bluuebunny/crossref_metadata_2025_split huggingface dataset:
QT interval prolongation is a novel predictor of one year morality in patients with coronavirus disease-19 infection
Authors: Banai A , Lupu L , Levy E , Chorin E 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
QT interval prolongation is common in critically ill patients and is associated with increased mortality. However, the predictive value of a prolonged corrected QT interval (QTc) for myocardial injury and long-term mortality among patients hospitalized with COVID-19 infection is not well known.

Purpose
To evaluate the association of prolonged QTc with myocardial injury and with 1-year mortality among patients hospitalized with COVID-19 infection.

Methods
A total of 335 consecutive patients hospitalized with COVID-19 infection were prospectively studied. All patients underwent a comprehensive echocardiographic evaluation within 48 hours from admission. Using the Bazett formula, the QTc interval was calculated from the first ECG tracing recorded at the ER. QTc ≥440 msec in males and ≥450 msec in females was considered prolonged. Patients with elevated cardiac biomarkers and/or echocardiographic signs of myocardial dysfunction were considered to have myocardial injury. The predictive value of QTc prolongation for myocardial injury was calculated using a multivariate binary regression model. One-year mortality rate of patients with and without QTc prolongation was compared using the log-rank test, and a multivariate Cox regression model adjusting for multiple covariates was performed to evaluate the 1-year mortality risk.

Results
One-hundred and nine (32.5%) patients had a prolonged QTc. Compared to patients without QTc prolongation, patients with prolonged QTc were older (70±14.4 vs 62.7±16.6, p &lt;0.001), had more comorbidities, and presented with a more severe disease. Prolonged QTc was an independent predictor for myocardial injury (adjusted HR 2.07, 95% CI 1.22-3.5; p=0.007). One-year mortality of patients with prolonged QTc was higher than those with no QTc prolongation (40.7% vs 16.9; p &lt;0.001, adjusted HR 1.85[1.2-2.84]; p=0.005). Compared to patient without QTc prolongation and no myocardial injury, the adjusted 1-year mortality risk was highest in patients with prolonged QTc and myocardial injury (HR 6.63, 95% CI 2.28-19.3; p=0.001), followed by patients with QTc prolongation without myocardial injury (HR 6.12 95% CI 1.83-20.49; p=0.003), and patients with myocardial injury without QTc prolongation (HR 4.95 95% CI 1.83-20.49.; p=0.003).

Conclusion
Prolonged QTc is an independent risk factor for both myocardial injury and 1-year mortality among patients hospitalized with COVID-19 infection.
Advanced electrocardiography predicts early cardiac involvement and incident arrhythmias in Fabry disease
Authors: Vijapurapu R , Maanja M , Schlegel T , Augusto J , Kurdi H , Moon JC , Hughes DA , Geberhiwot T , Ugander M , Steeds RP , Kozor R 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Fabry disease is an X-linked disorder, with cardiovascular involvement characterised by progressive myocardial sphingolipid deposition. Cardiac disease is a major contributor to morbidity and mortality. Cardiac magnetic resonance (CMR) with T1 mapping and advanced electrocardiography (A-ECG) offer both diagnostic and prognostic potential.

Purpose
To evaluate the predictive power of A-ECG markers in identifying: 1) early cardiac involvement defined as low myocardial T1 on CMR, and 2) adverse cardiovascular outcomes defined as any arrhythmia requiring therapy, atrial fibrillation, hospitalisation for heart failure or mortality.

Methods
Patients included in this longitudinal, multi-centre study underwent same-day standard resting 12-lead ECG and CMR. CMR included standard cine imaging, T1 mapping with modified Look Locker inversion recovery (MOLLI, 5s(3s)3s), and late gadolinium enhancement (LGE). ECG digital files were analysed using in-house A-ECG software. A-ECG analysis included conventional ECG measures, derived vectorcardiographic measures, and singular value decomposition measures of waveform complexity. Significant A-ECG variables were identified using stepwise forward regression and incorporated in a multivariable logistic regression A-ECG score. A Youden index was applied to identify best threshold score and bootstrapping performed to calculate the area under the receiver operating characteristics curve (AUC), sensitivity, specificity, and 95% confidence intervals (CI).

