bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence of atrial fibrillation/flutter, one-year re-admission rates, and practice patterns among patients &lt;65 years of age: a Danish nationwide study
Authors: Schak Nielsen L , Kofoed Petersen J , Emborg Vinding N , Andersson C , Weeke P E , Lund Kristensen S , Gundlund A , Schou M , Koeber L , Fosboel E L , Oestergaard L 
Published: October 2022

Abstract

Background/Introduction
The general atrial fibrillation/flutter (AF) population is well explored and described, but there is sparse data on temporal changes in the incidence, AF-readmission rates, and practice patterns in patients with AF under 65 years of age from unselected cohorts.

Purpose
To investigate temporal changes, AF readmission rates, and practice patterns in patients under 65 years of age with first-time AF diagnosed between 2000–2018.

Methods
Using Danish nationwide registries, we identified patients &gt;18 years and &lt;65 years with a first-time AF-diagnosis from 2000–2018. The cohort was categorized according to calendar periods; 2000–2002, 2003–2006, 2007–2010, 2011–2014 and 2015–2018. Incidence rate (IR) of AF per 100,000 person years (PY), AF-readmission, and practice patterns of medical treatment, electrical cardioversion, and catheter ablation was investigated in the first year following AF-diagnosis.

Results
In this study 60,917 patients were included; 8,150 patients (13.4%) in 2000–2002, 11,898 (19.5%) in 2003–2006, 13,560 (22.3%) in 2007–2010, 14,167 (23.3%) in 2011–2014 and 13,142 (21.6%) in 2015–2018. No major differences were seen in patient characteristics according to calendar period. A stepwise increase, as seen in the Table, in the crude IR of AF per 100,000 PY was observed across calendar periods, except for 2015–2018 (Crude IR [95% CI]: 2000–2002: 78.7 [77.0; 80.4], 2003–2006: 86.3 [84.7; 87.8], 2007–2010: 97.9 [96.3; 99.6], 2011–2014: 102.3 [100.7; 104.0], 2015–2018: 93.6 [92.0; 95.2], while no difference in AF readmission was identified (AF-readmissions: 2000–2002: 32.7%, 2003–2006: 31.1%, 2007–2010: 32.2%, 2011–2014: 32.1% and 2015–2018: 31.7%), as seen in the Figure, right panel. In the first year following AF-diagnosis, the cumulative incidence of catheter ablation increased stepwise from 1.2% in 2000–2002 to 7.6% in 2015–2018 and electrical cardioversion from 2.0% in 2000–2002 to 8.7% in 2015–2018 (Figure, left panel). Treatment with oral anticoagulant therapy (OAC) increased from 28.5% in 2000–2002 to 47.8% in 2015–2018, while there was no change in treatment with rhythm or rate medication therapy.

Conclusion
From 2000–2018, we found an increase in the incidence of atrial fibrillation/flutter (AF) in patients &lt;65 years from 78.7/100,000 person years (PY) to 93.6/100,000 PY and an increase in the use of catheter ablation, electrical cardioversion and OAC in the first year following first-time AF-diagnosis. AF readmission rates were stable over calendar periods.

Funding Acknowledgement
Type of funding sources: None.
Electrocardiographic profile of asymptomatic adolescents by the TELE ECG system in Brazil: analysis of 11058 patients
Authors: Nogueira M F , Andalaft R , Hinkelmann Berbert G , Valdigem B , Pinto V B C , Moretti M P , Felicioni S P , Fernandes R C , Franca F F A C , Freitas R V , Feres F 
Published: October 2022

Abstract

Introduction
The search for markers that can serve as screening methods for young practitioners of physical activity has always raised an intense discussion between pediatricians and cardiologists. Thus, the ideal investigation algorithm should identify patients at high risk also among asymptomatic patients and be of low cost to society. This would only be possible by including a low cost diagnostic method and largely accessible. In this context, telemedicine systems and in particular tele-electrocardiogram (tele-EKG) systems have low cost and agility and can collaborate to solve this problem.

Purpose
To analyze the electrocardiographic pattern in asymptomatic patients aged between 10 and 20 years old who underwent EKG by the tele-EKG system between 2007 and 2014

Methods
All EKG valid results from asymptomatic patients aged between 10 and 20 years old from 2007 and 2014 sent to the tele-EKG system of a large tertiary hospital were analysed aiming to determine the prevalence of abnormal findings.

