bluuebunny/crossref_metadata_2025_split huggingface dataset:
Single-chamber versus dual-chamber pacing in very elderly patients with sinus node disease and AV block: a real-world study
Authors: Bedir A , Nageye F , Cherek P , Godley C , Ghani S , Cheong J , D'Souza S , Cecaro F , Petzer E , Martin W , Kabunga P 
Published: October 2022

Abstract

Background
Elderly patients with sinus-node disease, have been reported to have better clinical outcomes with dual-chamber pacing compared with single chamber pacing. In contrast, randomized studies have shown no clinical benefit of dual-chamber pacing compared to single-chamber pacing in the elderly with high grade AV block., For truly elderly patients (&gt;80 years), the optimal choice of pacing mode remains uncertain. In this real-world observational study, we analysed the clinical outcomes in a cohort of very elderly patients.

Methods
We analysed retrospective data of all new pacemaker implantations for sinus node disease or high-grade atrioventricular block in patients ≥80 years a district general hospital in south-east England, UK over a 7-year period. Patients with an existing diagnosis of stroke, congestive cardiac failure and/or atrial fibrillation (AF) were excluded from the study. Patients were categorised into two analysis cohorts based on pacing mode, i.e dual chamber (DDD) pacing versus single chamber (VVI) pacing. Clinical outcome data including all-cause mortality, new onset AF and CCF were recorded.

Results
A total of 208 patients were included in the study, of which 117 received (DDD) pacing vs 91 who underwent VVI pacing. The mean age was 85.8 years (84.63 DDD, 87.3 VVI, p=0.01). Single chamber pacing was associated with greater all-cause mortality (51.7% vs 31.5%, p=0.01). 23.1% of patients who underwent DDD pacing developed AF, vs 21.9% who underwent VVI pacing (p=0.85). Congestive cardiac failure was observed in 6.48% of patients who received DDD pacing vs 8.14% of patients who received VVI pacing, (p=0.66).

Conclusions
In this real-world observational study of very elderly patients with sinus node disease and/or high-grade AV block, single chamber pacing was associated with a greater all-cause mortality. However, the pacing mode did not affect the incidence of atrial fibrillation and congestive cardiac failure.

Funding Acknowledgement
Type of funding sources: None.
Prediction model for left ventricular ejection fraction recovery in atrial fibrillation-induced cardiomyopathy
Authors: Arroyo Monino D F , Izquierdo Bajo A , Fernandez Valenzuela M I , Bastos Amador P , Cozar Leon R , Diaz Infante E 
Published: October 2022

Abstract

Introduction
Arrhythmia-Induced Cardiomyopathy (AIC) is a cardiac disfunction secondary to fast, asynchronous or irregular ventricular contraction. Its diagnosis is usually retrospective, subsequently of the recovery of the left ventricle ejection fraction (LVEF) after controlling the responsible arrythmia (most frequently atrial fibrillation (AF)).

Objective
Our aim is to try to estimate the recovering of LVEF in patients diagnosed of AIC caused by AF, based on individual baseline characteristics.

Methods
Retrospective analysis of patients diagnosed with AIC related to AF between January 2015–2022. Clinical and demographic characteristics, as well as echocardiographic parameters prior to diagnosis and after recovery of ventricular function, were assessed. Recovered LVEF (final minus initial LVEF) was calculated in all patients. The best model was selected from the method of all possible equations, the one with the lowest Mallows Cp index, maintaining a sufficiently high multiple correlation coefficient (R2).

Results
134 patients with AIC were gathered in this period, 99 of them AF-related. Baseline characteristics are summarized in Image 1. The changes in the values of LVEF, left ventricle end-diastolic diameter and (LVEDD), tricuspid annular plane systolic excursion (TAPSE), which represents both left and right ventricular ejection fraction are showed in Image 2. The LVEF recoveredwith treatment was 22±8,5%.
The model was selected using up to 16 potential variables: age, sex, chronic kidney disease (CKD), obesity, enolism, hypertension, diabetes, obstructive sleeping apnoea (OSA), LVEF at the diagnosis, heart rate at diagnosis, angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs), neprilysin inhibitors (ARNI), mineralocorticoid receptor antagonists (MRA), ablation performed, rhythm control strategy and the interaction between ablation andrhythm control (the latter being rejected because of collinearity).
32.767 models were estimated. The best model was: Recovered LVEF = 51.79 + 1.15×Female Sex − 1.11×OSA − 4.40×RNI − 091×LVEF at diagnosis + 3.43×Rhythm control. The Cp of the selected model was 2.07 and R2 0.496, which means that 49.6% of individual variability of recovered LVEF was justified by this simple model.
After that, we performed an internal control using cross-validation, which did not show significative differences according to the estimation ability of the model (0.496 − 0.474 = 0.022, &lt;10%).

