bluuebunny/crossref_metadata_2025_split huggingface dataset:
New parameter of the second part of the P-wave predict atrial fibrillation: comparison with P-wave signal-averaged electrocardiography
Authors: Lee Y , Kim J , Lee J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private hospital(s). Main funding source(s): Kyung Hee University

Background
A study to predict the risk of AF by analyzing the P-wave of the electrocardiogram in detail has been attempted for a long time, and P-wave signal-averaged ECG is also known to be helpful. Recently, the P-wave was analyzed by dividing it into two parts, and when the latter part is extended, it suggests left atrium dilatation or delayed conduction, and it is suggested that this may be a slightly more sensitive parameter.

Objective
The purpose of this study was to find the best predictor of atrial fibrillation by comparing the characteristics of the P-wave in the subjects with AF and healthy controls using 12-lead ECG and signal-averaged ECG (SAECG).

Methods
We recruited 58 paroxysmal atrial fibrillation patients in AF group and 57 people in the control group. All subjects underwent 12-lead ECG, P-wave signal-averaged ECG, and transthoracic echocardiography. The total P-wave duration (PWD), the second part of the P-wave were measured with an electronic caliper in lead II.

Results
The second part of the P-wave was higher in the AF group, which was statistically significant (70.8 ± 20.6 vs. 60.5 ± 12.3ms, respectively, p&lt;0.01). Filtered PWD and the integral of the P-wave were significantly higher in the AF group. The second part of the P-wave, filtered PWD, and the integral of P-wave were univariate and multivariate predictors of AF. The second part of the P-wave showed ROC (Receiver operating characteristic curves) area of 0.635, and the cut-off value was 61.5ms with 59.6% sensitivity and 59.6% of specificity. Of the SAECG parameters, the longer filtered PWD predicted a history of AF with an AUC (Area under the ROC curve) of 0.669.

Conclusions
We confirmed that second part of the P-wave which reflects the electrophysiological status of the left atrium is a valuable marker for predicting AF. Also, Filtered PWD and the integral of the P-wave among the SAECG parameters were useful predictors of AF.
Extended use of preprocedural data to detect expiratory airflow limitation in patients with atrial fibrillation scheduled for ablation
Authors: Hereijgers M J M , Van Der Velden R , Verhaert D V M , Habibi Z , Betz K , Gawalko M , Hermans A N L , Gietema H , Mihl C , Schotten U , Vernooy K , Simons S , Linz D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In patients with atrial fibrillation (AF), expiratory airflow limitation adds to overall morbidity and may impair the response to heart rhythm control strategies.

Purpose
We aimed to determine the prevalence of expiratory airflow limitation in patients scheduled for AF ablation and evaluated whether routine preprocedural cardiac analyses can detect occult lung disease.

Methods
Consecutive AF patients scheduled for catheter ablation were systematically screened for expiratory airflow limitation with handheld (micro)spirometry devices. As part of routine preprocedural care, patients underwent cardiac computed tomographic angiography (cCTA), transthoracic echocardiography and respiratory polygraphy. Qualitative analyses of cCT was performed for emphysema, airway abnormalities and lymphadenopathy. Sleep apnea severity and nocturnal desaturation were derived from polygraphy. Multivariate logistic regression was performed to assess if routinely preprocedural studies were associated with expiratory airflow limitation.

Results
(Micro)spirometry was performed in 110 consecutive patients and expiratory airflow limitation was detected in 25% of patients (previously unknown in 24 of 28 patients; Figure 1). Patients with expiratory airflow limitation more often presented with pulmonary abnormalities on cCTA, such as mild-to-severe emphysema (odds ratio [OR] 4.2, 95% confidence interval [CI] 1.12-15.1, p &lt; 0.05), lymphadenopathy (OR 3.6, 95% CI 1.1-11.3, p &lt; 0.05) and bronchial wall thickening (OR 2.6, 95% CI 1.0-6.5, p &lt; 0.05; Figure 2). The negative predictive value of the absence of pulmonary abnormalities on cCTA to identify patients with normal lung function was 85%. Polygraphy-derived sleep apnea status and nocturnal desaturation was less severe in patients with expiratory airflow limitation compared to patients with normal lung function (32% vs 48% moderate-to-severe sleep apnea, p = 0.23; oxygen desaturation index 3.0 [2.4-6.5] vs. 6.7 [3.4-11.4], p = 0.03). Echocardiography data did not differ between patients with compared to patients without expiratory airflow limitation.