Results
Of the 797,115 exams on the analysed period 25,326 were from patients aged between 10 and 20 years old and 11,058 (55% male) of them were asymptomatic. Regarding disorders of rhythm, ventricular arrhythmias were found in 0.54% and atrial premature beats in 0.47% of the exams. There were 5 episodes of supraventricular tachycardia (0.04%) and one episode of atrial fibrillation. Atrioventricular blocks were: first degree (0.71%) and second degree (0.03%). There was 1 case of 2:1 AV Block and 1 case of advanced AV block. Short PR interval was observed in 0.76% of the exams, with 15 of them showing ventricular pre-excitation (0.13%). Regarding morphological changes in EKG pattern, right bundle branch disorders were present in 7.5% of the patients and left bundle branch in 0.04%. Right bundle branch block occurred in 0.63% and left bundle branch block in only 1 case. Repolarization changes occurred in 1.8% of patients. We found left ventricular overload in 0.25% and right ventricular overload in 0.14% of cases. Only 5 patients had typical EKG of septal hypertrophy (0.045%). There were 1751 diagnostics overall, representing 15.8% of the sample. The most prevalent was right bundle branch abnormalities, followed by repolarization abnormalities (graphic below).

Conclusion
EKG screening in asymptomatic adolescents is a low cost and feasible method to identify individuals with electrical alterations and who require detailed clinical evaluation. This also may contribute to reduce risk of sudden events during sports activities.

Funding Acknowledgement
Type of funding sources: None.
Impaired heart rate variability one and six months post acute COVID-19
Authors: Lampsas S , Oikonomou E , Souvaliotis N , Goliopoulou A , Papamikroulis G A , Anastasiou A , Theofilis P , Zakynthinos G , Gialamas I , Pantelidis P , Gounaridi M A , Tsatsaragkou A , Siasos G , Tousoulis D , Vavuranakis M 
Published: October 2022

Abstract

Background
Long COVID-19 syndrome is an increasingly recognized problem. Post-infectious cardiac autonomic dysfunction is commonly reported. This study aims to evaluate autonomic dysfunction by means of Heart rate variability (HRV) on post-COVID-19 patients.

Methods
Hospitalized patients for COVID-19 (either at the medical ward or Intensive Care Unit (ICU)) were followed up at 1 and 6 months after hospital discharge. Medical history and clinical information were collected. HRV was assessed by 24-hour ambulatory electrocardiography Holter, with the measure of the standard deviation of normal RR intervals in 24 h, ms (SDNN). The comparison was conducted with age and sex-matched non-COVID-19 controls.

Results
Thirty-four patients hospitalized with COVID-19 (20.6% admitted in ICU) were examined 1-month and 6-months post-hospital discharge. SDNN was significantly (p&lt;0.001) reduced in the COVID-19 group (111±23 ms) compared to the control subjects (152±24 ms) 1-month after discharge. Subgroup analysis between COVID-19 group revealed that ICU subjects presented significantly (p&lt;0.001) reduced SDNN compared to the medical ward, respectively (83±20 ms vs. 118±17 ms). At 6-months, an improvement was noted at SDNN 24h (6-month: 133±24 vs. control: 151±24 ms, p=0.004; 1-month: 111±23 ms vs. 6-month: 133±24 ms, p&lt;0.001). Also at 6-months, ICU subjects noted significantly (p=0.003) reduced SDNN 24h compared to medical ward subjects (107±17 ms vs. 140±20 ms). On the 6-months follow-up, 32% of the subjects had “long-COVID-19” symptoms. Subjects with long COVID-19 symptoms had low SDNN values (“long-COVID-19”: 112±17 ms vs. non-“long-COVID-19”: 142±20 ms, p=0.001)

Conclusion
Patients hospitalized for COVID-19 have reduced SDNN, at one month post-hospital discharge which is improved at the six months follow-up. These findings emphasize the increased sympathetic drive activity in the post-acute COVID-19 phase and imply a link between autonomic dysfunction and long COVID-19.

Funding Acknowledgement
Type of funding sources: None.
Premature ventricular complexes are not independently associated with concurrent paroxysmal atrial fibrillation on mobile cardiac telemetry
Authors: Maneheim A , Juhlin T , Dziubinski M , Slusarczyk M , Grotek A , Engstrom G , Johnson L S B 
Published: October 2022

Abstract

Background
Premature ventricular complexes (PVCs) on 24hECG predict incident atrial fibrillation in long-term prospective studies, but whether PVCs detected on ambulatory monitoring indicate a risk of concurrent paroxysmal atrial fibrillation is unknown.

