bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical outcomes associated with left atrial appendage occlusion via implanted device in atrial fibrillation:a Nationwide Matched Control Study
Authors: Maille B , Defaye P , Herber J , Clerc JM , Cuzol F , Deharo JC , Fauchier L 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction / Background
Left atrial appendage occlusion (LAAO) has emerged as a nonpharmacological alternative for stroke prevention in patients with atrial fibrillation (AF). Contemporary data regarding the characteristics and outcomes of patients undergoing this procedure compared to a control group not treated with LAAO are limited.

Purpose
Our objective was to compare outcomes following first LAAO implantation in an exhaustive nationwide matched cohort.

Methods
This French longitudinal cohort study was based on the national hospitalization database covering hospital care from for the entire population. All adults (age ≥18 years) hospitalized in French hospitals with AF from January 1, 2015 to January 1, 2020, who underwent a LAAO implantation were identified. Owing to the non-randomized nature of the study, and considering for significant differences in baseline characteristics between AF patients treated with LAAO and no LAAO, propensity-score matching was used to control for potential confounders of the treatment outcome relationship. The primary outcome was a composite of ischemic stroke, major bleeding (Bleeding Academic Research Consortium ≥3) or all-cause mortality during follow-up.

Results
After propensity score matching 2,682 patients with LAAO were matched 1:1 with 2,682 AF patients not treated with LAAO. Baseline characteristics of matched patients are illustrated in Figure 1. Mean follow-up was 7 months (median 5, interquartile 1-11 months). As illustrated in Figure 2, AF patients treated with LAAO had a significantly lower risk of the primary composite outcome as compared with patients not treated with LAAO (hazard ratio [HR] 0.59, 95% confidence interval [CI]: 0.52 to 0.68). Total events and event rates per 100 patient-years were (LAAO vs. no LAAO) 315 vs. 591 and 20.6%/year vs. 36.1%/year, respectively. The risk of ischemic stroke was comparable between groups (HR 1.06, 95% CI: 0.75 to 1.17), while risk of major bleeding (HR 0.49, 95% CI: 0.37 to 0.65) and all-cause mortality (HR 0.57, 95% CI: 0.48 to 0.67) were significantly lower in patients treated with LAAO.

Conclusion
Among AF patients with a high risk of bleeding, our nationwide study highlighted a high risk of clinical events during follow-up. Patients treated with LAAO may have similar stroke prevention efficacy but lower risk of major bleeding and mortality when compared to propensity score-matched patients not treated with LAAO.
Prevalence and outcomes of hypoattenuation defects and appendage patency on computed tomography after left atrial appendage closure
Authors: Cochet H , Legghe B , Bouyer B , Blanc G , Elbaz M , Thambo JB , Iriart X 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Research Council

Background
Hypoattenuation (HAT) on the atrial aspect of the device and persisting LAA patency are not uncommon on CT images after left atrial appendage closure (LAAC), but their prognostic and therapeutic implications remain unclear.

Purpose
To analyze the prevalence, aspects and outcomes of HAT and LAA patency on CT after LAAC.

Methods
Consecutive patients from 2 French centers underwent cardiac CT 3 months post-LAAC. All CTs were reviewed by 2 readers in consensus to detect LAA patency and HAT. Linear defects of less than 1mm thickness in continuity with the adjacent LA wall were not considered as HAT but rather suggestive of device endothelialization. Defects &gt;1mm thickness were categorized as low grade HAT (if 1-3mm thick and linear/regular), or high grade HAT (if &gt;3mm and/or nodular/irregular). Patients with HAT underwent trans-esophageal echocardiography and received anticoagulation at the discretion of the cardiologist. We analyzed the relationship between CT findings and patient outcomes at follow-up.