Conclusions
Spirometry detected expiratory airflow limitation in 25% of patients scheduled for AF ablation. Routine preprocedural cCTA includes pulmonary features which may help in triage referral for formal pulmonary assessment.
The relationship of plasma catestatin concentrations with the extension of left atrial fibrosis
Authors: Katic J , Sikirc I , Breskovic T , Jurisic Z , Borovac J A , Anic A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Atrial fibrosis is increasingly considered an important part of vulnerable substrates, with an essential function in the induction of left atrial (LA) conduction abnormalities underlying the transition from paroxysmal (PAF) to persistent atrial fibrillation (PeAF), contributing to disease continuation. A substantial number of studies suggest a correlation between atrial fibrosis and low voltage zones (LVZ) (1). Previous studies have shown that catestatin (CST) regulates cardiac remodeling. The CST inhibition of catecholamine inhibits the Ang II-induced cell proliferation, and the extracellular matrix (ECM) downregulation to protect the heart from fibrosis produces similar results inhibition of catecholamine and the regulation of the beta-adrenergic receptors (β-ARs) (2). From the results, it is clear that CST inhibits cardiac fibrosis by regulating nitric oxide (NO) and the reactive oxygen species (ROS) pathways via inhibiting catecholamine release and influencing the production of the downstream molecule (2).

Purpose
This study investigated the potential association of serum catestatin level and LA fibrosis in AF patients.

Methods
The current study enrolled 18 consecutive patients with PeAF who had undergone bipolar voltage mapping of the left atrium before catheter ablation. The proportion of the mapped LA surface exhibiting low voltage (&lt;0.5mV) was expressed as a percentage of the overall mapped LA surface area. In all participants, fasting laboratory tests were drawn at admission. The primary outcome measure of the current study was the association of serum CST and low-voltage zones (%LVZ ≥ 10% as a reference for severe LVZ).

Results
The patient characteristics were summarized in Table 1. The LA was mildly dilated, and the median %LVZ was 4 (IQR 0.75-31.25). The lower degree of cardiac fibrosis (LVZ &lt; 10%) is significantly associated with higher levels of catestatin compared to severe LVZ &gt;10% (8.6 (interquartile range-IQR 4.6 – 25.0) vs. 21.9 (IQR 11.1-100.0), p= 0.040)(Figure 1).

Conclusion
The higher catestatin level was associated with the lower extension of atrial fibrosis (low LA voltage zones).
Benefit of integrated care in patients with atrial fibrillation- a predictive heterogeneous treatment effect analysis of the ALL-IN trial
Authors: Trinks-Roerdink E M , Geersing G J , Van Den Dries C J , Rutten F H , Hemels M E W , Rienstra M , Van Smeden M , Van Klaveren D , Kent D M , Van Doorn S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Integrated care is effective in reducing all-cause mortality in patients with atrial fibrillation (AF) in primary care. Although this overall effect is undisputed, some individual patients may benefit more than others. The aim of this post-hoc analysis of the cluster-randomized ALL-IN trial, performed in primary care, is to explore heterogeneity of the effect of integrated AF care.

Methods
A model was developed and validated to predict the outcome all-cause mortality using the CHA2DS2-VASc items as predictors. The hazard ratio and absolute risk reduction were plotted as a function of this predicted mortality risk using the ALL-IN data. The interaction between treatment and predicted risk was tested for significance to identify treatment heterogeneity.

Results
Among 1,240 AF patients included in the ALL-IN trial (median 77 years (range 65-104), 49.4% female) the model for predicted mortality showed a c-statistic of 0.72 [95% CI 0.66-0.78] with good calibration. The hazard ratio for the intervention across all risk levels ranged from 0.28 to 0.81, yet without a significant interaction effect (p for interaction=0.93). However, the absolute risk reduction of integrated AF care was greatest in patients with the highest predicted risk.

