bluuebunny/crossref_metadata_2025_split huggingface dataset:
Monitoring for arrhythmia in transthyretin cardiac amyloidosis with remote patch devices
Authors: Bruce S , Cuomo M , Yarmohammadi H , Wan E Y , Saluja D , Sciacca R , Garan H , Griffin J M , Maurer M S , Biviano A B 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Transthyretin cardiac amyloidosis (ATTR-CA) is associated with an increased incidence of arrhythmias. We hypothesized that non-invasive, two-week outpatient cardiac rhythm monitoring of patients with ATTR-CA would detect high rates of ventricular tachycardia and atrial fibrillation/flutter (AF).

Purpose
To characterize arrhythmia in patients with ATTR-CA on two-week, non-invasive cardiac rhythm monitors.

Methods
38 patients with ATTR-CA (mean age 76.9 SD 10.0 years, 89.5% male) who underwent two-week remote external patch monitoring were included in this single center retrospective study. An age-matched control group included 38 patients (mean age 73.9 SD 12.3, 76.3% male) who underwent the same cardiac rhythm monitoring as part of neurological workups.

Results
NSVT was detected on the remote monitor in 81.6% of ATTR-CA patients and AF was detected in 26.3% of patients. ATTR-CA was associated with higher rates of NSVT and AF compared to the control group (28.9% with NSVT and 5.3% with AF). As seen in Figure 1, there were only three ATTR-CA patients without either AF, NSVT, advanced atrioventricular block, or a significant pause detected on remote monitor. Among the ATTR-CA group, at median 45 weeks follow-up, there were 4 heart failure hospitalizations, 2 cardiovascular events (1 episode of sustained VT and 1 stroke), 6 permanent pacemakers placed, and 3 implantable cardioverter-defibrillators placed, including one for sustained VT. NSVT and AF were not associated with a composite of these adverse outcome.

Conclusion
ATTR-CA was associated with high rates of NSVT and AF on noninvasive remote monitors. While evidence regarding the management of arrhythmias, particularly NSVT/VT, in ATTR-CA remains limited, two-week noninvasive cardiac monitoring can be considered to aid in risk stratification for both atrial and ventricular arrhythmias in ATTR-CA.
Diagnostic accuracy of smartwatch in detecting atrial fibrillation: a systemic review and meta-analysis
Authors: Vetta G , Magnocavallo M , Parlavecchio A , Caminiti R , Polselli M , Sorgente A , Pannone L , Chierchia G B , Rossi P , Bianchi S , Natale A , De Asmundis C , Della Rocca D G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Atrial fibrillation (AF) is the most common sustained arrhythmia and an important risk factor for stroke and heart. Recent technology advances allowed for heart rhythm monitoring using Smartwatches which can be used for early AF diagnosis.

Purpose
We performed a systemic review and meta-analysis to assess the accuracy of AF diagnosis by smartwatches.

Methods
We systematically searched Medline, Embase and Cochrane electronic databases up to September 28th, 2022 for observational studies of the diagnostic accuracy of smartwatches devices in detecting AF. Studies with 12-lead ECG or single-lead ECG interpreted by a cardiologist as gold standard were included. We calculated the area under the curve (AUC) of the summary receiver operating characteristic curves (SROC) and pooled sensitivities and specificities.

Results
A total of 20 studies were included enrolling 3447 patients, 57%(95% CI: 55-59%) male with average age of 68.3years (95% CI: 63 – 74). The pooled prevalence of AF was found to be 40% (95% CI 27 – 53%). In the overall analysis of all smartwatches, the AUC was 0.99 (95% CI: 0.98-1.00) (Figure 1), the sensitivity 94%(95% CI: 90 – 96%) and the specificity 97%(95% CI: 95 – 98%) (Figure 2). Smartwatches in primary prevention showed an AUC of 0.97 (95% CI: 0.96-0.99), sensitivity of 83%(95% CI: 52 – 96%) and specificity of 98%(95% CI: 87 – 100%) whereas in secondary prevention showed an AUC of 0.99 (95% CI: 0.98-1.00), sensitivity of 95%(95% CI: 94 – 97%) and specificity of 97%(95% CI: 96 – 98%). In the subgroup analysis by technology, smartwatches with single lead ECG showed an AUC of 0.99 (95% CI: 0.98-1.00), sensitivity of 95%(95% CI: 89 – 97%) and specificity of 97%(95% CI: 94 – 99%) whereas smartwatches with photoplethysmography pulse waveform technology showed an AUC of 0.99 (95% CI: 0.97-0.99), sensitivity of 95%(95% CI: 92 – 96%) and specificity of 97%(95% CI: 95 – 99%).

