bluuebunny/crossref_metadata_2025_split huggingface dataset:
Invasive risk stratification and implantable loop recorders in brugada syndrome: a single centre experience
Authors: Abela M , Meilak S , Sammut M A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Risk stratification in Brugada syndrome (BrS) is challenging. Cardiogenic syncope, family history of sudden cardiac death and ECG markers are useful variables in determining patient risk. Invasive risk stratification is sometimes needed in those with an intermediate risk phenotype. Implantable loop recorders (ILR) may be considered in those patients with no inducible ventricular arrythmias during programmed ventricular stimulation (PVS).

Objective
The aim of this study was to retrospectively evaluate the outcome of BrS patients referred for PVS and ILR implantation.

Methodology
Demographic, clinical and follow-up data of BrS patients seen in clinic were retrospectively analysed from hospital databases. A p vale of &lt;0.05 was considered significant.

Results
129 patients have been diagnosed with BrS since launching the inherited arrhythmia clinic service (53.5% males). 15 (high risk patients) had an ICD (n=13, 10.1%) or PM (n=2, 1.6%) implanted because of a hospital cardiac arrest, ventricular arrhythmias, high grade AV Block or cardiogenic syncope.
26 (20.2%) were placed in the intermediate risk category, (65.4% males). Patients were offered an electrophysiology study (EPS/PVS) or an ILR depending on the clinical indication (Figure 1). Most were male (65.4%), with a mean age of 41.8±17.7 years at the time of risk stratification. 6 had a likely or definite pathogenic mutation (n=5 19.2% SCN5A, n=1 3.8% MYBPC3). This group had a median Shanghai score of 4.0±0.9. Gender (p=0.429), age (p=0.246), genotype (p=0.273) and shanghai score (p=0.746) did not differ between strategies.
Most (n=12, 9.3%) were offered an EPS/PVS from the offset. Ventricular arrhythmias were induced in 1 (8.3%), an ICD was then implanted. The rest were implanted with an ILR on the day.
Patients not offered an EPS (n=14, 10.9%) were initially implanted with an ILR because of insufficient grounds to proceed with an EP study.
Patients with an ILR (n=25, 19.4%) were followed up for a median 39 ± 21 months. ILR monitoring identified actionable events in 3 (12.0%) patients. One (4.0%) needed a pacemaker for sick sinus syndrome. Two (8.0%) recorded non-sustained ventricular arrhythmias. Both were subjected to an EPS/PVS, one needed an ICD. None of the patients who had an EPS initially had any significant events during follow up.

Conclusion
ILR implantation has a role in risk stratifying intermediate risk patients who do not fulfil criteria for EPS referral. This may also be considered in intermediate risk patients who are not keen on an invasive risk assessment with EPS.
Management of modifiable risk factors and comorbidities in atrial fibrillation: suggestions for improvement from a patient perspective
Authors: Klaveback S , Svennberg E , Braunschwig F , Lidin M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): SLL Region Stockholm Innovation
SLL Region Stockholm Klinisk Forskare.

Background
In patients with atrial fibrillation (AF), improved management of modifiable risk factors, unhealthy lifestyle and concomitant diseases is highly recommended by guidelines, in particular if rhythm control is desired. Yet, many AF patients have suboptimal management of risk factors and comorbidities. There is a lack of understanding how patients can be better aided to achieve these goals in clinical practice. Digital health solutions may offer support in this matter.

Purpose
To identify what patients with atrial fibrillation would find important in a digital tool aimed at optimization of modifiable risk factors and comorbidities.

Methods
This is a qualitative, descriptive study based on semi-structured interviews that were analyzed by manifest content analysis. 16 AF patients with recent in- or outpatient encounters were included (age 68 (52-78) years; 43% female; BMI 29.5 (20.4-35.8) kg/m2; paroxysmal/persistent AF (50%/50%); AF duration 7 (0-22) years). Four semi-structured focus-group interviews were conducted. Study results were intended to inform the development of a digital tool aimed to support risk factor and comorbidity optimization in patients scheduled for rhythm control interventions.

