bluuebunny/crossref_metadata_2025 huggingface dataset:
P410 ROLE OF TELEMEDICINE IN PRIMARY AND SECONDARY PREVENTION OF CARDIOVASCULAR DISEASES
Authors: Nodari S , Fioretti F , Bollani G , Glisenti F , Gabbrielli F
Published: May 2022

Cardiovascular diseases have a high prevalence and incidence and are associated with a high rate of mortality and hospitalization; this is reflected in a reduction in quality of life and a high health care expenditure. The aim of our study was to evaluate the effectiveness of telemedicine in primary and secondary prevention, through the use of ECG, ABPM and Holter monitoring. Health Telematic Network, in collaboration with the University of Brescia and Federfarma, has installed in 6527 territorial pharmacies distributed in the country, a telematic network interconnected to a single Telemedicine platform, where cardiologists are available for H24 reporting and teleconsultation. The pharmacies performed 12–lead ECG in healthy subjects, with cardiovascular risk factors or ongoing symptoms referable to the cardiovascular system, ABPM in accordance with the guidelines for hypertension and Holter ECG in symptomatic patients (heart palpitations, syncope, lipothymias) or positive history for brady and tachyarrhythmias. In the period between 2016 and October 2021, we analyzed 660508 exams: 411526 ECG, 143869 cardiac Holter and 105113 ABPM. Of the 411526 ECGs, 14.5% of tracings showed abnormalities not compatible with the reported anamnestic data, therefore 59671 users were sent to the caregiver for further evaluation or diagnostic investigation; in 1.5% of cases, major abnormalities were detected, necessitating immediate referral of the patient to the emergency department. Of the 105113 ABPM, 37.2% of the examinations revealed abnormal blood pressure trends according to the SIIA classification, 39102 users were sent to the physician for the appropriate diagnostic and therapeutic measures. Of the 143869 Holters, 26326 patients (18.3%) were referred to the attending physician for major arrhythmias, 3008 patients (2.1%) were referred to the emergency department for red code arrhythmias (VT, grade 3 BAV, long QTc, high or low ventricular response AF with critical pauses). Our data show the important role of a Telemedicine network in primary and secondary cardiovascular prevention, able to provide early diagnosis and treatment of major events; the use of a national telemedicine network has also proved effective in the appropriate referral of subjects to the Emergency Department, with a positive impact in terms of health care expenditure containment.
P411 MINOCA OR NOT MINOCA? THE DECISIVE ROLE OF CARDIAC MAGNETIC RESONANCE IN THE DIFFERENTIAL DIAGNOSIS OF MYOCARDIAL DAMAGE
Authors: Dal Passo B , Cardelli L , Perugini E , Bugani G , Canovi L , Frascaro F , Zanarelli L , Piscitelli L , Colletta M , Casella G
Published: May 2022

Cardiac MRI can facilitate the differential diagnosis of myocardial damage in patients without coronary artery disease. Our case report is about a 50–year–old man who was admitted to the Emergency Department of the Maggiore Hospital in Bologna in October 2021 for oppressive chest pain at rest; previously he had experienced a similar episode but of minor intensity. He had not previous medical records. When the patient arrived at the emergency department chest pain had regressed, blood pressure was elevated (170/110 mmHg). The ECG showed sinus tachycardia at 100 bpm without electrocardiographic abnormalities suggestive of acute ischemia. Cardiac biomarkers were elevated (hsTnI 312 ng / L –> 975 ng / L – n.v. <19.8 ng / L); blood gas analysis showed pH 7.42, pO2 47 mmHg and pCO2 33 mmHg. Chest CT scan excluded pulmonary embolism and acute aortic syndrome. The patient was transferred to Cardiology Ward in the suspicion of acute coronary syndrome, where echocardiogram showed normal biventricular volumes, mild wall hypertrophy and hypokinesia of the lower middle wall (EF 52%). Coronary angiography didn’t showed any obstructive stenosis in any epicardial vessels. In consideration of the clinical presentation and instrumental evidences, the patient was discharged with a diagnosis of myocardial infarction with non–obstructive coronary arteries (MINOCA), but a cardiac MRI was scheduled in the post–discharge to clarify its genesis. MRI didn’t showed any areas of signal hyperintensity, any perfusion deficits in the first pass study and any areas of late gadolinium enhancement (LGE). Those images permitted to exclude areas of necrosis or inflammation, orienting the diagnosis to myocardial damage during hypertensive crisis. Therefore, the antiplatelet therapy recommended at discharge was suspended. In this case report, cardiac magnetic resonance showed that it can improve the etiological diagnosis of MINOCA, allowing for better clinical and therapeutic management.
P413 ISCHEMIC ECG CHANGES, NOT ALWAYS CORONARY ISSUES
Authors: Zanarelli L , Canovi L , Cardelli L , Dal Passo B , Frascaro F , Piscitelli L , Pallotti M , Colletta M , Casella G
Published: May 2022

