bluuebunny/crossref_metadata_2025_split huggingface dataset:
Explainable Paroxysmal Atrial Fibrillation Diagnosis Using Electrocardiogram with Artificial Intelligence
Authors: Lee K H , Ko B G , Jin Y B , Chang W J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research Foundation of Korea (NRF) funded by the Korea government (MSIT)

Background
Paroxysmal atrial fibrillation (PAF) is common among patients with cryptogenic stroke or transient ischemic attack, and has a silent nature. Therefore, robust and reliable early detection of atrial fibrillation would be valuable for managing cardiovascular comorbidities. Therefore, robust and reliable early detection of atrial fibrillation would be valuable for managing cardiovascular comorbidities. Despite many efforts to predict or detect atrial fibrillation, an adequate explanation for estimation remains problematic.

Method
We present a statistical prediction model employing a deep-learning approach to identify a PAF from normal electrocardiogram (ECG), and interpret their causes. Based on 552,372 12-lead ECG data of 318,321 patients, we show that an AI-based model can capture the features of atrial fibrillation during normal sinus rhythm using ECG and additional characteristics. As a result of applying our labelling method, only 26,541 ECGs (4.8%) were annotated with PAF. We also applied Layer-wise Relevance Propagation(LRP) algorithm to investigate the regions of the ECG that primarily affect the discrimination of PAF.

Results
The performance of our model was evaluated as the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. The AUC for predicting PAF was 0.910. The predictive performance according to the class was 0.837 in the negative prediction and 0.705 in the positive prediction. The sensitivity analysis results showed that the difference in PAF prediction information for each lead was not significant. Among the features obtained from ECG, the PR interval and QT interval were significant explaining factors for the prediction of PAF, and this fact was confirmed by visualizing the ECG data using the LRP algorithm.

Conclusion
We expect that the discrimination of undetected atrial fibrillation can be used as a pre-emptive assistive tool to provide probabilistic predictions for the screening of PAF and could be enables insights into the cardiac dysfunction.
Impact of novel insertable cardiac monitoring system on real-world cardiac device clinic workflow
Authors: Rosemas S C , Archer N , O'connor E , Coughlan F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Insertable cardiac monitors (ICMs) continually monitor for cardiac arrhythmias, enabling appropriate therapeutic intervention. However, clinic workload to manage ICM patients can be significant. The recent LINQ II ICM system was designed with several features to streamline clinic practice, including remote reprogramming and on-demand data pull capabilities, tablet-based clinician device programmer, smartphone app-based patient monitor, patient management service, and elective data triaging service.

Purpose
To characterize the impact of the LINQ II ICM system on clinic workload compared to previous ICM systems.

Methods
A detailed workflow survey was taken by clinicians at 66 unique cardiac device clinics across UK/Ireland. The total number of ICM patients per clinic averaged 563 patients (median = 500). Respondents included cardiac physiologists (94%), cardiac nurses (4%), and physicians (2%).

Results
Overall, 82.5% of respondents reported that the LINQ II ICM system is more efficient compared to previous ICM workflow, with a total clinic time savings of 9.3 hours/week (Table). Use of a tablet-based device programmer was estimated to save 19.9 minutes per ICM patient during the initial device insertion and activation, while the patient management service saved 30.6 minutes per new patient on monitor set-up and education. Two-thirds (68.6%) of respondents reported that app-based patient monitoring increases efficiency of remote monitoring, attributable to fewer disconnected monitors and reduced patient calls due to information available in the app (e.g., device battery life, data transmission status). The majority (85.7%) felt that remote reprogramming increases efficiency, as remote reprogramming was estimated to save an average 20.0 minutes of staff time compared to an in-clinic reprogramming. More frequent reprogramming of device alerts also led to an average 13.5% reduction in the rate of non-actionable ICM alerts, and overall 43.1% fewer in-person clinic visits.