Results
Relevant comorbidities were hypertension (88%), heart failure (25%), diabetes mellitus type 2 (19%) and ischemic heart disease (13%). Only 19% stated that they were satisfied with their current level of physical activity and 19% were satisfied with their current eating habits. The participants’ suggestions were summarized into three main categories. First, person-centered information is essential, meaning that information should be customized, conveyed in an appropriate tone and include practical tips. Second, there is an unmet need for help with managing lifestyle habits in a way that is easily applicable in everyday life, and patients desire help with creating habits. Third, regular communication is necessary including inspirational reminders and motivational feedback.

Conclusions
From a patient perspective, person-centered information, practical help with managing lifestyle habits, and regular communication are considered essential in helping to optimize treatment of comorbidities and associates risk factors associated to lifestyle. This can, at least in part, be done digitally and should be implemented more in standard care to improve outcomes and reduce cost.
Accelerometer-derived physical activity and the risk of death, heart failure, and stroke in atrial fibrillation patients: A prospective study from UK Biobank
Authors: Ahn H J , Rhee T M , Kwon S , Lee S R , Choi E K , Oh S , Gregory L I P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Data on the risk of cardiovascular outcomes according to the objectively measured physical activity (PA) in atrial fibrillation (AF) is scarce.

Purpose
We aimed to explore the association between accelerometer-derived PA and the risk of death, heart failure, and stroke in patients with AF.

Methods
From the UK Biobank prospective cohort, 2324 AF patients with valid wrist-accelerometer data recruited between 2013 and 2015 were included. Wrist accelerometers were used to define the intensity and duration of light, moderate, and vigorous PA. The primary outcomes were all-cause mortality, cardiovascular disease (CVD) mortality, heart failure (HF), and stroke. Restricted cubic splines were used to evaluate the dose-response associations between moderate to vigorous physical activity (MVPA) duration and the primary outcomes. We analyzed the adjusted hazard ratio (aHR) of primary outcomes in AF patients who adhere to the PA guideline of the World Health Organization (MVPA≥150 min/week) compared to the patients with low PA.

Results
The mean age was 61.1±6.2 years and 64.9% were male. During a median of 6.9 years, 184 all-cause deaths, 62 cardiovascular deaths, 225 heart failure, and 92 stroke events were observed. There was a linear inverse dose-response relationship between MVPA time (≥108 min/week) and all-cause mortality. A certain range of MPVA time (105 to 590 min/week) was associated with a lower risk of HF. The risk of stroke and CVD mortality had no significant relationships with MVPA time. AF patients with guideline-adherent PA levels have lower risks of all-cause mortality and heart failure: aHRs (95% CIs) were 0.70 (0.50-0.98), p=0.04 for all-cause mortality and 0.67 (0.49-0.93), p=0.02 for heart failure.

Conclusion
In this study of objectively measured PA data, AF patients with higher PA showed lower risks of all-cause mortality and heart failure. AF patients adhere to PA guideline (MVPA≥150 min/week) might have a lower risk trend of CVD mortality and stroke. Exercise should be strongly encouraged for AF patients as in the general population.
The outcomes of cryoballoon, high-power short-duration, and conventional radiofrequency atrial fibrillation catheter ablation: a propensity score weighted study
Authors: Park H , Park J W , Kim D H , Yu H T , Kim T H , Uhm J S , Joung B Y , Lee M H , Hwang C , Pak H N 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Purpose
We compared the efficacy, safety, and heart rate variability (HRV) after cryo-balloon (Cryo-PVI), high-power short-duration (HPSD-PVI) or conventional radiofrequency pulmonary vein isolation (conventional-PVI) in patients with atrial fibrillation (AF).

Methods
In this retrospective analysis of single-center cohort, we included 2,975 patients who underwent AF catheter ablation (74.1% male, median 60 years old, 74.1% paroxysmal AF). We compared the procedural factors, rhythm outcomes, complication rates, and post-procedural heart rate variability (HRV) between the Cryo-PVI (n=493), HPSD-PVI (n=638), and conventional-PVI (n=1,844).

