bluuebunny/crossref_metadata_2025 huggingface dataset:
Left bundle branch pacing with normal paced QRS axis produce more physiological left ventricular lateral wall depolarization than its pacing resulting in heart axis deviation
Authors: Curila K , Jurak P , Jastrzebski M , Sussenbek O , Waldauf P , Halamek J , Stros P , Smisek R , Znojilova L , Plesinger F , Leinveber P , Viscor I , Herman D , Osmancik P
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health of the Czech Republic

Background

Left bundle branch pacing is defined as the pacing of the trunk or its proximal fascicles, usually with septal myocardial pacing at low output. It preserves physiological left ventricular activation; however, it is unknown if there is a difference between captures with normal or deviated axes and pacing in proximal vs. distal locations.

Objective

To study ventricular activation during nonselective LBB pacing (nsLBBp) resulting in different paced QRS axes and proximal vs. distal pacing positions using ultra-high-frequency ECG (UHF-ECG).

Methods

This was a retrospective analysis of patients with bradycardia in which nsLBBp was archived during an implant procedure, and UHF-ECG analysis of ventricular activation was performed. nsLBBp captures were classified according to paced QRS axis as with superior (-30°;-90°), normal (-29°;60°), or inferior (61°;120°) axis deviation and proximal (LBbpo to ventricular EGM signal distance ≥ 26 ms) vs. distal (LBBpo to ventricular EGM signal distance < 26 ms). UHF-ECG electrical dyssynchrony parameters – e-DYS (difference between the first and last ventricular activation), local depolarization durations in precordial leads (V1-V8d), and their mean value (Vdmean) were calculated.

Results

We have studied 79 nsLBBp, of which 35 had superior, 28 normal, and 16 had inferior paced QRS axes. There was no difference in LBBpo to V distance, QRSduration, V5 RWPT, or e-DYS (-27 ms vs. – 22 ms vs. -25 ms for superior vs. normal vs. inferior axes; p = NS) between them. However, nsLBBp with normal paced QRS axis had shorter Vdmean (43 ±6 ms) compared to captures with superior (48 ± 7 ms) and inferior axis deviation (48 ± 6 ms); p < 0.05. It was mainly due to shorter V7-8d during nsLBBp with normal axis (mean difference of - 10 ms; p < 0.05) than in captures with superior or inferior axes. No difference in any of the studied parameters was noted when comparing proximal vs. distal pacing locations.

Conclusion

Nonselective capture of the left bundle branch resulting in normal paced QRS axis produces more physiological LV activation compared to captures with superior or inferior axes deviations.
Pacemaker upgrade to Cardiac Resynchronization Therapy-defibrillator or Cardiac Resynchronization Therapy-pacemaker without prior ventricular arrhythmias
Authors: Schwertner W R , Tokodi M , Behon A , Veres B , Merkel E , Kuthi L , Masszi R , Kovacs A , Zima E , Geller L , Osztheimer I , Kosztin A , Merkely B
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the ÚNKP-21-3-II-SE-47, ÚNKP-20-3-I-SE-43 New National Excellence Program if the Ministry for Innovation and Technology in Hungary. Project no. NVKP_16-1–2016-0017 (’National Heart Program’) has been implemented with the support provided by the National Research, Development and Innovation Fund of Hungary, funded under the NVKP_16 funding scheme. The research was financed by the Thematic Excellence Programme (2020-4.1.1.-TKP2020) of the Ministry for Innovation and Technology in Hungary, within the framework of the Therapeutic Development and Bioimaging thematic programmes of the Semmelweis University. This work was also supported by the Semmelweis 250+ Excellence PhD Scholarship (EFOP-3.6.3-VEKOP-16-2017-00009).

Background

Cardiac Resynchronization Therapy (CRT) can reverse the harmful effects of right ventricular pacing (RVP). Data are scarce on comparing long-term survival among patients who undergone CRT-defibrillator (CRT-D) or CRT-pacemaker (CRT-P) upgrade from pacemakers (PM) without prior ventricular arrhythmias (VAs).

Purpose

We compared the differences in long-term all-cause mortality among PM patients receiving CRT-D or CRT-P upgrade.

Methods

Patients with conventional PMs developing heart failure despite optimal medical treatment and a high rate of RVP with no prior VAs were included. Altogether 326 patients were investigated, 117 (36%) upgraded to CRT-D, 209 (64%) to CRT-P in our retrospective registry. The primary endpoint was all-cause mortality. Subgroup analyses were performed by comorbidities and CRT device types. Using topological data analysis, we identified risk groups based on the primary endpoint.

Results

During the median follow-up time of 3.6 years, 33 (28%) CRT-D and 145 (69%) of CRT-P upgrade patients reached the primary endpoint. The CRT-D upgrade group showed a lower risk of all-cause mortality in the total cohort (HR: 0.55; 95% CI: 0.38-0.81; p=0.002) and by ischaemic aetiology (HR: 0.47; 95% CI: 0.29-0.76; p=0.002) compared to CRT-P. After adjustment, CRT-D, male gender and loop diuretics proved as independent predictors of all-cause mortality. Patients upgraded with CRT-D demonstrated favourable survival in the high-risk group over CRT-P.