Conclusions
Smartwatches proved an excellent diagnostic accuracy for AF diagnosis.
Trends in the use of implantable loop recordertrends and diagnostic rate of the implantable loop recorder in nationwide database
Authors: Roh S Y , Lee D I , Lee K N , Kim D Y , Shim J , Choi J I , Kim Y H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Korea University

Introduction
Implantable loop recorder (ILR) is useful to reveal hidden arrhythmia. The real-world using trend of ILR implantation and indication were studied using nationwide database.

Purpose
To assess the indication of ILR and diagnostic rate of meaningful arrhythmia

Method
We analyzed the 1,460 patients who underwent ILR implantation (male 62%, mean age 62±16) from 2008 to 2019 using Korea Health Insurance review and assessment service database.

Result
The embolic stroke of undetermined source (ESUS) group, syncope group and palpitation group were 619 (42.3%), 765 (52.3%), 76 (5.2%) as implantation indication, respectively. From 2016 to 2019, the ESUS group increased by 14 times and the syncope group by 4 times. Among patients with ESUS, 191 patients (31%) were diagnosed with atrial fibrillation within 1 year. Bradycardia needed pacing therapy was revealed in 28%, tachycardia in 6% and atrial fibrillation in 24% in syncope group. The predictors of atrial fibrillation in ESUS group were age (OR: 1.024 per year, CI: 1.006-1.042, p=0.0072) and heart failure (OR: 2.215, CI:1.357-3.615, p=0.0015). The mean time from ILR to pacing therapy was 3±2 months in syncope group and that to anticoagulation in ESUS group was 6±3 months.

Discussion
The use of ILR for evaluation of ESUS is increasing, with atrial fibrillation diagnostic rate of 30%. The time to treatment differed by group.
Electroanatomical features of biopsy-proven cardiac amyloidosis
Authors: Casella M , Compagnucci P , Falanga U , Ciliberti G , Lofiego C , Vagnarelli F , Valeri Y , Stronati G , Principi S , Barbarossa A , Perna G P , Basso C , Guerra F , Dello Russo A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac amyloidoses (CA) are an increasingly recognized group of infiltrative cardiomyopathies associated with high risk of heart failure, thromboembolic events, arrhythmias, and sudden death. Endomyocardial biopsy may be required to differentiate the amyloid type (mainly, Immunoglobulin light chain [AL] versus transthyretin-related [ATTR]) in some cases.

Purpose
to provide a first description of electroanatomical characteristics of amyloid cardiomyopathy, and relate them to endomyocardial biopsy findings.

Methods
we enrolled ten consecutive patients (median age, 68 [63-77]; male, 50%) in an observational, retrospective study. All of them had a clinical diagnosis of CA, but a diagnosis of CA type was hampered by the presence of inconclusive or discordant laboratory-imaging findings (abnormal serum free light chain assay and positive bone scintigraphy, n=5; ambiguous imaging results, n=4; abnormal serum free light chain assay and TTR gene mutation, n=1). Therefore, all patients underwent right ventricular high-density electroanatomical mapping (EAM) using a multipolar catheter (Advisor HD Grid, Abbott), and EAM-guided endomyocardial biopsy (EMB). We recorded electrogram features at EMB sampling site, and explored their correlation with histological findings with mixed effect models.

