bluuebunny/crossref_metadata_2025_split huggingface dataset:
Catheter ablation of atrioventricular nodal reentry tachycardia and quality of life
Authors: Erkabayev SH , Amirkulov B , Amirkulov R , Sultanov B 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Objective
To present the results of radiofrequency catheter ablation of patients with atrioventricular nodal reentry tachycardia (AVNRT).

Materials and methods
Catheter ablation was performed in 488 patients with AVNRT. The age of patients is from 14 to 66 (mean age 40.2±14.7 years). Comorbidities such as ischemic heart disease and hypertension were in 234 (48%) patients, in 83 (17%) patients chronic myocarditis was detected. No organic pathology from the cardiovascular system was detected in 171 (35%) patients. In the anamnesis, tachycardia attacks were observed from 2 to 29 years (on average, 18.7 ± 4.9 years). After confirming the diagnosis of typical "slow-fast" AVNRT on the intracardiac electrophysiological investigation, an ablation catheter was inserted into the heart of the patient. Then radiofrequency ablation of "slow paths" of AV-connection was performed.
Traditionally, the quality of life associated with health is considered as an integral characteristic of a person’s physical, mental (emotional) and social well-being, based on his subjective perception of these attributes. We assessed the quality of life of patients with AVNRT using the SF-36 questionnaire and The Hospital Anxiety and Depression Scale (HADS) before and after performing of catheter radiofrequency ablation.

Results
In 488 patients, the criteria for the effectiveness of the destruction of the "slow pathways" were obtained and the effectiveness of the procedure was 99.38%.
During the study of indicators of QOL according to the SF-36 questionnaire, wich was obtained 6 months after Radiofrequency Ablation (RFA), the most significant improvement was noted in terms of role functioning RF (by 48.6%), physical functioning PF (by 25.5%) and GH general health (19.7%). The BP bodily pain index, although increased (by 13.8%), but not reliably. After 12 months, we observed a significant improvement in QOL in all indicators of the physical component of health, which did not differ from those in the control group.
Clinically manifested anxiety was observed in a reliably larger number of patients (63.6%). The total indicator of the anxiety level was 11.1±2.4 points and corresponded to clinically manifested anxiety. The majority (66.7%) of patients had a subclinical form of depression. The total value of the depression level was 9.8±1.8 points and corresponded to the indicator of subclinically manifested disorders. Testing on the hospital anxiety and depression assessment scale after 12 months showed that all patients had no significant symptoms of anxiety and depression. The total score of anxiety was -2.8±1.1 points (p&lt;0.0001), depression - 2.4±1.4 (p&lt;0.0001).

Conclusions
Radiofrequency catheter ablation is an effective, drastic and safe method of treating AVNRT, the effectiveness of the procedure reaches up to 100% and allows patients to improve their quality of life, get rid of the lifelong intake of antiarrhythmic drugs.
Gender differences in arrhythmias and psychological discomfort management
Authors: Giaccardi M , Strisciuglio T , Turreni F , Marinigh R , Carreras G , Pelargonio G , Bisceglia C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Palpitations and/or syncope are common in patients with psychoneurological disorders [1]. Arrhythmias may be associated to psychological discomfort as well [2]. Psychiatrics, epidemiology and commonplace agree that gender may lead to difference in symptom perception, and management [3-4]

Purpose
To investigate the abovementioned association we realized a retrospective multicentric registry including, after definite instrumental diagnosis, patients with previous mental disorder diagnosis, referring to arrhythmology ambulatories.

Results
64 pts (48 F, 75%), mean age 54±18y, were enrolled in 7 centers. Psychiatric diagnoses were: anxiety-depression disorder (N=50), panic attack (N=5), behavioural disorder (N=4), epilepsy (N=3), psychosis (N=1), diagnosed in 83% by General Practitioners and in 14% by Psychiatrists. 55 pts (86%) were on drug therapy: benzodiazepines (67%), SSRI (22%), neuroleptics (3%), antidepressants (2%), and natural products (5%). Among these, 89% reported no symptoms relief. 57 pts complained palpitations, 17 extrasystoles and 19 reported syncope. EPS study was performed in 48%, 24 h Holter ECG in 28%, and LR implantation in 5% of patients. We diagnosed AF (N=11), typical AFL (N=4), AT (N=8), AVNRT (N=16), AVRT (N=4), PAC (N=1), PVC (N=10), AV block (N=4), VT (N=3) and unspecified SVT (N=3). 44 pts underwent ablation. 62 pts (96,8) experienced strong symptoms reduction or resolution, and 42 psychiatric drugs withdrawal. One pt underwent PMK implantation.

