EP Europace最新文献

{"title":"Transcoronary Mapping with an Over-the-wire Multielectrode Catheter in Scar-related Ventricular Tachycardia Patients","authors":"Takuro Nishimura, Masahiko Goya, Miho Negishi, Takashi Ikenouchi, Tasuku Yamamoto, Iwanari Kawamura, Kentaro Goto, Takatoshi Shigeta, Tomomasa Takamiya, Susumu Tao, Masateru Takigawa, Taishi Yonetsu, Shinsuke Miyazaki, Tetsuo Sasano","doi":"10.1093/europace/euad365","DOIUrl":"https://doi.org/10.1093/europace/euad365","url":null,"abstract":"Background and Aims The usefulness of coronary venous system mapping has been reported for assessing intramural and epicardial substrates in patients with scar-related ventricular tachycardia (VT). However, there has been little data on mapping from coronary arteries. We investigated the safety and utility of mapping from coronary arteries with a novel over-the-wire multielectrode catheter in scar-related VT patients. Methods Ten consecutive scar-related VT patients with nonischemic cardiomyopathy who underwent mapping from a coronary artery were analyzed. Six patients underwent simultaneous coronary venous mapping. High-density maps were created by combining the left ventricular endocardium and coronary vessels. Results Substrate maps were created during the baseline rhythm with 2,438 points (IQR 2,136–3,490 points), including 329 (IQR 59-508 points) in coronary arteries. Abnormal bipolar electrograms were successfully recorded within coronary arteries close to the endocardial substrate in 7 patients. During VT, isthmus components were recorded within coronary vessels in 3 patients with no discernible isthmus components on endocardial mapping. The ablation terminated the VT from an endocardial site opposite the earliest site in the coronary arteries in 5 patients. Conclusions The transcoronary mapping with an over-the-wire multielectrode catheter can safely record abnormal bipolar electrograms within coronary arteries. Additional mapping data from coronary vessels have the potential to assess three-dimensional ventricular substrates and circuit structures in scar-related VT patients.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138684964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ablation for atrial fibrillation improves the outcomes in patients with heart failure with preserved ejection fraction","authors":"Zhonglei Xie, Baozhen Qi, Zimu Wang, Fuhai Li, Chaofeng Chen, Chaofu Li, Shuai Yuan, Shun Yao, Jingmin Zhou, Junbo Ge","doi":"10.1093/europace/euad363","DOIUrl":"https://doi.org/10.1093/europace/euad363","url":null,"abstract":"Background and Aims Patients with heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) have worse clinical outcomes than those with sinus rhythm (SR). We aim to investigate whether maintaining SR in patients with HFpEF through a strategy such as AF ablation would improve outcomes. Methods This is a cohort study that analyzed 1034 patients (median age 69 [63-76] years, 46.2% [478/1034] female) with HFpEF and AF. Of these, 392 patients who underwent first-time AF ablation were assigned to the ablation group, and the remaining 642 patients, who received only medical therapy, were assigned to the no ablation group. The primary endpoint was a composite of all-cause death or rehospitalization for worsening heart failure. Results After a median follow-up of 39 months, the cumulative incidence of the primary endpoint was significantly lower in the ablation group compared to the no ablation group (adjusted hazard ratio [HR], 0.55 [95% CI, 0.37-0.82], P = 0.003) in the propensity score-matched model. Secondary endpoint analysis showed that the benefit of AF ablation was mainly driven by a reduction in rehospitalization for worsening heart failure (adjusted HR, 0.52 [95% CI, 0.34-0.80], P = 0.003). Patients in the ablation group showed a 33% relative decrease in atrial tachycardia/AF recurrence compared to the no ablation group (adjusted HR, 0.67 [95% CI, 0.54-0.84], P < 0.001). Conclusion Among patients with HFpEF and AF, the strategy of AF ablation to maintain SR was associated with a lower risk of the composite outcome of all-cause death or rehospitalization for worsening heart failure.