Results
In spite of significantly shorter procedural time in the Cryo-PVI group (73 min for Cryo-PVI vs 110 min for HPSD-PVI vs 153 min for conventional-PVI, p&lt;0.001), major complication (2.8% for Cryo-PVI vs 2.4% for HPSD-PVI vs 2.5% for conventional-PVI, p=0.875) or freedom from late recurrence (log-rank, p=0.357) did not differ among the three ablation groups. Cryo-PVI showed significantly lower risk for AF recurrence in patients with paroxysmal AF (weighted hazard ratio [WHR] 0.62, 95% confidence interval [CI] 0.41-0.93), but worse rhythm outcome in those with non-paroxysmal AF (WHR 1.47, 95% CI 1.06-2.05, p for interaction=0.002) as compared with conventional-PVI. In the subgroup analysis for HRV (n=1,429), Cryo-PVI group showed significantly higher low-frequency to high-frequency ratio at post-procedure 3 month (p&lt;0.001), 1-year (p&lt;0.001), and 2-year (p=0.023).

Conclusion
Cryo-PVI showed better rhythm outcome in patients with paroxysmal AF, but worse outcome in those with non-paroxysmal AF with higher long-term post-procedural sympathetic nervous activity as compared with conventional-PVI.
Early recurrences predict late therapy failure after pulsed field ablation of atrial fibrillation: midterm clinical outcome from a high-volume center
Authors: Plank K , Bordignon S , Schmidt B , Urbanek L , Chen S , Schaack D , Tohoku S , Chun K R J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulsed field ablation (PFA) is a new myocardial-specific ablation technology for atrial fibrillation (AF). Direct current electric energy is applied to cells and disrupts cell membranes by creating pores. Data regarding midterm outcome are sparse.

Purpose
The aim of this single-center study was to report midterm clinical outcomes following PFA-based pulmonary vein isolation (PVI).

Methods
Consecutive patients with symptomatic AF were enrolled to undergo PFA-PVI based on the "5S Study" ablation strategy. Procedures were done between March 2021 and January 2022. A dedicated catheter with five splines delivering bipolar energy with a voltage of 1.8-2.0 kV was used. Arrhythmia recurrence was defined as documented AF/atrial tachycardia (AT) lasting more than 30 seconds after a 90 days blanking period (BP). Procedural and demographic data were analysed.

Results
231 patients (42% female, age 69±12, 55% paroxysmal atrial fibrillation [PAF]) were included in this preliminary analysis. 901 pulmonary veins (PV) were identified, and all PVs could be isolated using solely the PFA device. 895 (99.3 %) PVs were isolated with the first application. 32±4 applications per patient were delivered. The overall complication rate was 3.5% (vascular access complication: 2.2%, stroke: 0.9%, tamponade: 0.4%). Median follow-up time was 323 days. 22% of patients experienced a recurrence during the BP after a median of 23 days. Kaplan Meier estimated freedom of AF/AT out of the BP was 75% at one year, 83% for PAF and 64% for persistent atrial fibrillation (persAF, p&lt; 0.0036). In a multivariate analysis blanking recurrence (p&lt;0.001) and female sex (p=0.002) were the only independent predictors for late recurrence.

Conclusions
This study indicates high acute efficacy of PFA based PVI. 75% of patients are free of AF at one year. Blanking recurrence is an independent predictor for late recurrence after PFA-PVI: further studies are required to better define the duration of the BP after PFA PVI.
Very high power- short duration radiofrequency ablation in patients with congenital heart disease and atrial fibrillation: safety and outcome
Authors: Lengauer S , Telishevska M , Krafft K , Bahlke B , Englert E , Lennerz L , Popa P , Reents R , Deisenhofer D , Hessing H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
It has been shown recently that ablation of paroxysmal and persistent atrial fibrillation (AF) using very high-power-short duration (vHPSD) ablation protocol is safe and effective. Data for vHPSD ablation protocol in adult patients with congenital heart disease (ACHD) are lacking. We searched our database for ACHD patients undergoing AF ablation using vHPSD ablation regarding periprocedural safety and outcome.

Methods
The data of 62 consecutive ACHD patients with mild (n=43; 69.4%), moderate (n=15; 24.2%) or complex (n= 4; 6.4%) CHD were analysed (Table 1 ). Mean age was 60,43 ± 12,7 years ( 46% male) with a Cha2ds2-VASc2 Score median of 2. Patients were diagnosed with paroxysmal AF (n= 24; 38%) or persistent AF (n= 38; 61%). In 6 patients (9,6 %), a previous conventional pulmonary vein isolation (PVI) had been performed.
Settings used for vHPSD ablation were 70 W/5-7 s or 60 W/7-10 s using irrigated-tip catheters. Circumferential PVI was performed in all 62 patients; in 30 patients (48%) additional substrate ablation was performed. The 30-day incidence of adverse events was analyzed and patients followed-up in regular visits at our outpatient clinic using repetitive 7 days Holter ECGs every 3 months.