Conclusions

Patients had survival benefit after CRT-D upgrade, compared to CRT-P, in the high-risk group and with ischaemic heart failre aetiology. However, no difference could be observed between the two groups among low- and intermediate-risk patients.
Improvement in ECG parameters predictive of sudden death in patients with ventricular dysfunction and left bundle branch block after cardiac resynchronization through His Bundle pacing
Authors: Lopez-Masjuan Rios A , Esteve-Ruiz I , Moraleda Salas M , Arce-Leon A , Venegas-Gamero J , Fernandez-Gomez JM , Morina-Vazquez P
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Electrocardiographic (ECG) parameters predictive of sudden death have been described in patients with ventricular dysfunction. Cardiac resynchronization therapy (CRT) in patients with left bundle branch block (LBBB), in addition to improve the left ventricular ejection fraction (LVEF), can correct part of them, which could have an important impact prognostic at follow-up. Repolarization changes in patients resynchronized via permanent His Bundle pacing (p-HBP) have not been described yet.

Methods

We designed a prospective descriptive study of patients with LBBB and CRT indication proposed for CRT by p-HBP. We analyzed different ECG patterns of sudden death (QT interval, corrected QT interval, QT interval dispersion, Tpeak-Tend, Tpeak-Tend dispersion, Tp-Te/QT ratio, rdT / JT index, T wave voltage, T wave duration) and the changes of them at 6-month follow-up after His resynchronization.

Results

We included 21 patients (57.1% male, 70 [63.5-80] years). 90.5% had hypertension, 57.1% diabetes mellitus and 66.7% dyslipidemia. 90.5% had structural heart disease (median LVEF 38 [30-52.5] %); 52.9 % had non-ischemic cardiomyopathy, being the principal cause of the dysfunction in these patients the dyssynchronipathy caused by LBBB. Other causes of cardiomyopathy were hypertensive cardiomyopathy (5.9%), valvulopathy (11.8%) and pacing induced cardiomyopathy (11.8%). 66.7% were resynchronized with dual chamber pacemakers, 28.6% with tricameral defibrillator and 4.8% with tricameral pacemaker. ECG parameters predictive of sudden death basally and at 6-month follow-up are summarized in table 1. All predictors improved in the follow-up with statically significant differences. Fig 1 shows basal (A) and 6-month follow-up (B) changes in repolarization parameters.

Conclusion

There is an improvement in the ECG parameters predictive of sudden death in patients with LBBB resynchronized via p-HBP. CRT through p-HBP could improve the risk of sudden death.
The patient perspective on remote monitoring of cardiac devices: a german patient survey
Authors: Hillmann HAK , Hansen C , Przibille O , Duncker D
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Current guidelines recommend remote monitoring for patients with implanted cardiac devices. Nevertheless, data regarding patients’ attitude using remote monitoring is lacking. This study aims to analyze the patient perspective on remote monitoring of cardiac devices in Germany.

Methods

Patients with an implanted cardiac device and remote monitoring (continuous device follow-up and remote device follow-up) of all current manufacturers in three German centers were asked to participate in the study filling in a patient questionnaire between 07-11/2021. The questionnaire consisted of 37 questions regarding patient’s baseline characteristics, individual use and judgement on remote monitoring, as well as the patient’s opinion regarding future remote monitoring perspectives. Survey participation was anonymous and on a voluntary basis.

Results

617 patients (28.4 % women) out of three cardiac centers in Germany participated. Implanted cardiac devices were pacemakers ± cardiac resynchronization therapy (CRT) (11.9%), implantable defibrillators ± CRT (70.3%) and implantable loop recorders (17.8%). Technical problems with remote monitoring transmitter were reported to occur: never (60.3%), seldomly (25.5%), sometimes (12.0%) and all the time (2.2%). The majority of patients (84.9%) take part in remote monitoring without the help of others. After starting remote monitoring, patients reported a significant prolongation of the intervals (p<0.001) of their in-person follow-up visits (figure 1). 44.0% of the participating patients answered to have a better, 1.2% a worse and 54.8% an equal disease management since participating in remote monitoring. Regarding possible future perspectives using remote monitoring, 73.0% patients answered to own a smartphone. 48.3% of the patients would prefer a smartphone-based application for remote monitoring. 15.0% had no opinion on that question, whereas 36.7% would prefer the use of a transmitter in their bedroom.

Conclusion

In this patient survey, remote monitoring was a widely accepted tool for patients with implanted cardiac devices. Patients perceive an improvement of their disease management through telemonitoring. Furthermore, patients answered that intervals of outpatient visits could be prolonged by the use of remote monitoring. Most patients would appreciate a smartphone-based remote monitoring of their cardiac device.
Lead extraction with the "pisa technique" - experience of a portuguese tertiary care center
Authors: Dias Ferreira Reis JP , Valente B , Portugal G , Lousinha A , Silva Cunha P , Oliveira M , Cruz Ferreira R
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The "Pisa Technique" (PT) is an increasingly used method of lead extraction (LE) that has shown excellent results in terms of clinical (Cs) and radiological success (Rs) associated with the lowest rate of complications reported in ELECTRa Registry.

Purpose

To characterize the adult population submitted to LE with the PT and evaluate its short-term results.

