bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety of leadless pacemaker implantation in very eldery patients in a one-center study
Authors: Martinez-Sande JL , Gonzalez-Melchor L , Garcia-Seara J , Rodriguez-Manero M , Fernandez-Lopez XA , Minguito C , Gonzalez-Ferrero T , Gonzalez-Juanatey JR
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Leadless pacemakers (LPM) have demonstrated safety in patients with multiple commorbidities. Very elderly patients have multiple commorbidities and are more prone to develop complications in pacemaker implants.

Purpose

We present our experience with LPM in a subgroup of very elderly patients.

Methods

We present a prospective clinical trial that including all consecutive LPM implantation from June 1 2015 to December 25 2021. We divide the patients in two groups according to age: older or younger than 85 y/o. Clinical and electrical, characteristics, as well as related complications and electrical parameters were compared between the two groups according to age.

Results

A total of 300 LPM were implanted and divided in two groups: 231 patients of less than 85 y/o and 69 patients ≥85 y/o. Clinical and electrical characteristics were described in table 1. Mean follow-up was of 36 months. There were 7 complications, all during the implantation procedure and there were no significant differences in complications between both groups . Electrical performance had no differences between the patients and was stable at long-term follow-up. (Figure 2)

Conclusions

There were no significant differences in complications or electrical performance between both groups and LPM were safe at long-term follow-up in very elderly patients with multiple commorbidities.
Early experience with the second generation of leadless pacemakers and correlation with ecg parameters
Authors: Breitenstein A , Perucchini F , Gasperetti A , Hofer D , Schiavone M , Forleo GB , Algibbawi M , El-Chami MF , Steinwender C
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Leadless pacing has evolved as a safe and effective treatment option in selected patients. With the updated generation that allows sensing of atrial contraction, atrioventricular synchronized pacing is now possible in a VDD mode. Previous retrospective analyses have demonstrated that echocardiographic parameters may be helpful in selecting patients with a higher chance of good atrioventricular synchronous pacing behaviour.

Purpose

Analysis of the early experience with the second generation of leadless pacemaker and the role of ECG parameters to predict a good atrial contraction signal (so-called A4 amplitude) in patients who underwent leadless pacemaker implantation in four tertiary centres.

Methods and Results

In this retrospective analysis, a total of 136 patients were included. Mean age was 78.0 (64.7 - 84.2 years) years with 48.9 % being male. Coronary artery disease was the leading underlying heart disease with 27.1 % affected patients. 61.7 % of the population suffered from sinus rhythm with complete or intermittent atrioventricular block. The majority of devices were implanted at the mid-septal (61.2 %) or high-septal (25.6 %) right ventricle, respectively. Electrical parameters were optimal at implant (Table 1) and remained stable over time (Table 1). In addition, A4 signal amplitude remained stable too during follow-up compared to the value early after implantation (Table 1). From this entire cohort, patients with an ECG available at implant and those in which the device was working predominantly in the VDD mode were selected for further analyses (62 patients). PR interval measured from the ECG prior to implantation did not correlate with the A4 signal amplitude (Figure 1A; P = NS). Next, P wave amplitudes were measured in all 12 ECG leads. There was a correlation between P wave amplitude from lead V2 with the A4 amplitude (Figure 1B; P = 0.034, R2 = 0.09), whereas the other right-sided ECG leads (V1/aVR), either alone or in combination, did not correlate with the A4 signal amplitude (P = NS).

Conclusions

In our cohort of patients with the second generation of leadless pacemakers, offering VDD pacing, good electrical parameters can be achieved as it has been observed with the first generation. Also the A4 signal amplitude as a marker for atrial contraction remains stable over time. In regard to ECG parameters measured prior to device implantation, only the P wave amplitude in lead V2 correlated with a amplitude of the A4 signal.
Predictors of heart failure events detected by a multisensor implantable defibrillator algorithm
Authors: Santobuono V , Tavoletta V , Manzo M , Calo’ L , Bertini M , Santini L , Savarese G , Dello Russo A , Viscusi M , Lavalle C , Amellone C , La Greca C , Valsecchi S , Favale S
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiovascular and non-cardiovascular comorbidities are common in heart failure (HF) patients and determine disease severity and prognosis. Select modern implantable defibrillators (ICDs) are equipped with multisensor algorithms for HF monitoring. The HeartLogic index combines multiple ICD-based sensor data (heart rate, heart sounds, thoracic impedance, respiration, activity), and the associated alert has proved to be a sensitive and timely predictor of impending HF decompensation in cardiac resynchronization therapy (CRT) patients.

Purpose

This analysis aims to investigate the performance of the algorithm in non-CRT patients, as well as in relation to the presence of comorbidities.

Methods

The HeartLogic feature was activated in 568 ICD patients (410 with CRT) from 26 centers. The median follow-up was 25 months [25th–75th percentile: 15-35].