Conclusion
Female sex, absence of OSA, the lower the LVEF at the diagnosis, the absence of treatment with ARNI and the rhythm control as the treatment strategy predicted higher LEVF recovery in patients with AIC caused by AF, explaining nearly half to the individual variability.

Funding Acknowledgement
Type of funding sources: None.
Atrial fibrillation incidence in SARS-CoV-2 infected patients: predictors and relationship with in-hospital mortality
Authors: Maloberti A , Giannattasio C , Rebora P , Occhino G , Ughi N , Fabbri S , Cartella I , Algeri M , Scarpellini S , Rossetti C , Epis O M , Molon G , Bonfanti P , Valsecchi M G , Genovesi S 
Published: October 2022

Abstract

Background
Among the different CardioVascular (CV) manifestation of the COronaVIrus-related Disease (COVID) particular attention has been paid to arrhythmia and particularly to Atrial fibrillation (AF). The aim of our study was to assess the incidence of AF episodes in patients hospitalized for COVID and to evaluate its predictors and its relationship with in-hospital all-cause mortality.

Methods
We enrolled 3435 cases of SARS-CoV2 infection admitted in four hospitals in Northern Italy. We collected data on clinical history, vital signs, Intensive Care Unit (ICU) admission, laboratory tests and pharmacological treatment. AF incident and all-cause in-hospital mortality were considered as outcomes.

Results
145 (4.2%) patients develop AF during hospitalization, with a median time of 3 days (IQR: 0, 11.5) from admission. Incident AF patients were older and had lower eGFR, lower platelet and lymphocytes count and higher C-Reactive Protein (CRP), were admitted more frequently to ICU and more frequently died compared to subjects that didn't present AF. At the Cox regression model significant determinants of incident AF were older age (HR 1.070; 95% CI: 1.048, 1.092), history of AF (HR 2.800; 95% CI: 1.465, 5.351), ischemic heart disease (HR 0.324; 95% CI: 0.130, 0.811) and ICU admission (HR 8.030; 95% CI: 4.511, 14.292). Incident AF was a predictor of all-cause mortality (HR 1.679; 95% CI: 1.170, 2.410), together with age (HR 1.053; 95% CI: 1.042, 1.065), dementia (HR 1.553; 95% CI 1.151, 2.095), platelet count (HR 0.997; 95% CI: 0.996, 0.999) higher CRP (HR 1.004; 95% CI: 1.003, 1.005) and eGFR (HR: 0.991; 95% CI: 0.986, 0.996)

Conclusion
AF present as the main arrhythmia in COVID-19 patients and its development during the hospitalization strongly relates with in-hospital mortality.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): ASST GOM Niguarda Ca' Granda, Milan, Italy
Cerebral hemodynamics during atrial fibrillation: computational fluid dynamics (CFD) analysis of lenticulostriate arteries using 7T high-resolution magnetic resonance imaging
Authors: Saglietto A , Scarsoglio S , Tripoli F , Zwanenburg J J M , Biessels G J , Ridolfi L , De Ferrari G M , Anselmino M 
Published: October 2022

Abstract

Background
Lenticulostriate arteries (LSAs) are small perforating arteries (0.1–1 mm diameter), perpendicularly departing from middle cerebral artery (MCA) and supplying blood flow to important cerebral subcortical and basal ganglia areas. LSAs are involved in silent strokes and cerebral small vessel disease, potentially leading to cognitive decline and vascular dementia. There is growing evidence that atrial fibrillation (AF), the most common cardiac arrhythmia, increases the risk of dementia even in the absence of clinical strokes. AF also increase the risk of small vessel disease. AF may alter deep cerebral hemodynamics per se, however no data exists regarding a possible impact of AF on MCA-LSA branching sites hemodynamics.

Purpose
To use computational fluid dynamics (CFD) analysis to study the hemodynamics of LSAs-MCA branching sites.

