bluuebunny/crossref_metadata_2025_split huggingface dataset:
ANMCO position paper on antithrombotic treatment of patients with atrial fibrillation undergoing intracoronary stenting and/or acute coronary syndromes
Authors: De Luca Leonardo , Rubboli Andrea , Lettino Maddalena , Tubaro Marco , Leonardi Sergio , Casella Gianni , Valente Serafina , Rossini Roberta , Sciahbasi Alessandro , Natale Enrico , Trambaiolo Paolo , Navazio Alessandro , Cipriani Manlio , Corda Marco , De Nardo Alfredo , Francese Giuseppina Maura , Napoletano Cosimo , Tizzani Emanuele , Nardi Federico , Roncon Loris , Caldarola Pasquale , Riccio Carmine , Gabrielli Domenico , Oliva Fabrizio , Massimo Gulizia Michele , Colivicchi Furio 
Published: May 2022

AbstractPatients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) with or without acute coronary syndromes (ACS) represent a subgroup with a challenging pharmacological management. Indeed, if on the one hand, antithrombotic therapy should reduce the risk related to recurrent ischaemic events and/or stent thrombosis; on the other hand, care must be taken to avoid major bleeding events. In recent years, several trials, which overall included more than 12 000 patients, have been conducted demonstrating the safety of different therapeutic combinations of oral antiplatelet and anticoagulant agents. In the present ANMCO position paper, we propose a decision-making algorithm on antithrombotic strategies based on scientific evidence and expert consensus to be adopted in the periprocedural phase, at the time of hospital discharge, and in the long-term follow-up of patients with AF undergoing PCI with/without ACS.
ANMCO position paper: 2022 focused update of appropriate use criteria for multimodality imaging: aortic valve disease
Authors: Nardi Federico , Pino Paolo Giuseppe , De Luca Leonardo , Riccio Carmine , Cipriani Manlio , Corda Marco , Francese Giuseppina Maura , Gabrielli Domenico , Oliva Fabrizio , Gulizia Michele Massimo , Colivicchi Furio 
Published: May 2022

Abstract
This document addresses the evaluation of the Appropriate Use Criteria (AUC) of multimodality imaging in the diagnosis and management of aortic valve disease. The goal of this AUC document is to provide a comprehensive resource for multimodality imaging in the context of aortic valve disease, encompassing multiple imaging modalities. Clinical scenarios are developed in a simple way to illustrate patient presentations encountered in everyday practice.
Long-term remodelling and arrhythmogenicity after myocardial infarction using a novel image-based estimator: the Scar Maturation Score
Authors: Nunez Garcia M , Finsterbach S , Ly B , Lorenzi M , Cochet H , Sermesant M 
Published: May 2022

Abstract

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

Introduction
Post-infarction scar remodelling may start and evolve at a different pace across patients, often requiring years until the affected tissue becomes arrhythmogenic. Current risk stratification strategies lack sensitivity and specificity, and therefore more knowledge is required (e.g. new biomarkers and insights about the appropriate time point to evaluate them).

Purpose
We introduce a model of scar maturation and a novel estimator of scar remodelling based on fully automated analysis of cardiac computed tomography (CT).

Methods
We retrospectively included patients with history of myocardial infarction and available cardiac CT at the scarring stage (i.e. &gt;6 months post-infarction). A fully automated pipeline was introduced including LV wall segmentation, reformatting to short-axis view, and LV wall thickness (WT) computation. 4 biomarkers representing moderate to severe LV wall thinning were considered (i.e. WT &lt; {5, 4, 3, 2} mm). A statistical approach based on Bayesian Gaussian Process regression was used to model the biomarkers’ evolution. The Scar Maturation Score, a subject-specific parameter encoding the maturation stage relatively to the group-wise model was introduced, and its relationship with sustained ventricular arrhythmia (VA) was analysed.

