bluuebunny/crossref_metadata_2025_split huggingface dataset:
The relationships between the plasma metabolome and orthostatic blood pressure responses
Authors: Zambach C , Jingxue P , Gerward S , Fedorowski A , Smith G , Engstrom G , Hamrefors V 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): the Swedish Heart-Lung Foundation

Objective
Impaired orthostatic blood pressure responses may be an indicator of cardiovascular autonomic dysfunction, which can be seen in the metabolic syndrome. Whereas autonomic dysfunction and the metabolic syndrome are clinically associated, the relationships with the plasma metabolome is unknown.
We explored the association between orthostatic blood pressure responses and over 800 plasma metabolites in middle-aged subjects from the general population.

Methods
We included 3,803 subjects (mean age, 57 years; 52 % women) with information on smoking habits, diabetes, antihypertensive drug treatment, anthropometrics, hemodynamic measurements and 818 plasma metabolites (mass-spectrometry). The associations between each metabolite and orthostatic systolic blood pressure responses as well as orthostatic hypotension were determined using multivariable linear regression analysis. The Bonferroni corrected p-value was used in this study (p value &lt; 6.11×10-5 (0.05/818) and 2.273×10-3 (0.05/22) respectively).

Results
We identified five amino acids, five vitamins, co-factors and carbohydrates, nine lipids and two xenobiotics that were associated with orthostatic blood pressure responses. After additional adjustments for BMI, diabetes, smoking and antihypertensive treatment, the association remained significant for six lipids, four amino acids and one xenobiotic, with the most significant relationships for lipids in the dihydrosphingomyelin and sphingosine pathways.

Conclusions
In this exploratory study, we found that 22 out of 818 plasma metabolites were associated with orthostatic blood pressure responses. Eleven metabolites, including lipids in the dihydrosphingomyelin and sphingosine pathways, were independently associated with orthostatic systolic blood pressure responses after additional adjustment for markers of cardio-metabolic disease.
Electrocardiographic markers of subclinical atrial fibrillation detected by implantable loop recorder
Authors: Xing L Y , Diederichsen S Z , Hojberg S , Krieger D W , Graff C , Olesen M S , Nielsen J B , Brandes A , Kober L , Haugan K J , Svendsen J H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The LOOP Study was funded by Innovation Fund Denmark [grant number 12-1352259], The Research Foundation for the Capital Region of Denmark, The Danish Heart Foundation [grant number 11-04-R83-A3363-22625], Aalborg University Talent Management Program, Arvid Nilssons Fond, Skibsreder Per Henriksen, R og Hustrus Fond, the European Union’s Horizon 2020 program [grant number 847770], Læge Sophus Carl Emil Friis og hustru Olga Doris Friis’ Legat, and an unrestricted grant from Medtronic.

Background
Atrial fibrillation (AF) is a well-known and treatable risk factor for stroke, which has sparked a substantial interest in AF screening. However, further insights into subclinical AF development are warranted to inform strategies of screening and subsequent clinical management upon AF detection.

Purpose
This study sought to identify 12-lead electrocardiogram (ECG) parameters associated with the onset, burden and progression of subclinical AF detected by long-term continuous monitoring.

Methods
We included AF-naïve individuals aged 70-90 years with ≥1 additional stroke risk factors (hypertension, diabetes, heart failure, or prior stroke) who underwent implantable loop recorder (ILR) monitoring in the LOOP Study. Using data from daily ILR recordings and computerized analysis of baseline ECG, we studied empirically selected ECG parameters for AF detection (≥6 minutes), cumulative AF burden, long-lasting AF (≥24 hours), and AF progression.

Results
Of 1370 individuals included, 419 (30.6%) developed AF during follow-up, with a mean cumulative AF burden of 1.5% [95% confidence interval (CI): 1.2-1.8%]. Several P-wave-related and ventricular ECG parameters were associated with new-onset AF as well as with cumulative AF burden in AF patients. P-wave duration (PWD), P-wave terminal force in lead V1, and interatrial block (IAB) further demonstrated significant associations with the risk of AF episode ≥24 hours. Among AF patients, we observed an overall reduction in cumulative AF burden over time (incidence rate ratio 0.70 [95% CI: 0.51-0.96]), whereas IAB was related to an increased risk of progression to AF episodes ≥24 hours (hazard ratio 1.86 [95% CI: 1.02-3.39]). Further spline analysis revealed longer PWD to also be associated with this progression in AF duration.