Background

Many abdominal deseases can mimic cardiac symthoms at their presentation and they can lead to electrocardiographic (ECG) changes, acting as a confounding factor for the physichan during the diagnostic process.

Case presentation

A 77–year–old man, former smoker, with high blood pressure not being treated, came to the emergency room with mesogastric pain and vomiting, since three hours before. The ECG showed a sinus rhythm, at 55 beats per minute and a slight elevation of the ST segment in the leads DII, DIII and aVF, evolving as T waves negativization in the same leads and flattening in V5– V6. Laboratory tests showed increasing Troponin I values from 23 to 277 ng / L. Because of this pathological context, the patient was taken to our Unit to perform a coronary angiography study in the hypothesis of acute myocardial infarction. The examination showed diffuse atheromatous lesions in the coronaries without haemodynamically significant stenosis. The patient developed fever during the hospitalization, abdominal CT study with contrast was performed, with a definitive diagnosis of acute cholecystitis and the patient was finally moved to the Internal Medicine ward.

Conclusions

ECG alterations in acute cholecystitis are not specific, but some of them are recurrent: among these there are ischemic modifications affecting the ST segment or the T waves, widely described in the scientific literature. All these ECG modifications solve with the treatment of cholecystitis, whether conservative or surgical, without acting on the cardiological side in any way; on the other hand, they can lead to unnecessary diagnostic–therapeutic investigations, to a diagnosis’delay and to complications’ onset. It is important for the clinician being able to consider abdominal pathology in case of diagnostic investigations’ inconsistency. However, ST segment’s changes during cholecystitis may deserve a cardiological study, as they are specific for acute myocardial infarction, especially in patients with high cardiovascular risk. This reminds to us, once again, the importance of anamnesis, physical examination and appropriate tests, to reach the correct diagnosis.
P415 NEUROGENIC STRESS CARDIOMYOPATHY
Authors: De Sanctis G , Rizzo M , De Pascali I , Guasti S , Chianta V , Bruno N , Monzo L , Tanzilli G
Published: May 2022

