bluuebunny/crossref_metadata_2025_split huggingface dataset:
Detection of endo-epicardial atrial low-voltage areas using unipolar and omnipolar voltage mapping
Authors: Van Schie MS , Knops P , Zhang L , Van Schaagen FRN , Bogers AJJC , Taverne YJHJ , De Groot NMS 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): NWO-Vidi
Medical Delta

Background
Endocardial bipolar voltage mapping has emerged as an invasive tool for defining potential target sites for ablation therapy of atrial tachyarrhythmia. Bipolar low-voltage areas (LVA) are commonly considered surrogate markers for areas of conduction disorders. However, bipolar LVAs can be located exclusively at either the endocardium or epicardium. Furthermore, identification of bipolar LVAs is hampered by considerable directional differences in bipolar voltages. Omnipolar voltage mapping, on the other hand, provides maximal bipolar voltage from a collection of electrograms and is directional independent. Unipolar is preferred to identify intramural or epicardial substrates as unipolar electrograms comprise a larger region of myocardial electrical activity. It, however, remains unknown whether simultaneously recorded endo- and epicardial unipolar and omnipolar voltages are complementary or contradictory on identifying LVAs at the opposite layer.

Purpose
To 1) examine endo-epicardial characteristics in unipolar and omnipolar voltages, 2) explore the relation between various types of voltages in identification of LVAs from an endocardial and epicardial point of view and 3) examine whether characteristics of LVAs can be predictive for LVAs at the opposite layer.

Methods
Intra-operative simultaneous endo-epicardial mapping (interelectrode distances 2mm) of the right atrium was performed in 93 patients (67±9 years, 73 male). Cliques of 4 electrodes (2x2 mm) were used to define maximal omnipolar (Vomni,max) and unipolar (Vuni,max) voltages. LVAs were defined as Vomni,max ≤0.5 mV or Vuni,max ≤1.0 mV.

Results
Epicardial Vuni,max were larger than corresponding endocardial Vuni,max (8.2 [4.9–11.6] mV vs 6.1 [3.2–10.9] mV, P&lt;0.001) and they were strongly correlated (R2=0.85, P&lt;0.001). Epicardial Vomni,max were also larger than endocardial Vomni,max (6.7 [3.2–10.9] mV vs 3.3 [1.1–8.6] mV, P&lt;0.001), although there was no correlation between both layers. The majority of unipolar and omnipolar LVAs occurred at either the endocardium (74.2% and 82.0%) or epicardium (52.7% and 47.6%) alone and the opposite areas frequently contained normal voltages. Epicardial Vuni,max and Vomni,max were most accurate in identifying endo-epicardial-LVAs (respectively 47.3% and 52.4% vs 25.8% and 18.0%).

Conclusions
Unipolar and omnipolar LVAs are frequently located exclusively at either the endocardium or epicardium and could be undetectable when measuring from the opposite layer only. Endo-epicardial LVAs are most accurately identified using combined epicardial unipolar and omnipolar voltages. Therefore, a combination of simultaneously recorded endo-epicardial low unipolar and low omnipolar voltage may be more indicative of dual-layer LVAs and probably arrhythmogenic substrates.
Atrial high-rate episodes in patients with devices without a history of atrial fibrillation
Authors: Doundoulakis I , Gavriilaki M , Tsiachris D , Arsenos P , Antoniou CK , Soulaidopoulos S , Dimou S , Xintarakou A , Xydis P , Kordalis A , Dilaveris P , Gatzoulis KA , Tsioufis K 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Atrial high-rate episodes (AHREs) recorded with cardiac implantable electronic devices (CIEDs) have been associated with the development of clinical atrial fibrillation (AF) and increase in stroke, and death risk.

Purpose
We sought to perform a systematic review with a meta-analysis to evaluate the prevalence of AHREs detected by CIEDs, their association with stroke risk, development of clinical AF, and mortality among patients without a documented history of AF.

Methods
We searched several databases, ClinicalTrials.gov, references of reviews, and meeting abstract books without any language restrictions up to 9 September 2020. We studied patients with CIEDs in whom AHREs were detected. Exclusion criteria were an AF history. Our primary outcome was the risk of ischemic stroke in patients with AHREs.