Conclusions
We identified several ECG parameters associated with new-onset AF detected by ILR. Especially PWD and IAB were robustly related to the onset and the burden of subclinical AF as well as progression over time.
Left atrium surface mesh reconstruction from cardiac MRI
Authors: Sharp A , Pope M T B , Wijesurendra R , Gala A , Betts T R , Banerjee A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The strive towards personalised medicine is universal across all aspects of healthcare. In the management of atrial fibrillation (AF), this can take the form of shape analysis tools to predict an individual’s outcome from catheter ablation (1–3), or electrophysiological simulations to plan an ablation strategy (4–6).
Fundamental to their application is our ability to derive accurate three-dimensional (3D) anatomical models of a patient’s left atrial geometry from cross-sectional imaging. MRI is widely utilised in this regard due to its excellent tissue characterisation. However, constructing surface meshes can be challenging given its relatively sparse two-dimensional (2D) image planes. A particular challenge exists in producing a mesh that balances concordance with left atrium segmentation and smoothing terms to eliminate sharp edges and artifact from the contouring process.

Objective
Here, we describe a novel method for left atrium surface mesh reconstruction from MRI contours.

Methods
Cardiac MRI was performed on ten patients with paroxysmal or persistent AF, on a 3T clinical MR scanner using phased-array receiver coils. Image sequences included respiratory and ECG-gated 15-minute post contrast late gadolinium enhancement, with a 1.3mm slice thickness and in-plane resolution of 0.66×0.66mm2. Seven individuals were in sinus rhythm, and three in AF at the time of MRI.
A single, custom, graphical interface tool implemented in Matlab R2014a enabled 3D mesh reconstruction from 2D MRI slices (7,8). Endocardial surfaces of the left atrium were manually segmented by an experienced clinician, with the pulmonary veins and left atrial appendage excluded at their ostia (Figure 1A). Our tool produced an initial sparse representation with vertices equally spaced along the contours (Figure 1B). Attractor points were defined along the contours, with subdivision and Laplacian smoothing applied to the mesh. This was balanced with a deformation step, which iteratively pulled the mesh towards the attractor points (Figure 1C), resulting in its final shape (Figure 1D).

Results
Reconstruction performance was evaluated by measuring the distance between heart contours and the reconstructed 3D surface for each case, producing the value for average misalignment 0.71 ± 0.58mm, which compares favourably to the in-plane resolution.

Conclusions
Our approach offers a highly accurate method for producing 3D anatomical models of the left atrium from MRI, which is fully automated following segmentation through an interactive graphical interface. The iterative optimisation between attractor-based deformation towards the original contours and the Laplacian smoothing enables us to create smooth geometries which remain true to their segmentations. Furthermore, our approach does not require the use of a template mesh, which can result in final geometries being biased towards the template.
Use of intracardiac echocardiography in Latin America: a case series
Authors: Mejia Lopez E , Matos C , Santana Mejia G , Joubert L M , Rivera C 
Published: May 2023

Abstract
Funding Acknowledgements: Type of funding sources: None.
The use of Intracardiac Echocardiography (ICE) for cardiac arrhythmia ablations has been associated with reductions in fluoroscopy dose and procedure time, while enabling operators to locate the ablation catheters more accurately in the setting of complex arrhythmias. The added cost of ICE per procedure is a significant barrier for its implementation in developing countries. Reprocessing ICE catheters could be the alternative that allows electrophysiologist working with limited resources to implement this state of the art tool.
Electrophysiology procedures using ICE in a private practice in the Dominican Republic that reprocess ICE catheters were retrospectively evaluated. Complications and reported compromise of the structural integrity or the quality of the images were recorded. The total cost of the catheters was distributed among the amount of cases where they were used to determine cost-per-use of each catheter.
In the evaluated period, 2 catheters were used for 26 procedures, submitting each catheter to 12 reprocessing cycles. There was no reported compromise of the structural integrity of the catheter or the quality of the image. The only complication reported was 2 pericardial effusion after an ablation of atrial fibrillation plus atrial flutter; notwithstanding, the events were not related to the performance of the ICE. Distributing the cost of each catheter among a total of 13 uses per catheter, the total cost per use of ICE catheter was US$265.38.
Reprocessing of ICE catheters was safe and effective in the series of patients evaluated. The complications reported were not attributed to the performance of the ICE catheter. A significant reduction of the cost of the catheter from original amount implies a potential increase in the use of this technology in the Dominican Republic, without compromise on the benefits. This could also serve as a model for the implementation of ICE in other developing countries of the region.
Quality of life and perception after pulmonary vein isolation and app-based mental training - Results from the randomized controlled MENTAL AF Trial
Authors: Lurz J A R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): German Heart Foundation

