bluuebunny/crossref_metadata_2025 huggingface dataset:
The God-Awful Small Affair of the Invisible Organist: David Bowie Translated
Authors: Hilson Jeff
Published: May 2021

Following the sudden death of David Bowie in January 2016, perhaps the least expected tributes were the various organ renditions of his 1973 single ‘Life On Mars’ played by the organists of St Albans Cathedral, Kelvingrove Art Gallery in Glasgow and Dublin’s St Joseph’s Church. Becoming instant social media sensations, what are we to make of these different versions of Bowie’s song played on the pipe organ, the so-called ‘King of Instruments’, and why did the organists choose ‘Life On Mars’ over any other Bowie song? In this essay, I consider these and other related questions from a range of theoretical perspectives, initially drawing on philosopher and musicologist Peter Szendy’s notion of the musical arrangement as translation, whilst also conceding that as a translation, something in the process of arrangement is lost. What might that ‘something’ be? Understanding him to be one of the most conspicuous musical artists of our time, I go on to employ media philosopher Sybille Kramer’s transmission theory of communication, positing Bowie as a messenger-translator who is also a powerful cultural interferer. As such, he is the antithesis of the church organist who, like the person of the textual translator as outlined by translation theorist Lawrence Venuti, has occupied a marginal if not abject space within musical history. Given this relegated position, how does Bowie’s own use of the organ sit with its use as an instrument of elegy in the various renditions referred to above, and can it tell us anything else about translation?
May Measurement Month 2019: an analysis of blood pressure screening results from Albania
Authors: Qirjako Gentiana , Mone Iris , Beaney Thomas , Xia Xin , Draçini Xheladin , Poulter Neil R , Fico Albana , Ylli Alban , Çumashi Rudina , Roshi Enver , Burazeri Genc
Published: May 2021

This article discusses the results of the May Measurement Month (MMM) 2019 campaign, which contributed to a third round of MMM hypertension screening campaigns carried out in Albania, a transitional country in the Western Balkans. The hypertension screening campaign in Albania was carried out during the period 1–31 May 2019 in 30 sites in many districts of the country. Overall, 19 154 participants aged ≥18 years were included (approximately 68% of these were women), with an overall mean age of 47.0 ± 15.3 years. Blood pressure (BP) was measured with OMRON sphygmomanometers (Omron Healthcare, Kyoto, Japan). Hypertension was defined as systolic BP ≥140 mmHg, or diastolic BP ≥90 mmHg, or on treatment for hypertension. Self-reported data consisted of height and weight, pre-existing conditions, including smoking status and alcohol consumption. Overall, the proportion of participants with hypertension was 38.6%. Less than two-thirds (64.7%) of hypertensive individuals were aware of their condition. Also, less than half (48.3%) of participants on antihypertensive medication had controlled BP (<140/90 mmHg). The most sizable correlations of high BP were with known hypertension status, use of antihypertensive medication, and obesity. The MMM campaign contributes to routine hypertension screening in Albania. Hence, health professionals and policymakers in Albania should act on the findings of MMM screening campaigns and continue its support as a valuable tool for early detection of hypertension in the general population.
May Measurement Month 2019: an analysis of blood pressure screening results from Bangladesh
Authors: Malik Fazila-Tun-Nesa , Al Mamun Mohammad Abdullah , Choudhury Sohel Reza , Ishraquzzaman Mir , Kalimuddin Mohammad , Huq Tawfiq Shariar , Rahman Mohammad Shamimur , Jubayer Shamim , Bhuiyan Mahfuzur Rahman , Sobhan Sheikh Mohammad Mahbubus , Faruque Mithila , Beaney Thomas , Xia Xin , Poulter Neil R , Malik Abdul
Published: May 2021

According to the Non-communicable disease Risk Factors Survey of 2018, more than one-fifth (21.0%) of adults aged 25 years or older have hypertension and one-third of the adults did not have their blood pressure (BP) measured in their lifetime in Bangladesh. The National Heart Foundation of Bangladesh participated in May Measurement Month (MMM) 2017 and 2018 as well as this 2019 as a part of a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. This opportunistic screening of voluntary participants aged ≥18 years was carried out from May to July 2019. Data were collected from 100 screening sites in 16 districts in Bangladesh. BP measurement, the definition of hypertension, and statistical analysis followed the MMM protocol. Data on 24 941 individuals were analysed. Among the participants, 12 658 (50.8%) were female. After multiple imputation, 6990 (28.0%) had hypertension. Among the 6990 participants with hypertension, 5007 (71.6%) were on antihypertensive medication and 5331 (76.3%) were aware of having hypertension. Among 6990 participants with hypertension, 3217 (46.0%) had controlled BP (<140/90 mmHg) and among the participants with hypertension and on antihypertensive medication, 64.2% had controlled BP. Opportunistic BP screening can identify significant numbers of people with raised BP and thus assist in the prevention of cardiovascular diseases.
May Measurement Month 2019: an analysis of blood pressure screening results from China
Authors: Chen Xin , Liu Chang-Yuan , Xu Li-Ying , Wang Hong-Yu , Liu Min , Zhang Yu-Qing , Yin Xin-Hua , Wang Xiao-Long , Yu Jing , Li Wei-Hua , Beaney Thomas , Xia Xin , Poulter Neil R , Li Yan , Wang Ji-Guang
Published: May 2021