Results

We recorded 1200 HeartLogic alerts (0.71 alerts per patient-year) in 370 patients. Among patient characteristics, atrial fibrillation (AF) at implantation (HR: 1.62, 95%CI: 1.27-2.07, p<0.001) and chronic kidney disease (CKD) (HR: 1.53, 95%CI: 1.21-1.93, p<0.001) independently predicted alerts. HeartLogic alerts were not associated with CRT vs. non-CRT device implantation (HR: 1.03, 95%CI: 0.82-1.30, p=0.775). Comparing the combined index and all physiologic parameters during clinically stable periods we did not notice differences between CRT and non-CRT patients. Thoracic impedance was significantly lower in CKD than non-CKD patients. (46±11ohm versus 49±10ohm; p=0.047). We found a higher S3 amplitude (0.9±0.3mG versus 0.8±0.2mG; p=0.005) and nocturnal heart rate (72±9bpm versus 66±7bpm; p<0.001), and lower S1 amplitude (2.0±0.8mG versus 2.4±0.9mG; p<0.001) in AF patients vs non-AF. These differences persisted at the time of alerts (all p<0.05). In the overall population, and in patients stratified by device type, CKD and AF, we measured significant changes of all contributing sensors (paired t-test; p<0.05) from clinically stable periods to the time of alert.

Conclusions

The burden of HeartLogic alerts appears similar between CRT and non-CRT patients, while patients with AF and CKD seem more exposed to alerts. ICD-measured thoracic impedance is sensitive to the fluid overload that characterizes kidney disease, as well as the first and third heart sound amplitudes seem sensitive to the reduced ventricular efficiency during AF. Nonetheless, ICD sensors seem to equally contribute to the HeartLogic alerts in all patient subgroups.
Incidence of premature battery depletion in subcutaneous cardioverter-defibrillator patients. Insights from a multicenter registry
Authors: Luker J , Strik M , Raymond-Paquin A , Elrefai MH , Cano Perez O , Franqui-Rivera H , Pott A , Veltmann C , Schmitt J , Collinson J , Van Stipdonk AMW , Fluschnik N , Haeberiln A , Andrade J , Steven D
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

A subset of more than 35,000 S-ICD is under FDA advisory, warning of the potential of premature battery depletion (PBD), caused by a faulty low-voltage capacitor. Based on internal data, the manufacturer projects the incidence at 3.7% after 5 years. Data independent from the manufacturer is sparse.

Methods

This study was a multicenter effort of 14 centers in Europe, the US, and Canada. Consecutive patients who received a S-ICD at the participating centers were included in this retrospective analysis. Patients with the 1010 S-ICD generator model, and those without available follow-up information were excluded. Data was collected and managed using REDCap electronic data capture tools hosted at the University Hospital Cologne.

The primary endpoint in this registry was device explantation, generator replacement, or generator failure. Reasons for explantation, replacement, or failure were collected. Device longevity was defined in months. It was calculated as the time from device insertion to the time of replacement, or explantation, or failure, where applicable. Premature battery depletion was defined as the occurrence of battery depletion requiring generator replacement after 60 months or less.

The study complies with the Declaration of Helsinki. Ethics committee approval was obtained. This study is registered with Clinicaltrials.gov.

Results

Data of n=1,102 S-ICD devices was analyzed. The registry comprised of S-ICD generators implanted between 03/2015 and 09/2021 (43.4% A209 model and 56.6% A219 model). Of these, 611 devices (55.4%) were identified by the Boston Scientific serial number lookup tool as affected by the advisory. The mean and median follow-up duration was 2.43±1.66 and 2.29 years, respectively.

During follow-up, 110 devices (10%) were explanted after 2.9±1.7 years. Battery depletion was the indication in 52. The endpoint of PBD (battery depletion after less than 5 years) was met in 37 devices (6% of the devices under advisory), after 4.1±0.6 years.

In 58 cases, the S-ICD was explanted for reasons other than battery depletion.

Infection (16), system upgrade (20), heart transplant or LVAD therapy (7), and inappropriate shocks or inappropriate sensing (7) were the most common indications.

Discussion

This registry provides a systematic and manufacturer independent analysis of premature battery depletion in S-ICD patients. In the affected devices, the incidence of premature battery occurred in 6%. This is higher than what is projected by the manufacturer. The rate of PBD increases notably around the 4-year mark.

Conclusion

S-ICD generators under advisory suffer from PBD at a higher incidence than previously reported. Patients equipped with these devices should be closely monitored.
Septal flash correction with His-Purkinje pacing predicts echocardiographic response in resynchronization therapy
Authors: Pujol-Lopez M , Jimenez-Arjona R , Guasch E , Doltra A , Borras R , Roca-Luque I , Castel MA , Garre P , Ferro E , Niebla M , Carro E , Arbelo E , Sitges M , Tolosana JM , Mont L
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Grant of the Catalan Society of Cardiology, 2019; Research Grant Josep Font 2019, Hospital Clínic de Barcelona

His-Purkinje conduction system pacing (HPCSP) has been proposed as an alternative to cardiac resynchronization therapy (CRT); however, no predictors of echocardiographic response have been described. Septal flash (SF) is a marker of intraventricular dyssynchrony.

Methods

The study aimed to analyze whether HPCSP corrects SF in patients with CRT indication, and if correction of SF predicts echocardiographic response. Prospective observational study (n=30). Left ventricular ejection fraction (LVEF) was measured with echocardiography at baseline and at 6-month follow-up. Echocardiographic response was defined as increase in 5 points LVEF. ECG Imaging was performed in 2 patients to validate ventricular activation shortening and to study the basal and HPCSP activation pattern.

Results

HPCSP shortened QRS duration by 48±21ms and SF was significantly decreased (baseline 3.6±2.2mm vs HPCSP 1.5±1.5mm p<0.0001) (Fig.1). At 6-months, mean LVEF improvement was 8.6% ± 8.7% and 64% of patients were responders. There was a significant correlation between SF correction and increased LVEF (r=0.61, p=0.004). A correction of >1.5mm had 81% sensitivity and 80% specificity to predict echocardiographic response (area under curve 0.86, p=0.019).