Methods

A single-center prospective study of consecutive procedures (P) of LE using the PT between February 2013 and October 2019. Demographic, clinical, and P related variables, mortality (M) and reimplantation (R) data were assessed.

Results

320 electrodes (E) were removed in a total of 171 Ps and 159 patients (pts). 80.7% of these P’s were due to CIED infection (55.1% due to pocket site infection, 18.8% to occult bacteremia with probable CIED infection and 26.1% due to both local and systemic infection, with 44% of pts presenting with valvular/ lead vegetation) and the remainder due to E dysfunction or venous occlusion. Pts averaged 67.7 years of age, 71.9% were male with a mean left ventricular ejection fraction of 47.8%.

19.3% presented coronary artery disease, 42.1% overt heart failure and 43.9% atrial fibrillation. 29 pts had cardiac resynchronization devices, 20 pts implantable cardioverter-defibrillator devices and 110 pts pacemaker systems (mostly DDD). The mean "age" of the extracted E’s was 83.2 months, 244 of which were atrial or ventricular pacing, 26 pacing E’s via the coronary sinus and 50 shock E’s. In 31.0% of the cases, the E’s were of active fixation, with 42.7% of the pts being pacing dependent. 14% of pts had a previous attempt of LE, 37.4% had already been submitted to generator replacement and a third to CIED upgrade. In 66.7% of pts, a new contralateral CIED was implanted during the hospital stay - H -(mean time for R of 6 days) and in 19% of R’s an antibacterial envelope was used. The Rs and Cs rates were 91.2% and 98.3%, respectively. There was 1 case of cardiac tamponade during LE, which was stabilized by pericardiocentesis and 2 pocket site hematomas requiring surgical drainage. There were no deaths during the P. During a mean follow-up (FU) of 33 months, 11 pts had to undergo a new P, 5 of them due to pocket reinfections. The M rate during FU was 24.2% (37 pts), with 8 pts (5.0%) dying during H, mostly due to septic shock, and 19 pts during the first year post-P.

Conclusion

Our center’s experience with the PT confirms the method’s high efficacy and safety in the percutaneous extraction of E’s in pts with CIED.
Risk factors of mortality after secondary procedures during the world-wide randomized antibiotic envelope infection prevention trial (WRAP-IT)
Authors: Mittal S , Poole J , Kennergren C , Birgersdotter-Green U , Lustgarten DL , Tomassoni GF , Hilleren G , Lande J , Lensing C , Wilkoff B , Tarakji K
Published: May 2022

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Medtronic

Background

Previous analysis of WRAP-IT (World-wide Randomized Antibiotic Envelope Infection Prevention trial) data identified both patient and procedural characteristics as risk factors for cardiac implantable electronic device (CIED) infection. In the current analysis, we sought to similarly use prospectively collected WRAP-IT data to assess risk factors of all-cause mortality. Understanding if mortality risk can be modified and identifying baseline characteristics associated with high risk can help guide physician decision making.

Purpose

To identify modifiable and non-modifiable risk factors for 1-year all-cause mortality after a secondary (replacement, revision, or upgrade) CIED procedure.

Methods

This analysis included 5,461 secondary procedure patients from the WRAP-IT study. Included as candidate factors were patient and procedural characteristics. Patients with more than one year follow-up were censored at one year. A multivariate Cox Proportional Hazards model was reached by stepwise selection to minimize Akaike Information Criterion.

Results

The overall one-year mortality rate was 5.2% after secondary procedures. Of the 26 patient and 18 procedural characteristics analyzed, the following variables best predicted risk of a 1-year all-cause mortality: age, NYHA class, renal dysfunction, anticoagulant use, ischemic cardiomyopathy, diabetes, BMI, procedure time, myocardial infarction, valve surgery, and hypertrophic cardiomyopathy (Table).

Conclusion

In WRAP-IT patients undergoing secondary procedures, the only procedure characteristics that had any association with all-cause 1-year mortality risk was procedure time suggesting that most of the risk factors of mortality are non-modifiable. Baseline patient characteristics and co-morbidities were the principal risk factors of all-cause 1-year mortality. Specifically, increasing age, NYHA class, and a history of renal dysfunction were strongly associated with mortality.
Studying the relation between post-infarction ventricular arrhythmia and left ventricular myocardium thinning on computed tomography images using explainable deep learning
Authors: Ly B , Finsterbach S , Nunez Garcia M , Bacoyannis T , Cedilnik N , Sridi S , Jais P , Sermesant M , Cochet H
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): National Research Agency, 3IA Côte d’Azur (ANR-19-P3IA-0002),

IHU Liryc (ANR- 10-IAHU-04)

Background

Infarct heterogeneity plays a critical role in the development of scar-related ventricular arrhythmias (VA). Wall thickness (WT) from CT was shown to correlate with arrhythmogenic sites in the context of ablation.

Purpose

To analyze the relationship between WT distribution and the presence VAs in patients with history of myocardial infarction (MI).