To report the blood pressure (BP) data obtained in the May Measurement Month (MMM) 2019 in China. Study participants were recruited if ≥18 years of age and had ideally not had their BP measured for ≥1 year. BP was measured three times consecutively with a 1-min interval in the sitting position, using a validated electronic BP monitor. Trained volunteer investigators administered a questionnaire to collect information on lifestyle, medical history, and use of medications. The measurement was performed in 238 387 participants in 250 sites across 31 China provinces. The majority of screening took place in hospitals or clinics (78.7%), with 17.1% in outdoor public areas and 4.2% in other settings. The study participants included 127 853 women (53.6%) and had a mean (±SD) age of 48.9 ± 16.2 years. The mean (of readings two and three) systolic/diastolic BP was 121.8/73.8 mmHg. In all hypertensive patients (n = 66 181, 27.8%), the awareness, treatment, and control rates of hypertension were 51.5%, 48.4%, and 29.1%, respectively. Linear regression models showed differences in systolic and diastolic BP according to sex and age and several other major characteristics, such as previous stroke, myocardial infarction, and diabetes mellitus, antihypertensive medication use and known hypertension, previous hypertension in pregnancy and current pregnancy, alcohol intake and current smoking, and body mass index. The MMM 2019 campaign has been successful in measuring BP in a large member of participants in China.
May Measurement Month 2019: an analysis of blood pressure screening results from Mexico
Authors: Alcocer Luis , Rosas Martin , Estrada Alfredo , Ruiz-Gastelum Edith , Pombo Ernesto J , Cardona Ernesto G , Borrayo Gabriela , Galvan Hector , Alvarez Humberto , Gomez-Alvarez Enrique , Chavez Adolfo , Beaney Thomas , Clarke Jonathan , Poulter Neil R ,   the MMM-19-Mexico group
Published: May 2021

May Measurement Month 2019 (MMM19) in Mexico was an opportunistic survey, aimed to improve blood pressure (BP) awareness at the individual and population levels. This survey followed the methodology of MMM19, previously published. The total number of participants screened was 39 700, 56.7% female, 36.6% were of mixed ethnicity, mean age [standard deviation (SD)] was 46.9 (17.4) years, and mean body mass index was 27.2 (SD: 4.4) kg/m2. Seven per cent of the participants reported having diabetes, 2.4% reported having a myocardial infarction in the past, 1.1% stroke, 2.0% were pregnant at the time of the survey, 3.7% of women had suffered from hypertension in a previous pregnancy, 11.4% declared that they were smokers, and 47.0% drank alcohol at least once a week. After multiple imputations, of all 39 700 participants, 10 140 (25.5%) had hypertension; of all participants with hypertension, 43.8% were aware of their diagnosis, 41.7% were on antihypertensive medication, and 27.8% had controlled BP (systolic BP <140 mmHg and diastolic BP <90 mmHg). Of those on antihypertensive medication, 27.8% had controlled BP. In Mexico, MMM is the largest hypertension survey ever done, it provides complementary data to the existing information on arterial hypertension in the country and helps to increase the visibility of hypertension: a priority health problem.
May Measurement Month 2019: an analysis of blood pressure screening results from Nepal
Authors: Bhattarai Harikrishna , McLachlan Craig S , Khanal Pratik , Adhikari Tara Ballav , Ranabhat Kamal , Koirala Sweta , Parajuli Surya B , Pokharel Yashashwi , Paudel Santosh , Soti Pabitra Babu , Subedi Bishal , Wagle Chetan Nidhi , Mahato Sweta , Pandey Ghanashyam , Gyawali Pawan , Pandey Sadhana , Gyawali Vivek , Devkota Surya , Lohani Guna Raj , Koirala Bhagawan , Xia Xin , Beaney Thomas , Neupane Dinesh
Published: May 2021

May Measurement Month (MMM) is a global initiative to screen high blood pressure (BP) in the community and increase awareness at the population level. High BP is the leading risk factor for mortality worldwide and in Nepal. This study presents the results of the 2019 MMM in Nepal. Opportunistic BP screening was conducted in 30 out of 77 districts across Nepal and aged ≥18 years at the community and public places. BP was measured three times in a seated position. A total of 74 205 individuals participated in the study, mean age 39.9 years, and 58% were male. BP measurements for the second and third readings were available for 69 292 (93.3%) individuals. The proportion of the population that were hypertensive was 27.5% (n = 20 429). Among those hypertensives, 46.3% were aware of their hypertensive status and of these, 37.5% were on antihypertensive medication. Only 54.3% of those on antihypertensive medication had their BP controlled. Of the community screened, those self reporting to have diabetes, current tobacco users, and current alcohol drinkers were 6.7%, 23.6%, and 31.9%, respectively; 20.6% of the participants were overweight, and 6.5% were obese. Since the first BP screening campaign, MMM 2017 in Nepal, the number of participants screened has largely increased over the years. MMM’s success in Nepal is through a coordinated mobilization of trained health science students and volunteers in the communities. The Nepal MMM data demonstrates that large community-based BP screening campaigns are possible in low resource settings.
May Measurement Month 2019: an analysis of blood pressure screening results from Pakistan-South Asia
Authors: Memon Feroz , Beaney Thomas , Clarke Jonathan , Ishaq Mohammad , Bai Kavita
Published: May 2021

High blood pressure (BP) is well recognized as a huge health problem worldwide and is often described as a silent killer. To develop awareness and screening of this health issue globally, the International Society of Hypertension created ‘May Measurement Month (MMM)’ a campaign to provide BP screening and advice to interested participants. This screening and awareness campaign in Pakistan is a continuation of the efforts of the first MMM programme in Pakistan in 2017. This study was conducted in May and June 2019. This public based cross-sectional study included and screened 6919 individuals of either gender and aged ≥18 years, after informed consent. Information about prior diagnosis and treatment of hypertension with history about comorbidities and life-style were taken by a standard pre-designed form. Participants also asked about previous participation in MMM 2017/18. Arterial BP was measured using the OMRON digital BP apparatus and three successive readings were taken. Hypertension was defined as a systolic BP ≥140 mmHg or a diastolic BP ≥90 mmHg or taking antihypertensives. Participants had a mean age of 45.8 years and 47.1% had never had their BP checked. Of all those screened, 3601 (52.1%) participants had hypertension, of whom 56.2% were aware of their diagnosis, 49.5% were on antihypertensive medication and 19.8% had controlled BP (<140/90 mmHg). Of the 1783 participants on antihypertensive medication, 40.0% had controlled BP. In Pakistan, there are still low levels of awareness, counselling and screening about high BP. Further large-scale studies are required in this region to evaluate these problems and link them with potential solutions.
May Measurement Month 2019: an analysis of blood pressure screening results from the Democratic Republic of the Congo
Authors: M’Buyamba-Kabangu Jean-René , Katamba Fortunat K , Ntambwe Mireille L , Ngoyi Georges N , Tshiswaka Trésor M , Bayauli Pascal M , Lubenga Yves N , Kazadi Serge M , Beaney Thomas , Xia Xin , Poulter Neil R , Buila Nathan B
Published: May 2021