Case Report

Caucasian 84–years–old woman was found on the floor at her house and was brought to the ED of Policlinico Umberto I with the diagnosis of cranial trauma following a syncope. A head CT showed right paramedian fracture of the occipital bone, left frontal subarachnoid hemorrhage and left frontal subdural hemorrhage. The neurosurgeon gave no indication to urgent evacuation of the hemorrhage. Then elevation of cardiac enzymes and ST–segment elevation at the EKG were found but due to the state of the patient a coronary angiography was not performed and the patient was transferred to the CCU. The patient was hemodynamically stable with right hemiplegia. The EKG showed rapid ventricular rate atrial fibrillation with ST segment elevation in inferior and lateral leads with T wave inversion in the same leads and elevated serum troponin levels. ETT showed: EF 30% with a global reduction of left ventricular systolic function with diffuse akinesis. Intravenous therapy with mannitol and corticosteroids for perilesional oedema was started. Beta blockers and a class III antiarrhythmic drug were also started, but hemodynamic conditions declined and acute kidney failure occurred with progressive hypotension followed by cardiogenic shock. The patient had an episode of nonsustained ventricular tachycardia treated with antiarrhythmic drugs and magnesium sulfate. The EKG started to show a normalization of the repolarization phase with regression of ST segment elevation and persistent T wave inversion.The patient’s neurological conditions were complicated with epileptic seizures.On the fifth day of hospitalization the TTE revealed a slight improvement of global systolic function and the presence of an apical thrombotic apposition.The patient’s clinical conditions worsened and led to exitus.

Discussion

The interpretation of this patient’s history was made more difficult by the lack of witnesses of the trauma.The patient’s age, her history of hypertension and the presence of regional wall motion abnormalities at the TTE suggested the presence of CAD. On the other side the atrial fibrillation could hint a primitive cerebral event. This case report shows the potentially severe cardiac manifestations of cerebral hemorrhage and the necessity to consider cerebrovascular events as the cause of EKG changes mimicking a myocardial infarction, cardiac enzymes elevation and ventricular wall motion abnormalities, in order to avoid inappropriate or delated therapies.
P419 CARDIAC SARCOIDOSIS IN A CARRIER OF TTR GENE MUTATION
Authors: Scheggi V , Menale S , Mazzoni C
Published: May 2022

Abstract A 39–year–old man came to our attention after being identified as a carrier of the mutation lle68Leu in the transthyretin (TTR) gene, following his father’s diagnosis of cardiac amyloidosis. From then on, the patient underwent periodical follow–up for early detection of target organs involvement, with normal echocardiographic results of blood test and echocardiography.

At the age of 41, he was hospitalized after a transient loss of consciousness (TLS) episode while riding a bicycle. The echocardiogram showed normal systolic function with an akinetic basal septum. A coronary angiogram excluded the presence of coronary artery disease. One year later, ECG abnormalities developed, with a new–onset right bundle branch block and posterior fascicular block. The echocardiogram showed a dilated cardiomyopathy with severe left systolic function impairment (ejection fraction 30%). SPECT with bisphosphonate ruled out cardiac amyloidosis. Cardiac MRI was significant for patchy areas of late gadolinium enhancement in the left ventricle. Before the following cardiological evaluation for a possible ICD implantation the patient was again hospitalized after a resuscitated cardiac arrest.Thoracic CT, performed in the emergency department, was significant for hilar lymphadenopathies and pulmonary nodules highly suggestive for sarcoidosis. FDG–PET showed multiorgan phlogistic–infiltrative involvement, including the myocardium. A subsequent hepatic CT–guided biopsy eventually confirmed the diagnosis of sarcoidosis. In secondary prevention, the patient underwent ICD implantation but continued to experience arrhythmic events.
P422 EARLY EXERCISE PRESCRIPTION AFTER ACUTE CORONARY SINDROME. A NEW MODEL FROM BEDSIDE TO THE COMMUNITY
Authors: Lordi R , Veronese S , Mandini S , Raisi A , Piccinini A , Ferro A , Zerbini V , Piva T , Grazzi G , Biagio S , Pasanisi G
Published: May 2022

Purpose

Physical inactivity is a major risk factor and negative prognostic index of cardiovascular disease. It is necessary to define effective strategies to direct patients after an acute coronary syndrome (ACS) to physically active lifestyle. The aim of this study was to examin efficacy, feasibility and long term adherence of a new physical activity prescription, adapted to patients (pts) early after ACS.