Objectives
To determine whether PVCs predict paroxysmal atrial fibrillation on ≤30-day ambulatory mobile cardiac telemetry (MCT).

Methods
US patients aged 17–100 years with 2–30 full days of ambulatory full-disclosure ECG using a mobile cardiac telemetry device, without atrial fibrillation on their first day of recording, were included. The association between PVC frequency on recording day 1 and and the outcome of atrial fibrillation ≥30 seconds during subsequent recording days was analysed using age and sex adjusted logistic regression models and restricted cubic splines, with additional adjustment for premature atrial contractions (PACs).

Results
The study population included 18,220 patients with a mean age 64 years; 58% were female. Median monitoring duration was 19 days (interquartile range 9–29). PVC and PAC frequency were moderatly correlated, Spearmans rho 0.359, p&lt;0.0001. Using logistic regression analyses adjusted for age, sex and recording duration, PVCs were associated with atrial fibrillation detection (Figure 1a), but in models additionally adjusted for PAC frequency there was no remaining effect of PVC frequency on atrial fibrillation risk (Figure 1b).

Conclusions
A finding of PVCs, in the absence of PACs, on 24hECGs does not imply increased risk of concurrent paroxysmal atrial fibrillation detected on ≤30 day MCT.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Hjärt-Lungfonden, Swedish Society for Medical Research
Recurrence of atrial fibrillation following pulmonary vein isolation: impact of body mass index on one- and three-year outcomes
Authors: Milstein N , Saberito M , Bhatt A , Habibi M , Sichrovsky T , Preminger M , Shaw R , Mittal S , Musat D 
Published: October 2022

Abstract

Background
Cryoballoon (CB) pulmonary vein isolation (PVI) is an accepted method for ablation in patients with paroxysmal and persistent atrial fibrillation (PAF, PeAF). However, there are a paucity of data about the impact of body mass index (BMI) on one-year and longer-term outcomes following ablation.

Objective
To objectively understand the impact of BMI on outcomes following CB PVI.

Methods
We enrolled consecutive AF patients undergoing CB PVI; all patients had an implantable loop recorder (ILR), which transmitted data wirelessly daily. We assessed AF recurrences after excluding an initial 3-month post-ablation blanking period.

Results
The cohort included 222 pts (66±9 years; 143 [64%] male; 120 [54%] PAF; CHA2DS2-VASc 2.6±1.6). The mean BMI was 30±5. Patients were followed for 763±347 days, during which time 50% and 68% had recurrent AF 1- and 3-years post ablation. We divided the cohort based on the mean BMI into 2 groups: BMI &lt;30 and BMI &gt;30. Heavier patients were younger and more likely to have PeAF. Over 1-year of follow-up, patients with a BMI &lt;30 had similar likelihood of being free of AF to patients with a BMI &gt;30 (46% vs, 56%, p=0.0.097, Figure 1, left). However, as patients were followed for 3-years, freedom from AF was significantly higher in patients with a BMI &lt;30 (59% vs. 81% in BMI &gt;30, p=0.002, Figure 1, right).

Conclusions
Our data show that although patients had similar outcomes 1-year post-ablation, during longer-term follow-up patients with a BMI &gt;30 had a much worse outcome. Our study uniquely offers objective (using an ILR) assessment of the impact of BMI on long-term outcomes following CB PVI (homogenous ablation strategy). These data highlight the need to identify strategies to improve outcomes in obese patients.

Funding Acknowledgement
Type of funding sources: None.
Atrial fibrillation detection in ambulatory patients using a smart ring powered by deep learning analysis of continuous photoplethysmography monitoring
Authors: Kwon S , Choi E K , Lee S R , Ahn H J , Lee B , Oh S , Lip G Y H 
Published: October 2022

Abstract

Background
Atrial fibrillation (AF) detection could be effective with photoplethysmography (PPG) signal monitoring by a wearable device.

Purpose
We aimed to validate the performance of AF detection among ambulatory patients who underwent electrical cardioversion for AF using a smart ring capable of continuous PPG monitoring and deep learning analysis.