Conclusion
Independent of the risk of mortality related to comorbidities, all AF patients benefit from integrated care in the primary care setting. Importantly, on an absolute scale, the effect is greatest in patients with a high-risk profile of comorbidities. These results stress the need for integrated AF care, including patients at high-risk of mortality and with multimorbidity.
Clinical application of virtual antiarrhythmic drug test using digital twins in patients who recurred atrial fibrillation after catheter ablation
Authors: Hwang T , Kwon O , Lim B , Jin Z , Yang S , Kim D , Park J , Yu H , Kim T , Uhm J , Joung B , Lee M , Hwang C , Pak H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
We previously reported a proof-of-concept study that digital twins can test antiarrhythmic drug (AAD) effects on atrial fibrillation (AF) after integrating the patients’ cardiac CT imaging and electroanatomical map (EAM). In this study, we evaluated the reproducibility of the virtual AAD test (V-AAD) in the clinical setting in patients who recurred after AF catheter ablation (AFCA) and took AADs.

Methods
This single-center retrospective study included 232 patients (71.6% male, 60.5±10.2 years of age, 40.9% paroxysmal AF) who were prescribed AADs after AFCA due to real or high chance of recurrence. Clinical AADs (C-AAD) were chosen at the discretion of the primary care physician blinded to V-AAD test. All those included patients underwent V-AAD test using digital twins reflecting the patients’ atrial anatomy, histology, and electrophysiology by integrating cardiac CT and EAM. The ion currents for each AAD (amiodarone, sotalol, dronedarone, flecainide, and propafenone; 2 doses for each drug) were defined based on previous publications. We defined the most efficient V-AAD as the V-AAD that terminated virtual AF the fastest. We evaluated the association between AF recurrence rate while using C-AAD and the most efficient V-AAD, which showed excellent termination/ defragmentation of AF in the digital twins.

Results
In the clinical setting, the most effective V-AAD was administered in 72 patients (31.0%), and not effective V-AADs in 61 patients (26.3%). During the median 782 (IQR 582-1047) days follow-up, AF recurrence was observed in 132 patients (56.9%) (under the class IC 44.4% and class III 57.4%). The recurrence rate within a year after using the effective V-AAD was 40.9%, and that of using the ineffective V-AAD was 54.1%, respectively (log-rank p=0.046). The recurrence rate within a year in patients with ≥2 effective V-AADs and those with 0 or 1 were 42.4% and 59.3%, respectively (log-rank p=0.056).

Conclusions
The digital twins-guided V-AAD test was feasible for evaluating the efficacy of multiple AADs in patients with AF who recurred after AFCA. We need a prospective randomization study to evaluate the prediction power of the V-AAD test.
Impact of the individual relationship between focal or rotational regions of interest and atrial cardiomyopathy in patients with chronic forms of atrial fibrillation
Authors: Guckel D , Kramer K , Bergau L , Piran M , El Hamriti M , Fink T , Sciacca V , Koerperich H , Isgandarova K , Khalaph M , Imnadze G , Friedrich S , Ruehl J , Sommer P , Sohns C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The mechanisms for the initiation and perpetuation of atrial fibrillation (AF) are still not completely understood. The CARTOFINDER module represents a novel approach for the visualisation of repetitive focal and rotational activations in patients with AF.

Purpose
The aim of this prospective observational study was to evaluate the potential relationship between findings from CARTOFINDER mapping and individual atrial arrhythmia substrates. Beyond that, the impact of atrial fibrosis on patients’ outcome was analysed.

Methods
A total of 20 consecutive patients (69 ± 9 years, 55 % male) underwent ablation for persistent AF (PERS) applying a 3D-mapping system with the integrated CARTOFINDER module. Regions of interest (ROIs) were identified before ablation. The individual amount and distribution of atrial fibrosis in the left atrium (LA) based on anatomical segments was determined by LGE CMR prior to the ablation procedure. 3, 6 and 12 month-follow-up data were assessed.