Hypertension, the foremost cause of global morbi-mortality, is linked with a high mortality from numerous cardiovascular endpoints. The May Measurement Month (MMM) campaign is an annual initiative of the International Society of Hypertension (ISH) to collect information on blood pressure (BP) and other risk factors for cardiovascular disease (CVD) in adults. MMM2019 in the Democratic Republic of the Congo (DRC) was an opportunistic cross-sectional survey of volunteers aged ≥18 years that took place in Kinshasa and Mbuji-Mayi after the training of observers to familiarize with the ISH ad hoc methods. We screened 29 857 individuals (mean age: 40 years; 40% female). Hypertension was present in 7624 (25.5%) individuals. Of them, 2520 (33.1%) were aware, 1768 (23.2%) on treatment with 910 (51.5%) controlled BP (systolic BP <140 mmHg and/or diastolic BP <90 mmHg). Of all hypertensives screened, 11.9% had controlled BP. Of all respondents, 16.7% had participated in MMM18 and 60.5% did not have their BP verified during the last year. Fasting, pregnancy, and underweight status were linked with lower BP levels whilst smoking, drinking, antihypertensive medication, previous stroke, diabetes as well as being overweight/obese were associated with higher BP levels. Our results reflect the high rate of hypertension in the DRC with low levels of awareness, treatment, and control. A nationally representative sample is required to establish the nationwide hypertension prevalence.
May Measurement Month 2019: an analysis of blood pressure screening results from Italy
Authors: Torlasco Camilla , Faini Andrea , Pengo Martino F , Borghi Claudio , Grassi Guido , Ferri Claudio , Muiesan Maria Lorenza , Salvetti Massimo , Sechi Leonardo , Minuz Pietro , Mulatero Paolo , Pucci Giacomo , Volpe Massimo , Carugo Stefano , Sarzani Riccardo , Mulè Giuseppe , Beaney Thomas , Poulter Neil R , Xia Xin , Parati Gianfranco
Published: May 2021

Cardiovascular (CV) diseases are burdened by high mortality and morbidity, being responsible for half of the deaths in Europe. Although hypertension is recognized as the most important CV risk factor, hypertension awareness, and blood pressure (BP) control are still unsatisfactory. In 2017 and 2018, respectively >10 000 and >5000 individuals took part in the May Measurement Month (MMM) campaign in Italy, of whom 30.6% and 26.3% were found to have high BP, respectively. To raise public awareness on the importance of hypertension and to collect BP data on a nation-wide scale in Italy. In the frame of the MMM campaign, an opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2019. BP measurement, the definition of hypertension, and statistical analysis followed the standard MMM protocol. Screening was conducted in multiple sites by health personnel. Among the 10 182 people screened (females: 52.3%, mean age 58 ± 16years) mean BP was 127/78 mmHg, and 3171 (31.1%) participants had arterial hypertension, of whom 62.1% were aware of being hypertensive. Diabetes, body mass index >25 kg/m2 were associated with higher BP and previous myocardial infarction with lower BP. For the third consecutive year we collected a nation-wide snapshot of BP control in a large sample of individuals. The high participation, with some yearly fluctuations likely due to the limitations of the sampling technique, confirms the power of this kind of health campaign in reaching a significant number of people to raise awareness on health topics.
May Measurement Month 2019: an analysis of blood pressure screening results from Ecuador
Authors: Peñaherrera Ernesto , Ramírez Maria , Peñaherrera Rubén , Duarte Yan C , Cáceres Silvia , Avila Elisa , Jarrin Estefania , Ullauri Vladimir , Aucancela Hugo , Bayas Miguel , Oña Freddy , Arteaga Fabricio , Ruales Jose , Liendo Kisbel , Avila Jessenia Bravo , Hidalgo Eric , Clarke Jonathan , Poulter Neil R , Beaney Thomas
Published: May 2021

Arterial hypertension is a growing burden worldwide, leading to over 10.8 million deaths each year. In Ecuador, it is the main risk factor for the major cause of death, coronary, and cerebrovascular disease [GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioral, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392:1923–1994]. The May Measurement Month Campaign in 2019 (MMM19) is a global initiative of the International Society of Hypertension aimed at raising awareness of high blood pressure (BP) and to act as a temporary solution to the lack of screening programs worldwide. A volunteer cross-sectional survey was carried out in May 2019 across 42 health centres in Ecuador. The average age was 51 (SD ±17.6) years. Blood pressure measurement, the definition of hypertension (mean of the second and third BP measurement ≥140/90 mmHg or who were medicated for high BP), and statistical analysis followed the standard MMM protocol. In total, 15 885 volunteers participated in MMM19. After multiple imputation, 6654 (41.9%) had hypertension. Of individuals not receiving antihypertensive medication, 2383 (20.5%) were hypertensive. Of individuals receiving antihypertensive medication, 1004 (23.5%) had uncontrolled BP. May Measurement Month 2019 was the largest BP screening campaign done in Ecuador. In the survey, including 6654 participants with hypertension, only 49.1% had their BP values controlled (<140/90 mmHg). May Measurement Month 2019 demonstrated a high prevalence of hypertension among volunteer screenees in our country. The high percentage of persons untreated or with uncontrolled hypertension while on pharmacologic treatment suggest that appropriate screening can help to identify a significant number of people with high BP. These data should attract the attention of health care providers and the healthcare system in Ecuador.
May Measurement Month 2019: an analysis of blood pressure screening results from Nigeria
Authors: Wahab Kolawole W , Kolo Philip M , Odili Augustine , Iwuozo Emmanuel , Ifebunandu Ngozi , Ademiluyi Babatunde , Okunola Oluyomi , Sani Mahmoud U , Akinlade Mathias , Isezuo Simeon , Ale Olagoke K , Beaney Thomas , de la Rosa Consuelo Nohpal , Clarke Jonathan , Poulter Neil R , Omotoso Ayodele B
Published: May 2021

