bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gender, ethnic difference in arrhythmic risks and prognosis in patients with non-ischaemic cardiomyopathy
Authors: Chung KKI , Lim CJ 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The mortality benefits of Automatic Intracardiac Defibrillator (AICD) in non-ischaemic cardiomyopathy patients is less clear. Subgroup analysis of Definite trial showed that female patients favoured medical treatment. Ethnic difference in arrhythmic risk also not known.

Method
447 patients with heart failure and reduced left ventricular ejection fraction (LVEF &lt;40%) due to non-ischemic cardiomyopathy, all have coronary angiogram to exclude significant coronary artery disease (&gt;70% stenosis).
Continuous variables were compared by Student t tests and categorical variables compared by use of the Fisher exact test. Composite endpoints include death, sudden cardiac death (SCD), ventricular arrhythmias (VA ) and hospitalisations for heart failure. P&lt;0.05 was denoted as statistical significant.

Results
Mean age 63.07 ± 14.19 years, male patients 314 (70%), 360 Chinese and 87 non-chinese. Mean age of male and female patients were 61.21 ± 13.65 and 67.46 ± 14.52 years old respectively. Patients with diabetes mellitus 38%, hypertension 76%, atrial fibrillation 38%, stroke 9%. LDL 2.78 ± 1.04 mmol/l, HbA1c 6.56 ± 1.62%, baseline creatinine 98.43 ± 37.27umol/l. Patients taking ivabradine 9%, b-blocker 88%, Angiotensin inhibitors/Angiotensin Receptor Blocker 66%, Sacubitrial/ Valsartan 26%, spironolactone 57%, SGLT-2 inhibitor 9%.
Mean follow-up duration of 6.18 ± 4.16 years. There were 61 deaths (13%, 2.20% death/ year, 20 females and 41 males). 38 SCD, 22 VA, 218 hospitalisation for heart failure
There was a significant increase in LVEF from 24.88 ± 8.17 to 39.92 ± 13.88% and 22.05 ± 8.52 to 36.14 ± 8.17 % in female and male patients respectively (p=0.023). 190 patients (43%) have LVEF increased to or more than 35%.
40 patients (9%) received device therapy (AICD and Cardiac resynchronization therapy), 19% secondary prevention, 81% for primary prevention. The median time from diagnosis of NICMP to appropriate device therapy for VT/ VT storms was 85.5 months (interquartile range 35-131). 18/21 patients (86%) noted to have appropriate therapy for VT/ VT storms were males. HR for males 8, 95% CI (1.06, 60.34, p=0.044). All the device therapy occurred in patients with LVEF&lt; 35%. There is also gender difference in composite endpoints (p=0.0022)
LVEF improved from 23.31± 8.67 to 38.10 ±15.20 and 21.63 ±7.57 to 33.74 ±12.92% respectively (p=0.014) in Chinese and non-Chinese patients respectively. There are no significant difference in the VA or primary composite endpoints.

Conclusions
The study showed progressive improvement of the therapeutic regimens improve mortality by improving LVEF regardless of gender or ethnicity. The ventricular tachyarrhythmic risk, composite endpoints are significantly higher in male than female patients with non-ischaemic cardiomyopathy. There is no ethnic difference in clinical endpoints.
Tachycardiomyopathy: linear regression model for left ventricular ejection fraction recovery
Authors: Izquierdo Bajo A , Arroyo Monino DF , Fernandez Valenzuela I , Bastos Amador P , Cozar Leon R , Carreno Lineros JM , Diaz Infante E 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Tachycardiomyopathy is a common cause of reversible left ventricular disfunction, whose predictors are not well-stablished. Its individual estimation would be useful for the decision-making process.

Methods
Retrospective single-centre, observational study of consecutive patients with diagnosed tachycardiomyopathy between September 2014-2020. Sample was split in 2 parts: first for the construction of the lineal-regression model selected by the all-possible equation’s method (sample 1, 70% of the cohort), second for its validation (sample 2, 30%).