Conclusions
New ICM system features appear to streamline the clinic workflow associated with managing ICM patients, freeing up valuable clinician time to devote to patient care activities.
Covid 19 pandemic: the final boost for remote monitoring of implantable cardiac devices? : analysis from the nationwide remote monitoring registry (Covid-19 rm-spain)
Authors: Garcia Fernandez F , Calvo Simal S , Cano O , Calvo D , Villagraz L , Martin J , Cantero D , Aguilar Iglesias L , Fernandez Lozano I , Pombo M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Remote monitoring of implantable cardiac devices (CIEDs) has proven to be reliable, more efficient and even safer than conventional in-office follow-ups
However, its implementation has not been as desired. The COVID 19 pandemic and the need to keep patients away from hospitals may have been the final boost for this form of monitoring.

Purpose
We sought to evaluate the pre and post-pandemic trends in CIEDs remote monitoring activations from a large nationwide database in order to determine the global effect of the COVID-19 pandemic on CIEDs implants in Spain.

Methods
The Covid-19 Remote Monitoring Spain Registry (Covid-19 RM-Spain) is a survey supported by the Heart Rhythm Association of the Spanish Society of Cardiology to request the whole national data, regarding the number of CIED´s implants and remote monitoring activations from the five main manufacturers classified according to each autonomous community (not by institutions).All data were aggregated and anonymized to analyse the total sample. Appropriate permissions were granted to use the data and a confidentiality agreement was signed in order to avoid any transmission of sensitive information.

Results
The percentage of devices for which remote monitoring was activated was 24.5%; 28.4%, 42% and 49% in 2018, 2019 ,2020 and 2021, which implies that remote monitoring is now activated on more than twice as many devices in Spain as in 2018.
The table shows the differences in the percentages of remote monitoring activation between three different periods for each type of device. (Period 1 /pre-lockdown January 2018-February 2021; Period 2/ lockdown: March-June 2020 and Period 3/ lockdown: July 2020-December 2021.
Footnotes: Period A vs. B p&lt;0,001 :1 ; Period A vs. C p&lt;0,001:2; Period B vs. C p&lt;0,001:3
Abbreviations : CRT-D: Cardiac resynchronization Therapy -Desfibrillator; CRT-P: Cardiac resynchronization Therapy -pacemaker; ICD: Implantable cardiac defibrillators; ILR: Implantable Loop recorders; LLPM: Leadles Pacemakers; PM: Pacemakers; S-ICD: Subcutaneous Implantable cardiac defibrillator.
Improving efficiency, confidence, and readability in ECG interpretation; the role of signal processing
Authors: Easlea H , Mccord N , Wallace E , Mckenna S , Gibbs A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Project privately funded by B-Secur Ltd

Background
Electrocardiogram (ECG) interpretation is a crucial component in the cardiac clinical pathway that enables the triaging, diagnosis, and treatment of numerous medical conditions. However, noise contamination during signal acquisition can hinder clinical interpretation by hiding or distorting the pathology of the underlying ECG. By removing noise to uncover the true beat morphology, signal processing algorithms maximize the diagnostic value of the acquired ECG and reduce clinical burden by eliminating the need for costly and time-consuming repeat investigations.

Purpose
To evaluate the impact of robust signal processing software on the clinical interpretation and diagnosis of lead I ECGs. Additionally, to investigate whether signal processing could streamline the diagnostic process by revealing pathologies not previously seen in the ECG, improving the speed of diagnosis, and enhancing the readability of the ECG.

Methods
ECG strips (42 x 10 s) representative of a variety of beat morphologies, arrhythmias, and noise types were taken from a proprietary database and provided to healthcare professionals (N = 35) pre- and post-signal processing. Participants possessed varying degrees of experience (12 x Junior (&lt;5 years), 10 x Experienced (5-10 years), 13 x Senior (&gt;10 years)) and specialization in cardiology. Participants were asked to provide a rhythm annotation and corresponding confidence score for each strip when provided in a blinded, randomized order. Participants then provided an additional rhythm annotation when the raw and processed signals were presented side by side, in addition to answering three subjective questions on the impact of signal processing on the ECG interpretation process.

Results
Across all participants, 80.2% of processed ECG strips were able to be given a confident diagnosis. This increased to 86% when pre- and post-processed signals were provided alongside one another – an improvement of 10.8% over the raw signals (75.2%). In response to the questions, participants agreed that the processed signal had a positive or very positive impact on; i) helping to reveal a pathology not previously seen in the raw ECG (57% of strips), ii) speeding up the diagnosis (71% of strips), and iii) improving the readability of the ECG (80% of strips).

