Heart and Diabetes Center North Rhine-Westphalia

Atrial tachycardias (AT) represent an increasingly common cause of morbidity and mortality. Driven by substantial advances in mapping and ablation technologies, the mechanistic understanding and therapeutic strategies for AT management have evolved rapidly in recent years, and catheter ablation is now regarded as the most effective strategy for maintaining sinus rhythm. Against this background, the recently published international clinical consensus statement on the management of patients with AT introduces, for the first time, astructured 10-point plan for "SMART-AT care" as aframework for the diagnosis and treatment of regular AT. This review highlights key developments and clinical implications, taking into account recent changes within the healthcare system.

IntroductionAcute kidney injury after cardiac surgery (CSA-AKI) is a common complication after cardiac surgery and an independent predictor of morbidity and mortality. Since evidence-based care is based on risk mitigation and implementation of supportive measures, early risk stratification and consequent adjustment of treatment strategies are elemental. Artificial intelligence screening can aid in pre- and perioperative risk stratification.MethodsThis is a secondary analysis of 130 prospectively recruited patients from one center of a multicenter observational trial that investigated the implementation of a bundle of supportive measures to prevent AKI in patients undergoing cardiac surgery with cardiopulmonary bypass. Machine learning (ML) enabled artificial intelligence (AI) was used to retrospectively analyze patients' electronic health record (EHR) data and generate an AKI risk estimate. The aim of this study was to investigate the feasibility of AI-based risk scores to predict AKI within 72 hours postoperatively and the development of acute kidney disease (AKD) at day 30 after surgery.ResultsOf 130 patients, 33.1% developed CSA-AKI. Of 119 with 30-day follow-up data, 18.5% developed AKD. Day-of-surgery AI risk-scoring was evaluated with an AUROC of 0.79 for occurrence of CSA-AKI, postoperative risk predictions were evaluated with an AUROC of 0.83 for AKD at 30 days postoperatively. ANOVA testing revealed that patients who developed CSA-AKI or AKD had significantly higher predicted risk scores than those who did not, with large effect sizes. Predicted risk also increased significantly over the perioperative period in patients with adverse outcomes.ConclusionsRisk stratification with an ML-based AI approach based solely on EHR data provides a low-effort and high-yield screening method for identifying patients at risk of developing CSA-AKI and AKD. These findings indicate that an EHR (Electronic Health Record)-only model, trained on routine hospital data, provides clinically actionable discrimination in a real-world cardiac surgery cohort, supporting its use for early screening and targeted mitigation.

Abstract This bibliometric study focuses on the publication activity of senior staff, consisting of chief physicians, senior physicians, department heads, and division heads at German university hospitals specializing in cardiology. The aim is to identify topics, focal points, study types, and impact factors (IFs) achieved. No studies on this topic have been conducted to date. However, Millenaar et al. [1] provided an overview of the cardiovascular research landscape in Germany, highlighting publication activities by federal state, the gender distribution among first authors, and the most important areas of cardiological research. In a subsequent global scientometric analysis, Millenaar et al. [2] examined gender differences in authorship in cardiovascular research between 2010 and 2019. They found that the number of publications in cardiovascular research has increased over the last ten years, particularly among female authors. However, a detailed analysis of the associated IFs revealed that articles by female authors achieved a lower average IF compared to their male counterparts. Similarly, publications by female authors were cited less frequently. The aim of this study was to provide an overview of the publishing activities of senior staff in the cardiology departments of all 39 university hospitals. The hierarchy, academic rank, and gender of the authors were taken into account. The aim was to determine which specialist areas and topics are emphasized in cardiology publications and which impact factors were assigned to the respective areas. Furthermore, the composition of the hierarchical levels according to gender and academic rank of the management staff and the respective publication performance (number; impact factor) were determined. For comparison purposes, the methodological approach was adapted to previous bibliometric analyses in other medical fields such as visceral surgery [3], trauma surgery [4], and oral and maxillofacial surgery [5]. The aim was to investigate whether the pronounced gender-specific differences in publication output and academic leadership roles observed in these fields can also be observed in cardiology. This work can serve as a basis and reference for the effectiveness and implementation of measures to promote women.