Results
113 patients were gathered in this period. Most prevalent arrhythmia was atrial fibrillation (75.2%), followed by atrial flutter (22.1%), ventricular extrasystole (5.3%) and atrial tachycardia (2.65%). Mean left ventricular ejection fraction (LVEF) at diagnosis was 33.7% (±6.48) and mean left ventricular end-diastolic diameter 56.3 mm (±6.97). Rhythm control was achieved in 81.4% of patients, of whom 79.3% underwent an ablation procedure. After a mean of 11.4 months, mean final LVEF was 55.1% (±6.04). Recovered LVEF (final minus initial) was calculated in all patients. Using sample 1 131,071 models were calculated. The best model was selected based on the Mallows index (Picture 1), composed by arterial hypertension, sleep apnea syndrome, atrial fibrillation as the culprit arrythmia, LVEF at diagnosis and rhythm control strategy. The selected model explained nearly half of the individual variability of LVEF (R2 0.476). Subsequently in sample 2, predicted recovered LVEF was compared with the observed one (Picture 2), without significative differences in the determination coefficient r2 (R2 - r2 = -0.0064).

Conclusion
Arterial hypertension, sleep apnea syndrome, atrial fibrillation as the culprit arrythmia, LVEF at diagnosis and rhythm control strategy predicted LVEF recovery in tachycardiomyopathy patients.
Tachydysrhythmias in patients admitted with COVID-19 pneumonia: prevalence and impact on in-hospital mortality
Authors: De Almeida Fernandes D , Guimaraes J , Monteiro E , Costa G , Antonio N , Goncalves L 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The COVID-19 pandemic has shifted tremendously the paradigm of hospital care and treatment of cardiovascular (CV) patients. According to most recent evidence, due to its multisystemic impact, COVID-19 may lead to an increased risk of cardiac arrhythmias with subsequently increased morbimortality.

Purpose
Determine the prevalence of tachyarrhythmias in patients admitted with COVID-19, possible predictors and impact on in-hospital mortality.

Methods
A retrospective study of 3475 consecutive patients with COVID-19 pneumonia admitted to our hospital between February 2020 and November 2021 were included. The main outcome was tachyarrhythmias (high ventricular rate (HVR) or new-onset atrial fibrillation (AF), HVR or new-onset atrial flutter (AFL), other supraventricular tachycardias (SVT), ventricular tachycardia (VT) and ventricular fibrillation (VF)). Secondary outcome was in-hospital mortality. Sociodemographic variables and clinical data were recorded. Statistical comparison was made between groups, including logistic regression to determine odds ratios (OR).

Results
A total of 215 patients presented HVR AF (6.31%), 79 of which with new-onset AF (36.74%). 8 patients had HVR AFL (0.23%), 5 VT (0.15%), 4 VF (0.12%) and only 3 patients had a SVT identified (0.09%). Patients with tachyarrhythmias were significantly older (77. 74 ± 11.25 68.94 ± 17.51 years, p &lt;0.001) and had more hypertension (p 0.034), heart failure (HF) (p &lt;0.001), severe valvular heart disease (VHD) (p 0.007), coronary artery disease (CAD) (p 0.031), chronic kidney disease (CKD) (p 0.048) and paroxysmal AF (if previously diagnosed (p 0.001). There were no significant differences regarding gender, dyslipidemia, diabetes, cerebrovascular disease and obstructive sleep apnoea (OSA).
Patients with HF had the highest risk of tachyarrhythmia (OR 3.539; 95% CI 2.666-4.698; p &lt;0.001), followed by severe VHD (OR 1.990; 95% CI 1.192-3.365; p 0.009) and CAD (OR 1.575; 95% CI 1.040-2.386; p 0.032). Older patients or patients with hypertension or CKD were also at an increased risk. Also of note, patients previously diagnosed with paroxysmal AF were more likely to have episodes of HVR AF than the ones with persistent or permanent AF (OR 1.819; 95% CI 1.272-2.602; p 0.001)
Regarding the secondary outcome, patients with tachyarrhythmias during hospital stay had an odd almost 3 times higher of death (OR 2.820; 95% CI 2.151-3.695; p &lt;0.001).

Conclusions
Tachyarrhythmias is a common complication in COVID-19 patients during hospital stay that is significantly linked to higher in-hospital mortality. Patients presenting with high CV disease burden are at particularly significant risk and should be carefully managed.
Mortality and causes of death after new-onset atrial fibrillation: a nationwide study
Authors: Aro A , Haukka J , Halminen O , Putaala J , Linna M , Mustonen P , Hartikainen J , Airaksinen J , Lehto M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Sigrid Juselius Foundation

Introduction
Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide, and its prevalence is increasing with aging population. AF is associated with increased cardiovascular morbidity and mortality, but the prognosis of newly detected AF in the general population is not well established.

Purpose
Using data from the large FinACAF-study, a comprehensive nationwide retrospective cohort study including all diagnosed Finnish AF patients, we studied one-year mortality after new-onset AF in the general population and determined the causes of death of deceased AF patients.