Methods

From 2010 to 2020, we retrospectively included consecutive patients who underwent CT more than 1 year after MI.Automated LV wall segmentation, reorientation, WT computation and flattening methods were applied to obtain 2D WT bullseye maps.The population was divided into a training set (3/4) and a testing set (1/4). On the training set, a conditional variational autoencoder (CVAE) model was trained to encode the WT map in its latent representation,which was then used by a classifier model to predict VA. For each prediction, a gradient back-projection method was used to generate attention maps highlighting the bullseye region most influential in the model’s decision. The ability of the trained CVAE to identify patients with VA was then assessed on the test population, and compared to that of other clinical variables (age, gender, LVEF, scar size).

Results

641 patients were included (age 73±7 years, 83% males, LVEF 46±10%), including 166 (26%) with history of VA. From original CT images, automated processing methods allowed for the obtention of a WT bullseye, a VA prediction and an attention map in less than 2 min. On the testing population, univariable correlates of VA were LVEF (P<0.001), scar size defined as WT area (P<0.001), CVAE prediction (P<0.001), and male gender (P=0.007). Multivariable analysis identified CVAE prediction and male gender as independent VA correlates (P<0.001 and P=0.01, R2=0.364), while LVEF and scar size were not (P=0.052 and P=0.60). The CVAE model identified patients with VA with a sensitivity/specificity of 0.87/0.74. The analysis of attention maps confirmed that the CVAE actually used the MI region to predict VA, and showed that the CVAE was filtering out areas of physiological WT, thereby outperforming simple WT thresholding.

Conclusions

Fully automated analysis of WT from CT images is feasible in patients with MI, and allows for the extraction of robust markers of VA, outperforming conventional risk stratifiers
The effect of sacubitril/valsartan on device detected heart failure status
Authors: Giordano F , Striuli L , Pollina AV , Mumoli N , Spaziani D
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Sacubitril/Valsartan (S/V) improves survival in symptomatic patients with heart failure with reduced ejection function (HFrEF) when compared to standard treatment guidelines. The mechanism by which S/V further reduces mortality is not utterly clear: a favorable left ventricular reverse remodeling connected with a reduction of the arrhythmic burden, seems to play a key role in this setting. The HeartLogic multiparametric algorithm combines multiple cardioverter-defibrillator sensor and has emerged as a powerful and well-validated tool to follow patients with HF.

Purpose

To evaluate the effect of S/V on a device based algorithm to predict heart failure (HeartLogic) in HFrEF patients with an implantable cardioverter-defibrillator (ICD).

Methods

ICD patients with HFrEF and with at least an HeartLogic alert (HL index >16) were enrolled in this single-centre prospective observational study. S/V was added on top of medical therapy. All patients underwent device interrogation at baseline, before S/V administration, and at 12 months follow-up. Serum levels of NT-proBNP (pg/mL) were measured at baseline and at follow-up. The primary endpoint was the number of HeartLogic alerts after 12 months from the beginning of S/V. The secondary endpoint was the total number of ventricular arrhythmias recorded on the ICD controls.

Results

36 ICD patients (83% male, age 69±6) with HFrEF (LVEF ≤ 35%) and at least an HL alert, were consecutively enrolled and treated with S/V on top of standard therapy. At 12 months follow-up, HeartLogic alerts were significantly reduced (HL 38 vs 24; p=0,024) consistently with the reduction in NT-proBNP serum levels (2358 vs 1134 pg/mL; p=0,019). Both sustained and nonsustained ventricular tachycardia episodes decreased (3 vs 0.7; p =0,05 and 15.7 vs 2.2; p=0,04) irrespective of S/V dose.

Conclusion

The administration of S/V effectively reduced HeartLogic index and NT-proBNP values supporting the favourable impact of this drug in HFrEF patients. The results confirm the reliability of HeartLogic algorithm for heart failure management. Thus, an alert-based follow-up approach can be used for therapy optimization in this population.
Clinical validation of automated QTc measurements from single lead ECG using a novel smartwatch
Authors: Mannhart D , Hennings EH , Lischer ML , Vernier CV , Du Fay De Lavallaz JDF , Knecht SK , Schaer BS , Osswald SO , Kuehne MK , Sticherling CS , Badertscher PB
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

A possible side-effect of various medical drugs is prolongation of the electric repolarization of the heart, measured as the corrected QT-interval (QTc). Patients treated with these drugs should be monitored frequently via an ECG to screen for early changes indicating possible life-threating arrythmias. Especially during the Covid-19 pandemic, remote patient monitoring gained importance. The Withings Scanwatch offers automated analysis of the QTc remotely, thereby obviating the need for in-person visits. We aimed to compare automated QTc-measurements using a single lead ECG (SL-ECG) of a novel smartwatch (Withings Scanwatch, SW-ECG) with manual-measured QTc from a nearly simultaneously recorded standard 12-lead ECG.

Methods

We enrolled consecutive patients referred to a tertiary hospital for cardiac workup in a prospective, observational study. To obtain a SW-ECG, patients were instructed to keep their index finger on the stainless steel ring on the top case of the smartwatch continuously for 30 seconds The QT-interval was manually interpreted by two blinded, independent cardiologists through the tangent-method, using lead II or V5/V6. Bazett’s formula was used to calculate QTc.