Conclusions
In our series of cardiac symptoms ascribed to psychiatric disorders, women markedly prevailed. Psychologic discomfort could be caused by arrhythmias, as resolved or dramatically ameliorated by diagnosis and treatment. Further investigation in Psychiatric context is warranted.
Validation of the peak frequency of bipolar electrograms for detection of residual conduction in atrial scar tissue
Authors: Merino JL , Kim S , Relan J , Sanroman M , Castrejon S , Cervantes C , De La Vieja Alarcon JJ , Martinez Cossiani M , Rivero Santana B , Carton A , Tauber Molina P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Abbott

Background
Activation and voltage (Bi-V) maps (Panel A) based on conventional bipolar electrograms (EGMs) are influenced by both near-field (NF) and far-field (FF) EGM components. This represents a limitation in the accurate detection of residual conduction within regions of scar. Peak frequency (PF) EGM analysis may better distinguish NF from FF activation vs conventional detection methods. (Panels B & C)

Purpose
1. To validate the use of PF to detect residual conduction in a well-defined model of narrow isthmus of conduction such as subacute pulmonary vein (PV) reconnection following atrial fibrillation ablation. 2. To compare discrimination value of PF and conventional Bi-V to detect such isthmuses.

Methods
Bi-V and activation maps were acquired during redo PV isolation (PVI) procedures using a rectangular 16-pole catheter (HD-Grid). LA-PV conduction was assessed during coronary sinus (CS) pacing (500ms cycle length). Any conduction gap (GAP) site at which PVI was established using ≤3 focal radiofrequency applications was analyzed. (Panel A) EGMʼs ≤1cm from the site of PVI were classified as GAP (vs EGMʼs ≥1cm - No-Gap). (Panel B)

Results
28 GAPs were found in 12 of 14 consecutive patients in the study. 3,976 EGMʼs (1,547 GAP vs 2,429 No-GAP) were analyzed. GAP regions showed significantly higher PF than No-GAP regions (345 ±135 vs 181±116 Hz, P&lt;0.0001) (Panel E). GAP regions also showed significantly higher BiV than No-GAP regions
(1.86±2.11 mV vs 0.62±1.22 mV, P&lt;0.0001) (Panel D). ROC curves for GAP vs No-GAP discrimination were better for PF (AUC 0.84) than for Bi-V (AUC 0.74) with optimal cutoffs of 240 Hz and 0.2 mV, respectively. (Panel F)

Conclusion
PF better detects residual conduction within an atrial scar region than conventional Bi-V. The PF cutoff value for gap discrimination in the PV antra is 240 Hz.
Electrode tissue coupling is a new main determinant of RF lesion creation, experience from a cardiac animal model
Authors: Wachter A , Bahlke F , Popa M , Foerschner L , Krafft H , Maurer S , Englert F , Telishevska M , Lengauer S , Kottmaier M , Lennerz C , Reents T , Hessling G , Deisenhofer I , Bourier F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Radiofrequency (RF) current is a classic ablation technology used in the EP lab. By now it is assumed that RF lesion size is mainly determined by RF power, duration and contact force. This ex vivo animal model study shows that a new parameter - "electrode tissue coupling" (ETC) - plays an additional major role in RF lesion creation. The ETC level describes the amount of electric contact between the RF electrode and cardiac tissue: In minor ETC levels, only the distal electrode connects to tissue. In full ETC levels, the whole RF electrode is embedded in cardiac tissue.