Results
A total of 428 patients were included (age: 73±8 years, 83% males, LVEF: 46±11%), comprising 58 with 2 CT studies available (median scan delay: 2.1 years). The model estimated a progressive LV wall thinning over the years following the infarction. Patients without VA were typically assigned to low Scar Maturation Scores (i.e. early maturation stage), while VA patients were frequently associated with higher Scores. Scar Maturation Score, LVEF, area of wall thinning, and scar age were all significantly associated with VA (p &lt; 0.0001), the Scar Maturation Score showing the higher correlation ratio.

Conclusion
Fully-automated LV thickness measurements from CT allow for a plausible modelling of scar maturation that, together with the patient-specific Scar Maturation Score, may be useful to improve patient treatment (e.g. determine optimal time point for patient screening) and risk stratification.
Description of flecainide usage from 2005-2018 in the Danish population
Authors: Krogager E , Lock-Hansen M , Vibe-Rasmussen P , Dalgaard F , Ruwald M , Zoner C , Toennesen J , Schjerning AM , Gislason G , Pallisgaard JL 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Flecainide is an antiarrhythmic class 1C agent used to treat cardiac arrhythmias. Due to the risk of pro-arrhythmia and 1:1 conduction with flecainide, concomitant treatment with atrioventricular nodal blocking (AVNB) agents is advised. However, little data exist pertaining to the real-world use of flecainide and concomitant AVNB therapy.

Purpose
We sought to investigate the change over time in the use of flecainide and AVNB agents in relation to patient characteristics.

Methods
Using the Nationwide Danish registers, all Danish patients above 18 years with a redeemed prescription for flecainide between January 1st, 2005, and December 31st, 2018, and included at the date of the first prescription. The use of AVNB agents was identified in the period from 180 days prior to and 180 days after the inclusion date. Individual AVNB agents were divided into beta-blockers, class IV calcium channel blockers, and digoxin.

Results
The study cohort consisted of 6,594 patients with a median [IQR] age increasing from 59 [53-65] years in 2005 to 63 [56-69] in 2018, 59 % were men, and the most frequent arrhythmia diagnosis was AF (90.1%). In total, there were 297 patients starting flecainide in 2005 and 491 in 2018, with the highest number of patients in 2011, with 613 new users (Figure 1). Compared to the 144,215 patients with prevalent atrial fibrillation in Denmark in 2018, the number of patients using flecainide was only 0.3% this year.
The percentage of patients on concomitant AVNB treatment was high throughout the study period, with 93% in 2005 and 95% in 2018, giving an average increase of 0.3% per year over time. The most frequently used AVNB was beta-blockers, and the least frequently used were the class IV calcium channel blockers. (Figure 2)
Over time, the number of patients with concomitant AVNB treatment to flecainide decreased from 94% the first year in flecainide treatment to 90% between the second and third years. Between the firth and sixth year in flecainide treatment, the number was down to 86%.
The number of patients with a diagnosis of ischemic heart disease was 10% in 2005, dropping to 6% in 2018

Conclusions
Flecainide use increased from 2005 to 2018. The use of AVNB was high in patients prescribed with flecainide and increased over time, with beta-blocker as the most frequent.
Comparison between oral procainamide and mexiletine for the treatment of recurrent and refractory ventricular tachyarrhythmias
Authors: Toniolo M , Burelli M , Mugnai G , Rebellato L , Daleffe E , Bilato C , Muser D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The antiarrhythmic therapy of recurrent ventricular arrhythmias in patients having undergone catheter ablation and in whom amiodarone and/or beta blockers were ineffective or contraindicated, is a controversial issue.

Purpose
The present study sought to compare the efficacy and tolerability of oral procainamide and mexiletine in patients with recurrent ventricular arrhythmias, when the standard therapy strategy failed.