Results
We deemed eligible eight studies for the meta-analysis enrolling a total of 4322 patients with CIED and without a documented AF history. Evidence of moderate certainty suggests that patients with documented AHREs were 4.45 times (95% CI 2.87–6.91) more likely to develop clinical AF. Evidence of low confidence suggests that AHREs were associated with a 1.90-fold increased stroke risk (95% CI 1.19–3.05).

Conclusion
The present systematic review and meta-analysis demonstrated that among patients without a documented history of AF, the detection of AHREs by CIEDs was associated with significant increased risk of clinical AF and stroke.
Prognostic value of plasma neutrophil gelatinase-associated lipocalin for cardiovascular events in patients with chronic heart failure and atrial fibrillation
Authors: Lashkul D , Syvolap VD 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
We aimed to assess the prognostic value of plasma neutrophil gelatinase-associated lipocalin (NGAL), a marker of renal tubular damage, in patients with heart failure with or without atrial fibrillation (AF).

Methods
The study involved 113 (83.2% men) patients with mean age 60.0 [54.0-67.0] years with II-IV functional class (recommendations of the New York Heart Association) is due to ischemic heart disease. Serum levels of NGAL were quantified by ELISA. Echocardiography was performed according to the American Society of Echocardiography/European Association of Echocardiography recommendations. Receiver operating characteristic (ROC) curve analysis was used to determine the best NGAL cut-off to predict events. Cox proportional hazards models were used to investigate the prospective association between NGAL and events during follow-up. Outcome was cumulative incidence of the primary endpoint (cardiovascular death, myocardial infarction, stroke, HF hospitalization) at 36 months.

Results
Median plasma NGAL in patients with and without AF was 34 (25-46) ng/ml and 26 (18-44) ng/ml, p&lt;0.01, respectively. The ROC curve showed an optimal admission NGAL level cut-off &gt;25.5 ng/mL, with 70% sensitivity and 89% specificity. The area under the ROC curve (AUC) was (0.814; p&lt;0.01). In patients with CHF and atrial fibrillation multivariable analysis shows, that NGAL independently associated with outcomes (HR 2.35, 95% CI 1.2-4.61; p&lt;0.01).

Conclusions
Admission plasma NGAL &gt;25.5 ng/ml appears a sensible tool for in-hospital AF prediction as well as an marker for adverse cardiovascular outcome during long-term follow-up period.
The impact of different fat depots in the body on the progression of atrial fibrillation - data from RACE V
Authors: Weberndoerfer V , Van De Lande ME , Artola Arita VA , Nguyen BA , Elvan A , Hemels MEW , Thieleman RG , De Melis M , Schotten U , Van Gelder IC , Rienstra M , Crijns HJGM , Mihl C , Linz D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation, Medtronic

Background
Paroxysmal atrial fibrillation (PAF) progression is associated with cardiovascular complications and worse outcome. Obesity is independently associated with AF prevalence and progression. The association between different fat depots in the body with AF is unclear.

Aim
We aim to systematically investigate the association of different fat depots in the body with AF.

Methods
417 patients with PAF and continuous rhythm monitoring (implantable loop recorder or pacemaker) were included in the prospective RACE V study. In addition to extensive phenotyping at baseline including calculating BMI and measuring waist circumference (WC) epicardial and pericardial fat were measured on non-contrast enhanced cardiac CT scans by tracing the pericardium manually on every slice and afterwards fat automatically summed between -50 and -150 HU. Epicardial fat was defined as fat within the pericardium, pericardial fat as fat inside the pericardium and adjacent to the pericardium and thoracic fat as adjacent fat outside the pericardium. AF progression was defined as (1) progression to persistent or permanent AF, or (2) progression of PAF with &gt;3% burden increase within 2.2years of follow-up. Multivariable logistic regression analysis was used to analyse the association of different fat pads with AF progression.