Methods
7T high-resolution magnetic resonance imaging (HR-MRI) brain scans (Figure 1, panel a) were used to derive detailed geometrical models of LSAs-MCA branching sites. CFD analysis was then conducted, simulating AF conditions as well as sinus rhythm (SR), at different ventricular rates (from 50 to 130 bpm).

Results
Geometrical models were retrieved from HR-MRI scans of 7 patients. By means of the most significant metrics, such as wall shear stress (WSS; Figure 1, panel b), wall shear stress gradient (WSSG), and flow velocity (FV), a comparison between SR and AF was performed.

Conclusion
CFD analysis of LSAs-MCA branching sites using geometrical models derived from HR-MRI brain scans was feasible and allows to quantify the impact of AF on these critical ramifications of the MCA.

Funding Acknowledgement
Type of funding sources: None.
Evaluating the reversibility potential of atrial cardiomyopathy on a clinical and cellular level
Authors: Wiedmann F , Paasche A , Yesilgoez B , Kraft M , Blochberger P L , Frey N , Schmidt C 
Published: October 2022

Abstract

Background
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with various remodelling processes of the electrical and structural properties of the atrium, collectively referred to as atrial cardiomyopathy. Because these remodelling processes contribute significantly to the high recurrence rates and chronification of AF, the exact time course of their development and their reversion potential need to be further characterized.

Purpose
To investigate the time course and reversibility of atrial cardiomyopathy on a clinical, cellular and molecular level.

Methods
A clinically relevant porcine large animal model was used to study the structural and functional implications of atrial cardiomyopathy after different periods of burst pacing-induced AF (2, 4 and 8 weeks) and after a recovery period, following electrical cardioversion. The pigs were clinically characterized at each time point by echocardiography, cardiac MRI, and electrophysiological studies. After extraction of the heart, action potentials (APs) and ionic currents were measured on isolated atrial cardiomyocytes (CM) using the patch-clamp technique.

Results
After 4 weeks of AF induction, APD90 of isolated atrial cardiomyocytes was attenuated by 26%. Extending the AF induction period to 8 weeks caused an even stronger APD90 reduction by one-third, compared to SR controls. Accompanying, the TASK-1 current density was strongly upregulated in AF pigs. Those observations were in line with significant changes of the right atrial effective refractory period (AERP). At baseline, AERPS1=400 ms yielded 186 ms, whereas it was reduced to 141 ms after eight weeks of AF. Addressing the reversibility of those changes, following cardioversion of AF and an 8 week long SR recovery period, AERP baseline values were almost restored. Likewise, APD90 shortening was partially reversed. Furthermore, indication of reversibility of AF-associated remodelling was also observed on a structural level. After eight weeks of AF induction, echocardiography revealed severe dilatation of both atria, whereas atrial diameters decreased significantly after restoration of SR.

Conclusion
Remodelling processes underlying atrial cardiomyopathy display a partial reversibility upon restoration and maintenance of SR.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): DFG German Research Foundation
Blunted atrial reverse remodeling a year after catheter ablation for atrial fibrillation and their long-term rhythm outcome
Authors: Kim M H , Hwang I , Park J W , Yu H T , Kim T H , Uhm J S , Joung B , Lee M H , Pak H N 
Published: October 2022

Abstract

Background
Although active rhythm control by atrial fibrillation (AF) catheter ablation (AFCA) reduces left atrial (LA) dimension, blunted atrial reverse remodeling can be observed in patients with significant atrial myopathy. We explored the characteristics and long-term outcomes of AF patients who showed blunted atrial reverse remodeling despite no AF recurrence within a year after AFCA.

Methods
Among a total of 2,756 patients with AFCA, we included 1,685 patients (74.8% male, 60.2±10.1 years old, 54.5% paroxysmal AF) who underwent both baseline and 1-year follow-up echocardiogram, baseline LA&gt;40mm, and did not recur within a year. We divided them into tertile groups (T1–T3) based on one-year percent change of LA dimension after propensity matching for age, sex, AF type, and baseline LA dimension. We also investigated the patients' genetic characteristics with blunted LA reverse remodeling (T1) using a genome-wide association study (GWAS).

Results
Patients with blunted LA reverse remodeling (T1, n=424) were independently associated with body mass index (OR 1.082 [1.010–1.160], p=0.025), LA peak pressure (OR 1.010 [1.002–1.019], p=0.019), LA wall thickness (OR 0.448 [0.252–0.789], p=0.006), LA voltage (OR 0.651 [0.463–0.907], p=0.012), and pericardial fat volume (OR 1.004 [1.001–1.008], p=0.014). Throughout 65.9±37.4 months of follow-up, the incidence of AF recurrence a year after the procedure was significantly higher in the T1 group than in T2 or T3 groups (Log-rank p&lt;0.001). Among 894 patients with GWAS, ATXN1, XPO7, KRR1_PHLDA1, ZFHX3, and their polygenic risk score were associated with blunted LA reverse remodeling.