The aim of this study is to estimate the frequency of undetected hypertension across the six geopolitical zones of Nigeria. We conducted an opportunistic screening of adults aged at least 18 years in the month of May 2019. Participants were recruited by trained volunteers using the May Measurement Month protocol. Blood pressure (BP) was measured using validated digital and mercury sphygmomanometers. We defined hypertension as BP ≥140/90 mmHg or the use of BP-lowering medication. A total of 3646 participants (52.8% females) with a mean age of 44.5 ± 15.7 years were screened. Hypertension was present in 39.2% of the participants but only 55. 4% of these were on antihypertensive medications. Only 46.8% hypertensives who were on medications had their BP controlled (<140/90 mmHg). Previous history of hypertension in pregnancy, alcohol intake and smoking were associated with increased mean systolic and diastolic BPs. The frequency of Nigerians with hypertension is high while only about half of those on antihypertensive medications are controlled. A multi-pronged approach to reduce the burden of hypertension is needed.
Functional study of a N-terminal CPVT mutation RyR2R420Q in patient specific hiPSC-CMs model
Authors: Yin L , Joanne P , Perrier R , Gerbaud P , Lechene P , Alvarez JL , Benitah JP , Gomez AM
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ANR (Agence Nationale de la Rercherche)

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a lethal genetic arrhythmia that manifests by syncope or sudden death in children and young adults under stress conditions without obvious cardiac structural abnormality. A novel CPVT mutation located in the RyR2 N terminal portion has been identified in a Spanish family (RyR2R420Q). According to the studies of RyR2 function in HEK293 cell line, this mutation presented gain of function at low cytosolic intracellular Ca2+ concentration ([Ca2+]i) and loss of function at high [Ca2+]i. Moreover, KI mice heterozygous for this mutation presented bradycardia and sino-atrial node (SAN) dysfunction. Here we generated induced pluripotent stem cell (hiPSC) from two brothers (one with mutation, the other without mutation as control) of this family and differentiated them into cardiomyocytes (hiPSC-CM). In order to verify that the differentiated cells were well cardiomyocytes, we did immunofluorescence labelling to detect the α-actinin expression and found that around 90% cells were α-actinin positive in both groups of hiPS-CMs. Then the calcium transient was studied by confocal microscopy and the action potential (AP) by micro-electrode technique. The characteristics of spontaneous AP of mutated cells were mostly similar to that of control cells, but more mutated cells presented proarrhythmic behaviors under adrenergic stimulation. hiPSC-CM are immature cardiomyocytes and contract spontaneously. In order to be able to analyze [Ca2+]i transient characteristics, we paced the cells at a constant rate of 1 Hz by field stimulation through two Pt electrodes. Sarcoplasmic reticulum (SR) Ca2+ load was estimated by rapid caffeine (10 mM) application. hiPSC-CMs from the RyR2R420Q carrier presented smaller SR Ca2+ load than those from the control person, whereas their fractional release (the [Ca2+]i transient normalized by the amount of Ca2+ stored in the SR) was higher than that in control group, indicating a gain-of-function mutation.  Even if SR Ca2+ load was smaller in RyR2R420Q cells, they often presented proarrhythmogenic behavior such as Ca2+ waves. The fact was further enhanced during β-adrenergic stimulation, pointing to this model as a valuable tool to study the CPVT disease in human cells.
Three-dimensional vectorcardiographic characteristics of breast cancer patients treated with chemotherapy
Authors: Liu T , Wang Y , Yin X , Liang X , Chen Y , Pan S , Chen Z , Geng X
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

 Patients receiving chemotherapy for breast cancer (BC) may develop cardiac electrophysiological abnormalities. The aim of this study is to examined possible alterations in cardiac electrophysiological parameters detected by three-dimensional vectorcardiograms (3D-VCGs) in BC patients who received chemotherapy.

Methods

This was a prospective single-center cohort study conducted. Patients with BC referred for chemotherapy from May 1, 2019, to October 1, 2019 were invited to participate in the study. 3D-VCG and echocardiography were recorded at rest four times (baseline, after the first cycle, after third cycles and at the end of the regimen, respectively). 

Results

 A total of 63 patients were included. Compared with baseline, decreases in 3-dimensional maximum T vector magnitude (TVM) (0.29 ± 0.10 vs. 0.25 ± 0.10mV; p < 0.05) and 3-dimensional T/QRS ratio (0.26 ± 0.11 vs. 0.21 ± 0.11; p < 0.05) were observed by the end of chemotherapy regimen, while echocardiographic parameters showed no significant variation before and after chemotherapy (all P > 0.05). Maximum TVM showed a significant positive correlation with left ventricular ejection fraction (LVEF) (all p < 0.05). Furthermore, the cut-off value with 0.23 of 3-dimensional T/QRS ratio (the area under the curve [AUC] 0.725) for differentiating LVEF reduction ≥10% following initiation of chemotherapy. The AUC of the front plane T/QRS ratio and horizontal plane T/QRS ratio for the detection of an LVEF reduction ≥10% was 0.725 and 0.763, respectively.