Conclusion

HPCSP improves intraventricular dyssynchrony and results in 64% echocardiographic responders at 6-month follow-up. Dyssynchrony improvement with SF correction may predict echocardiographic response at 6-month follow-up (Fig.2.).
Apical versus septal pacing - can we chose the localization of ventricular lead in order to prevent upgrade to cardiac resynchronization therapy?
Authors: Silverio Antonio P , Couto Pereira S , Brito J , Valente Silva B , Alves Da Silva P , Garcia B , Simoes Oliveira C , Nunes-Ferreira A , Magalhaes A , Bernardes A , Lima Da Silva G , Carpinteiro L , J Pinto F , Marques P , De Sousa J
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Right ventricular apical pacing (RVAp) may be deleterious to ventricular function and hemodynamics due to pacing induced dyssynchrony. In the last decades, some studies showed that RVAp has been associated with heart failure, deterioration of left ventricular function and high mortality. Some patients (pts) may need, during the follow up (FUP), an upgrade to cardiac resynchronizaon therapy (CRT). New techniques have emerged such as RV lead implantation in the high septum or outflow RV tract (RVOT) and, more recently, His bundle/LB pacing.

Purpose

To compare the need for upgrade to CRT in patients with RVAp versus septal/RVOT pacing.

Methods

Retrospective single-center study of consecutive pts that implanted pacemakers in a tertiary center between January 1995 and December 2020. We collected data regarding pacing indication, RV pacing site (apex versus septum/RVOT) and need for an upgrade to CRT during follow up (FUP).

Our primary endpoint was upgrade to CRT during the FU period. In the model, the impact of localization of the implanted lead on the survival free from upgrade was estimated assuming a neutral effect on mortality. Statistical analysis was performed using T-student test and logistic regression.

Results

We included 8761 pts, 60.2% (n=5275) were male, with a mean age of 76.5±10.7 years. The main indications for pacemaker implantation were (1) complete atrioventricular (AV) block (2239, 25.6%), (2) sick sinus syndrome (2211, 25.2%), (3) atrial fibrillation with AV block or bradycardia with significant pauses (17.4%) and (4) Mobitz II 2nd degree AV block (1467, 16.7%).

RVAp was performed in 1746 (20%) patients and RVOT/septal pacing in 6933 patients (80%; RVOT in 657 (9,5%)). During FUP, 26 (1,5%) RVAp pts and 52 (0,8%) RVOT/septal pacing pts underwent upgrade to CRT, in a total of 78 pts (CRT-P in 54 patients and CRT-D in 24 patients).

We observed that patients with RVAp had twice the risk of CRT upgrade during FUP (OR: 2,0 (IC 95% 1,25-3,21), p=0,004) when compared to patients with RVOT/septal pacing.

Conclusions

Patients with RVAp presented a 2-fold higher risk for upgrade to CRT when compared to patients with RVOT/septal pacing in our center. This retrospective analysis shows that lead implantation in the septum/RVOT should be preferred instead of the apex to reduce pacing induced dyssynchrony and need for CRT upgrade.
Endocardial pacing results in better electrical resynchronization and hemodynamic improvement than epicardial pacing in CRT
Authors: Ghossein MA , Salden FCWM , Van Stipdonk AMW , Janssen B , Luermans JGLM , Westra S , Prinzen FW , Vernooy K
Published: May 2022

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The original study was financially supported by Medtronic (Minneapolis, Minnesota). The investigation of the current abstract is unrelated to the original financial support.

Background

Cardiac resynchronization therapy (CRT) is conventionally applied by means of a transvenous epicardial left ventricular (LV) lead. Studies suggest that endocardial LV pacing may result in better resynchronization and LV function than epicardial LV pacing.

Purpose

To investigate whether endocardial pacing results in better electrical resynchronization and hemodynamic improvement compared to epicardial pacing.

Methods

Patients with an indication for CRT were prospectively included from two hospitals. In all patients, LV pacing was performed endocardially and epicardially in the postero-lateral region. QRS area was calculated from vectorcardiograms that were synthesized from 12-lead ECGs. Acute hemodynamic improvement was assessed as the change in maximum rate of rise of LV-pressure (%ΔLVdP/dtmax). We assessed the effects of endocardial and epicardial LV pacing on the change in QRS area (∆QRS area) and LVdP/dtmax (%ΔLVdP/dtmax).

Results

A total of 16 patients (age 66 ± 11 years, 56% male, 31% ischemic cardiomyopathy, QRS duration 166±18ms, LBBB in 88%) were included. Endocardial pacing resulted in greater ∆QRS area than epicardial pacing (-51 ± 34 µVs vs. -24 ± 37 µVs, p = 0.021, Panel A). In addition, endocardial pacing led to a larger %ΔLVdP/dtmax as compared to epicardial pacing (21 ± 12% vs. 18 ± 9%, p = 0.025, Panel B).

Conclusion

Compared to conventional epicardial LV pacing in CRT, endocardial LV pacing results in better electrical resynchronization and acute hemodynamic improvement.
Impact of the electrocardiographic pattern in V1, aVL and I following cardiac resynchronization therapy at 2 years
Authors: Asensio Nogueira J , Salgado Aranda R , Garcia Fernandez FJ , Martin Gonzalez FJ , Villagraz Tecedor L , Sanchez Corral E , Fernandez Gonzalez B , Gomez Llorente M , Alvarez Calderon M , Abella Vallina D , Aguilar Iglesias L , Hernando Gonzalez R , Margalejo Franco A , Perez Rivera JA
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

There is little evidence regarding if the electrocardiographic pattern following CRT has impact on morbidity and mortality. In a previous study, a specific group of patterns in three leads of the ECG (Rs in V1, Qr in aVL or rS in I) was associated with lower incidence of the composite endpoint of death from any cause and heart failure hospitalization at 1 year.