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138684548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention of venous thromboembolism after right heart-sided electrophysiological procedures: results of an EHRA survey","authors":"Giacomo Mugnai, Michal Farkowski, Luca Tomasi, Laurent Roten, Federico Migliore, Carlo de Asmundis, Giulio Conte, Serge Boveda, Julian K R Chun","doi":"10.1093/europace/euad364","DOIUrl":"https://doi.org/10.1093/europace/euad364","url":null,"abstract":"Introduction Limited data are available regarding venous thromboembolism (VTE), specifically deep vein thrombosis (DVT) and pulmonary embolism (PE), following right-sided ablations and electrophysiological (EP) studies. Compared to left-sided procedures, no guidelines on antithrombotic management strategies for the prevention of DVT and PE are available. The main purpose of the present European Heart Rhythm Association (EHRA) survey is to report the current management of right-sided EP procedures, focusing on anticoagulation and prevention of VTE. Methods and Results An online survey was conducted using the EHRA infrastructure. A total of 244 participants answered a 19-items questionnaire on the periprocedural management of EP studies and right-sided catheter ablations. The right femoral vein is the most common access for EP studies and right-sided procedures. An ultrasound-guided approach is employed by more than 2/3 of respondents. Intravenous heparin is not commonly given by the majority of participants. About 1/3 of participants (34%) routinely prescribe VTE prophylaxis during (mostly aspirin and low molecular weight heparin) and 1/4 of respondents (25%) commonly prescribe VTE prophylaxis after discharge (mostly aspirin). Of note, respectively 13% and 9% of participants observed at least one DVT and one PE related to right-sided ablation or EP study within the last year in their center. Conclusions The present survey shows that only a minority of operators routinely gives intraprocedural intravenous heparin and prescribes VTE prophylaxis after right-sided EP procedures. Compared to left-sided procedures like AF ablation, there are no consistent systematic antithrombotic management strategies.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138684542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Major In-Hospital Complications after Catheter Ablation of Cardiac Arrhythmias - Individual Case Analysis of 43,031 Procedures","authors":"Lars Eckardt, Florian Doldi, Omar Anwar, Nele Gessler, Katharina Scherschel, Ann-Kathrin Kahle, Aenne S von Falkenhausen, Raffael Thaler, Julian Wolfes, Andreas Metzner, Christian Meyer, Stephan Willems, Julia Köbe, Philipp Sebastian Lange, Gerrit Frommeyer, Karl-Heinz Kuck, Stefan Kääb, Gerhard Steinbeck, Moritz F Sinner","doi":"10.1093/europace/euad361","DOIUrl":"https://doi.org/10.1093/europace/euad361","url":null,"abstract":"Objective and Background In-hospital complications of catheter ablation for atrial fibrillation (AF), atrial flutter (AFL), and ventricular tachycardia (VT) may be overestimated by analyses of administrative data. Methods We determined the incidences of in-hospital mortality, major bleeding, and stroke around AF, AFL, and VT ablations in four German tertiary centers between 2005-2020. All cases were coded by the G-DRG- and OPS-systems. Uniform code search terms were applied defining both the types of ablations for AF, AFL, and VT and the occurrence of major adverse events including femoral vascular complications, iatrogenic tamponade, stroke, and in-hospital death. Importantly, all complications were individually reviewed based on patient-level source records. Results Overall, 43,031 ablations were analyzed (30,361 AF; 9,364 AFL; 3,306 VT). The number of ablations/year more than doubled from 2005 (n=1569) to 2020 (n=3317) with 3 times and 2.5 times more AF and VT ablations in 2020 (n=2404 and n=301, resp.) as compared to 2005 (n=817 and n=120, resp.), but a rather stable number of AFL ablations (n=554 vs. n=612). Major periprocedural complications occurred in 594 (1.4%) patients. Complication rates were 1.1% (n=325) for AF, 1.0% (n=95) for AFL, and 5.3% (n=175) for VT. With an increase in complex AF/VT procedures the overall complication rate significantly increased (0.76% in 2005 vs. 1.81% in 2020; p=0.004). but remained low over time. Following patient-adjudication, all in-hospital cardiac tamponades (0.7%) and strokes (0.2%) were related to ablation. Major femoral vascular complications requiring surgical intervention occurred in 0.4% of all patients. The in-hospital mortality rate adjudicated to be ablation-related was lower than the coded mortality rate: AF: 0.03% vs. 0.04%; AFL: 0.04% vs. 0.14%; VT: 0.42% vs. 1.48%. Conclusion Major adverse events are low and comparable after catheter ablation for AFL and AF (around 1.0%), whereas they are five times higher for VT ablations. In the presence of an increase in complex ablations procedures a moderate but significant increase in overall complications from 2005-2020 was observed. Individual case analysis demonstrated a lower than coded ablation-related in-hospital mortality. This highlights the importance of individual case adjudication when analyzing administrative data.