Results
Among included patients (n=155, 40% male, age 46±14 years, 39% on enzyme replacement therapy), left ventricular mass index was higher in males compared to females (106 vs. 59 g/m2, p&lt;0.001), 80% of patients had myocardial native T1 below the local reference range (933 vs. 968 ms, p=0.06), and 51% (70/136) had focal LGE. Multivariable A-ECG scores for detecting low T1, any arrhythmia, or atrial fibrillation had an AUC [95%CI], sensitivity, and specificity of 0.82 [0.75-0.89], 72 [55-95]%, 85 [66-71]%; 0.89 [0.82-0.95], 82 [68-94]%, 88 [70-96]%; and 0.89 [0.80-0.96], 92 [77-100]%, 83 [76-92]%, respectively, Figure 1. No predictors of heart failure hospitalisation or mortality were found.

Conclusion
A-ECG analysis of the resting 12-lead ECG has good diagnostic performance for predicting early myocardial involvement and the occurrence of arrhythmias in Fabry disease. This supports the use of A-ECG both as a screening tool to diagnose early cardiac disease, and for identifying those at risk of adverse arrhythmic outcomes.
Atrial imaging and cardiac rhythm in cryptogenic embolic stroke: a preliminary analysis of the ARIES study
Authors: Castrejon Castrejon S , Rigual R , Fernandez-Gasso L , Martinez-Cossiani M , Garcia-Castro J , Ruiz-Ares G , Rodriguez-Pardo J , De Celis E , Casado L , Alonso De Lecinana M , Diez-Tejedor E , Perez-David E , Fuentes B , Lopez De Sa E , Merino JL 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cryptogenic stroke is frequently related to cardioembolic source previously unknown. We aim to analyze atrial fibrillation (AF), parafibrilatory status (para-AF) and echocardiographic signs of atrial dysfunction in patients (p) with cryptogenic stroke.

Methods
Consecutive p with cryptogenic stroke were prospectively enrolled in the on-going study ARIES (Atrial Imaging and cardiac Rhythm In Embolic Stroke). Cardiologic work-up includes external wearable 2-lead ECG monitoring system for 30 days (non-AF, AF, para-AF defined as &gt;3000 atrial ectopic beats/day or &gt;2 "micro-AF" episodes (fibrillatory burst &lt;30 s)/day) and advanced left atrial echocardiography (signs of atrial dysfunction as strain during three phases -reservoir, conduit, and contractile-). The first monitoring was started before hospital discharge, p without AF in the first monitoring and without extremely disabling neurologic sequelae underwent a further 30 days monitoring. We describe stroke recurrence at 90 days follow-up, and we compare echocardiographic signs of atrial dysfunction according to rhythm study.

Results
78 p completed follow-up (72±12 yo, 53% females). AF was diagnosed in 27 (34%) p: 22/78 (28%) in the first monitoring and 5/43 (12%) in the second one. para-AF was diagnosed in 22/51 (43%) non-AF p. Other arrhythmias: sustained (&gt;30 s) focal atrial tachycardia documented in 4/51 (8%) non-AF p, AVNRT in 1/51 (2%) non-AF p, advanced AV block in 1/78 (1%) p. Worse left atrial mechanical properties were demonstrated in p with para-AF compared to non-AF p (reservoir strain 22.2±9.8 vs 32.8±12, p=0.004; conduit strain -9.6±4.8 vs -14.4±9, p=0.008; contractile strain 12.6±4.8 vs 17.9±7.8, p=0.025), without significative differences compared to AF p. There were three stroke recurrences (3.8%), 2/3 in para-AF p.