Results
The clinical, electroanatomical, and histological features of enrolled patients according to the EMB-proven type of CA (AL, n=6; ATTR, n=4) are resumed in Table. Electrogram amplitudes in both the bipolar and the unipolar configuration were generally normal both in the overall right ventricle, and at EMB sites. We found a significant correlation between both unipolar and bipolar electrogram amplitude and the percentage of both amyloid tissue (p&lt;0.01 and p=0.016, respectively) and fibrous tissue (both p&lt;0.01) at EMB (Figure). We observed the strongest linear association (i.e., highest R2) between unipolar electrogram amplitude and amyloid tissue, as well as between bipolar electrogram amplitude and fibrous tissue. On the other hand, electrogram duration and the number of electrogram peaks were unrelated to histological findings. The unipolar voltage cutoff that best identified regions with &gt;15% amyloid tissue infiltration according to Youden index was 9.1 mV (sensitivity, 43%; specificity, 100%; accuracy, 77%).

Conclusion
CA is associated with normal electrogram amplitudes using ahigh density mapping catheter and conventional voltage cutoffs. Nevertheless, unipolar electrogram amplitude is strongly related to the extent of amyloid infiltration, and unipolar voltage&lt;9.1 mV is 100% specific for &gt;15% amyloid tissue deposition.
Association between regular exercise and the risk of major adverse cardiovascular events in patients with pacemaker
Authors: Lee S R , Lee J H , Choi E K , Jung E K , You S J , Oh S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The optimal amount of exercise for preventing cardiovascular events in patients with pacemakers has not been revealed.

Methods
Using the Korean National Health Insurance Service database, patients who had newly implanted pacemakers between 2009 and 2018 were included. The amount of physical activity was measured by a self-reported questionnaire included in the national health examination. Performing regular exercise was defined as ≥5 days of moderate-intensity exercise or ≥3 days of vigorous-intensity exercise per week. The occurrence of major adverse cardiovascular events (MACE) defined as the composite of stroke, heart failure, myocardial infarction, and all-cause death was evaluated during follow-up.

Results
A total of 13,542 patients were included (mean age 68±11 years, 45% of men); 51% of patients were atrioventricular block and 39% of patients were sick sinus syndrome, and 85% of patients were implanted with dual-chamber pacemaker. During a median 2.5-year of follow-up, the incidence rates of MACE was 5.4 and 3.7 per 100 person-years in non-exerciser and exerciser, respectively (Figure A). Compared to non-exerciser, patients performing regular exercise were associated with a lower risk of MACE (hazard ratio, 95% confidence interval: 0.745, 0.661-0.839, p&lt;0.001, Figure B). Patients with ≥450 metabolic equivalents (METs) which was the highest quartile cut-off of exercise amount were significantly associated with a lower risk of MACE (0.765, 0.686-0.853, p&lt;0.001) than patients with &lt;450 METs. Compared to persistent non-exerciser before and after pacemaker implantation, persistent exercisers and exercise-starters showed a significantly lower risk of MACE (0.788, 0.662-0.938, p=0.007 and 0.584, 0.462-0.738, p&lt;0.001, respectively, Figure C).

Conclusion
Regular physical activity was related to the risk of MACE in patients with pacemaker. A proactive cardiac rehabilitation program would be considered for this population.
Atrial fibrillation-specific refinement of the STOP-Bang sleep apnoea screening questionnaire: Insights from the Virtual-SAFARI study
Authors: Verhaert D V M , Betz K , Gawalko M , Hermans A N L , Habibi Z , Pluymaekers N A H A , Van Der Velden R , Hereijgers M J M , Simons S O , Westra S W , Lankveld T A R , Schotten U , Vernooy K , Hendriks J M , Linz D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Purpose
Sleep-disordered breathing (SDB) is prevalent in up to 50% of patients undergoing atrial fibrillation (AF) ablation. Currently, it remains unclear whether all AF patients should be systematically screened for SDB, or whether pre-selection of patients requiring screening can be improved. We aimed 1) to assess the accuracy of the STOP-Bang screening questionnaire as a tool for detecting SDB in patients scheduled for AF ablation; and 2) to develop a refined, AF-specific version of the STOP-Bang to improve pre-selection.