Conclusions
Patients with blunted LA reverse remodeling after AFCA were independently associated with low LA voltage, thin wall thickness, high LA pressure, and fat volume, and have a genetic background. Long-term clinical recurrence a year after AFCA was higher in this patient group with suspicious atrial myopathy.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health and WelfareNational Research Foundation of Korea
Micronutrient deficiencies and new-onset atrial fibrillation in a community-based cohort: data from PREVEND
Authors: Al Mubarak A A , Grote Beverborg N , Zwartkruis V , Van Deutekom C , De Borst M H , Gansevoort R T , Bakker S J L , Touw D J , De Boer R A , Van Der Meer P , Rienstra M , Bomer N 
Published: October 2022

Abstract

Background
Impaired nutritional status has been linked to cardiovascular diseases. Both selenium and iron deficiency have been associated with impaired exercise tolerance and worse prognosis in patients with heart failure (HF) as well as mitochondrial dysfunction in human cardiomyocytes. With exception of magnesium, little is known about the role of micronutrients in the development of atrial fibrillation (AFib).

Purpose
To elucidate the association of micronutrient deficiencies with new-onset AFib.

Methods
Selenium, magnesium and iron parameters were measured in a well-characterized Dutch prospective cohort study (N=5452). Selenium deficiency was defined as selenium &lt;70 μg/L, iron deficiency as ferritin &lt;30 μg/L, and magnesium deficiency as magnesium &lt;0.85 mmol/L. New-onset AFib was the primary outcome. All cases with suspected AFib as determined by electronic screening based on 12-lead ECG were manually reviewed and validated by 2 independent cardiologists. Competing-risk regression analyses were performed with death as a competing risk. Additionally, we tested for interaction between selenium deficiency and smoking status on the outcome because of the known lower serum selenium concentrations in smokers in various cohorts.

Results
The mean age was 53.3 (12.0) years and 2843 (52.1%) of all participants were women. During a mean follow-up of 6.2 years, 136 (2.5%) participants developed new-onset AFib. Of the participants who developed AFib, 25.7% had selenium deficiency, 5.1% had iron deficiency, and 75% had magnesium deficiency, compared to 21.1%, 14.9% and 65.8% of those who did not develop AFib, respectively. Smoking status significantly interacted with selenium deficiency on outcome (p=0.075). After multivariable adjustment for components of the CHARGE-AF model, selenium deficiency was associated with new-onset AFib in non-smokers (HR: 1.69, 95% CI: 1.08 to 2.66, p=0.022), but not in smokers (HR: 0.71, 95% CI: 0.27 to 1.90, p=0.494). There was no significant association between the new-onset AFib and magnesium deficiency (HR: 1.40, 95% CI: 0.93 to 2.12, p=0.108) or iron deficiency (HR: 0.59, 95% CI: 0.23–1.49, P=0.266). Participants with two or more deficiencies had higher risk to develop AFib compared to those without deficiencies (HR: 1.75, 95% CI: 1.00 to 3.06, p=0.050).

Conclusion
In a community-based cohort, selenium deficiency was associated with new-onset AFib in non-smoking participants. Interventional studies that investigate the effects of optimizing micronutrients status in a population at risk are needed to assess causality, especially in those with selenium deficiency.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): ENW-KLEIN grantthe Junior Scientific Masterclass-MD/PhD program of the UMCG
Impact of sex on the incidence of atrial fibrillation in the community setting: a systematic review and meta-analysis
Authors: Ali O , Sowah Quarshie L , Ali M , Vassiliou V 
Published: October 2022

Abstract

Introduction
Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with significant morbidity and mortality. By 2060, it is estimated that 18 million adults over 55 years will have AF in the European Union, and significant healthcare costs are projected to accompany this substantial increase in prevalence. Sex plays a major role in its pathogenesis, but conflicting results have been reported on whether the risk of new-onset AF differs between men and women.

Purpose
Undertake a systematic review and meta-analysis of epidemiological studies comparing incidence of new-onset AF between men and women in the community setting.