Methods

34 pts, mean age 67years, hospitalized for ACS, were enrolled consecutively and randomized 2:1 in treatment (TR) group (n = 23) or in control (CT) group. All pts were evaluated before discharge from hospital (T0) through Quality of Life (QoL) SF12 questionnaire, determination of physical activity during free time, six–minute walking test (6MWT). All pts were orally advised about the importance of changing life–style as recommended by current international guidelines. At T0, pts in the TR group performed a 500m moderate and perceptually–regulated (11–13 on the 6–20 Borg scale) treadmill walking test (500–m TWT) to estimate peak oxygen uptake (VO2peak). A home–based physical activity based on walking, was provided to pts in the TR group: it was recommended to maintain the level of perceived intensity of effort as indicated during 500m–TWT. These pts also received a reinforce phone–call at 2 and 4 weeks (T1 and T2), that allowed monitoring the adherence to the programme. All pts were finally evaluated 8 weeks after enrollment (T3) through the same tests performed at T0.

Results

Pts of the TR group at T3 reported significative improvement, compared to T0, in 6MWT (+79 m, p < 0.001), QoL (expressed in the items of SF12), usual physical activity during free time (+13MET/h/week, p < 0.001), VO2peak (+4 mL/kg/min, p < 0.001). Compliance to the programme resulted optimal since all TR group pts continued the planned physical activity for all the follow–up.

Conclusions

Results of this study on efficacy, feasibility and compliance of a new model of secondary prevention programme, suggest the importance of implementing programmes of tailored physical activity schedules, based on walking, that can be safetly started soon after clinical stabilization of ACS.
P424 SMALL HEART AND SINGLE CORONARY ARTERY IN A YOUNG PATIENT WITH CHRONIC FATIGUE SYNDROME: A CASE REPORT
Authors: Poleggi C , Perfetti S , Restelli D , Perna A , Donato R , Di Bella G
Published: May 2022

Introduction

Chronic fatigue syndrome/Myalgic encephalomyelitis (CFS/ME) is a clinically defined condition reported mostly in adults, characterized by severe and disabling fatigue limiting normal daily activities for at least 6 months accompanied by multiple unexplained symptoms including self–reported impairments in concentration and short–term memory, sleep disturbances, and musculoskeletal pain. Although rarely considered to have cardiac dysfunction, CFS/ME patients frequently have reduced stroke volume with a significant inverse relation between cardiac output and post–exertional malaise severity. We describe a case of a young man affected by CFS/ME and small heart with incidental findings of anomalous origin of the left main coronary artery (LMCA).

Case Presentation

A 19–year–old Caucasian male presented to our clinic complaining weakness, lack of concentration and excessive daytime sleepiness. Medical history included CFS/ME, D hypovitaminosis, inflammatory bowel disease associated with pancreatic insufficiency. Physical examination including cardiovascular auscultation was unremarkable, with normal blood pressure and heart rate. Electrocardiogram showed sinus rhythm at 75 bpm without any repolarization abnormalities. Echocardiogram revealed reduced diameters of left ventricle (LV) (end–diastolic diameter 36 mm), normal aortic root dimensions and, in a five–chamber apical view, a binary structure that seemed to cross the aorta perpendicularly to its long axis. Cardiac magnetic resonance (CMR) found significantly reduced LV stroke volume (34 ml/m2; normal values 44–68 ml/m2) and end–diastolic volume (57 ml/m2; normal values 68–103 ml/m2) together with reduced end–diastolic wall mass (51 g/m2; normal values 59–93 g/m2). Also, right ventricle (RV) volumes were reduced: stroke volume (32 ml/m2; normal values 40–72 ml/m2), end–diastolic volume (62 ml/m2; normal values 68–114 ml/m2). In addition, the exam confirmed the anomalous origin of LMCA stemming from the proximal segment of right coronary artery and following a retro–aortic course.