Methods
Consecutive patients scheduled for AF ablation without a previous history of SDB and/or SDB screening were included. Patients were digitally referred to the previously described Virtual-SAFARI SDB screening and management pathway1 including a home sleep test using polygraphy. An apnoea-hypopnoea-index (AHI) of ≥15 was interpreted as moderate-to-severe SDB. The accuracy of the STOP-Bang questionnaire (Snoring, Tiredness, Observed apneas, blood Pressure, BMI ≥35 kg/m², Age, Neck circumference, and Gender) was evaluated. Logistic regression was used to assess characteristics within and outside the STOP-Bang questionnaire associated with moderate-to-severe SDB. These characteristics were used to refine the STOP-Bang specifically for AF patients.

Results
Of 206 included patients, 51% was diagnosed with moderate-to-severe SDB. The STOP-Bang questionnaire performed poorly in detecting SDB, with an area under the receiver operating characteristic curve (AUROC) of 0.647 (0.573-0.721). AF-specific refinement of the STOP-BANG resulted in the BOSS-GAP score. Therein, tiredness and neck circumference were removed, while body mass index with cut-off point ≥27 kg/m² and previous stroke or transient ischaemic attack were added. The BOSS-GAP questionnaire performed better with an AUROC of 0.738 (0.672-0.805) in the overall population.

Conclusion
The STOP-Bang questionnaire showed limited value when used as a pre-selection tool for SDB screening. The refined, AF-specific BOSS-GAP questionnaire demonstrated slightly improved, but still limited accuracy in identifying AF patients with SDB. Whether questionnaires bring an advantage in pre-selection for SDB screening compared to structural screening in patients with AF, requires further study.
Weight-loss management after catheter ablation of atrial fibrillation
Authors: Burbelka A , Zarebski L , Futyma M , Futyma P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Overweight and obesity are modifiable risk factors for atrial fibrillation (AF). Pulmonary vein isolation (PVI) is a cornerstone therapy of AF, however elevated body mass index (BMI) is associated with higher AF recurrence rate. Weight loss in patients with increased BMI can improve ablation outcomes, however data on weight loss management after PVI is lacking.

Purpose
To determine impact of weight loss in overweight and obese patients before PVI and to determine BMI trends after PVI.

Methods
Consecutive patients with baseline BMI &gt;25 who underwent PVI were included into the study. All patients received comprehensive and intensive dietary and lifestyle modification recommendations. Anthropometric measurements were taken at initial visit (pre-PVI), on the day of ablation (PVI) and at the end of follow-up (post-PVI).

Results
60 patients (25 female, age 59±11 years) were included into the study. Mean achieved weigh loss was before PVI was 2±4 kg (pre-PVI vs PVI, 85.3 kg vs 83.3 kg, p=0.31). During follow up lasting 15±13 months 29 patients (48%) remained AF-free. Seventeen patients (28%) gained ≥1kg from baseline and these patients were more likely to experience AF recurrence when compared to these patients who managed to sustained their weigh (76% vs 42%, p=0.0065). Thirty-one (52%) patients who managed to sustain weight loss ≥2kg from baseline were more likely to remain AF-free during follow-up (69% vs 35%, p=0.038). There was no statistically significant difference between weight at baseline vs after follow-up (pre-PVI vs post-PVI, 85.3 kg vs 83.4 kg, p=0.36).

Conclusions
A substantial portion of patients can experience weight regain after PVI. Weight regain is associated with increased risk of AF recurrence following catheter ablation of AF. In patients with elevated BMI periprocedural risk factor modification resulting in weight loss is associated with improved AF-free survival.
Clinical features of cardiac sarcoidosis in a cohort treated with epi- and endocardial VT ablation
Authors: Nentwich K , Ene E , Berkowitz A , Sonne K , Deneke T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Clinical presentation of cardiac sarcoidosis is a chamaeleon. Detection of granuloma in the histopathology proofs the diagnosis of sarcoidosis, however myocardial biopsy is associated with a high sampling error. However, a prompt immune suppressive therapy would influence the patient’s prognosis significantly.
Analyzing our cohort of epicardial (and endocardial) VT ablation respectively we intend to identify additional markers supporting the diagnosis sarcoidosis.