Conclusions

 3D-VCGs can be used to detect electrophysiological abnormalities in BC patients receiving chemotherapy. Subclinical cardiac dysfunction can be revealed by 3D-VCGs before alterations in traditional echocardiographic parameters.
The impact of hydroxychloroquine and azithromycin on the corrected qt interval in patients with the novel coronavirus disease 2019
Authors: Murat B , Murat S
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Although long-term use of HCQ and AZT has been reported to cause QT prolongation and malign arrhythmia, there is not enough data about the effect of short-term use on arrhythmia. Purpose: The aim of this study was to assess the effect of HCQ alone and HCQ + AZT on corrected QT (QTc).Methods: A baseline ECG and on-treatment ECGs were retrospectively collected in COVID-19 patients who received HCQ and/or AZT. Also peak QTc intervals of monotherapy and combination therapy was compared. Results: Of the 155 patients included, 102 (65.8%) were using HCQ, 53 (34.2%) were using HCQ + AZT combination. The use of both HCQ alone and HCQ + AZT combined therapy significantly prolonged the QTc and the QTc interval was significantly longer in patients received combination therapy. QTc prolongation caused early termination in both groups, 5 (4.9%) patients in the monotherapy group and in 6 (11.3%) patients in the combined therapy group.Conclusion: Patients who received HCQ for COVID-19 were at high risk of QTc prolongation, and concurrent treatment with AZT was associated with greater changes in QTc. Comparison of baseline characteristics a Characteristic Total (n = 155) Hydroxychloroquine (n = 102) Hydroxychloroquine /Azithromycin (n = 53) P value Length of stay at ward, SD 9.54 ± 4.28 9.64 ± 4.31 9.31 ± 4.25 0.88 Length of stay Intensive care unite,SD 7.92 ± 3.76 7.18 ± 3.18 8.46 ± 4.15 0.29 Radiographic findings of pneumonia 118(76.1%) 76(74.5%) 42(49.2%) 0.32 Mechanically ventilation 16(10.3%) 7(6.9%) 9(17.0%) 0.049 In hospital death 19(12.3%) 10(9.8%) 9(17.0%) 0.15 ECG findings median(IQR) (ms) Baseline QRS duration 91.0(80.0-103.0) 92.5(80.75-105.50) 90.0(80.0-102.5) 0.5 Posttreatment QRS peak 97.0(86.0-109.0) 97.5(88.0-109.25) 95.0(85.5-109) 0.68 ΔQRS 4.0(0.0-9.0) 2.0(0.0-8.25) 5.0(1.0-9.5) 0.14 Baseline QTc duration 407.0(385.0-426.0) 408.0(389.25-427.50) 404.0(384.0-420.0) 0.1 Posttreatment QTc peak 437.0(414.0-460.0) 428.0(412.75-449.25) 456.0(422.0-467.5) <0.001 ΔQTc 27.0(13.0-45.0) 18.0(11.0-30.0) 46.0(40.5-54.5) <0.001 Baseline PR duration 145.50(128.7-160.0) 147.0(135.0-160.0) 144.0(120.0-160.0) 0.53 Posttreatment PR peak 159.0(140.0-170.0) 159.0(141.0-168.50) 156.0(139.5-171.0) 0.97 ΔPR 7.0(1.0-13.0) 5.0(0.0-12.25) 10.0(5.0-15.0) 0.022 QTc peak day 5.0(4.0-5.0) 5.0(4.0-6.0) 4.0(3.0-5.0) 0.022 Drug withdrawl due to QRS prolongation 11(7.1%) 5(4.9%) 6(11.3%) 0.12
Relationship between heart rhythm turbulence and ventricular arrhythmia in patients with multivessel lesion of coronary arteries
Authors: Kevorkov AG , Tursunov EY , Rasulov AS
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): MoH Research Grant "Development of methods for differentiated prevention and treatment of potentially dangerous heart rhythm disorders"

Prediction of adverse outcomes in patients after myocardial infarction (MI) remains a serious and not completely resolved problem, which pushes researchers to search for new technologies. One of the relatively promising new non-invasive methods for predicting sudden coronary death in patients with coronary heart disease and ventricular arrhythmias (VA) may be an assessment of heart rate turbulence (HRT). Given its important prognostic role, primarily in patients after MI, the aim of this work was to study the relationship between HRT and cardiovascular remodeling in patients with VA with history of MI and multivessel nature of coronary lesions.

Materials and research methods

123 patients with history of MI, aged 38 to 76 years (average age 61.0 ± 7.6 years), were included into the study. The multivessel nature of coronary lesions was established based on the results of diagnostic selective coronary angiography. All patients underwent Holter monitoring of the electrocardiogram (HMECG). HRT was determined using two indicators, in accordance with the guidelines: Turbulence Onset (To, %) and Turbulence Slope (Ts, ms/RRi).

Results

Potentially dangerous ventricular arrhythmias (PDVA) were noted in more than half of the examined patients (n = 67; 54.5%). In analyze of the structure of PDVA, II class of VA, as the highest class, was not observed in any of the examined patients, class III was detected in 35% of cases, IVA – in 37.5%, and IVB – in 27.5%. In assessing the frequency of VAs, according to the Bigger classification, frequent PVC >10 VA/hour was detected in 41.5% of patients.

The analysis of the HRT indicators did not reveal a decrease in the mean values both To (-1.2 ± 1.5%) and Ts (3.9 ± 3.1 ms/RRi) indicators in the main group of patients. However, after appropriate separation of the main group, 21.1% of them had disorders of only one (category 1; 15.4%) or both of the HRT indicators (category 2; 5.7%). Category 0 included patients without any disorder of HRT indicators. In analysis of the relationship between the PDVA and the category of HRT reduction, a significant interrelation between them was revealed (Table 1).