Methods
All patients with an implantable cardioverter defibrillator (ICD) treated with oral procainamide or mexiletine for recurrent ventricular tachycardia (VT) or ventricular fibrillation (VF) in 2 Cardiology Divisions between January 2010 and January 2020 were enrolled. The patients were divided in group A (oral procainamide) and group B (mexiletine) and the 2 groups were compared to each other. The primary endpoint was the efficacy of therapy; the secondary endpoint was the discontinuation of therapy. All the events occurring during procainamide or mexiletine treatment were compared with a matched duration period before the initiation of the therapy. Antiarrhythmic therapy was considered effective when an ≥80% reduction of the sustained ventricular arrhythmias (SVA) burden recorded by the ICD was achieved.

Results
A total of 68 consecutive patients (61 males, 89.7%; mean age 74 ± 10 years) were included in this retrospective analysis. In 27 (39.7%) patients catheter ablation of VT was attempted before therapy initiation. A concomitant therapy with amiodarone was present in 25 (36.8%) patients. The mean dose of procainamide was 1207±487 mg/die. The mean dose of mexiletine was 576±66 mg/die. After a median follow-up of 19 months, 38 (56%) patients had a significant reduction in the SVA burden. After multivariable adjustment (Table 1), therapy with procainamide was independently associated with an almost 3-fold higher efficacy on VA suppression compared to mexiletine (HR 2.54, 95% CI 1.06-6.14, p=0.03). Similar results (HR 2.89, 95% CI 1.26-6.62, p=0.01) were found after adjustment using inverse probability weighting by a propensity score including age, gender, left ventricular ejection fraction, ischemic heart disease and concomitant amiodarone therapy. Only 3 patients (9%) treated with procainamide presented severe side effects (dyspnea or hypotension) requiring discontinuation of therapy against 6 patients (18%) treated with mexiletine who interrupted therapy because of severe side effects (p=0.47).

Conclusions
Compared to mexiletine, oral procainamide has a higher efficacy for the treatment of recurrent and refractory VAs and shows a good profile of tolerability
Table 1. Multivariable Cox Proportional Hazards Analysis of Baseline Covariates in Relation to effective VAs suppression.
Dielectric-based tissue thickness measured during radiofrequency ablation catheter
Authors: Schillaci V , Stabile G , Arestia A , Shopova G , Agresta A , Salito A , De Simone A , Solimene F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
A new dielectric-based method of KODEX-EPD mapping system (EPD Solutions) for measuring tissue thickness at the catheter-tissue interface has recently been developed. We reported preliminary data on real-time catheter-based measuring myocardial wall thickness in vivo, during typical atrial flutter (AFL) RF ablation.
The Kodex version used to perform this type of analysis is a version not commercially available yet but only for case replay and research purpose, not used in clinical practice.
The study population consisted of 12 consecutive patients, suffering from symptomatic paroxysmal or persistent cavo-tricuspid isthmus (CTI) dependent. The Wall Viewer (WV) function is measured by assessing a series of dielectric signals derived directly from real-time local interrogation of the catheter-tissue interface. WV is displayed in millimeters, with either high or low confidence levels per met or unmet prerequisite acquisition criteria respectively and it is displayed as a color code scale (Fig. 1, A).
The anatomy of the CTI was identified using the 4mm MAP-iT irrigated ablation catheter. A suitable starting point for the ablation, in the proximity of the tricuspid valve, and a final location in the junction between the inferior vena cava and the right atrium, were precisely defined based on electrograms recorded. Subsequently, "point by point" CTI ablation was performed delivering RF energy with 30/40 Watts for 20-40 seconds with an interlesion distance ≤6 mm.
9 patients had paroxysmal common AFL, 3 persistent common AFL. The mean age was 64±9 years, 10 (83%) were male. The mean body mass index was 30±6, 9 (75%) patients had hypertension, and 1 (8%) had coronary artery disease. The mean procedure time was 37±13 min, the mean fluoroscopic time was 690±378 s, the mean RF time 763±205 s, with a mean number of RF pulses of 28±7. The mean cavo-tricuspid isthmus length was 29.5±2.6 mm. The atrial wall thickness was significantly higher close to the tricuspid annulus than close to the inferior vena cava (3.6±0.5 mm vs 2.4±0.3 mm, p&lt;0.001) and a trend towards a progressive decrease of atrial wall thickness was observed moving the mapping catheter from the tricuspid valve to the inferior vena cava (Fig. 1, B). Acute bidirectional cavo-tricuspid isthmus block was achieved in all patients without any complications.
We first describe a new mapping technology that allows atrial wall thickness measurement and, as expected, the wall thickness was higher close the tricuspid annulus and lower towards the inferior vena cava. The possibility to calculate the substrate thickness before RF delivery could deeply change the way to perform RF ablation, allowing a tailored energy delivery thus increasing the efficiency of the procedures and potentially reduction of the risk of complications.
Noise reduction in electrophysiological signals using transfer machine learning
Authors: Ruiperez-Campillo S , Deb B , Feng R , Ganesan P , Clopton P , Rogers AJ , Narayan SM 
Published: May 2022