Purpose

In this historical cohort study we analyzed if the specific pattern (Rs in V1, Qr in aVL or rS in I) was associated with outcomes at 2 years follow up.

Methods

Patients with CRT devices were consecutively included from January 2012 to April 2019. The primary endpoint was a composite of death from any cause and heart failure hospitalization at 2 years. Secondary endpoints included the individual components of the primary endpoint at 2 years. Survival analysis was performed using Kaplan-Meier test, comparing survival graphics through Log-Rank test. For multivariate analysis, Cox regression was performed.

Results

We included 111 patients. Baseline characteristics are reported in Table 1. Presence of any of the three patterns was not significantly associated with the primary endpoint (p=0.182). Patients who presented any of these patterns had not a significantly lower incidence of death from any cause (p=0.303), but had a significantly lower incidence of HF hospitalization (4.7% vs. 17.6%, hazard ratio 0.207, 95% confidence interval 0.046-0.93, p=0.04). Previous atrial fibrillation was independently associated with a higher incidence of primary and secondary endpoints. QRS duration postimplantation was independently associated with incidence of the primary endpoint.

Conclusion

The presence of the patterns Rs in V1, Qr in aVL or rS in I is an independent predictor of reduced HF hospitalizations at 2 years in patients with CRT. Previous atrial fibrillation and QRS duration were also associated with outcomes.
Long-term incidence of cardiac device complications with intrathoracic versus extrathoracic venous access: results from the PLACE (Planning Lead Access for Cardiac Electrostimulation) study
Authors: Ghiglieno C , Dell’ Era G , Palmisano P , Floris R , Pimpini L , Coluccia G , Delogu G , Colombo C , Marconetto C , De Zan G , D’amico A , Mazzoleni F , Patti G
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Optimal venous access is crucial in successful cardiac device implantation. Most commonly used accesses are subclavian or axillary vein puncture and cephalic vein cutdown. The extrathoracic access has the advantage of reducing the risk of pneumothorax and lead disfunction; thus, this approach is recommended as the first choice approach.

Purpose

The aim of our retrospective registry was to evaluate the incidence of long-term device complications (pneumothorax, lead rupture or displacement, hematoma, infection or bleeding) with different venous approaches in four high-volume centers in Italy.

Methods

We collected data from implantation and device complications during follow up using available electronic records from each center.

Results

We included 4443 patients, mean age 73±11 years. Median follow up was 118 months (IC range 59-198 months). The incidence of any complication was 7.7 %, without difference between intrathoracic and extrathoracic access (7.8% vs 7.7% respectively, p=0.70). However, lead rupture was more frequent in the intrathoracic group (5.3% vs 1.4%, p=0.04).

Conclusion

In experienced, high-volume centers, the use of intrathoracic vein puncture in the case of unsuitable extrathoracic access may represent a safe alternative of venous access in patients undergoing cardiac device implantation, although associated with a higher occurrence of lead rupture.
Cardiac surgery in cardiac implantable electronic device patients and risk of device infections: a nationwide nested case-control study
Authors: Frausing MARIA , Nielsen JC , Johansen JB , Jorgensen OD , Kristensen J , Olsen T , Gerdes C , Kronborg MB
Published: May 2022

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Karen Elise Jensen’s Foundation

Background

Cardiac surgery in patients with cardiac implantable electronic devices (CIEDs) has been associated with a higher risk of infective endocarditis, but how it influences risk of CIED-specific infections is not known.

Purpose

To examine risk of systemic CIED infections after cardiac surgery in patients with CIEDs.

Methods

Based on data obtained from Danish administrative registries and the Danish Pacemaker and ICD Register, we conducted a case-control study nested within a nationwide cohort of patients who underwent a de novo CIED implantation in Denmark between 1998-2017. Patients entered the study at six months after implantation. We defined cases as incident systemic CIED infections resulting in device system extraction. Controls were sampled 1:100 on age, sex and follow-up time using risk set sampling. Exposure was defined as coronary artery bypass graft (CABG)-, or cardiac heart valve replacement- or repair surgery.

Results

From a study cohort comprising 67,621 patients, we identified 170 cases and 16,966 controls. In the minimally adjusted model, the incidence rate ratio (IRR) for systemic CIED infection was 6.4 (95% confidence interval (CI) 3.9-17.1) with cardiac surgery, and after confounder adjustment, 7.0 (95% CI 4.1-11.9). IRRs were higher when exposure was restricted to heart valve replacement surgery (adjusted IRR (aIRR) 9.7, 95% CI 5.2-17.8), and when limiting our exposure time window to one year (aIRR 12.7, 95% CI 5.8-27.8).