Results
Six percent of patients per year showed AF progression (51/417) after a median follow-up of 2.2 (1.6-2.8) years. Multivariate analysis identified WC (odds ratio [OR] 1.03, 95% confidence intervals [CI] 1.01-1.06, p=.014) to be associated with AF progression. Epicardial fat (OR 1.00, 95%CI .99-1.01, p=.407), pericardial fat (OR 1.00, 95%CI .99-1.01, p=.311), thoracic fat (OR 1.00, 95%CI .99-1.01, p=.372), and BMI (OR 1.03, 95%CI .97-1.10, p=.328) showed no relation with AF progression.

Conclusion
AF progression occurred in 6% per year in patients with PAF. In contrast to epicardial, pericardial and thoracic fat measured in a semiautomatic way, WC was the only fat depot associated with AF progression. Whether a more different assessment of obesity and epicardial fat may demonstrate an association with AF progression warrants further study.
CHA2DS2-VASc score and the risk of death in atrial fibrillation
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

Background
Atrial fibrillation (AF) is recognized as a major public health problem due to increased mortality, morbidity and risk of stroke. Advanced age and burden of other comorbidities are potential contributors to AF development and adverse outcomes. Clinical risk factor based CHA2DS2-VASc score is widely used to assess thromboembolic risk in AF, but mortality risk associated with different CHA2DS2-VASc scores is not established.

Purpose
Using data from a nationwide AF registry study including comorbidities and outcomes of unselected AF patients, we wanted to study whether CHA2DS2-VASc score could be useful in estimating prognosis in newly diagnosed AF patients.

Methods
New-onset AF patients in Finland 2007-2017 were identified from comprehensive national registries. Comorbidities were gathered from individualized registry data on drug reimbursements and from ICD-10 diagnoses during hospitalizations and outpatient visits in primary and specialist care. These were used to create CHA2DS2-VASc risk score for each AF patient at cohort entry, including data on heart failure, hypertension, age, diabetes, stroke, vascular disease and sex. Patients were followed until the end of 2018 from the causes of death registry, which records every death in the country. All-cause mortality in each CHA2DS2-VASc category per 1000 person-years was determined, and relative risk (RR) of death according to the CHA2DS2-VASc category was calculated.

Results
A total of 229 357 patients with new-onset AF (mean age 73.2 ± 13.2 years, 50.0% female) were identified. Distribution of CHA2DS2-VASc score among these individuals is shown in Table. Mortality increased significantly with rising CHA2DS2-VASc risk score points, as demonstrated in Table. Compared to CHA2DS2-VASc 0, those with 2 points had a RR 2.9 (95%CI 2.7-3.1), 3 points RR 5.0 (4.7-5.3), 4 points RR 8.0 (7.5-8.4), 5 points RR 11.0 (10.4-11.7) and &gt;5 points RR 14.8 (14.0-15.7) for all-cause mortality.

Conclusions
In new-onset AF, mortality increased drastically with increasing age and comorbidities as depicted in the CHA2DS2-VASc score. Besides assessing thromboembolic risk, CHA2DS2-VASc score seems to be useful in estimating survival of AF patients.
Impaired heart rate variability triangular index predicts stroke and systemic embolism in patients with atrial fibrillation
Authors: Haemmerle P , Hennings E , Eken C , Aeschbacher S , Coslovsky M , Schlageter V , Osswald S , Kuehne M , Zuern CS 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation

Introduction
Despite the broad use of oral anticoagulants, stroke remains one of the most serious complications in atrial fibrillation (AF) patients. Stroke has been linked to disturbances of the autonomic nervous system as both share similar risk factors. Therefore, impaired cardiac autonomic function may indicate an enhanced stroke risk.

Purpose
We hypothesized that impaired cardiac autonomic function, quantified by means of heart rate variability (HRV), might be useful in predicting stroke in patients with AF.

Methods
We enrolled 1,933 patients with a documented history of AF from the multicenter Swiss-AF cohort study who were either in sinus rhythm (SR-group, n=1130) or AF (AF-group, n=803) on a 5-minute resting ECG recording. HRV triangular index (HRVI), standard deviation of normal-to-normal intervals, root mean square root of successive differences of normal-to-normal intervals, mean heart rate, 5-min total power and power in the high frequency, low frequency and very low frequency range were calculated. We constructed cox regression models to analyze the predictive power of HRV parameters for the composite endpoint stroke or systemic embolism.