Conclusion
By effectively removing noise whilst retaining true beat morphology, signal processing increased the amount of clinically diagnostic ECG data and allowed clinicians to make a more efficient, confident diagnosis. With the positive impacts observed across all participant experience levels, the results suggest that robust signal processing has the potential to streamline the clinical interpretation of ECGs.
Association between CHARGE-AF risk score and LA mechanics: LA reservoir strain can be a single parameter for predicting AF risk
Authors: Tan Kurklu T S T , Korkmaz K , Akbulut Koyuncu I M , Akin K , Yamanturk Y Y , Kurklu H A , Kozluca V , Esenboga K , Dincer İ 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Aims
Atrial fibrillation (AF) is a prevalent arrhythmia and the leading preventable cause of car-
dioembolic stroke. Scoring systems for predicting AF risk do not use imaging modalities. We sought to determine whether LA longitudinal strain could be used as a single parameter for predicting the risk of AF.

Methods and results
Consecutive patients diagnosed with diastolic dysfunction between December 2019 and March 2020 were included. Two-dimensional, colour flow, continuous pulsewave, and tissue Doppler transthoracic echocardiography (TTE) were performed using a Vivid E9 imaging system (GE Medical Systems, Chicago, USA). Measurements were obtained in the standard manner recommended by the American Society of Echocardiography. Moreover, LA longitudinal strain was measured using 2D speckle tracking echocardiography in the four-chamber view to evaluate left atrial function. The CHARGE-AF scoring system was used to predict AF risk.

Methods and results
A total of 148 patients (mean age: 57.6 ± 11.9; male: 53%) with feasible views for LA strain measurement were divided into two groups based on a 10% CHARGE-AF cut-off score. The &gt;10% group (48 patients; 32%) was defined as having a predicted 5-year AF risk &gt;10%, and the 10% group (100 patients; 68%) was defined as having a predicted risk &lt;10%. In the multivariate analysis, LA reservoir strain (LASr) was independently associated with CHARGE-AF score. Furthermore, using the Pearson correlation method, LASr was found to be highly correlated with CHARGE-AF score (r 1⁄4 –0.74, p &lt; 0.0001).

Conclusions
LASr was highly correlated with CHARGE-AF risk score and may be used as a parameter to predict atrial myopathy and hence AF risk.
The connection between systemic inflammation activity and the state of renin-angiotensin system with the course of cardiac arrhythmias
Authors: Marchenko O , Sychov O , Talaieva T , Romanova O , Stasyshena O , Tretiak I 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): NSC "Institute of cardiology, clinical and regenerative medicine named after acad. Strazhesko" NAMS of Ukraine
The purpose of the work is to compare the clinical course of paroxysmal and persistent forms of atrial fibrillation and flutter, depending on the systemic­ inflammation­ activity and the renin-angiotensin system state.

Materials and methods
The study involved 147 patients, including 103 people with rhythm­ disturbances, who werer divided into three main groups (with paroxysmal atrial fibrillation, persistant atrial fibrillation and persistant atrial flutter). Systemic inflammation activity was determined by the level of highlysensitive C-reactive protein in the serum. Renin-angiotensin activity ­ system was characterized by the angiotensin-converting factor level.The activity of ACE in blood plasma was determined by an express method using FAPGG as a substrate ("Sigma", USA), tris(oxymethyl)-aminoman, sodium chloride, EDTA ("Merck", Germany).

Results
The level of highlysensitive C-reactive protein in patients with Af and AFl was significantly elevated in 6. 7 times and was (8. 31±0. 42) against (1. 25±0. 01) mg/l is normal (p&lt;0. 001). In the group with the persistent form of AF, the content of CRP was higher than in the group with paroxysmal form of AF, by 8. 5%, although the difference between the groups was unreliable.
ACE activity in the blood plasma of the pts with arrhythmia was likely elevated, as the rateof ACE was 45. 10±2. 26 μkat/L and exceeded the nominal value by 180 %. 86 patients with rhythm disturbances, which was 83%, there was a significant increase of CRP level . Among patients with paroxysmal FP, it was 31 patients (88%), in the group with a persistent form of FP - 30 patients (78%) and in the presence of TP - 25 patients (83%, respectively). In contrast, in patients without rhythm disturbances who had hypertension and relatively healthy people, the number of patients with elevated levels is highly sensitive th CRP was only 9%, i.e. 4 patients. Comparing the data strong statistical significance was revealed. (p&lt; 0.005).