Result

Our study demonstrates presence of strong interrelation between HRT parameters disorder and severity of PDVA. Thus, study of HRT in patients after MI could be a strong and independent predictor of cardiovascular events including sudden cardiac death. Abstract Figure. Tab. 1. Interrelation between HRT and VA
Sudden cardiac death risk stratification in patients with a preserved or mildly reduced ejection fraction: role of cardiac magnetic resonance and electrophysiological study
Authors: Buia V , Muca M , Bastian D , Walaschek J , Rittger H , Bayer T , Vitali-Serdoz L
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

 Patients presenting with syncope of suspected arrhythmogenic origin or symptomatic documented non sustained ventricular tachycardia (NSVT) may represent a population with higher risk for sudden cardiac death (SCD). However today there are still no defined criteria to stratify the risk of SCD in this population.

PURPOSE

 To assess the prognostic value of magnetic resonance (MRI) and electrophysiological study (EPS) in the risk stratification for SCD of patients with a preserved or mildly-reduced ejection fraction (EF) that may benefit from implantable cardiac defibrillator (ICD) therapy.

METHODS

 We selected ischemic and non-ischemic patients with a preserved or mildly-reduced ejection fraction who came to our attention either after a probably arrhythmogenic syncopal event or a documented NSVT between 12/2018 and 09/2020. Patients with other ICD indications following current guideline-criteria were excluded (id est Brugada syndrome, Long QT and hypertrophic cardiomyopathy). All patients underwent an echocardiography, a coronary angiography, and an MRI with gadolinium, those among them with a positive LGE also underwent an induction EPS. Non inducible patients were followed-up clinically or with an implantable event-recorder, while inducible patients received an ICD.

RESULTS

 In our observational study seventeen patients with preserved or only mildly-reduced EF were enrolled (13 males and 5 females; mean age 68 years). Among these patients, nine were identified with an underlying myocardial scar with positive Late-Gadolinium-Enhancement (LGE) in MRI. Based on the clinical orientation and the MRI LGE pattern patients were divided in ischemic group (5 patients) and non-ischemic group (4 patients). All 9 patients underwent an induction EPS. Three of them, 2 with non-ischemic and 1 with an ischemic pattern, demonstrated a reproducible inducibility of a sustained ventricular tachycardia or ventricular fibrillation and were implanted with an ICD. During our follow-up two of the three patients had an adequate shock within a year from the ICD implantation. Among the 6 patients with negative induction EPS there were no clinical events in the follow up, except one death for unknown causes.

CONCLUSION

 Our preliminary results demonstrated that in patients with ischemic or non ischemic cardiopathy with preserved or mildly reduced EF, a positive MRI LGE pattern and the inducibility of ventricular arrhythmias during induction EPS identify a population at higher risk for clinical recurrence of ventricular arryhthmic events. Further investigation is needed to validate this combined diagnostic strategy as new SCD prevention tool.
Main determinants of physician-driven amiodarone discontinuation in clinical practice
Authors: Mihajlovic M , Mihajlovic A , Marinkovic M , Kovacevic V , Simic J , Mujovic N , Potpara T
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Amiodarone is the most prescribed antiarrhythmic drug, but drug-related side effects sometimes result in drug discontinuation. Not infrequently, physicians discontinue amiodarone without a medical reason. We explored the determinants of such permanent drug discontinuation. 

Methods

 A single-centre, longitudinal study included consecutive patients newly prescribed or already taking amiodarone when first seen in our health centre from January 2013 to December 2017. Baseline data were retrieved from the hospital electronic database and patients were scheduled for a follow-up visit in January to March 2019. 

Results

 Of 1212 patients taking amiodarone (mean age 64.2 ±11.2 yrs; female n= 358, 29.5%; median follow-up 22.5 months), the drug was permanently discontinued in 489 (40.3 %), see Figure. On univariate Cox regression analysis, female sex (HR 1.55; 95%CI 1.0-2.3; p = 0.032), non-multimorbidity (2.9; 2.0-4.3; p < 0.001), LV EF (1.0; 1.0-1.1; p < 0.001), NOAC therapy (1.9; 1.2-3.0; p = 0.003) and AF ablation (2.7; 1.5-4.6; P < 0.001) were associated with amiodarone discontinuation. Age (0.9; 0.9-0.9; p < 0.001), CAD (0.3; 0.2-0.5; p < 0.001), HF (0.5; 0.3-0.9; p = 0.020), ventricular arrhythmias (0.1; 0.0-0.3; p < 0.001), stroke (0.2; 0.1-0.9; p = 0.045), CKD (0.5; 0.3-0.9; p = 0.011), ICD (0.1; 0.0-0.6; P = 0.014), LV diastolic (0.9; 0.9-0.9; p = 0.001) and systolic diameter (0.9; 0.9-0.9; p < 0.001), polypharmacy (0.5; 0.3-0.7; P < 0.001), VKA therapy (0.6; 0.4-0.9; p = 0.027), aspirin (0.57; 0.4-0.9; p = 0.011), loop diuretic (0.5; 0.3-0.7; p < 0.001), spironolactone (0.4; 0.2-0.7; p < 0.001) and statin (0.6; 0.4-0.9; p = 0.009) therapy were associated with drug continuation. Multivariable risk factors for amiodarone discontinuation are showed in Table. 