Methods
All patients with new-onset AF in Finland 2007-17 were identified from nationwide primary care and reimbursements registries and hospitalization records. Baseline characteristics of these patients were determined, and their survival was followed from registries for one year. Principal cause of death was determined from death certificate’s International Classification of Diseases (ICD-10) Codes.

Results
A total of 229 321 patients with first-diagnosed AF were identified (50.0% female). Mean age of men and women with new-onset AF was 69.4 ± 13.4 and 77.1 ± 11.8 years, respectively (p&lt;0.001 for difference). In men and women, hypertension had been diagnosed in 68.0% vs 80.4% (p&lt;0.001), congestive heart failure in 15.4% vs 19.3% (p&lt;0.001), diabetes in 22.5% vs 20.7% (p&lt;0.001) and vascular disease in 27.2% vs 24.8% (p&lt;0.001), respectively. Prior stroke or transient ischemic attack had occurred in 14.0% of men and 16.8% of women (p&lt;0.001).
During the one-year follow-up, 11.6% of men and 13.7% of women died (Figure). Most common cause of death in these patients was ischaemic heart disease (26.2% of all deaths), followed by malignancies (17.4%) and dementia (12.4%). Cerebrovascular diseases were responsible for 10.8% of mortality.

Conclusion
In this population-based nationwide study, we demonstrated that one-eight of patients with new AF died within one year of the diagnosis. Ischaemic heart disease was most frequent cause of death.
Sleep apnea is associated with stroke in young patients with or without atrial fibrillation:A population study of &gt;2 million individuals
Authors: Deb B , Vasireddi SK , Clopton P , Ganesan P , Feng R , Rogers AJ , Baykaner T , Bhatia NK , Narayan SM 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NIH, R01 HL149134, R01HL83359

Background
Both Sleep Apnea (SA) and Atrial Fibrillation/flutter (AF) are known risk factors for stroke, and both are increasing in prevalence. They are both under-diagnosed in young adults &lt;60 Y. There is an urgent need to define stroke risk portended by SA and AF yet there a paucity of data in adults aged 20-60 years.

Purpose
To define the relationship between stroke, SA, and AF in a very large cohort of 2 million young-middle aged adults aged 20-60 Y in Northern California.

Methods
We probed the Stanford Research Repository of electronic health data from 01/01/2008 to 11/30/2021 for the diagnoses of stroke, transient ischemic attacks, AF and SA using relevant codes (stroke: 433.X, 434.X, 436.X, I63.X, I65.X, I66.X, G45.X, G46.X; AF: I48.X; SA: G47.X, 327.27).

Results
We identified 2267485 patients aged 20-60Y (55% F; 32% White, 12% Asian, 3% Black), of whom SA was diagnosed in 52730 (2.3%), AF in 10230 (0.4%) and incident stroke in 10385 (0.4%) (Figure 1A)
In patients with SA, 1.5% developed incident stroke. Stroke was more common in patients with SA than those without, regardless of co-existing diagnosis of AF; OR with AF: 1.5 [1.3-1.7, p&lt;0.001] and OR without AF: 3.0 [2.8-3.3 p&lt;0.0001]. Risk of stroke with SA than without was noted to be higher in the younger age subgroups (Figure 1B) regardless of AF.
Although AF was more common in patients with SA than without (odds ratio, OR: 10.1 [9.6-10.6, p&lt;0.0001]), the majority of SA patients (63% with CHADS2VASC ≥2) with stroke did not have a diagnosis of AF (75%), of whom 96% were not anticoagulated (Fig 1, left panel). Of the remaining patients with SA and incident stroke, who did have AF (25%), only 26% were taking OACs at the time of stroke despite median CHADS2 VASC score=3 (Fig 1A, left panel).
Finally, 7% of AF patients developed incident stroke. Of these, 73% had CHADS2VASC ≥2, yet 44% were not anticoagulated. Patients with SA comprised a third of all AF patients with stroke and, compared to AF patients with stroke and without SA, had higher CHADS2VASC (median 3 vs 2, p&lt;0.001) and a similarly low use of anticoagulation (56% vs 54% on OAC) (Fig 1A, right panel).