Results
From 2012 to 2020, 412 patients were included (age 76±8 years, 68% males, prior stroke or embolism in 39%, HASBLED 3.1±0.8, CHA2DS2-VASc 4.4±1.3). The devices were Watchman in 175 (42.5%) and Amplatzer in 237 (57.5%). On 3-month follow-up CT, LAA patency was detected in 185 (45%). It related to none of the clinical characteristics, but was more common in Amplatzer devices (52% vs. 35%, P=0.001), particularly when using large Amplatzer devices (P&lt;0.001). HAT were detected in 117 (28%), including low grade HAT in 98 (23.8%) and high grade HAT in 19 (4.6%). Patients with high grade HAT were older (P&lt;0.001), and showed higher CHA2DS2-VASc scores (P=0.03). No relationship was found between high grade HAT and device type (P=0.89). Over a median follow-up of 17 [Q1-Q3: 11-41] months, stroke occurred in 24 (5.8%), and death in 54 (13.1%). On survival analyses, stroke and death did not relate to LAA patency (P=0.69 and P=0.80), low grade HAT (P=0.81 and P=0.38), high grade HAT (P=0.22 and P=0.36), or device type (P=0.36 and P=0.27).
Conclusion: although relatively high rates of LAA patency and HAT are observed on post-LAAC CT studies, these do not significantly relate to adverse outcomes.
Association of epicardial adipose tissue and coronary artery calcium score in patients with atrial fibrillation
Authors: Fernandes S , Ladeiras-Lopes R , Cruz I , Silva G , Silva M , Queiros P , Diaz S , Barros A , Saraiva F , Faria R , Almeida J , Fonseca P , Ferreira N , Primo J , Fontes-Carvalho R 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Both coronary artery calcium (CAC) and epicardial adipose tissue (EAT) had been implicated in coronary artery disease (CAD) and risk of future adverse cardiovascular events. There are scarce data regarding the assessment and association of EAT volume and CAC score (CACS) in atrial fibrillation (AF) patients.

Purpose
To assess the association between EAT volume and the presence and severity of CAC in patients with AF.

Methods
Retrospective and single-centre study including consecutive patients with AF undergoing contrast-enhanced cardiac computed tomography for catheter ablation planning, from 2017 to 2019. Patients with known history of CAD and moderate to severe valvular heart disease were excluded. Baseline clinical and demographical data were collected, as well as their cardiovascular risk, based on the SCORE (Systematic Coronary Risk Evaluation) system and cardiovascular risk categories. We assessed CACS (Agatston method) and EAT volume and analysed their association. EAT was defined as the adipose tissue accumulated between the visceral pericardium and the myocardium and was semi-automatically reconstructed by manually tracing the pericardium. Patients were split into three groups according to CACS: 0, 1-99 and ≥100. A logistic regression (LR) analysis was performed to explore the relationship between EAT volume and the presence of CAC (CACS&gt;0), adjusted for age, gender, obesity, diabetes mellitus and hypertension.

Results
A total of 354 patients were included, with a mean age of 56 ± 12 years, 66% male and 21% with persistent AF. A CHA2DS2-VASc score ≥2 was present in 130 (37%) patients and most patients had low to moderate cardiovascular risk (n=213, 82%). More than half of the patients had a CACS&gt;0 (n=185, 52%), of which 63 patients (18%) had a CACS≥100. The mean EAT volume was 79 ± 39 ml. There was a significant association between EAT volume and the presence of CAC: CACS=0 69 ± 34 ml vs CACS 1-99 84 ± 38 ml vs CACS ≥100 95 ± 45 ml (p&lt;0.001) (Fig. 1). After covariate adjustment (LR model R2 = 0.373, p &lt;0.0001), the presence of CAC was not associated with EAT volume (OR 1.00, 95%CI 1.00 - 1.01, p=0.2) or obesity, and only with higher age, male gender, hypertension and diabetes mellitus (Fig. 2).

Conclusion
In our cohort of patients with AF undergoing catheter ablation we observed an association between EAT and CACS. Nevertheless, EAT volume was not an independent predictor of CACS and only the classical cardiovascular risk factors remained significant.
Conventional fluorscopy-guided vs zero-fluorscopy catheter ablation of supraventricular tachycardias
Authors: Prolic Kalinsek T , Sorli J , Jan M , Sinkovec M , Antolic B , Klemen L , Zizek D , Pernat A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Traditionally, X-ray fluoroscopy is used during catheter ablation procedures. The utilisation of ionising radiation carries non-negligible stochastic and deterministic risks to the health of both the patient and the professional staff. These effects are cumulative and behave in a linear no-threshold manner and, as such, are especially important in paediatric populations (1). The importance of reducing ionising radiation exposure has been recognised by the American College of Cardiology, which recommends the ALARA (as low as reasonably achievable) principle in all interventional laboratories (2). In recent years, advances in three-dimensional electroanatomical mapping systems and their utilisation have enabled the near-zero and zero-fluoroscopy approaches to be studied (3).