Conclusion
In this preliminary analysis, patients with cryptogenic stroke presented AF in 34% and para-AF in 28%. Para-AF patients show significative atrial dysfunction in echocardiography and more stroke recurrences. A longer follow-up is required to confirm these findings.
Change in health related quality of life is different in obese versus non-obese patients with atrial fibrillation after thoracoscopic ablation
Authors: Roelofs MJM , Meulendijks ER , Wesselink R , Al-Shama RFM , De Vries TAC , Van Boven WJ , Driessen AHG , De Groot JR 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Received research grants (through institution) from Atricure Inc, Bayer, Boston Scientific, Daiichi Sankyo, Johnson&Johnson, Medtronic
Received honoraria/speaker/consultancy fees from Abbott, AtriaN Medical, Atricure Inc, Bayer, Biotronik, CVOI, Daiichi Sankyo, IPP Med, Itreas, Medtronic, Novartis, Servier

Background
Obesity is an important risk factor for atrial fibrillation (AF), and negatively affects health-related quality of life (QoL) and treatment efficacy. The impact of obesity on the improvement of QoL and on AF recurrence in patients undergoing thoracoscopic AF ablation is unknown.

Purpose
To assess the change in QoL and the risk of AF recurrence in obese and non-obese patients with atrial fibrillation undergoing thoracoscopic ablation

Methods
Patients undergoing thoracoscopic AF ablation were prospectively included. Holters were performed before and at 3, 6, 9 and 12 months after the procedure. AF recurrence was defined as any atrial tachyarrhythmia episode &gt;30 seconds during one year of follow-up. QoL and AF recurrence rate were assessed for normal weight (BMI ≤ 24,9 kg/m2), overweight (25,0 – 29,9 kg/m2) and obese (≥ 30,0 kg/m2) patients. QoL was measured by the Short Form 36 questionnaire at baseline and at one year follow-up.

Results
Four hundred and eight patients were included for analysis. Six out of eight QoL domains scored lower in obese versus non-obese patients before the procedure. In all patients, six out of eight domains increased after the procedure (p&lt;0.01 for most domains). Obese patients showed a larger improvement of emotional related QoL (p=0.01) and a trend towards a larger improvement of mental QoL (p=0.07), while physical QoL increased similarly to non-obese patients (figure). In obese patients, QoL increased similarly for those with and without AF recurrence (p=0.78), whereas in non-obese patients, AF recurrence was associated with less improvement in mental QoL. AF recurrence at 1-year was similar in all groups (normal weight 72.4%, overweight 68%, obese 70.4%, p=0.692).

Conclusion
After thoracoscopic ablation, obese patients have a similar AF freedom rate as non-obese patients, but a greater improvement in mental quality of life, irrespective of AF recurrence status, after thoracoscopic ablation.
Acute safety and efficacy outcome of pulmonary vein isolation using pulsed field ablation technology
Authors: Nentwich K , Ene EE , Berkowitz AB , Simu GS , Sonne KS , Mueller JM , Deneke TD 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Pulsed field ablation (PFA) is a new technology for electrical isolation of pulmonary veins (PVI) using electroporation for irreversible cell death. First data imply a very low complication rate in terms of esophageal lesion, phrenic nerve palsy and pulmonary vein stenosis. We present our datas of our first patients concerning acute safety and efficacy.

Method
38 patients with paroxysmal and persistent atrial fibrillation (AF) consecutively underwent PFA ablation including complete PVI of all pulmonary veins in all cases (including 14 redo cases ), mean age 68,3 year, and a mean ejection fraction of 56 %, mean CHADSVASC Score 3. 19 patients had paroxysmal AF, in 21 patients additional posterior wall isolation was performed. Additional anatomical and voltage characterization with CARTO was performed before and after ablation. Post ablation, all patients underwent endoscopic evaluation of the esophagus and all eligible patients were screened for silent cerebral lesions (SCL) using cerebral magnetic resonance imaging (MRI). All acute procedure data and complications were documented.