Methods
In this prospective single-arm study, participants who underwent successful electrical cardioversion for AF were enrolled. The participants equipped a smart ring (CardioTracker, Sky Labs Inc., Seongnam, Republic of Korea) after the electrical cardioversion. The smart ring then continuously monitored PPG over 14 days to detect AF recurrence. The smart ring alarmed AF episodes based on deep learning analysis of PPG. The participants were asked to measure at least three daily ECGs using the smart ring to validate AF recurrence detected by PPG. All ECG snapshots were recorded along with lead I and saved with simultaneous PPG. ECG data were examined by the three cardiologists independently (SK, SRL, and EKC). The monitoring time, analyzable proportions of monitored signals, detection rates of AF episodes, and the diagnostic performance of PPG-based deep learning were evaluated. At the end of the monitoring, a survey on the use of the smart ring was performed.

Results
A total of 35 participants (mean age 58.9 years, male 74.3%) were enrolled. Figure 1 illustrates an example of PPG monitoring and PPG-ECG snapshots by the smart ring. The study participation period was a median of 14 days and the wearing time of the smart ring was a median of 9.2 days (IQR 7.1–11.5 days). Signal artifacts during daily activity decreased the analyzable proportions of monitored PPG by 68.5%. Irregular pulse episodes were detected by the smart ring in 29 (82.9%) participants after a median of 1 day from the cardioversion (Figure 2). A total of 2532 PPG-ECG snapshots were acquired and 1623 (64.1%) were interpretable by both the cardiologists (using ECG) and the deep learning analysis (using PPG). Comparing PPG by simultaneous ECG, the performance of AF detection by the smart ring was 98.7% for sensitivity, 97.8% for specificity, 2.2% for false positives, and 1.3% for false negatives (Figure 2). After using the smart ring, 76.9% of the participants responded that they had no discomfort in using the smart ring in daily activity and another 76.9% responded that it was helpful to monitor their disease.

Conclusion
Despite the signal artifacts during daily activity, AF detection with PPG monitoring by a smart ring could be effective for AF screening among ambulatory patients.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This work was supported by Sky Labs Inc, Seongnam, Republic of Korea, and by the grant No. 0320202040 from the Seoul National University Hospital Research Fund.
Syncopal patients without prodromes exhibit a diverse pattern of adenosine release during head-up tilt test
Authors: Fragakis N , Antoniadis A , Sotiriadou M , Virgiliou C , Ballauri I , Gika H , Boulmpou A , Triantafyllou K , Vergopoulos S , Bakogiannis C , Papadopoulos C , Tzikas S , Karamitsos T , Vassilikos V 
Published: October 2022

Abstract

Background/Introduction
In a significant proportion of patients with neurally-mediated syncope (NMS), the mechanism of syncope remains largely undetermined. Adenosine has been proposed as a central humoral factor in various forms of NMS: high Adenosine Plasma Levels (ADP) are encountered in patients with vasovagal syncope (VVS), low ADP in non-prodromes syncope (NPS), while ADP in patients with situational syncope SS are less well determined.

Purpose
We sought to assess ADP in patients with different clinical forms of syncope, with an emphasis on the presence or absence of prodromal symptoms, as well as the relation between ADP and the outcomes of Head-Up Tilt Table Test (HUTT) and Adenosine test (ADT).

Methods
Patients with different clinical types of NMS (n=124), i.e., VVS, NPS, or SS, were investigated using a standard protocol including HUTT and ADT. During HUTT, ADP was measured in the supine position, at table tilting, and in syncope.

Results
Baseline ADP did not differ among groups. ADP at syncope were higher in NPS compared to VVS (1.55±1.29 vs 0.16±0.05 μM, p=0.03) and SS (0.15±0.05 μM, p=0.02). In NPS, ADP increased from the supine position to the time of syncope (0.47±0.25 to 1.55±1.29 μM, p=0.04). In VVS, ADP increased only from the supine to the tilt position (0.23±0.04 to 0.35±0.10 μMu, p=0.02), while in SS ADP did not change in any stage of HUTT. SS was associated with cardioinhibitory HUTT (OR 3.40, 95% CI 1.05 to 9.56, p=0.04) and positive ADT (OR 4.22, 95% CI 1.47 to 11.46, p=0.012).