Purpose
The aim of this study was to evaluate the safety and efficacy of zero-fluoroscopy catheter ablation for supraventricular tachycardias (SVT).

Methods
584 consecutive patients referred to our institution for catheter ablation of SVT were analysed. Patients were categorised into two groups; zero-fluoroscopy (ZF) group and conventional fluoroscopy (CF) group. Patient characteristics, procedural information, and follow-up data were compared.

Results
The ZF group had a higher proportion of paediatric patients (42.2% vs 0.0 %; p &lt; 0.001), resulting in a younger age (30.9 ± 20.3 years vs 52.7 ± 16.5 years; p &lt; 0.001) and lower BMI (22.8 ± 5.7 kg/m2 vs 27.0 ± 5.4 kg/m2; p &lt; 0.001). Procedure time was shorter in the ZF group (94.2 ± 50.4 min vs 104.0 ± 54.0 min; p = 0.002). There were no major complications and the rate of minor complications did not differ between groups (0.0% vs 0.4%; p = 0.304). Acute procedural success as well as the long-term success rate when only the index procedure was considered did not differ between groups (92.5% vs 95.4%; p = 0.155; 87.1% vs 89.2%; p = 0.422). When repeated procedures were included, the long-term success rate was higher in the ZF group (98.3% vs 93.5%; p = 0.004). The difference can be partially explained by the operators’ preferences.

Conclusion
The safety and efficacy of ZF procedures in adult and paediatric populations are comparable to that of CF procedures.
Feasibility of open window mapping approach in accessory pathways ablation
Authors: Martinez-Sande JL , Gonzalez-Melchor L , Minguito-Carazo C , Rodriguez-Manero M , Otero-Garcia O , Garcia-Seara J , Fernandez-Lopez XA , Gonzalez-Ferrero T , Gonzalez-Juanatey JR 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction and Objectives
We described a new protocol of open window mapping (OW) in accessory pathways (AP) in CARTO® 3 system. This protocol automatically mapping conventional electrophysiology criteria of AP diagnostic, as shorter local EGM AV interval (extended early meets late tool), earliest local activation time (LAT) and annotation at unipolar signal (wavefront annotation).

Methods
Single center, prospective and observational study of 17 consecutive patients underwent AP catheter ablation.

Results
Mapping was performed in anterograde conduction in 13 patients (76.5%), retrograde in 5 patients(29,4%) and orthodromic tachycardia in 2 patients (11,7%). Mean of numbers of points were 3092±2246, with 30min ± 13min of mapping. Ablation was effective in 17 patients( 100%) and RF time until complete AP elimination was 2.6s. Image 1 show representation of EEML tool, targeting shorter interval EGM AV or VA and color adjust to determine earliest LAT.
Image 1 show representation of EEML tool, targeting shorter interval EGM AV or VA and color adjust to determine earliest LAT.

Conclusions
In our experience, automatically mapping of conventional electrophysiology criteria for AP diagnostic is able to localize AP insertion, suggesting an increasing in effectiveness of procedure, a reducing in mapping time, ablation time and X-ray exposure time.
Outcomes of cardiac pacing in patients with myotonic dystrophy type 1: A single specialist centre study
Authors: Zheng Y , Glover O , Walker R , Somani S , Lewis N 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Cardiac conduction disease and sudden cardiac death is known to be associated with Myotonic Dystrophy type 1 (MD). Patients often require device implantation to prevent sudden cardiac death. It is not known how frequently device implantation occurs and how quickly conduction disease progresses.

Objective
To define the rate and type of device implantation, rate of pacing and outcome in MD patients managed in a single specialist centre.