Conclusions

Not sufficient consideration was given to cardiovascular involvement in patients with CFS/ME, although many of signs and symptoms are suggestive of cardiovascular dysfunction. This case highlights that CFS/ME together with small heart is a condition possible also in young people. More studies and reports could be necessary to better define the association with cardiac congenital anomalies and CFS/ME.
P426 TELEMONITORING FOR THE SAFE MANAGEMENT OF NEW THERAPIES IN PATIENTS WITH MULTIPLE SCLEROSIS: THE RITMO PROJECT
Authors: Nodari S , Fioretti F , Bollani G , Glisenti F
Published: May 2022

Back in 2012 AIFA authorized the use of Fingolimod in patients with multiple sclerosis; due to possible adverse effects, continuous ECGraphic monitoring is mandatory during the first 6 hours after the administration of the first dose of the drug. Health Telematic Network, in collaboration with the Department of Cardiology of the University of Brescia, has provided a remote telemonitoring system based on the TelMed Telemedicine platform accessible from the computers of the departments, currently in use in 42 hospital departments participating in the project “Nuove Reti Sanitarie” of the General Directorate of Health of the Lombardy Region for the monitoring of patients with chronic heart failure and COPD; the patients were subjected to continuous ECG monitoring through a system consisting of the central unit IntelliVue M130, monitor IntelliVue MP2 and the traces were managed through the application WEBACCESS of the central unit M3150; the monitoring allowed the continuous recording of the ECG, the detection of arrhythmias in real time and the storage of any alarm detected; the WEBACCESS application allowed the cardiologist (local and remote HTN) to view in real time the traces and any alarm detected and stored; in case of detection of arrhythmias, the cardiologist liaised with the Neurology department to discuss the specific case and the necessary measures.

Results

21258 ECGraphic monitors were analyzed, in a total of 6865 patients (2282 males – mean age 44 years, 4583 females – mean age 45 years); drug–related side effects occurred in 30% of cases as sinus bradycardia, atrioventricular conduction disturbances in 3% of cases (first degree atrioventricular block 1.6%, transient episodes of second and third degree atrioventricular block in 1.4% of cases) and. QT interval prolongation in 9.8% of cases. Adverse events, transient and reversible, were immediately recognized and treated according to the AIFA recommendations for the use of the drug, allowing treatment for all patients monitored.

Conclusions

The use of Fingolimod has provided satisfactory clinical results with a high safety profile; the use of continuous telemonitoring has allowed to extend the number of subjects treated and to manage effectively and in real time the few side effects encountered.
P428 PRESCRIPTION APPROPRIATENESS AND EFFECTIVE CLINICAL IMPACT OF EXERCISE STRESS TEST IN ROUTINE DAILY PRACTICE
Authors: Prati D , Widmann M , Castaldi G , Zucchelli F , Tavella D , Ribichini F
Published: May 2022

Rationale

In the clinical setting, and particularly in the cardiovascular field, an exponential increase of non–invasive diagnostic tests has been observed. Between these, the exercise stress test represents a low–sensitivity and low–specificity diagnostic approach and its use has been less and less recommended in national and international guidelines. However, in the Italian clinical common practice it continues to be extensively prescribed both for chronic coronary syndrome (CCS) follow–up and for screening of coronary artery disease (CAD) in asymptomatic patients with multiple cardiovascular risk factors.

Materials and Methods

A retrospective cohort single–center study was conducted and 968 consecutives patients undergoing ECG stress test at our Department between October 2018 and March 2019 were included. Appropriateness of prescription and impact on the following diagnostic and therapeutic pathway has been analyzed.