Introduction
It was recently shown that app-based mental training (MT) reduces atrial fibrillation (AF) related symptoms as compared to usual care in patients undergoing catheter ablation for AF. We now report the effect of MT on quality of life (QoL) and AF burden.

Methods
MENTAL AF was a RCT with two parallel treatment groups enrolling patients undergoing catheter ablation for symptomatic AF during August 2019 and July 2021. Patients were randomized in a 1:1-ratio to app-based MT or usual care. The MT group gained access to a daily 10-minute app-based breathing, relaxation and meditation training, with a minimum requirement of 2 sessions/week.
A total of 183 patients were randomized of which 151 could be included in the final analysis (76 in the MT and 75 in the usual care group).
The primary outcome was the intergroup difference of the mean AF6 sum scores during the 3 months study period. Secondary outcomes included web-based QoL measures as assessed by the AF Effect on Quality of Life (AFEQT) and PROMIS Global Health as well as time in AF/atrial tachycardia documented on 7-day Holter.

Results
Baseline characteristics were well balanced between the MT vs control group, respectively: mean (SD) age 60.6 (8.7) vs 61.5 (8.7) years, female patients 42 vs 40%, paroxysmal AF 55 vs 55%, and left ventricular ejection fraction 58.0 (7.3) vs 57.5 (7.8) %. The primary outcome of AF6 sum score was 8.9 (6.9) points in the MT and 12.5 (10.1) in the usual care group (P = .011). The median difference of the AFEQT Global Score from baseline to 3 month was 18.3 (IQR 11.7 to 35) in the MT and 10.8 (IQR 1.7 to 31.7) in the usual care group (P = .026). The PROMIS Physical Health domain improved by 4.6 (IQR 0; 7.5) in the MT as compared to 0 (-2.6; 4.7) in the usual care group; P = .000. As for the Mental Health domain there was a trend towards a more pronounced improvement [2.9 (IQR 0 to 5.2) vs 0.8 (IQR -2.6 to 4.7); P = .061].
On 3-month follow-up 7-day-Holter 10 patients (16.9 %) in the MT vs 11 patients (14.3 %) in the usual care group exhibited AF/ atrial tachycardia (P = .67). During the registration period 35 patients (53.8 %) in usual care and 25 patients (35.7 %) in MT reported heart rhythm-related symptoms (P = .034).

Conclusion
MENTAL AF shows that an app-based mind & body intervention as an adjunctive treatment tool improves QoL despite an equal actual arrhythmia burden on 7-day Holter. These results suggest that mental training unfolds its effect by a modification of disease perception and coping.
Anterior mitral line in patients with persistent AF and anterior scar: a multicenter matched comparison. The MiLine Study
Authors: Bergonti M , Spera F R , Gonzalez Ferrero T , Nsahlai M , Saenen J , Huybrechts W , Miljoen H , Heidbuchel H , Valderrabano M , Rodriguez Manero M , Sarkozy A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The benefit of an anterior mitral line (AML) in patients with persistent atrial fibrillation (AF) and anterior atrial scar undergoing ablation has never been investigated.

Objective
to evaluate the outcomes of AML on top of standard treatment, compared to standard treatment alone (no-AML), in this subset of patients.

Methods
Patients with persistent AF and anterior low voltage zone (LVZ) treated with AML in three Centers were retrospectively enrolled. These patients were matched in a 1:1 fashion with patients with persistent AF and anterior LVZ, who underwent conventional ablation, in the same centers. Matching parameters were: age, LVZ burden, and repeated ablation. Primary endpoint was AF/atrial tachycardia (AT) recurrence.