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138684768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-lead ECG AI model with risk factors detects Atrial Fibrillation during Sinus Rhythm","authors":"Stijn Dupulthys, Karl Dujardin, Wim Anné, Peter Pollet, Maarten Vanhaverbeke, David McAuliffe, Pieter-Jan Lammertyn, Louise Berteloot, Nathalie Mertens, Peter De Jaeger","doi":"10.1093/europace/euad354","DOIUrl":"https://doi.org/10.1093/europace/euad354","url":null,"abstract":"Background and Aims Guidelines recommend opportunistic screening for atrial fibrillation (AF), using a 30-second single-lead electrocardiogram (ECG) recorded by a wearable device. Since many patients have paroxysmal AF, identification of patients at high risk presenting in sinus rhythm may increase the yield of subsequent long-term cardiac monitoring. The aim is evaluating an AI-algorithm trained on 10-second single-lead ECG with or without risk factors to predict AF. Methods This retrospective study used 13479 ECGs from AF-patients in sinus rhythm around time of diagnosis and 53916 age- and sex-matched control ECGs, augmented with seventeen risk factors extracted from electronic health records. AI models were trained and compared using one- or twelve-lead ECGs, with or without risk factors. Model bias was evaluated by age- and sex-stratification of results. Random forest models identified the most relevant risk factors. Results The single-lead model achieved an AUC of 0.74, which increased to 0.76 by adding six risk factors (95% confidence interval: 0.74-0.79). This model matched the performance of a twelve-lead model. Results are stable for both sexes, over ages ranging from 40 to 90 years. Out of seventeen clinical variables, six were sufficient for optimal accuracy of the model: hypertension, heart failure, valvular disease, history of myocardial infarction, age and sex. Conclusions An AI model using a single-lead sinus rhythm ECG and six risk factors can identify patients with concurrent AF with similar accuracy as a 12-lead ECG-AI model. An age- and sex matched dataset leads to an unbiased model with consistent predictions across age groups.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"59 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138572537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary artery disease in atrial fibrillation ablation: impact on arrhythmic outcomes","authors":"Ida Anna Cappello, Luigi Pannone, Domenico Giovanni Della Rocca, Antonio Sorgente, Alvise Del Monte, Sahar Mouram, Giampaolo Vetta, Rani Kronenberger, Robbert Ramak, Ingrid Overeinder, Gezim Bala, Alexandre Almorad, Erwin Ströker, Juan Sieira, Mark La Meir, Dries Belsack, Andrea Sarkozy, Pedro Brugada, Kaoru Tanaka, Gian Battista Chierchia, Ali Gharaviri, Carlo de Asmundis","doi":"10.1093/europace/euad328","DOIUrl":"https://doi.org/10.1093/europace/euad328","url":null,"abstract":"Aims Catheter ablation (CA) is an established treatment for atrial fibrillation (AF). A computed tomography (CT) may be performed before ablation to evaluate the anatomy of pulmonary veins. The aim of this study is to investigate the prevalence of patients with coronary artery disease (CAD) detected by cardiac CT scan pre-ablation and to evaluate the impact of CAD and revascularization on outcomes after AF ablation. Methods and results All consecutive patients with AF diagnosis, hospitalized at Universitair Ziekenhuis Brussel, Belgium, between 2015 and 2019, were prospectively screened for enrolment in the study. Inclusion criteria were (i) AF diagnosis, (ii) first procedure of AF ablation with cryoballoon CA, and (iii) contrast CT scan performed pre-ablation. A total of 576 consecutive patients were prospectively included and analysed in this study. At CT scan, 122 patients (21.2%) were diagnosed with CAD, of whom 41 patients (7.1%) with critical CAD. At survival analysis, critical CAD at CT scan was a predictor of atrial tachyarrhythmia (AT) recurrence during the follow-up, only in Cox univariate analysis [hazard ratio (HR) = 1.79] but was not an independent predictor in Cox multivariate analysis. At Cox multivariate analysis, independent predictors of AT recurrence were as follows: persistent AF (HR = 2.93) and left atrium volume index (HR = 1.04). Conclusion In patients undergoing CT scan before AF ablation, critical CAD was diagnosed in 7.1% of patients. Coronary artery disease and revascularization were not independent predictors of recurrence; thus, in this patient population, AF ablation should not be denied and can be performed together with CAD treatment.