Methods
RF-lesions were created using an ex vivo porcine cardiac model. The experimental setup consisted of a saline-filled container, a dispersive electrode, a heated thermostat and a circulation pump to imitate in vivo conditions. Global impedance was kept at 120 Ohm as well as the temperature at 37°C. RF-lesions were created using identic values of RF duration and contact force. A RF power of 20W, 30W, 40W, and 50W was used. The ETC levels were systematically varied between minor and full coupling. All parameters (power, temperature, global and local impedance, contact force, ETC, lesion size) were measured constantly during application of RF-current, enabling real-time correlation of RF parameters and lesion size.

Results
In total, 1923 measurements during application of RF-current were analyzed. In ETC III (full tissue coupling), lesions became significantly wider and deeper. In 20W ablations, lesion diameters were significantly (1.68 fold) larger when applying ETC III instead of ETC I. This relation was found in variations of RF parameters (Table 1).
Interestingly, baseline local impedance and local impedance drop showed a high correlation with selected ETC levels. The average baseline local impedance in ETC I was 207.2 Ohm, compared to 267.3 Ohm in ETC III (p &lt; 0.01).

Discussion
In addition to by now known parameters (power, duration, contact force), electrode tissue coupling is a main determinant of lesion size. Higher ETC levels result in higher amounts of RF current going into adjacent tissue instead of current dissipation into the blood pool. In clinical practice, the ETC level can be predicted by baseline local and global impedance. Observation of these parameters should become clinical practice during RF ablation.
Characterization of the circumferential cevel of the pulmonary vein isolation area using pulsed-field catheter ablation: Spatial distribution and extent of insufficient and excessive isolation areas
Authors: Bohnen M , Weber R , Eichenlaub M , Jadidi A , Neumann FJ , Arentz T , Lehrmann H 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The cornerstone of pulmonary vein isolation (PVI) is a wide area circumferential ablation (WACA) resulting in an isolation area encompassing the PV antrum. Pulsed field ablation (PFA) is a new non-thermal "single-shot" PVI device with promising success rates. However, the circumferential level of its PV isolation area is still unknown.

Objective
To characterize the circumferential acute PV isolation area by assessing the spatial distribution (qualitative analysis) and extent (quantitative analysis) of insufficient PV antral and excessive LA isolation areas.

Methods
In this study, patients with paroxysmal or persistent atrial fibrillation (AF) underwent PVI with a pentaspline PFA catheter. Before and immediately after PVI, ultra-high-density (UHD) voltage maps using a 20-polar circular mapping catheter were created. The insufficient isolations areas per antral PV segment (10-segment model) and excessive isolation areas per LA region (8-region model) were quantified.

Results
Between November – December 2021, in forty consecutive patients (age 62 ± 6 years, 28/40 [70%] male, LA 41 ± 4 mm) acute PVI using PFA was achieved and pre (5469 ± 1822 points) and post mapping (6809 ± 2769 points) was performed. The anterior antral PV segments of the left PVs were the most frequent locations of insufficient isolation areas (Table 1, Figure 1). The largest extent of insufficient isolation areas at the PV antral level was located again on the anterior parts of both left PVs (Figure 2A), but also in the anterior lower segment of the right inferior PV (Figure 2B). The posterior wall and roof region of both LA sides were the most frequent locations of excessive isolation areas (Figure 4). The extent of this excessive isolation at the roof and the posterior wall on both LA sides even resulted in a connection of the both-sided low voltage areas in 18% and 8%, respectively.

Conclusion
When using PFA to achieve a circumferential antral PVI, efforts should be made to enhance anterior antral PV segment and prevent excessive posterior wall and roof ablation. For further optimizing the procedure, full integration of PFA catheter visualization into 3D-mapping systems is needed.
Occurrence and predictors of severe arrhythmia in patients with myocarditis
Authors: Krisai P , Ruperti-Repilado FJ , Goeldi A , Kraus D , De Alencar B , Sticherling C , Balestra G 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Patients with myocarditis are at risk for severe, life-threatening arrhythmia. However, predictors to identify high-risk patients are lacking.

Purpose
We investigated the occurrence and potential risk factors of severe arrhythmia in myocarditis patients.