Method
In the last 4 years 130 patients (mean age 49 y, 63 % male ) were hospitalized for epicardial (and endocardial) VT ablation. 19 patients had the diagnosis sarcoidosis or were newly diagnosed. Mean follow up time was 4,3 a. ECG criteria, primary manifestation, histological findings, therapy, history of VT ablation, distribution of scar in MRI and anatomical mapping, PET CT findings, presence of atrial tachycardias, valve disease and comorbidities were documented.

Results
6 of 15 (40 %) patients showed right bundle block , 6 of 19 (31 %) had AV nodal disease, 4 patients primarily presented with AV-block III, 14 patients (73 %) primarily presented themselves with ventricular arrhythmias (3 with cardiac arrest), in 93 % patients biopsy revealed elevated CD 68 macrophages and CD 3 T- lymphocytes, 6 of 16 were positive for granuloma (37,5 %). All patients were treated with steroids, 13 patients with a combination of immune suppressive therapy. All were treated with VT ablation, mean 2 ablations per patient. 6 of 6 (100 %) patients showed positive PET CT. Analyzing the scar distribution the most common locations in the 17 segment model were segment 2,3,4 and 5 and septal RV. (septal substrate in 66 %). There was a high correlation between the scar findings in the MRI and the anatomical mapping. No patient died during follow up, 1 patient had high urgent transplant after withdrawal of the steroids. Statistical analysis (Kendall-Tau-b) found a significant correlation between presence of CD3 Lymphocytes, fibrosis, VT as primary manifestation, the presence of ICD, positive PET-CT and septal substrate.

Conclusion
Patients presenting with ventricular arrhythmias combined with a positive PET CT, elevated CD3 T lymphocytes and CD68 macrophages in the biopsy and septal substrate are suspective of sarcoidosis and immune suppressive therapy should be considered.
Further data are warranted to proof that observation and to differentiate from other cardiac diseases.
The safety and efficacy of rotor ablation in right atrium after pulmonary vein isolation in patients with persistent atrial fibrillation
Authors: Yoshida A , Akita T , Takami K , Tagashira T , Tsuda S , Terashita D , Takahashi Y , Suzuki M , Yamada S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Phase mapping using software of ExTRa Mapping is a new tool to clarify the localization of rotor in atrial fibrillation (AF), but the spatial distribution of rotor in right atrium (RA) and the effect of ablation is not clear compared with left atrium (LA).

Purpose
This study sought to investigate the spatial distribution of rotor in RA and the safety and effectiveness of RA rotor ablation after pulmonary vein isolation (PVI) in patients with persistent AF.

Methods
ExTRa mapping with a 20-polar Reflexion catheter in RA was performed in 2nd or 3rd ablation for recurrent AF after PVI in 16 patients with persistent AF (including 4 patients with long standing &gt;1 year AF, 15 men, mean age 67±7.7years old, mean LAD 42±5.4mm, mean EF 57±11%). Rotor was defined as NPAs (non-passively activated areas) in which the percentage of the non-passively activated period in the recording time of 5 seconds is over 50%. RA was divided into 5 areas of crista terminalis (CT), septum (Sept), free wall of RA appendage (fRAA), septal side of RAA (sRAA), behind aorta (Ao), and distribution of NPAs was investigated. RA minimal ablation to NPAs was performed to avoid sinus node and phrenic nerve. The outcomes of AF recurrence were analyzed.

Results
NPAs in RA were observed in 15 of 16 cases, and 67% of cases in CT, 75% in Sept, 80% in fRAA, 20% in sRAA, and 43% in Ao. RA minimal ablation was performed in 21 NPAs in 8 patients to avoid sinus node and phrenic nerve. In a mean follow-up of 307±204 days, freedom from any atrial tachyarrhythmias without antiarrhythmic drugs was achieved in 9 of 16 patients (56%). In 4 (80%) of 5 patients in whom more than 75% area of NPAs were eliminated, sinus rhythm was maintained. There was no serious complication.

Conclusion
Rotor in RA existed relatively frequently in septum, fRAA and CT. RA rotor ablation was safe and could be a new strategy after PVI for persistent AF.