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138562446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left ventricular septal pacing: how deep is enough?","authors":"K. Čurila, P. Jurák, P. Waldauf, J. Halámek, P. Stros, R. Smíšek, F. Plesinger, L. Znojilova, P. Leinveber, I. Viscor, D. Heřman, P. Osmančík, F. Prinzen","doi":"10.1093/europace/euac053.431","DOIUrl":"https://doi.org/10.1093/europace/euac053.431","url":null,"abstract":"Type of funding sources: Public Institution(s). Main funding source(s): Charles University Research Program When pacing in the left septal area, it is not clear where the pacing lead needs to be implanted to obtain the most physiological ventricular activation during pure myocardial pacing. To use UHF-ECG to compare ventricular activation between myocardial pacing of the left septum with and without the possibility to capture the left bundle branch by high output pacing. This was a retrospective study of patients with bradycardia and deep septal myocardial pacing close to LBB (paraLBBP) or deep septal pacing more distant from LBB (DSTP), which both produced a pseudo-right bundle branch morphology in V1. During paraLBBP, left bundle branch capture was feasible during increasing pacing output up to 5V at 0.5 ms, but during DSTP, LBB capture was not possible during high output pacing. Only patients with both paraLBBP and DSTP were analyzed. Paced QRS morphology, presence of LBBpotential, QRSduration, R wave peak time (RWPT) in V5, lead depth in the septum and UHF-ECG parameters of dyssynchrony, i.e., e-DYS as the difference between the first and last ventricular activation and local depolarization durations in precordial leads (V1-V8d) were compared between them. From 119 consecutive bradycardia patients enrolled, we identified 23 with both paraLBBP and DSTP during an implant procedure. On X-ray, a lead tip was placed shallower during DSTP than paraLBBP (12 ± 3 vs. 15 ± 3 mm, p < 0.001). A pseudo right bundle branch block morphology was present in all cases, but LBB potential was more frequently present in paraLBBP (17 of 23) than in DSTP (4 of 36; p < 0.0001). QRSd was not significantly different (146 ± 14 vs. 142 ± 14 ms, p = 0.08), but DSTP had longer V5RWPT (86 ± 11 vs. 83 ± 9 ms; p = 0.03). paraLBBP resulted in larger interventricular dyssynchrony, e-DYS (-20 ± 15 vs. -12 ± 18 ms; p = 0.046), the same V1-6d, but its local depolarization durations in V7 and V8 (V7 and V8d) were shorter compared to DSTP (-5 and -7 ms; p < 0.05). Interventricular dyssynchrony and LV lateral wall depolarization during myocardial pacing of the left septum are dependent on the relation of the leads´ tip to the LBB. Pacing positions closer to the LBB are responsible for bigger interventricular dyssynchrony and more physiological LV lateral wall depolarization.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"123 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73523227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computational modeling identifies the cellular electromechanical effects of disrupted intracellular calcium handling in arrhythmogenic cardiomyopathy patients","authors":"A. Lyon, WB Van Ham, S. Van Der Voorn, J. Heijman, F. Kirkels, A. Vink, A. Te Riele, J. Lumens, T. V. van Veen","doi":"10.1093/europace/euac053.593","DOIUrl":"https://doi.org/10.1093/europace/euac053.593","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NWO - ZonMw (VIDI grant 016.176.340 to JL) Dutch Heart Foundation (ERA-CVD JTC2018 grant 2018T094; Dr. Dekker Program grant 2015T082 to JL) The Netherlands Cardio Vascular Research Initiative (CVON): the Dutch Heart Foundation, Dutch Federation of University Medical Center, the Netherlands Organization for Health Research and Development and the Royal Netherlands Academy of Sciences (CVON-eDETECT 2015-12 and CVON-PREDICT2 2018-30 to TvV).