Conclusions
An increased level of highlysensitiveC-reactive protein as a marker of systemic inflammation is observed in groups of patients with arrhythmias compared with patients with hypertension without rhythm disturbances, indicating a higher intensity of systemic inflammation. Serum ACE levels in 82 % of patients with arrhythmias were higher than normal compared to 27 % of patients without rhythm disturbances (p&lt;0. 05), which may indicate hyperactivation of RAAS.
Etiological and molecular determinants of atrial endomysial fibrosis: results from the CATCH ME consortium
Authors: Winters J , Kawczynski M , Zeemering S , Isaacs A , Casadei B , Fabritz L , Kirchhof P , Chua W , Guasch E , Sinner M F , Kaab S , Hatem S , Verheule S , Stoll M , Schotten U 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): CATCH ME: Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly

Background
We recently demonstrated that in human atria, endomysial fibrosis causes conduction disturbances during atrial fibrillation (AF), while overall connective tissue content (over-all fibrosis) has no effect. Etiological and molecular determinants of endomysial fibrosis are largely unknown.

Methods
We quantified over-all and endomysial atrial fibrosis using staining with WGA in left (LA, n=95) and right (RA, n=76) atrial appendages sampled from a European cohort (CATCH ME) of patients undergoing cardiac surgery. The contributions of AF, heart failure (HF), sex, age, and 4 principal components accounting for confounding clinical characteristics to over-all and endomysial fibrosis were determined in a multivariate model. RNA sequencing was performed to explore biological pathways associated with the two types of fibrosis.

Results
Over-all and endomysial fibrosis were moderately correlated (LA: r=0.69, RA: 0.61, both p&lt;0.001) and more pronounced in RA than in LA samples (p&lt;0.001). In LA, persistent AF, female sex, and HF were independently associated with endomysial fibrosis, while over-all fibrosis was only associated with sex and HF. Likewise, in RA, persistent AF was associated with endomysial fibrosis, while over-all fibrosis was not. Expression of 18 genes was univariately associated with endomysial fibrosis in LA but only 1 in RA. There were no genes associated with over-all fibrosis. After correction for relevant clinical traits, BMP10 showed the strongest association with endomysial fibrosis amongst coding genes (p=3.16E-04, LA). In an independent validation cohort (RACE V Tissue Bank Project, n=162 pts undergoing cardiac surgery), out of 11 biomarkers reflecting inflammation, fibrosis, vascular dysfunction, or ischemia, BMP10 plasma levels were most strongly associated with endomysial fibrosis (p&lt;0.001), but not with over-all fibrosis.

Conclusions
Taken together, female sex, HF, and AF are the main drivers of fibrosis in human atria. However, endomysial fibrosis is independently associated with AF whereas over-all fibrosis is not. BMP10 is a specific marker of endomysial fibrosis. Our findings suggest that distinct mechanisms are involved in the development of over-all versus endomysial fibrosis in human atria and may provide an explanation for the recently reported predictive value of BMP10 biomarkers levels for AF recurrences after AF ablation and for stroke.
Heart failure, female sex and atrial fibrillation are the main drivers of atrial cardiomyopathy in cardiac surgery patients: results from the CATCH ME consortium
Authors: Winters J , Zeemering S , Isaacs A , Kawczynski M , Casadei B , Fabritz L , Kirchhof P , Guasch E , Chua W , Hatem S , Sinner M F , Kaab S , Verheule S , Stoll M , Schotten U 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): CATCH ME: Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly

Background
Atrial cardiomyopathy is emerging as independent prognostic factor in cardiovascular disease. Fibrotic remodeling, cardiomyocyte hypertrophy and a reduction in capillary density are histological hallmarks of atrial cardiomyopathy. The contribution of etiological factors to atrial cardiomyopathy has not been robustly quantified.

Purpose
To quantify the relation between histological features of atrial cardiomyopathy and the clinical profile of patients.