Results

We prospectively enrolled 317 patients (48% female, mean age 63.3 ± 17.2 years). The smartwatch was able to automatically measure QTc-intervals in 177 patients (56%). The diagnostic accuracy of SW-ECG for detection of a QTc-interval ≥ 460ms as quantified by the area under the curve (AUC) was 0.91 (95%CI 86.4-95.9). The Bland-Altman analysis resulted in a bias of 6.6ms (95% limit of agreement (LoA) –58.6ms to 71.9ms) comparing automated QTc measurements via SW-ECG with manual QTc-measurement via 12-lead ECG (Figure 1). In 12 patients (6.9%) the difference between the two measurements was greater than the LoA. Premature ventricular complexes, noise or differences in heart rate were responsible in 8.3%, 83.0% and 8.3%, respectively, for observed outliers.

Conclusion

In this clinical validation of a direct-to-consumer smartwatch we found fair to good agreement between automated-SW-ECG QTc-measurements and manual 12-lead-QTc measurements. The SW-ECG, however, was only able to automatically calculate QTc-intervals in one half of all assessed patients. Our work shows, that the automated algorithm of the SW-ECG needs to be improved to be useful in a clinical setting.
Clinical validation of a novel smartwatch for automated detection of atrial fibrillation
Authors: Badertscher P , Lischer M , Mannhart D , Knecht S , Isenegger C , Du Fay De Lavallaz J , Spiess F , Schaer B , Osswald S , Kuehne M , Sticherling C
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

The Withings Scanwatch is a novel smartwatch able to record an intelligent (i)ECG with automated detection of AF. While the iECG function from three major manufacturers have been extensively investigated, there is a paucity of data regarding the performance of the iECG function of the Withings Scanwatch.

Methods

We performed a prospective, observational study enrolling consecutive patients presenting to a cardiology service at a tertiary referral center. The aim was to assess the diagnostic performance of the iECG function of the Withings Scanwatch to detect AF compared to a simultaneously acquired cardiologist-interpreted 12-lead ECG. All iECG rhythm strips and 12-lead ECGs were anonymized and distributed to two blinded cardiologists who independently interpreted each tracing and assigned a diagnosis of sinus rhythm, AF or unclassified.

Results

iECGs and 12-lead ECGs were simultaneously recorded in 319 patients (67 yo (IQR 54-76), 48% female, Figure 1). Using the automated algorithm, rhythm was deemed inconclusive in 44 patients (14%). Overall, AF was present in 34 patients (11%). Among the tracings where the algorithm provided a diagnosis, it correctly identified AF with 76% (95%CI 55-91%) sensitivity, 99% (95%CI 97-100%) specificity, and a Kappa (K) coefficient of 0.72 when compared with cardiologist-interpreted 12-lead ECGs. Among patients in sinus rhythm, 3 were labeled AF (false-positive). From the 44 unclassified recordings, blinded cardiologists were able to correctly diagnose AF with 100% (95%CI 59-100%) sensitivity, 93% (95%CI 77-99%) specificity, and a K coefficient of 0.49. A total of 13 iECG recordings (4.1%) were determined to be noninterpretable by the cardiologists. Of the remaining 306 patients with simultaneous recordings, cardiologist interpretation of the iECG tracings demonstrated 97% (95%CI 84-100%) sensitivity, 99% (95%CI 96-100%) specificity and a K coefficient of 0.75.

Conclusion

Automatic rhythm classification was inferior to manual interpretation of iECGs. We found a lower sensitivity for the detection of AF using the Withings iECG function compared to data published on other devices. Cardiologist-iECG interpretation, however, was highly reliable with a diagnostic accuracy of 98% (95%CI 96-100%). Clinical interpretation of iECG readings by a cardiologist is therefore strongly encouraged
A webbased intervention for patients with an implantable cardioverter defibrillator, a qualitative study of nurses experiences
Authors: Helmark C , Egholm CL , Rottmann N , Skovbakke SJ , Johansen JB , Nielsen JC , Larroude CE , Riahi S , Brandt CJ , Pedersen SS
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Implantable cardioverter defibrillator (ICD) therapy is the gold standard for prevention of sudden cardiac death. Patients generally adapt well to living with an ICD, but 20% have difficulties adjusting, with increased risk of anxiety and depression and decreased quality of life. New web-based interventions engaging patients with an ICD might be efficient, but there is sparse knowledge on experiences with web-based care from the perspective of cardiac nurses.

Purpose

The aim of the study was to explore cardiac nurses’ experiences with a web-based intervention designed to empower patients with an ICD.

Methods

We conducted a qualitative study based on semi-structured interviews. The informants (n=9) were experienced cardiac nurses across 5 Danish university hospitals. They were delivering a comprehensive web-based intervention for patients with an ICD, including patient education, chats, monitoring of anxiety and depression and a patient forum. The intervention was tested in a randomized controlled trial. The interviews were transcribed verbatim, coded and analyzed using qualitative content analysis with NVivo software.