\u0000 \u0000 \u0000 \u0000 Patients with arrhythmogenic cardiomyopathy (ACM), an inherited progressive cardiac disease, mostly remain asymptomatic until the occurrence of life-threatening arrhythmias. Previous research identified disturbed calcium handling as a potential disease-initiating mechanism [1], but how this translates to arrhythmogenesis and cardiac mechanical dysfunction remains unknown.\u0000 \u0000 \u0000 \u0000 To characterize disturbed molecular regulators of intracellular calcium (Ca2+) handling in patients with ACM and predict their effects on action potential (AP), calcium transient (CaT) and tension development in both left and right ventricles (LV, RV) using a computer model of cellular electromechanics.\u0000 \u0000 \u0000 \u0000 We performed gene expression (qPCR) and protein level (Western blot) analysis using LV and RV tissue samples obtained from 5 ACM patients who underwent heart transplant and 5 controls with no history of cardiac disease. Changes in protein levels were implemented in our recent human electromechanical cardiomyocyte computer model [2]. CaT, AP and tension traces were simulated and compared to control. Clinical data (age, sex, genetics, ECG, echocardiography) were related to the simulation outcome.\u0000 \u0000 \u0000 \u0000 Measured protein levels varied significantly between the 5 patients and between individual LV and RV samples. Exemplary results for one ACM patient are shown in the figure below. In the LV, AP duration was shorter than control (221ms vs. 255ms), CaT peak was increased (0.52µM vs. 0.39µM) but CaT amplitude was reduced due to increased diastolic Ca2+ (0.26µM vs. 0.060µM). Relaxation was also impaired, as shown by a longer CaT and tension duration (965ms vs. 640ms), and an increased diastolic tension (10mN vs. 4.8mN). In the RV, AP duration was shortened, and CaT and tension peak were lower than in the LV (0.37µM and 13.6mN). Diastolic levels were elevated compared to control, and CaT and tension development were prolonged. This can be related to the measured Ca2+ changes: in the LV, a lower activity of the sodium-calcium exchanger (NCX) (22% of control) and SERCA pump (52%) combined with an increased ryanodine receptor (RyR) activity (96%) may impair the extrusion of Ca2+, leading to accumulation of Ca2+ and increased diastolic Ca2+ levels. In the RV, milder changes in NCX (48% of control) and RyR (11%) may explain the larger Ca2+ extrusion, leading to lower CaT peak and diastolic levels. The patient showed a normal LV size, a severely ","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"81 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73633852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights into the intracardiac electrogram from analytical and numerical modelling","authors":"L. Leenknegt, K. Zeppenfeld, A. Panfilov, H. Dierckx","doi":"10.1093/europace/euac053.567","DOIUrl":"https://doi.org/10.1093/europace/euac053.567","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Foundation. Main funding source(s): FWO-Flanders, KU Leuven internal starting grant\u0000 \u0000 \u0000 \u0000 Cardiac electrograms (EGMs) are one of the most important recordings obtained during electroanatomical voltage mapping and lie at the basis for planning most clinical electrophysiological interventions. Despite its widespread use, the relation of EGM shape and amplitude to the underlying excitation patterns and properties of cardiac tissue is not completely understood. Recent clinical studies [1] have provided important new guidelines on the relation between EGM amplitudes and the thickness of myocardial walls. The aim of this study is to quantify the effect of the wall thickness on EGM amplitudes and duration using analytical and in-silico approaches.\u0000 \u0000 \u0000 \u0000 We study bipolar EGMs both in-silico and analytically in a homogeneous slab of cardiac tissue (70 x 70 x L mm), where L = 2, 5, or 10 mm, with parallel fiber direction. Simulations were performed using the cardiac electrophysiology simulator openCARP [2]. Cardiac cells were described by the ten Tusscher-Panfilov 2006 model (TP06) [4] with epicardial tissue parameters. A plane wave propagating along the fiber direction was initiated. The extracellular voltage at 147 points arranged in a hemisphere around a point was measured to study the effect of bipolar electrode orientation (see Fig. 1A [3]). In addition, we developed an analytical approach to obtain an EGM, using an equivalent dipole representation of the depolarization wavefront and analytical evaluation of the corresponding integrals.