Results
186 patients (66±9 years, 34% women) were selected and included into two matched groups. Bidirectional conduction block was achieved in 95% of AML. After a median follow-up of 2 years, AF/AT recurrence occurred in 29% of the patients in the AML-group, vs. 48% in the No-AML-group (log-Rank p=0.024) (Figure 1). At Cox-regression multivariate­-analysis left atrial volume (HR 1.03, p=0.006) and AML (HR 0.46, p=0.003) were significantly associated with the primary endpoint. At univariate logistic-regression, lower BMI, older age, extensive anterior LVZ and the position of the left atrial activation breakthrough away from the AML (Figure 2), were associated with first-pass AML block.

Conclusion
In this retrospective matched analysis of patients with persistent AF and anterior scar, AML on top of standard treatment was associated with improved AF/AT-free survival compared with matched patients treated with standard treatment alone.
Cryoballoon ablation for atrial fibrillation in octogenarians: a propensity-score matching comparison with a cohort of younger patients
Authors: Cecchini F , Mugnai G , Kazawa S , Bolzan B , Iacopino S , Maj R , Placentino F , Ribichini F , Sieira J , Sofianos D , Sorgente A , Tomasi L , De Asmundis C , Chierchia G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation (AF) is the most frequent sustained cardiac arrhythmia in adults with a current estimated prevalence between 2-4% in the general population. AF prevalence increases with advancing age and it is estimated that nearly 10% of octogenarians may be affected by this arrhythmia. In terms of safety and efficacy Cryoballoon ablation (CB-A) has become a valid option for achieving pulmonary vein isolation (PVI) in patients affected by AF. However, data regarding CB-A in octogenarians are still scarce and limited to single center experiences, therefore the present multicenter study aimed to compare the outcomes and complications of index CB-A in patients older than 80 years-old with a cohort of younger patients.

Methods and Results
We retrospectively enrolled 97 consecutive patients aged ≥ 80 years who underwent PVI by means of the second generation CB-A. This group was compared with a younger cohort of patients using a 1:1 Propensity score matching. After the matching, 70 patients of the elderly group were analyzed and compared with 70 younger patients (control group). Mean age was 81.4 ± 1.9 years among octogenarians and 65.2 ± 10.2 years in the younger cohort. The global success rate after a median follow up of 23 [18 - 32.5] months was 60.0% in the elderly group and 71.4% in the control group (p = 0.17) (Fig.1). Phrenic nerve palsy (PNP) was the most common complication occurring in a total of 11 patients (7.9%): in 6 (8.6%) patients for the elderly group and in 5 patients (7.1%) of the younger group (p = 0.51). PNP always recovered within the day after CB-A and did not hinder electrical isolation of any of the septal PVs. Only 2 (1.4 %) major complications occurred: 1 (1.4%) small femoral artery pseudoaneurysm in the control group, which resolved with a tight groin bandage without the need of surgical repair and 1 (1.4%) case of urosepsis in the elderly group with subsequent acute kidney failure and need of renal replacement therapy. Arrhythmia recurrence during the blanking period (BP) and need of electrical cardioversion (ECV) to restore sinus rhythm after PVI were found to be the only independent predictors of late arrhythmia relapses (Fig.2).

Conclusions
The present study showed that CB-A PVI is as feasible, safe and effective among octogenarians as it is in younger patients.
Efficacy and safety outcomes of early versus late cryoballoon ablation of atrial fibrillation - 24-months-results from the Cryo Global Registry
Authors: Lawin D , Stellbrink C , Chun K R J , Li C H , Kueffer F , Selma J , Oh I Y , Herzet J , Nitta J , Chang T Y , Lawrenz T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Medtronic, Inc., Minneapolis, MN, USA

Introduction
Increasing evidence suggests early rhythm-control therapy in atrial fibrillation (AF) results in higher freedom from atrial arrhythmia (AA) recurrence and improved cardiovascular outcomes. However, the impact of specifically early cryoballoon ablation (CBA) is not well known.

Purpose
To assess the impact of early CBA of atrial fibrillation on efficacy and safety outcomes.