Results

In this series, the main indication for exercise stress test was subclinical ischemia detection in CCS follow–up (312 pts, 32.3%). 181 tests (18.2%) were undertaken for CAD detection in patients symptomatic for chest pain and 171 (17.7%) for CAD detection in asymptomatic patients with multiple cardiovascular risk factors. At last, 97 tests (10%) were prescribed for arrhythmic burden evaluation and exercise response in patients with documented hyperkinetic arrhythmias. 590 tests (61%) were considered significative for reaching heart rate significance threshold (85% of target heart rate); between these 53 (9%) were positives for symptoms or ECG modifications. Among the positive tests, 25 patients (2.6%) went to the catheterization laboratory for coronary angiography: the indications for the exercise stress testing were chest pain for 14 of these patients while 7 undertook the examination for CCS follow–up. No asymptomatic patient presented for CAD screening undertook coronary angiography. At the end of the diagnostic pathway, 9 patients (0.9% of the complete cohort) received percutaneous or surgical revascularization.

Conclusions

Routinary and extensive use of exercise stress test can lead to dispersion of resources with many inappropriate examinations. Accurate clinical evaluation and appropriate prescription, especially regarding chest pain evaluation, are the foundations for a significative impact on clinical history of patients.
SCN5A mutation is associated with severity of abnormalities detected by ECG imaging in Brugada syndrome
Authors: Pannone L , Monaco C , Sorgente A , Gauthey A , Calburean P-A , Overeinder I , Bala G , Almorad A , Stroker E , Pappaert G , Sieira J , Brugada P , La Meir M , Chierchia GB , De Asmundis C
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Brugada syndrome (BrS) is caused by mutations in SCN5A gene in 15%-20% of cases. Previous studies showed a worse prognosis in SCN5A mutation carriers (SCN5A+).

Purpose

To evaluate genotype-phenotype correlation with ECG imaging (ECGI).

Methods

All consecutive patients who underwent ECGI with CardioInsight for BrS were retrospectively analyzed. ECGI parameters analyzed before and after ajmaline administration were: 1) Right ventricular outflow tract (RVOT) activation time (RVOT-AT) and 2) RVOT recovery time (RVOT-RT). Genetic analysis was performed in all patients with SeqCap EZ Human Exome Probes v3.0 for BrS. Patients were defined as SCN5A+ if they had a pathogenic/likely pathogenic mutation in SCN5A following ACMG guidelines.

Results

Thirty-six BrS patients were included and 8 patients (22%) were SCN5A+. At baseline ECGI map, mean RVOT-RT was higher in SCN5A+ [384.8 ms vs 362 ms, p=0.037], with no difference in RVOT-AT (p=0.65). After ajmaline administration SCN5A+ patients showed higher RVOT-AT [125.6 ms vs 102.4 ms, p=0.045] (Figure) and higher RVOT-RT [426.4 ms vs 400 ms, p=0.038]. At univariate logistic regression, baseline RVOT-RT was a predictor of SCN5A mutation (specificity: 0.64, sensitivity 0.88, AUC 0.75).

Conclusion

In BrS syndrome SCN5A+ patients exhibit marked depolarization and repolarization abnormalities as assessed by ECGI.
Association between HV interval and electrocardiographic findings in individuals with syncope and left bundle branch block
Authors: Carvalho GD , Armaganijan LV , Ferreira MPN , Demarchi AV , Moreira DAR
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

The occurrence of syncope is associated with increased mortality in patients with left bundle branch block (LBBB). Among syncope risk scores, it is consensual that electrocardiographic (ECG) abnormalities and the presence of underlying cardiac disease are prominent factors. However, there is no further investigation directed towards this population and there is few that could add to clinical judgement in such cases, until electrophysiological study (EPS) is performed. The method’s modest sensitivity limits its practical usage in spite of current literature recommendation. Therefore, identifying those patients more prone to serious events is of clinical significance.

Objectives and methods

This was a cross-sectional study of patients with syncope and LBBB undergoing EP study in a tertiary hospital, which aimed to assess the relation between ECG parameters and prolonged HV interval on EPS.