Methods
212 myocarditis patients that were hospitalized for arrhythmia monitoring at a tertiary university hospital were retrospectively enrolled. Non-sustained ventricular tachycardia (VT), sustained VT, ventricular fibrillation or cardiac arrest were considered as severe arrhythmia. We used a stepwise logistic regression model to investigate potential predictors. These included age, sex, clinical presentation (chest pain, palpitations, dyspnea, syncope, cardiac murmur, edema, pericardial friction, arrhythmia at presentation, Killip-class), comorbidities (hypertension, diabetes, coronary heart disease), imaging parameters (left ventricular ejection fraction [LVEF], pericardial effusion, edema and LGE on MRI), ECG variables (PQ depression, ST elevation, ST depression) and maximum levels of blood biomarkers (CRP, leukocytes, Troponin T, CK-MB).

Results
Mean age was 40.8 years, 73.1% were male and mean LVEF was 52.9%. During the hospital stay, 40 (18.9%) patients experienced severe arrhythmia: 33 (15.6%) non-sustained VT, 9 (4.2%) sustained VT, 1 (0.5%) ventricular fibrillation and 3 (1.4%) cardiac arrests (arrhythmia not mutually exclusive). Most arrhythmia occurred in the first 72h of monitoring (Figure). Significant predictors selected by the stepwise model (OR [95% CI]) for severe arrhythmia were LVEF (per 1% increase 0.95 [0.92; 0.99], p=0.005), syncope at presentation (7.9 [1.5; 40.4], p=0.01), any arrhythmia at first presentation (6.5 [1.3; 32.7], p=0.02) and CK-MB (per 10-unit increase 1.2 [1.1; 1.3], p=0.001).

Conclusion(s)
Myocarditis patients with low LVEF, presenting with arrhythmia and syncope and with increased CK-MB are at increased risk for severe arrhythmia and should be closely monitored. Further studies are needed to define, if patients without these risk factors might be safely discharged early.
Gender-sensitive analysis of ICD indications in European heart failure guidelines
Authors: Rilo I , Beramendi Calero JR , Quintas Ovejero LAURA , Rengel Jimenez AINHOA , Cea Primo DANIEL , Hernandez De Alba LEIRE , Nunez Rodriguez ALVARO , Calvo Chumillas SERGIO , Querejeta Iraola RAMÓN 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Although there is evidence that women do not benefit as much as men from ICD implantation and receive a greater number of inappropriate discharges, the clinical practice guidelines for heart failure do not contemplate a different attitude taking into account gender.

Objective
The aim of this study is to analyze the clinical trials and registries on which the recommendations of the guidelines are based.

Methods
We selected in the bibliography of the 2021 European heart failure guidelines the registries and clinical essays and analyzed them attending to gender perspective according to the following questions:
Is gender treated as a primary variable? Is gender treated as a secondary variable?
Is there a differentiated analysis by sex? Are side effects described differently by sex ?
What is the proportion of women in the study?

Results
We analyzed 16 articles. The proportion of women is between 15 and 25%. Only 6 in 16 articles reported a differentiated analysis by sex and there was only one article that differentiated side effects according to sex. Among the studies that reported differentiated analysis by sex, two of then show that women didn`t benefit of the implantation of ICD.

Conclusions
Gender analysis should be mandatory in all the clinical essays carried out in the future. Guidelines should consider different recommendations according to gender. Being excluded or infrarrepresented in studies could conditionate a discrimination to women not only now but also in the future when the algorithms of artificial intelligence condition the decisions we make in the different pathologies
Local conduction heterogeneities promoted by premature atrial contractions in patients with and without atrial fibrillation
Authors: Van Schie MS , Razavi Ebrahimi P , Ramdat Misier NL , 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
The atrial conduction velocity (CV) provides important information about the underlying myocardium and is therefore widely used to identify potential mechanisms for arrhythmogenesis. Loss of cell-to-cell communication, which results in enhanced non-uniform anisotropy, contributes to local conduction disorders and conduction heterogeneity (CH). However, it remains challenging to clinically measure CV. Using discrete velocity vectors, areas of local CHs can be most accurately identified without smoothing of wavefront propagation.

Purpose
To quantify local CH using CV vectors and to examine differences between sinus rhythm (SR) and spontaneous premature atrial contractions (PAC) in patients with and without history of atrial fibrillation (AF).