Conclusion

Cardiac surgery in patients with de novo CIEDs was associated with a high risk of systemic CIED infections. Highest risk was observed after heart valve replacement surgery, and within the first year of surgery.
Smartwatch-based detection of atrial arrhythmia using a deep neural network in a tertiary care hospital
Authors: Fiorina L , Lefebvre B , Gardella C , Henry C , Coquard C , Younsi S , Ait Said M , Salerno F , Horvilleur J , Lacotte J , Mannenti V
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Smartwatch electrocardiograms (SW ECG) have been identified as a promising noninvasive solution to assess heart rhythm abnormalities, especially atrial arrhythmias (AA) which includes atrial fibrillation, atrial flutter and supraventricular tachycardia. This study evaluates the performance of the detection of AA with a smartwatch and compares the accuracy of two algorithms, the latest version of the original companion application (Apple ECG 2.0 App) and a novel deep neural network (DNN), in a population typical of an electrophysiology department.

Purpose

Determine if a novel DNN can improve the detection of AA on SW ECG in a tertiary care hospital.

Methods

101 patients from the electrophysiology department of one tertiary center were included in this ongoing study. Three simultaneous ECGs were collected for each patient: one 12-lead ECG (Mindray BeneHeart R12) and two SW ECGs (Apple Watch) taken from the left wrist (SWw ECG) and the lower left abdomen (SWa ECG). 12-lead ECGs were adjudicated by a blinded expert electrophysiologist as 52 AA and 49 not AA and considered as gold standard. The SW ECGs were processed by the ECG 2.0 App and the DNN in parallel. The proportions of inconclusive diagnoses returned and the performances were assessed and compared.

Results

Overall, the ECG 2.0 App yielded inconclusive diagnoses for 19% (19/101) of all SWw ECGs while the DNN reduced that number to 0% (0/101). A similar result holds for SWa ECGs (Figure 1). Regarding the detection of AA from SWw ECGs, the ECG 2.0 App had a sensitivity of 81% (95% CI, 67%-90%), a specificity of 97% (95% CI, 87%-100%) and an accuracy of 89% (95% CI, 80%-94%) while the DNN had a sensitivity of 92% (95% CI, 82%-97%), a specificity of 90% (95% CI, 78%-96%) and an accuracy of 91% (95% CI, 84%-95%). For SWa ECGs (Figure 2), the sensitivity of the DNN was found significantly higher compared to the ECG 2.0 App: 96% (95% CI, 89%-98%) vs 76% (95% CI, 61%-87%). Conclusion(s): A novel DNN algorithm decreased the number of inconclusive diagnostics in the detection of AA from SW ECG from around 20% to 0%, which could help limit the overreading time spent by the physicians. Excluding inconclusive diagnostics, we observed no significant difference in performance between the two algorithms except for the sensitivity for SW ECG taken from the abdomen where the DNN outperforms the ECG 2.0 App. Routine application of this SW ECG analysis in tertiary care hospitals offers significant promise in arrhythmia diagnosis.
FIND-AF: a widely applicable artificial intelligence algorithm to target systematic screening for atrial fibrillation in older individuals through primary care electronic health records
Authors: Wu J , Nadarajah R , Raveendra K , Cowan JC , Gale CP
Published: May 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): British Heart Foundation

Background

Systematic screening for atrial fibrillation (AF) in people ≥75 years of age can improve detection rates, anticoagulant prescription and clinical outcomes but is inefficient.(1) A large proportion of European populations are registered in primary care with a routinely-collected electronic health record (EHR).(2) An algorithm embedded in this system to identify people at higher risk of incident AF could facilitate targeted AF screening.

Purpose

To develop and internally validate a widely-applicable artificial intelligence (AI) algorithm for predicting incident AF in people ≥75 years of age using primary care EHRs.

Methods

We identified people who were ≥75 years of age (1998 – 2018), in the nationwide Clinical Practice Research Datalink (CPRD)-GOLD primary care EHR dataset and followed them until a diagnosis of AF, or withdrawal from CPRD, or 6 months. Each subject had 81 features including age, sex, ethnicity and comorbidities. Algorithms developed with random forest (RF) and multivariable logistic regression (MLR), were compared by area under receiver operating curve (AUROC) and the proportion of patient EHRs to which the algorithms could be applied

Results

440,000 patients were studied, with 3922 occurrences of AF. The RF algorithm achieved an AUROC of 0.77 after 10 fold cross-validation, 12% better than the MLR algorithm (0.68). Notably the RF algorithm could be applied to all EHRs. At 75% sensitivity, the RF algorithm would reduce the potential number needed to screen for one new case of AF to 11, an improvement of over 6-fold compared to using age alone.

Conclusions

This study showed a novel AI algorithm that can be widely applied in nationwide European primary care EHRs to target screening for AF in a population that derives clinical benefit.
The in-ear region as a novel anatomical site for ecg signal detection: validation study on patients affected by atrial tachyarrhythmias
Authors: De Lucia R , Zucchelli G , Della Volpe S , Fiorentini F , Parollo M , Giannotti Santoro M , Barletta V , Canu A , Mazzocchetti L , Bongiorni MG
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Purpose

Early detection of cardiac arrhythmias is a major opportunity for mobile health, as portable devices nowadays available can detect multiple-lead electrocardiogram (ECG). The study aims to validate the in-ear region as a new anatomical site for ECG signal detection in patients (pts) affected by atrial tachyarrhythmias.

Methods

We performed the ECG using KardiaMobile 6L device on 20 patients affected by tachyarrhythmias and admitted to our hospital for electrical cardioversion. All the digital ECGs were detected in a modified modality or using the left in-ear region instead of the right hand. All the recorded ECGs were analyzed by the device and the results checked by two cardiologists.