Results

We identified an overall theme: "Between traditional nursing and modern eHealth". The theme emerged from six categories, each covering three or four subcategories (Figure 1). The categories were: (1) comprehensive intervention, (2) patient-related differences in engagement, (3) following the protocol is a balancing act, (4) online communication challenges patient contact, (5) professional collaboration varies, and (6) an intervention with potential. Cardiac nurses were in general positive towards the concept of this web-based intervention and believe it holds a large potential. On the other hand, they were challenged by not establishing a personal relation and by losing face-to-face contact with patients, which they found valuable for getting a feeling for patients’ wellbeing and potential mental health issues. Ensuring face-to-face contact by either starting the intervention with a personal contact or including the possibility of video contacts might enhance the value of web-based interventions from the perspective of cardiac nurses. The nurses found the intervention especially suitable for patients who had suffered a cardiac arrest.

Conclusion

Specific training in eHealth communication is necessary as web-based care entails a shift in nursing role and a new format of communication for cardiac nurses. Future evaluations of web-based cardiac rehabilitation interventions in clinical practice are needed to assess the potential impact in "real-life" cardiac care.
Remote device monitoring shows long-term survival benefit in a propensity matched study of ICD patients
Authors: Kolk MZH , Tjong FVY , Knops RE
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Remote monitoring (RM) for implantable cardioverter defibrillators (ICDs) enables early detection of clinical events and reduces inappropriate shocks. However, although RM has been associated with improved clinical outcomes at short to medium-term follow-up, data on long-term survival benefit of RM is currently lacking.

Purpose

To investigate long-term survival of patients using RM and compare this to a propensity score matched non-RM group.

Methods

This is a retrospective, observational single-center analysis of patients ≥18 years old implanted with an ICD (single- and dual chamber, biventricular or subcutaneous ICDs) between 1995 and 2021. Data was extracted from the electronic health records. Patients were included in the RM group only if they were started on RM at some point during follow-up. To adjust for differences in baseline characteristics between RM and non-RM patients, propensity score matching was performed in a 1:1 fashion (caliper 0.20) using greedy matching. Estimation of the propensity score was done using logistic regression with RM as the outcome variable, adjusting for 17 covariates (age, gender, year of device implant, type of device, clinical variables and medication at baseline). Time-to-event analysis was performed using Kaplan Meier survival analysis, with significance indicated using a log rank P value. Hazard ratios and 95% confidence intervals (CI) were calculated using a Cox proportional-hazards model.

Results

A total of 3199 ICD patients were included in this analysis. After propensity score matching for the probability of RM use, 1160 RM patients and 1160 non-RM patients with similar baseline characteristics were selected (mean age 59.1 ±14.8 years, 72.8% male). During a mean follow-up duration of 8.1 ±5.2 years, 363 (31.3%) patients died in the non-RM group and 111 (9.6%) patients died in the RM group (log rank p<0.001, Figure 1). The hazard ratio of RM for mortality was 0.261 (95 CI% 0.211 – 0.323, p=0.001).

Conclusion

Long-term retrospective analysis indicates a significant survival benefit in ICD patients using RM.
Myeloperoxidase as prognostic factor for atrial fibrillation development in patients with ST-segment elevation myocardial infarction
Authors: Rodionova I , Kutya INNA , Hilova Y , Samburg Y , Godlevskaya OLGA , Tytarenko N
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Arrhythmia is among the most common and severe myocardial infarction complications. Myeloperoxidase as an important immune factor can be linked to atrial fibrillation (AF) development. Previous studies indicated myeloperoxidase (MPO) as a significant mortality predictor in ST-segment elevation myocardial infarction (STEMI). The MPO role in prognosis for adverse clinical outcomes, as atrial fibrillations in STEMI patients remains not fully understood.

The purpose of the investigation was to examine the MPO in prognosis of adverse outcomes presented by atrial fibrillations in patients with STEMI.

Methods

The study included 233 STEMI patients, 112 males, 121 females, and average age 67.87±7.11 years. Follow-up period was 14 days. Adverse outcome was observed and included atrial fibrillations. Plasma MPO levels were determined by ELISA, MPO was collected on admission.

Results

Patients with indicated adverse effects showed significantly increased MPO levels compared to those without ones, 169.91 IQR [89.45; 201.98] ng/ml vs 81.4 [33.91;181.29] ng/ml; p < 0.001. A ROC analysis determined a MPO cut-off value for arrhythmia (AF) development of 176.53 ng/ml with a sensitivity of 71.1% and specificity of 77.6%, AUC 0.732; 95 % CI 0.677-0.782; p <0.001. Elevated MPO concentration was a significant predictor for AF (OR 1.115; 95% CI: 1.007-1.841; p<0.001). Even adjusted for age and sex MPO remained significantly predictive for arrhythmia development.

Conclusions

The study suggests that increased levels of MPO are associated with the higher risk of atrial fibrillation. MPO could be a possible significant factor for therapy optimization in high-risk STEMI patients.
Increased 18F-fluorodeoxyglucose uptake in the cardiac atria: an evidence for increased atrial inflammation in patients with atrial fibrillation?
Authors: Nakamura O , Goetz C , Meyer P T , Arentz T , Jadidi A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial inflammation and fibrotic remodelling underlie the pathophysiology of atrial cardiomyopathy, which is associated with the development of atrial fibrillation (AF) and atrial flutter (AFL). 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) has been used to detect inflammatory processes. Recent studies have revealed an increased FDG-uptake in the atria of patients with AF, but also in patients with diagnosis of cardiac sarcoidosis with ventricular inflammation.