Results
Mean age was 71±8 years in the SR group and 75±8 in the AF group, 28% of the total study cohort were female. 36 patients in the SR group (3.2%) and 58 patients in the AF group (6.5%) experienced a stroke or systemic embolism during a follow-up time of 4.0±1.3 years. In patients with sinus rhythm, HRVI &lt;15 was the only HRV parameter independently associated with stroke or systemic embolism (hazard ratio 2.94; 95% confidence interval 1.3-6.8; p=0.011) after adjustment for multiple clinical confounders (age, sex, AF type, history of hypertension, history of diabetes, history of chronic kidney disease, prior stroke or transient ischemic attack, intake of oral anticoagulation, antiarrhythmics or betablockers). In the AF group, no HRV parameter was associated with the composite endpoint.

Conclusions
HRVI measured during SR on a single 5-minute ECG recording is an independent predictor of stroke or systemic embolism in AF patients. HRV analysis may help to improve risk stratification in AF patients.
BMP10 level helps to stratify risk of atrial fibrillation recurrence within one year after catheter ablation
Authors: Zink MD , Hermans B , Gramlich M , Philippens SAM , Vernooy K , Van Hunnik A , Linz DK , Zeemering S , Schotten U 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): DGK Electrophysiology grant

Background
Freedom of atrial fibrillation (AF) is the main purpose of catheter ablation. However, AF recurrence is commonly seen after catheter ablation. Cardiovascular biomarkers may help to identify patients at risk for AF recurrence.

Purpose
We investigated the association of preprocedural known and novel cardiovascular biomarker level with AF recurrence within one year after catheter ablation.

Methods
In 187 patients of the AFAB registry (University Maastricht, the Netherlands) clinical recurrence of AF after catheter ablation was investigated using Holter ECGs at 3- and 12-months follow-up. Blood samples taken before AF catheter ablation were analyzed for prediction of AF recurrence by known or novel cardiovascular biomarkers (FGF23, BMP10, Ang2, IGFBP7, CA125, NT-proBNP, TNT_hs, sFlt_1, ESM1_7F89A5, DKK3). Recurrence of AF was defined as any symptomatic, or ECG documented episode of AF within one year after catheter ablation. A logistic regression model adjusted for typical risk factors of AF recurrence (Sex, age, type of AF (paroxysmal or persistent), ongoing rhythm, LA diameter, heart failure, body mass index and hypertension) was calculated and receiver-operating analysis was performed for prediction of AF recurrence.

Results
AF recurrence was found in 86 patients within one year after catheter ablation. Elevated biomarker level in patients with AF recurrence were found for BMP10, Ang2, and NT-proBNP in univariate analysis (table 1). In the logistic regression BMP10 (Odds ratio 2.94, 95%CI 1.089-7.939, P=0.033) indicated a high probability of AF recurrence within one year. A model including factors of AF recurrence showed a predictability for AF recurrence of an area under the curve (AUC) of 0.68 (sensitivity 60%, specificity 64%). By adding each of the univariate significant biomarker the predictability of the model increases further Ang2 (AUC 0.69, sensitivity 69%, specificity 60%), NT-proBNP (AUC 0.69, sensitivity 65%, specificity 60%), and BMP10 (AUC 0.71, sensitivity 60%, specificity 73%).

Conclusions
Based on our data, Ang2, BMP10, NT-proBNP showed elevated values for patients with recurrence of AF within one year before catheter ablation. BMP10, which is likely associated with trabeculation of the heart, outperformed the other investigated known and novel biomarker indicating a higher probability of AF recurrence within one year after ablation.
A new prediction model for left ventricular systolic function recovery after catheter ablation of atrial fibrillation in patients with heart failure and reduced ejection fraction, The ANTWOORD Study
Authors: Bergonti M , Spera F , Tijskens M , Bonomi A , Saenen J , Huybrechts W , Miljoen H , Wittock A , Casella M , Tondo C , Heidbuchel H , Sarkozy A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In patients with heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation (AF), pulmonary vein isolation (PVI) improves left ventricular ejection fraction (LVEF), along with prognosis, in a variable percentage of patients.

Aim
To investigate the predictors of LVEF recovery after PVI and to develop a prediction model for individualized assessment.