Results
In all 38 patients effective PVI using only PFA catheter was achieved (100 %) within a mean procedure time of 81±15 min and a mean fluoroscopy time of 18± 5 min. In 2 patients left atrial macroreentrant tachycardia was effectively terminated with PFA pulses in the PV-mitral-annular isthmus region.
In no patient an esophageal lesion could be detected (0%). Cerebral MRI was performed in 18 cases and revealed SCLs (47 %) in 5 patients (3 patients with multiple lesions, 2 patiens with 3 lesions, max size of 8 mm). No symptomatic complications including pericardial effusion or access site complications were noted.

Conclusion
PFA is a highly effective method for acute PVI. No relevant symptomatic complications were noted. Of note, no patient had esophageal injury related to the ablation but 40% of patients undergoing post-ablation MRI had documented SCE. Further data have to be collected to discuss these findings properly.
Amplitude of fibrillatory wave correlates with long-term maintenance of sinus rhythm after ablation in persistent atrial fibrillation
Authors: Luca A , Baskaralingam A , Mccann A , Vesin J-M , Pascale P , Le Bloa M , Herrera C , Roten L , Kuhne M , Spies F , Knecht S , Sticherling C , Pruvot E 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Commission for Technology and Innovation (CTI), Switzerland

Background
Amplitude of fibrillatory wave (fWA) on surface ECG is regarded as a predictor of ablation outcome for atrial fibrillation (AF).

Purpose
We sought to investigate whether fWA and its changes during ablation predicts long-term maintenance of sinus rhythm (SR) after wide circumferential isolation of pulmonary veins (WPVI) in persistent AF (peAF).

Methods
41 patients (63±10 y, sustained AF 11±7 months) underwent a de-novo WPVI. A second WPVI was performed in patients with recurrent AF in order to provide complete PV disconnection. We defined "success" as patients who remained in SR after one or two procedures, and "failure" otherwise. 60-sec ECG signals devoid of QRST waves were recorded during the index ablation at baseline and at the end of ablation (end_WPVI, before cardioversion or conversion of AF into SR). fWA was computed on leads V1 and V6b (placed on the pts’ back) as the average difference between the upper and lower envelope of atrial ECG signals.

Results
Over a mean follow-up of 33±9 months, 30 patients remained free from AF (success group), while 11 patients had AF recurrence after 2 WPVIs (failure group). The clinical characteristics (e.g. age, body mass index, left atrial volume or duration in sustained AF) were similar between groups (p &gt; 0.05). The success group displayed significantly higher fWA values at baseline and end_WPVI than that of the failure group (p&lt;0.05, Panel A and B). No significant difference was found between baseline fWA values and those measured at end_WPVI (p &gt; 0.05).

Conclusion
As fWA is independent of PVs contribution, it is a marker of atrial body remodelling. Low fWA values identify patients with peAF unresponsive to WPVI.
Periaortic scar-related ventricular tachycardia in patients with aortic valve replacement: transcatheter ablation is feasible and decisive
Authors: Cardelli LS , Barbato G , Verardi R , Pergolini F , Carinci V , Leci E , Casella G 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Aortic valve replacement (AVR) is a common procedure. While conduction disturbances are well-recognized complications, ventricular tachycardias (VTs) have not been widely reported neither described mainly because prosthetic valves represent a potential practical problem in the access to the ventricles, and this may limit the use of radiofrequency ablation (RF).

Purpose and Methods
We report three cases of periaortic scar-related VT in patients with AVR.