Results
In all patients, ablation procedures were performed successfully (n=20, 100%). LA mapping time was 09.30 ± 03.53 min, mean ablation duration was 26.40 ± 07.51 mi, mean fluoroscopy time amounted to 6.66 ± 1.85 min. Consistent with Utah classes II-III, LGE-CMR revealed an intermediate degree of 21.41 ± 6.16% LA fibrosis. Focal and rotational ROIs were identified in all patients (mean no ROIs per Patient n = 416.45 ± 204.57). Univariate logistic regression calculation documented no consistent correlation between the percentage of LA fibrosis and the probability for the occurrence of ROIs (posterior: regression coefficient (b) =0.36, p-value (p) =0.24; anterior: b=-0.08, p=0.54; lateral: b=0.31, p=0,39; septal:b=-0.12; p=0.66; right PVs: b=0.34, p=0.27; left PVs: b=0.07, p=0.79; LAA: -0.91, p=0.11). Between the degree of atrial cardiomyopathy and the number of ROIs no association was observed (b=10.86, p=0.15). 12 months AF-free survival amounted to 70% (n=14). The degree of LA fibrosis showed no significant correlation with AF-free survival (logistic regression: posterior: b=0.33, p=0.12; anterior: b=-0.03, p=0.83; lateral: b=0.31, p=0,35; septal:b=-0.07; p=0.79; right PVs: b=0.81, p=0.15; left PVs: b=0.37, p=0.25; LAA: -0.16, p=0.54).

Conclusions
This study reports on initial observations concerning the relationship between focal and rotational activations and atrial fibrosis in PERS AF. No evidence for a consistent correlation between the occurrence or number of ROIs and the degree of atrial arrhythmia substrates was revealed. Beyond that, the amount of LA fibrosis did not correlate with the 12 months AF-free survival rate. Larger studies are warranted to verify our first results.
Safety, feasibility and success rate of cryoballoon pulmonary vein isolation without pulmonary vein phlebography
Authors: Saleh A , Wieczorek M , Mulyono A , Koujan O , Hoeltgen R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Catheter ablation is an effective therapy for recurrent, symptomatic atrial fibrillation (AF). Recent studies proved significantly lower rates of AF recurrence with catheter cryoballoon (CB) ablation compared to antiarrhythmic drug therapy.

Purpose
To evaluate the feasibility and success rate of CB pulmonary vein isolation (PVI) without pulmonary venography.

Methods
We enrolled a total of 200 patients undergoing PVI with CB. Among those 101 participants received pulmonary venography shortly after the transseptal puncture and before introducing the cryoballoon (group 1), the rest did not (group 2). Amount of injected radiocontrast, fluoroscopy time and dose, left atrium (LA) dwell time, procedure time and one year’s recurrence rate of AF were registered.

Results
Fifty five percent of the patients were male. Mean age of participants was 63 years. No significant difference in age, cardiac risk factors or BMI was noted between the two groups. Likewise, no difference was found regarding the procedure time (115 ± 30 minutes in group 2 vs. 116 ± 40 minutes in group 1). Fluoroscopy time was shorter in group 2 (23.9 ± 7 vs. 25 ± 11 minutes, P= 0,003). Fluoroscopy dose was lower in group 2 (579 ± 405 vs. 3310 ± 2408 µGy.m2 , P&lt;0,001). We injected less radiocontrast during PVI in group 2 patients (41 ± 21 vs. 81 ± 31 ml, P&lt;0,001). LA-dwell time was significantly shorter in procedures without venography (71 ± 26 vs. 82 ± 36 minutes, P=0,014). We observed comparable AF recurrence rates in both groups during follow-up (28% group 2 vs. 26% group 1). Four minor complications were noticed in the group 1 while five minor complications occurred in the group 2. Major complications were not elicited in both groups.

Conclusion
In our center, CB PVI without pulmonary venography was feasible and safe. It resulted in lower fluoroscopy dose and shorter fluoroscopy time. Amount of injected radiocontrast and LA-dwell time were significantly reduced, without an impact on AF recurrence rate or occurrence of procedure-related complications.
Bone morphogenetic protein 10 as a predictor for recurrent atrial fibrillation after catheter ablation
Authors: Hennings E , Aeschbacher S , Coslovsky M , Paladini R E , Spies F , Voellmin G , Conen D , Zuern C S , Krisai P , Badertscher P , Sticherling C , Osswald S , Knecht S , Kuehne M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation (AF) recurrence after catheter ablation (CA) poses a major challenge. The novel atrial-specific biomarker, bone morphogenetic protein 10 (BMP10), might aid in the selection of appropriate patients for CA.