Results
No adverse events such as cardiac tamponade, pericardial effusion &gt;10mm, transient ischemic attack/stroke, atrio-esophageal fistula, cardiac arrest or death occurred. Vascular access complications were detected in 7/62 patients (11%), including 4 patients with a need of intervention (surgical n=2, thrombin injection n=2).
Complete PVI was performed in all patients (mean procedure time 129 ± 42min, mean fluoroscopy time 9,09 ± 5.44 min. Radiofrequency (RF) time was 127.27 ± 7,25 min (111,43 ± 27,83 min PVI only, 148,76 ± 46,07 min PVI + substrate ablation).
After a mean follow up of 249 days, freedom of any atrial arrhythmia off antiarrhythmic drugs (AAD) after a single ablation procedure was present in 26/47 patients (55.3%). Success rate was significantly higher in patients with paroxysmal AF (n=16/18; 88%) compared to patients with persistent AF (n=10/29; 34.5%; p&lt; 0.001; Figure 1) Conclusion: In this first study using vHPSD in ACHD patients of variable complexity with paroxysmal or persistent AF, the technique was safe and effective. Major periprocedural complications were rare and limited to vascular access problems. No vHPSD ablation modality-related complications occurred. vHPSD was fast in all patintes regardless of CHD complexity. Results in the paroxysmal CHD group were excellent and encouraging for persistent AF.
New insight in epicardial ablations: 3D-printed additive manufacturing as intra-procedural diagnostic and operative tool
Authors: Monaco C , Pannone L , Della Rocca D G , Talevi G , Cappello I A , Ramark R , Candelari M , Terryn H , Baert K , Laha P , Bori E , Gharaviri A , La Meir M , Innocenti B , De Asmundis C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The feasibility of additive manufacturings (AMs) as peri-procedural tools has already been established. In order to extend their use to intra-procedural tools for surgical, interventional, or electrophysiology procedures, AMs must be able to convey specific data from cardiac imaging and to come into contact with both biological tissue and energy sources.

Methods
A resin (MED625FLX) and a urethane thermoplastic elastomer (TPU) were chosen as materials for AMs, printed in a variety of thicknesses and configurations. Geometry test was conducted to compare the properties of materials before and after sterilization. In-vitro test was carried out in a wet lab to validate the safety related to propagation of energy underneath the material during application of power sources; three different sources (cryothermal, bipolar radiofrequency, unipolar radiofrequency) were tested. The release of debris derived from the AM on the biological tissue was verified both with electron microscopy and Raman spectroscopy.

Results
Geometries below 1 mm and above 2.5 mm did not pass the test after sterilization for both materials. A total of 100 energy applications were delivered during in-vitro testing. Temperature was kept constant. The type of material used for the AM, the energy-type delivered and the factorial combination of distance/material and distance/energy-type had a significant p-value for temperature changes on the tissue underneath the AM (Temperature*Material p=0,003; Temperature*Energy p&lt;0,001; Temperature*Material*Position p=0,02; Temperature*Position*Energy p&lt;0,001). Post-hoc test using Dunn's procedure showed significant p-values for distance (Temperature*Position p&lt;.001) and energy-type erogated (Temperature*Energy*Cryo-biRF p&lt;.001; Temperature*Energy*Cryo-uniRF p&lt;.001; Temperature*Energy*biRF-uniRF p&lt;.001), while there were no significant differences of temperature in relation to AM thickness and material. Raman spectroscopy on biological tissues revealed that no AM particles &gt;1μm were released.

Conclusions
The use of AMs in intra-operative cardiac procedures may be feasible and safe, and it can be employed as a reliable integration of cardiological imaging into tangible localisation of certain specific structures or pathological substrates.
Determinants of left atrial local impedance: relationships with contact force, atrial fibrosis and rhythm
Authors: Bates A , Paisey J R , Yue A , Banks P , Roberts P R , Ullah W 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Boston Scientific

Background
The relationships between baseline tissue local impedance (LI), contact force (CF), atrial fibrosis and atrial rhythm are uninvestigated in a clinical setting.