Results
The first case was a 85 years old (yo) man, with both aortic and mitral biological valve replacement. The left ventricular ejection fraction (LVEF) was normal and the clinical VT (left bundle branch block (BBB) and inferior axis, cycle length (CL) = 305 ms) was induced. Left ventricle (LV) was mapped with a retrograde transaortic approach: to cross safely the prosthesis, a 6-French (F) pigtail catheter was first placed in the ventricle; a 8.5-F Braided Guiding Introducer (SL1) was placed across the valve over a guidewire. The 8.5-F ablation catheter allowed to locate the VT origin underneath the septal portion of prosthetic aortic valve (PAV).
The second case was a 85 yo man, with bioprosthetic AVR and replacement of the ascending aorta. LVEF was 40% with mild PAV degeneration. The clinical VT had left BBB morphology and inferior axis (CL = 352 ms). Transaortic approach was hampered by an unfavorable entry angle and by valve degeneration. Then we opted for the technique commonly used during transcatheter AVR: the access to the LV was obtained using a 6-F coronary catheter (AL1) and a stright tip 0.034" angiographic guidewire; subsequently a 8.5-F, 81 cm long, introducer sheath (SL0) was positioned across the PAV. The reentry circuit was mapped in the high anterior region, just below the PAV insertion.
The third case was a 65 yo man, with mechanical PAV. LVEF was normal and the clinical VT had right BBB and left inferior axis (CL = 290 ms). After transseptal puncture, a steerable introducer was placed in left atrium. The mapping catheter allowed to identify early and fractional potentials in the anterior portion of PAV.
In all cases, RF applications was delivered at the earliest ventricular activation site with termination of the VTs. Thereafter, no VTs could be induced. At 12 months follow-up, the patients are free of any VT relapses.

Conclusions
The most common origin of sustained monomorphic VT occurring after PAV is the surgical scar and catheter ablation is a feasible option. In case of mechanical PAV, the only practicable access is the transeptal one; on the contrary, with biological PAV the transaortic approach can also be used. In difficult cases, the access to the LV can be obtained with the technique routinely performed during transcatheter AVR.
Influence of tissue thickness on thermal latency during high-power short-duration radiofrequency ablation with proactive esophageal cooling
Authors: Kulstad E , Mercado-Montoya M , Gomez-Bustamante T , Berjano E , Mickelsen S , Daniels J , Hernandez-Arango P , Schieber J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Thermal latency, or delayed heating, is increasingly recognized as an important factor in the formation of both intentional and unintentional lesions during radiofrequency (RF) ablation for the treatment of atrial fibrillation (AF). High-power short-duration (HPSD) ablation appears to have greater thermal latency than low or medium power ablation. Proactive esophageal cooling (PEC) has been shown to reduce esophageal lesion formation under a variety of conditions by directly reducing the effects of thermal latency, but the influence of anatomic dimensions on the protective efficacy of cooling during HPSD ablation has not been investigated.

Purpose
Determine the impact of changes in pericardial tissue thickness on thermal latency in order to quantify the protective efficacy of PEC across a range of anatomic dimensions.

Methods
We created a mathematical model of the left atrium undergoing HPSD ablation, both with and without a PEC device in place, using a range of pericardial tissue thicknesses (0.5, 0.75, and 1 mm). HPSD ablation was set at 50 W for 10 s, or 90 W for 4 s. We then examined the temperature dynamics at a range of thickness, focusing on the layer of mostly fatty tissue between the atrial and esophageal walls by varying the thickness of this layer while quantifying the degree of esophageal damage using the Arrhenius equation to determine the fraction of damage after peak heating has occurred.

Results
Under control conditions, the growth of lesions from RF ablation at both 50 W and 90 W was found to continue for greater than 10 seconds beyond the cessation of RF energy application. Esophageal lesion formation ranged from 71% to 96% transmurality after 50 W ablation for 10 s, and from 50% to 72% transmurality after 90 W ablation for 4 s. With PEC in place, esophageal lesion transmurality was markedly reduced, with a maximum transmurality ranging from 12% to 32% with 50 W ablation, and from 2% to 20% with 90 W ablation (Figure). Increasing thickness of pericardial tissue (with simulations of 0.5, 0.75, and 1 mm) resulted in decreasing esophageal lesion transmurality (67%, 74%, and 83% at 50 W power, and 72%, 82%, and 96% at 90 W power, respectively, with the 0.5, 0.75, and 1 mm simulations).

Conclusions
Thermal latency with HPSD ablation contributes to lesion growth and can cause esophageal injury. Proactive esophageal cooling counteracts this effect across a range of pericardial tissue thicknesses, and reduces esophageal lesion transmurality by an average of 79%.