Methods
We examined left (LA, n=91) and right (RA, n=75) atrial appendages sampled from a European cohort of patients undergoing cardiac surgery. Quantification of histological cardiomyopathy features was performed a recently developed and validated imaging analysis algorithm following myocardial triple staining with wheat germ agglutinin (WGA), CD31 and vimentin. The contributions of AF, heart failure (HF), sex, age, and 4 principal components accounting for confounding clinical characteristics to over-all and endomysial fibrosis were determined in a multivariate model. K-means clustering of 6 atrial histological features was performed to identify different types of remodeling.

Results
LA samples showed less fibrosis (p&lt;0.001), a higher capillary density (p&lt;0.05), a smaller capillary size (p&lt;0.05), and larger cardiomyocytes (p&lt;0.01) than RA samples. In both LA and RA, persistent AF was associated with endomysial fibrosis, while over-all fibrosis was not. Men had larger cardiomyocytes (LAA), while women had a higher degree of endomysial fibrosis (LA). Heart failure patients had more endomysial and over-all fibrosis (LA), a higher capillary density (LA) and capillary size (LA/RA).
Samples clustered into 2 distinct clusters. One cluster showed fibrotic cardiomyopathy, with more endomysial (p&lt;0.001) and overall fibrosis (p&lt;0.001), more fibroblasts (p&lt;0,001) and a higher capillary density (p&lt;0.001). The other cluster showed hypertrophic cardiomyopathy, with hypertrophic cardiomyocytes (p&lt;0.001). Patients with fibrotic cardiomyopathy were more often female (LA and RA, p&lt;0.003) and had more often persistent AF (LA, p=0.031) or heart failure (LA, p&lt;0.001). Patients with hypertrophic cardiomyopathy were more often male (LA and RA, p&lt;0.003).

Conclusions
Fibrotic cardiomyopathy is associated with female sex, persistent AF and heart failure while hypertrophic cardiomyopathy more often occurs in men. More research is needed to establish whether treatment of AF and heart failure prevents the development of atrial cardiomyopathy.
Decreasing microtubule detyrosination by parthenolide restores sodium current in mdx cardiomyocytes
Authors: Casini S , Nasilli G , De Waal T , Dekkers Y , Van Amersfoorth S , Marchal G A , Rothenberg E , Delmar M , Remme C A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The cardiac sodium channel Nav1.5 is transported to the membrane by the microtubule network. Alterations in microtubule dynamics are known to impact on ion channel trafficking. Pathophysiological conditions such as heart failure and Duchenne muscular dystrophy (DMD) are associated with an increase in microtubule detyrosination as well as a decreased sodium current (INa) and pro-arrhythmia. Parthenolide, a compound that decreases the fraction of detyrosinated microtubules, has been shown to have beneficial effects on cardiac function in DMD mice, but its impact on INa has not been investigated.

Methods and Results
Cardiomyocytes (CMs) from wild type (WT) and mdx (DMD) mice were used to investigate the effect of parthenolide. Cells were incubated with either 10 µM parthenolide or DMSO for 3-5 hours. INa and action potential (AP) characteristics were assessed using the patch-clamp technique, while immunofluorescence and stochastic optical reconstruction microscopy (STORM), were used to investigate microtubule detyrosination and Nav1.5 cluster density, respectively. In accordance with previous studies, we observed increased levels of detyrosinated microtubules and decreased INa in mdx CMs compared to WT. Treatment with parthenolide decreased the fraction of detyrosinated microtubules and significantly increased INa magnitude in mdx CMs, but had no effect on INa in WT CMs. Accordingly, parthenolide significantly increased AP maximal upstroke velocity in mdx CMs, without affecting other AP properties. Parthenolide did not affect INa gating properties, indicating that it increased INa by enhancing Nav1.5 membrane trafficking. Indeed, STORM analysis showed that parthenolide increased Nav1.5 cluster density at both the lateral membrane (crest) and intercalated disc region in mdx CMs while it had no effect on WT CMs.

Conclusions
Parthenolide restores INa and Nav1.5 membrane expression in mdx CMs, and may be of potential benefit in other pathophysiological conditions associated with increased microtubule detyrosination and reduced INa. Further elucidation of the impact of microtubule dynamics on Nav1.5 may identify additional therapeutic targets for restoring conduction and preventing arrhythmias.