Abstract

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

Background/Introduction
Reducing electrophysiological signal noise is essential for diagnosis, mapping and ablation, yet most approaches are suboptimal. Template matching requires libraries of known signal types, that are difficult to obtain. Beat averaging can reduce noise, yet cannot be applied to single beats and obscures beat-to-beat variations. Beat smoothing can lose critical and subtle signal features. We set out to use neural networks (NN) based on encoder-decoders, which are able to extract key signal features and hence reconstruct them without noise and artifact.

Purpose
We hypothesised that electrograms with varying sources of artifact can be denoised using autoencoder neural networks. We further hypothesised that this could be achieved in a small data set by developing the method in a larger dataset of related signals, then using transfer learning. We tested this approach for atrial monophasic action potentials (MAPs) that have verifiable shapes.

Methods
The NN was first trained with 5706 left and right ventricular MAPs from 42 patients with ischemic cardiomyopathy (age 65±13y; fig 1.A): 60% for training, 20% (validation) and 20% (testing). Transfer learning and parameter-tuning were then used to apply this NN to a smaller sample of atrial MAPs (N=641, 21 patients, 67±5y, 13 women; fig D,F,H).

Results
The autoencoder was able to learn key features of MAPs, and hence reconstruct them without artifacts. NN learned ventricular MAPs with similarity coefficient 0.91±0.16, Pearson correlation 0.99± 0.01 (fig A) and learned key features (upstroke, triangular descent, terminus) to reduce noise (fig B-C). Applying this trained NN to atrial MAPs, the approach automatically eliminated ventricular artifact (fig E), high frequency noise (fig G), truncation (fig I), saturation and other artifacts. After fine-tuning, the NN reconstructed atrial MAPs with Pearson correlation = 0.99±0.01 (p&lt;0.001).

Conclusions
Machine learned encoder-decoders are powerful tools that can automatically eliminate diverse types of noise in single beats by learning essential signal features. Transfer learning makes this possible without large datasets for training, even from signals in a different cardiac chamber. This approach may have far-reaching applications for mapping and ablation.
Incident arrhythmias, heart failure and cardiovascular outcomes with SGLT-2 inhibitor use in diabetic patients: Insights from a global federated electronic medical record database
Authors: Fawzy AM , Rivera-Caravaca JM , Fauchier L , Lip GYH 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Sodium-glucose co-transporter 2 inhibitor (SGLT-2i) use has been associated with improved outcomes in patients with prevalent heart failure (HF), regardless of whether or not they have diabetes.

Purpose
We aimed to investigate the impact of SGLT-2i use on the risk of incident HF and adverse cardiovascular outcomes in patients with diabetes.

Methods
All diabetic patients between January 2018 and December 2019 were identified from a federated electronic medical record database (TriNetX), and followed up for 2 years. A 1:1 propensity score matched (PSM) analysis was performed to balance SGLT-2i and non-SGLT-2i cohorts. The primary outcome was incident HF and secondary outcomes included all-cause mortality, cardiac arrest, ventricular tachycardia/fibrillation (VT/VF), incident atrial fibrillation (AF), ischaemic stroke, a composite of arterial and venous thrombotic events, and a composite of incident VT/VF and cardiac arrest.