Methods
Intra-operative epicardial mapping (128 or 192 electrodes, interelectrode distance 2mm) of the right and left atrium (RA, LA), Bachmann’s Bundle (BB) and pulmonary vein area (PVA) was performed in 228 patients (158 male, 68±10 years, 54 history of AF). PACs were defined as abnormal atrial contractions with at least 25% shortening of cycle length as compared to the previous SR cycle length. CV vectors were computed at each electrode using a discrete velocity vectors method. Direction and speed of these vectors were compared to the surrounding electrodes to identify local CH.

Results
In total, 503 PACs were included with a prematurity index of 45±12%. Compared to SR beats, PACs had decreased CV (89.9 [80.7–99.3] cm/s vs 80.1 [70.7–89.6] cm/s, P&lt;0.001) and, in 96% of the PACs, more CH (3.3 [1.6–5.9] % vs 12.1 [8.5–16.3] %, P&lt;0.001). During SR, most CH were found at BB and LA (5.6 [3.4 – 8.6] % and 5.0 [2.7–6.4] %). Compared to SR, the largest increase in CH during PAC was found at BB and PVA (+8.7 [5.4–13.6] % and +8.9 [4.8–12.6] %, all P&lt;0.001). During PAC, CV decreased particularly at BB, PVA and LA (-8.4 [-20.3–-0.6] cm/s, -10.4 [-19.3–0.3] cm/s and -10.1 [-19.1–0.3] cm/s, all P&lt;0.001). Compared to patients without AF, more CH were found during SR in AF patients at BB (P&lt;0.001), while there was no difference in CH increase during PAC between both patient groups.

Conclusions
Intra-operative high-resolution mapping showed that PACs are characterized by decreased CV and an increased amount of local CH, particularly at BB and PVA. Patients with history of AF are characterized by considerable CH already present during SR at BB. These differences indicate local enhanced non-uniform anisotropy and hence possibly arrhythmogenic substrates underlying AF.
The features of atrial fibrillation occurrence in patients who have undergone COVID-19
Authors: Hazarapetyan LG , Grigoryan S , Ter-Markaryan AA , Drampyan MF 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
COVID-19 pandemic has a rather negative effect on patients with cardiovascular pathology, also in patients without cardiovascular disease because its pathogenesis is based on generalized vascuities of the microvasculature with the development of multiple thrombosis and thromboembolism. Atrial fibrillation (AF) is one of the major cardiac arrhythmias and accounts for almost one third of all arrhythmias. Changes in electrical, structural, and contractile properties of cardiac tissue that are thought to underlie AF maintenance and progression are reviewed. The aim of this study is to identify the features and predictors that contribute to the onset or development of AF in patients who have had COVID -19.

Methods
This was a three-center prospective study, conducted in the coronary care unit during the period of February 2020 to June 2021. This study included 196 patients with AF who underwent COVID-19 at different times of this period (I group). For comparison, the data of similar 203 AF patients without COVID (II group) were analyzed in the period from February 2018 to February 2019 from the same centers... Medical history, clinical, instrumental and laboratory data, including troponin-1, tissue factor (TF), and hsCRP were studied in all patients. The data obtained was analyzed for statistical significance including multivariable logistic regression using analyses by SPSS 16.

Results
The compared results showed that the first-onset AF in patients from first group was observed in 18.7% compared with 8.1% in second group. In intensive care units, AF were registered in 44.2% of patients in I group vs. 7.1% of patients in II group. In first group among patients with ACS, AF occurred in 12.7% of cases vs. similar patients in II group- 8.4%. In first group hypokalemia was observed in 67.8% of cases vs. 28.6% in II group... Multivariable logistic regression was shown that among tested biomarkers, hsCRP, troponin-I and TF were more higher in patients undergoing COVID in compared patients with AF without COVID (odds ratio, 3.48; p&lt;0.001, 2.36 p&lt;0.017 and 2.48 p&lt;0.01 accordingly).

Conclusions
Some features of the onset or development of AF were identified in patients undergoing COVID. So, In these patients compared with AF patients without COVID, AF more often occurs in clinically severe patients, with ACS, as well as in patients with severe hypokalemia, higher hsCRP, TF and troponin values.