\u0000 \u0000 \u0000 \u0000 Fig. 1B and 1C show the dependency of the EGM properties on the electrode orientation, as represented by the angles α (incidence angle) and β (angle between electrode and propagation direction) [3]. Solid lines represent data from a state-of-the-art numerical methodology, the dashed lines show our analytical estimations. Both the peak-to-peak amplitude and EGM width are well approximated by our theory for all orientations of the electrodes.\u0000 Fig. 2 shows how the EGM is influenced by the myocardial wall thickness L. Both the amplitude and the duration are in good agreement with our theory. We observe that the amplitude as well as the width increase with the slab thickness, confirming the result in [1] but also delivering an accurate analytical expression for this change. It may thus allow to discriminate effects of thickness and other factors affecting the EGMs, such as substrate abnormalities, for example.\u0000 \u0000 \u0000 \u0000 We developed an analytical approach which can correctly describe the amplitude, duration, and shape of the depolarization part of the EGM. Our theory agrees with the previous in-silico and clinical studies on the influence of catheter orientation [3,5], and wall thickness [1,3]. Subsequent work in this direction is expected to provide better guidelines for clinical interpretation of EGMs, accounting for the effects of the thickness of myocardial wall in the characterizat","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"307 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74158716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CHA2DS2-VASc score and the risk of death in atrial fibrillation","authors":"A. Aro, J. Haukka, O. Halminen, J. Putaala, M. Linna, P. Mustonen, J. Hartikainen, J. Airaksinen, M. Lehto","doi":"10.1093/europace/euac053.144","DOIUrl":"https://doi.org/10.1093/europace/euac053.144","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Foundation. Main funding source(s): Sigrid Juselius Foundation\u0000 \u0000 \u0000 \u0000 Atrial fibrillation (AF) is recognized as a major public health problem due to increased mortality, morbidity and risk of stroke. Advanced age and burden of other comorbidities are potential contributors to AF development and adverse outcomes. Clinical risk factor based CHA2DS2-VASc score is widely used to assess thromboembolic risk in AF, but mortality risk associated with different CHA2DS2-VASc scores is not established.\u0000 \u0000 \u0000 \u0000 Using data from a nationwide AF registry study including comorbidities and outcomes of unselected AF patients, we wanted to study whether CHA2DS2-VASc score could be useful in estimating prognosis in newly diagnosed AF patients.\u0000 \u0000 \u0000 \u0000 New-onset AF patients in Finland 2007-2017 were identified from comprehensive national registries. Comorbidities were gathered from individualized registry data on drug reimbursements and from ICD-10 diagnoses during hospitalizations and outpatient visits in primary and specialist care. These were used to create CHA2DS2-VASc risk score for each AF patient at cohort entry, including data on heart failure, hypertension, age, diabetes, stroke, vascular disease and sex. Patients were followed until the end of 2018 from the causes of death registry, which records every death in the country. All-cause mortality in each CHA2DS2-VASc category per 1000 person-years was determined, and relative risk (RR) of death according to the CHA2DS2-VASc category was calculated.\u0000 \u0000 \u0000 \u0000 A total of 229 357 patients with new-onset AF (mean age 73.2 ± 13.2 years, 50.0% female) were identified. Distribution of CHA2DS2-VASc score among these individuals is shown in Table. Mortality increased significantly with rising CHA2DS2-VASc risk score points, as demonstrated in Table. Compared to CHA2DS2-VASc 0, those with 2 points had a RR 2.9 (95%CI 2.7-3.1), 3 points RR 5.0 (4.7-5.3), 4 points RR 8.0 (7.5-8.4), 5 points RR 11.0 (10.4-11.7) and >5 points RR 14.8 (14.0-15.7) for all-cause mortality.\u0000 \u0000 \u0000 \u0000 In new-onset AF, mortality increased drastically with increasing age and comorbidities as depicted in the CHA2DS2-VASc score. Besides assessing thromboembolic risk, CHA2DS2-VASc score seems to be useful in estimating survival of AF patients.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"32 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75289024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}