Conclusion(s)
A distinct pattern of ADP increase is noted during HUTT in NPS, suggesting that an excessive increase of ADP may play the key role in triggering this type of clinical presentation of syncope independently of the baseline ADP. Cardioinhibition prevails in patients with SS without clear adenosine involvement. Such observations contribute to an enhanced understanding of the pathophysiology of different clinical forms of syncope which may offer the possibility to tailor the management approach appropriately.

Funding Acknowledgement
Type of funding sources: None.
Risk stratification of sudden cardiac death in subjects with asymptomatic ventricular preexcitation: diagnostic value of non-invasive and invasive methods
Authors: Chilabert D , Diangelo S , Lanzotti M , Antonietta C , Menoyo M , Pilon L , Viale S , Bagnera F 
Published: October 2022

Abstract

Introduction
In subjects with asymptomatic ventricular preexcitation (AVP) guidelines recommend follow-up by non-invasive methods. However, in some patients accessory pathways (APs) show high-risk invasive parameters and risk of sudden death.

Objectives
To assess the association between the non-invasive and invasive risk stratification (NIRS and IRS) in AVP patients in our center.

Material and methods
Retrospective and observational study in 58 patients with AVP, underwent NIRS and IRS. Association between NIRS (electrocardiogram, holter and ergometry testing) and IRS variables (AERP ≤250 msec, SPERRI ≤250 msec, atrioventricular reentrant tachycardia or AF, multiple APs) from the electrophysiological study (EPS), and sensitivity and specificity of NIRS to predict a high-risk EPS were determined.

Results
Of patients with high-risk EPS (n=41), 55% had a previously low-risk NIRS (n=11) while 78% (n=30) had a high-risk NIRS (p=0.05). A low-risk NIRS had a sensitivity (S) 27% and specificity (E) 47% to predict a high-risk EPS.

Conclusions
In our population, 1 of every 2 patients with low-risk NIRS presented a high-risk IRS. The NIRS methods present low S and E for risk stratification in AVP patients.

Funding Acknowledgement
Type of funding sources: None.
The veins of the left ventricular summit in patients undergoing cardiac resynchronization therapy
Authors: Zehan I G , Andrei M G , Coseriu G , Eotvos C A , Lazar R D , Jelnean M , Tentea C P , Porca A D , Negru A , Burde A , Moldovan M , Chiorescu R , Pop S , Heist E K , Blendea D 
Published: October 2022

Abstract

Introduction
While the coronary sinus and its left ventricular branches have been extensively described, the veins of the left ventricle summit (LVS) have been much less studied. The emergence of new ablation techniques for ventricular tachycardias, which make use of the LVS veins, has generated a renewed interest in the anatomy of these venous conduits.

Purpose
The aim of the study was to describe in detail the anatomy of the LVS veins using rotational venous angiography.

Material and methods
All patients (N=106, age 68±12 years, 72 men) underwent coronary venous angiography during the cardiac resynchronization implant procedures.

Results
The LVS veins identified were the great cardiac vein (GCV), the anterior interventricular vein (AIV) and the mitro-aortic LVS vein (MALVSV). The MALSV emerged from the GCV between 12 and 2 o'clock on the mitral ring, coursed inside the left atrioventricular groove, towards the aorto-mitral continuity (AMC), where it turned towards the ventricular septum and coursed parallel to the AIV, tapered down and ended at midventricular level. Most of the course of this vein was in the region of the LVS. The diameter of the venous conduit at the GCV-AIV junction was 4.9±1.0 mm. The MALVSV was present in 76 patients (72%; Figure 1). The MALVSV diameter was 2.4±0.6mm at the ostium (Figure 2) and 1.8±2.0 mm at the AMC. The takeoff angle was 134±27°. The total length of the vein was 34±16 mm, of which 23±14mm were inside the AV groove and 11±9mm, were along the ventricular septum. The length of the MALSV segment embedded in the left AV groove as well as the total length of MALSV correlated significantly with the left atrial diameter (r=0.44; P=0.040 and r=0.45; p=0.016 respectively) as well as with the right ventricular systolic pressure (r=0.50; p=0.028 and r=0.57; P=0.030 respectively).

Conclusions
This study brings new insights into the angiographic anatomy of the LVS veins. Detailed knowledge of these venous tributaries could help with the development of new strategies for ablation of LVS tachycardias.

Funding Acknowledgement
Type of funding sources: None.