Methods
We evaluated AA recurrence (≥30 sec after a 90-day blanking period), repeat ablation, and serious procedure-related complications in patients with early vs. later CBA (≤12 vs. &gt;12 months from diagnosis) in patients enrolled in the prospective, multicenter (121 centers in 37 countries). Subjects underwent CBA and were followed either 12 or 24 months per local standard of care.

Results
A total of 3447 subjects were followed through 12 months and a subset of 1220 through 24 months. In summary, 1573 patients (46%) had early CBA treatment at a median [IQR] of 0.3 [0.1 – 0.6] years from AF diagnosis (age 62±12 years, 35.8% female, 71.4% paroxysmal AF), and 1874 (54%) had later treatment at a median of 3.4 [1.9 – 6.7] years after diagnosis (age 61±11 years, 36.2% female, 75.0% paroxysmal AF). Early treatment patients were less hypertensive (53.5% vs 57.9%, p=0.01), had smaller left atrial diameters (41±7mm vs 42±7mm, p&lt;0.01), lower BMI (27±5kg/m2 vs 28±5kg/m2, p&lt;0.01), and less AF symptoms (1.5±1.1 vs 1.8±1.1, p&lt;0.01). Early treatment was associated with higher acute procedural success (97.1% vs 95.2%, p&lt;0.01). Freedom from AA recurrence in the early vs. later group was 86.0% (95% CI: 83.9-87.9%) vs. 81.0% (95% CI: 79.0-82.8%) at 12 months and 80.9% (95% CI: 77.9 – 83.5%) vs. 72.0% (95% CI: 69.0 – 74.7%) at 24 months (both P&lt;0.01). Freedom from repeat ablation was high and not different between early and later treatment groups at 12 (93.6% vs 93.8%) and 24 months (90.2 vs. 89.2%), respectively (p=0.82). Serious procedure-related adverse events occurred in 2.4% and 3.5% of patients in the early and later treatment groups (p=0.045), respectively.

Conclusions
After AF diagnosis, early vs. later CBA results in higher freedom from AA recurrence and is associated with fewer safety events in a real-world evaluation. The difference in comorbidities at baseline between the two cohorts may contribute to the CBA being less effective in the later treatment cohort.
A single atrial stimulation resetting his bundle during tachycardia: a new diagnostic methods of atrial tachycardia distinguishing from other tachycardias
Authors: Inaba O , Nakata K , Michishita T , Isonaga Y , Kono T , Oya H , Takagi T , Inamura Y , Sato A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Backgrounds
Catheter ablation for paroxysmal supraventricular tachycardia (PSVT) is curative treatment. However, diagnosis of atrial tachycardia (AT) distinguishing from other PSVTs are often challenging, especially when the tachycardia terminates after pacing or does not sustain long enough for diagnostic maneuvers. We sought a new method for diagnosis of AT.

Methods
One-hundred and thirty-four PSVTs including 20 ATs, 84 atrioventricular nodal reentrant tachycardias (AVNRTs) and 30 orthodromic reciprocating tachycardias (ORTs) were studied. Single atrial stimulation was started at intervals of 20ms shorter than the tachycardia cycle length during the tachycardia and coupling interval was shortened by 10ms. The pacing was performed from the proximal coronary sinus, which was not the earliest excitatory site, and pacing continued until the His potential was reset or the tachycardia terminated. The incidence of tachycardia resetting and the patterns of tachycardia termination were examined.

Results
Resetting of His was obtained in all AT patients without tachycardia termination. All ATs were not reset despite of His resetting.(Figure 1A) In AVNRTs or ORTs patients, 31 tachycardias (27%) were terminated with AH block before His resetting. In the 83 AVNRTs or ORTs, tachycardia was also reset when His was reset simultaneously.(Figure 1B) When tachycardia resetting was not observed despite His resetting, the diagnostic power of AT was 100% in sensitivity, specificity, positive predictive value, and negative predictive value. All cases which PSVTs were terminated before His resetting were AVNRTs or ORTs.(Figure 2)

Conclusions
A single atrial programmed stimulation resetting His during tachycardia was effective for differentiating PSVT even in cases that tachycardia terminates by the pacing.