Purpose

This study aimed to assess the capability of PET/CT to detect and quantify the degree of atrial inflammation (FDG-uptake) in a population with dedicated cardiac FDG-PET/CT.

Methods

We investigated 101 patients suspected of sarcoidosis (57±12 years, 72% male) who underwent 18F-FDG PET/CT scan with dedicated cardiac specific preparation (heparin infusion, 12 hours fasting, and high-fat low-carbohydrate diet). We excluded patients with active ventricular cardiac sarcoidosis or undergoing high-dose immunosuppressive therapy (prednisolone ≥20mg/day or prednisolone combined with other immunotherapy like methotrexate). We measured the maximum standardized uptake value (SUVmax) in atrial myocardium and mean standardized uptake value (SUVmean) in blood pool and calculated the target-to-background ratio (TBR) of SUVmax in atrial myocardium to SUVmean in blood pool. All medical records, ECG data on arrhythmia type and diagnosis of systemic sarcoidosis (with absence of ventricular involvement) were used for the analysis. Sarcoidosis was diagnosed based on the criteria established in 2006 by the Japanese Ministry of Health and Welfare. The collected data were sorted according to presence of arrhythmia and systemic sarcoidosis and TBR of each group were compared.

Results

AF or AFL was found in 30/101 patients. Systemic sarcoidosis was found in 37/101 patients. Patients with known AF/AFL had significantly increased TBR within the atrial tissue compared to those without AF/AFL: (median: 1.26, 1st-3rd quartile: 1.20-1.33) versus (median: 1.22, 1st-3rd quartile: 1.14-1.25; p = 0.004; figure A). Arrhythmia-associated atrial inflammation was consistently observed, independently of presence of concomitant systemic sarcoidosis (figure B). Patients with both atrial arrhythmias and systemic sarcoidosis had the highest atrial inflammation level, as identified by TBR (figure B).

Conclusion

Development of atrial fibrillation or flutter is associated with an increased atrial FDG-uptake as metabolic marker of atrial inflammation. The level of atrial inflammation is further enhanced by additional presence of systemic sarcoidosis.
The COVID-19 viral 3a protein forms a potassium channel that can be inhibited by antiarrhythmic drugs
Authors: Wiedmann F , Boondej E , Stanifer M , Paasche A , Kraft M , Seeger T , Uhrig U , Frey N , Boulant S , Schmidt C
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Deutsche Gesellschaft für Kardiologie /German Cardiac Society Joachim Herz Stiftung /Joachim Herz Foundation

Background/Introduction

Supraventricular and ventricular arrhythmias can often be observed in patients with COVID-19 infection. Both, the clinically observed increase in cardiac biomarkers as well as histological studies indicate virus replication within cardiomyocytes. The 3a open reading frame of the viral genome encodes for a transmembrane protein that is transported to the cell membrane where it can serve as a potassium channel.

Purpose

The aim of this study was to investigate whether COVID-19 infected induced pluripotent stem cell (iPSC)-derived cardiomyocytes also express the 3a protein and whether the potassium currents that are conducted through the 3a protein can be inhibited by clinically used antiarrhythmic drugs.

Methods and Results

iPSC-derived cardiomyocytes were infected with COVID-19 and subsequently subjected to immunoblotting, where expression of the 3a protein could be observed. Plasmid DNA, encoding the COVID-19 3a protein, was generated by gene synthesis and used for in vitro transcription of cRNA. 3–5 days after intracytoplasmic injection of the 3a protein cRNA into Xenopus laevis oocytes, potassium currents could be measured by two-electrode voltage clamp recordings. While class I and class IV antiarrhythmic drugs showed only minor effects on the potassium currents of the 3a protein, a robust inhibition by several beta-blockers and by class III antiarrhythmic drugs could be observed. The strongest effects were found with dofetilide (58.1 % inhibition at 100 µM) and amiodarone (50.1 % inhibition at 100 µM, IC50 level 4.7 µM). An in silico docking analysis, based on the recently revealed crystal structure of the 3a protein, identified the amino acid residues K61 and D142 as part of the binding site of amiodarone. After deactivation of these amino acid residues by site-directed mutagenesis, the inhibition by amiodarone was significantly attenuated.

Conclusion

The COVID-19 viral 3a protein is expressed in COVID-19-infected iPS-derived cardiomyocytes and forms a potassium channel that can be inhibited by antiarrhythmic drugs.
Using a Factorial Survey to Estimate the Relative Importance of Well-Being Dimensions According to Older People: Insights From a Repeated Survey Experiment in Flanders
Authors: Van Loon Veerle , Decancq Koen
Published: May 2022

Background and Objectives

Although it has become standard to include the views of older people when assessing their well-being, most existing methods are ill-suited to estimate the relative importance of well-being dimensions. This article investigates the potential of the factorial survey method to estimate the relative importance of six well-being dimensions (health, income, social relations, leisure, engaging activities, and religion) based on the views of older people themselves.

Research Design and Methods

We implemented a factorial survey in a repeated survey experiment among 800 older adults in Flanders (the Dutch-speaking northern part of Belgium). We performed several within-sample test–retests to investigate the consistency of the estimated coefficients over time (i.e., temporal reliability). In addition, we tested the feasibility of the factorial survey by studying two indicators of cognitive load: response time and response consistency.