Methods
We conducted an observational, retrospective, single-center study on 111 consecutive patients with AF and HFrEF undergoing PVI. Patients were divided into Responder vs. Non-Responder according to the "Universal definition of HF". Clinical predictors were evaluated by multivariate logistic regression analysis and cross-validation technique. Independent predictors were used to build an internally validated prediction model.
Results Responders (54%) had significantly shorter QRS duration and less dilated left atria. Persistent AF and absence of a known etiology more frequent among Responders. AF recurrence was non-significantly different between the two groups (p=0.2), although clinical AF burden was lower in Responders, after PVI (p&lt;0.001). Absence of known etiology, presence of persistent AF, left atrial volume index&lt;50ml/m2, and QRS&lt;120msec were independent predictors of LVEF recovery and composed the "Antwerp Score". Patients with Antwerp Score ≤1 had 90% likelihood of LVEF recovery, compared to 5% in patients with 3-6.
Conclusions Patients with wide QRS complex, known HF etiology, dilated left atria, and paroxysmal AF were less likely to recover LVEF after PVI. A new score system based on the above-mentioned parameters adequately predict LV function recovery after PVI. These results warrant confirmation and prospective validation.
Radiofrequency ablation impact on the morpho-functional state of the heart in patients with atrial fibrillation and chronic heart failure
Authors: Zolotarova T , Brynza M , Bilchenko O , Lopin D , Volkov D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Heart failure with preserved left ventricular ejection fraction (HFpLVEF) has become the dominant form of heart failure worldwide, along with an aging population and an increasing prevalence of obesity, diabetes and hypertension. Drug rhythm control has limited efficacy in HFpLVEF and a fairly high risk of side effects.
The aim of the study was to evaluate the radiofrequency ablation impact on the morpho-functional state of the heart in patients with atrial fibrillation and HFpLVEF based on 2-year follow-up.

Materials and methods
The study included 194 patients with an average age of 59.3±8.5 years with atrial fibrillation and concomitant HFpLVEF of I-III functional class of New York Heart Association. Patients were divided into 2 groups: 136 patients who underwent radiofrequency catheter ablation and 58 patients in the control group who did not undergo intervention and continued antiarrhythmic pharmacotherapy. Patients were comparable in terms of basic clinical and demographic indicators. In order to assess the morpho-functional state of the heart, transthoracic echocardiography was performed at the stage of inclusion in the study and 2 years after.
Results and discussion. According to the results of the analysis in the radiofrequency catheter ablation group 2 years after the intervention revealed: a statistically significant decrease in the mean end-systolic diameter of the left ventricle (3.3±0.48 cm versus 3.2±0.41cm, p&lt;0.001); decreased size of the left atrium (4.3±0.71 cm versus 4.2±0.30 cm, p&lt;0.001); LVEF increased significantly (61.9±7.14% versus 63.9±5.65%, p&lt;0.001); the E/e’ ratio decreased statistically significantly (11.9±1.65 versus 9.4±1.48; p&lt;0.001) and the left ventricular myocardial mass index (118.3±25.04 g/m2 versus 116.4±18.04 g/m2; p=0.045). In the pharmacotherapy group there were: a statistically significant increase in the average end-systolic size of the left ventricle (3.61±0.45 cm versus 3.63±0.41, p=0.007); statistically significant increased left atrium (4.3±0.61 cm versus 4.4±0.36; p &lt;0.001) and the right atrium (4.1±0.52 cm versus 4.2±0.26; p&lt;0.001); decreased left ventricular ejection fraction (58.1±6.12% versus 56.6±6.11; p&lt;0.001); increased values of the ratio E/e’ (12.1±1.63 versus 12.7±1.27; p=0.002) and decreased level of the left ventricular myocardial mass index (120.5±24.05 g/m2 versus 118.3±20.13 g/m2; p=0.044).

Conclusion
Radiofrequency ablation of atrial fibrillation in patients with HFpLVEF to control sinus rhythm is associated with improved morpho-functional state of the heart at the 2-year follow-up compared with antiarrhythmic pharmacotherapy strategy: the left ventricular ejection fraction increases, the left ventricular diastolic function improves according to the E/e’ value, the size of the left atrium decreases.