Conclusion

Study showed that within the first two years of treatment, despite persistent indication, amiodarone was discontinued in 1 out of 10 patients in the absence of side effects, mostly in younger patients with less comorbidities, which may not always be justified. There is a need for qualitative research to elucidate the reasons for such physicians’ decisions. Table.Multivariable Cox Proportional HAZARD Regression analysis of permanent Amiodarone discontinuation due to physician decisionVariableHR95% CIP valueAge0.9700.95-0.990.003VT/VF/electrical storm0.1390.04-0.450.001VKA therapy0.5980.38-0.940.026Ablation of AF2.5391.38-4.690.003Number of comorbidities ≤32.0241.26-3.270.004VT ventricular tachycardia; VF: ventricular fibrillation.Abstract Figure.
Withdrawal of anti-arrhythmic therapy after cavo-tricuspid isthmus ablation of typical atrial flutter
Authors: Couto Pereira S , Rodrigues T , Brito J , Silverio Antonio P , Valente Silva B , Alves Da Silva P , Cunha N , Nunes-Ferreira A , Bernardes A , Lima Da Silva G , Cortez-Dias N , Pinto FJ , De Sousa J
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Medical management of typical atrial flutter (AFL) is sometimes unsuccessful and may have adverse effects. Symptom control using radiofrequency cavo-tricuspid isthmus ablation (CTA) is a feasible alternative, given the fact that it is a simple procedure with a low rate of complications. However, in some patients (pts), new atrial arrhythmias may develop and the decision of anti-arrhythmic therapy (AAT) withdrawal is usually patient-based.

Purpose

To predict the recurrence of atrial arrhythmias (AR) after CTI ablation between pts that suspended AAT and those that maintained AAT.

Methods

Single-center retrospective study of pts with typical AFL submitted to ablation between 2015 and 2019. Pts clinical characteristics, current and follow up therapy were collected. Holter and/or 7-day event loop recorder were performed during the follow up to identify AR. For statistical analysis, we applied Chi-square, Mann-Whitney and Cox regression to identify predictors of AR.

Results

CTA ablation was performed in 476 pts (mean age: 66.3 ± 11.7 years, 79.8% males). At time of ablation most pts were in EHRA II class (70.8%) and 44.6% of pts had at least mild left atrial dilatation on transthoracic echocardiography. The mean follow up time was 2.8 years.

Two-hundred sixty-nine pts (57,6%) were under anti-arrhythmic therapy (AAT) before the ablation. After the procedure, 58 pts withdrawn AAT before AR and 8 pts after AR. During the follow-up period, we observed AR of typical AFL in 17 pts (3.6%), atypical AFL in 35 pts (7.4%) and AF in 118 pts (24.8%).

There were no statistically significant differences regarding AR between pts that maintained and suspended AAT (p = NS). Concerning the pts that suspended AAT, thyroid disfunction (p = 0.012), higher CHADs-VASc score (p = 0.033), ischemic cardiomyopathy (p = 0.001) and tobacco abuse (p = 0.005) were predictors of AR, being the last two also independent predictors (HR 0.243; 95%CI 0.76-0.778, p = 0.017; HR 4.449; 95%CI 1.128-17.553, p = 0.033, respectively). 

Conclusion

After CTA ablation, AF is the most frequent recurrent arrhythmia. Interestingly, the withdrawn of AAT didn’t seem to predict the recurrence of arrhythmic events. The decision of stopping AAT must be individualized regarding patients’ clinical characteristics. Abstract Figure 1: AAT withdrawal and AR
Clinical recurrence of palpitations following slow pathway ablation in patients with suspected paroxysmal supraventricular tachycardias but non-documented, non-inducible tachycardias
Authors: Ramos Jimenez J , Marco Del Castillo A , Lozano Granero VC , Lazaro Rivera C , Salgado R , Rodriguez Manero M , Ramos Fernandez P , Dallaglio P , Gunturiz Beltran C , Alonso Fernandez P , Ayala HD , Jimenez Sanchez D , Lopez Gil M , Arribas Ynsaurriaga F , Rodriguez Munoz DA
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Catheter ablation is recommended as first-line treatment in patients with atrioventricular nodal reentry tachycardias (AVNRT). However, the best therapeutic modality in patients with dual AV nodal physiology but non-inducible tachycardias in electrophysiological study (EPS) remains controversial, especially when no tachycardias have been documented.

Our objective was to evaluate the results of empirical slow pathway ablation in patients showing dual AV nodal physiology but non-inducible AVNRT.

Methods

Multicenter, retrospective, observational registry of consecutive patients undergoing EPS due to clinical suspicion of paroxysmal supraventricular tachycardias (PSVT), but with no prior ECG documentation. Clinical, EPS and ablation (when performed) data were collected and andalyzed. 

Results

427 patients of 12 centers were included. Mean age was 46.3 ±16.1 and 297 (69.6%) were females. AVNRT was induced in 188 patients (typical in 181 cases, atypical in 7). Dual AV nodal physiology with or without single nodal echo beats, but with no sustained tachycardia and without evidence of accessory pathway was present in 68 patients. Ablation of the slow pathway was performed in 187/188 patients with AVNRT and in 30/68 patients with dual physiology. Among subjects with non-inducible tachycardia, ablation reduced significantly recurrences (39.5% in non-ablated vs. 16.7%; p = 0.04), with a level equivalent to those with ablated AVNRT(14.4% vs. 16.7%; p = 0.75). Procedure-related complications were similar in both groups: empirical ablation n = 1; 3.3% vs. induced tachycardia n = 6; 3.2% (p = 0.98).

Conclusions

In patients with high clinical suspicion of PSVT but non-documented and non-inducible arrhythmias, the presence of dual AV nodal physiology makes AVNRT a likely mechanism of the clinical tachycardia. Catheter ablation of slow pathway reduces the risk of recurrence to a level equivalent to those with inducible and ablated AVNRT. AVNRT (n = 188) Dual nodal physiology (n = 68) p value Age (years) 48.6 ± 16.3 41.9 ± 14.0 <0.01 Female 71.8% 67.7% 0.52 Years symptomatic 9.3 ± 11.3 3.6 ± 8.1 <0.01 Sudden onset 83.9% 88.0% 0.54 Abrupt end 73.4% 74.6% 0.96 Previous rate-slowing drugs 30.9% 25.0% 0.36 Previous antiarrhythmic drugs 5.9% 2.9% 0.35 Isoproterenol in EPS 70.0% 89.7% <0.01
Radiofrequency catheter ablation of focal atrial tachycardia: characteristics and results of a series in a tertiary hospital
Authors: Castelo A , Portugal G , Vaz Ferreira V , Garcia Bras P , Teixeira B , Valente B , Cunha P , Guerra C , Delgado A , Cruz Ferreira R , Oliveira M
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Focal atrial tachycardia (AT) is a relatively uncommon arrhythmia with poor response to medical treatment. Radiofrequency (RF) ablation appears to be a good option for treatment of symptomatic patients (P).