Methods
We searched PubMed Medline and Ovid Embase for longitudinal studies from their inception to March 2021. We selected studies if they presented sex-specific incidence estimates of new-onset AF for participants without a prior history of AF. We assessed the risk of bias from methodological quality using the Newcastle Ottawa Scale (NOS). We pooled data using a random-effects model with inverse-variance weighting approach, and carried out subgroup analyses to explore heterogeneity based on age and sampling population. Risk ratio (RR) and 95% confidence interval (CI) were generated to compare the incidence of new-onset AF between men and women.

Results
A total of 54 prospective cohort studies met the inclusion criteria and were systematically reviewed. Of these, 45 with data on a total of 10,530,623 participants (40% women) were included in the meta-analysis. Pooled analysis demonstrated that men had a statistically significant higher risk of developing new-onset AF than women (RR 1.53; 95% CI 1.42–1.64; p&lt;0.00001) and this result remained robust on sensitivity analysis. The sampling population subgroup analysis suggests that the risk in men could be even higher based on studies that were part of health screening programmes (RR 2.88; 95% CI 2.16–3.83; p&lt;0.00001). However, the age subgroup analysis suggests that no statistically significant difference exists between the sexes beyond 50 years (RR 1.19; 95% CI 0.96–1.46; p=0.11).

Conclusion
This systematic review unequivocally demonstrates that men have a higher risk of new-onset AF than women in the general population. Future research could address the usefulness of screening programmes and provide more empirical evidence for the elderly.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Wolfson Foundation
Influence of obesity and overweight on the association between sleep-disordered breathing and atrial fibrillation: the DASAP-HF study
Authors: Boriani G , Diemberger I , Pisano' E C L , Pieragnoli P , Locatelli A , Capucci A , Talarico A , Zecchin M , Rapacciuolo A , Piacenti M , Indolfi C , Arias M A , Checchinato C , D'Onofrio A 
Published: October 2022

Abstract

Background
The association between sleep apnea (SA) and atrial fibrillation (AF) has been well described. However, it remains unclear whether the association is causative or primarily dependent on shared comorbidities such as obesity. The Respiratory Disturbance Index (RDI) computed by an implantable cardioverter defibrillator (ICD) algorithm accurately identifies severe SA, whether central or obstructive in origin.

Purpose
In the present analysis we studied in patients with heart failure the contribution of obesity in the relationship between SA, measured by RDI, and AF.

Methods
Patients with ejection fraction ≤35% implanted with an ICD endowed with an algorithm (ApneaScan) that calculates the RDI each night, were enrolled and followed-up for 24 months. The weekly mean RDI value was considered, as calculated during the entire follow-up period. The endpoint was daily AF burden of ≥6 hours.

Results
164 patients (age 67±10 years, 75% male, ejection fraction 29±5%) had usable RDI values during the entire follow-up period. Body mass index (BMI) was &lt;25 kg/m2 in 62 patients (normal), 25.0–29.9 kg/m2 in 66 patients (overweight), ≥ 30 kg/m2 in 36 patients (obese). When compared with normal patients (31±11 episodes/h), the average RDI value calculated during the entire follow-up period did not differ in overweight patients (35±13 episodes/h, p=0.114), but was significantly higher in obese patients (39±12 episodes/h, p=0.002). During follow-up, AF burden ≥6 hours/day was documented in 48 (29%) patients (BMI ≥ versus &lt;25 kg/m2; HR: 1.47, 95% CI: 0.83–2.60, p=0.197; BMI ≥ versus &lt;30 kg/m2; HR: 0.98, 95% CI: 0.46–2.09, p=0.963). Based on the ROC curve analysis, average RDI ≥37 episodes/h maximized sensitivity and specificity for the prediction of AF (Area under the curve: 0.63, 95% CI: 0.55–0.70, p=0.011). Device-detected RDI ≥37 episodes/h was associated with the occurrence of AF on univariate analysis (HR: 3.88, 95% CI: 2.02–7.44, p&lt;0.001), as well as after correction for either BMI ≥25 kg/m2 (HR: 3.76, 95% CI: 1.94–7.26, p&lt;0.001), or BMI ≥30 kg/m2 (HR: 4.15, 95% CI: 2.15–8.04, p&lt;0.001).

Conclusions
In heart failure patients, we confirmed the association between ICD-detected SA and AF, an association that persisted independent of patient body habitus.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The study is supported by a research grant from Boston Scientific