Method
Retrospective analysis of pacing and outcome data on consecutive MD patients managed at Specialist Centre in the UK between 2011 and 2021.

Results
24/119 MD patients were implanted with a cardiac device. Male:Female 13:11. At implant, patients had a mean age of 56 (95% CI 52 to 59), mean PR interval 217 ms (95% CI 203 to 230), mean QRSd 123ms (95% CI 109 to 137). Devices implanted included 16 DDDR, 4 CRT-D, 1 CRT-P, 1- ICD and 2 VVI pacemakers. 10 (42%) died during follow up of 10 years. 12 out of 19 (63%) with an atrial pacing lead required a mean increase in atrial pacing of 15% (95% CI 5 to 25) during follow up. 12 out of 24 (50%) of patients required mean increase of 13% (95% CI 5 to 22) in Ventricular pacing. 7 (88%) patients who died had evidence of progressive conduction disease prior to death.

Conclusion
In our cohort of myotonic dystrophy patients 20% required device implantation. There was a higher incidence of progressive atrial rather than ventricular pacing, despite the known concern about progressive AV block. Despite pacing, mortality remained high and was more frequent in patients with progressive conduction disease. Increases in pacing demand could be early indicator of disease progression.
Cardioneuroablation in patients with a prior pacemaker implant
Authors: Jansova H , Stiavnicky P , Peichl P , Stojadinovic P , Haskova J , Cihak R , Kautzner J , Wichterle D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardioneuroablation (CNA) is an alternative therapeutic method for patients with functional bradyarrhythmias, who are otherwise candidates for permanent pacing. In a specific clinical scenario, CNA can also be a treatment option for patients with already implanted pacemakers.

Purpose
We investigated whether CNA could substitute permanent pacing in selected patients in whom pacemaker is associated with complications, technical failures, or decreased quality of life.

Methods
Among 160 patients who underwent CNA by radiofrequency energy between 2014 and 2022, there were 13 patients (8%) with a pacemaker in whom CNA was indicated as a "substitute" treatment. The reasons were as follows: lead failure (n = 6), recurrent decubitus of the device pocket (n = 1), infective endocarditis (n = 1), recurrent syncope even after pacemaker implantation (n = 1) and discomfort associated with the implanted device (n = 4). In 4 patients, the pacemaker was explanted shortly before CNA because of serious complications. Biatrial CNA was guided anatomically with the use of a 3D mapping system and intracardiac echocardiography. Empirical sites of ganglionated plexi were targeted. The procedural endpoint was unresponsiveness of sinus and AV nodes to extracardiac vagal nerve stimulation.

Results
Patients (n = 13, 77% male, age: 41 ± 12 years) had a pacemaker implanted 11 ± 7 years ago. They responded to atropine (2 mg IV) administration by accelerating the sinus rhythm by 55 ± 33%. CNA was technically successful and uncomplicated in all of them. During the follow-up of 29 ± 16 months (range 6 - 56 months), 2 patients (15%) had a recurrence of syncope. In both, the syncope was reproduced by tilt testing and classified as a pure vasodepressor event. In the remaining patients, the follow-up was uneventful. Elective explantation of the pacing system has so far been performed in 3 of 9 patients, while this is planned in others after reaching a sufficient length of post-procedural follow-up.

Conclusions
CNA is an effective and safe method, which is not only an alternative to the pacemaker implant but can also be used in patients with functional bradyarrhythmias, and previously implanted pacemakers who experience significant adverse events associated with the pacing system.
Income and education are associated with incidence of sudden cardiac death in a general population cohort
Authors: Warming PE , Aagesen FN , Lynge TH , Prescott E , Banner J , Jabbari R , Tfelt-Hansen J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union’s Horizon 2020 research and innovation programme under acronym ESCAPE-NET, registered under grant agreement No 733381

Introduction
Socioeconomic status is associated to all-cause mortality and common cardiac risk factors. The association between socioeconomic status and sudden cardiac death (SCD) taking prevalence of other risk factors into account has not been fully established.

Objective
The aim of this study was to investigate the association between income and education level and incidence of SCD.