Results

We successfully collected all 20 modified digital ECGs performed on the group of 20 pts (age 68.4 ± 9.2 years; male 60%; 14pts in atrial fibrillation (AF); 6pts in atrial flutter (AFl); medium HR 94±28.4bpm; 65% affected by hypertension; 5% affected by diabetes mellitus; 95% in NOACs).

In case of AF, the KardiaMobile 6L diagnosis of the ECG detected by this modified modality was correct in 100% of cases. In the 6 pts affected by AFl the KardiaMobile 6L diagnosis was "normal" in 3 cases and "not classified" in the other 3. For that reason, in these 6 pts, we performed a new digital ECG using the KardiaMobile 6L in the standard modality, and the diagnosis for each patients was the same.

Conclusion

The in-ear region could be a reliable novel anatomical site for ECG signal detection in patients affected by atrial fibrillation. Further studies are needed to overcome the misdiagnosis of digital ECG in case of patients affected by atrial flutter. These data support the development of new portable ECG devices using the left in ear region and so leaving at least one hand free.
Magnetic field interactions of smartwatches and portable electronic devices with cardiovascular implantable electronic devices
Authors: Badertscher P , Vergne C , Fery C , Spies F , Schlageter V , Mannhart D , Quirin T , Kuehne M , Sticherling C , Pascal J , Knecht S
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Magnetic interference of portable electronic devices (PEDs), such as state-of-the-art mobile phones, with cardiovascular implantable electronic devices (CIEDs) has been reported.

Purpose

The aim of the study was to quantify the magnetic fields of latest generation Smartwatches and other PEDs and to evaluate and predict their risk of CIED interactions.

Method

High resolution magnetic field characterization of five smartwatches able to record an ECG Apple Watch, Series 6 and 7, Fitbit Sense, Samsung Galaxy Watch 3, and Withings Move ECG Watch was performed using a magnetic field camera consisting of 1024 calibrated three axis Hall sensors. Maximal distance of 1 mT (10 Gauss) field strength and 1 mT volume was calculated. Ex vivo measurements of the minimal safety distance (MSD) at which no mode switch can be observed between six representative CIEDs and the PEDs was performed. Results were compared to other PEDs, such as digital pens, headsets and their cases, and a Smartphone.

Result

Maximal 1 mT distances ranged between 10 mm and 19 mm, and 1 mT volumes between 6 cm3 and 19 cm3. The smartwatches and PEDs with measured 1 mT distance 15 mm (B: Microsoft surface pen, C: Airpods Pro case) showed device interaction up to > 15 mm (Figure). Linear regression analysis showed an inverse linear relationship of the MSD with 1 mT distance (B coefficient: 0.459; 95% CI: 0.246-0.672; p<0.001) but not with the volume (p=0.842)

Conclusions

Standardized measurements of the 1 mT field distance and volume is feasible and has the potential to assess the risk of CIED interaction. Smartwatches seem to be safe in contrast to other PEDs such as the Microsoft surface pen or Airpods Pro case with high 1mT volumes and maximal distances with regards to CIED interaction.
The impact of atrial fibrillation and atrial tachycardias on the hemodynamic status of patients with pulmonary hypertension
Authors: Dusik M , Fingrova Z , Marek J , Dytrych V , Jansa P , Havranek S
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Supported by Ministry of Health, Czech Republic – conceptual development of research organization (General University Hospital in Prague – VFN, 00064165)

Introduction

Atrial fibrillation and atrial tachycardias (AF/AT) have been reported as a common condition in patients with pulmonary hypertension (PH). The presence of arrhythmia in patients with PH leads to increased morbidity and mortality. The significance and possibilities of AF/AT treatment in patients with PH is still being discussed. The aim of this study is to evaluate the effect of acute heart rhythm change on hemodynamical parameters in PH patients with AF/AT being treated by catheter ablation.

Methods

We performed an analysis of hemodynamic parameters and their changes in relation to the present heart rhythm. The study group consisted of 11 PH patients with AF/AT (6 males, median age (IQR) 72 (53;76) years) and was compared with a control group of 9 patients with AF/AT without PH or other structural heart disease (5 males, 56 (49;62) years). The data was acquired during the catheter ablation procedure using a Swan-Ganz catheter.

Results

PH patients had higher mean pressures (median; IQR; mmHg) in the right ventricle (31 (24;32) vs. 23 (18;25), p<0.05) and in the pulmonary artery (36 (30;37) vs. 22 (19;25), p<0.05) compared to the control group. Other parameters were comparable. There was a significant decrease of the left atrial pressure in the presence of arrhythmia in the PH group compared to the left atrial pressure change in the control group (p<0.05). The changes of the remaining hemodynamic parameters did not differ significantly between the groups. There was no significant difference in cardiac output in sinus rhythm and AF/AT in both groups. The detailed results are presented in the table below.