Results
A total of 115,749 diabetic patients who were on SGLT-2i and 2,316,638 who were not on SGLT-2i were identified. After PSM, 115,749 patients remained in each group. In the PSM analysis, the risk of incident HF was significantly lower in patients who were on SGLT-2i, compared to patients who were not on SGLT-2i (hazard ratio [HR] 0.67, 95% confidence interval [CI] 0.65-0.70). SGLT-2i use was also associated with a significantly lower risk of all-cause mortality (HR 0.62, 95% CI 0.59-0.65), cardiac arrest (HR 0.62, 95% CI 0.55-0.69), incident AF (HR 0.78, 95% CI 0.75-0.81), ischaemic stroke (HR 0.93, 95% CI 0.88-0.96), composite arterial and venous thrombotic events (HR 0.93, 95% CI 0.90-0.95), and composite of incident VT/VF and cardiac arrest (HR 0.74, 95% CI 0.68-0.79), compared to SGLT-2i non-use. There were no significant differences between the two groups for VT/VF (HR 0.94, 95% CI 0.88-1.01).

Conclusion
SGLT-2i use was associated with a significant decrease in the risk of incident HF, all-cause mortality, cardiac arrest, incident AF, ischaemic stroke, thromboembolic events and VT/VF/cardiac arrest, when compared to the non-use of SGLT-2i.
Shift work and incident atrial fibrillation in younger and older individuals
Authors: Zwartkruis VW , Lochen ML , De Boer RA , Mathiesen EB , Njolstad I , Wilsgaard T , Sharashova E , Rienstra M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Shift work is associated with myocardial infarction and stroke. However, comparatively little is known about the association between shift work and atrial fibrillation (AF).

Purpose
We aimed to study if shift work is associated with incident AF, and if this association differs depending on sex and age.

Methods
We studied 22 339 participants (age 37±10 years, 49% women) with paid work and without prevalent AF from the third (1986-1987), fourth (1994-1995), fifth (2001), and sixth (2007-2008) survey of the population-based Tromsø Study. AF was ascertained by searching participants’ hospital records for AF events, which were further adjudicated by an endpoint committee. All AF was ECG-confirmed. Follow-up for AF was available through 2016. Shift work status was assessed by questionnaire at each survey. If participants attended multiple surveys, the first attended survey was considered the baseline visit. We used Cox regression models (unadjusted, age- and sex-adjusted, and multivariable-adjusted) to study the association of shift work at baseline with (1) incident AF during the first 10 years of follow-up and (2) incident AF during the total follow-up period (through 2016). Interactions with sex and age were tested in the multivariable model. Analyses were stratified when a significant interaction (p for interaction &lt;0.10) was present.

Results
Shift work was reported by 21% of participants at baseline. Participants with shift work were younger and had a lower average education level, lower prevalence of hypertension, higher BMI, and higher prevalence of smoking than those without shift work. During the first 10 years of follow-up, 129 participants (0.6%) developed AF. Shift work was not significantly associated with 10-year incident AF in any of the models. There was no interaction between shift work and sex (p for interaction = 0.687). However, there was a significant interaction between shift work and age (p for interaction = 0.059). In participants aged &lt;40 years, shift work was significantly associated with 10-year incident AF in the unadjusted model (HR 2.65, 95% CI 1.05-6.71) and age- and sex-adjusted model (HR 2.71, 95% CI 1.07-6.88), but not in the multivariable model (HR 2.37, 95% 0.91-6.17). In participants aged ≥40 years, shift work was not associated with 10-year incident AF (Table 1). During the total follow-up (22±10 years), 1244 participants (5.6%) developed AF. When considering the total follow-up duration, shift work was not significantly associated with AF in any model, and none of the interaction terms with age or sex were significant.

Conclusions
In the total study population, shift work was not associated with incident AF. However, our results indicate that shift work may be associated with 10-year risk of AF in younger individuals.