Methods
All participants in the third wave of the Copenhagen City Heart Study were followed from 1993 to 2016 and all deaths were adjudicated using high quality death certificates, autopsy reports, and national registry data. Medical history and social demographics were self-reported. Hazard ratios (HR) were calculated using Cox proportional hazards regression and adjusted cumulative incidences were predicted using cause specific cox models.

Results
The study enrolled 10099 participants who were alive at start of follow up (median age at entry (IQR): 61 (48-72) years, 56% female). During 24 years of follow up, there were 5575 deaths of which 834 were classified as SCD. Compared with lowest income group and adjusted for age, sex, job, and education, higher income was associated with lower HR of SCD: middle income HR 0.82 (95% CI: 0.69-0.98) and high income HR 0.62 (0.47-0.81). This effect was attenuated, but still present, when adjusting for common cardiac risk factors (smoking, alcohol, BMI, physical activity, AMI, diabetes, hypertension, hypercholesterolemia). Compared with no education, increasing length of education was associated with lower HR of SCD: apprenticeship HR 0.82 (0.68-0.98), short education HR 0.80 (0.67-0.96), bachelor’s degree HR 0.56 (0.41-0.76), master’s degree HR 0.41 (0.28-0.59). This effect was also attenuated when adjusting for risk factors, job, and income. Adjusted cumulative incidences of SCD during the first 10 years of follow up according to income and education are shown in the figures.

Conclusions
In this study we found an association between lower income and shorter education and increased risk of SCD, an association not fully explained by prevalence of common cardiac risk factors, calling for further research into competing causes of SCD.
Clinical characteristics, therapy and long-term outcome of short-coupled idiopathic ventricular fibrillation. A systematic review of published case reports with new extended long-term follow-up
Authors: Tovia Brodie O , Belhassen B 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Short-coupled idiopathic ventricular fibrillation (SC-IVF) is a rare, potentially lethal arrhythmia, initiated by SC-PVCs. Only small series have been published.

Purpose
To assess the clinical characteristics, therapies and long-term outcomes of patients (pts) with SC-IVF.

Methods
Data from all published case reports on SC-IVF/Polymorphic VT were collected. Inclusion criteria were normal cardiac work-up including during follow-up (FU), and documented SC-PVC-VF available for our analysis and ruling out early repolarization syndromes and CPVT at VF onset. Updated information was provided by 82% of authors contacted, with 22 additional ECG tracings provided.

Results
A total of 100 pts’ cases were identified, including 82 who met inclusion criteria. Mean FU increased from 2.75+3.6 years in the original publications to 10.5+7.9 years (p&lt;0.0001). There were 42 (51%) males, aged 39.6+13.5 years at the time of SC-IVF diagnosis. Pts presented with syncope (40%), aborted cardiac arrest (ACA) (16%), ACA + arrhythmic storm (13%), arrhythmic storm (10%), ICD shocks (8%) or palpitations (1%). Prior history included syncope in 32 (39%) pts. Mean coupling interval of the SC-PVC was 293.6+50.7ms. Presumed sites of PVC origin were the RV, LV and RVOT in 54%, 21% and 5% of pts, respectively. A total of 69 (84%) pts had an ICD implanted before or after SC-IVF documentation. During long-term treatment with quinidine (n=11) or verapamil (n=32), SC-IVF did not recur in 82% and 50% of pts, respectively (p=0.08). Ablation was performed in 43 (92%) of the 47 pts in whom it was attempted. Ablation sites were the Purkinje RV (43%) or LV (23%), and the non-Purkinje RV (19%) or LV (2%). Acute and late success rates after a first ablation were 83% and 61.7%, respectively. A second ablation in 7 pts yielded a 74.5% total success rate. No difference was found in the success rate of quinidine compared with ablation procedures (p=0.6). During FU, 4 pts died including 2 from sudden cardiac death; both pts were treated with verapamil and refused ICD implantation or replacement.

Conclusion
SC-IVF mainly presents following syncope. Quinidine and ablation procedures have comparable long-term high efficacy in arrhythmia control. The commonest sites of successful ablation are the RV and LV Purkinje fibers.