Conclusions
In &gt;2 million young individuals, we uncover a novel association between SA and incident stroke, regardless of the diagnosis of AF. Surprisingly, three quarters of patients with SA developed incident stroke in the absence of AF, and were not anticoagulated. These results underscore the need to screen for AF and sleep apnea in young adults.
Comparative effectiveness of early rhythm control versus rate control for cardiovascular outcomes according to sex in patients with atrial fibrillation
Authors: Yang PS , Kim DH , Jang E , Yu HT , Kim TH , Pak HN , Lee MH , Sung JH , Joung B 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health & Welfare, Republic of Korea

Background
Rhythm control is associated with better cardiovascular outcomes than usual care among patients recently diagnosed with atrial fibrillation (AF). However, there are limited data on the outcomes of AF ablation according to sex. The purpose of this study was to evaluate gender differences in the effects of early rhythm control compared to rate control on the primary composite outcome of cardiovascular death, ischaemic stroke, hospitalisation for heart failure (HF), or myocardial infarction.

Methods
We conducted a retrospective population-based cohort study including 22635 patients with AF newly treated with rhythm control (antiarrhythmic drugs or ablation) or rate control in 2011-2015 from the Korean National Health Insurance Service database. Propensity overlap weighting was used.

Results
Among patients with early AF treatment (initiated within 1 year since diagnosis), compared with rate control, rhythm control was associated with a similar lower risk of the primary composite outcome both women (weighted incidence rate per 100 person-years: 8.68 in rhythm control vs. 10.3 in rate control; hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.69 to 0.90; P&lt;0.001) and men (weighted incidence rate per 100 person-years: 6.33 in rhythm control vs. 8.32 in rate control; HR 0.77, 95% CI 0.67 to 0.88; P&lt;0.001). However, the effective initiation time for rhythm control therapy was within 6 and 11 months after AF diagnosis in female and male patients, respectively. Moreover, the effective times for other outcomes were different between genders (hospitalization for HF; female within 2 months, male within 9 months/ ischemic stroke; female within 11 months, male immediately).

Conclusions
Early initiation of rhythm control was associated with a lower risk of primary outcome in both genders. However, the effective rhythm control treatment initiation time for primary outcome, stroke and HF-related admission was different in both genders. For rhythm control treatment to be effective, women should start treatment earlier than men.
First human experience with catheter ablation using dipole charge density mapping integrated in robotics in the management of atrial fibrillation
Authors: Gagyi R , Noten AME , Wijchers S , Yap SC , Bhagwandien R , Hoogendijk M , Szili-Torok T 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Remote magnetic navigation (RMN) guided catheter ablation (CA) previously demonstrated high efficiency and efficacy in atrial fibrillation (AF) ablation. Heretofore, only the CARTO 3D mapping system was integrated in the RMN system. Recently, a novel high-resolution non-contact mapping system (AcQMap) can be used in combination with the RMN robotic system (AcQMap-RMN).

Purpose
To assess efficiency, efficacy and safety of dipole charge density mapping in RMN guided ablation procedures for AF.

Methods
All patients undergoing pulmonary vein isolation (PVI) or redo-PVI using the AcQMap-RMN system were analyzed. The AcQMap identifies different activation patterns such as focal firing, rotational activity, and localized irregular activation for substrate ablation. Procedural efficiency was characterized by procedure time, total ablation time and radiation doses. Efficacy data were based on 12-month follow up and number of redo procedures. Procedural safety was evaluated by intra- and post-procedural complications.

Results
A number of 71 consecutive patients were included in the study (47 male, 24 female, mean age 60.8±9.9, 49 redo, 22 de novo). Twenty-four patients had paroxysmal (PAF), 47 had persistent AF (persAF). After completing PVI, 42 patients underwent AcQMap based substrate ablation. Twenty-four patients converted to atrial tachycardia/flutter during the ablation. The mean procedure time was 170.5±43.3 min, mean ablation time 1749.6±950.7 s, mean radiation dose was 207.0 (IQR 128.5 - 349.5) mGy. In the PAF group, radiation doses (128.5 vs 256.0 mGy, p=0.00) and application numbers (21.1 vs 37.0, p=0.00) were lower, ablation times were shorter (1312.5 vs 1919.3 s, p=0.02) compared to the persAF patient group. Two patients in the PAF group, and 9 patients in the persAF group had documented recurrence at the 6-month follow-up visits. In the PAF group, 23 patients were AF-free (95.8%), in the persAF group, 34 patients were AF-free at the end of the 12-month follow-up period (72.3%). Six patients had a redo procedure. Two patients were documented with hematoma, as minor post-procedural complication (2.8%).