Conclusion

The left atrial pressure in PH patients changes significantly according to the actual heart rhythm. The acute impact of AF/AT on the other hemodynamical parameters, including cardiac output, has not been proven.
Genomics of Diversification of Pseudomonas aeruginosa in Cystic Fibrosis Lung-like Conditions
Authors: Schick Alana , Shewaramani Sonal , Kassen Rees
Published: May 2022

Pseudomonas aeruginosa is among the most problematic opportunistic pathogens for adults with cystic fibrosis (CF), causing repeated and resilient infections in the lung and surrounding airways. Evidence suggests that long-term infections are associated with diversification into specialized types but the underlying cause of that diversification and the effect it has on the persistence of infections remains poorly understood. Here, we use evolve-and-resequence experiments to investigate the genetic changes accompanying rapid, de novo phenotypic diversification in lab environments designed to mimic two aspects of human lung ecology: spatial structure and complex nutritional content. After ∼220 generations of evolution, we find extensive genetic variation present in all environments, including those that most closely resemble the CF lung. We use the abundance and frequency of nonsynonymous and synonymous mutations to estimate the ratio of mutations that are selectively neutral (hitchhikers) to those that are under positive selection (drivers). A significantly lower proportion of driver mutations in spatially structured populations suggests that reduced dispersal generates subpopulations with reduced effective population size, decreasing the supply of beneficial mutations and causing more divergent evolutionary trajectories. In addition, we find mutations in a handful of genes typically associated with chronic infection in the CF lung, including one gene associated with antibiotic resistance. This demonstrates that many of the genetic changes considered to be hallmarks of CF lung adaptation can arise as a result of adaptation to a novel environment and do not necessarily require antimicrobial treatment, immune system suppression, or competition from other microbial species to occur.
Black hole spin measurements based on a thin disc model with finite thickness – I. An example study of MCG−06-30-15
Authors: Jiang Jiachen , Abdikamalov Askar B , Bambi Cosimo , Reynolds Christopher S
Published: May 2022

We present a re-analysis of the XMM–Newton and NuSTAR observing campaigns for the well-studied, X-ray-bright AGN MCG−06-30-15. In particular, we consider a disc model with finite thickness. By fitting the disc reflection spectra in the data, we obtain a black hole spin of 0.87–0.99 (90 per cent confidence range) after taking the thickness of the disc into consideration. Spectral models with a grid of mass accretion rate from 0 to $30{{\,\rm per\,cent}}\,\dot{M}_{\rm Edd}$ are calculated for MCG−06-30-15. This result is obtained by considering a free disc reflection fraction parameter frefl and is consistent with previous measurements based on razor-thin disc models. Besides, an isotropic, point-like geometry, i.e. the ‘lamppost’ geometry, is assumed for the corona in our model. We find that such a geometry overestimates frefl in the data. Therefore, thin disc models with consistent ‘lamppost’ values of frefl provide a worse fit than ones with a free frefl parameter. We discuss possible reasons for the discrepancy between the observed and theoretical values of frefl at the end of the paper. Modifications for the over-simplified lamppost model might be needed when the thickness of the thin disc is considered in future work.
A puzzle solved after two decades: SN 2002gh among the brightest of superluminous supernovae
Authors: Cartier Régis , Hamuy Mario , Contreras Carlos , Anderson Joseph P , Phillips Mark M , Morrell Nidia , Stritzinger Maximilian D , Hueichapan Emilio D , Clocchiatti Alejandro , Roth Miguel , Thomas-Osip Joanna , González Luis E
Published: May 2022

We present optical photometry and spectroscopy of the superluminous SN 2002gh from maximum light to +204 d, obtained as part of the Carnegie Type II Supernova (CATS) project. SN 2002gh is among the most luminous discovered supernovae ever, yet it remained unnoticed for nearly two decades. Using Dark Energy Camera archival images we identify the potential supernova (SN) host galaxy as a faint dwarf galaxy, presumably having low metallicity, and in an apparent merging process with other nearby dwarf galaxies. We show that SN 2002gh is among the brightest hydrogen-poor SLSNe with MV = −22.40 ± 0.02, with an estimated peak bolometric luminosity of 2.6 ± 0.1 × 1044 erg s−1. We discount the decay of radioactive nickel as the main SN power mechanism, and assuming that the SN is powered by the spin-down of a magnetar we obtain two alternative solutions. The first case, is characterized by significant magnetar power leakage, and Mej between 0.6 and 3.2 M⊙, Pspin = 3.2 ms, and B = 5 × 1013 G. The second case does not require power leakage, resulting in a huge ejecta mass of about 30 M⊙, a fast spin period of Pspin ∼ 1 ms, and B ∼ 1.6 × 1014 G. We estimate a zero-age main-sequence mass between 14 and 25 M⊙ for the first case and of about 135 M⊙ for the second case. The latter case would place the SN progenitor among the most massive stars observed to explode as an SN.
The impact of 17O + α reaction rate uncertainties on the s-process in rotating massive stars
Authors: Frost-Schenk J , Adsley P , Laird A M , Longland R , Angus C , Barton C , Choplin A , Diget C Aa , Hirschi R , Marshall C , Portillo Chaves F , Setoodehnia K
Published: May 2022