Objectives
To compare the relationship of LI and CF between atrial fibrillation (AF) and sinus rhythm (SR). Establish the effects of atrial fibrosis as assessed by bipolar voltage and LI.

Methods
Patients undergoing persistent AF ablation were recruited. The ablation catheter was placed against the left atrial wall and CF levels varied from 1-40g. LI was recorded concurrent to changes in CF at these locations, with data collected at the same locations in AF and SR following DC cardioversion. LI values were referenced to patient blood pool, (LIr).

Results
20 patients were recruited. 109 locations were sampled obtaining 1903 datapoints (SR: 966, AF: 937). CF correlated strongly with LI (repeated measures correlation = 0.64). The relationship between CF and LIr was logarithmic. Rhythm and CF had a significant main (both p &lt; 0.0005) and interaction effect (p = 0.022) on tissue LI: AF demonstrated higher LIr values than SR for similar CF (Figure 1). Furthermore, AF modelled a more predictable relationship between CF and LI than SR (R2 = 0.21 vs 0.13).
Bipolar voltage had no effect on the relationship of CF to LIr in either rhythm when using conventional cut-offs to determine scar (0.05mV and 0.5mV). Cut-offs for assessing scar using LIr used values of 0.5Ω and 10.5Ω based on concurrent work. Through assessing fibrosis using these values, LIr showed an interaction effect with CF for LIr in SR and AF, (SR: p &lt;0.0005, AF: p = 0.01), with more fibrosis demonstrating shallower CF-LIr curves than healthier tissue, (Figure 2).

Conclusions
CF and rhythm significantly affect the measured LIr of LA myocardium. Optimal catheter-tissue coupling may be better achieved with higher levels of CF and in AF rather than SR. Atrial fibrosis as assessed by bipolar voltage did not affect the CF-LI relationship, but was when assessed by LIr.
Cardioneuroablation for the treatment of vasovagal syncope, functional sinus node dysfunction and functional atrioventricular block: initial experience in one center
Authors: Minguito Carazo C , Rodriguez Manero M , Martinez Sande J L , Garcia Seara J , Gonzalez Melchor L , Fernandez Lopez X A , Gonzalez Ferrero T , Gonzalez Juanatey J R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background and purpose
Cardioneuroablation (CNA) or ablation of the ganglionated plexi (GP) is an emergent procedure that has been used in the treatment of vasovagal syncope (VVS), functional sinus node dysfunction (SND) and functional atrioventricular block (AVB). The aim of the present study was to describe our initial experience with this technique.

Methods
Prospective, unicentric, observational study of consecutive patients which were referred to our institution for VVS, functional SND or functional AVB. Prior the procedure, all the patients underwent atropine test.

Results
A total of 19 patients were included in the study (51.5 ± 12.7 years, 68.4% males). 15 patients (78.9%) had prior syncope with a median of 1.6 ± 3.8 episodes per month. 8 patients (42.1%) underwent the procedure due to recurrent VVS, 6 patients (31.6%) due to SND and 5 patients (26.3%) due to AVB. Prior the procedure there was an increase of 39 ± 8% of the heart rate (HR) with the atropine test. Extracardiac vagal stimulation, was attempted in 11 patients (59.7%) and from them, only 63.6% had vagal responses. We used an anatomic approach in 79% of the patients. The right superior GP was ablated with a bi-atrial approach in 100% of the patients. At the end of the procedure all the patients had a negative atropine test with an increase in the HR significantly lower than prior the procedure (39 ± 8% vs 5 ± 5%; p=0.002). After a median follow-up of 8.5 (3.9-17.7) months, freedom from syncope was 93.3% and the incidence decrease from 1.6 ± 3.8 to 0.02 ± 0.11 episodes per month. Freedom from pacemaker implantation was 88.8%. There was a significant reduction in the patients who experience presyncope after the procedure (94.7% vs 21.1%; p=0.002) (Figure 1). No complications were observed related to the procedure.

Conclusions
In our initial experience CNA could be a reasonable option for young patients with recurrent VVS, and functional SND or AVB, which could even be an alternative to pacemaker implantation. However more prospective and randomized studies are needed to support these conclusions.