Purpose
We aimed to assess the predictive value BMP10 for AF recurrence after CA in a large cohort of AF patients.

Methods
We measured baseline BMP10 concentrations in AF patients who underwent elective CA for the first time. Patients were enrolled in a single-center prospective cohort study. The primary outcome variable was AF recurrence during 12 months’ follow-up using 2 x 24h and 1 x at least 4-day Holter. We constructed Cox proportional hazard models to determine the association of BMP10 and AF recurrence. The multivariable model was adjusted for age, sex, body mass index, and cardiovascular risk factors.

Results
A total of 1,112 AF patients (74% male) with a mean age of 61 ± 10 years were included in our analysis (60% paroxysmal AF, 40% persistent AF). The 12-month follow-up examination revealed that AF recurred in 374 (33.6%) patients. Kaplan-Meier curves for recurrent AF according to BMP10 quartiles are shown in the Figure (BMP10 quartile I: 0.76-1.50 ng/mL, quartile II: 1.50-1.72 ng/mL, quartile III: 1.72-1.99 ng/mL, quartile IV: 1.99-3.75 ng/mL). In the unadjusted Cox proportional hazard model, a per-unit increase in log transformed BMP10 was associated with a hazard ratio (HR) of 2.28 (95% CI 1.43, 3.62; p &lt; 0.001) for AF recurrence. After multivariable adjustment, the HR of BMP10 was 1.98 (95% CI 1.14; 3.42, p = 0.01) for AF recurrence.

Conclusion
The novel atrial-specific biomarker BMP10 was associated with AF recurrence after CA in our large cohort of AF patients.
Pulsed-field ablation based pulmonary vein isolation: reconnection pattern and comparison to cryoballoon ablation
Authors: Lemoine M , Obergassel J , Rottner L , Moser F , My I , Wenzel J P , Moser J , Reissmann B , Ouyang F , Kirchhof P , Rillig A , Metzner A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulsed-field ablation (PFA) integrated into a pentaspline catheter is a novel single shot device to perform pulmonary vein isolation (PVI) for treatment of atrial fibrillation (AF). While initial data demonstrated high safety and efficacy, long-term PVI durability and reconnection patterns are unknown. Here, we analyzed findings from repeat ablation procedures after index PFA compared to cryoballoon ablation (CBA) based PVI.

Methods
We prospectively included consecutive patients with index PVI applying PFA (n=161) or CBA (n=302) who underwent repeat ablation due to symptomatic recurrence of AF or atrial tachycardia (AT) after a blanking period of 3 months. All repeat procedures were performed with a 3D mapping system and RF energy.

Results
We identified a total of 14 patients after previous PFA and 23 patients after previous CBA. PV reconnection was detected in 9/14 (64%) patients after PFA and in 16/23 (70%) after CBA (p=1.000). A total of 24/55 (44%) vs. 34/92 (37%) initially isolated PVs demonstrated electrical reconduction (p=0.487) after PFA and CB ablation. In both groups the right inferior PV was reconnected most frequently (9/24 (38%) patients after PFA and 10/34 (29%; p=0.578) patients after CBA). Distribution of conduction gaps is shown in figure 1. All PVs were successfully reisolated. Repeat procedures after index PFA and CBA showed similar duration (115±32 min vs. 114±49 min; p=0.785), fluoroscopy time (13±4 min vs. 14±8 min; p=0.558) and number of RF applications (38±23 vs. 36±34, p=0.738).

Conclusion
During repeat AF/AT ablation after previous PFA- or CBA-based PVI a comparable incidence of PV reconduction gaps was found. Repeat procedure times and fluoroscopy exposure were similar. Randomized controlled trials and longer follow-up are necessary to draw further conclusions.