Abstract Background The DES gene encodes the intermediate filament protein desmin, which connects different multi-protein complexes like the cardiac desmosomes and is highly important for the structural integrity of cardiomyocytes. Pathogenic DES -mutations cause filament assembly defects leading to cardiomyopathies. However, most DES -variants listed in genetic disease databases are currently classified as variants of unknown significance. Here, we functionally characterized 21 different DES -variants of unknown significance and 18 additional proline variants, localized in a highly conserved stretch at the C-terminus of the desmin coil-2 subdomain. Methods We inserted desmin variants via site-directed-mutagenesis and investigated the filament assembly in transfected cell lines and cardiomyocytes derived from induced pluripotent stem cells by confocal microscopy. In addition, we purified recombinant wild-type and mutant desmin and analyzed the filament formation by atomic force microscopy. Co-expression with wild-type desmin delivered by adeno-associated virus was used to model the heterozygous status of cardiomyopathy patients. Results Twelve DES -variants of unknown significance formed cytoplasmic aggregates, which was likewise verified by atomic force microscopy. Of note, these twelve variants disturb the filament assembly even when co-expressed with wild-type desmin. Using a proline screen, we showed that proline residues localized at nearly each of the positions in this stretch cause filament assembly defects. By modelling the tetrameric structure of desmin, we demonstrated that specific heptad positions as well as positions of intra- and intermolecular ion bridge sites are particularly susceptible mutations that promote desmin aggregation. Conclusion In summary, our study demonstrated that the highly conserved stretch at the C-terminus of the coil-2 subdomain is a hotspot region, where several pathogenic DES -mutations cause an aberrant desmin aggregation. Based on our functional data we suggest to re-classify the aggregate-forming variants as likely-pathogenic mutations rather than variants of unknown significance. Our study may have relevance for the genetic counselling of cardiomyopathy patients with similar DES -variants.

Single-shot pulsed-field ablation (PFA) catheters show promising safety and efficacy for achieving pulmonary vein isolation (PVI) in atrial fibrillation (AF). However, additional PFA applications are sometimes required after standard PFA delivery to achieve PVI. This study aimed to evaluate the real-world frequency and location of acute residual pulmonary vein (PV) connections using 3-dimensional electroanatomic mapping (3D-EAM) during index PFA. Patients undergoing index PVI with a single-shot PFA catheter and receiving postablation 3D-EAM were prospectively studied. First-pass isolation (FPI) rates and distribution of residual PV connections were assessed. A total of 535 patients from 48 international centers (89 operators) were included (paroxysmal AF 375; persistent AF 160). Mean procedure time was 75.9 ± 31.9 minutes, and mapping time was 8.4 ± 5.2 minutes. Ablation was performed with a pentaspline, variable conformation PFA catheter in 72.7% of cases and a fixed-loop PFA catheter in 27.3%. Bilateral FPI was achieved in 75.1% of patients (paroxysmal AF 77.1% vs persistent AF 70.6%; P = .126). The individual PV FPI rate was 92.7% (1834 of 1978 PVs). Excluding common PVs, residual PV connections were more frequent in superior PVs (superior 8.9% vs inferior 3.8%; P < .001), specifically in the left superior PV (10.1%). Predictors of FPI included standard 4-vein anatomy (odds ratio, 1.83; 95% confidence interval, 1.09-3.07; P = .021) and the pentaspline catheter (odds ratio, 3.53; 95% confidence interval, 1.81-6.87; P < .001). Using 3D-EAM, an acute residual connection of at least 1 PV was observed in a quarter of patients after standard PFA delivery and was most common in the left superior PV. Potential mechanisms include reversible electroporation, highlighting the potential need for additional lesions and the value of a mandatory post-PFA "waiting period."