Conclusion
AcQMap-RMN integration provides high acute and long-term success rates, improved efficiency and low complication rates in paroxysmal and persistent AF ablation.
Fifty-fifty - a comparison of two 50 watts high power short duration protocols using temperature- versus power- controlled radiofrequency ablation for atrial fibrillation
Authors: Guckel D , Bergau L , Braun M , El Hamriti M , Lucas P , Isgandarova K , Fink T , Sciacca V , Khalaph M , Imnadze G , Sommer P , Sohns C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Radiofrequency-guided catheter ablation (RFCA) is an established treatment option for atrial fibrillation (AF). New approaches applying higher than usual energy levels for shorter periods (high power short duration, HPSD) to improve lesion quality have been reported. The novel DiamondTemp (DT) catheter allows for temperature-guided high power RFCA. Data on a direct comparison of the two emerging RFCA approaches are lacking.

Purpose
This observational single center study aimed to compare the efficacy, safety and characteristics of the novel DT catheter to an ablation index (AI) guided 50 W high power short duration (HPSD) ablation protocol using a conventional force-sensing equipped ablation catheter with surround-flow.

Methods
A total number of 101 patients undergoing RFA for AF were included. 33 patients treated with the DT catheter (50 W, 9 sec), were compared to 69 consecutive patients undergoing AI-guided AF ablation (AI anterior 550; AI posterior 400) with an open-irrigated catheter adherent to a 50 W HPSD protocol. Procedural data and recurrence rates were documented. Follow-up examinations were scheduled after 3, 6 and 12 months.

Results
Acute procedural success was achieved in all patients (n=101, 100%). DT-guided AF ablation was associated with a significantly longer mean procedure duration (98.8±30.1min vs. 78.2±25.6, p=0.002*). PVI using the DT ablation catheter required significantly more RF applications (75.4±30.8min vs. 61.3±14.1, p=0.019*). Total RF duration was significantly lower in the DT group (792.1±311.2sec vs. 1035.5±287.2sec, p&lt;0.001*) as well as fluoroscopy time (4.6±2.1min vs.5.5±2.5min, p&lt;0.006*) and dose (183.8±178.1yGym2 vs. 295.8±247.5yGym2, p&lt;0.013*). Procedure related mayor complications occurred in 1 patient from the DT group (acute stroke; 3%) and in no patients from the HPSD cohort. Early recurrence was reported from 4 patients treated with the DT catheter (12%) compared to 8 patients undergoing HPSD RFA (12 %) (p=1.000).

Conclusion
Temperature- and power- controlled AF ablation using 50 W was safe and effective. AI-guided HPSD ablation resulted in significantly shorter procedure times with significantly fewer RF applications for PVI, whereas total RF duration and fluoroscopy times were significantly higher in this cohort. Further studies are needed to confirm this initial observation.
First real-world experience with pulmonary vein isolation using pulsed field ablation for paroxysmal atrial fibrillation
Authors: Neven K , Fueting A , Hoewel D , Brokkaar L , Rahe G , Reinsch N 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Catheter ablation for AF using thermal energy can cause collateral damage. Pulsed field ablation (PFA) is a novel nonthermal energy source. Only a few small clinical studies have been published.

Objective
We report on the first “real-world” experience with PVI using PFA for paroxysmal AF.

Methods
Pre and post ablation, phrenic nerve function was assessed. A high-density LA bipolar voltage map was created. All PVs were individually isolated using a steerable sheath and a pentaspline over-the-wire PFA catheter. After ablation, mapping was repeated to assess lesion formation.

Results
In 30 patients (63 years; 47% male), uncomplicated PFA was performed, with all PVs isolated. Procedure time was 116 min. PFA catheter LA dwell time was 29 min. Fluoroscopy time was 26 min. (All values are median). In 1 patient with roof dependent flutter, a roof line was intentionally created. In 2 patients, unintentional bidirectional mitral isthmus block was created. There was no phrenic nerve or esophageal damage. In 1 patient, pericardial drainage after cardiac tamponade was performed. In-hospital stay, and 30-day follow-up were uneventful. After 90 days, 97% of patients were in sinus rhythm.

Conclusion
PVI using PFA for paroxysmal AF in a “real-world” setting is safe and feasible. Procedure and ablation times are short. Atrial ablation lines can easily be created. Unintentional ablation of atrial tissue can occur, accurate catheter alignment to the PV ostium and PV axis should be ensured.
Figure: Postero-anterior view of a LA bipolar voltage 3D map. Left panel: pre ablation. Magenta areas in the PVs are conducting (&gt;0,5 mV). Right panel: post ablation. Non-magenta (&lt;0,5 mV) and red (&lt;0,1 mV) areas in the PVs are ablated and electrically silent.