prespecified subgroup analysis verified that a high dose TTI strategy (with &gt;120 s duration of cryotherapy post-TTI) compared to the conventional protocol could significantly increase the patients without atrial arrhythmia during follow-up (OR: 1.39; 95% CI: 1.05-1.83). TTI strategy could also significantly decrease total procedure time (SMD: -26.24 min; 95% CI: -36.90 to -15.57) and phrenic nerve palsy incidence (OR: 0.49; 95% CI: 0.29-0.84).

Conclusion
Moderate confidence evidence suggests that an individualized CBA dosing strategy based on TTI and extended (&gt;2 min post-TTI) duration of CBA is accompanied by fewer recurrences post-AF ablation.
Evaluation of redo procedures in blanking period following atrial fibrillation catheter ablation
Authors: Coteli C , Menemencioglu C , Ates A H , Yorgun H , Aytemir K 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background and Objective
Although early recurrence after atrial fibrillation catheter ablation (AFCA) is a risk factor for late recurrence, 3 months blanking period (BP) is generally an accepted period to wait for re-do intervention. In this study, we aimed to evaluate the cases of early recurrences in BP after AFCA using either radiofrequency (RF) or cryo-balloon (CB).

Method
One thousand fifty patients who had undergone AFCA between January 2017 and January 2022 were evaluated retrospectively. Seventy-five patients had documented tachyarrhythmia episodes in the BP. Among these, 33 patients underwent electrophysiologic study (EPS) and re-do catheter ablation for atrial tachyarrhythmia.

Results
The index procedure was performed with CB in 15 (45.5%) patients and RF in 18 (54.5%). 20 (60.1%) patients had paroxysmal atrial fibrillation before the index procedure. EPS was done routinely in all patients after the recurrence. In 3 patients, typical AVNRT was induced in EPS, the slow pathway was ablated, and substrate mapping (SM) was not performed. In 19 patients, atrial tachycardia, whose 3 were typical atrial flutter, was induced. Pulmonary vein (PV) reconnection was detected in 7 patients whose three also had non-PV triggers.

Conclusion
PV reconnection is responsible for the recurrence during the period of BP in a small percentage of patients. However, additional triggers are present in most. The optimal approach for the recurrence occurring in BP is still controversial. Performing EPS and SM may reduce the recurrence rate in this patient group.