Results

Ninety-four consecutive patients were eligible for the final analysis. Mean age was 63.1 ± 11.9 years (68.1% male). As for main comorbidities, the prevalence of smoking was 39.3%, hypertension 84%, diabetes mellitus 29.7%, coronary artery disease 28.7% and reduced left ventricle ejection fraction (LVEF) (≤ 40%) 48.9%. In the univariable analysis, LVEF ≤ 40% appeared to be somewhat important but this was not confirmed upon logistic regression. QRS duration ≥ 165 ms (OR 7.79; p = 0.0005) and PR interval ≥ 220 ms (OR 7.10; p = 0.003) were independent predictors for HV interval ≥ 70 ms. For each 10 ms increase in QRS and PR duration, the odds of HV interval ≥ 70 ms enhanced by 39.8% and 27.1%, respectively. For the subgroup presented with such outcome, mean QRS was 170.88 ± 26.81 ms, significantly larger than the patients with HV interval < 70 ms. When combined, QRS ≥ 165 ms and PR interval ≥ 220 ms had an accuracy of 80% to predict an HV interval ≥ 70 ms in the EPS. Other analyzed data were not systematically associated with the evaluated outcome.

Conclusion

In patients with syncope and LBBB, prolonged QRS and PR interval were independent predictors of increased HV interval on EP study. Larger studies are needed to confirm these findings.
Electrocardiographic imaging a valid tool or an inaccurate toy?
Authors: Parreira A , Carmo P , Mesquita D , Marques L , Chambel D , Pinho J , Ferreira A , Amador P , Chmelevsky M , Machado P , Ferreira J , Nunes S , Goncalves P , Marques H , Adragao P
Published: May 2022

Funding Acknowledgements

Type of funding sources: Private hospital(s). Main funding source(s): Learning Health

Background and aim

Electrocardiographic imaging (ECGI) is capable of performing an activation map with a single beat. However, previous studies using the epicardial-only system, have suggested a bad accuracy for the assessment of the epicardial breakthrough. Recent systems using endo-epicardial analysis have shown promising results. The aim of this study was to assess the accuracy and reproducibility of two endo-epicardial ECGI systems using different cardiac sources one based on the extracellular-potential, and the other on the equivalent double layer model, respectively the AMYCARD (EP Solutions SA, Switzerland) and VIVO (Catheter Precision, NJ USA) systems.

Methods

We studied 11 consecutive patients referred for ablation of frequent idiopathic premature ventricular contractions at our center that had an ECGI performed using both systems on the same day. The AMYCARD system uses a dense array of body-surface electrocardiograms with up to 224 leads and VIVO uses just the 12-leads ECG. Both systems use a patient-specific heart torso geometry obtained with a CT-scan or cardiac magnetic resonance. The localisation of the PVCs based on ECGI was done using a segmental model with 22 segments on the left ventricle, to include the classical 17 segment model plus the aortic cusps and the papillary muscles, and 12 segments on the right ventricle including 4 on the right ventricular outflow tract (RVOT): (anterior, lateral, right septum and left septum). A perfect match was defined as a predicted location within the same anatomic segment, whereas a near match as a predicted location within the same segment or a contiguous one.

Results

The median (Q1-Q3) number of leads used for the AMYCARD was 131 (118-144). Seven patients underwent ablation and in 4 ablation is pending. The predicted locations and the ablation site are depicted on the Table. We found a perfect match between both systems in 73% (Figure) and near match in 91% of cases. In patients that underwent ablation the systems localised the site of origin of the PVCs within the same segment or the contiguous segment in all patients with VIVO and in six out of seven with AMYCARD.

Conclusions

ECGI is an accurate diagnostic tool with reproducible results regardless the cardiac source used for analysis.
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

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 <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 <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

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<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

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 >3000 atrial ectopic beats/day or >2 "micro-AF" episodes (fibrillatory burst <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 (>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

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 >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<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

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

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 > 0.05). The success group displayed significantly higher fWA values at baseline and end_WPVI than that of the failure group (p<0.05, Panel A and B). No significant difference was found between baseline fWA values and those measured at end_WPVI (p > 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

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.