Massive stars are crucial to galactic chemical evolution for elements heavier than iron. Their contribution at early times in the evolution of the Universe, however, is unclear due to poorly constrained nuclear reaction rates. The competing 17O(α, γ)21Ne and 17O(α, n)20Ne reactions strongly impact weak s-process yields from rotating massive stars at low metallicities. Abundant 16O absorbs neutrons, removing flux from the s-process, and producing 17O. The 17O(α, n)20Ne reaction releases neutrons, allowing continued s-process nucleosynthesis, if the 17O(α, γ)21Ne reaction is sufficiently weak. While published rates are available, they are based on limited indirect experimental data for the relevant temperatures and, more importantly, no uncertainties are provided. The available nuclear physics has been evaluated, and combined with data from a new study of astrophysically relevant 21Ne states using the 20Ne(d, p)21Ne reaction. Constraints are placed on the ratio of the (α, n)/(α, γ) reaction rates with uncertainties on the rates provided for the first time. The new rates favour the (α, n) reaction and suggest that the weak s-process in rotating low-metallicity stars is likely to continue up to barium and, within the computed uncertainties, even to lead.
Shocks in the stacked Sunyaev-Zel’dovich profiles of clusters II: Measurements from SPT-SZ + Planck Compton-y map
Authors: Anbajagane D , Chang C , Jain B , Adhikari S , Baxter E J , Benson B A , Bleem L E , Bocquet S , Calzadilla M S , Carlstrom J E , Chang C L , Chown R , Crawford T M , Crites A T , Cui W , de Haan T , Mascolo L Di , Dobbs M A , Everett W B , George E M , Grandis S , Halverson N W , Holder G P , Holzapfel W L , Hrubes J D , Lee A T , Luong-Van D , McDonald M A , McMahon J J , Meyer S S , Millea M , Mocanu L M , Mohr J J , Natoli T , Omori Y , Padin S , Pryke C , Reichardt C L , Ruhl J E , Saro A , Schaffer K K , Shirokoff E , Staniszewski Z , Stark A A , Vieira J D , Williamson R
Published: May 2022

We search for the signature of cosmological shocks in stacked gas pressure profiles of galaxy clusters using data from the South Pole Telescope (SPT). Specifically, we stack the latest Compton-y maps from the 2500 deg2 SPT-SZ survey on the locations of clusters identified in that same data set. The sample contains 516 clusters with mean mass $\langle M_{\rm 200m}\rangle = 10^{14.9} \, {\rm M}_\odot$ and redshift 〈z〉 = 0.55. We analyse in parallel a set of zoom-in hydrodynamical simulations from the three hundred project. The SPT-SZ data show two features: (i) a pressure deficit at R/R200m = 1.08 ± 0.09, measured at 3.1σ significance and not observed in the simulations, and; (ii) a sharp decrease in pressure at R/R200m = 4.58 ± 1.24 at 2.0σ significance. The pressure deficit is qualitatively consistent with a shock-induced thermal non-equilibrium between electrons and ions, and the second feature is consistent with accretion shocks seen in previous studies. We split the cluster sample by redshift and mass, and find both features exist in all cases. There are also no significant differences in features along and across the cluster major axis, whose orientation roughly points towards filamentary structure. As a consistency test, we also analyse clusters from the Planck and Atacama Cosmology Telescope Polarimeter surveys and find quantitatively similar features in the pressure profiles. Finally, we compare the accretion shock radius ($R_{\rm sh,\, acc}$) with existing measurements of the splashback radius (Rsp) for SPT-SZ and constrain the lower limit of the ratio, $R_{\rm sh,\, acc}/R_{\rm sp}\gt 2.16 \pm 0.59$.
New de-excitation rates of the open shell dicarbon monoxide C2O(X3Σ−) in collision with He(1S)
Authors: Khadri F , Hachani L , Elabidi H , Hammami K
Published: May 2022

In order to derive accurate physical conditions of the interstellar clouds (like TMC-1) from the rotational transitions of C2O, collisional rates are needed. Based on a new two-dimensional potential energy surface (2D-PES), we report a new rate coefficients calculation of C2O(X3Σ−) induced by collision with He. This PES was obtained from the explicitly correlated restricted open-shell coupled cluster with single, double and perturbative triple excitation (rccsd(t)-f12) ab initio approach associated with aug-cc-pVTZ basis sets. The C2O–He PES presents one minimum below its dissociation limit with a well depth of 42.376 cm−1. The close-coupling quantum time independent formalism was used to derive cross sections for E ≤ 370 cm−1 and N ≤ 10. De-excitation rate coefficients are obtained for thermal temperature below 80 K.
Objectification
Authors: Walker Michael L.
Published: May 2022

This chapter accomplishes three goals. First, the author argues that it is in jail that “the criminal” is constituted. In so doing, the author defines “the criminal” as a kind of social object and explains criminal objectification as its own justification for the maltreatment of penal residents. The chapter walks readers through intake processes while highlighting how criminal objectification unfolds from one processing station to the next. Second, this chapter zooms in to the period of time spent in “pre-housing holding cells” to highlight what is different about “newbie” residents relative to experienced residents and to note the unique nature of social relations in those temporary cells. Finally, the author introduces readers to the jail’s different classifications to give a sense of how each can matter for the type of punishments a penal resident might experience.
Romantic Empiricism
Authors: Nassar Dalia
Published: May 2022

Romantic Empiricism uncovers an understudied philosophical tradition that emerged in Germany in the late eighteenth and early nineteenth centuries, traces its development, and argues for its continued significance. Moving from the late Kant’s notion of reflecting judgment, to Herder’s articulation of the idea of “animal worlds,” Goethe’s explication of the obligations of the scientist, and Alexander von Humboldt’s aesthetic science, the book demonstrates how these thinkers developed a sophisticated empirical approach to the natural world, which focuses on the phenomenon, while also emphasizing the creative role of the knowing subject. The book explores how these four thinkers worked together—sometimes as rivals, but more often than not as teachers and collaborator—and illustrates how their search for a new methodology culminated in a new, ecological understanding of the world and the human place within it. By investigating the ways in which romantic empiricist methodology took insights from romanticism, empiricism, and rationalism, while also developing their own distinctive approach—an approach that recognizes the cognitive value of art and aesthetic experience, and emphasizes the ethical dimensions of knowledge—Romantic Empiricism sheds important light on the history of nineteenth-century philosophy, and reveals the ways in which historical insights and approaches can address urgent ecological questions and concerns.