Results

We estimated the relative importance of increases in six well-being dimensions. Increases from the lowest level to the highest level in the dimensions of health, income, and social relations had the highest effect on well-being—followed by leisure, engaging activities, and religion. The results proved to be consistent in most of the test–retest analyses. Furthermore, we found that respondents produced a high level of response consistency within an acceptable amount of response time.

Discussion and Implications

The findings suggest that the factorial survey method offers a promising way forward to elicit older people’s views on well-being and, hence, in developing tailored policies that matter to them.
Gut Microbial Ecology of Five Species of Sympatric Desert Rodents in Relation to Herbivorous and Insectivorous Feeding Strategies
Authors: Kohl Kevin D , Dieppa-Colón Etan , Goyco-Blas José , Peralta-Martínez Karen , Scafidi Luke , Shah Sarth , Zawacki Emma , Barts Nick , Ahn Young , Hedayati Stefanie , Secor Stephen M , Rowe Matthew P
Published: May 2022

The gut microbial communities of mammals provide numerous benefits to their hosts. However, given the recent development of the microbiome field, we still lack a thorough understanding of the variety of ecological and evolutionary factors that structure these communities across species. Metabarcoding is a powerful technique that allows for multiple microbial ecology questions to be investigated simultaneously. Here, we employed DNA metabarcoding techniques, predictive metagenomics, and culture-dependent techniques to inventory the gut microbial communities of several species of rodent collected from the same environment that employ different natural feeding strategies [granivorous pocket mice (Chaetodipus penicillatus); granivorous kangaroo rats (Dipodomys merriami); herbivorous woodrats (Neotoma albigula); omnivorous cactus mice (Peromyscus eremicus); and insectivorous grasshopper mice (Onychomys torridus)]. Of particular interest were shifts in gut microbial communities in rodent species with herbivorous and insectivorous diets, given the high amounts of indigestible fibers and chitinous exoskeleton in these diets, respectively. We found that herbivorous woodrats harbored the greatest microbial diversity. Granivorous pocket mice and kangaroo rats had the highest abundances of the genus Ruminococcus and highest predicted abundances of genes related to the digestion of fiber, representing potential adaptations in these species to the fiber content of seeds and the limitations to digestion given their small body size. Insectivorous grasshopper mice exhibited the greatest inter-individual variation in the membership of their microbiomes, and also exhibited the highest predicted abundances of chitin-degrading genes. Culture-based approaches identified 178 microbial isolates (primarily Bacillus and Enterococcus), with some capable of degrading cellulose and chitin. We observed several instances of strain-level diversity in these metabolic capabilities across isolates, somewhat highlighting the limitations and hidden diversity underlying DNA metabarcoding techniques. However, these methods offer power in allowing the investigation of several questions concurrently, thus enhancing our understanding of gut microbial ecology.
Epidemiology of falls in 25 Australian residential aged care facilities: a retrospective longitudinal cohort study using routinely collected data
Authors: Wabe Nasir , Seaman Karla L , Nguyen Amy D , Siette Joyce , Raban Magdalena Z , Hibbert Peter , Close Jacqueline C T , Lord Stephen R , Westbrook Johanna I
Published: May 2022

Background

Falls are frequent among older adults and have significant health and economic consequences. There have been few studies on the epidemiology of falls in residential aged care facilities (RACFs).

Objective

To determine the incidence of falls in RACFs using longitudinal routinely collected incident data over 5 years (July 2014–December 2019).

Methods

A retrospective cohort study is conducted using fall incident data from 25 RACFs in Sydney, NSW, Australia. Incidents relating to a population of 6163 aged care residents aged ≥65 years were included. Outcome measures were incidents of all falls, injurious falls and falls requiring hospitalization. The risk-adjusted incidence rate (IR) for each outcome indicator for each of the 25 facilities was calculated.

Results

A total of 27 878 falls were reported over 3 906 772 resident days (a crude rate of 7.14 incidents per 1000 resident days; 95% confidence interval (CI) 6.81–7.48). Of these, 10 365 (37.2%) were injurious and 2733 (9.8%) required hospitalization. The crude IRs were 2.65 incidents per 1000 resident days (95% CI 2.53–2.78) for injurious falls and 0.70 incidents per 1000 resident days (95% CI 0.66–0.74) for falls requiring hospitalization. The incidence of falls was significantly higher in respite compared to permanent residents for all falls (adjusted IR ratio (aIRR) 1.33; 95% CI 1.18–1.51) and injurious falls (aIRR 1.30; 95% CI 1.14–1.48) and for men compared to women for all outcomes (all falls aIRR 1.69; 95% CI 1.54–1.86; injurious falls aIRR 1.87; 95% CI 1.71–2.04 and falls requiring hospitalization aIRR 1.29; 95% CI 1.12–1.48). The risk-adjusted IRs per 1000 resident days between facilities varied substantially (all falls 0.57–12.93 falls; injurious falls 0.25–4.47 and falls requiring hospitalization 0.10–1.70).

Conclusion

Falls are frequent in RACFs, often resulting in injury and hospitalization. The study provides robust and comprehensive information that may help inform future initiatives to minimize the incidence of falls in RACFs.