Purpose

To describe the clinical characteristics, electrophysiological (EP) findings, safety and short-term efficacy of catheter ablation in P with AT.

Methods

Retrospective analysis of consecutive P submitted to AT ablation using electroanatomical mapping between 2015 and 2020. If the AT was not present spontaneously, pacing maneuvers (atrial drive or burst pacing with up to 3 extra-stimuli) and isoprenaline was employed until reproducible induction of an ectopic atrial rhythm. Radiofrequency (RF) ablation was delivered at the site of earliest activation after validation of local electrograms until non-inducibility.

Results

A total of 46P (61% female) were included, with a mean age of 48 ± 23 years (minimum 8 months, maximum 86 years). Idiopathic AT was observed in 47,8%, while 52.2% had other relevant comorbidities (chronic pulmonary disease 17.4%; previous cardiac surgery 8,7%; congenital heart disease 10.9%; coronary artery disease 6.5%). Despite anti-arrhythmic therapy, daily palpitations were present in 87% of the cases and dizziness or syncope occurred in 22%). Nearly half (47.8%) had previously sought urgent medical care and 30.4% had a hospital admission due to arrhythmia. The clinical arrhythmia was documented in 34P (47.8% by 12-lead electrocardiography and 26.1% in 24h Holter monitoring). During the EP study a focal AT was documented in all P (spontaneously in 54.3% and induced with pacing maneuvers in 45.7%). AT origin after electroanatomical activation mapping is depicted in figure 1. After focal RF ablation, a second AT was induced in 16P (34.8%) and a new ablation was performed in 15 cases (93.8%). Total RF time was 508 ± 386 sec. One P developed right phrenic nerve palsy after ablation on the lateral wall of the right atrium. No other complications were noted. On follow-up (mean 320 ± 92 days), symptoms improved in 88.1% of the P, with a 3-fold decrease in urgent medical care visits and hospital admission for arrhythmia. Three P (8.7%) were submitted to a new EP study, in which an AT was documented and ablated in 2P.

Conclusion

AT is a very symptomatic arrhythmia, associated with increased usage of hospital resources and poor response to antiarrhythmic therapy. Ablation is an efficient treatment option, with a high success rate, low rate of complications and short-term clinical benefits. Abstract Figure. Distribution of focal atrial tachycardia
Low-fluoro workflows and impact in radiation exposure in the electrophysiology lab
Authors: Ferreira V , Portugal G , Cruz Coutinho M , Silva Cunha P , Valente B , Lousinha A , Castelo A , Garcia Bras P , Grazina A , Guerra C , Delgado A , Paulo M , Cruz Ferreira R , Oliveira M
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

 During electrophysiology (EP) procedures, fluoroscopy imaging is employed to visualise catheters position in real-time. However, ionizing radiation is a health hazard to both the patient and operator. In recent years, the use of electroanatomical mapping systems and operator adoption of low-fluoro workflows has allowed a reduction of radiation exposure. The aim of this study was to assess the evolution of fluoroscopy time (FT) in EP procedures, using conventional technique or an electroanatomical mapping system (EMS).

Methods

A retrospective analysis of consecutive EP procedures performed at a tertiary centre between September 2018 and October 2020 was conducted. The procedures were divided in 3 tertiles according to date (T1, T2 and T3), with T3 corresponding to the most recent interventions. Procedural duration, FT, use of EMS, radiofrequency time (RT), acute ablation success and procedural complications were examined.

Results

A total of 615 procedures were analysed: atrioventricular node reentry tachycardia (AVNRT) – n = 144, accessory pathways (AP) – n = 83, typical atrial flutter – n = 106, atrial fibrillation (AF) ablation with radiofrequency (RF) – n = 61, AF ablation with cryoballoon – n = 92, ablation of ventricular arrhythmias – n = 53, and 75 miscellaneous procedures (including atrioventricular node ablation, left atrial flutter ablation and cardioneuroablation). Mean age was 54.6 ± 18.2 years with 59.4% male sex patients. An EMS was used in 75% of the procedures, without significant differences between tertiles. A progressive reduction in median FT was observed over the tertiles (T1 6.3 min, interquartile range [IQR] 2.9-13.6; T2 5.4 min, IQR 2.1-12.0, and T3 3.1 min, IQR 1.2-7.2, Figure 1), and a statistical significant difference was found when comparing T1 to T3 (p < 0.001) and T2 to T3 (p < 0.001). The decrease in FT was observed throughout the study period for all different EP procedures (Figure 2). The number of procedures with zero fluoroscopy had gradually increased (T1 6.1%, T2 8.5% and T3 14.1%; T1 vs. T3 p <0.01). Younger patients (<20 years) were submitted to low fluoroscopy doses with a significant decrease over tertiles (T1 1.2 min, IQR 0.0-4.3; T2 0.9 min, IQR 0.0-2.5; T3 0.0, IQR 0.0-2.2, T1 vs.T3 p < 0.001). No significant difference in procedural duration, RT, acute procedural success or complication rate were noted between tertiles.

Conclusion

Reduction in radiation exposure can be achieved without compromising duration, safety and effectiveness of the procedure.  The commitment of operators to reduce radiation exposure using 3D mapping technology can lead to a significant decrease in the use of fluoroscopy. Abstract Figure. Fluoroscopic time analysis